Complications of Botulinum Toxin

  • Deborshi Roy
  • Neil S. Sadick


Botulinum toxin is a powerful medication that has been used to treat various conditions for over two decades. In the last few years, there has been an explosion in the use of this drug for cosmetic purposes. While millions have benefited from the therapeutic effects of botulinum toxin, many have experienced complications. For the neophyte clinician or casual user, technique-related complications are more common. For those who treat a large number of patients or use large volumes, systemic reactions can become more common. In this chapter, the mechanisms, treatment options, and strategies for avoiding the complications of botulinum toxin therapy will be discussed.


Botulinum Toxin Cervical Dystonia Botulinum Toxin Type Frontalis Muscle Botulinum Toxin Therapy 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Sakaguchi G. Clostridium botulinum toxins. Pharmacol Ther 1983;19:165–194.CrossRefGoogle Scholar
  2. 2.
    Carruthers JDA, Carruthers JA. Treatment of glabellar frown lines with C botulinum-A exotoxin. J Dermatol Surg Oncol 1992;18:17–21.PubMedGoogle Scholar
  3. 3.
    Keen M, Blitzer A, Aviv J, et al. Botulinum toxin A therapy for hyperkinetic facial lines: results of a double-blind, placebo-controlled study. Plast Reconstr Surg 1994;94:94–99.PubMedCrossRefGoogle Scholar
  4. 4.
    Hambleton P. Clostridium botulinum toxins: a general review of involvement in disease, structure, mode of action and preparation for clinical use. J Neurol 1992;239:16–20.PubMedCrossRefGoogle Scholar
  5. 5.
    de Paiva A, Meunier FA, et al. Functional repair of motor endplates after botulinum neurotoxin type A poisoning: biphasic switch of synaptic activity between nerve sprouts and their parent terminals. Proc Natl Acad Sci U S A 1999;96:3200–3205.PubMedCrossRefGoogle Scholar
  6. 6.
    Bhatia KP, et al. Generalised muscular weakness after botulinum toxin injections for dystonia: a report of three cases. J Neurol Neurosurg Psych 1999;67:90–93.CrossRefGoogle Scholar
  7. 7.
    Lange DH, Brin MF, Warner CL, et al. Distal effects of locally injected botulinum toxin: incidences and effects. Adv Neurol 1988;50:609.PubMedGoogle Scholar
  8. 8.
    Tugnoli Y, Eleopra R, Quatrale R, et al. Botulism-like syndrome after BTX-A for local hyperhidrosis. Br J Dermatol 2002;147:8080.CrossRefGoogle Scholar
  9. 9.
    Klein A. Botulinum toxin complications. Dermatol Surg 2002;29:5:549–556.CrossRefGoogle Scholar
  10. 10.
    Goschel H, Wohlfaqrth K, Frevert J, et al. Botulinum A toxin therapy: neutralizing and non-neutralizing antibodies: therapeutic consequences. Exp Neurol 1997;147:96–102.PubMedCrossRefGoogle Scholar
  11. 11.
    Jankovic J, Schwartz K. Response and immunoresistance to botulinum toxin injections. Neurology 1995;45:1743–1746.PubMedGoogle Scholar
  12. 12.
    Sarifakioglu N, Sarifakioglu E. Evaluating effects of preservative-containing saline solutions on pain perception during botulinum toxin type-a injections at different locations: a prospective, single-blinded, randomized controlled trial. Aesthetic Plast Surg 2005;29:113–115.PubMedCrossRefGoogle Scholar
  13. 13.
    Alam M, Arndt KA, Dover JS. Severe, intractable headache after injection with botulinum. J Am Acad Dermatol 2002;46:62–65.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • Deborshi Roy
    • 1
  • Neil S. Sadick
    • 2
  1. 1.New YorkUSA
  2. 2.Department of DermatologyWeill Medical College of Cornell UniversityNew YorkUSA

Personalised recommendations