Are Botox injections safe?

“Are Botox injections safe?” This is one of the most common questions we get from people enquiring about this treatment and this post aims to give you an honest accurate insight into the safety of this treatment.

A very quick answer to this question is that toxin injections, commonly known as “Botox” are one of the safest non-surgical cosmetic treatments, with millions of people having these injectable treatments each year.

Below is a more detailed explanation of all the considerations that you and the person carrying out these injectable treatments should discuss together.

Let’s first look at what “Botox” is and then it will be easier to understand the answer to “Are Botox injections safe?

Botox is a brand of Botulinum toxin type A, which is a protein extracted from the bacterium Clostridium Botulinum.   This protein or toxin is a neurotoxin, which means it affects nerve tissue and when it is used in a small therapeutic clinical dose it is a very safe treatment. There are also other brands such as Azzalure and Dysport, all of which have demonstrated the equivalent effectiveness and it usually comes down to the preference of the practitioner.

Regardless of which brand is used, the most important factor you need to consider if you are thinking of having this treatment is to ensure an experienced medical practitioner is carrying out the treatment in a registered clinic. Botulinum toxin is a prescription medicine and can only be deemed safe when a Doctor, Dentist or an Aesthetic Nurse Independent Prescriber prescribes it.

Below are the risks that are associated with these treatments:

  1. The toxin is prepared in egg albumen and so is not suitable for anyone who has an allergy to eggs. A careful history will be taken to determine this. You also have to be aware of this should you be Vegan.
  2. It is a neurotoxin meaning that it temporarily blocks the function of the nerve that innervates muscles and sweat glands. Because of this involvement with the nerve tissue, anyone who has had any motor neurone diseases, syndromes with poor nerve function or who have suffered Bells Palsy, even if the full function has returned, cannot have this treatment.
  3. Droopy eyebrows. This is a more widely known possible side effect and many patients do have questions about this. To put your mind at rest it is not common for an eyebrow to droop and to give you more clarity on this there are two types of “eyebrow drooping”. The first incidence is when the eyebrow actually falls lower than its natural position – this is extremely rare and is caused by injecting a higher dose of toxin in the wrong area. (An experienced practitioner knows not to do this).  The second incidence is when clients think their eyebrows have dropped because of an inability to raise them. In most of these cases it isn’t the eyebrows that have dropped; the actual skin in the eyelid, which is looser, can look hooded due to being unable to raise the eyebrows.  A full consultation will assess skin laxity to determine if immobilising the muscle will have the desired effect or not. Sometimes a client’s main goal is to do whatever they can to reduce wrinkles across the forehead and are happy to accept a heavy feeling for a few weeks so that the skin can get the rest it needs to reduce wrinkles. On the other hand some clients’ goals are to achieve an eyebrow raise and do not want any heaviness at all; in these instances, we can alter the dosage to minimise any heavy feeling and these clients may have to have their treatment more frequently to achieve the desired result with minimal risk of heavy feeling brows.
  4. The risk of bruising exists, as it does from any injection. There is a huge capillary network in the skin and these can be traumatised with the needle, however small the injections are. Bruising is not common, it is usually very small and can be covered by makeup very easily.
  5. The risk of infection. The skin should be cleansed appropriately and the practitioner should have followed hand washing and disinfection protocols, and be wearing suitable disposable gloves. Injections should be avoided on areas with active skin infections as that could increase the chance of the infection spreading.
  6. Avoiding treatments if pregnant or breastfeeding is crucially important. It is a neurotoxin and although it is thought not to be able to pass through the placental barrier, the treatment would categorically not be performed. It would reach breast milk and so in both instances, it must be avoided.


These are the risks and although they exist, they are very small indeed. Common medications probably pose greater health risks than Botulinum Toxin injections. The most important considerations you need to make though are choosing a trusted clinic, ideally from a recommendation, and choosing a clinic who provide valuable education and have time to answer all of your questions.   Make sure you are offered a consultation first so that you can discuss what to expect and then make the best decision for you.