Abstract

Objectives: In the present study, we examine the effectiveness of combined HIFU and eye booster treatment performed in a specific protocol plus botulinum toxin A, as a way to correct periorbital skin aging. As these treatments target structures that are located in different anatomical level, it is of great importance to evaluate the efficacy and interaction of them when combined together, as well as the safety and patient satisfaction. Introduction: High-intensity focused ultrasound (HIFU) treatment heats the reticular dermis and SMAS to greater than 60 οC, provoking the contracture of denatured collagen and promoting neocollagenesis. Specific eye boosters improve under eye and lateral canthal wrinkles, sagging skin, dark circles and the tear valley. In this study, we used Onabotulinum Toxin A injected in crow’s feet and the lower eyelid, combined with eye booster (0.5ml per eye, consisting of hyaluronic acid 2mg/ml, amino acids, niacinamide and glutathione). In addition, HIFU was performed, involving 2 mm depth transducers at 0.4J/mm2. Materials / method: 53 patients (39 women, 14 men, mean age 46) with medium to severe skin aging were included in the study. All patients had undergone Botulinum toxin A in the past as monotherapy. Neurotoxin was performed in crow’s feet in all patients (15iu on orbicularis oculi) and in the lower eyelid (4iu in the inf. pretarsal portion) in 15 patients. In 15 days, 3 monthly eye booster sessions were initiated, performed on day 15,45 and 75 after neurotoxin. HIFU was performed in 3 monthly sessions on days 30, 60 and 90 after neurotoxin. Photographs were taken on day 1 and 2 months after the last session. Results: A significant reduction of lateral canthal and under eye wrinkles was noticed 15 days after the last treatment, with a patient satisfaction rate of up to 85% on month 4, compared with 55% when neurotoxin was used alone. The patients reported better results in static wrinkles, duration of the result, skin elasticity, sagging and dark circles. Nearly all patients mentioned a better appearance in the skin tone, hydration and tired – eye effect, whilst none of them complained about any severe side effects, except for a mild erythema after HIFU and minimal bruising after injectable eye booster. Conclusion: The combination of HIFU plus eye booster with botulinum toxin A is a safe, minimally invasive therapeutic approach with great results in periorbital skin rejuvenation. The combined protocol targets all periocular structures that contribute to periorbital skin aging. In addition, botulinum toxin A seems to have better performance and longer duration when applied as part of Energy Based Device and injectable booster protocol.