A Randomized Study to Assess the Efficacy of Skin Rejuvenation Therapy in Combination With Neurotoxin and Full Facial Filler Treatments

January 2018 | Volume 17 | Issue 1 | Original Article | 48 | Copyright © January 2018

Steven H. Dayan MD FACS,a,b,c Thuy-Van T. Ho MD,c Jonathan T. Bacos BA,a,d Nimit D. Gandhi MD,a Arjun Kalbag PhD,a Selika Gutierrez-Borst MS RNa,b

aDeNova Research, Chicago, IL bChicago Center for Facial Plastic Surgery, Chicago, IL cDivision of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology, University of Illinois at Chicago, Chicago, IL dNorthwestern University Feinberg School of Medicine, Chicago, IL


BACKGROUND: Although non-surgical treatment options for facial rejuvenation are well-established, the literature remains limited regarding the combined effect of topical skin treatment with filler and neurotoxin on patient appearance and satisfaction. The objectives of this study were to assess the impact of a skin rejuvenation therapy in combination with neurotoxin or hyaluronic acid filler injection on skin quality and general aesthetic improvement as well as on short-term self-esteem.

METHODS: From 2015 to 2017, 20 female patients were enrolled in our study and were randomized into two groups. Patients in Group A used a basic skin care regimen following hyaluronic acid filler and neurotoxin treatment, while those in Group B utilized the Nu-Derm® skin care system (Obagi Medical Products, Inc) afterwards. Each subject and the principal investigator filled out various assessments pre- and post-treatment to evaluate for change in skin quality (Fitzpatrick Wrinkle Assessment Scale [FWAS] and Skin Quality Assessments [SQA]), aesthetic appearance (Global Aesthetic Improvement Scale [GAIS]), patient satisfaction (Subject Satisfaction Assessment [SSA]), and self-esteem (State Self-Esteem Scale [SSES]).

RESULTS: Subjects in both treatment groups demonstrated significant improvement in skin quality, as illustrated in the change in FWAS and SQA scores, at 12 weeks after initiating full facial rejuvenation treatment. However, there were no significant differences in FWAS and SQA ratings between the treatment groups. Regarding aesthetic appearance, a statistically significant difference in GAIS scores between Groups A and B was observed at 6 weeks after treatment only. In evaluating for patient satisfaction and self-esteem, there were no significant differences in SSA and SSES ratings over time within each treatment group or between the treatment groups.

CONCLUSIONS: Our study confirms that facial rejuvenation therapy involving hyaluronic acid filler and neurotoxin injections combined with a topical skin treatment regimen leads to improvement in skin quality and aesthetic appearance as well as to patient satisfaction. Additional larger studies are needed to better delineate the most ideal combination facial rejuvenation therapy for optimizing patient appearance and satisfaction.

J Drugs Dermatol. 2018;17(1):48-54.


Non-surgical treatment options including hyaluronic acid filler and neurotoxin injections for facial rejuvenation have gained an increasing prominence in aesthetic medicine. The American Society of Plastic Surgery, for example, reported that over 2.4 million soft tissue filler procedures were performed in 2015. This was a 6% increase from 2014 and a 274% increase from 2000.1 Hyaluronic acid filler and neurotoxin treatments are often employed to create subtle improvements that restore facial symmetry and focus on the eyes and ultimately impart a more natural and youthful appearance.2,3 Furthermore, fillers and neurotoxins in combination have been demonstrated by several studies to improve both patient appearance and satisfaction.4-7 The effects of botulinum toxin type A alone extend to improvement of quality of life and self-esteem,8 and this treatment is currently in phase 3 clinical trials for treatment of Major Depressive Disorder.9In the realm of facial rejuvenation, topical skin care products have also been shown to slow the progression of skin aging. The Nu-Derm® System (Obagi Medical Products, Inc) is one established skin care system that helps correct and reduce visible signs of aging such as age spots, rough skin, erythema, sallowness, and hyperpigmentation. Nevertheless, the literature remains limited regarding the impact of the combination of both topical skin treatment with filler and neurotoxin on patient appearance and satisfaction.The primary purpose of this study was to evaluate the effect of a skin rejuvenation therapy in combination with neurotoxin or