Wrinkles on earlobes slowly develop as we age and our earlobes deflate, just like the rest of your face! In the medical literature an earlobe crease has been correlated with some cardiovascular diseases. The simplest way to treat earlobe wrinkles is to place a small amount of filler in the earlobe. The wrinkles immediately improve. Filler in the earlobes tend to last significantly longer than in most other parts of the face. If it helps make you feel better, probably no one else is noticing your wrinkled earlobes!

Temples are actually one of the best places to put filler since it seems to last an extra long time in this part of the face. There are several filler options in the temples. These include Juvederm, Radiesse, and Sculptra. Each has its own unique advantages and disadvantages. I have seen filler last well over 2 years in this part of the face, but I advise patients that they might have to come about once a year for a slight top off. As for how much filler you might need, well, that depends on how hollow you are. On average patients tend to need at least half a syringe of filler to an entire syringe of filler PER temple. Sometimes more if there is significant hollowing. Usually I can estimate before hand about how much filler it will take.

Fat injections are another way to fill in hollow temples, but this is probably best for patients who need a significant amount of filling of their entire face.

Some surgeons use an incision in front of the hairline in the temple region. This can sometimes leave a noticeable scar especially if your skin color is not very pale white. Sometimes this also distorts the shape of the hairline in the temple region. Even if the scar healed well it could still be noticeable in this region. This same kind of problem can arise after a temporal brow lift if the incision was not placed correctly.

A scar revision is not always the best solution to solve this problem. Because hair bearing scalp might have been excised during the surgery, the shape of the hairline might be distorted. There are several other options that can be used to address this problem.

The first and simplest is especially useful in patients who have a pale scar with darker skin. The color contrast between the scar and normal skin is a big contributor to it being noticeable. Permanent tattoo makeup can be used to place pigment into the scar and reduce the contrast with the skin.

The second option is to use hair grafting to reshape the hairline and to add hair in front of the scar. As the hair grows in the scar will be more hidden inside the hairline.

Although it has yet to be proven that certain laser treatments can accelerate facial volume loss, anecdotal evidence shows that especially around delicate thin skin such as around the eyes and temples lasers might accelerate facial volume loss. It is normal to lose facial fat with the normal aging process so it would be hard to tell what is truly causing the facial volume lose or the loss of fat round your eyes. Unless there is a controlled trial where a laser was only used on one half of the face we might never know!

People with orbital fat loss or hollowing around the eyes usually state that their eyes actually look better when they wake up in the morning and they are puffy. As the day progressed they state that they eyes look worse and more tired and hollow.

It is possible to address this orbital volume loss and hollowness with injections of either fat or fillers.

Unfortunately once fat has been placed it is extremely difficult to try to remove. Sometimes too much volume in the temples and around the eyes can make the eyes seem smaller and more deep set. At times that is desirable especially for patients with bulging eyes or prominent eyes.

At times steroids or 5-FU can be injected judiciously to help reduce some of the fat volume but it is difficult and not very predictable. That is why it is always safer to underfill when it comes to fat or even fillers for that matter. It is always easier to put more in than to remove what's there.

Orbital fat loss is probably the most important contributor to the aging of our eyes. In some people it leads to hollowness while in others it leads to loss of support of the brow and upper eyelid with resultant sagging and drooping. Adding volume is the most effective and most natural way of making the eyes look much more youthful, while also adding support to the eyelids leading to better eyelid function. Some people with complaints of dry eyes actually can benefit from adding volume and hence support around the eyelids. This might improve their dry eye problems.

What is the best way of adding volume? Fat or fillers such as restylane? Both can be effective and can have similar results. I routinely use both so can speak of the pros and cons of each. Fat injections can work very well in the upper eyelids. It is a bit less effective and can have more issues in the lower eyelid with potential for lumps. In the upper eyelids there could also be lumps from it but it is less of an issue. Fat injections are not the most predictable way to add volume because of the variable of how much fat will actually "take" in each area. It is not uncommon that a touch up will need to be performed several months after the first procedure.

The advantage of using fillers include ease, short recovery times, and much higher predictability that fat injections around the eyes. It takes just a few minutes to perform and you are set to get back to life as soon as the procedure is over. There of course can be some swelling and occasional bruising from filler injections around the eyes, but it is usually significantly less than fat injections for orbital fat loss. Fillers, of course, are not permanent, or at least Restylane isn't. In my experience filler injections around the eyes last a long time, sometimes several years, especially in the upper eyelid.

