Question:
I am a 62 year old woman interested in having a forehead lift. However, I have seen many people who look as if they have a “surprised” expression on their faces after having the procedure and I fear that I may look the same. How often does this happen and how can I be sure that this won’t happen to me?
Answer:
Patients develop a surprised look after a forehead lift because the surgeon was overly aggressive with the procedure. This is easily avoidable, however you must understand that the desired result from the lift is a subtle elevation of the brow and not to compensate for other issues by over-elevating the brow. Believe it or not some patients request their brow to be lifted to a level which is unnatural. We refer those patients to another surgeon. We are also conservative in selecting patients for a brow lift and believe that often the aging is not due to brow descent, but instead due to the brow fat pad decreasing in size and no longer filling out the skin of the brow and leading to the illusion of brow descent. The best way to understand this is to look at a photo of the patient in youth to determine the relative contribution of descent versus volume loss. In many cases we will use fillers of Restylane, Juvederm, Radiesse or autologous fat to rejuvenate the brow by adding the lost volume back to the area rather then lifting the brow. This creates a more youthful appearance without the unnatural look of an overzealous brow lift.
Posted by Dr. Buckingham
Question:
I have had regular Botox injections for the past 18 months. I recently read about Dysport and would like to begin using it. How long should I wait after my last Botox injection before starting Dysport?
Answer:
Botox and Dyport are nearly the same products. They differ only in the companies that manufacture them and in the inactive surface proteins that encapsulate the active molecule. Immediately upon injection the outer proteins are separated from the active molecule releasing it to bind the the nerve end-plates causing the clinical muscle relaxation. In my opinion, the onset and duration of Botox and Dysport are exactly the same. So, to answer your question, you can begin using Dysport as soon as your Botox begins to decrease in activity.
Posted by Dr. Buckingham
Question:
I am a woman in my late fifties interested in cheek augmentation. I understand that the procedure is done either with an implant or with the patient’s own fat cells. Is either method superior to the other, and how would you determine which is best for me?
Answer:
Chin augmentation can be done with the either technique. We perform the procedure with either implants or fat cells or occasionally both. Usually if a patient is in need of projecting the chin more anterior in a significant way we will recommend an implant. The implant has the benefit of reliability and longevity as well as ease of insertion. When a patient has only a prejowl deficiency or has only minimal need for augmentation of the chin then fat cells work great. The difficulty with fat cells is that the more you have to put in to one location the less percentage of the cells are likely to survive. So if you really have to add a fair bit of volume to the chin, one fat transfer may not provide as sufficient result. You can of course add more fat at a later date, but it makes more sense to just use an implant. On occasion when a person has significant need for augmentation and a soft tissue deficit, we may place an implant and then add fat to the surface to increase the soft tissue covering.
Posted by Dr. Buckingham
Question:
I am interested in having a chin augmentation. However, I am afraid that the procedure will change the proportions of my face too much. Will this be a problem?
Answer:
Usually a chin augmentation will only change the proportions of you face in a favorable way. The best way to convince yourself of this is to look at the surgeons before and after photos of other patients. Chin implants come in multiple shapes and sizes that can be tailored to the individual patient needs and if a patient is concerned that the implant may cause too much of a change a smaller implant may be selected. Usually patients are very satisfied with the procedure.
Posted by Dr. Buckingham
Question:
I am a 39-year-old female who has a slightly more relaxed looking (droopy) left eyelid. Would getting a Botox injection near my other eyelid relax that area and thus make my eyes appear more balanced?
Answer:
That is a difficult question to answer without seeing you, but the answer is probably no. A droopy eyelid can be caused by a number of factors, but it can be summarized into three categories, brow ptosis, dermatochalasia, eyelid ptosis. Brow ptosis is when the forehead and brow drop causing the upper eyelid skin to fold and look more redundant and tired. In the case of asymmetry, sometimes the more droopy looking lid is the normal one and the person is really activating the forehead muscle and elevating the other side. This is the only situation that Botox may help. A browlift may also be needed. Upper eyelid dermatochalasia is when there is a redundancy of upper eyelid skin. This is usually corrected with a blepharoplasty. At times a brow lift may also be indicated. Eyelid ptosis is when the actual eyelid margin is too low and covering the upper part of the iris (colored part of the eye) or pupil. This usually needs to be corrected surgically.
Posted by Dr. Buckingham
