You booked six weeks ago. There’s a wedding on Saturday, your Botox treatment is on Thursday, and a quick search for what you’re supposed to do between now and then has produced seven answers that contradict each other. One page says no ibuprofen for two weeks. Another says 24 hours. A third mentions arnica, fish oil and something about not lying down. None of them were written by the aesthetic practitioner holding the needle, and none of them know which Botox product is going into your forehead or at what dose.
Much of that advice gets recycled from one clinic page to the next without anyone checking it, and some of it is wrong in a way that matters. This is what actually changes your outcome in those seven days, what makes no difference at all, and the one instruction you should never follow without speaking to your general practitioner first.
How to Prepare for Botox and What It Actually Controls
Preparation controls one thing well and two things partially. That’s the honest version.
It controls bruising. Injections into the forehead, glabella and around the eyes go through skin with a dense superficial vascular network. A needle catching a small vessel is the most common cosmetic complication and it’s the one your behaviour genuinely influences.
It partially controls how accurate your practitioner’s assessment is, because that depends on you giving them a complete medical history rather than the edited version.
It partially controls timing, in the sense that booking sensibly means you aren’t bruised in photographs.
It does not control how well the toxin works. The onset and duration of the result come from the dose, the injection depth, the muscle being treated and your own metabolism. No amount of hydration, arnica cream for bruises or clean living will make 20 units behave like 30. Anyone telling you otherwise is selling something.
The Seven-Day Checklist That Actually Matters
The useful version of what to do before botox is short.
Book two weeks clear of anything photographed
Bruises from injections around the eyes typically take seven to ten days to fade fully, and they often go through a yellow-green stage before they disappear. Onset of effect also takes time. You’ll usually see the first softening at three to five days and the settled result at ten to fourteen days.
Two weeks between appointment and event covers both. One week is tight. Two days is how people end up with a green glabella in the group photo.
Write down every medicine and supplement you take
Not a summary. The actual list, including things you don’t think count: the daily aspirin, the cod liver oil capsules, the ginkgo you started for concentration, the antibiotics you finished last Tuesday.
Antibiotics matter more than most people realise. Aminoglycosides, meaning gentamicin, neomycin and streptomycin, interfere with transmission at the neuromuscular junction. The Botox Summary of Product Characteristics notes that the effect of botulinum toxin may theoretically be potentiated by aminoglycoside antibiotics or spectinomycin, or other medicinal products that interfere with neuromuscular transmission. Amoxicillin, which is the one most people in the UK have actually been prescribed, is not a problem.
Neuromuscular conditions are a separate and more serious category. The SmPC states that Botox should only be used with extreme caution and under close supervision in patients with subclinical or clinical evidence of defective neuromuscular transmission, such as myasthenia gravis or Lambert-Eaton syndrome, and in those with peripheral motor neuropathic diseases, because these patients may have increased sensitivity even at therapeutic doses. If any of that applies to you, say so at the consultation, not on the treatment couch.
This is exactly why the consent form isn’t just paperwork to get through before treatment starts. A proper consent process is where medications, allergies, neuromuscular conditions and previous reactions should all be disclosed and reviewed, giving the practitioner the chance to catch a contraindication before the needle comes out, not after. Rushing through it, or treating it as a formality signed on the couch, defeats the point. Take the time to read it, ask questions if anything is unclear, and be honest about your medical history. A good practitioner will want that conversation to happen properly, and a good consent form gives both of you the paper trail to show it did. You can read here about the Botox consent form to see what it actually covers.
Check there’s nothing brewing on your skin
Active infection at the injection site is an absolute contraindication. That includes a cold sore working its way up, an infected ingrown hair on the brow, or an inflamed spot in the glabella. It won’t be a conversation about aesthetics. A competent practitioner will simply reschedule you.
What Not to Do Before Botox: Medicines, Supplements and One Exception
This is where most online advice becomes actively unsafe, so read this section properly.
