Addressing the whole patient: the role of Botox, fillers, and surgery

By Joseph Walrath, MD | Oct 25, 2011 | Botox, Cosmetic, Filler

My goal is to produce excellent results and happy cosmetic patients by whichever means make good sense for each individual.  There are many patients for whom surgery simply does not make sense, and these patients are best served with injectable fillers and Botox (or Xeomin). These patients tend to be younger, and without cheek and brow descent.

However, even the patients who benefit from surgery often require filler or Botox to maximize their results. For example, surgery generally only removes the wrinkles and folds that are present at rest.  Wrinkles that appear during facial expression or smiling can only be addressed with Botox.  Some patients have deep grooves that can be softened with surgery — in some cases, using the patient’s own fat from another location — but occasionally these grooves are not eliminated.  Injectable fillers like Restylane and Juvederm can be helpful in these patients to achieve the final cosmetic results.

Botox also can become an important part of presurgical and postsurgical care.  Prior to (or just after) brow-lifting, Botox injections can weaken the patient’s ability to bring the eyebrow back down temporarily, which helps me to achieve a stable elevation during the healing phase.  Additionally, it is not unusual for surgical incisions to cross areas that are very active during facial expressions (think: crow’s feet); Botox in these regions can weaken those movements temporarily and produce a thinner, less noticeable scar.

Finally, in the patient who simply does not want to have surgery at this point, the combination of Botox and injectable filler can achieve wonderful results by addressing both the static problems (the hollow spots and deep grooves) and dynamic problems (the wrinkles that appear with smiling or other facial expressions) that bother the patient.

Please keep in mind as well that I am currently offering Xeomin at 20% less than my usual Botox price because of manufacturing pricing changes!