Which filler (Sculptra, Radiesse, Voluma, etc.) for jawline?

Dr. Dean Kane Q & A.

Q. I decided to get Sculptra treatments to create a more angled, masculine jawline as sort of very, preliminary 'try out' before thinking of jaw augmentation down the line. While the volume and width are very good after seven months and three treatments, is there any other filler (short of augmentation) that may more of a sharp, angled contour to the haw as opposed to a slight of amount of a bloat from Scupltra? Would I have to wait until the current Sculptra effect dissipates?

A. ​The use of Sculptra as a trial is a good idea particularly if injected under the dermis and along the bone as it will stimulate firming of the skin and growth of the bone.​

​During the next few months as the effects of Sculptra continue to stimulate and improve, Radiesse may provide the sharper, more angled contour you are looking for.
​
​Any one of these fillers can be used BUT as notice, they will not provide the same effect.
​
​For this reason, it is best to be evaluated by a well experienced and Board Certified Plastic Surgeon or ENT facial surgeon to examine and review your concerns.
​
​Considerations along the jawline include:

1. ​Skin,soft tissue and fatty laxity creating an uneven jawline with jowling and / or weak angle.
2. ​Lack of teeth causing the bony jaw to resorb providing less projection
3. ​Angle of the jaw and balance of the jaw, maxilla-zygoma and temple regions
4. Level of placement, action and projection from each filler
5. Duration of each filler before your investment dissolves
6. And other considerations

Each injectors skill levels and understanding of anatomy is different. Consider different opinions.
​
​All the best!

Will Botox get rid of my wrinkles under the eye?

Dr. Dean Kane Q & A.

Q. Will Botox get rid of my wrinkles under the eye? I am 26 and have very tired looking eyes. I was looking into getting blepharoplasty in the next year or two, but before doing a drastic surgery, are there other options for me?

A. ​Without photos it is most difficult to comment. It is best for you to consult with a well experienced Board Certified Plastic Surgeon or Facial ENT surgeon.

​There are so many considerations for wrinkles under the eyes such as:

1. ​Sun damage,
2. Skin thickness,
3. ​Eye shape; where the eyelid corners meet,
4. ​Bone shape and projection,
5. ​Bags, fat, swelling,
6. ​And others

Botox under the eyelid except in special circumstances may create worsening of eyelid wrinkles and relaxation bulging of the fat bags.
​
​Consider:
​1. ZO Obagi Skin Health using retinoids,
​2. Chemical and laser peels,
​3. Superficial filler,
​4. Deep filler,
​5. And finally blepharoplasty.
​
​I hope this has been helpful. All the best!

What surgery what you recommend to fix my face, teeth and jaw?

Dr. Dean Kane Q & A.

Q.  What surgery what you recommend to fix my face, teeth and jaw? I have been interested in surgery for a while now and curious to what surgeries that would help my face look better, example my jaw, chin, nose and teeth?

A.  ​Thanks for sharing your photos. You appear young and pretty with teeth and possible jaw and bite irregularities.

Please explore your community for a multi-talented, well experienced and Board Certified Plastic Surgeon, ENT Facial Surgeon or Oral MaxilloFacial Surgeon to review your “orthognathic” concerns, perform a proper examination and make his or her recommendations.

A proper exam will include XRays or CT scan of the face to determine proper upper and lower jaw alignment, cheek and chin shape. It appears that your front teeth do not allow your jaw to fully close and this will also require the expertise of a orthodontist to work with your facial surgeon. Your facial surgeon will also address your nose, chin and cheeks regarding changes to shape with and without your surgical or non-surgical options.

​I wish you luck with this endeavor!

Botox doesn’t work anymore! Is there a way to make it work again?

Dr. Dean Kane Q & A

Q.  I have been getting botox, Dysport an Xeomin injections for years and now none of them work! I get a small effect but it does not last long. The procedure has been done by several different clinicians so I don't think it is the way it is done. I think I have built up a resistance. I love the effect when it works. Is there any new formulas or way to make it work again?

A. ​I hear this about once a day. While it is possible that Antibodies to the molecule reduce its effectiveness, I have yet to see this following 1000's of patient injections.

