Harold L. Kent, MD (retired)

Botox will paralyze the orbicularis oris muscle near where it is injected. Our experience is that the effect is very subtle. We inject anywhere from 4 to 10 units above the pink part of the upper lip--usually about 1 cm medial to the lateral border of the lip and about 1 cm lateral to the philtrum column on each side. Generally this would be expected to let the upper lip turn outward slightly to give a fuller appearance. Small doses for this can make it difficult to whistle or use a straw to drink. A larger dose can mean that the patient needs to be careful when drinking from a cup or glass. With Botox, if the results aren't what you want, the effect will go away within a few months and you can try something else.

Exilis Ultra uses no needles, knives or injection. This is a totally non-invasive treatment that uses radiofrequency to tighten skin and destroy fat. A wand which channels radiofrequency current and ultrasound to the skin or fat (depending on the settings) can be used to destroy fat cells or tighten the skin. Exilis can be used to treat from "nose to toes" and it feels like a hot stone massage. This would be a good option for you.

My opinion is that your left eyebrow is slightly more arched in the outer third than the right eyebrow. There are times when we do Botox treatments and one or both eyebrows end up with an pronounced upward arch. This is sometimes referred to as a "Spock eye". We routinely treat this by injecting about one unit of Botox one centimeter above the highest point of the arch. This would be an quick and inexpensive thing to try. The results would last for two to three months.

You have had several procedures to tighten your facial skin. You could add Exilis Ultra to this in order to further tighten your skin in your lower face and neck. Exilis Ultra uses as combination of radiofrequency injury and ultrasound to cause a subclinical injury to your face. Your skin will respond to these treatments (usually 4 or 5) by producing more collagen and elastin which would be expected to tighten your skin further. Our practice is to treat the lower face and neck on one side then move to the other side of your body and repeat the procedure on both sides. This "dual treatment" at one session helps to produce better results. You can also use a SkinCeutical product called HA Intensifier. This has been proven to cause the skin to make more hyaluronic acid (something we all lose as we age) and we would expect this to help. The SkinCeutical products have been evaluated by doing pre and post treatment skin biopsies which prove that they have the intended effect.

Most surgeons would consider patients safe to return to full activities within 6 weeks of major surgery that has had no complications. This is because most post operative healing takes place within this time frame although complete healing will require about a year. You should be safe to start Coolsculpting at any time.