Stacey Tull, MD

If you are still able to frown and see an increase of the "11's" above your baseline, it may be that you need to have your dose tweaked.  Sometimes although you may block some of the muscles from contracting, the other muscles that form the frown (there are 4 groups in all) will overcompensate.  Typical dosing for a woman to treat the frown is from 20-40 units.  If you are paying by the area, it may be that you were undertreated (with the philosophy that you can always add more but not take it back).  Make sure that if you are paying by the area, what the touch-up policy is (touch-ups should be done about 2-3 weeks out).  We charge by the unit at our practice because no two patients are alike.

Why not consider a chemical peel?  This is a perfect way to remove or fade age spots (depending on the depth of the peel which in turns determines your down time) and unlike lasers it will not remove facial hair.  It will also tighten the skin and can be preventative against pre-cancers.

This is likely due to over treatment of the forehead lines.  The good news is that you may still get some brow elevation to offset this at about 2 weeks post injection (or you can have it done if you did not get injections at the midpoint of your brows above the pupil).  This comes from the relaxation of the frown muscles which takes about a week longer to set in than the initial blocking of contraction that you get within the first week of injection.  If you choose to have your forehead lines treated in the future, I would recommend that they only inject in the top 1/2 of your forehead and maybe use a more conservative dose.

The photos look more suggestive of photodamage rather than distinct vascular lesions.  Photodamage tends to have both a vascular and pigment component.  For this reason, I would recommend a series of IPL or BBL treatments.

Long pulsed Nd:YAG is the strongest and most effective treatment for vascular lesions on the face.  IPL is not specific but does treat the overall redness that is more associated with sun damage.

The younger you are the quicker your skin heals and responds.  Men also tend to heal faster than women (because of increased hair follicles).  Younger men can be treated as early as 3 weeks and young women as early as 4 weeks.

Aldara only works for the most superficial of skin cancers (and obviously pre-cancers).  If you treat a lesion with Aldara instead of surgically removing it and getting pathological confirmation that it is gone, you run the risk of allowing the roots to continue to grow down and around the scar of the superficially treated lesion.  While this may be a risk willing to be taken off the face, it is not a good place to wind up having a recurrent skin cancer years down the road and needing major reconstructive surgery for.

In the past, we did a lot of punch excisions for deep, ice-pick acne scars.  This worked for some lesions but sometimes you just traded the acne scar for a new scar that was no better or even worse.  I the recent years, we have been treating these types of lesions with a combination of fractionated resurfacing for the more shallow scars and for overall tightening and using a very strong chemical peel applied to the inside of the deep scars to get them to seal themselves off.

This is a thick filler so you should expect swelling for up to a week and bruising for up to a week.  Don't exercise for 24-48 hours after the treatment to minimize further bruising.  Ice and arnica montana help.

This completely depends on how deep the lesion is and where on the cheek it is.  Your surgeon should be able to look at the defect and help you determine not only what will look the best but also heal the fastest.  The most superficial of lesions can take 2 weeks to heal "naturally" while most facial sutures are taken out a t one week.  Also to consider is whether by letting it heal naturally you will be at higher risk for a keloid scar (which not only looks bad but can be quite irritating).