Combination Therapy of Injectables With Energy-Based Treatments for Facial Rejuvenation: An Updated Review

BACKGROUND: Fillers are frequently combined with other injectables and energy-based devices to target volume loss, dynamic rhytides, and photodamage. Questions remain regarding optimal treatment sequencing, safety, and synergistic clinical efficacy.OBJECTIVETo evalute the current evidence regarding the efficacy and safety of combining injectable therapies with energy-based treatments for facial rejuvenation. METHODS: MEDLINE, Embase, and Scopus were searched using keywords on dermal fillers with neuromodulators, intense pulsed light (IPL), laser, microfocused ultrasound with visualization (MFU-V), high-intensity focused ultrasound (HIFU), or radiofrequency (RF). Studies reporting safety, efficacy, sequencing, or clinical outcomes were included. RESULTS: Combining fillers with neuromodulators produces synergistic improvements in facial rejuvenation by addressing volume loss and muscular hyperactivity with superior outcomes and longer treatment durability compared with monotherapy. Intense pulsed light, nonablative lasers, MFU-V, HIFU, and RF appear safe when used with fillers, with studies demonstrating no significant adverse interactions or compromise of filler integrity. Combination treatment may enhance optimize facial contouring, improve skin quality, and improve patient satisfaction and retention. Histologic and clinical studies suggest synergistic effects when MFU-V/RF are combined with biostimulatory fillers. CONCLUSION: Combination treatment with fillers and complementary modalities offers a comprehensive approach to facial rejuvenation. Current evidence supports the safety of most nonablative combination protocols. Additional studies are needed to assess the safety and efficacy of combining fillers with more aggressive resurfacing procedures and novel devices.