Study: With Botox 'Chemodenervation,' Dermal Fillers Last Longer

Tuesday, January 12, 2016 | Fillers & Injectables , Research and Publications


Experimental evidence supports a simple technique for prolonging the effects of Hyaluronic acid (HA) dermal fillers: using them together with botulinum toxin, according to a study published in the January issue of Plastic and Reconstructive Surgery®, the official medical journal of the American Society of Plastic Surgeons (ASPS).

"Chemodenervation" using botulinum neurotoxin-A (BoNT-A) can prolong the life of the HA fillers by reducing muscle activity in the treated area, according to the study by Dr. İsmail Küçüker of the Ondokuz Mayıs University Faculty of Medicine in Samsun, Turkey.

Dermal filler injection is one of the most common minimally invasive cosmetic procedures, with 2.3 million procedures performed in 2014, according to ASPS statistics. Hyaluronic acid dermal fillers are most commonly used because they are natural, gel-based products that are highly compatible with the body. However, early degradation of HA fillers limits the duration of the cosmetic improvement. Longevity is affected not only by the properties of the HA fillers, but also by forces applied to them—including contraction of neighboring muscles.

To reduce these forces, physicians sometimes use HA fillers in a combination procedure with botulinum toxins, like Botox. This causes temporary paralysis of the muscles in the treated area, lasting a few months. Several studies have suggested that this chemodenervation procedure improves the clinical results of HA filler injection.

For a more objective demonstration of this approach, Dr Küçüker and colleagues designed a study in rabbits in which a small amount of HA filler was injected under the skin in front of each ear. This area was chosen because it corresponds to the forehead region in humans—a common area for dermal filler treatment.

On one side, HA filler alone was used. On the other side, HA filler was combined with BoNT-A to paralyze the muscle in that area. After three months, MRI scans were performed to compare the amount of filler remaining on the two sides.

The follow-up scans confirmed that BoNT-A slowed degradation of the injected filler. At three months, chemodenervation with BoNT-A decreased the degradation rate of the HA fillers by 42 percent. At the same time, the remaining volume of HA filler was 50 percent greater on the side where BoNT-A was used. The difference was visible as well as measurable, supporting the clinical experience that BoNT-A injection provides longer-lasting outcomes in patients.

"This study showed that HA filler application in combination with BoNT-A significantly decreases the degradation process and increases the remaining volume at the end of the paralyzed period," Dr. Küçüker and colleagues conclude. They believe their study provides objective evidence to support the use of this combination procedure in patients undergoing dermal filler treatments.

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