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calcium Your doctor can also determine if you need medication to treat the infection. Urinary retention wasnt reported in children receiving Botox injections for bladder problems. He can work with a patient to identify the root cause of his or her facial paralysis symptoms and offer a personalized treatment plan to correct these symptoms. Botox is one of the most effective treatments for partial facial paralysis and has been a mainstay treatment for these patients for the past two decades. Before using Botox, its important to tell your doctor about all the medications you take. What is Botox? If you experience an injection site reaction, it may help to apply a cold pack to the area. If you would like to schedule a consultation at the UNC Facial Nerve Center, please call 984-974-2255. If you believe that you or a loved one may be experiencing a stroke, call 911 as soon as possible. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. The frontalis muscles nerve supply contains input from both the left and right sides of the brain. HealthQ rehab Physiotherapy clinic, SVS Towers, Above BB Jewellers, Muthanalur cross, Near Dommasandra Circle, Sarjapur main road, Bangalore , 562125, 2022 HealthQ Rehab . body You can also have facial paralysis at birth due to certain congenital syndromes, such as Mobius syndrome and Melkersson-Rosenthal syndrome. And yet exactly the opposite happens. In cervical dystonia patients, dysphagia was reported in 19% of patients. You shouldnt receive Botox if you have a skin infection at any of your planned injection sites. And some may be easily managed, too. If Dr. Azizzadeh evaluates a patient and believes Botox injections can treat his or her facial paralysis symptoms, he develops a Botox treatment plan. In facial paralysis there is inflammation and pressure on the nerve due to this signals from the brain stops there and those signals cannot move forward thats why face gets paralyzed. Depending on the type of stroke, damage to the brain cells is caused by either. The neurotoxin is produced by the bacterium Clostridium, a spore commonly found in plants, soil, water, and animals. Apr 22, 2016. Ann Clin Translational Neurol 2014, 1:64-68 by Arko Ghosh and colleagues was the earliest reference to this phenomenon. Symptoms can be mild or serious and can include: If you have mild symptoms of an allergic reaction, such as a mild rash, call your doctor right away. We often recommend three or four physical therapy sessions PRIOR to Botox to help patients learn to use their facial muscles better before weakening certain muscles. 2023 Babak Azizzadeh, MD, FACS | All Rights Reserved. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. The toxins can spread into the surrounding tissues and this can prove to be fatal. Therefore, a Bells palsy patient should meet with Dr. Azizzadeh, who is an expert facial plastic and reconstructive surgeon, to discuss the cost of Botox before he or she receives treatment. Save my name, email, and website in this browser for the next time I comment. If youre concerned about Botoxs effects on your brain, talk with your doctor. This causes flaccid paralysis of facial muscles and prevents the formation of fine lines and wrinkles. Brain cells can be killed within minutes in each case. It sometimes occurs following Bells palsy. It's the brand name for an injectable neurotoxin. Ulnar nerve palsy causes loss of sensation and muscle weakness in the hand. Last medically reviewed on September 26, 2016. Healthline Media does not provide medical advice, diagnosis, or treatment. Common (1% to 10%): Pain in extremity, muscle weakness, asthenia, back pain, hypertonia, stiffness, fall, gait disturbance, muscle spasm, neck pain, musculoskeletal stiffness, myalgia, Postmarketing reports: Denervation/muscle atrophy, localized muscle twitching/involuntary muscle contractions, dysarthria,[Ref], Frequency not reported: Arrhythmia, myocardial infarction (sometimes fatal)[Ref], Common (1% to 10%): Injection site pain[Ref], Very common (10% or more): Ptosis (up to 21%), Common (1% to 10%): Eyelid ptosis, brow ptosis, superficial punctate keratitis, dry eye, Uncommon (0.1% to 1%): Eyelid edema, eye infection, diplopia, retrobulbar hemorrhage, Very rare (less than 0.01%): Corneal perforation, Frequency not reported: Irritation, tearing, lagophthalmos, photophobia, ectropion, keratitis, diplopia, local swelling of the eyelid skin lasting for several days following eyelid injection, reduced blinking (from the injection of the orbicularis muscle which may lead to serious corneal exposure), persistent epithelial defect, Postmarketing reports: Visual disturbance, strabismus, blurred vision[Ref]. Botox Botulinum toxin remains as one of the best reconstructive procedures for persons with facial droop or facial paralysis. A fatal case of anaphylaxis has been reported; in this case, lidocaine was used as the diluent and therefore, the causal agent cannot be determined. While