​With careful observation, a well experienced, Board Certified  Plastic Surgeon, Facial ENT, or Dermatologist will find that:
​
​1. The muscles previously injected have atrophied to a point of not working. You will find that injections to other muscles will relax them. You will need a more skilled injector.
​
​2. With aging, the laxity of the tissues and the attachments of the frontalis (and other) muscles to the skin, release and slide. Greater pull or relaxation using these muscle balancers will not produce the same effects. You will need to consider a surgical option.
​
​Consider a 2nd opinion in-person consultation.
​
​I hope this has helped.
​All the best.

Dr. Dean Kane Q&A – I am a 35 year old man that is having some issues with some loss of volume around the corner of the mouth area.

Question from Jersey City, NJ:  I am a 35 year old man that is having some issues with some loss of volume around the corner of the mouth area. I noticed this occurred about a year after using a antidepressant for some sleep issues. I have read online that using antidepressants causes people to look older because of the constant relaxation of the facial muscles. I just want to know which procedures would benefit me. I have attached some photos. Your opinions are highly appreciated.


 Answer from Dr. Dean Kane, Board Certified Plastic Surgeon from Baltimore:​
I do see mild laxity causing your cheeks to soften, creating a minimal wave across the corners of your mouth and marionette folds. 

I would like to review the options that go through a well experienced and Board Certified Plastic Surgeons mind AND THEN make some recommendations...

Various options for face enhancements including facelift, minimally and non-invasive facial options and skin texture improvements are available according to the skin laxity and areas of lift or tightening you wish or need. Both surgical and minimally invasive / non-surgical options are listed below.

Surgical lifts would be likened to pulling the bedspread and or top-sheet of your bed up to the head-board and removing the excess material.

Minimally invasive procedures such as fillers provide volume such as adjusting a pillow under the bedspread. Botox and Dysport act by pulling the top-sheet which drags the bedspread upwardly. If the bedspread (or skin) continues to fall to the foot of the bed despite fillers, Botox or Dysport you will need to consider a facelift.

Non-invasive options such as laser and light therapies, skin tightening products and technologies perform their tightening and smoothening of the skin similar to sending your bedspread to the dry cleaners. A more refreshed, even colored, glowing smoother and tighter spread covers the surface of the bed.

The most popular of the fillers, Restylane and Perlane, a jelly-like clear skin filler is used to fill lines, wrinkles and folds. Juvederm and its longer lasting "cousin" Juvederm Ultra Plus are similar skin fillers, used to soften and fill the nasolabial ("parentheses") and marionette folds, the brow ("number 11") lines and fill and lift the cheeks and lateral brow or chin.Voluma is the longest lasting, up to 2 year duration HA filler. Each one is used to expand or volumize the loss of tissue associated with expression, weathering or aging. All the fillers come with numbing anesthetic!.

Non-surgical facial contouring is possible with fillers such as Radiesse, a bone mineral for the nose or cheeks, jaw and chin as well.

Scuptra is the latest of the injectibles stimulating collagen at different levels of the skin, adding volume but primarily firming and adding resistance to the formation of wrinkles, folds and descent.

Botox and Dysport too have been found to rebalance excessive facial expression, provide a non-surgical brow lift and lip lift and reshape the nose, as well as reducing wrinkles!

Dr. Obagi's new, second generation ZO Skin Health programs may be added to personalized chemical peels, light and laser resurfacing and tightening and will, smoothen and even the color of your skin.
IPL and fractionated lasers such as CO2 and erbium and now RF (radiofrequency) are additions to smooth the texture of the skin, tighten and reduce red and brown uneven pigmentation.

Focusing on you, try:

1.    1. Voluma as it is a very projecting 2 year filler. Add Juvederm or Perlane to the corners of the mouth and marionette folds. 

2.    2. Sculptra will continuously stimulate firming of the skin for up to 2 years. 

3.    3. ZO (Zein Obagi) Skin Health programs with retinoids will exfoliate and stimulate the skin for added external rejuvenation.

Any of these procedures and their combinations should be discussed following a proper examination by a Board Certified Plastic Surgeon who performs all of these options so you will not receive a biased approach because he or she is limited in their skills.

All the best!

Dr. Dean Kane Q&A – My face is aging from weight loss and age. I have Ehlers Danlos. What are my options?

