Botox Aftercare: The First 4 Hours, Day and Week

Plainly: For the first 4 to 6 hours after Botox, stay upright and keep makeup off the treated area. For 24 hours, don’t rub, massage or press it, skip weights and cardio, and avoid alcohol for 12 to 24 hours. Wait 48 hours for HIIT or headstands, and 48 to 72 hours for hot showers, saunas, hot tubs or hot yoga. Most people see Botox start working within 3 to 7 days, with the full effect at about 2 weeks. These are the instructions Jasmine Saggu, RN, gives her patients at Bar Beauty Medical, including the less obvious ones like sleeping position, dental work and flights. For current per-treatment pricing, see our price list.

Botox aftercare at a glance

Botox aftercare: the long version

The first 4 to 6 hours

Botox attaches to the nerve endings in the treated muscle, is taken up inside them, and then cuts a protein called SNAP-25 that the nerve needs to signal the muscle. How long that uptake takes isn’t well established, but research suggests minutes, not hours (Hallett 2015). So the first few hours of care are a precaution, and we still ask for them because they cost you little. When a result does go wrong, such as a heavy eyelid, it’s usually from the toxin spreading beyond where it was placed, and a 2021 review found that happens more often with less experienced injectors (Nestor 2021).

• Stay upright. Sit or stand for 4 to 6 hours after treatment. No lying down, and no head-back hair washing.
• Don’t massage, rub or press the treated area for 24 hours. That includes scrubbing your face, leaning on your hands and pressing skincare in.
• No makeup on the treated area for 4 to 6 hours. Foundation around the eyes, forehead and between the brows stays off until then.
• Make active expressions. For the first 2 to 4 hours, frown, smile and raise your brows now and then. Muscle activity seems to help the toxin get taken up (Hallett 2015), though a 2020 expert consensus says it isn’t essential, so don’t worry if you forget.
• No headstands or yoga inversions for 48 hours.

The rest of the first day

After 4 to 6 hours you can lie down and wash your face gently, with no scrubbing or exfoliating. The 24-hour rules below still apply.

• Sleep on your back if possible. Side-sleeping during night 1 doesn’t usually cause migration, but back-sleeping is the safe move.
• No weights or light cardio for 24 hours, and no HIIT for 48 hours.
• No hot showers, sauna, hot tub or hot yoga for 48 to 72 hours.
• No alcohol for 12 to 24 hours. It can make bruising worse.
• No ibuprofen (Advil), naproxen (Aleve) or aspirin for 24 hours unless a doctor prescribed it. Never stop a prescribed aspirin or blood thinner without asking the doctor who prescribed it.
• Acetaminophen (Tylenol) is fine for any discomfort.
• Hydrate. 2-3 L of water.

Day 2 to 7: kick-in phase

Most people see it start working within 3 to 7 days. Some feel a faint heavy sensation as the muscles weaken, which is normal.

• Exercise: weights and light cardio are fine after 24 hours, HIIT and inversions after 48 hours, and hot yoga after 48 to 72 hours.
• No facials, peels, lasers or RF/Morpheus8 on the treated areas for 2 weeks.
• No dental work involving cheek pressure (cleanings, fillings) for 2 weeks after lower-face or masseter Botox.
• Normal skincare resumes. Including retinoids, vitamin C, AHAs.
• If you can, avoid flying for 24 to 48 hours.

Day 10 to 14: full effect

This is when your Botox is fully kicked in. If anything looks asymmetric, heavy, or “off”, this is the time to book your 2-week touch-up.

• Photograph the result with the same lighting and angles as your before photo.
• Book the touch-up if necessary.
• Mark your calendar for the 3-month re-treatment window.

Botox aftercare dos and don’ts (printable)

DO

• Stay upright for 4 to 6 hours.
• Frown and raise your brows now and then for the first 2 to 4 hours.
• Sleep on your back tonight if possible.
• Drink 2 to 3 litres of water.
• Use acetaminophen for any discomfort.
• Resume normal skincare day 2.
• Photograph at day 14.
• Book your 3-month re-treatment.

