In many patients, different anti-ageing treatments may need to be combined and hence proper knowledge of the effects of such combinations is essential.
Fillers and lasers
As the chromophore for lasers used for skin rejuvenation is water, there is a theoretical risk of dissolution of hyaluronic acid-based fillers, when such lasers are administered to treated areas. Goldman et al., administered 1320-nm Nd:YAG laser, 1450-nm diode laser, monopolar radiofrequency and/or intense pulsed light immediately after injecting hyaluronic acid-based dermal fillers (Restylane™) into the nasolabial groove. They found no reduction in the clinical outcome. However, larger studies are essential to authenticate this observation.
In patients with prominent photoaging, De Maio suggests that laser resurfacing should be done first and then the filler procedure, once the process of collagen remodeling has been completed. He has also opined that nasolabial grooves become shallower due to overall tightening of skin. However, aggressive resurfacing is fraught with risk of dyspigmentation in darker skin types.
Fillers and chemical peels
All chemical peels elicit some amount of inflammation and this inflammation has a theoretical risk of degradation of the filler. De Maio and Rzany opine that as the inflammation elicited by superficial chemical peels is not significant, superficial peels can be done immediately after filler administration. They advise to defer medium-depth peels, namely trichloroacetic acid till the post-peel erythema fades or till collagen remodeling is completed (probably in 1–2 weeks)This opinion is in contrast to that of Deprez who has found no such association. IN the absence of proper studies, it is difficult to arrive at a consensus on this aspect.
Fillers and botulinum toxin
Combining fillers with botulinum toxins is a new rejuvenation paradigm. Since the hyperactive or hypertonic muscles play a prominent role in producing wrinkles, it is better to relax the muscles first with the botulinum toxin, and later administer fillers after 2 weeks. However, for the nasolabial groove, fillers are injected first and then the botulinum toxin is injected.
Fillers and radiofrequency
Radiofrequency is one of the common modalities employed for non-ablative skin rejuvenation. The efficacy of a filler (both hyaluronic acid- and non-hyaluronic acid-based fillers) was found unaltered when non-ablative radiofrequency was performed over areas treated with the filler. However, more data are needed to draw concrete conclusions on this aspect.
Fillers and aesthetic plastic surgery
Plastic surgery for facial contouring and other aesthetic indications can be supplemented by fillers. Fillers have the advantage of achieving finer corrections.