1. The instructions with a clear rationale
Keep the area clean and leave it alone. Injection points are breaches in the skin barrier. Keeping them clean and not touching them reduces the chance of introducing bacteria. Avoid makeup over injection sites for the period advised, usually until the points have closed.
Do not massage filler unless you have been told to. Product placement is deliberate. Moving it around is not helpful, and pressing on a lump in the early days is more likely to displace product than to smooth it.
Sun protection after any resurfacing. Skin that has been through controlled injury, whether by peel, laser or needling, is more prone to pigment change. Sun exposure in the following weeks is the most reliable way to convert a good result into a pigmentation problem, and this instruction is not optional.
Report the warning signs immediately. Covered above, and covered fully in vascular occlusion.
2. Reasonable caution, weaker evidence
Staying upright and avoiding lying down for a few hours after botulinum toxin. The theory is that product could spread before binding. The evidence is thin, the cost of complying is nil, and almost everyone advises it. Comply and do not worry about it.
Avoiding strenuous exercise for a day or so. Increased blood flow may worsen bruising and swelling. It is not established that it affects the result. A day of restraint is cheap insurance.
Avoiding alcohol before and after. Alcohol dilates blood vessels and may increase bruising. A sensible precaution around the treatment rather than a rule with a strong evidence base.
Avoiding heat, saunas and very hot showers for a couple of days. Similar reasoning, similar strength of evidence.
3. Advice that gets repeated without support
Elaborate facial exercises after toxin. Advice to frown repeatedly for hours afterwards circulates widely. There is no good evidence that it improves uptake. It is harmless and it is not a requirement.
Precise numbers pulled from nowhere. Instructions to remain upright for exactly four hours, or to avoid exercise for exactly forty eight, imply a precision that is not there. The underlying caution is reasonable; the specific figure is convention.
Expensive proprietary aftercare products presented as necessary. Sometimes a specific product genuinely matters, particularly after resurfacing. Frequently it is a retail opportunity attached to a treatment. Ask what it does that a basic emollient and a broad spectrum sunscreen do not.
4. The thing to sort out before, not after
Anticoagulants and antiplatelet medication increase bruising. So do some supplements, including fish oil and various herbal preparations. So does alcohol the night before.
None of this should be stopped without medical advice, and prescribed anticoagulants should not be stopped for a cosmetic appointment. What should happen is that the practitioner takes a proper history, knows what you are taking and plans accordingly. That belongs in the consultation, which is why it is in what a good consultation looks like.
5. Dental work, illness and vaccinations
Delayed inflammatory reactions to filler have been described following dental procedures, viral illness and vaccination. The practical advice most practitioners give is to leave a gap between planned dental work and filler treatment, in either direction, and to postpone treatment when you are unwell.
This is proportionate rather than proven, and it is worth mentioning if you have planned dental work, a scheduled vaccination or a recent illness. The wider picture is in filler migration and delayed swelling.
6. Managing what actually happens
For bruising: cool the area gently in the first day if it is comfortable, avoid pressure, and be patient. Arnica is popular and the evidence for it is not strong; using it does no harm.
For swelling: sleeping with the head slightly raised for the first night or two is reasonable and comfortable. Swelling that is increasing after seventy two hours, or accompanied by heat or fever, is not swelling to manage at home.
For tenderness: simple pain relief is generally fine, though anti inflammatory painkillers may increase bruising slightly. Ask what the clinic advises for your treatment specifically.
7. The appointment that is worth keeping
The review is the part of aftercare people skip and the part that is worth most. Two weeks after botulinum toxin, two to four weeks after filler. It is when asymmetry can be corrected while correction is easy, when the result can be recorded properly, and when the plan for next time is made.
If a review is not offered, ask for one and ask what it costs. A clinic that has no interest in seeing you again once the payment has cleared is telling you how it thinks about the work.
8. The two questions to ask before you leave
What specifically should make me call you, and what number do I use out of hours. Write the answer down before you leave the building, because that is the only aftercare instruction that has to work at eleven at night. The rest of the checklist is in the questions to ask before any injectable treatment.