DON’T

• Don’t lie down for 4 to 6 hours.
• Don’t rub, massage or press the treated area for 24 hours.
• Don’t exfoliate for 24 hours.
• Don’t put makeup on the treated area for 4 to 6 hours.
• Don’t do weights or cardio for 24 hours, or HIIT for 48 hours.
• Don’t drink alcohol for 12 to 24 hours.
• Don’t take ibuprofen, naproxen or aspirin for 24 hours unless a doctor prescribed it.
• Don’t take hot showers or use a sauna, hot tub or hot yoga for 48 to 72 hours.
• Don’t get facials, peels, lasers or Morpheus8 for 2 weeks.
• Don’t book dental work with cheek pressure for 2 weeks after lower-face or masseter Botox.
• Don’t do headstands or inversions for 48 hours.
• Don’t fly for 24 to 48 hours if you can avoid it.
• Don’t book back-to-back Botox, 3 months minimum between treatments.

Sleeping position after Botox

The no-lying-down rule covers the first 4 to 6 hours. After that you can lie down normally, but for the first night, back-sleeping is best:

• Why? A pillow pressing on your face goes against the 24-hour no-pressing rule.
• How strict? Day 1 strict. Night 2 onwards normal.
• Stomach sleepers: switch to your back for the first night.

Exercise after Botox, the realistic timeline

Alcohol after Botox

Wait 12 to 24 hours. Alcohol widens blood vessels, which can make bruising at the injection points worse. There’s no evidence it weakens Botox, so a glass of wine on day 2 won’t waste your treatment.

Dental work after Botox

Procedures involving cheek pressure (cleanings, fillings, extractions) should wait 2 weeks if you had Botox in the masseters or lower face. For pure upper face Botox (forehead, glabella, crow’s feet), dental work the next day is fine.

Flights after Botox

If you can, avoid flying for 24 to 48 hours after Botox. There’s little research on flying after Botox, so this is a precaution. If you do fly, the other rules still apply, including no pressure on the treated area.

What’s normal vs. what’s not, when to call us

Get emergency care right away if you have any trouble swallowing, speaking or breathing after Botox, even days or weeks later: go to the nearest emergency department or call 911. Health Canada lists these as serious warning signs, and the Botox Cosmetic patient information says to seek immediate medical care for them. Do not wait to call us first.

If your eyelid droops, call us. We’ll see you in the clinic, check it, write down what we find and let our medical director know. If it suits you, the medical director may prescribe apraclonidine eye drops, which can partly lift the lid while the Botox wears off, and we’ll book a follow-up. A droop from Botox usually starts 3 to 14 days after treatment and goes away as the effect wears off (Nestor 2021). If anything about it looks unusual, we’ll refer you to your own doctor or an ophthalmologist.

Red flags, if your clinic does NOT give you this aftercare

• No written aftercare instructions.
• “You can work out in an hour”, you shouldn’t for 24 hours.
• “Massage it in.” We ask for no rubbing or massage for 24 hours.
• “Lie back, we’ll do a facial mask after”, major aftercare violation.
• No drug name on your receipt. If your receipt doesn’t list “Botox,” “Dysport,” “Xeomin” or “Nuceiva” with units, you don’t know what you got.
• Per-unit pricing far below the going rate. Genuine, properly stored neurotoxin has a real wholesale cost, so a quote that looks too good to be true can be a red flag for diluted, expired, or counterfeit product. Botox at Bar Beauty Medical is $10 per unit.

How long until you see Botox results?

How to make Botox last longer

1. Daily SPF. UV degrades treated tissue and increases new line formation.
2. Daily retinoid. Builds collagen between treatments, lines stay softer.
3. Hydrate.
4. Don’t crowd treatments. 3-4 months between sessions; closer crowding may build antibody resistance.
5. Pick the right neurotoxin. Some people find one brand lasts longer for them than another, so if yours wears off quickly, ask about trying a different one.
6. Adequate dosing. Under-dosing the forehead/glabella means you’ll be back at month 2; correct dose lasts 3-4 months.
7. Expect a shorter run if you train hard. In a 2023 study of 60 women, the effect faded sooner in the most physically active group (Morhy 2023).
8. Zinc supplementation is in the literature for Botox longevity but the data is mixed.

Frequently asked questions

When can I exercise after Botox?

Walking is fine the same day. Weights and light cardio are fine after 24 hours, HIIT and headstands after 48 hours, and hot yoga after 48 to 72 hours because of the heat.

When can I drink alcohol after Botox?

Wait 12 to 24 hours. Alcohol can make bruising worse.

How long until Botox starts working?

