Table 1.

The most common side effects related to cosmetic use of botulinum toxin

Mechanisms of side effects	Type of side effects	Prevention	Treatment
Injection site side effects:
Injuring a blood vessel	Erythema, ecchymosis Bruising, hematoma	Thorough medical history	Tamponade, pressure, ice packs
The needle puncturing the skin	Tenderness and pain at the site of injection, injection trauma	Topical anesthetic creams, correct needle size	Topical anesthetic creams
Decreased sweat gland activity	Dry skin	No recommendations	Emollients
Contamination of the injection site	Local infection, abscess	Aseptic technique	Course of antibiotics
Nerve injures	Paresthesia or dysesthesia	No recommendations	No specific treatment
Technique-dependent side effects:
Aesthetic in periorbital area	“Mephisto sign”, exaggeration of wrinkles, brow ptosis, periorbital edema	Correct dose and technique	Paralysis of antagonist muscles
Functional in periorbital area	Blepharoptosis, ptosis Sctropion, dry eyes, corneal irritation, corneal exposure Blurred vision, accommodation difficulties, retinal detachment, diplopia, strabismus	Correct technique	α-Adrenergic drops Topical lubricating drops Ophthalmologic consultation
Aesthetic in perioral area	Asymmetric smile, lip ptosis, changes in facial expression	Correct technique	No specific treatment
Functional in perioral area	Trismus	Correct technique	Mechanotherapy
	Xerostomia	Correct technique	Sialagogues
Allergic reactions:
Localized	Redness, edema, urticaria,	Thorough medical history	Antihistamine drugs, local steroids
Generalized	Generalized urticaria, diffuse edema, anaphylactic shock	Thorough medical history	Steroids, adrenalin injection, monitoring of patients
Other mechanism	Headache	No specific prevention	Analgesics
Diffuse spread of toxin (botulism)	Severe dysphagia Generalized muscle weakness	Minimal dose, correct technique Minimal dose, correct technique	Neurotrophic drugs, systemic support and symptomatic treatment botulinum antitoxin serum