1) Fine lines and wrinkles in the forehead, the area between the eyes called the glabella where “11’s” (also called “frown lines”) form and lines around the eyes called “crow’s feet.”
2) Volume loss, mostly in the form of fat but also collagen, muscle, and bone. This creates hollows under the eyes, around the mouth and generally cause the face to sink and sag.
I do two main procedures at my office. The first is the use of botulinum toxin A in the form of either Dysport or Botox. These products work on the muscles that contract and create the “etched” lines in the overlying skin in the areas mentioned above. The Dysport/Botox relaxes the muscle, so it is unable to vigorously contract and keep etching those lines into the overlying skin. Additionally, the Dysport/Botox “trains” you not to use those muscles as aggressively. The result is a nice curtain of relaxation where the lines soften. Initially, we thought that this was only a temporary fix but regular use three to four times per year is now found to be reversing some of those etched lines which is unexpected but exciting. The main difference between Botox and Dysport is that Dysport is the “newer” version and is different by a particular small protein. I inject both, but Dysport seems to provide a smooth cosmetic result with the injection method I created. Botox works very nicely as well, but I tend to use it medically to treat migraines and bruxism (teeth grinding).
Xeomin (incobotulinumtoxin A) is another form of botulinum toxin A that I am investigating. One of the benefits is that it is thought that because an animal protein in the form of albumin is used to make Dysport and Botox, a small percentage of people may become resistant. Xeomin is not made with albumin and thus it is hoped that Xeomin will work on the small population of people who develop resistance.
There is a new (as of October 2022), long-acting botulinum toxin called Daxxify which apparently lasts six months as opposed to the 3 months for Dysport and Botox. It has been FDA-approved and will likely be released in 2023. Whenever a new medication or procedure is released, I always wait to make sure they “work out the kinks” and that it is safe and either as effective or more effective than what I typically use. I would also be wary of having such a long-acting toxin in the event there is an unwanted effect. I will update this segment with time.
The second procedure I do is called a “filler” injection. There are several types of filler on the market such as Versa and Belotero. These products are made of hyaluronic acid, (HA), which is basically a group of sugars known as a polysaccharide. Hyaluronic acid is already part of our body and 90% is in our skin. Thus, I like to call it “liquid skin” as it naturally restores what we lost without creating allergic reactions or toxic side effects. It also is quite malleable and given I literally “sculpt” your face, I like the hyaluronic acid products for the innovative technique I have created. The difference between Versa and Belotero and the other hyaluronic acid fillers are not that significant. Within each HA filler are subtle variations in the thickness of the product. I choose the product based on what area I am treating, what your goals are, and what fits best with your anatomy. Your treatment is individually tailored.
I will typically use Versa and Belotero to fill in areas of volume loss in the cheeks, under the eyes, and around the mouth and jaw when using a hyaluronic acid filler. I typically use Belotero and Versa for the lips.
The second class of filler I use to fill in hollows, lift the face, jaw, and neck, and smooth out wrinkled skin is called Radiesse. This is also natural and is made of calcium hydroxylapatite. Again, I may use one or more of the fillers to individually tailor treatment to your face. I will also use Radiesse to “body sculpt” and treat areas of the neck, décolleté, backs of hands, treating cellulite and lifting the glutes.
Again, fillers are for deeper areas of volume loss such as deepening nasolabial folds or hollowing cheeks and under-eye bags. I made it my personal goal to become an under-eye expert as physicians typically do not inject there due to the time and care needed to improve that area. I’m also the physician that shapes lips rather than just volumizing them and making them large and fat. Lips were meant to be shaped, and sculpted, not fattened, as that makes people look like ducks. I even use filler to trace etched lines that are too deep to respond adequately to Dysport/Botox. Think of it as filling a car dent from the inside out. I call the line filling procedure “magic erase.”
Thus, when you come in for a consult, I review everything and look at your overall face. I focus on the cause of the volume loss and not the effect. I simply replace what has been lost with time and then sculpt it using your own scaffolding (i.e., your cheekbones/jawbones, etc.), to create a very natural and harmonious effect. Your face should be injected like a piece of art, and not in a rushed, factory assembly-line model. So even when I am injecting your cheeks, I am balancing it out with your forehead, chin, mouth, etc. Everything must blend.
In conclusion, aging is just loss of volume. After genetics, our faces are influenced by age and environmental factors (such as smoking, pollution, sun damage, poor diet, etc.). As we age, the bones in our cheeks slowly flatten, and the fat starts to dissolve, (but fat unfortunately ends up going elsewhere if you gain weight). Fat does not typically go back into the face. Once it is lost, that is usually permanent, and the Vertical Volume Lift Technique I created is based on that fact. So, there are two main principles of my technique: The first is I am just replacing what fat, collagen, muscle, and bone is lost without overdoing it. The second is individually tailoring the filler to the patient and area being treated and sculpting it in, so it blends perfectly with the rest of your face. The key is to correct the imbalance and loss of harmony conservatively, creating a very natural appearance. When we lose volume, the resulting pull of gravity creates the lines, hollows and sinking and sagging of the face. Thus, when I inject, I lift, fill, and sculpt.
That is my philosophy in a nutshell. Please let me know if you have any questions.
Best of Health,
Dr. Messenger
