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

Hi there,Thanks for your question. It is important to stay upright for 4 hours to avoid having the medicament migrate to areas other than the desired ones. The facial gestures, meaning doing the expressions that engage the muscles being injected, is a recommendation and is thought to have the effect "kick in" faster. It is not a "safety" issue rather one related to the "uptake" of the medicament into the muscle.Hope this helps. Best wishes, Manish Khanna, MDFRCPC

You should do the facial expressions as many times as you can in the first hour after your injections, you should not lay down or do any strenuous exercise for at least 4-6 hours after treatment.  This will prevent the Botox from moving to unwanted places.  You also do not want to massage the areas that were injected for at least 4-6 hours, for instance when applying make-up dab the areas do not rub them.  
Good Luck to you, You will love the results if you follow the instructions from your provider. 

Botox is a quick, safe and effective procedure which is becoming more commonly used to minimise lines and wrinkles especially in the upper face. It can be difficult to remember that botox is a prescription only medicine and this is a medical treatment. The aftercare advice is very simple and comprises of a few basics to stop the botox from migrating and potentially causing unwanted side effects as well as keeping the injection sites clean to avoid infection.
After treatment I advise the following if possible.
For 6 hours - no excessive exercise and try to maintain an upright position (4hrs min)
For 12 hours - no alcohol, make up (mineral makeup can be used) Normal expressions should be maintained.
2 days - when washing your face pat your skin dry, do not rub. Avoid tight fitting headbands / headwear.
Before treatment it is best to avoid NSAID (Ibuprofen / Aspirin) and any other blood thinning medication. Other considerations are not to drink alcohol. The phase of your menstrual cycle and use of HRT can also have an effect on bruising.
I hope this helps
Dr Anna Hemming

Thank you for your question. I always recommend to avoid laying down for the first four hours after treatment and to avoid exercise for 24 hours this is to help prevent the migration of the product. It is also best to avoid taking blood thinners like aspirin after treatment for the first couple of days, as this increases the risk of bruising. I recommend contacting your treating physician with any concerns you may have. Best of Luck!

Botox is a quick and safe procedure which has very little impact on usual activity on the day of injection. Tiny injections are delivered to relax the action of the muscles that create excessive movement and leave wrinkles on the skin. To allow the Botox to work optimally in the target muscle, the following precautions are usually suggested:
No rubbing or massaging of the injected area for 4 hours after treatment.

No strenuous exercise for 24 hours after treatment.

Keep upright for 4 hours — no lying on your front.

Avoid headwear that is tightly fitted across the forehead.

Avoid excessive alcohol or blood thinning medication before the treatment to prevent bruising.

It is important not to lay flat or bend forward for four hours post Botox procedure to avoid the product (Botox) migrating into the undesirable areas, potentially causing unwanted side effects.  We do not advise to make facial gestures as recent research shows that it has little effect. Hope this helps.
Best wishes Dr Tracy Mountford