How long should I wait between Botox on chin and Xeomin for forehead?

Question

If I get 20 units of Botox for my chin/mouth area how long do I have to wait until I can get 20 units of Xeomin for my frown lines? I only had Xeomin once, 20 units for my 11s and it's wearing off. I'm seeing a doctor for Botox for my chin (never had it before). I will go back to my original injector for Xeomin for my forehead. I don't want to overwhelm by body - last time I felt numbness everywhere in my body after Xeomin in forehead (everything went away in a few hours, I calmed myself down).

Jason Emer, MD · Answer

We treat various parts of the face with Botox / Dysport / Xeomin on the same day. However, if you wish to separate the treatments in order to avoid overwhelming your body, I would discuss this with your physician and determine an appropriate waiting time before obtaining the second treatment. The Botox results typically take about 1 to 2 weeks.In our practice, we use neuromodulators like Botox, Dysport and Xeomin and soft tissue fillers like Belotero to improve the appearance of the forehead by reducing lines, wrinkles and folds. Deeper lines and wrinkles need a combination approach with Botox, fillers, lasers, and microneedling/PRP. I recommend getting a formal evaluation with a cosmetic dermatologist to develop a treatment plan that works for you. Best, Dr. Emer

N. Bill Aydin, MD · Answer

Thank you for your question, Bkbaby. There is no need to wait in between areas, both of these areas could be treated in one day. There is no problem waiting in between or seeing different providers but it is also not necessary to do so.

Richard W. Westreich, MD · Answer

As long it is a different area that is being injected, there is no time concern for treatments with one product versus another. You should feel free to move ahead with the second treatment

Jonathan Pontell, MD, FACS · Answer

There is no need to wait in between Botox and Xeomin treatments.  They can be done at anytime.

Anteneh Roba, MD · Answer

You can get the Xeomin when its effects wears off and get the botox when you are ready. There doesn't  have to be a gap between the two treatment times.

Camille Cash, MD · Answer

You do not need a specified amount of time to have injections on your forehead after treating your chin.  In the future you can have both areas treated at the same time.  I've included a video about neuromodulators that I hope you find helpful.

