These days always everyone is familiar with the fact that Botox (and the other neuromodulators, such as Dysport and Xeomin) work well for treating dynamic wrinkles, i.e. those lines, wrinkles, crinkles and furrows that result from the repetitive movement of the muscles of facial expression. Well known examples of lines that respond well to neuromodulators are the smile lines, forehead "worry lines," and "crow's feet" lines around the sides of the eyes.Likewise, it is equally well known that the use of fillers and volumizers are excellent nonsurgical ways to deal with the static wrinkles, lines and furrows, i.e. those creases that are present when the face is at rest and result from years of "folding" the skin like a piece of paper with each act of expression. Together, Botox and fillers are excellent nonsurgical ways to quickly and easily rejuvenate the skin.What is recently becoming more fully appreciated is that it is often not enough to simply deal with the lines and wrinkles. When the background "canvas" of the skin looks weathered, rough, blotchy and finely crinkled, the overall effect of the Botox and filler treatments can be lessened. For this reason, there has been a burgeoning of laser and light-based (e.g fraxels and IPL), and other energy-based technologies, such as ultrasound (e.g. Ulthera) and radiofrequency devices (e.g. Thermage, Pelleve) that purport to tighten and firm skin and/or deal with irregular pigmentation. Unfortunately, to date, I have been far from impressed with the plethora of "next best things" that seem to crop up seemingly every day and garner enormous media hype without the requisite hard science to back up the marketing claims.For this reason, if the background canvas of the skin requires treatment in addition to neuromodulators and volumizers, I prefer to recommend tried and true techniques, such as chemical peels, dermasanding or medical microneedling, which have stood the test of time for safety and efficacy and are generally far less expensive alternatives to the glitzy and pricey "next best things." To my way of thinking the question should not be whether Botox and fillers can follow a certain energy-based modality, but whether the light and energy-based technologies are needed at all and, if something is needed to improve the background skin, whether one or the other of the tried and true technologies may better and more inexpensively serve the purpose. I recommend proper due diligence homework before going any route.
