Can You Do Botox and Microneedling on the Same Day?
Whether Botox and microneedling can be combined in one visit, what the evidence and labeling say, why many providers stagger them, and how to plan the order.
Some providers do Botox and microneedling on the same day, but there's little research on combining them in one session, and many prefer to space them out. The short answer: if they're done together, microneedling usually comes first and Botox last, or the two are separated by about one to two weeks. Follow your provider's plan, since technique and products vary.
What we know and don't know
- Botox Cosmetic labeling: It's approved for moderate to severe glabellar (frown) lines, lateral canthal lines (crow's feet), forehead lines and platysma bands. Infection at the injection site is a contraindication. The label also warns that the toxin's effect can spread beyond the injection area (Botox Cosmetic label, DailyMed).
- Research on same-day combination: We found no controlled clinical trials testing Botox and microneedling in the same session.
- Combination products in general: The FDA notes that the safety of dermal fillers combined with neuromodulators or other treatments hasn't been evaluated in controlled clinical studies (FDA: dermal fillers). The same caution applies to stacking treatments in one visit.
Why many providers stagger them
| Concern | Reasoning |
|---|---|
| Swelling and redness after microneedling | Can make it harder to place Botox precisely |
| Massaging or pressing the treated skin | Microneedling aftercare can involve touching the face, which providers often ask you to avoid right after Botox |
| Broken skin barrier | Microneedling creates tiny channels; injecting through irritated skin adds infection risk |
| Judging results | Spacing them out makes it easier to tell which treatment caused a side effect |
Common approaches
Option A: separate visits (most conservative)
- Botox first, then microneedling about 2 weeks later once the Botox has settled, or
- Microneedling first, then Botox once redness and swelling have resolved, often about a week.
Option B: same day
- Microneedling first, avoiding areas that will be injected, then Botox. Some providers inject first and avoid microneedling over injected areas. Ask how your provider handles this.
Side effects of each on its own
| Treatment | Common side effects |
|---|---|
| Botox Cosmetic | Most common in trials: eyelid drooping (3%) for frown lines, eyelid swelling (1%) for crow's feet, and headache (9%) and brow drooping (2%) for forehead lines (Botox Cosmetic label) |
| Microneedling | A review of 9 randomized trials for acne scars found no serious adverse effects and called it well tolerated (Sitohang et al., Int Wound J, 2021) |
Combining them in one visit means you can get both sets of side effects at once, and it's harder to tell which treatment caused a problem.
Questions to ask your provider
- Have you done these on the same day before, and how often?
- What aftercare applies to each?
- Which areas will you treat with each?
- What should make me call you afterward?
Warning signs after Botox
The label lists trouble swallowing, speaking or breathing, and muscle weakness away from the injection site, as signs of toxin spread, which can appear hours to weeks after injection. Seek care right away if they occur (Botox Cosmetic label).
Frequently asked questions
Will microneedling make Botox wear off faster? We found no good evidence either way.
Can I microneedle at home after Botox? Avoid at-home microneedling on treated areas unless your provider approves.
Does it matter which neuromodulator I get? Each has its own labeling; ask your provider about the specific product.
This article is for educational purposes only and is not medical advice. Talk to a board-certified dermatologist about your situation.
Sources
- Botox Cosmetic (onabotulinumtoxinA) prescribing information. DailyMed
- Sitohang IBS et al. Microneedling in the treatment of atrophic scars: a systematic review of RCTs. Int Wound J. 2021. PubMed
- U.S. Food and Drug Administration. Dermal fillers (soft tissue fillers)
