Are anti-wrinkle injections safe?

Are anti-wrinkle injections safe?

the botox and hyaluronic acid are resorbable products, that is to say that they are naturally degraded by the skin over time. The result is therefore transitory, but it is a guarantee of security. The risk of a reaction is much lower than with a product that remains permanently in the skin. However, these two injected products do not obey the same regulations.

Botulinum toxin is a drug

This drug has a marketing authorization. Used since the 1970s, it is a safe product. In France, three products have marketing authorization to improve forehead wrinkles, lion and crow’s feet (Azzalure, Bocouture, Vistabel). Only surgeons (maxillofacial surgery, face and neck surgery and reconstructive and aesthetic plastic surgery), dermatologists and ophthalmologists are authorized to inject it.

“Today, it is the most secure anti-wrinkle treatment we have,” says Dr. Martine Baspeyras. However, there are side effects. The National Medicines Agency has only received around thirty reports of the 2.56 million bottles marketed since 2003.

Contraindication : botulinum toxin should not be used in people suffering from certain muscular diseases (myasthenia, etc.).

What are the dangers of a botox injection?

A study reveals that botox can lead to multiple complications in many patients. Its results published in September 2021 in the Guardian have led its authors to plead for better regulation of the products used but also for the obligation for practitioners to declare any complications or side effects observed. After analyzing 30 studies involving 17,352 botox injections in the facethe latter claim that this anti-aging treatment causes side effects in one out of six patients, for an overall rate of complications by about 16%.

Among the complications identified, sometimes simultaneous: muscle stiffness, dizziness, vertigo and pain. In some cases, it is even cardiovascular symptoms ranging from high blood pressure to heart attacks. The study authors also found that despite the high number of incidents caused by the procedure, only 188 ‘adverse effects’ have been reported to the UK Medicines and Healthcare Products Regulatory Agency over the past 29 years. A figure that does not reflect reality at all according to them.

The product itself is not in question: the concern of doctors lies in the people who inject on patients without proper training. This is why they are calling for better regulation regarding the use of “fillers. This observation also leads them to ask that clinics administering botox be licensed and required to report observed complications as a condition of their licence. In France, the French Association of Aesthetic Medicine wants to be reassuring and indicates that there are “risks and side effects, even if the real complications and great dangers remain extremely rare. »

What are the side effects of botox injections?

Botox injections are not without risk and can lead to certain complications. Whatever the type of undesirable effects, they disappear after some time because botulinum toxin is a absorbable product.

Bruising at injection sites

“More frequent in crow’s feet or frown lines, they are often due to an anatomical peculiarity: we inject near a vessel which, normally, should not be in this place”, explains Dr Élisabeth Daumergue Than Trong. Bruises at injection sites can last up to three weeks, but the application of a arnica cream before the session can prevent or minimize their occurrence. “Advice that is all the more justified if the person is under antiplatelet or anticoagulant treatment. »

drooping upper eyelid

“Extremely rare, it is often due to an overdose or a technical error,” says Dr. Domergue Thân Trong. “Or again, specifies Dr. Baspeyras, to an unpredictable diffusion of the product in the levator muscle of the eyelid which, suddenly, sags. » It takes one to six months for a complete regression.

A problem with the eyebrows

Eyebrows lower. This may be related to too low a toxin injection on the forehead, slightly excessive doses or too soft skin. ” From eyebrow lifting exercises can improve the situation, but it takes a month, sometimes less, for a return to normal,” says Dr. Baspeyras. They give a “Mephisto” effect. “This inverted V appearance of the eyebrow is due to a poor evaluation, during the injection, of the game of balances between the different muscles of the upper face”, says Dr. Domergue Thân Trong. They are simply corrected during the touch-up appointment on the fifteenth day.


The appearance of edema linked to a botox injection is most often localized in the forehead or eyes (puffiness), more marked the following morning, to decrease in a few weeks.


Headaches may appear during the session, sometimes on one side only. They improve spontaneously within hours or days.

Double vision (diplopia)

Diplopia is a rare complication, which disappears in a few weeks. It is due to a diffusion of the toxin in the muscle responsible for the movement of the eyeball.

Frozen lines

It may happen that the patient has the frozen features in case the doctor used slightly higher concentrations to have a more lasting result. This effect fades in the following weeks.

Advice to reduce the risks during botox injections

To note : the name of the toxin, the expiry date, the batch number, the date of injection. “This allows you to know what has been done and, if other injections are being considered, if they are compatible with the product already injected,” says Dr. Thân Trong.

