Botox

Lip Fillers

Juvederm

Microneedling

This is often related to technique and amount of filler and depth of placement of the filler. For example, someone with prominent cheek/body mid face structure may not need much ‘superficial’ filler placed. However, they may need some deeper filler placement with a cannula, laid under the muscle, or along the bone. This is an advanced technique.
Alternatively, you may consider something less ‘filling’ like a bioactive filler to help more with your own collagen production. These fillers (Sulptra and Bellafill are two examples) are more subtle and create a slow/gradual improvement over months/years and work with your body’s natural ability to build collagen. HA fillers like Voluma, are more dramatic at filling lost volume and have an immediate effect.

Hi doctors, I’m female age 44, When not smiling my cheeks have obvious volume loss and are quite flat w nasolabial lines. I’d love to get filler but when I smile, my cheeks pull up significantly and are very full. When smiling, I can’t imagine what I’d look like if my face had more volume. I tried having Voluma at the cheekbones a few years ago and it lifted my face fine but it looked really weird at my temples- an obvious bump on the sides of my face. Do you have any suggestions? Thanks!

Need filler… but already have big cheeks. Do you have any suggestions?

There are several ways to improve the appearance of Jowls or sagging skin along the jaw. At Dermablue, we look at the underlying cause, ie where the skin laxity/jowling is happening. In most patients, this is a result of mid face bone/fat loss because of normal aging. It is well known that you lose about the equivalent of a ‘tablespoon’ size of bone/fat for every decade of aging beyond your ‘peak’ in your 20’s. When you lose fat/bone in the mid face, your skin no longer has the ‘scaffolding’ to hold up the skin, which can create ‘jowls’ in the lower face.
The most cost-effective way to replace this fat/bone loss is through filler treatment. There are two common ‘categories’ of filler.
1. HA, ie Hyluronic Acid fillers, or ‘temporary’ fillers. These fillers last anywhere from 1 or more years in the midface/cheek area and are made of Hyluronic Acid, which is ‘bioidentical’ or what your body recognizes as collagen. These are safe, effective and there are ways to reverse these fillers if you do not like the appearance of them. At Dermablue, we commonly use Voluma for this area. Although there are several other HA fillers which we use in this area. Often a ‘syringe’ of filler is the equivalent of a ‘tablespoon’ of volume. So, for a patient in her 40’s I would replace the equivalent of 2 syringes of filler (Voluma) on each side of the face (one for each decade of bone/fat loss).
2. Bioactive Fillers or ‘permanent’ fillers. There are three long term/permanent fillers on the market in the US, which have long term data, ie they last 5 more years. Like HA fillers, they will occupy space, although not as much volume/space, however they work by providing a scaffolding/space for your body to rebuild collagen slowly over time. Often this effect can take months to see the full benefit and often we use these along with HA fillers (which have an immediate filling effect).
Other treatments we provide at Dermablue to help minimize the appearance of jowls include lifting the skin with thread lifting, which is using very special absorbable stitches. These have been used for over a decade and provides a safe/immediate result with works well with fillers.
Last, we use technology to help ‘tighten the skin’ and our favorite for ‘jowls’ is RF microneedling with the Genius system. Genius® uses very tiny needles that are sterile and insulated to deliver RF energy to precise locations and depths in the skin while reducing damage to the surface of the skin. This stimulates both collagen and elastin to tighten skin and smooth imperfections for an effect that can be a good option for patients who are seeking an anti-aging procedure with minimal downtime. You can use RF microneedling along with thread lifting and fillers; however there needs to be some time between the treatments, often up to a month or more to avoid damage to the thread or filler. At Dermablue, we can create a care plan to get the most out of these combination treatments.

I have a lot in sagging in my lower face. I’m 40 years old and I look like I have marionette lines. I thinking to get 3 syringes of voluma (1.5 for each side) in my cheeks. Will this help to pull my face up? My cheeks are also very flat. I wondering how much filler I will need to help my appearance. Thanks!!

