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 – Is midface reduction a good treatment for a prominent nasal spine + long midface?

Question from California City, CA: Hi, i have a long midface (made up of a long nose) coupled with a prominent nasal spine, so prominent/low down that it pushes my lip down and gives me collumellar show and makes my nose droop. Is a midface reduction a good option along with a anterior nasal spine reduction?

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

​The mid-face is considered that triangular area of the cheeks from: 

1.    ​the eye-lid / cheek crease above, 

2.    ​to the naso-labial and lateral nose centrally, 

3.    ​and the corner of the lips to the high point on the mid-cheek.

Lifting the mid-face is performed through different ways and requires significant skill by your surgeon. 
​
​The nasal spine is not part of this feature. It is hidden under the columella or fleshy division of one nostril with the other. Removing the nasal spine may further lengthen your upper lip and possibly create a droopy nasal tip. These photos do not provide enough visualization of the length of your nose.
​
​Based on these photos, these are not procedures I would necessarily recommend. You may be best off with proper skin healthcare and fillers. 

​Please, consult several well experienced and Board Certified Plastic Surgeons or Facial ENT's to identify what is best for you.
​
​All the best!

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. 
​
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.
​
​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. 
​
​I hope this was helpful! All the best!

Dr. Dean Kane Q&A – Can a filler be effective on11 lines after Botox poor result?

Question from Hallandale, FL: After 7 days Botox does not seem to work on the 11 lines.my injector said that she might have to use a filler like volume or restyling. Does this sound right?

 Answer from Dr. Dean Kane, Board Certified Plastic Surgeon from Baltimore:
​
​Botox begins to work after 5-7 days and is optimal at 10-14 days following injection. So please be patient before discounting the effects of Botox. 
​
​After 2 weeks, revisit your injector to see if there is another set of muscles (called the orbicularis oculi muscles) which may be "recruiting" the skin from the outside brow to create those "11's". If so, it takes great skill to inject these recruitment muscles without causing eyebrow or eyelid droop and stop the skin folding inward towards the middle.
​
​If the "11's" are permanent lines from continuous creasing, fillers properly injected and retinol / Retin-A will smooth out those lines. It will also allow the Botox to "work" longer by reducing the amount of squeeze and line formation. 
​
​It is imperative that you find a expert injector with these finer techniques. There are risks of complications involved not typical of the more common injector. Please consult with a well experienced, Board Certified Plastic Surgeon, Facial ENT or Dermatologist. 
​
​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!