Passing life, time leaves its indelible marks on every living being, and our skin is no exception. Skin aging undergoes multiple changes, including loss of elasticity, decreased collagen production, volume loss, dynamic wrinkles caused by muscle contractions. But also, excessive sweating, open-pores, dyskeratosis and increase of superficial telangiectasias can increase facial aging. Over these, extrinsic factors like smoke can increase skin aging.

The Poly-HA-Biorevitalization with multiple selected ingredients and Free HA (NCTF 135 HA) addresses many of these various aspects simultaneously [2,3,4], restoring elastine, collagen and hydration. AboBoNT-A (Azzalure/Dysport) is very effective in the reduction of acetylcholine release. Meso-Abo-botulinumtoxinA targets particular very superficial dynamic wrinkles and other superficial targets as sweating glands, hair muscle and the very superficial insertion of mimetic muscles in dermal network. All these targets are acetil-coline related and answer very well to injections of AboBoNT-A. The Author uses this combination of Poly-HA-Biorevitalizer (PHaB) and Meso-Abo-botulinumtoxinA (MABA) from many years, confirming with his experience its safety but especially their synergistical action. Poly-HA-Biorevitalizer provides immediate elasticity, hydration and stimulate collagen production [3,4], while MesobotulinumtoxinA, often referred to as "microbotox" or "mesobotox," is a relatively newer concept to target superficial structures of the skin acetylcholine-sensitive [6]. It provides a subtle muscle-relaxing effect that complements the overall rejuvenation. Together, they can achieve a more natural and harmonious result compared to using either treatment alone [5].

Assessment and Treatment Plan: A 57 years Caucasian lady was assessed pre-treatment: she is smoker, and showed signs of early skin aging, including fine lines around the eyes and mouth, mild skin laxity, and visible pores. After a thorough consultation and examination, it was decided that Poly-biorevitalization HA and meso-abo-bont-a could be an effective solution to achieve her desired results.

Preparation of Poly-HA-Biorevitalization (+ freeHA) and Meso-Abo-botulinumtoxinA for treatment
The patient was asked to come 20 minutes before treatment without makeup and well cleansed. An informed consent for bio-HA-biorevitalization and meso-AboBoNT-A has been signed (Off Label technique). Pictures before procedure have been done in frontal, 45° and profile both sides. Over this a macrophotography of ala nasi and nearby tissues has been done.

Face neck and décolleté were thoroughly disinfected to remove anyway makeup and face was divided in upper and lower face with a line from tragus to ala nasi. No numbing cream is used since the treatment is quite painless.

1 vial Poly-HA-Biorevitalizer (NCTF 135 Ha), 3 ml is divided into 3 insulin syringes 1 ml each. The luer-lock syringe is better otherwise the normal lock is acceptable. The medical device nanosoft needle (Fillmed France) is used all over the face for all injections [1].

The first syringe 1 ml, without AboBoNT-A, was used to inject the upper face with a micro papule technique. Micro papules at the basal membrane (Nanosoft needle, 3 little needles 0,06 mm long allows this very superficial injection) are distributed all over the forehead, upper and lower eyelids, periocular and malar zygomatic area, around 1 cm apart [1].

AboBoNT-A (Azzalure 125U) was then diluted with 0,63 ml normal saline, (on label). In each of the remaining 2 syringes of NCTF 135 HA, 1 ml each, 10 units AboBoNT-A, (0,05 ml) aspirated with a BD 0,3 ml syringe, are added x single syringe through the cone without needle. After short, these 2 syringes have been used to inject perioral, cheeks neck and décolleté.

The same micro papules technique was used in lower face, perioral, neck and décolleté remaining always very superficial using the nanosoft needle and without injecting too much liquid, less than 0,02-0,03 ml, a very little papule, but perfectly visible. The blue line of nanosoft needle must be strictly upward. Better avoid pushing too much. The injection with this medical device arrives exactly to the basal membrane.

These papules disappear in few hours. The patient was again disinfected and came back immediately to work. No complications have been reported. The patient was asked to come back 1 week later and 2 months later to check results and do pictures after procedure and rate the results from 1 to 5 (1 no results-5 great results)