What are the reported adverse events due to therapeutic and cosmetic injection of botulinum toxin (BoNT)?

Updated: Oct 10, 2019
  • Author: Divakara Kedlaya, MBBS; Chief Editor: Elizabeth A Moberg-Wolff, MD  more...
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Adverse events due to therapeutic and cosmetic injection of BoNT reported to the FDA include respiratory problems, dysphagia, seizure, flulike syndrome, facial and other muscle weakness, ptosis, and skin and injection site reactions. [142] Of the 406 reports related to therapeutic use, 217 met the FDA's definition of serious, with 28 deaths and 17 seizures reported. Clinical characteristics submitted to the FDA for therapeutic cases differed from those of cosmetic BoNT cases, which were usually less serious. Most of the adverse effects linked to local tissue diffusion of BoNT. Careful attention to drug dose, dilution, handling, storage, and site of injection are required for optimal treatment outcome and to minimize adverse effects.

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