Thank you for your question.
You submitted your question with two photos and you describe in your question that one
day prior, you underwent Botox® injection and that you recall that there was pain as
the Botox® was being injected into the muscle and that this following day, you have swelling
in the inner corners of your eyes and you have pain on one side.
And so naturally, you’re looking to figure out what’s going on.
Well, I can certainly share with you my perspective based on this information in the absence of
course of a physical examination.
A little bit of background, I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial
plastic and reconstructive surgeon.
I have been in practice in Manhattan and Long Island for over 20 years.
And I have been using Botox® for patients since 1993.
In fact our specialty of oculofacial plastic surgery, we’re amongst the first physicians
to use Botox® long before the rapid expansion and growth of the indications for cosmetic.
So to begin with, let’s start with understanding a little bit about the anatomy because I think
it’s always important to at least understand the anatomy because that will ultimately lead
to some degree of understanding of possible explanations.
So when Botox® in the way it was done for you is being injected, the needle is going
through the skin and entering the muscle.
And the point is that the Botox® is being delivered to the muscle to relax the muscle.
And there is certainly a couple of possibilities just by that alone.
Muscle itself is fairly vascular.
It can maybe get some degree of irritation or inflamed so that can account for some of
the fluid as well as there are multiple sensory nerves and these are the nerves that give
you sensation to the skin that travel in that same region.
So it’s also a possibility that upon entering the skin and going into the muscle, the needle
could’ve also irritated some of these nerves and that can also be responsible for this
spasm that results in headache.
Now interestingly of course, you are probably aware that Botox® actually helps treat headaches
and a lot of people who have a history of tension or migraine headaches will benefit
from the use of Botox®.
I think for now what you’re dealing with is a little bit of fluid that naturally is
a response to either the amount of volume that was injected into the forehead depending
on how your doctor does the dilution for the Botox®.
It can also be from, as I mentioned earlier, irritation of the muscle as well as irritation
of the nerve.
So generally speaking, in a situation like yours, conservative management is typically
indicated.
That means doing things like taking anti-inflammatories like non-steroidals and even doing something
like cold compresses in the first 48 hours to try to mitigate some of the potential swelling.
There is so much nuance in the art of placement of Botox® that is always individualized.
There are techniques that we employ that minimize penetration of the muscle.
There are different dilution strategies and there are different ways that can be done
so that this type of situation could potentially be avoided in the future and I think that’s
worth discussing with your physician.
And I’m assuming that there’s some follow-up planned for you.
In our practice, when we do Botox® injection or any injectable, we see our patients in
two weeks after the procedure for me to see what the outcome is, also to see any enhancement
is indicated and further to learn about what the dosing and response of the patient is
so that this strategy can always be tailored to future treatments.
So I think that for now, there is no reason to feel that there’s anything much more
serious going on other than the consequence of some localized reaction.
I would advise that you keep in contact with your doctor.
Mention this to your doctor as soon as you can so that at least your doctor is aware.
Your doctor may want to see you in person and maybe give you something more than just
a non-steroidal to help expedite the management of this fluid.
But in the meantime, certainly, it is important to at least learn about this anatomic relationship
where muscle, nerves and needles can sometimes interface and result in inflammation and swelling
but certainly is not usually anything to be concerned about long-term.
So I hope that was helpful, I wish you the best of luck and thank you for your question.