lip-lines Archives | The Aesthetic Clinique

The Unintended Consequences of Gum Chewing: Accelerated Aging of the Lower Face and Mouth.

People chew gum to help clean their teeth after eating, freshen their breath, and even try to keep them whiter. What isn’t readily known is the havok gum chewing has on the aesthetics of the lower face.

The simple act of excessive chewing will lead to muscle hypertrophy of the masseter. Enlargement of this muscles leads to squaring of the lower face and jawline, an undesirable shape in females. The aesthetically pleasing lower face is V-shaped or Heart-shaped. Widening of the lower face is particularly prevalent in the Asian population where the women go to great lengths to slim their face with cosmetic procedures, including surgery. Gum chewing leads to similar problems which fortunately can be reversed with weakening of the masseter muscles with Botox/Dysport.

A much more problematic issue to fix is the negative side effects which occurs around the mouth secondarily to gum chewing. The movements of the soft tissue and perioral muscles is significantly more when chewing than in a relaxed state. Just as with the frown lines and crows feet, the more movement in these areas, the more wrinkles and etched in lines are created. (Ever notice Kim Kardashian doesn’t smile in pictures? It’s because she’s afraid of creating wrinkles, so she limits her facial movements.) In essence, gum chewing accelerates the aging process around the mouth and lower face. Unfortunately, Botox/Dypsort aren’t as easy a remedy for this area because restricting muscle activity can lead to eating and vocalization difficulties. However, lasers, radiofrequency, microneedling, and judicious use of Botox/Dysport can improve the perioral aging process.

Straws can also lead to upper lip lines due to excessive muscle use of the lip muscles (orbicularis oris). The recommendations to improve lower face and mouth asethetics: stop gum chewing and straw use and consider breath mints as a substitute.

Commonly Asked Questions About Lip Filler Problems

My lips are swollen, lumpy, and a little uneven, when will they get better? This is the most commonly asked question on Realself.com. The lips take about 7-10 days to settle down after getting filled. Restylane Silk will swell the most of all the fillers. Juvederm, and Restylane are the most commonly used fillers and the swelling and lumps will all even out gradually over the first week. Sometimes there is asymmetrical swelling, and that usually evens out too. Elevating the head of bed will help lessen the swelling. Unless there is bruising, ice will not change the swelling, nor will antihistamines. The swelling is most often related to the HA filler absorbing water from the surrounding tissues. On an extremely rare occasion, the lips and surround tissues swell abnormally, and this is called angioedema. This most often occurs in people that take a blood pressure medicine that is in the “ACE inhibitor” family. If this occurs, immediate attention is needed by your doctor or the emergency room.
I’m very bruised, when will it go away? Bruising is related to technique, not the filler itself. Bruising can take up to 10 days to go away. Early bruising can be treated with a laser (VBeam or Excel V) to decrease the duration to 2 or 3 days. It is best to stop all supplements, anti inflammatories, fish oils, vitamin E, or all other medications that can thin the blood a few days before injections if possible. Aspirin takes 12 days to get out of the system. Cannulas help minimize bruising as does careful technique, but bruising isn’t always avoidable. Arnica will help bruising too.
My upper lip is very full, is this normal, I look like a fish or duck? There is an art to filling the lips. The upper lip should be smaller than the lower lip by the golden ratio of phi, 1:1.6. If the doctor does not abide by normal anatomic ratios, the lips look done and abnormal. It does not happen to most people and is unrelated to the product injected. It is poor technique by the injector. In ethnic people, sometimes a 1:1 ratio does look normal, but never when the upper lip is larger. Click here to learn about perfect lip anatomy.
Can the corners of mouth be turned up, I always look sad? The corners of the mouth can be lifted with properly placed filler. Also, an injection with a neuromodulator such as Botox or Dysport can be injected into the depressor angularis oris, DAO, to relax the muscle pulling the corners down. Often, support is also needed in the above the upper lip in the triangle of volume loss near the corner. Also, injection into the corner (commisure) is needed.
I’m not happy with my lips after injection, what can I do? First thing is to discuss with your injector. After waiting the 10 days, lips that still have bumps, look odd, or are uneven, can be dissolved with hyaluronidase. This is not a precise procedure, so fine tuning is not possible. Most often, one treatment is needed but sometimes 2 are needed. Sometimes a little filler can be added to make things more symmetric. Asymmetries are very frequently noticed after injections by patients, but after careful review of photos, were present before the procedure too.
I have severe pain, days after the injection. Pain should not be present after about a day or 2 from the procedure. This needs to be discussed with your injector. Concerns would be possible injection, or herpetic outbreak. Severe overfilling can cause this too.
What can be done for my upper lip lines, “smokers lines”? Upper lip lines, “smokers lines”, are some of the hardest wrinkles to treat. This occurs even in non smokers and is mostly a volume related problem. Best treatments include filler placed horizontally in the white lip or ergotrid (with cannulas), a fine bead of filler along the vermilion border, and a small amount in the lip body. Adding Botox in small amount help too. Don’t expect elimination, just improvement. Longer term solutions are laser resurfacing with ablative lasers, Infini, or dermabrasion.