Question from Chicago, IL: I am 45. Until 3 months ago, I had a youthful face. I've lost weight over the last year, about 20 pounds. I weight 105 and am 5'2.5". Lines around my mouth are forming that weren't there before and I have mildly lax neck skin. I'm also wrinkling around my eyes. I've been told to stay away from lasers, as a treatment burned and scarred me. Retina-A made my pores worse. Honestly, with Ehlers-Danlos, what are my options for this aging -- do I have any? Or is my best course to regain a few pounds?

 Answer from Dr. Dean Kane, Board Certified Plastic Surgeon from Baltimore:​

You appear to have lost significant weight creating a more laxed skin as well as creasing around the lips. 
​
​Ehlers-Danlos Syndrome is a constellation of elastic tissue problems due to improper production of the various forms of collagen in the skin, joints, intestines, blood vessels and other organs and tissues. 
​
​Depending on the type of inherited problems you have will there be different options for you. 
​
​It will probably take a university hospital group effort with your Dermatologist to provide the best opportunities in achieving a more youthful appearance. For greater fullness, fillers with different properties may help. Consider the use of Sculptra to stimulate greater fibroblast formation of skin molecules such as collagen. Ask about the use of laser or light therapies. As you probably know, surgery may not heal well. 
​
​As this is not my super-specialty, I can only offer you these usual options to consider.
​
​I hope this has been somewhat helpful. All the best!

Dr. Dean Kane Q&A – Hello! Do I need a facelift or a mini facelift? Thank you

Question from Toronto, ON: I am thinking about a Face lift but I am confused after reading so much about Facelifts. Please give me your opinion. Thank you very much.

 Answer from Dr. Dean Kane, Board Certified Plastic Surgeon from Baltimore:

​You appear to have a fuller and tighter face than the usual individual requesting a face lift. You also appear to have a fuller side and a flatter side which is found in almost all patients. 
​
​Both a "Face Lift" and a "mini Face Lift" primarily redrape the skin in a upward and outward direction, followed by removing skin excess and then sewing the edges together. Based on your photos, I do not believe this will significantly help you. 

Various options for facelifting, minimally and non-invasive facial enhancements and skin texture improvements are available according to the skin laxity and areas of lift or tightening you wish or need. Both surgical and minimally invasive / non-surgical options are listed below.

Surgical lifts would be likened to pulling the bedspread and or top-sheet of your bed up to the head-board and removing the excess material.

Minimally invasive procedures such as fillers provide volume such as adjusting a pillow under the bedspread. Botox and Dysport act by pulling the top-sheet which drags the bedspread upwardly. If the bedspread (or skin) continues to fall to the foot of the bed despite fillers, Botox or Dysport you will need to consider a facelift.

Non-invasive options such as laser and light therapies, skin tightening products and technologies perform their tightening and smoothening of the skin similar to sending your bedspread to the dry cleaners. A more refreshed, even colored, glowing smoother and tighter spread covers the surface of the bed.

The most popular of thefillers,RestylaneandPerlane, a jelly-like clear skin filler is used to fill lines, wrinkles and folds. Juvederm and its longer lasting "cousin"Juvederm Ultra Plusare similar skin fillers, used to soften and fill the nasolabial ("parentheses") and marionette folds, the brow ("number 11") lines and fill and lift the cheeks and lateral brow or chin.Volumais the longest lasting, up to 2 year duration HA filler. Each one is used to expand or volumize the loss of tissue associated with expression, weathering or aging. All the fillers come with numbing anesthetic!.

Scuptrais the latest of the injectibles stimulation collagen at different levels of the skin adding volume but primarily firming and adding resistance to the formation of wrinkles, folds and descent.

BotoxandDysporttoo have been found to rebalance excessive facial expression, provide a non-surgical brow lift and lip lift and reshape the nose, as well as reducing wrinkles!

Dr. Obagi's new, second generationZO Skin Healthprograms may be added to personalized chemical peels, light and laser resurfacing and tightening and will, smoothen and even the color of your skin.

IPLand fractionatedlaserssuch asCO2 and erbium and now RF(radiofrequency) are additions to smooth the texture of the skin, tighten and reduce red and brown uneven pigmentation.

If you can pinch more than an inch of skin along the jawline in front of your earlobe, you should consider a surgical option to redrape and remove extra skin. 
​
​Returning to your concerns, it appears that lipo-contouring the lower cheek / jowl / neck,  fillers, Sculptra and proper skin healthcare with retinoids may be best options for you. 

