Balanced Rejuvenation: More than just Botox and Filler

Botox + Filler are great, but are not enough to address all the signs of facial

aging.

There are four distinct elements of facial aging. Trying to correct all of them with only 2 tools, Botox and Filler, won't work and often leads to a distorted, unnatural appearance I

refer to as "pillow face"

• 1. Volume loss: as we age we naturally lose volume in our cheeks, our temples, our lips and in some people around their eyes.

• 2. Tissue Descent: of course with collagen/elastin loss and gravity all of our facial tissues slide downwards. This includes our eyebrows, cheeks, jawline, neck.

• 3. Bone loss: As we age we also lose boney support of our soft tissues. In facial aging this happens around our orbits, leading to the sunken in appearance of eyes, around our nose leading to changes in tip support and a widen nose appearance + in our jaw bones leading to lengthening of our upper, non-red lip and an internal rotation of our lips leading to the thin lips of an aged face, and accentuating jowls.

• 4. Sun/ Environmental Skin Damage: Years of sun exposure, pollution, tanning, and lack of skin hygiene leads to the formation of discolourations, sun spots, skin cancers, and thickened dull skin, all of which contribute to an aged appearance.

Using only 2 tools (botox and filler) to address these concerns will lead to an unnatural + unbalanced appearance. The distorted "pillow face" seen in many celebrities and non-celebrities alike is a result of using only volume (i.e. fillers) to address both volume and tissue descent. Using only 1 tool to correct two distinct elements is the source of this unbalanced appearance. Even plastic surgeons are not immune to leaving an unbalanced appearance as one fault of traditional surgical facelift is treating only tissue descent without addressing volume loss leading to a skeleton- like result. And, failing to address skin changes via laser or chemical peels leads to an out of balance lifted

appearance with aged skin colourations and texture changes. Ideally volume, tissue descent and external skin changes will be addressed for a balanced, natural rejuvenation.

These 4 elements occur in different proportions and at different rates in different people, so a careful evaluation is required to create a customized short and long term treatment plan. Lifting can be accomplished by surgery, threads, lasers, radiofrequency. Volume replacement by fat grafting, HA fillers, Sculptra or Radiesse. Skin texture changes by microneedling, lasers, or chemical peels. Bone loss by surgical implants but ultimately maintenance of bone density through nutrition and proper dental care remains key. There are surgical and nonsurgical options to correct each element of aging, ultimately the optimal choice for you depends on how much correction will make you happy, the longevity you are looking for, the downtime/healing time and potential complications you are willing to accept.

As always, make sure to post your comments or questions!