What type of rejuvenation procedure would be recommended? Hate my marionette lines & crows feet plus I'm battling acne. (photo)

I am 34 years old but feel like I look 44. I am always being asked if I'm sad when I'm not based on the appearance of my face. I've had 3 children in the last 5 years and really feel that it has taken a toll on my face. The one picture is me in November 2009. The compilation picture is me May/June 2014. What procedures should I have done? I want to look like I feel inside.

Doctor Answers (7)

A visual appearance boost

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Most people see things about their appearance that they want to change. Ongoing acne is an issue no one likes to deal with. At your age, you should have some sort of control program in place. That will also help get you out of the doldrums. You're a very pretty woman with nice features and a great smile and you certainly don't look your age.

Your can get a lift from Botox for brow and mouth corners if you tend to look sad in repose. Dysport is a quick fix for crows feet (sounds like you've earned them with 3 children in 5 years!) Some volume loss is typical for your age and if you decide that's something you want to address earlier than later, Sculptra is a very nice option, lasts a long long time and at your age should act quickly.

Don't simply try to "fill a fold" because there is usually something that's creating it that you can correct at a more substantial structural level.



Los Angeles Dermatologist
4.0 out of 5 stars 17 reviews

Marionette lines and crows' feet

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Dear Clair,

Clair, you are presenting with a constellation of superficial skin concerns and potentially early subtle volume loss that have conspired to make you unhappy with the aging furrows around your mouth, specifically the marionette lines or mouth frown. Ongoing acne can also disrupt beautiful, smooth, bright skin that you desire. Your picture shows a very smiley face, which will push your cheek pad fat up higher and give you a more oval shape to the face, camouflaging the marionette lines, and you have learned this tactic early. Crows’ feet, of course, result from the cheek fat pads being elevated and the eye-crunching muscles at the side of your eye creating crows’ feet. Because of your young age, you fall into what I commonly refer as pre-juvenation rather than advanced rejuvenation.

Pre-juvenation usually is treated with a constellation of very minimally-invasive techniques designed to address all layers of the skin and soft tissue to correct minor imperfections like you’re starting to notice. Pre-juvenation also prevents degeneration to more aging facial signs and symptoms that will occur later in this decade. There may be a genetic tendency in your family – perhaps your mother or grandmother – towards deflation, loss of volume and mouth frowning/marionette lines and crows’ feet. Fortunately, we’re in an era of tremendous technological advancement in the non-surgical, minimally invasive treatment of these concerns.

For acne, before it creates ongoing damage, you can treat it through medical acne treatment programs such as blue light therapy, photodynamic therapy and medical acne skin care. Combine these treatments with eye peel photorejuvenation to treat any redness, erythema, early vessel formation before these macro pores and acne-related degeneration or scars can occur. These treatments are non-invasive, with no down time. Early pre-juvenation of animation lines, such as crows’ feet or frown lines, would be very judicious; what I would call “baby Botox®” applied very infrequently – perhaps twice a year – to stop lines from forming that would surely have gotten deeper over the ensuing decade.

Finally, the face ages in what I call 3-D fashion – deflation, descent and deterioration. Deflation and descent of your lovely full cheeks, as it moves down through your face, will lead to downgoing corners and mouth and marionette lines. At your young age, a combination of very judicious soft tissue fillers such as Juvéderm®, Voluma®, Radiesse® or even biostimulants such as Sculptra® or Radiesse® will help combat this. The non-surgical application of non-ablative radiofrequency skin tightening and gentle fractional resurfacing will not only improve the texture of your skin, but also tighten the skin very naturally to minimize ongoing descent.

So, generally, I would recommend a comprehensive consultation for non-invasive treatment options as listed above. Like all young patients in their 30s, the right combination of non-invasive treatments can have you looking always five to ten years younger than your chronological age. I have been treating faces surgically for 20 years and have helped develop and pioneer many of these non-invasive treatments. Pre-juvenation has become a very real phenomenon and has gotten to the point where patients who can’t control chronological aging, but appearance aging is now an elective decision.

I wish you luck on the successful venture you are about to embark upon, which is always looking your best, looking fresh and natural and not done.

Hope this helps.

Sincerely,
R. Stephen Mulholland, M.D., Certified Plastic Surgeon, Yorkville, Toronto

R. Stephen Mulholland, MD
Toronto Plastic Surgeon
4.5 out of 5 stars 6 reviews

Botox Works Well For Crow's Feet & Volumizers Work Well For Marionette Lines.

