Botox & Fillers

Two Weeks Before Your Injections

• Medications and supplements. Talk to your primary care doctor or specialist. If you are on blood thinners, you may need to stop them a few days to weeks before your treatment. Speak to your prescribing physician about the safety of stopping and restarting these medications. We do not recommend that patients on life-saving medications stop them in order to have any cosmetic procedure.
• Cold sores. If you are prone to cold sores, you may need to start a preventive dose of an antiviral medication before your injections. Your physician will prescribe it before your treatment if it is needed.

Day of Your Injections

• Eat and drink before your treatment. It is not uncommon for patients to pass out or feel lightheaded during injections. Good blood sugar and hydration make it less likely that you will feel queasy during your treatment.
• Dress comfortably, cool, and in layers. Wear something you can take off if you get warm. Patients who feel too warm are more likely to feel lightheaded or faint during injections.
• Minimize makeup and lotions in and around the areas to be injected. Our medical assistants will remove your makeup before treatment. You can bring makeup to apply right after your treatment.
• Topical numbing: 20–30 minutes. We recommend numbing cream before injections. It needs a good 20–30 minutes to take full effect. We ask all filler patients to come a little early to allow time for numbing.

Bruising and Filler Safety

• Bruising is very common. It almost always happens to some degree, and many patients are surprised to hear it. Bruises usually last 1–2 weeks, sometimes longer, and can show up several days after treatment. Full-coverage concealer can usually cover them. Tear troughs and lips bruise more easily because they have more blood vessels.

After Your Injections

After filler injections it is normal to have some swelling, pinpoint bleeding, and bruising. If numbing cream was used, you will feel numb for another 1–2 hours. Follow these instructions to minimize swelling and bruising and shorten your downtime.

• Ice. Use a small bag of frozen peas or crushed ice in a sandwich bag to gently ice the area. No heavy ice bags. Ice for 20 minutes on and 20 minutes off, and continue for 48 hours after filler injections if possible.
• Minimize strenuous exercise. No strenuous exercise for 24 hours, to reduce swelling and bruising from filler injections.
• Do not manipulate, massage, rub, or poke the area. Unless your provider specifically advises it, do not massage or manipulate your face. You can wash your face gently. Avoid facials and rough scrubbing for 72 hours; after that, a facial is fine as long as you are not bruised or very swollen.
• Makeup and concealer. You can use makeup and concealer the day of your injections to help cover any bruising.
• Non-surgical rhinoplasty: glasses and goggles. Avoid glasses that dig into the injected area. Bring your glasses to your appointment so we can evaluate whether they are appropriate to wear afterward. If you are an avid swimmer, mention swim goggles during your consultation.
• Arnica and bromelain. Start Arnica and bromelain supplements after your injections, not before. They help bruising and swelling fade faster.
• Pineapple. Eat pineapple, including the center core, and drink pineapple juice. Pineapple has natural anti-inflammatory properties that help minimize swelling after injections.
• Do not over-evaluate your face for the first two weeks. Bruising, swelling, and asymmetry are normal for the first two weeks. Wait until the swelling and bruising are completely gone to judge your final result.
• Tylenol for pain. Some pain and sensitivity in the injected area is normal. Most patients find Tylenol relieves it. Avoid NSAIDs such as Motrin and ibuprofen; they can make swelling and bruising worse.

What to Expect

• Botox® and Dysport®. They take up to 2 weeks to fully work. You may notice the effect as soon as 3 days, but do not be surprised if it takes the full 2 weeks. On average they wear off in 3–4 months and are repeated 3–4 times a year.
• Botox in the neck (platysma). Rarely, neurotoxin in the neck can cause difficulty swallowing or breathing. Call us right away if you have trouble swallowing. If you have trouble breathing, call 911.
• Swelling. Swelling may not be even from side to side, depending on existing facial asymmetry, the amount of filler, and bleeding at each injection site. Initial swelling takes 2 weeks to settle. Sleeping propped up and icing help. Avoid exercise for the first 24 hours or longer, and do not massage the area; both can aggravate swelling.

• Lumps and bumps can be normal. Filler is stiffer than your own fat, so you may be able to feel it, especially if you feel the area thoroughly. Do not massage or manipulate the area. The lumpy feeling usually improves within 2 weeks.
• Subtle results. A 1 cc syringe of filler is about one-fifth of a teaspoon. Once swelling subsides, you may want more filler for more volume. Our physicians are conservative, never over-inject, and prefer to add volume gradually. Results tend to fade faster after your first treatment; with repeat treatments they last longer as you build your own collagen around the injection sites.
• How long does filler last? Every person is different. We never want filler to wear off completely before we add more, so instead of asking how long filler lasts, think about how often you need a small touch-up to maintain your result. For most areas that is typically twice a year. Lips tend to fade faster, so they may need touch-ups more often.
• Dry lips. Lips will be drier after injections. Ice them (no more than 20 minutes at a time) and keep them lubricated with Vaseline.