Posted on November 15th, 2011
*Asked on RealSelf
Q: After Three Laser Facials, Still See Fine Lines Around my Mouth
I have had a problem with some fine lines on my lower face, I have had a serious of three laser facials one month apart. My last was in November. The dematologist said it would take about 12 months to see the final results, however, that is a long time to be stuck with lines that I don’t like. What else can I do? I am only 33. Yes I use strong sunscreen everyday.
A: Superficial Laser Treatments Won’t fix Lines
Wrinkles are a property of the dermis. Any type of peel that you would be doing as a series is almost certainly not getting into your dermis at all. A peel such as that is taking off the top part of the epidermis, which grows back, then you peel it again, it grows back, and so on. As you can see, the only thing this type of peel affects is the epidermis over and over, but the wrinkle is in the dermis.
You need a single aggressive peel to address wrinkles. At age 33, you could consider a fractionated deep peel such as Matrix, DOT, Fraxel Repair or others that use a CO2 laser and go well into the dermis. While this isn’t as effective as a regular deep peel, the healing will be far less and 33 year old wrinkles should respond nicely. The non-ablative treatments such as Fraxel do even less than a superficial peel in that they usually affect neither complexion or wrinkles.
Web reference: http://www.dr-apo.com/surgical-procedures/laser-skin/
Posted on October 24th, 2011
About a year ago I underwent a septoplasty to correct a severely deviated septum that resulted from a broken nose when I was younger. My surgeon removed what must of been sizeable bone spur that was obstructing the nasal passage which definitely helped with my breathing. Unfortunately, it did little to correct the aesthetic appearance of my nose. The septum is still very deviated midway up the nose so it has maintained its crooked appearance. This is due to the septum pushing out against the nostril while the other “droops”. Furthermore, my right nasal bone is caved in slightly due to the break adding to the appearance of crookedness/curve. When I consulted a plastic surgeon a bit later about the possibility of a septoplasty revision he said it would not be worth it considering a lot of cartilage was removed. This would make it hard to re-anchor/attach the septum and would also increase the risk of perforation. What can i do to fix this asymmetry? Is a rhinoplasty still possible? And what can be done about the crushed right nasal bone? I have considered fillers to even out the appearance of the curve and create symmetry. Though i’d want permanent results, Is this a better option? Thanks in advance!
A: Rhinoplasty After Septoplasty Is Very Possible
It is absolutely possible to do a rhinoplasty after having had a septoplasty. It is probably true that you have a higher risk of having a septal perforation occur but this risk is still very small in the hands of a qualified surgeon. Ideally you would have had your rhinoplasty and septoplasty done together at your first surgery, but we can’t go back in time and change that so there is no reason to fret over it now.
It is important that you find someone who really enjoys doing rhinoplasty, is skilled at both external and internal nasal surgery, and makes this a significant part of their practice. This won’t be an easy surgery and the surgeon needs to have the patience to stand there for whatever amount of time it takes to disassemble your nose and reassemble it as straight, strong, and functional as possible.
Posted on October 17th, 2011
Look at my picture, can you see my eyelid is drooping…I would like this raised,can this be done with a injection of Botox ?. I don’t want to have a eyelid lift. Where would you inject and how many units do I need ?
A: Lifting with Botox
Botulinum products (Botox, Dysport, Xeomin) can be used to create a subtle brow lift and thus a subtle eyelid lift. Treating the muscles that pull downward on the brow will relax them and allow for a slight shift upward for some people. This affect is not consistent from one person to the next. It typically produces only a subtle lift but I have seen some people get significant lifts. One should be careful not to produce “joker” eyebrows doing this as it is very unnatural and I see many injectors do this somehow thinking it looks good.
The two main muscles that pull down on the eyebrows are the outside portion of the orbicularis occuli muscle (crows feet area) and the corrugator muscle (between the eyebrows). Treating the frontalis (forehead) muscle can help shape the result.
In the end, however, you really are better off having an eyelid lift if that is the main effect you are trying to achieve. Using Botox exclusively for this purpose is a very inefficient use of your time and money.
Posted on October 3rd, 2011
I’ve been wondering how extensive Rhinoplasty would be to shorten my nose without (if possible) changing the overall shape or angle of the nose. Thank you for your help!
A: Changing the length of your nose
Looking at your photographs, I think you can certainly achieve what you are looking for.
First, however, we need to clear up what “length” means in nose talk. If you put a tape measure at the top of the nose where it ends between your eyes, and measured down to the tip, that would be length. Length is a result of how turned up or turned down you nose is and how long your face is from top to bottom.
I think what you probably want to say is, can the “projection” of my nose be changed. If you were to walk through a doorway, projection would be how much sooner the tip of your nose enters the next room as compared to the rest of your face. In other words, how far out-in-front is the tip of your nose as compared to your upper lip.
