Can Fraxel Laser Cause Botox to Diffuse to Mouth?

Recently, I had Botox for frown lines between eyes, lines on my nose, and crow's feet. I also had Juvederm in cheeks. Seven days later, I had Fraxel on face. Two hours later, my smile was crooked. It improved 3 weeks later, but right side around my mouth is still not normal. Could the Fraxel have caused the Botox to diffuse down to my mouth? I had Bell's palsy 30 years ago, but I'm sure it is not related because only my mouth is affected. I am having another Fraxel next week, and am scared that it will happen again.

Doctor Answers 5

Fraxel Laser, Botox, and Uneven Smile

Hi bia,
I have not heard of, or seen this adverse effect with Fraxel, and most of my patients are on Botox at the time of their treatments.

If you had a nerve block there is a possibility that the needle punctured or traumatized a branch of the facial nerve. If that is the case, and it is improving, then it should resolve with time.

Speak with your treating physician before your next treatment, but I do not think that the side effect is due to the Fraxel treatment.

Please let us know how it goes. Be well.

Dr. P

Encino Facial Plastic Surgeon
4.8 out of 5 stars 36 reviews

Most likely this had nothing to do with the Fraxel

Dear Bialli08

Fraxel is a very well tolerated superficial treatment. If you told us that the fraxel was done right after the BOTOX treatment on the same day, then it would be possible that the pressure applied to the face during the treatment might have pushed the BOTOX around and contributed to the problem.

However, you are telling us that the Fraxel was a week later, so this is unlikely. Could swelling associated with the Fraxel exacerbated motor weakness associated with you Bell's maybe but this is also less likely.

It is more likely that the BOTOX used to treat the lines on the nose affected the levator labii alaeque nasi muscle or other lip elevators and the degree of weakening was not the same on each side accounting for the asymmetry of the smile. When the treatment side effect is minor, it generally does not last a long time. Also a week is about when these effects are seen.

Bring this issue to the attention of your doctor. However, you should be fine for your next fraxel.

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

Botox and Fraxel

Thanks for your question -

It is unlikely that these issues are related. Botox seven days later should not be able to migrate at all. And even immediately after injection it would be likely impossible for a normal dosage of Botox to travel from the upper third of your face to your muscles of facial expression in the lower third of your face.

In addition there's no mechanism for Fraxel to cause the botox to move.

I hope this helps.

Steven H. Williams, MD
San Francisco Plastic Surgeon
4.8 out of 5 stars 49 reviews


Botox is injected within the muscle sheath and diffuses minimally after it is injected. After injection the toxin finds it's way to the nerves and enters within a short period of time.

Fraxel works by penetrating the dermis only and stimulating collagen production. This is significantly more superficial than the muscle. In addition your treatments were separated by a week.

I suspect the smile difference has come from different tightness in the skin secondary to the Fraxel.

Christopher L. Hess, MD
Fairfax Plastic Surgeon
4.4 out of 5 stars 34 reviews

Fraxel and Botox are most likely unrelated

The Fraxel laser is not likely to have altered the distribution of the Botox.

Any stress to the face including surgical trauma, laser or chemical peels may re-activate sub-clinical or latent pox infections which are associated with Bell's Palsy. You may want to consider a prophylactic course of an antiviral medication prior to your next Fraxel treatment.

As mentioned in the other comments, nerve blocks may have injured the nerve, altered the distribution of Botox or caused driect mechanical trauma to the muscle.

Discuss this wih your surgeon.

Otto Joseph Placik, MD
Chicago Plastic Surgeon
4.9 out of 5 stars 82 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.