Lumps, heavy feeling and tenderness after Botox? (Photo)

Question

I got botox today and above each eyebrow is a lump. I bled a bit and the lump is larger on the side I bled the most. I did my 11s, forehead, crows feet and under eyes. No other lumps anywhere. My forehead is a bit heavy and the lumps are tender. Do i need to worry?

Nicolette Picerno, MD · Answer

These bumps are actually small collections of blood under the muscle being treated with Botox.  They can be a little tender too for a few days.  They are nothing to worry about and will not affect your actual outcome from the treatment. However, you may want to ask your injector to apply pressure immediately after placing the needle to lessen the chance this might occur in the future.  The bumps are very common though and may happen even with pressure. The heaviness you feel right now is likely from the bumps and should resolve as they resolve.  I agree with others answers, it is too soon to see any Botox effect. Good Luck!

Monika Soni, MD · Answer

Thank you for your question. Swelling can occur for 1-2 hours after Botox injection. However, this may be due to your microneedling treatment. I recommend following up with your injector for an evaluation and possible treatment. Best of Luck!

Shaun Patel, MD · Answer

No, nothing to worry about. Too soon to the see the results of the Botox treatment. What you are feeling and seeing are probably bruises related to the injection. These "lumps" should resolve on their own over the next few days if not sooner.

Michael H. Gold, MD · Answer

Thanks for the question and sorry that you are having these concerns following your Botox injections. We always recommend that you have these injections in the offices of board certified dermatologists or plastic surgeons as we are the true experts in the anatomy in these areas and understand these procedures the best. It would be good to know how much Botox was injected was injected into the glabella and forehead areas and what you were instructed to do after the injections.  While what you are describing has been seen, it is not very common and I do believe that the heaviness and tenderness will resolve – use ice and see if it resolves in the next day or so – if not, please see your provider to see if there is a bruise or something else which can be corrected.

Alex Eshaghian, MD, PhD · Answer

Thank you for your question and for sharing your photograph ktkdmommy4. 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 without a formal exam in the office where I can view the skin in multiple angles and observe wrinkles formed with facial expression. However, I hope the information provided here is useful.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 as described above. 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.Please consult with a doctor for specific recommendations. Good luck!

Richard Ort, MD · Answer

You are most likely experiencing small hematomas or deep bruises in the lumpy, tender areas.  This should resolve on its own.  Sometimes the Botox needle will hit a blood vessel and a bit of bleeding or bruising will result.  It helps if your injector applies immediate pressure to any injection sites that bleed.  Ice can also be applied on the day of injection.  If you continue to have concerns, you should touch base with your injector.Regards,Dr. Ort

Leonard Grossman, MD · Answer

Painful bumps after Botox imply a deep hematoma also known as a collection of blood. With a few days time the blood clot will resolve and you will feel considerably better. In order to help it dissolve faster you may use warm, moist compresses applied to the area a few times a day. Botox will take 3 to 5 days to start working. Good luck from New York City

Seth Kates, MD · Answer

Thanks for your question.  The lumps are almost certainly a small bruise which is very common after getting Botox.  It doesn't mean that you will see a black and blue mark later and they usually go away after a few days.  The heaviness is likely due to that.  Too much Botox in the forehead can make the forehead feel "heavy" but that usually takes several days to develop and not just a portion of one day.  My guess is that it will feel much better over the next day or two.  Have a good weekend...

Kimberly Eickhorst, MD · Answer

It is not uncommon after Botox Cosmetic to have small little "welts." I tell my patients to expect "bug bite" like bumps immediately after the procedure. For some patients, they have no reaction at all to the injections, and for others their bumps can persist for some time but usually have resolved with a 24 hour period. It also is not uncommon to bleed after receiving Botox, but again the bleeding is usually pinpoint and should cease fairly quickly after the procedure; if however, you are on blood thinners (aspririn/ Advil/ or have even drank alcohol recently) bleeding can be more pronounced. It's most likely that if your "lumps" are persisting you simply have either a bruise or little collection of blood (hematoma); these will both resolve over the next week or so and you do not need to worry .

Justin Harper, MD - Account Suspended · Answer

Hi ktkdmommy4, Please don't worry at this point. No matter how skilled or careful the Injector is, you can have these small lumps which can be a collection of fluid from the injection or blood. This will resolve on its own but you can help by applying a warm compress. You may have some bruising after this hematoma resolves but it shouldn't be very visible after a few days.All the best, Justin Harper, M.D/

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