A common question is whether Botox© administration is painful. A 31-gauge insulin needle is used, the smallest needle size available in clinic. As a result, treatment is generally associated with little-to-no pain.

Another common question is whether Botox© administration is safe. The answer is yes in a significant majority of cases. Its approval by the FDA is an endorsement of its overall safety profile. The best way to evaluate the safety of Botox© treatment is to review both the highest quality data (i.e. RCTs) but also the Adverse Event (AE) reporting to the FDA that occurs whenever a medication is approved for use by the FDA. A 2005 study of FDA-reported AEs associated with botulinum toxin type A used for both therapeutic and cosmetic purposes demonstrated the vast majority of reported AEs at the time were labelled “non-serious,” with 63% of those AEs being a “lack of effect,” 19% involving an injection site reaction (e.g. pain, bruising, swelling, allergic reaction), and 11% involving eyelid ptosis, or a drooping eyelid, which is a temporary possible risk that can be decreased with appropriate technique. A significantly smaller percentage of AEs were labelled as “serious,” the most common of which was swallowing difficulties. It is important to note, however, that reported AEs included injection of botulinum toxin for neck banding, which is in an area very close to muscles that contribute to swallowing. That could explain the above reporting. Moreover, a large majority of AEs reported with botulinum toxin administration were for therapeutic use (e.g. strabismus), not cosmetic use. It is suspected that serious AEs are likely related to both the amount used and the location it is used. Therapeutic uses involve much higher doses than cosmetic uses and are placed in areas with a higher risk of functional problems.

Assessing individuals for possible contraindications and appropriate counseling and informed consent is essential. It is very important to evaluate patients who may not be good candidates for the medication. One example is patients with a history of neuromuscular disorders, including Myasthenia Gravis (MG) and Lambert-Eaton Syndrome (LES). Pregnant and/or nursing mothers should not receive it. Patients actively taking aminoglycoside antibiotics or streptomycin should not receive it because the antibiotics could potentiate the effects of the medication.

Dr. Harmon has a detailed discussion of the potential benefits and risks of injecting Botox© with every client who is interested in treatment. As a fellowship-trained facial plastic surgeon, he has the detailed understanding of facial anatomy necessary to provide these treatments safely and effectively.