Botox

Dermal Fillers

Treatment options for these persistent lines include very carefully placed filler directly within the superficial dermis, using a very soft product and a very conservative approach. This must be done only by an experienced injector or plastic surgeon familiar with the anatomy, since the deeper layers are close to blood vessels where complications can occur. Another option in the right setting is facial fat transfer, sometimes using nanofat. Good luck!

I get Botox regularly (about every 4 months) and recently this line appeared in between my forehead that won’t go away after treatment. Do I just need more Botox or how can I get rid of it? Injector won’t put filler in that area

How to get rid of this stubborn line that appeared after Botox? (Photo)

It is difficult to give a precise answer without an in-person examination, but your question raises an important point about the balance between the brows and the upper eyelids. Botox in the upper third of the face typically relaxes muscles that elevate the brows, which can slightly lower them. In patients with preexisting excess skin of the upper eyelids, called dermatochalasis, even small changes in brow position can alter how the eyelid hooding appears.
At your age, you may be a candidate for procedures such as upper eyelid surgery (blepharoplasty) or, in some cases, repositioning of the brow. These procedures can restore a more natural balance between the eyelids and brows and give a longer-lasting improvement than Botox adjustments alone.
The best next step is to consult in person with a board-certified plastic surgeon who can assess your anatomy and advise you on whether surgical or non-surgical approaches will give you the most natural and satisfying result.
Sincerely, Michael Chung, MD Plastic and Reconstructive Surgery

I have always had hooded eyelids, like Kathleen Turner. Since getting glabella Botox, my eyelids have lost the hooding. My injector has tried the trick of putting a unit over the peak of my brows, which only helps a little. I'm in my 60s. Is there a way to get Botox and maintain natural eyelid hooding?

Can Botox be used to maintain natural eyelid hooding?

What you are describing could be related to the underlying muscles of the nose that become active when you smile. Botox can sometimes be used to soften this by weakening those muscles, but it requires very careful placement and a detailed knowledge of nasal anatomy. The main risk is that certain muscles are also responsible for helping keep the nasal valve open, and weakening them could affect your ability to breathe comfortably through your nose.
The good news is that Botox is temporary, so if you and your injector decide to try it, the effect will wear off in a few months if you are not satisfied. It is very important to see an experienced injector or plastic surgeon who understands these nuances, as the injections are highly precise.
Sincerely, Michael Chung, MD Plastic and Reconstructive Surgery

Hi, as you can see on the pictures, my nose looks totally normal on repose, but when I smile, there is this bump/fold (skin or muscle?) that pops out on both sides of my nose, and it looks white and unsightly. Is there any way to make this go away, e.g. with botox? And if so, exactly where should it be administered - and are there any risks? Thank you!

Could Botox help with skin bunching at the nose when I smile? (Photos)

The best treatment depends on your anatomy, skin quality, and age. Fillers can enhance contour in certain patients, but they generally will not slim the lower face and can sometimes make it look heavier. Botox only helps if the masseter muscles are enlarged, which does not seem to be your main concern.
If your fullness is due to fat, submental liposuction can provide definition. If there is also loose skin or jowling, then a neck lift or a combination of a lower facelift with a neck lift may be the most impactful option. The right choice can only be determined through a thorough in-person examination by a board-certified plastic surgeon, who can guide you to the treatment best suited to your anatomy and goals.
Sincerely, Michael Chung, MD Plastic and Reconstructive Surgery

I have a round face shape and I hate it. However, I am interested in exploring fillers, especially if they can help with my jawline area. I have had kybella under my chin but I think the problem area is jowls? Or neck? But the lower face. Will Botox or filler help to slim this down and give a defined jawline? Any recommendations on any treatments before I spend money on something?

What can help to slim down lower face area and give a more defined jawline? (Photos)

First, congratulations on your tremendous weight loss. That is an extraordinary accomplishment and something to be very proud of. It is common after significant weight loss to notice areas of facial hollowing, particularly around the mouth, cheeks, and temples. This can be accentuated if you are on medications such as GLP-1 inhibitors, since they accelerate fat loss in the face. Although some of these changes overlap with the natural aging process, they can appear earlier or more pronounced after such a significant transformation.
Yes, the hollow area near your lip can often be improved. The most straightforward approach would be soft tissue augmentation. This can be done with either a dermal filler or with fat transfer. Hyaluronic acid fillers are the most common first step because they are precise, reversible, and provide an immediate result. Fat transfer is another excellent option, using your own fat to restore volume. Fat can provide a more natural and potentially longer-lasting correction, but the outcome is somewhat less predictable, and a portion of the transferred fat may resorb over time.
Surgery is generally reserved for more advanced cases of facial aging or laxity. Given your age healthy skin elasticity, starting with either filler or fat transfer would be a very reasonable and conservative way to address this hollowing. It is important to do it carefully and conservatively, as even small amounts of volume can make a noticeable difference in the delicate perioral region.
A consultation with a board-certified plastic surgeon will allow you to review the options in detail and decide whether a temporary filler or fat transfer best aligns with your goals.
Sincerely, Michael Chung, MD Plastic and Reconstructive Surgery