Will Juvederm Voluma help with my sagging lower face and marionette lines? (photos)

With microneedling, you are not able to break down collagen, as it’s only a mechanical process. This can be an effective starting point to treat acne scarring for a very mild effect. At Dermablue, we use RF microneedling for acne scarring. With RF microneedling, you add ‘heat/energy’ to the needles to enhance the effectiveness of neocolagenesis, ie collagen formation (volumization, ie mild filling of scarring) along with the ‘mechanical’ or physical breaking up scar tissue with the microneedles. 
Yes, you need to be careful with the depth of treatment with RF microneedling. If you treat ‘too deep’ you can theoretically break down fat. With advanced machines/technology, this effect is minimized, as the machine is ‘smart’ enough to know the difference between scar tissue/dermal tissue and fat based on the different water content of the tissues. Not all machines are created equally; at Dermablue we use the ‘Genius’ system by Lutronic. It’s been a game changer for us.
Often with severe scarring, you need to fill the scarring with fillers. CO2 laser works well to smooth and tighten the top layer of skin. For significant scarring, I recommend a variety of treatments to use together to get an optimal outcome.

Will microneedling at depth of 3mm or more have the risk of losing facial fat/volume loss? I researched that microneedling w/ rf such as morpheus8 can kill the fat if it were to go beyond the dermis into the subcutaneous layer but not sure if this is the case for regular microneedling. I am mainly targeting acnes scars. What about for lasers such as co2 fractionated ablative laser? If volume loss is the result how can it build collagen and tighten the skin as that seems counterintuitive. Thanks

Will Microneedling cause facial volume loss?

Based on your description above, it sounds like you did not have enough filler injected in one place. Typically we would inject one syringe for the lips alone and often more than one syringe to see significant results in the mid face/cheek area.
At Dermablue, we use various HA products&mdash;however, if you would like a more robust filling effect, I’d suggest Juvéderm Ultra or even Juvéderm Ultra Plus, if injected into the body of the lip (not for everyone, and based on your photo, I’d stick with plain Juvéderm). We also like Vollure for lips and often start with this product. It’s not as robust as Ultra.

I’ve had lip injections before, once long ago &amp; once last December (versa). I was super unhappy with the last time, my lips were uneven &amp; it didn’t seem to change my lips much. I did 1 syringe split between cheeks/lips. It also seemed to go away over night &amp; was lumpy. I’m looking to do it again but I want to make sure it’s worth it. I am going to get the whole 1ml in them this time. Which filler is the best for dramatic results and lasts longest?

Which filler is the best for dramatic results and lasts longest? (photo)

If your lips are overfilled, you have two options. The first, leave it alone and the HA filler will slowly break down and go away over the span of a year or so, depending on the filler and where it was injected. 
The other option is to find a practice/provider who is skilled in the use of hyaluronidase, which is an enzyme which can be injected into HA fillers to accelerate the breakdown of the product. It typically works within one to two weeks and is extremely safe and effective.

I would like to ask you, what can happen to you if your lips are overfilled by hyaluronic acid? Is there any health risk over time? ( Not only duck face look). Thank you.

What can happen if your lips are overfilled with hyaluronic acid?

A lip flip allows the upper part of your lip to relax and flip outward, creating the appearance of fuller lips. We make the lip flip happen with an injection of 4-6 units Botox carefully delivered to your upper lip. A lip flip is actually not filler at all, but can subtly create the appearance of ‘fuller lips’
Pros
· The lip flip amplifies the natural shape of your lips, without exaggerating, for an all-natural effect.
· There’s no downtime after the injections. You’re ready to step back out into your typical day.
· The lip flip can compensate for a gummy smile, or a smile that shows a lot of your top gums and a thin stretch of upper lip.
Cons
· The lip flip doesn’t last as long as filler. It lasts about 4-6 weeks maximum, since the lips are so heavily used for expressions, eating and more. Consistent upkeep is required for a continual effect.
· There’s a delay in results. Complete results can be seen about a week after your visit.
Lip Filler
You need to use filler, like Juvederm or Vollure to physically make your lips fuller in volume.
At Dermablue, we put a topical numbing cream on your lips to reduce any discomfort you may feel during the treatment. During the treatment, we inject the clear, hyaluronic acid gel into your lips as well as around them. The gel contains a soft filler that creates the effect, as well as lidocaine to decrease pain.
Pros
· Filler can last up to a year, for a long-term, consistent look.
· There’s no illusion. It actually makes your lips plumper in shape and size while smoothing the lines around them.
· You see results right away.
· The acid is naturally found in the body so it’s safe, with a low risk of allergic reaction.
· Our team can control your increase in lip volume, since we can control how much gel we inject, to meet your vision.
Cons
· Lip filler is more expensive than a lip flip with botox
· Side effects may range from tenderness to bumps, swelling, bruising and redness. However, any side effect is usually mild and doesn’t last more than a month.
Can you combine a lip flip and filler?
Yes, and we do this often at Dermablue. This can be a rewarding option for someone who has really thin lips, and or who may have some lip lines/wrinkles

