Mark Hamilton, MD

This is a great question, thank you for asking. It sounds like you are being proactive about using pharmaceutical grade skin care which is an excellent choice. When it comes to incorporating TNS Recovery Complex into your skin care routine, TNS Recovery Complex is applied first, in the morning and evening after cleansing and toning, followed by retinol (evening only). An example of your aesthetic skin care prescription may look something like this: Step 1: In the AM and PM, begin your routine with a Skin Medica Facial Cleanser and Toner Step 2: Next, apply corrective serums, like TNS Recovery Complex, followed by retinol (evening only). For TNS Recovery Complex, apply to your entire face, neck and chest if desired. TNS Recovery Complex is applied first, in the morning and evening after cleansing and toning. For retinol, apply in the evening only. If a retinol product has never been used before, begin 2-3 days apart, increasing frequency slowly until daily use is tolerated. Mild redness, peeling and irritation is expected when using this product. Step 3: In the AM and PM, apply moisturizer, like Skin Medica’s Rejuvenative Moisturizer or Dermal Repair Cream. Apply a small amount all over the face and gently massage in the skin. Step 4: In the AM, apply a sunscreen, like TNS Total Defense and Repair. Be sure to reapply every 2 hours if in direct sunlight and apply generously to face and other sun-exposed areas. Thank you for your question. Please be sure to consult with a board certified physician for all your pharmaceutical grade skin care needs.

Thank you for your questions and attached photos. Nonsurgical lip augmentation is best achieved with a hyaluronic acid based dermal filler such as Juvederm or Restylane. There are not one size fits all approaches to treating this area. However, in general a poutier look can be achieved by expert placement of filler into the tubercles of the body of the upper and lower lip with the dose tapered to the corners. You have a beautiful upturn to the corners of the mouth, defined vermilion border and cupids bow, full lower lip, and defined philtral columns. It appears the upper lip may benefit from added fullness to the body. Depending upon the degree of fullness you are wanting to achieve this can typically be done with 1/2 to 1 syringe of Juvederm or Restylane in one visit or slowly over time. Additional filler can be placed at 2-4 week intervals if the desired outcome has not yet been achieved. The typical cost for 1 syringe of product varies by region and provider, but may cost similar to our practice of around $500. Additional ways to enhance the lips are by adding filler to other areas of the face which add support and change the shape. Considerations include adding filler to the nasolabial fold and lower half of the face such as the chin. Lastly, a small amount of Botox can be injected around the lips to achieve a poutier look. This is a pseudo-augmentation and can provide a 1-3 mm lift to the upper lip and eversion to the lower part of the lip for added show of the pink part of the lip. Thank you for your great questions. Please seek a consult with a board certified physician. Good luck with your aesthetics journey.

This is a great question. As a general rule of thumb, skin care products are best applied from thinnest to thickest. For incorporating Retinol and Lytera 2.0 Skin Medica products, the following aesthetic skin care prescription is recommended: Step 1: In the AM and PM, begin your routine with a Skin Medica Facial Cleanser and Toner. Step 2: Next, apply corrective serums, like TNS Essential Serum, followed by Lytera 2.0, followed by Retinol (evening only). For TNS Essential Serum dispense on the back of hand and blend together before applying to skin. Apply to face, neck, and chest. For Lytera 2.0, product can be applied to entire face, neck, chest, or other affected areas. For Retinol, apply in the evening. If a Retinol product has never been used before, begin twice a week 2-3 days apart, increasing frequency slowly until daily use is tolerated. Mild redness, peeling and irritation is expected when using this product. Step 3: In the AM and PM, apply moisturizer, like Skin Medica Dermal Repair Cream. Apply a small amount all over the face and gently massage into the skin. Step 4: In the AM, apply a sunscreen, like TNS Total Defense + Repair. Be sure tp reapply every 2 hours if in direct sunlight and apply generously to face and other sun-exposed areas. Thank you for your question. Please be sure to consult with a board certified physician for all of your physician dispensed skin care needs.

Thanks for your question and sending images. Discussing techniques can get fairly complicated and probably should not be your first goal. Rather I would spend time finding a surgeon (ENT, facial plastic surgeon, plastic surgeon) who regularly performs rhinoplasties and you are comfortable with. There are many acceptable techniques and more important for you is finding a surgeon who can trust and can give the results that you want- Hope that helps!

