Combined Treatment for Skin Rejuvenation and Soft-tissue Augmentation of the Aging Face
February 2011 | Volume 10 | Issue 2 | Original Article | 125 | Copyright © February 2011
Multiple types of anti-aging treatments are required to address the various etiologies of facial aging. Soft-tissue augmentation provides
a minimally invasive option for patients seeking to look younger. However, due to changes in facial skin, musculature, fat and
bone, anti-aging treatment requires a multifaceted approach. Injectable fillers may be combined with neurotoxins to resolve superficial
wrinkles and restore facial volume. These modalities may be used with laser resurfacing or chemical peels to address epidermal
and superficial dermal problems. Combining injectable soft-tissue augmentation treatments allows clinicians and patients to take
advantage of the benefits of each modality and to address the multiple effects of facial aging. This review is based on clinical experience
and a MEDLINE search for articles about volume replacement and soft-tissue augmentation. It provides a rationale that supports
the use of combination techniques/products for soft-tissue augmentation.
J Drugs Dermatol. 2011;10(2):125-132
Changes to the aging face result from a dynamic process involving thinning of the skin and loss of collagen,
fat redistribution, muscular recontouring and bone remodeling.1–3 The rate of change differs in the major facial compartments (skin, muscle, fat and bone)
and changes in one compartment affect all compartments.1,3 With increasing age, more prominent wrinkles, folds and furrows arise due to further loss of
skin elasticity and structural organization.1,3
Many patients require more than one type of aesthetic treatment to address these multiple etiologies and maximize
treatment outcomes.2,4,5 The variety of available treatments has greatly expanded the ability to reverse the visual signs of facial aging. Because each
modality has its own strengths and limitations, combinations of products may be required to achieve optimal outcomes. The purpose of this article is to
briefly review available soft-tissue augmentation modalities and to discuss relevant clinical experience with possible combinations of products.
Head-to-head comparisons have not been identified for most combinations mentioned in this review. Further combinations
of anti-aging treatments described herein have not been reviewed or approved by the U.S. Food and Drug Administration (FDA).
Numerous treatments are available for soft-tissue augmentation (Table 1). Each treatment, used appropriately, can help restore the youthful appearance of the face; the selection of
treatments with complementary modes of action may produce a synergistic effect. Furthermore, application of different modalities can be varied either spatially or temporally, potentially
optimizing outcomes and improving tolerability.
Botulinum Toxin Type A
Injection with botulinum toxin type A (BTX-A; Botox®, Allergan, Irvine, CA, and Dysport® [abobotulinum toxin A],
Medicis, Scottsdale, AZ) results in temporary denervation and relaxation of injected muscles and reduction in dynamic
furrows and lines.6,7 BTX-A has been used widely to treat the glabellar area, crow's feet and forehead.4 Overcorrection
must be avoided, as the full effect may not be apparent for seven to 10 days post-injection and persists for 90–120 days
with BTX-A;4 and up to 180 days with abobotulinum toxin A.7 The safety record of BTX-A is good and most adverse events
(AEs) are reversible without long-term consequences;6 an AE profile similar to placebo was noted with abobotulinum
toxin A.7 Botulinum toxins may be used with volumizing treatments to enhance outcomes.