Video of Dr. Weiner discussing the most commonly asked questions about lip filler from RealSelf.com

What’s new in Botox Treatments, MicroBotox, and the Upcoming “Botox Cream” by Revance Theraputics

New Botox techniques: MicroBotox, Mesobotox. Revance RT001.

Dr. Weiner answers questions about Botox

Botox was originally FDA approved for treating stabismus (lazy eye) and blepharospasm (spasms of the eyelids) in 1989. When treating around the eye, patients and doctors were noting the wrinkles around the eyes were improving and brows were elevating. Studies were then initiated by Drs. Jean and Alastair Carruthers to test the cosmetic effects of Botox. It actually took 4 years to recruit enough patients to complete the study. In 2002, the first indication for Botox cosmetic use in the glabella (frown line) was approved. Botox has since become the most popular cosmetic procedure in the world. Its no downtime, consistent and effective results have made it a mainstay for people desiring a quick wrinkle improvement. Earlier this year, the FDA approved the second indication: for use in the lateral canthal rhytids (crows feet). Although the crows feet and other areas of the face and neck have been used (legally) off-label since the early 2000’s, this new approval will allow the company, Allergan, to market this new indication to the public. This will create more public awareness about what Botox can do, and make it even more popular.

The newest buzz about Botox is a technique that has been used by Dr. Weiner for several years is called “MicroBotox”. This is when the diluted Botox is injected in multiple very small doses in the area treated. The theory here is that the effects of the Botox are more evenly spread over the areas treated and the chances of having areas over treated is less. The most notable area for this technique is in the forehead. The result of MicroBotox is a more natural look which is not frozen and the dosage of Botox is less. This technique has also been described for use in the neck by a Korean physician at a recent meeting. It was shown to mildly improve the neck wrinkles and improve the texture of the skin. For some people who have recalcitrant acne problems, MicroBotox (sometimes called “mesoBotox” when used in this situation) can be injected very superficially into the facial skin. However, there is a risk of affecting facial muscles and Revance’s RT001, a topical “Botox”, should be a better alternative to this technique.

In the near future, a cream to apply a substance similar to Botox will be FDA approved. Revance Therapeutics is developing RT001 for use in the lateral canthal rhytids (crows feet) and has shown great promise. It will be a cream which is applied in the physicians office and stays in place for about 15-30 minutes. This will eliminate injections for this area and is completely painless. The results seem to be impressive, possibly better than injections. The reason the results are better is similar to why MicroBotox is better for the forehead- the dosing seems to be more evenly applied to the muscles around the eyes. Other areas being tested by Revance are: underarm hyperhidrosis (sweating), migraines, and rhinitis (runny nose). Off label potential uses are for acne and general overall skin improvement of the face and neck. Unfortunately, the other areas which Botox is injected in, frown lines and forehead line, have muscles which are too deep to allow the topical ingredient to get to those depths. Whether or not the upper lip lines (smoker lines) will be treatable with RT001 has yet to be tested.

Even though Botox has been FDA approved since 2002 for cosmetic uses, there are still new techniques, new uses (approvals), and a new delivery model (topical) for a competitor which will soon get approval. The aesthetic industry is constantly changing and Dr. Weiner works hard to stay at the forefront of all the latest techniques and technologies. To learn more about Dr. Weiner, visit his website: http://www.theclinique.net For a consultation call: 850.622.1214. Dr. Weiner is a Facial Plastic Surgeon who devotes 100% of his practice to noninvasive and minimally invasive cosmetic procedures. His practice is called the Aesthetic Clinique and is located in Santa Rosa Beach, which is between Destin and Panama City Beach, Florida.

