Dermal fillers and anti-wrinkle injections for nose and lip treatment

Fillers Before And After

Doctor: 00:00 Now this is a video you can watch if you really want an insight into what goes on in a cosmetic consultation and treatment.

Doctor: 00:15 Have a patient, Erin. Erin has very graciously laid it all on the table for us and she's shared her experience completely from the minute I met her to the follow up. You'll get to see the consultation and how we marry up the patient's concerns with what I have felt to be the best thing for the patient and putting them together so that she has a great result and she's really happy. And for the treatment, I hope you don't have a fear of needles. It looks quite gory when you see it. And of course the bit that you guys want to see is the before and after. We'll be showing you all those things, but don't skip to that at the end. Please watch through, see the process. Okay, so let's get to it.

Patient: 00:58 Hi, nice to meet you.

Doctor: 00:58 Nice to meet you.

Doctor: 00:58 So thanks for coming on our video today. Tell us a bit about what's brought you here.

Patient: 01:04 In particular, so I would like to do something with my frown line. I just sort of like a more youthful look, but I also don't mind like the fake look.

Doctor: 01:15 Okay. Why is your frown line bother you?

Patient: 01:18 It's been there for so long and I don't feel like I've been frowning.

Doctor: 01:23 You’re quite young, aren’t you? Do you mind if I ask your age?

Patient: 01:25 I'm 32.

Doctor: 01:26 You're 32, okay. Any other concerns that you have?

Patient: 01:29 In the last couple of years I've developed wrinkles. Not awful ones,

Doctor: 01:35 In your message to us you mentioned your nose as well.

Patient: 01:39 Yeah. Yeah. My nose. I'd love to get a nose job one day. I don't mind my nose front on, but side on, not that I see it often, but when I do see it just like blows my mind how it's like there's no nothing there.

Doctor: 01:55 Can you show us your profile?

Doctor: 01:57 Yeah, so just this part over here?

Patient: 02:00 Yeah.

Doctor: 02:01 Okay. Can you tell us a bit about how this came about?

Patient: 02:04 About six years ago, I was in a bad relationship and I got hurt on my nose. And it was swollen, but I wasn't sure if it was broken and then it just healed. And then it wasn't till like a year ago and My mum came to Melbourne, I'm from Sydney, and my mom came down to Melbourne and she, she's a nurse, and she said, have you broken your nose, and it just jogged my memory back to then and she thinks that my nose is still broken.

Doctor: 02:34 What, what would it mean to you to, to straighten it out?

Patient: 02:37 Like it doesn't bother me on a day to day thing, but when I do see it, like I'd love that. That would be the ultimate to have it better.

Doctor: 02:46 We can use dermal fillers, so you can actually inject a dermal filler into that, which will help to lift up the indentation in the nose.

Patient: 02:53 Yep.

Doctor: 02:54 Um, as opposed to having to go in and, you know, um, open the nose up. So it’s a good alternative and it’d give you an idea of what it might look like. Maybe more like the nose, you know, um, that you had before this all happened.

Doctor: 03:08 I'll go through what we can do.

Patient: 03:10 Yep.

Doctor: 03: 11 Yeah. Actually, before we go on. Any other, any other areas that you’d like treated today.

Patient: 03:15 I’m happy to have whatever you wanna do to me?

Doctor: 03:19 Okay, sure.

Patient: 03:21 If you feel like I need volume in my cheeks you can.

Doctor: 03:23 You’ve got nice cheeks actually. You look young and you've got a nice facial shape and you've got good volume in your cheeks. Cheeks are probably not something that needs… needs enhancement so much, but I was thinking for you, framing the eyes would be nice.

Doctor: 03:37 You've got a little bit of hollowness under the eyes, what we call “tear troughs” and putting in a bit of filler through that will help to smooth the transition between the lower eyelid and the cheek. So…

Patient: 03:49 Yeah, that would be amazing.

Doctor: 03:50 It would make you look like you've had, you know, full eight hour sleep. You have a little bit of volume loss above, just above here.

Patient: 03:57 Yup.

Doctor: 03:58 In the upper eyelid, in the brow area. And putting a bit of volume just along there will actually help to improve the contour of the brow, making it more, sort of, smooth and, and even as it goes from outside to inside.

