A woman in her mid 50’s who is bothered by submental fullness. She is shown before and again, 2 months after a single treatment with 3 vials of Kybella. The “selfie view” with the chin down demonstrates the decrease in submental fullness. She also has some nice tightening of the neck in a side view. She plans to return for a second treatment when her schedule allows.
UPDATE: She is now shown 1 year after a second treatment with 3 vials of kybella. She has also had Juvederm Voluma to her cheeks and restylane to her nasolabial creases.
A woman in her early 50’s who is bothered by loss of her neck line and a double chin. She is shown 3 months after her second treatment with Kybella. She has had a total of 7 vials- 3 vials with the first treatment and 4 vials with the 2nd treatment. The Kybella allows us to tailor the injections, and her Jowls and lateral neck were treated as part of her second treatment. With experience we have learned that more vials per treatment and more lateral treatment including the jowls when indicated can give a more dramatic result, as in her case. The results have indeed been dramatic. She no longer worries about having a double chin and the loss of her neck line which had bothered her before. We can expect that she may continue to shrink for another month. She is considering an additional treatment to give even more definition to her neckline.
Here is our patient that I used to demonstrate at the recent Allergan Master Class, given at the Seaport Hotel in Boston. She is in her late 50’s , and is bothered by drooping of her cheeks, volume loss of the lips with “bar code” vertical lines of the upper lip and well as decreased volume of her lips with age. The lower lip vermillion is “corrugated” from volume loss.
She had Botox to the frontalis muscle to shape and arch her eyebrows. She had Botox to the corrugator muscles to treat the frown lines, sometimes called “the 11’s”. She had Botox to the lateral orbicularis muscle to treat the “crow’s feet” lines. And Botox to the Procerus and Nasalis muscles to treat the “bunny lines”
Juvederm Voluma was placed over the upper cheeks to treat the volume loss in this area.
Juvederm Ultra was used to augment the lips along the lip roll, but also to add volume to the vermillion and evert the lower lip and fill the upper lip vermillion without looking “ducky”.
The Volbella is a new product and is similar to Restylane Silk and Belletoro in that it can be used as a superficial filler to treat the “bar code lines” of the upper lip. It was also threaded superficially below the vermillion of the lower lip to add smoothness and shininess to the lip vermillion- she feels that her lips look ok without lipstick now.
A woman with a prominent submental fat pad despite significant weight loss. She is shown 4 months after a single treatment of the submental fat pad with 2 vials of Kybella, and 2 months after a chin implant.
A man in his mid 50’s who has had lower lid blepharoplasty elsewhere and was told that he might eventually need some volume to the midface.
As we age, we are losing volume in our face- like a peach that’s been left on the counter too long. We can pull up skin that sags from volume loss with a face lift, but this doesn’t correct the volume loss. When the neck and jaw line is good, we can add volume back to give a more rested look. If we are in the operating room and a patient has enough fat we will use their own fat with fat grafting. But we can also add volume in the office. I prefer the non-animal stabilized hyaluronic acid (NASHA) fillers because they seem to give the best balance of the longest duration with the least chance of problems. And they can be reversed by dissolving them in the office with hyaluronidase, an enzyme, if they do have a rare problem.
I also prefer “slow and steady” with correction. The best results are slightly underdone-tnis still looks natural but slightly overdone looks funny from across the room. This patient is shown after a series of 3 injections done at 2 week intervals. A total of 5 cc of “Restylane Lift” (formerly called Perlane) was used. The plan now will be to wait 6months or so and then add a little more as needed to maintain his results.
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.