Combined Use of Relabotulinum Toxin A and NASHA Gel Skinbooster for Rejuvenation of the Upper Third of the Face

January 2026 | Volume 25 | Issue 1 | 9621 | Copyright © January 2026


Published online December 23, 2025

Ivano Iozzo MDa, Magda Belmontesi MDb, Carlo Di Gregorio MDc, Matteo Tretti Clementoni MDd, Valentina Angela Antonucci MDe, Alessandro Innocenti MDf

aCMIA Medical Center, Bologna, Italy
bAGORA' Clinical and Training Center, Milan, Italy
cPrivate Practice - Plastic and Aesthetic Surgery, Palermo, Italy
dLaserplast SRL STP, Milan, Italy
eCMIA Medical Center, Bologna, Italy
fPlastic and Reconstructive Microsurgery, Careggi University Hospital, Florence, Italy

Abstract
Background: Aging of the upper third of the face is characterized by dynamic forehead wrinkles and volume loss in the temporal region, resulting in a fatigued and aged appearance. Addressing both muscle hyperactivity and soft tissue atrophy is essential for effective rejuvenation.
Objective: To evaluate a combined injectable treatment protocol using Relabotulinum Toxin A for frontalis muscle modulation and NASHA™-based gel skinbooster for temporal skin quality enhancement.
Methods: Patients received intramuscular injections of Relabotulinum Toxin A targeting the frontalis muscle, followed by three monthly sessions of NASHA gel skinbooster injected subcutaneously into the temporal region using a blunt cannula technique. Dosages and injection points were individualized based on detailed anatomical and functional assessments.
Results: Preliminary clinical evaluations indicate that the protocol is minimally invasive and well-tolerated, producing progressive aesthetic improvements lasting beyond six months. Patients reported enhanced skin tone, elasticity, hydration, and a natural-looking lift of the eyebrow tail. Improvements in psychological well-being and patient satisfaction were also observed.
Conclusion: This combined neuromodulation and skin quality improvement approach provides a comprehensive and synergistic strategy for upper facial rejuvenation. The ready-to-use liquid formulation of Relabotulinum Toxin A allows for precise application, rapid onset of results within 24-48 hours, and sustained improvement of forehead dynamic wrinkles for up to six months. The collagen-stimulating properties of NASHA gel deliver natural, long-lasting enhancement of the temporal region, contributing to high levels of patient satisfaction.

 

INTRODUCTION

Rejuvenation of the upper third of the face is integral to achieving comprehensive facial aesthetic restoration. Prominent age-related changes in this region include dynamic rhytides secondary to repetitive frontalis muscle activity, as well as progressive soft tissue atrophy and volume depletion in the temporal fossa. These anatomical alterations contribute to the characteristic skeletonization of the temples and deepening of horizontal forehead lines, resulting in a fatigued and senescent appearance. Addressing these anatomical changes is critical for restoring a youthful and balanced upper facial contour.

Targeted relaxation of facial expression muscles with botulinum toxin A remains a first-line treatment for reducing the appearance of dynamic rhytides in the upper face. By limiting repetitive muscle movement, it smooths the forehead and produces a more relaxed, youthful expression.

Skin degeneration in the temple region results from a combination of photoaging and chronological aging. It is characterized by sagging, loss of tone and elasticity, increased roughness, reduced hydration, and diminished radiance. Additionally, subcutaneous fat loss in this region contributes to temporal hollowing and lowering of the lateral eyebrow tail.
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