Using Botox in Combination with Other Treatments

Updated 3/2017 -- all links (except to my own posts) removed as many no longer active. 

Recently I read and completed a nice CME article on Medscape (first reference below).  It focused on the consensus panel’s (second reference, from first article and not read by me) recommendations. 

As Botox and Dysport are used more often, it is becoming more common for them to be used in combination with other treatments (ie Laser resurfacing, fillers, and surgery).  It was nice to see a consensus regarding how to approach multimodal treatment with BoNTA. 

Treatment Recommendations

Botox+ Injectable fillers

BoNTA and injectable fillers can be administered the same day or separate days. However, it may be preferable to inject the first agent, wait until effects are clinically evident, and then follow up with second agent as needed.

Upper face: Typical to inject BoNTA first.
Mid and lower face: Typical to inject filler first.

Botox + Ablative laser resurfacing

Inject BoNTA several days prior to the ablative procedure and wait until BoNTA effects are clinically evident.

Botox + Nonablative lasers/chemical peels

Nonablative procedure first. Inject BoNTA 10-15 minutes after nonablative procedure.

Botox + Surgery

Avoid injecting BoNTA on day of surgery. Follow-up BoNTA injections can continue beginning 3 months after surgery.

REFERENCE

Aesthetic Treatment With Neurotoxins: Options and Individualized Treatment: Practical Use of Botulinum NeurotoxinA in Aesthetic Practice; Medscape article,   06/18/2010;  Michael A.C. Kane, MD

Kane M, Donofrio L, Ascher B, et al. Expanding the use of neurotoxins in facial aesthetics: a consensus panel's assessment and recommendations. J Drugs Dermatol. 2010;9;7-22.