Cause of lump after Botox injection in masseter? (Photo)

Question

I got 25 units botox injected in each side of my masseter 3 weeks ago. For a week after my jaw was extremely swollen on both side. The swelling has reduced since then but there is still a visible bulge when i clench my jaw. Could it be a hematoma or seroma? Would massaging it help? The doctor did 2 injection sites on each side and also had me keep my jaw clenched during the injection which i thought was strange. Its funny my jaw is actually bigger than it was after getting botox..

Jason Emer, MD · Answer

It's difficult to tell from your picture. I recommend following up with your injector. Botox results resolve in 3-4 months. See an expert. Best, Dr. Emer

Michael A. Zadeh, MD, FACS · Answer

It could be a couple of things. There is a chance that it may be a hematoma. A seroma is unlikely. The other possibility is that your injector may have weakened only part of the muscle and what you are noticing is the areas that were not weakened by your injection. The only way to determine the actual cause is to be examined in person. I would recommend following up with your doctor. Best wishes.

Steven H. Dayan, MD · Answer

Dear yuke14,

Thank you for your question. It is difficult to make an accurate assessment and recommendations based on photographs alone. I recommend you seek further repeat evaluation with your provider to address your concerns. Swelling at the site of injection could be due to a number of causes including hematoma. In our practice, we also typically ask patients to clench their jaw prior to injection so we can best localize the muscle.

Asaf Yalif, MD, FACS · Answer

As noted below it is likely a hematoma in the muscle. Consult with the injecting physician as to how they would like you to address it.

Paul C. Dillon, MD · Answer

It is very important to follow up with your injector.  My suspicion would be that the portion of the muscle that is "swollen" is most likely active masseteric muscle  that has not been affected by the botox injection.

Michael S. Mall, MD · Answer

First, thank you for you questions and picture. Before making a diagnosis as to what this could be, I strongly recommend you return to your injector and allow them to examine the area.  To answer your questions, it is possible for the lump to be a hematoma or seroma and massaging may help; however, be gentle and do return to your injector.

Patrick Flaharty, MD FAACS · Answer

it is unusual to have swelling in the masseter after Botox injection however it is a thick muscle and swelling or bleeding from the injection is certainly possible.  It will most likely resolve over the next few weeks. The shrinkage of the masseter can take a few months so you may well see the intended effect over the next few months.

Melvin Elson, MD · Answer

Most likely it is a hematoma deep in the muscle which should improve with massage and warm compresses. it is very unusual to inject only 2 sites and more so to have the patient clench the muscle

Leonard Grossman, MD · Answer

To start with, you should be asking all of these questions of your doctor. Secondly, by evaluating your photograph, I don't see anything that's abnormal, in fact the bulges that are seen on both sides are absolutely normal when one is clenching their teeth and they should be different on both sides. I would compare a picture of yourself clenching your teeth to something that you have taken before your treatment. Good luck from New York City

Carmen Kavali, MD · Answer

Thank you for you question and photos.It could be a hematoma given the swelling you had following the injections. If it is a hematoma, massage and heat can help to break up the blood collection. I would also recommend following up with your injector for a physical exam.Best wishes,Dr. Kavali

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