Could slight tightness in my throat and a feeling of chest congestion mean I've been injected in the wrong area?

Question

I had 28 units total of Botox - Nefertiti - injected into my lower jawline and neck bands yesterday. I have since been experiencing what feels like a slight tightness in my throat and a feeling of chest congestion. No cough or anything. Is this normal? Could it have spread or been injected into the wrong area?

Jeffrey T. Steitz, MD · Answer

If you just had the botox injected yesterday, then its very unlikely that it would be taking effect yet to create that discomfort, but if injected too deep in the neck, it can absolutely create throat tightness and discomfort.  I would recommend following up with your injector as soon as possible to evaluate you and potentially alleviate your concerns.  Good luck!

Michele S. Green, MD · Answer

It is not clear to me whether these side effects are from Botox or something else like a virus.  You can have these side effects with Botox so I would urge you to consult your treating physician to examine you and please keep us posted.  Best, Dr. Green

Alex Eshaghian, MD, PhD · Answer

Thank you for your question melonyj. 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.Although Botox is most commonly used in the upper face, it can also be used in various areas in the lower face. Botox can be placed just under the jawline in what is called the Nefertiti lift to relax the platysma muscle which pulls down on the lower face, thereby improving jawline definition. When placed lower in the neck Botox can address vertical neck bands. Approximately 10 units are used below each jaw and in each band.
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.
  
While Botox is one of the safest treatments offered, there are some situations where it is not appropriate. These include anyone who has an allergy to any of the inactive ingredients or who has had an allergic reaction to any botulinum product including Botox, Dysport, Xeomin, or Myobloc. The safety and efficacy of Botox has not been established in women who are pregnant, trying to become pregnant, or breast feeding. Therefore, women in these categories are advised to wait until breast feeding is completed prior to having a Botox treatment. Botox should not be placed in the skin on the site of an infection. Those who are taking an aminoglycoside antibiotic, an anesthetic, D-penicillamine, antimalarials, or immunosuppressants should not be treated, nor should those who have undergone chemotherapy within the previous six months. It is important to avoid blood thinners before and after a treatment. These include both prescription and non-prescription medications such as warfarin (coumadin), aspirin, ibuprofen, alcohol, fish oil, vitamin E, and ginko biloba. Those with conditions that affect muscles and nerves such as amyotrophic lateral sclerosis (ALS or Lou Gehrig's disease), myasthenia gravis, or Lambert-Eaton syndrome should not undergo Botox treatments.If I had a patient with the concern described here I would recommend following up with the injector. This is likely not secondary to the Botox and I would recommend consulting with a general physician.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!

Could slight tightness in my throat and a feeling of chest congestion mean I've been injected in the wrong area?

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Could slight tightness in my throat and a feeling of chest congestion mean I've been injected in the wrong area?

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Everything you need to know about Botox

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