Case Studies Facial Fillers

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Chief Complaint

The patient is a 50-year old nursing supervisor who wished to have a bit more facial symmetry and elegance. She was focused on her under eye area (tear trough) hollowness in particular.

Assessment

The patient has a hyperactive right frontalis (forehead) muscle causing her right eyebrow to lift asymmetrically. She had early line formation in the glabelle (Between her eyebrows) and crows feet. Her facial shape was oval with the aesthetic ideal being more heart-shaped (wider in the middle of the face).  Her left hemi-face was naturally larger than her right resulting in a significant cheek asymmetry. She had a modest tear trough deformity and skin freckling. Lastly, given her pale complexion, I felt that aesthetically, she would be better served with a slightly darker hair color.

Procedures

The forehead muscles were relaxed with Botox to create better left-right eyebrow symmetry. Botox was also placed in her glabella and crows feet to soften the lines. Her tear troughs were re-volumized with Restylane®, which softened the lid-cheek transition and her right cheek was volumized with Voluma®. Note that her left cheek was not injected. The overall effect was to create a more symmetrical, heart-shaped mid-face. Her skin was treated with intense pulsed light to reduce her freckling and lastly, the patient darkened her hair and reduced the volume on top creating a pleasing frame for her beautiful face. The patient is shown 5 months after the procedures.

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Chief Complaint

The patient is an author in her mid 70’s who was unhappy with her facial appearance.  She was focused on looking healthy and vibrant but would only consider non-surgical solutions.

Assessment

The patient had substantial, asymmetric facial volume loss, most noticeably under her eyes and in her mid-face with the right cheek even less volumized than her left.   Her central lower lip was a bit small and her earlobes were very deflated. Her lower face had significant skin laxity with the skin folding into pleats in her lateral, inferior cheek. This was predominantly due to a generalized loss of facial volume. Her skin had a nice texture with few lines or wrinkles. Her upper eyelids had asymmetric excess skin and her neck was lax, however, she was not interested in addressing these issues as this would require surgery.

Procedures

To improve the patient’s appearance without surgery, the focus was placed on replenishing her significant facial volume loss. Restylane® was used to re-inflate the lower lid-cheek junction and Voluma® was utilized to re-volumize the cheek. Juvederm Ultra Plus® was used in her central lower lip to add slight fullness and Juvederm Ultra® was used to re-inflate her earlobes, which allowed her earrings to sit properly. Note that no fillers were placed in the lower face but this area showed significant improvement due to the lifting of the mid-face. The patient is shown at 1 year following her facial volume procedures.

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Chief Complaint

The patient is a woman in her 50’s who was unhappy with her facial appearance.  She was focused on looking healthy and vibrant but would only consider minimally-invasive, office-based procedures.

Assessment

The patient had a significant amount of upper eyelid hooding due to excess eyelid skin. The lower lids had good tone, moderate pseudo-herniated peri-orbital fat and a deep, extended tear trough deformity. Cheek volume was adequate. Most significantly, her chin was  weak and the skin stippled. This resulted in a short distance from her chin to her neck creating an unattractive lower facial-neck contour. Her skin had a nice texture with few lines or wrinkles.

Procedures

To improve the patient’s appearance while respecting  her desire to due things that were easy to recover from and could be done easily in the office, we began by replenishing her  facial volume loss. Restylane® was used to re-inflate the lower lid-cheek junction (tear trough) which gave the illusion of a lower eyelid surgical procedure.  Voluma® was utilized to improve the chin projection and jawline contour.  Botox® was used to relax the forehead, glabella (area between the eyebrows), crow’s feet and chin muscle to reduce the stippling in this area. She then had an upper eyelid blepharoplasty, in the office procedure room using local anesthesia supplemented with an oral valium, immediately following the injectable treatments, She is shown 6 weeks after her treatments. Notice how rejuvenated the patients under eye area and lower face, chin and jawline look. It almost seems like she had a facelift. In the areas that were volumized, the fillers were placed deeply, just above the bone. In these anatomically quiet areas of the face, her results may last up to 2 years before she will need re-treatment. The upper eyelids now have a pleasing contour with an appropriate amount of upper eyelid platform. The contour will continue to improve as the swelling resolves with time.

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Chief Complaint

The patient is a woman in her early 50’s who was generally happy with her appearance but wished to look refreshed. She was interested in facial fillers.

Assessment

The patient had moderate, symmetrical temple hollowness and significant hollowness under the eyes at the the lid-cheek junction (tear trough). There was moderately crepe skin of her lower eyelid but otherwise, her skin looked good.

Procedures

To improve the patient’s appearance while respecting  her desire to use only fillers, I placed  Voluma® to her temples and Restylane® to her  extended tear troughs. All fillers in these areas are placed deeply, just above the bone. Since these areas are anatomically quiet, the fillers should last about 24 months in the temples and 18 months in the tear trough.  The patient is shown 1 month after her treatment. Notice that her face appears softer and fuller in the middle one-third, which is most desirable in a woman. Also,  the lid-cheek junction is now connected giving the patient a more youthful and vibrant appearance. In the future, if the patient wishes to smooth and tighten the skin in the lower eyelid area, she  would be an ideal candidate for lower eyelid and crow’s feet CO2 laser skin resurfacing. area.

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Chief Complaint

The patient is a woman in her early 60’s who was unhappy with her heavy upper eyelids, puffy lower eyelids and neck laxity.  She was focused on looking healthy and vibrant and was open to both surgical and non-surgical solutions.

Assessment

The patient had a significant amount of upper eyelid hooding due to excess eyelid skin. The lower lids had substantial crepe skin changes with good lid tone and a deep hollowness at the lid-cheek junction (tear trough). She had significant loss of cheek volume manifested by a deep medial cheek hollowness, an isolated cheek highlight (notice the triangular shape to this lateral cheek area) and loss of lateral cheek width. This is indicative of substantial cheek devolumization, which leads to a disconnected look in the mid-face and is quite aging. Lastly, the patient had early jowl formation along her jawline, moderate neck skin laxity, wide platysma muscle bands and blunting of her chin-neck angle.

Procedures

To improve the patient’s appearance, we first re-inflated her extended tear trough with Restylane® and her cheeks with Radiesse®. This non-surgical intervention  had the most impact in creating a youthful, healthy look and is what you should focus on for the purpose of understanding the aesthetic power of injectable fillers. To further address the patients concerns, she had Botox® to her crows feet in preparation for CO2 laser skin resurfacing to the lower eyelids.  Two weeks after the injectable products were placed, the patient was operated upon in a certified, outpatient surgical facility, under general anesthesia and had an upper eyelid blepharoplasty (eyelid contouring procedure), CO2 laser  skin resurfacing of her lower eyelids and crows feet (to smooth and tighten the skin) and a modified, deep-plane facelift with platysma muscle midline plication to tighten and lift her lower face and neck. The patient is shown 7 months after her treatments. The patient looks radiant and most importantly, felt confident and happy.