How to Prepare for BOTOX Injections
Medications and Supplements to Adjust Before BOTOX
According to the Cleveland Clinic (2023) and Stanford Medicine (2021), you should avoid blood-thinning medications and supplements for 7 to 10 days before BOTOX injections. These substances impair platelet function and increase bruising at injection sites.
Over-the-counter medications to pause include aspirin, ibuprofen, and naproxen. Ask your doctor before stopping any prescription blood thinner like warfarin or other anticoagulants. Your prescribing doctor must approve any changes to medically necessary medications.
If you cannot stop a prescription blood thinner, let your injector know. Your doctor can still perform the treatment, but you should expect more bruising than usual. Adjusting the injection technique and applying ice can help reduce bruising in patients who must continue these medications.
Fish oil, vitamin E, garlic supplements, ginkgo biloba, and green tea extract can thin your blood and increase bruising. Stop these supplements at least one week before your appointment (Stanford Medicine, 2021). These are not prescription medications, so you can safely pause them without medical clearance in most cases.
Make a list of all supplements you take and share it with your injector at least a week before treatment. Some supplements you may not think of as blood thinners can still affect how easily you bruise.
Some injectors recommend starting arnica supplements three days before treatment to help reduce bruising. While controlled clinical evidence for arnica varies, many practitioners and patients find it helpful (Fort Worth Med Spa, 2024).
According to the Cleveland Clinic (2023), avoid alcohol for at least 24 hours before your BOTOX appointment. Alcohol acts as a vasodilator, opening blood vessels and thinning your blood, which increases bruising and swelling at injection sites.
Moderate caffeine intake on the day of treatment is fine for most patients, though excessive caffeine may increase sensitivity. Staying well hydrated the day before and the morning of your appointment helps your body respond well to treatment and reduces the chance of lightheadedness.
Eat a normal meal before your appointment. According to the Cleveland Clinic (2023), arriving well-hydrated and having eaten reduces lightheadedness during and after the procedure.
Medical History and What to Tell Your Doctor
According to the FDA (2021), patients with neuromuscular junction disorders like myasthenia gravis, Lambert-Eaton syndrome, or ALS (amyotrophic lateral sclerosis) should disclose these conditions before treatment. BOTOX can cause unpredictable muscle weakness in patients with these disorders.
BOTOX is not recommended during pregnancy or breastfeeding. According to the FDA (2021), animal studies showed adverse effects at clinically relevant doses, and adequate human safety data do not exist. If you are pregnant, planning to become pregnant, or breastfeeding, postpone treatment.
Tell your doctor about any previous BOTOX or neurotoxin treatments, including when you last received injections and whether you experienced any complications. Previous adverse reactions or reduced effectiveness may influence your treatment plan.
According to Stanford Medicine (2021), patients with an active skin infection, rash, or cold sore (herpes simplex) at or near the planned injection site should postpone treatment until the skin has cleared completely. Injecting through compromised skin increases infection risk.
If you have a history of cold sores around the mouth or nose area, tell your doctor even if you do not have an active outbreak. Your doctor may prescribe antiviral medication to take before treatment as a preventive measure.
Recent facial treatments like chemical peels, microdermabrasion, or laser procedures may leave your skin sensitive. Let your doctor know about any procedures you have had in the past month so they can determine whether your skin has healed enough for BOTOX.
Bring a complete list of all prescription medications, over-the-counter drugs, and supplements to your appointment. Your doctor needs this information to identify any substances that increase your risk of side effects.
Disclose any allergies, including allergies to botulinum toxin products, cow's milk protein (present in some formulations), or any other medications. If you have had an allergic reaction to a previous cosmetic treatment, describe what happened.
- List all prescription medications, including blood thinners and muscle relaxants
- Include over-the-counter pain relievers and allergy medications
- Note all vitamins, herbal supplements, and dietary products
- Mention any previous adverse reactions to injectable treatments
Practical Preparation for Your Appointment Day
Schedule your BOTOX appointment at least two weeks before any major social event. Full results take 7 to 14 days to appear (Cleveland Clinic, 2023), and mild bruising or swelling may be visible in the first few days. Giving yourself a two-week buffer ensures you look your best for important occasions.
Avoid scheduling BOTOX during an active illness, when you are running a fever, or immediately after dental procedures that used local anesthesia. Your immune system should be in good shape on treatment day.
Morning appointments work well for many patients because you can follow aftercare instructions for the rest of the day. If you schedule an afternoon appointment, plan a quiet evening at home without exercise or social obligations.
Arrive with a clean face and no makeup in the treatment area. Your doctor needs to see your skin clearly and apply antiseptic before injection. If you normally wear makeup to the office, bring it to reapply after your appointment if desired.
Wear comfortable clothing that does not require pulling over your face, since you should avoid touching the treatment area after injections. A button-down shirt or zip-up top works well.
Bring a list of your current medications and supplements if you have not already shared them with your doctor. Also bring your photo ID and any paperwork your provider requested in advance.
BOTOX injections use a very fine needle, and most patients describe the sensation as a quick pinch. According to the Cleveland Clinic (2023), topical numbing cream can be applied 30 to 45 minutes before treatment to reduce discomfort.
Ask your provider whether they apply numbing cream as part of their standard protocol or if you need to request it in advance. Some offices ask patients to arrive early so the numbing cream has time to take effect.
Cold packs applied briefly before injection can also reduce discomfort. Many patients find that the procedure is quicker and less uncomfortable than they expected.
Preparing for BOTOX: Your Questions Answered
Light exercise on the morning of your appointment is generally fine. However, intense exercise that raises your heart rate and body temperature can increase blood flow to your face and make you more prone to bruising. Consider saving your vigorous workout for a rest day and keeping your morning activity light.
You do not need to stop most skincare products before BOTOX. However, avoid applying retinol, glycolic acid, or other potentially irritating products on the treatment area the day of your appointment. Your doctor can advise on specific products to pause if your skin is sensitive.
Reschedule your appointment if you have an active infection, fever, or are not feeling well. Your immune system is working hard when you are sick, and your body may respond differently to treatment. Most providers prefer to treat patients when they are in good health.
Stop using gua sha tools, jade rollers, microcurrent devices, and facial massage tools for at least one week before periocular BOTOX. According to CosmeticInjectables.com (2024), these devices can increase baseline skin sensitivity and make you more prone to bruising at injection sites.
Yes. Acetaminophen does not thin the blood and can be used before your appointment if you need pain relief. Avoid aspirin, ibuprofen, and naproxen because these are anti-inflammatory drugs that impair platelet function. Your doctor can confirm which pain relievers are safe to use in the days leading up to treatment.
Tell your injector at the start of your appointment. Your doctor may decide to proceed with the understanding that you have a higher bruising risk, or may suggest rescheduling if you recently took a strong blood thinner. Honest disclosure helps your doctor make the safest decision for your situation.
Schedule Your BOTOX Consultation
Your eye doctor can evaluate your treatment areas, discuss preparation steps specific to your medical history, and answer any remaining questions. Contact our office to schedule your BOTOX consultation and start planning for your treatment.