• Hema Sundaram, Steven Liew, Massimo Signorini, André Vieira Braz, Steven Fagien, Arthur Swift, Koenraad L De Boulle, Hervé Raspaldo, Ada R Trindade de Almeida, Gary Monheit, and Global Aesthetics Consensus Group.
• Rockville, Md.; Sydney, New South Wales, Australia; Milan, Italy; Rio de Janeiro and Sao Paulo, Brazil; Boca Raton, Fla.; Montreal, Quebec, Canada; Aalst, Belgium; Cannes, France; and Birmingham, Ala.
• Plast. Reconstr. Surg. 2016 May 1; 137 (5): 1410-1423.

BackgroundCombination of fillers and botulinum toxin for aesthetic applications is increasingly popular. Patient demographics continue to diversify, and include an expanding population receiving maintenance treatments over decades.MethodsA multinational panel of plastic surgeons and dermatologists convened the Global Aesthetics Consensus Group to develop updated guidelines with a worldwide perspective for hyaluronic acid fillers and botulinum toxin. This publication considers strategies for combined treatments, and how patient diversity influences treatment planning and outcomes.ResultsGlobal Aesthetics Consensus Group recommendations reflect increased use of combined treatments in the lower and upper face, and some midface regions. A fully patient-tailored approach considers physiologic and chronologic age, ethnically associated facial morphotypes, and aesthetic ideals based on sex and culture. Lower toxin dosing, to modulate rather than paralyze muscles, is indicated where volume deficits influence muscular activity. Combination of toxin with fillers is appropriate for several indications addressed previously with toxin alone. New scientific data regarding hyaluronic acid fillers foster an evidence-based approach to selection of products and injection techniques. Focus on aesthetic units, rather than isolated rhytides, optimizes results from toxin and fillers. It also informs longitudinal treatment planning, and analysis of toxin nonresponders.ConclusionsThe emerging objective of injectable treatment is facial harmonization rather than rejuvenation. Combined treatment is now a standard of care. Its use will increase further as we refine the concept that aspects of aging are intimately related, and that successful treatment entails identifying and addressing the primary causes of each.Clinical Question/Level Of EvidenceTherapeutic, V.

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