Craig Koniver, MD

In addition to Botox, you should consider an Ultherapy Brow Lift. It's a quick 15 minute treatment that lifts and tightens the tissue in that area. We've had several patients who have gotten great correction when one brow is higher than the other. The downside is, you have to wait about 3-6 months for your final result. 

There are quite a few dermal fillers on the market today and they vary in terms of longevity. However, there are none whose effects dissipate in as quick as a month and certainly not in a few days or weeks. It's true that following your treatment you could have some immediate swelling and some patients do love that "happy swelling" look. However, once the product settles and migrates into the skin, the swelling naturally goes down which is ideal for most patients who desire a more natural look.  If you are looking for a more pronounced (strong and sharp) look that mimics the initial swelling you might get, you will simply need more product from the onset. You should also consider a product like Radiesse that is made of calcium and tends to last longer. It is great for providing structure and support to the jaw, chin, and cheek. 

The Blu-U light is very effective for acne when used with or without Levulan. Many patients who do the PDT treatment for acne will then maintain the results with just the Blu-U treatment. The Blu-U targets the p.acne bacteria in the skin and can be used several times a week if you have a special event coming up or can be used once a week/twice a month/whatever works for your needs and budget. It's a super safe and easy treatment and works to reduce inflammation. If acne is not the primary concern, there are better treatment options available. 

Ultherapy wont hurt the situation as it lifts and tightens the skin. The question is just how much benefit you will derive. Depending on how much cellulite you have and how badly it bothers you, there are better options for treating it in our opinion. Check out Cellfina. We offer Ultherapy and do not offer Cellfina so hopefully you can appreciate this non-biased response for what it is. 

Given your age and sun damage you reference, we would suggest you start with a .025% Retin-A (Tretinoin). A Retinol will be much milder but has to convert twice to become a retinoic acid thus is considerably less potent. Having said that, the best retinoid strength for you is the one you are able to use consistently. We tell patients that it really takes a solid 12-16 weeks for their skin to fully adjust to a product like this so you just need to be patient and consistent. You can always buffer Retin-A with a moisturizer if you can't seem to get past the initial irritation. 

We have a few favorites. Neocutis Lumiere and Obagi Elastiderm. If lines are deep, or you need extra hydration, both products also come with a Eye Serum that you can apply prior to the Eye Cream. It's important to remember that the eyes are one of the first places we start to show signs of aging. Therefore, it is important to be consistent with whatever product you use and use it twice a day. If an eye cream is not enough, you might evaluate a neuromodulator (Botox, Dysport, Xeomin) and/or dermal filler. We like Restylane and Belotero Balance for the delicate eye region. 

Hi. I would not recommend Fraxel in lieu of surgery in your case. We do a lot of Fraxel eyelid treatments in our practice with the appropriate ocular shields. However, the tightening that you get from Fraxel is almost better described as a side effect than anything. The 1550 wavelength on the Fraxel Dual stimulates collagen production which over time leads to some degree of skin tightening but if your main concern is skin laxity, I'm not sure Fraxel, or any of the other options previously mentioned, is going to give you the desired results you want. We hate to see people waste money going down a rabbit hole when a good surgeon is all they really needed. And please note, we do not do surgery in our practice so we are just giving you what we view as the best advice for your concern. 

What strength tretinoin are you using and are you also using a moisturizer afterwards? Obagi makes one that comes in the normal/dry kits called Hydrate. You can use that over the tretinoin to combat the dry/irritated skin. However, it takes skin about 12-16 weeks to adjust fully to the Nu derm system and the redness and irritation are a clear sign that the active ingredients are working as they are supposed to so your best bet is to just stick with it as best you can and if you continue to stay very irritated, consider using the moisturizer before the tretinoin as it will buffer it a bit. Other options are to reduce the strength of your tretinoin or space it out to every third night. 

Ultherapy would be a great option for addressing your skin laxity as it is not severe yet. We find in our practice that the patients who get the absolute best results are those whose laxity falls in the mild to moderate and moderate range. Once you get severe laxity, about the only (or at least best) thing you can do is surgery. However, a combination approach would be better for you as you have both volume loss and laxity. Both occur as the collagen, elastin, and hylauronic acid degrade in our skin. Addressing the laxity but not the volume loss or vice versa will render ok (but not "wow") results. We often encourage patients to combine Sculptra (a collagen stimulator) with Ultherapy. Both are foundation level treatments and really encourage your body to do the work of rebuilding and renewing its collagen and elastin thus resulting in a much more natural result. A liquid facelift generally uses a variety of dermal fillers to restore volume to your face. While either option would work for you, we are inclined to recommend Ultherapy and injectables for the most natural and long lasting (thus cost-effective) results. You look great and now is the perfect time to prevent and maintain future "gravity" concerns. 

It is unlikely that you did any damage at all. If anything, you may just have an exacerbated response in that area which could result in additional healing time. PDT is very safe and while one must be careful with the sun post treatment because the skin is still photosensitive, the only real side effect we've seen in our office is prolonged discomfort. We have not had any experience with PDT damaging patients (even when they have gotten accidental sun exposure) and we do a fair number of these treatments for AKs, acne, and general rejuvenation.