Dr Marina Landau is a medical and cosmetic dermatologist in Israel. She has been trained in Dermatology at Tel Aviv Sourasky Medical Center and participated in fellowships in New York University, NY, USA and Sunnybrook Hospital, Toronto, Canada.

On 29 November 2017 Dr Landau took part in a live IMCAS Academy webinar on combining botulinum toxin with other procedures. Dr Landau answered our questions on this theme.

1. You will be discussing combining botulinum toxin with fillers. Why should we combine these two procedures?

To achieve better cosmetic outcomes. Aging involves, in general skin, fat, muscles and bones. In each part of the face one of the components is more dominant, eg muscular component in the upper face, volume deflation in the midface. By combining toxins and fillers a more comprehensive solution is provided.

Additionally, for particular areas of the face, combining toxins with fillers in the same location will achieve a better or more long-lasting correction, eg deep wrinkles between eyebrows or droopy mouth corners.

2. What are some of the potential complications involved?

When using fillers and toxins simultaneously but in different facial locations, or when the procedures are performed at the same location but not in the same sitting, no increase in complications, or complications other than the usual potential ones, are reported.

Combining injections of toxins and fillers at the same location at the same time had a potential of very slight increase in toxin diffusion.

3. What particular aspects do you have to keep in mind when combining these techniques?

Because of aforementioned considerations, when treating the same area with both toxin and filler, the injector has to decide whether to space or inject simultaneously. And if both products are injected at the same session, which should be injected first?

4. What are some particularly exciting aspects in the research into fillers and toxins?

Research into specific characteristics of in vivo behavior of fillers, the proper methodology to address severe complications of fillers, primary prevention of aging using injectables - is it possible? Is it ethical?

5. As an expert, what do find other doctors reach out to you the most about?

Specific injections techniques and complications...

6. What would be your advice to new dermatologists interested in aesthetics?

Go for it! It is exciting and challenging. Then have the proper training and gain adequate knowledge.