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Consensus Recommendations for Combined Aesthetic Interventions Using Botulinum Toxin, Fillers, and Microfocused Ultrasound in the Neck, Décolletage, Hands, and Other Areas of the Body

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

doi: 10.1097/DSS.0000000000000869
Original Article

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.

CONCLUSION 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

Address correspondence and reprint requests to: Sabrina G. Fabi, MD, 9339 Genesee Avenue, Suite 300, San Diego, CA 92121, 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. The participants have disclosed financial relationships with the following companies: 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.G. 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.K. 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.P. 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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