Hyaluronic Acid Compound Filling plus Mesotherapy Versus Botulinum Toxin A for the Treatment of Horizontal Neck Lines: A Multicenter, Randomized, Evaluator-Blinded, Prospective Study in Chinese Subjects

BACKGROUND Although energy devices and botulinum toxin-A (BTX-A) could alleviate the age-related laxity, ptosis, and platysmal bands, they have limited efficacy on horizontal neck lines. OBJECTIVES The purpose of this study was to investigate the efficacy, safety, and subject satisfaction of non-cross-linked hyaluronic acid (HA) compound filling plus mesotherapy combined treatment for the correction of horizontal neck lines, in comparison with BTX-A. METHODS This multi-center, randomized, evaluator-blinded, prospective study enrolled female patients with moderate-to-severe horizontal neck lines corrected with either 2-3 sessions of non-cross-linked HA compound filling plus mesotherapy combined treatment or one session of BTX-A injection. Improvement of the neck lines grades, global aesthetic improvement scale (GAIS), patient satisfaction, and adverse events (AEs) were evaluated and compared on 1, 3, 6, and 10 months after the final treatment. RESULTS Twenty-five patients received HA filling plus mesotherapy combined treatment and 23 received BTX-A injection. Compared with BTX-A, the HA compound filling plus mesotherapy combined treatment significantly improved the horizontal neck lines grades on all follow-up visits (P=0.000). Cases of different baseline grades (2, 2.5, and 3) demonstrated similar outcomes. The GAIS and patients' satisfaction ratings were significantly higher for the HA combined treatment group (P=0.000). Significantly higher pain ratings, higher incidence, and longer recovery of AEs (erythema, edema, and ecchymosis) were noticed in the combined treatment group (P<0.001). No serious AEs occurred. CONCLUSIONS Compared with BTX-A, the HA compound filling plus mesotherapy combined treatment significantly improved moderate-to-severe horizontal neck lines and achieved a high level of patients' satisfaction.