Could a lump after Botox on my jawline be a hematoma?

Question

I got botox injection a month ago for jaw slimming purpose (25 units each side). Now I have this little lump in my right jaw around the area where I got injection. No pain and can’t tell by looking at my face. I can only feel the little lump when pressing the area. I did some search and it may be hematoma? Is this a side effect of Botox and how should I treat it? Will it go away eventually?

Alex Eshaghian, MD, PhD · Answer

Thank you for your question Sisharon25. 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.Botox can be placed in the masseter muscle in the lower face to contour the lower face and address pain associated with TMJ. In this area 20-40 units of Botox are used per side. Depending on the reason for the enlargement of the muscle, permanent results may be achieved. For example, some people have a habit of grinding, clenching, or biting their teeth subconsciously. Often times this happens in their sleep when they are not aware of it. Botox placed in this muscle will relax the muscle and the grinding, clenching, and/or biting will decrease. This will reduce the size of the muscle. If the brain gets accustomed to this and the person stops grinding, clenching, or biting, then the muscle will not become enlarged or as enlarged again. However, if the habit starts again, the muscle will likely get larger.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.Treatment of the masseter is a deep injection. If a bruise occurs here, a deep lump may be felt. Bruises resolve on their own after one to two weeks. If I had a patient with the concern described here I would recommend that she be patient until it resolves.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!

Andy Shieh, DMD · Answer

Unlikely to be a hematoma because hematoma will show signs of bruising as the heme breaks down from blood. The bump sounds small so give it time to heal. Massage the area. It is good that you can’t see the bump.

Onir Spiegel, DDS, PhD · Answer

A lump forming following Botox injections can be a result of hitting a blood vessel and creating a hematoma. These usually resolve themselves within a few days to a few weeks.. However, in your description you are suggesting that it is not painful. Hematomas tend to be very tender and painful. My recommendation is to go have this checked out as it could be something else that may have coincidentally formed following your Botox injections. Best of luck from Boston, Dr. Onir

Monika Soni, MD · Answer

Thank you for your question! Botox injections can cause bruising if the needle hits a blood vessel on the way in. Often, it is impossible to see these vessels beforehand.  The initial bump that forms is from the blood pooling in the skin and muscle. Once the bleeding stops, the body has to work to get rid of it. An inflammatory reaction will develop to breakdown the blood and carry it away.  This is why the swelling gets worse after a few hours.  It will all resolve with time, but may take a week or two. Best of luck!

Could a lump after Botox on my jawline be a hematoma?

Answers (4)

Answer: Botox injections can cause bruising if the needle hits a blood vessel on the way in.

Answer: Botox injections can cause bruising if the needle hits a blood vessel on the way in.

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Could a lump after Botox on my jawline be a hematoma?

Answers (4)

Answer: Botox injections can cause bruising if the needle hits a blood vessel on the way in.

Answer: Botox injections can cause bruising if the needle hits a blood vessel on the way in.

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Everything you need to know about Botox

Our mission is to create a world where every investment in modern beauty is Worth It.