Most concerns about Botox are about around how it could change the appearance of the face. Might it lead to asymmetrical facial expressions, an inability to express signs of empathy, an overly tight forehead or stiff cheeks?
For some people, it’s less the appearance of the skin but the way Botox and anti-wrinkle injections make them feel. Fatigue, headaches and chills are common complaints after an appointment. This is colloquially known as “Botox flu”.
Here, we break down if Botox can trigger a cold and, if not, what is going on.
Why does Botox trigger cold-like symptoms in some people?
“‘Botox flu’ is not a medical term,” Dr Dascha Berek, owner and medical director of Love Your Face (Lieb Dein Geischt) explains. However, it is commonly used to describe flu-like symptoms that can occasionally occur after treatment with botulinum toxin.
“In medical literature, the term ‘flu-like symptoms’ is used instead as a possible side effect of the treatment,” adds Berek. These are referred to in studies, as well as in the product information for various botulinum toxin preparations, but they do not resemble the actual influenza virus. “These symptoms are usually mild, temporary and do not represent a true influenza or infection.”
Reported flu-like symptoms include fatigue, mild body aches or pains, headaches and, rarely, a slightly elevated temperature or sub-febrile fever. This is a slightly elevated body temperature between, approximately, 37.5°C and 38°C. “These symptoms typically appear within hours to a few days after treatment. They usually resolve spontaneously,” adds Berek.
How common is “Botox flu”?
Berek and her team perform over 2,000 botulinum toxin treatments per month and she says “flu-like symptoms are extremely rare.” However, headaches after treatment, especially immediately after botulinum toxin therapy for migraines, are not uncommon.
In some therapies, relatively high amounts of the toxin are administered at numerous injection points, including the forehead, back of the head, temples and shoulder girdle. The large number of injections and the resulting local irritation can trigger a migraine attack in the short term.
“In such cases, we often recommend taking pain relief, such as ibuprofen, as a preventative measure.” As a general rule, “the risk of side effects increases with the total dose and also depends significantly on the experience of the practitioner,” Berek advises.
Is there anyone who should be more cautious during treatment?
Certain patient groups should only be treated with botulinum toxin under special precautions, in particular people with neuromuscular diseases, such as myasthenia gravis, Lambert-Eaton syndrome and amyotrophic lateral sclerosis (ALS).
Certain medications can also intensify the effects (and therefore the side effects) of botulinum toxin, including muscle relaxants, aminoglycoside antibiotics, quinidine and anticholinergics. Furthermore, Berek and her team do not perform botulinum toxin treatments in their practice during pregnancy or while breastfeeding, in cases of acute infection, with uncontrolled autoimmune diseases, or in severely immunocompromised patients.
“Systemic side effects* are relatively rare in aesthetic medicine, as significantly lower doses are usually used than, for example, in neurological therapy, such as for spastic paresis,” says Berek. Nevertheless, the doctor adds, it is important to report any potential side effects early and transparently. Symptoms such as difficulty swallowing, shortness of breath or persistent flu-like symptoms should be reported to a doctor immediately.
“At the same time, the range of botulinum toxin applications in aesthetic medicine is currently growing rapidly,” says Berek, adding: “Procedures such as ‘Trap-Tox’ or the ‘Nefertiti Neck Lift’ can also lead to higher cumulative doses (i.e., a higher total amount of the active ingredient accumulated over several treatments) in aesthetic medicine.” The problem is that “these developments are sometimes presented as universally beneficial on social media without adequate scrutiny.”
*Side effects that do not only occur locally at the injection site, but affect the entire body.
Is it possible to prevent “Botox flu”?
As it’s not fully understood how exactly flu-like symptoms develop in the body following Botox, there are no well-defined prevention strategies. “Based on my many years of expertise and current literature, some basic principles can be administered,” says Berek. Some of her key recommendations for safe use are:
- Use the lowest effective dose possible: As the dosage increases, so does the risk of systemic side effects.
- Use only approved preparations: Adverse event reports are often related to contaminated products or counterfeits.
- Medical expertise and correct injection technique: Many complications can be traced back to injection or preparation errors. Treatments should therefore only be performed by experienced specialists.
- Aftercare: “We recommend that our patients refrain from strenuous exercise for 48 hours,” says Berek. “Our practice can be reached via a 24/7 emergency hotline after the treatment, so that any potential side effects can be assessed quickly.”
- Avoid overly frequent injections, as this can increase the risk of immunological reactions. Not only can this trigger Botox resistance, but it is also possible to achieve a local overdose in the synaptic cleft, which could lead to systemic spread of the toxin.
