Facial Exercise or Scowling for Working Botox into Muscles?

Question

I had a Botox injection (8 units) for the first time yesterday, for the frown lines between my brows. I was wondering, why I was told to exercise the injected muscle frequently by scowling for the following two days? I thought that the muscle is supposed to be paralyzed, not being exercised. I asked my doctor and she said it's for working the Botox into the muscle. Can someone (preferrably a doctor) give me some more input on this matter because it does not make sense to me. Thank you.

Harold J. Kaplan, MD · Answer

It sounds like the practitioner in this case does not have a lot of experience with Botox. 8 units is not enough for the area injected and "exercising the muscle" to work the Botox into place is not necessary when it is injected correctly. We would suggest finding a new practitioner and filling that injector in on the work that was dine thus far.

Jason Lichtenberger, MD · Answer

Facial exercises have not been shown to increase the absorption of Botox or Dysport (Botulinum Toxin type A), however it won't hurt to move the muscles.  Strenuous exercise after Botox is discouraged, however, as it may 'wash out' the Botox before it is taken in by the muscle.

	The fact that you can still move the muscles after Botox is due to the fact that it may take up to a week to see the full effects of the injection.

Steven H. Williams, MD · Answer

Thanks for the question -
 
I agree with Dr. Shafer that 8 units is a small amount botox to use for this area.  
In our San Francisco office we do not ask patients to "exercise" the muscles after injection.  We discourage massage or any other technique to move the botox from where we've injected it.
I hope this helps.

David Shafer, MD, FACS · Answer

Taken in Tampa,
First of all 8 units of Botox is a drop in the bucket. You are going to see minimal results with such a small amount of Botox. I hope you did not pay very much for this. For the glabella (area between your eyebrows) you should receive between 20 and 30 units on average. As for the exercise, if they are injecting it correctly into the muscle, then there is no need to try and make it go somewhere else with exercise. The Botox does paralyze the muscle, but it takes 3 to 7 days to start working.

Nissan Pilest, MD · Answer

Botox is one of the leading cosmetic treatments done around the world. Common cosmetic usages include wrinkle reduction and Hyperhidrosis.
 A Study by Northwestern University showed exercising facial muscles after treatment may speed up results by one day. This topic is still up for debate, and should be at the discretion of your injector. 
  
As a precaution it is recommended that patients stay upright for 4 hours, and additionally no exercising for 24 hours post treatment. Always discuss common side effects prior to your treatment with a Board Certified Dermatologist.

Jennifer Trent, MD, FAAD · Answer

You do not have to exercise your muscles after Botox injections in order for the Botox to work. Always seek treatment from a qualified physician.

Monika Soni, MD · Answer

After a Botox injection our practice recommends our patients avoid exercise for the afternoon. By performing facial exercises or scowling, you will not change the rate in which Botox absorbed into the muscles. These muscles take their own time. This is why you can see some of the effects of Botox one to two days after the injection but you have to wait up to a week to see the final facts.

Joseph Franklin, MD · Answer

In the past, many doctors recommended exercising muscles following Botox or other neurotoxin injections.   Today, we understand that it is unnecessary.   The only recommendation that I currently make is to avoid a facial the day of your treatment.  Otherwise, no restrictions.  And, exercising the muscles doesn't make it work faster or more efficiently.

Jessica J. Krant, MD, MPH · Answer

Many doctors on this thread are saying that 8 units of Botox is not enough for the glabellar region and that it sounds like your doctor didn't know what he or she was doing. I don't necessarily agree with this. I tend to use smaller doses of Botox than many doctors say, and have many, many happy patients. The point is that Botox is an art, and for someone who wants softening of the muscle action, but not necessarily total paralysis, or who has no lines and just wants to gently prevent lines, 8 units may be perfectly fine.

	As for whether or not it's important to use the muscles a lot after Botox to optimize the uptake of the molecule into the neuromuscular junction... it's probably not important. What's more valuable is for the patient to understand that it's not necessary to hold the treated area still for the Botox to work. It will work itself into the area over two weeks.

Neil J. Zemmel, MD, FACS · Answer

That is a great question.  People respond to Botox at various rates, usually between 2-7 days after the injections regardless of exercising the treated muscle groups.    The best advise is to leave the area alone and avoid massaging or rubbing the area.  I also have to agree with my peers that 8 units is a very small amount to treat the glabella region in between the eyes.  I find 20-25 units to work the most effectively on these muscles.  Hope this helps.

	Best wishes

	Neil J Zemmel, MD

Facial Exercise or Scowling for Working Botox into Muscles?

Answers (13)