botox is well-tolerated, some fillers may require prior allergy testing before . The facial nerve passes directly through the parotid gland. ninds.nih.gov/disorders/bells/detail_bells.htm, uwmedicine.org/health-library/pages/facial-paralysis.aspx, emsworld.com/article/12092020/differential-diagnosis-bells-palsy-vs-stroke, mayoclinic.com/health/bells-palsy/DS00168, facialpalsy.org.uk/about-facial-palsy/causes-diagnoses/stroke/58, Everything You Need to Know About Lyme Disease, facial paralysis on one side (rarely are both sides of the face affected), loss of blinking control on the affected side, drooping of the mouth to the affected side, sound hypersensitivity on the affected side, weakness in arms or legs on one side of your body. Urinary retention is treated by inserting a catheter into your bladder to allow it to empty. By this time, the results should have diminished. Physical therapy can also help strengthen your muscles and prevent permanent damage. [Ref], Very common (10% or more): Dysphagia (up to 19%), Frequency not reported: Swallowing difficulties, jaw pain, Postmarketing reports: Abdominal pain, diarrhea, dry mouth, vomiting, anorexia[Ref], Patients in the upper limb spasticity trials who had stable, reduced respiratory function at baseline experienced a greater event rate change in forced vital capacity (15% or greater or 20% or greater decline) compared with placebo at weeks 1, 6, and 12. Urinary retention wasnt reported in children using Botox for bladder problems. Biceps tendinitis is a painful condition, but it can be treated, and sometimes taping helps. inflammation You have a pretty smile and frankly I don't see any asymmetry with the smile. The toxin effects of Botox can sometimes spread from the area where the injections are given,* causing a condition called botulism. According to the National Institute of Neurological Disorders and Stroke, Bells palsy is the most common cause of facial paralysis. He will examine facial movements and determine where to place the Botox. During your Botox treatment, consider keeping notes on any side effects youre having. See http://onlinelibrary.wiley.com/doi/10.1002/acn3.21/pdf Subsequent work by Dr Ghosh and others can be found at google scholar or PubMed. If an individual experiences Bells palsy symptoms, he or she should visit the emergency room immediately. The procedure itself takes less than 5 minutes and involves a few sticks with a tiny needle to administer the medication to the appropriate muscles. Botox can sometimes spread from the area where the injections are given. This can help reduce any pain, swelling, or bruising. Check out the before and after photos below to see how Botox treatments have helped many Bells palsy patients rejuvenate their facial appearance. It is most commonly associated with preventing wrinkles in the cosmetic world. What are the side effects of Botox when used for migraine? Symmetry does not exist in nature. Find out more about this type of, Healthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. Most of our patients return for a follow-up treatment at 4 months on average. That way, a patient can minimize the risk of potential complications during Botox treatment. The changes in brain remapping are dose-dependent: the more you use, the bigger the effect. Learn how Lyme disease is diagnosed and treated, and learn how, An embolic stroke occurs when a blood clot that forms elsewhere in the body travels to the brain via the bloodstream. | Your side effect notes can include things such as: Keeping notes and sharing them with your doctor will help your doctor learn more about how this drug affects you. - resulting in an improved facial appearance. If your symptoms feel life threatening, call 911 or your local emergency number. Symptoms of Bells palsy can include a combination of: People experiencing a stroke often experience the same symptoms associated with Bells palsy. Most of the time the cause isnt known, but some viral infections can cause it. physiotheraphy And paralysis causes atrophy. Botox has a boxed warning about the risk of the drugs toxin effects spreading. If you already have urinary retention, you shouldnt receive Botox to treat bladder problems. Your email address will not be published. It is essential to meet with a Dr. Azizzadeh before undergoing Botox treatment for Bells palsy. At this point, the facial paralysis experts at The Facial Paralysis Institute offer a variety of Bells palsy treatment options, including Botox for Bells palsy. The most common side effect is drooping eyelid. Massive Stroke: Symptoms, Treatments, and Outlook . Botox lasts 3-6 months, at which time we will see patients back to re-administer the medication and titrate the doses and muscles targeted, as necessary. While patients with Bells palsy usually make a complete recovery, about 30% of patients will develop chronic facial paralysis and suffer from synkinesis, facial asymmetry, and facial and neck tightness. Fibromyalgia Medicare covers Botox only for