Can Botox Cause Botulism?

Botox cause Botulism?

Yes, when injected incorrectly and with certain patient factors.  But please read on.

Botox from Allergan is a highly purified protein derived in the laboratory from a bacteria which can cause botulism.

What Bacteria does Botox come from?

Botox is purified in the lab from a bacteria known as Clostridium botulinum.  It is a gram-positive, rod-shaped, anaerobic, spore-forming bacterium.

Botulism and the Bacterial cause

Botulism is a rare illness that causes paralysis of the body including breathing muscles.  It can be caused by several different strains of Clostridium: Clostridium botulinum, Clostridium butyricum, and Clostridium baratii.

Various forms of Botulism

There are about 5 various forms of botulism, but the three main forms are  foodborne botulism, wound botulism, and infant botulism (which can be caused by honey ingestion in infants).  The bacterial spores from clostridium botulinum are common in soil and water.

Various forms of Botulinum Toxin

The Botulinum toxin are a varied group and consist of 8 types.  Botulinum toxin types A, B, E, F, and H affect humans.  The other types affect other mammals.  Botox is Botulinum toxin type A.  There are three forms of Botulinum toxin type A used medically:  Botox, Dysport, and Xeomin, and there is a botulinum toxin type B called MyoBloc which is also used medically.

Iatrogenic = accidental overdose.  Another form of Botulism.

An iatrogenic form of botulism (in addition to the three main types described above) can occur from accidental overdose of these botulinum toxins.  How can an overdose occur?  Too high of a dosage, injected into blood vessels or accidental spread from intended medical targets.

“Botox is to Botulism as Penicillin is to Mold”

But one elegant way to think about Botox is this analogy:  “Botox is to Botulism as Penicillin is to Mold.”  That statement is trying to say that Botox is harnessing the good powers of something considered harmful; just like how penicillin was derived from mold.

With cosmetic dosing and usage, the chance of overdose related (iatrogenic) Botulism is small.

“Good Medicine given in dangerously high doses is a Bad Poison”

Medicine can become a poison when given in supra-physiologic amounts.  That goes for just about every medicine.  This is my own quote, but in many ways, this can be considered common sense and applicable to many facets of life.  The common quote is “too much of a good thing is bad.”

In my opinion, when genuine cosmetic Botox is injected properly, it is one of the safest drugs I’ve used.

The risk of Botulism from Botox is extremely small

Hopefully this discussion isn’t too scary.  What I mean to say is that if Botox is injected in huge amounts and incorrectly, there is a risk of Botulism.  There may also be risks when patients inadvertently push the Botox away from their intended targets.  But when injected in small amounts (ie. for cosmetic use) and carefully (and with experience), the risk of Botulism is extremely small.   Medical Botox usually is a higher dose of Botox than Cosmetic Botox.  Medical Botox is frequently 10 times higher dosage than Cosmetic Botox.  But even so, the risk of iatrogenic Botulism is miniscule.   As with any potential risk, we should be aware and treat Botox with respect.

Treat Botox with respect – a message to myself as a Botox injector.  Here are some tips to avoid Botox complications

As injectors we should continue to watch out for high doses of Botox.  Perhaps we should break up those doses into a staged approach, meaning that the patient could come back a few days later for more Botox instead of cramming it all in at once.

We need to watch out for blood vessels.  We should aggressively seek out vessels that we can see or feel with our hands and avoid them, and consider taking notes of offending vessels when repeated Botox is anticipated.

We should take care to think of Botox as a three-dimentional injection.   The depth of injection matters to me.

And it goes without saying, that we should use the proper Botulinum toxin for the indication.  No shortcuts here.

As for patient factors, I continue to warn my patients to avoid large amounts of pressure on the injected spots and avoid rattling the area with devices such as clarisonic for a few days after the injections.  This is just my own thoughts on the topic of Botox migration.

Please visit us in person for more of your concerns and questions about Botox.

Calvin Lee, MD

More info on Botox and Botulism

Our website: Modesto Botox –  or visit the home page of our Modesto Botox Blog or visit our Plastic Surgery page.

Please see your own doctor or Botox injector for a personalized discussion.  There is no medical advice here, just medical information.  This is just my own opinion for this blog.  Allergan has nothing to do with this blog.  In fact Allergan sales people have said things to me before which make me believe that they wouldn’t agree with this blog.  Please double check facts in this blog which may change with time.