Link to the app for Brilliant Distinctions, the reward program for Botox, Juvederm, SkinMedica Products and Peels, and Latisse

YouTube: http://www.youtube.com/user/StevenFWeinerFacial

Blog: http://stevenfweinermd.wordpress.com/

Ultherapy – Non Invasive skin tightening with no rivals

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Dr. Weiner answers questions about Ulthera

Ulthera (or Ultherapy) was introduced in 2010 in the US. It uses ultrasound (high frequency) to cause an extremely predictable controlled injury at a certain depth (1.5, 3, 4.5mm depending on the hand piece) and a certain tissue volume. On the face, the level treated corresponds to the tissue called the SMAS, which is the area tightened during a facelift. So in essence, the Ulthera is tightening the SMAS without any incisions. The treated area is tightened and lifted gradually over the next 3-6 months as collagen is laid down in response to the treatment. Clients will notice a firmer jawline, less turkey neck, elevated cheeks and eyebrows, and less fine lines around the eyes. The newest hand piece, 1.5mm, is designed for the superficial fine lines around the mouth and eye area.

Almost all the other technology available (Thermage, Affirm, Exilis) for non invasive skin tightening uses radio frequency (RF) to heat up the underlying tissue to cause a thermal injury. Although Thermage was the gold standard for years, it’s problem was unpredictable results. That is because RF needs to heat the tissue to about 41-45 degrees C. Any more than that, too much damage is caused, and any less, no improvement is seen. RF requires the treated tissue to conduct the energy through existing collagen fibers, and the conductivity of people’s skin is different, and not predictable. (As previously stated, Ulthera will lay down it’s thermal injury at the exact skin depth and energy level in ALL PATIENTS similarly.)

The future of Ulthera is exciting. As experience grows, treatments are becoming more aggressive. More treatment line, more levels of treatment, seem to be able to create better corrections. Off the face treatments are beginning on the chest, knees, and soon buttocks.

Keep in mind that Ulthera does nothing to improve the outermost skin (pigment, vessels, texture) and does not create much additional volume. That is where lasers and fillers are needed to complete the total package of facial rejuvenation.

(We are very fortunate to have recognized the value of Ulthera and were very early adopters. Sandy, our RN, is a major contributor in the Advance Providers Round Table discussions at the company headquarters.)

Dr. Steven Weiner is a Board Certified Facial Plastic Surgeon practicing in Santa Rosa Beach, Florida, between Destin and Panama City Beach, Florida. After laying down his scalpel in 2005 he has devoted his practice to Lasers and Injectables.Blog: http://stevenfweinermd.wordpress.com/YouTube: http://www.youtube.com/user/StevenFWeinerFacial

Website: http://www.theclinique.net

After years of evaluating Sculptra, “I’m a believer”.

Patient had volume loss from weight loss and age. She was treated with 6 vials of Sculptra. Right side of picture is 1 year after treatment.

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Dr. Weiner answers questions about Sculptra

DR WEINER IS NOW A PHYSICIAN TRAINER FOR ADVANCED SCULPTRA INJECTION TECHNIQUES

Sculptra is a unique facial filler. It uses the body’s own collagen to create volume to the aging face. It is made up of Poly L Lactic acid, which is broken down to lactic acid, a natural occurring substance in the body. It comes as a powder to the physician, and is mixed with lidocaine and saline in the office days before the procedure. A series of 2-4 injection sessions is needed to get the full results, with at least a 6 week interval (because it takes 6 weeks to see the complete result of the prior treatment). After the treatment, your face will appear filled, but only for a day or two, and then the saline is absorbed. Gradually over the next 6 weeks, the Sculptra will stimulate the collagen, and create the volumization. Results are said to last 2-3 years. Touch ups are recommended at 12-18 month intervals.

Sculptra was initially FDA approved in 2004 for HIV associated facial atrophy, however it was used off label for cosmetic use soon after that. In 2009, it was formally FDA approved for cosmetic use. So what took me so long to get on board? There were problems with people developing nodules (bumps). Although, these were usually minor and not visible in most cases, they were a problem for some. I’m finally comfortable that this problem has been addressed and minimized. The steps take have been:

Make the Sculptra more dilute by adding more saline and lidocaine when mixing
Inject deeper in the areas where it is possible
Mix the Sculptra up days ahead of time instead of the night before
Have the patient massage the area
Do not inject too close to the mouth, lip, or eye area, the areas where most of the nodules were noted
Do not inject patients with autoimmune disease

Following these guidelines, the formation of nodules is now <1%, and comparable to the risk of developing these with Restylane and Juvederm.

Sculptra is unique in that it can volumize the entire face (except close to the eye, mouth, and lips) for a long duration. Considering its longevity, it is a cost effective solution when compared to Restylane and Juvederm. When comparing to fat grafting, its advantages are: