Dermal Fillers

Botox

Thank you for sharing your photos and for doing your homework before jumping into a treatment, that speaks volumes. I agree with your injector that Botox is not the right tool here. While it can be used to subtly lower one brow, it's difficult to control with precision and risks an unnatural or fatigued appearance, which is the last thing we want. I would gently offer a different perspective on the etiology. Facial asymmetry is most often entirely congenital, simply a reflection of the natural variation in skeletal and soft tissue development that exists on either side of the face, and in my assessment temporal volume is unlikely to be the primary driver of what you're noticing, meaning augmentation of that area alone may not meaningfully address the brow position. 
What I would recommend instead is an indirect brow lift. Brow lifts are one of the more patient-friendly procedures I perform, with most patients experiencing only mild bruising, mild swelling, and minimal pain, feeling like themselves again well within one to two weeks. It's performed through small incisions hidden entirely within the hairline and directly elevates and repositions the brow into a more symmetric position, lifting both the central brow and the lateral tail in a way that opens the eye beautifully. Based on your reference photo, it looks very achievable for your anatomy.

28F. I recently had a consultation with a cosmetic injector about the possibility of using Botox to even out my asymmetrical eyebrows. She informed me that the imbalance was actually due to one side of my face being flatter in the temple area than the other, so Botox would be ineffective. Instead, she recommended filler to add volume. Now that I know the cause, I’d rather invest in a more permanent solution if possible. Based on the images provided, would my goal be achievable through implants, or is filler my only option? I’ve posted an image of my unedited face and my ideal outcome for reference. Thanks.

Can temple implants correct assymetrical eyebrows? (Photos)

I can appreciate the asymmetry and heaviness you are describing and the great news is that it's very correctable. The most effective and long-lasting solution in your case would be an indirect brow lift, a straightforward procedure performed through two small incisions of roughly an inch each, tucked within the hairline where they are completely hidden. This directly elevates and evens the brows to match the opposite side. Recovery is quite manageable. Most patients experience moderate bruising, mild swelling, and minimal discomfort, with the majority feeling like themselves again within one week.

30F, had Botox 2x 1-2 yrs ago. Ever since then my left eyebrow feels heavy and like it has a large muscle knot, and I can’t raise it as high as my right eyebrow. I really hate the look of it and just want it to match my right eyebrow. How can i fix this?

Permanent Brow Droop from Botox 1 year ago - How Can I Fix This? (Photos)

What a thoughtful and insightful description of your anatomy. I want to reassure you right away that nothing you're noticing is related to your weight or the presence of excess fat. What you're describing is a structurally smaller chin: the bony foundation is less projected and cannot support the lower lip and jawline to its fullest potential, which is an entirely anatomical and hereditary characteristic. Because the underlying driver here is skeletal rather than muscular, Botox to the platysma unfortunately wont make any meaningful difference &mdash; it's a wonderful tool, but best suited for dynamic muscle activity rather than a structural bony deficiency. 
The exciting thing is that the chin is one of the most impactful and under appreciated areas of the face. A modest change in the chin creates remarkable downstream improvements along the jawline and beneath the chin, giving the neck a dramatically more defined and structured appearance even in motion. When you're ready to explore it, the options range from a customized chin implant tailored precisely to your anatomy, or a genioplasty which is a surgical reshaping of your own chin bone. Both are highly effective, and the right choice depends on your specific anatomy and goals.

I have always had a weak jawline and small chin. I don't have am orthodontic issues, though. My concern is purely aesthetic. I notice that when I talk, I have a double chin that isn't there at rest. The double chin doesn't feel soft or squishy, it feels tight. I think it could be my muscles, but I'm not sure. Would botox in these muscles (is it platysma, maybe?) help the jawline appear sharper, more structured, and stop my double chin from forming? Is there another procedure that might help? My weight is normal, I'm not skinny but I don't think fat is the primary driver of my double chin, it seems to me more like an anatomical/structural concern.

Weak jawline and double chin appearance when speaking. Can botox help? (Photos)

You've done a wonderful job researching this and asking the right questions. What you're experiencing is most likely a combination of the natural periorbital changes that begin in the mid-20s: early herniation of the small fat pockets that sit behind the lower eyelid pushing forward through the tissue, early hollowing of the tear trough (the groove that runs from the inner corner of the eye downward along the cheek, which becomes more visible as volume shifts with age), and fine lines that become more apparent with smiling as the skin thins over time. I'm not aware of compelling data linking spironolactone directly to structural lower eyelid changes. What you're noticing is most likely an anatomical process that was already underway and perhaps became visible during a period of heightened self-awareness. 
Filler is a wonderful option for many patients and something I have great respect for in the right hands and the right candidate. However, given your dry, thin skin and the degree of hollowing you're describing, I do have some concern that filler in this area could increase your risk of malar edema (chronic puffiness along the cheekbone) and paradoxical darkening, which can be difficult to reverse. My tailored recommendation for you would be a lower eyelid blepharoplasty performed from the inside of the eyelid with no external scars, combined with nanofat grafting; this is a technique in which your own fat is processed into a liquid rich in stem cells and growth factors that is then introduced into the lower eyelid skin to improve its texture, thickness, and overall quality from within. Recovery is typically a couple of weeks and offers a one-time option for treatment.

