Ironing out the Creases – Botulinum toxin complications

As with any treatment, botulinum toxin can come with complications. This month, Shaadi Manouchehri discusses what these complications can be and how to manage them.

Non-surgical facial aesthetics treatments continue to rise in their popularity.

Injectables were a £1.4 billion industry in Europe last year – a 17.3% increase compared to the previous year. There are hundreds of thousands of people undergoing these treatments annually and it’s a lot closer to home than you think!

In last month’s column, we discussed why dentists are ideally suited to provide facial aesthetics treatments. Venturing out into a new field can be both exciting and terrifying.

At the London School of Facial Aesthetics we are always curious to find out what barriers practitioners can have that stops them from venturing into the field of aesthetics.

What complications could you encounter?

A commonly occurring fear is the fear of encountering complications and being unable to manage them. As healthcare professional we do our utmost to look after our patients holistically and above all: do no harm.

Therefore, it is paramount to ensure your aesthetics training is comprehensive and there is emphasis on complications management. This is the reason that we have developed our comprehensive complications management online masterclass empowering delegates with the knowledge and skill to identify and manage aesthetics complications.

As with any treatment, facial aesthetics treatments come with their own set of possible complications and we are going to discuss some of these.We will cover botulinum toxin complications this month and dermal filler complications in next month’s column.

Any treatment that breaches the skin barrier has the potential to cause complications listed below and treatment with botulinum toxin is no exception. These include:

  • Bruising
  • Swelling
  • Excessive bleeding
  • Oedema
  • Haematona
  • Infection.

As always, we would check the medical history to ensure we are aware of any pre-existing conditions that may increase risks of excessive bleeding or bruising and manage these appropriately.

Infection is very unlikely as we follow strict aseptic techniques.

Complications which may relate to injection technique include:

  • Brow ptosis (medial or lateral)
  • Eyelid ptosis.

How can these complications be managed?

Complications relating to injection technique are usually unilateral and transient in nature and will start to wear off when the muscles return to full strength or even slightly prior to this.

Medial brow ptosis could be due to treatment of frontalis without treatment of the glabellar complex. In addition, it can be corrected with further toxin treatment.

In addition, lateral brow ptosis could be due to treatment of the lateral frontalis without treatment of the orbicularis oculi (muscle responsible for the appearance of crow’s feet). This could also be managed with further toxin treatment.

Eyelid ptosis can occur due to poor injection technique (injections are too deep and too close to the orbit) or due to spread of toxin to the levator palpabrae superioris muscle which is in charge of keeping the eyelid lifted.

Inadvertently treating this muscle with toxin will cause the eyelid to droop and can obstruct the patient’s vision. Therefore, we need to manage this until the toxin starts to wear off.

Management includes advising use of 0.5% aproclonidine eye drops three times a day as a temporary solution. This will stimulate the superior tarsal muscle to improve the presentation of the eyelid ptosis until toxin starts to wear off.

To find out more about managing facial aesthetics complications or to sign up for our complications masterclass please visit our website or email us at [email protected].

You can also check out our Instagram and Facebook.

Read more from this series:

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