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Consensus Recommendations for Combined Aesthetic Interventions in the Face Using Botulinum Toxin, Fillers, and Energy-Based Devices

Carruthers, Jean MD, FRCSC; Burgess, Cheryl MD, FAAD; Day, Doris MD; Fabi, Sabrina G. MD; Goldie, Kate MD; Kerscher, Martina MD; Nikolis, Andreas MD, MSc, FRCSC; Pavicic, Tatjana MD; Rho, Nark-Kyoung MD; Rzany, Berthold MD, ScM; Sattler, Gerhard MD; Sattler, Sonja MD; Seo, Kyle MD; Werschler, William Philip MD; Carruthers, Alastair MD, FRCPC

doi: 10.1097/DSS.0000000000000754
Original Article

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 AND MATERIALS 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.

CONCLUSION 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

Address correspondence and reprint requests to: Jean Carruthers, MD, FRCSC, 820-943 West Broadway, Vancouver, BC Canada V5Z 4E1, or e-mail:

Merz Pharmaceuticals GmbH supported the Vancouver consensus meeting and the creation of these recommendations. The content of the publication reflects the experts' independent opinions and experiences. C. Burgess is a consultant for Allergan, Galderma S.A., and Merz Pharmaceuticals. J. Carruthers and A. Carruthers are consultants and researchers for Allergan, Alphaeon, Kythera, Merz Pharmaceuticals, and Revance. S. Fabi is a consultant and researcher for Allergan, Galderma S.A. Lumenis, Merz Pharmaceuticals, Revance, and Zeltiq. A. Nikolis is a consultant for Allergan, Galderma S.A., and Merz Pharmaceuticals. T. Pavicic is a consultant, speaker and advisory board member for Merz Pharmaceuticals, a consultant and speaker for Dermaceutic, Eucerin, and Galderma S.A., and a consultant for Ipsen and Kythera. N. Rho is an advisory board member, speaker, and consultant for Allergan, Medy-Tox Inc., and Merz Pharmaceuticals. B. Rzany is a consultant and/or speaker for Croma Pharma, Galderma, Ipsen and its distributors, as well as Merz Pharmaceuticals. W. Werschler is an advisory board member, clinical investigator, consultant, and/or speaker for Allergan, Galderma, Merz Pharmaceuticals, Neothetics, Nuvesse, Revance, Suneva, and Ulthera. The remaining authors have indicated no significant interest with commercial supporters.

© 2016 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved.
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