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Most patients find that Botox® injections cause little discomfort. Many compare the feeling to a little insect bite! As the treatment is very quick, the needles used are tiny and only minute amounts of liquid are being injected into the skin; few patients experience any significant pain.
A few patients do, however, prefer to have an aesthetic cream applied half an hour or so prior to treatment to help numb the skin.
Other risks or side effects include a small amount of temporary bleeding or mild swelling which may occur at the injection site. In some cases more extensive bruising may occur, especially around the eyes, but this can usually be covered up with make-up, and is only temporary.
Occasionally, patients experience a headache after treatment, and, very rarely, double vision. 
When botulinum toxin is injected into the forehead area, there is a very slight possibility that it may cause weakness of the muscle holding up the eyelid causing a “partial ptosis” or drooping of the upper eyelid.
In experienced hands this tends to happen in less than 1% of patients and will disappear over a period of 2 - 10 weeks. Some doctors also use an eye drop called apraclonidine to help to speed up the recovery if this effect occurs.
If the forehead muscles are relaxed too much, especially in patients with looser skin, the treatment may cause the eyebrows to drop slightly. Again, this is only a temporary condition and will vanish usually within 10 weeks. 
Sometimes, the eyebrow position may alter so that the edges of the eyebrows become elevated. Some women like this effect, but it is generally unwanted in men. It is easily corrected with a small amount of botulinum toxin injected above the raised area of the eyebrow to help change its position.
All patients should remember that because the results of botulinum toxin are not permanent, any unwanted effects will disappear usually within a 3 month period. 
During 2003 there were some press reports claiming that Botox® may cause more wrinkles to appear. We have looked at these claims and can find no evidence in the scientific literature, at this point, to support these reports.

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