Anil R. Shah, MD

Hello! My name is Jessica, I am a physician assistant, and one of the providers at Aesthetic Skin - Winnetka & Chicago. This is a great question. I'm really sorry you're going through this—scarring, especially on the face, can be incredibly distressing both emotionally and physically. Given that you're 10 months post-op and have already tried a comprehensive range of treatments including silicone gel, massage, steroid injections, and IPL with limited improvement, I recommend considering CO2 laser resurfacing as a next step. CO2 laser is one of the most effective treatments for improving the texture, color, and overall appearance of surgical scars, particularly when they are raised, thickened, or red. It works by removing damaged skin layers and stimulating collagen remodeling, which can significantly smooth and soften the appearance of scar tissue. Multiple sessions may be needed, and downtime is expected, but many patients find it well worth the investment for long-term results. I hope this helps and best of luck!

Hello! My name is Jessica, I am a physician assistant, and one of the providers at Aesthetic Skin - Winnetka & Chicago. This is a great question. Thank you for sharing your concerns—what you’re describing is actually quite common, and there are definitely options to help bring more balance and harmony to your facial features. At 33, if you feel that your cheeks appear overly wide when you smile and give your face a pear-shaped appearance, buccal fat removal may help, but only if you're a good candidate. This procedure is best suited for individuals with fuller, more rounded cheeks, and should be approached cautiously since too much volume loss in the midface can lead to premature aging over time. In terms of your concern about your nose feeling disproportionate, a rhinoplasty—whether surgical or non-surgical—could absolutely help bring more balance to your facial profile, especially if the nose appears more prominent in contrast to the width of your lower face. Sometimes, subtle changes to the nasal bridge, tip, or projection can make a significant difference in overall facial harmony. Depending on your facial structure, cheek contouring with filler or even jawline slimming with Botox (masseter reduction) could also help refine the proportions of your face, making the smile appear more balanced and softening the width of the lower face without surgery. It’s all about customizing the right combination for your features. I hope this helps and best of luck!

Hello! My name is Jessica, I am a physician assistant, and one of the providers at Aesthetic Skin - Winnetka & Chicago. This is a great question. To improve overall facial harmony, I recommend cheek filler and chin filler as foundational treatments. Cheek filler helps restore midface volume, creating lift and definition that can subtly rejuvenate the entire face. It also supports the under-eye area and softens nasolabial folds, enhancing balance between the upper and lower face. Chin filler, on the other hand, brings proportion to the lower third of the face—especially helpful if the chin is recessed or lacking projection—as it creates a more structured, contoured profile and balances facial features when viewed from the front and side. In addition to those, you might also consider a few other options depending on your aesthetic goals. Brow shaping or a subtle brow lift, either with Botox or threads, can help open the eye area and create a more refreshed, lifted look. If your lips have lost volume or definition with age, a conservative amount of lip filler can enhance shape and restore balance to the lower face without overfilling. Each of these procedures can be customized and combined for a natural, harmonious result. I hope this helps and best of luck!

Hello! My name is Jessica, I am a physician assistant, and one of the providers at Aesthetic Skin - Winnetka & Chicago. Thank you for your thoughtful message—it's very common to notice subtle but impactful changes in facial volume and structure over time, especially when comparing photos from several years ago. At 49, even with minimal weight change, natural aging processes like fat pad descent, bone resorption, and collagen loss become more apparent. From what you've described, volume loss in the upper cheeks is a key contributor to a more aged appearance. When the cheekbones lose support, it can cause a cascade effect—flattening of the midface, deepening of the nasolabial folds, and even subtle sagging around the mouth or jawline. You also mentioned possible volume loss around the mid-lower lip, which may relate to thinning of the lips themselves or loss of support in the chin or perioral area, leading to a more tired or deflated look. For restoring a more youthful balance, cheek filler using a structured, lifting product like Voluma or Restylane Contour can be very effective in replenishing midface volume and subtly lifting the lower face. If lip volume or mouth area support is lacking, a small amount of filler in the vermillion border or oral commissures (corners of the mouth) using a softer filler like Restylane Kysse can help restore shape and definition without looking overdone. Since you’ve had filler in the past and responded well, a conservative approach focusing on structural support and natural contouring can help you regain that refreshed, youthful appearance you saw in the older photos. I hope this helps and best of luck!

Hello! My name is Jessica, I am a physician assistant, and one of the providers at Aesthetic Skin - Winnetka & Chicago. This is a great question. Yes, under-eye filler migration can often be corrected without surgery. If it's been two years since your treatment and you're noticing puffiness, shadowing, or an unnatural contour under the eyes, it’s quite possible that the filler has shifted or hasn’t fully broken down. Hyaluronic acid-based fillers, which are commonly used in the tear trough area, can be dissolved using an enzyme called hyaluronidase. This is a non-surgical treatment typically provides fast results, sometimes within 24-48 hours. Dissolving the migrated filler can help restore a more natural look and improve contour irregularities. I hope this helps and best of luck!