The good, the bad, the realistic - can Botox give me a brow lift?

Neurotoxins (Botox, Dysport, etc.) are a great option to achieve a bit of brow elevation without surgery. The key to understanding the answer to this question is understanding that there are different muscles around the eyebrows and eyelids that pull the brows in different directions.

The main forehead muscle, the frontalis, lifts the brows up. The main eyelid muscle, the orbicularis oculi, pulls the brows down. And in the middle of the brows, in a region we all the glabella, there are a group of muscles, the procerus and corrugators, that pulls the brows down and towards each other.

The key to a non-surgical, or chemical, brow lift, is appropriate dosing and injection of neurotoxin into each of these areas. Think of it like a scale – if you want to raise the brows, you’ll need to dose one are a bit higher than the other.

The other important thing to note about neurotoxins is that they don’t last forever. While there are some differences in duration between the different brands, patients will generally start to notice the medication wearing off in 3-4 months. So just like getting your nails done or hair dyed, it requires regular maintenance to achieve an ongoing look.

Can I massage after a facelift to help speed my recovery?

It is generally recommended against massaging or manipulating your own face after a facelift. The reason is that you don’t want to disrupt or pull too hard on the areas as they are trying to heal and knit back together. Excess manipulation in the early phases of healing could result in incision separation, hematoma (blood collection under the skin), or seroma (fluid collection under the skin).

Some surgeons will allow for lymphatic massages postoperatively, performed by a professional that is under the direction of the surgeon. These early, gentle lymphatic massages can assist with healing by promoting blood flood to the area and helping move some of the fluid responsible for swelling out of the area.

How long do blepharoplasty results last?

For simplicity, let’s talk upper blepharoplasty that is being performed to address age-related changes of the upper eyelid. During an “upper bleph,” a surgeon will remove excess skin and/or fat of the upper eyelid to give a cleaner, brighter, more open appearance to the upper eyelid. The skin redundancy is secondary to loss of collagen and elasticity, sagging due to gravity, and overall volume loss. Further, the fat beneath the skin begins to bulge as we age as a result of a weakening orbital septum.

The key to this question is understanding that any surgery that’s performed to address aging, whether it’s eyelid surgery (e.g., blepharoplasty), facelift surgery, etc., will turn the clock back X number of years. But nothing can stop the clock. You will continue to age.

And age-related changes of the face occur differently for different individuals. So there’s no defined answer to this question. It really depends upon how the patient continues to age. Patients who age more rapidly may have a handful of years before they begin to notice excess upper eyelid skin while patients that age more slowly may never notice recurrent excess of their upper eyelids long-term.

Can I work out after getting lip filler?

You can, yes. It’s generally advised to avoid vigorous exercise, extreme heat, and direct sunlight for the first 48 hours following injection of lip fillers. This precaution aids in reducing the risk of bruising, swelling, and other unwanted complications. Light exercise, such as walking, is generally fine after receiving lip fillers.

In comparison to other areas of the face, the lips are especially prone to swelling and bruising, given their tissue composition. The last thing you want to do after spending the time an resources getting your lips augmented is to overdo it at the gym and experience prolonged (and very annoying) swelling. Give your body a couple days after the procedure in order to aid in a relatively stress-free healing phase.

I want to apply some coverup. How long after blepharoplasty can I wear makeup?

Incisions like healing in a clean, stress-free environment. And happy, healthy incisions yield inconspicuous scars.

Proper wound care, adequate blood flow, healthful nutrition, and lack of foreign material/debris are all part of that stress-free healing zone. This is most critical in the first 1-2 weeks.

Makeup can contain irritating ingredients, bacteria, and foreign material. All of these should be avoided, as much as possible, during the acute healing phase.

I advise patient to wait at least 2 weeks after a blepharoplasty to apply any eye makeup. In rare circumstances, you may be advised to wait even longer.

How long should you wait to work out after Botox?

Botox, or any other name brand neuromodulator (Dysport, Xeomin, etc.), works by softening the muscle contraction of the area it’s injected into. Aesthetically, it is common for Botox to be injected into the forehead to help with horizontal lines, around the eyes to help with crow’s feet, in between the eyebrows to help with 11 lines, etc.

