Can You Get Botox, Fillers and a TCA Peel in One Visit?

I have bad wrinkle lines across my forehead even when my forehead is relaxed the lines are very visable. I just spoke to a surgury and booked she advised me i would need about 20 Units, How many units would you advise? Also considering a TCA Peel, but its not advised to be done the same day as botox is this correct? Is botox enuff to completely rid these lines? and is it normal for nurses in the sugurys to perform these practices as she told me the Dr doesnt do them? thank you

Doctor Answers 8

Botox, facial filler, and chemical peel in one visit

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Yes, Botox cosmetic, injectable facial filler, and chemical peel may all be performed in one office visit. The decision to perform all the procedures depends on the patient, cosmetic specialist, specific filler & peel, and areas treated.

For example, one may choose to have nasolabial folds filled with hyaluronic acid, use Botox cosmetic for Crow's feet, and have a superficial chemical peel with light-strength TCA. There are advantages and disadvantages to combining procedures. However, the procedures may not be combined if more extensive. Only after a comprehensive evaluation by a plastic surgeon or dermatologist can he/she may an appropriate recommendation for you. Best of luck.

Washington DC Facial Plastic Surgeon
4.9 out of 5 stars 89 reviews

Botox and fillers for forehead wrinkles

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After looking at your picture, I think that 20 units of Botox is a reasonable way to start, but you may find that you need some more after 1-2 weeks. I believe in using the smallest amount of Botox needed to get the job done. However, your lines are deep, so the fillers will be necessary, too. I would not do the TCA peel on the same day. In my practice, my nurse and I both do Botox and filler injections, but this varies from office to office.

Bruce E. Genter, MD, FACS
Abington Plastic Surgeon
4.3 out of 5 stars 17 reviews

Botox for Forehead Lines

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Based on your picture, I would suggest approximately 30 units of Botox for your forehead. Also, another 25 or so for your glabella. I would have to see your forehead both at rest and contracted to tell for sure. Your static lines (at rest) will not go away completely with Botox. Over time, if you continue Botox, the lines will slowly improve as the skin heals from less stress from constant movement. In the mean time, you may want to choose to have dermal fillers placed in these lines. However, you should not expect full correction with the fillers. If too much is placed, you will get bumps instead of grooves. As for the chemical peel, you can have the treatment on the same day without a problem. Good luck.

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These treatments work well together

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In looking at your photos it is not clear that you need a TCA peel. I would start with Botox and fillers. For a botox dose in my office, I would treat you with 33 unitsof Botox using my Microdroplet method. Generally I think it is best to avoid nurses in getting a treatment. It is my opinion that you do better with being treated by a phyisian rather than a nurse.

Kenneth D. Steinsapir, MD
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

Botox for forehead lines

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Your creases seem to be deep on your forehead, and as you said, they're noticable at rest. If you want a TCA peel for general skin texture improvement, but not forehead line improvement, then you can have it the same day as the Botox. You might need 20 to even 30 units in the forehead, but youshould have the glabella area (between the eyebrows) treated to help lift the forehead as the Botox on the forehead will cause it to lower.

Ronald Shelton, MD
Manhattan Dermatologic Surgeon
4.9 out of 5 stars 39 reviews

Botox and fillers at same time

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It is not uncommon to have Botox performed on the same day as fillers such as Restylane or Perlane. However, combining these procedures with a TCA peel is probably too aggressive for one day's work. I would discourage it. Also, we do not permit nurses to perform Botox, fillers nor TCA peels in our practice.

Steven Hacker, MD
West Palm Beach Dermatologic Surgeon

Botox for forehead wrinkles

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I see your concerns are valid with respect to the forehead lines.

There are 3 forces creating facial wrinkles although some wrinkles may have more than 1 contributory force to varying degrees:

  1. aging & sun exposure of the skin - cheek skin wrinkles in the elderly, adynamic wrinkles
  2. chronic muscle action - crow's feet, horizontal forehead wrinkles & vertical wrinkles between the 2 eyebrows, dynamic wrinkles
  3. weakened supporting tissues with age & the constant forces of gravity - the jowl wrinkles on either side of the chin

Botox only works on the muscle contribution to wrinkle formation (dynamic wrinkles) & the more muscle action contributes to a wrinkle the more effect Botox will have, temporarily. If the wrinkle cannot be effaced with finger pressure prior to botox injection the injection will be less effective because the problem is then permanent damage to skin layers. This is unaffected by muscle paralysis. Looking at your photos it looks like the forehead lines have been present awhile & are deep with skin changes i.e. thinning in the depths of the wrinkles. I doubt they will efface or disappear when spread apart by finger pressure and so will not completely disappear after botox injections.

I don't know how old you are but doubt you are past 40 so it's more likely that the forehead wrinkles are due to the way you personally move the forehead muscle along with exposure to the Australian sun than to forehead drooping.

Botox will likely smoothen the forehead lines but not completely erase them-you waited too long and the lines are too deep. I can't see what you hope to achieve with a TCA peel as the skin pigmentation is even without blotches and have virtually no adynamic skin wrinkles.

Aaron Stone, MD
Los Angeles Plastic Surgeon

No Advantage TO YOU in combining Foreheaf Botox,Fillers and a TCA Peel

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The REAL reason why you have lines across your forehead is because you are getting older and your brows have sagged. If you look critically at your bows you will note that instead of having a gentle masculine arch they are both nearly straight with your right being positioned lower than the left. As a result of this sagging, the amount of upper lid skin is increased making seeing things in the upper field of vision harder. As a result, when you drive you will tend to both tilt your head back and constantly use the forehead muscle , the Frontalis, to keep lifting your sagging brows to clear skin from the upper field of vision.

The result - a large frontalis muscle and permanent creasing of the Forehead skin.

Placing Botox in the frontalis will temporarily take away the muscle's ability to crease the forehead. This would allow fillers placed in the wrinkles to remain in place and not be squeezed out by the muscle's contractions. (Bear in mind though that it takes 5-7 days for the effect to take place. Therefore, if you REALLY wanted to make sure your filler money was not wasted, you should have the fillers put in 7-10 days AFTER the Botox injections).

As regards Botox - 2 cautionary notes:
1. Make sure you are NOT injected closer than 1-2 fingers from the brows. If you are injected lower than this line your brows will fall much lower and you will have a hard time seeing. (See link below for BAD BOTOX).
2. In my opinion, 20 units of fresh, active Botox (Again, read the link below to understand) is optimistic. If you absolutely wanted Botox in the Forehead, I would place AT LEAST 25 Units with the understanding that when you are seen 7-10 days later you may need a touch up.

20% TCA in my opinion is a useless procedure for what you are seeking. I would not do it at the same time and I do not offer it in my practice. The peel is a VERY superficial peel that will not smooth lines of any significance.

As far as WHO should be giving Botox. Although there are good non-MD injectors out there, I firmly believe that a Plastic Surgeon/ENT/Dermatologist with an intimate knowledge of facial anatomy and cosmetic proportions is the best choice.

For the best BOTOX resource on the Internet, follow the link below -

Dr. P. Aldea

Peter A. Aldea, MD
Memphis Plastic Surgeon

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.