The list of things that increase bruising risk is well established. Aspirin, ibuprofen, naproxen and other NSAIDs all affect platelet function. So do several common supplements: fish oil and omega-3, vitamin E, ginkgo biloba, ginseng, high-dose garlic and St John’s wort. Alcohol is a vasodilator with mild blood-thinning properties on top.
The standard advice is to stop the over-the-counter versions of these for around seven days beforehand, and the alcohol for 24 to 48 hours.
Here’s the exception, and it’s the important one. If you take an anticoagulant or antiplatelet because a doctor prescribed it, meaning warfarin, apixaban, rivaroxaban, clopidogrel, or low-dose aspirin after a cardiac event, do not stop it. Not for a day, not for a week, not because a clinic’s pre-treatment email said to avoid blood thinners. Those emails are written with paracetamol and fish oil in mind. Stopping prescribed anticoagulation for a cosmetic appointment carries a risk of stroke or clot that is not remotely proportionate to the risk of a bruise on your forehead.
Tell your practitioner you’re on it. A good injector will use a finer gauge needle, work more slowly, apply firmer pressure and warn you that you’re likelier to bruise. That’s the correct adjustment.
If you need pain relief in that window, paracetamol doesn’t affect platelets and is the sensible choice.
Can I Exercise Before Botox?
Yes. This is one of the most searched questions on the topic, and the answer is less restrictive than people expect, because the restriction most people are half-remembering applies afterwards, not before.
The only sensible caveat is timing on the day. Finishing a hard session an hour before your appointment leaves your heart rate and blood pressure raised and your face flushed, which makes you marginally more likely to bruise and makes it harder for the injector to assess your resting muscle tone. Give it a couple of hours, or train in the morning for an afternoon appointment.
The real planning point is the 24 hours afterwards. Strenuous exercise, hot yoga, saunas and steam rooms are all off the table for a day post-treatment. If you train five days a week, book on a rest day or the evening before one. That’s the scheduling decision worth making a week out, and it’s covered properly in the Botox aftercare guide.
What Not to Do the Night Before Botox
It comes down to three things, and only one of them is really important.
Skip the alcohol. This is the one that counts. A bottle of wine the night before is the most reliable way to give yourself bruises the next day.
Don’t start anything new on your skin. That evening is not the moment to trial a retinol you’ve never used or a strong acid exfoliant. Irritated, compromised skin bruises and reacts more.
Sleep normally and eat breakfast. Fainting during injections happens, it’s usually vasovagal, and it happens far more often to people who arrived tired on an empty stomach. It isn’t dangerous but it’s unpleasant and it can turn a fifteen-minute appointment into an hour.
Caffeine gets a lot of attention in pre-treatment advice. The evidence for it meaningfully increasing bruising is thin. If you want to skip your second coffee, fine. If you’re anxious about the appointment and coffee makes that worse, skip it for that reason instead.
Before Botox Care for Your Skin
Good skin preparation is mostly about doing less than usual.
Pause retinoids, glycolic and salicylic acids, and any strong exfoliant for around three days beforehand. These thin the stratum corneum and leave skin more reactive at the injection points. Keep cleansing gentle and moisturise normally.
Don’t book facials, chemical peels, microdermabrasion or laser treatments in the same week. Space them at least two weeks either side.
Turn up with a clean face. Makeup over the injection area has to come off anyway, and arriving without it saves time and removes a source of contamination at the puncture sites.
Skip the arnica. It’s recommended constantly and the clinical evidence for oral or topical arnica preventing bruising is weak. It won’t hurt you, but it isn’t preparation.
What to Do Before Botox Appointment
The morning checklist is short: eat, arrive without makeup, bring your medication list, and bring photographs of your face expressing, so frowning, raising your brows and smiling hard, if you have concerns about asymmetry you want to discuss.
