Combined Botulinum Toxin Type A and Hyaluronic Acid Versus Exclusive Hyaluronic Acid Injections: A Potential...

Nonsurgical chin augmentation with hyaluronic acid (HA) fillers is a widely used technique in aesthetic medicine. However, outcomes may be influenced by hyperactivity of the mentalis muscle, which may lead to reduced longevity. Botulinum toxin type A (BoNT-A) may improve filler integration through myomodulation of muscles. To evaluate whether a combined protocol using BoNT-A followed by HA provides advantages over HA alone in nonsurgical chin augmentation in terms of aesthetic outcomes, HA volume required, longevity of results, and patient-reported pain. A retrospective study was conducted on 46 nonconsecutive patients treated between March 2022 and September 2024. All patients presented with chin retrusion assessed using the Galderma Chin Retrusion Scale (GCRS). Patients were divided into 2 groups: group 1 (n=23) received HA filler alone; group 2 (n=23) received a BoNT-A injection into the mentalis muscle, followed by an HA injection 10 to 15 days later. Follow-up was performed at 30 to 40 days and at 3, 6, 9, and 12 months. Both groups showed significant improvement in chin projection. The mean GCRS improved from 1.65 to 0.39 (Δ -1.26) in group 1 and from 1.83 to 0.35 (Δ -1.48) in group 2 (P>0.05). Group 2 required fewer HA touch-ups at 30 to 40 days (7 versus 14 patients). At 6 months, no patient in group 2 required HA reinjection, whereas 7 patients in group 1 required additional filler. Pain perception was lower in group 2. The combined BoNT-A and HA protocol appears to improve treatment stability and patient comfort in nonsurgical chin augmentation.