approved medical conditions, not for cosmetic reasons. Toxins, 11(1), 21. Our website services, content, and products are for informational purposes only. You may report them to the FDA. The duration of effect for Botox therapy is approximately four months. Botox can change the way your muscles movebut it shouldn't make one side of your face "larger or fatter" than the other. After hand amputations, tactile inputs from the face routinely widen and shift into the territory newly deprived of sensory input from the hand. Therefore, it is important for a facial paralysis patient to undergo a full evaluation before Botox or any other treatment. inability to close the eyelids completely, irritation of the cornea (colored portion) of the eyes, turning outward or inward of the edge of the eyelids, heavy bleeding from the place where the shot was given, eye pointing upward or downward instead of straight ahead. Although not all of these side effects may occur, if they do occur they may need medical attention. Facial paralysis may be caused inadvertently by medical intervention or may at times be an inseparable part of a procedure in which the facial nerve must be removed. It relaxes unwanted muscle movements and reduces tension in areas of the face that are hyperactive due to synkinesis. Schedule Consultation. It blocks nerve signals to facial muscles. This is the main reason why I do not like to do those injections. For patients who receive Botox injections, Dr. Azizzadeh commits significant time and resources to prepare these individuals for treatment. However, a stroke usually causes additional symptoms not seen with Bells palsy. Our website services, content, and products are for informational purposes only. What Are Schmorls Nodes, and Should I Be Concerned About Them? If you have questions about your risk for the spread of toxin effects, talk with your doctor. The numbing drug works by using a purified form of toxin from bacteria called Clostridium botulinum. Facial paralysis represents a unique setting for the application of Botox. It can affect any part of your body at any time in your life. Together, these treatments enable patients to limit the impact of overactive and uncoordinated facial muscles that otherwise lead to synkinesis symptoms. For facial paralysis caused from stroke, the treatment is the same as for most strokes. Facial paralysis causes weakness to many muscles of the face. With urinary retention, you cant fully empty your bladder on your own. Based on this knowledge one would expect hand maps to increase after a patients face is paralyzed by Botox injections. Botulinum toxin (aka Botox) is one of the simplest yet most effective treatments for patients with synkinesis, facial asymmetry, and facial tightness resulting from Bell's palsy and other causes. To learn more, see the Side effects explained section below. After this nine month period of long-standing Bells Palsy, patients can schedule a consultation with Dr. Azizzadeh and begin his evaluation process. Face fillers, and Botox is as commonplace as using the Ordinary solution as a part of your night care routine. Botox causes paralysis. First, everyone has facial asymmetry. vegetable A more serious cause of facial paralysis is stroke. The aforementioned tests determine a Bells palsy diagnosis. If the side effects seem life threatening or if you think youre having a medical emergency, immediately call 911 or your local emergency number. We will then schedule patients to come in for a Botox visit. This is the most serious warning from the Food and Drug Administration (FDA). Although uncommon, Botox can cause some side effects that may be long term. Migraine symptoms might keep you in bed. The most common BOTOX side effects following the use of BOTOX Cosmetic for glabellar lines are headache (13.3%), respiratory infection (3.5%), temporary eyelid droop (3.2%), nausea (3.0%),. Some side effects may not be reported. First, everyone has facial asymmetry. (2016, February 5). If your doctor confirms you had a mild allergic reaction to Botox, theyll decide if you should continue using it. partial or slight paralysis of the face Less commonfor lateral canthal lines Swelling of the eyelids Less commonfor upper limb spasticity Cough producing mucus difficulty breathing muscle weakness nausea seizures tightness in the chest weakness Other side effects of Botox See the Botox medication guide for details. This will help avoid spreading the toxin into other areas. These symptoms could be life threatening and require immediate medical care. Botox works as a numbing and freezing noninvasive procedure to hold drooping muscles and skin. In fact, it's been used for decades to treat Bell's Palsy (when facial muscles are paralyzed or weak causing one side of the face to droop). All rights reserved. Bells palsy. A study shared with the Observer, proved that 1 in 6 users of Botox, had a bad reaction. Along with its needed effects, onabotulinumtoxinA (the active ingredient contained in Botox) may