Most clients who sit in my chair are not starting from scratch. They have a bathroom shelf with a half dozen serums, an eye cream they like, maybe a prescription retinoid from their dermatologist, and photos on their phone of a friend’s Botox before and after. The question comes up in almost every consultation: can I keep using retinol if I get Botox injections? The short answer is yes, with timing and technique that respect how both work. Done right, the combination often gives smoother lines, more even tone, and a polished look that neither treatment delivers alone.
Below, I will walk you through how Botox and retinoids interact, what to do the week of treatment, how to build a smart skin routine around injections, and the edge cases where I adjust the plan. Expect practical details from real clinic life: how long I ask patients to hold actives, what improves tolerance, and what to do when skin is already irritated.
How Botox and Retinoids Do Different Jobs
Botox is a neuromodulator. In aesthetics we use botulinum toxin type A brands like Botox, Dysport, Xeomin, and Jeuveau to temporarily relax targeted facial muscles. That relaxation softens expression lines such as horizontal forehead lines, glabellar frown lines between the brows, and crow’s feet at the outer eyes. The active effect builds over three to seven days and peaks by two weeks. Results typically last three to four months for most people, sometimes five to six with consistent maintenance. Units are tailored to your anatomy and goals, and the injection sites are precise to shape rather than freeze expression.
Retinoids, including cosmetic retinol, retinaldehyde, adapalene, and prescription tretinoin, signal skin cells to turn over faster and produce more collagen and elastin over time. They improve fine lines, mottled pigmentation, and texture. They do not paralyze muscle, so they do nothing for dynamic wrinkles that crease when you frown, squint, or raise your brows. Instead, they remodel the dermis, refine pores, and even help with acne. With steady use, most people see textural improvement by 8 to 12 weeks and firmer, more even skin by four to six months.
When you pair the two, you target both sides of the aging equation. Botox addresses muscle-driven lines at the source. Retinoids improve the canvas itself: tone, texture, and very fine lines that Botox does not touch. The result can look more complete, like a reset rather than a single fix.
The Safety Question: Can They Be Used Together?
There is no chemical or pharmacologic interaction between topical retinoids and Botox. Retinoids applied to the skin do not interfere with the mechanism of neuromodulators injected into muscle. The risk is not about the actives interacting in your body. The risk is about skin tolerance and procedure comfort.
Retinoids can cause irritation, peeling, and a compromised skin barrier, especially at the start, after a dose increase, or in dry climates. Irritated skin is more sensitive to needles and antiseptics. It also makes aftercare less pleasant if you continue retinoids too soon after injections. That is why the advice you often hear, including from me, is to pause around the procedure window. Not because retinol makes Botox less effective, but because calm skin tolerates the process better and heals with less redness.
Timing Retinoids Around Your Botox Appointment
This is how I ask most patients to handle retinoids:
- Two nights before treatment: skip retinoids. Come to your appointment with a calm, hydrated barrier. You can continue gentle cleanser, moisturizer, and sunscreen. Night of treatment: skip retinoids and exfoliating acids. Cleanse, moisturize, and leave the area alone. For the next 24 hours: still avoid retinoids. Keep the injected areas clean, apply a bland moisturizer if needed, and follow standard Botox aftercare guidelines. After 24 to 48 hours: resume retinoids at your usual schedule if the skin feels comfortable, with no unusual redness or tenderness. If you are acclimating to retinoids or prone to irritation, wait 72 hours.
That window reduces sting and limits the chance of overlaying a peeling cycle on injection points that may already be a bit pink or bumpy. The neuromodulator itself is unaffected by what you put on the surface once placement is done. The concern is simply comfort and barrier integrity.
If you are on a high-strength prescription like tretinoin 0.05 to 0.1 percent, or you layer other actives such as glycolic acid, salicylic acid, or benzoyl peroxide, extend the pause: two to three nights prior and two to three nights after. Sensitive and rosacea-prone skin often benefits from that wider buffer.
