Contraindications & red flags for toxin — who do you decline or refer?
Building my own 'do not treat / think twice' list. What are your absolute and relative contraindications for botulinum toxin?
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A sensible working list: Decline / do not treat: • Pregnancy or breastfeeding. • Known neuromuscular disorders — myasthenia gravis, Lambert-Eaton, and similar. • Known allergy/hypersensitivity to the product or its constituents. • Active infection or inflammation at the injection site. • Under-18 for cosmetic purposes (illegal in England). Think twice / assess carefully: • Concurrent aminoglycoside antibiotics or other agents affecting neuromuscular transmission. • Unrealistic expectations or signs of body dysmorphic disorder — a red flag to slow down or decline. • Significant pre-existing brow/lid ptosis or asymmetry — manage expectations and dose lightly. When in doubt, don't inject today. 'I'd like to check something before we go ahead' is always a safe sentence.
The BDD point deserves emphasis. Screening for it and being willing to decline is part of practising safely, not being difficult.
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