Melissa Young Szalay, MD

SkinPen microneedling is FDA approved to treat acne scarring.  This treatment can have additional benefits of improving skin texture, hyperpigmentation, fine lines and wrinkles.  I typically recommend to my clients that they wait at least 2 weeks after getting filler placed before proceeding with SkinPen microneedling.  As the other responders have said, you need to be off Accutane for at least 6 months before considering microneedling.  SkinPen microneedling for acne scars will require multiple treatments, about 1 month apart.  From a budget standpoint, I would recommend that you plan for at least 6 treatments to see optimal results.  Acne scars are improved with the SkinPen microneedling procedure because it creates microtraumas to the skin, stimulating a healing response. This ultimately stimulates more collagen and elastin production, and results in glowing, radiant skin.  It's one of my very favorite procedures to do because clients can see a definite improvement in their skin!

Best, Dr. Melissa

TNS Essential Serum has 2 chambers: one holds the growth factor formula (red color) and the other holds the serum including lots of antioxidants (cream colored).  The antioxidants can be quite active, and for more sensitive skin can be irritating.  If my clients have the symptoms you describe, I recommend the TNS Recovery Complex, which only has the growth factor formula.  Remember to use this on your neck as well as your face!

Best, Dr. Melissa 

While it is rare, you can develop antibodies to the botulinum toxin that subsequently interfere with the desired results of the toxin.  If this is the case, the general recommendation is to wait 1 year and then try again.  I don't believe that one can test for these antibodies.  More commonly, you may need a higher dose, ie more units, to get the desired effect.  Dose and duration are intimately related; that is, for clients who only get a few weeks of results, they would benefit from a higher dose at their next treatment.  Also, it's important to adhere to the interval of at least 3 months between treatments.  

Best, Dr. Melissa

It's important to share your goals and concerns with your provider when you are contemplating Botox treatment.  Yours is a common concern, that you don't want to look frozen after getting Botox.  In other words, you may want "movement without lines."  I find that most clients do not want the frozen look, rather an improvement of their lines that occur with expression.  I typically start with a more conservative number of units, because I can always add more, but I can't take it away once it's injected.  I like to reassess my new Botox clients 2 weeks after treatment, so we can collaborate on the results so far and whether we need to consider additional units to achieve desired effects.

I like to assess my patients sitting up, at rest and with expressions, and from different angles. Patient position during the injections is really up to the preference of the injector. For lip and cheek filler, I prefer to have a patient reclined about 30 degrees so he/is is in a comfortable position and his/her head is supported by the bed.  For jawline filler, this is done with the patient in many different positions, depending on the portion of the jawline being addressed.

Best, Dr. Melissa

Kudos to you on your weight loss success!  Keep up your healthy lifestyle goals!  When you lose weight, you also lose weight in your face.  Dynamic lines are normal in the face with expression.  I find it interesting to observe children when they are making expressions to confirm this statement.  The question is whether you have smile lines at rest that bother you.  If so, filler is an option.  However, at your young age I would recommend concentrating instead on a professional level customized skin care program that will help keep your skin healthy and youthful. Additionally, treatments such as microneedling can help brighten the skin and address fine lines.

Best, Dr. Melissa

Your concerns are related to a few contributing factors. With weight loss, results are typically great everywhere except in the face, where fat actually is valuable to maintain a youthful appearance.  Also, in general, with aging, we loss volume in the face, including the lips.  Restoring volume to the lips can be done with dermal filler.  Choice of filler is up to your treating provider, but in general we like to choose a softer, more malleable filler that can move with your lips for natural results.  In terms of the vertical lines around your lips, these can also be treated with a soft filler, but care needs to be taken not to add too much volume here or it can create a "monkey" look.  For these resting lines (not only around your mouth but also the chin), I would recommend microneedling and/or platelet-rich plasma (PRP) injections to helps stimulate collagen and elastin production, which helps "heal" the skin and improve resting lines and wrinkles.  Finally, a professional level skin care program is a must!  I remind my clients that I can do great things for them in my studio, but they can optimize their results by doing a customized skin care routine every day.

Best, Dr. Melissa