Botox

Skin Rejuvenation

TotalFX

Botox is very effective when used for dynamic wrinkles.&nbsp; When it fails to work, it is usually because not enough was used or the botox was expired or stored incorrectly.&nbsp; Very rarely there are patients who develop resistance to botox if they have been using it for a very long time.&nbsp; In this case it is best to use an alternative such as Dysport.

Has Botox Ever Not Worked for Frown Lines, and if Not Why?

If you have wrinkles present at rest and these lines are due to muscle movement (typically between the brows or horizontal forehead lines), these can be improved significantly by botox.&nbsp; They may not disappear completely if they are present at rest.&nbsp; In addition to botox, a small amount of filler can be used to minimize, even further, the presence of lines at rest.&nbsp; I have found many of my patients to be very satisified with botox alone since they still have a great result and appear more relaxed.&nbsp;

Will botox make my permanent worry lines dissapear?

Permanent Worry Lines. Will Botox Help This?

There is no age limit to botox use.&nbsp; I don&#39;t treat patients who have a history of neuromuscular disorders such as myasthenia gravis or other neurologic conditions or allergies to any components of botox.&nbsp; Clinical history is always important to obtain, particularly a history of prior procedures (face lift for instance) since the musculature that is injected may be in different positions.&nbsp; In addition, older patients may have wrinkles due to skin laxity, rather than muscle movement and these wrinkles&nbsp;are less likely to be&nbsp;improved by botox.&nbsp; Finally, lower doses may be used in older patients due to weaker muscles and there are nuances to injection sites in older patients, so that&nbsp;I typically do not inject extensively in the forehead as there is a higher chance of a&nbsp;brow ptosis (inability to raise eyebrows).

I have had botox in the past, just not in last two years. Had only between brows.

I Am 66. Is There an Age Limit for Botox Injections?

Botox does wonders for crows feet as well as for undereye wrinkles that are caused by excessive movement of the muscles.&nbsp; That being said, if someone has a lot of loose skin under the eyes and crepiness (loss of elasticity, etc), then I typically never treat infra-orbitally and very conservatively (low units) will treat the lateral lines.&nbsp; Sagging of the lower lids is an issue whenever there is skin laxity and needs to be addressed as a potential problem prior to injecting this area.&nbsp; I will often perform a clinical test to determine if there is a lot of lid lag (and therefore too much loss of elasticity) before injecting this area.

Can injecting around the upper cheek area under the outer edges of the eye cause muscle weekness affecting lower eyelid sag. I was showing the signs of crepey lower eye lid but it looks so much worse now after the botox because it seems my eyes are too weak to hold the skin up? Is this common? I realize that other parts of the look better but this was the second time I have had botox and didn&#39;t have this problem.

Sagging Lower Eyelids After Botox

Botox is very effective for wrinkles on the upper part of the face, forehead, frown lines (between the brows) and crow&#39;s feet.&nbsp; These lines are due to repeated muscular movement and are known as dynamic wrinkles.&nbsp; The lower face wrinkles, such as the marionnette lines (lines radiating from the lateral corners of the mouth towards the chin) are better treated with fillers to replace volume.&nbsp; Occasionally, a tiny amount of botox can be used in the depressor angularis oris (DOA muscle), a lip depressor, to relax marionnette lines and create an uplifting effect on the mouth corners.&nbsp; This is better done in combination with a filler.

What&#39;s best for marionette lines? botox or fillers? I&#39;ve heard a small amount of botox can be injected to correct marionette lines, is that true? If so, how about the tight feel it leaves? Is it safe? I had botox in between my eyebrows and crow&#39;s feet.I even like that tight feel it brings, but around the mouth area I feel it might be a different story. My doctor said I dont&#39; need any correction to marionette lines, but suggested a small amount of botox there if I really insisted.

Can Botox Be Used to Correct Marionette Lines? Is That Possible?

