look? Budget is $2,000

I have an appointment with an oculoplastic board certified plastic surgeon to get filler

in my tear troughs. He comes highly recommended. I feel confident about his abilities. But

I have questions about treatments for my forehead and lips. Re: my forehead, can I get Botox

in just my 11's and not the rest of my forehead? Or could I ask to get a natural looking forehead

instead of the smooth as glass look? For my lips, what's best to lessen these lines and

restore volume and address asymmetry?

Thank you for your question!

You’re very detailed in your question and stated your situation. You’re going to a

board certified plastic surgeon to have the treatment to your tear troughs and in addition,

you want to ask about treating the forehead with botox and what’s the best recommendation

for your lips.

Well, it is likely also just a side note that your oculoplastic surgeon should be able to

help you with those areas as well. Botox was one of the, oculoplastic surgeon were the

first to use botox long before it became used for cosmetic reasons so I’ve been using

botox for patients since 1993. Now I’m also trained in facial cosmetic surgery board in

the American Board of Cosmetic Surgery so I do a lot of facial work as well. I would

also say that as far as just commenting about the concern about botox and whether to do

glabella or the number 11s or to the whole forehead, you certainly have the option and

so we’ll just isolate that area.

From my perspective, one of the best areas to do treat in the forehead is the number

11s. It has such an impact. This set of muscles called corrugator and procerus muscle really

affect overall facial appearance. So if you’re someone who always thinks critically and looks

at something and frowns, then the number 11s being treated with botox, dysport or any other

neurotoxins can really be tremendously effective. You can certainly do that in isolation without

doing the rest of the forehead so that you don’t get the over smooth look as you described

it. It’s very individual. Examination really helps determine that. And you can take little

steps. You can just do the number 11s and try the forehead another time.

As far as the lip lines are concerned, in our practice, we generally treat the lip lines

with hyaluronic acid filler whether it’s Restylane or Juvederm. The lip lines can be

tricky because they can be deep line or they can be fine lines or even crisscross superficial

lines. And so the other options can also be entertained. We also, besides using fillers

to restore volume for deeper lines as well as to create a nice contour of the lip border,

we also use something like fractional CO2 laser or some type of resurfacing modality.

We’ve also used micro needling as well as something called platelet-rich plasma.

Platelet-rich plasma is using your own growth factors, derived from your own blood. That’s

basically the concentration of the necessary wound healing factors taken in a simple blood

draw and using that to build up collagen. What you’re describing is volume loss and

volume loss particularly the layers of the dermis or the backbone of the skin. So there

are a lot of different options and it all depends on what defines a satisfactory outcome

for you. I know you put down a number of budget that you want to work with and I think that

as we do every day in our practice in Manhattan and Long Island, people come to us with a

long list of things they want to do and then we figure out based on priorities and what

they can afford, what they are able to do at that time, then we’ll give them the most

value and based on what’s most important to you.

So with that being said, I think you can certainly discuss this with the oculoplastic surgeon

and your doctor. I’m sure they can be honest about what they’re comfortable with but

I wouldn’t be very surprised. Oculoplastic surgery really now is oculofacial plastic

surgery and most people trained in oculoplastic surgery are trained in facial cosmetic surgery

and it is common oculoplastic surgeons to perform facelifts and other things beyond

the limited area of the eye. So I think you can be able to get everything in one stop

and learn about your options at one place and that’s kind of a nice thing when you

don’t have to go to piece meal to people. So I hope that was helpful, I wish you the

best of luck and thank you for your question!