The issue with exercise after injection of a neuromodulator is that exercise increases blood flow and body temperature. Both of these factors can lead to the medication spreading to surrounding areas…which is what we don’t want. We want the medication to stay right where it is injected. Why? Because if it migrates to nearby areas of the face (e.g., eyelid or mouth), it can cause weakened muscle contractions in areas we don’t want weakened.

For example, let’s say a patient has Botox injected into their forehead and in between the eyebrows to give them a softer appearance and less visible lines in those areas. If that Botox migrates into the upper eyelid, they may have difficulty fully opening the eyelid for the following 3 months.

Generally, I tell patients to wait until the following day to perform any vigorous exercise.

Can a neck lift help with sleep apnea?

Generally, no.

Obstructive sleep apnea is just that – obstruction, or blocking of the airway, while a patient is sleeping to the point they become apneic, or no longer breathing. There are many contributors to sleep apnea, including obesity, unfavorable anatomy, medications, etc. And the big issue with sleep apnea is that it predicts poorer health outcomes in nearly all arenas. Patients with untreated or undertreated sleep apnea are statistically at greater risk for heart attack, stroke, high blood pressure, heart arrhythmias, diabetes, and obesity.

The gold standard treatment for sleep apnea is nighttime use of CPAP (or continuous positive airway pressure, where a machine physically forces the airway open and allows for continued breathing).

A neck lift is a cosmetic surgery in which various layers of the neck are surgically addressed to give a leaner, more contoured appearance. To date, there have been no large studies demonstrating that a neck lift has helped with sleep apnea.

For postpartum mamas: can I get lip filler if I’m breastfeeding?

The safety is many cosmetic procedures during pregnancy and breastfeeding is not well established. Why? Because they are cosmetic treatments, meaning not medically necessary, and we as a medical community tend to not test non-medically necessary treatments on women of such status.

That said, the placement of lip filler is a fairly straightforward procedure. Generally, no sedation is required and risks are minimal to the patient.

As long as patients are otherwise well with no illness, symptoms, or signs of mastitis/acute breast inflammation, dermal filler placement is argued by many physicians to be safe while breastfeeding.

I heard someone say they’re not allowed to nap after Botox. What’s that all about?

As a mother, surgeon, and cat lover, I’m a huge advocate of naps. In all scenarios. The reason this question is being asked is that some injectors will instruct patients to not lie flat for so many hours following Botox injections.

This is because laying supine, hanging upside down, or riding a roller coaster may encourage migration of the neuromodulator into an area that was not injected.

Botox, or any other name brand neuromodulator, works by softening the muscle contraction of the area it’s injected into. Aesthetically, it is common for Botox to be injected into the forehead to help with horizontal lines, around the eyes to help with crow’s feet, in between the eyebrows to help with 11 lines, etc.

After injection, we want the medication to stay right where it is injected. Why? Because if it migrates to nearby areas of the face (e.g. eyelid or mouth), it can cause weakened muscle contractions in areas we don’t want weakened.

Let’s say a patient has Botox injected into their forehead and in between the eyebrows to give them a softer appearance and less visible lines in those areas. If that Botox migrates into the upper eyelid, they may have difficulty fully opening the eyelid for the following 3 months.

Generally, I advise patients to not lie flat for 2-3 hours following neuromodulator injections.

Give me the skinny on Kybella

Kybella is a prescription medication (deoxycholic acid) used in adults to address fat under the chin. The medication is injected in to the subcutaneous (or top layer) of tissue and dissolves fat. While certain providers have found Kybella to be helpful for their patients, I simply don’t think it’s worth your time or money.

The issue with Kybella is threefold.

1. The need for repeated injections. Often times, you need three or more injections in order to achieve meaningful results. That means three visits and three downtimes. It can turn into a long process to get what you’re wanting.

2. The inability to address deeper issues within the neck. Kybella only treats the superficial, or top layer, of fat within the area of the neck. For most patients with significant fullness under the chin, it’s not just that top layer of fat causing the issue. More often than not, it’s the deeper fat, muscles, and sometimes glands that need to be addressed in order to achieve a better neck contour. Kybella simply isn’t able to address those deeper structures.

