The Botox Doctor is in the House!

(Dr Botox has answered some of your questions in the comments section below. If you have any further questions, please email him directly or pop over to the Health24 Q&A section where Alek is the resident anti-aging expert)

My friend, the dear Botox Doctor has agreed to do a little guest feature on my blog.  If you have any questions on Botox, fillers, laser treatments, or any anti ageing stuff that you've always wanted to know, fire away.

Comments

[Tripsmom]

Dear Dr. Botox,

Question 1:
On your website you say it is possible to lift breasts with botox? How is this done and how permanent is this lift? How much does this cost?
Question 2:
I have 2 DEEP frown lines between my eyes - they bother me everytime I look into the mirror and have seriously considered Botox, what bothers me is that I will have to keep going back - is there a more permanent treatment, eg. a more permanent kind of Botox?

[Julia]

Dear Dr Botox
I have just turned 30 and have quite a lovely skin. I never ever want to see a trace of a wrinkle. I don't have a frown line as yet. Do I need to start Botox now in order to avoid wrinkles forever?
Another question: Why is Botox so expensive?

[Julia]

Dear Dr Botox
I have just turned 30 and have quite a lovely skin. I never ever want to see a trace of a wrinkle. I don't have a frown line as yet. Do I need to start Botox now in order to avoid wrinkles forever?
Another question: Why is Botox so expensive?

[kirstyphysio]

Dear Dr Botox
Can I be the fabulous model in your brochures and have some botox for free??
I won't even charge you a modelling fee for the priviledge!What a bargain!
What do you say? Come on ... you know you want to...

[Stef]

Dear Dr Botox

a friend of mine had a botox injection done for a frown line... it barely made a diff, is this common?

[Addie]

Dear Dr. Botox,

I had Botox a few times for deep frown lines between my brows - while the lines lessened, they didn't go away and the effect wore off after only 2 months or so each time. My doctor said over time they'd relax further and the effect would last longer, but that doesn't seem to have been the case. I'd love to lose these lines but I can't keep returning every couple of months - any ideas for me?

Thanks Tertia and Dr. Botox!

[Sister Mel]

Dr B
I am incredibly gorgeous with a perky nose and breasts to match.
Unfortunately, I have a rather unfortunate crevice between my eyes (was unaware of this until my aunt pointed it out, B*tch!) due to frowning and driving with no sunnies on.
I am also not keen on repeat visits, nasty poisens or spending lots of money. Any one time miracle job or great product you can suggest?

[RosaceaHater]

Dr Nikolic,

I suffer from Type II rosacea. It has become so bad, that I must now take accutane (20 mg/day) to try to keep the pauples/pustules under control.

1) What is the latest and greatest laser treatment for the rosacea skin to reduce the redness (which has now spread to my chin)?
2) How long must I wait before starting laser treatments when I finish my course of accutane?

Thanks!

[Maddy]

Concerning Laser treatments - any new developments for mature (i.e. white/silver) stretch marks? I have been reading about the Fraxel Laser, some results claimed are a 75% improvement, some feedback from patients is advice to run far, far away.
Any ideas?

[stayathomemom]

ooh, ooh, me, me. Hand up high in the air for my question to be answered please. I have a crevice on the right hand side of my top lip (as a result of smoking - I now try and smoke on the other side of my mouth!). Question: Will Restyline take this crevice away and how long will it last?

[21stCenturyMom]

I have 3 questions:
1). I have had botox between the eyes several times. I also need a filler but that's question 2. I also have lines just about my eyebrows toward the outside of my face. The first time I had botox the nurse told me that if you inject botox too far off the midline you risk droopy eyes. That makes me not want botox for these lines and yet I would like to make them go away. What can you tell us about the risk of drooping eyes due to botox injections far out from the mid-line?

2). Fillers - which do you prefer - Juvaderm or Restalyn and why? This is for facial lines like frown line and nasolabial crevasse.

3). laser hair removal - I had some very expensive laser work done on my copious facial hair (in early days I would have been put in the circus). It didn't work. Is laser hair removal suitable for heavy whisker hair?

[maddy]

I have lines from my nose to around my mouth on both sides...I think they are called "marionette" lines? Eek. What can be done about them? Someone once told me to quit smiling, but I don't think that's gonna happen. ;) (I'm in my 40s).

[Liz]

Dear Dr.

What's the best and safest way to get rid of acne scars on the face?

[Claire]

How long has botox been used on humans as a cosmetic aid? I'm interested in it's long term safety (not just for the primary user but chidren of in regards to future risk to illness).

Also, is Tertia getting a discount on future works for your featured advertorial (if not, Tertia possibly you could look into this? Also see it expanding into other areas, vets, cleaners, car dealers etc.) :)

[ExAfrica]

Good Doctor,

Is it true that fillers feel like gummy worm under your skin?

I have a big nasty wrinkle under my left eye and it must go. But I'm a little freaked out about the whole gummy worm thing.

Please help.

[Coral]

Hello Doc!!

Why is it that I can spot botox a mile off because the ladies look like plastic and appear to have no expression left in their face - is this overdose?

[Cat]

Tertia's Doctor,
I have constant puffiness under my eyes, and have since my 20s. Even after a restful vacation, people are ALWAYS telling me how tired I look. Can anything be done about this? I hate looking exhausted even when I feel good. Thank you for your time and expertise.

[Dr Alek Nikolic]

Dear Dr. Botox,
Question 1:
On your website you say it is possible to lift breasts with Botox? How is this done and how permanent is this lift? How much does this cost?
Question 2:
I have 2 DEEP frown lines between my eyes - they bother me every time I look into the mirror and have seriously considered Botox, what bothers me is that I will have to keep going back - is there a more permanent treatment, e.g. a more permanent kind of Botox?
Posted by: Tripsmom | 02 September 2008 at 10:09 AM

Hi Tripsmom, thank you for the question.
The Botox ‘Breast Lift’ is a relatively novel approach to this area and the lift is achieved by either injecting the inferior (lower) border of the Pectoralis muscle and/or the origin of the Pectoralis minor muscle (improves posture). Results are seen within 2 weeks; a total lift of (average) 1.8 cm can be achieved and should last between 3 to 4 months. The procedure can be fairly expensive as one can use between 90 to 180 units therefore costing between R4, 000.00 to R8, 000.00 respectively.
Unfortunately, the frown area is best treated with Botox as the wrinkles are formed from constant movement of the frown muscles resulting in the skin creasing. Fillers may be used in this area and depending on the filler used results can last between 6 to 9 months. However, permanent fillers will last ‘forever’, but would not recommend them in this area due to a high complication rate. Laser may also be considered (Lumenis Ultrapulse FX) but again the procedure may need to be repeated every 6 to 18 months.

Dear Dr Botox
I have just turned 30 and have quite a lovely skin. I never ever want to see a trace of a wrinkle. I don't have a frown line as yet. Do I need to start Botox now in order to avoid wrinkles forever?
Another question: Why is Botox so expensive?
Posted by: Julia | 02 September 2008 at 12:53 PM
Hi Julia, thank you for the question.
Firstly, a good topical regime is important and consists of the following basic guideline:
A good SPF (30 or higher) that contains zinc oxide and/or titanium dioxide
A moisturizer that contains glycolic acid and other alphahydroxy acids, Anti-oxidants such vitamin A (or its derivatives), vitamin C, and vitamin E
Glycolic acid peels (monthly or every 2 months)
Secondly, Botox is used successfully to prevent the formation of wrinkles and the recommended age to start is late twenties, however, this does depend on the degree of sun damage. I am definitely seeing an increase in patients that are younger and in these cases one does not need to consider high doses. This ultimately means that more movement (facial expression) will be allowed following the treatment. So yes, your best approach would be to consider Botox to prevent the onset of wrinkles.

Dear Dr Botox
I have just turned 30 and have quite a lovely skin. I never ever want to see a trace of a wrinkle. I don't have a frown line as yet. Do I need to start Botox now in order to avoid wrinkles forever?
Another question: Why is Botox so expensive?
Posted by: Julia | 02 September 2008 at 12:56 PM

Dear Dr Botox
Can I be the fabulous model in your brochures and have some Botox for free??
I won't even charge you a modeling fee for the priviledge! What a bargain!
What do you say? Come on ... you know you want to...
Posted by: kirstyphysio | 02 September 2008 at 01:26 PM

Hi Kirsty, thank you for the question.
I unfortunately do not (at the moment) need any models for Botox before & after photos. However, I am on the lookout for filler treatment before & after photos for my web page. Furthermore, several times a year, I teach advanced training to doctors in SA and we do occasionally require ‘models’. Please let me know if you are interested in either of these 2 options.

Dear Dr Botox
A friend of mine had a Botox injection done for a frown line... it barely made a diff, is this common?
Posted by: Stef | 02 September 2008 at 02:37 PM
Hi Stef, thank you for the question.
In a nutshell no, not if done correctly, however the answer is not always as simple as that. Occasionally with very deep frown lines one may need to undergo several Botox treatments before smoothing out of these deep wrinkles are seen. In some instances one may need to combine both Botox and a filler to completely smooth out a frown line. A good test weather a frown line has been treated correctly with Botox is quite simply: can you move the frown muscles once the Botox has started working? If the answer is yes the dosage is incorrect or it has not been placed in the correct muscle structures, and therefore, the line will not improve.

Dear Dr. Botox,
I had Botox a few times for deep frown lines between my brows - while the lines lessened, they didn't go away and the effect wore off after only 2 months or so each time. My doctor said over time they'd relax further and the effect would last longer, but that doesn't seem to have been the case. I'd love to lose these lines but I can't keep returning every couple of months - any ideas for me?
Thanks Tertia and Dr. Botox!
Posted by: Addie | 02 September 2008 at 03:42 PM
Hi Addie, thank you for the question.
There are a number of reasons for Botox not lasting the usual 3 to 4 months:
Dosage chosen is too low for your muscle size
Hyperkinetic (excessive) movement of facial expressions
Variants of Botox have different effects and durations
Occasionally deep glabella lines may need a filler treatment together with Botox but as a general rule the Botox should be lasting 3 to 4 months in the frown area.

Dr B
I am incredibly gorgeous with a perky nose and breasts to match.
Unfortunately, I have a rather unfortunate crevice between my eyes (was unaware of this until my aunt pointed it out, B*tch!) due to frowning and driving with no sunnies on.
I am also not keen on repeat visits, nasty poisons or spending lots of money. Any one time miracle job or great product you can suggest?
Posted by: Sister Mel | 02 September 2008 at 04:38 PM
Hi Sister Mel, thank you for the question.
Firstly, Botox that is used for medical and cosmetic reasons is not a poison or toxin. It is derived from the toxin (Botulinum Toxin) by separating one of the 7 proteins (the A protein to be exact). This A protein is then split in half and only the long chain molecule is used in the preparation for injecting. It is therefore far removed from the true toxin. Furthermore, 12 year old children suffering from cerebral palsy will have 400 units in each leg for the treatment of spasticity while an adult for cosmetic purposes will get an average dosage of 50 units. I am sorry if the above sounds like a lecture but there is a general misconception out there about the safety of Botox and its nature.
Unfortunately, there is no miracle cure or product to eliminate the frown lines. I will paste a previous answer for alternatives to treating the frown area:
“Unfortunately, the frown area is best treated with Botox as the wrinkles are formed from constant movement of the frown muscles resulting in the skin creasing. Fillers may be used in this area and depending on the filler used results can last between 6 to 9 months. However, permanent fillers will last ‘forever’, but would not recommend them in this area due to a high complication rate. Laser may also be considered (Lumenis Ultrapulse FX) but again the procedure may need to be repeated every 6 to 18 months.”

Dr Nikolic,
I suffer from Type II Rosacea. It has become so bad, that I must now take accutane (20 mg/day) to try to keep the papules/pustules under control.
1) What is the latest and greatest laser treatment for the Rosacea skin to reduce the redness (which has now spread to my chin)?
2) How long must I wait before starting laser treatments when I finish my course of accutane?
Thanks!
Posted by: RosaceaHater | 02 September 2008 at 04:55 PM
Hello Rosacea Hater, thank you for the question.
It is not recommended to undergo any light or laser treatment while one is on Roaccutane and you will need to have stopped the drug for at least 6 months before this type of treatment can be considered.
The best laser for vein removal is known as the Pulse Dye Laser, however IPL with Bi-Polar Radiofrequency (Syneron) or a good quality IPL (Ellipse) have excellent clearance rates for the fine veins.
Another technology to consider for Rosacea treatment is Photo Dynamic Therapy (PDT), an example of a PDT machine is the Omnilux.

Concerning Laser treatments - any new developments for mature (i.e. white/silver) stretch marks? I have been reading about the Fraxel Laser, some results claimed are a 75% improvement; some feedback from patients is advice to run far, far away.
Any ideas?
Posted by: Maddy | 02 September 2008 at 08:04 PM
Hi Maddy, thank you for the question.
Stretch marks (striae) appear as parallel streaks of red, thinned, glossy skin that over time become whitish and scarlike in appearance. The stretch marks may be slightly depressed and have a different texture than normal skin.
Stretch marks are caused through skin that is subjected to continuous and progressive stretching; increased stress is placed on the connective tissue due to increased size of the various parts of the body. It occurs on the abdomen and the breasts of pregnant women, on the shoulders of body builders, in adolescents undergoing their growth spurt, and in individuals who are overweight. Prolonged use of oral or topical corticosteroids or Cushing syndrome (increased adrenal cortical activity) leads to the development of striae. Genetic factors could certainly play a role, although this is not fully understood.
Stretch marks are difficult to treat with topical products only and typically one needs to consider combining a good topical regime with laser or needling.
Topical products that contain glycolic acid and vitamin A and one should add glycolic acid peels and/or microdermabrasion may produce some improvement to the appearance of the stretch marks.
Lasers, such as the pulsed dye laser - used at wavelengths of light that are non-ablative (will not remove any skin), remodels the dermis (the layer of skin just beneath the surface layer, the epidermis) by stimulating the growth of fibroblasts, cells that help produce the elastic tissues collagen and elastin.
The excimer laser, an altogether different system from the pulsed dye laser, does nothing for collagen or elastin growth. Instead, its aim is repigmentation by stimulating melanin production. If it works, the old and lighter scar is rendered similar in color to the surrounding skin, and therefore less visible.
Laser is not your only option for stretch marks as needling has shown good results with this cosmetic problem. As with laser, you will need a number of sessions of needling. Needling is a procedure that involves rolling a device that has 1mm needles that allows deep penetration of high doses of Vitamins (A, C, E and K). This causes the fibroblasts to reactivate and promotes wound healing with new cell formation. Ultimately one gets stretch mark removal, as well as other benefits to the area treated.

ooh, ooh, me, me. Hand up high in the air for my question to be answered please. I have a crevice on the right hand side of my top lip (as a result of smoking - I now try and smoke on the other side of my mouth!). Question: Will Restylane take this crevice away and how long will it last?
Posted by: stayathomemom | 02 September 2008 at 08:05 PM
Hi Stay At Home Mom, thank you for the question.
Restylane or Juvederm HV generally works well to fill these lines (known as smoker’s lines or whistle lines) and smooth the ‘crevice’ out. Other alternatives are laser (Fraxel, Lumenis Ultrapulse FX).

I have 3 questions:
1). I have had Botox between the eyes several times. I also need a filler but that's question 2. I also have lines just about my eyebrows toward the outside of my face. The first time I had Botox the nurse told me that if you inject Botox too far off the midline you risk droopy eyes. That makes me not want Botox for these lines and yet I would like to make them go away. What can you tell us about the risk of drooping eyes due to Botox injections far out from the mid-line?
2). Fillers - which do you prefer - Juvederm or Restylane and why? This is for facial lines like frown line and nasolabial crevasse.
3). laser hair removal - I had some very expensive laser work done on my copious facial hair (in early days I would have been put in the circus). It didn't work. Is laser hair removal suitable for heavy whisker hair?
Posted by: 21stCenturyMom | 02 September 2008 at 09:44 PM
Hello 21stCenturyMom, thank you for the question.
If Botox is administered correctly there should be no risk in developing a droopy eyebrow or eyelid (eyebrow or eyelid ptosis) purely as a result from injecting too far laterally. I routinely inject my patients across the forehead (centrally to above the outer eyebrow area) to eliminate the wrinkles that develop with the upward lift of the eyebrows. The important part to preventing this droop is not to over inject the forehead muscle (frontalis) and to make sure the upper face depressor muscles have been treated with Botox as well.
My personal preference is Juvederm HV purely based on the FDA approval:
Juvederm HV has 12 month longevity FDA approval
Restylane has 6 month longevity FDA approval
I use both of these fillers (Juvederm and Restylane) in my practice, as I see patients who have a preference for one over the other.
Laser hair removal should work on facial hair as long as it is not the fine hormonal hair that develops on our faces (known as Vellus hair). Syneron emax and elight are indicated for all hair colours (from dark to blonde).

I have lines from my nose to around my mouth on both sides...I think they are called "marionette" lines? Eek. What can be done about them? Someone once told me to quit smiling, but I don't think that's gonna happen. ;) (I'm in my 40s).
Posted by: maddy | 02 September 2008 at 10:34 PM
Hi Maddy, thank you for the question.
The lines from the corner of the nose to the outer corner of the mouth are known as nasolabial folds (NLF). Marionette lines are those that extend from the outer corner of the mouth towards the chin – also known as mouth frown or scowl.
NLF’s are typically treated with a filler but one may consider laser.

Dear Dr.
What's the best and safest way to get rid of acne scars on the face?
Posted by: Liz | 02 September 2008 at 11:16 PM
Hi Liz, thank you for the question.
Both Fraxel and Lumenis Ultrapulse have good treatment results for acne scarring.

How long has Botox been used on humans as a cosmetic aid? I'm interested in its long term safety (not just for the primary user but children of in regards to future risk to illness).
Also, is Tertia getting a discount on future works for your featured advertorial (if not, Tertia possibly you could look into this? Also see it expanding into other areas, vets, cleaners, car dealers etc.) :)
Posted by: Claire | 03 September 2008 at 12:55 AM
Hi Claire, thank you for the question.
Point blank Botox is one of the safest drugs and most researched drugs in the world today. It has been used for approximately 30 years for medical reasons and about 25 years for cosmetic reasons. Literally hundreds of thousands of studies exist in both these fields. The cosmetic use of Botox has not so far caused a single death or severe allergic reaction and Paracetamol, to mention only one common over the counter drug, cannot boast that record!

Good Doctor,
Is it true that fillers feel like gummy worm under your skin?
I have a big nasty wrinkle under my left eye and it must go. But I'm a little freaked out about the whole gummy worm thing.
Please help.
Posted by: ExAfrica | 03 September 2008 at 03:49 AM
Hi ExAfrica, thank you for the question.
No, if applied correctly non animal stabilized hyaluronic acid fillers (NASHA) do not feel like worms under the skin. In fact the area injected should feel smoother than the surrounding skin, as a large number of water molecules are attracted to the NASHA, resulting in the smooth and natural feel.

[Poltzie]

I've heard that new research suggests that it can really screw you up for life. True or untrue?

[Dr Alek Nikolic]

Hi Claire, sorry forgot to finish your answer regarding Botox and pregnancy.
Botox has been inadvertently injected during cosmetic procedures when a patient has been pregnant. These pregnancies have been monitored carefully and no side effects have been noted so far. In fact, in the USA, 8 licensed clinics exist that inject Botox in pregnant females for specific medical reasons only (not cosmetic!). Considering that the Botox dosage used for medical reasons are typically 5 to 10 times higher than cosmetic doses one can conclude it is a safe procedure. Please note that Botox should never be injected in pregnant women for cosmetic reasons – it is considered a contra-indication.

[Andrea]

Many thanks for your explanation of botox that you gave to Sister Mel.

Since botox is a contractindication for cosmetic reasons in pregnancy, is it correct then to say that it is also contro-indicated if one is planning or undergoing fertility treatment? Or is there a time line one could fit it in? Then if there were, one could not get top ups during the pregnancy.

Thanks!

Andi

[Tripsmom]

Me, Me, waving my arms madly in the air. I can be you "model" for filler/training - have deeeeeep frown line between my eyes - I assume that this will be free then?

[LEILAH]

Hi Dr Botox

I`ve been doing botox and fillers for about two years now, and I have no plan to quit. :) I just wanted to know if botox or fillers could have any negative impact on IVF?

[Dido]

hello dr. botox, how nice of you to be with us!
i will be turning 40 this year and am pretty satisfied with my looks - but being nicely thin has its downsides, which is looking gaunt in the face :-((
i hardly have any wrinkles other than NLF, which are rather mild i'd say, but i hate that i look tired and older than i otherwise would (since i have no wrinkles) because i am so thin and have guant cheeks (more noticeable if i don't get enough sleep, which does happen unfortunately)...
what is usually done in such cases - it is possible to use some sort of a permanent filler to rejuvenate the face (and how safe would that be?!), or do you prefer some sort of a 'mini lift' procedure that pulls the cheeks a bit tighter?
thanks a lot!

[21stCenturyMom]

Thank you Dr. Botox. My next question is - is prostitution an acceptable way of earning enough money for all of these wonderful treatments?

That isn't really my question. Never mind.

My real question is this - I plan on coming to S. Africa (Cape Town) next winter (my winter - your summer) to visit my daughter who will be in school there. As I understand it, cosmetic procedures are much cheaper in S. Africa than they are in the states (botox costs $11/uint on sale here). If I wanted to have some botox/juvaderm treatments how far ahead should I make an appointment? Can I do it in email? Can I be your patient?

[ExAfrica]

Thank You Doctor!!! I am copying and pasting your answer and taking it straight to my cosmetic surgery place (right down the street - lucky me). I will not look lop sided any longer!

Great idea Tertia - and please do not go for the hideously layered Jenifer Aniston look - the other one is WAY cooler (we say things like that in America).

[DrAlekNikolic]

Hello Carol, thank you for the question.

The teaching for both surgical and non-surgical cosmetic procedures is based on two broad principles: firstly, the end result should look natural, and secondly, the treatment plan should be tailored around the patient. The main reason for this is that every person has their own individual likes and dislikes and the cosmetic doctor should know how to achieve those desired results. Furthermore, we are seeing more and more patients who work as presenters or on stage and therefore require more movement for facial expression. By choosing specific areas to inject and changing the doses used one can achieve a natural looking end result.
So finally, if you can spot ‘Botox a mile away’, it was either that persons request for nothing to move or the doctor injecting has decided on a dosage that allows no movement and has not tailor made the treatment according to the patients wishes.

[DrAlekNikolic]

Hi Cat, thank you for the question.

This is a difficult one to answer over the net and your best option would be to consult a cosmetic dermatologist or an aesthetic medical practitioner with special training in this area. The most common reason for ‘bags’ developing under the eye area is a gradual shift of fat from the lower eyelid into the area were the skin meets the lower eyelid (just above the mid cheek area). This is highlighted even further by the groove that appears in the tear trough due to the thinning of the supportive fat pad. Please check out the before and after photograph of this area on my web page at:
http://www.aestheticfacialenhancement.co.za/index.php/treatment-photographs/dermal-fillers
and scroll to the bottom of the page. If this is what you mean by looking tired then the treatment options are as follows:
A groove below the lower eyelid develops as a result of a small pocket of fat that ‘drops’ allowing for what is known as the shadow effect and for the skin to lie closer to a venous plexus increasing the darkness noted. Hemoglobin may ‘leak’ out of the venous plexus and sit in the skin increasing the darkness noted. My first approach would be to use a filler (Restylane, Juvederm 24, or fat) in the infra-orbital area, as this would lift the skin out of the groove and away from the venous plexus. This will have the added benefit of removing the tired look and giving the eye area a youthful and refreshed appearance. Furthermore, one may then add a product like Cernor XO to further reduce the darkness noted from any hemoglobin still present in the skin.

[DrAlekNikolic]

Hello Poltzie, untrue. Not sure what you have heard but these types of comments are typically sensationalized by the media.

[DrAlekNikolic]

Hi Andy, thank you for the question.
Botox is not contraindicated during fertility treatments only when pregnant and breast feeding. My advice though is to be very aware during the time you are trying to fall pregnant and to be sure you are not receiving Botox in the early stages of pregnancy. I have had patients undergoing fertility treatments who see me for cosmetic treatments, and as long as the doctor and the patient is aware of the timing one can safely administer Botox.

