Botulinum Toxin and Filler Gallery

This patient in her 70s underwent bilateral upper blepharoplasty, bilateral ptosis repair, and botulinum toxin @raleigheyeandface

*The after photo is a selfie from our patient.

Cosmetic botulinum toxin injections can prevent or improve wrinkles. Areas treated for this patient were the forehead, the glabella (between the eyebrows), the crow's feet, and botulinum toxin lip flip to add volume to the lips. In total, 62.5 units were used. The treatment is customized to help each patient achieve the desired result.

Watch a before and after of this patient here:

https://raleigheyeandface.com/video-gallery

This patient underwent lip augmentation with 1 cc of filler and her results are demonstrated 2 weeks after the procedure.

This case is a great example of how botulinum toxin can be used for enhancement. Botulinum toxin weakens muscles temporarily in a dose dependent fashion. Most commonly, patients prefer to have facial movement reduced but not eliminated. Such treatment allows for normal facial expressions while reducing the depth of wrinkles. Treatment is customized for each patient to provide optimal results to improve appearance at rest and with certain expressions. In this case, you can see prominent crow’s feet with a smile. After customized treatment, the crow’s feet are reduced, the area between the eyebrows is soften, and the brow contour and position is improved. The medication effect fades over time. Most commonly, patients return approximately every three months for repeat injections.

Here is a summary of what was done in this case:

Botulinum toxin was strategically placed to treat forehead and other facial wrinkles and relax the facial muscles.

This patient underwent tear trough filler treatment. The treatment enhanced the transitions from her lower eyelids to her cheeks which resulted in improvement in hollows and dark circles. The ‘after’ photo is four weeks after the injections.

This patient underwent tear trough filler treatment. The treatment enhanced the transitions from her lower eyelids to her cheeks which resulted in improvement in hollows and dark circles. The ‘after’ photo is two weeks after the injections.

Eyelid asymmetry may occur only with certain facial expressions such as smiling. In this case, the patient noticed that her right eye appears smaller when smiling but otherwise, her eyes appeared similar when she was not smiling.

In this case, the noted asymmetry was caused by imbalance in contraction of the orbicularis oculi muscle, which is a sphincter like muscle that flexes when we smile.

Botulinum toxin was used on the upper third of the face (for general rejuvenation) with attention to the right eyelids to address the imbalance and asymmetry. Injections in the right eyelids decreased the strength of the orbicularis oculi muscle which plays a role in the appearance of the eyelids when we smile (and when we don’t).

This treatment resulted in improved symmetry.

The effect of botulinum toxin last for approximately three months. Injections can be repeated periodically to maintain results.

To enhance symmetry, this patient underwent:

Right upper blepharoplasty to remove heavy skin and reform the eyelid crease

Right internal ptosis repair to elevate the right upper eyelid

Right Botulinum toxin brow lift

Botulinum toxin treatment to lower the right lower eyelid

This patient also had general facial Botulinum toxin treatment to reduce wrinkles (notice the improvement in the forehead lines)

We lose volume in our temples as we age leading to a sunken appearance.

Filler can be used to add volume to the temple, improving facial contours and supporting the lateral brow.

Temple filler is less susceptible to post procedure swelling or lumps and bumps and can provide an instant result.

This is a great example of how surgery and non surgical procedures compliment each other to provide the best results. Surgery, botulinum toxin, and laser all play different roles in rejuvenation. Here is what was done in this case.

Upper blepharoplasty surgery: excess upper eyelid skin was removed and the upper eyelids were contoured to reestablish an eyelid crease on each side.

Lower blepharoplasty surgery: orbital fat that shifted forward over time was sculpted to create a smooth transition between the lower eyelids and cheeks.

Botulinum toxin was strategically placed to balance the brows and relax the facial muscles.

Laser resurfacing was performed to rejuvenate the skin, improve skin quality, fine lines, wrinkles, and pigmentary changes. In this case, higher energy settings were used on the malar area where some mild redness is apparent - this will improve. This patient is shown approximately 3 weeks following laser resurfacing. There will be continued overall improvement in the skin over the course of months.

Botox is a cosmetic injectable medication that weakens muscles temporarily.

The medication can be strategically placed to rejuvenate the face.

In addition to generally softening or preventing wrinkles, Botox treatment can be tailored to address specific concerns.

Most patients return for injections approximately every 3 months.

This patient had tear trough filler injections performed by another injector. She developed painless firm nodules in the areas where filler was injected that caused associated skin discoloration. The patient was referred to me for further management. She was told by the original injector that the filler injected was a naturally occurring substance that was not permanent. From this description, one would infer that this patient was injected with a hyaluronic acid based filler. Review of records revealed that the patient was actually injected with a permanent filler made of an acrylic plastic in a collagen gel. Based upon the history and evaluation, the patient was diagnosed with filler granulomas. A series of injections containing steroid and 5-fluorouracil was planned. The patient underwent 3 injections. Another injection of steroid and 5-fluorouracil was planned but deferred by the patient as she was pleased with her improvement.

We lose volume in our temples as we age leading to a sunken appearance.

Filler can be used to add volume to the temple, improving facial contours and supporting the lateral brow.

Temple filler is less susceptible to post procedure swelling or lumps and bumps and can provide an instant result.

This was an interesting case that highlights how combining treatments can lead to the best results. This patient in her 60s had volume loss in her upper lids and temples which was accentuated by her prominent cheekbones. This volume loss along with ptosis and a compensatory brow hike resulted in an aged appearance with hollow upper eyelids. Additionally, her skin quality had diminished over time. She underwent multiple treatments to address the various contributing factors. This is a great example of how surgery and non surgical procedures compliment each other to provide the best results. Surgery, botulinum toxin, filler and laser all play different roles in rejuvenation. Here is what was done in this case.

Ptosis repair surgery: the upper eyelids were raised to a normal height.

Lower blepharoplasty surgery: orbital fat that shifted forward over time was sculpted to create a smooth transition between the lower eyelids and cheeks.

Upper blepharoplasty surgery: excess upper eyelid skin was removed.

Botulinum toxin was strategically placed to treat forehead and other facial wrinkles and relax the facial muscles.

Filler was placed in the temples to address age related volume loss. This improved facial contours by treating a relative depression above this patient’s high and prominent cheekbones.

Laser resurfacing was performed to rejuvenate the skin, improve skin quality, fine lines, wrinkles, and pigmentary changes.

When one eyelid is too high or too low relative to another, eyelid asymmetry becomes more apparent.

In this case, the right lower eyelid was too high relative to the left.

Botulinum toxin was used on the upper third of the face (for general rejuvenation) with attention to the right lower eyelid to address the imbalance in the lower eyelid position. Injections into the right lower eyelid were used to decrease the strength of the orbicularis oculi muscle which plays a role in lower eyelid position.

This treatment resulted in an optimal right lower eyelid position which improved symmetry.

The effect of botulinum toxin last for approximately three months. Injections can be repeated periodically to maintain results.