Background and Objectives: Facial attractiveness and youthful appearance play an important role in human social interactions. Previous research has shown tremendous social and economic benefits to being attractive. People pay more attention to attractive people; they judge and treat them better than those being less attractive. Aesthetic dermatology offers a wide range of options to increase facial attractiveness and achieve a more youthful appearance, e.g. through injection of botulinum toxin type A (BoNTA) and dermal fillers. However, there is minimal literature about the effect of minimally invasive treatments on perceived attractiveness and age. Therefore, the study aimed to assess the effect of combination treatments with BoNTA and fillers on perception of attractiveness and age. Methods: To evaluate the effect of minimally invasive combination treatments on social perception of attractiveness and age, 277 naïve, blinded female raters – with no information about treatment – were recruited to judge standardized randomized before-and-after treatment images. Attractiveness was rated on a 7-point Likert scale ranging from 1 (very unattractive) to 7 (very attractive). Prior to rating procedure, standardized digital images were taken before and 4 weeks after treatment. Therefore a total of 30 women aged 39 to 65 years were treated according to an individualized treatment protocol with incobotulinumtoxin A to reduce hyperkinetic facial wrinkles as well as with calciumhydroxylapatite (CaHA) and stabilized hyaluronic acid filler (HA) to treat facial volume loss and wrinkles. Results: The distribution of attractiveness scores changed, showing an increase of scores in the positive range (from 5 to 7) of the attractiveness scale for post-treatment photographs. Furthermore, there was a significant difference (p < 0.001) in perceived attractiveness before and after combined treatments with toxin and fillers. Post-treatment images were associated with a significant decrease (p < 0.001) in perceived age and a significant increase (p < 0.001) in perceived attractiveness compared to pre-treatment images. Moreover, there was a statistical trend toward a treatment-related difference in gained attractiveness between younger and older patients (p = 0.064). Older patients could gain on average more attractiveness than younger patients. Conclusion: Combination treatments with BoNTA and fillers increase perceived attractiveness and decrease social perception of age. Full face treatments with BoNTA and fillers not only convey a high therapeutic index in terms of restoration of wrinkles and facial volume but also improve facial attractiveness which might be accompanied with socioeconomic benefits. More research is needed to get a deeper insight into socioeconomic treatment benefits of combined minimally invasive treatments.

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