Consensus Recommendations for Combined Aesthetic Interventions Using Botulinum Toxin, Fillers, and Microfocused Ultrasound in the Neck, Décolletage, Hands, and Other Areas of the Body.
BACKGROUND
The popularity of aesthetic procedures in the face has led to greater disparity between treated areas and those that still show evidence of true age. Although many areas of the body often require multiple treatment procedures for optimal rejuvenation, combination therapy for specific areas is not yet well defined.


OBJECTIVE
To develop recommendations for the optimal combination and ideal sequence of botulinum toxin (BoNT), hyaluronic acid, calcium hydroxylapatite (CaHA), and microfocused ultrasound with visualization in nonfacial areas across all skin phototypes.


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
Recommendations have been provided for the neck, décolletage, and hands and include the timing and sequence of specific procedures when used concurrently or over several treatment sessions. Position statements are offered in lieu of consensus for the upper arms, abdomen, buttocks, and knees.


CONCLUSIONS
Nonfacial rejuvenation often requires multiple procedures for optimal results in individuals with significant age-related changes. Further clinical studies are recommended to raise awareness of non-facial indications and provide clinicians with the best evidence for best treatment practices.
*Cosmetic Laser Dermatology, San Diego, California;†Center for Dermatology and Dermatologic Surgery, Washington, DC;‡University of British Columbia, Vancouver, Canada;§Day Dermatology and Aesthetics, New York, New York;‖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;##Rosenparkklinik, Darmstadt, Germany.
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