A woman in her mid 20’s who is bothered by a hollow appearance of her lower eyelids and cheeks. She is shown before and 2 months after Restylane to the “tear trough” area and 1 month after Restylane Lift to her upper cheeks.
A woman in her mid to late 50’s who is bothered by an aged appearance of her face. She is interested in improvement without surgery. The first step in any consultation, after I find out what is bothering my patient is to make the diagnosis. There is a diagnosis with facial aging as in other areas of medicine. As we age, we lose volume in the face, through bone and fat resorption . She has significant loss of volume in her cheeks and middle face which makes her look older. She also has very active “crows feet” lines when she smiles, from activity of her lateral orbicularis muscles. Her brows are flat and give her a sad appearance. I have treated her with BOTOX to shape the brows, and weaken the lateral orbicularis muscles. Her brows have arched in a pleasing, but natural way. Her “crows feet” lines are markedly improved when she smiles. She has also had several treatments with non animal derived hyaluronic acid fillers (NASHA) including VOLUMA to her cheeks and the off label use of PERLANE to her cheeks. She has had RESTYLANE to improve the lines around her mouth. It is important to remember that this is not one treatment. The BOTOX is typically repeated in most patients every 4 months with a range of 3-6 months. The NASHA type fillers typically “last” 9 months with the first dose and 18 months with the subsequent doses. Allergan, the makers of VOLUMA reports that it lasts “up to 2 years” in the cheeks with full correction. I typically start with an improvement and then “tweak” the results as we go along. So over the past 18 months we have slowing enhanced her volume as she has returned to repeat her BOTOX. But of course, we want to stop short of creating a deformity with too much volume. “Slow and steady wins the race” and also helps us to achieve a natural result. I am grateful that she has allowed us to share her results with you.
Although she has not had surgery, and does not wish surgery, I perform the same analysis with every patient who is considering correction of the deformity of facial aging. After discussing the options available, I try and anticipate what options that a patient and myself are likely to be pleased with. She could have had a “face lift” to tighten the skin of her neck and jowls, but this alone would not have given her the same improvement as addressing the volume loss of her face, (unless we performed fat grafting at the same time, which is another discussion) Many patients come in and tell me that they “want a face lift” because they think that this will somehow magically address all of the signs of aging on the face. I have found it best to carefully analyze the signs of aging and address as many as possible to achieve a balanced improvement, without creating a deformity. So whether with or without surgery, it is best to make a careful diagnosis and then consider all of the options.
A woman in her early 50’s who does not like the “bunny lines” on the side of her nose. She is also bothered by the horizontal line at the top of the nose (from the procerus muscle) and the forehead lines. In addition, she has a small “hump” and irregularity of her nose and was considering a rhinoplasty. She is shown before and after 30 units of Botox to the forehead/frown lines/”bunny lines” and procerus muscle. I have camouflaged the irregularities of her nose with 1/2 cc of Restylane- a non surgical rhinoplasty!. She is shown inunretouched photos before and after. The Botox typically is repeated at 4-6 months. The Restylane will usually last a year or longer.
Our patient had 1 cc of Juvederm Voluma XC to each cheek, 1 cc of Juvederm Ultra split between her medial cheeks, and 1 cc of Juvederm divided between her nasolabial creases. The company is reporting a duration of “up to two years” with a full correction. I think it is too early to tell. Our patient reported minimal bruising after her treatment that she was able to easily cover with makeup, and no significant pain or swelling. She is thrilled to look younger but in a way that is subtle and natural.
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.