Association of AbobotulinumtoxinA and Skinbooster for Periorbital Wrinkles: A Randomized, Controlled, Double-Blind, Split-Face Study

Background: Although multimodal aesthetic treatments are used, the combined effects of botulinum toxin A and hyaluronic acid skinbooster for periorbital rejuvenation have not been properly evaluated. This study assessed the efficacy and durability of associating abobotulinumtoxinA and Restylane^® Skinbooster Vital for the treatment of canthal lines. Methods: Twenty-four Brazilian women with dynamic periorbital wrinkles (Merz 5-point scale, levels II-IV) participated in this randomized, double-blinded, split-face trial. After bilateral abobotulinumtoxinA injections, one side of the face was randomized to receive Restylane^® Skinbooster Vital, and the contralateral side underwent a simulated injection. Electromyography (EMG) activity, wrinkle severity, skin texture, and satisfaction with treatments were assessed at baseline and at 1, 2, 3, and 6 months. Data were analyzed using two-way repeated measures ANOVA, Bonferroni’s post-hoc tests, and the Mann-Whitney U test. Results: EMG showed significant reductions over time, with no differences between treatments protocols (p > 0.05). For canthal wrinkle severity, the combined protocol (AbobotulinumtoxinA + Restylane® Skinbooster Vital) demonstrated lower scores at 3 months (p = 0.0001) and 6 months (p = 0.003) compared with AbobotulinumtoxinA alone, as reported by patients. Skin texture progressively improved following Restylane® Skinbooster Vital application, remaining significantly higher at 3 (p = 0.0001) and 6 months (p = 0.002) when compared with AbobotulinumtoxinA alone. Patient satisfaction increased in both protocols, with superior results at 3 months in the combined protocol group (p = 0.009). Conclusion: The association of abobotulinumtoxinA with Restylane® Skinbooster Vital provides enhanced and lasting improvements in severe canthal wrinkles. Level of Evidence I: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.