Question: I had eyelid surgery approximately two years ago, now I have small wrinkles under my eyes. Is this normal? I recently moved to Milwaukee and would like to know if you can remedy this and if it would require another surgery.

Answer: It is certainly not unusual for people to have a small amount of wrinkling under their eyes after a blepharoplasty since that is highly dependent on the patient’s skin elasticity as opposed to skin excess.  I would have to evaluate you personally to determine whether or not you do truly have a skin excess or if it is just the inability of the skin to rebound when you squint, but there are options available that would not require you to undergo another surgical procedure.  One would be some sort of laser resurfacing where the skin is treated to improve the collagen in the skin and this will then in turn improve skin texture, tightness, and wrinkle reduction.  For a no downtime option, Ultherapy can actually be used on the lower eyelid skin especially the newer transducer that treats 1.5 mm below the surface.  The results are not as significant as a full laser resurfacing but, considering there is absolutely no downtime involved with it, it certainly is still an option.  If you do have a significant amount of excess skin causing the problem then you may want to consider a simple in office pinch procedure to the lower lids where the excess skin is removed, sutures are placed, and these are removed in three or four days.  As you can see, there are a variety of options depending on your particular problem and tolerance of any downtime and I would, therefore, recommend a consultation with a board-certified facial plastic surgeon.   

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Question: I recently heard of something called lip sculpting. Is this different from lip augmentation?

Answer: Lip sculpting and lip augmentation are similar, but in lip sculpting we are not necessarily just trying to make the lip look bigger or trying to just augment the lip, but we are actually trying to improve the shape of the lip by placing filler in areas that you would not even consider to call the lip.  For instance, the philtral ridges are the small ridges that go from the nose down to the lip at the top of the Cupid’s bow.  These tend to flatten as we age and by placing an injectable filler in this area to recreate the philtral ridges in combination with recreating a much more significant Cupid’s bow to the upper lip, we can have a very nice rejuvenation and augmentation to the lip without making the lip look overly large.  Essentially, every lip augmentation procedure that I personally perform would be considered a lip sculpting procedure since we are going to customize the placement of the filler to give the patient the best result possible.  

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Question: I’ve been interested in lip augmentation for some time but I’m a little scared that I may not like the results. If I opt for lip augmentation with injectable fillers, how soon will the results wear off if I don’t like them?

Answer: For the most part, I recommend that patients stick to the hyaluronic acid fillers for lip augmentation since these are extremely safe and reliable and do not tend to create nodules or bumps like some other fillers can.  With that said, if you do not like the lip augmentation the injection of hyaluronidase will dissolve the injectable filler in a matter of hours, so the result can be reversible.  I will say though if you see an experienced injector there is very little chance that you will not like the results since customized injection techniques can create wonderful lip augmentation that looks very natural but significantly enhances this area of your face.

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Question: My daughter has a few keloid scars on her hands and her face that she’s very embarrassed about. Is there anything that can be done to lessen their appearance?

Answer: Keloid scars can be extremely difficult in certain patients and, therefore, I would have to evaluate your daughter to decide what the best treatment option would be.  If the scars are relatively new, then injection of dilute steroid solution into the keloid can oftentimes greatly reduce the thickness and firmness of the resulting scar tissue.  If these are old, then we would want to have a conversation about the risks and benefits of resecting these since, in a small percentage of patients, you can actually end up with keloids that are worse when you are actually trying to make them look better.

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Question: I am a woman in her mid-fifties with deep nasolabial folds. Would Juvederm injections give me a more youthful look?

Answer: Yes, it seems like you would be a great candidate for Juvederm in your nasolabial folds.  Depending on how deep the folds are, it may take anywhere from one to four syringes to give you an adequate improvement, but as long as it is performed by an experienced injector, you will get a very natural looking rejuvenation that will last somewhere between nine and twelve months and in some individuals quite a bit longer.

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