Am I a good candidate for Botox or would something else work better for me? (Photos)

Question

Hi! I am turning 39 in 2 months and would like to address the issues of aging on my face and neck that are starting to make me really self-conscious. I am worried about the heaviness of my eyelids, the thinning of my lips, the lines appearing around my lips and eyes, and everything else that is causing me to look older. Would Botox be the best non-invasive treatment for me? Thank You

Jason Emer, MD · Answer

Wrinkles can be improved with a combination of Botox and/or fillers for the lines themselves and to build anatomical support with Sculptra for collagen building. Ultherapy is a great skin tightening device, but works best in combination with other treatments like RF treatments, lasers, microneedling/PRP or sculptra to get increased collagen, tightening and improve skin tone. I recommend getting a formal evaluation with an expert. Best, Dr. Emer

Tim Neavin, MD · Answer

Thank you for your question and for your photos. Based on your photos provided, you are an ideal candidate for botox and fillers. I would advise you to schedule a consultation with a board certified plastic surgeon for a detailed examination to discuss all possible treatment options and what your expectations are.

Thomas J. Walker, MD, FACS · Answer

A combination of Botox and fillers would be excellent. Fillers are used to volumize and shape the face to restore volume we lose as we age and elevate the cheek bones. I suggest you see a board-certified facial plastic surgeon, dermatologist, or plastic surgeon for a consultation. Good luck!

Nelson Lee Novick, MD · Answer

Although there is no substitute for an in-person examination that allows for palpation and manipulation of the skin, there are certain recommendations that may be made based upon the photos provided. There clearly appears to be some age-related volume loss in the cheeks, particularly the mid-facial regions. This volume deficit within the cheeks and mid-face regions is likely not only responsible for the more tired look seen, but for the deeper smile folds and incipient marionette lines that are evident in the photos and for the beginnings of the loss of the more youthful and desirable, overall heart-shaped appearance of the face. Volume loss is likely contributing to thinning of the lips, as well.  A volumizing filler, such as Voluma XC, which I would use in my Manhattan office and Stylage XXL, which I would use in my Israel satellite facility, where a far greater number of regulatory agency approved volumizing fillers are available, would help to restore the more youthful heart-shaped of the face, and, at the same timely, likely improve the smile folds and any jawline definition problems (without even the need for directly treating those areas). I would suspect, however, that the smile line region has already become superficially creased and "etched" by this stage, which may necessitate the use of  an additional superficial filler, such as Belotero Balance (NY) or Aliaxin FL (Israel) to elevate and smooth them even further. The lips may be augmented with Juvederm Ultra Plus XC (NY) or Princess Volume (Israel).  Finally, Botox (or Dysport or Xeomin) may be injected into the glabella "frown" lines between the eyes and forehead "worry" lines to help to diminish the muscular hyperactivity that plays a part in their development with the passage of time.  A couple of microdroplets of neuromodulator injected in the outside "tails" of the eyebrows would help to raise the brows and open up the eyes a bit more. All of the aforementioned together should not take ore than about thirty minutes to perform and engender little to no significant downtime. However, contouring and shaping of the face with volumizing fillers should not be left to the hands of novice injectors or medspas accustomed only to injecting simple Restylane or plain Juvederm into ordinary smile lines. Make sure that you consult with a board certified aesthetic physician and insist upon seeing his/her before and after photos before agreeing to proceed. Best of luck to you.

Thomas Trevisani, MD · Answer

In person exam is essential. Based on your photos- there're various procedures that can be offered- both surgical and non-surgical. Surgical, of course, will give you the best most reliable and longer lasting effect, and non surgical -is less dramatic -temporary. Be sure to seek in person exam by an experienced Board Certified PS

Aldo Guerra, MD · Answer

Thanks for your question. I believe Botox is a good place to start. You seem to have great skin and you will need to take care of it with a skin care regimen and sunblock. Botox can help with lines in the forehead and the heavy eyebrows. Next, you should consider dermal fillers for thin lips and other lines and depressions in the face. Always see an experienced physician/injector!

Nelson Castillo, MD · Answer

Thank you for sharing your questions and photographs.  One recommendation I would advise is to establish a good skin care routine.  The basics include a retinoid or tazorac cream (to thicken your skin, and accelerate skin cell turnover leading to a "fresher" skin appearance), a lightening cream (to even skin tone), and a titanium or zinc oxide based sunblock.  These will go a very long way.   As far noninvasive treatments, wrinkle relaxers such as Botox will help the creasing in around around your eyes and the vertical lines between your brows.  Dermal fillers can help smooth smile lines and improve cheek projection giving a more lifted/refreshed look.  Hope this helps

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question.  The
best advice you can receive is from an in-person consultation.  Based on
your photographs, you would benefit from botox in your forehead and lateral eyes area.  Fillers such as juvederm would work well for your nasolabial folds.   Make sure you specifically look
at before and after pictures of real patients who have had this surgery
performed by your surgeon and evaluate their results.   The most
important aspect is to find a surgeon you are comfortable with. I recommend
that you seek consultation with a qualified board-certified plastic surgeon who
can evaluate you in person.
Best wishes and good luck.
Richard G. Reish, M.D.  FACS
Harvard-trained plastic surgeon

Benjamin Barankin, MD, FRCPC · Answer

I think in your case, Botox for the frown lines is a great starting point. Botox can also be used to help with eyelid heaviness. As for thinning lips and lines around the mouth, filler is where its at. Best to speak with a highly trained expert physician such as a dermatologist for optimal results and safety.

Kristin J. Tarbet, MD, FACS · Answer

Hello and thank you for your question. Looking at your photos I see areas that would benefit from muscle relaxation with Botox or Xeomin. The area between your eyes would benefit from Botox. In doing a "glabellar" injection you would most likely raise your eyebrows a millimeter or 2 and soften your "11's".  I think it is important for you to find an injector you like and trust before proceeding. Good luck to you should you decide to proceed.