Great doc! I am thrilled with my results. I had lip filler with this doctor and loved it. I am so happy I was referred by a friend to him. He is a nice guy, smart, funny and has excellent manners. It was not super painful and the entire experience was awesome. My lips used to be thin and looked like old lady lips! I actually now have more red lips and have perfect volume!
My frown lines made me look tired and older than I actually am. I heard that this doctor was great from a friend that visits his office often. This doctor was caring, gentle and informative. I learned a lot about this procedure. What to expect, how to maintain a schedule that minimized the wrinkles. I will for sure return and have this again in the schedule suggested by the doctor. I saw great results and I now look refreshed. I will go back to see Dr. Bouzoukis and will get filler next time. Great job! No pictures as I want some privacy.
It is difficult to fully analyze your face and make recommendations with only the above photo submitted, and your age omitted. Frontal, lateral, 3/4 view and basal view are important in assessing facial contour, including any bone or soft tissue related volume loss. This is further confirmed with an exam in person. That being said, I agree completely with the others who did not recommend ThermiTight to that area. It has not been proven safe in that area, and is the wrong type of treatment for your issue.The cause of prominent nasolabial folds in the majority of patients is from volume loss in the cheek fat pads as well as loss of bone in the malar region. The combination of both bony and fat pad volume loss with age is well established. The appropriate treatment for the majority of patients is restoring volume in the malar region over the bone, as well as in the appropriate fat pads. Simply placing filler into the folds, or the nasolabial fat pad directly above the fold makes the appearance worse in most cases.Without knowing the amount and location of the filler placed previously it is difficult to comment on why you did not see an improvement. In our practice, we often see patients from outside offices who either did not have enough filler placed, or more commonly it was misplaced; both of which can make the NL folds appear worse.It does appear from the limited view in the photo you could benefit from filler in the medial fat pad (above the NL fat pad), as well as over the bone in the region of the malar highlight. You may even have some residual misplaced Juvederm in the NL fat pad worsening the appearance which could be dissolved with Vitrase (Juvederm is more difficult to melt than Restylane or Perlane and often requires several sessions to fully dissolve it).Also keep in mind that it is normal for people to have some degree of nasolabial fold, especially when smiling. Attempting to completely efface the NL will look unnatural. I recommend you find an experienced injector and review their before and after photos to get an idea of their aesthetic eye and skill. In addition, bringing in pictures of yourself in which you are younger is useful to guide the doctor in rejuvenating your face, while not changing who you look like. I would avoid a permanent filler. If there were any issue with misplacement or lumpiness there would be no way to dissolve it, as can be done with hyaluronic acid fillers. In addition, as our entire skull shrinks with age, properly placed permanent filler may wind up in the wrong area 15 years later and look unnatural. Lastly, although rare, infections involving permanent fillers in the face can lead to permanent disfigurement. This is more commonly seen in South America and Asia where permanent fillers are more widely used.
I'm sorry you're having issues after your first Botox injection. For many patients, Botox improves fine lines and wrinkles and can give a subtle lift to the brow when injected properly. It's difficult to know exactly what is happening without knowing the areas that were injected and seeing a more complete photo of your face. That being said, based on the close up photo and your description it appears the creases in your lid are caused by the tail of your eyebrow (the lateral end) being pulled up by a still functioning lateral frontalis (the lateral forehead muscle), while the medial part of your eyebrow is low because the central frontalis is weakened from Botox. This can happen when the Botox from an injection into the corrugators (the furrow muscles) between your brows migrates up and weakens the frontalis muscle, or when the central forehead is injected and the lateral forehead is skipped. The forehead muscle is injected to reduce lines in the forehead when raising the eyebrows, but over injection can cause the brow to drop, which is not desirable. Some injectors avoid injecting the lateral forehead to prevent this, but that can lead to an overly high lateral brow, which tents the delicate eyelid skin. In addition, Botox in the crow's feet can also increase elevation of the lateral eyebrow. The post injection appearance of a low medial eyebrow and overly raised tail is something that should be avoided with appropriate technique. A small dose of Dysport or Botox injected in the lateral forehead above the tail of the brow will lower the tail several millimeters, improving the overall shape of your brow and reducing the tenting effect and creases in your upper eyelid. Another option is to wait it out. By 2 weeks, 90% of the Botox effect is present, by 3 weeks, 100% in the vast majority of patients. In 6-8 weeks, the Botox will start to wear off and the lines in your eyelid will start to improve. At this point it shouldn't continue to worsen, but it will take time to improve.
