Do I really have to sit up for 4 hours after Botox? Do I need to make the required facial gestures continuously for 4 hours?

Every injector has their own personal instructions for Botox after care. My patients are instructed to avoid rubbing the face, lying face down, getting a facial massage, exercising, or inverting their head for about 4 hours after injections. I do not instruct my patients to move their facial muscles post-injection. I also do not restrict my patients from lying down, just lying FACE down. Always see an expert physician injector.
All the best,

We have a great article that covers this, but while some sources believe you need to stay upright, we have never seen any adverse reactions to laying down after injections.

Thank you for your question. I typically focus my aftercare on restricting activities that make you hot, sweaty or flushed: Examples include strenuous activities, alcohol, saunas, hot baths, etc… This will increase your chance of bruising. If no bruising, by the next day, the you should be good to go. If there is, then I recommend another day to make sure the bruise is not getting worse. I am not as worried about the not laying down after four hours.

The theory of not lying flat or bending over for a few hours after Botox or Dysport was mentioned by some of the pioneering doctors who developed the clinical uses of botox.  It was thought that the positional changes might induce diffusion of the Botox to unwanted nearby regions and cause unwanted relaxation of other muscles. 

It was also mentioned that purposeful contraction of the muscles that cause the overlying unwanted wrinkles, could help bring the neuromodulator into the muscle-nerve junction which is how Botox blocks the signal from being transmitted and the muscle then doesn't contract.

Neither of the above recommendations have been proven to be necessary but many doctors still recommend them.

After Botox treatment there is no specific after care required. Obviously we ask our patients not to massage or manipulate the areas for the first day but no facial exercises or physical restrictions are required