WRINKLES

Officially, a wrinkle is a line that is deeper then 2mm. Less than that, and it’s called a ‘fine line’.

Frown lines are quick, simple and easy to treat with Botox. I have improved thousands of frown lines like this over the years. It takes just a couple of minutes.

After your 20s, collagen production slows down and you produce less oil, hyaluranon and elastin and your skin becomes thinner and weaker. This is called “intrinsic ageing” and it’s an internal process that happens regardless of outside influences.

“Extrinsic ageing” is caused by external factors that accelerate the loss of collagen and elastin, like sun, smoking, pollution, repetitive facial expressions and even sleeping positions. If you minimize your exposure to these, you’ll keep wrinkles away for longer.

The good news is that most wrinkles are easy to treat with safe, effective treatments like Botox and dermal filler. I treated this lady with Botox to smooth her crow’s feet.

The best strategy is to avoid the external influences that accelerate “extrinsic” ageing. In NZ, our worst culprit is the sun. Our high UV levels blast deep into our skin cells and destroy collagen and elastin.

Wear a zinc-based sunscreen on your face every day, rain or shine, and if you’re outside wear a hat. My favourite face sunscreen is Dermquest which has 18% zinc without a chalky look.

Avoiding excess sugar is wise. Sugar in our bloodstream reacts with proteins and fats to produce ‘advanced glycation end products’ (AGEs) which cause inflammation and wrinkles.

There’s not much you can do to stop facial fat loss with aging. It usually happens first around the eyes and can make us look tired. I corrected this by carefully placing thin filler around her eyes to replace the lost fat, reduce wrinkles and restore the smooth contour.

Here is the result of this 34-year-old woman’s first ever Botox treatment to her frown and forehead lines. This was 10 years ago – she still comes to see me for treatment now!

I only treated this lady’s frown, but it also reduced her horizontal forehead lines. This can happen with a full dose of Botox which spreads upwards and often improves forehead lines too.

Botox is also one of the best treatments for forehead lines.

The muscle that gives you horizontal forehead lines also lifts your eyebrows, so it’s important I don’t treat heavily, or I could drop your brows. I prefer to scatter tiny doses of Botox to soften your lines but keep your muscles moving, so you can still lift your eyebrows.

If your brows sit really low, or you have droopy upper eyelid skin, dermal filler is a better option to avoid any chance of dropping your brow. Treating your forehead with dermal filler is an advanced technique, so choose a very experienced injector.

I smoothed this 35-year-old woman’s horizontal forehead lines with a scatter of Botox in her frown and forehead. Why did I treat her frown when she didn’t have frown lines? To stop her brows dropping too much. Treating horizontal lines with Botox weakens the upwards pull of the muscle that lifts your brows. This can result in a brow droop, unless I also weaken the downwards pull of the frown muscles. Treating both sets of muscles keeps everything balanced.

This 60-year-old lady has loose skin above her eyelid, so I can’t use Botox to treat her horizontal forehead lines because even the tiniest drop in her brow will cause her eyelids to rest on her lashes – not good! Instead, I used Juvederm Volbella, putting a row of tiny dots along each line. It’s painstaking and time consuming, but worth it.

I use Botox to reduce crow’s feet, but in smaller doses and placed differently than other practitioners.

High doses can leave you looking blank and frozen, hollowed around your eyes, or give you a “shelf” of skin that bunches when you smile. That doesn’t look good.

Patients who have had bad crow’s results from other clinics, are pleasantly surprised to find they can often get a good result from my lower dosing and different placement.

I frequently combine Botox with dermal filler to contour your cheek, which supports your crow’s feet from below. Sometimes, I place a very thin filler like Juvederm Volbella precisely into the lines themselves. It depends on your face shape and which layer of your skin has lost support.

I treated this woman with a full dose of Botox to her crow’s feet to give her a dramatic improvement. I usually use lower doses for crow’s feet, but this was for TV, so I gave it everything.

This fabulous 48-year-old lady’s crow’s feet are due to loss of fat around her eyes. Botox would not be a good solution as it would make the area look hollow. Instead, she needs dermal filler to replace the lost fat. I restored her cheek volume first and then I delicately placed a thin layer of Juvederm Volbella under the skin around her eyes, like carpet underlay. This has plumped and supported the skin and made her look less tired and more refreshed.

Lip lines are harder to treat than they look. You might think you can just inject filler under the line. But this can give a rounded contour above your lip that we call “monkey muzzle” or “The Marge Simpson”. It looks unattractive, especially from the side.

A scientific knowledge of lip anatomy combined with an artistic touch is needed to get a really natural rejuvenation of your lip lines.

I carefully assess the entire area and reconstruct each structure, including the border of the lip, the philtrum and the corners of the mouth, with precisely placed dermal filler.

Choosing the right filler is also crucial. I use Juvederm Ultra for structure, Juvederm Volift for soft support, and the thinnest options, Juvederm Volbella or Belotero Soft, right into the lines themselves.

This is one of my favourite transformations because I love how much happier this wonderful 48-year-old lady looks now. I used 3 syringes of Juvederm over two sessions to lift her mouth corners, increase her lip size, restore her lip border and fill her lip lines. I wasn’t aiming to improve her acne breakout – I think that was just good luck.

I treated this 42-year-old over two sessions using a total of 2 syringes of Juvederm Ultra. Here she is immediately after the second session. I have increased the size of her lips as well as gently treating her lip lines and lines, smile lines and chin crease.

This is the side view of the same patient showing the improvement in her lips and the lines around her mouth. I think you can also see the better skin hydration created by the nourishing hyaluranon in the dermal filler. I took the after photo a couple of minutes after finishing her treatment, so there is a little swelling.

I treated this woman with the softest, most subtle fine line filler available, placing just a little into the lines and a thin border around her top lip to give her crisp definition and stop lipstick bleeding.

Smile lines are ‘dynamic’, which means they appear when you move your face. This makes them challenging to treat, as using a thick or stiff filler can be visible when you smile. It’s also important not to widen your lower face by using a heavy filler, as you might appear fat or bulky.

They key is a light touch using a thin, flexible filler like Juvederm Volift or Volbella, or Belotero Soft or Balance.

Although it’s rarely possible to remove smile lines completely, they can often be improved with filler.

Treating areas distant from the smile lines like the cheeks and chin can also stretch the skin in this area, reducing the lines indirectly. This is often a necessary first step before placing a thin filler in the lines themselves.

Here I used one syringe of Juvederm Ultra to soften this lovely 43-year-old lady’s smile creases at the corners of her mouth. You can see they are not gone, but they are much less visible. They will never completely disappear, as her smile muscle pulls on her skin at that location.

I treated this lovely 57-year-old lady with the hyaluranon dermal filler Juvederm Volift into her smile lines. Volift is a flexible filler that improves ‘dynamic’ or moving lines, such as smile lines. Her lack of jowl has allowed me to inject Volift straight into the creases without adding bulk.

This shows the same lovely lady as above, smiling. It’s important to check that smile line treatments look natural with smiling. A stiff, heavy filler won’t flex and could look unnatural.