A Review of Complications Due to the Use of Botulinum Toxin A for Cosmetic Indications

Aesthetic Plast Surg. 2021 Jun;45(3):1210-1220. doi: 10.1007/s00266-020-01983-w. Epub 2020 Oct 13.


Background: Botulinum toxin A (botulinum toxin A) was found to provide a wide variety of therapeutic and aesthetic benefits as one of the most potent toxins in the world. Injectable remedies, including soft tissue fillers and botulinum toxin, have become very common in wrinkling and face rejuvenation management. While these methods of treatment are relatively safe, serious side effects can occur. In this review, the complications of BoNTA are highlighted.

Methods: A literature research considered published journal articles (clinical trials or scientific reviews). Electronic databases (PubMed, Scopus, Science Direct) were searched using key terms, and for identification of additional relevant studies, reference lists have also been examined. Only articles published in English were included in this review with a time restriction from 2000 to 2020.

Results: There are various injection-related adverse effects associated (AE) with botulinum toxins such as erythema, oedema, pain, ptosis of eyelid or brow and ecchymosis. The overall majority of adverse events identified are mild and temporary.

Conclusion: As the use of toxins becomes increasingly more common, adverse events can be expected to increase as well. The practitioners need to be aware of such AEs, and the patients should be informed of these before undertaking such procedures.

Level of evidence iii: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Keywords: Botulinum toxin A; Complication; Wrinkles.

Publication types

  • Review

MeSH terms

  • Botulinum Toxins, Type A* / adverse effects
  • Esthetics
  • Face
  • Humans
  • Rejuvenation
  • Skin Aging*


  • Botulinum Toxins, Type A