Patient: 04:13 Yup.

Doctor: 04:14 I'll, I'll explain what we can do. First thing, let's talk about the frown. So, the frown is an area which, you know, we treat a lot, usually with Botox and that helps to relax the underlying muscle that contracts and causes a crease.

Doctor: 04:29 So you could be contracting your muscles at night, it could be a night frown, it could be habitual thing. Um, but breaking that habit with Botox can be very effective. So, putting a little bit of Botox in there just to stop the actual contraction of the muscle.

Patient: 04:46 Yeah.

Doctor: 04:47 Looking at you, as well, you have a frown line at rest. In other words, even when you're not frowning, there's a frown line there. So, what will happen with Botox is that it will relax the underlying muscle, but even though the muscle’s relaxed, the crease will still be there because the line is there at rest. The other thing that will be necessary to do to get that pushed out more is to actually put a bit of dermal filler in there as well. So that like, um, um, it fills up the space underneath it and lifts the frown line out.

Doctor: 05:13 Can I just feel how stretchable this is? Let's see how stretchable. It doesn't fully stretch out. So even when I fully stretch your frown line with my finger, it doesn't fully flatten out. So that tells me that when I put fillers in, um, it may not completely go, but at least it’ll be a bit better. So that will look nicer, look fresher.

Doctor: 05:34 There might be a bit of tethering of the skin as it is pulled down, tied down, almost, to the underlying muscles or fascia. And, and um, that sometimes you can make it hard to lift back up with fillers. So, so I think you get some improvement with bit of Botox and fillers, but in terms of complete resolution in one session, it's probably unlikely. I think if you did it over a period of years consistently and you gave that muscle a bit of rest and you give the skin a bit of a rest, then you'd find that frown line would dissipate.

Doctor: 06:06 I've often seen that with, um, you know, patients who I've seen over the past decade or so, where, you know, we look at the before photos from 10 years ago and we look at the after photos and the frown line on the head, you know, many years ago is completely gone.

Patient: 06:18 Yeah.

Doctor: 06:19 But it doesn't happen overnight. It happens over a period of years. So as the skin relaxes and regenerates.

Doctor: 06:25 For the nose, um, we use a sort of stiffer filler. It's got also a greater lifting capacity and it's just placed in areas to bridge the gap between the, um, elevated sections and the, and the lower section. We try to shape it in a sort of a natural, um, nose shape. If the light reflects on your nose, you get two columns of light reflecting down either side of the nose and they're straight. And you can tell when you, when you have a light shine on you that, that the nose looks nice and straight and there's two natural columns of light reflecting back on your eye.

Doctor: 06:59 Let's talk about the eyes. The eyes are an area which we often treat. Often, we put filler in the transition zone, which is the tear trough, where the lower eyelid meets to the cheek. So, by doing so you’re making a smooth transition. It's probably one of the hardest areas to fill in the face because it's such fine skin, you know, the skin is really fine there. You don't have much margin for error. Too much or too little. And being right center face, patients, they always want obviously perfect. So, it's often the case that you may need to come back and have a little top up. They’re one of the hardest areas to fill. Certainly, um, I think the best thing to do is to go a little bit under, you can go try to go perfect, but half the time it looks like it's too much and the other half the time fluctuates with the time of day.

Doctor: 07:45 You know, it might be more in the morning, less at night. You know, more in the morning when you're hydrated in the face. Um, so I usually aim for a natural look, which is just a little bit under perfect and a that looks a lot better than, you know, filling it too much.

Patient: 07:58 Yeah

Doctor: 07:59 I think that's, that's the most of it. Looking at your lips, they're pretty nice and full. So, I'm not sure you need it too much there.

Patient: 08:04 Oh, I'd like a bite more if you want to.

Doctor: 08:07 Oh, let's see a side profile. Maybe been in the upper lip. Well maybe, maybe what we could do today is actually really look at your profile.

Patient: 08:16 Yeah, that’d be awesome.

Doctor: 08:18 Because, I mean, if you look at your profile, have a look.

Patient: 08:22 Let’s make my profile awesome.

Doctor: 08:24 I don't know if you can see your profile very well within one mirror. The frown line interrupts a little bit. Then this interrupts it and the upper lip technically should poke out one to two mil more than the lower lip.

