Background: The forehead is particularly prone to repetitive facial expressions and hyperdynamic activity, resulting in deep wrinkles and a loss of elasticity and hydration. Although botulinum toxin type A (BoNTA) has been shown to reduce the appearance of wrinkles and allow patients to have a smoother and hence younger upper face, it cannot help to improve the other aspects that determine overall skin quality. Objective: This case series aims to evaluate the clinical efficacy of combining BoNTA injections with a biorevitalizing treatment (NCTF®135HA) on skin aging signs and quality using a split face approach. Patients and Methods: A total of eight patients from 30 to 55 years old were treated with botulinum toxin type A combined with NCTF®-135HA or alone. Results: At D60, clinical skin quality scoring showed that NCTF®135HA injection significantly reduced wrinkles and enhanced skin homogeneity, hydration, firmness, and radiance. The Global Aesthetic Improvement Scale (GAIS) by the evaluator at D60 reported mean scores of 2375 (much improved) on the side of the face treated with BoNTA + NCTF®-135HA compared to the side of the face without NCTF®135HA. According to patients, the NCTF®135HA injections resulted in a significantly better aesthetic improvement score on D60 (mean score of 2.5 compared to 0.125 without NCTF®135HA, p 0.001). Conclusions: Our findings show that combining a biorevitalizing treatment with a BoNTA injection can significantly improve the skin’s overall appearance and decrease the wrinkle score when compared to the BoNTA injections alone. The results suggest that the combinatory strategy is effective, safe, and associated with a high level of patient satisfaction.
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