With the new year comes new questions. Dr. Vipond has selected a variety of patient queries for this month’s cosmetic corner.
Q: I heard that Botox can help treat depression. How can it affect emotions?
A: There is a relationship between certain facial expressions and our perception of emotion. Some have termed this association “Biofeedback”. Simply put, when we smile, even if we are not happy, we can experience a brief feeling of mood elevation. Conversely, if we frown, we can cause ourselves to feel a short sensation of irritability. There was a study that looked at mood scores both before and after treatment of the frown lines with Botox. The study found that there was a statistically-significant increase in positive mood scores when the study participants were not physically able to frown as the result of the Botox. Not only may Botox affect our emotions, but it may also affect the way we are perceived by others. If we cannot frown, then someone with a severe or stern appearance may start to look more relaxed and consequently, may be perceived more approachable. While this certainly may sound like a good thing, too much Botox could interfere with our social interactions. If we are “frozen” and unable to express any emotion, then we might be perceived as cold or standoffish. In my opinion, Botox is a wonderful treatment, but it is important to find the right balance between too much and too little facial expression.
Q: My friends and co-workers are always asking me why I look tired. What can I do for the dark circles under my eyes? By the way, I don’t think that I am ready for surgery.
A: Unfortunately, the thin and delicate skin around the eye area can be one of the first areas to age. This is often a very genetic trait that we inherit from our parents and grandparents. Dark circles, crow’s feet, bags and fluid retention can make us look exhausted and angry as well as years older. In fact, eyelid surgery is one of the most popular cosmetic surgical procedures in both women and men. Additionally, the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS) reported that in 2016, facelifts, browlifts, and blepharoplasty (eye lift) were the three most commonly performed procedures in adults over 55.
While lower eyelid surgery generally offers a more comprehensive and long-lasting result, there are several intermediate steps that can be done to help improve the appearance without surgery.
• Fillers underneath the eyes to lessen dark circles and decrease the prominence of the hollows.
• Botox to relax muscles/creases around the eyes and to help lift a heavy eyebrow
• Laser resurfacing can help improve thin and wrinkled skin to smooth the area
• Autologous fat transfer where fat from your own body is injected beneath the skin and muscle of the cheek and lower eyelids to help improve volume loss.
With any of the above treatments, it is important to understand their limitations, the duration of the effect, and what a reasonable expectation may be.
Q: I’m tired of having to repeat filler injections. Are there permanent fillers that I can use instead?
A: While there are two FDA-approved permanent fillers, Silicon Oil and BellaFill (Polymethyl methacralate), I am hesitant to use either. Certainly, there are a number of practitioners that use and like these products. However, I worry about injection products that are truly permanent. If there is a problem, there is no easy way to remove the filler. This is not the case with solid silicon implants which can be removed or replaced surgically. With non-permanent fillers, any problems often resolve with either dissolving or reversing the filler (in the case of hyaluronic acid fillers), or just waiting for the body to resorb the product.
Q: I have heard that buccal fat pad removal can give me more sculpted cheeks. What do you think of the procedure?
A: Most people are familiar with adding fillers to create volume in the cheeks and make the cheekbones more prominent. A lesser-known procedure is buccal fat reduction/removal where some of the fat in the cheeks can be removed to create more sculpted cheekbones. It is definitely important to be well-informed prior to deciding to proceed as the effect is very difficult to reverse if you change your mind, or if too much fat is removed. It is a relatively-brief procedure that typically involves a small incision on the inside of the cheek and works especially well in patients between 18 and 35 years old who have genetically-large “chipmunk cheeks”.
My opinion is that buccal fat pad removal may look good initially, especially in young patients with good overall facial volume. However, as the swelling resolves and the aging process continues, many patients end up looking overly-sculpted and hollow.
Q: I don’t think that I am ready for a facelift, but I hear that threadlifting is a less invasive option. Is that a good first step?
A: Threadlifting, in its original form, involved the placement of permanent barbed suture underneath the skin to help pull up the muscle layer of the face and neck. The attraction of the procedure was that it could be done under local anesthetic and gave immediate results with very little recovery time. However, there were also problems with the procedure. Occasionally the barbed suture would break and the tightening effect would come undone. Alternatively, the suture might start pulling through the muscle and create a dimpled, pulled appearance, rippling, or bunching of the skin. While I never performed this threadlift procedure, I certainly had to correct numerous patients who had problems with theirs. In fact, the company that manufactured the original sutures lost its FDA approval and the product was taken off the market.
The newest iteration of the threadlift has replaced permanent sutures with a dissolving or absorbable suture material, Polydioxanone. They are placed in a similar fashion as the original procedure, often requiring just local anesthetic. However, the suture material starts to lose tensile strength and dissolve after 6 weeks. Some patients can experience a mild reaction to the dissolving process. In theory, the body will be stimulated by this suture placement to make its own collagen and that will lead to a longer-lasting increase in volume and tightness. While this may sound promising, I am a little skeptical at the amount of long-term improvement. With permanent sutures, the result was severely compromised if the suture broke, even months after the procedure. If a dissolving suture is used, I do not feel confident that there will be much long-term improvement. I think that dissolving sutures are safer as any potential problems will tend to resolve as the suture absorbs, but I don’t think the results will deliver what patients expect. In fact, when I perform face and neck lifts, I use permanent sutures to help resuspend the muscle so that support will be there much longer than if I used an absorbable suture.
It is always important to be well-informed before embarking on any facial cosmetic procedure. Dr. Vipond encourages any potential patients to research before an appointment and to not be afraid to ask questions of your physician or practitioner. While any procedure has some element of unpredictability, it is very reasonable to know as much as possible about anything that will be done to your face.