How to avoid migration of forehead Botox causing eye or brow droop? How long to be cautious of answers to instructions given?

Question

Do I exercise forehead muscles post Botox? Or little/no movemnt in face? Do I excersice eyes post forehead Botox? Or keep eyes less movemnt? Do I need to keep head still/steady w little/no movment? Will hot shwr/steam make Botox migrate? Can I wash face? Is washing hair/massaging scalp ok? Can I recline/lie on back? Shld Dr. open a brand new bottle of Botox before injection? Can I wrkout before Botox injection and next day? I drink A LOT of water, is that ok? What meds to take if I get headache?

Jason Emer, MD · Answer

Please seek experienced physician for a consultation to answer all of these questions you may have as every injector is different. If botox caused your dropping eyes and brows this cannot be fixed until the botox wears off.  It will take a few months.  Keep using the eye drops if this has already occurred to help for now. Best, Dr. Emer.

Kyle Coleman, MD · Answer

Botox treatments have been known to cause brow or eyelid drooping.  The risk of this is very low and is generally linked to technique and dosages.  The package insert says to not exercise or lie down for 4 hours after treatment; this is unlikely to really be a huge factor but is easy to do.  Avoidance of vigorous manipulation or compression via clothing such as hats is advised.   The number one way to reduce the chance of side-effects is to see an expert injector; this will save you time and money in the long run.   Proper dosing and placement of botox can reduce the risk of drooping.  Exercising prior to botox, water intake, and washing your hair will have no effect on the botox.  After botox, any medication for headache will be fine; use of aspirin / ibuprofen products and alcohol intake in the few days prior to botox may increase the risk of bruising.

Marla M. Klein, MD · Answer

There is some research that suggests that Botox will last longer if you purposely move the muscle post treatment right afterward.  I find that most people move those muscles anyway without being instructed, so I don't advise anyone to do this and my Botox treatments last a long time.  Do what you normally would do, learn not to frown/squint so much and the Botox will help you achieve this goal.Hot water and steam do not matter for Botox. Certainly wash your face and care for it like you normally would.Even though Botox vials are labeled "single use only" I know of ZERO injectors who follow this, as there are 100 units in a vial, and people only need 15-70 units in a treatment.  When sterile technique is followed, there is no reason to discard and waste the remainder of the vial.  If doctors followed this advice from the manufacturer, it would probably quadruple the cost to the patient... and the investors would make a lot more money.Botox lasts about two weeks if diluted and stored refrigerated properly.  In a busy clinic like mine we go through many vials each day, so there is never a risk to the patient of getting "old" or ineffective Botox.You can workout before.  If you are prone to bruises, wait about 24 hours before working out.  Water is always good for you, aim for 40 oz per day, and if you get a headache after Botox you can take a couple Tylenol for it.  I hope this helps.  Best regards, Marla Klein MD

William Marshall Guy, MD · Answer

Hello luvfit,You have a lot of questions.  Each injector is going to have his or her preferences for post treatment care.  You will likely see conflicting answers on what to do afterwards on here.  The best treatment is to listen to what your injector says.  Having said that, I tell my patients not to lay down for 4 hours post treatment, don't massage the area, don't exercise for the rest of the day, and avoid getting your head below your heart for the rest of the day as the increased blood flow could theoretically move the Botox slightly.  I hope this helps and good luck.

Hratch Karamanoukian, MD, FACS · Answer

Thank you for your question.I would not change anything except instruct my patients not to massage the area(s) where Botox was injected to prevent migration, which itself, is a rare occurrence. BestDr. Karamanoukian

Francis R. Palmer, III, MD (retired) · Answer

Hi, I have performed many Botox injections for over 30 years.  Botox, xeomin or Dysport shouldn't be injected within 1 fingerwidt of the upper aspect of the eyebrows to prevent weaken that section of the Frontalis muscle which causes eyebrow droop.  This goes with experience and a good reason to choose an experienced Botox injector.I massage the Botox into the tissues immediately after injection and the fluid is absorbed within minutes.  There is no fluid that will move or travel within the tissues, so moving, lying or standing upright has no impact in that regard.  Actively contracting muscles that ahve been weaken ed with Botox makes the muscle create new neuromuscular junctions at a quicker rate lessening the duration of action of the Botox.  Drinking water will no impact at all one way or the other.  We ask that patient avoid exercise the day of Botox (before is no problem) and you can take Tylenol for any headache.  Washing the face or steam shower (sauna) will also have no affect on the Botox.Hope this helps.

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