So I've decided for a combination of Botox and ultheraphy. Perhaps next year I'll try fillers. Any thoughts? (photos)

I want to refresh my look. Concerned about a fine line ive recently developed on upper eyelid (dropping) and fine wrinkles when I smile on lower eye lid. I had the dark circles forever and learned to live with them (cover them with makeup as much as possible).

Doctor Answers 13

Botox and Suggestions to Refresh Your Appearance

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Botox would be the ideal treatment to inject into the glabella and forehead area.  I would also inject a small amount of Belotero into the tear trough area.  I much prefer Thermage to Ultherapy for tightening and lifting the skin.  I find Thermage works better with the new CPT technology and is pain free.  For the best cosmetic results please consult a board certified dermatologist with a great deal of experience with lasers and facial injections.

Botox will help to soften the lines between and around your eyes.

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
Botox will help to soften the lines between and around your eyes. Botox, if injected skillfully can provide a small brow lift. Schedule a consultation with an expert injector to discuss your concerns and obtain information for a treatment.


Martin Jugenburg, MD
Toronto Plastic Surgeon
4.9 out of 5 stars 518 reviews

Botox and Ultherapy to refresh you face

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
Looking at your photo, I think that Botox will be an excellent way to smooth out the dynamic wrinkles between your brows and around your eyes.  This will also allow you to have a modest brow lift which will further open your eyes and make you look more refreshed.  As far as Ulthera, it is a wonderful treatment and works very well.  In my practice, I recommend this treatment for my patients who are in their mid 30s and on.  It serves as a wonderful way to tighten the muscles and the skin of the face.  It becomes a great preventative as well as corrective treatment.  I feel that everyone after 35 can benefit from this treatment.

Victoria Karlinsky, MD
Manhattan General Surgeon
4.7 out of 5 stars 26 reviews

You might also like...

Try Toxin between the Eyes, then Ulthera to Open Eyes More

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
When I look at your pictures, you are a perfect candidate for a toxin: Botox, Dysport or Xeomin. That will take care of the lines between your eyes. If you want to open your eyes some more (reduce the upper lid) having an Ulthera treatment can surely help here. And under the eyes, where you have tear troughs, a dermal filler would help a great deal. On top of all this, an appropriate skin care regimen will help greatly and should be part of the treatment plan.A board-certified dermatologist or plastic surgeon can give you all the appropriate treatment options — someone mentioned going to 3 plastic surgeons — not sure that is needed. In fact, finding the appropriate dermatologist or plastic surgeon is the best call.

Michael Gold, MD
Nashville Dermatologic Surgeon
3.9 out of 5 stars 17 reviews

Facial Treatments with Fillers Botox and Ultherapy

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
This is one of the best combinations out there for looking younger and maintaining youthful lifted skin.  I suggest going to an expert who is meticulous about keeping someone natural and improved not different.  Best, Dr. Emer.

Jason Emer, MD
Los Angeles Dermatologic Surgeon
4.8 out of 5 stars 207 reviews

Facial aging treatment without fake or done look.

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
Facial aging treatment without fake or done look. Can be done if u see an experienced facial surgeon who does natural looks. Conservative surgery will give u a much better result. 

Toby Mayer, MD
Beverly Hills Facial Plastic Surgeon
4.8 out of 5 stars 38 reviews

Combination Procedures

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
Based on your description and photo, a liquid facelift which incorporates fillers and botox would be a better combination treatment than botox and ulthera. The amount of tightening and duration of ulthera does not warrant the cost. Consult with 3 board certified plastic surgeons who are master injectors to better understand your options.

Kris M. Reddy, MD, FACS
West Palm Beach Plastic Surgeon
4.5 out of 5 stars 56 reviews

Combination therapies: Botox, Ulthera, Fillers, others

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
Dear veronicamessi:

Thanks for sharing your photo. This is helpful. I presume the combination therapy you speak of are for the "11's" lines between your brows. The expanded photo provides other clues including pigmenation (freckles) and fine lines and creases under your eyes from age and sun exposure or weathering. 

For the ultimate in non-surgical face enhancements including filling, lifting, smoothening and glowing, consider a "Liquid Face Lift!" This is the use of non-surgical options to rejuvenate the skin and reverse the folds, creases and lines. 

Botox and Dysport too have been found to rebalance excessive facial expression, provide a non-surgical brow lift and lip lift and reshape the nose, as well as reducing wrinkles!

