I have had Botox in forehead and got pimples (small cysts w whiteheads) at the injection sites. Not a rash. Why?

I can't say that I've heard of this before. However, it is interesting that the timing seems to coincide with the injection of Botox. I would definitely mention this to the surgeon who performed your injection so that your surgeon is aware. Another point is that the effects of Botox should last about 3-4 months, not 6-8 weeks as you have mentioned in your question. You may want to discuss that with your surgeon as well. Good luck!Dr. Harmych

Thank you for your question and photo. It is always best to avoid Botox/Fillers in active infected areas. You can apply warm compresses to the red area to help resolve it quicker. I recommend having a follow up with your injector for an evaluation and possible treatment. Best of Luck!

This is a highly unusual story of a sequela of Botox injections. If you were my patient, I would want to review carefully the prep that is used before each treatment, making certain that there is no bacterial contamination from what is being used from my office on your face, and that your skin is cleansed with Hibiclens or CLn wash prior to the injections. I might culture one or more of the cysts, and if indicated by the culture, look for a source of staph bacteria colonizing your skin such as the nose.Some water sources have atypical mycobacteria, so the sterilizing prep may be helpful. Is the doctor having similar problems with any other patients?

This could possibly be caused by the cleansing product used prior or after your treatment, a sensitivity to the toner/alcohol/or antiseptic cleansing solution.  Another possibility if topical numbing cream or ointment is used prior to injections you may be sensitive to one of the ingrediants, causing temporary pustules if not completely wiped off after your injections.

My personal mantra in medicine is make the correct diagnosis and then apply the correct treatment.That certainly applies in your situation.First, a diagnosis of what your whiteheads or pimples are is needed.Pimples or small skin infections and whiteheads are a buildup of sebaceous secretions from an oily sweat gland.Is it possible your provider had a topical anesthetic on your skin that was not wiped off completely before injections?It is possible your skin simply has a tendency to form milia or whiteheads after even minor trauma such as an injection.Do follow up with your provider.Consider seeing a dermatologist while your whiteheads are present.Best of luck,Mats Hagstrom, M.D.