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In 2009, the FDA issued a black box warning for Botox and other BTX injections after a number of cases occurred where the drug spread far beyond the injection site

W.et al (2017)

Once you find the dose that is not creating these problems, over time your body may adjust to it and you won't have such a strong reaction

Prioritize Patient Comfort: Because inflammatory tissue is often tender, the golden rule of this examination is to apply pressure very slowly while watching the patients face for signs of discomfort