The short answer to your question is “yes”. The projection can be reduced and the dorsum (ridge) can be reduced in a similar fashion to maintain the overall proportions of your nose. It just won’t “stick-out” so far.
Posted on September 26th, 2011
Q: Should Restylane Be Injected to the Lateral Area of the Eyes?
I have quite a noticeable hollow in the lateral area of my left eye when I smile…it is though the muscle does not come up high enough. I also have hollows in the temple area bilateraly after a mid face lift (redraping of obicularis) Can Restylane be used here?
A: Restylane Works Well Around the Eyes
Restylane works very well around the eyes, especially the lower eyelids. It fills hollows or what is often called a “tear-trough”.
You say that the hollow is only present when smiling. This may not be something that you can use Restylane to correct. Restylane will be present at all times, so if the depression is only there when you are smiling, Restylane may create too much fullness when you are not smiling.
Botox or Dysport may be helpful since your problem is related to muscle activity.
You can use Restylane in the temples, but I prefer Radiesse in that area.
Posted on September 19th, 2011
A: Lip implanting has a sordid past. Over the years there have been many brands and styles. It wasn’t until I started using Surgisil Implants that I embraced the procedure. These implants are made of silastic and have a “gummy bear” feel. The procedure itself takes only 20 minutes and you can drive yourself home. Surgisil lip implants are quite easy to remove and return your lip to its pre-surgical shape/size should you change your mind.
You can upsize or downsize the implants. Bruising and swelling are mild. The procedure is done through a tiny little incision that typically leaves no discernible scar. Kissing partners don’t feel the implant, however you can feel the implant if you grasp or chew on your lip. I have never seen an implant get infected, but should an infection occur, it is possible that permanent damage to your lip could result.
Posted on September 12th, 2011
I was skiing- a woman wrapped her arms around me from behind to stop herself, we fell backwards and her poles pushed my nose upward. My nose is not large and previously looked a bit like a ski jump (lovely irony) but has had a bump in the middle ever since the accident 10 years ago. I was told by a plastic surgeon at the time that it would gradually become less obvious and return to normal but it hasn’t.
A: How to Fix a Hump After Trauma
Without seeing your nose in person I can’t say for sure, but, I would speculate that you are an excellent candidate for a rhinoplasty. Hump removal is the single most common type of rhinoplasty I perform. Whether the hump is natural, the result of trauma, or some combination of both, the procedure should have a high success rate and typically can be done without any external incisions (closed approach).
Posted on September 5th, 2011
A: Botox and/or Dysport not for laugh lines
Hello,
The laugh lines (aka smile lines, naso-labial folds, melo-labial folds) are not treated with a botulinum toxin. Certainly these products would work, but you would no longer be able to smile (or move your upper lip much at all) if you treated them this way.
Good news, however, fillers work great for this purpose. Hyaluronic Acid products such as Restylane and Juvederm are excellent choices in this area. You can expect to use 1cc for mild creases, 2cc’s for moderate creases, and 3cc’s for deep creases. Most patients see long term improvement from these products on the order of 1 or more years. For moderate and severe creases, I typically will do 2 or 3 cc’s to start, another 1 or 2 cc’s 6 to 12 months later, and 1cc every 12-24 months for maintenance.
Web reference: http://www.dr-apo.com/lunchtime-procedures/
Posted on August 29th, 2011
Q: Is Botox Safe To Use for Treatment of
Frown Line If I’ve Had Bells Palsy?
I am 32 year old and I had a bell’s palsy around 15 years ago and still I have left with a few residual drooping in my left eye and eyebrow especially in cold weather. I want to have botox for cosmetic purpose in order to treatment my frown line, I want to know is botox injection risky for my face or not? Could it cause my problem to come back again? Is there another treatment for it?
A: Botox And Bell’s Palsy, A Helpful Combination
Not only is the use of Botox or Dysport OK for someone who has had Bell’s Palsy, it is a very effective tool to help someone who’s Bell’s Palsy is currently active or if it never fully resolved.
For the patient who has never fully recovered from Bell’s Palsy or who currently is in the midst of the condition, botulinum toxin products can be used on the “good” side to balance muscles and produce better facial symmetry. Also, people whose nerves recovered from Bell’s Palsy incorrectly can use Botox to control improper muscle activity on the “bad” side. Things like spasms and “bulk” motion of your face can be permanent complications of having had Bell’s Palsy and Botox is the best tool available to treat these problems. After Bell’s Palsy, some patients can’t separately control different parts of the face. For example, smiling may cause the eye to close. Botox can improve this condition.
If you have had Bell’s Palsy and are fully recovered, the fact that you have had Bell’s Palsy in the past should not affect your current use of Botox.
