Nonsurgical Alternatives to Facial Rejuvenation

By James Moore, MD, FACS

We all want to look our best. However, not all of want to “go under the knife.” Issues related to incisions, healing, downtime, and overall risks frequently discourage patients from surgical options. Fear no more! With recent advances in fillers and injectables, significant improvements can now be delivered in our offices using combinations of these products.

The forehead and brows are ideal spots for Botox injections. Botox can smooth some of the forehead furrows, as well as soften the vertical “11’s” between the brows. Many of us also have some asymmetry in terms of brow position. One may be higher or flatter than the other. Botox can even those out. Finally, the smile lines or crow’s feet around the eyes can be flattened with small injections.
In the mid-cheek and jaw area, the issues are not just sagging skin but volume loss as well. There is progressive loss of fat in our face with age. We now routinely treat these areas with volumizing fillers such as Juvederm Voluma. The cheekbones can be enhanced and the hollowness in the cheeks can be filled. This results in a lifting of the cheek and softening of the cheek folds. The results are immediate and the effect can last up to two years.

The step off seen at the eyelid-cheek junction (tear trough) can be smoothed with a lighter filler such as Restylane Silk. Treating this area can also minimize some of the dark circle effect of the lower lids. Over time, there is also progressive thinning of the lips, loss of shape and the development of vertical lines. The lip shape and volume can also be enhanced with these same types of fillers. The goal here is not to overfill the lips but to give better definition and smoothing. The upper lip and lower lip are not the same volume. The lower should be somewhat fuller. To complete the process, we now offer these two fillers along with HA5, “liquid Juvederm,” in our Liquid Facelift package. The HA5 is a combination of five different hyaluronic acids that act to replenish and hydrate the skin in as little as 15 minutes. The Liquid Facelift is an office procedure without the need for anesthesia and without downtime. Patients get to observe the results while we are performing the procedure and give feedback. This feedback is critical, as I want you, the patient, to direct the process. Some bruising may occur and we recommend that aspirin be stopped about a week before the procedure.

The chin and neck now have two additional options for treatment beyond traditional liposuction. Kybella is a series of injections that melt the fat over a 12 week period. There is swelling directly after the injections which resolves within 48 hours. Coolsculpting, as the name implies, freezes the fat and again, over a 12 week period, the fat disappears. The coolsculpting session takes about 45 minutes but there is usually no swelling. In both cases, the fat is permanently removed. And in both circumstances there is a progressive improvement of the neck angle.

The first step is a consultation to evaluate your goals and your desires. As always this evaluation is complementary.
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