Face and neck enhancements or any of the other procedures and their combinations should be discussed following a proper examination by a Board Certified Plastic Surgeon who performs all of these options so you will not receive a biased approach because he or she is limited in their skills.

I hope this has been helpful! All the best!

Dr. Dean Kane Q&A – Wrinkles under eyes - would more Botox help or should I try a filler like Sculptra?

Question from Brooklyn, NY: I'm starting to get fine lines and little wrinkles underneath my eyes. I've been having Botox for a few years to treat my crows feet and the results are very subtle in fact not that great to be honest. I refrain from having too many units for fear of looking frozen. Would more Botox help or should I try a filler like Sculptura? 

 Answer from Dr. Dean Kane, Board Certified Plastic Surgeon from Baltimore:

It is best to be evaluated directly by a well experienced and Board Certified Plastic Surgeon, Facial ENT or Dermatologist for wrinkles around the eyes.
​
​Botox relaxes the muscles that pull on the skin to create wrinkles. Occasionally and in particular when injected for the radiating lines below the horizontal of the outer eyes and for the creasing of the lower eyelid, side-effects such as swelling or bulging of the eyelid fat pads, lower lid rounding and cheek sag. Botox would therefore not be my first choice in this area.
​
​Consider a skin tightener such as retinol / Retin-A, TCA peels or laser depending on the thinness and pigmentation of the skin.
​
​Another option in very skilled hands is the use of Sculptra. For my patients, the results are wonderful and exampled below.
​
​Traditional hyaluronic acid (HA) gel fillers may cause side-effects such as swelling or a bluish tinting BUT the recent introduction of Restylane Silk maybe your best bet.
​
​Silk, due to its very tiny particle size and hydration properties will smoothen fine wrinkles and lines. It is on-label around the mouth and lipstick lines and proving very useful around the eyes for crows feet and wrinkle lines as well. 
​
​I hope this has been helpful. All the best!

Dr. Dean Kane Q&A – What payment options are available for self pay cosmetic surgery clients?

Question from Allentown, PA: The approximate costs after an assessment by a surgeon I respect for a facelift and neck surgery was $11,000. The receptionist mentioned insurance options. I'm wondering what is out there and whether any one has used a particular insurance company? 

 Answer from Dr. Dean Kane, Board Certified Plastic Surgeon from Baltimore:

​​Thanks for this question! It is a source of confusion and frustration for both the Patient and the Cosmetic Surgery Practice. 

​
​The medical insurance industry separates "RECONSTRUCTIVE" surgery from "COSMETIC" surgery. 

1. ​Reconstructive means it is covered but needs approval from your medical insurer. (Unfortunately, some insurers such as Blue Cross Blue Shield, Medicaid and Medicare will not pre-approve, so you are financially at risk until you submit and they approve payment or not). 

2. Cosmetic means it is for personal enhancement with no "therapeutic" improvement and is not covered by the terms of your medical insurance contract. 

​It also non-verbally expects you to recognize that ALL surgery is:

1. ​"ELECTIVE" (meaning the choice of time, date and place are variable and may need pre-authorization approval) from 

2. ​"EMERGENCY" (in which case, surgery is required to recover a life or limb threat).

​Your particular medical insurance contractual agreement will explain what is covered for:

1.  Direct payment to the physician and healthcare facility (where deductibles and co-pays are paid by you)

2.  Or whether the procedure(s) are fully "self-paid" by you. 

​The options our patients have used for lending sources outside of their own means or that of family and friends include:

1.  ​Your bank,

2.  ​Reverse or second mortgage,

3.  ​Care Credit

4.  American Health Lending

Many practices, like ours, will offer a link on the Finance Page of their website directly to some lending sources. It is best to have those lined up prior visiting your consulting cosmetic surgeon. Tips for loan approval also include:

1. If your credit score is too low for the loan you are requesting, ask for less and later come back and ask for more.

2. Review all the fine print to understand your payout as some options are overwhelming and some may even have 0% financing within a limited time.

3. Many practices have "private" banking lines for their patients who are more flexible than standard banks or lending sites. Ask the patient coordinator if you may speak with them directly. 

I hope this was helpful! All the best!