About me: 34F, 5’2”, 113 lbs. Dry, acne-prone skin. Hx: high DHEAS, eczema. No weight loss (gained ~2–3 lbs). Historically looked much younger than my age BUT Over the past 2–4 months, I’ve noticed a sudden change in my under-eye area: increased creasing/wrinkles when smiling, more hollow/shadowed appearance, and overall a more fatigued look. This was abrupt &amp; noticeable to others who’ve asked me if I’ve been in tu sun too much or not sleeping (negative). During this same timeframe, I started spironolactone (50–100 mg) for acne/DHEAS. It cleared my acne &amp; improved menstrual pain, but caused frequent nighttime urination. I’ve since reduced to ~50 mg intermittently. I also use retinol a couple times a week (including an eye cream), sunscreen, and basic skincare. I don’t drink caffeine or much alcohol, mostly just drink water, and haven’t had major lifestyle stressors. I stopped working 3 months ago (previously high screen time), so eye strain should be less. Questions: - Could this be dehydration/skin barrier damage vs early volume loss (tear trough)? - Could spironolactone or retinol be contributing? - Best conservative treatment approach? - Am I a candidate for PRF vs very conservative tear trough filler? - Are lasers appropriate or too harsh for dry/thin under-eye skin? Goal: understand cause and safest, most effective treatment.

Evaluation and Treatment for Sudden Under-Eye Changes (Hollowness, Creasing, Thin Skin Appearance) (Photos)

You are absolutely not alone in this - under eye changes in the late 20s and early 30s are incredibly common and what you're describing sounds like early herniation of the small fat pockets that sit deep beneath the lower eyelid. They slowly push forward through the tissue over time creating that puffy, rolled appearance while simultaneously dropping leaving the hollowness and the skin less taught when smiling. 
While filler is a wonderful tool and absolutely an option some patients love, in your specific case (given the volume of the bags and the skin laxity you're describing) it can sometimes lead to unwanted side effects like malar edema, prolonged swelling, or irregularities. My recommendation would be a lower eyelid blepharoplasty that leaves no external scars and addresses the root cause directly with the results that are long-lasting and natural. Recovery is typically 2 weeks and for the right patient is really a one-stop solution.

Hello! Im 26 F and have noticed my under eye hollows are on my face permanently, not just when im tired. What makes the worse, i have big jelly rolls that have grown in size and have a lot of baggy skin when I smile. I have heard about jelly rolls Botox as and option - is this safe? Also will filler look good in the tear trough area or will it look puffy and lumpy? Thanks!

How to improve the look of my jelly roll and under eye hollowness? (Photos)

You have beautiful moist and textured skin with feminine features. This should be a very straightforward fix!
What you're likely noticing is a small pocket of cheek fat, called buccal fat, which has aa naturally tendency to shift downward toward the mouth and jawline over time contributing to early jowling. This is a very gradual process which is why patients often don't notice it until they catch themselves in photos from a certain angle. Jowling is the soft tissue heaviness along the jawline that becomes more pronounced with time. Buccal fat reduction is a simple procedure performed entirely through the inside of the mouth, leaving no external scars, with a recovery time of just 3-5 days.

I’ve noticed in a recent video I had to film for work that I have a very pronounced little pocket of something (fat?) on the side of my mouth and not sure what to do about it. I don’t have smile lines or marrionette lines, just that random pocket creating a line right by the top side of my mouth. Any advice appreciated!

Small pocket and line on side of mouth - how can this be treated? (Photos)

You have a beautifully structured lower face and jawline with excellent skin quality, which are wonderful assets to work with. That said, based on review of your x-ray and clinical images, you would likely benefit most from a reduction genioplasty as both the bony chin and soft tissue chin pad contribute to the prominence you're noticing. Nonsurgical modalities will fall short in helping you achieve your desired goal. While chin reduction is a nuanced procedure that requires careful planning, advanced techniques and technology today allow for a very satisfying result with only a couple of weeks of recovery and mild, manageable swelling and bruising. Most importantly, the expressiveness and animation you bring when you smile, talk, and laugh is truly what makes your face uniquely and beautifully yours.

Hi. I a wondering if there is anything I could do to try and soften my profile, besides surgery? I have a very expressive lower face when i smile, talk, laugh. Just wondering if there are any suggestions. Thank you.

Is there anything I can do to soften my chin, side profile? (Photos)

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University of Pennsylvania, Children's Hospital of Philadelphia (residency)

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