Therapies involving injections of botulinum toxin (botox) are very popular today? Can they disturb care plans? What can they be combined with. What treatments should paused after taking an injection? Here we will clarify some typical doubts. Many clients are interested in injections of botox, hyaluronic acid or other substance because of immediate visibility of the result. For instance, it can take up to a few months before a series of wrinkle-smoothening peeling sessions will do the job. For the injections, there is no need to wait: a droplet of the filler can eradicate an existing wrinkle, or prevent the formation of a new one. Today, the injection is advertised as an “over the lunchtime” treatment: fast, well tolerated, not preventing anyone from going back to work after just a few minutes.

How to have the best of the two worlds: the tempting rapid effect and a thoughtful long-term care?
As beauticians, we should support our clients’ decisions to undergo aesthetic treatments (obviously, only reasonable and safe ones) and, on the other hand, propose such treatment plans that will make the quick results of injections more permanent. Our clients often ask whether the combination of the injection of botox with other treatments is a good idea. The answer is: “This depends on a number of factors”.
The following are descriptions of proven, safe and very effective combinations of injections of botox and fillers with long-term conditioning treatments.

Botox and fillers
An increasing number of clients ask whether they may combine botox with other fillers (such as those based on hyaluronic acid). The injection of a filler, like botox, is considered a quick treatment involving no disruption of the daily activities, which can be applied during a single visit.

When botox and a filler can make a good match?
For various types of wrinkles: Botox- and hyaluronic acid-based preparations are used to correct mimic and dynamic wrinkles, respectively. The both ones can be applied during a single session as a remedy for various wrinkle types associated with the ageing.
For various target areas: In general, botox works well for the surroundings of the eyes and for the forehead while other fillers are recommended for correction of the middle and lower parts of the face.
For prolonging treatment results: Hyaluronic acid decomposes faster in more mobile facial muscles (e.g., around the mouth). If the target area is relaxed with botox before application of the acid, the result can be better and lasting longer.

Basic care
It is best to wait at least 24 hours (or, preferably, a few days) after taking the botox injection before taking any other facial treatment. This will give the punctured skin time to regenerate. Another important argument in favor of the one-day break is the fact that botox can spread under the skin within four hours from the injection, which process would be promoted by the supine body position on the patient’s couch. Alternatively, the other treatment can be applied on the same day but before the injection of botox. The treatment will cleanse and refresh the surface of the skin and, then, the injection will smoothen deeper wrinkles. What will be the result? A more relaxed and radiant complexion.

Chemical peeling
In general, a gentle chemical peeling and the injection of botox on the same day may be considered in specific cases, provided that the peeling is applied first (reversing this order is not recommended). The peeling acts on superficial skin layers (alleviates minor imperfections and improves skin color and texture) while botox reaches down to the muscles, so there is no conflict. However, taking a deeper peeling is not a good idea. Such treatment may can be planned for a few weeks after the injection to minimize the risk of skin infection.

Microdermabrasion
This treatment is similar to the chemical peeling in terms of its compatibility with the botox injection. Whenever possible, the beautician should carefully check the condition of the client’s skin and consider whether application of the microdermabrasion before the injection makes sense. After the injection, any such peeling should be avoided.

Micropuncturing
The injection of botox and the micropuncturing should not be performed on the same day or within a very short time interval. These two treatments should be separated in the care plan by at least a few weeks. The time span between the treatments is more important than their sequence. Which of them will be applied first depends on the client’s skin condition and other important factors, which should be considered in the comprehensive action plan for the client.

Expert opinion
Botox injections are the prevailing type of treatments performed by aesthetic medicine clinics. This is not surprising because the injection is the best treatment: both preventive, for early wrinkles, and corrective, for more pronounced changes associated with the aging. However, this substance has more important properties.
Botox has been proven as an effective therapy against hyperhidrosis, bruxism, facial erythema and even progressing alopecia. Particularly bruxism, caused by the masseter muscle hypertrophy, is a widespread affliction and aesthetic medicine clinics receive massive referrals from orthodontists for relaxation of these muscles with botox.
Many myths and prejudices have arisen around the application of botox as a consequence of incomprehension of its acting mechanism. Many patients jib at relaxing their mimic wrinkles with botox fearing the effect of an unnatural look of the cheeks or “inflated lips”. However, it is not botox that causes these effects!
Botox acts on the neuromuscular junction (and not on the skin as such), causing a transient relaxation of the mimic muscles. The effect lasts 3-4 months due to the renervation of the muscular junction. This is very fortunate for physicians and for patients, particularly in the context of post-treatment complications (the number of which is increasing because the procedure rapidly gains on popularity and because such treatments are not always performed by professionals).
Note that botox is a prescription drug and may be administered only by licensed physicians under criminal penalty for jeopardizing the health or life of the patient. In most cases the application of botox is an introduction to other procedures. Whenever possible (when the client is not a “weekend patient”), the injection of botox should be applied as the single procedure during the visit. The treatment will take almost 100% of its effect after approximately 2 weeks and then the patient can be offered the follow-up.
It is particularly important not to combine botox with platelet-rich plasma (PRP) during a single session because the latter substance will suppress the former.
Next, concurrent application of hyaluronic acid and botox can significantly increase the risk of complications.
The procedure recommended for patients with the so-called “lion’s wrinkle” consists of relaxing the muscles with botox first and of applying hyaluronic acid during the follow-up visit (if necessary). It is also useful to inject botox two weeks before lifting the skin around the eyes or eyebrows by the insertion of threads for improvement of the lifting effect. The fractional laser, micro-needle thermolifting or HIFU treatment may be applied safely after just two weeks from the application of botox. In either case, there is one rule: the fewer different procedures per single session, the better. Each of them should be patiently allowed to accomplish its goal for the avoidance of conglomeration of effects.