Expert Body & Facial Plastic Surgeon

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Facial Injectables: Botox Vs. Fillers

In recent years, the fields of cosmetic surgery and medicine have seen an increased popularity in minimally invasive procedures. In particular, cosmetic injectable treatments have become a backbone of aesthetic procedures. These include filling and relaxing agents, both of which are generally used to reduce the appearance of wrinkles, creases, furrows or scars.


Filling agents work by the injection of a volume of products such as Restylane, Juvederm, Radiesse and Artecoll, under or within a targeted skin region such as a wrinkle, thereby decreasing its appearance. Fillers do not provide a dramatic result when treating the upper third of the face, however they are a great treatment for the nasolabial folds (the creases on the cheeks running from the nostril to the corner of the mouth), and the “marionette lines” (the creases running from the corner of the mouth down the side of the chin). The specific type of filler product to be used is often based on physician preference in terms of which product a particular MD feels works best and is most comfortable injecting.


Relaxing agents such as botox work by relaxing a muscle group that, by virtue of involuntary muscle tension, causes overlying skin to crease, furrow, or wrinkle. Botox is the most convenient treatment for the upper third of the face, including the horizontal wrinkles on the forehead, the furrows between the eyebrows, and the “crow’s feet” lines found at the outside corners of the eyes.

Can Scars Be Removed?

One of the most common questions asked as a cosmetic surgeon is the patient’s concern of the possibility to remove scars with plastic surgery. The answer is simply "no". Although cosmetic and plastic surgeons are trained to use meticulous, careful techniques to minimize scars and place them in inconspicuous areas of the body, the complete removal of them is not possible. Rest assured however, several treatments such as cortisone and laser are available to improve the appearance of scars.

Smoking and Cosmetic Surgery

Nicotine use can lead to major complications following plastic and cosmetic surgical procedures. Cigarette smokers will inevitably wake from general anesthetic procedures with extra build up in their chests and throats. This can lead to coughing and straining which can disrupt sutures and even cause surgical incisions to start bleeding during the immediate post-operative period. Even more important is the impact cigarette smoke has on blood flow. Nicotine is an extremely potent vasoconstrictor which causes the flow of blood to be severely restricted to tissues. Under normal, everyday circumstances, this effect may not be noticeable to an average smoker. When a surgical incision is in the process of healing, tissues need robust blood flow into the healing areas in order to bring oxygen in. The constriction of blood flow caused by even a single cigarette can result in a lack of circulation to reach the healing zone. This can lead to enormous problems with healing such as necrosis (dead skin), infection, and poor scarring.

Facelift Post-Op Care

  1. Leave the head dressing on and dry.
  2. You can bath or sponge bath but avoid wetting the bandages.
  3. Keep your head elevated at all times and place 2 or 3 pillows under your head when lying down.
  4. Expect bruising. Bruising can "migrate" and end-up around your eyes or even on your neck or upper chest. This is normal.
  5. You may find that your face or mouth feel weak or that your facial movements or smile are asymmetric. This will pass.

Vitamin E After Plastic Surgery

Vitamin E is used to minimize scarring after plastic and cosmetic surgery. A scar is the "glue" that our bodies create to heal wounds, be they traumatic lacerations or plastic surgery incisions. Scar tissue is composed of blood vessels and collagen amongst other substances. The blood vessels in scar tissue gives scars their characteristic redness which makes the scar stand out against the generally lighter skin. The collagen component of the scar is the major component that provides strength and closes a wound or plastic surgery incision. Fine and desirable scars occur when only minimal amounts of blood vessels and collagen are laid down in the scar during the healing process. When blood vessels and collagen are minimal, a scar will blend well into the skin and appear narrow, flat, and fine. Vitamin E ointments minimize the amount of collagen laid down in the scar during the healing process. The precise value of vitamin E has never been conclusively proved in scientific studies, although many plastic surgeons prescribe it because it minimizes scars and has minimal to no risk, other than the very rare possibility of allergy.

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