What to keep in mind after botox

What does botulinum toxin do?

Botulinum toxin (commonly known as botox) temporarily reduces the signal from nerve to muscle in the area where it is applied. As the muscle contracts less, the appearance of the expression lines formed by that muscle's movement is reduced. The effect is reversible and wears off on its own over time. Its use for facial lines has been examined in systematic reviews that bring together a large number of randomised controlled trials^[1].

The dos and don'ts after the treatment are intended to help the medicine stay in the area where it was applied and to reduce possible mild side effects. The recommendations below are the general advice given to every patient at our clinic; your doctor may give you additional advice specific to you.

The first hours

• Do not wash the treated area for 1–2 hours.
• Do not apply make-up to the area on the same day; avoid rubbing and massage.
• In the first hours, avoid bending forward and lying down.
• Mild redness or small bumps may appear at the injection points; these usually go away on their own within a short time.

Some of these precautions are traditional, cautious recommendations. The scientific literature also includes reviews questioning whether post-treatment restrictions are necessary, as well as studies examining large groups of patients who followed only short-term precautions^[4][5]. So if you accidentally bent over or touched your face, there is no need to worry; even so, it is advisable to follow your doctor's recommendations.

The first days: when does the effect start?

You can return to your daily life, work and social life straight after the treatment. The effect is not immediate: the relaxation in the muscles begins to be noticeable around day 3 on average, and the full effect settles by days 7–10. This varies from person to person. It is also possible for one side to relax slightly earlier than the other in the first days; it is more accurate to assess the result once the full effect has settled.

The effect lasts about 5–6 months on average; this varies with muscle structure, the area treated and individual characteristics. When this period is over, muscle movement gradually returns.

Why is the follow-up important?

It is recommended that you come for a follow-up within 30 days of the treatment. At the follow-up, your doctor assesses how much the muscles have relaxed and the balance between the two sides, and plans a small top-up treatment if needed. A top-up can be done within this 30-day period; once this period has passed, no top-up is done. This is why it is important not to postpone your follow-up appointment.

Possible side effects and when to call your doctor

In studies, the great majority of side effects are mild and temporary: redness, mild swelling, bruising and tenderness at the injection site, and headache are the most commonly reported^[2][3]. Less often, drooping of the eyelid or brow and a feeling of heaviness around the eyes have been reported^[2]. These effects are also usually temporary, but they should be assessed by a doctor.

Call your clinic in the following situations:

• If you notice marked drooping of the eyelid or brow,
• If you have blurred vision, double vision or difficulty closing your eyelid,
• If you have an unexpected symptom such as difficulty swallowing, speaking or breathing (in this case, seek emergency medical care),
• If there is increasing redness, warmth or pain in the treated area.

Further reading

• Botulinum toxin (botox)
• Botox or filler? The difference between the two treatments
• Teeth clenching (bruxism) and botulinum toxin for the masseter
• Preparing for an aesthetic treatment