Frown lines, express injection, return to work an hour later: the image of Botox as a safe beauty procedure has established itself in aesthetic medicine practices. For thousands of people living with a chronic illness, this promise of simplicity hides a much riskier reality.
Published in the Aesthetic Surgery Journalit shows that some chronic diseases increase the risk of complications after these supposedly banal injections. And the figures are edifying.
When chronic illnesses cause Botox complications to explode
In the UK, botulinum toxin injections are one of the most popular cosmetic procedures, with around 900,000 treatments performed each year. Previous work estimated that effects such as pain, swelling or headache affected nearly 16% of patients, and a large survey found bruising in 26.1% of cases and headache in 24.7%.
A large study in the United Kingdom by Anglia Ruskin University examined 919 adults who had cosmetic botulinum toxin injections, revealing results that challenge common perceptions. According to the research, individuals with type 1 diabetes are 92 times more likely to experience nausea after treatment compared to those without the condition. Additionally, people with thyroid disorders or chronic migraines have an approximately increased risk of nausea. 10 times higher.
Other complications associated with pre-existing conditions include headaches, bruising, muscle weakness, and persistent eyelid ptosis (a drooping of the upper eyelid). Patients with cataracts were 30 times more likely to report headaches, while those with a history of injury had a 21 times greater risk of losing facial expression.
For Professor Lee Smith, professor of public health at Anglia Ruskin University and co-lead author of the study, the message is clear: “This national study, the largest patient-reported safety analysis of botulinum toxin to date, debunks the myth that botulinum toxin is a trivial cosmetic procedure. Our data establish that it is a complex medical intervention, whose complication profiles are strongly influenced by chronic diseases, psychiatric history, immune status and anatomical factors.”
Botox and fragile ground: a medical procedure, not a simple “express rejuvenation”
The authors plead for these injections to be carried out only by doctors, maxillofacial dentists or experienced prescribing nurses, in controlled structures.
“Safe administration requires not only injection skill but also diagnostic discernment, psychological understanding and systemic medical knowledge. Injecting into the human face and neck, particularly in patients with pre-existing conditions or psychological vulnerability, is not a task of beauty. It is a medical act that requires expert judgment. Parliament must legislate for this, as the current system leaves patients exposed“, explained Professor Lee Smith.
Chronic patients and aesthetic injections: the right reflexes
For a patient suffering from a chronic illness, a few reflexes can reduce the risk:
- Report all ongoing treatments;
- Mention neurological or autoimmune history;
- Avoid any offer of injection outside a medical setting.
This study comes at a time when in France, the National Agency for the Safety of Medicines and Health Products (Ansm) published a health alert in October 2025 after the discovery of several cases of severe botulism, linked to illegal botox injections. Since spring 2025, three new serious cases have been reported to health authorities, after eight cases recorded in 2024.
In France, botulinum toxin injection is reserved for authorized healthcare professionals: doctors specializing in plastic, reconstructive and aesthetic surgery, dermatology, face and neck surgery, maxillofacial surgery and ophthalmology.