Richard W. Westreich, MD

Nowadays, younger people have more neck lines due to the constant neck flexion that occurs when looking at personal electronic devices. This has become known as “tech neck.” Typically our recommendations are to perform a baseline skin tightening with fractora or Morpheus. This helps for long term correction. If lines are still visible then filler is used to selectively smooth the lines. 

eyebrow can drop from too much forehead botox or forehead botox placed too low. The only way to raise the brow is towards the side of the brow. Injecting the orbicularis below the brow can give 1-3mm of elevation. But it will give an arched brow which some patients don’t want. Alternatively, botox begins to wear off even at a month so brow dropping usually only lasts 4-6 weeks, not 4 months. This is especially true if you still have movement. 

Generally the before and after photos a doctor posts on his or her website are indicative of what they believe their best work is. The results they show are, therefore, reflective of their personal aesthetic and the outcome of their typical techniques. This is not to say that surgeons cannot modify to achieve an outcome that is a little different than their typical ones, but it should give you a good indication of what your likely result will be. If you want a very refined nose, then the website should reflect that type of result. If you want a more natural result, then that should also be evident on the website. As an aside, I can tell you that your nasal tip is somewhat of a challenging one and that extensive restructuring will be required to produce results similar to the ones you are looking for. Make sure you see a Rhinoplasty specialist who has done  a lot of cases.

Fillers are the easiest way to try out changes to the facial shape and proportions. If you are uncertain as to what type of change would meet your goals, then this is definitely the best option, given that they eventually go away on their own or can be dissolved if you don't like the results. Down the line, you can consider implants in some places to have a more permanent outcome. For anything you want smaller, such as a nose, surgery is generally the only option.

We have treated many Asian patients for skin tightening with Morpheus8. It has coated pins that deliver radiofrequency and is safe for all skin types. There should not be any type of pigmentation post procedure. Expect redness and goosebump like skin for a few days.  I suggest reaching out to our office to speak with our nurse who specializes in treating ethnic skin . 

Liquid or 'non-surgical rhinoplasty' involves using filler to smooth out and build up the nose, making a bump disappear on the bridge or have the nose look narrower from the front. The best candidates are those with flat or small noses that need additional height in their bridge. When the nose has a very tall profile, surgical Rhinoplasty is a much better option, since it makes the nose smaller, not bigger.

Your expectations for Rhinoplasty are appropriate. When you say you want a more feminine nose, typically that means a lower profile with a supratip break and refinement from the frontal view. All of these are typically achievable with Rhinoplasty. The limiting factors are skin that is too thick to contour, which is uncommon, and soft cartilage, which is more common. Even in the setting of soft cartilage, grafts can be used to overcome this. Thickner skin will only limit the degree of narrowing that can be achieved. If patients are accepting of that limitation, then they are still good candidates.

Filler to the region of the lateral retinaculum is possible and preferable. I fill this area often and it gives a very nice and NATURAL result. The eyes look especially refreshed. When combined with temporal filling and/or filling of the platform underneath the eyebrow, results can be stunning. 

Certainly for the eye area, surgery for upper or lower lids can give lasting corrections. Fat grafting can also be considered as part of an overall permanent strategy. If fillers aren’t lasting or you’re spending a lot of money, surgery should be considered for the long term. For lips, temporalis transfer or a lip lift can be considered. Fat grafting can also be considered for cheeks. Skin tightening can be very helpful for the jawline. So there’s a lot of alternatives you should explore, especially if you’re spending nearly $10,000 a year. I suggest consulting with a plastic surgeon to look into these options. 

especially in the eyes, the hydrophilic properties of hyaluronic acid fillers can cause an overfill. After waiting 2 weeks to allow settling, if the area is over filled, then a small amount of dissolving can be useful. Typically, you only need to remove about 10% to flatten the area nicely.