Think about the first image that crosses your mind when you hear the word Botox or facial filler. It is likely one of a plastic, frozen faced woman with evidence of one too many facial plastic surgery procedures, unnatural facial proportions, oversized lips and unnaturally tight skin.  These are the extremes that websites and the media have convinced us are common place.  For this reason, many of my patients are hesitant or scared about using these products as they don’t want that unnatural look.  But they are still in my office asking about what can be done.  So where is the happy medium?  Reverse aging changes in a way that doesn’t appear artificial.  Herein lies the art of facial plastic surgery.  Artfully using these medications can yield great improvements in facial appearance.  Misuse or overuse can do the opposite at great cost to you.

The key to Botox/Dysport is putting the right amount in the right place.  That seems intuitive, but results can vary greatly by the technique used and experience of the injector.  Botox is popular because it works and most people who are happy with their Botox treatment get a nice flattening of the lines between the brows, on the forehead and in the crow’s feet.  When improperly placed, brows drop or have a “Spock” appearance, lower eyelids can sag, and the face may look too inanimate to be real.  To get a natural effect, first start with an experienced injector, one that will study your facial expression and target the problem muscles, rather than just injecting in a standard pattern.  Then, expect to be invited back after the first week to ensure the proper result was attained.  Sometimes, I feel I’ve given my patients enough to relax the forehead evenly, but after a week I need to add a few more units to the outer forehead muscles.  This allows me to better map out the face and subsequent injections will be on target.  Where a few get into trouble is wanting to eliminate every facial wrinkle with Botox and convincing someone to inject them.  Your face needs expression, which is an underappreciated part of facial beauty.  An appropriate dose of Botox will allow for this movement and still soften the telltale signs of aging.  If your doctor takes his/her time and follows up, your results should end up exceeding your expectations.

In like fashion, the key to good filler is the right filler, in the right amount, in the right place.  Again, that seems intuitive, but many people get into trouble when they want either the wrong type of filler or too much filler placed.  An experienced injector will have a preference for certain brands and types of fillers in different areas of the face.  This is usually based on their experience and results. It is in your best interest to let the injector direct you on what filler they want to use.  If you have a strong preference, seek out a person who specifically advertises using that brand.  With regard to the amount of filler placed, many people think more is better.  This is where the unnatural appearance is most likely to enter the picture.  Overinflated lips, cheeks and tear troughs are dead giveaways that work has been done.  My advice is start slow and add as necessary. Fillers all come by the vial.  An injector can inject part or all of the vial and save the rest for a few days until the initial swelling has resolved.  This allows a metered approach and can give you a maximum improvement without overdoing it.  The flip side to this comes when patients expect a maximum improvement at a minimal cost.  Often two to three (or more) vials are necessary to get a significant improvement, especially in the smile lines and cheeks.  With one vial retailing for around $500-600, many people aren’t willing to spend that much on a non-permanent procedure.  This is where you need to have a frank discussion with your injector about what result you can expect and whether you’d be better off saving for a surgical procedure or maximizing other less invasive treatments.  Having appropriate expectations is key to your satisfaction.