Treatment plan needed: V-shaped glabella lines still visible after Dysport. Smile lines & nasolabial folds as well (Photo)

Botox works only for dynamic wrinkles, i.e. those wrinkles that appear in the overlying skin as a result of movement of the facial expression muscles below. What is being described here, however, are static wrinkles, i.e. lines, creases and folds that have become etched into the overlying fabric of the skin after years of innumerable times daily use of the muscles of facial expression. For these issues, appropiate HA fillers properly injected are the treatments of choice. Plain ordinary Juvederm, much like simple Restylane are typically used by novice inexperienced injectors, but would not be expected, as you found out the hard way, to be of much benefit. A low viscosity, cohesive HA filler would be more appropriate for the V-shaped glabella creases. A more robust, lifting HA filler would be more appropriate and much longer-lasting for elevating and smoothing the nasolabial lines and for stratighening the downturned angles of the mouth. You would be wise to consult an experienced, board certified cosmetic dermatologist and best of luck.

I recommend fillers to soften the nasolabial folds themselves and also lift around the mouth and cheeks to build underlying anatomical support. In our practice we combine Sculptra with other fillers "layered" on top and lasers, skin tightening treatments such as Thermage, Fractora, and Renuvion (J Plasma), thread lifting, and peels to get the most conservative, natural look. I suggest seeing a facial sculpting expert for a formal consultation. Best, Dr. Emer

It sounds like you are incorporating the correct things. You can consider adding Morpheus8. This treatment combines microneedling with RF technology to improve overall skin tone and texture. We also recommend using medical grade skin care products like Transform MD and wearing sunscreen every day.

The two sides of our face are not identical and aging does speed up on the side on which you favor to sleep. You might get good improvement with radiofrequency skin tightening and texturing treatment like /secret.

Without seeing you teeth it is obvious that there is an underlying structural issue that is Epigentic or developmental in nature. The DNA Appliance is, in my opinion the best non-surgical approach to your issues. There are also SARPE and MARPE approaches.

If you watch shows like CSI where they find a skull and then create a soft tissue image of what they think the person looked like then you understand that the face is a reflection of the bony and tooth support.

Your face reflects what the bony support creates and demands. Changing the underlying bone is best for correction of facial tissues that lasts a lifetime and slows signs of aging.

Trying to fix it cosmetically is one approach. A far better approach is to correct the underlying cause, an underdeveloped maxilla. To learn more about the cause Google "Shrinking Jaws Stanford"

The narrow maxilla can cause airway issues like snoring and sleep apnea, postural issues like forward head posture and it can increase problems with TMJ Disorders, Headaches, migraines and other health issues.