Treatment of forehead/glabellar rhytide complex with combination botulinum toxin a and hyaluronic acid versus botulinum toxin a injection alone: a split‐face, rater‐blinded, randomized control trial

Summary Background Forehead and glabella rhytides are treated mostly with neurotoxins, although some practitioners prefer the concurrent use of fillers. It has been suggested that combination treatments can result in a better overall improvement. Aims To compare the safety and effectiveness of treatment of forehead and glabellar lines with botulinum toxin A alone versus botulinum toxin A and filler. Methods Split‐face, randomized control trial. Twenty subjects with forehead/glabellar rhytide complex (static and dynamic creases) enrolled. Subjects were randomized and injected with botulinum toxin alone on one side of the forehead/glabella and hyaluronic acid filler followed by botulinum toxin on the other side. Blinded ratings were obtained to assess the effectiveness of treatment for static and dynamic rhytides, respectively, at 2‐week, 6‐week, 3‐month, and 6‐month follow‐up visits. Subjects performed a self‐evaluation at the end of the study. Adverse events were recorded. Results Ratings of both treatments showed comparable efficacy, with 100% of subjects experiencing improvement from baseline regardless of treatment type at weeks 2, 6, and 12. Combination treatment produced longer‐lasting results in dynamic forehead wrinkles, and greater static and dynamic wrinkle reduction in the glabella at week 24. Subject self‐evaluations showed that both treatments were effective, with a nominal preference for combination treatment. Conclusions Glabella and forehead lines can be effectively and safely reduced with neurotoxin alone as well as neurotoxin in combination with fillers. Combination treatment may provide a slightly better cumulative benefit and also increase the persistence of effect.