摘要

Objectives: The aim of the study is to evaluate the efficacy of a combination protocol with High-Intensity Focused Ultrasound (HIFU), Poly-D,L-lactic acid (PDLLA) and botulinum toxin A in mild to moderate neck skin aging. Neck skin aging, involves horizontal lines, prominent platysmal bands, sagging skin, fine lines, loss of jawline definition and is a challenging problem, as patients’ satisfaction rates are relatively low when a monotherapy is applied. Introduction: Botulinum toxin A is the gold standard for platysmal bands and vertical bands of the neck. HIFU, through thermal damage, leads to collagen production, skin tightening and rejuvenation, targeting to deep dermis and SMAS. PDLLA is a biocompatible collagen biostimulator that promotes neocolagenesis, enhances elasticity, and promotes skin rejuvenation and gradual skin tightening. In the present study, we examine the effectiveness of combining BTX-A with PDLLA and HIFU as a way to address stubborn signs of neck aging. Materials / method: 89 patients (69 women, 20 men; mean age:53y) with moderate neck aging were enrolled in the study. All patients had undergone BΤΧ-Α in the past as monotherapy. The protocol consisted of BTX-A administered on day 1 (average:41u in platysmal bands & 25u in jawline -Nefertiti lift). HIFU was performed on day 14, 35 and 56 after BTX-A, targeting depths of 3 and 4,5 mm (mean shots: 350 per session). PDLLA injected by cannula in average dose of 3ml per neck side, diluted in 10ml SWFI per vial, followed on day 28, 49 and 70 after BTX-A. Photographs were taken on day 1 & 2 months after the last PDLL. Results: A significant reduction in vertical neck bands and neck skin texture was observed 15 days after the completion of treatments, with a patient satisfaction rate of 89% on month 4, way higher than botulinum toxin A monotherapy (55%). Patients reported improvement in both dynamic and static wrinkles, skin elasticity and thickness, sagging, overall texture and firmness. Nearly all patients reported improved skin tone, hydration, and jawline definition, with no severe side effects observed, apart from mild erythema and slight bruising after HIFU and PDLLA. Conclusion: The combination of BTX-A, HIFU and PDLLA is a safe minimally invasive therapeutic approach with excellent results in treating neck skin aging. The combined protocol targeted all structures of neck and lower face that contribute to skin aging. In addition, BTX-A seems to have a better performance and longer duration when applied as a part of an EBD and PDLLA potocol.