Botox Complications and Satisfaction Outcomes Following Botulinum Toxin Type A Facial Injections: A Prospective Study of 2,012 Procedures in 489 Patients

Abstract Botulinum toxin type A is widely used for facial rejuvenation, but prospective real-world data integrating safety and patient-reported outcomes (PROs) remain limited. To evaluate complication rates, patient satisfaction, and predictors of satisfaction following standardized upper-face injections. Prospective, single-center cohort study. A total of 489 patients undergoing 2,012 procedures were treated using a standardized protocol. Clinically significant complications were recorded over 4 weeks. PROs were assessed using a customized 20-item questionnaire. The per-patient complication rate was 13.1%, while the per-procedure rate was 3.3%. Most complications were mild and resolved without sequelae. Overall, 94.1% of patients reported improvement, and 79.6% achieved ≥ 9/10 satisfaction. Younger age, female sex, and lower complication severity were associated with higher satisfaction. Standardized botulinum toxin protocols provide low complication rates and high patient satisfaction. Combined reporting of safety and PROs supports reproducible and clinically relevant evaluation.