What is a lip flip filler injection? What does it do to improve appearance? And how is it different from getting traditional lip injection?

What is a "lip flip" filler injection?

There are two ways to work on this area of concern without surgery; based on your age/skin elasticity, I would suggest using a HA, hyaluronic acid filler in this area to ‘fill’ the fold. It’s extremely safe and effective when performed with the right filler and the right provider. Often, at Dermablue, we use a cannula and a less cross-linked filler, so there’s not as much localized absorption of water and/or something called the Tyndall effect (creating a shadow/change in skin coloration.) We find older fillers like restylane to provide good results in this particular area.
The other method we use is fractional CO2 in the eye area. This can have a ‘shrinkwrap’ effect to the skin, resulting in significant tightening. At Dermablue, we use intraocular eye shields to protect the eye and allow us to treat very close to the edge of the eyelid (both upper and lower). When you treat patients with the fractional CO2, the laser will actually carefully remove some of the extra tissue which creates a significant tightening effect, something we call "Dr Dave’s shrinkwrap effect". This is similar to a surgical result in the right patient.

I posted a question similar like this 3 weeks ago, but I think the way I labeled it was confusing. I’m just curious to what procedure I can do to erase the under eyes creases. I’m unsure if Botox is the right procedure to fix it because my lines are more like folds. It seems as if they’re only lines, but they’re semi folded.

What procedure should I do to get rid of my under eye folds? (photos)

There are two considerations; first, the technique may need refinement. The proper technique to provide true muscle relaxation and/or lifting for the brow area is delivering Botox directly into the muscle. If botox is delivered too superficially, it will smooth the skin with less effect on the actual lifting/relaxing of the muscles.
The second consideration is some patients do not respond as well to certain products. At times, some patients may need to use dysport or other alternative toxins to get the desired effects

I had 40 units of Botox administered to my frown lines (11s) and horizontal forehead lines about 4 weeks ago. I have not had any results whatsoever. I'm 21, female, and this is the first time I have ever gotten it done. I went in after 2 weeks to let them know nothing had happened, and they administered more. Still no results weeks later. These are not static- they go away when I rest my face. I have full movement. Any advice for treating them?

Botox didn't work. What can I do to treat these lines and prevent their continued development? (Photo)

