Eye Area – Wrinkle Correction
Crow’s feet are lines that transverse or extend from the lateral canthus (outer corners of the eyes). They are also known as periorbital wrinkles. Sometimes these lines fan out and can arc downward over the cheekbone and even down onto the lower cheeks (sub malar area). In most individuals, crow’s feet are caused by smiling and squinting, in combination with some degree of loss of facial volume or collagen.
Most individuals develop crows feet wrinkles to one extent or another at some time. The lines are usually superficial (fine), but may also deepen in some individuals. They can range from a few lines to multiple fanning lines.
For patients exhibiting shallow crows feet, the primary method of treatment is with applications of BOTOX®. In more pronounced or longer lines, we may also place additional BOTOX® in points that are another half a centimeter or so lateral to the first points (further away from the eye area). Usually, if the lines are deeper or more grooved, then an advanced dermal filler such as Juvederm® or Restylane® is applied.
Lower Eyelid Wrinkles
On the lower eyelids and subocular region of the face, individuals will develop wrinkles from loss of facial volume and elastin around the eyes and upper parts of the face. These wrinkles may run parallel underneath and along with the shape of the lower eyelid or may hatch up into the lower eyelid. In some individuals, the skin can develop a crêping look (like crêpe paper).
These lines may be treated with BOTOX® or advanced dermal fillers, either alone or in combination therapy.
Upper Eyelid Wrinkles
Folds or creases on an upper eyelid may be caused by depleted collagen, loss of elastin, and skeletal degeneration, among other factors. Treatment of wrinkles, creases, and folds of the upper eyelids can be accomplished with liquid facelift products, utilizing a variety of procedures or techniques. Lifting the eyelids with liquid facelift products will cause some or all of the wrinkles to disappear. The procedures may enhance the smoothness of the skin as well. One of the ancillary benefits is a more energetic, brightened appearance.
Chin Area Wrinkle Correction
Many individuals develop a rough skin texture on the front area of the chin that can look something like an orange peel, which is how it gets the name, peau d’orange (French for orange peel skin). This crêping of the skin is mostly a result of repeated contractions of the mentalis (chin muscle). Over time, the contractions may result in numerous thin, cross-hatched lines that give the chin this undesirable look.
Most physicians treat peau d’orange with small amounts of BOTOX® that are placed with one or two tiny injections at the origin of the mentalis muscle, which is at the bottom tip of the chin. Over time, this treatment can have a significant impact to eliminate or greatly reduce the crêping. If BOTOX® injections are repeated as close as possible to the time that the BOTOX® effects begin to wear off, then it is likely that treatments will be needed less and less frequently, with only minimal amounts of product over time. In effect, the thin grooves tend to fade away in many individuals after a few treatments.
The mental crease is a horizontal groove between the chin and the area below the lips. The mental crease can be a single deep groove or a combination of more than one line or groove. It gets its name because it appears to be a noticeable indentation or “crease” and it is formed near the top of the mentalis (chin) muscle.
The mental crease can contribute to an aging puckered look of the mouth area. It can also make an overly pronounced chin look even more exaggerated or “witch” like. In some instances where the mental crease is really deep (and other aging effects in the area are pronounced), a mental crease can make an individual look a bit like an aging cartoon character – sort of unnaturally old. Even in less noticeable occurrences, it can be an unappealing facial feature.
As with peau d’orange, BOTOX® is the first line of treatment for the mental crease. Small amounts of BOTOX® are placed into the origin of the mentalis muscle, near the tip of the chin. A touch-up treatment may be applied a couple of weeks after the initial treatment (if the initial treatment is not effective enough). In addition to BOTOX®, we may also place an advanced dermal filler such as Juvederm® or Restylane® along the mental crease to help fill in the crease.
Other Chin Wrinkles
In some instances, individuals may have wrinkles on the chin that sort of fan up from around the jawline on or around the chin. Most of the time, these wrinkles are very fine and shallow. Most experienced physicians will treat these wrinkles with small amounts of BOTOX®, the same way as described above in the peau d’orange and mental crease sections. BOTOX® will soften these wrinkles over time, which may result in the need for less frequent injections.
Depending upon the depth of the wrinkles, advanced dermal fillers, such as Juvederm® or Restylane® may be used, in conjunction with BOTOX®, to treat the wrinkled depressions. The combination of BOTOX® and dermal fillers can work together to extend the life of the dermal fillers.
Cheeks – Wrinkle Correction
Upper Cheek Wrinkles
Wrinkles around the outer corners of the eyes are commonly called crow’s feet. Crow’s feet wrinkles in some individuals can elongate over the cheekbone and onto the cheek hollow. These lines are generally superficial and relatively shallow. To treat these lines, dermal fillers such as JUVEDERM® Ultra and Restylane® are typically combined with BOTOX® to fill and relax the wrinkles.
Lower Cheek Wrinkles
Some individuals have wrinkles that arch up the cheek hollow from around the jawline. Wrinkles in this area are commonly treated with a dermal filler such as JUVEDERM® Ultra or Radiesse®.
For more shallow wrinkles, a product like JUVEDERM® Ultra is an effective product that may last up to a year, particularly in this part of the face. Radiesse® is an excellent product for deeper wrinkles as it not only helps initially fill & lift deeper wrinkles, but it works to stimulate the body’s own collagen for some enduring results. Depending upon the origin and placement of the wrinkle, some lower cheek wrinkles may be treated with BOTOX® as well.
