Kosmetische Medizin 3-2010: 132 – 138

Efficacy of combined treatment using hyaluronic acid (Belotero® Soft)and botulinum type A (Xeomin®) to optimize aesthetic outcome in radial upperlid lines


KEY WORDS: Perioral lines, combined treatment, botulinum toxin, hyaluronic acid

Fillers with hyaluronic acid are effectively used to correct facial wrinkles of dynamic or static nature. In areas with low muscle activity the dwell time of the bio-degradable filling agents and the corresponding durability of treatment effect may last up to 6 months. However in areas with high muscle activity (particularly in the perioral region) the longevity of the desired cosmetic effect will be shorter in most cases.

This study was run to investigate wether the efficacy of the hyaluronic acid filler Belotero® Soft may be prolongated by pre-treatment with botulinum toxin type A Xeomin®, which is free of complexing proteins. Methods: In this controlled study 21 female patients with radial lines of the upper lip were treated with the hyaluronic acid filler Belotero® Soft. Eleven of the patients received in this area a pretreatment with the botulinum toxin Xeomin® (1 U to 1.5 U per injection). The efficacy of combined use of Belotero® Soft plus Xeomin® was followed-up over a period of 6 months in comparison with hyaluronic acid alone. Outcome measures were changes in the wrinkle severity rating scale (WSRS) value and the responder rates defined as percent of patients with improved WSRS by at least one point.

Results: The initial responder rates were 100% of patients in both groups. In the Xeomin® pre-treated group the respective responder rates after 4 and 6 months were 100 % and 70 %. In the group with filler only the responder rate declined to 57.1 % after 4 months and to 12.5 % after 6 months. Wrinkle depth was significantly reduced in the group with combined treatment during the whole observation period.

Conclusion: We conclude that temporary chemodenervation of the m. orbicularis oris by small doses of botulinum toxin Xeomin® prolongated the aesthetic result of hyaluronic acid filler Belotero® Soft significantly. Satisfying cosmetic results could be sustained over the period of 6 months by combined treatment for radial lines of the upper lip.

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