There are several ways to improve the appearance of jowls, or loose skin in the jaw area. At Dermablue, we look at the underlying cause, where the skin laxity or "jowling" is happening. In most patients, this is a result of mid face bone/fat loss because of normal aging. It is known, you lose both bone and fat, about the equivalent of a ‘tablespoon’ size of bone/fat; for every decade of aging beyond your ‘peak’ in your 20’s. When you lose fat/bone in the mid face, your skin no longer has the ‘scaffolding’ to hold up the skin, which can create ‘jowls’ in the lower face.
The most cost-effective way to replace this fat/bone loss is through filler treatment. There are two common ‘categories’ of filler.
1. HA, ie Hyaluronic Acid fillers, or ‘temporary’ fillers. These fillers last anywhere from 1 or more years in the midface/cheek area and are made of Hyaluronic Acid, which is ‘bioidentical’ or what your body recognizes as collagen. These are safe, effective and there are ways to reverse these fillers if you do not like the appearance of them. At Dermablue, we commonly use Voluma for this area, although there are several other HA fillers which we use in this area. Often a ‘syringe’ of filler is the equivalent of a ‘tablespoon’ of volume. So, for a patient in her/his 50’s we may need to replace the equivalent of 3 syringes of filler on each side of the face (one for each decade of bone/fat loss).
2. Bioactive Fillers or ‘permanent’ fillers. There are three long term/permanent fillers on the market in the US, which have long term data&mdash;these last 5 or more years. Like HA fillers, they will occupy space, although not as much volume/space, however. They work by providing a scaffolding/space for your body to rebuild collagen slowly over time. Often this effect can take months to see the full benefit and often we use these along with HA fillers (which have an immediate filling effect).
Other treatments we provide at Dermablue to help minimize the appearance of jowls include lifting the skin with thread lifting, which is using very special absorbable stitches. These have been used for over a decade and provides a safe/immediate result with works well with fillers.
Last, we use technology to help ‘tighten the skin’ and our favorite for ‘jowls’ is RF microneedling with the Genius system. Genius® uses very tiny needles that are sterile and insulated to deliver RF energy to precise locations and depths in the skin while reducing damage to the surface of the skin. This stimulates both collagen and elastin to tighten skin and smooth imperfections for an effect that can be a good option for patients who are seeking an anti-aging procedure with minimal downtime. 
You can use RF microneedling along with thread lifting and fillers&mdash;however, there needs to be some time between the treatments, often up to a month or more to avoid damage to the thread or filler. At Dermablue, we can create a care plan to get the most out of these combination treatments.

Hello! I am 28 y/o and already have sagging jowls. Pls see the pictures. I assume it's genetics, but I would really love to reduce the appearance of jowls. Is there anything that can be done ? I have cheek filler ( 1 ml each, done in May), and chin filler ( 1 ml, done in December)

How to get rid of jowls? Is there anything that can be done? (Photos)

Botox injections temporarily block signals to muscles, these signals cause muscles to contract, which over time can create unwanted wrinkles/expression lines. The most common use of these injections is to temporarily relax the facial muscles that cause wrinkles in the forehead, between the eyebrows and around the eyes. At Dermablue, our providers have advanced training and we provide botox in the mid face, lower face, neck lift, jelly roll, lip flip and for hyperhidrosis, ie excessive sweating.
Botox Cosmetic has been in use here in the US for over 30 years and is extremely safe and effective. At Dermablue, it is the most common procedure we provide and has the highest satisfaction rate. We typically see patients in 3-to-4 month intervals and use it in two ways.
1. Typically, botox is used to relax muscles in the face which create lines/wrinkles. Additionally, advanced practice providers are able to create a lifting effect with botox, by relaxing muscles which pull facial expression down. We refer to this as a botox ‘lift’ which can rival minor plastic surgery in the right patients.
2. The other way we use botox at Dermablue is in ‘micro’ dosing, ie lower doses, which doesn’t relax muscles, however it can significantly improve skin texture and very fine lines. This ‘microbotox’ technique can be combined with the traditional technique in the muscle (#1) to create an overall lift and smoothing effect.

Hi! I'm thinking about doing botox for lips. I have thin lips. I would like to make them a bit bigger. I'm wondering what the results of Botox to expect. Also, how long do Botox results last?

How does Botox work? What results can I expect? (photos)

David LaMond, DO

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Family physicians are specialists who deliver a range of acute, chronic, and preventative medical care to individuals of all ages.

Family Physician

11 Answers from Board Certified Family Physician David LaMond, DO See Education, Board Certification, and Treatments Offered.

Meet David LaMond, DO, a trusted Board Certified Family Physician. See 11 expert answers, 0 before-and-after photos, credentials, treatments, and 0 real patient reviews. Book a consultation today!

Albany Medical College

Albany Medical College, 2004

University of Michigan, 1996

LECOM, 2001

Doctors

North Carolina

Asheville

Meet David LaMond, DO, a trusted Board Certified Family Physician. See 11 expert answers, before-and-after photos, credentials, treatments, and  real patient reviews. Book a consultation today!

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