Alex Eshaghian, MD, PhD · Answer

Thank you for your question Bkbaby. I understand your concern. Botox is a purified protein used to address wrinkles associated with facial expression. When injected into the skin Botox will relax the muscles and smoothen out the overlying wrinkles. The most common areas of treatment are in the upper face. These include the horizontal lines seen on the upper forehead when one raises the brows, the vertical lines seen between the brows when one frowns (frown lines), and the crow's feet seen around the eyes when one smiles.
It is difficult to make an assessment without a formal exam where the entire medical history is reviewed. However, I hope the information provided here is useful.The appearance of frown lines is variable from person to person. Usually they are in a vertical orientation but sometimes they can be oblique and sometimes a horizontal line is seen across the upper portion of the nasal bridge. The most common variation is to have two parallel lines, hence the common term "11's" to describe them. But some people have one, three, or more lines. Some people also will see a bulge in the area when contracting the muscle. This bulge is smoothened out after a Botox treatment.
The pivotal studies used 20 units of Botox in the glabella area between the brow to address the frown lines. These studies demonstrated that the peak results are seen 14 days after the treatment and most people enjoy their results for 3-4 months. At that point, a maintenance treatment is recommended. While some people start to see results as early as the next day, it can take two weeks for full results so patience is important. We have our patients return two weeks after their treatment to assess their results via photographs. At that time additional units may be added if necessary. 
Botox can also be used in various areas in the lower face. The nasalis muscle on the bridge of the nose is responsible for the bunny lines that are sometimes seen there when one frowns or smiles. Usually 2-4 units of Botox are used per side for this area. Botox (onabolutimun toxin) is what we call a neuromodulator. This means that it controls nerves to relax the muscles by preventing them from contracting. Botox is the most popular neuromodulator available, has been the most studied, and is cleared for the most number of indications. Other neuromodulators available in the United States include Dysport (abobolutimun toxin), Xeomin (incobolutimun toxin), and Mybloc (rimabolutimun toxin). Botox, Dysport, and Xeomin are type A toxins while Myobloc is a type B toxin. This means the structure of the protein is slightly different. Overseas many others are also available. Dysport is the most commonly used neuromodulator other than Botox in the United States. The dosing for Dysport is different than that for Botox. Approximately 2.5 to 3 units of Dysport are required for every unit of Botox. For example, in the glabella 20 units of Botox is most commonly used. If Dysport were to be used in this area 50 to 60 units of Dysport would be required. The investment per unit of Dysport is approximately 2.5 to 3 times less than that of Botox. While the manufacturer states that the units of Xeomin are a one to one equivalent of Botox, many doctors find that a higher dose of Xeomin is required to produce the same effects as Botox. Each product has slight differences, but all of them work. Dysport, for example, is known to spread more than Botox. This makes it useful in places like the underarms where it can be used for excessive sweating. However, if it spreads near the eyes it can lead to side effects such as a droopy eyelid. Xeomin is also called a naked protein, because it does not contain the accessory proteins that are included with Botox or Dysport. It is thought to have a slightly faster onset (by one to two days faster) than Botox or Dysport. It is also thought to have a decreased likelihood for allergic reactions, although allergic reactions to Botox and Dysport are incredibly rare. In the United States Myobloc is not FDA cleared for cosmetic use and is primarily used for muscle pain in those with cervical dystonia. The majority of our patients find that they like the results of Botox the best. Additionally, Allergan, the maker of Botox, offers the Brilliant Distinctions Program. This is a rewards program where patients receive points from their Botox treatments which can be used toward discounts at subsequent treatments. Points are also received when patients purchase other treatments in the Allergan portfolio including Juvederm Ultra, Juvederm Ultra Plus, Voluma, Volbella, Vollure, and Kybella or products such as Latisse or Skin Medica products.
If I had a patient with the concern described here I would say that the two areas can be treated on the same day or on different days and it is not necessary to wait between the two treatments.With any injection, there are risks such as pain, bleeding, bruising, redness, swelling, tenderness, and infection. We take special precautions to minimize these risks such as using a painless technique. We also treat bruises with a laser as early as the next day. Bruises usually resolve within two weeks if untreated. After a laser treatment bruises usually resolve in 1-3 days, but may still take two weeks for full resolution. In addition to these risks, with Botox there is also a risk that the product spreads or diffuses to nearby structures. Spread to nearby muscles can lead to side effects such as the temporary appearance of droopy eyelids or a temporary asymmetric smile.
  
After a Botox treatment, I recommend that my patients avoid heat exposure, alcohol consumption, and strenuous exercise for 24 hours and not lie down flat for four hours. This is because all of these activities may possibly lead to the movement of the product and consequent side effects such as droopy eyelids. Although there have been no definitive studies shown that these actually occur and some physicians do not provide such aftercare instructions, in the absence of data I err on the side of caution and recommend that my patients avoid such activities.
  
Please consult with a doctor for specific recommendations. Good luck!

Neel Bector, MD · Answer

Hi, thank you for the question. All the Botulinum toxin (Botox, Xeomin or Dysport) containing products can be injected simultaneously. As in your case site of injection is different, its safe and recommended to administer both at same time. So,that their progress can be monitored and results are availed together.  I would recommend you to consult one reputable injector and discuss your concerns in detail. 
Best Regards,
Dr. Neel Bector

Satyen Undavia, MD · Answer

Thanks for your question. You should not have to wait between these injections. At the levels you are getting it is safe to receive both within close proximity of each other. Good luck

Melvin Elson, MD · Answer

There is no difference between the 2 sort of like Bayer aspirin and Walgreens aspirin.  you will not get too much to overwhelm your body by having the injections you stated

How long should I wait between Botox on chin and Xeomin for forehead?

Answers (16)