Most popular answers from Tal Dagan, MD, FACS
Q: I am a man wanting to get fillers for my nasal folds and mouth to chin folds. I plan on losing weight. Should I wait?
A: There are a variety of cosmetic fillers you may use in order to improve the appearance of facial lines wrinkles and contours. Some fillers are shorter lasting and some are longer lasting. If you plan on losing a great deal of weight in a relatively short period of time (2-5 months) then by all means wait and dont spend your money on fillers just yet. But generally weight loss is a process that can be lengthy and during the process if you would like to enjoy an improved appearance and reduction of age lines around the nose and mouth you may absolutely get treatment with fillers such as restylane, juvederm, voluma and other hyaluronic acid injectibles that will last up to a year. They will correct the nasolabial folds (the parentheses as they are called by Allergan) or the melolabial folds (the marionette lines that jutt from the corner of the mouth toward the chin), for the flattening of cheeks, under the eyes for lower lid hollows, or even behind deeper folds or wrinkles anywhere really where the objective is to flatten the contour and smoothen out the appearance of the skin.
Q: Removal of under eye hollowness?
In your pictures there are two findings that can be addressed. On the left hand picture although not head on there is a minimal depression that runs from the inside corner of the eye in a diagonal ark downward underneat the lower lid. This hollow is called the tear trough area or lacrimal groove. It reflects the very slightest loss of volume (generally fat) in the area underneath your lower lids. This can be easily addressed by fanning technique of a cosmetic injectable underneath the muscle surrounding the bottom of your eye, the orbicularis oculi. This is a special filling technique that removes the “dark circle” created as a shadowing effect rather than actual discoloration of the skin surface.On the right hand picture you are seen smiling lightly which accentuates the action of the muscle surrounding the eye (the orbicularis oculi) causing it to contract and shorten and “fatten” the lower lid a slight bit. This can either be left alone or very carefully with the appropriate experience weakened slightly to flatten. Alternatively there is a procedure that can be done under local anesthetic that can do away with this problem and flatten the area.
Q: Options to ease the appearance of loose pocket near laugh lines?
The pictures you have submitted represent the beginning of jowl formation. Our facial skin has an inner layer between it and the muscles of facial expression called the Superficial Muscular Aponeurotic System (SMAS). The SMAS becomes loose with time and because of the facial attachment to this layer, the skin is pulled down with “gravity” in a sliding fashion creating the marionette lines and the “pockets” you are describing. The gold standard for correcting the jowls is a minilift, a procedure that can be performed under local anesthesia to bring back the tissues to their original place. Fillers can be used to mask the effect for a little while but the most natural result would still be to correct the problem underneath the skin. The technique that I have developed utilizes seamless closure without stitches on the outside of the skin surface. Consult with a facial plastic surgeon in your area regarding conservative minilift techniques and fillers for the smile lines and the marionette lines to learn more.
Q: How to fix the crease above my smile?
When we smile we are utilizing a muscle around the lips called the orbicularis oris. Occasionally the contraction of this muscle as we smile creates undesirable creases including the horizontal upper lip one. Because this crease is created by the movement of muscle, Botox can be used to erase this line but cosmetic fillers can also be used with a longer duration and effect.
Q: What kind of fillers should I use under my eye area? Or cheeks? To remove “tired” look?
The area under the eyes may be injected by a variety of fillers in order to correct the depression underneath that follows the contour of your facial skeleton underneath. If this is your first time, I usually consult my clients to choose hyaluronic acid fillers because they are reversible and safe with a very low side effect profile. This allows you to see a result immediately but that may last up to a year. When you are going to someone for the first time and not sure about the results, the treatment using hyaluronic fillers may be totally reversed. There are so many medical and paramedical practitioners including dentists, nurses and non facial plastic surgery trained practitioners who inject fillers that choosing someone you can trust is a bit difficult. If you are happy with the results of your first treatment you can always convert from products like Juvederm and Restylane (hyaluronic acid fillers) to longer lasting fillers like Radiesse and Bellafil.
Q: Enhancing/softening my look.
As a general disclaimer, a true assessment should always take place in a doctor’s office not online. When you look in the mirror, you should be able to see certain features that you have either always been unhappy with or those that have developed over the years. You may want to consider whether the discoloration spot on the left cheek bothers you, the height of your brows or their mild assymetry, the nasolabial folds (the parentheses or smile lines), the volume of the upper lip or the areas underneath the eyelids. You should always consider highest priority what bothers you rather than what bothers anyone else including a facial plastic surgeon.When you have decided which areas on your face bother you the most, fixing them can be done conservatively not always requiring surgery and ultimately will make you much happier than addressing issues that you may not be bothered by (that perhaps were recommended by a doctor).
I hope this information is helpful.
Q: What’s a girl to do? Acne scars! What’s really going to work?! PLEASE HELP I WANT MY SOCIAL LIFE BACK.
There are several ways to improve the appearance of your skin including, resurfacing treatments using lasers or chemical peels, dermapen microneedling and using fillers to touch up and “photoshop” the pock marks individually which has a more immediate gratification factor associated with it.If you have patience for a multi session treatment, using resurfacing techniques will have longer lasting results.
Q: Granuloma from nose fillers?
How long has the wound on your nose been present? If it is relatively fresh, allow it to heal with good wound care, antibiotic ointment and when it is dry, scarguard. Ultimately, if there is a depression it can be addressed in various ways. Consult with a good Facial plastic surgeon near you.
Q: I have very fine smile lines in the corner of my mouth.
Fine lines and wrinkles around the corner of the mouth can be treated with fillers and occasionally even with specific botox injections, you do have to Consult with a master filler instructor. Someone who is either very experienced or trains others for the company selling the fillers. I know some of my Patients have found me by calling the reps for the filler companies who referred them directly to me.
Q: Under-eye filler gone bad – Puffy eyes?
My first question would be what filler was used and then how long you’ve waited since the injection and each subsequent treatment. The fullness can be due to post treatment swelling if it has only been a short while since the treatment of any followup intervention, it can also be inadvertent injection into the incorrect area under the eye. I would apply warm compresses and take advils for 2-3 weeks if there is no contraindication to it first, Consult with a Facial plastic surgeon about a corticosteroid trial. If the swelling has not subsided at that point, your options are to wait (the swelling will likely go away on its with time), or possibly (last option) surgical correction.
Q: Under eye folds/wrinkles that Botox can’t correct?
From your picture, this wrinkles CAN be corrected with votox, I would suggest consulting with a Facial plastic surgeon that is experienced with the various applications of botox before your consider fillers or surgery.
Q: How can i get my lips to look better?
Although you seem to have a lip with adequate volume, in answer to your question, asymmetry I the lip can be corrected in various ways, the least invasive of which is the use of cosmetic fillers that help us to reshape, sculpt and give proper form and when needed volume to the lips, face, Nose, hands, and neck. Consult with an experienced Facial plastic surgeon in your area who is comfortable with lip reshaping about your options.