Perfect pairs: Which noninvasive procedures complement each other and which clash?

Some things go better together, like peanut butter and jelly, burgers and fries or Batman and Robin. There is a word for it, too – synergy. Two or more components are combined to create an effect greater than the sum of their separate parts, essentially making the perfect pair. The same is true in the world of plastic surgery. Specific procedures, when combined with others, create an effect greater than either procedure could achieve on its own. However, combining the wrong procedures can be disastrous.

Understanding which procedures are perfect pairs and which ones will compete with each other, like Betty David and Joan Crawford, to the detriment of your face, is essential.

Which noninvasive procedures are the perfect pairs

Some things simply complement one another to the point where you can't believe one should be separated from the other. When you think about it, plastic surgery procedures are the same way. Some noninvasive procedures work wonderfully together, softening lines, smoothing facial texture and creating an ethereal, glowing complexion, but there's a catch. The catch is understanding how facial anatomy and specific products interact to complement each other rather than clash.

"In aesthetic medicine, the most effective noninvasive treatments are those that reinforce one another across shared anatomical regions," said Lara Devgan, MD. "When procedures are grouped by facial subunit, they create harmony, balance and coherence in a way that isolated interventions cannot. In my practice, I design combination plans that follow the natural logic of the face."

One of the natural pairings that often yields complementary results for patients is the combination of neurotoxins and fillers.

"For noninvasive procedures, the easy answer is neurotoxin and filler for facial rejuvenation," said Sara Dickie, MD. "Classically, Botox is used in the upper face to correct and prevent wrinkles around the eyes. Filler is best for wrinkles in the lower and mid-face, where we see volume loss rather than animation-related lines. Sometimes, if lines are too deep around the eyes or the lips, laser resurfacing or serial microneedling and neurotoxin is necessary to achieve the surface skin changes and get deeper into the wrinkle to correct it."

Neuromodulators and fillers can work beautifully together to soften fine lines and wrinkles and enhance volume in specific facial regions. Still, careful placement of noninvasive injectables is crucial to allowing different injectables to work in harmony, rather than against each other.

"Neuromodulators are another area where thoughtful pairing matters," said Dr. Devgan. "I recommend keeping facial and neck neuromodulator treatments on the same calendar so that animation patterns, skin texture and muscle relaxation age in sync. Harmonizing these zones prevents the mismatch that occurs when the lower face remains active while the upper face is smooth, or vice versa."

Dr. Devgan also offered other advice to patients looking to refresh their appearance by combining procedures. She recommended that patients choose the area they are most concerned about, then customize an approach to target their specific concerns.

"Treatments around the eyes and cheekbones pair beautifully because they belong to the same aesthetic zone – the upper and mid-face," said Dr. Devgan. "When we support the lateral cheekbone with subtle contouring and improve the periorbital area with neuromodulators, energy resurfacing or tear-trough restoration, the entire upper third lifts visually. Patients look brighter and more rested because these structures work together to frame the eyes."

However, perfect pairs don't stop at noninvasive treatments. Surgical procedures, combined with noninvasive ones, can also help patients achieve a more balanced and aesthetically pleasing outcome.

"Each procedure has its place, and it can only do what it does," said Dr. Dickie. "So, pairing things to achieve someone's goals is often necessary. I constantly pair noninvasive with invasive procedures to enhance both and complement what each lacks. Like a facelift complemented with laser resurfacing. Changing the underlying structure and the surface skin because neither one can do the other, but both are important for rejuvenation and the final outcome."

Dr. Devgan also has a list of surgical procedures that tend to work together.

"Profile-enhancing procedures – the nose, chin and lips – complement each other because they exist along the same sagittal plane (vertical plane that divides the body into right and left halves)," said Dr. Devgan. "A nonsurgical rhinoplasty becomes even more elegant when the chin is proportionally refined, and balanced lip augmentation can unify the profile from top to bottom. These adjustments are small, but together they create a powerful sense of symmetry and alignment."

She also recommended combining cheekbone and jawline augmentation, which can create clean shadow lines and better definition when paired.

"Patients seeking a model-esque structure benefit most when both ends of the facial contour are addressed simultaneously," said Dr. Devgan.

Clash of the plastic surgery titans

Many procedures can be paired together to deliver a powerful one-two punch that can help achieve a patient's aesthetic goals. Some noninvasive procedures should not be combined. "Clash" may even be too strong a word. Numerous noninvasive procedures target the same types of concerns. When these procedures are combined, the cumulative effect is greater than the sum of the parts. However, that isn't always a desirable outcome. Sometimes that can be overkill.

"Just as certain treatments work synergistically, others are best kept apart to protect the skin and maintain predictable results," said Dr. Devgan. "I typically avoid pairing lasers and chemical peels in the same session because stacking two resurfacing modalities can be overly aggressive for the epidermis, increasing the risk of irritation, prolonged erythema (reddening) or post-inflammatory pigmentation. Thoughtful sequencing is essential. When procedures are spaced and layered appropriately, patients achieve safer healing and more elegant, stable outcomes."

Surgical procedures that require conflicting recovery positions or noninvasive procedures in different regions of the face can make recovery challenging. Specific noninvasive procedures that target separate anatomical areas of the face can also create a lack of symmetry or upset facial balance when not combined in a harmonizing way.

A consultation with an ASPS Member Surgeon can help you narrow down which procedures work together to enhance your aesthetic and which ones you need to space out on your calendar for optimal results.

To find a qualified plastic surgeon for any cosmetic or reconstructive procedure, consult a member of the American Society of Plastic Surgeons. All ASPS members are board certified by the American Board of Plastic Surgery, have completed an accredited plastic surgery training program, practice in accredited facilities and follow strict standards of safety and ethics. Find an ASPS member in your area.