Botox Aftercare: The First 24 Hours

Botox needs very little aftercare, and you can go straight back to work. There is a short list of things we ask you to do for the rest of the day. It is worth being honest about them: most are sensible precautions rather than rules proven in trials, and we will say which is which.

What we ask you to do

• Stay upright for about four hours. No lying down or napping.
• Do not rub, massage or press on the treated areas for the rest of the day. If you wear makeup, apply it gently without pressing or rubbing it in.
• Leave strenuous exercise until tomorrow. Normal walking and everyday activity are fine.

How much evidence is behind these?

Less than you might think. A review of common beliefs about aesthetic botulinum toxin concluded that post-treatment instructions are widely used despite a lack of evidence that they change results or side effects. It specifically found no evidence that lying down affects eyelid drooping or how far the toxin spreads. A 2025 study of about 5,000 patients treated for upper-face lines with minimal aftercare restrictions found low complication rates and high satisfaction. That study looked back at records rather than comparing groups in a trial, so it does not prove the rules are unnecessary either.

Reputable sources also disagree on the details. The American Academy of Dermatology advises waiting two hours before strenuous activity. Cleveland Clinic advises staying upright for three to four hours, avoiding rubbing or pressure for 12 hours and avoiding physical exertion for 24 hours. We sit toward the cautious end because these steps cost you very little, and they are aimed at the result everyone wants to avoid: product affecting a muscle it was not meant for.

One more thing that surprises people: you do not need to keep your face still. Some early research suggests that using the treated muscles normally afterwards may, if anything, help. We simply ask you not to rub or press on the area.

What is normal

Small raised bumps at the injection points, which settle within hours to days. Some redness. A bruise, which can take about a week to fade. A headache on the day.

Do not expect to see a change the same day. The effect typically starts after one to two days, builds through the first week, and is complete at around two weeks. That is when we check how you have responded, so try not to judge the result before then. Our first-time guide covers that check.

When to call us

Call the office at (703) 250-5072 if you notice a drooping eyelid or a heavy brow, a smile or expression that looks uneven, dry or irritated eyes that do not settle, or redness, warmth or swelling at an injection site that gets worse instead of better. These are uncommon, and most are temporary, but we want to know.

When it is an emergency

All botulinum toxin products carry an FDA boxed warning. Rarely, the effect can spread beyond the injection site, and symptoms can appear hours to weeks after treatment, not only on the first day. If you have trouble swallowing, speaking or breathing, double or blurred vision, or new muscle weakness away from the treated area, call 911 or go to the nearest emergency room, and tell them you have had botulinum toxin. The same applies to signs of a serious allergic reaction, such as hives, swelling of the face or throat, or difficulty breathing.

The BOTOX Cosmetic label reports no definitive serious cases of distant spread at its labeled cosmetic doses, so this is rare, but knowing the signs is part of having the treatment safely. For how long your results should last and when to rebook, see how long Botox lasts.