Why can't IBurp?A free UK guide to R-CPD

Recovery

After Botox: what to expect, day by day

Burt lounging in a deckchair with sunglasses and a fizzy drink, bubbles floating up

Quick summary

This guide is based on 854 experiences people shared on Reddit's r/noburp (opens in a new tab) between May 2025 and November 2026, plus published studies of over 1,000 patients. We counted each person once. We used AI to read the posts in bulk, not one by one, and people tend to post more when something's worrying them. So treat the community numbers as self-reported (people telling their own story), rough and not official. Each number below says where it came from.

Everyone's recovery is different. The dose (how much Botox is used), whether you're awake or asleep, and your own body all make a difference. If yours doesn't match this page, it doesn't mean something's wrong. Your clinic is the best place to ask.

Day 1typical day for the first burpFrom posts by 498 people, a rough guide
87%burping within a weekFrom posts by 525 people, a rough guide. In a study of 200 patients, 93% of those who burped did so within a week (Hoesli 2020)
About 10 daysof odd swallowing, typicallyFrom posts by 106 people, a rough guide

How Botox helps

  1. Botox relaxes the muscleA small dose goes into the valve muscle. It makes the muscle relax, so it can open (Bastian 2019 (opens in a new tab)).
  2. Air can escapeAir can now get out as a burp. Of the first 200 people treated, 99.5% could burp afterwards (Hoesli 2020 (opens in a new tab)).
  3. It often keeps workingBotox wears off after a few months, but most people keep burping. In a UK group of 72, 96% still could (Karagama 2021 (opens in a new tab)).
How Botox helps. Everyone is different, and it doesn't work for everyone first time.

Day by day

  1. Day 0: the day of your treatment

    • Under a general anaesthetic, expect to be in hospital for 2 to 3 hours. The treatment itself is short, about 30 minutes from getting ready to waking up (Laryngopedia).
    • Awake in clinic, you'll usually be watched for a little while, then go home (Cosentino 2025).
    • Don't expect burps yet, and skip fizzy drinks today (Laryngopedia).
    • About 1 in 3 people who said when their first burp came had a small one on the same day.

    Sources: Laryngopedia, Cosentino 2025 (a study of 67 patients). The 1 in 3 is from community posts by 498 people, a rough guide, not official.

  2. Days 1 to 3: the first small burps

    • Small "micro burps" usually start 24 to 48 hours after the injection (Bastian 2019).
    • In the posts we read, the typical first burp came on day 1. Most people had one somewhere between day 0 and day 3.
    • Swallowing can start to feel odd around day 2 or 3, as if food hangs low in your throat. Lots of people call this slow swallow. It's very common and it passes. It's not stuck. A sip of water helps it down (Bastian 2019, Laryngopedia). See slow swallow in our jargon buster.

    Sources: Bastian 2019 (a study of 51 patients), Laryngopedia, community posts (498 people said which day their first burp came), a rough guide, not official.

  3. Week 1: most people are burping

    • In the first 200 people treated, 99.5% could burp, and 93% of them within a week (Hoesli 2020).
    • In the posts we read, 87% had burped within a week (458 of 525), small burps included. It was about the same awake or asleep.
    • Gurgles are often still there at first, and fade as burping takes over.
    • About 1 in 4 people mentioned some chest pressure or trapped air in the early days, and about 1 in 4 some reflux.
    • After the awake version, 7 of 18 people had some noisy breathing in the first week. It all settled (Wajsberg 2021).

    Sources: Hoesli 2020 (200 patients), Wajsberg 2021 (18 patients), community posts (525 people for burping, 854 people for the rest), a rough guide, not official.

  4. Weeks 2 to 4: swallowing settles

    • Odd swallowing is the most common side effect. Studies put it at about half of people (51% across 699 patients), and it's temporary (Yeo 2025).
    • When people said how long it lasted, the typical time was about 10 days, usually between 3 days and 3 weeks (106 people). It was often shorter after the awake version and longer after a general anaesthetic, which fits a study that found more swallowing trouble after the bigger dose used asleep (Doruk 2024).
    • By 2 weeks, 94% of the people we read about were burping, and 97% by 4 weeks.
    • In a UK group of 72 people, everyone could burp within 4 weeks (Karagama 2021). If you're not burping by about 4 weeks, let your clinic know.

