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No matter their origins, [scars](https://aedit.com/concern/scars) are often fraught with meaning. For some, they’re a sign of victory: the mark of survivorhood. For others, they’re a reminder of a chapter they’d prefer to close. Regardless, there remains the fact that, for a multitude of reasons, some scars heal better than others. 

When it comes to [mastectomy](https://aedit.com/aedition/what-to-expect-before-during-after-mastectomy-breast-cancer) and [breast reconstruction](https://aedit.com/aedition/comprehensive-guide-to-breast-reconstruction-nipple-reconstruction-after-breast-cancer), for example, how well your scar blends into your surrounding skin over time depends on your surgeon’s skill and your unique physiology. Proper aftercare, along with [topical scar therapies](https://aedit.com/aedition/scar-minimizing-skincare-to-use-after-surgery) (think: silicone gel or strips) and [cosmetic procedures](https://aedit.com/aedition/how-to-treat-every-type-of-scar) (like microneedling and lasers) can make a noticable difference.

In recent years, a newer scar-minimizing treatment has been gaining popularity. It’s called scar camouflage, and it uses techniques similar to [permanent makeup](https://aedit.com/aedition/permanent-makeup-after-chemotherapy-cancer) (a.k.a. cosmetic tattooing) to, well, camouflage the appearance of the mark. Here’s what you need to know about the trend.

## **What Is Scar Camouflage?**
Also known as skin color tattooing or camouflage tattooing, scar camouflage is a needle and pigment technique that blends scars into the surrounding natural skin using permanent makeup pigments. Typically performed by a medical or paramedical tattoo technician/artist, skin repigmentation has become increasingly popular for its ability to improve the appearance of scars, [stretch marks](https://aedit.com/concern/stretch-marks), and other areas affected by hypopigmentation (read: missing color).

Just like other forms of paramedical tattooing, scar camouflage isn’t the same as a typical decorative tattoo. Let’s review what makes cosmetic tattooing different from traditional tattoo techniques:

### **Traditional tattoos**
- Considered a ‘cosmetic’ by the FDA (meaning they’re not regulated)
- Ink (black and bright colors) derived from a variety of chemicals, including metals
- Injected deeper into the dermis
- Cannot be broken down by the body (i.e. they’re permanent)
- May fade slightly and/or become fuzzy over time

### **Cosmetic tattoos**
- Considered a ‘cosmetic’ by the FDA (meaning they’re not regulated)
- Micropigments (neutral skin tones adjusted with white) made primarily from titanium dioxide, as well as organic and inorganic substances
- Injected more superficially into the dermis
- Partially broken down and faded by the body (i.e. they’re semi-permanent)
- Likely to fade completely over time

## **What Type of Scars Can Be Camouflaged?**
When evaluating a scar for corrective micropigmentation, the source of the scar is not as important as its look and feel. Once fully healed, any type of pigment loss is generally amenable to micropigment color correction, including:

- Scars (from surgery or injury)
- Stretch marks
- Areas lacking pigmentation (from skin conditions like [vitiligo](https://aedit.com/aedition/guide-to-vitiligo-causes-treatments))

“Any type of surgery scar can be camouflaged, what matters most is how the scar healed,” says [Nicole Johnston](https://www.instagram.com/nicolejohnstontattoo/?hl=en), a cosmetic and restorative tattoo artist at [Studio Sashiko](https://studiosashiko.com/) in British Columbia, Canada. Typically, technicians recommend waiting until the scar is, at a minimum, one year old before opting for scar camouflage. “Scars cannot be worked on shortly after surgery,” Johnston explains. “A scar will go through many stages of healing and will change in appearance over time,” she notes. As such, Johnston typically asks clients to allow their scar to heal for at least two years before visiting her. 

Whether or not a particular scar can be repigmented depends on both the artist’s skill and the nature of the scar. The most ideal scars and stretch marks are those that are flat (or nearly flat) and paler than the surrounding tissue. “Most scars can be camouflaged,” Johnston shares. “But there are times when we won’t see ideal results.” She lists several characteristics that will likely impede a technician’s ability to successfully camouflage a scar:

- Keloid or highly textured
- Hyperpigmentation 
- Thinned, translucent skin

## **How to Prepare for a Scar Camouflage Treatment**
If you think skin color correction may be the solution for your scar, there are a few things you need to know beforehand:

### **1. Do Your Homework**
When considering corrective pigment camouflage, finding a skilled and qualified medical or paramedical tattoo artist is extremely important. Although some states are stricter than others, the United States Food and Drug Administration (FDA) considers scar camouflage to be a subset of permanent cosmetics and does not impose much regulation.

Here’s what you need to look for when searching for a provider:

- **Training & Certification**: A one-day training session isn’t going to make a technician an expert. Look into your local municipality’s laws around credentials and be sure to research how long the provider has been practicing and what certifications they’ve acquired.
- **Experience & Knowledge**: As mentioned above, a certain level of expertise can only come from years on the job, and you'll also want to be treated by someone who has experience working with clients with similar features or concerns to your own.
- **Facility**: Check to make sure the salon or office the technician works at is clean and appears to be following local standards.
- **Photos**: Standardized before and after pictures will give you a good idea of the caliber of the work. Check out our [guide to viewing B&As](https://aedit.com/aedition/importance-of-before-and-after-photos-in-plastic-surgery) to learn more about what to look for.
- **Happy Clients**: A skilled and reputable artist will never shy away from allowing past clients to share their experience with you, so don’t be afraid to ask.

According to Johnston, “experience and honesty” are two of the most important qualities to look for in a skin camouflage professional. “Scars are complicated and every situation is different,” she explains. “If an artist gives you an immediate ‘yes’ without indications of what to expect with your results, you may want to keep researching.” As it relates to honesty: “I regularly turn away clients if I know I cannot make worthwhile improvements,” she adds.

