Caroline Sangers, MD

The general recommendations after Botox treatment is no lying down or impact activities for 4 hours so as to keep the treatment area in a relatively neutral position.  The general recommendations regarding filler is no exercise or make-up for the rest of that day and can resume normal activities and habits the next day.

For marionette lines and upper lip lines, the best approach if considering filler as a treatment is to correct the underlying volume loss in the mid face first then the lower face.  Marionette lines are often a symptom of cheek volume loss and this should be addressed first.  Upper lip lines are often a symptom of lip volume loss and conservative lip filler should be considered first.  Wrinkles in general are also treated by botulinum toxin if in specific areas such as between the eyes or if generalized then considered medical-grade skin care including sunscreen, chemical peels, laser peels and/or laser resurfacing.

 The best filler for treatment of under eye hollowing or tear troughs is the filler that your chosen physician is most comfortable safely injecting and experienced with injecting in that area.  Other things to consider are surgical options which often give good long-term results but are expensive and not without risk, cheek volume filler treatments which can often improve the appearance of tear troughs without even injecting the tear trough and platelet rich plasma injections into that area as a very safe alternative to filler which can over time cause some long-term swelling.  The important issues to address in treating the under eye area if not considering a surgical approach is to correct the surrounding volume issues then address the tear trough and choose appropriate filler for the area which should be the main consideration over longevity of the filler.  In general filler can last for months or years after a few tear trough treatments with some requiring more treatments than others.

It usually takes about three to four weeks and up to eight weeks to see results.  If you have a large amount of submental fat then you will require more treatments to see meaningful improvements.  Usually swelling lasts for seven to 10 days +/- few days.  Most people need multiple treatments to see significant improvement unless the submental fat is minimal.  I suggest you follow up with your provider to review your treatment including technique and product used (some providers have their deoxycholic acid compounded and so results can vary unlike with Kybella which is standardized) and also discuss realistic expectations with the treatment plan provided.

Kybell is deoxycholic acid or bile salts and specifically dissolves fat by creating an intense inflammatory response.  The fat cells break open and the contents are cleared through the blood.  Most people need on average two to four treatments and some up to six treatments to see optimal results.  Treating submental fat earlier than later may decrease the overall number of treatments.  Social downtime is usually a week +/- a few days.  Work obligations may be met depending on how comfortable you are with the appearance of the swelling.  Swelling is usually less with subsequent treatments.  Treatments should be six to eight weeks apart or longer.  The results are considered permanent.  Five year studies show even further improvement over time.