Thank you for your question and sending images. Although nothing replaces an in person exam, it does appear you would be an excellent candidate for a facelift. In general, facelift techniques have incorporated more vertical lifting and this is a part of most procedures whether deep plane, high SMAS or even biplanar. Threadlifts have limited value in lifting someone like you and are very temporary- 6 months on average. I would only explore this option if you are opposed to surgery. Other things to consider to enhance your result would be chin augmentation and fat grafting. Hope that helps- please consult with a facial plastic surgeon or plastic surgeon experienced with facelift procedures to explore your options!

Thank you for your question. While you may be seeing some early signs of aging, it is way too early to consider surgery. A lot can be done with fillers and neuromodulators to lift and modify the face- you should explore these options first. I would recommend consulting with a physician experienced in non surgical cosmetic treatments such as a dermatologist, facial plastic surgeon or plastic surgeon to explore your options.

Thank you for your question and sending images. You look beautiful and have excellent skin! Although nothing replaces an in person exam, it appears that you really have minimal signs of aging and are too early for surgery or even threadlifting. At the most, I would consider injectable fillers to highlight and lift the cheeks as well as camouflage some of the very early shadowing you are seeing in the lower face. I would recommend consulting with an experienced facial plastic surgeon for a consultation to explore your options.

Thank you for your question and corresponding photo. A pseudo augmentation of the lip is possible using Botox. A small amount of Botox can be injected into the muscle that surrounds the mouth which results in more show of the rubor or pink part of the lip. By relaxing the muscle surrounding the upper part of the lip, Botox inadvertently lifts the upper lip. The technique produces a subtle augmentation, possibly 1-2 mm increase in the visibility of the pink part of the lip. Botox can be used to enhance the visibility of both the top and bottom lip. For this treatment I recommend seeing a board certified physician. Thank you for your question and best of luck to you. 

Thank you for your question and attached photos. From looking at your photos it appears you would be a candidate for non-surgical augmentation of your cheeks and chin with injectable dermal fillers. Adding projection to the anteromedial and lateral portion of the cheeks and gonium, the apex of the chin, will help achieve your goal of a V shaped face. Studies have found a heart or oval shape of the face is viewed as most aesthetically pleasing. Therefore, this is a common request. There are several products ideally formulated for this. For maximal lift and projection, a dermal filler with a high degree of firmness or G prime is recommended. Restylane Lyft, Voluma, Juvederm Ultra Plus and Radiesse are examples of dermal fillers which can be used to add and enhance anteromedial and lateral projection of the cheeks. Typically, 1-3 syringes are recommended in this area. To augment the chin area which creates more downward and outward projection of the chin, typically requires 1-3 syringes of product. A combination of techniques, utlizing cannulas and needles, may be used to achieve desired results. Results typically last approximately 6-18 months, or in some cases up to or beyond 2 years. In addition to dermal fillers, Botox can be injected into the masseter muscle on both sides of the face. The masseter muscle is a strong muscle of mastication. Carefully placed injections of Botox into this muscle typically results in facial slimming. Results are temporary and take effect in approximately 1-2 weeks and last approximately 3-6 months. Overall, I am confident you can achieve your goals. For best outcomes, I recommend seeking consultation with a board certified physician. Thank you for your question and best of luck to you. 

Thank you for your questions and attached photo. There are several treatment options including both nonsurgical and surgical for which you may be a good candidate. Botox is most commonly used to help soften frown and forehead lines and is an effective tool with a proven low risk safety profile. However, Botox does require maintenance injections to maintain good results and if you do not want Botox there are alternatives.One such alternative to Botox sometimes utilized is hyaluronic acid based dermal fillers such as Juvederm or Restylane. Dermal fillers would be injected into your frown lines to give a similar effect. This treatment typically lasts approximately 6-12 months on average. All of the non-surgical options would require repeat treatments to maintain your desired appearance given your body will naturally metabolize the substance.For permanent removal of the frown furrows between the eyes the ideal option is surgery performed by a board certified facial plastic surgeon. At your consultation the surgeon would determine if you would be a good candidate for surgery based on your medical history and perform an exam. Based on your pictures, you would benefit from clipping of your corrugator muscles to smooth your wrinkles and give a softer look. This could be done endoscopically from several small incision near or behind the hair line. This can be combined with a brow lift if desired, but that does not appear to be an issue for you. Physician dispensed skin care, routine chemical peels, neurotoxins such as Botox, dermal fillers, nonablative and ablative laser treatments such as Halo, and surgical intervention can all be very good options. No treatment is ever 100% guaranteed but your surgeon will help guide you to your best outcome. I do not use Thermirase at my practice therefore cannot comment on its outcomes. I recommend consultation with a board certified facial plastic surgeon to explore your options. Good luck to you and thank you for your interesting questions.