I hate my forehead wrinkles and crow’s feet, but I also don’t want my face to look frozen. Is there any way I can eliminate the lines and still look natural with Botox?

Posted on November 19, 2012 by Donald B. Yoo, M.D.

You are echoing a common concern for many patients considering treatment with Botox or Dysport. These two neuromodulators are great for treating “dynamic rhytids”, meaning the wrinkles that are formed from the movement of the muscles underlying the skin. For example, the horizontal lines in your forehead are caused by the action of the frontalis muscle. This muscle is responsible for raising your eyebrows, but when the eyebrows are raised excessively the skin of the forehead is wrinkled – leaving an imprint. With constant wrinkling of the skin, these lines will become etched into the skin.

Botox and Dysport “modulate” the function of muscles. When injections are performed with a heavy hand, the muscle can be completely frozen instead of softened, resulting in an unnaturally smooth appearance. By respecting the anatomy of the underlying muscle, and using microinjections in areas that are critical to movement instead of full doses, the normal movement can be maintained while softening and eliminating wrinkles. Over time, even the etched in lines will begin to soften as the skin is allowed to recover from years of wrinkling.

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I have a very sqaure jaw. Is there any way I can make it look more tapered and feminine without having surgery?

Posted on November 15, 2012 by Donald B. Yoo, M.D.

There is an excellent nonsurgical option for improving the appearance of the jawline and making it more feminine without surgery.  The “V-line” procedure or masseter reduction, is a very safe procedure that involves using Botox or Dysport to decrease the prominence of the muscles on the side of the jaw (masseter muscles).  These muscles can easily be felt on the sides of the jaw when you bite down.  When they are treated with Botox or Dysport, it reduces the prominence of the muscle and eliminates the fullness that they cause, resulting in a more tapered, “V-line” shaped jaw. With repeated treatments, more and more tapering will be noted as the muscle becomes smaller and smaller.

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What can I do to get rid of the puffiness below my eyes and my deep tear troughs?

Posted on November 13, 2012 by Donald B. Yoo, M.D.

Most commonly the puffiness under the eyes is a result of a forward outpouching (pseudoherniation) of the fat that surrounds your eye.  Normally this fat is contained around the eye (where it’s hidden) by a thin structure called the orbital septum.  It acts very much like a sheet holding the fat back.  As we age, this septum becomes thinner and weakens, allowing the fat to “pooch” forward.

In addition to the bags, with aging and gravitational changes, the volume of your cheeks and midface is being reduced and pulled downward.  This downward descent of the midface  structures and volume loss leaves a deficiency or hollowing under the eyes, resulting in a “tear trough” (nasojugal groove) deformity.

A lower eyelid surgery called lower blepharoplasty with fat repositioning is available to help combat these issues.  Lower blepharoplasty is performed through a hidden incision on the inner surface of your eyelid.  Through this incision the fat that is “pooching” is mobilized and moved to an area where it is useful – the tear trough, where there is volume deficiency.  This serves to move fat away from an area of excess and fill the area of deficit, smoothing the contour between the lower eyelid and the cheek.

Some bruising and swelling is expected after surgery, but most patients are out and about in 10-14 days.  Pain and discomfort is mild after surgery.

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