Anti-wrinkle injections downtime:
pinpoint marks, bruises and what is not normal

What happens on the day of anti-wrinkle injections?

On the day, each injection point shows a small raised wheal, like a mosquito bite, where a tiny volume of botulinum toxin sits in the muscle or just above it. The bumps flatten quickly, usually before you have left the building, and leave pinpoint marks that are hard to see by the evening. Mild redness around the points is common and settles. A bruise is possible wherever the needle crosses a small vessel, most often at the crow's feet, where the skin is thin and vessels superficial, and more likely in anyone taking blood thinners, aspirin, fish oil or similar supplements, which are asked about beforehand.

The pattern of marks follows the muscles that were examined. Dr Sin Yong examines the upper face at rest, on a full brow raise, in a frown and with the eyes closed, maps where each muscle is active and how strongly, and places small doses accordingly, so the points on one side may not mirror the other; the botulinum toxin Singapore page explains how brow position and lid reserve are read first. The jaw, when treated for slimming, shows a few points over the masseter and can ache slightly on chewing.

Nothing about the face moves differently on the day. The medicine takes effect gradually, so leaving the clinic looking exactly as you arrived is expected. You leave with written aftercare; the anti-wrinkle injections aftercare page sets out the first hours in full.

What do the following days look like and feel like?

Over the following days the pinpoint marks disappear and any bruise passes through the usual colour sequence and fades; it can be covered with make-up once the points have closed. The treated muscles then begin to relax gradually. People often notice the frown feels harder to make before they see any change in the lines, and the full effect is judged at a review timed individually once the medicine has taken effect, which is when any early asymmetry is corrected with a small balancing dose.

The headache note

A mild headache, or a feeling of heaviness or tightness across the forehead, can occur in the first days after upper-face treatment. It is reported in the published literature as one of the commonest effects, is thought to relate to the injections and the change in muscle tone rather than to the medicine spreading, and usually passes on its own; paracetamol is enough if anything is needed. A headache that is severe, one-sided or accompanied by visual change is a different matter and is reported.

What to avoid in the first hours and days

• Rubbing, massaging or pressing on the injected areas, which can move the medicine toward a neighbouring muscle
• Lying flat, bending forward for long periods, and strenuous exercise in the first hours, as advised
• Heat, saunas and alcohol on the day, which increase bruising
• Facials, facial massage, tight headbands, hats or helmets that press on the area, until the medicine has settled
• Judging the effect, or asking for more, before the planned review

“You should leave looking exactly as you arrived. The change comes over the following days, and a lid that drops comes with it, which is why I dose the forehead for the eyelids first and the lines second.”

Dr Sin YongOn recovery after anti-wrinkle injections

What is not normal after anti-wrinkle injections, and when should you call?

Not normal: an upper eyelid that droops, so that the eye looks smaller or the lid sits lower on one side; a brow that feels heavy or sits lower than the other, especially on raising the eyebrows; a smile that has changed, with one corner lifting less, or the upper lip moving differently; double or blurred vision; increasing redness, pain or warmth at an injection point; or a rash or swelling of the face after the injection. Each has a mechanism and each is assessed rather than waited out without advice.

A drooping eyelid, ptosis, follows if the medicine reaches the muscle that lifts the lid, usually from the frown-line points; it appears in the days after treatment, not on the day, and it is temporary but lasts as long as the medicine does, which is why it is managed rather than ignored. A heavy brow follows from relaxing the frontalis more than the lids can afford, which is the reason brow position is read first and the forehead dosed conservatively. A changed smile follows from spread near the muscles that shape it, after crow's feet or bunny-line points. Eyelid drooping, double vision, difficulty swallowing, speaking or breathing, or generalised weakness, appearing hours to weeks after injection, are rare and need emergency care without waiting for a reply.

Contact the clinic during clinic hours with a photograph of the face at rest and in movement; the complication care page lists what goes to an emergency department the same day, wherever you are. The forehead and frown lines page explains why the glabella and forehead are planned as a set.

Can I wear make-up, exercise and fly after anti-wrinkle injections?

Make-up can usually go on after the first hours, once the points have closed, applied gently without pressing or rubbing over the injected areas; a bruise can be covered at that stage. Exercise waits until the first hours have passed, as advised, because exertion and bending forward increase blood flow and can encourage spread; after that, ordinary activity resumes. Heat, saunas and alcohol are left for the day, since they make bruising more likely. Gentle use of the muscles as normal is fine and does not need to be avoided.

Sun protection applies as it does every day, with no special rule beyond avoiding strong sun and heat on the day. Normal skincare resumes gently, with strong actives restarted when the skin is comfortable. Flying is not usually restricted, since nothing is open and the effect develops wherever you are; the flying after treatment page covers how review by photograph works for visitors who have returned home.

How should you plan anti-wrinkle injections around work and events?

Anti-wrinkle injections can be fitted around a working day, because the marks are pinpoint and the bumps have gone before you leave. Plan instead around two things: a possible bruise at the crow's feet, which a face that bruises easily should allow to fade before a photograph; and the tempo of the effect, which develops gradually and is checked at a review timed once the medicine has worked. An event the day after treatment shows you the marks without the effect; the review and any balancing dose need to have happened before the day that matters.

Dosing starts conservatively, because an effect cannot be reversed on demand and lasts as long as the medicine does, so the review is where early asymmetry is corrected, where a bulge at the jaw angle from an untreated layer of the masseter is addressed, and where the timing of any repeat is decided. No duration is promised. Whether the lines you see are dynamic, and suit this treatment, or are etched at rest and need a skin treatment or filler instead, is decided at consultation; the botulinum toxin vs dermal fillers comparison sets out the difference.