Complications of botulinum toxin A use in facial rejuvenation.

The esthetic application of botulinum toxin type A (Botox) is a safe treatment modality; nevertheless complications can occur as a result of patient-and physician-related factors. Fortunately, adverse effects and undesirable sequelae after Botox injections are temporary. Complications may be more serious in patients who have more severe rhytids (which require more Botox), previous facial plastic surgery (altered anatomy), and those who have pre-existing neuromuscular disease. The physician can reduce complications by using proper injection techniques, appropriate regional Botox dosing, and by being conservative in the overall approach to Botox-mediated facial rejuvenation.