Before surgery: what to prepare
Stop aspirin, ibuprofen, naproxen, fish oil, vitamin E, ginseng, ginkgo for 5–7 days before to reduce bruising. Skip alcohol for 24 hours before. Avoid scheduling Botox the day of a major event; allow at least 2 weeks for the effect to settle and any touch-ups to take effect. If you have a history of headaches that have ever been diagnosed as related to a neurological condition, mention this in consultation. Botox is contraindicated in pregnancy, breastfeeding, and in patients with neuromuscular conditions including myasthenia gravis, Lambert-Eaton syndrome, and amyotrophic lateral sclerosis. Aminoglycoside antibiotics potentiate the toxin and should be flagged. Tell the injector about any current antibiotics or recent neurological diagnoses.
The day of surgery
Botox is performed in clinic without anaesthesia (numbing cream is optional for sensitive patients), takes 10–20 minutes, and you walk out immediately. Tiny pinprick bleeding at the injection sites stops within minutes. There are no dressings, no bandages, no restrictions on going back to work the same day.
Days 1–3: peak swelling
No visible change in the muscle effect yet. Botox takes 3–7 days to begin working. Small bruises at the injection sites are possible and can appear in the first 24 hours. Mild headache for some patients in the first 48 hours, typically resolved with paracetamol (not ibuprofen). Avoid lying flat, rubbing or massaging the treated area, and strenuous exercise for the first 4–6 hours to reduce migration risk. Skip saunas, hot tubs, and intense workouts for 24 hours, heat and elevated blood flow can move the toxin to muscles you do not want treated, most concerning around the eyelid.
Week 1: stitches out, bruising fades
The muscle effect becomes visible between day 3 and day 7. Forehead lines smooth out, frown lines soften, crow's feet relax. Small bruises fade. Office work and normal activity throughout, no restrictions beyond the first day.
Weeks 2–4: back to public
Effect is at peak by week 2 and stable. Any minor under-correction or asymmetry is assessed at the 2-week follow-up and can be touched up with a small additional dose if needed.
Months 2–3: swelling resolves
Effect remains stable for most patients through month 3. Masseter Botox for jaw-slimming starts to show visible muscle reduction between weeks 4 and 8 and peaks around weeks 8–12; the muscle physically atrophies from disuse, which is a slower physical change than the wrinkle effect from upper-face Botox.
Months 6–12: the final result
Effect wears off gradually between month 3 and month 6 for most patients; masseter and other large-muscle treatments can last 6 months or longer. Repeat treatment is scheduled before the effect fully wears off, usually at month 3–4 for upper face and month 5–6 for jaw. Long-term repeat use of Botox at the same site can lead to gradual muscle atrophy and longer-lasting effect over years.
Red flags: when to call the clinic
Call the clinic the same day for: sudden swallowing difficulty, breathing difficulty, drooping of an eyelid (mild ptosis can occur from migration and usually resolves over weeks, but it should be reported), facial weakness on one side that is asymmetric in an unexpected way, vision changes, or generalized muscle weakness, these are rare effects of botulinum toxin migration or systemic spread. Go to an emergency room for difficulty breathing or swallowing combined with generalized weakness, especially in the first 1–2 weeks. Routine pinprick bruising, mild headache in the first 48 hours, and small under-correction at week 1 are not red flags.