Then use the consultation properly. Ask which product is being used and which unit strength. Ask who prescribed it. In the UK, botulinum toxin can only be prescribed by a doctor, dentist, or nurse or pharmacist prescriber, and that prescriber must have assessed you personally. If nobody has examined you and someone is preparing to inject, that’s the point to stop the appointment. The detail on verifying this is in our guide to how to check your Botox practitioner is qualified, and the Joint Council for Cosmetic Practitioners maintains a public register you can search.
What’s Actually in the Vial
Understanding the product helps you read a price list and spot when something is off.
Botulinum toxin type A is supplied as a freeze-dried powder that the practitioner reconstitutes with sterile saline immediately before use. It’s measured in units of biological activity, not millilitres, and the units are brand-specific. Twenty units of one toxin is not equivalent to twenty units of another. This is why “how many units” is the only meaningful question about dose.
Vials come in fixed sizes. Botox 50 Units is the smallest, typically used by lower-volume clinics or for single-area treatment where waste matters. Botox 100 Units is the standard vial most UK aesthetic clinics work from, and a full upper-face treatment across frown lines, forehead and crow’s feet usually falls somewhere between 30 and 64 units depending on your muscle bulk. Botox 200 Units is a higher-strength presentation used mainly for larger therapeutic doses such as hyperhidrosis or masseter work.
Once reconstituted, a vial has a limited window. It should be stored refrigerated and used promptly, which is one practical reason a busy clinic with a full appointment list is a better bet than one opening a vial for you alone.
Two things you’re entitled to ask about: where the stock came from, and whether it’s genuine. Toxin bought outside a registered UK pharmacy supply chain has no traceability and no guarantee of cold-chain integrity. Practitioners sourcing through a regulated route, meaning a verified UK pharmacy with an approved prescriber attached, can tell you exactly what’s in the vial and where it came from. Ones buying from social media sellers cannot.
Book With a Practitioner Who Consults Properly
The week beforehand matters, but it matters far less than who you’ve booked with. A practitioner who takes a full medical history, has a named prescriber who assesses you, and sources from a regulated pharmacy supply chain will produce a better and safer result than any amount of preparation on your part.
Search verified aesthetic clinics on Faces by location and treatment, check what each one offers, and book directly. Every clinic listed runs digital consent and medical history forms as part of the booking, so your medication list is captured properly before you arrive rather than scribbled on a form in the waiting room.
If this is your first appointment, read what to expect from your first Botox treatment next.
FAQs
What should you not do before Botox?
Avoid alcohol for 24 to 48 hours and stop over-the-counter NSAIDs and blood-thinning supplements for about a week. Don’t stop prescribed anticoagulants. Also avoid starting new active skincare, booking peels or lasers in the same fortnight, and turning up with an active skin infection in the treatment area.
What is the 4-hour rule for Botox injections?
It refers to staying upright for around four hours after treatment rather than beforehand. The usual advice is to avoid lying down, bending forward for long periods, or pressing on the treated area for three to four hours, on the reasoning that this reduces the chance of the product migrating from the target muscle. The evidence base for it is modest but the cost of following it is nil.
How should I prep my skin before Botox?
Stop retinoids and acid exfoliants roughly three days beforehand, keep your routine gentle, and arrive with a clean, makeup-free face. Avoid facials, peels and laser for two weeks either side. Skin that’s calm and intact bruises less and reacts less.
How do I get the best results for Botox?
Choose the injector before you optimise anything else. Dose, placement and anatomical accuracy account for almost all of the variation in outcome, and none of them are in your control once you’re in the chair. Beyond that, arrive with an honest medical history, follow the aftercare, and book your review at two weeks rather than two days, so you’re judging the settled result.
How long should I leave between Botox treatments?
At least twelve weeks. Treating more frequently is associated with a higher risk of developing neutralising antibodies to the toxin, which can make future treatments progressively less effective. If the result is fading at eight weeks, the answer is a conversation about dosing, not an earlier appointment.