During your initial consultation, be sure to mention all of the medications, vitamins, and herbal remedies that you are taking. In addition, describe any complications you have experienced during previous neuromuscular blocking toxin injections. To minimize the chance of bruising it is important to avoid consuming alcohol, ingesting anti-inflammatory medications like Advil or Motrin (i.e. NSAIDS) as well as certain herbal preparations and vitamins like Vitamin E, Ginkgo Biloba etc. known to increase bruising.

You will be asked to remove any makeup before your doctor starts injecting Botox® Cosmetic, Dysport®, or Xeomin®. This will help your doctor identify and avoid the veins at injection sites that are prone to bruising, like the crow’s feet area. During the procedure, you will be placed in a sitting position. The areas to be treated will be cleansed and topical ice applied to help shrink the blood vessels and desensitize the skin. Just before the injections, Dr. Dishakjian, the cosmetic surgeon at the Center, will ask you to repeatedly contract and relax your problematic muscles. Dr. Dishakjian will then assess the thickness and quality of your skin, the thickness and size of the underlying muscles, and determine the most appropriate dose and point suitable for the injections. Finally, Dr. Dishakjian will inject the targeted muscles with the finest possible needle, thus minimizing discomfort and bruising. In the unlikely event that skin bleeding occurs, you will be asked to apply manual point pressure. This helps minimize the extent of bruising. Makeup may be applied as soon as the bleeding stops.

For most practical purposes Botox®, Dysport®, and Xeomin® injections are considered lunchtime procedures, whereby people can return to normal activities immediately after the treatment. However, it is advisable for patients to avoid lying down for 2-4 hours after a treatment, as well as avoiding vigorous exercise, hot showers, sauna and bathtub. These activities may lead to excess blood congestion in injected areas and wash out the medication before it has a chance to interact with the targeted muscles. Furthermore, manual pressure should not be applied on certain injection sites, like the frown line (glabella), in order to avoid diffusion of the injected medication toward the upper eyelid area which may consequently lead to droopy eyelids. Currently, most physicians do not consider exercising the injected muscles after a treatment to be necessary to achieve the desired effect.