Fillers – Patient 116
A woman in her late 40’s who has been through a stressful year and wants to look more rested. She has a strained look in the “11’s” due to over-activity of the corrugator supercilii muscles and has creases there at rest. She also has age-related volume loss of the mid face ( cheeks and lower eyelid area). As the cheeks have deflated, the “parentheses” (nasolabial and melolabial creases) have gotten deeper as well, and the corners of the mouth are turning down. She is shown 4 weeks after the placement of 15 units of Botox to the corrugator supercilli muscles combined with 0.5 cc of Restylane to the deep “11” lines and 3 cc of Juvederm Voluma to her cheeks. She returned 2 weeks later and had 1 more syringe of Juvederm Voluma to the cheeks and 2 cc of Restylane to the nasolabial creases and corners of the mouth. She is shown two weeks after this second treatment. Her forehead is relaxed and she no longer has a strained or angry appearance. I did not place Botox to her upper forehead because her brows are a little low and I wanted to avoid a “Mephisto” look that might occur in her case by overly dropping the medial eyebrows and overly elevating the lateral eyebrows. The volume loss of the midface is improved but not overdone. Slightly underdone looks normal but slightly overdone looks funny from across the room. She will plan to return at the 4 month mark to repeat her Botox.
Fillers – Patient 115
A woman in her mid 50’s who is bothered by a tired and aged appearance. As we analyze her face we notice a strained look in the mid forehead at rest- this can be improved with Botox and a small amount of “filler” to the deeper lines. When we examine her face she has significant volume loss with aging. The cheeks are deflated. The “marionette” lines around the mouth are prominent. She is shown before and again, just 2 weeks after 15 units of Botox to the corrugator supercilii muscles. She has 4 syringes of Juvederm Voluma to her cheeks. And 2 syringes of Restylane Lyft to her marionette line area. She feels that she looks much younger and more rested, but is happy that it is still natural in appearance.
Fillers – Patient 114
A woman in her early 60’s with deep frown lines she dubbed “the Mercedes” because of its shape. She had received
Botox 1 ½ years before in another practice but it hadn’t worked well and caused too much drooping of her medial brows.
She is shown before and again, 2 weeks after treatment with 25 units of
Botox and 1 cc of Restylane.
Discussion: She has more than normal activity of her corrugator supercilli muscles (the main “frown” muscles) , and needs a larger dose than the typical 15 units of Botox that is used here. She also has deep lines at rest- these won’t go away with weakening of the muscle activity alone, and need to be filled with the Restylane. As the forehead deflates with age ,she is more at risk for over descent of her medial brows from Botox, so I avoided the typical treatment to her upper forehead. This gives her improvement but does not cause the medial brows to drop as much. The “Mercedes” and lines of her forehead are dramatically better at rest, with maximum frown and even with smiling. Her friends ask is she has “lost weight”. When you look better in a natural way, it is difficult for others to determine why, so a typical comment is “did you have your hair done” or “did you lose weight” because you look better but people are not sure why.
So, “one key does not fit all locks”, and one treatment pattern does not fit all patients. Her case illustrates how careful analysis of her anatomy and the aging process can help to give us a good result.
Fillers – Patient 112
A woman in her late 50’s who wants to look more rested. On examination she has prominent frown lines which make her appear stressed. She also has significant volume loss of the cheeks which makes her look older and more tired. The frown lines are present at rest, so it is helpful to fill them with restylane as well as weakening their overactivity with Botox. She is shown before and again, two weeks after placement of 15 units of botox to her frown muscles, as well as one cc of Restylane to the deep frown lines of the forehead and 3 cc of Restylane Lyft to the cheeks. I have avoided Botox to the upper forehead in her case to avoid dropping the medial brows and overarching the lateral brows ( a “Mephisto” look). Even with the small dose to the lower forehead she does get some nice arching of the lateral brows.
Fillers – Patient 111
A woman in her late 40’s who is bothered by a tired appearance. Her diagnosis is volume loss of the midface, which gives her an aged appearance. Volume can be restored during surgery with fat grafting, but she is quite thin and does not have enough fat stores for adequate fat grafting. She elected for non-surgical treatment. I prefer the Non Animal Stabililized Hyaluronic Acid (NASHA) fillers such as Juvederm and Restylane, because they are reversible and can be dissolved if needed with an injectable enzyme called hyaluronidase, but have the benefit of lasting. In her case Juvederm Voluma was used, which can last up to 2 years in treatment studies. She has had Botox to the forehead and Juvederm Voluma to the cheeks. She has had a total of 7 syringes of Juvederm Voluma placed one or two at at time over a 3 month interval. And is shown one month after her last treatment. The red mark on her right cheek was an area of irritation from an ice pack that she had used at home.
Fillers – Patient 110
A woman in her late 50’s who wanted fuller but still natural lips and improvement of some age related deflation of her cheeks. She had one cc of Juvederm Voluma split between her cheeks, and 2 cc of Juvederm Ultra to her lips. The lips were treated in two separate sessions with one cc placed at each session to avoid over augmentation of the lips- she did not want a “trout pout” look. She is shown one month after the second session.
Fillers – Patient 109
A woman who wished to enhance her lips but did not want them to appear unnatural. She is shown 2 weeks after treatment with a single syringe of Juvederm Ultra. The upper edge of the lip (the white roll) is subtly filled but not overly so- we don’t want to see a “trout pout” which can look funny from across the room. The philtral columns ( the two ridges just above the middle of the upper lip) are subtly enhanced. And the pink portion of the lip ( the vermillion) is subtly filled to add shape to the lip.
Fillers – Patient 108
A woman in her mid 70’s who is bothered by volume loss of her lips. She would like to have this corrected and have the lips fuller, but does not want “the trout pout”. It the lip roll is overly enhanced in a lip that has lost volume with age, it can look unnaturally prominent. But if one of the stiffer fillers is placed in the upper part of the lip it can look unnaturally prominent as well- the upper lip should have a natural concavity, not be prominent like a monkey’s lip.
The solution is to use one of the Non Animal Stabilized Hyaluronic Acid (NASHA) fillers that spreads out in the dermis such as Volbella or Restylane
Silk. In her case, 2 syringes of Restylane Silk were placed to the upper and lower lips. She is shown just before and again, 2 weeks later. This corrects the atrophy and volume loss of the white portion of the lip in a natural way and softly adds volume to the red portion of the lips as well. The lips no longer have the atrophy of aging and appear more youthful as well as slightly fuller.