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.
- Kenner JR. Hyaluronic Acid Filler and Botulinum Neurotoxin Delivered Simultaneously
in the Same Syringe for Effective and Convenient Combination
Aesthetic Rejuvenation Therapy. J Drugs Dermatol. 2010;9(9):1135-39.
- Cohen JL, Mariwalla K. Combining Fillers and Neuromodulators in the Same
Syringe. J Drugs Dermatol. 2013;12(9):976-977.