Normally, Botox injections last for about 4-6 months. However, in this article, the doctor will delve into the latest research on pre- and post-injection practices that can extend the duration of Botox effectiveness. Neglecting these steps can result in more frequent injections, leading to increased costs and potentially building a tolerance to Botox.

Pre-injection practices include:

1. Choose only authentic Botox.
   Authentic Botox has low drug dispersion, meaning it stays localized to the injected area, resulting in minimal diffusion.
   Therefore, before each injection, it’s crucial to verify that it is “genuine Botox” only.
   Before the injection, it’s advisable to educate yourself on how to distinguish between various brands of authentic Botox. You should also ask the doctor to open the box and mix the Botox in front of you.

   After the injection, request to take the box and vial back home or snap a photo for verification. This ensures confidence in receiving genuine Botox. (If it’s a clinic using authentic products, they will happily allow patients to verify.)

2. Saline Solution Mixing (dilution)
   Authentic Botox, regardless of the brand, typically comes in a lyophilized (freeze-dried) powder form. It appears as white, powdery flakes without any water content. Saline solution needs to be added to reconstitute it for injection. If the saline solution is overly diluted, it can lead to easier diffusion of the Botox, reducing its effectiveness.

   Before each injection, it’s advisable for the physician to mix the Botox directly. This ensures confidence that the saline solution hasn’t been overly diluted. If pre-mixed, it’s difficult to ascertain whether the solution is too diluted or concentrated.

3. Injection Technique
   It’s important to choose a clinic that adheres to standards and employs experienced physicians who can accurately assess the muscles to be injected.

   They should know the depth and precise location where nerve endings attach to the muscles. Injecting in the wrong spot may yield similar results, but with delayed onset and shorter duration because the Botox needs time to spread from the injection site to the nerve endings.

4. Avoid using more than 300 units per session
   Beware of developing botulinum toxin resistance. Also, it’s important to steer clear of injection techniques that don’t directly deliver Botox into the muscle, as it heightens the risk of developing resistance to the medication.

   Additionally, using too few units per injection site can lead to rapid ineffectiveness, necessitating more frequent injections and increasing the risk of developing resistance. The physician should evaluate and inform patients of the appropriate number of units required for their specific needs.

5. During the injection
   it’s advisable to apply cold compresses to reduce blood circulation around the injection site. This helps to localize the Botox at the intended injection site and prevents it from diffusing away.

Post-injection practices include

1. Immediately after injecting Botox into each area
   it’s advisable to promptly contract the injected muscle 1-2 times. After completing all injections, it’s recommended to actively engage all injected muscles for 30 minutes. This helps maximize the absorption of Botox by nerve cells, minimizing diffusion.
   However, during this post-injection period of muscle contraction, cold compresses should be avoided as they may hinder the absorption of Botox into nerve cells. (This means we use cold to block circulation during injection and then contract muscles after injection to draw Botox into cells.
   
   Afterward, try to change habits involving excessive movement of those specific muscles. For example, avoid unnecessary chewing of sticky foods. Frequent stimulation of muscles can prompt nerve cells to grow anew, even if the effects of Botox haven’t worn off completely. Moreover, continual muscle movement increases blood flow to the area, facilitating the quicker breakdown of residual Botox within nerve cells.
   
   Muscles left unused for prolonged periods tend to atrophy over time, making them less responsive. This can contribute to prolonged Botox effects. Conversely, frequent stimulation of muscles, such as smiling often or minimizing unnecessary frowning (common in individuals who play sports like squash or habitually chew gum), strengthens muscles and may shorten the duration of Botox effects.
   
   
2. After Botox injections, it’s recommended to avoid lying flat for 3 hours.
   Facial swelling post-Botox injection is a common occurrence. Take care not to rub or massage the injected areas, and refrain from bending your head lower than the heart level, as it increases blood flow to the face, potentially causing more diffusion of Botox.

   For the Botox Type A within nerve cells, which functions to inhibit muscle activity, it takes 7-14 days before you begin to see the muscle-relaxing effects.

   The potency of Botox gradually diminishes over time due to factors such as heat and blood circulation (metabolism), which expedite its breakdown.

3. It’s advisable to administer Botox injections at appropriate intervals—not too frequently (at least every 3 months) and not with excessively long gaps (shouldn’t exceed 5-6 months).

   If the intervals between injections are too long, muscles may return to normal function, necessitating higher Botox unit dosages in subsequent injections.

Post-Botox Injection Restrictions:

1. Avoid all forms of heat and activities that cause facial flushing. Particularly in the first 2 weeks after the injection (if not possible, at least 48 hours after), steer clear of heat, such as saunas, intense exercise, sun exposure, alcoholic beverages, and deep skin-layer heating treatments like RF Thermage lasers. Also, refrain from lying face down and bending your head lower than your chest.
2. After Botox injections, it’s prohibited to consume the following for 14 days post-injection:
   * All types of alcoholic beverages: liquor, beer, wine, fermented beverages.
   * Grilled or barbecued pork, grilled items, hot pot meals that require sitting in front of hot steam.
   * Very spicy foods that cause facial redness and irritation.
   * Pickled or fermented foods containing substances that dilate blood vessels, such as fermented fish, pickled bamboo shoots, pickled mango.
   * Smoking cessation is advised, as cigarettes contain various substances that dilate blood vessels.

   After the initial 2 weeks, engaging in the mentioned activities may have some impact on the longevity of Botox, but it won’t be significant. The activities that have the most significant impact are saunas and hot laser treatments. However, other activities don’t necessarily need to be avoided.

3. After Botox injections, should heavy exercise be avoided?
   It’s not necessary to abstain from heavy exercise after Botox injections. Avoiding exercise to prolong the effects of Botox isn’t worth it because exercise is beneficial for health and contributes to clearer skin. Simply avoiding excessive heat as much as possible is sufficient.