Contraindications and complications with the use of botulinum toxin.

Cosmetic use of BTX has skyrocketed in recent years, especially since the approval of BTX-A for treatment of glabellar lines. Complications and adverse reactions can easily arise, particularly for the novice injector. This paper provides insights from an experienced physician on how to avoid these complications, and how to treat them when and if they occur. The main cosmetic uses for BTX are analyzed for possible complications and adverse events. Injection techniques are discussed. Comparisons between BTX-A and BTX-B are given to point out the need for different injection techniques based on the product being used. Treatment recommendations for the Glabella, Brow, Crow's Feet, Upper Lip Wrinkling/Lines, Depressor Anguli Oris, Nasolabial Folds, Mentalis, Neck and Hyperhidrosis are discussed, as well as systemic complications. It is important for the injecting physician to be familiar with these potential complications, even though the use of BTX has been safe and generally well tolerated, because it will lead to even greater success with the use of BTX.