Injection of hyaluronic acid and mixed application of botulinum toxin

Now most of the routine use of nonsurgical therapy for facial beauty doctors younger, including dynamic wrinkles by botulinum toxin (BNT) treatment, as well as the filling agent for soft tissue filler and facial shape.
Most often in beauty therapy clinical consideration are: cost, pain, recovery time, the number of metabolic pathways, and need to see.
In face the same area (such as peri-orbit, brow and forehead, jaw and chin) injection of hyaluronic acid (HA) and standard operation of BNT is using different syringe and injected in the different service time. Many doctors like to injections of BNT, BNT effect stable after 1-2 weeks after the injection of filler, this is also good for making best estimate to requirement. However, many of the busiest people often do not go to the clinic twice, so plastic surgeons in the injection of HA in a service and the trend of BNT. Usually has the following several ways:
1. BNT and HA by different injection syringe, order preference decision by a doctor
2. Some doctors inject needle bureau hemp agent, 3 continuous injection of HA and BNT to relieve discomfort
3. Some are mix bureau hemp agent and HA in the same syringe (or use a joint in the process of the preparation products), BNT the injections before or after injection
Traditional methods of faults: 2 needle, especially weak areas (such as orbit weeks), can cause discomfort, often lead to shortcomings.
In order to avoid the above shortcomings, the author puts forward using the same syringe injection of HA and BNT technology at the same time.
methods
Patient: five women aged 45-61 volunteers
Photo: the baseline period, before injection, immediately after injection, injection after 1, 2, 4, 6, 8 weeks
Treatment parts: eye, or corner + brow (canthus patients can choose only injection, or choose two parts injection)
Ingredients: HA (Perlane ®, Medicis, Scottsdale, AZ), 62-153 - u BNT (Dysport ®, Medicis, Scottsdale, AZ)
Preparation: 1.300 u BNT mixed 1 cc contain saline preservative for the preparation of fresh neurotoxin
2. The mixed injection preparation process is as follows: (figure 1-6)
A. 1 cc/bottle HA filler mixed 0.25 cc2 % of lidocaine with 1:10 0000 adrenaline, using two-way tube 3 cc syringe injection, before and after the shake at least 10 times, to ensure the mixing
B. again according to each patient will preparation good BNT the required volume of the injected into another 3 cc syringe
C. using two-way tube mixed BNT and HA injection (HA in a 3 cc syringe before anesthesia agent mixture)
D. moving again at least ten times
Figure 1-3

 Figure 1: equipped with adrenaline lidocaine injection 3 cc syringe;

 Figure 2: a mixture of HA into the anesthetic;

 3: using tuberculin syringe measuring BNT.

Figure 4-6

Figure 4: BNT into 3 cc syringe;

Figure 5: the two-way mixed BNT and HA - narcotics;

In figure 30 g o cc syringe BNT - HA - anesthetics mixed injection

Injection: injecting the mixture to volunteer or brow + canthus canthus (figure 7), dependant on the number of unit injection quantity according to the need of BNT, 30 g to 0.5 inches of syringes used leather, a beaded sample or continuous prick. Immediately after the injection and after treatment are for regular massage.

Figure 7
 Figure 7: the patient before the injection mark injection point.

As a result
1. All the volunteers injection process is well tolerated and experienced mild bruises, canthus place back in a few days. No drooping eyelids, hematoma or superficial injections of nodules.
2. Injection on the same day, slightly visible mixed injection pieces immediately after injection, immediately after the massage, level off, even into the treatment area (FIG. 8, 9).
3. Upon these volunteers, BNT present steady fast (3-5 days), and separate to give same BNT (figure 10, 11).
4. All volunteers are satisfied with the treatment immediately and the curative effect of the whole observation period.
Figure 8, 9

Figure 8, 9: injection before, immediately after injection, two weeks after the injection.
Figure 10, 11

To discuss
This pilot study shows for the first time BNT and HA can be mixed injection at the same time, and will not cut their safety and effectiveness. The advantage of this method are as follows:
1. To halving the number of needles
2. Patients with curative effect in the process of waiting for neurotoxin, can see the effects of filler, which enhances the beauty to experience
3. The mixed injection of anesthetic can also reduce the pain and injury treatment parts, at the same time within a few hours after injection parts keep treatment, can make the filler treated by massage and evenly spread throughout the region
4. Sticky HA and neurotoxins and anesthetic injection blend to form a thin, small syringe injection can be used, further reducing the pain and injury
5. In theory, neurotoxin mixes with gelatinous HA, can prevent the spread of the nerve poison ACTS on the target muscle and make it more accurately.