Most Popular in:


Email This Item! Print This Item!

Chemodenervation From Physiology of the Skin, Third Edition

By: Zoe Draelos, MD, and Peter T. Pugliese, MD
Posted: January 5, 2011, from the January 2011 issue of Skin Inc. magazine.
female spa client's face

page 5 of 6

Botulinum toxin is quite safe, if used in experienced hands. Proper dilution and correct injection techniques are a must. Problems arose several years ago because an inexperienced physician in Florida purchased animal botulinum toxin and injected an overdose into himself and several friends. One person required hospitalization due to difficulty breathing from the overdose. Only branded botulinum toxin designed for human use should ever be injected. Only people experienced with its use should be injectors, and the dose must be carefully calculated.

More common side effects of botulinum toxin injection are either too little or too much effect. Patients who elect to undergo toxin treatment need to realize that not every wrinkle on their face will go away with treatment. Toxin does not work where it is not injected. For example, a frown injection in the glabella will not help with crow’s-feet. Furthermore, an injection in the glabella is intended to relax the majority of the muscles and minimize—not eliminate—movement. If all movement is eliminated from the eyebrows, a “deer in the headlight” stunned look is achieved, which is quite unnatural and unattractive. Movement of the face is important to emote, and lack of movement is simply not human.

On occasion, too much botulinum toxin that has been poorly placed may cause problems, such as drooping of the eyebrows. The problem should be assessed by the injecting physician and changes should made to prevent a recurring problem. All physicians should keep an injection map detailing how many units were placed in a given location. This can prevent problems and ensure that the same excellent placement is used in the future. Fortunately, if a problem occurs, in time, the toxin effect will resolve and no harm will be done. There are no long-lasting side effects to botulinum toxin, and perhaps this accounts for its safety.

Esthetic considerations

Botulinum toxin is an important topic for the esthetician to consider. Understanding how botulinum toxin works and how it may influence other esthetic facial procedures is important. For example, a facial massage should not be performed immediately after botulinum toxin injections. It is possible to move the toxin to unwanted areas and relax muscles that should not be relaxed. It was also originally recommended that the patient remain upright for four hours after botulinum toxin injections and not fly in an airplane, again to prevent movement of the toxin. Although these restrictions may not be as important today, it is probably best to wait one day after botulinum toxin injections before offering any services. This will prevent any problems and minimize worries for the esthetician.

Zoe Draelos, MD, is a practicing board-certified dermatologist and a Fellow of the American Academy of Dermatologywith a research interest in cosmetics, toiletries and biologically active skin medications. She is in private practice in High Point, North Carolina, and is a consulting professor of dermatology at Duke University in Durham, North Carolina. In 1988, she founded Dermatology Consulting Services, serves on eight journal editorial boards and functions as the editor in chief of the Journal of Cosmetic Dermatology. She is also a member of the 2010–2011 Skin Inc. magazine advisory board.