Adverse effects of botulinum therapy in facial and neck muscles for aesthetic and neurological indications and recommendations for their prevention. Possibilities of using ultrasound navigation

Objective. To evaluate the effectiveness of ultrasound navigation to minimize adverse effects during botulinum therapy in facial muscles for aesthetic and neurological reasons. Material and methods. The analysis has been carried out on the frequency and nature of adverse effects during injections of botulinum toxin type A into the upper, middle and lower thirds of the face in patients with neurological diseases (blepharospasm, hemifacial spasm, bruxism, migraine, etc.) and for aesthetic reasons (correction of hyperkinetic facial folds). The effectiveness of ultrasound imaging methods, a comparative analysis of injection techniques, and the evaluation of the effectiveness of the drug Relatox have been assessed. Results. The overall incidence of adverse effects with the standard botulinum toxin type A injection technique is 16-18%, and decreases to 5-10% when using ultrasound navigation. In the upper third of the face, the most common complications are ptosis (15%), diplopia (8%), and dry eye (6.5%). The use of injection monitoring reduces the risk of ptosis from 25-30% to 10-15% (p<0.001) due to precise penetration into the pretarsal part of the m. orbicularis oculi. In the middle and lower third of the face, the use of ultrasound navigation minimizes the development of smile asymmetry, dysphagia, and paradoxical bulging of the masticatory muscle. The drug Relatox demonstrates high efficacy (87-92%) in the correction of migraines, facial pain and hyperkinetic wrinkles with a frequency of 3-5%. Conclusion. Ultrasound navigation significantly improves the accuracy of botulinum toxin type A administration, reduces the risk of developing adverse effects, and improves treatment outcomes. The integration of the ultrasound method into clinical practice is recommended for neurological and aesthetic procedures.