What is the difference between Botox and Fillers ?

in Botox and fillers, Infographics, Wrinkles/by drkotlus

Botox or fillers ?

“Do I need Botox and fillers?”

I’m asked this question almost every day in any of my New York offices (not to imply that wrinkles only happen to New Yorkers, it’s just where I practice).

The answer depends on where you have wrinkles or loss of fullness.

Sometimes the answer is both Botox and filler

Botox works best around the eyes- the frown lines between the eyebrows, the crow’s feet, and the forehead. Botox (and Dysport) relax the muscles that cause these expression lines.

In the hands of a Botox expert, Botox can gently lift the eyebrows, improve lines around the mouth, and lift the corners of the mouth.

Fillers are best for deeper creases, nasolabial creases (from the side of the nose to the mouth), lines that are not from expressions, and sunken areas (under eyes, cheeks, lips, temples).

“Will I have to do it again?”

Yes, if you want to keep looking younger . This infographic I made describes some of the differences and applications of Botox and fillers including the very popular Juvederm Voluma, Sculptra, and Restylane. Most of my patients who enjoy the benefits of injectable treatments undergo Botox approximately 3 times per year and fillers once or twice a year.

Under eye creases of youth

in Eye lift, Wrinkles/by drkotlus

The lower eyelid crease

When we are born, many of us have a crease on our lower eyelids. This crease is a horizontal line below the eyelashes that is more noticeable when looking downward. I like to call this the lower eyelid crease of youth.

Not every crease is a wrinkle

I recently answered a question on Realself about lower eyelid creases of youth. These creases can persist into adulthood but they shouldn’t be considered as wrinkles that need erasing. Taking away a youthful-looking feature will not necessarily make you look better or younger.

What the eyelid crease of youth looks like

Below is an image of my 2-year-old son’s eyelid. Notice the line on his lower eyelid that is rather deep when looking down.

This crease is made by the extension of the lower eyelid retractors, the muscles that pull the eyelid down when you gaze downward. See the large blue arrow in the diagram below (image borrowed from a book chapter I co-wrote in Clinics in Plastic Surgery).

If you have these creases…

Consider yourself youthful-looking and lucky. Removing or softening them can be done with surgery or Botox, but is not recommended in most situations.

How to find out if your skin cream is safe

in Technology, Wrinkles/by drkotlus

Is your skin care product safe?

When a product is applied to the surface of your skin, it has the potential to be absorbed into your bloodstream. Not every cream can penetrate deeply enough to cause bodily harm, and this ability depends on multiple factors including the chemical nature of the product, the resistance of the outer layers of your skin surface, the length of exposure, and others.

Some creams are designed to penetrate the skin

A skin-lightening agent or a collagen-boosting cream is meant to access the middle layer of the skin in order to do its job. In order to be effective, some of these products are chemically designed to get through the outer protective skin layers. In doing so, the ingredients may penetrate deeply enough to contact the dense network of blood vessels and capillaries (tiny vessels) found in the face.

Which ingredients are potentially toxic

Many of the components of anti-aging creams and moisturizers that have known toxicity are stabilizers and preservatives. The major offenders are parabens and pthalates. Newer nanoparticle formulations have also been called into question. The risky ones are too numerous to list, but fortunately, someone has already screened the most popular products for you…

There’s an app for that

I recommend 2 smartphone apps that can scan your skin products and give you a rundown of the ingredients and their known safety.

I looked up Regenerist Advanced Anti-Aging Night Recovery Moisturizing Cream by Olay and found “moderate risk” for developmental/reprotoxicity and “high risk” for allergy. The ingredients with restrictions included butylparaben and ethylparaben.

EWG’s Skin Deep app can be found for both Apple and Android devices.

The Think Dirty app is available for Apple devices.

How to get rid of crow’s feet

in Botox and fillers, Wrinkles/by drkotlus

Crow’s feet arise from repeated expression

“Crow’s feet” are the creases that radiate outward from the outer corners of your eyes when you smile or squint. They begin to show up for most people in the mid 30’s to early 40’s. They are thought to convey sincerity when you smile (see this video about the SQUINCH by photographer Peter Hurley). The crow’s lines can make you look more photogenic, but if you have too many or they are too deep, they make you look older.

