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Pyridostigimine to reverse botox?
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Injectables

Keywords:

Botulinum toxins

Anonymous

Posted on July 27th, 2025 10:21

Patient description

Dear all,

I received a report that pyridostigmine sometimes is used to antagonize undesired effect of botox on facial muscles (frozen face).

Pyridostigmine is a medication which can have serious side effects, it needs close monitoring and I don’t use it.

It did not find pyridostigmine in guidelines for treatment of botulinum toxin induced brow ptosis, nor eyelid ptosis.

I found literature about it is use for treatment of botulism and for example treatment of swallowing difficulties and hoarseness caused by botulinum toxin used for dystonia.

Searching for pyridostigmine on Imcas platform showed only one video with case reports, saying it shortens recovery time of eyelid ptosis.

Does anyone use of pyridostigmine to antagonize facial botox ?

Kind regards

Case description

Dear all,

I received a report that pyridostigmine sometimes is used to antagonize undesired effect of botox on facial muscles (frozen face).

Pyridostigmine is a medication which can have serious side effects, it needs close monitoring and I don’t use it.

It did not find pyridostigmine in guidelines for treatment of botulinum toxin induced brow ptosis, nor eyelid ptosis.

I found literature about it is use for treatment of botulism and for example treatment of swallowing difficulties and hoarseness caused by botulinum toxin used for dystonia.

Searching for pyridostigmine on Imcas platform showed only one video with case reports, saying it shortens recovery time of eyelid ptosis.

Does anyone use of pyridostigmine to antagonize facial botox ?

Kind regards

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Dr. Fadi HAMADANI

Alert coordinator

Plastic Surgeon, Palestine

Posted on July 27th, 2025 10:50

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Anonymous

Posted on July 27th, 2025 11:34

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Dr. Roberta D EMILIO

MD, Italy

Posted on July 27th, 2025 12:10

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Dr. Robyn D SIPERSTEIN

Alert coordinator

Dermatologist, United States

Posted on July 27th, 2025 17:37

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Dr. Tzachi SHELKOVITZ

Dermatologist, Israel

Posted on July 27th, 2025 18:27

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Dr. Juliah TBARANI O SHEA

Cosmetic Surgeon, Ireland

Posted on July 27th, 2025 19:53 Edited on July 27th, 2025 20:00

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As far as I remember, I have only given pyridostigmine once in my entire career in medicine to an MG patient in a life threatening situation. 
Correct me if I’m wrong, but it feels like more and more practitioners are unintentionally complicating situations—intervening aggressively in cases where the issue is neither life-threatening nor severe enough to warrant high-risk treatments. 
 
Take mild lid ptosis, for instance. Something as simple as a vibrating tool—like an electric toothbrush or a pain-minimising vibrator—used for just a day or two can significantly improve the situation. It’s safe, inexpensive, non-invasive, and surprisingly effective. 
 
While I’m comfortable performing pretarsal injections (I managed the toxins list during my five years in ophthalmology), I still prefer to start conservatively. I often advise patients to try the vibrating method first, and in some cases, I’ll add a topical alpha-adrenergic eye drop like apraclonidine. 
 
Sometimes the smartest solutions are the simplest. Why overcomplicate things and put patients health at risk

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Pyridostigimine to reverse botox? Solved

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Pyridostigimine to reverse botox?
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