What Not to Do After Botox: The First 24 Hours

Botox aftercare is short and simple, and almost every rule exists for one of two reasons: to keep the product where the physician placed it, or to limit bruising. Once you know which reason sits behind each rule, the list stops feeling arbitrary and the questions about edge cases mostly answer themselves.

The direct answer: for 4 hours, stay upright and do not touch the area. For 24 hours, skip exercise, alcohol, heat and anything that presses on your face. For about two weeks, delay facials, peels and other skin treatments on the treated area. After that, there is nothing to protect. The sections below take each rule in turn, with the reason and the time limit, and finish with what is normal in the first days and when to call. This is the list we give patients at Vital Medical Care & Aesthetics after every relaxer treatment, whether the product is Botox, Dysport, Jeuveau or Daxxify. Lip filler comes with its own list, our aftercare checklist for lip filler.

The first 24 hours at a glance

Everything on this list is time limited, and most of it ends within a day. The table is the short version; the sections below give the reasons.

Avoid	For how long	Why
Rubbing, pressing or massaging the area	24 hours, strictly for the first 4	Keeps the product where it was placed
Lying down or bending forward	4 hours	Same reason, plus pressure on the face
Exercise and strenuous activity	24 hours	Blood flow and heat; sweat and headbands press and rub
Alcohol	24 hours, ideally the day before as well	Widens vessels, more bruising
Saunas, hot tubs, hot yoga, direct sun	24 to 48 hours	Heat and flushing increase bruising and swelling
Makeup over the injection points	Rest of the day	Open needle points, rubbing during application
Facials, peels, microneedling, lasers on the area	About 2 weeks	Pressure and heat while the product settles

Nothing on the list changes how the product works once it has bound to the nerve, which happens within the first several hours. The treatment itself is described on our Botox page.

Do not rub, press or massage the treated area

This is the rule with the clearest reason. Botox is placed in a specific muscle, in a specific amount, at a specific depth. Firm pressure in the first hours can push some of it into a neighboring muscle, and the neighbor you least want it in is the one that lifts the eyelid. Eyelid droop after a frown line treatment is uncommon, and this is one of the ways it happens.

Washing your face gently with your fingertips is fine the same evening. What to avoid is anything with pressure or repeated friction: a facial massage, a gua sha tool, a face roller, leaning your forehead on your hand at a desk, or scrubbing in the shower. After 24 hours, normal touch is fine.

Stay upright for 4 hours, and how to sleep the first night

Stay upright for about 4 hours after the injections. Upright means sitting, standing or walking; it does not mean you cannot look down at a phone. The reason is the same as the no rubbing rule: lying flat, or face down, puts pressure on the treated area and makes it easier for the product to move before it has bound where it belongs.

Sleeping position after Botox

By bedtime the 4 hour window has long passed, so sleep is not a risk to the result in the way the first hours are. Still, for the first night we suggest sleeping on your back if you can, with an extra pillow to keep your head slightly raised. That keeps your face off the pillow and avoids the one position that matters, face down with the forehead pressed into the mattress for hours. If you are a side sleeper and wake up on your side, do not worry about it. From the second night, sleep however you normally do.

No exercise or strenuous activity for 24 hours

Skip the gym, running, hot yoga, cycling and anything that raises your heart rate and body temperature for 24 hours. Three things are going on. Vigorous exercise increases blood flow to the face, which raises the chance of bruising at the injection points and, in theory, may encourage the product to spread slightly from where it was placed. Sweating, wiping your face and wearing a headband or helmet all add the rubbing and pressure covered above. And some positions, such as inverted yoga poses or bending over a bench, put your head below your heart.

Walking is fine, including the walk from the LIRR station. If you train hard most days, plan the treatment for a rest day, or for a Tuesday evening when the clinic is open until 7pm, so the restriction costs you nothing.

Skip alcohol, and ask before blood thinners and supplements

Alcohol does not interfere with Botox itself. It widens blood vessels, which makes bruising more likely and makes a small bruise larger, and it dehydrates, which makes the skin look worse while you are watching it closely. Skip it for 24 hours after treatment, and ideally for the day before too. A glass of wine on day two will not change your result.

