Combined Effect of Botulinum Toxin with a Biorevitalizing Solution on Crow’s Feet Wrinkles and Neck Rejuvenation: A Case Series Study

Abstract

Background: Facial and neck aging are multifactorial processes involving both muscular hyperactivity and deterioration of dermal quality. Botulinum toxin type A (BoNTA) improves dynamic wrinkles related to muscle contraction but does not directly address hydration, texture, or overall skin quality. Multimodal approaches combining neuromodulation with dermal revitalization may enhance aesthetic outcomes. Objective: This paper aims to evaluate the clinical effects of combining BoNTA with a poly-revitalizing hyaluronic acid-based solution (NCTF®135HA) compared with BoNTA alone for the treatment of crow’s feet wrinkles and neck aging. Methods: This split-face and split-neck exploratory case series included five female patients (mean age 50.8 years). All patients received BoNTA injections on both sides of the face and neck. One side additionally received three sessions of NCTF®135HA at D0, D30, and D45. Clinical wrinkle scoring, skin quality assessment (radiance and hydration), VISIA® imaging analysis, and Global Aesthetic Improvement Scale (GAIS) evaluations were performed over 60 days. Results: At D60, the combination treatment demonstrated a greater reduction in crow’s feet and neck wrinkle scores compared with BoNTA alone. For crow’s feet, 80% of patients achieved a BCFWS score of 0 - 1 on the combination side versus 20% on the BoNTA-only side (p Conclusion: In this exploratory case series, combining BoNTA with NCTF®135HA was associated with greater short-term improvement in wrinkle severity and skin quality parameters compared with BoNTA alone. These findings support the rationale for a multimodal approach targeting both muscular activity and dermal quality in facial and neck rejuvenation. Larger controlled studies are needed to confirm these results and evaluate long-term outcomes.