Botox and Dysport can both be used to relax the muscle along the side of the upper eyelid. This muscle causes the brow to be pulled down and by relaxing this muscle, one can get a small elevation of the brow or a browlift by the use of this Botox or Dysport. The amount of Dysport or Botox used is highly customized dependent on the activity of the patient’s musculature, but typically 4 to 8 units are placed on each side to allow this muscle to relax and elevate the brows. More frequently I will use 10 to 12 units on each side to treat the entire crow’s feet area and by doing so this will not only improve the crow’s feet wrinkles, but also provide the brow elevation that is desired. Dysport is used in an identical fashion, only three times the number of units of Dysport is used in relation to Botox. Therefore, a total of 20 units of Botox are used and 60 units of Dysport would be used for the same area.
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The short answer to that question is no, intense pulse light is not safe if you have a suntan; however, it does partially depend on what treatments and what correction you are requesting. If you are interested in treating pigmented areas on the face, then I would consider it an absolute contraindication to treat someone with intense pulse light that has a suntan. However, if you are mainly interested in the vascular component or if you are using intense pulse light for a deeper treatment such as Skin Tyte for skin tightening, you should be able to have a treatment performed even though you have a suntan. Obviously the correct answer to this question is you want to avoid excessive sun exposure and I highly recommend use of a sunblock on a daily basis to avoid the negative aspects of too much sun.
Typically, injections of Juvéderm do not cause any visible bruising; however, there may be a 10 percent or up to a 20 percent chance that bruising will occur with this type of injection and I do caution patients that if they have a very important function that they give me at least a few days to allow any bruising to subside. Otherwise, cover makeup can be applied immediately after the injection to hide any sort of redness or early bruising. With that said, I find it extremely difficult to adequately treat the chin crease as this area of the face has very dense dermal collagen and it can be rather difficult to get the typically deep wrinkle that goes across the upper portion of the chin to lift and disappear. Fortunately there are other treatment modalities such as erbium laser resurfacing or ProFractional laser treatments that can do a wonderful job in wrinkle reduction and are not only affective, but also permanent.
Retin-A is a wonderful product that I recommend to virtually every one of my patients; however, I do not recommend it for wrinkle reduction and certainly would not recommend it for under eye hollows. Retin-A essentially increased the cellular turnover of the skin. It can provide a very small amount of very fine wrinkle reduction, but this would be very difficult to really appreciate visually. Fillers; however, are excellent at filling in depressions in the under eye if placed extremely precisely and carefully. Products such as Restylane or Juvéderm Ultra can do a wonderful job of filling in these troughs or depressions in the lower eyelid and this will essentially give the illusion that the lower eyelid bag has disappeared. This can create a very natural rejuvenated eyelid appearance without surgery. The only two drawbacks are that it is not a permanent solution, but will last approximately one year. The other drawback is that if not placed properly, can actually create a worse problem than the original under eye hollow. Fortunately any sort of difficulties with over injection of these types of products can be treated rather easily and therefore any complications from filler material in the lower eyelids can be corrected with injection of hyaluronidase.
When comparing those two filler materials, I would absolutely recommend Juvéderm for the lips as Radiesse is essentially contraindicated in that location. Due to the fact that Radiesse is calcium based and relatively thick, it tends to create some irregularities in the lips and will often migrate and become visible just below the mucosa. Juvéderm, on the other hand, is very smooth. It is softer. It is more gel-like and when injected into the lips, has a very natural feel and when injected properly, can give an extremely natural appearance to the lips. With that said, I feel it is extraordinarily important to see someone with significant experience in injecting lips as improper injection techniques can lead to the complication of “duck lips” or “sausage lips” both of which are quite undesirable from an esthetic perspective. Fortunately, if someone presents in my spa or office with one of these undesirable complications of lip injection, it can be corrected with the use of an enzymatic product called hyaluronidase, which will allow the Juvéderm or other hyaluronic acid type filler to dissolve in a matter of 24 to 48 hours. Obviously prevention of the complication is much easier to deal with than the treatment. I therefore once again stress seeing someone with a significant amount of experience in injecting the lips.