Wrinkles vs Folds
When patients are in my office for a facial consultation, I discuss the following to help educate them, because an educated patient is the best patient.
There are three things you can do to a wrinkle.
1)You can temporarily paralyze the wrinkle with Botox. Botox is most commonly used in three areas: the horizontal forehead wrinkles (this has the secondary benefit of conservatively lifting the corners of the eyebrows), the frowns (“angry 11’s”), and the crows’ feet.
2)The second thing you can do to a wrinkle is to fill it with fillers, which in essence turns the valley of the wrinkle into a plane by filling its base. I use hyaluronic acids (a substance which naturally exists in the body) such as Belotero, Restylane, and Voluma, and calcium hydroxylapatite such as Radiesse, as well as Sculptra, a poly-L-lactic acid. There is nothing worse than someone looking inflated; the goal of filler is to help soften and sculpt, and the results should be beautiful and natural. Areas most commonly filled are the nasolabial folds (the lines that extend from the edges of the nose to the outer corners of the mouth) and the marionette lines.
3) The third thing that can be done to a wrinkle is that it can be smoothed from the top down with a laser or a peel, almost like polishing away the wrinkles. There are differing strengths of lasers and peels, some which can be performed in the treatment room without the need for anesthesia, and deeper lasers and peels which require gentle anesthesia.
When a wrinkle becomes a fold, it is time for a surgical approach.
For example, I can create gentle lift with Botox to the corners of the eyes which helps pick up excess upper-eyelid skin, but when the skin becomes too saggy, it is then time for a blepharoplasty (eyelid lift). The desired outcome is that the eyes look naturally refreshed.
Another example of when a wrinkle progresses to a fold is when the nasolabial folds, extending from the corners of the nose to the corners of the lips, become overhanging. No amount of filler will correct this, although one often sees the mistake of chipmunk cheeks caused by overfilling.
The best approach is a gentle, short-scar face lift, with the incisions hidden in the folds of the ears so no telltale signs of surgery exist. This surgery repairs the mid-face, softens the nasolabial folds, alleviates overhanging jowls, sharpens the jawline, and removes excess neck-skin laxity by employing a corset plication. The resulting hammock effect recreates the smooth neck of youth.
Natural beauty is always the goal.