The best treatment for skin rejuvenation varies depending upon an individual&#39;s skin type, age, ethnicity, sun exposure, and overall health.&nbsp; I am a major proponent of a healthy lifestyle:&nbsp; diet high in fruits, vegetables, nuts, legumes and fish, 8-10 hours of sleep, limiting alcohol intake other than the occasional glass of red wine, and regular excersize.&nbsp; Next step for all skin types is sun protection including daily sunscreen, sun hats and sunglasses....and avoiding sunburns!&nbsp;

	Moving on to reversing signs of damage, I would recommend first and foremost using a daily topical vitamin A product such as tretinoin&nbsp; (by prescription) or retinol (over the counter).&nbsp; If these cannot be tolerated, then anti-oxidant topical creams such as vitamin C, E, co-enzyme Q, coffeeberry, or green tree extracts can be used.&nbsp; Regular exfoliation with topical AHA/BHAproducts (glycolic acids, fruit acids, salicylic acids) either&nbsp; as leave on products or peels are extremely helpful to use at least 1-2 times weekly.&nbsp; Maintaining skin hydration using&nbsp;topical moisturizing creams is also beneficial.&nbsp; Older, delicate and drier skin may require&nbsp;thicker moisturizers and younger, acne&nbsp;prone skin may require oil free moisturizers or serums.

	It is never too late to start a skin care&nbsp;regimen.&nbsp;&nbsp;After years of neglect, it may be helpful to first undergo a series of&nbsp;medical grade peels, supplemented with photofacials as necessary.&nbsp;

	Deep folds and dynamic wrinkles and fine wrinkles are best treated by combinations of fillers, botox and resurfacing laser procedures.&nbsp;

My skin is lets say, 'mature' ;) i'd like <a href="/Skin-care/info">skin care</a> experts to suggest best ways to rejuvenate and repair from years of ignoring skin maintenance.

What's the Best Skin Rejuvenation Treatment?

We charge 250 to 500 per treatment.&nbsp; A spot treatment is 250 and full face is 500.&nbsp; 2-4 treatment sessions are necessary and depends on the goals of the patient.&nbsp; Greater number and intensity of treatment is required for more sun damaged patients or for individuals with moderate to severe rosacea/red blood vessels.

How Much Does IPL Cost?

Downtime from IPL treatments are minimal.&nbsp; Typically shortly after the procedure the patient will appear flushed, may have a bit of puffiness and brown spots appear darker.&nbsp; It is possible to use sunscreen and cover up with makeup, immediately following the procedure.&nbsp; In addition, a patient may even return to work after a treatment.&nbsp; Over the course of the next few weeks (about 2) the dark spots will raise and there will be a &quot;coffee ground&quot; appearance to these areas and eventually slough away.&nbsp; Gentle cleansers and moisturizers with sunscreens are the mainstay of topicals that can be used during this time.&nbsp; I recommend avoiding the use of products containing AHA&#39;s and retinoids for one week prior and three weeks following an IPL treatment.&nbsp; Occasionally, when patient&#39;s with darker skin types are treated, they may develop post-inflammatory hyperpigmentation.&nbsp; This is reversible and can be managed with prescriptions lightening creams.&nbsp; In my patients with darker skin tones, I prescribe lightening agents one week prior and for one month post treatment.

time to recover from IPL laser? any info about IPL post-treatment is very appreciated

How long does IPL recovery take?

Dear Alisha,

	I would be very cautious about the use of total fx in Asian skin types.&nbsp; It can be done&nbsp; with excellent results but it is critical to have the procedure performed by a physician experienced in the use of this laser in Asian skin.&nbsp; The parameters need to be adjusted to skin type and lower energies as well as more treatments may be necessary.&nbsp; In general, skin hyperpigmentation (or darkening) following treatment is expected and is reversible.&nbsp;

	Sincerely,

	Dr. Mikkilineni

I Have Been Recommended to Have Total Fx, I Have Been Using Obagi for the last 12 months,I have been using it twice a week from May but had to stop using it on my upper lip after about 5 months as my skin became lighter on my upper lip compared to the rest of my face. Am concerned about the recovery time and side effects on my asian skin tone, should I have the treatment on my upper lip as well.

TotalFX Recovery and Side Effects (Asian Skin Tone)

Radha Mikkilineni, MD

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My upper lip is very small and asymmetrical. She use Restylane on both my upper and lower lip. At first it kind of felt firm for about 2 days and I was diffidently swollen. With in a few days the swelling started going away. Dr. RM differently made my lips look sexy and beautiful. I am very happy with my results.

Lip-augmention by Dr Rahda Mikkilineni NYC

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9 Answers from Board Certified Dermatologist Radha Mikkilineni, MD See Education, Board Certification, and Treatments Offered.

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Yale University

Dermatology, Case Western Reserve

Dermatopathology, New York University

MD, Georgetown University School of Medicine

Radha Mikkilineni, MD

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