March 1st, 2013
This is a question I have been asked many times, and seems to be a common concern in the general population. This concern stems from just a couple of cases that have been reported in the medical literature about blindness occurring after injection of filler around the eyes. This is something I have never seen in my own practice. Why could this have happened? Well, there are theories concerning the filler accidentally being injected right into a major vein that also connects to the eyeball. I do know that injection technique is extremely important especially around the eye. Sometimes I have been shocked by witnessing extremely poor injection technique by some physicians and nurses. Fillers are tools for technicians to use. Poor technique is truly the reason for the majority of complications. Some complications like bruising and swelling are sometimes inevitable and luck based. Lumps should rarely occur if injected well. Again, I have injected thousands of eyes and have yet to ever witness a major issue like blindness. Is it possible? Sure. But I would put the probability at an extremely low level in an experienced injector's hands.
February 27th, 2013
It is possible to do a blepharoplasty (upper eyelid surgery) and at the same time add volume to the upper eyelids and brows. Natural aging consists of volume loss in the brow pad and upper eyelids. Sometimes there is also increased laxity or relatively too much skin which ideally would be trimmed away as well. Depending on the particular case, sometimes a blepharoplasty is needed, sometimes just filler, and sometimes a combination of the two.
February 27th, 2013
With the hairline lowering surgery, or forehead reduction surgery, the eyebrows are NOT raised with my technique. I cannot speak for other surgeons who's techniques can raise the eyebrows, but with my technique there is NO chance of that happening. Some people actually would like higher brows. For them it is possible to combine a browlift with the forehead reduction at the same time. That is an additional procedure though.
January 11th, 2013
One of the most over neglected and under appreciated parts of the face when it comes to facial rejuvenation are the temples. As we age, the temples tend to narrow and hollow out, shifting the balance of the face downward towards the mouth and lower cheeks. This gives our cheeks the appearance of it drooping and sagging and changes the harmony of our face. Injecting either filler or fat into the temples is a quick and simple way to give the face a more youthful harmony. Carefully examine your old photos when you were younger and pay close attention to the width of the temples compared to now. It is possible to pick up subtle differences even in your 20's.
Temple rejuvenation usually goes hand in hand with both upper eyelid and brow rejuvenation as well as with cheek rejuvenation. It is important to keep these structures well balanced and in harmony with one another otherwise treatments can look unnatural and fake.
July 30th, 2012
This could vary from person to person and from issue to issue. There are different reasons to inject filler around the eye such as under eye bags, under eye hollowness, upper eyelid hollowness, and upper eyelid laxity and droopyness. Filler needs to be injected in different ways to correct each of these issues. That is why there is no standard way to inject filler that is applicable for every issue.
Different people will react to filler differently. Some might swell a large amount, some might not swell at all. Some will not bruise at all, some might have significant bruising. Sometimes it is just luck, other times people might have a propensity to swell or bruise.
It also takes filler a few weeks to soften up and feel more natural. In thicker skin areas this is not a noticeable issue, but around the eye the filler might be palpable and sometimes noticeable for a few weeks.
Injections around the eyes should be taken as seriously as surgery at times. True, a majority of people will look great almost immediately and not have any problems, but a small number of people will have significant swelling and bruising. Make sure you are mentally prepared to maybe be one of those people before deciding to have injections around your eyes. Just because your friend came to me and looked amazing the next day doesn't mean that you are guaranteed to have the same result.
June 20th, 2012
It is very common to have a slowly developing asymmetry to certain parts of the face. The upper eyelid is a very common place to see asymmetries that were not present at a younger age. Patients always ask me why one side is aging faster or losing more volume than the other. A few theories might be that the left side of the face in our country is exposed to more sun while driving. I have had patients that had severe burns on one side of the face when they were younger which sped up the volume loss on that side.
The best way to deal with upper eyelid asymmetries due to volume loss is with filler. Filler is way more accurate than fat or anything else that is currently available. To correct an asymmetry of the upper eyelids usually only a small amount of filler is needed. This can usually be done with just one treatment, but occasionally a touch up might be needed once the swelling settles to get it as perfect as possible.
There sometimes is an asymmetry in the actual amount of upper eyelid skin. If this is the case filler can be used to make the creases appear more symmetric, but the eyes will never be entirely symmetrical unless the superfluous skin is removed surgically.
The biggest indicator of upper eyelid symmetry is the position of the crease, more so than actual volume or amount of skin. The amount of eyelid that is seen is the most critical element. Usually even if there is an asymmetry in the amount of eyelid skin, or even mild ptosis of the eyelid on one side, the eyes can be made to look more symmetrical by adjusting the amount of eyelid show.
To learn more about upper eyelid fillers you can visit our upper eyelid filler page.
June 13th, 2012
There is really no such thing as a perfect sized forehead. A forehead must fit your face. A forehead that might be a good size for your face might be too large for someone with a smaller face or too small for someone with a bigger face. A forehead can also be used to provide a short face with some length or a long face with a reduction in length.
To decide how much I lower a hairline or reduce the size of the forehead I try to make the forehead match the rest of the facial features. This is not a cookie cutter approach. The resulting forehead should just fit your face and it should not be obvious that anything was done. If your forehead is too big for your face it is leading to an imbalance in facial features. When the facial features are rebalanced by lowering the hairline the face should just look in greater balance.
To learn more about Forehead Reduction of Hairline Lowering follow this link
June 13th, 2012
It would be extremely unsafe to shave down your cheek bones so your face is less wide. There are many crucial nerves that would be in danger in that area. If you have hollow temples the safest thing would be to fill in your temples. This will bring your cheeks into greater balance and your cheeks will not appear to be as wide.
The easiest way to add volume to the temples is with filler. Juvederm can be used to fill the temples in quickly and easily with minimal downtime or bruising. Sculptra can also be used in the temple but tends to take months and months to show a noticeable difference. Fat injections can also be used in the temples but are only cost effective if a large amount of volume is needed for the entire face.
June 13th, 2012
In general I can give patients a very good idea of how much filler around the eyes they will need before starting. That is why a consultation is so important. I can give most patients a reasonable idea based on a good quality photograph. Determining how much volume will be needed also depends on your aesthetic goals for what you want your eyes to look like. Some patients desire a very full look while others would just like to fill in some of the hollowness around the eyes.
As a rough starting point, an average patient will need anywhere from 1/2 a cc to 1cc of filler in each upper eyelid. Same goes for the lower eyelid or under eye area. If there is a considerable degree of hollowness you might need as much as 2 cc in each upper eyelid or under eye. This will be discussed during your consultation.
To learn more about fillers around the eyes click here for the eyelid procedures page
June 13th, 2012
Belotero is a new hyaluronic acid based filler sold by Merz. The advantages that I have seen using it is that it is fully hydrated, which means it should not cause as much swelling as the other HA fillers. It also seems to be more liquidy which means it it much less likely to cause any sort of lumps. The disadvantage of that quality is that it is not a good filler for building volume. The other advantage is that it seems, so far, to not cause the tindel effect--the bluish tinge that other HA can cause when injected superficially. This means that Belotero can be safely injected into fine lines, acne scars, and under the eyes without worrying about the bluish tinge.
Disadvantages of Belotero are that it is not a good filler for volumization. The longevity of it in different areas is still not well known.
In my practice I use Belotero for superficial fine lines and acne scars as well as superficial injection under the eye.