Many of the questions I get about Botox and Dysport are related to safety concerns and possible side effects. It seems every couple of years something comes up that causes patients concern and I get more questions than usual.

Once again, this is what I tell my patients. If you are not my patient you should listen to what your doctor tells you.

Will I have any side effects?

• Very minor bruising is the most common side effect. Occasionally temporary eyelid droop, headache, nausea, and rarely temporary double vision occur.
• Usually the only side effect is that you will like it.

Is it safe?

• The FDA has recently changed safety labeling pertains to all of the botulinum neurotoxins (Botox, Dysport and Myobloc) in response to rare reports of distant spread after injection for medical—not aesthetic—purposes, resulting in heart problems, breathing/swallowing problems and allergic reactions. Most of these reports involved children who were being treated for spasticity. Since many occurred months after injection and many patients had other risk factors the relationship, if any, to the injection is unclear. There have been no confirmed reports of distant spread after the aesthetic use of botulinum neurotoxin. The cosmetic use of Botox and Dysport is typically at doses that are significantly lower than the doses for therapeutic use of botulinum neurotoxin.
• Some patients have suffered serious health problems after receiving substances which were fraudulently represented as Botox. Neither Botox nor BotoxCosmetic were in any way involved with these unfortunate events.
• Patients who are pregnant or breastfeeding, have ALS, Myasthenia Gravis or Lambert-Eaton syndrome, should not be treated.
• The majority of physicians who administer Botox and Dysport have treatments themselves. Believe me they wouldn’t do it if they weren’t comfortable with its safety record.

I heard that I can order Botox online, watch a YouTube video and learn how to inject myself and save money. Is that OK?

• Believe it or not there are online stores selling “do it yourself Botox and Dysport” or their “special” toxins. They sell it to anyone with a credit card. You are supposed to trust them to sell you authentic Botox or Dysport, or trust that their “special” brand is safe. They promote their stores on YouTube with videos on how to inject yourself. There is a group of “do it yourselfers” who vehemently insist on their right to inject themselves to save money, and to get better results than “those greedy doctors.”
• Counterfeit Botox is commonly produced in China, Russia, Chechnya and other countries. The counterfeits are part of a booming trade in fake pharmaceuticals ranging from cancer-treating medicines to knockoff Viagra. Terrorist groups are known to both sell counterfeit drugs to raise money and to be seeking botulinum toxin to weaponize. You do the math.
• Although I am quite comfortable with the safety, purity, and authenticity of the medication when purchased from Allergan or Medicis and injected by an experienced physician, I would never consider buying Botox or Dysport anywhere but directly from the manufacturer. There is not enough money in the world to pay me to inject myself with a “toxin” bought online. You shouldn’t either.
• If you think it is a good idea to buy one of the world’s most potent toxins online, with the significant risk of purchasing a counterfeit, adulterated, impure, and dangerously dosed “toxin” and try to inject it into yourself in your bathroom, you need more help than I can give you in this column.

Next: Botox vs. Dysport and cost of Botox and Dysport