Patient: 08:38 Yeah.

Doctor: 08:36 So you in terms of proportion wise looking at you, you got really good size. But in terms of...

Patient: 08:44 What about a lip flip?

Doctor: 08:46 You could do that. Do to this for me.

Doctor: 08:48 Have you had that before?

Patient: 08:50 No.

Doctor: 08:51 One of the things we're doing a lip flip is you can treat it with Botox and that relaxes the muscles so it flips live out. So, when you smile their lip doesn't curl in. The downsides of it are that you lose control of your lip to a degree. Now I have had a patient, um, you've got pulled over by the booze bus and she…

Patient: 09:10 Couldn’t do that…

Doctor: 09:11 Yeah, she couldn't purse her lips. She tried that several times.

Patient: 09:14 Oh, yeah, ‘cause of the muscle.

Doctor: 09:15 So, can't blow up a balloon, can't suck on the straw, can't sip on tea root for, at least a month. And I'd say probably nine out of 10 women stick to it. You know, probably one out of 10 women say I'm never having that again.

Patient: 09:27 Yeah.

Doctor: 09:28 So most of the time it's all right.

Patient: 09:33 I just feel like when I have had my lips done, I feel like they’re full in the middle but I don't feel like they're very full here. And that’s what a lip flip would do.

Doctor: 09:40 On the outside part?

Patient: 09:41 Yeah, I feel like they just, I don't know.

Doctor: 09:43 Okay.

Patient: 09:44 Do you know what I mean?

Doctor: 09:44 Yup. They are quite… You got central volume and not as much laterally.

Patient: 09:50 Yeah.

Doctor: 09:52 Although I do like your shape a lot and you know, one thing you have to avoid with lips is losing good shape or, or making… you have to frankfurts for lips. You don't want two frankfurt's and you got a beautiful shaped lips. Let's maintain that and maintain good proportions and um, just help improve the profile.

Patient: 10:09 Okay.

Doctor: 10:11 So I’m just gonna have a look at your face and examine your face. I guess it's important to do so just like, um, any other doctor would examine, um, you know… That sounds bad! We’ll put that in the bloopers. Um, I guess it's important just as any doctor needs to examine their patients. In cosmetics, we need to do the same so it can't just be an across the table sort of thing. So we always examine our patients, um, always examine them really well.

Doctor: 10:43 It sounds terrible.

Doctor: 10:46 We always examine our patients, just like we're going to do a cardiovascular examination or circulatory system examination. It's important to have a good look at patient, have a feel that face, their skin, see what it's like, gauge elasticity of the skin and also you can also feel and see a lot of things that you ordinarily wouldn't see across from the consultation time.

Doctor: 11:08 We're going to do a top down examination. I'm looking at her forehead, not too much in the way, volume loss in the forehead and not too much in the way of worry lines or wrinkles. But she has got this frown she is worried about. And let's see how well that stretches out. So, it stretches out a little bit, but there's still certainly a bit of a frown in there.

Doctor: 11:22 Now the frown line. You can see even at rest there's a crease there and a little bit of resting tension.

Doctor: 11:26 So it's a bit of, you can feel the muscle bulk in that, in that frown. So, you actually have developed a bit of a… bit of muscle bulk by frowning and that might be a habit that we've got to break you out of. All right, now we'll just systematically move down and I can see under there there's a little bit of volume loss in comparison to the fullness over here in the lateral brow. The medial brow is a little bit less full. You can see there's a sort of peak that occurs around there. So, we're gonna try that, make that contour really smooth. Same on the other side. And if you look at the tear through - look up to the ceiling - yeah, you can see there's not too much in the way of fat under there. She’s got a little bit of a hollow just around her eyes. We'll fill that right up today.

Doctor: 12:14 The nose. Now one of the areas we're going to treat, one the main areas. You can see the skin pinches up fairly well. So, there's really good elasticity of that skin there. And, um, it's good space in there. So, there's not too tight. I can, I think, from what I can feel. But the most important thing is to actually, you know, to see when you start, um, if that is hard to penetrate through that area.

Speaker1: 12:42 The side profile. So, you can see there's slight indent in the nose and on the other side as well. Um, the nose will look different from both sides because the indent is not exactly symmetrical. So, it looks like we'll probably need to fill a bit more on this left side in the indent than the right.

