John A. Fry, MD

Fillers are an excellent treatment to improve nasolabial folds. For deep folds it is common to use a combination of dermal fillers. Often I will use PDO lifting threads in combination with filler for enhanced result. Best of luck!

I only recommend Botox dilution per Allergan guidelines using sterile saline. If your results are only lasting 6-8 weeks you may need to consider having higher doses placed. Usually results lasting less than three months are from too small of a dose to the area in question.

Thank you for your question. This is a very common issue. For optimal results most patients require a combination of therapies. If there is some fat but not enough for Coolsculpting I prefer a combination of Kybella and Trusculpt. Jawline enhancement can then be performed with the newer longer lasting fillers. For the jawline I also like to add PDO threads for enhanced results. For mild skin laxity of the neck I like to use a combination of Ulthera and PDO threads. Best of luck!

Either treatment could be done first but I commonly recommend treatments with energy devices first followed by Botox or other neuromodulators usually at 2 weeks. 

Liposuction would give you the most immediate and biggest result but is associated with some risk and downtime. Many non invasive options are available. Coolsculpting is a nice option if you have enough "pinchable" fat that will fit into the applicator. From your pictures I would question whether the applicator would fit. Trusculpt is another non invasive option that uses radio frequency (heat) energy and has similar % fat reduction as Coolsculpting but is not as limited in requiring a fit with the applicator. EMsculpt results in some fat reduction but also will increase muscle definition. Finally, there are off label uses of Kybella injections that can dissolve areas of fat on the body. Often, a combination of therapies can give you the best result.