What would cause injection site soreness after Botox?

Question

I have had botox at least 6 times. Last three times with the same Doctor. Never had any issues. Yesterday treated as usual, crows feet and 11's, but having significant injection site soreness in all areas which started last night. However no redness or swelling. Any ideas on what happened? Should I be concerned that the side effect will get worse next treatment? Thanks!

Martin Jugenburg, MD · Answer

Thank you for your question. Every time you have a Botox treatment it can feel different depending on many variables. Sometimes soreness can be attributed to personal factors including stress levels or diet. Discomfort can also be due to injection technique or the individual needle. It may have been a one time occurrence. In any case, it does not seem to be something you have to worry about for the time being. Consider discussing your concerns with your injector at your next treatment. Best,

Brian M. Harmych, MD, FACS · Answer

Injection site tenderness, pain and redness is pretty common and usually lasts less than a few days. I would suspect that this would improve over the next few days. If it doesn't, or you have any additional concerns, I would recommend returning to the physician who performed the injections and discuss this with them.

Shelby K. Brantley, Jr. MD · Answer

Hey Kathleen17.  The good news is that you have no redness or swelling.  Keep an eye on the areas and if they get worse or not any better over the next 72 hours than I would contact the doctors office to ask for their advise.  There are a couple of questions that come to mind when there is burning or soreness at injection; has the product been mixed correctly, has it been refrigerated and stored correctly and was the doctor a little 'heavy handed'?  No, I would not expect the effects to get worse at your next treatment.

Stephen Weber MD, FACS · Answer

This is an uncommon complaint but, personally, I've felt mild discomfort after Botox injections. The fact your skin looks normal is encouraging. If this is not improving daily, discuss with your injector. In the meantime, ice and anti-inflammatory medications can be very helpful. I hope this information is helpful for you.Stephen Weber MD, FACSDenver Facial Plastic Surgeon

Steven F. Weiner, MD · Answer

It is possible that the injector was a bit "heavy handed" and caused some slight trauma to the areas. I suspect it will improve in next 48 hours.

Mats Hagstrom, MD (license on probation) · Answer

The most common reason patients have pain after injections is the accidental touching of the periosteum, or membrane over the bone, with the needle during an injection.This is most common when injecting the forehead.When this happens, it tends to give an achy, headache-like feeling.It can last up to eight days.Other reasons include using poor quality needles or allowing needles to lose their sharpness.Very small, high-quality needles have very delicate tips and need to be changed often.I will often use three to six needles during a full Botox treatment.I will typically only miss one needle for two to three needle sticks, and then I switch to a new one.Even the highest quality needles are cheap, and the difference in perception is quite amazing.Pain because of damaged or poor quality needles is typically immediate and not long lasting. You may want to bring this up to your provider and ask if there was any difference in technique or equipment.Hormonal levels can also change the perception of discomfort from a procedure, but this should not have any long lasting implications.Best of luck,Mats Hagstrom, M.D.

What would cause injection site soreness after Botox?

Answers (6)

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