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Botox FAQ

Botox FAQ

Do you have a question about Botox? Charles Slonim, MD, a member of the AllAboutVision.com Editorial Advisory Board, has answered the most frequently asked questions below.

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Botox Basics

Q: How does Botox work? — A.C.A.

A: Botox works by weakening the muscles into which it is injected. As facial muscles contract, the loose skin above those muscles wrinkles. By weakening the muscles, the wrinkles are reduced. — Dr. Slonim

Q: How long do results last? — L.S.

A: The effects of Botox can last up to three months. — Dr. Slonim

Q: How safe are wrinkle-relaxing injections? How can you lengthen the effects of Botox? How often should you get Botox after your first injection? How many times can you have Botox? — K.

A: Botox is very safe when injected by experienced physicians.

Some oral zinc supplements have been shown to lengthen the effect of Botox.

As soon as your wrinkles return, you can have Botox again. There is no defined limit to the number of injections one can have. However, the body's immune system is capable of developing antibodies to the Botox molecule which can render it ineffective at some point in the future. — Dr. Slonim

Q: Is there a rebound effect when Botox wears off and one does not go for repeat injections? — P.T.

A: No, the muscle activity should return to its original state when the Botox wears off. — Dr. Slonim

Q: Is Botox painful? I have a very low pain threshold. — A.S.

A: Botox, itself, is not painful. The pain is associated with the needlestick. The smaller the needle, the better it is tolerated. When a volume of fluid is injected under the skin, it temporarily stimulates some of the nerve fibers. Everyone's threshold for these occurrences differs from person to person. — Dr. Slonim

Q: How many Botox treatments are needed before you see results, does it hurt, and what is the healing period and aftercare? — E.

A: When injected appropriately, the results will be seen after the first treatment. Botox takes two to four days before the muscle weakening effect takes place. The maximum effect occurs at about 10 to 14 days. The effect then lasts up to three months.

Pain and discomfort depends on one's tolerance for needle injections around the face. There is typically no "healing period and aftercare." Most physicians suggest that the areas of injection should not be rubbed or manipulated for a few hours after the injections. — Dr. Slonim

Q: Who can perform Botox? — L.J.

A: Botox is a prescription drug. It is administered by a physician or his/her designee (eg, nurse, physician assistant, aesthetician). — Dr. Slonim

Q: I'm 62 years old and Botox isn't achieving the same results on me as it did in the past. At what point does Botox become ineffective in treating deep-set wrinkles and skin sagging? — C.S.

A: There is no defined limit to the number of injections one can have. However, the body's immune system is capable of developing antibodies to the Botox molecule which can render it ineffective at some point in the future. — Dr. Slonim

Q: Is it true that the more I have Botox, the less I need to use it? — G.H.

A: This has been a topic of discussion among many physicians. Muscles that are not used tend to atrophy and weaken over time. Muscles that have been continually injected with Botox may actually fall into this category and produce a similar effect. This might result in using less Botox. — Dr. Slonim

Q: Is anesthesia used for the procedure? I'm a bit of a chicken when it comes to needles! — R.W.

A: Some doctors will anesthetize the surface of the skin with a topical anesthetic cream. This makes the stick of the needle much more tolerable. — Dr. Slonim

Q: I'm getting married and want to have Botox to "freshen" my face. How far out do I need to have it? I don't want to be bruised or swollen on my wedding day! — J.S.

A: Botox takes about two to four days to take effect. Its maximum effect occurs around 10 to 14 days and lasts up to three months. A bruise from a needlestick usually lasts five to seven days. With an impending event, such as a wedding, I usually suggest that my patients get their Botox injections one month before the event. — Dr. Slonim

Q: Does Botox always have to be performed in a doctor's office? Who is certified to inject Botox? — N.B.

A: Botox is a prescription drug. It is administered by a physician or his/her designee (eg, nurse, physician assistant, aesthetician). It does not have to be injected in a doctor's office. — Dr. Slonim

Q: If one undergoes electronic impulse treatment to supposedly encourage collagen production and activate muscular activity in facial areas prone to wrinkling, does this negate the muscle relaxant effect of Botox injections in same area? — K.L.

