As we age, we suffer from both skeletal loss AND subcutaneous fat loss. Volume loss is typically more pronounced in Caucausian vs ethnic patients.
Our facial bones undergo bone atrophy as we age (similar to other bones in our body) resulting in a change in facial height, and increase in facial width and depth.
While the degree of volume loss varies from each person, what remains clear is that volume loss plays a pivotal role in the aging process. We now know that gravity alone is not responsible for sagging skin but rather atrophy of fat pads
Facial animation is an important part of human communication & expression, and should always be preserved. That being said, Botox has become a blockbuster drug for a reason. It does an excellent job at parlaying muscles to stop overlying wrinkling of the skin. In my opinion, the goal of Botox is to prevent wrinkles at rest NOT animation!
Look in the mirror and evaluate facial expressions with smiling & laughing. Now look at your face in repose.
Do you have wrinkles at rest in your forehead when in repose?
Do you have wrinkles at rest between your brows when in repose?
Do you have wrinkles when you animation around the corners of your eyes (aka crows feet)?
We can use neuromodulators to perform tricks of paralyzing one part of a muscle to allow unrestricted action of another part of the muscle resulting in for example, a brow lift or elevation of the corners of the mouth. There are certain types of muscles (i.e. sphincter muscles) where this type of constant paralysis does not cause problems (see below).
Neuromodulators should not be performed in a pattern that is replicated with each patient at a discount spa or you will end up with a discount expression. It is important to have a strategy to your Botox to achieve natural animation with human expression that doesn’t alter your face over time.
When should you start using neuromodulators?
Botox should be tailored for each person and there is no one right age to start using this treatment but there is a correct way it should be utilized. Each patient will start at a different age depending in their anatomic features. When you start noticing wrinkles at rest is when you should consider Botox.
How frequently should you use Botox?
You want to keep in mind that repeated Botox use causes atrophy of that muscle over time (this is sometimes the intended use i.e. when used in the masseters to slim the face). However, in certain areas (like the forehead) constant freezing of that shape of muscle can result in an atrophy forehead with a heavy brow. This can be prevented by alternating areas of Botox and prevent muscle atrophy.
In general, Botox lasts 3 months. I will generally recommend Botox touch ups every 6 months in a given area to my patients. This gives periods of animation in between paralysis and prevents muscle atrophy.
Botox & Xeomin are FDA-approved products that relax the muscles between your brows, forehead, and around the eyes. Off-label uses include treatment of a gummy smile, repositioning of the mouth, slimming the face, & correction of nerve palsy. The procedure is quick and comfortable. You will see results as soon as three days later, but full results happen at 7-10 days. Botox and Xeomin last up to 3-4 months
This condition is defined as sweating that disrupts normal activities. It can be focal and is commonly active in armpits, hands, feet, and groins where sweat glands are concentrated. Hyperhydrosis can cause embarrassment and anxiety and be refractory to over the counter treatments. Botox injections block the nerves that trigger the sweat glands. Patients with hyperhidrosis may need several injections for effective results.
This condition often results in disabling neck pain and can occur (aka torticollis, laterocollis, anterocollis, retrocollis) and can be treated effectively with Botox. Additionally, Botox can be used to aesthetically lengthen the neck in patients who have a short neck due to trapezius hypertrophy.
Prominent muscle (platysma) bands in the neck can be injected with a neurotoxin to relax the muscle and make the neck appear more smooth during animation. The platysmal bands are often cut during neck lifts and this is a non-surgical option for softening neck bands in the right patient.
The temporo-mandibular joint (TMJ) is used when talking, eating, swallowing and other activities. When this joint becomes overworked through excessive teeth grinding or is overworked, a person may suffer from severe tension headaches, as well as sharp pain the jaw. In combination with our chiropractic alignment, neurotoxin injection into facial muscles afflicted with soreness and discomfort relieves TMJ and jaw tension
WHAT TO EXPECT DURING YOUR NEUROTOXIN PROCEDURE
How long do injections take?
Treatment times will vary depending on the number of areas you are getting injected. In general, a number of small injections are required to selectively paralyze muscles.
How do the injections feel?
Most patients describe Botox injections as very comfortable and similar to acupuncture treatments. The needle used is the smallest size to allow maximal patient comfort. If you have a phobia of needles please let one of our office staff know so we can discuss additional measures to make your experience more comfortable.
How long does the neurotoxin last?
Neurotoxins generally last for 3 months but this can vary slightly from person to person. In general, you want to count on a visit every 4-6 months for maintenance depending on your treatment strategy.
