Tender Lumps and Swelling After Botox to the Forehead

Thank you for your question. Swelling is possible everytime a needle penetrates the skin. Having said that, I typically find that the degree of swelling varies based on the treatment and location. For example, swelling after Botox is usually minimal (unless you bruise). Juvederm in the nasolabial folds also has minimal swelling. Juvderm in the lips, however, can result in a lot of swelling. It's a good treatment to do on Friday so the swelling can be reduced by Monday.I would give this a few more days to resolve.  Benadryl is safe to take during this time but may not help with the swelling.  I would also visit with your physician who injected you to let them be aware of what is going on.

Often there will be small lumps at the injection site secondary to the volume deposited.  There can be some residual swelling for a little while.  It can also be something more complicated like a hematoma, (rare).  Of note is your description of "flu like symptoms."  Best to contact the doctor where you got your injections, and make him/her aware of what is going on.

There are a variety of explanations for your findings but in any event you should report these promptly to your physician or practitioner.

Any time any product is inected there is a risk of bruising. These can be tender. Flu-like symptoms *re very rare but might be related to some small amunt of the Botox getting into a small vein. This would not be an allergic reaction and would not prevent you from having the Botox again but be sure to mention your side effect to your doctor.

Hi,

the tender lumps and swelling are from bleeding under the skin or within the muscle.  The first 48 hours cold compresses are helpful, the next 48 hours warm compresses.  Benadryl helps with allergic swelling, not swelling from bruises. Rarely do patients have flu like symptoms, these usually go away within a day or so.

Good luck and be well.

Dr. P

Thank you for your question! It usually is just a reaction from the injection of the needle in the skin at the injection site. This is very common and usually goes away in just a few minutes after treatment. In rare cases it can last 2-3 days, but is nothing to be alarmed about.  Your situation sounds more severe.  I would check with your physician immediately. Best of luck! 

Thank you for your question 3500anon. I understand your concern. Botox is a purified protein used to address wrinkles associated with facial expression. When injected into the skin Botox will relax the muscles and smoothen out the overlying wrinkles. The most common areas of treatment are in the upper face. These include the horizontal lines seen on the upper forehead when one raises the brows, the vertical lines seen between the brows when one frowns (frown lines), and the crow's feet seen around the eyes when one smiles.It is difficult to make an assessment in the absence of consistent photographs before and after in the same lighting and angles for comparison. However, I hope the information provided here is useful.The appearance of frown lines is variable from person to person. Usually they are in a vertical orientation but sometimes they can be oblique and sometimes a horizontal line is seen across the upper portion of the nasal bridge. The most common variation is to have two parallel lines, hence the common term "11's" to describe them. But some people have one, three, or more lines. Some people also will see a bulge in the area when contracting the muscle. This bulge is smoothened out after a Botox treatment.The pivotal studies used 20 units of Botox in the glabella area between the brow to address the frown lines. These studies demonstrated that the peak results are seen 14 days after the treatment and most people enjoy their results for 3-4 months. At that point, a maintenance treatment is recommended. While some people start to see results as early as the next day, it can take two weeks for full results so patience is important. We have our patients return two weeks after their treatment to assess their results via photographs. At that time additional units may be added if necessary.The safety record of Botox is well established. The product has been used for over 20 years for a variety of treatments with minimal side effects. Botox is amongst the safest treatments for treating facial wrinkles.With any injection, there are risks such as pain, bleeding, bruising, redness, swelling, tenderness, and infection. We take special precautions to minimize these risks such as using a painless technique. We also treat bruises with a laser as early as the next day. Bruises usually resolve within two weeks if untreated. After a laser treatment bruises usually resolve in 1-3 days, but may still take two weeks for full resolution. In addition to these risks, with Botox there is also a risk that the product spreads or diffuses to nearby structures. Spread to nearby muscles can lead to side effects such as the temporary appearance of droopy eyelids or a temporary asymmetric smile.
After a Botox treatment, I recommend that my patients avoid heat exposure, alcohol consumption, and strenuous exercise for 24 hours and not lie down flat for four hours. This is because all of these activities may possibly lead to the movement of the product and consequent side effects such as droopy eyelids. Although there have been no definitive studies shown that these actually occur and some physicians do not provide such aftercare instructions, in the absence of data I err on the side of caution and recommend that my patients avoid such activities.
If I had a patient with the concern described here I would recommend that she return to her provider for an assessment and specific recommendations. Applying cold compresses such as ice packs, keeping the head elevated on an extra pillow, and reducing salty food intake will decrease swelling. Benadryl may or may not provide benefit, but is likely safe depending on a person's medical history.
Please consult with a doctor for specific recommendations. Good luck!

You may just have some bruising from the needle injections but you should see your physician to be assessed.

It usually is just a reaction from the injection of the needle in the skin at the injection site. This is very common and usually goes away in just a few minutes after treatment. In rare cases it can last 2-3 days, but is nothing to be alarmed about.  Your situation sounds more severe.  I would check with your physician immediately.