Botox is expensive, and to get the most for your money, you’ll need to follow specific post-injection guidelines to prevent compromising your results. While the aftercare instructions are not necessarily “safety” concerns for your general health, there are “aesthetic ramifications” to not following protocol, said Kristina Kitsos, an aesthetic registered nurse of 20 years who practices in Beverly Hills.

“If you don’t follow the proper aftercare, you risk uneven or unnatural results due to the Botox migrating to unintended muscles, droopy eyelids or asymmetry from Botox shifting, increased bruising and swelling ... and reduced longevity of Botox results due to increased metabolism from intense activities too soon,” explained Melanie Abeyta, a nurse practitioner aesthetic injector and the owner of Harmony Aesthetics Center in Los Angeles.

To avoid impacting your results, cosmetic injectors would never do the following immediately after getting Botox:

1. Rubbing Or Massaging The Area

“You should avoid rubbing or massaging the treated area for at least 24 hours after getting Botox injections,” advised Abeyta. “Botox needs time to settle into the muscle, and pressure can cause it to migrate, potentially leading to uneven results or affecting unintended muscles, such as causing a droopy eyelid.”

“The reasoning is twofold,” explained Kitsos. “One reason is that rubbing or massaging the treated area would increase the temperature and blood flow in the tissue, possibly dilating blood vessels and increasing blood perfusion rates in the tissues. This would increase the chances that small vessels punctured with injections re-open and can cause bruising and swelling.”

“The other reason is that, theoretically, manipulating the tissue could alter where the Botox ends up,” Kitsos continued. She explained that the muscles of the face are very small, and many are interconnected and in close proximity to one another. “Botox injections are very precise, and it is possible for the product to migrate into an adjacent muscle especially when getting a facial or having any sort of manual manipulation of the tissue. Leaving the tissues alone gives the body enough time to properly heal and seal the small vessels and prevent unnecessary bruising, swelling and prolonged healing.”

2. Getting A Facial The Same Week

Similarly, “facials involve massage, pressure and sometimes heat, all of which can interfere with Botox placement,” added Abeyta. “Avoid facials, chemical peels and microdermabrasion for at least seven days post-injections to ensure optimal results.”

3. Exercising Within A Couple Days

After Botox, you should “wait 24 to 48 hours” before getting a workout in, said Kitsos. “This is because exercise increases temperature, blood pressure and perspiration rates. These all increase blood perfusion rates, thus raising the chances that small vessels punctured with injections reopen and can cause bruising and swelling that would otherwise not have been an issue.”

4. Wearing Tight Headgear

“Items such as helmets or tight hats can put pressure on the treated areas and should be avoided for at least 24 hours,” said Abeyta.

5. Drinking Alcohol Within A Couple Days

You’ll also want to postpone a post-Botox night out. “Alcohol is a vasodilator, meaning it causes blood vessels to widen,” said Kitsos, who recommends waiting 24-48 hours before drinking alcohol. “Alcohol’s vasodilatory effect can lead to increased blood flow and flushing of the face. This facial flushing increases the chances of swelling and product migrations into adjacent muscles, which would ultimately lead to a less-than-ideal aesthetic outcome.” She also added that alcohol is also pro-inflammatory, which could slow healing and recovery.

6. Flying In An Airplane

It’s best to leave a gap between your pre-vacation injections and stepping on a plane. “Changes in cabin pressure and increased movement may cause swelling,” explained Abeyta. “If possible, wait 24 hours after getting Botox before flying.”

7. Taking Blood Thinners

“Blood thinners can increase bruising post-injection,” explained Abeyta. “If blood thinners are required for a medical condition, you must mention that [to] your provider or injector before your Botox treatment so they can advise you appropriately. I also recommend avoiding taking aspirin or ibuprofen for at least 24 hours before and after treatment unless otherwise advised by your doctor.”

Kitsos even recommended that patients avoid blood thinners “seven to 10 days” before treatment to “decrease the chances of bruising and swelling.”

8. Applying Harsh Skin Care Actives

“Avoid using strong acids, retinoids, or exfoliants for at least 24 to 48 hours post-Botox injections to prevent irritation,” said Abeyta.

9. Using A Sauna Or Tanning Bed

“I recommend that my clients wait at least 24 hours after injection before going into a sauna,” explained Kitsos. “It’s never a good idea to use a tanning bed, but if they were to use one, I would recommend that they also wait to do so for 24 hours post injection.”

“Waiting 24 hours gives the body enough time to properly heal and seal the small vessels and prevent unnecessary prolonged healing.”

10. Lying Down Within Four Hours

“Lying down too soon after your treatment can increase the risk of the Botox migrating,” said Abeyta. “I advise patients to remain upright for at least four hours post-treatment. This helps ensure the product stays exactly where we intended it.”

11. Sleeping On Your Face

When you do get some shut-eye, “avoid sleeping face-down for at least 24 hours post-injections to prevent Botox from shifting,” added Abeyta.