    Sources: Yeo 2025 (699 patients, 13 studies), Doruk 2024 (108 patients), Karagama 2021 (72 patients), community posts (510 people at 2 weeks, 502 people at 4 weeks, 106 people for how long swallowing felt odd), a rough guide, not official.

  5. Months 2 to 6: the Botox wears off, the burp usually stays

    • The Botox wears off after about 3 months, but most people keep burping (Karagama 2021).
    • About 4 in 5 could still burp 6 months after one injection (79.9%, Hoesli 2020). In the UK group, 96% kept burping (Karagama 2021).
    • Needing a second injection was uncommon after the asleep version: 6.5% in one study (Hoesli 2020) and about 4% in another (Karagama 2021). After the awake version it's more common. In one study, about half had another awake injection, and the doctors now plan for this (Office versus theatre study, 2025).

    Sources: Hoesli 2020 (200 patients), Karagama 2021 (72 patients), office versus theatre study 2025 (198 patients). We didn't count second injections from posts, because people who need one post much more.

Tips that help

When to call your clinic

We haven't found an NHS aftercare leaflet (a sheet on looking after yourself afterwards) just for R-CPD, so these tips come from NHS pages and an NHS leaflet for Botox into the same muscle. Your own clinic's aftercare sheet comes first, so keep its number handy.

Worries and how to handle them

Lots of people feel nervous before treatment. That's completely normal, and you're in good company. Here are calm, honest answers to the worries we see most, and what you can do about each one. Tap a worry to open it.

Laryngospasm: my throat might clamp shut

What it is. Laryngospasm is a reflex where your vocal cords suddenly squeeze shut for a short time. It's your body protecting your airway (Chekol 2020 (opens in a new tab)).

How rare is it? Under a general anaesthetic (medicine that puts you to sleep for the procedure), it's uncommon. In a very large study of over 136,000 patients, it happened in about 9 in every 1,000 people, across all kinds of operations (Olsson and Hallén 1984 (opens in a new tab)). With R-CPD Botox, it happened to 1 person out of the first 200, while waking up (Hoesli 2020 (opens in a new tab)). A UK study of 72 people had no breathing problems at all (Karagama 2021 (opens in a new tab)). The clinic that has treated over 1,000 people calls it "extremely unlikely" (Laryngopedia (opens in a new tab)).

What the team does. Anaesthetists (the doctors who put you to sleep and look after you while you're under) are trained and ready for it. They check for things that raise the risk before you start (Al-alami 2009 (opens in a new tab)). If it happens, it's usually settled quickly. In one study, most cases needed only oxygen through a mask (Chekol 2020 (opens in a new tab)). The anaesthetic for this treatment is short, about 10 minutes from going to sleep to breathing on your own again in one study (THRIVE 2025 (opens in a new tab)).

What you can do.

Feeling sick after a general anaesthetic

How common is it? Feeling or being sick is one of the most common side effects of a general anaesthetic. It usually gets better within a few hours, and medicine can help (RCoA (opens in a new tab); NHS (opens in a new tab)). It's more likely after long operations, over 2 or 3 hours (RCoA (opens in a new tab)). R-CPD treatment is much shorter, about 30 minutes (Laryngopedia (opens in a new tab)).

