The aftercare that matters and the aftercare that is theatre

Staying upright for four hours after a neuromodulator. We do say this, and we say it honestly: the mechanism is plausible, in that the product can diffuse a short distance in the first hours, but the evidence that lying down for twenty minutes changes anything is thin. We keep it because four hours is cheap. We do not pretend it is established.

Arnica and bromelain. The trials are small, mixed and largely unimpressive. Both are harmless, and if someone finds them reassuring we have no objection. Nobody should be spending meaningfully on them, and neither should be offered as the reason a treatment went well.

A week without alcohol. Alcohol on the day of injection is reasonable to avoid, because it dilates vessels in the window where bruising happens. A glass of wine on day five is doing nothing at all to your filler.

Avoiding flights for weeks after filler. Cabin pressure is not doing what people imagine. The sensible reason to delay travel after an injectable is that you should be within reach of the clinic for a few days in case something needs to be seen, which is an argument about geography rather than air pressure.

Sleeping on your back for a week. Two nights, elevated, for swelling. After that the product is where it was put.

Lymphatic supplements, detox teas, dairy avoidance and anything sold as flushing toxins. No mechanism, no evidence, no.

Fragranced post-laser cooling gels with botanical extracts. Aloe, cucumber and essential oils applied to a barrier that has just been opened is how people acquire a contact dermatitis on top of a treatment. Petrolatum is boring and better.

Home LED devices immediately after a neuromodulator. Harmless, not useful, and occasionally an excuse to skip the review that is useful.

• Skipping sunscreen after pigment work, and then reporting that the laser did not work.
• Picking the flaking after fractional resurfacing.
• Hot yoga at forty-eight hours after injectables, because a sauna felt like it counted and a class did not.
• Restarting a retinoid too early after a peel or a laser.
• Missing the two-week review, which is where a small asymmetry is corrected for nothing.
• Waiting a month to mention a problem because it seemed too minor to call about.

Call the after-hours number the same hour, not tomorrow, for any of the following after a filler treatment: pain that escalates rather than settles, skin that blanches white or turns dusky and mottled, a lacy or net-like discolouration, or severe pain somewhere other than where you were injected. These are the signs of vascular compromise, and the treatment for it is time-critical.

Any change in vision after a filler treatment is an emergency. Go to an emergency department, and call us on the way.

After forty-eight hours, spreading redness with heat, tenderness and fever suggests infection and needs to be seen the same day rather than at your next appointment.

Everything on that list is uncommon. The reason it is written down is that the cost of hesitating is high and the cost of calling is nothing at all. Nobody has ever irritated us by getting in touch about their own face.