### **2. Expect a Consultation**
During your consultation, your tattoo artist will evaluate your particular scar and ask many questions — particularly about your medical history — in order to gain a better understanding of your body chemistry. This includes questions about:

- Medications (including vitamins and supplements)
- Any traditional, medical, or cosmetic tattoo history
- Skin type
- Allergies
- Autoimmune conditions
- Scar tendencies
- Ability to schedule follow-up treatments

### **3. Be Prepared to Prep**
Based on the appearance of your scar, your medical tattoo artist may suggest any number of pre-treatments. “Often, I will recommend a client get laser or microneedling done on a scar prior to coming to me so that we can see the best results,” Johnston says. “[Laser](https://aedit.com/procedure/nonablative-fractional-lasers) and [microneedling](https://aedit.com/procedure/microneedling) will help flatten the scar and improve its texture.” Another benefit of lasers, she adds, is that they can also lighten [hyperpigmentation](https://aedit.com/concern/uneven-skin-tone). “By doing this first, the client can see a much better result than if I were to only work on the color of the scar,” Johnston shares.

### **4. Consider Cost**
The price of a skin repigmentation varies by geographic location and the experience level of your tattoo professional. Expect to pay anywhere from several hundred dollars for work on a very small scar to several thousand for larger, more complex scar work performed by an in-demand artist. Typically, scar camouflage is not [covered by insurance](https://aedit.com/aedition/insurance-coverage-for-plastic-surgery-cosmetic-procedures) — unlike other types of medical tattooing, like [reconstructive nipple and areola](https://aedit.com/aedition/reconstructive-nipple-tattoos-for-breast-cancer-survivors-dominique-bossavy), for which some insurance companies do reimburse patients (at least partially).

## **What to Expect After a Scar Camouflage Treatment**
“I always tell my clients that they shouldn’t expect to see immediate results,” Johnston says. The reason for this is because the tattoo needs to continue to be perfected. “In order for the results to look the most natural, I am conservative with the amount of color I add in one session to the scar,” she shares. “My focus is for the result to look like skin and not like I’ve applied makeup to the area.” As a result, “clients will see full results after their touch up session,” Johnston notes — and she offers additional touch ups as needed. 

As with any healing process, it’s important to remember that the recovery from scar camouflage is an evolution. “A phrase I use with my clients is, ‘everything looks worse before it looks better,’” she says. “Scars and stretch marks are more fragile than the surrounding skin, therefore they tend to respond with a bit more redness or swelling when being worked over.” These side effects usually subside within a couple days, Johnston explains, but, for some individuals, the residual redness can last a few weeks.

### **What Are the Risks of Scar Camouflage Tattooing?**
Just like a conventional tattoo, corrective cosmetic tattooing carries certain risks. Choosing a well-qualified provider will minimize your chances of complications, which include:

- Infection
- Allergic reaction
- Granulomas 
- Poor color match
- Fading
- Discoloration

Sticking to the recommended after-care regimen is also extremely important, as your tattoo is essentially an open, healing wound for two to four weeks

## **Is Scar Camouflage Reversible?**
[Laser tattoo removal](https://aedit.com/procedure/laser-tattoo-removal) has come a long way in recent years. When it comes to skin repigmentation tattoos, however, trying to reverse the process isn’t as straightforward as it seems. Lasers target the color molecules and break them apart to be excreted by the body, but they can’t be used on titanium dioxide (a white pigment very often used to match lighter skin tones). Lasers turn this white metal gray, leaving an even more conspicuous mark.

Although there are alternative options for removing permanent makeup pigments, scar tissue doesn’t behave the same way healthy skin does. All of these factors make it much more difficult to alter a cosmetic tattoo than a decorative one or even [microblading](https://aedit.com/aedition/microblading-treatments-for-fuller-thicker-eyebrows).

## **The Takeaway**
A well-executed scar camouflage tattoo can be life-changing for clients — improving self-esteem and helping them move on. “This procedure can have incredible effects on a patient’s quality of life,” Johnston notes. As she explains, scars are often associated with difficult memories. “For our breast cancer survivors, it can help them feel like themselves again and recognize what they see in the mirror,” she shares. “We also help clients cover the scars from their abusers or from self-harm done in the past.” In many cases, scar camouflage represents a fresh start. “It’s a way for them to move on,” Johnston says, “and not see the reminder every day.”

Aesthetics

Using techniques similar to permanent makeup, scar camouflage tattoos can, well, camouflage the appearance of scarring, stretch marks, and more. Here’s what you need to know.

Scar Camouflage Tattooing: Benefits, Treatment, Cost, Results

Everything You Need To Know About Scar Camouflage Tattooing

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Us non-physicians tend to view ‘filler’ as one category, but actual aesthetic experts are quick to note that [there is a difference](https://aedit.com/aedition/hyaluronic-acid-filler-vs-biostimulatory-injectables) between hyaluronic acid (HA)-based dermal fillers and biostimulatory injectables. HA-based fillers, like [Juvéderm®](https://aedit.com/procedure/juvederm) and [Restylane®](https://aedit.com/procedure/restylane), quite literally fill treatment areas — like the lips, tear troughs, and cheeks — to temporarily add volume, contour, and smooth lines and wrinkles. This is different than the way biostimulants work.

While they often get lumped together for the sake of simplicity and the fact that they sometimes have similar end goals, biostimulatory injectables actually deserve their own category. Sculptra® is perhaps the buzziest of the bunch. “Sculptra® isn’t a conventional filler,” says [Michele Green, MD](https://aedit.com/provider/michele-green-md-34642), a board certified dermatologist in New York City, which is a sentiment echoed by fellow providers. “It definitely is not a filler,” adds [Samuel Hahn, MD](https://aedit.com/provider/samuel-hahn-md-20403), a double board certified facial plastic and reconstructive surgeon in Baltimore. 

Instead of hyaluronic acid, [Sculptra®](https://aedit.com/procedure/sculptra) injections are made from poly-L-lactic acid (PLLA), a compound that stimulates natural collagen production. Once injected, it encourages the body to create new collagen, which leads to a firmer skin, fuller features, and an overall rejuvenated look. So, why is everyone talking about the biostimulant? Here’s what you need to know.