The Week of Treatment: What I Want You to Do
The best outcomes come from small details. I consider this essential pre and post routine for a standard Botox procedure on the forehead, frown lines, and crow’s feet:
- Two to three days before injections, switch to a minimalist routine: a gentle cleanser, a hydrating serum if you like, and a fragrance-free moisturizer. Keep sunscreen during the day, at least SPF 30. Skip facial waxing, scrubs, and at-home microderm devices. The day of your appointment, arrive with clean, product-free skin. No makeup on the upper face if we are treating the forehead and eyes. This lowers contamination risk and speeds the visit. After injections, avoid massaging the treated areas, heavy exercise, saunas, hot yoga, and tight headwear for the rest of the day. This is standard Botox aftercare and has nothing to do with retinol specifically, but it is vital to placement stability. For bedtime that night, cleanse lightly with lukewarm water, pat dry, and apply a bland moisturizer. Hold retinoids, acids, and scrubs. If you feel tender at any point injection sites are allowed to look like little mosquito bites for a few hours use a cold compress gently, 5 to 10 minutes at a time. Resume your usual skincare the next night or the one after, depending on comfort.
These steps respect the Botox procedure and your barrier without sacrificing your broader routine.
Where Retinoids Shine Versus Where Botox Wins
It helps to map results on the face. Botox is efficient for local botox in New York NY expressive areas: the forehead lines that show up when you look surprised, the 11s that crease when you concentrate, the crow’s feet from smiling or squinting. It also shapes the brow subtly, relaxes a gummy smile, softens pebbling of the chin, slims a bulky masseter for jawline contour when appropriate, and improves vertical neck bands in selected candidates.
Retinoids show best results on texture and tone. Crepey skin under the eyes that makeup catches on, coarse pores across the cheeks, pigment from old acne or sun, and the whisper-fine lines under the eyes and around the mouth that persist even when the face is relaxed. Retinoids also keep acne under control for many, which matters because breakouts can emphasize lines and disrupt an otherwise smooth finish.
If you are budget-conscious and deciding where to start, ask what bothers you most in the mirror. If the issue is expression lines, Botox for wrinkles offers the biggest visible change within two weeks. If your complaint is dullness and roughness with scattered dark marks, retinoids may give a better return over three months. Most patients end up choosing both in sequence. Botox first for the quick win and an anchor for your results timeline, then a retinoid layered in to slowly upgrade the surface.
Retinoids After First-Time Botox: Setting Expectations
First-time Botox patients often come back at the two-week check thrilled with smoother movement but surprised that the skin itself still looks the same up close. That is normal. Botox relaxes muscles. It does not shrink pores, reduce pigmentation, or fade old acne marks. This is where retinoids enter.
A realistic cadence looks like this. Week 0: injections. Days 1 to 3: gentle care. Day 3 onward: resume retinoids two to four nights per week if you are a beginner, or nightly if your skin already tolerates it. Weeks 3 to 4: your neuromodulator is stable, makeup sits better, and you notice your forehead skin looks a touch more glassy simply because the surface is not folding repeatedly. Weeks 6 to 12: retinoid benefits start to show in photos and in daylight. At three months: you schedule maintenance Botox and continue retinoids uninterrupted.
When patients follow this arc, the second and third Botox cycles tend to look better for the same number of units. You are not fighting static etching as hard because the retinoid is improving the dermis while the muscle is resting. That synergy is a quiet secret behind the “my results last longer now” comments I hear at visits four and five.
A Practical Skincare Routine that Plays Well with Botox
If you enjoy structure, here is a simple, sustainable routine that preserves Botox results and keeps retinoids working without unnecessary friction.
Morning: cleanse with lukewarm water or a gentle cleanser if needed. Apply a hydrating serum with glycerin or hyaluronic acid. Layer a fragrance-free moisturizer. Finish with broad-spectrum SPF 30 to 50, nickel-sized amount for the face, a bit more for the neck. If you use vitamin C, apply it before moisturizer and sunscreen, and skip it for the first 24 to 48 hours after injections if your skin is reactive.
Evening on retinoid nights: cleanse, pat dry, wait a minute, then apply a pea-sized amount of retinoid to the entire face, avoiding immediate proximity to the corners of the nose and mouth if you tend to peel there. Follow with moisturizer after five minutes. People with sensitive skin can sandwich the retinoid between two thin layers of moisturizer. Avoid this step on the night of injections.
