Ask a doctor

Is It Normal for the Forehead to Bulge Slightly After Botox Treatment, or is This Residual Swelling? (Photos)

Had 1st injections Wed.: 20 units in Glabulla, 12 in forehead. Thurs. morning had throbbing pain + swollen to the point of disfigurin. It's now Sat.: pain mostly gone, forehead evened out, but clearly a mild bulging--does not look/feel natural (outline of treated muscles is visible). Is this residual swell, or is Botox supposed to add 'fullness' to treated muscles? I dislike this look, & want forehead flat. I still have a lot of movement, mostly lateral brows, where there is no bulging at all.

Doctor Answers (12)

Combination of swelling and need for additional injections

+2

Hi Ruca,

I agree with most of the advice you have been given here.

While swelling can certainly be present after botox injections it is typically located only in the areas where the needle is inserted. While a hematoma (collection of blood under the skin) is possible it is not very common and unlikely to be the case when looking at your photos.

i think there is a good chance that by the time you read this the "bulging" will have settled itself out but if not please do go see you physician as additional injections may be needed to balance out the tension across your forehead muscles.

Take care,

Dr. J


New York Facial Plastic Surgeon
5.0 out of 5 stars 8 reviews

Botox relaxes muscle

+2

Botox is injected into the muscle.  It can be common to sometimes see slight swelling at each injection site, resembling a mosquito bite.  The swelling subsides after minutes and typically does not last for days.  By looking at your photos, it looks as though your lateral brows are still quite active and may need a touch-up dose of Botox to relax them.  This may help transition the area you are seeing between the treated and un-treated areas on the forehead.

Boris Volshteyn, MD, MS
East Brunswick Plastic Surgeon
4.0 out of 5 stars 8 reviews

Bulge

+2

All of my Botox patients see a bulge at the injection site that only lasts about 20 minutes. My guess is that you have a little bleeding causing the swelling and that should go away. Don't expect to see the results you want for 4-10 days

David A. Bray, Sr., MD
Los Angeles Facial Plastic Surgeon
4.5 out of 5 stars 6 reviews

You might also like...

Is It Normal for the Forehead to Bulge Slightly After Botox Treatment, or is This Residual Swelling? (Photos)

+2

Dear Ruca,

Botox injection normally causes mild swelling of the treated area that usually dissipates within several minutes. Bruising is also possible but relatively uncommon.

Botox injection does not add fullness to the treated area nor should it cause any other swelling. Looking at your pictures, it appears that you may need additional treatment of your lateral forehead. I would suggest returning to your physician for an evaluation and possible touchup.

Botox is a simple medicine that works very well but requires a deep understanding of human anatomy. This is why, given a choice, I would see a Board Certified Plastic Surgeon, Cosmetic Dermatologist, or Facial Plastic Surgeon for Botox injections.

Warmest wishes,

Larry Fan, MD

Larry Fan, MD
San Francisco Plastic Surgeon
4.5 out of 5 stars 10 reviews

Botox for your forehead

+1

Wait for 2 weeks to see the full effect of your Botox.  You will probably require Botox for your lateral forehead.  You will have a more natural result with less Botox for the frown lines next time.  Consider treatment with an experienced dermatologist or plastic surgeon.

Martie Gidon, MD, FRCPC
Toronto Dermatologist
5.0 out of 5 stars 15 reviews

Forehead "bulge" after Botox.

+1

Ruca, I think you have had a bit too much Botox to the central forehead. Your brows have dropped significantly in the center (due to complete central frontalis paralysis), and your intact lateral frontalis activity allows the lateral brows to still be pulled upwards, giving you the "Spock brows" your photos show clearly. The swelling should already be gone by now, but your (central) frontalis will be paralyzed for 2-6 months. I suspect what you described as central forehead bulging was simply the lateral frontalis activity (on each side of the paralyzed central frontalis) "framing" the inactive area.

You will certainly have flat forehead for a while, but IMHO, this may be a bit too much Botox to your central forehead. As others have suggested, you may need a tiny bit of additional Botox to the lateral brows to "calm things down" and drop the sides of your brows a bit. Then, next time, ask for a bit less centrally and keep a bit of muscle tone here to elevate the brows and avoid the sad, pensive, or "Spock" brows. Best wishes!

Richard H. Tholen, MD, FACS
Minneapolis Plastic Surgeon
5.0 out of 5 stars 109 reviews

Swelling after botox

+1

Swelling after Botox on the forehead, is usually minimal and centers around the needle insertions but it is very rare to swell a lot. Some factors for increased swelling may be more trauma, more dilution volume, technique, or your personal immune system's reaction (some people have excessive swelling to slight stimuli, dermatographia, pressure urticaria) but swelling goes away.  If too much of the forehead is treated, then the "mask"-like forehead can take four months to return to normal.

Ronald Shelton, MD
Manhattan Dermatologist
5.0 out of 5 stars 31 reviews

"Bad Botox" - Bulging Forehead After Botox Treatment, or is This Residual Swelling? (Photos)

+1

Facial Animation, the expressions which makes us human and convey the full range of sadness, anger, curiosity, joy, happiness and sexuality derive their name from ANIMA or soul. In being able to convey expression we manifest that we have a soul and have the full range of human feelings.

The goal of Botox is NOT to erase our ability to express emotion but ONLY to smooth out certain wrinkles while still retaining others along with a human appearance. When being treated by an injector with no knowledge of Anatomy or artistry Botox is placed without consideration and the apparent misguided goal is a zombie-like, freaky completely smooth forehead with flat sagging brows - a clear example of Bad Botox.

In your case the entire Frontalis muscle was "taken out" causing a collapse of the central brows but the lateral brows were spared and are a witness to this poor technique. in other words, you were "Spockfied" (turned into Mr Spock of the old Star Trek).Your option is now to smoosh and flatten the lateral brows with more Botox (resulting in an older appearing straight brow for a while) or to wait for the recovery and elevation of the central brows.

A MUCH better way to have done it was to have placed the Botox higher to keep the sensual arch of the brow while SELECTIVELY smoothing the forehead. To read all you need to know about Botox and Bad Botox, please go to the link below.

Peter A Aldea, MD 

Peter A. Aldea, MD
Memphis Plastic Surgeon
5.0 out of 5 stars 58 reviews

It can happen.

+1

Hello,

Depending on the dilution of botox used, one can have residual swelling for a short time.  Your forehead looks fairly still in your photos except for the lateral brow where no botox was placed.  Several possible explanations for your experience could be: mild bleeding with swelling, residual swelling that will resolve, relaxation of the muscles into a more expanded position making forehead look fuller, etc.  I would just give it time to see what happens.  After 7-10 days you should have better idea of your look and can adjust the lateral brows if needed.

Good luck,

Dr. Shah

Manish H. Shah, MD, FACS
Denver Plastic Surgeon
5.0 out of 5 stars 19 reviews

Fort Lauderdale Botox

+1
Placement is an art. I feel that a touch up is definitely due, however I feel that your frontal is in the most medial portion was over treated resulting in visualization of the underlying frontal bone.

Will Richardson, MD
Fort Lauderdale Dermatologic Surgeon
4.0 out of 5 stars 8 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.