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From the description (more so than from the photo provided), your crow's feet and marionette lines have obviously begun to trouble you. Happily, both problems can be easily remedied nonsurgically.

I  have been injecting Botox for the treatment of dynamic wrinkles for twenty-three years, and already in the early 1990s, treating crow's feet lines, along with treating the frown lines and forehead worry lines, had become routine among experienced injectors. Today, we can also use either of the two other approved neuromodulators, Dysport and Xeomin, for these purposes, if so desired or deemed necessary, .

The nonsurgical treatment of downwardly drooping marionette lines (aka sad lines) at the corners of the mouth are also today easily treatable via the use of volumizing fillers. Such treatment is now also routine among experienced aesthetic physicians. My favorite injectable for this region in my Upper East Side Manhattan practice is Perlane L, either alone or in combination with Radiesse. In my Israel satellite office, where a greater number of regulatory agency approved fillers and volumizers are available, I prefer to use Restylane SQ, a more robust volumizer, combined with Radiesse. 

For the acne, nowadays we fortuantely also have a wide array of topical and oral preparations with an impressive track record for achieving clearing and control within three to six months or sometimes even much sooner.

In this particular case, consultation with a board certified aesthetic dermatologist would likely prove the best best for having all your aesthetic and acne concerns taken care of under one roof.

Congratulations on the three children in five years and best of luck.

Nelson Lee Novick, MD
New York Dermatologic Surgeon
5.0 out of 5 stars 11 reviews

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#botulinum toxin #fillers #cosmeticsurgery , ways to enhance your #beauty

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Dear Clair15683

Thank you for your question!  You have had a lot on your plate!  It is difficult to give a detailed answer without seeing you in consultation.  In general , Botox and soft tissue fillers are a starting point for lines and folds.  For the acne- this depends on the cause- and there are several ways to treat- topical Salicylic acid peels, clarisonic brush, Retin A cream, topical antibiotics and or oral low dose antibiotics.... lastly the the birth control pill.

With Warm Regards
Trevor M Born MD

Trevor M. Born, MD
Toronto Plastic Surgeon
5.0 out of 5 stars 46 reviews

Apperance change at age 34

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First of all take pride in your accomplishment (3 children in 5 years). With such hormonal fluctuations, sleepless nites, and no time for reflection there are changes that happen inevitably. I hear this concern quite often during child bearing years. The photo submitted to cyberspace will not give you the answers you seek. This is a one on one face to face discussion with an experienced facial plastic specialist who practices both none invasive and surgical techniques. Most often if you consult a specialist who mainly practices noninvasive (fillers,RF,laser etc) will often recommend only procedures he/she practices. Your best bet is to consult with reputable board certified face specialist who performs both none invasive and surgical invasive techniques and he/she will help you select the approach that is most suitable for your concerns and gives you the most "bang for your dollar" spent on yourself as opposed to spending on your kids. You deserve to happier about your apperance and choose wisely.

Julian Henley, MD
New Haven Facial Plastic Surgeon

What type of rejuvenation procedure would be recommended? Hate my marionette lines & crows feet plus I'm battling acne. (photo)

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Minimum a front and a profile view without animation is needed to offer you some advice. You do not seem to be in need of any major rejuvenation in this picture. Some fat injection in the upper and lower eyelids, crows feet area, lips, marionette lines,your acne scars and around your chin and perhaps reduction of you chin (hard to judge on the front view alone) may soften your lower face. You could be a good candidate for a laser resurfacing for the acne scars. 

Bahman Guyuron, MD
Cleveland Plastic Surgeon
4.5 out of 5 stars 6 reviews

Fillers to make you "feel" younger

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Your comments are the same ones that I hear everyday.  It is dificult to tell from the 1 photo I can see.  It has you smiling and in truth you look young and healthy.  If this is an older photo then perhaps things have changed, but my guess is that it is not as much as you think.

My best advice is to see a surgeon to have a proper consultation.   I would suggest that you use very little product.  You have nice looking skin and are really at the age where preserving your youthful look is the goal. Nothing too radical. Usuaully good skin care and possibly minimal Botox can make a nice but subtle improvement.

Dr Rodger Shortt
Oakville Plastic Surgeon

Rodger Shortt, FRCSC
Toronto Plastic Surgeon
5.0 out of 5 stars 10 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.