## **How Does Sculptra® Work?**
With HA fillers, the filling effect comes from the substance itself. The same cannot be said of Sculptra®. Instead, volume enhancements come from the [collagen](https://aedit.com/aedition/guide-to-collagen-in-skincare-supplements-aesthetic-medicine) your body creates as a result of the PLLA (a synthetic, biodegradable substance used to make sutures). Any firming or plumping you notice is your own, which makes Sculptra® enticing to patients looking to turn back the clock.

What you see when you leave the injector’s office is far different from the results that develop over time. Immediately after receiving Sculptra® injections, you will notice a small amount of plumping due to the saline solution that the poly-L-Lactic acid is suspended in. That initial volume fades in about 24 hours, at which point it takes six to eight weeks (or up to three months) for your body to begin building new collagen. It is then that you’ll start seeing the actual results.

## **When Do You See the Results of Sculptra®?**
Unlike hyaluronic acid-based filler injections that offer immediate results after, in many cases, one appointment, Sculptra® requires multiple sessions. “Most people won’t see the results they want after one treatment,” Dr. Hahn says. Instead, patients come in monthly for up to three months. But all the patience is rewarded. While the effects of HA fillers last six to 12 months, results from Sculptra® can last two to three years. 

After an injection appointment, patients are advised to massage their faces according to the five-five-five rule: five times a day for five minutes over the course of five days. This step is crucial, Dr. Hahn shares, as it helps disperse the Sculptra® particles smoothly and evenly under the skin. “If you don't massage, then those particles can clump up in a very finite area,” he cautions. “To have good results, it’s very important to use vigorous massaging to create an overall sense of fullness.” 

If it sounds like a lot of pressure, don’t fret. Dr. Green assures us that the massaging process is simple and easily understood by patients.

## **Who Should Try Sculptra®?**
When consulting with patients who are weighing injectable options, Dr. Hahn says he takes a few factors into account: 

1. The location of the patient’s desired result 
2. The patient’s degree of volume loss

Sculptra® is unique in that it is the only PLLA-based cosmetic injectable approved by the United States Food and Drug Administration (FDA) to stimulate natural collagen production. It was first approved by the FDA in 2004 to treat facial lipoatrophy (read: fat loss) in people living with HIV. In 2014, Sculptra® Aesthetic [gained approval](https://www.accessdata.fda.gov/cdrh_docs/pdf3/p030050s002c.pdf) for the correction of shallow to deep [nasolabial folds](https://aedit.com/aedition/nasolabial-fold-treatments) (a.k.a. smile lines) and other facial wrinkles.

Generally speaking, Sculptra® works best in areas without much movement, such as the smile lines, cheeks, jawline, and temples. For that reason, [lips](https://aedit.com/procedure/temporary-lip-fillers) and [under eyes](https://aedit.com/procedure/under-eye-filler) are best treated with HA fillers. If a patient asks for filler in a Sculptra®-appropriate area, Dr. Hahn’s next step is to determine whether they are experiencing [“global” volume loss](https://aedit.com/aedition/best-procedures-to-restore-facial-volume). As we age, the face gets thinner and begins to look more gaunt or hollow. “Sculptra® will get those patients a much better result of general youthfulness because it can treat the whole face,” he explains. 

With hyaluronic acid fillers, one syringe equals one cubic centimeter (cc) of product. With Sculptra®, patients can go as high as 15 cc in one treatment, which allows for a subtle boost in multiple areas of the face. “People who feel like they need rejuvenation of the full face rather than a specific area that they’re concerned about will really benefit [from Sculptra®],” Dr. Hahn says.

But it isn’t just the face. Some providers and patients are opting to use Sculptra® off-label to restore fullness to the body in treatment areas such as the hands, décolleté, chest, [hip dips](https://aedit.com/aedition/cosmetic-procedures-for-hip-dips), and buttocks because the collagen stimulant can provide natural-looking, long-term rejuvenation. “Sculptra® injections in the neck and décolletage areas can provide much needed volume restoration,” Dr. Green says. She also likes Sculptra® as a non-surgical alternative to a [Brazilian butt lift (BBL)](https://aedit.com/aedition/brazilian-butt-lift-procedure-safety). 

It should be noted that, if you choose to treat the body with Sculptra®, expect to pay for more product than you would for the face. For example, in Dr. Green’s practice, she uses eight to 12 vials to create a “more voluminous buttocks.” And, speaking of cost, vials of Sculptra® are generally more expensive than HA-based filler, though there is less maintenance involved. You can learn more in our [complete guide to the cost of Sculptra®](https://aedit.com/procedure/sculptra/cost).

## **What Are the Drawbacks of Sculptra®?**
Hyaluronic acid fillers come with an antidote in the form of [hyaluronidase](https://aedit.com/procedure/hyaluronidase), an enzyme that can dissolve unwanted lumps and even nullify the filler entirely. Sculptra® has no such magic eraser, which makes it especially important that patients work with an experienced injector. 

Some Sculptra® patients develop nodules under the skin that may be palpable and visible. These lumps form when the product is too heavily concentrated in one area and fails to disperse — either due to the technique of the injector or the patient’s lack of post-appointment massage.

In addition, because Sculptra® relies on the body’s (newly stimulated) ability to create collagen, patients don’t know the exact level of response they’ll get prior to injection. “The vast majority of our patients who get Sculptra® have a response,” Dr. Hahn notes. “Some have a tremendous response and it does wonders for them, and, in others, it may not result in the fullness they were looking for.” That doesn’t mean you’ll never reach your desired results, but it may take a few more treatments than expected.

Unlike hyaluronic acid-based fillers, the biostimulatory injectable restores volume by stimulating natural collagen production. Sound too good to be true? Here’s what you need to know.