A: I am unaware of any research that compares the effects of "electronic pulse treatments" with Botox treatments. The muscle relaxant effect of Botox injections occurs directly in the muscle into which it is injected. Whether or not electronic impulse treatments affects this activity needs to be studied scientifically. — Dr. Slonim

Q: What happens if I discontinue Botox after the first time or after several times? Will my forehead look worse than before I started treatment? Some people tell me once you start using it, you can never stop. — M.H.C.

A: The wrinkles of your forehead should return to their original appearance when the Botox wears off. Discontinuing the Botox will not worsen your wrinkles.

The reason "you can never stop" using the Botox is because after seeing the disappearance of your wrinkles, you "never want to see the wrinkles" again. You can stop anytime you want without consequences (other than the return of the wrinkles). — Dr. Slonim

Q: I am 47 years old and dislike the aging appearance of my neck. When I talk, I see these long "stringy" protruding muscles. I read that Botox injections along the problematic muscles can reduce this. Is this true?

How can I find an experienced doctor to do it? What are the possible side effects? — D.M.

A: Yes, Botox has been used to reduce some of the cosmetic effects of the aging appearance in the neck region. This is an off-label use of the Botox, which is specifically indicated by the FDA for the reduction of frown lines (wrinkles between the eyebrows). Your injection should be done by someone who is experienced in giving these injections.

You can find an experienced doctor either by word-of-mouth from other patients or by calling the office directly and specifically asking about the doctor's experience in injecting necks for cosmetic purposes. A possible side effect is weakness in the neck muscles that were injected, which will last three to four months until the Botox wears off. — Dr. Slonim

Are You a Candidate for Botox?

Q: Is it considered safe to have Botox around your eyes shortly before or after LASIK surgery? Thanks in advance for an answer. — R.

A: The decision to have Botox injections before or after LASIK surgery should be left up to your LASIK surgeon. The injections should be safe. However, the effect of Botox around the eyes can reduce the strength of the blink reflex, which might create a sense of dryness of the eye. This might affect the healing process of the LASIK surgery. LASIK surgery is known to create temporary dry eyes immediately after the procedure. — Dr. Slonim

Q: I'm 25 years old and am starting to notice fine lines around my eyes. Am I too young to have Botox? — C.M.

A: No, but be warned; once you start, you are bound to be "hooked!" — Dr. Slonim

Q: I have high blood pressure (hypertension). Is Botox safe for me? — T.

A: When injected appropriately, Botox should not have a direct effect on blood pressure. Always consult with your physician prior to considering Botox injections. — Dr. Slonim

Q: I have fibromyalgia and use lyrical pregabaline medication. Is fibromyalgia a contraindication to Botox? — D.A.

A: There are reports of patients with fibromyalgia getting some relief of their tender points with Botox injections. This would be an "off label" of Botox and should be performed by someone very experienced in these kind of injections. — Dr. Slonim.

Q: Is Botox injection safe for patients with lupus erythematosus? What are the possible risks for these patients? — E.

A: Lupus patients are known to have some skin conditions. Botox must be used very cautiously in any area where the skin is not completely normal. — Dr. Slonim

Q: In the United States, the FDA has approved Botox Cosmetic for people aged 18 to 65. Why is the age limit cut off at age 65? Just wondering if Botox or filler would help deep wrinkles on my upper lip? — B.R.

A: If the original studies for FDA approval did not include persons over the age of 65, the FDA will not approve the drug above that age limit. Botox and dermal fillers are used in the upper lip for a variety of reasons. Fillers will not weaken the muscles around the lips as Botox will. The side effects of Botox injections around the lips can be bothersome to some patients. — Dr. Slonim

Q: I would like to get Botox, but I have retinitis pigmentosa (RP). Is this a contraindication for Botox? Will it make my condition worse at all? — K.V.

