My smile has completely changed after Botox on forehead, frown lines, crows feet, & under eyes. Any suggestions?

Dr. Dean Kane Q & A.

Q.  My top lip doesn't lift enough. When smiling with lips together it looks normal but when smiling or laughing with lips apart my top lip isn't lifting so looks like half a smile. My injectant didn't inject low down on crows feet but could it still have an effect on my smile muscles?

A.  Botox is a miraculous drug when used correctly. It is extremely artful and injector dependent on his or her skills.

Thank you for sharing your photos. When Botox or any of the muscle relaxer injectibles is not specifically targeted, adjacent muscles may be affected causing relaxation and therefore an imbalance on facial appearance. It appears that the muscles of your eyelids, your right lower lip and your cheeks received a dose of Botox during your injection session causing your eyelids and upper lip to drop and your right lower lip to raise.

The good news is that if minor amounts of Botox reached these muscles, the waiting time for the muscles to return to normal function is shorter than the average 3 months. It will also return to full function.

You may consider discussing the eyelid droop with an ophthalmologist as there is a eye drop than can help if seeing is a problem. You may also consider widening the area of placing your lipstick to camouflage the reduction in lip opening.

If you have concerns with your injector, consider another opinion by a well experienced, Board Certified Plastic Surgeon or ENT Facial Surgery injector to review these problems.

I wish you the best!

What's a good filler may I use for scar in forehead?

Dr. Dean Kane Q & A.

Q. I got full forehead scars I tried juavederm ultra but didn't get good reasult but better than before. May I use sculptra?? It really bothers me.

A. Every scar is different. Each person and each body or face site that the skin is cut or punctured will heal with a different quality of scar.

Some are flat and thin but many are thick and ropey, red or pigmented brown.

Some pull causing a contracture or are lumpy. There are many different treatments depending on the quality of your scar(s) which I will address below.

When it bothers you as it does, you may consider the following options:

1. Waiting for the scar to “mature” i.e. become soft and flat

2. Massaging the scar, using scar creams and silicone sheeting to soften it

3. IPL and vascular laser and light therapies to reduce the redness and ‘ropeyness’

4. Steroid injection to reduce the growth and lumpiness

5. Retinoids, hydroquinone skin therapy to reduce the thickness and pigmentation

6. Surgical removal and revision of the scar.

7. Fillers to fill the loss of tissue under the scar and make it smoother.

8. Microdermabrasion or Dermabrasion to reduce the raised surfaces making the scar smoother.

​9. Micro-needling to restart the inflammatory phase of healing in the hopes of remodeling the scar and re-epithelializing the surface.

​10. Sculptra injection to remodel the scar and fill the depression. This, like any technique is very skill dependent.

A scar is permanent and many times becomes imperceptible. Time, of course will help scars improve.

You can appreciate the many ways to help your scar.

​I recommend you consult with various well experienced and Board Certified Plastic Surgeon, ENT or Dermatologist to evaluate and provide you with their recommendations.

Dr. Dean Kane Q&A – Botox and Facial toners. Can they complement each other to prevent muscle atrophy?

Question from England, AR: I recently had botox in my forehead & above the eyebrows. I use facial toners for saggy skin around the eye & jowls etc. It could be psychological but I felt it helped. I read articles recommending using facial toners in conjunction with botox to prevent muscle atrophy as a result of botox, even if it only targeted the surrounding non-botoxed muscles. Not much was injected so I still have some movement. How long after the injections can I use these devices & is there a risk of the botox moving?

 Answer from Dr. Dean Kane, Board Certified Plastic Surgeon from Baltimore:
​Expression appearances are created when muscles which are attached from the bone to the skin produce dynamic furrows, wrinkles and lines. ​ Permanent lines in the skin develop from the continuous creasing and thinning of the skins various layers. 

​Botox and Dysport are muscle relaxing medications injected cosmetically in micro amounts to relax and reduce dynamic wrinkles and lines created by over-used expression muscles. 
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The ​"Facial Toners" you speak of are electrical stimulators of the underlying muscles to create an increased tone or contraction with the desired effect to shorten or "tighten" the skin. Skin does not tighten in this manner. Skin will only "shrink-wrap" with the created rejuvenating effects of forming collagen, elastin and other molecules which are lost with aging, sun-damage or disease.  Facial Toners may in fact worsen the dynamic creasing of the skin resulting in wrinkles and lines. Retinoids with their ability to stimulate production of these molecules and lasers which heat the molecules to shrink or form collagen-scar result in a tighter appearing skin.
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​As you can understand then, Botox and Facial Toners produce opposite effects. These and proper skin care, chemical peels and lasers all have different actions on the skin. There are trade-offs to each option and these should be presented to you following a proper consultation by a well experienced and Board Certified Plastic Surgeon, Facial ENT or Dermatologist. 
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​I hope this was helpful! All the best!