Restrictions After Botox
Activity limitations following injection
I recommend that you refrain from exercise or vigorous manipulation of the area for at least 6 hours after injection.
I will be interested to see what other physicians have to say in this regard because this is a common recommendation but I am not sure that there is any scientific basis for this recommendation.
The thought is that you do not encourage movement away from the site of injection.
WE do have studies that show that it can spread locally for up to 3 cm from the injection site and that there is some evidence of distant dissemination to the CNS via retrograde neuronal transport.
However, we are nor sure if exercise has an effect on this distribution. It is most likely an empiric recommendation. (Otto Joseph Placik, MD, Chicago Plastic Surgeon)
Avoid Getting Facials, Chemical Peels
What to Do Following Botox Injections
The post treatment instructions following botox injections are designed to minimize migration of botox. When botox migrates to surrounding structures complications can occur including droopy eyelids. In an effort to avoid these complications, a series of steps should be taken to avoid displacement of botox.
Patients don’t have to sit still following botox treatment and should be able to resume most of their normal activities. However they should avoid strenuous activities and heavy lifting for at least 24 hours following botox injections.
Exercise can increase blood flow and theoretically decrease the effect of botox. In addition most providers recommend avoiding massage or manipulation of injected areas because this might cause migration of botox. Conversely many providers advise actively contracting these muscles to accelerate the onset of the response to botox.
Avoid Rubbing And Massaging The Treated Area
Although some providers recommend not lying down for four hours following botox injections, there is no scientific evidence to support this practice.
It’s important to discuss these issues with your injector. In most cases patients should be able to resume normal activities after botox injections. (Richard J. Bruneteau, MD, Omaha Plastic Surgeon)
I always tell my patients not to bend down for four hours after Botox and no heavy exercise for 24 hours. (Michele S. Green, MD, New York Dermatologist)
Because there is no concensus on this issue, and no scientific data to support any specific practice, physicians who inject Botox rely on their own logic, recommendations from the manufacturer, or similar practice by peers.
I personally do not suggest sitting still, or keeping the head elevated. I ask patients to move the involved muscles for about a half an hour after injection, in order to gently disperse the med and encourage it’s binding to the receptors that light local activity would stimulate.
Avoid Strenuous Physical Activity
I do not like patient massage. I limit activity only to avoid intense physical activity for 4 hours after injection, because logic tells me that the extra blood supply such activity stimulates might wash away the drug before it can bind.
All opinion, no fact. I believe Allergan distributed a survey to physicians about a year ago, in order to pinpoint suggestions of this nature.
The majority of doctors, if I remember correctly, it was at least 70 to 90% for these questions, limit activity to some degree post injection, avoid patient massage, and otherwise don’t restrict head position, elevator rides, alcohol.
You can probably get that information from Allergan if you contact them. (Kevin Robertson, MD, Madison Facial Plastic Surgeon)
Not a bit of truth to sitting still after Botox
Don’t Touch Your Skin Where The Botox Was Injected
Interstingly, some doctors thought that it was important to move the treated muscles. Now we understand that these restriction make absolutely no difference to the outcome of treatment. In my office, I recommend that patients wait 24 hours before returning to their work out.
This stems from an experience I had with a patient who had a BOTOX treatment and immediately did a spin class. She developed a whopper of a black eye (she swears it was the spin class and not the boy friend).
To be on the safe side I now tell people not do work out until the day after treatment. (Kenneth D. Steinsapir, MD, Beverly Hills Oculoplastic Surgeon)
One does not need to sit still after Botox. I ask my patients to exercise the muscles in the area treated for an hour. I suggest they avoid strenuous exercise that day. I also tell them not to touch or manipulate the area for 6 hours after injection.
How You Take Care Of Your Skin Is Very Important
For added security it is advised to sleep on your back on a few pillows the night after injection. (Julia Carroll, MD, Toronto Dermatologist)
Activity after Botox
In my practice, I don’t recommend that patients sit still after Botox but that they avoid strenuous exercise or heavy lifting that day. That’s about that is necessary all in my opinion to let the Botox set up. (Richard P. Rand, MD, FACS, Seattle Plastic Surgeon)
Recommended Inactivity after Botox
Botox acts by attaching itself to the muscle receptors to which nerves send their signals and interfering with signal transmission and muscle contraction.
The attachment of the Botox is rapid. But to prevent Botox from migrating elsewhere it is recommended you NOT lie down or bend over, lift anything heavy or strain and do NOT engage in strenuous activity for 4 hours or so, or rub towards the upper lid for the next 24 hours.
Shouldn’t Do After Getting Botox Injections
There is NO reason though to “sit still” and be immobile for any period. (Peter A. Aldea, MD, Memphis Plastic Surgeon)
Botox Recommendations
The official line from Allergan is to avoid lying down for at least 6 hours after injection. However, I advise my patients to exercise their brow muscles via exaggerated expression and to avoid rubbing the area until at least the next morning.
I have never recommended limitations on lying down and I have never seen any negative consequences as a result. (Stephen Prendiville, MD, Fort Myers Facial Plastic Surgeon)
Lying still for hours after Botox treatment is a wive’s tale
I don’t believe there is any consensus or scientific basis for telling patients to lie still for a set amount of time after Botox treatment. This goes back to the first “injectors” and concern about spread of Botox.
What To Do AFTER Botox
I even know a number of doctors who tell their patients to squeeze their facial muscles to get the Botox to “work into” the muscle.
So, what I tell my patients is to skip the gym that day, don’t vigorously rub the area, otherwise to go about their normal business.
