With the advent of Botox and Dysport and various fillers, such as the Juvederm, Restylane, and Sculptra, to restore facial volume, men and women alike have jumped on the bandwagon to take advantage of these products to look more youthful.
The goal should be to look younger and better, but not look “freakish” or different. The goal is to enhance one’s looks and look more youthful, but not to have others look at you to wonder “Why do you look strange and disfigured?”
One of the most common “bloopers” is overfilling the lips to the point they appear they have been stung by bees, although some patients actually do request overfilling.
The injector putting too much filler in the lips or putting it too deep or even into the cutaneous part of the lips (the skin between the red part of the lip and the nose) results in the “duck-like” lips. For a natural appearance, the fillers should be added to the mucosa of the lips (the red part) and not into the muscle above the lips.
This results in a “shelf” of filler above the lips that gives the person a Simian-like appearance, because the cutaneous upper lip now can extend beyond the red part of the lip.
Another frequent “blooper” can occur when untrained injectors of Botox or Dysport inject the frown lines between the brows (known as the “elevens”). If the injection extends above the inner brow closest to the nose, the result is drooping of the brow in this area.
Then, when raising the brow, the inner part cannot elevate, so the outer brow over-compensates and elevates too much, giving one the Dr. Spock appearance. This also makes the patient have a brow that looks surprised all the time, which is not a normal appearance.
Body dysmorphia, such as over-sized rear-ends, overfilled lips, overfilled facial areas with fillers, and incorrectly injected Botox or Dysport, is linked to some celebrities. Many younger patients see these results as the norm and often request the obviously overdone look.
This results in many patients shying away from using these products. However, if done by skilled injectors, the actual results can make one look years younger with little if any downtime. If the injector understands the anatomy of the face and can re-volumize the areas that are causing the sagging and wrinkles instead of just filling in the wrinkles, results are dramatic and look totally natural.
In most cases, loss of facial volume contributes to the aged look as much as or more than loss of elasticity. To turn back the clock naturally, the fillers must be placed skillfully and artfully into the areas of volume loss.
E. Ronald Finger, MD, FACS is a board certified plastic surgeon with offices in Savannah and Bluffton. fingerandassociates.com
