A practical, evidence-informed patient guide
Botulinum toxin
aftercare
For most people, aftercare is straightforward. Be gentle with the injection sites, allow time for the effect to develop, and know when to seek help.
For people who have already had cosmetic facial botulinum toxin injections. Follow your treating clinician’s individual instructions and the leaflet for your specific product. Other procedures, injection areas or medical conditions may need different care.
Keep care simple
Usual daily activities are generally possible if you feel well. Keep the injection sites clean and handle them gently.
Review your response
Effects develop gradually. A review can assess your response; it does not automatically mean more treatment.
Act on warning signs
Serious symptoms need medical help, even if they start days or weeks after your appointment.
Everyday care
- Resume ordinary activities as comfortable. Use gentle cleansing and avoid firm rubbing or massage immediately afterwards as a simple precaution; a precise restriction period has not been established by good trials. [1] [3]
- If bruising or swelling is uncomfortable, a wrapped cool pack applied lightly for a short period may help. This is optional comfort care. Avoid direct ice contact and firm pressure. [3]
- Do not stop prescribed medicines to reduce bruising without advice from your prescriber. Tell any doctor, dentist or pharmacist you see about your recent injections, particularly before starting a new medicine. [2] [3]
Recovery
& review
Local redness, tenderness, swelling or bruising, and sometimes a mild headache, can occur. These should improve rather than worsen. Bruises may take a week or longer to fade; recovery varies. [1]
The effect develops over several days. Timing differs by product, dose, area and individual response. A review at around two weeks is useful, especially after a first treatment or a new treatment area. It is not a universal deadline for the maximum effect, or a reason to arrange an automatic top-up. Let your clinician assess any concern before further treatment. [2] [4]
What does the
evidence show?
Many familiar restrictions are precautionary, with limited direct evidence. That does not prove every activity is harmless for every person.
- A 2016 expert panel found no evidence supporting routine bans on pressure, strenuous exercise or air travel. This is expert consensus, not a trial proving that restrictions never matter. [3]
- A 2025 retrospective study included 5,014 upper-face patients; 4,000 attended follow-up. It questioned extended restrictions, but had no control group, incomplete follow-up and short observation. It cannot establish the safety of each activity or every injection area. [5]
- Professional advice differs. Follow any specific instructions given for your treatment, and ask your clinician if they conflict with general online advice.
When to seek help
Call 000 immediately
Difficulty breathing, swallowing or speaking; tongue or throat swelling or tightness; collapse; or severe or rapidly worsening general weakness need emergency help. Do not wait for a clinic reply. [6] [10]
Get medical assessment immediately for new blurred or double vision, marked eyelid drooping, generalised weakness, new face or lip swelling, or widespread hives. If immediate assessment is unavailable, go to an emergency department. Do not drive if your vision or strength is affected. [2] [6] [10]
Contact your clinician promptly for an isolated mild eyelid or brow droop. Difficulty fully closing an eye needs same-day assessment. Severe eye pain, light sensitivity or a change in vision needs immediate assessment. Increasing injection-site pain, warmth, redness, swelling, discharge or fever also needs same-day medical assessment; do not wait for a routine review. [2] [11] [12]
Rare effects beyond the injection site can occur. Symptoms may begin hours to weeks later; the MHRA’s July 2026 update reports delayed symptoms up to four weeks after treatment. Seek care whenever warning symptoms appear. [6]
Common questions
When can I exercise?
The AAD advises a two-hour pause before strenuous activity. This is a precaution, rather than proof that exercising sooner causes spread. A routine 24–48-hour ban has not been established as necessary. [1] [3]
A separate study of 60 women linked higher habitual activity with shorter effects. It did not test immediate aftercare or show that taking a day off improves duration. It is not a reason to abandon healthy exercise. [8]
Must I stay upright, change my sleep position or avoid flying?
Research has not established that blanket rules about lying down, sleeping position or flying improve outcomes. If you already bent over or lay down, that alone does not establish that treatment has been affected. Follow any individual advice and seek help for symptoms, rather than assuming they are harmless. [3] [5]
Can I wear makeup or have a facial massage?
Makeup advice varies: some guidance allows careful application, while other experts suggest a short wait. Keep sites clean, use clean hands and tools, and apply products gently. Avoid firm massage immediately afterwards; ask your clinician before a facial or other procedure. Fixed 12- or 24-hour bans are not proven universal requirements. [1] [9]
Do I need to exercise my facial muscles?
A small randomised crossover study of 22 women found that deliberate facial movements brought the effect forward by about a day, with no difference at two weeks or in duration. This limited finding does not make facial exercises a necessary aftercare routine. [7]
What about alcohol, hot baths or saunas?
Some clinicians advise a short pause as a precaution, for example to limit flushing or discomfort. Research has not established an exact avoidance period that prevents toxin spread or improves results. Follow your individual instructions; avoid claims that heat or alcohol inevitably “moves” the medicine. [13]
Does this guide cover fillers or other injections?
No. Dermal fillers, injections for medical conditions and other procedures have different risks and may need different aftercare. If treatments were combined, follow the instructions for each.
Sources & evidence notes
Medicine information and regulator alerts guide safety advice. Clinical studies, expert consensus and patient guidance inform routine care; consensus is not the same as evidence from randomised trials.
- AAD patient guidance: daily activities, makeup and exercise precautions
- Australian consumer medicine information: product-specific effects and precautions
- Global Aesthetics Consensus (2016): expert recommendations and evidence gaps
- Australasian consensus (2020): aftercare and follow-up
- Santorelli et al. (2025): retrospective upper-face aftercare study
- MHRA safety update, 15 July 2026: rare delayed toxin-spread symptoms
- Alam et al. (2019): small randomised crossover trial of facial exercise — researchers’ university report
- Morhy et al. (2023): habitual physical activity and treatment duration
- McDonald et al. (2025): expert consensus on skin care around injectable procedures
- Healthdirect Australia: recognising anaphylaxis
- Healthdirect Australia: skin infection warning signs
- Healthdirect Australia: urgent eye symptoms
- Office-based facial plastics procedures: Neuromodulators (2023 review)
Evidence checked and content updated 22 October 2026. Patient education from MA360; this guide does not replace individual medical assessment. Ask your clinic for the leaflet for the product you received.