Roger Shiffman, MD

Looks like the filler has accumulated in the tear trough. It needs to be dissolved using a reversal agent like Hylenex. After it is successfully dissolved you can be reassessed to see how to best treat this area. I prefer a filler product with a low G prime, such as Juvederm Volbella. It is a really soft product for this area and doesn't pull too much water and create that worm like bulge. I prefer using a cannula to carefully and safely inject the product and by using a fanning technique. Less is more as well. I prefer to undertreat this area and gradually add more if needed at subsequent appointments. I often suggest that the cheeks be injected to help lift the mid face and that will also improve the appearance of this are.

You are a perfect candidate for any of the neuromodulators.  They can definitely help you achieve a softer more youthful appearance in these areas.  Botox is a great choice, as well as, Dysport or Xeomin.  Any of these can address your complaints of wrinkles between and around your eyes.  They are all FDA approved to be used in these areas.  Some injectors may place a small amount around your lips to help control the wrinkles around your mouth, however, you would need a qualified injector to assess and inform you of your options in this area.  You may be a candidate for a small amount of filler to your lip lines as well.  Fillers and neuromodulators are a technique-sensitive treatment. It is very important to speak to a licensed, trained, medical expert in facial anatomy but the outcomes with the right medical professional is absolutely beautiful!  

I have great success in softening these lines with Hyaluronic acid fillers such as Belotero, or Juvederm.  The newer Refyne and Defyne are fun to use as well because they move with the face and don't swell too  much for a natural look.  Just know that these type of smile lines may become deeper as you age so it's best to start sooner than later. Your expectations should be to soften because these lines occur in an area of movement.  We want you to smile but realistically they may never be completely gone with facial expression.  But, we can make the static lines ( the lines you still see when you are not smiling) go away for a smoother look!!  Be sure to wear sunscreen to prevent more skin laxity and certainly other methods of keeping the skin firm are helpful like Ultherapy, laser, and topicals that encourage skin turnover. Keep smiling!!

The important thing to remember is that hair growth cycles vary on different parts of the face and body.  The hair on the face and head cycle faster than on other body areas. We usually schedule laser hair removal on the face closer together than on legs and bikini.  You are just fine waiting 10 weeks in between treatments!!

Yes, folliculitis is common.  A glycolic scrub such as SkinMedica's GlyPro Exfoliating Facial Cleanser is not just for the face and I often recommend it for this with nice results.  You can start it three times a week and increase as needed.  A loofah can be helpful at all.  Just don't pick!!! If you are a darker skin type you are at risk for hyperpigmentation.