“Should I have a booster, or a lifting treatment?”
People ask it as a choice between two options, when in practice it is a question of sorting which of the two your own concern belongs to. An injection works on the material of the dermis; a device works on the structure lying deeper than that. And the line you will hear everywhere — that doing both together produces synergy — was put to a randomised trial twice, and twice it was not confirmed.
The short answer
If the trouble is the texture of the skin, that is an injection; if the trouble is a contour that has come down, that is a device. The two are not competing options — they work on different layers. And there is no evidence for the claim that doing both is better — it was actually tested in two randomised trials, and both times the answer came back as no difference against either treatment on its own. So when we do treat with both, we do not describe it as synergy. We describe it as two separate problems each being dealt with.
Why the question feels hard to answer
Most clinics have both. Which makes “you would do well to have both” an easy sentence to reach for at consultation. It is not a false sentence, but it skips the work of sorting out which problem is the main one.
Skip that sorting and two things follow. One is having treatments you did not need. The other is not having the treatment you actually needed. Someone whose contour has descended can repeat boosters indefinitely: the skin texture improves and the jawline stays exactly where it was. Someone whose dermis has thinned can have device treatment and end up saying “there is a tightened feeling, but my make-up still sits badly.”
This column sets out how we do that sorting. And at the end it sets out the order and interval when the two are combined, along with how far the evidence behind those recommendations actually reaches.
The layers the two work on
| Injection (booster) | Radiofrequency device (lifting) | |
|---|---|---|
| Where it works | The dermis — the material of the skin itself | Below the dermis — the structure that has slackened |
| What it does | Puts material in, or changes how the dermis behaves | Delivers heat to contract collagen and prompt renewal |
| What changes | Density · texture · fine lines · the feel of hydration | Firmness · the jawline · slackness of the cheek |
| When to judge it | From two to four weeks, cumulative if planned as a course | Not on the day but 2–3 months later |
| What it cannot do | Lift a contour that has come down | Create volume, or change the material of the skin |
The last row of that table is the important one. Neither of them creates volume. If the main complaint is a hollow cheek or a hollow temple, the answer is neither a booster nor a lifting device but something that replaces volume — and this is a branch missed more often than you would think.
How to sort which side your concern falls on
In the consulting room we divide it three ways.
| If this is what you see | The problem is | What we look at |
|---|---|---|
| Make-up sits badly and the texture feels rough | The material of the dermis | Injection — the booster family |
| The skin has thinned and fine lines have multiplied | The material of the dermis | Injection |
| The jawline has blurred and the cheek has come down | Structural descent | Device — the XERF family |
| Shadows are starting to form around the mouth | Structural descent | Device |
| The cheek or the temple has hollowed | Volume | Neither of them |
| The skin is loose enough to fold | Past the range of these treatments | The territory of surgery |
Most people match more than one row. When that happens, the job at consultation is not to say “let us do all of it” but to pick the single thing that bothers you most. Doing that one first and watching how it goes is better than doing several at once and losing any way of telling which of them worked.
The claim that “doing both together produces synergy”
This is the part of the column we most want to put in front of you.
The explanation that an injection and a device reinforce one another is a common one. What is less often mentioned is that the claim has actually been tested.
- A randomised split-face trial in 36 patients. One side received hyaluronic acid filler alone; the other received the same filler followed immediately by non-ablative laser, monopolar radiofrequency and IPL. The result was no significant difference in wrinkle severity or global assessment at any timepoint
- A second randomised split-face trial, 12 patients, in Korea. The title of the paper is itself the conclusion — “combining a non-ablative infrared device with hyaluronic acid filler does not increase efficacy”
- A 2025 systematic review of combination treatment. It gathered 11 studies, of which not one was a randomised controlled trial; only 1 of the 11 had any comparison group at all, and every study was rated at serious risk of confounding. On top of which the review was funded by the company that makes both the device and the filler in question — and even that review concluded that most of the studies had no control arm
Put plainly: that the two are safe to combine is supported. That combining them is better than either alone is not supported. Those are entirely different sentences. And the two studies that tested the second one directly came back with no difference.
So why do clinics combine them? In a survey of Korean dermatologists, 79% of those who use PN injections said they combine them with device treatments — most commonly with non-invasive radiofrequency, needle radiofrequency and focused ultrasound. It is close to universal practice, and there is no published guideline supporting it.
When we do treat with both, the reason is not synergy. It is that the person in front of us has both a texture problem and a descent problem. Two problems, two treatments. One problem, one treatment.
If you are combining them — the order
The recommended order is device first, injection afterwards. Expert consensus and several guidelines agree on this. There are two reasons: one is to avoid pressing or rubbing over material that has just been placed (which needs no trial, it is common sense), and the other is to avoid applying heat to a drug that has just gone in.
The honest addition, though, is that no study has randomised the order and compared the results. It is custom, and it is mechanistically plausible, but it is not a tested fact.
What to do when, and with what spacing, depends on the class of material you were given and when you were given it, and on the state of your skin now, so it is settled in consultation. The data are not thick enough to write down a single number of days that applies to everyone.
“I have already had an injection — can I still have a device treatment?”
This is the question we are asked most, and the answer is that the state of the evidence is completely different from one class of material to the next.
