Is Fractional Laser Compatible with Botox?

i applied urbium laser 1 week after botox for forehead and eyes. only 3 weeks later the effect of botox disappeared and wrinkles recurred. is this due to laser that might have denatured botox?

Doctor Answers 15

Botox and Fractional CO2 Laser Combination

It is unlikely that the Botox is ineffective due to Fractional CO2 Laser treatment. You may simply need to be enhanced in terms of Botox units or it may have not been full strength Botox when placed in your forehead and eye areas for wrinkle treatment.

New York Oculoplastic Surgeon
4.3 out of 5 stars 72 reviews

Use Botox After Laser Treatments

While fractionated C02 or Erbium laser work well with Botox, there is a theoretical risk of the Botox "moving" to places where it is not intended by lasering over an area, immediately after Botox.  We usually like to space out the treatments by a few days or inject the Botox after the laser procedure has been performed.

Jason D. Bloom, MD
Philadelphia Facial Plastic Surgeon
5.0 out of 5 stars 20 reviews

Botox and Fractional Laser Work Well Together

No. Having a fractional laser treatment will not cause the Botox to wear off. In fact, used together they can create great results and provide and a more rejuvenated look. 

Mitchel P. Goldman, MD
San Diego Dermatologic Surgeon
4.9 out of 5 stars 25 reviews

Fort Lauderdale Botox

Fraxel following neurotoxin injection should not affect Botox. As a cell biologist, it does beg the question of the effects of resurfacing on wound healing and neuropeptide release at the nerve-muscle junction. As the esteemed physicians noted above, there should be no affect. I do feel this is an area in need of research. I recommend resurfacing followed by neurotoxin to avoid this possibility to arise entirely.

Will Richardson, MD
Fort Lauderdale Dermatologic Surgeon
4.3 out of 5 stars 10 reviews

Laser does not effect Botox.

The laser from either CO2 laser or Yrbium laser does not go deep enough to reach muscles.  Therefore, theoretically, it cannot effect Botox.  Botox and laser work very well together.  However, to be safe, if use the botox after I do the laser.

David Alessi, MD
Beverly Hills Facial Plastic Surgeon
4.7 out of 5 stars 16 reviews

They are compatible as long as they are done at separate visits

Botox paralyzes your muscles so that with expression, prominent lines made during expression (crow's feet, frown lines, forehead lines) are diminished.  A fractioral laser treatments aim is to remove the top layer of skin to rejuvenate the skin.  The level of rejuvenation depends on how much energy you use.  But regardless, the laser treatment treats your skin, not your muscle like Botox does.  Used together, they can be very compatible and effective.  But, these 2 treatments can't be performed at the same time since the swelling created from the laser treatment could cause extensive migration of the botox leading to unwanted side effects like brow droop or facial nerve paralysis.  These 2 treatments should be separated by at  least 2 weeks. 

Carla R. Retief, MD
Nashville Dermatologic Surgeon
3.7 out of 5 stars 6 reviews

No, the laser does not go deep enough to affect the Botox.

No, the laser does not go deep enough to affect the Botox.  You may be developing a Resistance to Botox.  I would recommend that you try Dysport for your next treatment.  It will often work in patients who have become resistant to Botox.

Mark Taylor, MD
Salt Lake City Dermatologic Surgeon
4.2 out of 5 stars 18 reviews

Lasers after Botox

Within 20 to 90 minutes after it is injected, botulinum neurotoxin type A can be detected inside the motor nerve endings. Therefore the muscles and nerve endings take up the Botox or Dysport very quickly before they can spread far from the injection site. In my office, there are no restrictions after the first few hours post Botox injections as the final outcome of the treatment will not be affected.


Mitchell Schwartz, MD
South Burlington Dermatologic Surgeon
4.7 out of 5 stars 12 reviews

Fractional Laser and Botox Use

Botox irreversibly alters the functional part of the tip of the nerve.  Once the affect takes hold, nothing can reverse it, erbium lasers included.  Botox only "wears off" when your body replaces the functional part of the nerve tip with a new one, typically in about three months.

Your perception that the Botox failed is based on seeing wrinkles.  However, the direct affect of Botox is not on wrinkles, it is on the nerve/muscle connection.  Only after a period of time where the muscle is no longer "scrunching" the skin will the wrinkle improve. 

You noted the wrinkle went away after your erbium treatment, this was in all likelihood the result of swelling which has an amazing affect on wrinkles, all-be-it short lived.  Contrary to what you were probably told when you signed up for the erbium treatment, this type of laser as used most commonly has little or no affect on wrinkles, only complexion.  Only dual mode erbium lasers have the ability to produce long standing wrinkle repair, and this treatment requires several months to heal from, so it is sounding like you did not have it.

So, either your Botox never worked and the only affect you observed was swelling from the laser treatment, or, the Botox did work and continues to work, it is just that cessation of the muscle has not produced the wrinkle improvement you desire (at least not yet).

Louis W. Apostolakis, MD
Austin Facial Plastic Surgeon
4.7 out of 5 stars 33 reviews

Can Erbium laser deactivate Botox?

No, laser cant deactivate Botox or Dysport. The simple fact is that the protein is absorbed by the nerve and the connection with the muscle is disconnected for a time. Laser will not touch this because the protein is already absorbed

Botox or Dysport that does not last is usually the result of not enough material being placed- usually the injections are not dosed with enough material in an effort to 'get a deal".


Kenneth Beer, MD
Palm Beach Dermatologic Surgeon
5.0 out of 5 stars 8 reviews

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.