Natural Looking Results with Botox + Dermal Fillers

Regardless of whatever is trending, natural looking results are always the goal for us when it comes to facial rejuvenation with Botox and dermal fillers. Thankfully, “natural looking” is the current trend in cosmetic dermatology – aka. treatments of Botox and filler are never obvious. Even so, many inexperienced and over-zealous injectors are out there keeping Overfilled Syndrome alive. #pillowface #distorted #unnatural

Overfilled Syndrome (aka overindulgence in dermal fillers; too much of a good thing): 

A continuous mid-face bulge is appropriately called “pillow face.” 

Gone is the natural lower lid/ cheek junction. Gone are bright, open eyes. 

Gone are teeth when smiling. Gone is a balanced, youthful face.

How do we “keep it real” when using Botox and dermal fillers for facial rejuvenation?

In regards to Botox for upper face (forehead, brows, glabella, crows feet):

Let’s first be reminded that youthful faces move, and while there are places where a deep freeze is desirable (ie. Antarctica, the North and South Poles), there are places where it is not (ie. our faces). 

The first words which may come to mind with the word “youthful” are movement, expression, fresh, natural, beauty.

Skillful Botox injections do not alter the way you look. Skillful Botox injections in the upper face soften lines and wrinkles on your forehead and around your eyes, even the position of your brows, have you looking well rested and feeling happy. Skillful injections of Botox never leave you looking “frozen” (aka a little detached and unnatural). Check out this link.

Other ways we use Botox with natural looking results which may surprise and delight you as much as it does me:

• facial slimming for those who work those jawline masseter muscles like a bodybuilder works pecs and gluts

• teeth grinding (Bruxism) while you still have teeth to grind 

• excessive sweating (hyperhidrosis) that has supplied your dry cleaners with enough business to put their children through college (usually lasts longer than facial injections of Botox)

• lip lines that make you look as if you have been a multi-pack smoker for decades (a tiny amount of Botox injected here makes a HUGE difference)

• bunny lines on either side of the nose – only cute on actual bunnies btw 

• smoothing chin dimpling as “peau d’orange” may be a key ingredient for a solidly concocted Old Fashioned, but “skin of an orange” is never a good thing anywhere on the face 

• wound healing by preventing any stretch around them as they heal – great around stitches to keep the line thin, smooth and flat

• Smooth and tight as Nefertiti Neck Lift (personal fave)

• Pore-tox for pore shrinking (aka glass skin)

• a slight lift of the tip of the nose to which I give a tip of the hat

• for Resting Middle Aged Face or Frowny Face – When Botox is injected into the depressor muscles, those frown-y or flat corners of your mouth are forced to turn upward, helping also to soften the appearance of marionette lines.

In regards to keeping it real with dermal fillers:

1. We don’t chase lines and folds with filler. Lines and folds oftentimes result from volume loss in other areas. For the most natural results, addressing the areas responsible for skin’s descent – forming jowls, deep nasal labial folds, marionettes, drooping brows, etc. – should be first addressed with respect to the face in its entirety.
2. We respect the anatomy of the patient. If you’ve never, ever had cheeks, you probably never, ever should. However, if you have always had a weak chin, chin augmentation with filler can be life-changing and confidence boosting. (see #4) Also, a little filler in lips, helps them look smooth and hydrated.
3. We respect the age of the patient. When filler is done well, it is never discussed; everyone just thinks you look great for your age, no matter your age.
4. We respect the aesthetic ideals of facial balance and proportion in relation to individual facial anatomy. (See #2 and Dermal Fillers.) 

Every face is different, and the differences should be maintained. A “fill-by-numbers” approach is not a good one. For instance, bee-stung lips and a razor sharp jawline may not be appropriate for all.

Skill dictates outcome. There truly is nothing scary about Botox and legitimate dermal fillers; the scary part almost always involves the injector. Technical expertise and artistic sensibility are of equal importance. Again: Technical expertise and artistic sensibility are of equal importance. 

ATTENTION PRICE-SHOPPERS: Botox and dermal fillers are medical procedures. Botched jobs can cost you far more than a fist full of dollars. Skill and quality oftentimes cost a bit more. #worthit

Natural looking results using dermal fillers requires skillful injections of:

• the right product – dense fillers for heavy lifting and maximum projection with minimal product (Volluma), softer, more liquid fillers for soft areas (Volbella, Juvederm, Restylane), bio-activators (aka collagen stimulators) for gradual lifting, filling and smoothing generalized areas (Bellafill, Sculptra).

• in the right layers/planes/points – Deep layers of volume loss (fat and bone depletion) should be addressed before addressing shallow or superficial layers. When the bulk of correction is deep, lifting looks natural.

• in the right amounts – less amounts of fillers over the course of several months is the best approach. Fillers will settle with facial movement, sleep positions and other activities and habits. It is best to make adjustments as needed over multiple sessions.

Once the desired degree of rejuvenation has been reached, the most common question from patients: When will I need more? 

The answer:  It depends.

The ideal strategy for maintaining these natural looking results, and seriously slowing the aging process in general, is with other cosmetic treatments (chemical peels, lasers, microneedling, RF, etc.), consistent use of therapeutic products (retinoids, antioxidants, sunscreen, etc.), touch-ups with Botox (generally 3x per year) and dermal fillers as needed (generally 1-2x per year), and staying healthy and hydrated. Let’s face it, while Botox and fillers can work a special magic, they do not stop time; aging continues with or without these age-defying, facial sculpting potions. 

A few important words of advice: Don’t wait until things deflate to your pre-filler, pre-Botox days to schedule an appointment. It is far less expensive and far less time consuming to just keep up with treatments as needed or recommended.