Botox: points to consider before undergoing non-surgical cosmetic treatments

Posted: 03/05/2018

Botulinum toxin injections, such as Botox, are medical treatments that can be used in the cosmetic surgery industry to help relax facial muscles.This makes lines and wrinkles, such as crow's feet and frown lines, less obvious. They can temporarily alter your appearance without the need for surgery. When Botox injections are used for cosmetic reasons, they are not available on the NHS.

Botox is derived from the bacterium clostridium botulinum, which is found in soil. It can cause severe paralysis in humans and other organisms through ingestion or inoculation of a wound via the toxin that it produces, ie botulinum. Botulinum toxins affect nerve endings by blocking the conduction of nerve impulses. The effects of administered botulinum toxins do wear off depending on the dose, site of use and nature of the underlying condition requiring its use.

Botox can also be used therapeutically in the following conditions:

• cerebral palsy - to reduce increased muscle tone in limbs that are ‘tight’, ie showing signs of spasticity;
• to help with the management of increased tone in the upper limbs, or lower limb spasticity following a stroke;
• the management of spasms in the face;
• assisting with the management of chronic migraine;
• bladder dysfunction not controlled by medication, such as an overactive bladder, or increased activity of the area of the bladder associated with urinary incontinence (neurogenic detrusor overactivity); and
• excessive armpit sweating (hyperhidrosis).

Side effects can occur with Botox injections even if previous injections have been tolerated without any issues. This means that for each subsequent administration of the Botox, the patient should be advised about problems to look out for and when to seek help.

Botox use has increased exponentially over the past two decades, with the majority of its use being for cosmetic purposes. As it may take up to five days for the Botox to start working, a patient could wrongly assume that the procedure has failed and manually rub the Botox in order to spread it and therefore lessen the intended local effects. Complaints also arise when patients do not fully appreciate that Botox only lasts (for intramuscular injections) approximately three to five months, with the effects increasingly diminishing with each subsequent dose in a number of patients.

Botox should not be given to pregnant or breastfeeding women as the effects of the drug are not understood in this population.

The incidence of adverse reactions is, on the whole, uncommon but the treatment should only ever be administered by trained practitioners, and as it is a prescription-only medication, prescribed by a regulated healthcare practitioner such as a doctor, dentist, nurse or pharmacist prescriber. Legally the prescriber can delegate the administration of the injection to someone else, but they remain responsible for ensuring it is given safely and must examine the patient prior to administration. There has been a case where a doctor prescribed Botox for a nurse to administer without having examined the patient and he was subsequently suspended from practising for 12 months.

In a case settled in 2014, a woman received £12,500 in damages after she was injected with a used needle whilst having a Botox injection for excess sweating. She had to undergo regular blood screenings for a year before being given the all clear. The claimant suffered an acute stress reaction for 15 months following the incident. She continued to suffer from a chronic needle phobia and alleged that the stress she suffered had exacerbated her symptoms of Crohn's disease.

Alison Johnson, associate director in the clinical negligence team at Penningtons Manches LLP, says: “If you've had Botox injections and are not happy with the results or are experiencing problems, take up the matter with your practitioner through the clinic where you were treated. If for any reason you feel unable to, you should speak to your GP as soon as possible, in case you need any further medical treatment. For concerns relating to poor medical care during Botox treatment, including if you feel you weren’t properly advised of all your options and the pros and cons of treatment before you went ahead, please contact us. A member of our specialist cosmetic surgery team can assess whether you may be able to bring a clinical negligence claim.”

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