Key points
- Sagging skin, volume loss, wrinkles, and sun damage to the skin all contribute to facial aging, and while surgery can address sagging and volume, it cannot fully correct skin texture [1].
- There were once safety concerns about combining a facelift with laser skin resurfacing, but it has been summarized that there is now ample evidence that the two can be safely combined when performed appropriately [1].
- Treatment combining hyaluronic acid and calcium hydroxylapatite has been reported to bring high satisfaction and mild side effects, but improvement and satisfaction tended to decline gradually after 6 months [2].
- Skin rejuvenation using platelet concentrates has generally been reported with favorable results, but the studies are limited by their low quality [3].
Why use several methods together?
Facial aging is not a single change. The skin loosens, volume decreases, wrinkles form, and sun damage to the skin (solar elastosis) accumulates, all at the same time [1]. The literature notes that surgery can address sagging skin and restore volume, but cannot fully correct skin texture [1].
For this reason, approaches that combine methods targeting different layers are used. The literature explains that the goal of combining several minimally invasive treatments is to achieve a harmonious, natural result as effectively and safely as possible [4]. There is also a view that complex areas with a lot of movement, such as the upper face and the area around the eyes, require several methods used together to fill hollows, soften wrinkles, improve pigmentation, and relax the muscles without masking facial expressions [5].
Combining a facelift with laser treatment
In the past, there were concerns about whether it was safe to combine a facelift with laser skin resurfacing [1]. A 2021 review summarized that there is now ample evidence that this combination can be used safely, and that when performed appropriately, the two methods can enhance each other's effects [1].
The same review also discussed which of the many lasers can be safely combined with surgery and how, and how to select the right situations and patients to reduce complications [1]. Whether to combine them is therefore decided by looking at the condition of your skin and the surgical plan together.
Combining injectables and threads
Botulinum toxin and filler have become popular methods for correcting facial aging because of their safety and versatility, and more recently, dissolvable threads (bioabsorbable threads) that reposition sagging tissue have also been used alongside them [4]. A growing number of doctors are using threads, filler, and botulinum toxin together to achieve longer-lasting and more natural results [4]. This publication summarizes the authors' experience with anatomical landmarks, the intervals between treatments, and care before and after treatment [4].
Combining different fillers has also been studied. A 2025 systematic review examined treatments that use hyaluronic acid (HA) and calcium hydroxylapatite (CaHA) together, either as separate injections or mixed in one syringe [2]. This combination stimulated collagen production through different pathways, and high cosmetic effectiveness and satisfaction across various areas of the face, along with mild side effects that resolved on their own, were reported [2]. However, a gradual decline in cosmetic improvement and satisfaction was observed after 6 months, and because the studies differed greatly, their figures could not be pooled and the results were only summarized qualitatively [2].
For the upper face, a strategy combining botulinum toxin, filler, lasers, intense pulsed light, microfocused ultrasound, and microneedle fractional radiofrequency was described [5]. The authors considered that experienced doctors can safely combine these methods when safety recommendations are followed, and that performing several treatments in one session leads to greater improvement in a shorter time than spreading them over multiple visits, as well as a shorter overall recovery, which increases satisfaction [5]. This conclusion is based on a literature review and the authors' clinical experience.
Combining with skin regeneration treatments
Platelet-rich plasma (PRP) is a concentrate of platelets and growth factors collected from your own blood, and the literature notes that when used together with lasers, microneedling, filler, or fat grafting, it has a synergistic effect that improves cosmetic results [6]. The same publication stated that future research is needed to standardize PRP treatment methods for each indication [6].
A 2022 review of autologous platelet concentrates (platelet concentrates made from your own blood) examined 100 publications and considered them safe and well tolerated for skin rejuvenation, but rated the quality of the studies as low even though the results were generally favorable [3]. It concluded that more high-quality clinical trials with adequate follow-up periods are needed [3].
It has been pointed out that mesotherapy and microneedling have grown in popularity, but research on their effectiveness and long-term results has lagged behind [7]. Chemical peels are one of the oldest methods of facial rejuvenation and can be tailored to the individual by adjusting the type and strength of the agent and how it is applied [7].
