Botulinum and Facial Fillers

There are many options to treat facial wrinkles, including botulinum toxin and facial fillers. Botulinum toxin, a substance that helps to relax muscles, is often used to treat the dynamic wrinkles that result from muscle contraction. In contrast, facial fillers (a sugar-like substance found in skin) are often injected into areas of static wrinkles to help restore the volume loss stemming from the aging process.

The most common areas where botulinum toxin is used include the outer corners of the eyes (crow’s feet), areas between the eye brows (glabellar frown lines), or in the forehead to improve the horizontal lines. It can also be used to reshape and elevate the eyebrow or treat vertical lip lines or down turning of the lips, as well as fixing any pre-existing facial asymmetries.

The most common areas where facial fillers are used on the face include the smiles lines or parentheses (nasolabial folds), hollowness in the lower eyelids (tear trough area and nasojugal fold), the lines below the corners of the lips (marionette lines), and the cheeks and lips. The effect of botulinum toxin  typically lasts for 3-4 months whereas semi-permanent fillers may last for 6 months to 2 years.

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Ptosis (Droopy Eyelids)

Ptosis (pronounced “toe-sis”), is the term for droopy eyelids. Droopy eyelids are usually due to the normal aging process, whereby the pulley muscle that opens the lid becomes stretched out and the eyelid falls, covering part of the pupil. In children, the pulley muscle may develop abnormally, causing blockage of the vision.  On occasion, droopy eyelids may be signs of a more serious medical condition, such as muscular problems (i.e. myasthenia gravis or other neurological problems (third-nerve palsy) or Horner’s syndrome. Patients with ptosis often have problems keep the eyelids open, and constantly raise the forehead or arch the eyebrows, or even tilt the head back in order to see, leading to fatigue. When severe, the droopy eyelids can block the upper part of your vision and interfere with daily activities.

Untreated children with ptosis may develop amblyopia (lazy eye), astigmatism, or blurred vision, leading to developmental delay. If the droopy eyelid is significant, insurance companies will often cover the surgical procedure. Ptosis repairs are very successful in improving visual field function. The surgery is typically performed under local sedation on an outpatient basis.

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Eye & Brow Lift

Droopy eyebrows or forehead typically results from the aging process, but can also arise from Bell’s palsy, stroke, tumors, infections, or trauma resulting in facial nerve injury. When the brow and forehead droops, it may crowd more skin down over the upper eyelids. In addition to causing the upper eyelids to block part of the superior visual field, the droopy brows may also make you look tired or angry. If significant visual field loss exists, insurance companies may cover the procedure.

For milder cases, the surgery would be considered cosmetic and is typically not covered. For mild cases of droopy eyebrows, non-surgical treatment can be performed with botulinum toxin and fillers to lift the brow. For more for more significant cases, outpatient surgery is often performed. It is sometimes combined with upper lid blepharoplasty or upper eyelid ptosis repair, depending on its contribution to the superior visual field obstruction.

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Eye Lash Enhancement (Latisse®)

Latisse®, (bimatoprost ophthalmic solution) is a FDA-approved prescription treatment for inadequate or not enough eyelashes. This treatment allows the lashes to grow longer, fuller, and darker. Topical solution is applied to the upper eyelashes each night and full results are seen after 12-16 weeks. If you stop using Latisse®, your eyelashes are expected to return to the original appearance after several weeks to months.

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Eyelid Lift

The medical term for an eyelid lift is blepharoplasty. This procedure can remove puffiness or bags under the eyes. It can also correct droopy eyelids. In this procedure, the physician surgically removes excess fat, muscle, and skin from both the upper and lower eyelids to redefine the shape of the eye.

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