Tell your doctor if you received any other botulinum toxin product in the last 4 months; have received injections of botulinum toxin such as Myobloc®, Dysport®, or Xeomin® in the past (tell your doctor exactly which product you received); have recently received an antibiotic injection; take muscle relaxants; take allergy or cold medicines; take sleep medicine; take aspirin-like products or blood thinners.
According to the PREEMPT injection paradigm, 5 units of onabotulinumtoxinA is to be administered to two sites on each side for a total dose of 20 units across four sites in the cervical paraspinal muscle group near the midline. The first injection site is approximately 1 cm left of the midline of the cervical spine and approximately 3 cm (2 fingerbreadths) inferior to the occipital protuberance. The second site is measured approximately 1 fingerbreadth diagonally up at a 45° angle from the first injection. The injections should be administered in the most superficial aspect of the muscle, angling the needle 45° and superiorly. To aid in the placement of the injections, the patient should be positioned upright with the head in a neutral position. If the neck is flexed too far forward, injections may be too deep. Injections that are too low or too deep in this muscle group can lead to muscle weakness and neck pain. Injectors should use a suboccipital approach to ensure that the injection sites are not too low. In addition, a horizontal line can be visualized across the neck, approximately 2 fingerbreadths down from the occipital protuberance, to make certain the injections remain above the line and are not administered too low in the neck. The higher these injections are, the more likely that they will be in the muscle fascial condensation, which will minimize the potential for neck weakness. These injections should not be done below the hairline. Patients who have trigger points in the neck should not be injected at these sites as these are generally areas where muscles may be weakened and injections of onabotulinumtoxinA at these sites might worsen their neck issues.
Three percent of patients experienced eyelid drooping in the frown lines studies, one percent of patients experienced eyelid swelling in the crow's feet studies, and one percent of patients experienced brow drooping in the forehead lines studies. Other possible side effects include: dry mouth; discomfort or pain at the injection site; tiredness; headache; neck pain; eye problems: double vision, blurred vision, decreased eyesight and dry eyes; and allergic reactions. These are not all of the possible serious side effects of BOTOX® Cosmetic. Please see the Important Safety Information including Boxed Warning and Medication Guide and talk to your specialist.
This medication can spread to other parts of the body after your injection, causing serious (possibly fatal) side effects. These can occur hours or even weeks after the injection. However, the chances of such serious side effects occurring when this medication is used for migraines or skin conditions such as wrinkles, eye spasm, or excessive sweating are extremely unlikely.
Tell your doctor about all your medical conditions, including: plans to have surgery; had surgery on your face; have trouble raising your eyebrows; drooping eyelids; any other abnormal facial change; are pregnant or plan to become pregnant (it is not known if BOTOX® Cosmetic can harm your unborn baby); are breast-feeding or plan to (it is not known if BOTOX® Cosmetic passes into breast milk).