This is a question I hear all the time. It’s an understandable question, especially since some fillers tout their “natural” look in ads. There are differences among the various fillers, but with rare exceptions, how natural they look has almost nothing to do with the filler and everything to do with the technique of the doctor injecting the filler.
Every face is different, and most faces are different from one side to the other. That’s why it’s absolutely imperative that your physician has an artistic eye, a passion for detail and the thorough, in-depth knowledge of facial anatomy that come only with years of training.
Also, some fillers work better in one part of the face, while another may be more appropriate for another part of the face. That’s one of the reasons why we may use different fillers on the same face in different areas.
A major difference among fillers is their longevity. Fillers can last a few months, many months – and up to many years. Some fillers are essentially permanent, and they require faultless technique and an eminently conservative approach. However, when done properly and with an eye to future structural changes in the face, they can be a godsend to people, particularly after trauma.
So remember, the soft, natural and beautiful improvement that we can have with the optimal use of fillers is all about the knowledge, skill, artistry and integrity of your doctor. The claims of a more natural look by ads trying to sell you their own brand is, to put it kindly, a bit misleading.
With the New Year almost always come new plans for our habits, our attitudes, our appearance or any number of different aspects of our lives. My practice of course, deals with improving the appearance of our faces, but often the conversation in the exam room turns to seemingly unrelated subjects. I love to read and I love to help my patients in any way I can. This has eventuated in my writing down book names for people numerous times, mostly on the back of an appointment card. So to start 2016 I thought I’d share some of those titles with you in hopes that you’ll find the same delight and inspiration in those you choose as I did.We’ll start with some well-researched and ultimately beautiful books that pull together the science that proves our connectedness. This is a particularly important subject this year as the upcoming elections are going to pull us into a quagmire of vitriol from both sides. After over 22 years and thousands of patients, I wish to remind us all that good people can come to different conclusions, and the more we appreciate our collective connectedness in the midst of our differences, ultimately the more peaceful our lives will be.Three of my favorites are by an American journalist living in the U.K. She has interviewed scientists from all over the world and has pulled their information together in a well-referenced book called simply, The Field. After writing this excellent book, so many people wanted to know how to apply its discoveries to their own lives that she wrote a great follow-up, The Intention Experiment. Her third book, which specifically articulates the science behind our connectedness is called The Bond.There is a fabulous author, Gregg Braden with whom many of my patients have been unfamiliar, but his books are amazing, fun to read and fascinating page-turners. He is a former aerospace computer systems designer who has been all over the world to gather as much information on “who we are” as he can. A quick Google search will give you a list of all his books, but my favorites are:
Gregg Braden’s good friend, Bruce Lipton, PhD, is a molecular biologist who has written an inspiring and science-based book called The Biology of Belief.I’m always glad to offer interesting sources on diet, exercise and health in general. But I wanted to start the year with nourishment from the inside. May every happiness be with you in this exciting coming year!
BoTox/Dysport injections are the most common nonsurgical cosmetic procedure performed in the United States. Yet the effects are pretty subtle compared with some other procedures, and the most common objection I hear to the procedure is that, “BoTox lasts only a few months and I want something permanent.” Here are a few things you may want to know about BoTox/Dysport – and if you want to skip down, I’m saving the best for last.
It's the only game in townRight now, there just isn’t anything else other than some form of Botulinum A (BoTox and Dysport being the most commonly used in the USA) that is going to relax your muscles other than cutting them. There may be other things going on in a face requiring other procedures, but if it’s muscle movement that’s contributing to something you don’t like (like frown lines between your brows), basically the only way to treat those muscles is BoTox/Dysport.
The more the betterThis isn’t about big doses; it’s about repetition. Certainly one BoTox session can be helpful for a special event, but the real beauty of how it works is in keeping to a schedule and repeating the injections so the muscles don’t have the ability to regain their strength. Indeed, this may be every few months for a year or two, but just as with any other muscle we work out in the body, if it remains unexercised long enough, it will undergo “disuse atrophy”, a good thing for muscles whose only purpose in life is to pull our faces down and in. As this atrophy happens, and I have seen this over and over in my 20+ years of giving BoTox, the BoTox doesn’t have as much of a battle to fight and often we eventually can reduce the effective dosage and/or significantly extend the time between treatments.
And the other side of that coin?With certain parts of the face, the muscles that pull the face down have opposite muscles that pull the face up – the “happy” muscles. As the muscles we treat get weaker over time, the happy muscles no longer have the “sad, angry” muscles working against them, and the happy muscles contract more and get stronger. At some point that area of the face just gets a bit of a lift that the single session of BoTox would never have been able to achieve. This is particularly amazing at the corners of the mouth!
