Non-Invasive Gallery

A woman in her late 70’s who wanted to have a more youthful appearance and asked about a “facelift.”  The quality of results with a facelift is very dependent on the quality of the skin“ It’s not just the tailor, it’s the fabric that the tailor is working with.” And the skin in the late 70s is not as elastic so she would not be expected to see a dramatic improvement by “tailoring” her neck.   Her main issue is volume loss which occurs with aging and loss of soft tissue support. A “facelift” does not treat these issues, which require volume replacement.  She had two 20-minute treatments in the office with Resilient Hyaluronic acid filler ( RHA) that is flexible, moves with facial animation, and can last 2 years in many cases.

A woman in her later 60s who wants to look better in a natural way but does not want surgery.  She is shown before and again, one month after her third treatment in the office.  She is already getting compliments from friends, who ask her if she has lost weight.  They know that she looks better but are not sure why. The Daxxify/Botox will typically last 5 months.  The RHA fillers for 18-24 months.

A woman in her early 50s who is bothered by an aged appearance.  She is shown before and again, after several stepwise treatments with NASHA fillers in the office ( including Juvederm Voluma and  RHA), and is seen 6 months after her last Daxxify treatment when she is returning to repeat the Daxxify. The age-related volume loss has been carefully replaced but not overcorrected.

A woman in her later 40s who wanted a natural-appearing enhancement of her lips.  Restylane Kysse typically lasts about a year or longer and gives a soft but natural fullness to the lip vermillion.

She is shown 7 months after her first syringe of Restylane Kysse.  She then returned at 14 months for a second syringe of Restylane Kysse.  She is shown again, 5 months after the second syringe. A beautiful enhancement of the shape of the lip is seen after each treatment.  No “sausage lips” “trout pout” or “duck lips” which can give an unnatural look to the lip.

A woman in her mid 40’s is shown before and again, 3 weeks after 100 units of Daxxify, 2 syringes of RHA 2, and 1 syringe of Redensity (RHA1)

Wow, her forehead lines are relaxed but she doesn’t have the “Botox” look of overly arched brows.  Her lateral canthal “crow’s feet” lines are dramatically better.  She has a wonderful effect when she tries to frown because she can’t.  She has a healthy skin glow- some patients are starting to call Daxxify “Glow-Tox” because of this, not everyone gets it but we think it is from the proprietary peptides used in the Daxxify formulation.

The resilient hyaluronic acid (RHA2) helps to correct her deep dimple lines but is flexible and moves normally as she smiles.   Her Barcode lines are 60-70% better than the Redensity but it doesn’t add any noticeable bulk to the upper lip. Even at rest, her results are dramatic from the front and oblique views.

A woman in her early 60s who had a rhinoplasty more than 40 years ago.  She has developed some settling of the mid-dorsum and a palpable septal cartilage bump in the “open roof” area between the reduced nasal bones.  We could consider returning to the operating room to rasp down the bump and add some additional tissue such as a temporalis fascial graft.  But we elected to try the much simpler option of augmenting the area with 0.6 cc of Restylane.  At two weeks she has an excellent result.  This can typically last for 2 years or longer in this area and is relatively easy to repeat as necessary.

A woman in her mid-50s is bothered by “smoker lines” on her upper lip when she is putting on her lipstick.  She does not smoke.  The lines are from subtle soft tissue loss with aging.

She is shown before and again, one month after the placement of one syringe of Redensity, one of the Resilient Hyaluronic acid fillers from Revance that helps to correct this without adding bulk to the lip.

A nurse in her early 30s is bothered by a lip-piercing scar.  She wore a hoop in her lip 12 years before.  She has not worn it since but is bothered by the stigma of having a prior lip piercing and wishes to have this removed before her wedding.

We were able to core this out like an apple core with a round biopsy punch from both sides and then close the outside with sutures.  She is shown before and again, 8 years later when she returned to see us in the office for a new concern.  The small scar has healed well, and she no longer has the stigma of an obvious piercing scar on her lower lip.

A nearly 60-year-old woman is bothered by “smoker’s lines” or “lipstick lines” of her upper lip but does not want the lips to look noticeably fuller.  She is shown before and again 7 weeks after one syringe of redensity to the white portion of her upper lip.  The dynamic lines when she is pursing her lips are much better.  At rest, there is not a large change as per her request just a subtle improvement in the lines.

A woman in her mid to late 60s who winters down south and summers in Massachusetts.  She saw me initially one year ago and wished to look better in a natural way but without surgery.  Much of the aging process is volume loss, and when we replace it carefully and leave things a little under-corrected patients look natural but more “rested”  If you need 2 coats of paint on your house, you can’t start with one can.  She has significant volume depletion and benefits from multiple syringes to replace the deficit in stages.

The first treatment diagram shows our first treatment with 3 syringes of resilient hyaluronic acid “3”   ( RHA 3)  and 3 syringes of RHA 4.  The RHA’s have the benefit of other Non-Animal Stabilized Hyaluronic Acid (NASHA) fillers such as the Restylane family and the Juvederm family but are a little more Resiliient- it is flexible and move well with the face, avoiding unusual bunching or deformities with animation.  The RHA 4 is the thickest and is better for deep filling.  The RHA 3 is a little less thick and is better closer to the surface.  She was on her way back to Florida and didn’t have a chance to come back until this summer.

With the second treatment this summer, I placed 5 syringes of RHA 4 to augment her chin and jawline. This is not a facelift but when enough volume is used can improve the jawline nicely and lasts for nearly 2 years.  I also place short-acting neurotoxins to the corrugator (the 11’s”) muscles and the long-acting neurotoxin DAXXIFY to the lateral canthal lines and procerus muscle.  We were fortunate to be one of the first 300 preview practices in the United States with Daxxify and were some of the first to use it, starting last December.  What we found is that as documented in the studies it lasts 2 months longer than the shorter-acting neurotoxins such as Botox, Dysport, Xeomin, or Juveau.  The effects seem stronger, and it is especially great at the lateral canthal lines, where it lasts closer to 5 months with the maximum we typically saw with Botox there being 3 months.  It is also stronger in the “11’s”.  But in patients that have an early but compensated drooping of the eyelid- in her case, she has this on her left eyelid- the Daxxify is so strong that it seemed to enhance this and make it more noticeable.  The eyelid ptosis rate with Daxxify is the same as Botox in the studies, 1-2 % so this is not true ptosis or drooping but does make it more noticeable.  So in someone like our patient here I use a hybrid or “blended” approach with Botox or another short-acting neurotoxin to the corrugator muscles and Daxxify elsewhere.

Her afterview shows a nice improvement in side/oblique and frontal views.  She is back to her winter home and we plan to see her for an update when she is back in  Massachusetts next summer.