Combination therapies reshape, rejuvenate face with less downtime

Key Points

San Francisco - As the "baby boom" generation has begun to age, many of its members have been seeking ways to ward off the signs of advancing years.

At the same time, however, many prefer to stay away from cosmetic procedures that require substantial amounts of time in the hospital and for recovery.

"My opinion is that that the paradigm of how we look at the aging face is changing - we're looking at reshaping rather than correcting a particular defect, like wrinkles or smile lines," says dermatologist Seth L. Matarasso, M.D.

In order to meet this need, cosmetic dermatologists now are focusing more on total facial shaping and less on a particular defect.

"We're looking at treating the aging face with combination therapies," Dr. Matarasso tells Dermatology Times.

"For example, multi-modality injectables like Botox (botulinum toxin, Allergan) are now combined with hyaluronic acid fillers to help correct defects around the eyes. For very fine lines, injections of collagen-based fillers are called for.

"With nasolabial folds, it's common to use Restylane (hyaluronic acid/HA, Medicis) injections followed by collagen - one to buttress up the deep fold, the other to help correct etched-in lines."

Combination therapy also is being used more for rejuvenating lips, Dr. Matarasso says.

"The lip area is a prime example of how combination therapy is being used to great effect," he says.

"Collagen fillers - Zyplast and CosmoPlast (both Allergan), for example - are being used in combination with the hyaluronic acid fillers, like Restylane, for the vermilion border of the lip. It's also not uncommon to put Botox into the lipstick line," he says.

According to Dr. Matarasso, topical preparations and antioxidant creams are increasingly being used with fractionated lasers and intense pulsed-light (IPL) devices to correct signs of facial aging.

"Again, what we're going for is a global rejuvenation without surgery," he says. "Where previously we would have used just one product or device, we are combining, for example, topicals with laser treatments or collagen with Botox or hyaluronic-acid-based injections."

The advent of using combination therapies in facial rejuvenation makes much sense when one considers what's been learned in recent years about what causes signs of facial aging, Dr. Matarasso says.

"It's not just aging," he says. "It's genetics, it's photodamage, it's gravitational changes and, especially nowadays, it's stress. So many factors contribute to the facial signs of aging that to treat them with one therapy is not beneficial to the patient."

Dr. Matarasso sounds a note of caution, however, saying that with all the options and combinations available today for facial rejuvenation, it's easy for patients - and, for that matter, those who treat them - to get carried away.

Generally speaking, Dr. Matarasso says, the physician must have open discussions with the patient about all the techniques available, including risks, alternatives and the expense involved.

"These procedures can get very costly," he says, "and the discussion about this factor must be broached, as well as discussions regarding the many other factors involved in a particular treatment plan."

As for what the future holds, Dr. Matarasso says combination therapies for correcting facial signs of aging are here to stay.

"The pendulum has swung from deep chemical peels and laser therapy to the not-so-strong lasers," he says. "Now the newest thing is combining fractionated lasers with injectables and topical therapeutics. In addition, there are even more sophisticated laser devices coming down the pike."

Dr. Matarasso says that in the future, what's become common in treating signs of facial aging will be expanded to treating signs of aging elsewhere on the body.

"The backs of the hands and the neck, for instance, will, in the not-so-distant future, also be treated with the kinds of combination therapy now being used facially - Botox, for instance, already is being used for treating signs of aging in the neck and chest," he says.

"When you think about it, what sense does it make to have a younger-looking face while the neck area and backs of the hands still look old?"