Speaker1: 13:06 On profile, you can see a little bit of a frown line, little bit of a dent in the nose there.

Doctor: 13:14 The upper lip should protrude a little bit more than the lower lip. And in fact, if you line it up with a straight line, the chin, the lower lip, the nose and the upper lip should form one line. So, they should all meet and be a straight line, ideally. We do need to enhance her upper lip to get that effect.

Doctor: 13:38 Now interestingly, one of Erin's main concerns is a crow's feet, but looking at them - smile hard for me - yeah, she barely wrinkles up at all. And it's funny that people often say that, you know, areas like crow's feet are one of their concerns when in actual fact it looks very pleasant. So, I think in actual fac, Erin, and I reckon if we treat your crow's feet, you might end up with a funny look because it will reduce the natural movement of your eyes and that will actually, when you animate and smile, it'll make you look like, like this look like that. Which I think doesn't look as good.

Doctor: 14:12 So I think we're going to leave it, we're going to volumize that area from there to there. All right?

Patient: 14:18 Alright.

Doctor: 14:18 And that will hopefully smooth out any wrinkles that you might see. In terms of skin elasticity, let’s have a pinch… Like a rubber band. There's no slack in that at all. Gosh, that's great. Fantastic elasticity. Um, do notice a bit few sand spots which we could laser at another date and you'd be ideal candidate for that being fair-skinned.

Doctor: 14:41 First thing, um, alcohol with chlorhexadine. This will provide some anticeptic for the skin.

Doctor: 14:47 Just give you a good clean her. You have to be somewhat paranoid when cleaning skin. You don't want any bugs to get in there at all or makeup, for that matter. And I think that's one of the main causes of complications with fillers, in particular, is inadequate cleansing of the skin.

Doctor: 15:03 It gets up your nose.

Patient: 15:03 It feels nice.

Doctor: 15:05 It feels nice? You’re the first person ever say that to me.

Doctor: 15:09 Next step, marking. Now I think marketing's really important. Marking the patient gives me a visual roadmap, um, and helps me plan visually, uh, what I'm going to do. So, I'm going to get to marking.

Doctor: 15:19 We're gonna mark Erin, the patient, um, with, uh, check all veins. We mark that in red. And we use our AccuVein machine, which, if you've seen some of our videos, uh, this helps to detect, um, veins under the skin. So, reduces the incidence of bruising significantly.

Doctor: 15:40 Okay. Now try and relax and lay back there. Relax, that’s good.

Doctor: 15:52 How often do you get to sit back and relax or this, Erin?

Patient: 15:55 Oh, not often at all. This is so nice.

Doctor: 15:59 Even though I'm going to inject you with needles?

Patient: 16:00 Yeah

Doctor: 16:01 All right. Now, in white I'll mark where I would have put my filler.

Doctor: 16:07 So first we'll just mark out the eyes. A little dent in the upper lip, that usually occurs from sleeping. Do you sleep on your side like this?

Patient: 16:14 Uh-huh.

Doctor: 16:15 And you squish. Okay. You can tell cause there's a little hollowing there which needs to be filled, otherwise it gets deeper. So, we fill in this space, reinforce it, so when you sleep, when you sleep on your side, it won’t crush that part of skin as much.

Doctor: 16:26 And there.

Doctor: 16:28 I used to not mark patients, but I found that since marking I've been able to visualize better what I want to do. It just helps, you know, if you visualize something in your mind, you know, usually what you want to occur - occurs more easily.

Doctor: 16:41 Okay, we'll start with the anesthetic. Couple of tricks. Um, we use a bit of ice to numb the skin. Vibration, which helps to block the pain signal to the brain. So, when we inject a little bit of anesthetic, um, we would, it would… it won’t be as painful. Also, you’ll notice that we are using a very, very fine needle and syringe here, which helps also reduce pain.

Doctor: 17:06 So, I'm going to just numb you a little bit here, Erin. Okay, so a bit of vibration.

Doctor: 17:12 I’ll do one in the cheek and through this one we'll put a drop of anesthetic in the skin here and then through that we'll put some anesthetic to numb the nerve. So, you just feel this one here. That'll sting here.

