Will tensing/wrinkling injected facial muscles soon after Botox or Dysport administration cause migration to unintended areas?

I do not believe that tensing or wrinkling the facial muscles treated with Botox or Dysport will cause migration of the product to unintended areas.  I also do not believe that tensing or wrinkling those muscles affects the results in any way.  

There is no research out there stating that if you tense your muscles following a botox injection that it will make it work more effectively. In addition, ,you don't have to worry about the product migrating. However, for 4 hours post injection i would avoid rubbing and touching the area tanning and saunas. 

Thank you for your question, and I am not aware that by forceably or actively using these muscles will there be any effect one way or the other. Using these recently injected muscles will not cause it to migrate or make it act faster. Botox will typically begin to "kick in" after 4-7 days, but some may see results earlier. The full effect is usually seen after 7-10 days so two weeks after your injections is a great time for a follow-up with your injector if you are not getting the results you desire. Additional injections may be given at 2 weeks if more correction is desired/needed. Botox typically lasts 3 months, and after that it begins to slowly wear off. I tell my patients not to rub the treatment areas or lie down for 4-6 hours after injections to be safe.

Dr. Benjamin J. Cousins MD

Board Certified Plastic Surgeon

Some providers tell their patients to "move" the muscles injected with neurotoxins.  There isn't any real research as to whether or not this "distributes" the materials outside of the intended area or not.  We tell patients to not "exaggerate" their facial expressions, on the theory that we know where we placed the toxin and we'd like it to stay where we injected it.  So, this really isn't a true answer to your question but may explain why you hear different things by different providers.

As long as you do not massage directly over the treated areas immediately after treatment, there is very little risk of migration.  And there is no evidence that actively contracting the treated muscles makes botox or dysport work faster or better.  

This is a good question to ask. Migration of the Botox to unintended areas is certainly a concern, but I think if properly injected, the amount that the Botox will diffuse into the treated muscles will not be significantly affected by exercising those muscles. We do not have strong evidence either way, but it is safer to err on the side of caution. I do encourage patients to take it easy for the rest of the day after injection, partly to lower any potential (but likely low) risk of spreading, and also to reduce bruising (more important for fillers). I think the main factor in preventing Botox spreading to unintended areas is the technique and skill of the injector to ensure proper placement. 

There is some evidence that working muscles after Botox does make it work faster and perhaps better and it is not a problem with regards to  migration

I don't think there is any concern about unwanted over dissemination by being active right after injections.  The botulinum gets uptake into the neuromuscular junctions pretty quickly and don't spread to any significant effect very far.  I've been injecting for nearly 20 years, and don't counsel my patients to avoid physical activity or squeezing of the injected muscles.  The ways to avoid over dissemination and spread to unwanted areas is to avoid anything that thins your blood prior to injections (aspirin, motrin, fish oil, others).  Have injections by a well trained experienced injector that knows appropriate dosing and injection placement.  Dysport tends to spread more than Botox or Xeomin, which can be advantageous under certain circumstances.  I use all three main wrinkle blockers also called neuromodulators (Xeomin, Botox, and Dysport).  Best regards.  

Thank you for your question pac99 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 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. 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 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. While some physicians advise repeatedly contracting the muscles for a few hours after a treatment to help the product get into the muscles, there have been no studies demonstrating that this is actually true. Additionally, in practice I find that the same results are achieved if the muscles are not contracted. So I tell my patients that it is optional.Botox (onabolutimun toxin) is what we call a
neuromodulator. This means that it controls nerves to relax the muscles by
preventing them 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 (abobolutimun toxin), Xeomin (incobolutimun toxin), and Mybloc
(rimabolutimun toxin). Botox, Dysport, and Xeomin are type A toxins while
Myobloc is a type B toxin. This means the structure of the protein is slightly
different. Overseas many others are also available. Dysport is the most
commonly used neuromodulator other than Botox in the United States. The dosing
for Dysport is different than that for Botox. Approximately 2.5 to 3 units of
Dysport are required for every unit of Botox. For example, in the glabella 20
units of Botox is most commonly used. If Dysport were to be used in this area
50 to 60 units of Dysport would be required. The investment per unit of Dysport
is approximately 2.5 to 3 times less than that of Botox. While the manufacturer
states that the units of Xeomin are a one to one equivalent of Botox, many
doctors find that a higher dose of Xeomin is required to produce the same
effects as Botox. Each product has slight differences, but all of them work. Dysport,
for example, is known to spread more than Botox. This makes it useful in places
like the underarms where it can be used for excessive sweating. However, if it
spreads near the eyes it can lead to side effects such as a droopy eyelid.
Xeomin is also called a naked protein, because it does not contain the
accessory proteins that are included with Botox or Dysport. It is thought to
have a slightly faster onset (by one to two days faster) than Botox or Dysport.
It is also thought to have a decreased likelihood for allergic reactions,
although allergic reactions to Botox and Dysport are incredibly rare. In the
United States Myobloc is not FDA cleared for cosmetic use and is primarily used
for muscle pain in those with cervical dystonia. 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.Please consult with a doctor for specific
recommendations. Good luck!