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Steven J. Pearlman, MD, FACS Dual Board Certified in Facial Plastic Surgery

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Botox, Facial Fillers, Juvederm New York

Role reversal or just an early Mother’s Day?

New York, NY: A few weeks ago, I treated three Baby-boomer moms. What made that day unique was that each was brought in by their daughter for facial rejuvenation. One was the mother of a beautiful teen on whom I did a rhinoplasty and had a fabulous result. The second daughter had prior Botox and the third just found me through “sources” and dragged her mother in for a fix-me-up. Each of these mothers are vibrant ladies in their 50’s and were there for their daughters, now it was the daughters who were telling the moms what they needed.

Each mom had office facial rejuvenation with Botox, fillers and skin care. Botox was used to soften their frown lines, reduce crow’s feet, reduce downturned corners of the mouth; and in one mother smooth the forehead. By individualizing treatment and using only the necessary amount of Botox, each looked smoother yet retained facial expression.

Next, they had Juvederm to restore youthful cheeks. As we age, one of the first things to go is mid-face fat. Nasolabial folds aren’t so obvious in a young adult, but become much more visible when the mid-face gets hollow. When I used to just fill nasolabial folds, patients were happy but not ecstatic. Restoring youthful “apple” cheeks give what I call the “wow factor,” each looked in the mirror after only one cc per side (cheek, nasolabial fold and marionette line) and said exactly that: “wow, this is how I used to look” and could now compare themselves to their daughters. One of the mothers also had Restylane to her tear troughs to camouflage the appearance of lower eyelid bags.

Lastly, each was put on a skin care regimen designed for their face. The core for each of their product selections was TNS, a great skin rejuvenation product that I even use myself on a daily basis. So, mother’s watch out, your daughters are watching out for you too! Steven J. Pearlman, MD, FACS

Beautiful cheeks

As I perform more and more facial fillers to restore youthful cheeks, I continue to be excited about the wonderful changes we see with only one or two cc’s of filler. Most patients who are candidates either ask about treating nasolabial lines and folds (they run from the corner of the nose to the mouth). However if you look more closely at their cheeks, as people age beyond the mid 30’s we lose the baby fat that gave us youthful fullness. Remember those cheeks that your aunts and grandmother used to pinch?

Now, when I look closely at these cheeks, I often see a mound (cheekbones), hollowness beneath, then a nasolabial “mound” then the nasolabial fold. Filling just the nasolabial fold doesn’t go very far in making patients appear more youthful. What I prefer, and most patients agree, is to first restore volume to the cheeks. I use filler to restore volume under the cheekbones. Then I need only a little filler in the actual nasolabial fold since the volume restoration lifts the nasolabial folds up and out. On “beginners” we often start with only 1 cc (syringe) of filler. For more volume, 1 per side is sufficient. To enhance cheekbones, the filler can be tailored to each patients’ needs by highlighting, restoring or creating beautiful cheekbones as well.

What filler do I like to use? On a first-timer, I usually start with Juvederm Ultra. This is the smoothest, most mold-able filler and it gives the most subtle enhancement. I sometimes use Restylane as well but find that Juvederm is more mold-able. These fillers typically last from 6 to 9 months in the cheeks. For more volume and a longer lasting effect the next choice is Juvederm Ultra Plusor Perlane (basically, this is thick Restylane). These fillers provide more volume. Plus they often last from 9 months to a year. Want even longer lasting effects, especially for building high cheekbones? I will address this in a future blog. It is what I call Runway Cheeks. The next choice following hyaluronic acid fillers (Juvederm, Restylane and Perlane), I use Radiesse, for a 1 year plus result.

When patients have very hollow cheeks and require a large volume replacement. My first choice is Scuptra. Using one’s own fat for fat transfer is also an option.

So for beautiful, youthful cheeks there are many options. The best option is to come in or visit your favorite facial plastic surgeon for personalized recommendations. By the way, the same choices and process applies to melolabial folds or marionette lines that run from the corners of the mouth downward.

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