A woman in her mid 50’s who had blepharoplasty elsewhere 18 months ago and was still bothered by the appearance around her eyes. On examination she has some brow ptosis from the normal deflation that occurs with aging, and the excess skin around her eyes corrects as the brow is elevated. She also has prominent crow’s feet lines with smiling. Although we could consider a brow lift I thought it would be prudent to try Botox first and see how much shaping of the brows and lateral brow elevation that we might obtain. She also has some deflation of the midface and Juvederm Voluma was placed. She had 45 units of Botox and 2 syringes of Juvederm volume. The effect on her brows was dramatic. Her cheeks appear more youthful as well. Additional Juvederm Voluma could be placed to the cheeks but we plan to wait until she returns to repeat her Botox, typically at 4 months.
A woman in her mid 70’s who would like to look a little more rested in her appearance but without surgery. She has prominent “11’s” (corregator lines) of the forehead at rest. Because of age related volume loss the “marionette” lines ( chin-cheek creases) and nasolabial lines (lip cheek creases) are prominent. She is shown before and after Botox to the corrugator muscles and Restylane to the deep “11” lines. The Botox weakens the over active muscles here and the Restylane fills the “ditches” that have formed from this area being creased over and over . This gives her a less stressed look. 2 syringes of Restylane Lyft were placed to her “Marionette” lines and 2 syringes of Restylane Lyft to her nasolabial lines. This gives her a nice improvement that looks better in a natural way.
A woman in her early 60’s who is bothered by an aged appearance and wants to look better, but is not ready to consider surgery. She is bothered by brow asymmetry with her right eyebrow always being higher. Analysis of her face shows a strained appearance in the frown area ( sometimes called the “11’s”), age related volume loss of the midface and jowls, as well as prominent crow’s feet lines around the eyes at rest and with smiling. We decided on a plan of step wise correction. She first had Botox to balance the brows along with Restylane to the deep frown lines and Restylane lyft to the naso labial creases ( sometimes called “the parentheses” ) and chin –cheek lines ( sometimes called “marionette lines” after the lines around a puppets mouth). I then saw her 2 weeks later and placed some Juvederm Voluma to the cheeks. Finally, she returned for Restylane lyft to the “chin notch” and groove in front of the jowls.
She is pleased by her improvement which is natural in appearance. Friends ask her “if she has had her hair done”. This is one of my greatest compliments, because it means that others notice that she looks better but because it is natural, are not sure why, so they attribute the improvement to a new hair style.
A young woman in her mid to later 70’s who has had previous face lift surgery in the Midwest but is bothered by an aged appearance and wants non-surgical improvement.
Evaluation shows a downward sloping position of the eyebrows that gives her a sad appearance. She has volume loss of the cheeks from the aging process. She also has deflation of the subcutaneous volume under the skin of her lips.
She is shown again, 5 weeks after Botox to shape the forehead, and 2 syringes of Voluma to her cheeks. She is also 3 weeks after placement of 3 syringes of diluted Restylane Lyft to the upper and lower lips, and “marionette-line” area.
Botox works great to weaken overactive muscles. When we treat the horizontal lines on the forehead, only the middle forehead is treated to prevent “dropping” of the eyebrows. But this leaves the muscle activity above the brows that some patients still find objectionable. As these lines become more prominent, many men and women choose to be treated surgically with a brow lift. But not everyone wants surgery. So we can attempt to fill these lines to improve their appearance.
As a general rule, lines at rest are more successfully treated with fillers than “dynamic” lines or lines that move. This woman in her mid 50’s is shown in the first photo after botox and in the second photo, 2 weeks after “Restylane Silk” to the forehead lines.
Our patient is seen 2 weeks after neurotoxin placement (Botox/Xeomin and Dysport are all neurotoxins) to her forehead. I have partially corrected her brow asymmetry. Her “stressed” look is also corrected. And her eyebrows no longer have the flat posture of sadness. They have arched in the lateral third, giving her a happier look. Friends are already asking if she has changed her hair color(she has not). They know that she looks better but aren’t sure why.