Michael O'Gorman, MD

Hi Ninjaattacks, thank you for posting your question. Your forehead line is suitable for a botulinum toxin treatment. This line would be expected to eliminate completely. Having said that, it is best for the dosage to be kept to a minimum - the forehead frontalis muscle is a lifting muscle, and over-treating with too high a dosage can lead to heaviness of the brows. Ask your practitioner to treat this conservatively.

Hi Angela ss, thank you for posting your photo and question. It is true that Botox can be used to create a slimmer facial profile. This is primarily by treating the masseter muscles which can be overdeveloped in some patients leading to a wider jaw and overall rounder face. Injecting the masseter muscles leads to a slimming effect on these muscles thereby slimming the jawline. Treating the neck's platysmal muscles along the jawline can also enhance the definition of the jawline (nefertiti lift). It is difficult to assess your photograph as it is not full facial and there are no oblique views. From the photo you have posted, it would appear that you already have a nice v shape but it is difficult to assess completely without viewing the full face proportions. As a guide, when injecting the masseters, I mostly work in the 25-30 units per side. I hope this helps.

Hi Crestsmile, thank you for your question. It is important to let your doctor know of any medications you are taking prior to receiving a Botox treatment. Blood thinners such as aspirin, warfarin, anti-inflammatories, garlic, fish oil, and ginko biloba should be avoided for a few days prior to your treatment to minimise the risk for bruising. Alcohol is best avoided for 24 hours prior to your treatment. There are some medications that may interact with Botox which include some antibiotics (including aminoglycosides such as gentamicin, polymyxin), Alzheimer's disease medications, myasthenia gravis medications and quinidine.
The medications you mention, metformin and high blood pressure medications, would not pose a problem.

Thank you Peaceful9125 for your question. The side effect you are referring to, being blockage of a blood vessel with dermal filler, leading to disturbance of the blood flow distal to the blockage and resulting in tissue necrosis is very rare. This is unlikely to occur in experienced hands and can be resolved with filler dissolving injections if the side effect is diagnosed immediately which should be the case. The reason this can occur is that dermal fillers have a gel consistency and so if the needle inadvertently penetrates a blood vessel, the blood flow in that blood vessel can be blocked. This cannot occur with Botox. Botox is in a liquid form and does not have the ability to block a blood vessel or disrupt blood flow. Botox cannot cause blindness or a stroke. I hope this helps to alleviate your concern.

Hi apple08, thank you for posting this question. There are a few possible treatments that can be considered in the non-surgical rhinoplasty category. This includes botulinum toxin to reduce the pull down on the nasal tip or to reduce nostril flare, thread lifting to lift the tip or stimulate collagen production along the nose, or dermal filler.
Most people are referring to dermal filler when they are looking at non-surgical rhinoplasty. If done by an experienced practitioner, results can be excellent, and risks minimised. I would consider the most important factor in choosing to undergo this procedure is that you ensure you are in the hands of an experienced practitioner. The cost for this procedure is variable between clinics and practitioners but my own charge for this is $1000 AUD. This cost includes reviews and any touch up if required as the filler settles in over the first few weeks.

Hi, thank you for posting this question. Choice of dermal filler for the under eye area is very important. Sometimes the product needs to be gradually built up over a few treatment sessions, particularly if the skin is very thin. Restylane is my preferred product for the under eye area. It addresses volume loss here very well, it is quite soft and so blends easily, and in my experience of using it for 17 years now, it can last a considerable length of time. The under eye area is an area where dermal filler tends to last longer than many other facial areas. Typically, I don't re-treat my patients for a couple of years, and then often with only 1/2 ml. I also like Teosyal Redensity 2 which is a little less volumising and has some additional ingredients such as glutathione which helps reduce darkness. It sounds like you've had a nice treatment, and I would suggest you stick with your current management. I expect you will be happy for much longer than you expect. Top up treatments in the future may require less product than used in your first treatment.

Hi, thank you for posting a great question and photo. I agree with your suspicions that this is indeed tyndall effect. Your tear trough area does not appear to be over filled which is good. The tyndall effect may be relating to the type of product used or the placement may be too superficial. This can last many years so I would advise dissolving with hyaluronidase is best. You will feel hollow here after dissolving, but this can be re-treated with a suitable dermal filler and injected on the bone to minimise the risk for repeat tyndall effect. If the amount of hyaluronidase is kept to a minimum, and injected directly into the problematic filler, then adverse effects on your own natural tissue can be avoided.

Hi, thank you for a great question. I am a big believer in combination therapies. Combined therapies are always better than stand alone therapies. Microneedling is a great treatment that creates micro traumas to the skin which induce collagen formation in the healing process. PRP delivers more than 30 bioactive growth factor proteins into the skin and this leads to a very intense collagen production. The two treatments go hand in hand very well. Great for scarring, for addressing fine lines, crepey skin, loss of skin elasticity, and a reduction in pigmentation and dark circles. It is best that the PRP is injected into the skin rather than massaged on top of the skin. It can take 6-8 weeks to see the full results, and a number of treatments are usually required. I like to combine hyaluronic acid with the PRP also, delivered at 1.2 - 1.6 mm below the skin surface. I hope this information is helpful to you.

Hi, thank you for your questions. A non-surgical rhinoplasty can be achieved with the use of dermal filler. This is a relatively quick procedure and can be a great option for hiding a nasal bump, a rounded hump, a hooked nose, a deep nasal bridge, a flat nose and a drooping tip. It can also effectively address asymmetry. I like to use a firm HA filler such as Restylane Lyft (Perlane) and inject the product on the surface of the bone or cartilage. The majority of my patients do not require re-treating for 1.5-2 years. If the re-fashioning of the nose is extensive, then an earlier interval to re-treatment can be expected. And over time, once this area has been treated a few times, the result can last many years. It is reversible with the use of hyaluronidase injection. It is of extreme importance to ensure that you are in very experienced hands for this procedure as critical nasal arterial supply can be blocked resulting in tissue breakdown.

Thank you for your question. The side effects you outline are common plus temporary numbness. Swelling is the most common side effect and patients can be self conscious about their appearance for 2 - 5 days. In general, the greater the fat pad and the greater the dosage of Kybella required, the more swelling can be expected. Some patients will wear a turtle neck or neck scarf to minimise visibility of swelling. Application of cold packs and use of anti-inflammatories such as ibuprofen can be used to speed up the resolution of swelling. Using ibuprofen does not interfere with the effectiveness of the treatment. A rare side effect, that the manufacturer has recently brought to the attention of practitioners, is ulceration and tissue necrosis (breakdown) - this is thought to be due to injections being too superficial or intra-arterial. To minimise side effects, ensure you have your treatment with an experienced practitioner.