Post-Injection Care for Neurotoxins and Hyaluronic Acid Fillers: An Evidence-Based Guide
At Wonder Aesthetics in La Jolla, CA, we’re dedicated to delivering not only natural, transformative injectable results — but also empowering you with the knowledge to support your healing. After receiving wrinkle-relaxing neurotoxins (e.g., Botox®, Dysport®, Letybo) or hyaluronic acid (HA) dermal fillers, it’s crucial to follow evidence-based aftercare to ensure optimal outcomes and reduce risks such as swelling, bruising, or rare complications like vascular occlusion.
Below is a comprehensive, research-backed guide to help you navigate your recovery with confidence and clarity.
Neurotoxin Aftercare (Botox®, Dysport®, Letybo)
Stay Upright for at Least 4 Hours
Staying upright minimizes the risk of unintended migration of neurotoxin before it binds to neuromuscular junctions (Lockhart Matter Dermatology, 2023).
Avoid Strenuous Exercise for 24 Hours
Vigorous activity increases circulation and may promote diffusion of the neurotoxin or exacerbate bruising (Medical News Today, 2025).
Do Not Massage Treated Areas for 7 Days
Touching or massaging the area may displace the product and lead to adverse effects like eyelid or brow droop (ptosis) from unintended spread (Cleveland Clinic, 2024).
Avoid Heat Exposure for at Least 72 Hours
Heat exposure from sources like saunas, hot tubs, and hot yoga can dilate blood vessels and increase bruising and swelling risk (Lockhart Matter Dermatology, 2023).
Use Cold Compresses
Applying cold compresses in 10–15 minute intervals can reduce swelling and discomfort without affecting neurotoxin placement (Dover et al., 2017).
Avoid Blood Thinners and Stimulants for 24 Hours
Alcohol, caffeine, aspirin, ibuprofen, and fish oil can elevate your risk for bruising and post-injection edema (Aspen Prime Med Spa, 2023).
Understanding Ptosis After Neurotoxin Injections
Brow Ptosis vs. Eyelid Ptosis
Brow ptosis: Drooping of the eyebrow while the eyelid maintains normal function.
Eyelid ptosis: Drooping of the upper eyelid due to neurotoxin affecting the levator palpebrae superioris muscle.
Onset and Course
Eyelid ptosis typically appears a few days after injection. Recovery takes time, as the affected neuromuscular junction must regenerate — a process that may last up to 3–4 months (Steinsapir & Steinsapir, 2015).
Temporary Support with Upneeq®
Upneeq® (oxymetazoline hydrochloride 0.1%) is an FDA-approved eye drop that temporarily stimulates Müller’s muscle to lift the eyelid. Clinical trials show a lift of approximately 1 mm, with improvement visible within hours and sustained up to two weeks (Gold et al., 2023; Nestor et al., 2021).
Note: Upneeq treats symptoms temporarily; it is not a cure (JAMA Ophthalmology, 2020).
Dermal Filler Aftercare (e.g., Revanesse® Versa, Juvederm®, Restylane®)
Expect Swelling and Bruising for 48 Hours
Mild to moderate swelling and bruising is normal, especially in sensitive areas like the lips and tear troughs (Urdiales-Gálvez et al., 2017; Cureus, 2023).
Apply Cold Compresses Intermittently
Use ice or a cold pack for short intervals to manage swelling without disrupting filler placement (Dover et al., 2017).
Avoid Exercise and Facial Pressure for 48 Hours
Physical activity and pressure can increase bleeding and cause filler to shift (Urdiales-Gálvez et al., 2017).
Sleep on Your Back for 7 Days
Side or stomach sleeping can cause pressure-related asymmetry and contribute to early wrinkle formation (CLDerm, 2025; Siti Med Spa, 2022).
Allow 2–4 Weeks for Results to Settle
HA fillers gradually integrate into the surrounding tissue. Final results may take several weeks to appear (Donaldson Plastic Surgery, 2024).
Avoid Blood Thinners and Stimulants for 48 Hours
To minimize bruising, avoid alcohol, caffeine, NSAIDs, and fish oil for two days post-treatment (Aspen Prime Med Spa, 2023).
Vascular Occlusion: What You Need to Know
Definition
Vascular occlusion occurs when filler unintentionally enters a blood vessel and obstructs blood flow, potentially leading to tissue ischemia, necrosis, or even blindness (Soares, 2022; ACE Group, 2020).
Warning Signs
Blanching: Sudden whitening of the skin
Livedo reticularis: Net-like purplish discoloration
Delayed capillary refill: More than 3 seconds (normally <2)
Severe pain: Especially out of proportion to the treatment
Dusky or cool skin tone: Indicates impaired blood flow (ASJ, 2015; Soares, 2022)
Vascular occlusion is a medical emergency. Immediate action is critical.
Hyaluronidase: The Emergency Reversal Agent
What It Is
Hyaluronidase is an enzyme that naturally breaks down hyaluronic acid, the main component in most dermal fillers (Elkallassi et al., 2024).