What you can do. The Royal College of Anaesthetists says (RCoA (opens in a new tab)):

  • Tell your anaesthetist you have emetophobia, or that you're anxious. They can talk it through, and sometimes offer medicine to help you relax.
  • Ask for anti-sickness medicine in advance. Mention it at your pre-assessment (the health check a few days or weeks before your procedure). You can be given medicine before or during the anaesthetic to stop you feeling sick (NHS (opens in a new tab)).
  • Tell them if you've been sick after an anaesthetic before, or you get travel sick. There are things they can do to lower the risk, including choosing a type of anaesthetic that's less likely to make you feel sick.
  • Fast exactly as you're told (no food or drink for a set time before). It keeps you safe. Then eat and drink as soon as you're allowed, starting with small sips of water.
  • Ask for help as soon as you feel queasy (a bit sick). It's easier to treat early. Ask for pain relief too, as pain can make you feel sick.
  • Sit up slowly and take slow, deep breaths.
  • Think about the awake option. Botox awake in clinic avoids a general anaesthetic altogether, where it's suitable for you. Both ways work well (Doruk 2024 (opens in a new tab)), though the awake way more often needs a second injection (office versus theatre study (opens in a new tab)).

Our page on emetophobia has more support.

Swallowing feels strange afterwards ("slow swallow")

People often call this "slow swallow". It's the most common side effect, for about half of people (Yeo 2025 (opens in a new tab)). Food can feel like it sits low in your throat. It's in a safe place and it isn't stuck (Laryngopedia (opens in a new tab)). It usually settles in 1 to 2 weeks (Hoesli 2020 (opens in a new tab)). In the posts we read, about 10 days was typical (106 people said how long, rough, not official).

Small bites, soft food, a drink to hand and your head tilted slightly forward all help (Cosentino 2025 (opens in a new tab)). If you can't swallow liquids or your own spit, call your clinic. See slow swallow in our jargon buster.

Will my voice change?

Voice changes are rare after the asleep version and a bit more common after the awake one, when a little Botox reaches the voice muscles (Laryngopedia (opens in a new tab)). In a UK group of 72 people, nobody had a hoarse voice (Karagama 2021 (opens in a new tab)). When it does happen, it's usually mild and goes away. In one study of the awake injection, 1 in 4 had a hoarse voice for a while (Cosentino 2025 (opens in a new tab)). About 1 in 12 of the people we read about mentioned a voice change (rough, not official).

What if it doesn't work first time?

It works first time for most people. Early relief was 91% across 699 patients (Yeo 2025 (opens in a new tab)). About 4 in 5 can still burp 6 months later (Hoesli 2020 (opens in a new tab)).

If the burp doesn't come, or it fades, a second injection is common and usually works, often at a slightly bigger dose (Malhotra 2024 (opens in a new tab)). After the asleep version, only about 3 to 8 in 100 needed more treatment (Hoesli 2020 (opens in a new tab); Karagama 2021 (opens in a new tab)). After the awake version, more people do, and two awake injections worked about as well as one asleep (office versus theatre study (opens in a new tab)). For the very few where it keeps coming back, a small operation on the muscle is an option (Bastian 2020 (opens in a new tab)).

How much does a second injection cost?

It depends on the clinic, so always ask before your first treatment. In posts in two UK Facebook groups (rough, not official):

  • Awake, in clinic (London): some people paid roughly the cost of the Botox for a repeat, about £80 to £232. Others said about £500 to £645.
  • Asleep (Manchester): one 2022 quote offered 50% off a second treatment. A 2025 report said half the consultant's fee, but full hospital and anaesthetist costs.
  • With insurance: repeats are often refused, even when the first was paid (r/noburp thread (opens in a new tab)). Ask your insurer about repeats before you start. Our insurer letter tool can help.

See prices for first treatments.

I'm just really nervous

That's OK, honestly. The Royal College of Anaesthetists suggests breathing exercises, mindfulness or a walk before the day, and bringing something to keep your mind busy, like music or a book. It has relaxation recordings too (RCoA: preparing your mind (opens in a new tab)). Tell the team how you feel. They can talk it through, and sometimes offer something to help you relax (RCoA (opens in a new tab)).

You might read scary stories online. The clinic that has treated the most people says those are the unusual ones, and most people's recovery is much calmer (Laryngopedia (opens in a new tab)). In one study, anxiety went down after treatment (Doruk 2024 (opens in a new tab)).

This page is for information only and isn't medical advice. Always follow your own clinic's advice. In an emergency, call 999.

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