A: Retinitis pigmentosa is not a contraindication for the use of Botox. When injected into the muscles that surround the eye, it should have no effect on your condition. — Dr. Slonim

Q: I have a two-year-old daughter who was recently diagnosed with strabismus. Her doctor said that she needs to have strabismus surgery, however, he did not give me other options. I read that Botox injections can be used to treat strabismus. How safe are Botox injections for a two year old? What major side effects can they cause that may affect my daughter later on? Also, are there any other options such as glasses or treatments that may be available besides surgery? — A.P.

A: The safety and effectiveness in pediatric patients below the age of 12 have not been established by the FDA in the treatment of strabismus, however, Botox has been used safely and effectively in children below the age of 12.

Botox has its effects directly on the muscle into which it is injected. Its effects only last about three months. In strabismus, the goal is to weaken the affected muscle on one side of the eye so that the muscle on the opposite side of the eye can work better.

The two major side effects are that the muscle wasn't weakened enough (undercorrection) or weakened too much (overcorrection). In both cases the Botox will eventually wear completely off so the side effect goes away in two to three months. As your ophthalmologist will probably inform you, the eye muscles are positioned against the eyeball so there is always a small risk that the needle could penetrate the eye. This has a very rare occurrence.

The different treatments for strabismus depend on the type of strabismus that your daughter has. Sometimes a simple pair of glasses will correct a small strabismus and, occasionally, glasses with prisms will be required. Botox injections and strabismus surgery are other options. — Dr. Slonim

Q: My 4-year-old daughter suffers from paralysis on the left side of her leg and hand. Would Botox injections help? — B.P.

A: It all depends on the cause of her paralysis. Botox reduces the strength of contraction of the muscles (paralysis-like) into which it is injected. Botox has been used (off-label) to reduce the contracture (or spasm) of the opposing muscles associated with neurologically paralyzed muscles.

For example, when a muscle like the bicep (which flexes the arm) is paralyzed, the tricep muscle (which extends the arm) will contract and keep the arm extended. Reducing the muscle contraction of the tricep muscle with Botox could possibly help the mobility of the arm, prevent permanent contracture and allow it to assume a more comfortable position. — Dr. Slonim

Botox: Indications and Uses

Q: I have heavyset brows and am after an eye lift, but I don't want to resort to surgery. Can Botox be used for a "mini-lift"? — A.L.

A: When injected in the correct areas under the eyebrows, Botox can raise the eyebrow ("mini-lift") to a certain degree. There is a relative risk, however, that the same injection could inadvertently cause the upper eyelid to fall. — Dr. Slonim

Q: I've heard Botox can stop excessive perspiration on the palms and feet. Is this safe and are there any side effects? — Z.N.

A: Yes, Botox has been successfully used to reduce excessive perspiration (hyperhidrosis) on the palms and feet. The side effects are related to the number of muscles that are injected. Weakening muscles in the palm of the hand can affect the strength of one's grip. The same can occur in the foot; although gripping with the foot is not a normal function, walking may have an unusual sensation. — Dr. Slonim

Q: Does Botox diminish horizontal forehead wrinkles? — W.F.

A: Yes, when injected into the frontalis muscle of the forehead (the one that lifts your eyebrows), the horizontal wrinkles can be diminished. — Dr. Slonim

Q: Can you get Botox in your lips? — K.P.

A: Yes, but the side effects can affect the ability to hold a straw or to sip from a cup. These injections should be performed by someone very experienced in these kinds of injections. — Dr. Slonim

Q: Can you use Botox to increase your lips and buttocks? — M.H.

A: No, Botox is not a filler. — Dr. Slonim

Q: Can you have Botox in numerous places at the same time, ie, both forehead lines and crow's feet? — J.

A: Yes, Botox is frequently given in multiple sites at the same time. — Dr. Slonim

Q: Which areas of the face can you get Botox? And can it be used on the body? — J.O.

A: The most common areas of the face that are injected with Botox are the frown lines between the eyebrows, the forehead wrinkles and the crow's feet. It can be injected into any muscle in the face. The cosmetic use of Botox is FDA-approved only for the frown lines. All other facial injections would be an "off-label" use.