Doctor: 17:22 How are you doing so far, Erin.

Patient: 17:24 The vibrations are awesome.

Doctor: 17:25 Yeah it works great.

Patient: 17:27 That just totally takes your mind off it all together.

Doctor: 17:28 Definitely.

Doctor: 17:30 That it's going to be one of the more painful parts, now. Erin's gonna do a bit of injection into the nose. I'm gonna ice it for a bit longer.

Doctor: 17:38 How was that?

Patient: 17:40 That’s fine.

Doctor: 17:41 She’s fine. She’s brave.

Patient: 17:42 It actually didn't hurt at all?

Doctor: 17:44 Oh, excellent.

Patient: 17:44 Yeah.

Doctor: 17:46 You have a little scar through here, too.

Patient: 17:48 Yeah. That was when I was a child, too.

Doctor: 17:51 I reckon you were a bit of a terror when you were a kid.

Patient: 15:52 Yes. And when I was an adult. I’ve settled down in the last few years.

Doctor: 17:57 You’ve only settle down recently.

Patient: 17:58 Yeah.

Doctor: 17:58 We make you look like a kid again.

Patient: 18:01 I used to get 22 until I turned about 30.

Doctor: 18:06 Got some plain Xylocaine here, which you're gonna inject around the infraorbital nerve, which will numb from the eye to the upper lip.

Doctor: 18:13 Ready? We're going to put a little bit of vibration on. The anesthetic injection point is also through the dermal filler entry point. But the key here is to inject very slowly at the beginning and then you can speed up once the anesthetic kicks in.

Doctor: 18:26 How's that?

Patient: 18:27 Fine.

Doctor: 18:27 No problem?

Patient: 18:28 Not at all.

Doctor: 18:29 Your lip might start going a bit tingly.

Patient: 18:29 Yup.

Doctor: 18:31 We'll start with the frown line. So, I'm using a cannula, here. It's a blunt tip, so that won’t penetrate through the skin. We actually need to make a little hole with a needle just to pierce the skin. Then we can insert the cannula.

Doctor: 18:44 So, the key advantages of using a cannula are that it helps to prevent entry of filler into arteries and veins causing bruising or worse. And also, they're fairly long. Those are the entry points for the cannula and through those we can do the whole face, all the areas that we wanna do here.

Doctor: 19:11 We’ll start with the frown line.

Doctor: 19:13 You can feel a bit of tethering there, it's very tough in there. So not easy to do. Probably even heard that pop on the microphone.

Doctor: 19:24 It's improved already. Definitely better. If you can see already that frown line looks a lot less.

Doctor: 19:30 Does that numb here?

Patient: 19:30 Yup.

Doctor: 19:32 Are your lips numb?

Patient: 19:32 Yeah. It's number on this sid.

Doctor: 19:34 Over that side?

Patient: 19:35 On this side.

Doctor: 19:36 So, I'll just do a little test with an icebox. So… Cold, cold, cold?

Patient: 19:39 Yup.

Doctor: 19:41 Cold? Cold?

Patient: 19:41 No.

Doctor: 19:42 Cold.

Patient: 19:42 Yeah.

Doctor: She's not quite numb. We just need a little bit more anesthetic. So, this time usually the second round of anesthetic doesn't hurt much cause it's sort of partially numbed from the first round. Feel that

Patient: 19:52 Nope.

Doctor: 19:54 Nothing? Zero?

Patient: 19:55 Zero.

Doctor: 19:55 I was injecting fairly fast there.

Doctor: 19:57 So, with the tear throughs we're gonna to put a deep feeler in first, which lifts more. And then over the surface I'm gonna put a finer filler to bled it all in.

Doctor: 20:03 So like a double layer approach. Like Sara Lee, layer upon layer here, okay? Alright, here we go.

Doctor: 20:12 So this probably you'll feel on the outer edges, but in the middle parts you won't feel much.

Doctor: 20:19 Feel an odd sensation here. Is that completely numb?

Patient: 20:21 Yup.

Doctor: 20:22 So I'm right under here at the moment.

Patient: 20:24 It feels like you're in my cheek

Doctor: 20:26 I’m very deep so I don't want this filler to show, it's more of a lifting filler. I dunno if you can see that in the camera, but it's actually lifting as we speak. I can see that being smoother than that side already. See there? In comparison to there. Can you turn a little bit? Look up the ceiling.

Doctor: 20:46 All right. That's better already. Now I’m gonna do the side. No pain?

Patient: 20:48 No pain at all.

Doctor: 20:50 It's interesting, isn’t it?

Patient: 20:51 It’s so weird.

Doctor: 20:53 You sort of know where I am but you don't… you can feel something, but it's not painful. Without anesthetic this is sharp.

Doctor: 21:01 What we'll do now is switch filler. This is the filler designed for the eyes, Teosyal Redensity II and it blends beautifully. And you'll find that putting this second layer on top gives you a really nice smooth appearance.

Doctor: 21:15 So this is a placed more superficially.

Doctor: 21:19 All right, let's do the upper eye.

Doctor: 21:22 We can, you can use the same filler here as the previous. This feels really weird.

Doctor: 21:32 I'm actually going fairly deep here, right onto the bone. I'm sure you really wanted to know that, Erin.

Doctor: 21:40 Funny the patients can hear filler noises. It actually makes noises as it goes in. They can hear it about 20 times louder than we can. It's amazing how noisy it is. That's one of the things that really freaks people out, is the noise. Did you hear a lot of funny squirting.

Patient: 21:55 Yeah, like (blows lips)

Doctor: 21:56 Yeah, yeah - funny noises.

Doctor: 21:59 All right. Now we're going to do the nose. How are you feeling about that?

Patient: 22:02 I’m excited.

Doctor: 22:03 Excited?

Patient: 22:03 I think, yeah.

Doctor: 22:04 That’s what she says now.

Doctor: 22:05 This is a very firm lifting filler. It’s called Belotero Intense and it's one of my favorites for the nose, because it's actually quite firm and it blends well at the same time. But it has really good lifting capacity. So that's what you need to lift a nose.

Doctor: 22:26 I'm seeing an immediate effect as I inject.

Doctor: 22:30 Any pain or anything like that?

Patient: 22:31 No, not at all. No,

Doctor: 22:33 Now I'm injecting under the areas of deficit.

Patient: 22:38 There's actually no pain in that at all.

Doctor: 22:40 No pain, okay.

Doctor: 22:42 I think she's just being brave.

Patient: 22:44 I’m actually not.

Doctor: 22:45 There will be a certain limit to how much this filler can lift, but certainly it's a difference. Molding and shaping the nose as I go.

Doctor: 22:54 I’ll also check the nose from both sides ‘cause remember the problem was not symmetrical. So we need to ensure that we fill to make it look good from both sides.

Doctor: 23:06 I think there is a bit of tethering there at that point so it doesn't lift completely.

Doctor: 23:11 Have a look from the top for that light reflection. So, it's definitely better. That's the mille feuille injected into her nose. And there's definitely, you can see, some immediate improvement in the concavity there.

Doctor: 23:25 Once again, another filler. So, I'm going to use a filler now called Juvederm, a sort of soft filler, great for lips, because it fills a lot. The longevity's great in lips, which is one of the issues with many dermal fillers is they don't last in them. So, this is one of the longer lasting dermal fillers for the lips.

Doctor: 23:39 Now our goal here is to give her support and structure to the lip as well as size. So, support and structure often have to come first. Now I've actually changed my cannula to a slightly finer one.

Doctor: 23:50 So typically people would inject the upper lip with needles. And the problem with that is that, um, you have to use multiple punctures with a needle, which causes a lot of swelling and discomfort, um, and also an increased risk of bruising, too. So, with the cannula and a bit of anesthetic, you don't feel much at all. It's one entry point, it's much less painful. There’s much less swelling and you can sort of see the final result at a much earlier stage, um, rather than having to wait for all the swelling to dissipate.

Doctor: 24:26 Any pain there?

Patient: 24:26 No, none at all.

Doctor: 24:27 Okay, so as requested by Erin. Wanna put volume on the outside edges of the lip here, so just from there to there, she’s really fairly full from there to there.

Doctor: 24:40 Now lips do swell even with the use of cannula, so, um, you have to advise the patient that.