3. The superiority of surgery. With either isolated neck liposuction or a deep neck lift, a surgeon can more thoroughly address all layers of the neck and achieve a better, more contoured result with one procedure, one cost, and one downtime.

Why do my eyebrows feel heavy after I get Botox?

Botox, a common neurotoxin, is injected into a muscle to soften or paralyze its movement. As we age, repetitive muscle contraction leads to the formation of overlying skin lines and wrinkles. We can treat these lines and wrinkles with routine neurotoxin injections every 3 to 4 months.

Placement and dosing of Botox is key. In order to achieve a natural and non-heavy look, we have to target particular muscle groups in conjunction while treating others.

Let’s talk specifics. We commonly use Botox in the forehead to smooth horizontal lines that begin forming in our late 20s/early 30s. But it’s important to know that the forehead muscle raises our eyebrows while several other muscles pull the eyebrows down. If we only treat the forehead muscle, the eyebrows will begin to fall. This is the result of unopposed downward pull by the untreated muscles. So, if you’re receiving Botox in the forehead muscle, it’s important to inject the muscles that pull the eyebrows down at the same time in order to achieve a balanced and natural look.

Think about it like a scale. One side of the scale pulls the eyebrows up and the other side of the scale pulls the eyebrows down. If we treat only one side of the scale, the eyebrows will be preferentially pulled in the other direction. We often need to treat both sides of the scale in order to get our desired look.

Let’s talk perioral rhytids (aka Smokers Lines)

The vertical lines that appear around the mouth are the result of two things: repetitive movement of the muscle around the mouth and thinning of the overlying skin.

These stubborn and deep lines can become difficult to treat and are a very common concern as we age.

The key to addressing these lines is two-fold: careful and subtle filler within the lines alongside skin resurfacing to promote collagen formation. And for certain patients, a few drops of Botox into the muscle around the mouth can be the icing on the cake.

Think of the lines as peaks and valleys. The best results are achieved if we work to bring the peaks down (skin resurfacing with medical grade skincare, in-office chemical peels, and laser treatments) and raise the valleys (meticulous placement of filler alongside a small amount of Botox to soften the underlying scrunching muscle).

Facelift Q&A

What is a deep plane facelift?
In contrast to a traditional facelift in which the skin is pulled tight over the face’s aging underlying structure, a deep plane facelift adjusts the deeper tissues in the face for more comprehensive and natural-looking results. A deep plane facelift can lift the cheeks, restore lost volume in the midface, improve the appearance of nasolabial folds, and lift the muscles around the jawline to eliminate the appearance of jowls.

What's the best age for a facelift?
While there is no “perfect age” for a facelift, Dr. Umstattd can help determine if a deep plane facelift is the most appropriate treatment for your specific concerns. While undergoing a facelift earlier than needed limits the potential for improvement, waiting too long may also prevent you from achieving optimal results. In general, the 40’s and 50’s is the optimal time for truly beautiful facelift surgery but Dr. Umstattd also transforms patients in their late 70’s and above.

Where are the incisions placed?
The incision placement is designed so as to heal as imperceivable as possible. We utilize natural landmarks such as the hairline and ear to help conceal incisions. Dr. Umstattd also places a small incision under the chin to access the deeper contents of the neck.

Is a neck lift done in combination with a deep plane facelift?
Almost universally, yes. The aging process tends to happen concurrently for the mid- and lower-face as well as the neck. The substructures of the neck are routinely addressed during a deep plane facelift in order to achieve a crisper neckline and more contoured jawline.

What is the average downtime after a facelift?
While recovery varies from individual to individual, most patients are able to resume normal social functions about 3 weeks following surgery. Younger, healthier patients tend to heal a bit quicker while older patients, or those with more medical comorbidities, may take up to 4+ weeks before they feel comfortable being around close friends and family.

Am I a good candidate for a facelift?
The best candidates for a deep plane facelift are generally healthy, non-smoking adults who would like to reverse the signs of facial aging and have realistic expectations for their treatment.

What are the risks of a facelift?
Risks associated with a deep plane facelift include infection, swelling, bruising, bleeding, asymmetry, and facial nerve damage. However, as with any procedure, you can minimize your risks by choosing a surgeon who specializes in facial cosmetic surgery.