Lumps on forehead after Botox injections? When will they go away? (Photo)

Question

I've gotten Botox injections in my forehead from my dermotologist for a little over 2 years now and have never had an issue. This time, I experienced a lot of pain after and that night lumps started to form at the injection sites. The next day I called my doctor and went back in. He said he had never seen anything like this before. His best guess was a reaction to the saline in the Botox. He gave me a steroid shot. Does this mean I have an allergy to saline? Do I need to never get Botox again?

Jason Emer, MD · Answer

I have seen this 3 times in the past.  They go away but take 6-8 weeks.  Massage and warm compresses help.  I think it is an allergic reaction from the injection not necessarily from the Botox or the saline itself.  I would avoid more injections, steroid or otherwise.  Best, Dr. Emer.

Jose Barrera, MD · Answer

It's very rare to get lumps in the forehead after Botox injection that persists more than a few hours. I would have your doctor perform an allergic test to the preservatives in the botox mixture.

Jo Herzog, MD · Answer

My best guess is that these are a reaction to being stuck not to the products. In response to some of the above about preservatives in saline; I think that most injectors use saline WITH PRESERVATIVE to reconstitute Botox. The benzyl alcohol(the preservative) is the reason why Botox injections do not sting.

Marilyn Pelias, MD · Answer

The saline used to reconstitute botox should be preservative free saline.  There is nothing in it to be allergic to.  The botox may have been contaminated, or your skin may have had a bit of soap or other substance that was introduced into your skin with the needle puncture.  In any case, I would use massage and warm compresses now and let your body heal.  It may take a week or two for the lumps to disappear, but they should.

Kate Ross, MD · Answer

I don't believe that you have an allergy to Botox after having it injected for the last 2 years. If your dermatologist recently switched brands of the saline they used to dilute the Botox and it had a preservative, you be allergic to that. The steroid will help with swelling.Thank you for your question and for sharing your pictures!

Benjamin Barankin, MD, FRCPC · Answer

The vast majority of patients have no marks or mild swellings that last 10-30 minutes. A small percentage of people will develop a tiny purple dot (small bruise) that lasts a few days, while another smaller percentage develop a bruise or hematoma where the Botox was injected, which resolves within 2 weeks or so. Its important not to hit the bone with the Botox needle as that can create new bone formation which can also cause a lump and is very rare in trained hands. Your dermatologist will easily be able to figure out the cause of your problem. Incidentally, almost impossible to be allergic to saline or Botox.

Darryl J. Blinski, MD · Answer

Was it freshly mixed Botox or residual and the same question for the saline. was it a unopened bottle? Bet there was a cross contamination of the products or syringes or needles used... No you are NOT allergic to saline nor Botox. Sounds like an in office mishap to me...

F. Victor Rueckl, MD (in memoriam) · Answer

Did you doctor use a different type of saline than usual? I'd clarify that point first. Perhaps a different brand or preservative vs. preservative free version was used? I think some questions need to be answered before we jump to the conclusion that you "can never have it again". Especially considering you had it for 2 years with no issues... "This answer has been solicited without seeing this patient and
cannot be held as true medical advice, but only opinion. Seek in-person
treatment with a trained medical professional for appropriate care."

Lumps on forehead after Botox injections? When will they go away? (Photo)

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