Most people notice it within 3 to 7 days, and the full result shows at about 2 weeks.

Can I lie down after Botox?

Stay upright for 4 to 6 hours. After that you can lie down normally, but sleep on your back the first night.

Can I get a facial after Botox?

Wait 2 weeks, pressure and massage during a facial can theoretically migrate Botox.

Can I get Morpheus8 after Botox?

Wait 2 weeks. That’s a precaution. A small 2005 study found lasers, IPL and radiofrequency used within 10 minutes after Botox didn’t weaken it (Semchyshyn 2005), but we’d still let it settle first.

How long does Botox last?

3-4 months for most patients on the forehead/glabella/crow’s feet. Masseter Botox typically lasts 4-6 months.

What happens if I exercise too soon after Botox?

There’s no good research showing what one early workout does, and a 2020 expert consensus says normal activities are fine after 4 hours. We still ask for 24 hours before weights or light cardio and 48 hours before HIIT, because it costs you little. Jasmine is strict about this one. She has had patients rebook their workout class from the chair once they heard the rule.

Can I rub my face after Botox?

Not for at least 24 hours. Massage can migrate the toxin to adjacent muscles.

Do I need to ice after Botox?

It’s optional. If you use a cold compress, hold it on lightly without pressing, since pressure on the area is off limits for 24 hours.

What is the 4-hour rule for Botox?

It’s the common advice to stay upright and leave the treated area alone for about four hours after Botox, to give the toxin time to be taken up where it was placed. Research suggests the uptake itself takes minutes, so the rule is a precaution. At Bar Beauty Medical, Jasmine asks for 4 to 6 hours upright with no makeup, 24 hours with no rubbing, weights or cardio, and 48 to 72 hours away from heat.

What is the rule of 3 in Botox?

“Rule of 3” is an informal phrase you will see online, and people use it a few different ways: results take about 3 days to start, Botox lasts about 3 months, and you wait about 3 to 4 days before judging the outcome. None of these are hard medical rules, but they are a reasonable rough guide. We give you specific timelines for your treatment at your visit.

Can I wash my face after Botox?

Wait 4 to 6 hours, then wash gently with a downward (not upward) motion. No exfoliators or scrubbing for 24 hours.

Can I take ibuprofen after Botox?

Not for 24 hours, unless a doctor prescribed it. Acetaminophen (Tylenol) is fine. If you take aspirin or a blood thinner a doctor prescribed, never stop it without asking that doctor.

Can I fly after Botox?

If you can, wait 24 to 48 hours. There’s little research on flying after Botox, so this is a precaution.

What should I do if my eyelid droops after Botox?

Call us. We’ll see you, check it and let our medical director know. They may prescribe eye drops that can partly lift the lid while it wears off. A droop usually shows up 3 to 14 days after treatment and settles as the Botox wears off.

Is aftercare different for Dysport or Nuceiva?

No. We give the same aftercare for Botox, Dysport and Nuceiva.

Book your Toronto Botox consultation

Bar Beauty Medical emails every Botox patient their aftercare instructions after treatment and follows up at two weeks. Touch-ups are not included in the original price. See our 2026 Toronto Botox pricing for current rates by brand (Botox, Dysport, Nuceiva) and area.

Book a Botox consultation

The Pharmacology of Botulinum Toxin: Why Aftercare Matters Biologically

Botulinum toxin type A (Botox, Dysport, Nuceiva) stops the nerve from releasing acetylcholine, the signal that tells a muscle to contract. The toxin attaches to the nerve ending, is taken inside, and cuts SNAP-25, a protein the nerve needs to release that signal. The muscle stays relaxed until the nerve ending recovers, which takes about 3 to 4 months. How long the uptake takes isn’t well established, but a 2015 paper puts it at minutes, and notes that muscle activity speeds it up and cooling slows it (Hallett 2015). The rules on lying down, heat and hard exercise are there to lower the small risk of the toxin spreading beyond the treated muscle while it settles.

Hour-by-Hour Aftercare Protocol (Expanded)

The first few days after Botox break down into three windows:

• Hours 0 to 6: Stay upright for 4 to 6 hours. Don’t touch, rub or massage your face. No makeup and no facials. For the first 2 to 4 hours, frown, lift your brows and squint now and then.
• Hours 6 to 24: Wash gently if you like, with no exfoliating. No weights or cardio beyond a walk. No sauna, hot yoga, hot showers or hot tubs. No alcohol for 12 to 24 hours.
• Days 2 and 3: Weights and light cardio are fine from 24 hours, HIIT and headstands from 48 hours, and heat from 48 to 72 hours. Light bruising or pinpoint swelling at the injection points is normal, and mineral concealer over fully closed punctures is fine.