“Crow’s Feet”

How do I get rid of them?

STEP 1 – PREVENTION

Use a broad-spectrum sunscreen of at least SPF 30 and preferably a mechanical blocking agent like zinc oxide. Even while you are driving, your face is exposed to damaging UV radiation that causes aging signs and wrinkles. Other ways to prevent these lines from forming or worsening, use scientifically-proven topical creams like a prescription-strength retinol and a vitamin C (L-ascorbic acid). I don’t recommend that you stop smiling in order to prevent smile lines. You may look younger, but you will lead a less happy life!

STEP 2 – TARGETED MUSCLE RELAXATION

Botulinum toxin type A (Botox, Dysport, Xeomin) are liquid protein injections that selectively relax the muscles that create the crow’s lines. An expert injector can do wonders by placing small amounts of Botox in just the right places. Botox done well looks natural and gives your eyes a younger glow.

STEP 3 – SKIN RESURFACING

Lasers (fractional CO2 and erbium) and chemical peels (glycolic, TCA, phenol) will remove the outer skin layers leaving space for newer, smoother skin to take over. In the case of crow’s feet, if you continue to crease with repeated expressions, the lines will eventually return. A combination of resurfacing with Botox as maintenance will provide the longest-lasting results.

What about fillers like Juvederm or Restylane?

Fillers have a limited role in treating crow’s lines but can be helpful in smoothing very deep, fixed creases. Dermal fillers can also stiffen and plump the skin to limit the amount of folding and creasing that occurs when you squint.

What about eye lift surgery?

A lower or upper eyelid lift may somewhat reduce crow’s feet but is not a good choice if your primary target is expression lines. Surgery is better for heavy upper eyelid skin or lower eyelid bags.

Does sleeping on your side cause wrinkles ?

in Wrinkles/by drkotlus

Sleep lines are wrinkles created while you sleep

Wrinkles and creases can develop during sleep, depending on the interaction between your face and the pillow. These sleep lines can be noticed as vertical creases under your eyebrows, next to your nose, and on your chin. Back sleepers are probably less likely to develop sleep lines than stomach sleepers. So why do they call it beauty sleep?

Where vertical sleep lines occur (in red)

Does it matter which side you sleep on?

In 2013, I published my research on the relationship between sleep position and facial aging in the peer-reviewed Dermatologic Surgery Journal. My team collected photographs of 100 women who came to me for consultations for facial aging (seeking Botox, eyelid lifts, facelifts, filler injections, etc). We also surveyed these women and asked which side they preferred while sleeping. These photos were split vertically down the middle and the sides were randomly flipped using photoshop. An independent observer was then asked to rate which side of each subject’s face looked older and had more wrinkles. The statistics showed there was no association between the side you mostly sleep on and the side of your face that looks older (is droopier and has more wrinkles). So, while sleeping does cause sleep lines, the side you prefer to sleep on doesn’t appear to develop more wrinkles than your non-preferred side.

Driving a car causes wrinkles on the left side of your face

A majority of the women photographed in the study had more wrinkles and droopiness on the left side of their faces, independent of the side they sleep on. The most likely explanation is that driving causes more UV exposure on the left side, which is also the reason that sun-induced skin cancers are more common on the left side of the face. Sun damage is a more significant and dangerous cause of facial aging than sleep position.

Should you use an anti-wrinkle sleep pillow?

There is little evidence supporting the claim that a special pillow prevents wrinkles. Anti-wrinkle pillows are often promoted as being able to relieve facial pressure points by changing the traditional pillow shape. Others claim to nourish the skin with special fabrics. My study indicates that it is more important to be diligent about wearing a broad-spectrum sunscreen, even when driving. Daily, high quality sunblock should be the primary foundation of your anti-aging strategy. Sleep should be refreshing and restful, so my professional advice is not to worry about sleep wrinkles – worry about awake wrinkles.