Swelling of inner eyelids after Botox and persistent headache, what do I do?

Question

I had Botox yesterday.The injections were more painful than usual, not the needle but the pain of the liquid being injected into the muscle. It was enough to make me feel sweaty and nauseous.Today woke up and didn't recognise myself.The inner corner of both eyelids is completely swollen and bulging and it makes me look like a completely different person, my eyes are too wide apart.It's worse on my right side and I still have a headache on my right side. I don't want to leave the house.

Amiya Prasad, MD · Answer

Thank you for your question. You submitted two photos, and describe that one day prior, you underwent Botox® injection, and recall there was pain as the Botox® was being injected into the muscle. The following day, you had swelling in the inner corners of your eyes and pain on one side, so you’re looking to figure out what’s going on.
I can share with you my perspective based on this information, in the absence of a physical examination. A little background: I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial plastic and reconstructive surgeon. I have been in practice in Manhattan and Long Island for over 20 years. I have been using Botox® for patients since 1993, and our specialty of oculofacial plastic surgery are among the first physicians to use Botox® long before the rapid expansion and growth of indications for cosmetic use. 
It’s always important to understand the anatomy because that will help possible explanations. When Botox® was being injected for you, the needle went through the skin and entered the muscle to relax the muscle. There are a couple of possibilities just by that alone. Muscle itself is fairly vascular, so maybe some degree of irritation or inflammation can account for some of the fluid. There are also multiple sensory nerves that give sensation to the skin that travel in that same region, so it’s possible that upon entering the skin and going into the muscle, the needle could’ve also irritated some of these nerves, and that can be responsible for a spasm that results in headache. Interestingly, you are probably aware that Botox® actually helps treat headaches, so a lot of people who have a history of tension or migraine headaches will benefit from Botox®. 
I think what you’re dealing with is a little fluid that is a natural response to either the amount of volume injected into the forehead, depending on how your doctor does the dilution for the Botox®; or it can also be from irritation of the muscle or the nerve. 
Generally, in a situation like yours, conservative management is typically indicated. That means taking anti-inflammatories like non-steroidals, and cold compresses in the first 48 hours to mitigate some of the potential swelling. There is so much nuance in the art of placement of Botox® that is always individualized. There are techniques we employ to minimize penetration of the muscle. There are different dilution strategies, and other ways this type of situation could be avoided in the future, which are worth discussing with your physician as I’m assuming there’s some follow-up planned for you. 
When we do Botox® or any injectable, we see our patients two weeks after the procedure so I see what the outcome is, to see if any enhancement is indicated, and further learn about what the dosing and response of the patient is so this strategy can be tailored to future treatments. 
For now, there is no reason to feel there’s anything more serious going on, other than the consequence of some localized reaction. I would advise you to keep in contact with your doctor. Mention this to your doctor as soon as you can so at least your doctor is aware. Your doctor may want to see you in person, and maybe give you something more than just a non-steroidal to help expedite the management of this fluid. In the meantime,  it is important to learn about this anatomic relationship where muscle, nerves, and needles can sometimes interface, and result in inflammation and swelling, but it is not usually anything to be concerned about long-term. I hope that was helpful, I wish you the best of luck, and thank you for your question.This personalized video answer to your question is posted on RealSelf and on YouTube. To provide you with a personal and expert response, we use the image(s) you submitted on RealSelf in the video, but with respect to your privacy, we only show the body feature in question so you are not personally identifiable. If you prefer not to have your video question visible on YouTube, please contact us.

John P. Guste, MD · Answer

Sorry to hear about your issue. Typically, botox is a relatively painless procedure with minimal complications. But not always. There are two main sensory nerves near the areas you had injected. IT is not unreasonable to conceive that the needle could have hit the nerve itself making the injection more painful than normal. Also, and I doubt this is the cause, the botox could have been mixed inadvertently with sterile water making the injection more painful. You should use ibuprofen for pain, but it should resolve.
Without examining you before or after, it would be difficult to make an accurate assessment for you swelling. But more than likely, this will improve shortly as well.

Alex Eshaghian, MD, PhD · Answer

Thank you for your question and for sharing your
photographs zigzagah. 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.
The appearance of frown lines is variable from
person to person. Usually they are in a vertical orientation but sometimes they
can be oblique and sometimes a horizontal line is seen across the upper portion
of the nasal bridge. The most common variation is to have two parallel lines,
hence the common term "11's" to describe them. But some people have
one, three, or more lines. Some people also will see a bulge in the area when
contracting the muscle. This bulge is smoothened out after a Botox treatment.
The safety record of Botox is well established.
The product has been used for over 20 years for a variety of treatments with
minimal side effects. Botox is amongst the safest treatments for treating
facial wrinkles. 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. For my patients I recommend applying cold compresses such as ice packs throughout the day and sleeping on an extra pillow if not uncomfortable to reduce any swelling.
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!

Swelling of inner eyelids after Botox and persistent headache, what do I do?

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Swelling of inner eyelids after Botox and persistent headache, what do I do?

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