Combining Fillers and Neuromodulators in the Same Syringe

I am writing in response to a letter to the editors written by Drs. Cohen and Mariwalla in the September 2013 JDD entitled “Combining Fillers and Neuromodulators in the Same Syringe”² in which delayed comments were made on an article I published 3 years ago.

My article entitled “Hyaluronic Acid Filler and Botulinum Neurotoxin Delivered Simultaneously in the Same Syringe for Effective and Convenient Combination Aesthetic Rejuvenation Therapy"¹ was peer reviewed by clinical leaders in the field belonging to the editorial board of this journal.

This article was a companion article to a similar pilot study (which was not referenced by Drs. Cohen and Mariwalla), conducted using a different manufacturer’s set of botulinum toxin and hyaluronic acid,² and showed the same results. Both articles at the time of publication generated constructive intellectual interest.

My articles described pilot data, and in no way were implying the technique was definitive. The volunteers for these pilot studies were unanimously satisfied with their treatments, and their photographs provided one objective measure of this outcome. In the discussion of both articles, I clearly stated the need for further study on the matter, to include clinical as well as histological analysis. Drs. Cohen and Mariwalla did not conduct additional studies to objectively support their concerns.

I published these pilot studies because they were provocative, and offered a way ahead for scientific discussion and potential generation for further study in an active area of aesthetic medicine, an area in which dermatologists should maintain leadership.

Failing to encourage publication of innovative ideas, whether or not they ultimately result in a paradigm shift, will thwart the advancement of our field.

The author has no conflicts of interest to disclose.