How do I know if my Botox was injected too far to the surface? Something isn't right!

Question

Last week, I got my botox. I used to go to someone else, but I recently moved. I always get 20 units in my forehead and I am always happy with it. This time, I had an RN injector, which was fine! We decided to do 24 units just to give it a little extra tightening. But after being injected, every injection site on my forehead looked like HUGE BEE STINGS. Normally, i have little red dots, occasionally a tiny bruise. Now, 7 days later, there is no change in my skin, when it usually sets in 3 days.

Brock Ridenour, MD · Answer

Superficial injection in the forehead while creating small wheals at the surface is just as effective as injecting Botox deeper into the muscle. In addition, this technique may very well reduce the risk of bleeding and deep bruising in the forehead. Both the technique you describe and the reported dosage seems not to be an issue. I agree with others that you should wait a full two weeks before passing final judgement. Unfortunately, you always have to consider the possibility that an unscrupulous provider would profit from injecting less Botox than stated, akin to watering down drinks at a bar. I choose to remain optimistic and I hope that you will see noticeable improvement in the next few days. If not, I recommend that you  bring your concerns to the attention of your provider. My very best wishes.

Nelson Castillo, MD · Answer

Thank you for sharing your question and I am sorry to hear of your injection issues. Though swelling is not uncommon following botox administration, it should resolve in a matter of hours after treatment.  Persistent swelling may indicate a deep bruise or small hematoma has formed, or a possible allergic reaction.  I would revisit your injector to see what may be taking place.

Shaun Patel, MD · Answer

It seems like a reasonable dose was used. I would give the Botox up to 14 days to see the full result. At that point, I would followup with your injector if you remain unhappy with your results.

Michele S. Green, MD · Answer

The Botox pattern that you described should still be effective.  However, it will take two full weeks to see the results.  If after two weeks you don't have an effective result you should return to your treating injector.  Best, Dr. Green

Steven F. Weiner, MD · Answer

There have been studies showing the superficial injection of Botox in the forehead, as you describe, is just as effective than deeper injections. There is less bruising with this technique. I don't know why you are not reacting to the Botox and you should discuss with the injector. 24 units is more than adequate to place in the forehead. My usual dose is 8-10 in females. The bee sting look is superficially placed Botox in the upper dermis and the swelling should go away in about 20 minutes. It leads to less bruising.

Pamela Stuart, MD · Answer

Swelling after Botox is not unusual, but typically it resolves within several days. If you are still having swelling a week after your injections, I would recommend that you contact your injector for a reevaluation.  If you have also seen no improvement after 7 to 14 days, this should also be addressed with your provider. Best wishes,

Leonard Grossman, MD · Answer

Therr is nothing usual about having a bump at the point of Botox injection. I always explain to my patient that this bump will disappear in about 15 to 20 minutes after the treatment. The fact that you have no effect after a week is a different story and I think you should address that with your injector. Good luck from New York City

Shalini Gupta, MD · Answer

Hi there.  While it can take up to 14 days for Botox to completely set in, you should definitely be seeing at least partial effects by 7 days.  Hard to say how the injections were performed but I would definitely follow up with the provider or the supervising doctor to have this checked and see why it may not have worked as well this time and if there were other surrounding factors that may have contributed to this.  Best wishes, Dr. Gupta

Lisa Vuich, MD · Answer

Thanks for your question.
Injectors vary as to how much saline they reconstitute their botox with. The usual range is from 1ml to 2.5 ml  added to the vial. Some add even more. The more saline the injector adds, the more volume they need to inject in order to deliver the desired number  of units, thus the "bumps" will be more prominent. You should follow up with your injector if you have not gotten your usual result after 10 days.
Best,
Lisa Vuich, MD

Anna Sylwestrowicz, MD, FRCP(C) · Answer

Botox has to be reconstituted with normal saline. It is possible you had a reaction to the preservative in the saline. I suggest icing the area and rest assured it should settle down. You can also try small dabs of hydrocortisone cream to settle the inflammation.
Dr. Anna Sylwestrowicz MD FRCP(C)
Victoria, BC

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