The most popular of the fillers, Restylane and Perlane, a jelly-like clear skin filler is used to fill lines, wrinkles and folds. Juvederm and its longer lasting "cousin" Juvederm Ultra Plus are similar skin fillers, used to soften and fill the nasolabial ("parentheses") and marionette folds, the brow ("number 11") lines and fill and lift the cheeks and lateral brow or chin. Voluma is the longest lasting, up to 2 year duration HA filler. Each one is used to expand or volumize the loss of tissue associated with expression, weathering or aging. All the fillers come with numbing anesthetic!.

Scuptra is the latest of the injectibles stimulation collagen at different levels of the skin adding volume but primarily firming and adding resistance to the formation of wrinkles, folds and descent.

Dr. Obagi's new, second generation ZO Skin Health programs may be added to personalized chemical peels, light and laser resurfacing and tightening and will, smoothen and even the color of your skin.

IPL and fractionated lasers such as CO2 and erbium and now RF (radiofrequency) and US (ultrasound )(eg Ulthera) are additions to smooth the texture of the skin, tighten and reduce red and brown uneven pigmentation.

Given your concerns, Botox will work very well to quickly relax the muscles which make the "11"s. Used in the lower lids may lead to drooping of the eyelid and puffiness.

Ulthera will show a fast effect of tightening but will relax quickly and use its heat component to stimulate collagen for a longer term effect. 

I would recommend returning to your Board Certified well experienced Plastic Surgeon or Facial ENT 2-3 weeks following Botox use and starting a retinol / tretinoin / pigmentation rejuvenation program such as that by ZO and filling in the "11's" for an immediate, short and long term effects. 

Use lasers and RF or US options to smooth the rough textured skin and for additional tightening.

I hope this was helpful! All the best!

Dean P. Kane, MD, FACS
Baltimore Plastic Surgeon
4.9 out of 5 stars 103 reviews

Fillers Work Well & Immediately For Improving Dark Circles & For Performing A Nonsurgical Browlift

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
Botox, which I have been using for aesthetic reasons since 1991, is helpful for dynamic wrinkles, i.e. those wrinkles that become more pronounced with expression. In this case, Botox (as well as other neuromodulators, like Dysport and Xeomin) can help to soften the scowl (frown) lines between the eyes, the crow's feet on the sides of the eyes and the forehead worry lines. 

However, for dark circles and depressions under the eyes, fillers would be more appropriate. (My favorite for this area, especially when there is darkening, is Belotero Balance, which has little to no tendency to engender the unwanted, bluish Tyndall Effect when it is injected superficially into the delicate tissue beneath the eyes. And for extra lightening, I also add a tiny amount of Radiesse, a whitish colored filler). 

For an instantaneous nonsurgical browlift, consider The Nonsurgical 3D Vectoring Browlift, which may be performed with Juvederm Ultra Plus XC (in my Upper East Side Manhattan office) and Stylage XXL (in my Israel satellite facility where a far greater number of regulatory agency approved fillers and volumizers are available). The entire procedure typically takes no more than fifteen minutes.

I am personally not much of a fan of Ultherapy, or for that matter many of the lasers, including fraxels, and radiofrequency devices. Treatments tend to be expensive, very uncomfortable, and for the most part seem to yield subtle results at best. 

It is important to seek consultation and treatment by a board certified aesthetic physician with experience and expertise in nonsurgical facial rejuvenation techniques.

Nelson Lee Novick, MD
New York Dermatologic Surgeon
4.9 out of 5 stars 33 reviews

Combination of Botox, Ultherapy, and Fillers

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
Hello Veronica. Botox, Ultherapy and Fillers work very well when used in combination together to address total facial rejuvenation. The Botox will help with the dynamic lines and wrinkles of your brow and crow's feet area. Ultherapy will help lift your brows, tighten loose skin underneath your eyes and provide a full face rejuvenation. Hyaluronic Acid based fillers (Belotero, Juvederm, Restylane) will help add volume under your eyes and improve the appearance of your dark circles. Chemical peels and at home skin care products can also help with the dark circles under your eyes. It's important to choose a physician provider who has expertise with all these treatments and can develop a long term treatment plan for you. Best of luck!

Michael A. Zadeh, MD, FACS
Sherman Oaks General Surgeon
5.0 out of 5 stars 10 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.