Aesthetic Medicine is more than just surgery, and with the rapid advancements in Non-Surgical technologies we are able to achieve results that could never be achieved with surgery alone. In the past, Non-Surgical interventions were treated as a way to bridge patients until they were ready to commit to surgery. They have quickly become a staple in the practice of Plastic Surgery because they allow a more comprehensive approach to treating patients. Our goals have evolved and now, its about prevention, maintenance of results,  optimization of surgical results, and using small changes to create harmonization of the face and neck. 

 

WRINKLE PREVENTION

Younger and younger patients are realizing the benefits of using Neuromodulators (Botox, Dysport, etc.) to help with the prevention of facial wrinkles. Prevention is key because it is easier to prevent wrinkles than to correct them once they have developed. 

 

Botox Cosmetic, Dysport, Xeomin, and Jeaveau are  non-surgical medications used to temporarily smooth moderate to severe wrinkles of the forehead, brows, and smile lines. These categories of medications, termed “neuromodulators,” cause temporary relaxation of the muscles of the face responsible for creating wrinkles. When injections are maintained over time, patients will notice a softening and/or complete elimination of targeted wrinkles. Common areas of treatment include the frown lines between the eyebrows (glabella), forehead wrinkles, smile lines at the corners of the eyes, and “bunny lines”on the bridge of the nose. Injections can also be used to address more subtle features of the face such as providing a subtle “brow lift”, softening chin dimpling, reducing the downturning of the mouth, or narrowing out the jawline. Despite common perceptions, injections can be used to create a soft, natural appearance as opposed to a frozen, unnatural look.

 

At your first appointment, you will undergo a full facial assessment by Dr. Megan in order to determine your areas of concern and how to best address them.  If neurotoxin injections are indicated, the procedure can easily be done quickly at the time of your visit and does not require any type of anesthetic.The amount of product used (units) can vary widely between patients as every patient’s anatomy and cosmetic goals are unique. Additionally, it may take more than one session to achieve your desired results. There is no down time after the injection but bruising, swelling, and pain at the injection site may occur. Typically, results are visible within 5 to 7 days and last 3 to 4 months, although this may vary between patients.  In order to maintain results, routine injections are required.

 

WRINKLE CORRECTION

While prevention remains key in our fight against anti-aging, once wrinkles are present, fillers are a great way to help decrease their appearance. Injectable fillers are a non-surgical way to diminish wrinkles and add volume to the face and body. They can not only offset the signs of aging but also help to create symmetry and enhance natural facial features. The majority of fillers, including all Restylane and Juvederm products, are composed of a substance called Hyaluronic Acid. Because Hyaluronic Acid is produced naturally in the body, these fillers are dissolved over time and do not require any allergy testing prior to injection. Injectable dermal fillers last anywhere from 6 to 24 months, depending on which product is used and the area in which it is placed. The specific product recommended by our team will depend on numerous factors such as skin quality and texture, degree of aging, area being treated and the patient’s desired results.

 

WHICH FILLER IS RIGHT FOR ME? 

There are so many products on the market it can be overwhelming. Oftentimes, more than one filler would be a great choice for any given treatment area. Choosing a filler depends on a number of factors such as patient anatomy (skin quality, depth of wrinkles), patient goals, and which area we are treating. For example, the filler we choose in the lips needs to be soft and flexible in order to move naturally with the mouth as we speak or smile. In the cheek, however, we want a filler that can provide a more firm structure to help add projection and volume to the cheek bones. 

 

Some of the most common areas of injection for wrinkle correction: 

  • Nasolabial folds (corners of the nose to the corners of the mouth)

  • Marionette lines (from the corners of the mouth to the chin)

  • Vertical lip lines (smokers lines)

  • Corners of the mouth

  • Minor jowling along the jawline

  • Filling of deep and superficial lines throughout the face


HOW MUCH FILLER WILL I NEED? 

There is no ‘one-size-fits-all’ approach to fillers as every patient’s needs and goals are different. Some patients will require a single syringe to achieve their desired goals while others will need four. A thorough examination and discussion between patient and provider is key to help ensure the appropriate treatment plan is implemented. More than one injection session is often required. 

 

WHAT SHOULD I EXPECT AFTER MY INJECTION? 

Any injection can leave redness, bruising or swelling. Ice packs, Arnica, keeping the head elevated, and avoiding exercise immediately after injection can all help reduce these. The product will continue to settle for up to 2 weeks after injection. Depending on the area injected, gentle massage may be indicated but this will be discussed further during the appointment. 

BEFORE AND AFTER OF COSMETIC LIP INJECTIONS

*This patient before (above) and after (below) correction of Nasolabial folds, sides of mouth, lips and chin area. 

 

DOUBLE CHIN CORRECTION

Even in very thin patients, the fat pad under the chin can be seeminly impossible to get rid of. Traditionally, liposuction has been the treatment of choice for removal.  While still a great option in some patients, the introduction of Kybella has given us more options for patients desiring a non-surgical approach to fat removal.

 

Kybella is the only FDA-approved injectable treatment designed to permanently dissolve fat below the chin, also referred to as submental fullness or a “double chin.”  This area of fat deposition is often most noticeable in side profile, and can make patients look and feel older and/or heavier than they really are. Kybella, or Deoxycholic Acid, is a naturally occurring substance that facilitates the breakdown and absorption of fat cells. The number of treatments required will depend on how much fat is present under the chin and on each patient’s aesthetic goals. However, because fat cells are permanently destroyed with this treatment, once the desired effect is achieved no further injections are required.