Risks of combining treatments
When several methods are combined, the risks of each method come along as well. As filler use has increased, reports of related complications have also increased; most are mild and temporary, but serious and long-lasting complications have also been observed [8]. The main complications named were changes in pigmentation, hypersensitivity reactions, infection, nodules, granulomatous reactions, blockage of blood vessels (vascular occlusion), and filler migration [8].
The same publication stressed that a good understanding of strategies for preventing and managing complications is needed to prepare patients in advance and respond effectively when problems arise [8]. In combination treatment, planning also includes leaving appropriate intervals between treatments to reduce recovery time [4].
What to check during your consultation
Most of the sources reviewed here are literature reviews and summaries of the authors' experience, and no results from randomized studies directly comparing combination treatment with single treatment could be found in the research summaries. The 2025 systematic review also stated that rigorously designed studies are needed to build evidence on long-term safety and effectiveness [2]. Which combination is right for you varies from person to person depending on how you are aging, the condition of your skin, and how much time you have for recovery, so it is a good idea to check the following during your examination.
- Whether your aging is closer to sagging, volume loss, wrinkles, or changes in skin texture
- The order of the combined treatments and the intervals between them
- The recovery period for each treatment and the combined overall recovery period
- How filler complications are handled if they occur
- How strong the evidence is for each method and what range of results to expect
Frequently asked questions
- Can I have several treatments at once?
- A review of combination treatment for the upper face considered that experienced doctors can safely combine several methods when safety recommendations are followed, and that performing them in one session shortens the overall recovery period and increases satisfaction [5]. However, this conclusion is based on a literature review and the authors' experience, and it does not apply to every combination. Depending on the condition of your skin and the types of treatment, it may be better to have them separately.
- Can I have a facelift and laser treatment at the same time?
- A 2021 review summarized that, contrary to past safety concerns, there is now ample evidence that the two methods can be safely combined when performed appropriately [1]. However, the approach differs depending on the type of laser and the selection of patients, so a decision tailored to your individual condition is needed [1].
- Will adding PRP improve my results?
- The literature explains that PRP has a synergistic effect when used together with lasers, microneedling, filler, or fat grafting [6]. However, a review of studies on platelet concentrates rated the quality of the studies as low, even though the results were generally favorable [3]. It is best to make your decision knowing that the evidence is not yet sufficient.
References
- Hessler JL, Trujillo O. Combining Laser Resurfacing and Facial Rejuvenation Surgery. Facial Plast Surg. 2021.PubMed 33845493DOI
- Meçani R, Amiri M, Kadouch J, et al. Combined and Hybrid Treatments of Hyaluronic Acid (HA) and Calcium Hydroxylapatite (CaHA): A Systematic Review of Mechanisms of Action, Aesthetic Effectiveness, Satisfaction, and Safety Profile. Aesthetic Plast Surg. 2025.PubMed 40481158DOI
- Buzalaf MAR, Levy FM. Autologous platelet concentrates for facial rejuvenation. J Appl Oral Sci. 2022.PubMed 36074433DOI
- Moon H, Fundaro SP, Goh CL, et al. A Review on the Combined Use of Soft Tissue Filler, Suspension Threads, and Botulinum Toxin for Facial Rejuvenation. J Cutan Aesthet Surg. 2021.PubMed 34566355DOI
- Langelier N, Beleznay K, Woodward J. Rejuvenation of the Upper Face and Periocular Region: Combining Neuromodulator, Facial Filler, Laser, Light, and Energy-Based Therapies for Optimal Results. Dermatol Surg. 2016.PubMed 27128248DOI
- Emer J. Platelet-Rich Plasma (PRP): Current Applications in Dermatology. Skin Therapy Lett. 2019.PubMed 31584784
- Lee JC, Daniels MA, Roth MZ. Mesotherapy, Microneedling, and Chemical Peels. Clin Plast Surg. 2016.PubMed 27363773DOI
- Chiang YZ, Pierone G, Al-Niaimi F. Dermal fillers: pathophysiology, prevention and treatment of complications. J Eur Acad Dermatol Venereol. 2017.PubMed 27662522DOI
This article is an English translation of general health information that DOY JUN Plastic Surgery compiled in Korean from the summaries (abstracts) of papers in international academic journals. Treatment methods and results vary depending on each person's condition, so please consult a specialist for an accurate diagnosis and treatment plan.
