Migration of Botox to other areas, when does the risk stop?

Question

I know the guidelines are not to lean over for 4 hrs to prevent migration of botox to other areas, however after that is it ok to lean over, for example to wash hair over the sink. Does the 'migration' risk stop after 24 hours and is it ok to sunbathe face down after 24 hours

Richard Baxter, MD · Answer

Botox diffuses through the tissues over about a centimeter diameter area, which is what you want for a smooth effect. I do not advise my patients to limit their activities after Botox injections.

Douglas Wu, MD · Answer

In my practice, I haven't seen any migration with Botox. Leaning over should not be a problem if your forehead was treated, because if the Botox did migrate, it would go toward the scalp – lifting more – rather than the eyebrows. We recommend refraining from vigorous exercise and heat exposure for 24 hours post-Botox more as a precaution than because there's a real risk for migration. As for sunbathing, there is never a good or right time to do it, whether you have Botox or not. Exposing your skin to the sun guarantees that it will be damaged. Always use sunscreen and barrier protections, such as hats, when you are outdoors. Consulting with a board-certified dermatologist will help you get the best results from your Botox treatments.

Kenneth D. Steinsapir, MD · Answer

Other doctor advise to avoid lying down.  That also seems invalid.  I do advise my patients not to exercise for 24 hours to reduce the small risk of bruising.  Most of the "migration" occurs at the moment the product is injected.  By using the Microdroplet Lift, the microdroplets are effectively trapped in the tissue reducing the risk of migration to about zero.

Daniel Ezra, MD, FRCS · Answer

Dear Milly, Generally adverse reactions to botox are not due to 'migration', rather incorrect injection technique/dose selection or more rarely, patient sensitivity. The toxin injected is rapidly absorbed within 1-2 hours and there is no risk of 'migration'. Thats is to say that if you are going to get a problem, the dice was rolled at the time of injection.  As a final note, different types of botox tend to behave and spread differently so there is more chance of adverse reactions with certain types of toxin. 
There is no problem leaning forward and enjoy the sunbathing!

Paul Munsanje, MD · Answer

Hi Milly,

Botox migration is rarely a an issue and there are no issues with leaning over after treatment.

Kind Regards
Dr Paul

Ravi Jain, MBBS · Answer

There is no clear evidence to suggest it's important to minimise movement for 4 hours despite it being a common recommendation. I remember attending a seminar with Prof Andy Pickett who is a world leading authority on botulinum Toxin and he said there is new evidence to suggest the toxin binds within 30 mins.

So I would relax!! Just don't rub the area for a few hours!

So I would relax!! Just don't rub the area for a few hours!

Aurora DeJuliis, MD · Answer

I will not worry about botox migration when you lean over. After injection to avoid migration you should not massage the area. If you band over for a prolonged period of time  you could have some bruising.

Adam Goodwin, MBBS, FRCS(Plast) · Answer

so there is a lot of rubbish talked about botox migration. I personally dont think gravity has anything to do with it, more likely the anatomical plane into which it is injected. I don't have any rules as to how people should lie or sleep after botox and I have an almost zero rate of 'migration' to the eyelid openers or where it is not wanted. As a result take whatever advice you feel comfortable with but I am not sure it makes too much difference either way. Hope that helps, Adam Goodwin

Jessica H. Kim, MD, FAAD · Answer

Migration is typically minimal and only local.  There is no significant risk after 4 hours.  You should be able to resume your normal activities after 24 hours.

Melvin Elson, MD · Answer

The migration of the  Botox is in the adjacent areas and very small so don't be concerned about distant spread and by the next day there is no risk of any spread at all

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