Combining Dermal Fillers & Botox

It cannot be overemphasized that the approach to facial aesthetics should be a comprehensive one. No one type of procedure will achieve facial harmony in all aesthetic subjects. Fillers are merely one instrument to achieve this goal. Combining fillers with other modalities will often optimize results.

It has been shown for instance that the combination of hyaluronans such as Restylane and Botox will provide a superior result than either alone for the upper face. Studies have also demonstrated that it is safe and effective to combine previously injected fillers with radiofrequency skin-tightening procedures. Reports have demonstrated that Botox combined with light procedures such as intense pulsed light and laser resurfacing tend to increase the rejuvenation effect. Many practitioners have added facial fillers to this comprehensive rejuvenation philosophy, particularly when using non-ablative light therapy.

Similarly the combination of a rhytidectomy and fat transfer to the cheeks, or filler injection to the perioral region, will not only provide smoother lower facial contours, but will replace the volume that a face lift alone cannot achieve. This is particularly crucial in an individual with a thin, elongated face. A face lift may also reduce the amount of filler needed in the NLFs and marionette lines.

The major limitation of today’s fillers, and a concern of patients, is that they are very temporary in the hands of most practitioners. While this is true, permanency can present unforeseen problems when an individual’s face ages, when there is deepening and subtle repositioning of lines. Perhaps in the future there will be a filler that is easy to inject, inexpensive and remains effective for 2-3 years. Until that time, appropriate education of the patient and combination therapies will result in the highest patient satisfaction.