So what we're going to be doing today is actually filling some creases and the
nasolabial folds which we see here. A crease that's on the side of the lip and
if we see these vertical creases on the forehead. And this is one area that is
very commonly mistreated. Patients come in bothered by these lines on the side
of the forehead and they come in asking for Botox and that line is not caused by
frown. That line is caused by sleep, by side sleeping. And one of the ways we
know that this line is caused by side sleeping we look for other lines that
are parallel to it on the side of the nose as well as the side of the lip. And
if I put a little bit of a force here, lo and behold you'll see how well each of
those lines line up. So the treatment of choice for this is to fill these lines
with very superficial dermal filler and then what we do is hopefully change the
way that someone sleeps, which is not the easiest thing in the
world. It usually relies on changing the pillow, sometimes which is even more
difficult, changing spouses, right? Because sometimes
spouses refuse to switch sides of the bed. So the question is if we want the
lines to go away sometimes it takes a lot to do that. But we're kidding so
there are different pillows that can help you sleep on the back which is
really best for the face. So again what we're gonna do today we'll put a little
topical anesthetic on to numb and then we're going to use a fine little tool
a needle and a superficial filler called Restylane Silk. We have to use
filler that is very very thin we don't want to create a bump or a lump or a
change in shape, we just want it to fill that line. If someone changes the way
they sleep that line should be gone forever. You'll notice on this side if she really
doesn't sleep like that, there's nothing. You'll see the difference between the two sides. Got it?
So what we're using here is called the dermal cannula a dermal cannula is a
blunt little tube that has no point so it's less traumatic, less bruising, less
swelling. "How are we doing good?" "Good I don't even feel it!" So we're just giving
support from underneath, when we inject the lines the sleep lines however that
we have to injecting much more superficially and that we're going to do
the tiny little needle. Almost done with this side. Now we're gonna go right on to the
lip and give that lip a little support so it doesn't crease in case we don't get
a new spouse.
What we're doing now is using Restylane Silk, which is a very very fine filler
and we're injecting it very superficially into the surface of the
skin right into that superficial line. It'll blend away and that line will be gone.
The two best fillers for superficial lines are Restylane Silk and Belotero. The advantage
of Restylane Silk is it lasts longer.
So these are called frown lines or
glabella lines, so they're caused by excessive muscle movement so how do we
treat that? We slow down the movement using Botox but for the lines at rest,
what we call static lines, those we have to fill so it's not uncommon that we'll
put Botox in and even though those lines improve, a patient comes back and said
"How come I still see lines?" Well the residual lines left over are
really a skin problem not a muscle problem and that we fill. There's
very common to use Botox or Dysport in combination with the dermal filler. Botox
and Dysport for the muscle part of the problem that caused the line and filler
for the actual skin. Injecting the frown line with the filler is something
that should only be done by an expert it's an area that looks very simple but
it actually is one of the more dangerous areas on the face to inject because
there could be communication with other parts of the skin or even the eye so
there are reports when this is done poorly of actually blindness. So it's
something not to take lightly and something that should be never be
performed like someone that isn't number one experienced, and number two able to
deal with a problem God forbid it ever existed.
A little bit of swelling, that this will all be gone by this
evening you can see the difference. "Yeah okay this is it last time sleeping
on my side because I have a choice new pillow your spouse I'll let you know when I come back!" "Go for the new Pillow!"