Doctor: 24:46 They may like it. Often they… often, they love the swelling. Yeah. Like Erin will love the swelling. She says… she's nodding already. And they get a little bit disappointed sometimes when… when it comes down.

Doctor: 24:57 Looking at the profile now. That's much better. So, probably the best way to judge whether they've done an even job on the lips is to have a feel. So, let’s have a feel of your lips. I’m just pinching them, seeing what the thickness is like between my fingers there.

Doctor: 25:10 That's pretty good. We supported that dent in the upper lip, so that will be more resilient to when she sleeps on her side . I'm looking at the bottom lip. Still looks in proportion and not too big or too small.

Doctor: 25:30 And there's no apparent bruising from the fillers. Um, I've just wiped off all the marks - it looks much better now. Um, just have to do the Botox and we're done.

Doctor: 25:38 So we're going to do the Botox at the frown. So it's the tiny needle. We put a bit of ice and vibration again

Doctor: 25:45 Frown for me. Relax.

Doctor: 25:48 So when she frowns (frown again), you can see the tail of the muscle there. That’s the corrugator muscle and the tail of it just hits there.

Doctor: 25:56 So he can just put a little bit in the tail there. Make sure we got the whole muscle there. That one stings a bit.

Patient: 26:02 I liked it.

Doctor: 26:03 You liked the stinging?

Doctor: 26:04 You can feel that way you know you're having something done.

Patient: 26:08 I just feel like my face is really fat from being numb.

Doctor: 26:10 Yeah, you’ll feel that for the next little bit.

Doctor: 26:14 Now the lip flip. So that's what she's been waiting for. We're gonna put a few drops of Botox into the Orbicularis Oris muscle, which is the muscle which causes pursing of the lips. And by doing so it's going to relax it and flip it out.

Doctor: 26:34 Now you're done.

Patient: 26:35 Oh, okay.

Doctor: 26:38 Are you ready? Have a look.

Patient: 26:40 Oh, cool, yeah. I can see a massive difference in my eyes.

Doctor: 26:43 Yeah. So the eye is definitely a smooth and they're going to improve with time with over the next few weeks.

Doctor: 26:49 The lips, probably be your favorite, ‘cause all the girls love lips.

Patient: 26:52 Yeah.

Doctor: 26:55 Alright. No worries there. We did really well. It was pretty nice.

Patient: 26:57 Awesome. Thank you.

Doctor: 26:59 22 again

Patient: 27:00 I was excited.

Doctor: 27:00 Alright, l'll let you get up.

Patient: 27:03 Cool.

Doctor: 27:04 Okay. Here we go. We're back now. It's been like…

Patient: 27:09 Four weeks.

Doctor: 27:09 …four weeks. Have Erin here looking extremely beautiful. I said to her when, when you came here and I said, I think sometimes the best judge of whether something has gone well or not is that first, second when I see you walk in from the waiting room. And when I saw you walk in from the waiting room, I really thought you look, you look amazing. So, I actually got that instant, wow effect. Um, how have you been?

Patient: 27:31 Yeah, really good. Um, I'm really happy with the results.

Doctor: 27:34 When you finished the treatment, how did, how was, how was your face?

Patient: 27:39 Um, I had no pain during the treatment and afterwards I didn't have pain. It felt a little bit different. Like, like, cause my nose was hard and my nose was always like, just, you know, soft and there was nothing there. So, it just felt different and it took a while to adjust to it, but, um, otherwise like really great recovery.

Doctor: 27:57 In terms of bruising and things like that, how'd you go?

Patient: 28:01 Zero bruising. Not one bruise at all.

Doctor: 28:04 Everything's healed up nicely, now. Um, unfortunately for you, your youth has come back and you've got a little pimple right on the filming day.

Doctor: 28:12 Looking at the profile, let’s have a look at the profile, so significant improvement in both profiles.

Doctor: 28:23 Now the, the nose is not completely elevated. There's probably some scar tissue in there, so it's actually tethered down. So today, um, we're electing not to put any more filler in the nose.

Doctor: 28:32 One of the more important things for Erin was her frown line. You can see her frown line is significantly reduced. Give us a frown, Erin.

Doctor: 28:40 And she's got a really strong frown despite but the dose of Botox we used in there. It's still managing to contract a little.

