Plastic Surgeon Dr. Dean Kane of Baltimore Answers Question Regarding Botox

Q. I wanted to get rid of the small lines on my forehead and underneath my eyes. I also may want some filler in addition to my lip implants. My face is still swollen from a nose and lip augmentation so please keep that in mind. Wrinkles under the eyes have always been the same, but my eye area is puffy. Wrinkles on my forehead may be hard to see due to the lighting and makeup, however, they’re very light. What kind of upkeep would I be looking at? What would the ballpark price be? Thanks!

A. You appear beautiful. Without over using cliches, there are “no magic bullets” and everyone is dealt a different hand of cards.
It is difficult to pin-point your needs without an in-person consultation.

The process of aging is the passive inability for your body’s tissues to repair and regenerate themselves. The act of rejuvenation is to actively reverse and dynamically assist the repair of your tissues on a daily basis. When significant laxity exists, surgical skin and soft tissue redraping or lifting are required.

Facial Aging develops from the 5 different layers of the skin, fat, muscle and bone.
During the first 20 years or so of life, the body genetically determines how to mature and repair a constantly changing “face” including all these layers (as it does elsewhere in the body). Thereafter it remains robust in repairing itself from injury but the accumulation of environmental, health and nutritional exposure will add to the passive inability for the body to care for itself after 30. This is when physical changes such as skin laxity, irregular pigmentation, lines and wrinkles and skin diseases occur. We now have many options to rejuvenate the layer or layers of the face which need care or stimulation to reverse the aging trend.

1. The top layer or stratum corneum of the epidermis is the rough, pigmented layer of the skin; creating most of the depth of the wrinkle.

-Exfoliation is best for this using:
-microdermabrasion,
-Retin-A (ZO Obagi Skin Health System), which also renews and regulates improved function of the deeper epidermis,
-Some lasers and chemical peels.

2. The second layer is the dermis which thins with aging. The natural collagen, elastin and hyaluronic acid (which hydrate and toughen the skin) are thickened by the use of:

-fillers (Restylane and Juvederm), or
-Retinoids (ZO Obagi Skin Health System), which also renews and regulates improved function of the deeper dermal skin cells.
-Sculptra properly managed is the latest sensation to stimulate firming and thickening of the dermis
-Thermi RF is a non – surgical option. Use ThermiSMOOTH superficially or ThermiTIGHT  to tighten THE skin using a micro-invasive technique.

3.The next layer or fat also thins or droops with age and maybe:
-filled (Restylane and Juvederm), fat grafting or
-redraped (threadlift, short-scar, traditional, endoscopic face / neck / brow lifts / cheek)
– LipoContouring of the face and neck with or without fat grafting may provide the balance and contour you seek without general anesthesia.

4. The muscle which creases the skin into wrinkles and folds is weakened and rebalanced with
-Botox or similar injectable muscle relaxers like Dysport or Xeomin.

Everyone needs one or more layered improvement and in personalized combinations to achieve their optimal result. You can understand why it takes a talented individual, preferably a Board Certified Plastic Surgeon with great experience to evaluate your needs and find a plan that works best for you.

All surgical, minimally invasive and non-invasive procedures and their combinations should be discussed following a proper examination with a well versed, Board Certified Plastic Surgeon who performs all of these options so you will not receive a biased approach because he/she are limited in their skills.