Evening on non retinoid nights: cleanse and use moisturizer. This off night maintains the barrier and gives your skin a breather if you are still acclimating. If you love acids, slot in a mild lactic or mandelic acid once weekly, but not the night before or after Botox.
Over the eyes, tread lightly. Botox for crow’s feet softens lines from squinting. A low-strength retinoid around the orbital bone can help crepiness over time, but start once or twice weekly and stay on bone, not the lash line.
What About Stronger Retinoids and Compromised Barriers?
Retinoid strength and the state of your skin at baseline matter more than the brand of neuromodulator. Someone who has tolerated nightly tretinoin for a year often sails through Botox with a two-day pause. Someone who just started a 0.1 percent cream last week may arrive chapped and stinging, which I do not inject through.
If you are peeling or burning, we adjust. I push the appointment a week, simplify skincare, and sometimes switch retinoid vehicles. A microencapsulated retinol or a lower concentration tretinoin can bring you back into the productive zone. Moisturizer choice matters as well. Look for ceramides, cholesterol, and fatty acids to replenish the barrier. If you absolutely need to proceed with injections due to scheduling, we extend the no retinoid window and use extra gentle prep on the day.
Post procedure, a compromised barrier lengthens the restart timeline. Wait until the redness from injections resolves and your skin feels calm to the touch, then resume retinoids every third night for a week before increasing.
Common Myths I Hear and How I Address Them
A few persistent misconceptions deserve clear answers.
Retinol will make my Botox wear off faster. No. Retinoids work in the epidermis and dermis. Botox acts at the neuromuscular junction. They operate in different compartments. If anything, retinoids can make your results look better for longer because the surface quality improves as the muscle rests.
I should stop all skincare for a week after Botox. Not necessary and not helpful. You can cleanse, moisturize, and wear sunscreen the next morning. The key is avoiding aggressive rubbing, heat, and actives for 24 to 48 hours.
I can’t use retinoids near injection sites at all. You can, once the initial window passes and the skin is comfortable. Spread a thin, even layer rather than dotting directly over single sites. The goal is consistency, not spot treating injection points.
If I do baby Botox or mini Botox, I need a different plan. The plan is the same. Lower units simply reduce muscle movement while preserving more expression. The aftercare and retinoid timing does not change.
I should apply retinoid the night before so the skin drinks it in. Please don’t. Arrive with calm skin. Irritated, peeling skin increases discomfort with the alcohol-based prep and the needles, and it complicates aftercare.
Costs, Maintenance, and the Realistic Long View
People often ask me whether to spend on Botox or skincare. Think of Botox as a quarterly investment and retinoids as a small, consistent monthly investment. Botox cost varies with area and units. Forehead, frown lines, and crow’s feet together might involve 30 to 60 units depending on anatomy and aesthetic goals. Maintenance is every three to four months for most, with some extending to five or six once they settle into a routine. A retinoid ranges from a drugstore retinol under 40 dollars to a prescription that may cost more, depending on insurance.
The combined plan pays off over years. Botox prevents new etching in high movement zones. Retinoids prevent and correct the fine, diffuse signs of aging across the face. If you take photos in consistent lighting every three to six months, you will see the cumulative effect. The face looks rested without looking frozen, the skin looks smoother without heavy makeup, and the transition between treated and untreated areas is seamless.
Special Areas: Under Eyes, Lip Lines, and the Neck
Under eyes are delicate. Botox for under eyes is used cautiously, typically in very small units laterally to support crow’s feet. True under eye crepiness responds better to retinoids, peptides, and diligent sun protection. Start with a lower strength retinoid in a cushioned base two nights a week and increase slowly. If puffiness or eczema is part of your picture, prioritize barrier repair and work with an injector who can explain why certain injection sites may not be right for you.
Vertical lip lines around the mouth respond variably to Botox. Micro doses can help when lines are driven by pursing, and a Botox lip flip softens a tight upper lip by relaxing the orbicularis oris. Those moves do not replace volume loss. Retinoids help the perioral skin’s texture over months, but for etched lines, a combined approach that may include a tiny amount of filler or resurfacing can be appropriate.
