Five Possible Side Effects of Botox

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Before you make a decision about having a cosmetic procedure, such as Botox, it is always best to educate yourself with as many facts as possible. What are the possible side effects is one of the first questions people will ask before proceeding. Picking the right doctor is key, and they should be able to talk you through the risks and know how to avoid them!

We asked Dr. Paul Munsanje, of Amara Aesthetics and Beyond MediSpa Harvey Nichols in Knightsbridge, to tell us the five most common side effects and why they can happen. Here is what he had to say.

The Dreaded Eyelid Droop!

This is the fear of every Botox aficionado. The droop is caused by Botox affecting the levator palpebri superioris. This muscle is tasked with lifting the eyelid only and opening the eye. As it is a very small muscle, not a lot is needed to cause this, but a small amount in the wrong place and not following aftercare instructions can cause this to happen. I have to say I have never had anyone having this effect, as it’s easy to avoid.

Eyebrow Droop!

Eyebrow droop, or brow ptosis is not a good look, but thankfully it is not as bad as an eyelid droop. The eyebrows are lifted by the frontalis muscle, a large muscle across your forehead. When the muscle is used, it pulls your eyebrows up and causes those horizontal lines across your forehead. If it's done right, you can still move the eyebrows and all is well with just softened lines. Underdone, you can move them a little too much, and overdone will cause the droop. Not only can you not lift the eyebrows, even worse, they are lower than they usually are.


Luckily with appropriate care and attention, bruises can be few and far between. A doctor should get less than 2% bruise rate (that means 1 bruise in every 50 injections), and a master will get even lower than this. When bruises happen they should be small and easily covered with concealer.

Double vision

This is extremely rare. It is another side effect, like the dreaded droop, which I personally can’t understand. The muscles that move your eyes are quite deep in your eye socket.

To get this side effect, large quantities need to be used very close to the eyes. If your doctor doesn’t do this, then this side effect is practically impossible. The general rule is to stay 1cm outside the orbit (the edge of your eye socket).

New lines may appear

What?? Botox can cause lines? Bad Botox can cause new lines. The trick is – do not go heavy with Botox. The heavier you go, the more likely the muscles that usually have a partner to play with or pull against can lose control when they act unopposed. Examples of these lines include bunny lines, under eye, over eye and some diagonal forehead lines.

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