Almost every clinic sends a list of things to stop before an injectable appointment, and almost none of them explain which items are about your safety and which are about your holiday photographs. The distinction matters more than the list does, because one category is worth following closely and the other category contains advice that can do genuine harm if you follow it without asking anybody.
What the pre-treatment list is actually for
Botulinum toxin and dermal filler are delivered with a needle or a cannula through skin that contains a dense network of small blood vessels. Piercing one of those vessels produces a bruise. That is the ordinary, expected event that most preparation advice is designed to reduce, and it is a cosmetic problem rather than a clinical one.
Anything that makes platelets less sticky, thins the blood, or widens blood vessels makes a bruise more likely and larger when it happens. That is the whole mechanism behind the familiar list. It explains why fish oil, alcohol and aspirin appear on it, why a hot bath and a hard gym session appear on the after version of the same list, and why none of it changes the risk of the things that genuinely matter, such as infection or vascular occlusion. Those are governed by technique, product choice, anatomy and sterility, not by whether you took a multivitamin on Tuesday.
Read the list with that in mind and it becomes easy to prioritise. If your appointment is two days before a wedding, follow all of it. If your appointment is on a quiet Tuesday in February and you have four weeks before anyone sees you, most of it is optional.
The category you never stop on your own
Some medicines that increase bruising are prescribed for a reason that outweighs a bruise by an enormous margin. Anticoagulants such as warfarin and the direct oral anticoagulants, antiplatelet medicines such as clopidogrel, and low dose aspirin taken for cardiovascular protection all fall into this group, as do prescribed anti-inflammatories taken for an ongoing condition.
Stopping any of them to avoid a bruise is a decision with a clinical consequence, and it is not a decision for you, for a receptionist, or for a practitioner who is not the person who prescribed the medicine. The correct route is to tell the clinic what you take, let them decide whether the treatment is still appropriate, and if anyone suggests a pause, take that suggestion to the prescriber before acting on it. A clinic that tells you to stop a prescribed anticoagulant without involving your prescriber has told you something important about itself.
The same applies in reverse. If you are on one of these medicines and the clinic does not ask, that is a gap in the assessment rather than a convenience, and it belongs on the list of things covered in what a good consultation looks like.
The timing table
| Item | Common timing | Why | Category |
|---|---|---|---|
| Prescribed anticoagulant or antiplatelet | Do not change | The reason it was prescribed outweighs a bruise | Ask the prescriber, never self-stop |
| Aspirin or ibuprofen taken occasionally for a headache | About 3 to 7 days | Reduces platelet stickiness | Optional, discuss if you need it for pain |
| Fish oil, omega 3, vitamin E, high dose garlic, ginkgo, ginseng | About 7 days | Associated with easier bruising | Cosmetic only |
| Alcohol | 24 to 48 hours | Widens blood vessels | Cosmetic only |
| Retinoids and exfoliating acids on the treatment area | 3 to 5 days | Reduces irritation at the entry points | Cosmetic and comfort |
| Waxing, threading, epilation on the area | About 7 days | Reduces skin trauma and follicular disruption | Cosmetic and comfort |
| Non-urgent dental work | About 2 weeks either side | Common precaution around filler and oral bacteria | Clinic policy, ask yours |
| Feeling unwell, active infection, cold sore, sunburn on the area | Reschedule | Treatment into inflamed or infected tissue is avoided | Reschedule, not a pause |
Clinics differ on the dental and vaccination intervals because the evidence behind them is thin and the precaution is inexpensive. Follow the policy of the clinic treating you rather than an interval you found somewhere else, and if the two conflict, ask which one your practitioner will be working to.
Supplements, and why the list is longer than it needs to be
The supplement list circulating in aesthetics is largely inherited from surgical pre-operative advice, where the stakes are bleeding during an operation rather than a purple patch above the lip. Fish oil, vitamin E, high dose garlic, ginkgo biloba and ginseng are the items that appear most consistently, and a week is the interval most clinics settle on because it is comfortably longer than it needs to be for something with no downside.
Two practical points. First, a standard multivitamin is not the same thing as a high dose single ingredient supplement, and there is no reason to stop one. Second, if you take a supplement on the advice of a clinician for a diagnosed reason, it moves into the category above and the same rule applies: ask the person who advised it.
