Cong Ivy Ran, MD

It is common to use botox to change contour. However, botox works to relax muscles. It would be very difficult to use botox to "tighten" the lower eye lid. In fact, botox used in relaxing the crows feet may make eyes rounder in appearance. Using Botox to change your brow shape may give an illusion that your eye shapes are different, so that maybe something to consider.

Hopefully, this is helpful.

Dear Philosophical999974,
Thank you for sharing your photos and concerns. Some of my patients also seem to have higher rate of metabolizing fillers in their lips, and that is very frustrating. The first options are often switching to different fillers try finding one that can last longer. I am sure you have tried as well but if not, this could be a quicker fix than surgery.

Now as to using fat, there are at least two ways historically fat is used for lip augmentation. One is called dermal fat grafting where a strip of fat with the associated dermal tissue is harvested and placed into the lips like an implant. The other is using processed autologous fat, also called microfat / nanofat, which functions like an injection. Neither procedure is consistent in outcomes and is riddled with problems of irregularity with most surgeons and that is why they are not more popular. Other less common procedures include lip implants with either silicone or gortex; these two procedures can be successful but because it is a foreign body in the lips and it is not without problems.

Instead the more common procedures that people now do (for upper lip) is lip lift to give more red lip show.

Hope this helps.

Dear Sincere9280,

There are a few different things you can do to make NLF better. Hyaluronic Acid Filler is one of the easiest and most immediate ways to smooth out NLF. And it is reversible. Other dermal fillers can also work. Alternatively, you can try some tightening devices, such as radiofrequency treatments or high intensity ultrasound treatments.

It is important to understand that NLF is not a fine line. It is a fold that is created with tissue laxity, where tissue above hovers over the natural ligaments. Therefore, while skin care like that of tretinoin will improve skin quality but because of the little effect it has on laxity of the deep tissue, topical skin care is going to be limited on treating NLF.

Dear Rayray,

While this question is best answered by the surgeon that is going to do your procedure, we routinely combine all of those procedures in one and without increased complications. Hope it helps.

Forehead filler can be done safely and effectively in patients who either want rejuvenation or camouflage defects. However, there are definitely zones that are more dangerous both in terms of vascular occlusion and for potential blindness. Therefore, to have an in person consultation is the key to evaluate the risk prior to treatment.

Ultrasound, as it is not a commonly used tool with filler injection, it is hard to draw any specific conclusions at this time. Ultrasound in injectors that are used to using it may be helpful, but an injector does not necessarily need the ultrasound to feel confident in his/her injection.

Filler can migrate overtime but migration into a vessel has not been reported. Usually, to have filler particles enter a vessel, it requires high pressure. That's why vascular occlusion events usually happens during or at around the time of injection.