Complications of Botulinum and Fillers

“Thanks to Botox and fillers, as well as the work that I’ve already had, my face pretty much maintains itself.”  ~ Dolly Parton

With any injection into the skin, there is a risk of bruising, swelling, tenderness or infection.

Today we will share with you some of the more specific complications of botulinum and dermal fillers.

With all procedures there are risks.

Botulinum is a common aesthetic injection used to reduce wrinkles. The botulinum toxin paralyzes the muscle beneath the skin producing a smooth exterior. 

One of the most common complications with botulinum is injector error.  If your injector accidentally injects botulinum into or too close to the wrong muscle, this muscle will become paralyzed which will in turn make you look funny or have lopsided features.   The most common cosmetic botulinum injector error is in the forehead (frontalis muscle).  Injections in this area are intended to smooth the horizontal forehead lines.  Too much botulinum or injections too close to the brows can cause heaviness of the brows.  A less common error is droopy eyelid (ptsosis) when botulinum intended for the frown muscles instead paralyzes the levator palpebrae muscle which holds up the eyelids.  

Although these errors are upsetting and you may look unsightly, the effects of botulinum are always temporary.  The muscle paralysis will resolve in 3 to 4 months at which time your facial features will return to normal. 

Be comfortable with your doctor and ask questions! 

Dermal fillers are not the same as botulinum and instead they replace lost volume in the face (fat/muscle/bone loss of aging) which fills hollows, removes shadows, plumps the face and pulls up folds and sagging skin. The most common and safest filler is hyaluronic acid (e.g. Restylane®, Juvéderm®) since it is reversible.

As with botulinum, one of the most common complications with dermal fillers is injector error.  Commonly areas are overfilled or filler is injected into the wrong area, which can make you look overdone or abnormal.  Fillers when injected correctly will transform you back to how you used to look.  Your youth should be restored in such a natural way that you look rested and refreshed, not different.   

The worst complication from dermal fillers is when the filler is inadvertently injected into an artery. This may block the artery, resulting in loss of blood flow and oxygen to tissue. We call this arterial occlusion and subsequently the tissue may die. Filler material injected into blood vessels can also travel to other areas and cause stroke, vision problems, blindness and damage or death of the skin and underlying facial structures.

It is important to pick your injector wisely. 

A skilled injector is familiar with facial anatomy and will aspirate before injecting the filler which decreases the risk of filler ending up in a blood vessel.  An experienced injector will recognize the signs and symptoms of ischemia as it is happening and will know how to treat this immediately with the reversal agent (hyaluronidase) to restore blood flow.  

We strongly advise when considering any type of cosmetic procedure to research your doctor, their training and experience.  During your consultation with the doctor ask what product will be used, what are the common side effects and risks.  Ask to see before and after pictures, and observe the clinic staff to see if they look natural.  Ensure your provider knows how to deal with a complication should it occur.   

As with all our clients we do a free consultation to discuss your needs and the options available to you. 

Contact our office and we’d be happy to answer any of your questions when you come in for your free consultation. 

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