Complications

Complications

Complications are rare when clients are selected properly, and correct techniques are used. Complications such as hematoma and oedema hardly ever occur. Pain is the adverse event most often reported. Injection into the dilator nasi hardly results in complications. In contrast, at the nasal base, over-blocking of the m. depressor septi nasi can result in upper lip ptosis. This is more prone in clients with a long upper lip in whom any relaxation could lead to elongation at the medial tubercle and philtrum. As a result, the central upper incisors become hidden and through the contraction of the zygomaticus major with upper lateral pulling of the lips, the ‘joker’ smile could result. If the zygomaticus major traction is excessive and there is social impairment for the client, a very careful injection at the upper part of themodiolus where the zygomaticus major inserts should be performed. A small dose of 0.5 unit of botulinum toxin must be carried out very superficially. Extra small doses can be injected at the same level with 7 days apart until the desired effect is obtained. To improve upperlip ptosis, very little can be done. In general, 15 days after the injection there is some recovery of the muscle tonus with upper lip lifting and an aesthetic improvement.