Kybella can be safely injected without anesthesia in our office. Treatments typically will take approximately 20 minutes. Localized swelling will usually occur at the site of treatment but is only temporary. Results are typically seen within 30 days of treatment, and most patients will require 2-4 treatment sessions to achieve their desired goals.

To learn more about this product and others, call to schedule your complimentary consultation with our experienced providers. 

kybella fat removal chin double chin correction

* This patient above shown after two treatments with Kybella

 

ADD VOLUME

One of the most popular indications currently for Fillers is to add volume to the face and neck region. Whether it be replacing volume lost over time, correcting naturally occurring asymmetries of the face, or enhancing a patient's natural features, using Fillers to augment areas such as the cheeks, midface, chin or lips has become increasingly popular amongst all ages of patients. Most fillers used are Hyaluronic Acid (HA) based. These are popular because HA is a naturally occurring substance in the body, is degraded over time, and HA Fillers can be reversed should complications occur or at the request of the patient. 

 

Common Areas of Use: 

  • Enhancing the volume and contour of the cheeks

  • Adding volume, shape & definition to the lips

  • Chin projection and symmetry

  • Restoring volume to the thin skin of aging hands

  • Filling hollow temples

  • Correcting under eye hollowing (tear trough)

 

WHICH FILLER IS RIGHT FOR ME? 

There are so many types of Fillers on the market and picking the correct one can seem overwhelming. Dr. Megan considers a number of factors when deciding on the optimal Filler and, often, more than one Filler can be an appropriate choice. Factors to consider include patient age and skin quality, the area of injection, and the degree of correction needed.  

 

Anatomic Characteristics to Consider: 

  • Tear Troughs: The lower eyelid skin is thin, delicate and is prone to dark discoloration (think dark undereye circles). In this area, a delicate, thin filler which will not enhance dark undereye circles is best suited. 

  • Cheeks: Fillers used to add volume and definition to the cheeks are placed directly over the bone. They are ideally sturdy, hold their volume, and can act as a structural scaffold to the area. 

  • Lips: The lips tend to bruise and swell (they are highly vascular), and a natural result requires a Filler that is flexible and soft. Furthermore, some patients desire more definition of the lips for which a finer, thinner Filler is best suited. Others desire more projection and volume for which a thicker, firmer Filler will be the best option. 

  • Hands: The skin of aging hands is often very thin and the area to inject is often large. A Filler that holds its volume and spreads evenly throughout the backs of the hands is most appropriate here. 

 

HOW MUCH FILLER WILL I NEED? 

There is no ‘one-size-fits-all’ approach to Fillers as every patient’s needs and goals are different. Some patients will require a single syringe to achieve their desired goals while others will need four. A thorough examination and discussion between patient and provider is key to help ensure the appropriate treatment plan is implemented. Put simply, the more volume needed in a given area, the more Filler will be required to achieve and maintain that volume. More than one injection session is often required. 

 

WHAT SHOULD I EXPECT AFTER MY INJECTION? 

Any injection can leave redness, bruising or swelling. Ice packs, Arnica, keeping the head elevated, and avoiding exercise immediately after injection can all help reduce these. The product will continue to settle for up to 2 weeks after injection. Depending on the area injected, gentle massage may be indicated but this will be discussed further during the appointment. 

BEFORE AND AFTER LIP AUGMENTATION WITH FILLER
BEFORE AND AFTER FILLER FOR HAND REJUVINATION
BEFORE AND AFTER LIP FILLER
 

JAWLINE

The jawline is a key structural feature of the face in both men and women. In women, a slim and soft jawline is considered aesthetically ideal while in men, a strong and structured jawline is desired. Surgical options for correction of the jawline are invasive, expensive and are unappealing to most patients. As a result, Non-Surgical interventions have become increasingly popular to help patients achieve improved, natural results with little to no down time. The 3 key features of the lower face include chin projection, jaw width and the jaw angle on side view. 

 

MASSETER SLIMMING: 

The masseter muscle is a muscle which frames the jaw on either side, playing a key role in movement of the lower 1/3rd of the face during eating and speaking. Because of its integral role, it can become thickened over time leading to the appearance of a widened jaw on frontal view. Patients seeking to slim the jaw line can undergo Botox injections into the muscle to weaken it. With repeat injections over time, the muscle will actually thin out to give a more feminine appearance to the lower face. 

 

CHIN/JAWLINE AUGMENTATION: 

Fillers are a great way to create structure to the angle of the jaw, correct pre-existing asymmetries, or add volume and projection to the chin. By adding volume with Fillers, the chin projection, angle of the jaw, and width of the jaw can all be enhanced to meet a patient’s aesthetic goals.

 

NON-SURGICAL RHINOPLASTY

The nose is one of the central features of the face around which all other features sit in relation to. Because of its direct visibility from all angles, even the slightest millimeter of imperfections can negatively impact our self-image and confidence and throw off the overall balance of our face. Traditional Rhinoplasty used to be the only option for refinement of the nose, but with the development of newer technology combined with our growing knowledgebase of facial anatomy, Non-Surgical interventions are quickly becoming an integral tool in every Plastic Surgeon’s treatment options. 

 

Non-surgical Rhinoplasty is an increasingly popular procedure where small amounts of strategically placed filler are used to create more balance and refinement to the nasal dorsum and tip. As with any Hyaluronic Acid based Filler, results are not permanent and repeat injections are needed for maintenance. The duration of results depend on the type of Filler used and can vary from patient to patient. An intimate knowledge of the blood supply in and around the nose is needed to ensure the safety of a Non-Surgical Rhinoplasty.