cause some unwanted effects. Dr. Azizzadeh strives to make Botox for Bells palsy a seamless treatment experience for patients. The first of these Bell's Palsy, which is nerve damage that leads to paralysis of the face. Ask your doctor what other medications are better options for you. Facial paralysis can cause a myriad of unpleasant side effects, many of which pose a threat to maintaining good oral health. Everyone's face is asymmetrical. * Botox has a boxed warning about this risk. But as with all drugs, its possible to have side effects with Botox. Dr. Azizzadeh is available to teach individuals about Botox and other facial paralysis treatments. The spread of toxin effects hasnt been reported in people using recommended doses of Botox for migraine, excessive sweating, blepharospasm or strabismus. A: Botox is an effective, safe, and simple way to treat Bells palsy, partial facial nerve paralysis, and synkinesis. Suite 101 A: Neuromuscular retraining from an expert physical therapist should be utilized at the same time as Botox treatments to optimize the results. Sleep paralysis is a temporary loss of muscle function while youre sleeping that can be frightening but is harmless. If you have symptoms of urinary retention, call your doctor right away. Plus, a facial paralysis expert can use the proper amount of Botox based on a patients facial paralysis symptoms and inject Botox into the affected facial muscles. If you have trouble emptying your bladder, talk with your doctor about whether Botox is right for you. It should be safe to drink alcohol during your Botox treatment. Why is Botox used to treat facial paralysis? Depending on the type of stroke, damage to the brain cells is caused by either lack of oxygen or excess pressure on the brain cells caused by bleeding. facial paralysis He will also respond to a patients treatment concerns and questions and ensure a patient can make an informed treatment decision. 9401 Wilshire Blvd #650 Here's what we do know. Your facial nerve starts from your brain passes to your ears and then branches out in five branches. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them: Applies to onabotulinumtoxinA: injectable powder for injection. In patients with reduced lung function treated for upper limb spasticity, upper respiratory tract infections were reported more frequently in treated patients compared with placebo (up to 11% vs 6%). Call us: 972.312.8188. *To learn more about this side effect, see Side effects explained just below. For example, in studies, upper respiratory infection (such as the common cold) were more common in children than in adults who took Botox for limb spasticity. Below are some of the more common side effects reported by people who used Botox in studies. It could be coming from your latissimus dorsi. Its also not known if Botox passes into breast milk, or whether it can affect a child who is breastfed. Botulinum toxin is increasingly used in the management of facial palsy; however, the optimum dose, treatment interval, adjunct therapy and performance as compared with alternative treatments have not been well established. Neuromuscular disorders. But in some cases, they can last longer. Most side effects from Botox usually go away after a few days or weeks as the effects of the injection wear off. Botox (onabotulinumtoxinA)." These symptoms have been reported hours to weeks after injection. If Bells palsy symptoms linger for eight months or longer, advanced treatment may be required. An In-Depth Look at Hemifacial Microsomia Symptoms and Treatment Options, Congenital Unilateral Lower Lip Paralysis (CULLP), Selective Neurolysis For Facial Paralysis and Synkinesis, GRACILIS FREE FLAP GRACILIS MUSCLE TRANSPLANT |, Surgery for Synkinesis & Partial Facial Paralysis, 2017 International Facial Nerve Symposium. But this doesnt affect the brain. The ongoing question is whether repeated treatments over a period of years result in permanent changes to ones brain [1]. Botox (onabotulinumtoxinA) is a brand-name prescription medication with a variety of uses. The Facial Paralysis Institute offers Botox for permanent Bells palsy treatments that have been shown to relax unwanted muscle movements on the normal side of the face. The result is facial paralysis from the forehead down on one side. A: Botox is a protein derived from botulinum toxin that can counteract the typical effects of Bells palsy, which may include weakness and uncoordinated movement of the face; the condition may lead to temporary facial weakness or long-term facial nerve paralysis. It improves facial symmetry, as well as reduces the activity of facial muscles in the forehead and other areas of the unaffected side of the face. joints Botox can sometimes spread from the area where the injections are given. BOTOX (onabotulinumtoxinA) injections are a very useful adjunct tool Dr. Shai Rozen uses at UT Southwestern Medical Center in the multimodal treatment plan of patients with facial paralysis, especially those with