Answer: Injectables such as Botox and fillers are excellent products that have revolutionized aesthetic medicine. They are safe and effective and can be performed during a brief office visit, with little or no anesthesia and with little or no down time. They should not however be mistaken for the non-surgical equivalent of surgical procedures. In general, injectable procedures give much more temporary and less dramatic results when compared with surgical procedures. They are wonderful for correction of earlier, more minor changes of facial aging, and for patients who desire more subtle improvements or who cannot take time off for recovery from surgery. There is no amount or technique of filler injection that can accomplish what a facelift, eyelid lift, or nose job can. When practitioners who are not surgeons attempt to do so, the procedures may be equally or more costly compared with surgery, and sometimes give unnatural or even grotesque results.

Answer: I perform all types of brow lifts. I select the best procedure for each patient based on their individual anatomy and what specific aesthetic improvements they wish to achieve from the surgery. For those who prefer the least invasive approach and who have less severe brow ptosis (drooping) and worry lines, Botox injections may be a desirable alternative to surgery. Botox will soften or eliminate worry lines and will slightly but noticeably lift the brow. The effects are temporary though. When a surgical procedure is indicated, I usually prefer the endoscopic approach, whenever possible. An endoscopic brow lift is best for patients with relatively short foreheads and relatively anterior hairlines. It will effectively lift the brow and allow for permanent weakening of the frown muscles. It is performed through a few small incisions hidden behind the hairline and does not result in as much loss of sensation and scarring as other open approaches. For patients with taller foreheads and more posterior hairlines, I usually prefer an open approach through a frontal hairline incision. This allows very effective lifting of the brow and at the same time reduces the excessive forehead height and pulls the hairline forward. The hairline scar is usually very well concealed but there will be some loss of sensation in the scalp behind the incision. In patients for whom a scar at the hairline is not acceptable, and who are not good candidates for the endoscopic approach, a traditional coronal brow lift would be another option. This is performed through an incision from ear to ear, across the top of the head. For some patients, particularly men with severe brow ptosis and deep wrinkles in the forehead, a direct brow lift through an incision within the forehead crease can yield excellent results with well hidden scars.

Answer: Botox and injectable fillers are similar only in that they are both indicated for correction of facial wrinkles caused by aging and or muscle activity. They differ in the parts of the face for their intended use and in their mechanism of action. Botulinum toxins like Botox and Dysport are primarily used in the upper one third of the face. Their only FDA approved indication is for correction of the frown lines between the eyebrows. All other uses are “off label”. Botulinum toxins are neuro-muscular blockers that paralyze facial muscles. They temporarily correct facial wrinkles by reducing or eliminating the muscle activity that causes them. Their effects last about 3 to 4 months. Injectable fillers such as Restylane, Juvederm and Radiesse are primarily used in the lower two thirds of the face. They temporarily correct facial wrinkles and folds by directly filling them in and restoring lost volume. Their effects last from 6 to 12 months.