Botox can be injected into other muscles in other parts of the body. — Dr. Slonim

Q: I'm 28 years old and would like to have Botox injections on both sides of my face to make my face look smaller. How does this work? What are the side effects? I often hear people say that a side effect is an unnatural smile as well as trouble chewing food.

How long can the effects of Botox when administered around the jaw last? My doctor says that after the fifth injection (within five years), the facial shape will be quite permanent. Is this true?

Lastly, I want to have smaller arms and my doctor suggested Botox injections for this area as well. I have never heard of this before — can it be done? — J.L.

A: Botox is being used by some physicians to make the face appear thinner. The masseter muscle which is used for chewing is sometimes enlarged, causing a squaring of the facial shape. When Botox is injected directly into this muscle, it can cause some flattening of the muscle and possibly some narrowing of the jaw, creating a thinner facial appearance. The obvious side effect could be difficulty chewing and facial asymmetry. It should be performed by someone very experienced in these kind of injections.

The effects would last the same as the injections anywhere else. Botox effects can last up to three months.

Muscles that are not used constantly can begin to atrophy and shrink physically. There are theories that muscles that are continually injected with Botox and weakened may have a similar effect.

Lastly, I am unaware of any use of Botox for making arms appear smaller. — Dr. Slonim

Other Neurotoxins and Fillers

Q: What's the difference between Botox and fillers? — T.M.

A: Botox weakens the muscles that cause wrinkles in the skin that overlies those muscles. Dermal fillers are injected directly into the wrinkle to plump up the skin and smooth the surface. Botox can last up to three months and fillers can last up to a year. — Dr. Slonim

Q: What else would you recommend instead of Botox for a deep line between my eyebrows that makes me look very tired and unhappy, and also lines around my mouth? — B.

A: Lines that are not helped by Botox can frequently be filled with dermal fillers such as Restylane, Juvederm, Radiesse, Perlane and Sculptra. These substances are injected under the wrinkle to alleviate the line and smooth the surface. Their effects, depending on which filler is used, can last six to eight months and longer. — Dr. Slonim

Q: Are there any alternatives to Botox? — R.J.M.

A: There are other "neuromuscular blocking agents" that have similar effects to Botox. Xeomin, Dysport and Myobloc are some alternatives produced by other manufacturers. — Dr. Slonim

Botox Cost and Units Needed

Q: How much do Botox injections cost for frown lines? — E.C.

A: Prices vary from doctor to doctor. Some doctors charge a single price for a single zone. For example, the frown lines would be one zone, the forehead would be one zone, and the crow's feet would be one zone. Some doctors charge based on the number of units of Botox injected and, therefore, have a price per unit of Botox. Botox vials come in two different sizes: 50-unit vials and 100-unit vials. The number of units injected depends on the number of wrinkles that want to be alleviated. — Dr. Slonim

Q: How many units are required to treat a male armpit? — J.

A: This varies from doctor to doctor. I typically give 25 injections per armpit and use two units of Botox per injection site for a total of 50 units per armpit. A bigger person with a bigger armpit might get more injections and a smaller person might get less. — Dr. Slonim

Q: Where can you buy Botox? — L.Y.

A: Botox is a prescription drug and is not available for sale directly to the public. — Dr. Slonim

Botox Side Effects and Complications

Q: I had 40 units of Botox injected two months before I had cataract surgery. I now have a very droopy eyelid on the inner corner of the operated eye, as well as very blurred vision. Could the Botox have caused any of this?

I am praying it will improve, but it has been two and a half months since the cataract surgery, and my doctor will not comment. Help! I wanted more Botox after these injections wore off, but now I am scared! — F.

A: It all depends on where the Botox was injected (e.g., near the upper eyelid). If the droopy eyelid was the result of some Botox that accidentally found its way into the muscle that raises the eyelid, then this will wear off when the Botox wears off (usually three to four months after the injection). Your eyelid should resume its original position.

