Combination vs Single Treatments: What Patient Research Shows

A 2021 study looked back at the records of more than 2,600 patients at seven clinics on five continents. It found that people who had both a neuromodulator and hyaluronic acid filler were more likely to continue care at the same clinic over one, three and five years than people who had only one of the two. The authors used that as a stand-in for satisfaction, but it does not mean combination treatment is right for everyone.

Why this was studied

Neuromodulators and fillers do different jobs. Wrinkle-relaxing injections of botulinum toxin type A soften lines caused by muscle movement, such as frown lines and crow's feet. Hyaluronic acid filler restores volume or support where it has been lost. Many clinicians believe that addressing both movement and volume, when both are actually contributing, gives a more balanced result than treating one alone. Our article on filler versus neuromodulator explains the difference.

Measuring satisfaction over many years is hard. Surveys are costly and often have low response rates. This group of international clinicians, working together as an advisory panel, chose to look at whether patients kept coming back as an indirect measure.

What the researchers did

The study's summary reports that the team reviewed records from seven aesthetic practices and compared three groups: people who had only a neuromodulator, only hyaluronic acid filler, or both. They looked at what proportion were still attending the same practice at one, three and five years.

What they found

According to the published summary, people who had combined treatment were significantly more likely to remain with their practice at every time point than those who had either treatment on its own. The detailed percentages were not available in the summary we read, so we have not reported them here.

How strong is this evidence?

This is a retrospective review of existing records, which can show an association but not cause and effect. Several points are worth keeping in mind:

• Returning is not the same as being satisfied. People stay with a clinic for many reasons, including convenience, trust in the clinician and cost. People who leave may have been satisfied but no longer wanted treatment, or moved away.
• The groups were not randomly assigned. People who chose both treatments may already have differed, for example in age, budget, goals or how engaged they were with their care.
• Combination patients had more reasons to visit. Neuromodulators are typically repeated every few months, and adding filler creates more contact points, which could on its own increase the chance of staying.
• Clinics involved were experienced practices, which may not reflect every setting.
• We read only the summary, so we could not check details such as funding or how missing records were handled.

The study does not show that combined treatment gives better-looking results, is safer, or that people who had one treatment would have been happier with two.

What it means for you

The more useful idea behind this research is about matching treatment to the cause. If your concern is mainly lines that appear when you move your face, a neuromodulator alone may be enough. If it is mainly volume loss, filler may be the focus. If both are clearly contributing, addressing each can make sense. And for some concerns, such as skin texture, pigment or mild early changes, skincare or other approaches may be more appropriate than either injectable.

It also helps to think about what "staying with a clinic" really reflects. When people trust their clinician, understand their options and feel their concerns were heard, they are more likely to come back, whether for treatment, a check-in or advice. That relationship, rather than the number of treatments, is probably the more meaningful lesson for patients. It also means you can ask questions and raise concerns with someone who already knows your face and your preferences. A clinician who knows your history over several years can also spot changes, adjust doses and recognize when less is more.

A good plan starts with a careful assessment and explains why each part is being suggested. You should never feel pressured to add a treatment, and it is reasonable to start with one step, see how you feel, and decide later. Our article on combination treatment plans discusses how this is approached in more detail.

Combining treatments also means combining risks. Neuromodulators can cause temporary bruising, headache, or rarely a drooping brow or eyelid. Fillers can cause swelling, bruising, lumps and, rarely, blood-vessel blockage. People who are pregnant or breastfeeding, have an active skin infection, or have certain neuromuscular conditions should wait or avoid treatment.

Questions to ask at your consultation

• What is causing the change I am concerned about: movement, volume loss, skin quality, or a mix?
• What would you suggest if I only wanted one treatment?
• What happens if I do nothing for now?
• Do the treatments need to be done on the same day, or can they be spaced out?

Frequently asked questions

Can neuromodulator and filler be done in the same visit?

Often, yes, depending on the areas and your clinician's approach. Some prefer to space them out so each result can be judged separately.

Does combining treatments make results last longer?

This study did not measure how long results lasted. Some clinicians believe relaxing muscle movement may reduce wear on filler, but that is a separate question.

Will I be offered more treatment than I need?

You should not be. A plan should be based on your goals and anatomy, and declining any part of it is always fine.

At HealthPark, consultations focus on understanding what is driving your concern and discussing whether one treatment, a combination, a non-injectable option or no treatment suits you best.

Source

Humphrey S, de Almeida AT, Safa M, Heydenrych I, Roberts S, Chantrey J, Ogilvie P. Enhanced patient retention after combination vs single modality treatment using hyaluronic acid filler and neuromodulator: a multicenter, retrospective review by The Flame Group. Journal of Cosmetic Dermatology, 2021. Read the study