Our brains get the hintWith the exception of the part of the closing muscle of the eyelids (the orbicularis oculi) that contracts with a natural smile, the facial muscles that we treat with BoTox/Dysport have voluntary and habitual components to them. This means that if we treat a muscle and keep it relaxed long enough, our brains tend to forget that contracting that muscle is part of our repertoire and we tend not to use it as much. Again, this is something that happens over time and is a side effect of BoTox/Dysport that often eventuates in needing less and/or extending the time between injections.
It's often effective for depression and anxietyDid you know that researchers have found that when someone holds a pencil in their teeth, forcing a sort of smile, they find cartoons to be funnier? And when a person is asked to put on a frown they rate photographs more negatively? That is because of a link between facial muscles and nerve pathways through the “emotion” part of our brain that then affects our mood. This evidence supports the idea that “the emotion follows the expression”. Indeed, research has shown that BoTox/Dysport placed in the frown muscles (the corrugator muscles) between the eyebrows compares in effectiveness with anti-depressant medications in treating depression. You can try this yourself. Sit quietly, relax your face and put on a little smile. Holding this relaxed expression is incompatible with negative thoughts. If they bubble up, your face will tighten and the smile goes away. Those of you who meditate know all about this. If you’re interested, a short and excellent article with this research information appears in Aesthetic Surgery Journal (35) 6, page 759 and is by Dr. Steven Dayan.
There’s a little axiom among many of my colleagues who specialize in facial rejuvenation, and it goes like this:
What do women stress out about most when they look at themselves? Their necks.What is everyone else looking at? Their eyes.
That’s true, but it’s only partially true. There’s plenty of research out there now that’s been facilitated by our friends the computers. Basically, researchers will throw up a photograph of a person from the shoulders up and show the photos to observers. With the computer, the researchers can track the eye movements of the observers to see what they’re looking at and where their eyes settle for the longest amount of time when shown the photos.
As it turns out, the area that people are looking at is in the shape of an inverted triangle that essentially has its base across the brows and has its tip at the center of the chin. The features that observers look at the most are the eyes and the lips.
This is not to say that our concerns about our necks aren’t important. Especially from the side, someone can look much more vital with a firm, smooth neck. Also, the healthiest reason to have rejuvenation procedures done is for our own sense of well-being. Moreover, our skin is what people notice first. That said, this research may help us to prioritize when we’re thinking about “having something done”.
Reading all the kind reviews from my clients makes my job so much more rewarding. Thank you to all who take the time to submit your feedback and kind words. Here are some client testimonials from recently.
• Doctor Barbour treats me as if I were her only patient. I know in my heart all others entering this door receive the same care and feel the personal attention I experience upon each visit. It's a joy to know I'm in the most professional care.
• Everything Dr Barbour does is EXCELLENT. Not only is her work excellent but her personality and understanding makes the experience extremely gratifying.
• Dr. Barbour is a delightful person and an outstanding surgeon, sculpting and correcting the neck and face.
• Dr Barbour is without a doubt one of the most professional and yet personable doctors I have ever had the pleasure of having contact with. She is a true artist in her profession. I would recommend her to anyone that wants a beautiful, believable radiant look! Thank you Dr. Holly Barbour for your wonderful skill, God given talent and my new confidence.
• Dr. Barbour is so wonderful and very knowledgable. Another bonus is she is sweet and kind. She is very unique she spends time with you and really listens to your needs. I have been with her for seven years and I will continue coming to see her. I drive over an hour to see her she is that wonderful. I would highly recommend anyone to visit the office, I know they will be wowed at the experience. The entire staff is just wonderful and they all go above and beyond. They are all wonderful and help make your experience unique by working as a great team.
Thank you to the many clients who have taken the time to write comments and feedback about the work I've done. It really means a lot to read how happy you all are and it is the reason I do what I do. Here are some of the wonderful comments you all have left me.
• It has been my pleasure to know and be treated by Dr. Holly Barbour for some years. I am happy to report that I have enjoyed both the process and the result. Dr. Barbour has used her innate artistry to create a program that enhances my best features and reduces the perception of my flaws. I always feel that I am in the best possible hands!
• Dr. Barbour is a caring, warm, wonderful physician who treats her patient's face as if it were a canvas for beautiful artwork. I trust her implicitly to make the perfect suggestions for my face.
