When Dr. Yoo sees a patient who wants to look more youthful, his recommendations are most often injectables, surgery, or a combination of both, depending on the patient’s facial structure, aesthetic desires, and skin type. When does he recommend one versus the other? In this blog post, we’ll review the different treatment options and what factors Dr. Yoo considers when recommending one over another.

Botox is a great option for wrinkles that are formed when certain facial expressions are repeated over and over. To put it simply, Botox stops your muscles from making the facial expressions in the first place, thereby preventing those wrinkles from forming or deepening. For example, Botox will help with the horizontal lines that form when the eyebrows are raised.

However, with certain patients, Botox is not the best option to address forehead lines. Often as we age, the eyebrows descend and the upper eyelids sag, leadingto hooding of the eye. To compensate, people often unconsciously raise their eyebrows, even at rest, to lift the upper eyelid skin. This of course causes more forehead wrinkles. “For patients with this underlying aging-related issue, I do not recommend Botox to address the forehead wrinkles. If Botox is used to treat these wrinkles, the person will no longer be able to raise their eyebrows as much and they may feel like their eyelids are heavy and that their upper eyelid hooding is worse,” explains Dr. Yoo. “This is often the point that I strongly recommend a brow lift, blepharoplasty, or both depending on the person’s anatomy. After surgery has addressed the underlying laxity issues, Botox will then be an option to address any remaining forehead wrinkles.”

For wrinkles formed by laxity and/or volume loss, fillers are often an excellent option. For example, to address dark circles or puffiness under your eyes, Belotero or Restylane can create a smooth, youthful appearance by filling in the contour deficit along the lower portion of eyelid bags (the area is where the lower eyelid skin meets the cheek skin). However, at some point, the eyelid bags succumb to aging, pooch out more and become too prominent. “At this point, adding filler to this area will only make the entire area look unnaturally puffy,” states Dr. Yoo. “This is the point where I tell patients that they would be better off having lower blepharoplasty surgery rather than more filler.”

The jowls and neck area tend to be more challenging. The saggy skin and wrinkles in this area are caused by volume loss and laxity, mainly in mid face, so your first instinct may be to use fillers to add volume and provide lift. According to Dr. Yoo, “I think that fillers have a limited role in this area personally. I find that fillers quickly add to the weight of the lower face and do not look very good or at least do not give the results that the patient had hoped for. Certainly adding filler, such as Radiesse, to the mid face to give some lift to the frown lines can be done in many patients, but the volume required is usually more than the average person would expect and this can end up being quite expensive. The cost of the amount of filler to lift can approximate the amount of a facelift and the filler is only temporary whereas the facelift is permanent.”

The bottom line is that injectables are fantastic options for many patients, but it’s not one-size-fits-all. The best treatment plans are customized to your facial structure, aesthetic desires, and skin type. Surgery is sometimes the only option that addresses the root of the aging conundrum. Also, while injectables are temporary solutions, cosmetic surgery is permanent. Surgery doesn’t stop the clock on aging, but you will always look younger having had the surgery than you would without it.

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There’s a lot to consider and for most of us, it’s hard to know where we fall on the spectrum. If you want to know all your options and understand which option is the best for you right now, consider coming in to meet with Dr. Yoo for a personal evaluation and customized treatment plan. Consultations are a great way for you to get an expert opinion.

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