What are the guidelines for using Botox (Botulinum toxin) and Rejuran concurrently for cosmetic improvements?

Botox and Rejuran: Concurrent Use for Cosmetic Improvement

There are no established clinical guidelines or safety data addressing the concurrent use of Botox (botulinum toxin) and Rejuran (polynucleotide) for cosmetic procedures, and therefore no evidence-based recommendations can be made regarding their combined administration.

Current Evidence Landscape

Botox for Cosmetic Use

• Botulinum toxin type A is FDA-approved for cosmetic treatment of glabellar (frown) lines and crow's feet, with predictable results and high patient satisfaction when used as monotherapy 1
• The most common adverse events in cosmetic use include lack of effect (63%), injection site reactions (19%), and ptosis (11%) 2
• For frown wrinkle treatment, significant adverse events include headaches (RR 1.53), eyelid ptosis (RR 5.56), and heavy eyelids (RR 6.94) 3
• Serious adverse events in cosmetic cases are rare, with no deaths reported in cosmetic users and most serious events being previously recognized complications 2

Absence of Combination Data

• The provided evidence contains no guidelines, drug labels, or research studies evaluating the safety, efficacy, or timing of combining botulinum toxin with Rejuran (polynucleotide injections) 4, 5, 1
• All available cosmetic botulinum toxin studies evaluate monotherapy or combination with laser resurfacing only 6
• No data exists on potential drug interactions, optimal timing intervals, or modified adverse event profiles when these products are used together

Clinical Considerations in the Absence of Guidelines

Theoretical Safety Concerns

• Both products involve injection into facial tissues, potentially increasing cumulative risks of bruising, edema, and injection site reactions 5, 3
• The mechanism of action differs fundamentally: botulinum toxin causes neuromuscular blockade while Rejuran provides tissue regeneration through polynucleotides
• No evidence addresses whether concurrent use affects the efficacy or duration of either product

Common Pitfalls to Avoid

• Patients with known hypersensitivity to botulinum toxin should not receive Botox treatments as this is an absolute contraindication 4
• Contraindications for botulinum toxin include keloidal scarring, neuromuscular disorders (myasthenia gravis), and body dysmorphic disorder 1
• Minor bruising occurs commonly with botulinum toxin injection, and technique-dependent complications like blepharoptosis become less frequent with injector experience 1

Practical Approach When Evidence is Absent

• Given the complete absence of safety and efficacy data for concurrent use, practitioners should exercise extreme caution and consider sequential rather than simultaneous administration
• If both treatments are desired, spacing them apart (e.g., 2-4 weeks) may reduce cumulative injection-related adverse events, though no evidence supports any specific interval
• Patients must be informed that combining these treatments represents off-label use without established safety profiles 2
• Document thoroughly that patients understand the lack of evidence for combination therapy

Monitoring Requirements

• Botulinum toxin effects take approximately two weeks to fully develop and last 3-4 months 1
• Patients should be counseled on the expected timeline and potential adverse events of botulinum toxin specifically, as no data exists for the combination profile 5, 1