Is Botox before a facelift normal?

Question

I went in for a consult and the Surgeon wants me to come in two weeks before the surgery to apply Botox in my face. Is this normal? He also states on the paperwork that any revisions needed are an extra cost. I’m thinking that once the Botox wears off then you will Then see any potential symmetry problems

Steve Laverson, MD, FACS · Answer

You are correct to question the recommendation for Botox before a facelift procedure, but the WHY should be asked of your surgeon.  Where will the Botox be injected?  What are the target muscles and desired result?  How can the results be evaluated early after surgery if they are superimposed on Botox effect?  Will Botox influence assessment of facial nerve activity during the procedure?  We often include Botox after Lightscalpel 4020 CO2 laser resurfacing to smooth facial skin and prevent wrinkle recurrence, but never before.

Arthur Dean Jabs, MD, PhD, FACS · Answer

Typically I do not espouse Botox prior to facelift surgery in any area that would be affected by the lift. But, if you are doing a lift and you have upper forehead lines you would like to address then it should not be an issue. I would not advise peri oral botox for pre op. 
As far as the costs for revision that should be discussed with your surgeon so that you understand what he/she is specifically talking about. If I feel a revision, tuck-up, etc etc is warranted I will often only charge the OR fee. This should be a rare occurrence.

Best of luck,

Dr. J

Lucian Ion, FRCS · Answer

Thank you for your enquiry.

Botox treatment before brow lift intervention can help with the quality of the result as it reduces the activity of the muscles around the eyes that are attempting to reverse the effect of the brow lift. It is potentially beneficial to use it also along the jaw line to decrease the downward activity, but that is probably less likely to be recommended by surgeons.

With regards to symmetry aspects, when someone is lying down for the surgery, the elements of the facial shape that we see when standing up are significantly changed. Most of the results that we wish to achieve are already present.

As such, the face lift intervention is based more on a structured preoperative plan and the experience of how much release and repositioning is generally required to achieve a nice result. This is because it is not technically possible to sit someone up completely and see the full effect of gravity.

In that sense, the impact of botox treatments is negligible for planning and symmetry and counteracting risks of asymmetry after the surgery.

Earl Stephenson, Jr., MD, DDS, MBA · Answer

Dear lynnly63,

Thank you for your question. Every surgeon has his or her own preferences and treatment plan, so the most important thing is to ask directly what the purpose of the BOTOX® is before your facelift.

There may be a specific reason your surgeon prefers it as part of the process, but that should be explained clearly so you understand how it fits into your surgery and recovery. Your question about symmetry is a reasonable one, and it is appropriate to ask how much of the early appearance could be affected by Botox versus the surgery itself.

Revision policies also vary from office to office. Before moving forward, make sure you understand the policy fully, including what costs may apply and what your responsibilities are before, during, and after surgery.

If anything remains unclear after that discussion, getting one more consultation with a board-certified plastic surgeon would be appropriate.

Warmest regards,

Dr. Stephenson

Pasha Mostofi, MD, DMD · Answer

Yes, what your surgeon is recommending can be completely normal, depending on the type of procedure you’re planning. Using Botox (botulinum toxin) about 1-2 weeks before surgery is sometimes done strategically to relax specific facial muscles. This can help optimize surgical results, reduce tension on healing tissues, and in some cases improve symmetry, particularly in procedures involving the brow, forehead, or around the eyes. The timing matters because Botox takes about 10-14 days to reach full effect, so doing it shortly before surgery allows the surgeon to operate with the muscles in a more controlled, relaxed state.
That said, your concern about symmetry after the Botox wears off is very reasonable. In most cases, experienced surgeons account for both the temporary effect of Botox and the long-term baseline of your facial anatomy when planning the procedure. The goal is not to “mask” asymmetry but to enhance the final outcome. It’s absolutely appropriate to ask your surgeon how they factor in the temporary nature of Botox and what happens once it wears off.
Regarding revision costs, it is also standard practice for many surgeons to outline that revisions may carry additional fees. Policies vary widely, some include minor revisions within a certain timeframe, while others charge separate surgical or facility fees. This doesn’t necessarily indicate a problem, but it’s important to clearly understand what is covered, what isn’t, and under what circumstances a revision would be considered medically necessary versus elective.
Overall, nothing you’ve described is inherently unusual, but you should feel comfortable asking for clarification. A good follow-up question might be: “How does the preoperative Botox affect my long-term symmetry once it wears off, and what is your revision policy in detail?” Clear communication here will help you feel confident moving forward.

Gary Motykie, MD · Answer

Using Botox prior to surgery can be appropriate in certain cases. Some surgeons use it to help relax strong muscle activity (like frown lines or asymmetry), which can actually improve healing and optimize the final result. That said, it’s not something that’s universally required for every patient — it should be case-specific and clearly explained.

If anything feels unclear, I always recommend asking your surgeon to walk you through why Botox is being recommended in your specific case and how they handle revisions — that transparency is important.

If anything feels unclear, I always recommend asking your surgeon to walk you through why Botox is being recommended in your specific case and how they handle revisions — that transparency is important.

Nicholas S. Karter, MD · Answer

Hi. If you ask 100 different surgeons how they would approach a patients' facial rejuvenation, you would likely get 100 slightly different answers. Each surgeon has a particular way of performing the surgery and usually they have good reasons behind why they choose to do things that way (granted we are not always right). The easiest thing to do would be to ask why he does that before a surgery. From my perspective, doing Botox prior to a surgery would be helpful for some things and hurtful for others. If you are doing a forehead scar revision lets say, then Botox to the forehead would cause less muscular pull on the scarline and likely improved overall scar outcomes. If you are doing a browlift with blepharoplasty than it would be detrimental because it would alter or mask the resting position of the brows and could throw off the appropriate pre-op planning. I would encourage you to discuss this further with your surgeon, if they give you good reasons for why they are thinking pre-operative Botox would improve the outcome, than you can proceed more confidently. Hope this helps.

Is Botox before a facelift normal?

Answers (7)

More Facelift Questions

Delayed healing or neuropathy two years after a SMAS plication, neck lift, and an extensive upper and lower blepharoplasty?

58, male - what would be the best options to remove all wrinkles from my face, forehead and neck? (Photos)

I'm 28, lost 50LBS, want to fix my lower third heaviness. What surgery would you suggest to achieve this? (Photos)

Marionette lines/ jowls at 28 - Do I need a facelift? (Photos)

What will help these stubborn festoons? (Photos)

Perioral mounds or marionette lines - how can I fix this area? (Photos)

WE SEND PRETTY
EMAILS