However, if the droopy lid was the result of your cataract surgery, which is a well-known potential complication of many kinds of eye surgery, then the droopy eyelid may remain where it is and might require surgery to elevate it into its original position.

It is highly unlikely that the Botox would cause your blurry vision. This could be the result of your droopy lid position or some residual eyeglass prescription need after your cataract surgery. — Dr. Slonim

Q: Will I have a frozen appearance after Botox? I fear I won't be able to move my forehead. — A.H.M.

A: It all depends on where and how much Botox is injected. There are those persons who want their foreheads "frozen." Your desired Botox effects should be discussed with your doctor prior to the injections. The "where and how much" can be individualized to your wishes. — Dr. Slonim

Q: What are the risks and complications of Botox? Can I have Botox when I'm pregnant or nursing? — L.J.

A: The main risks and complications of Botox are associated with weakening a muscle that was not intended to be injected. This can include a myriad of symptoms depending on which muscle was inadvertently weakened.

I personally would not inject a woman who is pregnant or nursing. I am not aware of any of my colleagues that would, either. — Dr. Slonim

Q: I had Botox injections two weeks ago. After one week my left eyelid began to droop. How long will it last? — N.P.

A: Occasionally some of the Botox can migrate beyond the targeted area and affect another muscle. It sounds like the muscle that lifts your eyelid was affected in this way. Typically, a drooping eyelid as a side effect of Botox will last a couple of weeks, depending on how much of the Botox migrated into that muscle. As with the intended effects of Botox, this side effect will eventually wear off as well. — Dr. Slonim

Q: I had Botox injections two weeks ago and I've had continuous headaches ever since. Is this a side effect and how long will it last? The Botox was injected in my forehead and it actually hurts behind my eyeballs as well as my forehead. — D.W.

A: It is not unusual for patients who have had Botox injections in the forehead to experience a temporary headache depending on how many injections they've received. "Continuous headaches" for two weeks would be an unusual side effect and should probably be addressed with the doctor that injected them. This would apply to the discomfort behind the eyeballs as well. — Dr. Slonim

Q: I have read that muscle spasms can be a side effect of Botox. I experienced three different episodes of painless forehead muscle spasms, each preceded by a feeling of fullness in my forehead.

I had received Botox in my forehead about one and a half months prior to the first one. My daughter thought I was having a stroke. My eyebrows contracted intensely towards each other, creating deep lines in my forehead and between my eyebrows.

It hasn't happened since the Botox wore off completely. Is it common for this to happen? — B.

A: This is certainly not a common side effect of Botox. It is possible that the "muscle spasms" were occurring in the muscles that did not receive Botox injections while the surrounding muscles that did receive the Botox injections appeared "calm."

These muscles might be overcompensating. This could potentially enhance your frown lines if they were not injected when your forehead was injected. — Dr. Slonim

Q: I had Botox around my eye and three days later I had an eye floater. Could Botox have caused this? Or is it just coincidental? — S.

A: No, this would be highly unlikely and probably coincidental. — Dr. Slonim

Q: Three weeks ago I had sinus surgery and my ENT suggested Botox injections at the time of surgery for twitching under my eye. My face is now drooping — from my eye to my chin. I am very upset and believe it is because I had a severe reaction to the Botox. How long will the droopiness last? — P.B.

A: You seem to be describing a side effect of Botox and not a "severe reaction" to it. If the Botox was injected into muscles that typically support the facial structures then these muscles were weakened. This weakening will cause the facial structures held up by those muscles to droop. This muscle weakening effect is the desired effect of Botox unless, of course, it affects a muscle that wasn't intended to be weakened. Botox effects can last up to three months. — Dr. Slonim

Q: I had Botox around my eyes just where my cheek bones are about four weeks ago. Ever since, my cheeks have been red. Could I have an infection, or will it eventually go away on its own? It's starting to worry me! — M.E.

A: Without actually observing your condition, it would be difficult to make a diagnosis. This should, however, be brought to the attention of the physician that injected you as soon as possible. — Dr. Slonim

Q: Are there reports of Botox causing double vision and blurry vision and at what time after the injections? — N.H.

