Is Your Exercise Routine Undermining Your Botox Regimen?

“I really think my Botox has stopped working,” my friend tells me, demonstrating the range of motion available between her eyebrows and forehead. “Surely not,” I counter – I know her most recent top-up was just a few weeks ago. “It’s because of boot camp,” she moans. Record scratch. Er, sorry, what? Her religious Botox regimen had been scuppered by her intense, weight-swinging workouts? Could this be true?

Botox (officially known as botulinum toxin) is a neuromodulator, meaning it temporarily blocks the release of acetylcholine, the neurotransmitter that allows a muscle to contract. This is why people who receive regular doses of Botox are unable to form certain expressions – like crinkling their eyebrows together or smiling as wide as their face allows – while it is temporarily active.

“The treated muscles become less active, which means the overlying skin creases less and lines soften,” aesthetic doctor and founder of the eponymous clinic, Dr David Jack, explains. “The effect typically lasts between three and four months, depending on dose, muscle strength and individual metabolism.”

OK, so that’s how Botox works, but does it work less based on the amount or type of exercise you do? According to Jack, absolutely not – so long as you observe the post-treatment window.

“The idea that a gym session can burn off your Botox is a persistent myth,” he deadpans, quashing my (admittedly distressed) friend’s theory. “Yes, vigorous exercise immediately after injection is not ideal as, theoretically, increased blood flow and heat could influence diffusion in the first few hours.”

This diffusion he describes is the passive spread of the botulinum toxin to surrounding tissue away from the injection site, and is something to be avoided. It’s the reason Jack recommends his clients avoid inversions (think headstands and Downward Dog) for the rest of the day following injection, along with saunas and steam rooms. “After that window of time has passed, there’s no convincing evidence to show that exercise meaningfully reduces its longevity.”

When he says no convincing evidence, Jack could be referring to a 2023 trial that found that people who exercised vigorously showed a faster return of muscle activity and wrinkle movement compared with those with low or moderate activity. It’s a piece of research that consultant dermatologist Dr Derrick Phillips says has its limitations. “It only included women, relied on self-reported exercise levels, and used standardised rather than personalised dosing, which may mean it doesn’t fully reflect real-world practice.” Essentially the evidence should be approached with a pinch of salt.

There are some individual factors that do affect how well Botox works.

• The patient’s physiology
• The practitioner’s technique
• The product used
• The aftercare administered

One interesting element is a person’s metabolic rate. “The speed of someone’s metabolism can influence how quickly botulinum toxin is broken down,” Dr Mo Akhavani, co-founder of the Plastic Surgery Group, explains.

This is because their muscles (technically their “neuromuscular junctions”) recover more quickly. This is usually the case in people with very high overall metabolic rates, like endurance athletes. This is more about individual physiology, though, not just the act of exercising itself, Jack explains when I ask.

“For people with stronger or larger facial muscles (typically men), higher doses are usually required, along with older patients with deeper, more static wrinkles,” adds Akhavani’s co-founder, Dr Dan Marsh. This higher dose (or more regular maintenance) is true for people with higher metabolic rates and faster neuromuscular recovery.