Take precautions : arriving with your face cleansed, and ensuring that the doctor disinfects the stung areas beforehand, or even the entire face. By postponing the date of the injection in the event of an infectious disease or vaccine. By avoiding lying down for the next 2 hours and also, for 48 hours, anything that could cause the toxin to spread into the neighboring muscles: massage or compression of the injected area (motorcycle helmet, swimming goggles. ..), sources of heat (exposure to the sun, brushing, sauna…), violent sport. “Finally, adds Dr. Baspeyras, do not take an anti-inflammatory one week before the injection and inform the doctor if you are on anticoagulant treatment. »

Be careful with off-label injections: some doctors suggest injecting toxin into the lower face to improve wrinkles (lips, bitterness folds, etc.), a complex region to treat and more at risk of complications (asymmetry of the smile, etc.). To be avoided, therefore, unless you have great confidence in your practitioner.

Hyaluronic acid is a medical device

This large hydrating sugar molecule, which fix volumes, is a medical device, in the same way as breast prostheses or dressings. This invasive device (because it is injected into the skin) is therefore not considered a drug. He is subject to CE markingwhich only guarantees the sanitary quality of the formula.

In France, about a hundred products are marketed by 35 manufacturers, they are regularly checked by the National Agency for the Safety of Medicines and Health Products (ANSM), with the help of external experts. All doctors can inject it into the face.

What are the contraindications to hyaluronic acid?

Hyaluronic acid can be used on all skin types thanks to the variety of its formulations, but there are however some contraindications for hyaluronic acid injections in the face. Thus, it should not be used in people suffering from certain active, acute inflammatory or muscular autoimmune diseases (hepatitis C, myasthenia, etc.). Injections of hyaluronic acid are also strongly discouraged in people with keloid scars or in an inflammatory scar state. It is imperative to warn the practitioner if you have already made injections based on permanent products, because some products may be incompatible.

Hyaluronic acid: what are the dangers?

As with any medical procedure, there are. First of all aesthetic risks, if the result is not suitable. But also medical risks. According to the ANSM, the side effects related to hyaluronic acid injections would affect 0.1 to 1% of people.

The most common – oedemas, minor bleeding or hematomas – fade in a few days. Rare, theallergy to hyaluronic acid exists, causing a localized inflammatory reaction such as urticaria. In some women, nodules may appear and create a small lump in the injected area, sometimes several months after the operation. The white blood cells attack the hyaluronic acid to digest it and die. This nodule is treated by anti-inflammatory treatments based on corticosteroids and massages, or punctured.

It can also happen that hyaluronic acid is injected into an artery and the mouth. ” It’s here complication the most serious”, emphasizes Dr. Ludovic Lievain. It can cause skin necrosis or vascular emboli (kinds of clots). Injection with a cannula with a round tip avoids this phenomenon. These problems are extremely rare and can be resolved if the doctor reacts immediately by injecting hyaluronidase, an enzyme that dissolves hyaluronic acid. Subject to marketing authorisation, this is authorized exclusively in the event of a vascular complication. Only surgeons, dermatologists and ophthalmologists have this antidote. “Pain, skin turning white or vision blurring should be warning signs,” says Dr. Lievain.

Choosing the right practitioner when doing anti-wrinkle injections in the face

It’s not always easy to choose your doctor, especially since aesthetic medicine is not recognized by the National Council of the Order of Physicians. Prefer a practitioner who has undergone specialized training. “The anatomy of the face being little studied during medical studies, certain diplomas allow doctors to learn injection techniques”, explains Dr. Cécile Winter.

The practitioner must ask you about your medical backgroundcurrent treatments (if you are taking anticoagulants, these injections are contraindicated).

The practitioner must also provide a quote indicating the qualification of the doctor, his registration number with the Council of the Order and the references of the products injected. This estimate must be accompanied by an informed consent to be signed, but also by oral explanations on the precautions to be taken and the possible side effects.

On D-Day (after 15 days of reflection), the doctor must put on gloves before giving you a bite, use sterile equipment, remove make-up from the skin and disinfect it. He has an obligation to you communicate what he injected (name, manufacturer, lot number), and must provide you with the syringe label. If this is not the case, ask for your injection book.

“The doctor must be reachable within two or three days following the intervention, adds Dr. Martine Baspeyras. When in doubt about a reaction, send her a selfie. »

To find out what is really going on with the different techniques aimed at reducing wrinkles, plumping the skin, stimulating cell regeneration, listen to this episode of Hypercondriaque, the prevention podcast from Santé Magazine. Aline Perraudin, Editorial Director, receives Pr Brigitte Dréno, Head of the Dermato-Cancerology Department at Nantes University Hospital and member of the Scientific Committee of Santé magazine.

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