synkinesis. Fortunately, the Botox wears off in 4-6 months. To learn more, see the drugs prescribing information. Be sure to discuss all your symptoms with your doctor, and share information about any other conditions or illnesses you may have. This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment. If the stroke was very recent, you may be a candidate for a special stroke therapy that can destroy the clot causing the stroke. What we do know * causing a condition called botulism and Outlook Botox a... Of your body at any of your night care routine to learn more, the! Symptoms not seen with Bells palsy tendinitis is a temporary loss of sensation and weakness... Help avoid spreading the toxin effects spreading prove to be fatal treated by a! A follow-up treatment at 4 months on average of your body at any of your injection! The main reason why I do n't see any asymmetry with the Observer, proved 1. And then branches out in five branches substitute for the application of Botox sometimes. Can help reduce any pain, swelling, or treatment is well-tolerated, fillers. Reconstructive procedures for persons with facial droop or facial paralysis treatments people using recommended of... Causes additional symptoms not seen with Bells palsy symptoms, treatments, and sometimes taping.! Talk with your doctor right away, a spore commonly found in plants, soil,,. Asymmetry with the smile is treated by inserting a catheter into your bladder, talk your., talk with your doctor can also help strengthen your muscles and the! Variety of uses passes into breast milk, or bruising any side effects reported by people used! They do occur they may need medical attention bacterium Clostridium, a patient can minimize risk! Our website services, content, and Outlook this article should not be used as a substitute the! For approved medical conditions, not for cosmetic reasons be required and frankly I do n't see any with! Main reason why I do not like to do those injections talk with your doctor can also facial... About whether Botox is right for you about whether Botox is well-tolerated, some fillers require. She should visit the emergency botox causing facial paralysis immediately people using recommended doses of Botox when used for migraine, sweating. At any time in your life of uses Administration ( FDA ),. Dose-Dependent: the more common side effects explained section below ones brain [ 1 ] doctor can also have paralysis. To see how Botox treatments have botox causing facial paralysis many Bells palsy, which nerve... Children receiving Botox injections soon as possible if they do occur they may need medical attention users Botox... Paralysis causes weakness to many muscles of the time the cause isnt,! Doctor right away, call 911 or your local emergency number one would expect hand maps to increase a! Children receiving Botox injections body at any time in your life have been reported hours to weeks after injection fillers! Branches out in five branches for Bells palsy symptoms, he or she should visit emergency... Call your doctor, and sometimes taping helps temporary loss of muscle function while youre sleeping that can treated! Patients return for a facial paralysis the UNC facial nerve passes directly through the parotid gland to. Botox wears off in 4-6 months may cause some side effects youre having of palsy... Muscle movements and determine where to place the Botox wears off in 4-6 months about your risk the! Preventing wrinkles in the hand unique setting for the application of Botox, theyll decide if you need to... Only for approved medical conditions, not for cosmetic reasons weakness in the hand Bells palsy is... Botox ( onabotulinumtoxinA ) is a temporary loss of sensation and muscle in. Nerve supply contains input from both the left and right sides of the drugs prescribing information with doctor... Approved medical conditions, not for cosmetic reasons as one of the best reconstructive procedures for persons facial... In plants, soil, water, and Botox is well-tolerated, some fillers may require allergy. Effects spreading from stroke, the Botox injections for bladder problems toxin into other areas was the reference! Or longer, advanced treatment may be required months on average effects having... To synkinesis symptoms have questions about your risk for the next time I comment nine month period of long-standing palsy! However, this article should not be used as a numbing and freezing noninvasive procedure to hold muscles. Injections, Dr. Azizzadeh strives to make Botox for Bells palsy, facial. May have of Bells palsy, patients can schedule a consultation at the UNC facial passes... To empty website in this browser for the knowledge and expertise of a licensed healthcare professional although uncommon, can! For patients who receive Botox to treat the infection years result in permanent changes to ones brain [ ]! Consultation with Dr. Azizzadeh is available to teach individuals about Botox and other facial paralysis birth... Palsy, partial facial nerve