What Should Be Injected Where?

botox_fillersBotox and fillers are among the most requested aesthetic treatments here at Maine Laser Skin Care.  In fact, demand for these products increases at a rate of more than 10% every year since I started administering them in 2005.  This is largely due to high levels of satisfaction with both Botox and fillers as a result of quick and predictable results with minimal downtime and side effects.

Despite lots of educational material I have dispersed through my blog posts and e-newsletters, and information available through the Internet and other media, there is still an overwhelming amount of misleading information out there about what Botox and injectable fillers can and cannot do.  With all that misinformation obstructing the real facts, it’s understandable that the truth gets lost in translation.

One of the common sources of confusion amongst many is exactly where on the face Botox and fillers are used best.  In order to be able to assess and prevent signs of aging, I have to use my medical understanding of facial anatomy.  As a result, I can decide how aging will affect certain areas of your face, and then how to best correct it with the right treatments or combination of treatments.

Although every body is different, I will review the various parts of the face and give you a general indication of the best treatment for that area.  Realize, of course, that I can only give you a firm answer for your situation with a direct face-to-face consultation.

crows-feetCrow’s feet:  These are lines that start at the outer corners of the eyes and extend outwards, generally caused by muscle activity and repeated folding over of the skin while smiling and squinting.  These lines can be corrected by using small amounts of Botox injected into specific parts of the muscle group that cause the folding action and later the lines.

Droopy eyebrows:  Some are born with flattened eyebrows, while others lose their previous natural eyebrow arch over time as a result of excessive brow movement.  When Botox is injected very precisely into a specific location above the eyebrow, the eyebrow can be lifted subtly, giving the eye area a more awake and less heavy appearance.  The Botox injection can also has a subtle lifting effect on the upper eyelids as well.

frown-lines-botoxScowl lines or frown lines:  Between the eyebrows, in an area called the glabella, is a very strong complex of muscles.  Repeated squeezing of those muscles when we scowl or squint causes the dreaded “eleven” lines, although many will have only one line or worse, three lines.  Botox injected in a characteristic pattern in this muscle area will relax these strong muscles, allowing the overall face to look more relaxed and less angry.

Tear Troughs:  This area starts just below the bridge of the nose and lower eyelid and then extends at an angle down toward the cheek.  This phenomenon is caused by loss of volume of the cheek that can be caused by natural aging process or loss of weight.

The tear troughs can be corrected by use of a hyaluronic acid (HA) filler.  If the loss of volume is significant or has been present for a long period of time, Voluma, which is the thickest filler available, will be needed to elevate the whole cheek.  If the volume loss is relatively new or not extreme, Juvederm Ultra Plus may be sufficient.

cheeksCheeks:  Similar to the tear trough discussion above, when there is volume loss in the cheeks, the whole midface area can look deflated and make the person appear gaunt.  In this case, definitely Voluma is the best filler and the question is more likely to involve how much Voluma will be needed.

In general and in the cheek area, a minimum of 2 syringes will be needed.  Depending on the individual, I usually recommend seeing how this amount looks after several weeks and then deciding on more filler at that time.

Nasolabial folds:  These lines extend from the bottom of the nose to the outer corner of the lips and sometimes as far as the chin.  This line formation is also caused by loss of volume, but usually occurs because of loss of collagen directly underneath the folds.

These folds can also be aggravated by loss of cheek volume.  Juvederm Ultra Plus is the best filler for this area; thicker enough to show immediate improvement, and to last at least a year.  In some cases, Voluma may also be used in the cheeks to improve the longevity of this effect.

lipsLips:  Some people are born with thin lips.  Others have full lips when they are younger and then over time their lips tend to thin out and lose their shape and fullness.

To plump the lips back up without having them look fake or overinflated, I generally recommend Juvederm Ultra.  Juvederm Ultra is less thick than the Ultra Plus version, but can still give the lips good, natural-looking volume without having them appearing stiff.

I always warn people that lips are very tricky, and that everyone has their own ideas as to how they want their lips to look.  I always spend a considerable amount of time talking about what the person wants the lips to look like.  This is definitely a case where the art and science of fillers has to be mixed to produce the desired effect.

When it comes to erasing lines on the face and making one’s appearance look more well rested and frankly younger by 5-10 years, judicious use of Botox and injectable fillers can achieve these goals when used by a skilled injecting doctor like myself.  I do not normally like “to toot my own horn”, but experience does count.

I have performed these procedures on thousands of people, male and female, in ages ranging from their 20s to their 80s.  Do not worry if you have never had these procedures done.  You will be in good hands.

I will always give you my honest evaluation of what can be realistically done and how the available technology can help you.  If you would like a free consultation for that evaluation of your individual facial issue,  please give us a call at Maine Laser Skin Care and Medi Spa at (207) 873-2158.


About Dr. John Burke

John Burke M.D. has practiced medicine for over 25 years, and is the founding partner of MidMaine Internal Medicine. He established Maine Laser Skin Care in 2004 after devoting years to learning the latest in laser and dermatologic technology. Dr. Burke has treated patients from all over the United States. He is one of Maine's busiest practitioners in laser treatments, and in the use of Botox for upper facial lines and excessive sweating.
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