Swelling forehead after dysport injection 48 hrs ago. Is it normal? (Photo)

Question

Hi! I have had Botox and (I think) dysport a few times. Yesterday I went to a new location and got dysport injected. Today, I have two knots on my forhead(see picture) to which the MD thinks "will go away". I'm getting worried as it looks as if they are getting bigger!! What the heck is going on?

Jeffrey J. Roth, MD, FACS · Answer

Thank you for your question. You are early in your post procedure course. Usually the patient sees the start of the neuromodulators, (Botox Dysport, Xeomin), working at day 4.  The fillers usually see some result early, but some modulation continues.  In our office we have patients come back at 2 weeks for their check on their neuromodulator or filler.  At that point, most of the swelling is usually down, and we have an idea of the result.  This may be delayed if the patient has a bruise.  Often, asymmetry can be improved.  If you desire more volume, most practices would charge you, as they have to pay for the product, etc.  Please make sure your well trained, experienced injector knows your current status.Jeffrey J. Roth, M.D., F.A.C.S.Board Certified Plastic SurgeonLas Vegas Plastic Surgery

Jonathan Kulbersh, MD · Answer

It is unusual to have lumps as seen in your pictures after Dysport or Botox injections.  It is likely you developed bruise or hematoma.  I would have an evaluation by your injector in a timely manner.  I hope this helps.

Jason Emer, MD · Answer

I suggest you see an expert, this type of reaction needs to be evaluated in person.  It is not common to have bumps more than a few hours after injections.  Best, Dr. Emer.

S. Larry Schlesinger, MD, FACS · Answer

As I am sure you know, Dysport and Botox injections normally leave bumps on forehead for about 5-10 minutes, so 48 hours post injection is quite abnormal to still have bumps on one's forehead.The good news is that these bumps do not look like an infection, nor do they look like a hematoma (blood collection).  While an in person exam would certainly be useful, a reasonable assumption is that these two bumps represent some form of allergic reaction.I think it would be appropriate for you to call back your injecting physician and ask for appropriate treatment.  If he or she refuses or continues to say that the bumps will go away, I would get a second opinion from your family physician, plastic surgeon or dermatologist.

Nelson Castillo, MD · Answer

Thank you for your question and photograph.  I can see your areas of concern and it is most likely the result of a deep bruise or small hematoma.  At times it is difficult to miss the larger veins of the forehead when injecting a neuromodulator causing a knot to form if compression and ice are not applied immediately after.  I would closely watch the swellings and if they worsen see your injector.  These should resolve spontaneously over the next week or so.

Robert Drielsma, MBBS, BSc, FRACS · Answer

Some localised swelling is usually normal after botox injections but it normally resolves very quickly.  Its unusual to have swelling after 48 hours so you should return to your doctor for review.

Alim R. Devani, MD, FRCPC · Answer

Thanks for your question. This is a question that we
get asked often by our patients. The most common SIDE-EFFECTS of toxin
injections include: Swelling, Redness, and Bruising at the site of
injection. Complications are rare and only temporary, but may include
paralysis of other nearby muscles, temporary eyelid ptosis (dropping of
eyelids, 2% risk, lasts 2-3 weeks), temporary brow ptosis (dropping of
eyebrows, 2% risk, lasts 2-3 weeks), cross-eyes, ectropion or edema of the
lower eyelid, dry eyes, double vision, transient headaches (10%), local
numbness (lasting 2-3 weeks), flu-like symptoms, rash at the injection site,
pain at the injection site, infections, and bruising (need to avoid blood
thinning medications). Cold compresses may be used immediately after
treatment to reduce swelling only if needed. This may be applied for 3 minutes,
3 times per day, for up to 3 days. This is best done with a bag of peas in a
zip lock bag. Only apply light pressure to the area. Only take Tylenol if you
get a headache or migraine.

Victor Chung, MD · Answer

Anytime the skin is poked, you can expect a swelling response. With Botox and Dysport and Xeomin, the needle is tiny (30 gauge), and the swelling should go away in a few hours as the medication is absorbed into the target muscles.Swelling at the time of injection that sticks around is most commonly caused by a bruise or hematoma. If there is no black/blue color, it may be an allergic response, which is very uncommon. Swelling that pops up a few days later may be caused by infection. If any issues come up, I encourage my patients to come in to be seen in person. They can ask questions and I can examine them. I can start them on the correct treatment or counsel them about what's normal. Either way it's good, safe medicine.

Steven Wallach, MD · Answer

It is not uncommon to get a small bruise after injection. This can happen with any type of injection. Good luck.

Steven F. Weiner, MD · Answer

This is not normal. It's one of a couple things. Either is a bruise from hitting vessels twice or the beginning of an infection. Either way, it should be seen. If an unsatisfactory response is what you get, seek another opinion. One remote possibility it that you weren't injected with what you thought and this is a reaction to that substance.

Swelling forehead after dysport injection 48 hrs ago. Is it normal? (Photo)

Answers (13)

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