Collagen-Stimulating Sculptra Injections: Benefits, Ideal Candidate, Cost, Results

Why Everyone Is Talking About Sculptra

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When it comes to cosmetic breast surgeries, there are three main types of procedures: [breast augmentation](https://aedit.com/procedure/breast-augmentation-solutions), [breast reduction](https://aedit.com/procedure/breast-reduction-and-revision-solutions), and [breast lift](https://aedit.com/procedure/breast-lift-solutions). The first two deal with size. We probably don’t need to tell you that breast augmentation increases the size of the breasts, while a breast reduction reduces it. A breast lift, meanwhile, specifically addresses breast ptosis (or sagging), and it can be performed alone or as a complement to other breast surgeries.

During the COVID-19 pandemic, [doubling up on procedures](https://aedit.com/aedition/best-aesthetic-procedures-to-combine-to-maximize-appointments) offered a way to maximize time. But, in the case of many combos, the coupling also maximizes results. Exhibit A: [breasts](https://aedit.com/concern/breast-shape-and-size). “Breast reshaping has become more and more popular with refinements in technique, technology, and pain control limiting downtime and improving patient experience,” says [Ryan Neinstein, MD](https://neinsteinplasticsurgery.com/?gclid=Cj0KCQjw7MGJBhD-ARIsAMZ0eesF9voc8ntXcgbrEdZLeY6NKANEycl3vnMjnkdwPlKYwA3PZc-uTCkaAhgdEALw_wcB), a board certified plastic and reconstructive surgeon in New York City. 

For some women, combining a breast augmentation and breast lift is the best way to achieve their aesthetic goals. So, what makes someone a candidate for the duo and how does the combined procedure and recovery differ from solo surgeries? We asked the experts.

## **Breast Augmentation vs. Breast Lift: What’s the Difference?**
Before you can understand the benefits of pairing them, you first need to understand what makes each procedure unique. Also known as augmentation mammoplasty, breast augmentation refers to surgery that increases the size of the breast. There are three ways to do so:

1. Breast Implants
2. Fat Transfer
3. A hybrid of the two

Most commonly, breast augmentation involves placing [silicone or saline breast implants](https://aedit.com/procedure/breast-augmentation-with-implants) under the breast tissue or pectoral muscle. In a [breast augmentation with fat transfer](https://aedit.com/procedure/breast-augmentation-with-fat-transfer), fat is liposuctioned from one part of the body (think: the abdomen or thighs), purified, and then injected into the breast to add volume. It is considered a natural alternative to implants, though only patients with enough body fat qualify. Lastly, a [hybrid breast augmentation](https://aedit.com/procedure/hybrid-breast-augmentation) uses fat injections to smooth and perfect the appearance of implants for a more natural effect.

A mastopexy (a.k.a. breast lift) is a procedure that addresses breast ptosis (read: drooping or sagging). Depending on the degree of ptosis, a non-surgical, [radiofrequency (RF) breast lift](https://aedit.com/procedure/radiofrequency-assisted-breast-lift) may be enough to restore a perkier contour. For more advanced cases, there are an array of surgical techniques to lift the breasts. During a [surgical breast lift](https://aedit.com/procedure/breast-lift), one or more incisions are made to remove excess breast skin and breast tissue and shift the areola and nipple into a higher position. Deep tissue sutures are then used to support the new breast positioning.

## **The Ideal Candidate for a Breast Augmentation + Breast Lift**
For the most part, any healthy individual who is interested in a [breast augmentation](https://aedit.com/aedition/breast-implants-during-covid-19-pandemic) is generally a candidate for it. The parameters for a breast lift are a little more specific. To determine if you are a good fit, a plastic surgeon will examine the shape of the breast and the position of the nipple and areola relative to the inframammary fold, or the lower part of the breast where it meets the chest. The degree of breast ptosis (as classified on a three-grade scale) is determined based on where the nipple sits relative to the fold.

This combination of surgeries tends to be best for patients who have lost volume *and* have saggy skin, says [Lisa Cassileth, MD](https://www.drcassileth.com/), a board certified plastic and reconstructive surgeon in Beverly Hills. As Dr. Neinstein explains, it’s not uncommon for women to seek to address these concerns simultaneously — especially at certain times in their life. “[After breastfeeding and pregnancy](https://aedit.com/aedition/mastopexy-breast-lift-after-pregnancy-breastfeeding), many women will feel as though their breasts are deflated and lack a youthful look and feel,” he says. “For others, weight loss or genetics may be the driving force behind their breast changes that drive them to seek enhancement.”

### **Who Isn’t a Candidate for Combining These Procedures?** 
While it can be transformative for some patients, it’s not a given that a breast lift needs to be combined with a breast augmentation (or vice versa). “It isn’t necessary to do a breast augmentation to get a lift,” Dr. Cassileth notes. “So, this is only for patients that want more volume.”

Breast surgery — make that *any* surgery — can be overwhelming, and patients who are not physically and/or emotionally prepared should defer. “Patients with unrealistic expectations whereby they are hoping either a lift or augmentation alone will completely attain their desired goals should not seek surgery,” Dr. Neinstein says. Additionally, depending on the breast lift technique employed, [visible scarring](https://aedit.com/aedition/minimizing-scars-after-surgery) is possible. “Lifts entail scarring, which will have a different psychological burden on different people,” he adds.  

To ensure the most desirable outcome, it’s important for providers and patients to be on the same page. “It is essential to develop a therapeutic alliance with the surgeon in order to completely grasp all the risks, benefits, and alternatives to the desired procedure,” Dr. Neinstein shares.

## **How to Prep for a Breast Augmentation + Breast Lift**
The lead-up to a combined breast augmentation and breast lift procedure is not unlike most other cosmetic surgeries. “Typically, the patient must avoid aspirin, ibuprofen and other blood-thinning medication for one to two weeks prior to surgery,” Dr. Cassileth says. “All [herbals](https://aedit.com/aedition/vitamins-supplements-to-avoid-before-cosmetic-surgery) that may thin the blood, like ginger and ginkgo, must be stopped as well.” In addition, alcohol should be avoided for one week prior to surgery.

Typically, after thorough evaluation and consultation, the patient can proceed to surgery, Dr. Neinstein adds. Patients over 40 will obtain a baseline mammogram, along with standard pre-operative assessment. That includes discussing the patient’s aesthetic goals, so that an [implant can be chosen](https://aedit.com/aedition/how-to-choose-the-right-breast-implants). “A size, based on patient individual characteristics and desires, will be chosen preoperatively,” he adds. 