I don’t believe this is part of the official training and couldn’t find it anywhere on the Allergan website. (Steven J. Pearlman, MD, New York Facial Plastic Surgeon)
Bruising after Botox injections
Botox can migrate. Our office recommends Bruisestick ointment after Botox to reduce the risk of bruising and swelling after Botox. (Raffy Karamanoukian, MD, FACS, Los Angeles Plastic Surgeon)
I used to recommend not to lay flat for 4 hours, but studies now show this does not matter. I do ask patients to refrain from heavy lifting or strenous exercise for 6-12 hours, as I feel this will minimize their risk or bruising at the injection site. (Paul S. Gill, MD, Houston Plastic Surgeon)
What To Do BEFORE Botox
Unlike several years ago studies have now shown that movement after Botox injection does not affect the Botox. It is helpful not to rub the area as this may cause some unwanted diffusion of the Botox.
It may also help to exercise the treated muscles so that the effect may occur sooner. (Thomas Guillot, MD, Baton Rouge Plastic Surgeon)
No need to sit still after Botox or Dysport injections
Used to be that we instruct patients not to lie down for 4-6 hours after injections. However, a recent study showed that body position does not matter. What matter are these instrutions:
1) Do not rub the injected areas. Since the injections are placed specific for different muscles, rubbing the areas will cause Botox to diffuse to surrounding muscles.
What To Do DURING Botox
2) Do make facial expressions that involving the injected areas, which will help speed up the onset of results. (Isabel Zhu, MD, PhD, Boulder Dermatologist)
You do not have to sit still for any period of time after a Botox injection. It is important not to rub your forehead too aggressively and thereby massaging the Botox into the eyelid muscles.
It’s also important not to lay down for at least 4 hours after the injection. (William Portuese, MD, Seattle Facial Plastic Surgeon)
Don’t lay down for 4-6 hours after your Botox injections
It’s suggested that you do not lay down for about 4 to 6 hours after your injections. But you should move your facial muscles to enhance the effectiveness of your treatment. (Bruce E. Katz, MD, New York Dermatologic Surgeon)
Avoid Taking The Blood Thinning Medications
No lying down 4 hours after Botox is the accepted time
Generally, it is recommended that patients not lie down for 4 hours but more important is for patients to work the injected muscles for about an hour to help the absorption of Botox into the muscles. (Nissan Pilest, MD, Irvine Dermatologic Surgeon)
Rest after Botox
Although there are no formal studies proving or disproving this practice, I still recommend to all of my Botox and Dysport patients to stay generally upright and not lay flat or exercise for at least 3-4 hours after treatment.
I do recommend that they exercise (i.e. move) the muscles that were injected but other than that physical exertion should be kept to a minimum. (Jason R. Lupton, MD, San Diego Dermatologic Surgeon)
Consensus is 4 hours no activity after Botox
The consensus here is 4 hours of no exercise or bending down. I usually give more of an exact time frame of at least 6 hours, just to be safer. So if I have injected at 10 am than 4 pm is ok for activity. (Darryl J. Blinski, MD, Miami Plastic Surgeon)
Sit still after Botox
Despite there having been no formal study involving the movement of Botox as a result of bending over, most physicians insruct their patients not to bend for four hours after the treatment. A few might be limiting this to one hour. (Ronald Shelton, MD, Manhattan Dermatologic Surgeon)
Facial movement after Botox
I do tell my patients not to bend over for four hours (no shoe-shopping or bowling etc.), but I am not sure whether this is necessary. The only study I remember reading was performed two years ago and was published in a dermatology magazine, not really a journal.
If I recall, the study was done by a pair of Israeli dermatologists who found that the complication rate was no different whether patients received instructions to avoid lying down, bending over etc. or did not.
I think that some of the complications in the earlier days of Botox adminstration was due to the inexperience of the injectors but it was easier to blame the patients for “not following directions”. Since the physicians answering this query are experienced, they probably see no real need for the above advice.
I guess I give this advice out of force of habit rather than true scientific evidence based medicine. I do instruct my patients to move their facial muscles every ten minutes for two hours. This supposedly permits better dispersion.
Again, something not studied, but it does make physiologic sense. (Arnold R. Oppenheim, MD, Virginia Beach Dermatologist)
No movement restrictions after Botox
I don’t put any restrictions on my patients after Botox injections. It may be a good idea not to do anything too vigorous like a vigorous workout, but only to minimize any swelling or bruising, but this is minimal anyway. (Scott E. Kasden, MD, FACS, Dallas Plastic Surgeon)
Don’t exercise or lie on your stomach for 4 hours after your BOTOX Cosmetic treatment.
You should move your facial muscles frequently after your BOTOX treatment. I have my patients perform specific facial exercises the day of their procedure to enhance the effect of BOTOX Cosmetic. I’m not sure this is necessary, but it certainly can’t hurt.
I allow my patients to exercise with unrestricted activity 4 hours after their BOTOX Cosmetic procedure. (Eric M. Joseph, MD, West Orange Facial Plastic Surgeon)
The only thing I tell my patients not to do is lie face down or hang upside-down for at least 6 hours. I think swelling can cause diffusion. On the other hand, the one thing we all KNOW IS IMPORTANT IS TO MOVE THE MUSCLES WE INJECTED! (Mary P. Lupo, MD, New Orleans Dermatologist)
Waitng time after Botox
It has been suggested to wait about 4 -6 hours before perfroming any strenous activity after Botox injections. In addition, it is also recommended to not lay flat for the same amount of time. (Steven Wallach, MD, New York Plastic Surgeon)