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How I Decide Which Combination Is Best


Dr. Jegasothy explains how she tackles the decision of which combination therapy will result in the best possible outcome for her patients. According to her, it depends on multiple factors.

This is part 2 of a 3-part series with Dr. Manjula Jegasothy.

Part 1: Cutting-edge Rejuvenation: Injectables + Energy Devices

The optimal use of device-injectable combinations depends on the anatomy and muscular etiology of the patient’s laxity.

If the patient is sagging because he/she has muscular-only laxity of the neck, I might treat that patient with Dysport (abobotulinumtoxinA, Galderma). I use Dysport for the neck because it more evenly spreads over a large surface area comparted with competing neuromodulators. If the patient also has a lot of skin and soft tissue laxity, adding Ultherapy treatment is the better option. A combination of Ultherapy and Dysport tends to be my go-to nonsurgical combination for treating the neck when patients are older than 45 years.

To lift sagging jowls along the jawline, I like to inject Dysport along the inferior mandible, then use Ultherapy to lift the skin and soft tissue in the lower face. I also sculpt the cheeks using filler around and deep to the zygoma, and then sculpt underneath it by lifting the skin and soft tissue with Ultherapy.

For the face, tried-and-true Botox (onabotulinumtoxinA, Allergan), Xeomin (incobotulinumtoxinA, Merz) and Jeuveau (prabotulinumtoxinA-xvfs, Evolus) remain good options for lifting the upper face and brows. My new twist is adding Ultherapy or RF.

To treat the eyelids, for example, one should consider whether the patient has thicker or thinner eyelid skin. I like RF to tighten most eyelids, but if the patient has heavy, droopy eyelids and very thick skin, Ultherapy on the eyelids might be the better choice, along with an Ultherapy “brow lift.

For the mid and lower face, filler would likely be the first-line approach for patients who are thin but have laxity. RF is a good option for the patient who has a full face and sagging, which probably isn’t due to volume loss. Ultrasound is a great option for patients who have sagging and a lot of underlying fat and soft tissue.

Although we don’t often use energy devices on the nose, I’ve found that RF effectively tightens pores, and I use it for that indication.

NEXT: My Advice: Less is More With Devices

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