## **The Breast Augmentation + Breast Lift Procedure Process**
As Dr. Neinstein explains, the surgery will begin with the augmentation. In the majority of patients, he places smooth, round silicone gel implants under the pec muscle. Alternatively, saline implants or the patient’s own fat can be used to augment the breasts.

After the breast augmentation is completed, the lift is performed. “While surgeons will perform [preoperative markings](https://aedit.com/aedition/purpose-of-a-plastic-surgeons-markup-pen-during-cosmetic-surgery), the dynamics of the patient will change in surgery and the surgical plan must be re-evaluated,” Dr. Neinstein says. Most likely, either a lollipop or anchor-pattern lift will be performed. “The lollipop lift is typically used for shorter distance lifts compared to the anchor pattern, which allows greater movement and reshaping,” he explains. The nipple and areola are typically pivoted up, “dissolving sutures are placed, and long-acting numbing is strategically placed to enhance the healing process,” Dr. Neinstein adds. 

## **Recovering from a Breast Augmentation + Breast Lift** 
Adding a lift to augmentation tends to extend the healing time that each individual procedure would take. “This is because the procedure is longer and, therefore, the inflammation and stretch on the tissues is increased,” Dr. Neinstein explains. “Combining procedures, however, allows patients to meet multiple objectives within one procedure and limits the overall downtime and psychological burden associated with surgery.” Dr. Cassileth agrees. “Recovery is similar for both procedures, so we always perform them together in our practice,” she shares.

One thing to keep in mind? “If done together, extra care is taken to make sure to supply the nipple with continued good blood flow, as the mastopexy and the augmentation both can decrease blood flow to the nipple,” Dr. Cassileth cautions. Otherwise, the [recovery process](https://aedit.com/aedition/breast-augmentation-recovery-healing-process) tends to mimic those of the solo surgeries.

When recovering from a combined breast augmentation and breast lift, patients can usually expect to be sore for a week, but they should be off all [pain medication](https://aedit.com/aedition/opioid-crisis-plastic-surgery-recovery-pain-management) — except the occasional acetaminophen (Tylenol) and ibuprofen (Motrin) — by the second week, Dr. Cassileth says. An ointment is used on the incisions for about 14 days, before being swapped out for a special [scar cream](https://aedit.com/aedition/scar-minimizing-skincare-to-use-after-surgery) to minimize the appearance of post-op marks. Most patients will wear a [soft sports bra](https://aedit.com/aedition/benefits-of-compression-garments-after-cosmetic-surgery) for the first three weeks, Dr. Neinstein adds.

Patients can return to work after three or four days and do light activities in three weeks, Dr. Neinstein notes. [Normal exercise](https://aedit.com/aedition/when-to-start-exercising-again-after-cosmetic-surgery-procedures) can usually be resumed four to six weeks post-op. Results are immediate — save for post-op swelling — with full healing three to six months after surgery.

Alone, breast augmentations and breast lifts have a transformative effect. But, for some, pairing these popular procedures only enhances the results. Here’s how to tell if you are a candidate for the combo.

The Benefits Of Combining A Breast Augmentation With A Breast Lift

The Benefits Of Combining A Breast Augmentation And Breast Lift

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If you’ve been to a cosmetic dermatology or plastic surgery practice lately, you may have noticed a licensed aesthetician (or two) on the team — and it’s for good reason. Even the best aesthetic procedures and surgeries cannot make up for poor skin quality, and that is where the expertise of aestheticians comes into play. “It is important to have synergy between surgical and non-surgical treatments for patients, especially those undergoing facial procedures,” [Shay Moinuddin, RN, MS, CANS](https://www.fewinstitute.com/about/shay-beauty-rn/), senior aesthetic nurse and clinic director at [The Few Institute](https://www.fewinstitute.com/) in Chicago. 

The relationship between the services medical professionals offer and what aestheticians can provide is often what ends up giving patients the most comprehensive *and* lasting results. Case in point? “When our [facelift](https://aedit.com/aedition/popularity-of-facelift-cosmetic-surgery-for-aging-sagging-neck) patients maintain the health of their skin by undergoing medical-grade skincare procedures, it not only enhances and prolongs the results of their surgery, it assists in maintaining the health of their skin,” Moinuddin notes.  

We often talk about the importance of [credentials](https://aedit.com/aedition/finding-the-right-plastic-surgeon-dermatologist-or-cosmetic-dentist), [specialities](https://aedit.com/aedition/how-to-find-a-plastic-surgeon-who-specializes-in-cosmetic-procedures-for-men), and [board certification](https://aedit.com/aedition/medical-board-certification-in-plastic-surgery-cosmetic-dermatology) as it relates to doctors and surgeons, but it’s equally important for you to understand the value and role of aestheticians. In honor of National Aesthetician Day on October 15, we’re breaking down everything you need to know about the role these skin experts play in aesthetic medicine with the help of some top providers.

## **So, What Is an Aesthetician?**
Regardless of which way you spell it (with or without the ‘a’), the crux of the role remains the same. “Aestheticians are skincare technicians,” says [Sandra Peraza](https://pfrankmd.com/sandra-peraza/), master aesthetician at [PFRANKMD by Dr. Paul Jarrod Frank](https://pfrankmd.com/) in New York City. 

In that role, Peraza and her peers are laser-focused on the health of clients’ complexions both when they are in the office and when they are tending to it themselves at home. “As an aesthetician, I perform skincare treatments for patients who have minor problems on the skin’s epidermal layer,” she explains. “I also design the best [skincare routine](https://aedit.com/aedition/best-skincare-routine-products-ingredients-for-20s) for balance, radiance, maintenance of the skin’s health and vitality, and improving its overall look.”