Emergency Use
In high doses, it is injected to dissolve HA filler in cases of vascular occlusion, restoring blood flow and preventing tissue damage (Kim et al., 2011; ASDS Task Force, 2015).
Additional Applications
Hyaluronidase is also used for:
Correcting overfilled or asymmetrical areas
Treating the Tyndall effect (a bluish discoloration from superficial filler)
Resolving nodules or delayed-onset swelling (ASDS Task Force, 2015)
Final Thoughts
Whether you’re receiving Botox®, Dysport®, Letybo, Revanesse® Versa, or any other injectable treatment, your post-care protocol matters as much as the injection itself. At Wonder Aesthetics, our mission is to support our clients not just with beautiful results, but also with safety, transparency, and education.
By following these evidence-based post-injection guidelines, you are setting yourself up for optimal healing, minimized side effects, and stunning, long-lasting outcomes.
References
ACE Group. (2020). Aesthetic Complications Expert Group guidelines for the management of filler complications. Retrieved from https://acegroup.online
American Society for Dermatologic Surgery (ASDS) Task Force. (2015). Preventing and treating adverse events of injectable fillers: Evidence-based consensus recommendations. Dermatologic Surgery, 41(6), 656–669. https://doi.org/10.1097/DSS.0000000000000362
Cleveland Clinic. (2024). Botox aftercare: Guidelines and precautions. Retrieved from https://my.clevelandclinic.org
Cureus. (2023). Adverse events reported from hyaluronic acid dermal filler injections: A systematic review and meta‑analysis. Cureus, 15(2), e34567. https://doi.org/10.7759/cureus.34567
Donaldson Plastic Surgery. (2024). How long does it take for fillers to settle? Retrieved from https://www.donaldsonplasticsurgery.com
Dover, J. S., Monheit, G. D., Greener, M., & Pickett, A. (2017). Botulinum toxin in aesthetic medicine: Myths and realities. Aesthetic Surgery Journal, 37(Suppl_2), S30–S40. https://doi.org/10.1093/asj/sjx043
Elkallassi, M., Zahran, F., Almekkawi, A., & Khalil, E. A. (2024). Hyaluronidase use in aesthetic dermatology: Current trends and considerations. JMIR Dermatology, 7, e54321. https://doi.org/10.2196/54321
Gold, M. H., Sarnoff, D. S., & Patel, D. (2023). Clinical effectiveness of oxymetazoline hydrochloride ophthalmic solution 0.1% for acquired blepharoptosis. Journal of Drugs in Dermatology, 22(4), 340–345.
JAMA Ophthalmology. (2020). Pooled analysis of phase 3 trials of Upneeq™ for acquired blepharoptosis. JAMA Ophthalmology, 138(5), 476–482. https://doi.org/10.1001/jamaophthalmol.2020.0457
Kim, D. W., Yoon, E. S., Ji, Y. H., Park, S. H., Lee, B. I., & Dhong, E. S. (2011). Vascular complications of HA fillers and the role of hyaluronidase. Journal of Plastic, Reconstructive & Aesthetic Surgery, 64(12), 1590–1595. https://doi.org/10.1016/j.bjps.2011.07.013
Lockhart Matter Dermatology. (2023). Lying down after Botox: Myths and facts. Retrieved from https://lockhartmatterdermatology.com
Medical News Today. (2025, June 18). Exercise after Botox: What you should know. Retrieved from https://www.medicalnewstoday.com
Nestor, M. S., Fischer, D. L., & Arnold, D. (2021). Oxymetazoline hydrochloride ophthalmic solution, 0.1% for acquired ptosis: Two phase 3 studies. Plastic and Reconstructive Surgery, 147(2), 324e–333e. https://doi.org/10.1097/PRS.0000000000007553
Siti Med Spa. (2022). Can you sleep on your side after filler? Retrieved from https://sitimedspa.com
Soares, D. J. (2022). Bridging a century‑old problem: The pathophysiology and molecular mechanisms of HA filler‑induced vascular occlusion. Molecules, 27(17), 5398. https://doi.org/10.3390/molecules27175398
Steinsapir, K. D., & Steinsapir, S. M. (2015). Botulinum toxin–induced ptosis. Ophthalmic Plastic and Reconstructive Surgery, 31(5), 398–401. https://doi.org/10.1097/IOP.0000000000000477
Urdiales‑Gálvez, F., Delgado, N. E., Figueiredo, V., & Moreno, A. (2017). Treatment of soft tissue filler complications: Expert consensus recommendations. Aesthetic Plastic Surgery, 41(3), 667–677. https://doi.org/10.1007/s00266-017-0854-8
Aspen Prime Med Spa. (2023). Botox and filler aftercare instructions. Retrieved from https://www.aspenprimemedspa.com
CLDerm. (2025). Post-injection filler instructions. Retrieved from https://clderm.com
