Blog

Conservative Rejuvenation of the Lips
Posted November 28, 2012 10:14 AM

This patient is a nice example of conservative rejuvenation of the lips.  We used Restylane to carefully augment her lips in a way that respects her natural contours.  Note that she does not have one large pillow across each lip, but rather there are distinct subunits: 3 for the upper lip and 2 for the lower.  Also, note that we maintained the natural relationship of the upper lip to the lower lip: the lower lip is larger.  Knowledge of the detailed contours of the lips allows such a result, and prevents the "filled" look that so many are fearful of. Another reassuring thing to keep in mind is that the Restylane or Juvederm can be reduced or removed with Widase, the enzyme that breaks down these fillers if a patient were to think it looked unappealing, although with our conservative approach, that simply is not necessary.

Dissatisfaction with Fillers.
Posted June 15, 2012 4:10 PM

We  saw a patient today who has been treated elsewhere and  is displeased  with the firmness in the nasolabial fold region (the depression  from the  side of the nose to the corner of the mouth), and she did not feel  that  the area was adequately treated. We discussed the fact that some  patients’  soft tissue anatomy makes it difficult to fill that area  optimally to get a  fully smooth appearance, as it remains somewhat  tethered to the deeper  structures. Also, some patients have an overactive  muscle that raises the upper  lip and this contributes to the deepening of  the nasolabial fold. Most of the time,  when it occurs, the patients  benefit from filling of the cheek to help lift the skin away from the nasolabial fold and  therefore make the fold  more shallow, but we also occasionally have to  suggest a very small amount of Botox in the  muscles  that pull up the upper lip if the patient has an overactive  muscle in this  area.

The importance of avoiding lower eyelid malpositioning.
Posted June 06, 2012 2:15 PM

I saw a patient today who was one  of many patients I have seen with lower eyelid malposition after a  blepharoplasty done elsewhere. This gentleman was bothered by the excessive  show of the white part of his eyes because of a lower lid  blepharoplasty that was done through an incision just below the eyelash  line on the outside of the eyelid, called a “subciliary” incision. I do not  usually perform this incision because of the potential for a pulling effect on  the lower lid which exposes too much of the white portion  of the eye below the colored portion of the eye, creating a sad or drawn  appearance to the lower eyelids which I do not think this is acceptable; this  is also called “lower eyelid malposition”. My preferred approach is through the inside of the lower eyelid, called  the “transconjunctival approach”, which many surgeons are not comfortable with,  but I feel that it is a superior approach for a lower eyelid lift  (blepharoplasty).

For examples of results from  eyelid lifts, please see our before and after  gallery.

It is important to try to avoid  lower eyelid malposition because it can be  very difficult to treat.  We have had  success with filling of the mid face and cheek with a VolumeLiftSM,  and this helps to lift the skin of the mid face and lower eyelid, while at the  same time rejuvenating the cheek and lower eyelid area. For examples of  patients who had a VolumeLift^SM, please click  here.

How big are the needles used for injectable fillers?
Posted May 20, 2012 2:15 PM in Injectable Fillers

Question:
How big are the needles used for injectable fillers?

Answer:
Needles used for injectable fillers are quite  small, on the order of what is called a 28 gauge. There are even smaller ones  called 32 gauge needles.  These are among  the smallest needles used in Medicine and they help to ensure minimal  discomfort. Additionally, we are proud to be the first practice in our area to  use blunt tip cannulas for filler treatments, especially around the eyes, and  these have shown dramatically less bruising than with traditional needles.  Coupled with the best topical anesthetic  available, this helps to ensure the most comfortable experience possible.