Aestheticians, especially those that work within a larger aesthetics practice, are able to assess a client’s entire professional and at-home regimen and develop a treatment plan accordingly. “During my initial consultation with a patient, I spend about 30 minutes discussing goals, prior aesthetic history, medical history, and current products being used,” says [Emily Mariscal, LE](https://www.fewinstitute.com/about/tfi-staff/), senior medical aesthetician at The Few Institute. “I focus on educating a patient on what the skin really needs and ways I can incorporate our skin services in that mix.” 

As it relates to education, sometimes a bit of tough love is in order. “I also provide my professional recommendations to tweak their regimen,” Mariscal shares. “To be frank, most people are using way too many active acids on their skin these days causing redness, irritation, and inflammation.” Righting those wrongs is a big part of the role. “My job is to go over key [active ingredients](https://aedit.com/aedition/safely-trying-new-skincare-products-ingredients) in their skincare, why they shouldn’t over-exfoliate with too many anti-aging products, and just help simplify their regimen,” she adds.

As Peraza notes, the [facials](https://aedit.com/procedure/facials) and treatments aestheticians offer “are meant to be corrective and preventative.” But that doesn’t mean they are short on ambiance. “I perform a mix of corrective treatments tailored to each individual's particular skincare needs all within the confines of a relaxing experience,” says Danielle Gamble, an aesthetician at [The Spa at Fifth Avenue Aesthetics](https://www.mariehayagmd.com/) in NYC. “My clients leave refreshed with their skin glowing.” 

In fact, it’s that mix of form and function — delivering high-quality, visible results in a less clinical environment — that helps keep clients returning again and again.

## **The Relationship Between Aestheticians & Healthcare Providers**
Aestheticians are the skin whisperers who keep your complexion healthy and happy so that it is properly prepped and ready to go for any additional treatments or procedures you have planned. As such, they are, as Peraza describes, a “natural ally” to healthcare providers. 

She says her “main role” is to “focus on the longevity and maintenance of treatment results in between cosmetic procedures to improve efficacy,” which is very much a team effort. “I work with my aesthetician to create a synergy to treat and maintain skin’s health,” explains [Paul Jarrod Frank, MD](https://pfrankmd.com/), a board certified dermatologist and founder of PFRANKMD. “Patients have customizable treatments with our aesthetician, who is familiar with their cosmetic treatments performed in the office.”

Collaboration is a hallmark of care at The Few Institute, too. “We find the right fit for the given person’s goal and are an advocate for their best interest and results,” says [Julius Few, MD](https://aedit.com/provider/julius-few-md-15580), a board certified plastic and reconstructive surgeon and founder of The Few Institute. “We offer an integrated approach to patient care and coordinate all aspects of our approach.” As a result, Moinuddin says she works “very closely with aestheticians to create short- and long-term treatment plans” that are efficacious and budget conscious. “It makes patient continuity of care much more efficient when patients receive their skincare, injectable treatments, and minimally invasive skincare treatments in the same practice setting,” she notes. 

In some cases, doctors and surgeons refer patients to aestheticians for additional care, but the referral process can work in the other direction, too. “I advise my patients to the various skincare facials and medical-grade devices the aestheticians utilize that best suit their needs based upon my assessment and/or the cosmetic procedure performed,” explains [Marie Hayag, MD](https://www.mariehayagmd.com/), board certified dermatologist and founder of Fifth Avenue Aesthetics in NYC. “Likewise, many of my aestheticians have their own clientele that, based upon their assessment, will have me visit after a treatment for my medical assessment.”

That constant communication is all for the client/patients’ benefit. “This holistic skincare approach allows for the best possible patient outcome to meet their skincare goals and needs,” Dr. Hayag shares. “It is a wonderful thing for physicians and aestheticians to work together as a team to provide the ultimate beauty plan for each client.”

## **The Role of Aestheticians in Aesthetic Medicine**
At this point, you’ve likely gleaned that aestheticians play a key role in aesthetic medicine. “Patients can have the best facial plastic surgery outcomes, but, if their skin is wrinkled, sun damaged, etc., their surgical results won't shine through as well,” Moinuddin says. “A good aesthetician will put his/her patient on a consistent in-office skincare regimen that alternates exfoliation, energy-based skin tightening, laser therapy, and [medical-grade skincare products](https://aedit.com/aedition/maintaining-skin-with-devices-skincare-products-between-cosmetic-procedures).”

As technology continues to advance, so too does the capability of aestheticians. “When a licensed esthetician has at their disposal the latest devices, we can tailor a regular skincare regimen and treatment plan corresponding to the procedure performed and concern identified by the board certified dermatologist,” Gamble explains. “This synergy leads to optimal patient satisfaction and outcomes.” 

Dr. Hayag describes the role of Gamble and the other aestheticians at The Spa at Fifth Avenue as “complementary” to the work she does. “The treatments they provide improve medical cosmetic treatment outcomes,” she says. “Interaction between cosmetic procedures and medical-grade spa skincare treatments absolutely produce a combined effect greater than an individual procedure alone.” 

For example, she usually recommends that patients who undergo [cosmetic laser treatments](https://aedit.com/aedition/guide-to-ablative-laser-skin-resurfacing) schedule an [LED therapy session](https://aedit.com/procedure/led-light-therapy) with one of her certified lead aestheticians for the same day. “This light therapy device immediately reduces redness and inflammation and soothes the affected area while also boosting collagen production,” Dr. Hayag shares. Additionally, she suggests “regular” radiofrequency (RF) and [microcurrent](https://aedit.com/aedition/difference-between-professional-at-home-microcurrent-facials) treatments to “increase collagen and elastin production.” [RF microneedling](https://aedit.com/procedure/microneedling-with-radiofrequency), meanwhile, can “reduce fine lines, [acne scarring](https://aedit.com/concern/acne-scars), and sun damage.” “This comprehensive approach leads to better sustained outcomes and a superior overall patient experience,” she adds.

And let us not forget the [preventative nature](https://aedit.com/aedition/i-was-practicing-prejuvenation-before-it-was-a-trend) of these skincare treatments. “Many patients are realizing that quarterly or even monthly treatments from a licensed aesthetician utilizing the latest in skincare devices under a physician’s guidance are part of a routine that will greatly enhance their skin’s appearance and health,” Dr. Hayag says. The sooner you start, the more likely you are to successfully slow the effects of skin aging.

