Red, itchy, swollen eyes reaction to Botox, what is going on?

Question

I’ve had Botox a handful of times over the last few years and this is the second time this has happened. The first time I was told it couldn’t be related to the Botox and allergy testing did confirm something else. However, I had Botox injected for crows feet, forehead lines and in the glabella earlier today and am experiencing the same symptoms in my eyes- puffiness, redness and they’re irritated and itchy. Nothing else changed today, no new face products or foods eaten. What is going on?!

Ron Shelton, MD · Answer

There are a few possibilities.
1. true but very rare allergy to Botox itself
2. allergy to a preservative in preserved saline liquid used to dissolve the Botox. Many use this solution but it may be that if this is the case, that using non-preserved sterile saline would work for you.
3. allergy to a disinfectant used prior to the injections but as the eyelids are swollen it's doubtful that the disinfectant touched that skin as the Botox is usually injected outside of the eyelid area.
An allergist can help shed more light on your situation.
The information provided in Dr. Shelton's answer is for educational purposes only and is not intended to constitute medical advice.  The information provided should not be relied upon as a substitute for consultations with a qualified health professional who may be familiar with your individual medical needs.
The information provided in Dr. Shelton's answer is for educational purposes only and is not intended to constitute medical advice.  The information provided should not be relied upon as a substitute for consultations with a qualified health professional who may be familiar with your individual medical needs.

Jonathan Kulbersh, MD · Answer

While allergies to Botox are extremely rare, it can happen. If this persists, I recommend following up with your injector. Hope this helps.

Jason Emer, MD · Answer

Botox allergies are extremely rare, however, this is difficult to answer without an in-person evaluation. Botox results take 1-2 weeks and can be softened with venus legacy and thermage treatments. See an expert. Best, Dr. Emer

Monika Soni, MD · Answer

Thank you for your question. 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 where the entire medical history is reviewed.

Brian A. Pinsky, MD, FACS · Answer

Thanks for your question.  A true allergy to botox is possible but very rare.  I would suspect that other products used in the procedure such as the sulfite preservative in the saline, latex gloves, or skin prep solution may be the source of the allergic reaction.  Since this is the second time, I would consult an allergist to avoid worse reactions in the future. Once you have identified the issue, you should be able to make some minor changes that will allow you to continue using NT in the future. Also, you can consider other similar products such as dysport.  Best of luck.

Alex Eshaghian, MD, PhD · Answer

Thank you for your question caseywouldgo. 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 where the entire medical history is reviewed. However, I hope the information provided here is useful.The pivotal studies used 20 units of Botox in the glabella area between the brow to address the frown lines. These studies demonstrated that the peak results are seen 14 days after the treatment and most people enjoy their results for 3-4 months. At that point, a maintenance treatment is recommended. While some people start to see results as early as the next day, it can take two weeks for full results so patience is important. We have our patients return two weeks after their treatment to assess their results via photographs. At that time additional units may be added if necessary.Allergic reactions to Botox are very rare. On occasion, allergic reactions may be secondary to an ingredient in the saline used to prepare the product or to numbing cream. If I had a patient with the concern described here I would recommend following up with her doctor to look into such a possibility.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. 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!

Lynn D. Derby, MD (retired) · Answer

Botox allergies are extremely rare, but not impossible.  If it has happened twice following injection, I would suspect an allergy to latex gloves, glove powder, or the prep solution used to clean your skin before injection.

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