title: Treatment of forehead/glabellar rhytide complex with combination botulinum toxin a and hyaluronic acid versus botulinum toxin A injection alone: a split-face, rater-blinded, randomized control trial.
abstract: BACKGROUND
  Forehead and glabella rhytides are treated mostly with neurotoxins, although some practitioners prefer the concurrent use of fillers. It has been suggested that combination treatments can result in a better overall improvement.
  
  
  OBJECTIVE
  To compare the safety and effectiveness of treatment of forehead and glabellar lines with botulinum toxin A alone versus botulinum toxin A and filler.
  
  
  METHODS
  Split-face, randomized control trial. Twenty subjects with forehead/glabellar rhytide complex (static and dynamic creases) enrolled. Subjects were randomized and injected with botulinum toxin alone on one side of the forehead/glabella and hyaluronic acid filler followed by botulinum toxin on the other side. Blinded ratings were obtained to assess the effectiveness of treatment for static and dynamic rhytides, respectively, at 2-week, 6-week, 3-month, and 6-month follow-up visits. Subjects performed a self-evaluation at the end of the study. Adverse events were recorded.
  
  
  RESULTS
  Ratings of both treatments showed comparable efficacy, with 100% of subjects experiencing improvement from baseline regardless of treatment type at weeks 2, 6, and 12. Combination treatment produced longer-lasting results in dynamic forehead wrinkles, and greater static and dynamic wrinkle reduction in the glabella at week 24. Subject self-evaluations showed that both treatments were effective, with a nominal preference for combination treatment.
  
  
  CONCLUSIONS
  Glabella and forehead lines can be effectively and safely reduced with neurotoxin alone as well as neurotoxin in combination with fillers. Combination treatment may provide a slightly better cumulative benefit and also increase the persistence of effect.
authors.affiliation: Department of Dermatology, Northwestern University, Chicago, Illinois, USA.
authors.forename: Meghan
authors.initials: M
authors.lastname: Dubina
authors.forename: Rebecca
authors.initials: R
authors.lastname: Tung
authors.forename: Diana
authors.initials: D
authors.lastname: Bolotin
authors.forename: Anne M
authors.initials: AM
authors.lastname: Mahoney
authors.forename: Bailey
authors.initials: B
authors.lastname: Tayebi
authors.forename: Mauricio
authors.initials: M
authors.lastname: Sato
authors.forename: Fabiane
authors.initials: F
authors.lastname: Mulinari-Brenner
authors.forename: Trevor
authors.initials: T
authors.lastname: Jones
authors.forename: Dennis P
authors.initials: DP
authors.lastname: West
authors.forename: Emily
authors.initials: E
authors.lastname: Poon
authors.forename: Michael
authors.initials: M
authors.lastname: Nodzenski
authors.forename: Murad
authors.initials: M
authors.lastname: Alam
mesh_terms: D000328:Adult; D000368:Aged; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage*; D005260:Female; D005500:Follow-Up Studies; D005546:Forehead; D006801:Humans; D006820:Hyaluronic Acid / Q000008:administration & dosage*; D007271:Injections, Intradermal; D008297:Male; D008875:Middle Aged; D009498:Neurotoxins / Q000008:administration & dosage*; D012647:Self-Assessment; D016037:Single-Blind Method; D015595:Skin Aging / Q000187:drug effects*; D016896:Treatment Outcome; D014495:Universities; D014505:Urban Population; D055675:Viscosupplements / Q000008:administration & dosage*
chemical_list: D009498:Neurotoxins; D055675:Viscosupplements; D006820:Hyaluronic Acid; D019274:Botulinum Toxins, Type A
keywords: botulinum toxin; dermal filler; facial lines; filler; glabellar lines; rhytides