Botox After Care?

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? Why do I have to do this? What if I don't? What if I lay down? What will happen?

Doctor Answers 23

Botox is bound to the muscle after 90 minutes.

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Botox is bound to the muscle after 90 minutes.  I generally recommend to sit upright for the first 90 minutes to minimize the risk of diffusion.  This is a very remote possibility, but has been documented. I do recommend not to rub or massage the area. Otherwise, there are no restrictions after treatment. 

Dallas Dermatologist

Botox Aftercare

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You don't have to sit up, but don't lie down.  Don't rub the area as this may cause the toxin to drift into other

areas and cause undesirable side effects like eye droop.  The eye droop can last for 2-3 months.....

I don't know if making a lot of gestures really helps, but it is possible this aids in the uptake of the toxin

into the muscle.  Good luck and best of health,  Dr. S

Bruce Saal, MD
Los Gatos Dermatologic Surgeon
5.0 out of 5 stars 2 reviews

Aftercare for Botox

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Physicians have generally advised over the past decade or so that patients not lay down flat or rub the affected area for 4hrs, and to use the muscles for the first little while (whatever that means). Some physicians advise a longer period of time, while many others don't feel there is much of a difference whether you follow this advice or not.  Most likely, there is no real aftercare required, but I would follow whatever your physician injector has advised you.

Benjamin Barankin, MD, FRCPC
Toronto Dermatologic Surgeon

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Botox and facial gestures

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You should not rub or massage the treated area for 4 hours after your injections to prevent spreading of your Botox.  You are supposed to sit upright so you don't fall asleep and rub by accident.  It is advisable to make facial gestures to help Botox get into the treated muscles effectively. 

Martie Gidon, MD, FRCPC
Toronto Dermatologist

Botox after care

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We have been using Botox in our practice for over 12 years. We do not have the patients do anything special after treatment, although we still advise them to not lie down for up to 4 hours afterwards.

Steven Hacker, MD
West Palm Beach Dermatologic Surgeon

Botox aftercare

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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

Thomas Buonassisi, MD
Vancouver Facial Plastic Surgeon
4.9 out of 5 stars 114 reviews

Botox After Care

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The rationale for the recommendation to sit up comes from Allergan who advises that by doing so reduces the probability that toxins will move down to the eyelids.  This is a rare but documented occurence.

We generally recommend common sense. Minimize massage and manipulation of the injected areas. Otherwise, you can proceed with your daily activities.

Kris M. Reddy, MD, FACS
West Palm Beach Plastic Surgeon
4.5 out of 5 stars 56 reviews

Botox After Care Instructions

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Each injector develops their own post injection regimen designed to minimize complications. Often, these regimens are not scientifically validated, but rather subjective experiences that have shaped the perception of a cause/effect relationship with each negative outcome. So the objecting patient questions, "Do I really have to do -__x__-, or avoid -__y__-?," should be rephrased, "Will my performance of __x__-, or avoidance of -__y__- cause me any harm?" The answer for both queries is "probably not," so why not make your injector happy and follow their instructions for 24 hours?  

I advise no exercise for 6 hours before injection neuromodulator (Botox) therapy and 12 hours following the injection. Why? I want to minimize the risk of bleeding and bruising as well as the chance of exercise-induced increased facial blood flow decreasing the amount of time that the injected product has to work on target tissue (facial muscles). I also advise minimal facial manipulation (no facials, massage, etc) for several hours following injection to minimize product displacement/migration. 

Thank you for your question

Botox after care

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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,

Matthew Richardson, MD
Frisco Facial Plastic Surgeon
5.0 out of 5 stars 7 reviews

Aftercare instructions for Botox

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Thank you for your question greekgirrrlgreekgirrrl. 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. The pivotal studies demonstrated that the peak effects of a Botox treatment are seen 14 days after a treatment and most people enjoy their results for 3-4 months. At that point a maintenance treatment is recommended.

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 2 weeks if untreated. After a laser treatment bruises usually resolve in 1-3 days, but may still take 2 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. This can lead to side effects such as droopy eyelids or an asymmetric smile. Certain activities may increase the risk of the spread of the product. 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 4 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 as described above. 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.

Although some physicians recommend making facial gestures for a few hours immediately after a Botox treatment there have been no studies demonstrating the efficacy of such activities. Additionally my patients see great results without making such movements. Therefore I tell my patients that that may make such movements if they like, but don't have to do so.

Botox is what we call a neuromodulator. This means that it controls nerves to prevent the muscles from contracting. Botox is the most popular neuromodulator available, has been the most studied, and is cleared for the most number of indications. Other neuromodulators available in the United States include Dysport, Xeomin, and Mybloc. Overseas many others are also available. Each product has slight differences, but all of them work. The majority of our patients find that they like the results of Botox the best. Additionally, Allergan, the maker of Botox, offers the Brilliant Distinctions Program. This is a rewards program where patients receive points from their Botox treatments which can be used toward discounts at subsequent treatments. Points are also received when patients purchase other treatments in the Allergan portfolio including Juvederm Ultra, Juvederm Ultra Plus, Voluma, Volbella, Vollure, and Kybella or products such as Latisse or Skin Medica products.

I find that combining Botox with other treatments or skin care regimens enhances the results and allows patients to enjoy their results for longer. One specific topical product our patients have found to be outstanding in conjunction with a Botox (and filler) treatment is our Hydrating Serum, which contains hyaluronic acid. Hyaluronic acid draws water into the skin and helps to fill in fine lines and wrinkles.

Please consult with a doctor for specific recommendations. Good luck!

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.