Medications and supplements that thin the blood

Aspirin, ibuprofen and naproxen, fish oil, vitamin E, ginkgo, garlic supplements and high dose turmeric all make bruising more likely. If your doctor agrees, pause them for about a week before treatment and a day or two after. Acetaminophen is the pain reliever that does not affect bruising. Prescription anticoagulants such as warfarin, apixaban and rivaroxaban are different: never stop them for a cosmetic treatment. Tell the physician at the consultation, and the plan is adjusted around them with smaller injection volumes, firm pressure after each injection, and realistic expectations about a bruise.

Pregnancy, breastfeeding and neuromuscular conditions belong in the same conversation, since they decide whether treatment goes ahead at all.

Avoid heat and sun for a day or two

Heat makes the skin flush, which means more blood in the small vessels at the injection points and a higher chance of bruising and swelling. Saunas, steam rooms, hot tubs, hot yoga and long hot showers are the common sources, and a day at the beach in direct sun does the same. Give all of them 24 to 48 hours.

Sun also matters for the result over the longer term. Lines in the forehead and around the eyes are partly from muscle movement and partly from sun damage; a relaxer handles the first and daily sunscreen slows the second. Sunscreen the day of treatment is fine once the injection points have closed, applied gently.

Makeup, skincare, facials and other treatments: what to delay

Makeup can go on the same day once the pinpoint marks have closed, which usually takes an hour or two, though many patients simply wait until the next morning. The concern is not the product but the application: pressing a sponge or brush over fresh injection points rubs the area and can introduce bacteria. Mineral powder with a light touch is the gentlest option if you need coverage for a bruise.

Skincare

Keep the first evening simple: a gentle cleanser and a moisturizer. Pause retinoids, exfoliating acids and scrubs on the treated area for a day or two, since they can irritate the needle points. After that, your normal routine resumes, and a retinoid at night is one of the better ways to support a relaxer result.

Facials and in office treatments

Delay facials, massage of the face, chemical peels, microneedling, radiofrequency and laser treatments on the treated area for about two weeks. The pressure and heat involved are the issue while the product settles, and two weeks also lets the full effect arrive so that the next treatment is planned on the finished result. If you are combining a relaxer with a peel or microneedling, Dr. Vital sets the sequence at the consultation, usually about two weeks apart.

What is normal: swelling, bruising and the results timeline

Small bumps at each injection point are normal and settle within about 30 minutes. Pinpoint redness fades within a few hours. A small bruise at one or two points is common, especially around the eyes, and lasts up to a week; a cold compress held gently, not pressed, for a few minutes at a time in the first hours helps. A mild headache on the first day or two is reported in roughly one in ten trial patients on the label and passes.

What you will not see is the result. Botox shows its first change between day 2 and day 5, most of the effect by day 7, and the full effect at about day 14, which is when the review visit is scheduled. The full timeline is in our post on how long Botox takes to work.

Call the clinic the same day if

• An eyelid begins to droop, usually between day 3 and day 14
• A brow or smile is clearly uneven past day 10
• You have trouble swallowing, speaking or breathing, double vision, or weakness away from the treated area. These are rare at cosmetic doses and are the symptoms every relaxer label warns about

Maintenance, and how to book

Once the full effect is in, it typically holds for three to four months, and most patients rebook when movement is about halfway back. A regular schedule tends to lengthen the result over time; the details are in our post on how long Botox lasts. Weight loss medication has its own follow up, covered in our guide to why weight loss stalls on tirzepatide. Candidacy, dose and the choice between Botox, Dysport, Jeuveau and Daxxify are decided at the consultation with Dr. Vital, and pricing is confirmed there.

Vital Medical Care & Aesthetics is at 2209 Merrick Rd, Suite 202, Merrick, NY 11566, about a ten minute walk from the Merrick LIRR station on the Babylon Branch, with the NICE n19 bus along Merrick Road. Hours are Monday 9am to 5pm, Tuesday 9am to 7pm, Wednesday and Thursday 7:30am to 5pm, Friday 9am to 5pm and Saturday 9am to 2pm. Visits are by appointment: book a Botox maintenance visit online or call (516) 414-1101.

Questions readers ask

Read next

• How Long Botox Takes to Work: Day 3, Day 7, Day 14
• How Long Botox Lasts, and What Shortens It
• Lip Filler Aftercare: The Checklist We Give Patients