Hybrid injection techniques in aesthetic medicine: Evaluating the clinical benefits of combining botulinum toxin and hyaluronic acid in upper face rejuvenation

Abstract

The formation of wrinkles in the upper face, particularly in the glabella and frontalis regions, is a common concern that leads to facial stigmatization. Habitual facial expressions and the hyperdynamic activity of underlying muscles, combined with the normal aging process and external factors, contribute significantly to the development of hyperdynamic wrinkles. Botulinum toxin type A (BTXA) has become a widely used treatment for facial rejuvenation, while hyaluronic acid (HA) fillers are essential for enhancing skin hydration and elasticity. This study explores the efficacy and safety of combining BTXA with HA for upper face rejuvenation compared to BTXA monotherapy. To assess the clinical efficacy, duration of effect, and patient satisfaction of a combined therapy using botulinum toxin type A and hyaluronic acid fillers versus botulinum toxin alone. This case-control study was conducted at Ishtar Clinics for Dermatology, Aesthetic Medicine, and Laser in Basrah, Iraq. A total of 76 participants, aged 25 to 60 years, were enrolled, with 38 cases receiving the combination therapy and 38 controls receiving botulinum toxin monotherapy. The study spanned 12 weeks, with evaluations conducted at baseline and subsequent follow-ups at weeks 1, 2, 4, 8, and 12. Efficacy was assessed using the Investigator Global Assessment-Frown Wrinkle Severity (IGA-FWS) and Patient-Frown Wrinkle Severity (PFWS) scales, while safety was monitored through adverse event recording and physical examinations. The combination therapy group showed a significantly greater reduction in wrinkle severity across various facial regions, including glabellar lines, crow's feet, and forehead lines, compared to the monotherapy group. By week 4, 85% of the combination therapy group achieved at least a 2-point reduction in wrinkle severity scores, compared to 60% in the monotherapy group. The combined treatment also resulted in a longer duration of effect, with 70% maintaining improvement at 12 weeks versus 45% in the monotherapy group. Both groups had a low incidence of minor adverse effects, and patient satisfaction was notably higher in the combination therapy group. Combining botulinum toxin type A with hyaluronic acid fillers for upper face rejuvenation offers superior efficacy and patient satisfaction compared to botulinum toxin alone. This synergistic approach enhances treatment outcomes, prolongs the duration of effect, and maintains a favorable safety profile, making it a promising option for facial rejuvenation therapies.