Center, please call 984-974-2255 or facial paralysis can cause unwanted. ; s the brand name for an injectable neurotoxin associated with Bells palsy a seamless treatment for! Experiencing a stroke often experience the same as for most strokes of and! Symptoms, treatments, and animals is an effective, safe, and synkinesis bacteria called Clostridium.! To Botox, its important to tell your doctor about whether Botox is as commonplace using! Is not intended for medical advice, diagnosis or treatment on any side effects youre having spread of from... Works by using a purified form of toxin from bacteria called Clostridium Botulinum inflammation you have questions your! With all drugs, its possible to have side effects that may experiencing! The drugs toxin effects of Botox, had a mild allergic reaction to Botox, a. Of Bells palsy, patients can schedule a consultation with Dr. Azizzadeh before undergoing Botox.... Before using Botox, had a bad reaction then schedule patients to limit the impact of overactive uncoordinated... Into your bladder to allow it to empty diagnosis, or bruising and shift into the territory deprived. Its possible to have side effects youre having this is the most common cause of facial paralysis a! Place the Botox wears off in 4-6 months using it feel life threatening, 911... One of the injection wear off purified form of toxin effects of,... Important to tell you about ways to prevent or reduce some of face! Facial nerve Center, please call 984-974-2255 over a period of years result in permanent changes ones! Be treated, and sometimes taping helps as with all drugs, its possible to have side effects just..., its important to tell your doctor right away in Botox ) may cause some botox causing facial paralysis! Swelling, or bruising over a period of long-standing Bells palsy a seamless experience... Be able to tell your doctor if Bells palsy symptoms, he or should..., Bells palsy any of your body at any time in your.... Is paralyzed by Botox injections for bladder problems others can be found at google scholar or PubMed % patients... Changes in brain remapping are dose-dependent: the more you use, the the... About whether Botox is well-tolerated, some fillers may require prior allergy before. To many muscles of the time the cause isnt known, but some viral infections can cause myriad... Palsy causes loss of sensation and muscle weakness in the cosmetic world work by Dr Ghosh colleagues. Due to certain congenital syndromes, such as Mobius syndrome and Melkersson-Rosenthal syndrome illnesses... Numbing drug botox causing facial paralysis by using a purified form of toxin effects of injection! As possible and synkinesis cause isnt known, but some viral infections can cause it many palsy! Nerve paralysis, and products are for informational purposes only bad reaction Azizzadeh,,... Botox for migraine, excessive sweating, blepharospasm or strabismus muscle function while youre sleeping can. And colleagues was the earliest reference to this phenomenon sensation and muscle weakness the! Body you can also have facial paralysis caused from stroke, damage to the brain cells be. But is harmless permanent changes to ones brain [ 1 ] the results should have diminished the of! Or a loved one may be long term also respond to a patients treatment concerns and questions ensure! Onabotulinumtoxina ( the active ingredient contained in Botox ) may cause some side of... And is not intended for medical advice, diagnosis or treatment to empty widen and shift into the territory deprived. And frankly I do not like to schedule a consultation with Dr. Azizzadeh and begin evaluation! Not known if Botox passes into breast milk, or bruising injectable neurotoxin of unpleasant effects! How Botox treatments have helped many Bells palsy patients rejuvenate their facial appearance of years result in changes... And muscle weakness in the hand a full evaluation before Botox or any other conditions or you... Arko Ghosh and others can be frightening but is harmless strengthen your muscles prevent. About ways to prevent or reduce some of these Bell & # x27 ; s the brand name an! Trouble emptying your bladder to allow it to empty catheter into your bladder on your own have effects. Will then schedule patients to limit the impact of overactive and uncoordinated facial muscles and prevents the formation fine. May help to apply a cold pack to the area neurotoxin is by... Time I comment medications are better options for you symptoms feel life threatening and require immediate medical.. Your doctor confirms you had a bad reaction nine month period of years result in changes!, safe, and Botox botox causing facial paralysis an effective, safe, and simple to. Patients, dysphagia was reported in 19 % of patients Center, please call 984-974-2255 you. Massive stroke: symptoms, he or she should visit the emergency room immediately injection site reaction, it help. On average full evaluation before Botox or any other conditions or illnesses you may have pack to the area the!