A: This would depend completely on where the Botox was injected. Double vision and blurred vision are known temporary side effects of Botox injections around the eyes. — Dr. Slonim

Q: I had Botox a few days ago and don't like the results. What can I do? How do I reverse the effects of Botox? — K.J.B.

A: All you can do is wait for the Botox to wear off. The effects of Botox can last up to three months. — Dr. Slonim

Q: Would dizziness be a side effect as the Botox is wearing off? It's been about four months since I had it done and I've started to feel dizzy. — N.

A: It depends on where the Botox was injected. Dizziness is not a typical side effect as the Botox is wearing off. Your symptom of dizziness should be brought to the attention of your physician. — Dr. Slonim

Q: I have been getting Botox injections on my forehead, crow's feet and the lines between my eyes for two years. Recently I was told by my ophthalmologist that the glands in my eyes are blocked. Can Botox cause this? I have swelling and itchiness, too. — D.

A: No, Botox only affects the muscles into which it is injected. There are different kinds of glands in the eye that combine their secretions to produce the tears that moisten the eyes. There are water glands, oil glands and mucous glands. Blockage of each of these glands can have a different effect on the eye. — Dr. Slonim

Q: I had Botox injections about a week ago in my forehead and crow's feet (44 units). I now have extreme pain in my left armpit where I think my lymph nodes are. Could this be caused by the injections or is it coincidental and something else is wrong (I also have a sore throat and extreme fatigue)? — L.A.

A: Your symptoms should be brought to the attention of your physician. Your left armpit pain would be a very unusual side effect of Botox injections in the face and is probably coincidental. — Dr. Slonim

Q: I had Botox several months ago between my eyebrows. Ever since, I have had itching in this area. Is this a side effect? Will it continue if I get Botox again? — S.E.

A: As with the injection of any medication, there can be itching as a side effect. Itching should be very short-lived unless there is a true allergic reaction to the medication. If the itching does not subside, this should be brought to the attention of your physician. If the itching is caused by an allergy to the Botox, it will occur again (possibly worse) if the Botox is injected again. — Dr. Slonim

Q: I recently was told that you could get a sinus infection from Botox. Have you heard of this? — J.

A: There should be no physiological reason that Botox, when injected into the appropriate places, would cause a sinus infection. — Dr. Slonim

Q: Will a droopy eye caused by Botox go back to normal? How long would that take? Is there any way to correct it sooner? — R.

A: A droopy eyelid should return to normal as the Botox wears off. The effect of Botox can last up to three months.

There are some eye drops that are used to treat glaucoma (high pressure in the eye). One of the side effects of this specific class of eye drops is that the drop can occasionally and temporarily raise the upper eyelid. The drops are occasionally prescribed to patients whose eyelids droop after Botox injections. — Dr. Slonim

Q: I had Botox three times and after each session I looked and felt great. But when I had Botox for a fourth time, I developed blurry vision. After the Botox wore off, so did my blurry vision. I really want to get Botox again but I'm scared my vision will be blurred again. Do you think it's safe for me to try a small dose of Botox again? — C.

A: It depends where the Botox was injected. This should be discussed with your physician. Your blurry vision side effect that occurred during your fourth injection may have been caused by some Botox that went beyond the intended area of treatment. This could have been an isolated event that will not occur in future injections. Although, there is a possibility that it may occur again. — Dr. Slonim

Q: I had Botox done around two months ago and for the first two weeks I had a fever and general lethargy, accompanied by a phlegmy cough. Was this a Botox side effect? — Z.

A: This would be an unusual side effect of Botox injected into the face and may have been coincidental. This should be discussed with your physician prior to a second injection of Botox at some point in the future. — Dr. Slonim

Q: I had a dose of Botox injected in my forehead five days ago and on the third day I have puffy eyes and my eyelids feel "tight." How long will this last? — L.R.

