Claudia Legere, MD

This sounds appropriate. Typically there are 31 injection points placed in the forehead and neck region.  Each site is usually 5 units of botox which totals to 155units of botox. You retreat every 12 weeks. It typically takes 2 treatments to determine if the botox is helpful. 

Vollure does a great job with lip augmentation. It is a very smooth filler and acts much like regular juvederm. The feedback that I have gotten is that it lasts much longer then regular juvederm. Vobella is a very fine filler that does not have a great deal of longevity. It is great for patients that are looking to reduce lip wrinkles as opposed to volumizing or altering the shape of the lip.

I like juvederm as well for the lips. It goes in smooth, is long lasting and gives a very natural appearance. There are a lot of different techniques for creating lip symmetry. However, teeth and jaw asymmetry can complicate the matter. On occasion teeth that are rotated or are not lined up with the midline of the lip can create a challenge. I have found the small amounts of lip filler layered over time can create a scaffold to build a particular lip shape and allow for augmentation that is discrete. Often times friends and family don't even realize that it was done.

TCA peels will remove the top layer of skin and exfoliate away brown spots. These peels can be used on areas other then the face. From experience the skin on your face peels very differently then skin on the neck and chest. The neck and chest tend to flake over a longer period of time. The key with peels is not to pick at an area that is peeling as that can actually lead to the deposition of brown pigment in an area. Peels that contain hydroquinone or kojic acid do a great job at reducing hyperpigmentation.

I do not market microneedling as a good way to treat hyperpigmentation. You do get light peeling with a  treatment and this can help minimize brown spots. I microneedle areas other then the face such as hands, neck and chest with great results. The benefits are typically improvement in skin tone and texture and reduction in fine lines. In rare circumstances I have seen hyperpigmentation in individuals that are microneedled.

Be careful with dermarollers as they can create shear forces that can tear and damage the skin.