• I have been coming to Dr. Holly for 10+ years and she is absolutely the only person that I would ever let touch my face. I started with fillers in the smile lines and a bit to plump my upper lip and did the CO2 laser. Because of the amazing care and technique she used on me 10 years ago I have not needed a single thing until now. People think that I am at a minimum 10-12 years younger than my actual age. Now she is doing fillers around the eye and temple area to address age related changes. Even though I know what an artist she is I almost started to cry when I saw what a beautifully dramatic change it made in the look of my entire face! I hope that she never retires, I could never go to anyone else because she is such a true artist in regards to the minute proportions and dimensions of the face...and she has become a friend because she is as kind and caring as she is amazingly talented. She is one in a million!
• Dr. Barbour is always willing to take the time to answer questions. She is meticulous in her work and a perfectionist in what she does.
• I just love Dr. Barbour. I have been going to her for years. She is very sweet but most importantly very thorough with my cosmetic procedures. I look forward to my visits and to her office from start to finish; a pure pleasure.
I just returned from a national conference of the Foundation for Facial Aesthetic Surgery, a symposium attended by physicians in the three core specialties trained in this field. They are Oculofacial Plastic, ENT/Facial and General Plastic surgeons. This is a forum where generally the more enlightened surgeons, those who believe that instead of being competitors and guarding our “turf” (so last century) we and our patients benefit more by our getting together and sharing ideas from our various perspectives. Because this kind of mindset requires confidence, there were many nationally and internationally known surgeons in attendance, and the meeting was absolutely fascinating.
I had been asked to speak on integrating fillers and “neuromodulators” (BoTox, Dysport, etc.) for restoration of the face, but I asked to speak instead on permanent fillers, knowing that it would be a much more controversial and compelling topic. Besides, the issue of permanent fillers is one I feel more passionate about, both pro and con. Here are a few of the pros:
PROS• I’m happy to stand corrected on this, but I have conferred with a few surgeons regarding the statistic, and they agree that after the age of 30 we lose about 1cc of volume from the face each year. That’s 5cc per year (this would include both bone and soft tissue). Each syringe of filler that we use to correct volume loss contains between 0.8 and 1.5cc of product. Depending on the filler, these syringes run between about $450 and $1,000 a syringe for our patients. It doesn’t take much arithmetic to realize that this becomes prohibitively expensive for our patients unless they have unlimited resources, are content to chase their tails forever, or eventually just give up and/or age out of the process with little to show for it if nonpermanent fillers have been used.
• People generally don’t like having needles in their faces.
• Sadly, I do a considerable amount of “repair work” on poorly done surgery and fillers. Having suffered the results of that work usually involves some psychological trauma for the patient. Where fillers are concerned, the advantage of permanency is that once the repair work is done the patient can put the event behind them and move on rather than having to revisit the memory over and over as the “repair” wears away.
• We’re going to age anyway, and replacing lost volume in smaller increments rather than having to start essentially from square one each time, especially as the aging process becomes more profound, results in a better outcome.
• Most people want the attractive facial curves of youth, but they don’t necessarily want the world to know that they’re having something done to get them. With permanency, again we can do little bits at a time so that the upkeep attendant to the aging process is virtually undetectable.
We’ll look at the arguments against permanent fillers in our next blog. Check out our website to see client testimonials and to learn more about how permanent fillers could be right for you.
As I've told so many patients, this practice exists for your happiness. Fortunately, quite a few of my dear patients have rated this practice and the reviews can be found online. To make it easier to see them, for any of you who don't know us, we are posting links right here so you can be more easily directed to the various review sites. If you are one of my existing patients and you've reviewed our practice, thank you so very much for your support and for the generosity of the time it took you to write your comments. There is no advertising like word of mouth, and when it goes into cyberspace I am particularly grateful.
•Holly Barbour is a Superstar! I am a 58-year-old man. I had a facelift and my ear lobes trimmed down. Its not obvious that anything was even done, however, my friends are telling me how great I look! Dr. Barbour is a consummate professional with a very experienced team. My procedure took several hours and Dr. Barbour nor any of her team ever left my side. Unbelievable commitment and dedication to her patients. Dr. Barbour is a perfectionist. My wife is in awe that she cannot see any scaring at all. I would recommend Dr. Barbour and her entire team! 5 Stars!
• Dr. Barbour is consistently wonderful. She is extremely thorough and patient in her office visits and I was very pleased with the results of the surgery she performed. She does not pressure or rush her patients and I always feel she is totally honest and realistic.•I cannot express in words how unbelievably thrilled I am with my results. I look beautiful, stunning and so refreshed. There is no other Dr. that I would have touch my face. Dr, Barbour is beyond skilled, professional, she goes above and beyond what any one would ever do. I wish you could see how happy I am, I am gorgeous because of her. Thank you doesn’t express my gratitude enough.
