Thank you for your question.
You’ve submitted several photos and you’re asking about the Marionette lines or the smile
lines that are occurring at the age of 36 that you have noticed for a couple of years
and you’re wondering whether Botox or fillers or some kind of solution can help you.
Well certainly I can offer an opinion about this.
I’m a Board-certified cosmetic surgeon, practicing in Manhattan in Long Island for
20 years.
I’m also a fellowship trained oculo-facial plastic surgeon and in the perspective in
the history of the use of drug Botox, oculoplastic and oculo-facial plastic surgeons and neurologists
were amongst the first doctors to use Botox.
Now to explain a little bit more about what is causing this, we have to think about what’s
happening or why do these lines form?
Well, as we get older there is some volume loss at many levels.
Certainly the early to mid-30s as a time when these changes start to appear.
What we’re looking at when we think about volume loss at this level a concern that you
have is a combination of loss of collagen in the skin, a loss of some fat under the
skin and there’s a loss of some elasticity.
When you’re in your teens and 20s you could smile the same way as skin just kind of bounces
right back.
Now as we get older, those lines become more etched in and they go from being very dynamic
to becoming more static and present at all times.
Understanding that what is probably a practical solution that something that we do for our
patients in our practice is deciding to do some kind of filler.
Now filler that can be used for this is something in the hyaluronic acid family.
A filler such as Restylane and Juvederm.
These are fillers that are made of a material that’s naturally found in the skin and helps
to fill out or add volume to the skin at the level of the skin.
Now this is a very important distinction because at the level of the skin, the skin is not
that thick.
What we’re doing is we divide the skin and the epidermis, the dermis and the subq so
the under the skin area which has fat.
What we’ll do with the dermal fillers is place fillers in the dermis now the balance
is when you look at the universal spectrum of fillers, you look at fillers that are softer
and last the time, fillers that are thicker and last longer.
A lot of times a perception is let me get a filler that is thicker and last longer but
the flip side of that is that a thicker filler can also create more of an impression on the
skin that makes you look like you have a filler.
That’s the last thing you want.
Already at this stage, so many actors and models et cetera, et cetera who have been
plumped in a way that is well from a general perspective maybe undesirable is already creating
a concern amongst anyone who’s considering fillers as to avoid looking like they’ve
had something done.
My suggestion usually is to use a softer filler and even though you may need to come in more
often at least to blend them better with the skin.
Now we also do a combination of something called Platelet-Rich Plasma.
Now Platelet-Rich Plasma is derived from your own blood and it stimulates collagen and it
stimulates of what’s called fibrovascular in growth.
This is also proven based on wound healing study where an open wound was treated with
hyaluronic acid filler alone, PRP alone and then a combination.
The combination seem to work better and there’s some concept of a matrix being formed with
this combination.
It’s been my observation clinically that people get more long term benefit when there’s
a synergy.
Basically we’re using your body’s own natural healing ability to build collagen,
at the same time we’re using the hyaluronic acid to provide what’s called the scaffold.
That would be a typical approach in my practice to help someone like yourself.
In your mid-30s this is kind of a natural thing to do.
It is very common and certainly is worth considering.
Again understanding that you’re looking for improvement, you’re not looking for
erasure.
It is very difficult to completely erase a wrinkle but if we soften it and you create
a better balance over your face or the appearance of your face then it looks better and it becomes
less of a focal point when you look in the mirror.
I hope that was helpful.
I wish you the best of luck and thank you for your question.