A very common question I get from patients is how soon they can exercise after Botox. They are understandably concerned that doing so will negatively impact their treatment. Unfortunately, there is no scientific study to answer this question directly, so we have to review our understanding of Botox to come to a conclusion.
Why Would Exercise Affect Botox
The concern about exercising after Botox is that it will somehow affect Botox results. This concern probably stems from initial worries about the spread of Botox after injection
In the initial clinical trials, about 3% of patients got drooping of their eyelid. One guess as to why this occurred was that Botox diffused away from the initial injection site and affected surrounding muscles.
When injected into the frown muscles, it could have traveled to impact the small muscles that raise the upper eyelid.
To take it a step further, dermatologists have been concerned that the Botox alternatives Dysport and Xeomin may have different diffusion profiles. These could lead to a wider area of spread and a greater risk of unwanted effects.
To limit the risk of spread, injectors commonly recommend that patients avoid lying flat for 4 hours after injection. The worry is that a change in head position may influence the spread of Botox.
Since head position could change with exercise (especially yoga or pilates), if would make sense to avoid these activities. However, there is no evidence that lowering or changing head position after injection influences spread or increases that chance of eyelid droop.
For a shift in head position to really effect Botox distribution, Botox would have to flow easily under the skin similar to how melted wax would run down the side of a candle if it was tilted a little.
To my knowledge, no studies have looked specifically at this. However, we can get an idea of whether or not this could happen by looking at how Botox works.
How Botox Works
Botox is a purified toxin that gets absorbed by nerve endings upon injection. Once in the nerve endings, it blocks the release of chemicals that cause the associated muscles to contract. Thus, it stops wrinkling by blocking signals that trigger muscle contraction and folding of the overlying skin.
We know from scientific study that Botox moves into the nerve endings within 5-10 minutes of contact with them.
Given the facts that changing head position does not influence the spread of Botox and that Botox moves into nerve endings quickly after injection, it would seem unlikely that exercising after Botox would affect results.
Let’s see, though, what happens in the real world.
Botox After Exercise: Real World Observations
I don’t track closely track exactly what patients do after they have had a treatment and left my office, but I am certain that many of them exercise at some point that day. I am willing to bet that a good number have gone to the gym or for a run within a few hours of treatment. Some may even go right away.
If exercise really affected Botox results, I am sure my colleagues and I would have seen a suggestion by now. The truth is, I cannot recall anyone in my practice ever coming back with any concern after a Botox treatment with a history of having exercised shortly after injection.
Given my personal observations and the scientific facts we know about Botox, I think it is very unlikely that any form of exercise would significantly effect the results of a recent Botox treatment.
Right now, I still often recommend that patients avoid lying flat or avoid exercise with significant changes in head position such as yoga immediately after treatment. As we’ve learned, there’s no good evidence for these recommendations, but will I change what I say in regards to exercise after Botox? I probably will over time, but I don’t know yet. Most providers still recommend avoiding exercise after Botox for at least a little while after injection.