Fraxel Should Be Done Before or After Fillers?

Question

I want to have fraxel (2 or 3 sessions) to even out my skin tone, minimize wrinkles, pores, small scars, age spots, but I also need injectable fillers like restylane, radiesse, juvederm in my nasolabial folds, cheekbones, under my eyes. My question is what should I do first. If I have fillers and botox first and then fraxel laser, is there a risk that the fraxel laser will destroy the fillers? How many weeks should I wait between fillers, botox and fraxel? Thanks a lot, I read conflicting info

Ron Shelton, MD · Answer

Botox helps relax muscles so resurfacing heals on calmer less contracting skin, and it takes up to 1-2 weeks for Botox to work so it makes sense to do Fraxel after the Botox has had a chance to relax the muscles.After the series of Fraxel laser resurfacing treatments, fillers can be done.Of course, every patient is dealt with focusing on their history, examination, needs and timing. There is not a wrong way to do this as there has been no evidence that Fraxel laser would interfere with Botox or fillers, or vice versa.The information provided in Dr. Shelton's answer is for educational purposes only and is not intended to constitute medical advice.  The information provided should not be relied upon as a substitute for consultations with a qualified health professional who may be familiar with your individual medical needs.

James R. Gordon, MD, FACS, FAAO · Answer

Fillers should be injected a few weeks following Fraxel laser skin resurfacing. The
thermal damage from the laser could break down the filler if it is placed prior
to laser. In addition, a strong laser treatment could change the contour of the
face; therefore, it is best to judge the volume and location of filler placement
after laser treatment. Botox should be injected 1 week prior to the laser procedure. This will help diminish facial movement and allow the skin to heal with better
results. Botox injections should not immediately follow any procedure that cause skin swelling or it may risk migration to other undesirable
locations. I hope you find this helpful.

Sonia Badreshia-Bansal, MD · Answer

Thank you for your question. In clinical studies, there was no difference which is done first, lasers or fillers. However, some providers may have a certain preference and I would follow their protocols. Botox may be performed at any time as well. I would recommend a consult and treatment under the supervision of a Board Certified Dermatologist or Plastic Surgeon for best results and safest treatment options. I hope this helps!

Hardik Soni, MD · Answer

Fraxel laser should not affect fillers. Still, I would advise you to wait one month so you are definitely sure your filler is settled therefore you will minimize the risk of any complications. Good luck!

Melda A. Isaac, MD · Answer

It is controversial whether or not the heat from lasers and devices accelerate the breakdown of fillers. From my experience, it is best to have fillers injected after you complete your Fraxel treatment.  I typically tell my patients to wait 1-2 weeks after fillers are injected before having Fraxel or other treatments that drive heat into the skin. Radiofrequency and ultrasound devices for skin tightening deliver heat more deeply into the skin than Fraxel laser, so I suggest waiting 2 weeks after filler placement before undergoing these treatments. I do not hesitate to treat with Botox on the same day as any laser treatment.

Angela Sturm, MD · Answer

I would recommend having the Fraxel then fillers. The heat and healing process involved with Fraxel can cause fillers to absorb faster and not last as long. If you do decide to get fillers or Botox first, wait at least 2 weeks before Fraxel to minimize this effect.

Brian E. Dubow, MD · Answer

We recommend that fillers be put in after the Fraxel treatment. It is possible that the thermal injury and inflammation after laser treatment could accelerate the breakdown and absorption of the filler. In addition, the laser treatment would be expected to give some improvement and diminish the amount or location of filling injections needed.

Grant Stevens, MD · Answer

We always recommend you wait at least 2 weeks after gettting Botox  or filler injections and vice versa for if you get Fraxel done first and then want to get fillers or Botox.

	Dr. Grant Stevens            Marina Plastic Surgery Associates           Marina del Rey, CA The Institute

Michele S. Green, MD · Answer

I always tell my patients that if you are going to have Botox or Restylane/Juvederm first, then you should wait atleast a week for the skin to heal. Conversely, if you decide to have Fraxel first, then you can do your injections 1 to 2 weeks later on your post-Fraxel check-up that I do on every patient.

Steven Swengel, MD · Answer

Timing is always an issue when rejuvenating the face with these products. In general fillers and Botox can usually be done at the same time, but the potential swelling after a laser or fraxel procedure has the potential to move the freshly injected product, whether it be filler or Botox out of position. I prefer to have Botox in place a week before any laser work as it will allow me to assess and treat skin as it appears when rested. This is the same with fillers. If you can relax a line with Botox, you may not have to fill or you may be directing your fillers to other areas. Does Fraxel go deep enough to impact fillers? Most likely no. The only exception is Belotero which is the newest and most superficially placed filler for fine lines.

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