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Real Self Most Loved Injector Sari Katz, PA-C from Schweiger Dermatology Group on her favorite injectable cosmetic procedures.
To be or not to be – injected? As a cosmetic dermatology physician assistant specializing in injectables, this is the question I am often asked within minutes of revealing my profession. You see, my favorite part of being a cosmetic PA in Manhattan is that most patients coming in for a cosmetic procedure are happy to obtain natural-looking results without a drastic difference or significant downtime. So what procedures pack the biggest “punch,” without the literal bruising?
In my opinion a face can take off years and not look puffy with a little Botox, cheek lift, lip plump, and under-eye correction. As the face ages, expression lines in the skin become fixed and the inner tissues and fat pads underneath the skin start to lose volume, structure, and descend with gravity. How can we subtly fix this without looking “done”?
Cosmetic Neurotoxins (Botox, Xeomin, Dysport)
As we all know, New Yorkers can be considered pretty animated characters with big smiles, expressive brows, disgusted frowns, and gesturing hands. While our audiences may love our expressions, our skin does not. For example, the lines created by our brows furrowing with deep thought or raising in surprise eventually become stuck in the skin and earn the title of the dreadful “forehead wrinkles” and “‘11 lines.” Botox is a quick and easy procedure with close to zero downtime that can relax our expressive muscles and help iron out our wrinkles.
While Botox to the forehead, 11s, and crows-feet has become pretty mainstream, an area that, in my experience, is largely under-Botox-ed is the area around the mouth. Years of frowning and pursing our lips have a habit of creasing our faces but with just a little bit of restriction on the muscles above our upper lip or below the corners, we wipe those years away and the distress lines that came with them. If you haven’t started Botox yet, ask yourself “What am I waiting for?!?!”
Cheek Augmentation (Juvederm Voluma, Radiesse, Restylane Lyft)
Probably one of my favorite procedures to perform is cheek augmentation. Why? Even the smallest amount of filler in the cheeks, if placed strategically, can make the biggest difference in the aging face. As we age, both men and women alike, lose volume in their mid-face as fatty and connective tissues shrink and lose structure. What results from the tissue descent is the presence of the largely feared hanging “jowl,” the deepening of the folds around the mouth, and the sunken under-eye circles.
Providing a little filler to the cheeks can help lift the tissues back into place, taking the added weight off of the folds around the mouth, pulling up the sagging tissues at the lower face, and providing structure to the volume-depleted under-eyes. Now filling the cheeks can be tricky because if too much filler is placed in the apples of the cheeks, it can result in a face looking over-filled with closed-in eyes. I prefer to fill the side cheek bones and accentuate the contour of the cheek arches as opposed to the apples. We all love the Big Apple, just not on our faces.
Lip Injections for Wrinkles (Juvederm, Restylane, Volbella, Belotero)
What is the injectable procedure everyone is lining up for?? Lip filler! Thanks to Kylie Jenner, business has never been so good! All jokes aside, lips are not an area of the face that are only injected for fun. Do you look back at old pictures of yourself and wonder where your young plump lips have gone? Over time our lips not only lose volume and thin out, but also start to “invert” or curl in and become frowny at the corners. Lip filler is used to volumize the shriveled lip, support the droopy lip, and bring out the hidden lip. In giving extra volume to the upper lip, filler can also be used to mask a gummy smile.
A natural-looking “lip job” creates a youthful, sexy face. Be careful though; in the wrong hands lips can lose their natural proportion, become asymmetric, and appear lumpy. Choose your injector wisely as nothing screams “overfilled” more than an over-injected set of lips. If you don’t want a “duck lips” outcome, make sure your injector isn’t a quack. Read more on lip fillers.
Tear Trough Injections (Belotero, Volbella, Restylane Silk)
When was the last time you thought “I look so tired”? If you live in New York, probably at least twice in the last hour. Unfortunately, our undereye circles, called “tear troughs,” cannot be fixed by simply quitting our day jobs and catching up on sleep. Another result of the aging face, our undereye circles become more noticeable in our 30s and 40s as the structures that once gave volume to the area start to shrivel and fall. Our underlying vascular and bony anatomy cast a shadow that can be perceived through the thin skin as “dark circles.” Luckily for us, fillers do a great job filling in the “dead space” and lifting the tissues back up to give us a more bright-eyed, well-rested look.
Another tip here: make sure you go to a skilled injector as use of the wrong thickness or quantity of filling product in this area can result in worse looking under-eye circles, or a puffy looking under-eye bag we call “tindle effect”. More importantly, there are vascular structures below the lower lids that feed blood flow to the eyes and if compromised by filler can result in blindness! Now that I’ve really got your attention, my advice to you is: Don’t turn a blind eye when it comes to your face! Consider under-eye fillers.
There are a ton more tricks that I have up my cosmetic sleeve, but the procedures listed above are the ones I find most rewarding and appropriate for the aging face. Certain filler and toxin techniques can reverse the tell-tale signs of an aged face while still maintaining a natural look. So in answering the question, “To be or not to be injected?” my answer to you is always, “BE injected!”
Sari Katz, PA-C (https://www.instagram.com/skinbysari) practices cosmetic dermatology at Schweiger Dermatology Group Upper East Side and Financial District locations. Call 844-DERM-DOC for an appointment with Sari.
