Realistic downtime and recovery, treatment by treatment

The word downtime does a lot of quiet work in aesthetic marketing. It is usually taken to mean the period during which you would not want to be photographed, and it is quoted accordingly. It does not usually mean the period before the treatment has done what you paid for, which is a different and often longer interval.

Both matter when you are planning. What follows is what typically happens, and how far ahead to book if there is a date in the diary.

Recovery at a glance

Typical patterns in UK practice. Individual recovery varies with technique, depth, area, skin type and how prone you are to bruising. Deeper resurfacing sits at the longer end of each range.

Botulinum toxin

Social downtime is minimal. Small raised bumps at the injection points settle within about twenty minutes, and most people return to work immediately. Bruising is possible, particularly between the brows, and can last several days. Some people get a mild headache in the first day or two.

The real interval is onset. Effects begin at three to five days and reach full effect at around two weeks, which is when symmetry should be assessed and any small adjustment made. Booking a first ever treatment less than three weeks before an event removes the opportunity to correct anything, which is the main argument for the four week rule.

Standard aftercare is to stay upright for several hours, avoid rubbing or massaging the treated area, avoid strenuous exercise, saunas and heavy alcohol for the rest of the day, and avoid facials or other facial treatments for about two weeks.

Dermal filler

Recovery varies enormously by area. Lips swell more than anywhere else on the face and can be noticeably swollen for two to five days, occasionally longer, with full settling at around four weeks. Cheek and jawline treatment involves less visible swelling but the tissue takes just as long to settle. Bruising is common and can last five to ten days.

Expect the result at day one to overstate what you will end up with, because swelling is doing part of the work. Judging the outcome before four weeks is judging swelling. This is also why an immediate after photograph is a poor guide, as covered in reading before and after photographs.

Aftercare typically includes avoiding strenuous exercise, alcohol, saunas and steam for 24 to 48 hours, sleeping slightly elevated for the first night or two, avoiding dental treatment for a couple of weeks where possible, and not massaging the area unless specifically instructed.

Skin boosters and mesotherapy

These involve multiple small injections across an area, so expect visible pinprick marks and small raised bumps for roughly 24 to 48 hours, with occasional bruising. Social downtime is short. The result is not immediate: these treatments work by improving hydration and stimulating the skin over a course, usually two or three sessions spaced a few weeks apart, with the benefit building over two to three months.

Microneedling and radiofrequency microneedling

Immediately afterwards the skin looks as though it has caught the sun, with redness and warmth for one to three days depending on depth, sometimes with light flaking afterwards. Radiofrequency microneedling produces more swelling, particularly around the eyes, and can involve small grid marks for a day or two.

Sun protection is not optional during recovery, and makeup is usually avoided for the first day. Collagen remodelling takes months, so the result from a course typically appears gradually over three to six months rather than in the week after a session.

Chemical peels and laser resurfacing

This is where downtime becomes real, and it scales directly with depth. Superficial peels produce mild redness and light flaking for two to four days. Medium depth peels produce marked redness, swelling and visible peeling over five to ten days. Deeper ablative laser resurfacing involves an oozing, crusting phase, significant swelling and one to two weeks before makeup can be worn, with residual redness for weeks to months.

Rigorous sun protection during and after healing is essential, and the risk of post-inflammatory pigmentation is higher in deeper skin tones, which is why assessment of skin type matters before any resurfacing. The British Association of Dermatologists publishes patient information on skin procedures and sun protection that is worth reading beforehand.

Planning around an event

• Botulinum toxin: at least four weeks before, so there is time for full effect and a review with an adjustment if needed.
• Dermal filler: at least four weeks, six for lips or if you bruise easily.
• Skin boosters: allow for the full course plus a few weeks, so eight to twelve weeks.
• Microneedling: two weeks minimum for a single session, longer for a course.
• Medium depth peels and ablative laser: eight weeks minimum, and longer for deeper treatments.
• Anything you have never had before: add two weeks, because you do not yet know how you respond.

The single worst decision available in aesthetics is a first treatment the week before a wedding. Nothing about that timing gives anybody the room to fix an ordinary, manageable problem.

What makes recovery worse

Bruising is more likely on blood thinning medication, and on some supplements including fish oil and high dose vitamin E, though nobody should stop prescribed medication without speaking to the prescriber who issued it. Alcohol before and immediately after increases bruising and swelling. Strenuous exercise in the first 24 hours does the same. Heat, saunas and steam rooms increase swelling.

Sleep position matters more than people expect in the first two nights after facial injectables. Sleeping elevated reduces morning swelling considerably. The rest of the detail is in aftercare in the first six weeks, and the signs that recovery has stopped being normal are in recognising a complication.