RHA Fillers – Patient 129
A woman in her early 60’s who is shown before and again 2 weeks after the placement of 3 syringes of the RHA-3 .
We are pleased to be one of the first practices in the United states to be able to offer the Resilient Hyaluronic Acid fillers, which are manufactured in Switzerland by Teoxane and have been used in Europe for more than 5 years. They have just been brought to the US by Revance. They are still hyaluronic acid, and therefore have the same safety profile as the Juvederm collection from Allergan and the Restylane collection from Galderma. But they differ in being more Resilient, which allows them to move naturally with the face. This is described as the difference between a steel girder bridge and the golden gate bridge. They are both strong, but one is more flexible. This now allows me to treat the nasolabial creases and areas around the mouth without bunching or moving, and they are expected to last for 18 months. Our patient here is seen at rest and smiling. The correction is significant but appears absolutely natural with movement of the face.
Chin Augmentation with Kybella/Restylane Lyft – Patient 252
A woman in her late 20’s who is bothered by submental fullness and weakness of her chin. Although she could consider liposuction of the submental area and a chin implant, her schedule did not allow for surgery and recovery at this time. She is shown 2 months after 3 vials of Kybella to the submental area, and 1 month after 2 cc of Restylane Lyft to the chin.
Kybella/Restylane Lyft – Patient 253
A woman in her late 20’s who is bothered by submental fullness and weakness of her chin. Although she could consider liposuction of the submental area and a chin implant, her schedule did not allow for surgery and recovery at this time. She is shown 2 months after 3 vials of Kybella to the submental area, and 1 month after 2 cc of Restylane Lyft to the chin. There has been no change in her weight.
Fillers – Patient 128
A woman in her mid 20’s who is bothered by a hollow under her eyes. She is shown before and again, 1 month after the placement of a single syringe of Restylane Lyft to the “tear trough” area, with good correction that should typically last for a year or longer. The “chin down” view emphasizes the hollow area under the eyes. “dark circles” are not typically improved by filler because they represent the muscle just underneath the skin.
Botox & Fillers – Patient 127
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.
Fillers – Patient 127
A woman in her later 40’s who wanted fuller but still natural appearing lips. She is shown before and again, 2 weeks after a single syringe of Juvederm Ultra. Her lip has shape and fullness but is not overly prominent. She does not have “duck lips” or “the trout pout” which my patients do not like. Her friends notice that she looks better but are not sure why.
Botox & Fillers – Patient 126
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.
Botox & Fillers – Patient 125
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.
Botox & Fillers – Patient 124
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.
Rhinoplasty/Restylane – Patient 123
A woman in her late 40’s who was bothered by a “bump” on her left mid nose. She first noticed this after being struck by a ball in the nose a few years before. On examination she has very thin skin and has a prominent cartilage bump under the skin. A surgical rhinoplasty is an option to reshape the cartilages and add a strip of fascia from her scalp under the skin to add more thickness and help to camouflage this area. I recommended that she might try a “non surgical rhinoplasty” first with the use of Restylane injected under the skin to camouflage the area. This was done in a few minutes in the office with a topical anesthetic. She is shown 2 weeks after and has a significant improvement with ½ cc of Restylane. Although this is not permanent, it typically lasts for a year or longer in this area and is easy to repeat. She is pleased with her improvement. The nose looks straighter, and the “bump” is no longer as noticeable. The side view shows an improvement in the dorsum.