Question: I am a vegan that only likes to use items that are all-natural and mirror elements that are already in my body.  Are there injectable fillers that are derived from natural substances or mimic their action?

Answer: The hyaluronic acid fillers are the most commonly used fillers in the world and hyaluronic acid is a gel-like material that is made up of sugar molecules all linked together and then cross linked, and these are found naturally in all mammalian tissue, so it is essentially the same chemical that is already found inside of our bodies.  Overall, these fillers, such as Juvederm and Restylane, work extremely well, are very well tolerated by patients, last a relatively long time, and are overall affordable.  In fact, they are so good at creating a natural rejuvenation that they are most likely going to overtake Botox as the number one used cosmetic treatment in America.   

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Question: It’s been a full day since I had Restylane injected into my lips and I now have duck lips and severe bruising. What can I do?

Answer: Since it has only been one full day, I would not get too concerned as this occasionally happens with lip injections.  The bruising is going to add more swelling and the swelling is going to give you more of a duck lip type look and you, therefore, just need to be patient and allow the swelling and bruising to subside.  You can accelerate the process by keeping your head elevated, staying active, and intermittently icing the lips, but it may take about a week for all the swelling and bruising to go away and at that point, your lips should look like they did immediately after the injection.  Hopefully, this will give you the look that you desire but, if it does not, Restylane is reversible with the injection of hyaluronidase.

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Question: My coworker recently suggested a Botox treatment to reduce the wrinkles around my mouth. I have heard this injectable is derived from the pathogen that causes botulism. Can Botox have negative side effects?

Answer: Well, your friend is correct that Botox is a derivative of the chemical that causes botulism but, used under very controlled circumstances, can do a wonderful job of improving lines on the face. The specific lines that you mentioned, which are the lines around the mouth, are much more difficult to treat with Botox since we do not want to overly relax the muscle around our mouth for fear that we would then cause difficulties with our ability to drink, eat, and speak and this obviously would not be warranted for a cosmetic improvement in wrinkles. I, therefore, occasionally use Botox in and around the mouth but much more frequently either recommend filler injections such as Juvederm and Restylane or will recommend a laser resurfacing, which can provide an excellent improvement in wrinkles around the mouth.

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Question: I am a 56-year-old female who had a midface lift about 7 months ago. I have noticed some of my skin still sags around my nose. Is there another alternative to help fix this problem?

Answer: I am personally not a big fan of using midface lifts alone to try and improve the smile line from the nose down towards the corner of the mouth. My personal experience is that a deep plane facelift would do a much better job of effacing this fold than a standard midface lift would. With that being said, an easy remedy for your problem is simply to fill this area with some Juvederm or Restylane or even consider Radiesse or Sculptra as well. Another possibility is to consider cheek implants if you have a significant degree of volume loss in that area.

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