Alcohol, exercise and heat
Alcohol widens blood vessels and is the single easiest item on the list to act on. Most clinics ask for 24 hours and some ask for 48, and the interval matters more the closer you are to an event. Strenuous exercise, saunas, steam rooms and hot yoga have the same vasodilating effect and are usually asked about on the day itself and for a day or two afterwards, which is covered in more detail in aftercare in the first six weeks.
None of this is a rule of physiology so much as a way of stacking the odds. Plenty of people drink a glass of wine the night before and bruise not at all. Plenty of people follow every instruction and bruise anyway, because a needle found a vein and no amount of preparation prevents that.
Skin, hair removal and the surface of the area
Retinoids, alpha and beta hydroxy acids and any exfoliating routine leave skin more reactive, which does not affect the injection but does affect how the entry points look afterwards. Three to five days is the usual pause. Waxing, threading and epilation on the treatment area are usually stopped about a week ahead for the same reason.
Make-up is a separate question. Most clinics will remove it and clean the area before treating, and most ask you not to reapply for the rest of the day, because the entry points stay open for a period after the needle comes out.
When the answer is to move the appointment
A short list of situations is not a pause at all. Active infection anywhere near the treatment area, a cold sore breaking out if you are having work near the mouth, sunburn on the area, a fever or flu, and any new unexplained symptom you have not yet had looked at are all reasons to move the date rather than to prepare harder. If you have a history of cold sores and you are having treatment around the mouth, raise it at the consultation rather than on the day, because antiviral cover is a decision a prescriber makes in advance.
Pregnancy and breastfeeding are also a reschedule rather than a preparation question. Botulinum toxin and dermal filler are not offered in pregnancy in UK practice, and a clinic that does not ask has skipped something basic.
Booking around an event
The most common preparation mistake is not a supplement. It is booking too close to the thing you are preparing for. Filler swelling distorts the result for days and the final position is not visible for weeks, and botulinum toxin takes days to begin working and about two weeks to settle. The downtime guide sets out the intervals treatment by treatment, and the short version is that a month is comfortable and a week is a gamble.
What this does not cover
This is preparation advice for non-surgical injectable treatment in the United Kingdom. It does not apply to surgery, to general anaesthetic procedures, or to energy based treatments, which have their own preparation requirements. It is not a substitute for the instructions given by the clinic treating you, and where the two disagree, theirs is the one written by someone who has examined you. Nothing here is a reason to change a prescribed medicine.
Sources
- General Medical Council, standards and guidance for registered doctors
- Nursing and Midwifery Council, search the register of nurses and midwives
- Joint Council for Cosmetic Practitioners, the voluntary register for non-surgical practitioners
- Medicines and Healthcare products Regulatory Agency, the UK regulator for medicines and medical devices
- British Association of Dermatologists, patient information on skin and skin procedures
Frequently asked questions
How long before injectables should I stop taking fish oil?
Most UK clinics ask for about seven days. The interval is a precaution rather than a threshold, because the effect on bruising is modest and stopping a non-essential supplement for a week has no downside. If you take omega 3 on clinical advice, ask the person who advised it before stopping.
Can I stop my blood thinner before a filler appointment?
Not on your own, and not on a clinic's say so. Anticoagulants and antiplatelet medicines are prescribed for reasons that outweigh a bruise. Tell the clinic what you take, let them decide whether to treat, and take any suggestion of a pause to the prescriber who issued it.
Does drinking alcohol the night before really cause bruising?
It widens blood vessels, which makes a bruise more likely and larger if a vessel is caught. Most clinics ask for 24 to 48 hours. It is one of the more useful items on the list because it is easy to follow and the effect is short lived.
Should I stop using retinol before botulinum toxin?
Three to five days is the usual advice, and it is about comfort and the appearance of the entry points rather than the injection itself. If you are having a resurfacing treatment rather than an injectable, the pause is usually longer and the clinic will specify it.
Why do clinics ask about recent dental work?
It is a precaution around filler and oral bacteria, and clinics commonly ask for a gap of about two weeks either side of non-urgent dental treatment. The evidence behind the interval is limited, which is why policies differ. Follow the policy of the clinic treating you.
I have a cold sore coming. Should I still go?
If the treatment is near the mouth, contact the clinic before the appointment. Treatment through an active outbreak is avoided, and if you have a history of cold sores, antiviral cover is something a prescriber decides in advance rather than on the day.
Does any of this reduce the risk of a serious complication?
No. Preparation advice reduces bruising. The risks that matter, including infection and vascular occlusion, are governed by anatomy, technique, product choice and sterile practice. Reducing those is what practitioner selection and a proper assessment are for.