Botox is one of the most studied injectable treatments in the world and has a good safety profile — but Botox side effects do exist. Most are mild and temporary. Here is the complete list, from common to very rare.
Common Botox side effects (≥ 1 in 10)
- Headache — 1–2 days after treatment
- Bruising at the injection site
- Swelling / redness — resolves within hours
- Tenderness at the injection point
- Slight asymmetry during the first week
These side effects are normal and resolve without treatment.
Uncommon side effects (1 in 100)
- Ptosis (drooping eyelid) — if Botox diffuses into a nearby muscle. Resolves within 4–6 weeks.
- Eyebrow asymmetry — "Spock brow", can be corrected with a small top-up dose
- Dry eyes
- Itching or rash around the injection site
- Temporary weakening of nearby muscles
- Flu-like symptoms 1–2 days after
Rare side effects (< 1 in 1,000)
- Dysphagia (difficulty swallowing) — very uncommon when the treatment is correctly placed
- Voice changes — with masseter or neck treatment
- Allergic reaction — very rare
- Botulism-like symptoms — extremely rare, with too high a dose
Specific side effects by area
Forehead
- Heaviness in the forehead during the first week
- Loss of the ability to raise the eyebrows (desired or undesired)
- "Heavy brow" if the dose or placement is wrong
Crow's feet
- Upper eyelids may feel heavier
- Slight effect on your smile ("not as wide a smile")
Masseter (jawline)
- The chewing muscles feel weaker for the first 2 weeks
- Temporary difficulty with hard food
- The change in shape only becomes visible after 4–8 weeks
Lip flip
- Difficulty pronouncing "p" and "b"
- Difficulty drinking through a straw
- Temporary; resolves as the effect wears off
- Ptosis that has not resolved after 6 weeks
- Allergic reaction (rash, itching, swelling)
- Difficulty swallowing or breathing
- Severe headache that does not go away
- Fever or signs of infection
For acute symptoms — call 112.
How can you reduce the risk of side effects?
- Choose a licensed practitioner — a physician, nurse or dentist
- Avoid blood thinners 3–7 days before (but not prescription medicines without a physician's approval)
- No alcohol for 24 hours before
- Do not touch the area for 4 hours after treatment
- Do not lie flat for 4 hours after
- No intense exercise for 24 hours after
- No sauna/hot bath for 24 hours after
Can side effects be permanent?
No. Botox is broken down by the body within 3–6 months — and any side effects disappear then too. There are no known permanent side effects of correctly performed Botox treatment.
Also read: Is cheap Botox safe? and What should you consider before Botox?
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Detailed safety analysis
Risk ladder — from mild to serious
| Level | Risk | Frequency | Action |
|---|
| 1 | Swelling, bruising | 70–90% | Heals on its own in 3–7 days |
| 2 | Headache, redness | 20–30% | Paracetamol, rest |
| 3 | Asymmetry in the first week | 5–10% | Assess after 14 days |
| 4 | Lumps, migration | 1–3% | Hyaluronidase / massage |
| 5 | Infection | < 0.5% | Antibiotics, seek urgent care |
| 6 | Vascular occlusion | < 0.1% | URGENT hyaluronidase within hours |
| 7 | Visual disturbance | < 0.01% | 112 immediately |
- 🚨 White, grey or dark blue skin around the injection site
- 🚨 Severe pain that gets worse (not normal tenderness)
- 🚨 Sudden changes in vision or double vision
- 🚨 Difficulty breathing or swallowing
- 🚨 Fever > 38.5 °C + spreading redness (infection)
- 🚨 Marked asymmetry that gets worse
- 🚨 Loss of muscle control far from the injection site
For acute symptoms: Call 112 or go straight to the emergency department. For moderate symptoms: contact the clinic within 24 hours. All reputable clinics have an on-call service for such cases.
Checklist — how to verify that a clinic is safe
- Licence: Check the practitioner's licence at legitimation.socialstyrelsen.se. They must be a physician, nurse or dentist.
- IVO registration: The clinic should be listed in IVO's register — search at ivo.se.
- Hyaluronidase on site: Ask directly. If the answer is "no" or unclear — choose another clinic.
- Product name visible: Ask to see the original packaging before the treatment.
- Patient records: A legal requirement. You should receive written documentation.
- Statutory cooling-off period: Before an aesthetic injection treatment, a cooling-off period of at least two days applies after you have received the information about the treatment. If the same type of injection treatment is repeated within six months, no new cooling-off period is required.
- Written consent: A legal requirement. You should sign an informed consent form.
- Follow-up included: A check-up visit after 2 weeks.
- Clear price: A written quote with no hidden costs.
- Credible reviews: Reviews with concrete details about the treatment are the most reliable.
- Pregnancy and breastfeeding: Injection treatment is advised against entirely.
- Neuromuscular disease (myasthenia gravis, ALS, etc.): Contraindicated for Botox.
- Blood-thinning medication: Increases the risk of bleeding — requires an additional consultation with a physician.
- Autoimmune diseases during an active flare: May increase the inflammatory reaction.
- Active herpes or skin infection: Wait until it has healed.
- Previous filler complications: Discuss with the practitioner — hyaluronidase may be needed first.
