Is Botox safe? A straight answer from the doctor who injects it

You have probably heard two things about Botox. That everyone has it. And that it is a poison.

Both are true, in a way. So it is fair to be nervous. You are about to let someone inject a toxin into your face, and you want a straight answer before you do.

Here is the answer I give in my clinic, including the parts that are uncomfortable.

Yes, it is a toxin. The dose is the whole story.

Botox is a brand name. The medicine inside it is botulinum toxin type A, a protein made by a bacterium. In large amounts it causes a serious illness called botulism.

The amount used for frown lines is tiny. It is measured in units, and a typical frown-line treatment uses about 20 of them, spread across five small injections. The medicine stays mostly where it is placed. It relaxes a few small muscles for a few months, and then your body clears it.

The same medicine has been used for decades to treat eye muscle problems and muscle spasms, often in much larger doses than anything used on the face. It was approved in the United States for frown lines in 2002. It is one of the most studied medicines in aesthetic medicine.

What usually happens: the small, common things

Most people have nothing more than this:

• Small red bumps where the needle went in. They fade within about 20 minutes.
• A small bruise now and then. More likely if you take aspirin or fish oil. Make-up covers it.
• A mild headache on the first day or two, in some people.
• A tight or heavy feeling in the forehead for the first week or two, while you get used to moving less.

None of these last. None of them need treatment.

What can go wrong, and how often

A drooping eyelid. This is the one people worry about most. In the manufacturer’s own trials for frown lines, it happened to about 3 in every 100 people. It happens when a little of the medicine reaches the muscle that lifts the eyelid.

If it happens, it does not stay. It fades as the medicine wears off, usually within a few weeks. Eye drops can lift the lid a little while you wait. Careful placement, the right dose, and not rubbing the area on the first day all make it less likely.

A low or heavy brow. This comes from treating the forehead too strongly, especially in people whose eyebrows already sit low. It is a planning mistake more than a medicine problem, and it also wears off.

An uneven result. One eyebrow a little higher than the other. This is common, easy to see at two weeks, and usually fixed with one or two small extra units at review.

The medicine spreading far from where it was injected. The official prescribing information carries a strong warning about this. It is important to read it properly. The warning comes from medical uses with much bigger doses. The same document says there have been no confirmed serious cases of this with cosmetic use at the recommended dose for frown lines.

Allergic reaction. Very rare.

The real danger: fake product and the wrong hands

When people are seriously harmed by Botox, the story is usually not about the medicine itself. It is about where it came from and who gave it.

In 2024, US health authorities investigated a group of people who became seriously unwell after cosmetic injections. Most had been injected by unlicensed people, or in homes and salons, and several had received fake or badly handled product. Some needed hospital care.

Real botulinum toxin comes from a licensed supplier, in a sealed vial, and is kept cold. A doctor can show you the box. If someone offers you Botox at a house party, at a price that seems too low, or cannot tell you what brand it is, walk away.

Who should not have it, or should wait

• If you are pregnant or breastfeeding. It has not been properly studied. I will not treat you until you have finished.
• If you have a nerve and muscle condition such as myasthenia gravis. You may react much more strongly.
• If you have a skin infection or a cold sore where the needle would go. We wait until it clears.
• If you are on certain antibiotics, a group called aminoglycosides. They can make the effect stronger.
• If you have an important event in the next two weeks. Not a medical reason, but a practical one. The full result takes up to two weeks to show.

This is why I ask about your health and your medicines every time, even if you have been coming to me for years.

What about years of Botox?

This is a common worry. People have had regular treatment for more than twenty years, and there is no sign that repeated cosmetic doses cause lasting harm to the face or the body. If you stop, your muscles simply go back to how they would have been.

One thing is worth knowing. In a small number of people, the body learns to recognise the medicine and it stops working as well. This is more likely with frequent top-ups at short gaps. So I use the smallest dose that does the job, and I space treatments about three to four months apart.

How I do things

I use only licensed product from an approved supplier. I open the vial in front of you if you ask.

I look at your face moving before I plan anything. Where your eyebrows sit, how strong each muscle is, how your face moves when you talk. The dose is decided by your face, not by a menu.

For a first treatment, I usually go a little lighter. I see you again at two weeks. Adding a few units then is easy. Taking them away is not possible.

And I will say no. If your brows are already low, if you are hoping it will fix something it cannot fix, or if your health history makes me uneasy, I will tell you so, and tell you why.

If you want to know exactly what happens on the day, I have written it step by step: your first Botox appointment in Dubai.

Questions I get asked every week

Is Botox safe?

In small cosmetic doses, given by a trained and licensed doctor using genuine product, it has a long and well-studied safety record. Minor side effects are common and short. Serious problems are rare.

Can Botox spread through my body?

The official prescribing information reports no confirmed serious cases of this at the recommended cosmetic dose for frown lines. The warning mainly relates to much larger doses used for medical conditions.

What if my eyelid droops?

It happens to about 3 in every 100 people treated for frown lines. It fades as the medicine wears off, usually within a few weeks, and eye drops can help while you wait. Come back and see me so I can check it.

Is it bad to have Botox for many years?

There is no sign that regular cosmetic treatment causes lasting harm. If you stop, your muscles return to how they would have been. Keeping doses low and gaps long helps it keep working.

Can I have Botox while pregnant or breastfeeding?

No. It has not been properly studied in pregnancy or breastfeeding, so I wait until you have finished.

How do I know the product is real?

Ask to see the box and the vial. Genuine product comes sealed from a licensed supplier and is kept cold. Be wary of very low prices and treatment outside a licensed clinic.

The treatment page goes through the assessment, the areas treated and the risks in more detail: botulinum toxin in Dubai.

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Sources

• Allergan (AbbVie), BOTOX® Cosmetic (onabotulinumtoxinA) US prescribing information — 20 unit dose for glabellar lines; eyelid ptosis in about 3% of treated subjects in glabellar line trials; boxed warning on distant spread of toxin effect, with no definitive serious reports at the labelled cosmetic dose; warnings on neuromuscular disorders, aminoglycosides, pregnancy and lactation, and antibody formation.
• US Food and Drug Administration, approval of BOTOX® Cosmetic for temporary improvement of glabellar lines, April 2002.
• US Centers for Disease Control and Prevention, investigation of harmful reactions linked to counterfeit or mishandled botulinum toxin injections, 2024.