## **What Your Aesthetician Wants You to Know**
Before we let you go, here are three things that Mariscal, Gamble, and Peraza say you should know about what they can (and cannot) do for your complexion:

### **1. They Aren’t Doctors**
“Some people may not understand the level of education and experience aestheticians have, especially those who work in a medical setting,” Moinuddin says. “They usually have undergone extensive training and truly are experts in skin health.” With that said, they did not go to medical school. “We aren’t doctors,” Mariscal emphasizes. “I’m happy to assist patients with the wealth of knowledge that I’ve obtained over the years for certain skin issues, but I always recommend seeking medical attention for serious skin conditions like [eczema](https://aedit.com/aedition/best-skincare-products-to-treat-eczema-flare-ups-in-the-winter), [psoriasis](https://aedit.com/aedition/what-its-like-to-live-with-and-treat-psoriasis), dermatitis, or [possible allergic reaction](https://aedit.com/aedition/difference-between-sensitive-vs-sensitized-skin) they’ve gotten from use of a product.”

### **2. They Aren’t Just Putting Products on Your Face**
“There is, at times, a misunderstanding of the importance and long-term benefit a licensed aesthetician can add to a person's overall skincare health and beauty,” Gamble laments. The skincare treatments aestheticians offer can go a long way towards defending against premature signs of aging. “Many of the treatments I provide can reduce [inflammation](https://aedit.com/aedition/guide-to-inflammaging), aid in the healing and prevention of [acne](https://aedit.com/concern/acne), and increase [collagen](https://aedit.com/aedition/guide-to-collagen-in-skincare-supplements-aesthetic-medicine) production,” she says. But that’s not all.  “A reputable aesthetician has a vast knowledge of skincare products and their ingredients to recommend for a customized [at-home regimen](https://aedit.com/aedition/best-mens-skincare-routine-products-ingredients-for-20s) for their clients,” she adds. The net-net: “A [facial](https://aedit.com/aedition/what-its-like-to-get-a-hydrafacial-for-clear-glowing-skin) is so much more than putting creams on the face,” Gamble emphasizes.

### **3. They Work on the Skin in a Specific Way**
In keeping with lesson number one, there is a limit to what aestheticians are qualified to do. “While aestheticians serve an important role in the health and maintenance of the skin, they cannot perform treatments such as [Clear + Brilliant®](https://aedit.com/procedure/clear-brilliant), [Ulthera®](https://aedit.com/procedure/ultrasound-skin-tighteningultherapy), and other types of lasers commonly offered in medspa settings,” Peraza cautions. “Such treatments must be performed by a healthcare provider.” The reason? “As an aesthetician, we work mainly on the epidermis, while more aggressive treatments, such as lasers, work beneath this layer,” she explains. Consider this yet another illustration of the importance of the relationship between medical providers and aestheticians in aesthetic medicine.

## **The Takeaway**
If you have your dermatologist or plastic surgeon on speed dial, it’s high time to add an aesthetician to your rolodex as well. “[Aestheticians] complement the in-office treatments I perform by helping to manage issues such as pigmentation, moisture, acne, etc.,” Dr. Frank says. As Peraza puts it, she brings her “skills and experience on how to care for skin” as she “guides patients how to take care of their skin at home and as they undergo any medical cosmetic procedure.” 

At the end of the day, aestheticians are the advocate your complexion craves. “Contrary to popular belief, you don’t need a 13-step skin regimen to have glowing skin,” Mariscal shares. “Being a [minimalist](https://aedit.com/aedition/skinimalism-skincare-trend) with products, treatments, and injectables is our mantra for youthful, glowing, natural-looking results.”

In honor of National Aesthetician Day, we are breaking down the important part these skin experts play in the aesthetic journey.

The Role Of Aestheticians In Aesthetic Medicine, Skincare, Skin Health 

The Role Of Aestheticians In Aesthetic Medicine

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Unless you have the pain tolerance of a horse, there’s no getting around [topical numbing cream](https://aedit.com/aedition/everything-you-need-to-know-about-anesthesia) during many cosmetic treatments to make them more comfortable. Seemingly every procedure under the sun utilizes it, from [lasers](https://aedit.com/aedition/guide-to-ablative-laser-skin-resurfacing) and [injectables](https://aedit.com/procedure/dermal-filler-and-injectable-solutions) to [thread lifts](https://aedit.com/procedure/thread-lift), [microneedling](https://aedit.com/procedure/microneedling), and even [microblading](https://aedit.com/procedure/microblading) — the list goes on and on.  

Over the years, numbing cream has encountered its fair share of cautionary tales. In the early 2000s, reports of the cream were associated with life-threatening side effects, including irregular heartbeats, seizures, and even death (an extremely rare effect), due to abnormal amounts being applied. More recently, there's buzz saying that numbing cream can instigate [pimples](https://aedit.com/aedition/how-to-get-rid-of-a-pimple). Experts, however, are not convinced the anesthetizing agent is to blame.  

So, can numbing cream cause breakouts? Here, we get down to the nitty-gritty details to unearth the real story about the topical anesthetic and its ability — or inability (depending on many factors) — to be the cause of uninvited pimples.

## **How Numbing Cream Works**
Before launching into the debate at hand, here's a quick lesson on numbing cream and how it works. The first reported use of local anesthetic was back in 1860. Then, it was cocaine that acted as the leading anesthetizing agent; today, it’s primarily lidocaine. But lidocaine isn’t the only option. There are different types of ‘-caines,’ which are generally lidocaine, benzocaine, and tetracaine, or a combination of the three, says [Angela Lamb, MD](https://angelalambmd.com/), a board certified dermatologist in New York City. “Each has a different time of onset and lasts a different amount of time, so they are great to mix and give to patients for rapid effects and numbing that lasts long enough to make it through an entire procedure,” she explains.

