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

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.

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.

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.

 

 

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. 

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 should be first since it will take the longest to show effects, as results occur gradually over a few months time. Botox and/or fillers can be performed soon after an Ulthera treatment.  After a couple months I would then get the laser resurfacing treatment if needed. This combination of treatments often times gives patients remarkable results. Good luck!

Hi,

I agree with the other physicians to get Ultherapy first.  At the time of your Ultherapy treatment you can add Sculptra to get facial volumization for a technique if you are already numb with the Ultherapy treatment.   You should get Botox before any laser resurfacing so as you are generating new collagen after laser, you are not creating new dynamic wrinkle lines.

 

Best,

Dr. Liu

Thank you for your question. I would receive Ulthera before all other treatments, to ensure it does not disrupt the results of Botox and fillers. I would also suggest receiving laser resurfacing before Botox and fillers. 

You are right to question the order in which you should have these procedures done.  The company recommends to not perform ulthera over fillers because it is not clear whether or not it will degrade the filler.  This is especially relevant now that we could treat around the mouth with Ulthera with a 1.5 mm transducer. I would recommend having the ultherapy first, followed by the laser resurfacing and then the fillers and botox.