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Which filler would you recommend and which is more effective between Botox, Dysport, and Xeomin?

Dr. Dean Kane Q & A.shutterstock_21728728

Q. Right now in my life for being 43 years old I feel great and I think I look pretty good but, of course, we all have things we”d like to change. The thing that bothers me most is the tear trough area, and the upper eyelid. I know in the near future I will be getting an upper and lower eyelid lift, along with a face/neck lift. Until then can I get a filler that will last in the tear trough area, and botox/dysport in the upper eyelid area to lift a little. Is this possible without surgery? A.  ​​​​Every patient is unique. Your bony and soft tissues, their symmetry and aging, your personal and perceived appearance and how it bothers you are just a few of the factors to review with a well experienced, Board Certified Plastic Surgeon or Facial ENT Surgeon who offers ALL these and other options. ​Since the effects of aging, weathering, sun-damage, ethnic background affects everyone differently, you may consider filler for the tear trough and Botox for the brow elevation and / or stage your surgery at this time when healing is better, scars will usually be smaller and skin elasticity is at its best. ​ ​Consider more than one well experienced, Board Certified surgeons for evaluation as you may find that their Botox and Filler skills as well as their surgical skills and results will vary. ​ ​One consideration come to mind and that is you may wish to have the upper and lower lids improved at the same time. Using access gained by both incisions, a mid-face lift may rejuvenate your cheeks, eliminate the tear trough, possibly elevate your jowls and bring you a longer duration of satisfaction. ​ ​If you are a candidate for a short scar face lift (or MACS lift and other named procedures) you may improve the jowling and upper neck while younger and gain more youthful appearing years. ​ ​Regarding which Fillers or Muscle Relaxers; the options are getting so numerous that each filler or muscle relaxers have their own peculiar niche of use. ​ ​I happen to like Botox in the brow area for precision and Dysport in the lips for a softer relaxation. ​Hyaluronic Gel fillers such as the Restylane Family or Juvederm Family each have their nuances. Depending on each gels production and artificial molecular linking will determine:
  1. ​their duration,
  2. ​their projection,
  3. ​their volumization (ie. water attraction).
​This determines where they provide the best “fill” you desire. ​ ​Noting your tear trough example, some injectors have only superficial injector skills and will inject immediately under or within the skin (ie. dermis). Others, may feel comfortable injecting under the deeper muscles of the cheek next to the bone with a variety of techniques.
  1. ​You may wish to use Restylane or Juvederm superficially but it has the side-effect of radiating a “tindel” bluish coloration or lumpiness on eyelid skin.
  2. ​Silk in this location superficially may swell the tissues too much.
  3. ​I achieve my best appearance under and over the deep muscles of the cheek with a more linked, longer duration filler such as Voluma or Perlane.
Yes, the possibilities are endless today and so you must find and trust a surgeon with a lot of experience using each option selected for your anatomy, concerns and budget. ​I hope this has been helpful. All the best!
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