How bad is it if you accidentally roll onto your face when sleeping after Botox and fillers? I’m worried I moved it (Photo)

Question

I received Botox injections and fillers yesterday, and made sure I didn’t lay down for at least 6 hours. I was a bit paranoid to sleep, because I usually will roll onto my face.I woke up with my face smooshed into my pillow, applying pressure on the injection spots. I’m worried I messed up the filler, and now above my eyebrow where the Botox was injected is a dime size lump. Not sure if that’s from inflammation, or because the pressure from sleeping on it.It’s so hard for me to sleep on my back.

Michael I. Echavez, MD · Answer

In my opinion, there should not be any problem with sleeping on your face the evening after having had Botox and filler injections.  Sleeping on your face should not move the Botox or the filler.  The small lump you see where the Botox was injected is most likely just temporary swelling from the injection and should go away within a few days.

Matthew Richardson, MD · Answer

It is extremely unlikely that Botox or fillers are affected by sleeping if they do not lay face down within the first few hours after injection. Swelling and small bumps are very common with Botox and filler injections.  I would recommend speaking to your physician injector with any questions or concerns you might have.All the best,

Jason Emer, MD · Answer

nothing happens if you sleep on your face after fillers or botox. give it 2 weeks to settle and use LED light Stim at this time to decrease the swelling.
For facial rejuvenation, I would suggest a combination approach of :
1) skin care with products and PRP/microneedling
2) PDT light therapy few times a month with growth factors
3) laser treatments like clear and brilliant regularly and a few times a year Fraxel, Viva, Co2/Erbium
4) Sculptra injections a few times a year for collagen production with fillers like juvederm/restylane/belotero/radiesse/bellafill
5) thermage/ultherapy for yearly skin tightening with or without PDO or cone based instalift threads for lifting
6) botox every 2-3 months to stop movement lines and prevent lines at rest
7) deep microneedling RF like Fractora/morpheus8 for tightening of the skin
Best, Dr. Emer.

Luis Villar, MD, FACS · Answer

When properly injected and massaged for two minutes, the Botox/Xeomin is spread out and bruising is minimized. You may resume normal activities without incident. The same with fillers.  When properly injected and dispersed,they should not move around.  Now with fillers blended and used as agents of structural change rather than volume(fat is for volume now) lumps are less common.  Sleep without worry.

Lewis Albert Andres, MD · Answer

Hello!  Thank you for your question!  You likely did not do anything to harm your results. Regardless, there is nothing that can truly be done now. Continue with your injector’s instructions. Go in for evaluation if you have concern that things have changed - perhaps some massaging techniques may be considered. Best wishes!

Camille Cash, MD · Answer

It is unlikely that your sleeping position will affect the results from your Botox and filler treatments.  Swelling and bruising after treatment is not uncommon and typically resolves within two weeks.  If after that time you still have concerns, return to your injector for an evaluation.

Alex Eshaghian, MD, PhD · Answer

Thank you for your question and for sharing your photograph bangel10. 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.
It is difficult to make an assessment without a formal exam in the office where I can view the skin in multiple angles and observe wrinkles formed with facial expression. However, I hope the information provided here is useful.The safety record of Botox is well established. The product has been used for over 20 years for a variety of treatments with minimal side effects. Botox is amongst the safest treatments for treating facial wrinkles.
  
While Botox is one of the safest treatments offered, there are some situations where it is not appropriate. These include anyone who has an allergy to any of the inactive ingredients or who has had an allergic reaction to any botulinum product including Botox, Dysport, Xeomin, or Myobloc. The safety and efficacy of Botox has not been established in women who are pregnant, trying to become pregnant, or breast feeding. Therefore, women in these categories are advised to wait until breast feeding is completed prior to having a Botox treatment. Botox should not be placed in the skin on the site of an infection. Those who are taking an aminoglycoside antibiotic, an anesthetic, D-penicillamine, antimalarials, or immunosuppressants should not be treated, nor should those who have undergone chemotherapy within the previous six months. It is important to avoid blood thinners before and after a treatment. These include both prescription and non-prescription medications such as warfarin (coumadin), aspirin, ibuprofen, alcohol, fish oil, vitamin E, and ginko biloba. Those with conditions that affect muscles and nerves such as amyotrophic lateral sclerosis (ALS or Lou Gehrig's disease), myasthenia gravis, or Lambert-Eaton syndrome should not undergo Botox treatments.
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 two weeks if untreated. After a laser treatment bruises usually resolve in 1-3 days, but may still take two 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. Spread to nearby muscles can lead to side effects such as the temporary appearance of droopy eyelids or a temporary asymmetric smile.
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 four 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. 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.
If I had a patient with the concern described here I would say not to worry about the results of the Botox or filler and to patiently wait two weeks to assess the final results.Please consult with a doctor for specific recommendations. Good luck!

Stephen R. Weinman, MD · Answer

Pressure on the face should not affect your Botox injection. Pressure on the face  immediately after fillers could possibly move the fillers. Best to get the fillers in the morning if you can’t sleep on your back. You might consider getting some kind of sleep aid like ambient  for the night that you get fillers and line your bed with pillows so you don’t roll over.

Liliana Marcu Awan, MD, FAAFP - Account Suspended · Answer

It is not known for Botox or fillers from moving around into making your shape asymmetrical Best wishes

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