Both fat injections and fillers are great ways to add volume and support around the eyes for orbital fat loss. During your consultation the specifics of each will be discussed.

To learn more about orbital fat loss and eyelid surgery please visit our Eyelid Surgery page.

By Gal Aharonov

Before deciding on whether a man would be a good candidate for the forehead reduction surgery we have to make sure that he has few if any indicators of male pattern balding. If someone has a stable hairline and no obvious risk of male pattern balding, he might be a good candidate for the forehead reduction surgery. The hairline can usually be lowered by at least 3 cm in a one stage procedure. If someone needs significantly more of a forehead reduction a tissue expander might be necessary.

If the hairline is not that dense (but is still stable) I sometimes recommend having a small amount of hair grafting done at the same time as the forehead reduction to help camouflage the scar even more and thicken the hairline. Grafting can also be used to shape the hairline a bit and make it rounder.

For hair grafting I usually recommend The New Hair Institute who I work with closely. They are honest, fair, and do an exceptional job. During your consultation we will discuss all the options.

To read more about hairline lowering surgery and forehead reduction surgery please continue to our website.

Restylane in the upper eyelid stays longer than in pretty much any other place on the face. I routinely see patients back after longer than a year and the upper eyelid filler is still looking good with hardly any need for a touch up.

Because of the fact that filler lasts such a long time in the upper eyelids, combined with the precision and accuracy of the fillers, I believe it should be the treatment of choice in restoring upper eyelid volume over the use of fat. I think fat injections are more useful when it comes to total face rejuvination and are not worth the investment when only one small area such as the upper eyelids is to be treated. Fat injections are also not as predictable as the fillers thus necessitating possible touch ups and tweaks in the future.

Below is an example of a patient before and 3 YEARS AFTER Restylane injections into the upper eyelids to restore volume and correct an asymmetry caused by a previous eyelid lift by another surgeon.

Click here to view more before and after photos of upper eyelid fillers

By Gal Aharonov

One of the first signs of aging (and one that starts at a very young age) is volume loss around the eyes. It usually makes us look tired and not as refreshed. Volume loss is inevitable but can manifest itself in different ways. Some people start to hollow out and will show more eyelid, while others will have droopyness of the upper eyelid skin and brow as it seemingly deflates and loses support.

Most people wish they can have their youthful eyes back. These people are usually good candidates for eyelid filler injections or fat injections. Some people did not like the look of their eyes when they were young--they thought their upper eyelids where too puffy and full. These people would probably benefit from upper eyelid blepharoplasty or upper eyelid lift.

Below is an example of a young patient with hollowing of her upper eyelids. She felt this made her look tired and she wanted her youthful full eyes back with a lower crease. Restylane was used to lower her crease and give her fullness back.

Contrast this to the patient below who also had upper eyelid fat loss leading more to a deflated brow and upper eyelid and sagging and drooping. Restylane was also used to reinflate her deflated upper eyelid.

Filler treatment in the upper eyelid is safe and log lasting. The only issues I have encountered have been an occasional bruise, swelling for a few days, and very unusually a small lump which can be massaged away or dissolved.

To learn more about upper eyelid filler treatments visit our non surgical upper eyelid lift page

By Gal Aharonov

Thinner people with high cheek bones age with their cheeks looking more and more obvious in proportion to the rest of their face. When you are young there is more facial fat and padding around the cheek bones, in the temple, and in the submallar area (area below your cheek bone). As we age we slowly lose the fat and padding in our face: our temple become more hollow, we lose fat under our cheek bone, and our skin becomes thinner. Imagine having a rock under a thick comforter... It is difficult to see the edges of the rock under there. As we age that thick comforter turns to a thinner sheet and now all of a sudden you can see the outline of the rock. That is sort of what the cheek bone is like in people who have high cheek bones. this does not happen in people who's cheeks are mostly composed of fat. Those people end up with flatter cheeks as they age.

The treatment for you is not to shave down your cheek bones, which would be dangerous. The treatment is to add volume around the cheek bone--add padding like a thicker comforter. Your temple can be filled out as can the area below your cheekbone. This will soften your look and make your face more like it used to be when you were younger.

Notice how this patient's natural cheeks seemed large and artificial before. Fillers where used to soften the look of her cheeks.

To learn more about facial fillers go to our liquid facelift and facial filler information page

By Gal Aharonov