The Aesthetic Guide is part of the Informa Markets Division of Informa PLC

This site is operated by a business or businesses owned by Informa PLC and all copyright resides with them. Informa PLC's registered office is 5 Howick Place, London SW1P 1WG. Registered in England and Wales. Number 8860726.

A degree of synergy: Data shows the additive role of neurotoxin to IPL treatment

Article-A degree of synergy: Data shows the additive role of neurotoxin to IPL treatment

Key iconKey Points

  • Combination light and Botox appears to provide consistently better results than IPL and saline in treating wrinkles, erythema, and hyperpigmentation
  • However, exactly how and why it works is not completely understood

Dr. Khoury
LA JOLLA, CALIF. — It's not news that Botox (botulinum toxin type A; Allergan, Irvine, Calif.) is commonly used as part of combination therapy — what is in question, however, are the efficacy and applicability of the various combinations.

Case in point, some studies have shown that periocular Botox treatment enhances the aesthetic improvements attained with intense pulsed light (IPL). In 2004, researchers examined combined Botox and light treatments, versus light treatments alone¹ and found that there was a synergistic effect when the two modalities were used in combination.

Dr. Goldman
As a follow-up to this study, Jane G. Khoury, M.D., Raminder Saluja, M.D., and Mitchel P. Goldman, M.D., of Dermatology/Cosmetic Laser Associates of La Jolla, Inc., La Jolla, Calif., sought to evaluate whether intradermal Botox treatment (compared with intramuscular in the previous study) of the cheeks also enhanced the efficacy of IPL. Dr. Khoury reported the results of this study at the annual meeting of the American Academy of Cosmetic Surgery Meeting in Orlando, Fla.

STUDY SPECIFICS Fifteen females ages 33 to 59 were enrolled onto this prospective, randomized, double-blind, split-face study (14 completed; one was lost to follow-up). All patients received standard IPL treatment (one pass of full-face IPL) and were randomly assigned to receive eight 0.1-mL intradermal injections of Botox in one cheek (8 U total dose) and eight injections of saline in the contralateral cheek. Injections were placed approximately 2 cm apart.

The IPL consisted of a double pulse of 3.0/4.0 ms duration with a 560 nm cut-off filter; delay times of 10 ms to 30 ms, depending on the patient's skin type; and treatment fluence of 16 J/cm2 to 17 J/cm2 with the standard 20 mm x 50 mm crystal.

(Far left) before and (left) four weeks after IPL/Botox treatment
An additional pass was performed on any areas of skin showing erythema, using the small 8 mm x 15 mm delivery crystal at 19 J/cm2 to 20 J/cm2 with a double pulse of 4.0/4.0 ms duration.

After delivery of the IPL, a blinded physician was given pre-prepared, identical-looking syringes that were injected into the cheeks with a total of eight injections of each patient's assigned treatment: 0.1-mL nonpreserved sterile isotonic saline solution in one cheek, and 0.1 mL Botox (1 U/0.1 mL) for a total dose of 8 U in the other cheek.

(Right) before and (far right) four weeks after IPL/saline treatment. Photo credit: Jane G. Khoury, M.D.
Examiners evaluated small wrinkles and fine lines, erythema, hyperpigmentation, apparent pore size, skin texture and overall appearance for eight weeks. Evaluations were made using a five-point scale, where 0 = no improvement, 1 = mild improvement (up to 25 percent), 2 = moderate improvement (25 to 50 percent), 3 = marked improvement (51 to 75 percent) and 4 = excellent improvement (75 percent or better).

Hide comments


  • Allowed HTML tags: <em> <strong> <blockquote> <br> <p>

Plain text

  • No HTML tags allowed.
  • Web page addresses and e-mail addresses turn into links automatically.
  • Lines and paragraphs break automatically.