- Hyaluronic acid. The only class with anything much to go on. The small human studies, and the interval studies mentioned above, all sit here
- CaHA (the Radiesse and DCLASSY family). The human evidence is a single pilot study in 6 subjects, which found no difference on biopsy three days after treatment. A study in pigs reported a significant increase in inflammatory and foreign-body response after monopolar radiofrequency — which does not mean harm has occurred in people, but this result is frequently left out when the work is cited
- PN (the Rejuran family) and hADM (Re2O · CellREDM). We could not find a single study examining how these interact with radiofrequency or ultrasound. It is the most commonly combined pairing in Korea, and there are no data on it
- Liquid PCL (GOURI). There is one cadaver study and nothing in living people
One distinction matters here. A large part of the worry about radiofrequency over injected material comes from data on radiofrequency delivered through needles (needle RF). In cadaver skin, hyaluronic acid was seen to sustain thermal damage along the tracks the needles had passed through. Non-invasive monopolar radiofrequency, of the kind XERF delivers, puts no needle into the skin, which makes it a different situation. The two are routinely cited together under the single word “radiofrequency”.
And as far as we could search, there is no published case report of a device treatment damaging injected material or causing a complication in a patient. The concern as it stands comes from findings in cadaver and animal tissue, not from something that has been observed happening to patients. That does not make the concern baseless; it means there are no data that would settle it either way.
What we do
- We sort out what the main problem is first. Texture, descent or volume — the three have different answers
- We do not recommend several things at once. The default is to do one, watch how it goes, and then decide the next — because doing everything together makes it impossible to know what worked. That said, treating both on the same day is possible depending on the situation. Where there are clearly two problems to address and coming in often is difficult, for instance
- When we do combine them, we do not call it synergy. We say that there are two problems and so there are two treatments
- Device first, injection afterwards. If you have had an injection recently, we check which class of material it was and when, and decide from there
- Where there are no data on a combination, we say there are none. For radiofrequency after PN or hADM, we tell you plainly that we do not have evidence in hand, and we decide together
Frequently asked questions
Should I have a booster first, or a lifting treatment?
Surely doing both together is better?
Can I have both on the same day? Is there an order?
Are there people who should not have radiofrequency?
I have had Rejuran — can I have radiofrequency?
Does radiofrequency melt filler that has already been placed?
I keep having boosters and my jawline has not changed. Why?
When does radiofrequency show its effect?
Who wrote this
Written and reviewed by Lee Chi-Hak, MD, medical director of Miso Clinic in Daegu, South Korea. Every study cited above is given together with its design, its size and the limitations the authors themselves recorded, and where we could not find data, we have said that we could not find any.
| Medical director | Lee Chi-Hak, MD |
|---|---|
| Address | 4F Bombom Building, 125 Dongdeok-ro, Jung-gu, Daegu, South Korea · Exit 1, Kyungpook National University Hospital Station |
| Phone | +82-53-428-2700 |
| Hours | Weekdays 11:00–19:00 (lunch 13:00–14:00) / Saturday 10:00–16:00 (no lunch break) / Closed Sundays and public holidays |
| Columns | All clinical columns |
| Reference library | All booster and device references |
References
- The two randomised trials in which combination was not better than either treatment alone are Goldman et al., Dermatol Surg 2007;33(5):535–542 (36 patients, split face, nasolabial folds, filler alone versus filler plus non-ablative laser / monopolar radiofrequency / IPL) and Park et al., Dermatol Surg 2011;37(12):1770–1775 (12 patients, Korea, non-ablative infrared plus hyaluronic acid). Both were confirmed from the abstract.
- The systematic review of combination treatment is Amiri et al., Aesthet Surg J 2025;45(6):638–642. Of the 11 studies, 0 were randomised controlled trials and 1 had a comparison group; all were at serious risk of confounding. It was funded by the company that makes both the device and the filler (Merz), and most of the authors are advisors to or speakers for that company.
- The order recommendation (device first, injection afterwards) comes from the 15-member expert consensus in Carruthers et al., Dermatol Surg 2016;42(5):586–597 and from Urdiales-Gálvez et al., Aesthetic Plast Surg 2019;43(4):1061–1070, whose authors label their own evidence level as IV. We could not identify any study that randomised the order and compared results. On interval there are measured data, but they come from small studies of hyaluronic acid placed superficially in abdominal rather than facial skin, and the situation differs by class of material, so we have not written a single number of days into the body text.
- For CaHA, the human study is Alam et al., Lasers Surg Med 2006;38(3):205–210 (6 subjects, inner arm, radiofrequency at two weeks, biopsy three days later — no difference), and the animal study is Shumaker et al., same journal 2006;38(3):211–217 (significant increase in inflammatory, foreign-body and fibrotic response after monopolar radiofrequency). The second result is frequently omitted when this work is cited, so we have set it down alongside the first.
- The distinction between needle radiofrequency and non-invasive radiofrequency comes from Hsu et al., Dermatol Surg 2019 (excess abdominoplasty skin; fractional laser produced no change in morphology, while microneedle radiofrequency produced thermal damage to hyaluronic acid along the needle tracks). It should be read together with the limitations the authors recorded — that this was an ex vivo experiment, not facial skin, and in a model where no inflammatory response can occur.
- For PN and hADM we could not find a single study examining interaction with energy devices. For liquid PCL there is one cadaver study and nothing more. The combination practice of Korean dermatologists (79% of PN users) is Rho et al., J Cosmet Dermatol 2024, with 235 respondents, and this is from the abstract. The same survey contains nothing on interval or order relative to devices.
- The timepoint at which radiofrequency is assessed (2–3 months) and the nature of the immediate tightening are as set out in our XERF reference, and we could not identify any published clinical trial result for XERF itself. No sentence in this column claims an effect for that individual device.
Everything in this column is general information and does not replace medical diagnosis or treatment. Effects and side effects vary with individual skin condition, age and underlying illness, and the same result is not guaranteed for everyone. Any decision to proceed should be made in an in-person consultation with a physician.
← Clinical columns · Reference library · Miso Clinic home
한국어 · English · 日本語 · 简体中文 · Español · Tiếng Việt · ภาษาไทย · Bahasa Indonesia