“I want to look like me, just better.” Those are the words of one of our patients who so elegantly and simply defined her wants. I believe she also captured the essence of facial rejuvenation. I rail against the “FOX TV” expressionless foreheads and monster lips that scream Botox and fillers. An understanding of the aging face, characterized by volume loss, is absolutely essential to providing the best treatment options. We refer to the parts of the face as aesthetic units, each with its own unique character and requirements. As we now have more options than ever for non-invasive and subtle treatment of the aging face, knowing which injectable product will provide the best solution to every area is critical to great outcomes.
FOREHEAD – Forehead wrinkles are best treated with muscle relaxers, which block the release of the neurotransmitter acetylcholine. This freezes the muscles that cause the skin to wrinkle in the forehead, and creates an aesthetically pleasing smooth new look to the forehead. Botox and Desport are both temporary in duration and need to be injected every four months to maintain maximum correction
BETWEEN THE EYES – Glabellar frown lines, between the eyebrows, often called “ the elevens” or “nickel slots” are caused by contraction of the skin by the corrugator and procerus muscles. Botox is a perfect solution to these problems as well as the “crows feet” on the sides of the eyes,
UNDER THE EYES- Hyaluronic acid fillers such as Restylane or Juvederm are the treatment of choice to replace volume loss that appears over time, causing the face look older and tired. Hyaluronic acid is naturally occurring substance in many foods like sweet potatoes leafy veggies, citrus fruits and even red wine. It also occurs naturally in our body. There are studies to show that injecting hyaluronic acid also increases hydration to the skin by attracting water to the filler. Some suggest that injecting fillers may actually encourage the body to make more of its own hyaluronic acid in response to the injection
CHEEKS – Skill and finesse are needed to correctly replace volume in the upper face and restore the youthful contour of the cheek and cheekbone area. Hyaluronic acid products including Voluma and more long acting volume replacement injectable work well in this area. Understanding the facial anatomy, and the location of the arteries veins and nerves in the face, is essential to preventing complications
THE LOWER FACE- There are numerous HA products that have a role in this aesthetic unit. Correction of the “smile line” or nasolabial folds from the nose to the upper lip, softens the face and blunts the jowl that results as these lines deepen and loose volume. Marionette lines are folds, that extend downward from the sides of the mouth to the chin, making the mouth look stern, sad or angry. Correcting these lines also blunts lower faces jowls and makes the mouth and lower face look brighter and happier.
THE LIPS Studies have shown that when we look another person in the face, the first thing that our eyes focus on is the mouth. The lips and mouth are a very important aspect of the first encounter. As the aging process continues the lips become thinner and roll inward, showing less teeth in smile and conversation. The face appears more stern. Oral commissures, where the corners of the mouth turn downward contribute to an angry or grumpy appearance. The Judicious and conservative use of fillers in the lips is an important part of restoration of the youthful appearing in the aging face. Fillers in younger patients also have a role in making the elements of lip, cupids bow and vermillion, appear more beautiful, sensuous and inviting.
THE NECK- The area under the chin develops fullness over time, referred to as sub mental sagging. Kybella is a relatively new injectable recently approved by the FDA for treating the ‘double chin’ by dissolving the fat in that area. One caveat, the treatments can be uncomfortable and uneven appearance has been reported. Some success has also been reported using this injectable for “ off label “ fat deposits elsewhere. So…. stay tuned.
The results of using a combination of fillers and Botox definitely produce a “wow” effect, and are a quick way to brighten the face, or take away years of aging.
While the process may appear easy, there is a very long learning curve to becoming excellent with injectables and achieving reliable and safe results. Beware of who does your fillers!! Complications, while unusual, can and do occur and can be devastating. Fillers placed incorrectly can interfere with circulation to the skin and areas of the face. Filler is also an implant that has the potential to become infected if absolute sterile technique is not used. Fillers should always be done in a physicians facility, with all of the necessary equipment and medications to treat any complication immediately should one occur. In our facilities, all injectables are done by Plastic Surgeons only. We believe this is the best way to assure excellent results with ultimate safety.
