Combining Aesthetic Technologies and Injections

Skin aging processes involve various and diverse changes; therefore, many patients may require combined treatment with fillersת such as hyaluronic acid and bio-stimulantsת in combination with technologies like laser, IPL, and radiofrequency (RF), on the same day. The goal is to achieve optimal results that address multiple concerns simultaneously

The scientific evidence currently available regarding the combined use of HA fillers and laser/RF/IPL is limited and mainly consists of small and non-randomized studies. However, most of these studies have found that, on average, simultaneous use (on the same day) of laser and HA fillers for facial rejuvenation represents an effective and safe strategy, that improves clinical outcomes and patient satisfaction Well-designed future clinical studies are needed to assess the effectiveness and safety of combined filler/laser treatments

The use of laser/IPL/RF devices after HA filler injections may significantly reduce the effect of fillers and/or lead to rapid breakdown of the fillers. However, other studies have found that laser/IPL/RF treatments can be performed after HA injections without compromising their effectiveness. Additionally, the use of non-ablative RF (which does not penetrate the skin layers) before or after HA filler injections may positively influence skin rejuvenation

Although laser/IPL/RF treatments do not penetrate deeply enough to affect fillers, it is recommended to use them first and only then inject fillers. A literature review published in 2015 identified seven studies involving combined treatments with light-based technologies and fillers. According to this review, six studies did not document histological changes in fillers injected after radiofrequency, IPL, or laser treatments

Another study examined the effects of monopolar radiofrequency treatment on soft tissue fillers published by England et al in 2005. This study, conducted in a young pig model, examined tissue interactions of monopolar RF heating with five commonly injected fillers, namely human collagen cross-linked, HA, calcium hydroxyapatite, poly-L-lactic acid, and liquid injectable silicone. The results found no clear increase in the risk of local burns and no significant effect of RF treatment on the filler’s effects in the tissue

Furthermore, the presence of fillers did not increase the risk of undesirable thermal effects with monopolar RF treatment

In another study, the clinical and histological effects of RF treatment in combination with HA injections in the nasolabial area were examined. All participants were treated with RF on the right nasolabial fold before HA filler injection, while the left side was treated with HA filler alone. The results of this study found that participants treated with RF beforehand achieved better results than those treated with filler alone.

Another study demonstrated that RF microneedle devices may cause thermal damage to HA fillers along the injection areas, and therefore, it is recommended to avoid using microneedle RF after HA injections

The general guideline for performing a combined procedure on the same day (HA and light treatments) is to always start with technological treatment to avoid skin manipulation after HA injections. It is preferable for the treatment to be performed with non-ablative and non-functional technologies (which do not cause epidermal injury) to minimize the risk of skin injuries that may lead to infections (Staphylococcus)

Bio-stimulators, like Radiesse and Sculptra, are well-integrated into non-ablative treatments and significantly enhance treatment outcomes, providing a natural appearance. Proper diagnosis of photo-aging, such as skin tone uniformity, pigmentation treatment, vasculature, texture, and volume loss patterns, is critical for the correct adaptation of the treatment protocol

One combined treatment that should not be combined on the same day is deep laser and Botox—or other neurotoxins—since the combination may lead to the spread of Botox to areas that theoretically may result in undesired outcomes

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