Which filler would you recommend and which is more effective between Botox, Dysport, and Xeomin?

Dr. Dean Kane Q & A. 

Q. Right now in my life for being 43 years old I feel great and I think I look pretty good but, of course, we all have things we"d like to change. The thing that bothers me most is the tear trough area, and the upper eyelid. I know in the near future I will be getting an upper and lower eyelid lift, along with a face/neck lift. Until then can I get a filler that will last in the tear trough area, and botox/dysport in the upper eyelid area to lift a little. Is this possible without surgery?

A.  ​​​​Every patient is unique. Your bony and soft tissues, their symmetry and aging, your personal and perceived appearance and how it bothers you are just a few of the factors to review with a well experienced, Board Certified Plastic Surgeon or Facial ENT Surgeon who offers ALL these and other options.

​Since the effects of aging, weathering, sun-damage, ethnic background affects everyone differently, you may consider filler for the tear trough and Botox for the brow elevation and / or stage your surgery at this time when healing is better, scars will usually be smaller and skin elasticity is at its best.
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​Consider more than one well experienced, Board Certified surgeons for evaluation as you may find that their Botox and Filler skills as well as their surgical skills and results will vary.
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​One consideration come to mind and that is you may wish to have the upper and lower lids improved at the same time. Using access gained by both incisions, a mid-face lift may rejuvenate your cheeks, eliminate the tear trough, possibly elevate your jowls and bring you a longer duration of satisfaction.
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​If you are a candidate for a short scar face lift (or MACS lift and other named procedures) you may improve the jowling and upper neck while younger and gain more youthful appearing years.
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​Regarding which Fillers or Muscle Relaxers; the options are getting so numerous that each filler or muscle relaxers have their own peculiar niche of use.
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​I happen to like Botox in the brow area for precision and Dysport in the lips for a softer relaxation.

​Hyaluronic Gel fillers such as the Restylane Family or Juvederm Family each have their nuances. Depending on each gels production and artificial molecular linking will determine:

1. ​their duration,
2. ​their projection,
3. ​their volumization (ie. water attraction).

​This determines where they provide the best "fill" you desire.
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​Noting your tear trough example, some injectors have only superficial injector skills and will inject immediately under or within the skin (ie. dermis). Others, may feel comfortable injecting under the deeper muscles of the cheek next to the bone with a variety of techniques.

1. ​You may wish to use Restylane or Juvederm superficially but it has the side-effect of radiating a "tindel" bluish coloration or lumpiness on eyelid skin.
2. ​Silk in this location superficially may swell the tissues too much.
3. ​I achieve my best appearance under and over the deep muscles of the cheek with a more linked, longer duration filler such as Voluma or Perlane.

Yes, the possibilities are endless today and so you must find and trust a surgeon with a lot of experience using each option selected for your anatomy, concerns and budget.

​I hope this has been helpful. All the best!

I'm considering CoolSculpting for my arms as they have become saggy. Could it make them worse?

Dr. Dean Kane Q & A.

Q.  I'm considering CoolSculpting for my arms as they have become saggy. Could it make them worse?

A.  CoolSculpting is a "tried and true" method to reduce fat content in skin bulges!

​It has worked very well on properly selected patients for the arms. In fact, even heavy patients have been pleased because the small increments of arm fat reduction allows them to wear tops with sleeves that have previously been tight.

Thinner patients are pleased with CS's results on their arms as well. Caveat emptor: do not expect skin reduction or tightening with CS! On occasion, patients, particularly of color or reddish coloration have experienced some skin shrinking. This is due to the inflammatory response which is seen more in these patients, than those of white, north european descent.

You should discuss CS as well as other options such as lipocontouring and / or arm lift with a well experienced, board certified Plastic Surgeon who has properly examined you.​

​I hope this is helpful!

All the best!

Will lymph drainage massage help after a Facelift?

Dr. Dean Kane Q & A.

Q.  I have heard a Lymphatic Massage helps against swelling after a FL. Is this true or just performed because of the placebo effect? It is quite expensive and the Danish doctor says at least 5 treatments are needed? Is there any research proving this?

A.  ​It is a natural and expected side-effect following surgery or injury to develop swelling and scar. If fact, this is how the body heals itself. In some patients, the swelling may be quite uncomfortable and compromise the result of the surgery.

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​I, too, recommend massage following surgery but it must be performed by you with proper instruction or a well trained individual who understands the post-surgical and healing process.
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​The warmth of your hands improves circulation, the pressure placed and the technique of massage applied changes during the process of healing. I have developed and recommend 3 basic techniques and variations:

1. ​Swedish massage: light moisturizing or gentle washing - like upward touching of the skin. This will assist in sensitizing or de-sensitizing the skin as the sensation returns. It is very useful for individuals who are reluctant to touch the surgical site as well.
2. ​Lymphatic, "squeegee" massage: firmer compression or moving pressure pushing a wave of fluid out of the swollen area of surgery or injury. It is likened to squeezing water out of a sponge. Studies have shown that retained swelling or edema creates a cycle of lymphatic obstruction and persistent swelling. Retained swelling over many months also creates more lumpy scarring and collagen bundles. Lymphatic swelling, I believe, will assist in remodeling collagen in the direction to best match your facial contour, so massage firm but gently always in an upward direction.
3. ​Shiatsu, deep pressure or deep scar massage: directed deeper accentuated pressure with a rolling or rocking character to break up the lumpy collagen scar formation. Such lumpy scar, if it forms, does not occur for 3-4 weeks after surgery so do not use this technique unless your surgeon directs you too. It is followed by long strokes of lymphatic massage.

I recommend these techniques 3 to 5 times a day for very short periods of time.​

​Lymphatic and Shiatsu massage may also create different levels of trauma to the tissues or break sutures placed specifically to suspend or hold tissues in place.

​More IS NOT better.

DO NOT perform such therapy without the specific instructions of your surgeon. If deep scarring or reduced function occur, your surgeon may recommend physical therapy for other alternative techniques and ultrasound therapy.

​Higher protein, low carbohydrate diets also assist in healing and swelling reduction due to the hormones this dietary balance generates in the body.

Most importantly, consult your surgeon regarding the use of these or other techniques in assisting your healing following facelift or any other surgery or injury.

​I hope this has helped.

All the best!