Botox Aftercare: What Not to Do After Botox, and What the Evidence Says

What not to do after Botox: which rules have evidence and which are habit

There is no confirmed standard list of rules, and most Botox aftercare advice is clinic habit that no trial has tested. [1][2][4] This article is about Botox given by a doctor. The Botox Cosmetic documents say your doctor gives the injection. [2] For the names and types of botulinum toxin, see [[botox-botulinum-names]].

The patient information in the Botox label that we read has no list of activities to avoid, such as washing, exercise or sleeping position. [2] What it does spell out is the symptoms to watch for, which are covered in the last section below.

An Italian study that followed 5,014 patients describes the advice usually given for the first 4 hours: no facial expressions, stay upright, no physical activity, avoid direct sun and avoid heat. [1] The authors say this advice rests on experience more than on strong research, and that they found no clinical trial testing it. [1]

A literature review from Brazil concluded that widely repeated advice, such as not lying down for 4 hours, not exercising and not touching the treated area, has no consistent scientific support. [4] The parts with partial support are avoiding rough handling of the area and telling patients about possible side effects. [4]

None of this means you can ignore your clinic. It means there is no central list to copy. Before you leave, ask your doctor the questions below. Different treated areas may carry different cautions; see [[botox-wrinkle-areas]] for an overview.

• Should I stay upright or can I lie down, and for how many hours?
• When can I wash my face, put on cream or makeup, and have a facial massage?
• When can I exercise, use a sauna or take a hot bath?
• Do I need to stop or avoid any medicine or supplement I take?
• Which symptoms should make me call the clinic, and when is my follow-up?

Washing your face, skincare and makeup after Botox

One source says you may wash gently and pat dry but should not massage or press the injected area, and no study tested skincare directly. [5] The University of Florida Health patient page says you may gently wash your face and pat it dry, should avoid makeup for 12 hours, and should not massage or press the injection sites for at least 12 hours. [5]

Siriraj Hospital in Bangkok advises only that you should not massage the treated area, because it may let the drug spread to areas you did not want treated. [6]

A 2018 summary of a review in the PMFA Journal says the literature consistently advises not touching the treated area and avoiding makeup for 12 hours, even though data on skin infection after injection are scarce. [7] On whether rubbing or massage moves the toxin, the reviewer concluded there is a lack of evidence. [7]

For ordinary moisturiser or skincare, no source we read says either that it is banned or that it is fine, so the evidence cannot answer this. Ask your clinic when to restart each product. UF Health also advises talking to your provider before booking a laser, chemical peel or other procedure involving the treated area. [5]

Sleeping position after Botox: when you can lie flat, and what the evidence says

The sources we read advise not lying flat for about 3 to 4 hours, but a literature review says this advice has no supporting evidence. [6][5][4] Siriraj advises not lying flat in the first 3 to 4 hours after treatment. [6] UF Health advises staying upright for at least 4 hours; you may recline but should not lie completely flat. [5]

On the other side, a consensus paper by dermatologists in Australia and New Zealand, written from the authors' own experience, says patients may resume normal activities after 4 hours and need not move, or avoid moving, the treated muscles. [3]

The Italian study had 5,014 patients follow only a 10-minute precaution protocol after injection, under clinic supervision. Among the 4,000 who came for follow-up there were no cases of upper eyelid ptosis, and about 6% had some side effect. [1] The study looked back at existing records, had no comparison group and followed patients for a short time, so the authors themselves say the conclusions are limited and trials are needed. [1]

For your sleeping position on the nights after that, none of the sources we read gives a restriction. Ask the doctor who injected you. For how soon Botox starts to work, see [[botox-how-long-to-work-and-last]].

Exercise after Botox: what each source recommends

UF Health advises avoiding strenuous aerobic exercise for up to 24 hours, while the Australian consensus says normal activity is fine after 4 hours, so the figures do not match. [5][3]

The Italian study lists avoiding physical activity and heat sources among the usual advice for the first 4 hours, and says that advice rests on experience more than on research. [1] The PMFA summary says the evidence on exercise, UV exposure and travel after injection is insufficient and needs more study. [7]

The table below compares what each source says. Use it to see that the numbers differ, not as a schedule to follow.

What not to eat or take after Botox: medicines and supplements to tell your doctor about

We found no medical source that lists foods to avoid after Botox; the label's instruction is to tell your doctor every medicine you use and not to start a new one before telling them. [2] The patient information asks you to tell your doctor about all medicines, vitamins and herbal supplements, especially anti-platelet drugs similar to aspirin, blood thinners, muscle relaxants, sleep medicines, and allergy or cold medicines. [2] It also says not to start any new medicine until you have told your doctor that you have had Botox. [2]

On bruising, the Australia and New Zealand consensus suggests avoiding non-essential medicines or supplements that affect blood clotting, such as fish oil and vitamin E oil, for about 1 week before treatment, and says 1 week is enough for stopping non-essential aspirin and anti-inflammatory painkillers (NSAIDs). [3] The Italian authors likewise suggest avoiding NSAIDs, and telling patients to avoid clotting-impairing agents several days before injection, to reduce common side effects such as bruising. [1]

All of this is advice for before the injection, not after, and you should never stop a medicine your doctor prescribed without asking the doctor who prescribed it.

As for food and alcohol after injection, we found no medical source that lists what to avoid. Food lists you see on general websites are therefore habit that cannot be confirmed. Ask your doctor.

Symptoms after Botox that need urgent care, and the common ones that do not

Trouble swallowing, speaking or breathing, weakness all over the body, double vision or an allergic reaction are symptoms the label says to report to a doctor right away. [2] The label says swallowing, speaking and breathing problems can start hours to weeks after the injection and can be life threatening. [2] If you have muscle weakness, vision problems or dizziness, do not drive or do other risky activities. [2]

Other side effects listed on the label include pain or discomfort at the injection site, headache, drooping eyelids, drooping eyebrows and swollen eyelids. [2] In the trials for frown lines between the eyebrows, eyelid ptosis occurred in 3% of treated people. [2] The label says side effects usually occur within the first week, many are temporary, but some can last several months or longer. [2]

Siriraj reports headache or an itchy, sore feeling in about 2.5%, bruising from the needle usually at the outer corner of the eye, brow or eyelid droop with a 1 to 3% chance, pain and swelling at the site in 2.5% and local muscle weakness in 1.7%. These are usually mild to moderate and clear by themselves in 1 to 2 weeks. [6]

Before the injection, tell the doctor if you have a muscle or nerve disease, swallowing or breathing problems, or a skin infection where the injection would go, because the label lists these as precautions or reasons not to be treated. [2]

• Trouble swallowing, speaking or breathing [2]
• Weakness all over the body, double or blurred vision, hoarse voice or slurred speech [2]
• Itching, rash, red itchy welts, wheezing, dizziness or fainting, which are allergic reactions [2]
• Any side effect that bothers you or does not go away, such as a drooping eyelid or eyebrow [2]