The neck is its own conversation. Botox for neck bands improves the platysmal pull that can create vertical cords. Retinoids improve crepiness and sun damage on the surface. The skin on the neck is sensitive, so start slowly and use a moisturizer generously.
How to Choose an Injector and Set Up the Routine
Your injector should ask about your skincare, not just your wrinkles. Bring what you use, or take photos of your products. A good consultation covers medical history, medication use, previous procedures, and your daily routine. We want to avoid surprises like stacking a chemical peel on top of a strong retinoid two days before injections.
If you are new to everything, I build the plan in phases. First appointment: a conservative Botox treatment for the areas that bother you most. Two-week review: adjust if needed. Week three or four: start retinoid two nights per week, increasing to three or four as tolerated. Month three: repeat Botox on a maintenance schedule, review how your skin has tolerated retinoids, and consider adding in a vitamin C or a gentle acid on an off night if your goals include brightness.
What If You Are Prone to Breakouts?
Acne and neuromodulators do not conflict. If anything, fewer dynamic lines can make acne scarring less visually busy. Retinoids directly help with acne by normalizing cell turnover. The one adjustment is being thoughtful with occlusive moisturizers after injections if you are breakout-prone. Choose non comedogenic formulas and avoid heavy balms on the upper face for the first couple of nights. If you are on benzoyl peroxide, do not apply it adjacent to fresh injection points within the first 24 to 48 hours because it can sting and exacerbate redness. Resume your acne routine gradually as the skin feels normal.
The Subtle Art of Natural Results
The goal for most adults is not a perfectly still forehead. It is controlled movement that preserves expressions and keeps the surface smooth. That balance takes an experienced hand and good communication. Botox for men, for example, often uses different injection patterns to respect heavier brow muscles and a preference for a less arched brow. People who speak on camera want clarity without a shiny, immobile look. Retinoids support all of these aesthetic goals by improving the quality of the skin overlay, which is why they are a mainstay in maintenance plans.
If you have seen results you disliked in the past Botox overdone, a spock brow, a flat smile do not write off the whole category. Results reflect technique, dose, and follow up. Share photos of what you like and what you do not. Ask how many units your injector plans, what the expected timeline is, and what touch up policy they follow if an area needs refinement at two weeks.
When I Recommend a Longer Pause
There are scenarios where I ask patients to extend the no retinoid window. If we combine Botox with microneedling, light resurfacing, or even a filler appointment close in time, I want the barrier fully recovered before bringing actives back. If bruising occurs which can happen even with perfect technique, simply because facial vessels are variable I wait until the bruise is fading and the area is not tender. People with eczema, seborrheic dermatitis, or rosacea often need a slower cadence. For them, a gentle retinoid like retinaldehyde two or three nights a week can be more sustainable than high strength tretinoin nightly.
A Quick Reality Check on Side Effects
Botox side effects are usually mild: pinpoint redness, tiny swelling at injection sites for a few hours, occasional small bruises that fade in a few days, and a temporary headache. Rarely, diffusion to nearby muscles can cause eyelid heaviness. Proper placement and aftercare reduce this risk. Retinoids commonly cause dryness, flaking, and irritation at the start or after a strength jump. Slow and steady use, moisturizer layering, and sun protection make a big difference.
Neither treatment is a license to skip sunscreen. Ultraviolet exposure is the single strongest variable I see in how well results hold between visits. A patient who wears sunscreen daily and re-applies for outdoor time maintains a smoother look month to month, needs fewer corrective procedures, and spends less overall to keep results.
The Bottom Line
You can absolutely use retinol with Botox. They work on different targets and complement each other beautifully. The key is simple timing: pause retinoids for a couple of nights before and one to three nights after injections, keep the barrier happy, and then return to your normal routine. If your skin is sensitive or you are ramping up to a stronger retinoid, extend that window and build back slowly.
Choose an injector who welcomes questions about skincare, gives clear aftercare instructions, and calibrates units to your face and your taste for movement. Map your goals: dynamic lines get Botox, texture and fine etched lines get retinoids, and the best version of your skin usually gets both, supported by sunscreen and a steady routine. When those pieces line up, results look natural, last well, and feel like you on a good day, most days.