Botox aftercare: what to do (and avoid) in the first 24–48 hours

Most Botox aftercare instructions are based on a mix of evidence, tradition, and injector preference. Some restrictions are well-supported; others are myths. Here's what actually matters and why.

The first 4 hours: the critical window

The most important aftercare window is the first 4 hours after injection. The neurotoxin is diffusing from the injection site during this time — actions that might redistribute it matter most now.

Don't lie face-down for 4 hours

Why: Lying face-down creates pressure on the treated areas that could theoretically redistribute the toxin before it binds. Most relevant for forehead and glabellar injections — sustained pressure could push toxin toward the levator palpebrae muscle (eyelid lifter), causing eyelid ptosis.

Evidence level: Plausible mechanism; limited direct clinical evidence. Standard practice across providers.

Don't vigorously massage or rub the treated areas for 4 hours

Why: Massage can disperse the toxin from the intended muscle into adjacent tissues. This matters most for areas near sensitive anatomy (levator muscle near the glabellar/forehead injections).

Exception: Gentle touching (like applying sunscreen or makeup) is fine — you're not doing a deep massage. The concern is vigorous rubbing.

Avoid intense exercise for 4 hours (some say 24 hours)

Why: Increased blood flow from exercise may increase systemic uptake of the toxin and potentially spread it from injection sites. Some providers extend this to 24 hours.

Evidence level: Theoretical; limited clinical evidence. The 4-hour window is the conservative recommendation; 24 hours is the more cautious version. The difference in real-world outcomes is unclear.

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The first 24–48 hours

Avoid alcohol for 24 hours

Why: Alcohol is a vasodilator — it increases blood flow and can worsen bruising at injection sites. It also increases bleeding risk.

Note: Alcohol before the appointment (some patients try to "take the edge off") also increases bruising risk — best to avoid the day before and day of treatment.

Avoid NSAID pain relievers for 24 hours post-treatment

Why: NSAIDs (ibuprofen, aspirin, naproxen) inhibit platelet function and increase bruising. Better to use acetaminophen (Tylenol) for post-injection soreness.

Note: If you're on daily low-dose aspirin for cardiovascular reasons, do not stop it for this reason without consulting your prescribing doctor.

Avoid other facial treatments for 24 hours

No facials, chemical peels, microneedling, or laser treatments
No facial massage or massage devices
Why: Avoid any manipulation that could spread the toxin or traumatize injection sites before they've healed

Avoid saunas, hot tubs, and very hot showers for 24 hours

Why: Extreme heat increases blood flow and may increase bruising. A warm shower is fine.

Keep upright and avoid bending significantly for 4 hours

Why: Bending over repeatedly (like in an intense yoga class) creates facial pressure changes that some providers worry could redistribute toxin. The evidence is limited, but staying upright for the first 4 hours is a low-cost precaution.

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What you CAN do

Makeup: Fine to apply makeup after the appointment, avoiding vigorous rubbing
Gentle skincare: Normal moisturizer, SPF — apply with light touch
Normal daily activity: Walking, desk work, light tasks are all fine
Arnica gel: Can apply to bruised areas to reduce bruising speed — evidence is modest but it's safe
Ice: Cold compress to injection sites reduces swelling and bruising. Do not apply ice directly to skin; use wrapped ice or a cold pack.

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When to see results

Onset: Most patients notice initial effect at 3–5 days. The toxin requires time to be taken up by the nerve terminal and begin blocking acetylcholine release.
Full effect: 10–14 days for the complete result to settle. Do not judge results before 2 weeks.
Asymmetry at 2 weeks: Some asymmetry can be corrected with a small touch-up. Contact your provider if you're still seeing significant asymmetry at the 2-week mark.

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The "exercise myth"

A circulating claim suggests that exercising immediately after Botox makes it metabolize faster and last less long. This is not well-supported. The worry about exercise is primarily about bruising and, in the first 4 hours, toxin migration — not about affecting longevity of results. Once the toxin has bound to the nerve terminal (within hours), metabolic rate doesn't significantly change how long it lasts.

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What looks wrong vs. what is normal

Normal:
Small bumps or raised areas at injection sites (resolve in 15–30 minutes)
Mild redness at injection sites (resolves in hours)
Small bruises at injection points (resolve in 5–10 days)
Slight headache after glabellar treatment (common; take acetaminophen)
Mild heaviness in the forehead in the first 2–3 days (toxin activating)

Contact your provider if:
Eyelid ptosis (drooping): The eyelid itself is visibly lower on one side. This occurs in roughly 1–5% of glabellar treatments. It's temporary but can last 4–6 weeks. Apraclonidine (Iopidine) eye drops can help — only available by prescription; your injector should have a protocol for this.
Brow ptosis: Both brows feel very heavy or one significantly lower than expected. Common with forehead treatment; sometimes requires adjustment.
Significant asymmetry at 2 weeks: Call your provider — they may recommend a small touch-up.
Signs of infection: Increasing redness, warmth, swelling, fever. Rare but requires medical evaluation.
Visual symptoms: Any change in vision after injection — seek immediate medical attention.

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When can I book a touch-up?

Most providers recommend waiting the full 2 weeks before assessing results. At that point, if there's a correction needed (underdone area, asymmetry), a small touch-up can be done. Some providers include a 2-week follow-up in the treatment fee; others charge for additional product.

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Preparing before your appointment reduces aftercare concerns

The best aftercare starts before the appointment:
Avoid alcohol 24 hours before
Avoid blood thinners (fish oil, vitamin E, NSAIDS) 5–7 days before (unless medically required)
Arrive without makeup if possible — or be prepared for it to be removed before injection
Stay hydrated — dehydrated skin bruises more easily

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Quick reference: Botox aftercare

| Restriction | Duration | Evidence |
|---|---|---|
| No lying face-down | 4 hours | Plausible; standard practice |
| No vigorous face massage | 4 hours | Plausible; standard practice |
| No intense exercise | 4–24 hours | Theoretical; low risk to follow |
| No alcohol | 24 hours | Well-supported (bruising) |
| No NSAIDS | 24 hours | Well-supported (bruising) |
| No facial treatments | 24 hours | Standard practice |
| No saunas/hot tubs | 24 hours | Plausible |
| No bending | 4 hours | Theoretical |

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