Are combined same-day treatments the future for photorejuvenation? Review of the literature on combined treatments with lasers, intense pulsed light, radiofrequency, botulinum toxin, and fillers for rejuvenation

Background : Skin rejuvenation requires a treatment combination including lasers, intense pulsed light (IPL), radiofrequency, botulinum toxin (BT) and fillers. A combined approach is considered optimum but usually same-day combined treatments are avoid and lasers are performed prior to filler or toxin injections owing to the concern that the light may inactivate or degrade them. Objective : To review the literature on the use of combination treatments with radiofrequency, IPL, non ablative and ablative lasers plus fillers or BT. Results : review of the literature identified 15 studies of combination treatments: three of them on animal models and 12 were clinical studies. Seven studies contained combined light system treatments with fillers and eight studies combined physical therapies with botulinum toxin injection. In all of them treatments were used as standard protocols. Six studies documented no histological changes in fillers injected after applying radiofrequency, IPL or laser treatments and one studied documented improvement in collagen after IPL treatment and toxin injection. These studies reported clinical improvement in various features of photodamaged skin, no increase of adverse effects and neither decrease on efficacy of substances injected. Conclusions : review of the literature demonstrates safety of same day combined treatments for rejuvenation, which improve clinical results, are more comfortable for patients have no loss of efficacy or other apparent adverse effect.