Once I start Botox do I have to keep up with maintenance?
No. Botox frequency is an individual choice and you do not need to repeated paralyze your muscles if that is not part of your treatment strategy. Many patients will choose to maintain a specific problem area while alternating other treatment areas. Neurotoxins are part of an anti- aging strategy and one should not feel obligated to maintain once started.
What Are the Side Effects?
The most common side effects include redness & bruising. Less common side effects relate to diffusion or incorrect placement of the neurotoxin resulting in undesired paralysis of muscles. Choosing the correct injector is important in preventing this undesired result.
How Should You Prepare for Treatment?
Before you get Botox, try to stop taking any medication or supplements which may have a thinning effect on your blood. This includes ibuprofen, aspirin, vitamin E and fish oil for 1 week prior to injection.
Do You Need Any Recovery Time?
Recovery is not needed for botox. We recommend icing your face on the day of injections and avoid activities that increase blood flow to your face to minimize bruising or swelling. You will want to avoid massaging your face as this can cause the neurotoxin to migrate outside injection areas and result in undesired paralysis of muscles. This means you do not want to schedule a facial or exercise after receiving injections (you may do so before injections just not afterwards).
SUBCUTANEOUS VOLUME SUBSTITUTES
HYLUARONIC ACID FILLERS
Juvederm Ultra Plus XC
A new off-the-shelf alternative to autologous fat transfer in patients who do not wish to undergo fat transfer procedure or do not have donor site options. The adipose allograft is processed to preserve the extracellular matrix containing collagens, proteins, and growth factors found in adipose tissue. The resulting matrix serves as a framework to support the cellular repopulation and vascularization at the site of injection. Renuva is to be used where fat naturally exists.
There is no substitute for your own fat as a natural volume substitute that does not require the maintenance of dermal fillers to give you a long-lasting result. This requires a small procedure that can be performed in the office under local or in combination with other surgical procedures. A small area is liposuctioned and the fat is processed to create nano fat that is injected (similar to dermal fillers) in to volume deficient areas.
Hyluaronic acid fillers are dissolvable by injecting the enzyme that breaks it down hylauronidase. This is often utilized when patients have an undesirable result from dermal fillers or if an injection emergency occurs.
BONY VOLUME SUBSTITUTES.
Calcium hydroxy-appetite dermal filler that stimulates collagen and is slowly absorbed over time by the body making it a good temporary bony volume substitute
Consultation required for pricing. Customized facial implants are good permanent bony volume substitutes that help bring balance to your face. Typically implants placed in the chin, jaw, and/or cheeks. Unlike dermal fillers and injectables, facial implants require one procedure, eliminating retreatment costs but do
The specific area to be augmented in the cheek determines where an implant will be positioned on the cheekbone. Cheek implants are most often placed through incisions in the mouth. When performed with other procedures, alternate incisions may be recommended including placement through an incision inside the lower eyelid or one within the hairline.
For a chin implant, the incision may be inside your mouth, along the crease that joins your lower lip and gums. An incision just beneath the chin is an alternative.
Jaw implants are generally placed through the mouth with incisions inside the mouth, back along the jawline at the crease where the inside of your cheek and gums meet. Your incisions will be closed with absorbable sutures or stitches that will be removed within one to two weeks following your surgery.
A thread lift is a procedure where temporary sutures are used to produce a subtle lifting of the skin. In addition, the thread encourages collagen stimulation in the area of the thread placement. In the right candidate, this can be a good “gap
How do thread lifts work?
Temporary threads are introduced in to the deep layers of the skin and anchored to the skin. The thread is then suspended upwards to achieve an instant lifting effect.
Who is a good candidate for threadlifts?
A patient who is not ready for surgery who has mild laxity with moderate skin thickness.
Consultation required to determine candidacy.
How long do the results last?
Results typically last up to 1 year but this depends on location and patient selection.
How do I prepare for my procedure?
Avoid sun exposure for at least 1 week.
You must not have any active sores or acne during time of procedure.
If you have a history of cold sores, please discuss viral prophylaxis prescription with Dr. Christie.
If you are taking oral relaxants for the procedure you must arrange a ride to and from the clinic Prior to arrival be sure to fill out your medical history including your current home skin care routine on our online portal
WHAT IS A GAP PROCEDURE?
A gap procedure is a procedure performed in preparation for a more invasive procedure. These are excellent for preventative or partial results. For example, performing minimally-invasive neck tightening because the patient is not ready for a surgical neck lift.