Should Botox Be Administered While You Are Lying Down or Sitting Upright?

I've had 2 different doctors administer Botox. One indicates it is not acceptable to give the injections to a patient that is lying down. The other indicates it is okay to inject in a prone patient. Does it matter?

Doctor Answers 24

Botox injection and positioning.

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Thank you for your question. I do not think it matters much which position the Botox is injected so long as the injector can assess the underlying musculature.  I tend to do the majority of my injections with the patient in the upright position.

Botox while sitting up

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The risk of diffusion may be minimized when sitting up, therefore generally it's better to have the patient sitting up or slightly reclined. Lying down may be okay, but the patient should sit up right after the treatment.

Should Botox Be Administered While You Are Lying Down or Sitting Upright?

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Dear marcyd,
Thanks for your question. Botox is a neuromodulator that is injected into muscles to effect their ability to contract. Since the muscles don't move with gravity it doesn't make a difference whether you are sitting or lying down. Personally, I prefer to inject Botox while the patient is lying down because the technique I use makes it easier for me to be accurate. I do however inject fillers in a sitting position to fully appreciate the more mobile soft tissues I'm trying to fill. I hope this helps.  

Kevin L. Smith, MD, FACS
Charlotte Plastic Surgeon

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Position for placement of botox

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The insertion sites of botox are related to your muscular and bony landmark anatomy and doesn't change with position. Many doctors have been trained to inject aesthetic fillers with the patient sitting or reclining at a 45 degree angle but not less, so that they can see the effects of gravity and a more natural position of the folds and creases, which do change if one were to lie down. There has been no study to indciate if the injection of botox in a patient who is lying down will cause the botox to move to undesired muscle recipients in the adjacent area. 

Ronald Shelton, MD
Manhattan Dermatologic Surgeon
4.9 out of 5 stars 39 reviews

Botox may be injected with the patient sitting up or lying down.

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The position of the patient during the injection does not affect the efficacy or safety of the Botox. However, the evaluation and marking of the patient should be performed in the sitting up position.

Positioning During Botox Injection

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I prefer to evaluate and mark a patient while they are sitting up, then inject in a reclined position.  I do not think that lying down during the injection increases the risk of diffusion.  I do have patients sit up immediately after the procedure and advise them to avoid lying down or taking a nap for 3-5 hours after treatment.  

Lauren Fine, MD
Chicago Dermatologist


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It really doesn't matter, usually just based on the Dr administering preference.  I prefer all my patients sitting up, as this is how I examine them. 

Hannah Vargas, MD
Kansas City Facial Plastic Surgeon
4.8 out of 5 stars 48 reviews

Patient position during Botox Injection

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Patient position should not have an affect on Botox Cosmetic results. Most plastic surgeons and dermatologists have the patient recline in the chair a little. Choose whatever position that is most comfortable for you. Best of luck.

Dr. Chaboki


Houtan Chaboki, MD
Washington DC Facial Plastic Surgeon
4.9 out of 5 stars 89 reviews

Botox administration

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I prefer to inject botox with the patient sitting up. Be that as it may, some may find it easier for the patient to be lying flat.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Should botox be administered while lying down?

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It is usually ideal to have  a patient sitting up for injection or slightly reclined back. There is documented diffusion, seemingly greater with Dysport than Botox, so positioning is just to minimize that risk

Lori A. Brightman, MD
New York Dermatologic Surgeon

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.