Doctor: 28:50 The frown is a negative expression, we don't need it. So we'll just blast it out of the water today. We'll put a lot of Botox in there today for her.

Doctor: 28:59 In terms of the concavity, that's definitely filled out. But the muscle contraction’s still there. So that's the underlying cause of it. So, we're gonna have to put some more in there just to keep that going for you. And, and you know, not having treated Erin before, you don't really know what dose to give someone until you do it. So, I gave it to the standard dose. but I think in hindsight we could have given her a lot more and really hit that frown. So next time she comes in, we'll put in a bigger taste for you.

Doctor: 29:24 How'd you go with the eyes afterwards?

Patient: 29:26 I loved the eyes afterwards. I feel like they have sort of gone down a bit since then.

Doctor: 29:32 So it looked smoother at the beginning and--

Patient: 29:33 Yeah, they looked really smooth and, like, fresh.

Doctor: 29:36 Ah, yeah, yeah. So, this is, unfortunately, that was all swelling—

Patient: 29:41 Oh…

Patient: 29:44 We love the swollen stuff, don’t we?

Doctor: 29:46 Yeah, everyone loves swelling. Everyone loves swollen lips and eyes, why is that?

Doctor: 29:48 You know, I like them as they are, personally, but you know, when people look in the mirror, the eyes, uh, you know, are the window to the soul. Everyone looks at their own eyes and you know, you've got to get the eyes spot on. Everybody is a perfectionist with the eyes. Even the people who are not perfectionist are perfectionist with the eyes

Doctor: 30:04 Just for Erin , I'm gonna look after them and pop a little bit more in there. I’ve explained that possibility of overfilling. But what I'll do, I'll use a fine filler. The Teosyal Redencity II, which is really a magical filler for the eye area. So, I think we'll be able to get away with popping a bit more in there for her, and hopefully she'll, she'll be very happy with the extra smoother.

Doctor: 30:23 So, it’ll look even smoother, but not, but not swollen. Okay?

Doctor: 30:27 The lips, now, Erin did admit in the earlier in the video that she, she likes the fake look.

Patient: 30:33 Don’t mind, like, the fake look.

Doctor: 30:35 A lot of women will come requesting bigger and bigger lips and at some point we have to cut you off and say, look, we will, we've got to keep the lips in proportion to the rest of your face. And I think they look beautiful and nice. They look actually very full. Actually, really, you know, I go, wow, you've got really luscious, beautiful big lips and they look nice. But not overdone.

Patient: 30:53 Yeah.

Doctor: 30:53 So I really like them. And the effect of the Botox you put in here as good. It's actually kicked out your lip a little bit. Although you said you haven't felt too much different. So yeah, give us a look in the camera then give us a, give us a pout.

Doctor: 31:05 There's no vertical lip lines and the lip is having trouble sort of squishing together there. So, um, as a result of that, that's gonna prevent upper lip lines and also kick your upper lip out a bit there.

Doctor: 31:17 So just put the finishing touches on Erin. I'm going to put a bit more Botox in the frown and up in the forehead and under brows here. And we're gonna put another ton of filler in your lips.

Doctor: 31:29 No, I’m joking.

Patient: 31:30 That just got me excited.

Doctor: 31:32 No, we’re not gonna do that.

Doctor: 31:34 Let's get to work and we're going to pop a bit more filler and Botox into Erin's face now.

Doctor: 32:31 We are all done. We've achieved what we wanted to do. We've gotten rid of some frown lines and uh, we've improved the nose, around the eyes, and importantly also, we've made a good improvement to her profile, which I think is, um, is been a really nice change.

Doctor: 32:46 Also, um, her front facing. What do you call it? I dunno. Her nose actually looks better front. She looks better from all angles. But basically, she looks better from all angles. So no matter which way you look at her, she looks better.

Doctor: 32:58 Let's have a last look into this camera here, show everyone how you look.

About Dr. Carson Simmons, MD

Dr. Carson Simmons, MD, has been a licensed Aesthetician for over 7 years. As of 2013, he has also been a Board Certified Surgeon. He received his education and degree at the John Hopkins University School of Medicine and is well-known for his many papers on facial contouring and facial augmentation. Dr. Simmons has also used his extensive experience in this medical field to write two best-selling books that examine the connection between skin aging and nutrition.