On the flat plane of the cheek hollows sometimes wrinkles not only arch vertically from the cheekbone or the jawline (or both) but also emanate out horizontally from the middle of the face. This can occur when an individual has experienced a significant amount of collagen break down and loss of elastin. Some patients develop skin that looks a bit like crêpe paper.
Dermal fillers cannot only diminish or eliminate the wrinkles but often work to smooth the skin as well. Over time, most patients will notice a marked improvement of the skin’s texture in the treated areas. Maintaining the correction, over time with periodic treatments, will likely cause the patient to need lesser amounts of filler as the body responds by creating collagen.
Mouth Area – Wrinkle Correction
Lines that etch vertically from the upper or lower lips are commonly called lipstick lines or smoker lines. These lines are more prevalent on the upper lips. While they are sometimes called smoker’s lines, most individuals develop the lines for reasons other than smoking. The lines are a result of the loss of volume that occurs with age, along with repetitive bunching of the tissue from muscular activity. These lines can contribute to lipstick bleeding, hence the name ‘lipstick lines’. They are typically treated with advanced dermal fillers, BOTOX®, or a combination of both.
Oral Commissure (Marionette Lines)
The area at the corner of the mouth where the upper lip meets the lower lip is called the oral commissure. The oral commissures usually experience a gradual depression over time. In many individuals, the depression contributes to the formation of wrinkles and lines, as well as contributing to a more angry or stern appearance. Oral commissure lines may extend downward from the corners of the mouth, giving an individual an unnatural puppet or marionette-type appearance. In other instances, oral commissure lines may fan out from the corner of the mouth. Oral commissure lines are almost always treated with advanced dermal fillers. In some instances, BOTOX® is also used to help alleviate oral commissure lines.
Some individuals develop lines that arc around the corners of the mouth and look somewhat like a set of parentheses. These lines are usually an extension of nasolabial folds. They are often shallow, fine lines that are treated much the same way as the marionette lines, with advanced dermal fillers, such as Juvederm® or Restylane®. The filler is usually placed along the line to help lift and fill the line.
Neck – Wrinkle Correction
Exposure to the elements (photodamage), loss of collagen and elastin, as well as laxity of the platysma neck muscle can contribute to the formation of horizontal wrinkles and lines, commonly called necklace lines. These lines may be treated with BOTOX®, placed above and below the lines, at points 1 – 3 centimeters apart, along each line. In addition to BOTOX®, a soft dermal filler, such as Juvederm® or Restylane®, may also be used.
As we age, the platysma neck muscle may become laxer or more hypertrophic (enlarged). When this happens, vertical ridges or bands may become more pronounced when the muscle is contracted. BOTOX® may be used to relax the platysma muscle and diminish the appearance of the bands.
Forehead – Wrinkle Correction
Glabellar Scowl Lines
Scowl lines are an area of concern for many individuals. These lines, technically called glabellar lines, extend vertically above the nose, between the eyebrows. They can look like a number ‘11′ is etched into the face. In some individuals, they become pronounced, forming deep folds or furrows. Glabellar lines can contribute to an angry or scowling appearance. The lines are caused primarily by exaggerated scowling, squinting, or pensive movement of the eyebrows and forehead.
Glabellar lines are treated with BOTOX®. Treatments with BOTOX® in this area typically require around five quick injections with a very fine needle. As with other BOTOX® procedures, if the treatments are maintained regularly, many patients will require smaller amounts over time.
Horizontal wrinkles that form on the forehead are common to many individuals. They are generally called forehead rows. These lines are caused by repeated exaggerated lifting of the eyebrows and forehead. Exposure to the sun and the environment can make the lines become more pronounced or etched over time.
Forehead lines are typically treated with BOTOX®. In addition to BOTOX®, if the forehead lines are deep, then an advanced dermal filler such as Restylane® or Juvederm® may be applied to gently lift part of the grooved line. Together with BOTOX®, the dermal fillers will last an extended period of time, in many instances.
Nose Area – Wrinkle Correction
Bunny lines are wrinkles on the upper bridge of the nose or on either side of the nose that is caused by hyperactivity of nasalis muscles when smiling or laughing. They get the name bunny lines because they are formed from twitching the muscles of the nose. You can scrunch your nose to see bunny lines. These wrinkles may be horizontal, vertical, or diagonal. Bunny lines are often superficial or shallow. While only very small amounts of BOTOX® are used to treat bunny lines, individuals wishing to treat bunny lines will normally require regular small treatments as soon as they begin to reappear.
Nasolabial folds are deep creases or folds that run from the corners of the nose down to the corners of the mouth. Nasolabial folds vary in severity from lines to folds to crevasses, the latter being a very deep fold. In some instances, nasolabial folds arc around the corners of the mouth to form parentheses looking curves around the sides of the mouth. (See also: Mouth Area Wrinkles section) Nasolabial folds are usually a single crease, but can also be comprised of more than one line.
Nasolabial folds may be treated with a variety of methods, depending upon the severity and type of fold. For the fine lines that look more like a stiletto cut, physicians will often place a filler superficially in the fold. Deeper nasolabial folds are typically treated by placing liquid facelift products, more deeply underneath the fold. This technique will essentially push the fold up and alleviate the appearance of a fold, in some instances removing the fold entirely.
We take care not to over-treat the fold directly. Depending upon an individual’s unique facial characteristics, some subtle nasolabial depression may be a naturally desirable contour.
In addition to direct treatment of the nasolabial fold area, a liquid facelift procedure can have some additional positive effects on nasolabial folds. Lifting the upper face or adding volume to cheeks and other areas of the face will essentially pull back on the fold for an improved appearance.
Taking the next step
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