Consensus Recommendations for Combined Aesthetic Interventions in the Face Using Botulinum Toxin, Fillers, and Energy-Based Devices.
BACKGROUND
The aging process is a complex interplay of intrinsic and extrinsic factors across multiple layers of the face. Accordingly, combining aesthetic interventions targeting different manifestations of aging often leads to better results than single modalities alone. However, no guidelines for a pan-facial approach using multiple interventions have been published to date.


OBJECTIVE
To develop consensus recommendations for the optimal combination and ideal sequence of botulinum toxin (BoNT), hyaluronic acid, calcium hydroxylapatite, and microfocused ultrasound with visualization (MFU-V) in persons of all Fitzpatrick skin types.


METHODS
Fifteen specialists convened under the guidance of a certified moderator. Consensus was defined as approval from 75% to 94% of all participants, whereas agreement of ≥95% denoted a strong consensus.


RESULTS
Optimal aesthetic treatment of the face begins with a thorough patient assessment and an individualized treatment plan. Spacing consecutive treatments 1 to 2 weeks apart allows for resolution of side effects and/or to assess results. For same-day treatments, BoNT and fillers may be performed together in either sequence, whereas MFU-V is recommended before injectable agents.


CONCLUSIONS
Expert consensus supports a combination approach using multiple modalities in specific sequence for the safe and effective treatment of the aging face.
*University of British Columbia, Vancouver, Canada; †Center for Dermatology and Dermatologic Surgery, Washington, D.C.; ‡Day Dermatology and Aesthetics, New York City, New York; §Cosmetic Laser Dermatology, San Diego, California; ‖European Medical Aesthetics Ltd., London, United Kingdom; ¶University of Hamburg, Hamburg, Germany; #Victoria Park Medispa, Montreal, Canada; **Private Practice for Dermatology and Aesthetics, Munich, Germany; ††Leaders Clinic, Seoul, Korea; ‡‡RZANY & HUND, Berlin, Germany; §§Rosenparkklinik, Darmstadt, Germany; ‖‖Seoul National University, Seoul, Korea; ¶¶University of Washington, Seattle, Washington.
Jean
J
Carruthers
Cheryl
C
Burgess
Doris
D
Day
Sabrina G
SG
Fabi
Kate
K
Goldie
Martina
M
Kerscher
Andreas
A
Nikolis
Tatjana
T
Pavicic
Nark-Kyoung
NK
Rho
Berthold
B
Rzany
Gerhard
G
Sattler
Sonja
S
Sattler
Kyle
K
Seo
William Philip
WP
Werschler
Alastair
A
Carruthers
D001672:Biocompatible Materials / Q000627:therapeutic use*; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D003357:Cosmetic Techniques; D000067548:Dermal Fillers / Q000627:therapeutic use*; D017886:Durapatite / Q000627:therapeutic use*; D004954:Esthetics; D005145:Face; D006801:Humans; D006820:Hyaluronic Acid / Q000627:therapeutic use*; D012060:Rejuvenation; D015595:Skin Aging; D014464:Ultrasonic Therapy / Q000379:methods*; D055675:Viscosupplements / Q000627:therapeutic use*
D001672:Biocompatible Materials; D000067548:Dermal Fillers; D055675:Viscosupplements; D006820:Hyaluronic Acid; D017886:Durapatite; D019274:Botulinum Toxins, Type A