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Is It Normal to Have Swelling After Botox?

I had Botox injections 4 days ago in my forehead, and around my eyes. Today I noticed that everywhere I had the injection it looks lumpy and swollen. When I do my "surprised" face, I also get this lump right in the middle of my forehead just above where they do it for the crease between the eye. I have had Botox before and in some places it seems to leave an indentation. Can anyone tell me what might be happening? I am getting very nervous and am wondering if I should make an appointment to see a plastic surgeon. The Dr. that did it this time is qualified, but is a GP. Thanks for any information on this!

Asked 41 months ago by Claudia Spriggs in Lethbridge, Canada

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swelling

Botox bumps 4 days after injections?

Hi Claudia. The bumps you are describing sound more like an allergic reaction than anything else. The problem is that this type of reaction usually occurs immediately after injection when it does. And it has only occurred in 2 patients (out of thousands) that had grown resistant to Botox or have an allergy to Albumin - a preservative in Botox. Because these bumps are appearing days after the injections, we are not sure that this would be the type of allergic reaction we note here and... more

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Harold J. Kaplan, MD

Los Angeles Facial Plastic Surgeon

Swelling after Botox is unusual

I have seen occasional cases of incomplete muscle paralysis of the injected muscles, leading to an irregular contour upon frowning or raising ones eyebrows. This is either due to inadequate dosing of the Botox, or incomplete area of the muscle injected. Occasionally, patients may develop a small hematoma (bruise) at or near the injection site. Hematomas can be mildly painful, unless the injector punctures the periosteum (membrane attached to the bone), in which case it can be quite painful.... more

Wilfred Brown, MD

Fairfield Plastic Surgeon

ASAPS

Return to your injector for an exam

If the muscle has been weakened in an unusual pattern, it maybe that you are experiencing visibility of contracting muscle segments between the weakened segments but my guess is that this is highly unlikely. Within all likelihood this will resolve on its own with no intervention or side effects but I would advise you to seek the advise of your injecting physician.

Otto Joseph Placik, MD

Chicago Plastic Surgeon

ASAPS ASPS

Persistent lumps following Botox injections are unusual.

Claudia: I have been using Botox close to thirteen years and never have seen persistent lumps. We typically advise our patients to be off of all anti-inflammatory medications and aspirin products two weeks prior to any injections to minimize the risk of bruising. It sounds like this most likely represents bruising at the injection sites. If it is bruising that is causing the lumps, then I would expect to see this clear up with time. I would advise you to follow up with the treating... more

Stephen A. Goldstein, MD

Denver Plastic Surgeon

ASAPS ASPS

Bumps can be the result of muscle recruitment

Bumps after Botox can be the result of swelling, hematoma or muscle recruitment. Swelling can be the result of localized trauma and will go away shortly. Hematoma is the result of the needle injuring a small blood vessel and will also resolve within 1-2 weeks. More likely is the recruitment of muscle that was not paralyzed by the Botox. When muscle is paralyzed, your brain tries to accomplish the same motion by taking unaffected muscle to perform the same function. This can result in the... more

Robert M. Freund, MD

New York Plastic Surgeon

ASPS

Botox Complication

Hi Claudia, I agree with Dr. Lupo. I have never seen what you are describing in thousands of injections. I have seen very small hematomas (bruises) that may form a small lump for a few days, but not everywhere as you state. Your statement that "the Dr. that did it this time is qualified, but is a GP" is an oxymoron. You should have Botox and fillers injected by cosmetically trained specialists (plastic surgeon, facial plastic surgeon, dermatologist, and oculoplastic surgeon). If... more

Michael A. Persky, MD

Los Angeles Facial Plastic Surgeon

Follow up with treating physician

The situation you are describing is very unusual. I have been doing Botox injections for 12 years and have never seen what you are describing. I'd give the treating physician the benefit of the doubt and see if he/she can fix this. In general, I always recommend board certified dermatologists and plastic surgeons because they do so many injectables. In my opinion, there is value in experience and training in aesthetics and you just don't get those things at a weekend course. Good luck. more

Mary Lupo, MD

New Orleans Dermatologist

Go back and see your doctor

After Botox injections, it is normal to have temporary swelling - similar to mosquito bite, which resolves after a few hours. This is due to localized swelling around the site of injection. Occasionally, you can have areas of swelling due to small hematomas (bruises) which may take a few days to resolve. These are generally localized and may be tender to the touch. Additionally, you can have areas of swelling from localized infections from the needle puncture. However, these are also... more

Doctor's Website

David Shafer, MD

New York Plastic Surgeon

ASPS

See a dermatologist or plastic surgeon if swelling persists

It is difficult to determine without seeing a picture if the "bumps" are where the muscle is partially relaxed and you are seeing activation of the muscles next to the Botox-treated area. You often see a little swelling at the sight of the injection but that should resolve within a day. I definitely recommend that you see a dermatologist or plastic surgeon that does a lot of Botox injections because injecting looks easy but it is definitely an art!

Brenda Dintiman, MD

Fairfax Dermatologic Surgeon

Botox may have been placed unevenly or too forcefully

It sounds like the Botox was placed unevenly and maybe too forcefully causing the swollen areas. You should follow up with your doctor as it is usually possible to smooth this out. Wait at least 2 weeks as it may smooth out on it's own. If you don't want to go back to that doctor, see a physician very experienced with Botox, usually a dermatologist or plastic surgeon.

Kimberly Butterwick, MD

San Diego Dermatologic Surgeon

I have not seen what your are describing after using Botox for 11 years

Claudia, I have not seen the lumps you refer to. Usually any lumpiness disappears within a few hours. I also have not seen indentations as a result of Botox. Conceivably you could have some bleeding below the periosteum (lining of the bone). That could conceivably cause lumpiness that lasts longer and it may take a couple of weeks to resolve. Certainly seek a second opinion after finding out exactly how much Botox you had. In our office, we have used Botox since 1998, and we advise our... more

Francisco Canales, MD

Santa Rosa Plastic Surgeon

ASAPS ASPS

Not that uncommon

Bruising or lumps the first few days after Botox is not uncommon. But, it usually goes away within a couple of days. If it persists, you should probably go see your doctor.

Steven Wallach, MD

Manhattan Plastic Surgeon

ASAPS ASPS

Go back and see your physician

Having swelling 4 days after BOTOX is extremely unusual. First of all, I would not recommend a GP to inject BOTOX. There is a reason there are medical specialities because one cannot be an expert at everything. If I had a kidney infection I wouldn't see a cardiologist. You deserve the highest level of care for yourself and you should see the appropriate physician for your cosmetic needs. You may have developed a small hematoma where the needle was placed. If so this should resolve with... more

Samson Lee, MD

Seattle Facial Plastic Surgeon

See a plastic surgeon not a GP

You should see a plastic surgeon and not a GP because a plastic surgeon is more experienced and knows what they are doing. It may simply be a little bruise under the skin that is causing the lump.

Usha Rajagopal, MD

San Francisco Plastic Surgeon

ASAPS

Follow Up with your Physician

Hello, Bumps and swelling can occur after facial injections (Botox, fillers) for a number of reasons. They can occur after Botox due to normal swelling and bruising seen after injection trauma, or due to hematoma formation (rare but possible - this means a collection of blood organizes under the skin). Bumps and swelling from Botox can also occur due to the saline that is mixed with the Botox - although by four days out this would be unusual to see. Best thing to do is to go see the... more