This may seem like an absurd title but when it comes to understanding how the various technologies can improve and alter your appearance, there appears to be a widespread lack of knowledge among my patients here in Miami.  I’m referring to the modalities such as Botox, fillers like Juvederm, lasers for skin resurfacing and facelifts.

The key to understanding is determining whether the wrinkles are fixed or dynamic.  Botox will improve dynamic wrinkles, that is, wrinkles that arise from facial expression.  When we smile the lines around the eyes suddenly appear or the frown brings out the lines in the brow.  These are dynamic wrinkles and are treatable with Botox.  In general, the region of the face that can be managed is from the nose up to the hairline.

The fixed folds in the facial skin are the smile lines that radiate down from the nose area to the lips.  The lines that start at the outer edge of the mouth and angle down to the jaw are fixed.  This type of facial dynamic is treatable with fillers.  The deeper and longer the fold the more filler is required to give a nice contour.

Laser skin resurfacing is usually a full face treatment designed to reduce or eliminate wrinkles where the collagen of the facial skin has degraded and the overlying surface has lost its vitality.  The laser leads to collagen rejuvenation and secondary smooting of the surface.  Sun damaged skin is readily improved with this technology.

Lastly, facelift surgery is an operating room procedure whch can lead to major changes in the appearance but requires a substantial commitment of time and money as recuperation takes weeks and fees are often prohibitive.

When properly applied, Botox, Juvederm and laser skin resurfacing can be combined in a sequential manner with minimum down-time and with dramatic results.  I will be happy to discuss these options with interested folks.

Frequently, I speak with patients who are interested in improving the contour of their upper eyelids.  They see excess skin and want it surgically removed (blepharoplasty). If one looks closely at their appearance it becomes clear that the problem does not lie in excess skin but rather it is due to drooping eyebrows (eyebrow ptosis).  While this may look good on Clint Eastwood (back in the day) it is not an appealing look on most of us.

Before

By raising the eyebrows, the skin of the upper eyelids is secondarily tightened and the issue is resolved.  There are several surgical techniques whereby the eyebrows can be raised; a direct browlift requires an incision at the level of the upper eyebrow hairs and is cosmetically unacceptable in my view, then there is the  coronal incision across the scalp above the hairline  used to pull the frontal region of the face up and thus raise the brows and lastly, the endoscopic browlift.  While all three procedures are effective, the first can leave noticeable scars and the last two may be more surgery and recovery time than one wants to undergo.

Utilizing Botox, it is possible to effect an appealing improvement of the eyebrow contour and secondarily the issue of the excess skin of the eyelid is mitigated.  When one considers the anatomy of the face and particularly the musculature controlling the eyebrows, one sees that there are muscles that depress the brow and those that elevate them.  With the judicious use of Botox, the depressor muscles can be weakened and the apposing elevators will then raise the brows.  The technique requires injection at seven sites.  While it is not effective in all cases of eyebrow ptosis, this approach when applicable is safe and easy with no down time.