The first 14 days after botulinum toxin

What must not be done in the first 4 hours?

The first 4 hours are the critical window for the toxin to stay in the muscle it was placed in. During that time you do not lie flat and no pressure is applied to the area.

No massage, rubbing or pressure from a make-up brush over the treated area. Mechanical pressure can spread the substance to neighbouring muscles that were not the target.

In the same 4 hours, avoid bending forward or keeping your head down for long periods. Moving your face is not a problem; raising and lowering your eyebrows is fine.

What is restricted in the first 24 hours?

On the first day, activities that rapidly raise blood flow and body temperature are postponed. The restrictions below are typical instructions.

• Heavy exercise and anything that makes you sweat — not for the first 24 hours.
• Sauna, steam room, hot showers and sunbeds — not for the first 24 hours.
• Alcohol — not advised for the first 24 hours; it increases the chance of bruising.
• Sleeping face down — avoided on the first night.
• Facials, exfoliation and massage treatments — postponed for at least 14 days.
• Make-up — can be applied once the injection points have closed, usually after 4–6 hours.

What does it feel like on days 3–7?

The effect typically begins between days 3 and 7. What people usually notice first is not movement stopping altogether but a sense of the muscle becoming “heavier” when they make an expression.

The lines have not fully released at this stage. Deeply set lines improve over time as the muscle stays inactive.

It is normal for the effect to start at different speeds in different areas. The glabella usually responds earlier, the forehead muscle slightly later.

What happens at days 10–14, and why is the review then?

The effect settles fully at days 10–14. The dose is assessed then because looking earlier gives an incomplete reading.

Three things are checked at the review: how much movement has reduced in the target area, whether there is asymmetry between the two sides, and whether the brow level has changed.

Typically 2–6 units are added at that review to any area that has fallen short. The note taken at the review is the main record that sets the next session’s dose. If you have flown home, the review is done by photograph and message, and any adjustment is planned for your next visit — which is worth knowing before you book a single-day trip.

Are bruising and redness normal, and how long do they last?

Small bumps and mild redness at the injection points are expected and usually disappear within 15–30 minutes.

Bruising happens when the needle meets a small vessel and typically resolves in 3–7 days. Blood thinners, aspirin, fish oil and alcohol all increase the chance.

A mild headache can occur on the first day and usually passes in 24–48 hours. Any painkiller taken for it should be one that does not increase the tendency to bleed.

Which symptoms are not expected?

The findings below are not part of the normal course and should be reported to the clinic. Most are temporary and resolve as the toxin wears off — but tell us rather than waiting, especially if you are already home.

• Drooping of the eyelid (ptosis) — uncommon, usually resolving within a few weeks.
• Marked asymmetry between the two sides — balanced by adding units at the day-14 review.
• Double or blurred vision
• Difficulty swallowing or speaking
• Increasing redness, warmth or discharge at the treatment site
• Generalised muscle weakness or shortness of breath

How does the timeline run after day 14?

The effect lasts 4–6 months in the expression areas and 6–9 months for masseter and sweating treatment. At the end of that period, muscle movement returns gradually.

Repeat treatment before the effect has fully worn off stops the muscle regaining full strength and can, over time, allow a lower dose to achieve the result. At least 3 months are left between repeats regardless.

The first treatment usually lasts less time. By the second and third sessions the 4–6 month interval becomes more stable.