1. You look in the mirror and see your mother... -This happens not to be a good thing, as far as you're concerned.2. Your skin is in reasonably good condition, but you're getting/have gotten jowly. -Gravity and an accumulation of fat at the jowl area are usually the major culprits.3. Your skin is in reasonably good condition, but you're getting/have gotten a saggy neck. -Gravity, an accumulation of fat under the chin and/or prominent muscle edges (the vertical bands down the center of the neck) are usually the major culprits.4. You realize that a facelift is about the contour of your face and neck and not about pulling out wrinkles. -See #2 and #3. Notice that we didn’t mention wrinkly skin as a culprit. Wrinkles are the result of a loss of collagen and elastin in the skin. No surgery is going to put that collagen and elastin back. This is what lights and lasers are for, however the creases that result from the fat, gravity and loose muscles will be helped.5. If you've been losing weight or are planning to lose weight, you're within 20 pounds of where you realistically think you're going to land for the long haul. -This is a slightly arbitrary number – we're all a bit different – but you certainly don't want to invest in a lift and then lose 50 pounds, because you may need another lift after that to look your best. Conversely, if you want to lose 50 pounds, but the reality is that you won't lose more than 20, you could be waiting forever.6. You want to look refreshed and revitalized, but you're not looking to take off a specific (huge) number of years. -There are all sorts of little structural changes that take place over the years, not the least of which is that we lose about 20% of our skull volume over the course of our lives. Since on the face, every little millimeter shows (really - there's research that proves this), there is just no way that a 50 year old will ever look 20. But you no longer have to be a nymph to look absolutely gorgeous.7. You're in generally good health and are confident that your family medical doctor would clear you for the procedure. -This eminently elective surgery doesn't happen unless you're healthy enough for it. A facelift does not qualify as a last ditch attempt to save your life, no matter how we may think of it.8. You're moving up, moving on, starting a new page in your life, and you want to boogie into it looking your very best. -A good facelift is a real confidence-booster and should make you look just like you - the very best version of you.9. But you realize that a facelift isn't a guarantee of The Fabulous Job, The Fabulous New Boyfriend, The Fabulous Husband -- and a Fairy Tale Life Forever and Ever. -Confidence really does start from the inside out. Cultivate your mind and your spirit as well as the body you're living in. Any modern physicist will tell you that we're all energy. Make it good and the rest follows.10. You're willing to keep up/adopt healthy lifestyle choices and take good care of your wonderful self afterwards, so that this investment in yourself gives you years of rewards. -Enjoy!
The eternal facelift conundrum for almost everyone goes somewhat like this:
“I want to look better, even way better. I want to look in the mirror and see that I look awake and happy instead of tired and sad. I really want that change to happen, but I don’t want people to notice that I’ve had a facelift.”
If this is what you’ve thought, you have a lot of company. If you feel a little embarrassed about saying that, you have a lot of company. The good news is that you can have it both ways – and the reasons are twofold.
First, and most importantly, the facelift must look natural, but the road to natural has to be through the vision and skill of your surgeon, not just doing less. We could do nothing and get natural, but that’s not what you’re signing up for. You’re signing up for skilled surgery, artistic vision and the ethics of someone who will treat your face as if it were their own. Let’s say you’ve found that with your doctor and you get a result that makes you look more as you did in your youth. The vitality, radiance, lift and definition of your face are back, but what will people think????
Here’s the reality. Just to bring it into perspective, let’s look at a situation most of us have experienced. You go to a gathering. You wear a lovely outfit. A couple months later, a similar event is to take place with some of the same people. You agonize because while the outfit you wore to the first event is perfect and you feel fabulous in it, you’re a little embarrassed to wear the same thing again. But think of the people who were at that event. Can you remember what they wore? Chances are that unless something particularly stood out, you can’t.
For better or worse, human nature is engineered to make us a bit more self-absorbed than we’d like to admit.
Now back to the facelift. If it looks natural, most people will just subconsciously register that you look great, or they will consciously register that you look great and will ascribe it to just about anything but surgery on your face. They will think you changed your hair. (If you actually changed your hair around the time of the surgery, all the better.) They will think you lost weight, fell in love, went on a long vacation, retired, began working out, whatever. Of course there are exceptions to this, but mostly these will be people who either have had facial work done themselves and are now primed to notice these things or people who have been thinking about it and want to have some of what you got. And in the latter case they may pull you aside and ask where you had it done. In any event, the bottom line is that if it looks good, if it looks natural and if it looks like the best version of you, your face will cause endorphins to be released in those that look at you – and that’s all good.
Oculofacial Plastic Surgeon, Sarasota, Florida
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