Facial Exercises After Botox

Although it has never been proven, I accept the hypothesis that facial exercises, or moving the muscles responsible for the skin wrinkles that have been treated by Botox or Dysport might improve the effectiveness of the treatment. Theoretically, the muscle activity may "use up" the normal neurotransmitter chemical that the nerve uses to stimulate the muscle to contract and the Botox or Dysport has a better chance to get into the junction and block the further transmission of nerve signals to that muscle. We do have our patients refrain from lying flat, or bending over at the waist or performing general exericse for four hours after the Botox or Dysport to minimize a theoretical risk of migration of the product (this has not been proven either).

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.

Shortly after your treatment, you should exercise the treated muscles for a couple of hours to help improve the absorption of the injected BOTOX®. Frown repeatedly if the muscles controlling frowning were targeted. If forehead lines were targeted, raise your eyebrows. For crow’s feet, squint and smile. You may find that performing these facial movements takes a little more effort than usual.

Movement of facial muscles through your exercise regimen should not affect the performance of Botox.

Botox molecules target nerve fibers that release acetylcholine which causes muscles to contract. The result of course is that the muscles are able to stay relaxed.

Regardless of whether you are using Botox for antiaging purposes or not, there is really no need for the facial exercises. Wrinkles form because the skin loses its elasticity. This makes it more susceptible to developing lines on the skin when muscles in the forehead and eye area contract.

While Botox can improve the appearance of lines on the skin by keeping the associated muscles in a relaxed state, patients can also focus on treatments that help to correct sun damage on their skin. Fraxel laser and other dermal fillers (e.g. Radiesse, Juvederm and Restylane) can be helpful. But you would need to speak to a board certified specialist  about more precise recommendations for your objectives.

Some instructions direct you to perform facial exercises immediately after injection while avoiding digital manipulation or massage of the area.

While some may recommend that you use your facial muscles more after Botox injections, I persoanlly have never prescibed this.  In fact, we instruct patients to behave normally, but advise against undergoing facials for a day or so.

You just don't want the Botox (or Dysport) to "drift" into an area that was not intended.

Therefore, using you muscles excessively could theoretically contribute to this undesired "drift."

Like I said, I would go about your day as usual and avoid excessive massage of these muscles.

Hi Ciccia,

You may resume "pumping up" your facial muscles as soon as you are through with your botox injections.  The only exercise not advised for at least 3 hours after your injections is laying down , and hanging upside down from anti-gravity boots.  I guess if you are a trapeeze artist you should wait a few hours as well.  Be well.

Dr. P

After injecting patients with Botox, I encourage them to exaggerate facial expressions for several hours in order to promote diffusion throughout the injected muscle.  However, facial exercises as a means of facial rejuvenation is an unproven gimmick.

Thank you for your question Ciccia Nocca. I understand your concern. Botox is a purified protein used to address wrinkles associated with facial expression. When injected into the skin Botox will relax the muscles and smoothen out the overlying wrinkles. The most common areas of treatment are in the upper face. These include the horizontal lines seen on the upper forehead when one raises the brows, the vertical lines seen between the brows when one frowns (frown lines), and the crow's feet seen around the eyes when one smiles.With any injection, there are risks such as pain, bleeding, bruising, redness, swelling, tenderness, and infection. We take special precautions to minimize these risks such as using a painless technique. We also treat bruises with a laser as early as the next day. Bruises usually resolve within two weeks if untreated. After a laser treatment bruises usually resolve in 1-3 days, but may still take two weeks for full resolution. In addition to these risks, with Botox there is also a risk that the product spreads or diffuses to nearby structures. Spread to nearby muscles can lead to side effects such as the temporary appearance of droopy eyelids or a temporary asymmetric smile.
After a Botox treatment, I recommend that my patients avoid heat exposure, alcohol consumption, and strenuous exercise for 24 hours and not lie down flat for four hours. This is because all of these activities may possibly lead to the movement of the product and consequent side effects such as droopy eyelids. Although there have been no definitive studies shown that these actually occur and some physicians do not provide such aftercare instructions, in the absence of data I err on the side of caution and recommend that my patients avoid such activities.Some people recommend contracting the treated facial muscles after a treatment. However, I find that this does not affect the results. Therefore I tell my patients that they can either perform facial exercises after a treatment or not as they wish.Please consult with a doctor for specific recommendations. Good luck!

Once Botox is injected into a muscle it diffuses and immediately begins to block the nerve impulses that cause the muscle to shorten. The effect becomes maximal by 5-7 days. There is NO scientific evidence that doing a Jim Carrey repertoire of facial contortions would in any proven way hasten or prolong the Botox effect.

In other words, facial "exercises" are a Chicken soup-like exercise. It definitely cannot "hoyt" ( Yiddish for hurt) you and it keeps you busy and entertained making you part of the health care team.

Personally, I take my patients' personal time more seriously and would recommend more useful and fulfilling personal pursuits.

Dr. Peter Aldea