Ulthera, Botox and Fillers, Laser Resurfacing. In Which Order Should I Have Them?

Question

I am determined to keep my skin as flawless as possible for a long time. I plan on doing Ulthera, botox and fillers, laser resurfacing, but I don't know in which order I should have them. For instance, if I have fillers first, is there any chance that Ulthera and laser resurfacing will destroy the recently injected fillers? Or, if I have botox, first, is there any chance that laser will nullify the positive effects of botox? Thanks a lot

Ron Shelton, MD · Answer

I like to relax the musculature first with Botox cosmetic injections, preferably a week or two before, but even one day before is fine. The Botox is bound immediately and there is no evidence of which I'm aware that Ultherapy a day later would interfere with Botox's effect. In this way, after Botox, the Ultherapy's effect of collagen production and lifting can occur in a smoother environment with less active contraction of muscles and pleating of overlying skin. After Ultherapy I then do fillers, both for volume such as Sculptra or Radiesse and layered with more superficial fillers such as Restylane, Juvederm or Belotero.

Richard Baxter, MD · Answer

Ulthera takes some time to see the full effect, and you would not want to treat directly over fillers so it makes sense to do it first. Also, depending on how much lifting is achieved, it could affect the amount and placement of fillers. Botox could be done soon after but best not before.

Rebecca Fitzgerald, MD · Answer

Ultherapy first and then any laser resurfacing should be done before Botox and fillers.

	The heat from Ultherapy and laser resurfacing can interfere with Botox and fillers. The exception to the wait for fillers would be if you were having Sculptra, which works quite well immediately post Utherapy and can be done in the same treatment session.

	As far as time between treatments, that can get pretty complicated. It depends on the type of laser resurfacing and the kind of filler.

	For instance, in our practice we recommend our eMatrix patients wait a month for fillers or Botox and other relaxers.

	You might look at it as a "permanent 1st" and then "temporary 2nd" treatment sequence. Since treatments that alter the skin tissues themselves rely on heat, and the heat-induced subsequent deep tissue inflammation (the desired kind) takes time to subside, temporary cosmetic treatments including fillers like Juvederm, Restylane, Botox or Dysport will integrate better when the dermal tissues have had time to recover.

Hratch Karamanoukian, MD, FACS · Answer

I like the order that you have specified in your question because it addressed the issues from deep to superficial layers, addressing laxity, then volume and finally surface contouring. Read my Ultherapy ebook provided on the link below.

Dan Mills, MD · Answer

it is a good idea to work from deep to surface with non-surgical modalities.   Ulthera is  the deepest and doesn't affect the surface of the skin so it would be done before laser resurfacing and fillers.   Fillers would come after the Ulthera and Laser.  Botox should be planned to consider any swelling that the Ulthera could create or allowing ample time for the Botox to reach it's full effect. Because there haven't been any clinical studies published on timing for combining Ulthera with Botox, we don't have specific time tables. so best to be a bit conservative with separating the two if done in the same area.   

	Timing of your procedures is smart to consider  and it would be a good idea to set up a "plan and timetable" with your provider for them.

	Think of Ulthera as  the foundation of the house, and you can put the finishing touches on with Laser, Fillers, and  Botox.

Ulthera, Botox and Fillers, Laser Resurfacing. In Which Order Should I Have Them?

Answers (9)

Answer: Ultherapy, Botox and fillers followed by laser resurfacing

Answer: Ultherapy, Botox and fillers followed by laser resurfacing

Answer: Treat the foundation first and then up to the surface.

Answer: Treat the foundation first and then up to the surface.

Recommended reading

Everything you need to know about Ultherapy

Our mission is to create a world where every investment in modern beauty is Worth It.

Ulthera, Botox and Fillers, Laser Resurfacing. In Which Order Should I Have Them?

Answers (9)

Answer: Ultherapy, Botox and fillers followed by laser resurfacing

Answer: Ultherapy, Botox and fillers followed by laser resurfacing

Answer: Treat the foundation first and then up to the surface.

Answer: Treat the foundation first and then up to the surface.

Browse related questions

Recommended reading

Everything you need to know about Ultherapy

Our mission is to create a world where every investment in modern beauty is Worth It.