Effective and Safe Repeated Full-Face Treatments With AbobotulinumtoxinA, Hyaluronic Acid Filler, and Skin Boosting Hyaluronic Acid

July 2019 | Volume 18 | Issue 7 | Original Article | 682 | Copyright © July 2019

Per Hedén MD,a Doris Hexsel MD,B Hugues Cartier MD,c Per Bergentz MD,a Henry Delmar MD,d Fernanda Camozzato MD,B Carolina Siega BSc,b Cecilia Skoglund PhD,e Carolina Edwartz PhD,e Maria Norberg PhD,E Philippe Kestemont MDD 

aAkademikliniken, Stockholm, Sweden BBrazilian Center for Studies in Dermatology, Porto Alegre, RS, BrazilcCentre Medical Saint-Jean, Arras, FrancedMediti – Clinique Science et Beauté, Juan-les-Pins, FranceeGalderma Aesthetics, Medical Affairs, Uppsala, Sweden 


Background: It is important to study full-face aesthetic combination treatments to establish well-founded individual treatment plans.

To evaluate clinical outcome and perception of treatment with either abobotulinumtoxinA (ABO) or hyaluronic acid (HA) filler followed by repeated combined treatment with ABO, HA filler, and Restylane® Skinboosters (RSB).

Methods & Materials:
This study was conducted at four sites in Sweden, France, and Brazil and included subjects aged 35-50 years with mild/moderate nasolabial folds and moderate/severe upper facial lines. Monotherapy was ≤125 s.U ABO in at least two upper facial indications with optional touch-up or ≤1 mL HA filler in nasolabial folds/cheeks. At months 6 and 12, both cohorts received ≤125 s.U. ABO in upper facial lines with optional touch-up, ≤2 mL HA filler in nasolabial folds/cheeks (and other facial areas as applicable), and ≤1 mL RSB. Assessments included global facial aesthetic appearance and improvement, first impression, perceived age, wrinkle severity, satisfaction questionnaires, and adverse events.

Repeated full-face treatment with ABO, HA filler, and RSB was associated with better aesthetic outcome and higher levels of satisfaction than treatment with ABO or HA filler alone. However, even modest volumes of HA filler achieved good aesthetic outcomes and high satisfaction. Treatment of several indications was well tolerated. 

Aesthetic improvement and subject satisfaction was high and increased with each treatment. All treatments were well tolerated. These data may be used as support when establishing individual treatment plans. 

J Drugs Dermatol. 2019;18(7):682-689. 


Aesthetic treatment with either botulinum toxin type A (BoNT-A) or hyaluronic acid (HA) filler(s) is generally more common than combination treatment1-4; approximately one-third of patients receive a combination of injectable treatments.5

Upper facial aesthetic indications of BoNT-A include glabellar lines, lateral canthal lines, and horizontal forehead lines.6-10 The marketing authorization for abobotulinumtoxinA (ABO) includes treatment of hyperfunctional facial lines in Brazil and moderate-to-severe glabellar lines and lateral canthal lines in many European countries including France and Sweden.

HA fillers are most commonly used for aesthetic soft-tissue augmentation of the mid and lower face.11-16 Restylane® Skinboosters (RSB [Galderma Aesthetics, Sweden])17-19 are used for skin rejuvenation and improved skin quality.

The objective of this study was to collect data on subjects receiving monotherapy with either ABO or HA filler followed by repeated combination treatment with ABO, HA filler, and RSB to provide guidance to practitioners for individual treatment plans. BoNT-A in up to three upper facial indications has not previously been studied in combination with HA filler and RSB.


Study Design
This was an 18-month study conducted at four sites in Sweden, France, and Brazil (Figure 1). ABO cohort data up to 6 months have been published.20 The study protocol was approved by independent Ethics Committees and conformed to the Declaration of Helsinki, Good Clinical Practice, and local regulations.

Eligibility Criteria
Subjects between 35 and 50 years who provided signed in