I lost 130 pounds, and i have a hollow area on one side of my lip. Can this be corrected ? Can filler be placed here? Or is a thread lift an option ? I dont know what can be done to address this

What can be done about vertical lip line after weight loss? (Photos)

You are correct that the relationship between facial fillers and future facelift surgery is an important consideration. The primary concern is the creation of fibrosis or scar tissue within the subcutaneous planes where we normally work. This is most often noted with stimulatory fillers such as calcium hydroxylapatite (Radiesse) and poly-L-lactic acid (Sculptra). These products are designed to trigger a tissue response and collagen production, which can create more dense and less predictable planes for surgical dissection. This does not make facelift surgery impossible, but it can increase operative difficulty and, in some cases, affect outcomes.
Hyaluronic acid fillers such as Restylane or Juvederm tend to be more forgiving. They are reversible with hyaluronidase and generally do not create the same degree of long-term fibrosis as stimulatory fillers. However, it is increasingly recognized that hyaluronic acid fillers may persist far longer than previously thought, sometimes for many years, and they can migrate beyond the original site of injection. Migration into surrounding tissues can alter anatomy and in certain situations influence surgical planning. For example, lip fillers can migrate into the upper lip, contributing to elongation and potentially increasing the likelihood of needing an upper lip lift later.
Regarding timing, spacing treatments and surgery widely apart does reduce the risk of interference. A 15-year interval is a significant amount of time, and in most cases residual filler or associated scar tissue would not be expected to pose a major obstacle at that point, particularly with hyaluronic acid products.
Overall, hyaluronic acid fillers are the most conservative choice if future facelifting is anticipated. Careful placement and moderation in volume are equally important. If you are considering long-term surgical rejuvenation, it is worth discussing these issues with your surgeon so that your non-surgical treatments can be tailored in a way that preserves future surgical options.
Good luck! Michael Chung, MD Plastic and Reconstructive Surgery

More scientific literature and surgeons speaking as to how fillers make future facelifts more difficult (albeit not impossible) given formation of scar tissue. I understand this is particularly the case with non-HA based fillers like Radiesse and Sculptra, but are HA based fillers like Restalyne also "bad" in this regard (ie, making future facelift difficult)? Also - what are places in face that to get filler that least impact future facelift? I understand jawline for eg may be tough given near incision area, but what about zygos, nose, etc? Is it more acceptable if I space out 15 years apart?

Fillers make future facelift difficult, but are hyaluronic acid based fillers more acceptable?

I am very sorry to hear about your recent diagnosis. It is completely understandable that you would still want to feel like yourself and maintain your confidence. Wanting to preserve your sense of beauty is not petty in any way. It is an important part of overall well-being, and you absolutely deserve to feel comfortable and confident in your own skin.
Since your neurologist has advised you to avoid neuromodulators such as Botox, there are still a number of safe and effective alternatives that can improve forehead lines. One category is resurfacing treatments, including fractional laser resurfacing or erbium and CO₂ laser treatments, which stimulate collagen production and improve the appearance of fine lines and skin texture. Microneedling, sometimes combined with radiofrequency, can also promote collagen remodeling and provide gradual softening of etched lines.
Medical-grade skincare with topical retinoids, antioxidants, and consistent use of sunscreen can improve skin quality and slow the progression of wrinkles. Chemical peels performed by a qualified provider are another option to refresh the skin and enhance texture.
Finally, in some cases, deep forehead lines can be softened with either filler or fat grafting. In these patients, carefully placed dermal filler or fat transfer can soften deeper static lines. 
While none of these treatments are identical in effect to Botox, many patients do achieve meaningful improvement through a combination of these approaches. A consultation with a board-certified plastic surgeon who is aware of your medical history will allow for the creation of a treatment plan that is both safe and effective for you.
Sincerely, Michael Chung, MD

Is there any alternative to Botox to smooth or help eliminate forehead lines? I was recently diagnosed with a neuromuscular disease &amp; my Neuro said absolutely no botox. I asked if any other skin or wrinkle treatment were also to be avoided and he said that I only need to avoid Neuromodulator/Neurotoxin injections. I know it seems petty but I still want to feel pretty and like my old self amongst my dx. What else can I do? Pls help.

Botox alternatives for forehead lines? (Photo)

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