Botulinum toxin, also known as botulinum toxin A, is a bacterial exotoxin produced during the growth and reproduction of botulinum toxin, and is a neurotoxin protein that acts on peripheral nerve motor endings to inhibit the release of acetylcholine from the presynaptic membrane of peripheral motor nerves, causing temporary muscle relaxation paralysis. In recent years, botulinum toxin has been used to treat facial wrinkles and has proven to be an effective biological agent. Although botulinum toxin is easy to operate and quick to work, there are often different degrees of adverse reactions due to injection site selection, dose control and injection techniques and skills. 1, eliminate forehead lines headache, forehead tightness: the usual speech, visual objects when the patient used to raise the eyebrows, because of the sudden weakening of the forehead up function, the patient feels extremely uncomfortable, may appear headache, forehead tightness, serious headache, nausea. Sagging eyebrows: This is due to the low injection site when treating forehead wrinkles. For older patients * toxin can also aggravate their original frontal muscle attachment relaxation caused by eyebrow sagging. So in addition to the frontal lines, but also to maintain part of the motor function of the frontal muscle rather than completely paralyzed, otherwise there will be a stiff expression. 2, eliminate the interbrow lines photophobia and tears: most of the patients in the treatment of interbrow lines, due to the treatment of frowning, squinting function is weakened, the pupil regulation becomes poor, when the patient from the shadow to the sun, light suddenly shot into the pupil, causing photophobia, tears reaction. Ptosis: This is caused by the infiltration of the drug along the orbital rim when the toxin is injected into the upper eyelid or between the eyebrows, diffusing into the levator muscle. 3, eliminate crow’s feet expression dull: treatment of crow’s feet patients, because the injection point is too low or the dose is too large, the drug action affects the zygomaticus major muscle, zygomaticus minor muscle, when the patient smiles feel that the bilateral cheeks can not be lifted, giving people the feeling of dull expression. Injecting more downward may cause paralysis of the undesired zygomaticus major muscle, resulting in lip drooping and asymmetric smile. Increased wrinkles in adjacent areas (especially around the nose): In patients treated for crow’s feet, because the orbicularis oculi is a circular muscle, once the contraction of the muscle in the lateral area is restricted, the compensatory muscle force of the medial inferior muscle increases, leading to increased wrinkles around the nose. Blurred vision: It may be due to the weakened regulation of the orbicularis oculi muscle after Botox injection, etc. Keratitis: It is caused by paralysis of the orbicularis oculi muscle that causes rabbit eyes and reduced transient eyes, which can cause corneal irritation or exposure and lead to keratitis in severe cases. Large injection doses can lead to dry eye syndrome. Lower lid ptosis: If the injection site is too close to the center, the spread of Botox may affect the central orbital region of the orbicularis muscle, resulting in lower lid ptosis (retraction and/or ectropion), strabismus, lacrimation, and diplopia. Use a high concentration (small amount) of *Toxin and inject slowly to prevent possible spread to undesired areas. Ptosis: The cause is a drooping of the arch of the eyebrow due to paralysis of the lower frontalis muscle fibers caused by injecting more upward. Bruising: There is a rich network of blood vessels around the eyes, and the more injection sites there are, the more bruising there may be. Injections around the eyes should be subcutaneous or intradermal, with the needle back toward the orbital rim, so as to avoid or reduce subcutaneous stasis; in addition, those patients with lax canthal ligaments and/or lower eyelid atrophy should avoid injecting * toxin. 4, eliminate perilabial wrinkles upper lip sagging: some people apply a low concentration of * toxin solution injected away from the corners of the mouth zygomaticus major muscle starting point to reduce the nasolabial folds. * toxin injection nasolabial folds, lifting the upper lip muscle contraction on the medial segment of the nasolabial folds should have a greater impact than the upper lip lift when smiling, while the zygomaticus major zygomaticus minor muscle is more affected by the shape of the upper lip lift. When removing nasolabial lines, the injection should be superficial to avoid bruising, and should also avoid forceful massage or downward massage so as to avoid lip sagging. Lip ectropion: When using *Toxin to improve perioral wrinkles, injections should be superficial and symmetrical on both sides, avoiding midline injections and corner injections. Complete paralysis of the orbicularis oris muscle and subsequent mouth dysfunction and lip asymmetry can occur if these edges are violated. The reduction in the appearance of the lower teeth often occurs during the treatment of the labial descending muscles. In the treatment of patients with hypertrophy or spasticity of the occlusal muscles, care should be taken to operate with bilateral atrophy symmetrically. Avoid causing a decrease in chewing power, unnatural expression when smiling, and uncoordinated movement when chewing. 5.Elimination of transverse cervical lines Difficulty in swallowing: Difficulty in swallowing and difficulty in vocalization caused by the weakening of the deep neck muscles are caused by the migration and diffusion of * toxin. The toxin is restricted to the superficial broad cervical muscle rather than the deep muscle tissue. Weakness of the cervical flexor muscles and dysphagia caused by its injection into the swallowing muscle groups have been reported. This is especially true for those with thin necks. *Prevention of side effects of toxin: First, inject high concentration, low volume of toxin; second, accurate dilution and precise quantification; finally, pay attention to symmetry and uniformity. In addition, to reduce undesired muscle weakness and paralysis around the injection site, it is important to adhere to the surface markings and boundaries of the injection site. I hope that more doctors will give patients safe and effective treatment by controlling the action of Botox, minimizing or even avoiding complications, and at the same time achieving cosmetic results for the benefit of mankind. These are what the textbooks tell us, but as Botox becomes more and more popular, there are some situations that doctors should be aware of. As doctors, we cannot just tell our patients that certain conditions are fine as long as they recover slowly. These are “normal” conditions that can also affect a patient’s ability to work and study. We do want to be very specific about why each condition occurs, how long it takes to recover, and how it can be avoided. There are already reports from abroad, but in China it is still relatively easy for many doctors to do it by experience and books, but the products we use are not the same as those measured abroad, and there are problems with ethnicity. These require us to have the need to re-examine what we do. I would like to do my best to try to make a quantitative measurement with the advanced instruments of Beijing Aerospace University Physical Institute, and I hope it will be helpful to the majority of doctors and patients!