This patient is 54 years old and had never done any Botox or filler in the past. She wanted to soften the lines between her brows, lift eyelids and improve her forehead lines. She really disliked the hollowed area under her eyes and told me, “My sister did filler under her eyes and got a big lump, which looks horrible.” Although she hated the severe hollowing under her eyes, she was very reluctant and we discussed how lumps most commonly happen in this area. We also talked about my specific injection techniques for the eye area, conservative approach and the safeguards I do to avoid such unfavorable outcomes. She also wanted to improve the vertical lip lines and marionettes/nasolabial folds that made her feel that her face “is falling and heavy.”
I estimated needing 23 units of Botox and 3-4 syringes of Juvederm for the completion of the above areas. However, just starting conservatively with the eye area and cheek/midface will lift the lower face and we can always add more filler in the future as needed. We are both so pleased with her results thus far with 2 syringes and plan to do another syringe of Juvederm for the cheeks/nasolabial folds and possibly upper lip lines.