A: Your eyelids may feel tight as they overcompensate for the weakness in your forehead muscles. The puffiness of your eyelids would be an unusual side effect of Botox injections in the forehead. This should be discussed with your physician prior to receiving any future Botox. A lot depends on where the injections were given and how much Botox was given. — Dr. Slonim

Q: I had Botox and now have bumps at the injection site. They are very painful. Is this a common side effect? Is there something I can do to make them go away and keep them from becoming infected? — J.H.G.

A: Without actually observing your condition, it would be difficult to make a diagnosis. These bumps should be seen by your physician to make sure that they are not localized infections. — Dr. Slonim

Q: Since I had Botox, I have had double vision in my left eye. The left side of my mouth will not move and the left side of my face is droopy. I'm most concerned about the vision. Will it get better? It's been one month today. My doc doesn't seem too worried, but I am. — J.H.G.

A: The side effects caused by Botox go away when the Botox wears off, which can be up to three months. — Dr. Slonim

Q: If you correct strabismus by injecting Botox into the eye muscles, I've heard that the eyeball can collapse. Is this true? — L.R.

A: I am unaware of how an eyeball could collapse when the Botox is appropriately injected into the muscle. It is possible that the needle could inadvertently perforate the eyeball because the muscles injected for strabismus are against the eyeball. A single needlestick in the eyeball will not collapse the eyeball but it can cause a serious problem inside the eye including hemorrhage and infection. This treatment should be performed by someone very experienced in these kind of injections. — Dr. Slonim

Q: Is Botox toxic? Will it affect your health after several treatments? I want to use it only for cosmetic purposes on my forehead. — M.C.

A: All drugs and/or medications, when taken at certain high dosage levels, can produce toxic effects. When used appropriately, Botox should not have a toxic effect on your general health, even after several treatments. The amount required to effectively reduce the wrinkles on your forehead is far below any toxic level of the drug. — Dr. Slonim

Q: I had Botox for blepharospasm, and since the treatment I have felt discomfort in my chest. I've had three Botox sessions for my condition, but I seem to feel worse after this last treatment. Should I continue using Botox? — I.G.

A: The amount of Botox required to effectively treat your blepharospasm is far below any toxic level of the drug. It would be unusual for Botox to cause the symptom that you are experiencing.

Nonetheless, the discomfort in your chest should be thoroughly investigated by your primary care physician as soon as possible, to rule out any other possible causes. Your physician may want to discontinue your Botox injections until a correlation between the Botox and your chest discomfort has been ruled out. — Dr. Slonim

Botox and Other Medications

Q: I had Botox today, and six hours later I took a Tylenol PM. Will this lessen the effects of the Botox? — C.S.

A: Tylenol PM should not have any effect on the Botox. — Dr. Slonim

Botox and Supplements

Q: Which supplements interact with Botox injections? I take lots of fish oil, vitamin C and zinc. Would these be a problem? I also suffer from severe dry eyes and high eye pressure in my left eye. — C.K.

A: The one supplement that has been shown to interact favorably with Botox is zinc. In fact, there is a prescription product called Zytaze that has shown an enhanced effectiveness of Botox injections when taken four days prior to and on the day of Botox injections. This high concentration of this zinc formulation is claimed to assist the Botox in binding to the nerve receptors. — Dr. Slonim

Q: What vitamins and herbs affect Botox treatment? — S.S.

A: I am unaware of any vitamin or herb that has a direct effect on the effectiveness of Botox. Certain zinc supplements have been studied as products that might enhance the effects of Botox. There are many vitamins (eg, vitamin E) and herbs (eg, clove, garlic, ginger, ginseng, licorice) that have anticoagulant, or blood-thinning, effects. Since Botox is injected, avoiding these products prior to injections may help reduce possible bruising associated with injections. — Dr. Slonim

Please note: If you have an urgent question about your eye health, contact your eye care practitioner immediately. This page is designed to provide general information about Botox and cosmetic enhancement procedures in general. It is not intended to provide medical advice. If you suspect that you have a vision problem or a condition that requires attention, consult with an eye care professional for advice on the treatment of your own specific condition and for your own particular needs. For more information, read our Terms of Use.

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