[Dr Alek Nikolic]

Hi Tripsmom, yes all treatments during training are ‘free’ but one may have to sit around and wait as explanations on how to inject, one’s approach, and questions from attending doctors can take some time. If you are interested (or anyone else) please email me at: [email protected] and I will keep your contact details.

[DrAlekNikolic]

Hi Leilah, thank you for the question.
Botox will not impact on IVF but should not be injected when you fall pregnant. I have a number of patients undergoing fertility treatments and as long as you and the doctor are 100% aware of the timing there should be no problems.

[DrAlekNikolic]

Hello Dido, thank you for the question.
This is a difficult question to answer over the net as one would ideally like to examine the areas of concern to advise you on the appropriate treatment options. From your description, it seems that you have volume loss due to the facial fat pads thinning and shiftinh their positions. This is best treated with fillers that replace the fat pads to bring definition, support, and a more youthful shape to ones face. A good example of what fillers can achieve for volume restoration can be seen on my web page at:
http://www.aestheticfacialenhancement.co.za/treatment-photographs/combination-treatments.html
and at:
http://www.aestheticfacialenhancement.co.za/treatment-photographs/dermal-fillers.html

[DrAlekNikolic]

Hi 21stCenturyMom.
Cosmetic procedures are cheaper in SA than the US and you have the added advantage of the exchange rate. You can contact me for an appointment at:
www.aestheticfacialenhancement.co.za and click the ‘Ask a Question’ tab under the Resources column or by phone at + 27 21 797 0960. Please book 1 month before coming to SA and this should ensure an appointment time.

[Dido]

hey dr botox, i'm the one with the gaunt face :-) (or should i say :-( , i just wanted to add: i have tried restylane in my naso-labial lines, but it hardly made any difference; and i also tried fraxel (two or three sessions, don't remember), hoping that it might plump the face up a bit, refresh it - but any refreshing i got was for a few days really...
so i realised i need something to really concentrate on my cheeks, which are pretty hollow (marlene dietrich look!) - (either a filler if there is such a filler - i've heard something of a thing called aquamed?), or some sort of a minilift that would pull the cheeks back minimally and thus sort of tighten them...

or am i just dreaming...??

thanks!

[Dido]

dear dr., thanks for your answer! sorry for being a bore - i hadn't seen your reply before writing one more time...
the examples you sent look quite nice (though these patients seem to be older than me).
unfortunately, i live in europe so it's not 'that' simple for me to come over for a quick look... ;-)

thanks again! have a nice weekend!

[Marie]

Dr Botox:
Do you have any experience with Botox for migraine treatment?
Thanks,
Marie

[DrAlekNikolic]

Hello Marie, thank you for the question.
Botox has been used successfully for treating Migraine headaches. I have a few patients that see me for Migraine management. Furthermore, some of my cosmetic patients have noted that their headaches disappear once the Botox has started to work.

[DrAlekNikolic]

Hello Dido, sorry I seemed to miss your question my apologies.
One can get a slight lift with volume restoration to the mid and lateral cheek area and, which I think is more important, a more youthfull shape to one's face is achieved. My preference with NASHA fillers are the FDA approved fillers such as Restylane, Juvederm HV, and Hydrafill. I do not like useing Aquamed but this is my personal preference and is not anything directed toward the product. The choice between a mini face lift or fillers depends on what the problem area is and the areas that concern you. In some cases one may need both procedures to achieve the best results.

[Botox Side Effects]

My name is Diana Lee and i would like to show you my personal experience with Botox.

I have suffered with migraines and neck pain for many years. Botox has given me my life back. I have arthritis in my neck and Botox is the ONLY thing that has given me relief.

Side Effects-
None…miracle drug

I hope this information will be useful to others,
Diana Lee

[cosmetic surgery upland]

I am interested Dr.Botox,keep up the good work.

by: sphin

[Account Deleted]

Nice comments.

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[Anita Davis]

Dear Sir,
I'm looking at having botox and fillers and would like ti know if you require a model? I have deep lines and would i think i would be a great model for before and after photos??

Many many thanks
Anita