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Lump After Botox®: Causes & Treatment

For a medication derived from one of the world’s most powerful neurotoxins — that’s botulinum toxin, if you’re keeping track — Botox® has a low incidence of serious side effects and complications. 

Most are due to Botox being injected in the wrong place, improper injection technique, poor Botox aftercare, inadequate screening prior to Botox treatment. All of these risks can be reduced simply by working with a board-certified plastic surgeon or other provider who has completed an accredited Botox training course.

One Botox injection side effect that gets outsize attention is skin bumpiness or lumpiness. Though more often associated with facial fillers like Juvederm, Restylane, and Radiesse, lumps may appear in the forehead after Botox (and much more rarely in other parts of the face). Here’s why they occur and what you can do to manage them.

What Causes Lumps After Botox?

Lumps after Botox can occur for three main reasons. Two are much less common than the third.

Allergic Reaction

Allergic reactions caused directly by Botox are exceedingly rare, to the point that many years went by before any confirmed cases occurred.

It’s somewhat more common to be allergic to something else in the Botox preparation, usually the reconstituting agent or the topical anesthetic. Your provider should ask about known allergies to reduce the risk of such a complication.

Regardless of what causes the allergy, noticeable lumps or swelling should quickly develop around the injection site, possibly accompanied by localized redness and itching of the treated area. If more serious symptoms occur, such as hives or low blood pressure or difficulty breathing, seek medical attention immediately.


This is also relatively rare, though more common than allergic reaction. Unlike allergic reactions and the “recovery bumps” described below, infection-related bumps appear only gradually and tend to worsen over time. They’re generally accompanied by classic infection symptoms like tenderness or pain, redness, discharge, and possibly fever.

Injection Recovery

This much more common cause of lumps after Botox results from the unavoidable effects of needle injections into delicate skin of the forehead. Basically, forehead lumps after Botox occur as the body responds to tiny injuries inflicted by the needle. The swelling may be more noticeable because the needle may temporarily affect the skin’s natural drainage and cause temporary fluid buildup.

How to Treat Lumps After Botox

Botox-induced lumpiness is not a cause for concern if it’s caused by the body’s natural recovery process. If the lumps remain small, aren’t tender or painful to the touch, and disappear within a few days, you can put them out of your mind. While preventing them entirely is difficult, you can take the following steps to avoid making them worse:

  • Remain upright for at least four hours after treatment
  • Don’t rub or massage the treated areas
  • Don’t apply topical creams or jellies to the treated areas
  • Avoid facial treatments and scrubs for at least a day
  • Avoid vigorous exercise for at least a day

Lumps caused by allergic reaction or infection are cause for concern, however. Before your procedure, discuss best practices for allergic reaction response with your provider. Generally, immediate medical attention is warranted even if the symptoms don’t appear to be life-threatening at first.

Likewise, infection-related lumps need to be examined and possibly treated before they get worse. Call your Botox provider if lumps get larger or more painful over a period of several days to discuss next steps.