Why Can't You Lie Down After Botox?

Ever since Botox was discussed at conferences for cosmetic use, it was theorized that bending over or lying flat might make the Botox shift via gravity to other areas that we don't want to get affected. This has not been proven, nor studied as far as I'm aware. Most physicians tell their patients this recommendation to "play it safe" and mention from one to four hours as the guideline to follow the "rule."

Hi there!
Thank you for your question. It is important to remember not to rub the treated area. Therefore, I advise against lying on your front to avoid accidentally affecting the area for 4 hours post treatment.
Hope this helps!
Best Wishes,
Dr. Rupert

The injunction that a patient who has just received Botox injections to the face cannot lie down for four hours after this treatment is an urban myth borne out of patients' desire to have specific instructions for what they can, and cannot, do after this procedure, and physicians' belief that they must satisfy them in this regard.  To date, there are no clinical studies that support this instruction.  Nor, in our nearly twenty years of experience with injecting Botox, have we seen a patient ever sustain a complication from lying down in a SUPINE position immediately after a Botox injection.  Indeed, most physicians administer Botox when their patient is in a supine or semi-recumbent position.However, we do advise our patients not to lie down in a PRONE position for at least four hours after their injection of Botox.  Theoretically, pressure, e.g., from a pillow or a mattress, or any manipulation of the skin. e.g. with one's fingers while applying makeup or moisturizer, or from a massage of the skin overlying the site of injection, might induce the migration of some of the Botox.  For similar reasons, we ask patients who have just received injections of Botox to abstain from exercise or athletic activities until one day following the injection of Botox.  Avoidance of the increase in blood flow to the face that occurs with physical exertion may theoretically also improve the likelihood that the Botox stays put in the precise areas in which it was injected at the time of treatment.  Once again, even these instructions are based on theoretical considerations of how to avoid activities that might influence the possible migration of Botox after it has been injected.  To date, there have been no clinical studies to define what the optimal post-injection instructions for Botox patients might actually be.  However, until there are, we will continue to follow the protocols outlined above.  They haven't failed us yet.

We generally advise not to put any pressure on the injection sites or exercise for 24 hours after injection to prevent spread of the treatment. Otherwise, it is ok to lie down.

My patients are instructed that they cannot lie FACE down, rub the face, get a facial massage, exercise, or invert their head for 4 hours after Botox injections, but lying flat on the back is not something I instruct my patients to refrain from.
Always see an expert physician injector.
All the best,

I would not worry too much about lying down.  If however, you are planning to sleep and you sleep on your side and squish the sides of your face where you had injections, I might caution you to wait a few hours.  This might be akin  to you rubbing your area of injection.