Botox vs Dysport vs Xeomin vs Nuceiva Aftercare Differences

We give the same aftercare for Botox, Dysport and Nuceiva. What differs is timing:

• Botox Cosmetic (AbbVie): most people see results in 3 to 7 days (American Academy of Dermatology). The Health Canada patient information says the effect lasts about 4 months and it can’t be repeated sooner than 3 months.
• Dysport Aesthetic (Galderma): in its Canadian product monograph, some patients saw an effect within 24 hours and the median time to onset was 3 days. The effect may last up to 4 months, and it shouldn’t be given more often than every 3 months.
• Xeomin (Merz), which we do not carry: Onset 3-5 days, peak 10-14 days, lasts 3-4 months. No carrier protein, lowest theoretical immunogenicity. Listed here because patients compare it.
• Nuceiva (Evolus): its Canadian product monograph says it typically starts working about 2 days after injection and builds over the first 2 weeks. It shouldn’t be given more often than every 3 months.

Pre-Treatment Preparation: 7-Day Bruising-Reduction Protocol

The week before, if you can, stop anti-inflammatories like ibuprofen and naproxen, fish oil, turmeric and other supplements that thin the blood, such as vitamin E and ginkgo. If a doctor prescribed you aspirin or a blood thinner, keep taking it and ask that doctor before stopping anything. If you bruise easily, you can take arnica beforehand, following the label, and check with a pharmacist if you take other medication. Skip alcohol before your appointment and go light on caffeine on the day. Drink 2 to 3 litres of water a day.

Common Aftercare Mistakes

1. Sleeping face-down the first night. It presses on the treated area, which is off limits for 24 hours.
2. Wearing anything tight across the treated area in the first 24 hours, like ski goggles, a VR headset or a snug headband.
3. Booking a facial or massage too soon. Wait 2 weeks for facials and for any face-down massage.
4. Flying in the first 24 to 48 hours when the trip could wait.
5. Drinking in the first 12 to 24 hours. Alcohol can make bruising worse.

Decision Matrix: When to Call Us Back vs Wait It Out

• Emergency, get care now: any trouble swallowing, speaking or breathing, at any point after treatment. Go to the nearest emergency department or call 911.
• Call us: Eyelid droop (ptosis); severe asymmetric brow; persistent severe headache >48h; visual disturbance; injection-site infection signs (warmth, redness expanding, fever).
• Wait it out: Mild brow asymmetry within first 2 weeks (often levels by day 14); pinpoint bruise; small lump at injection site (resolves <48h); transient heaviness for first 3-4 days as toxin takes effect.

If something worries you outside opening hours, leave us a message and we will call you back the next morning. The emergency signs above still mean going to the nearest emergency department. Our patient help centre has the details.

Sources

• Health Canada, Drug Product Database: Botox Cosmetic, Dysport Aesthetic and Nuceiva product monographs and patient information.
• American Academy of Dermatology. Botulinum toxin therapy: overview.
• Goodman GJ, Liew S, Callan P, Hart S. Facial aesthetic injections in clinical practice: pretreatment and posttreatment consensus recommendations to minimise adverse outcomes. Australasian Journal of Dermatology, 2020. doi:10.1111/ajd.13273
• Hallett M. Explanation of timing of botulinum neurotoxin effects, onset and duration, and clinical ways of influencing them. Toxicon, 2015. doi:10.1016/j.toxicon.2015.07.013
• Nestor MS and colleagues. Botulinum toxin-induced blepharoptosis: anatomy, etiology, prevention, and therapeutic options. Journal of Cosmetic Dermatology, 2021. doi:10.1111/jocd.14361
• Semchyshyn NL, Kilmer SL. Does laser inactivate botulinum toxin? Dermatologic Surgery, 2005. doi:10.1111/j.1524-4725.2005.31105
• Morhy ON and colleagues. High levels of physical activity reduce the esthetic durability of botulinum toxin type A. Toxins, 2023. doi:10.3390/toxins15070463