While the definition is a little bit different depending on the source, combination therapies, or polymedicine, is essentially “a therapeutic intervention in which more than one therapy is administered to the patient. Examples of combination therapy include treatment regimens that involve administering several separate pills, each containing a particular drug, or single pills that contain several drugs.” (Source). While this is most commonly applied to the prescription and use of drugs, any and all procedures and therapies that are used together fall into this spectrum of treatment.
Combination therapies exist in almost every medical field, and are no exception in the practices of dermatologists, plastic surgeons, oculoplastic surgeons, aesthetic physicians and aestheticians. The most common type of polymedicine in our field is when non-invasive procedures are ‘stacked’ to treat signs of aged skin and also help to rejuvenate that same area of skin. There are dozens, if not hundreds, of known ways we can help our patients and clients become their most beautiful using this method.
Combo Therapies From the Patients’ Perspective
In 2016, DermStore wrote about the benefits of ‘combining multi anti-aging procedures’ from the point of view of the consumer. Oculoplastic surgeon Dr. Mathison Harris contributed to the article, in which the following points were made:
Instead of being in therapeutic overload, combination treatments may help conditions in which skin is easily aggravated… A holistic approach can target the inflammation behind the breakouts as well as the overall skin appearance. Blending therapies can target and treat flare-ups while maintaining positive results of treatment for clearer skin down the road… Along with the convenience of combining treatments, some practitioners find that procedures can work better together than when performed at different times…. As opposed to sidelining you for longer than expected or desired, combination therapies can actually ease the recovery process. This isn’t just because the equipment used in the procedures, such as lasers, has evolved. It’s because the next time you go in for treatment, the enhanced results from your combination therapy mean the practitioner doesn’t have to do as much upkeep work. That shortens recovery time each time you go in for new treatments.
Information like this is driving consumers to ask for the best combination therapies. While the options are endless, here are a few that tend to have good results on most people.
Botox, Fillers, and Mesotherapy
This combined therapy was written about and published (by the National Institutes of Health) in 2010. Developed in France, this is a combined non-surgical set of procedures that promise to deliver effective results with therapies that are simple.
Aesthetic mesotherapy, also known as anti-aging mesotherapy, uses intra-dermal injections of a nutritive and moisturizing solution to improve brightness, skin hydration and tonus, and also smooth out superficial wrinkles. Subcutaneous filler injections enable to fill wrinkles and folds; by using high density products it is also able to provide genuine facial volumetric reconstruction. Finally, botulinum toxin acts by reducing certain muscle contractions to smooth out expression lines and folds induced by facial dynamics…. A therapy combining anti-aging mesotherapy, botulinum toxin and filler injections, offers full treatment of the 3 biological levels of the covering tissues. This non-invasive therapeutic strategy brings patient satisfaction through a global approach to facial aging.
Botox and Fillers Without Mesotherapy
Almost a decade later the exact protocol and medications have changed a little bit to refine the results, but the significance remains proven, safe and effective for almost anyone that does not require surgery to be rid of their deep lines and wrinkles. A similar, but less effective, treatment can be done with just the botox and fillers, as discussed in the April 2016, Aesthetics Journal. The use of fillers such as hyaluronic acid, polylactic acid, or hydroxylapatite are recognized as very effective for use following botox treatments in people (women) between 35 and 55, according to Dr. JJ Masani, Founder and Director of the Mayfair Practice in the UK.
Combining Energy Treatments and Other Non-Surgical Techniques
A review of reported and published cases claiming that laser and other energy treatments, as well as same-day combinations including injectables, was conducted and the results analyzed in 2013 (Source). Those studies found definitive improvement in photodamaged skin without any addition of negative effects or decrease in treatment impacts. Thus, in most cases it is safe to combine treatments the same day for skin rejuvenation, and it is ‘more comfortable’ for the patient. The study included various treatments with lasers, IPL, and radiofrequency, as well as fillers and toxin injections.
Dermatology Times highlighted this topic earlier in 2018:
… combining energy-based devices and injectables provides optimal outcomes for patients. It’s important to remember, though, that while some treatments are safe to provide same-day, others must be staggered for safety and efficacy. For example, fillers, neuromodulators, and light-based technologies or energy-based technologies can be implemented in the same session… The long-held belief that introducing lasers could destabilize or damage fillers has been largely debunked. You can use both modalities in the same session without problems.
As with any treatment option, combination therapy has its positives and negatives. Overall, the biggest benefit of combining energy-based device treatments and injectables is time saving for the patient, But, there is a downside associated with this combination approach. To date, there’s a lack of evidence-based medicine to guide providers on how best to use the combination approach. The research base is growing, and an increasing number of dermatologists are sharing their grassroots experiences, but there’s still much to learn.
The topic of Combination Therapies, or Stacked Treatments, will be highlighted at SCALE 2019 Music City, with opportunities for practitioners to learn more about cutting edge research and the latest in methodology.