Here’s why you should not use Botox-type fillers in some instances

Leslie Baumann, M.D.
·3 min read
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There are now five brands of botulinum toxin type A (BTX-A): Botox, Dysport, Jeuveau, Daxxify, and Xeomin, and they all work the same way.

I’m calling them “BTX-A” to represent the entire group. These injectables are so popular and generally work well to achieve a wide range of cosmetic goals and are safe. However, there are certain instances when you should not get BTX-A injections.

Medical reasons not to get BTX-A

There are a few well-known medical reasons not to get BTX-A, as listed below. If you have any of these issues, discuss with your provider BEFORE getting any BTX-A injections.

▪ You’re pregnant or breastfeeding. There is very limited evidence regarding possible side effects of BTX-A injections while pregnant or breastfeeding, so it is recommended that you pause injections during this time.

▪ You’re on an aminoglycoside. This is a specific type of antibiotic that is known to exhibit neuromuscular blocking effects and therefore should not be combined with BTX-A. These include gentamicin, neomycin, and streptomycin.

▪ You have a neurodegenerative or neurologic condition. Do not get BTX-A injections if you have a condition such as amyotrophic lateralizing sclerosis (ALS), myopathies or myasthenia gravis.

My insight on when not to get them

In addition to the above reasons, I am sharing my personal recommendations and insights below. I realize that not everyone will agree with me on these points, but I have been injecting BTX-A since 1997 and have performed the FDA-approval trials for wrinkle indications on all of the toxins (except Xeomin).

Note that use of BTX-A is not yet FDA-approved for use in the platysma muscles of the neck, the bar code lines, the depressor anguli oris (DAO), or in the trapezius muscles.

▪ You have an autoimmune disease. Although many doctors inject people with autoimmune diseases, I always warn my patients that there is a low risk of triggering these, although it has never been proven.

▪ If your eyes are hollow, skip BTX-A in the crow’s feet area for six months to let the round muscles around the eyes (orbicularis oculi) bulk back up. Your other option is to get filler to fill in the concave area that occurs when the muscle gets smaller from not being used, but I find that skipping BTX-A in the crow’s feet area for about six months will usually solve the hollowness issue.

▪ If you have neck pain, don’t get BTX-A in the platysma neck muscles without consulting your doctor first.

▪ If you have rotator cuff or other shoulder issues, don’t get BTX-A in your trapezius muscle (“Barbie Botox”), as it may weaken your shoulder girdle.

▪ Don’t get BTX-A for “bar code lines” around the mouth, as I feel they often create an odd smile. I do not inject BTX-A in this area, but I know many doctors do.

▪ Don’t get BTX-A in the corners of the mouth before an important event. Injecting the depressor anguli oris (DAO) in the corner of the mouth can give you a crooked smile, so never do this right before an important event.

Bottom line

Botulinum toxin injections like Botox, Dysport, Jeuveau, Daxxify, and Xeomin are very popular and can yield excellent results. However, there are some instances when they should not be used, or used with caution, as outlined above.

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