Are there any reasons why I should avoid BOTOX or Dysport?

BOTOX is a nonsurgical cosmetic treatment that has been proven to be both effective and medically safe.  Millions of people enjoyed treatment with BOTOX and Dysport, another botulinum toxin A product, last year to improve their cosmetic concerns.

BOTOXexample2 Are there any reasons why I should avoid BOTOX or Dysport?

Microdroplet BOTOX Before and After

However, this does not mean that BOTOX is the right choice for everyone, and this is a decision your doctor can help you make.  The short answer to “Is there any reason to avoid BOTOX?” is that it is extremely unlikely that you will experience any complications from BOTOX, and given the temporary nature of the treatment, you needn’t worry that your looks will be changed permanently; on the other hand, side effects can occur even if you are treated by a highly qualified injector.  It is also reasonable to expect that side effects will be more likely when treatment is performed by relatively inexperienced injector.

Are BOTOX and Dysport safe and effective?—absolutely.  But like every medication, these drugs need to be used in an expert fashion, which includes knowing when treatment is not appropriate.

New Black Box Warning for BOTOX

The FDA has recently required the manufacturer of BOTOX, Allergan, Inc. and the distributor of Dysport, Medicis, Inc. to include a special health warning regard the use of these drugs, which both contain botulinum toxin A as the active ingredient.  Experience with these drugs since they were approved has demonstrated these drugs to be very safe and effective when used in the small doses needed for cosmetic treatment.

These drugs are also used for medical purposes in much higher doses.  At these higher doses, there have been serious side effects leading to the new FDA warning regarding systemic or so-called spreading effects.  Specifically, larger doses of either of these drugs can cause systemic side effects including a generalized weakness, medically referred to as asthenia, double vision, blurred vision, eyelid droopiness, difficulty swallowing, difficulty breathing, difficulty speaking, and urinary incontinence.  Note that droopiness of the eyelid and double or blurred vision is possible, though fortunately rare, if cosmetic treatments spread to other parts of the face.  Breathing and swallowing difficulties can be life threatening and have contributed to death in already very sick individuals in the treatment of medical conditions.  It is thought that very high doses of these drugs used to treat certain medical conditions in small children present the greatest risks.  Individuals with life threatening heart conditions should also be treated with caution.

No definitive systemic side effects have been reported for the doses typically used for cosmetic purposes or for treating excessive sweating in the armpit area.  However, certain precautions seem reasonable even for cosmetic use.

If you have had any prior episodes of any of the systemic side effects described above, you should advise your doctor and not accept additional treatment with any botulinum toxin agents unless it is for medical purposes and your treating physician and you agree that the potential treatment benefits out weigh the adverse side effects.  If you are not sure, discuss your prior reactions with your doctor.  Although, quite rare, if you have a known allergic response or hypersensitivity to any botulinum toxin preparations it is advisable to avoid these treatments in the future.

It is your responsibility to be completely honest with your doctor about your medical history and anything that may affect your treatment.  BOTOX has a great track record for safety in both clinical studies and in practice, helping to relax select facial muscles at the eyebrow and restore a more youthful appearance.  While systemic side effects of these drugs probably occur even for cosmetic treatments, these effects must be very rare or mild.  But for this reason, there are a few instances when BOTOX should be avoided.

If you are pregnant or breastfeeding, you should not be treated with BOTOX or Dysport.  There is a very small study of women who were treated with BOTOX while pregnant with no problems, but this is not enough evidence to state that BOTOX and Dysport are safe during pregnancy or while breastfeeding.  What should you do if you discover you were pregnant when you received BOTOX?  Don’t panic. While this practice is not recommended, this single study suggests that the exposure may be safe enough that there may be no reason for action.  However, it is recommended that you see your gynecologist/obstetrician for personalized care recommendations. For the same reasons, reputable physicians will not treat you for cosmetic reasons if you are known to be pregnant or breastfeeding.  Treatment with these agents for medical reasons is determined on a case-by-case basis.

If you have a known neuromuscular disease, you should generally avoid cosmetic BOTOX and Dysport treatment.  These are unusual and debilitating health conditions like myasthenia gravis, Lambert-Eaton syndrome, and peripheral motor neuropathic conditions like amyotrophic lateral sclerosis.  If you have an existing difficulties breathing or swallowing, it is important to make your doctor aware of these issues.  Because BOTOX and Dysport treatment could make these conditions worse, it is generally advisable to avoid treatment under these circumstances due to the potential spreading effect of these treatments in higher doses.  Again, no definitive problems have been reported for the smaller doses used for cosmetic treatment, but caution is warranted with these types of medical conditions.

Botulinum toxin products contain a tiny amount of human albumin, a derivative of human blood. Based on effective donor screening and product manufacturing processes, it carries an extremely remote risk for transmission of viral diseases. A theoretical risk for transmission of Creutzfeldt-Jakob disease (CJD) also is considered extremely remote. No cases of transmission of viral diseases or CJD have ever been identified for albumin.

BOTOX and Dysport can be potentiated by aminoglycosides, a type of potent antibiotic, or other medications that interfere with neuromuscular transmission including curare-like nondepolarizing blockers, lincosamides, polymyxins, quinidine, magnesium sulfate, anticholinesterases, and succinylcholine chloride.  If you are using any of these drugs, the effect of the toxin may be potentiated and caution is advised.  For this reason, it is important that you fully discuss with your doctor all medication that you may be using.

If you develop any unusual symptoms (including difficulty with swallowing, speaking, or breathing), or if any existing symptom worsens, notify your doctor at once.  If the symptoms seem serious, call 911 for emergency help and notify your treating doctor when this is convenient.  If you do experience loss of strength, muscle weakness, or impaired vision avoid driving a car or engaging in other potentially hazardous activities and seek medical care.

Very few people reading this and getting BOTOX or Dysport will have any of these issues.  However, if these warnings do apply to you, be honest with your doctor and seek alternatives to these products.

How Individualized Treatment Plans Make All the Difference

The key to effective BOTOX treatment and other cosmetic treatment in Los Angeles is to find a doctor who specializes in the help you need and has experience, education, recommendations, and results to prove that he or she is skilled and the best qualified.  If you are worried because you have heard of unsatisfactory results like the “BOTOX freeze,” you are likely hearing about a few examples of people either going to unqualified practitioners (they may not even be doctors; for example assistants and “physician extenders”).   Just because one of your favorite actors or actresses show up with a frozen forehead, don’t assume that this is a desirable treatment result.  There are great alternative to this type of treatment result.

Seek Help from Qualified Cosmetic Botulinum Toxin Specialist

Only a private consultation with a physician who is fully qualified to administer BOTOX and Dysport will be able to help you understand your best course of action.  BOTOX is a minimally invasive, safe, and effective treatment that helps millions of people each year restore balance to their face.  Dr. Steinsapir is multi-fellowship trained in both cosmetic surgery and oculoplastic surgery, and with many years of practical experience.  He is a Clinical Associate Professor at UCLA and has the practical know-how needed to understand complex facial dynamics and establish unique treatment plans that work.  Please contact us today to find out if you are a good candidate for BOTOX or Dysport treatment.

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