If you’re curious how a topical on the surface of the skin can create a numbing effect, [Scott Paviol, MD](https://pavioldermatology.com/), a board certified dermatologist in Charlotte, NC, explains it this way: “The lidocaine in numbing creams works by blocking sodium channels which act to stop nerves from sending impulses.” Simply put, it stops the nerves from sending signals to the brain. “Whenever we perform procedures, we aim to make the experience as comfortable as possible for the patient,” he says. “Therefore, topical numbing is a great choice for a variety of procedures, including microneedling, lasers, and injectables.”

Applying numbing cream is pretty straightforward. It starts as a thin layer of cream-gel that starts to ‘melt’ (for lack of a better term) the longer it sits on the skin. In about five minutes, it begins to take effect. “However, the time we leave on the cream is dependent on the procedures,” Dr. Lamb says. “For injections, it normally sits for 15 to 20 minutes; laser resurfacing requires 30 to 60 minutes.”

It's essential to know that numbing cream is generally only effective in the areas where it is applied. Your doctor will remove the numbing cream after the skin feels numb. Then, the skin is cleansed again, usually with an alcohol wipe, to thoroughly remove any remaining residue. As a result, there should be minimal pain or discomfort with the treatment that's about to ensue — though patients may report minimal tingling or itching.

Some providers choose to give numbing cream to the patient to apply at home before their procedure to save time in the office, however, not every doctor agrees with this method. Dr. Paviol warns that it's vital for the person administering the topical numbing to understand how to use it appropriately and how to look for and manage any side effects. “If you use a medication without knowing how to use it properly, it can lead to unwanted side effects,” he says. “I do not recommend using topical numbing without the recommendation of how to use it from a medical professional, as it is possible to have systemic effects if not used correctly.”
 
## **Comfortably Numb… and Breaking Out?**
Sure, skin irritations and blemishes can arise from just about everything, and Dr. Paviol explains that the idea that numbing cream can induce [acne](https://aedit.com/concern/acne) isn’t as far-fetched as it seems. “Often, stressors, whether they are physical or mental, cause breakouts to the skin,” he says. That treatment you have planned and its numbing cream constitute stressors. “Putting numbing cream on the skin and performing a procedure puts the [skin into a state of stress](https://aedit.com/aedition/impact-of-stress-on-skin-acne-wrinkles-dryness) — purposefully injuring the skin to create the desired cosmetic effect — and this can cause the skin to break out for a few days after a procedure,” Dr. Paviol adds.

Even so, Dr. Lamb says that post-procedure breakouts are likely not happening because of numbing cream. “Post-laser folliculitis is very common, and, if you go to a good physician, they should know how to avoid this,” she notes. “I will not share my secret, but there is something that I give all my patients post-procedure to make sure this does not happen.”
 
Irritation and allergic reactions can also occur. There are different categories of numbing agents, Dr. Paviol explains, so it’s possible to be allergic to one and not another. “Typically, reactions are mild and self-limited and include redness, itching, and hives,” he says. But more severe reactions are possible, if rare. “That is why it’s important to be under the care and supervision of a medical professional who can help you to manage complications should they occur,” he reiterates.

If, by chance, a microscopic amount of numbing cream gets pushed into the skin by a needle or cannula, Dr. Lamb says there's no reason for concern. Any excess product shouldn't cause a breakout.

## **Post-Procedure Skincare Matters**
Post-treatment care holds as much weight as the procedure itself. When you sign up for a cosmetic procedure, you’re also choosing to actively participate in the healing process. “If you’re investing in a procedure, invest in the recovery from the procedure so you can get the best possible result,” Dr. Paviol says.

Depending on the treatment, your skin may be compromised afterward. The post-procedure recovery phase is all about [letting the skin heal properly](https://aedit.com/aedition/skincare-after-facial-plastic-surgery-procedures), which is why your doctor will give you specific care instructions that are important to follow. “Procedures stress the skin, and post-procedure care aims to let the skin rest, recover, and heal,” Dr. Paviol shares. As such, he says, bland emollients and post-procedure balms with no active ingredients are best to use. 

## **The Takeaway** 
So, while you may experience breakouts after an aesthetic treatment or procedure, don’t blame the numbing cream alone. “It is not common to have breakouts after the application of numbing cream, even though they do tend to be in a petrolatum base,” Dr. Lamb says. If you are concerned about [clogged pores](https://aedit.com/aedition/at-home-treatments-for-clogged-pores), just make sure the area is properly cleansed — it’s likely your provider has already taken care of this. 

Speaking of providers, it’s important to find someone who is highly skilled and trained in the procedure you are interested in. “I think some of what people are attributing to numbing cream breakouts is really post-procedure complications or a side effect from the procedure itself and physicians or spas don't know how to get ahead of this known, common, and expected post-op reaction," Dr. Lamb explains. 
 
If you continuously experience irritation or breakouts after a treatment, [talk to your dermatologist](https://broadway.aeditor.com/aedition/skin-care-questions-for-your-dermatologist) about your skin. “Chances are,” Dr. Paviol says, “any breakouts are from the stress reaction from the procedure itself and are short-lived and self-limited.”

So many aesthetic treatments use it, but can the topical anesthetic be the culprit behind pesky pimples? We investigate.

Does Topical Numbing Cream Cause Acne Breakouts?

Can Numbing Cream Make You Break Out?

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No matter how strategic and efficient your skincare routine is, [signs of aging](https://aedit.com/aedition/skin-aging-habits) are unpredictable. Although you can speculate about how your skin will age based on genetics and lifestyle, there is no way to truly know until it happens. One area of the face where the effects of Father Time may appear suddenly and noticeably is the nasolabial region — or those parentheses-like laugh lines in the fold between your nose and mouth. With age, those creases start to deepen and droop, which can also impact the appearance of the cheek and the lower face as a whole (think: mouth, jawline, etc.).

Unlike some other facial concerns, treating nasolabial folds is rarely as simple as targeting the lines themselves. Because there is such a synergy between them and the rest of your visage, your provider will evaluate the entire face and recommend a treatment plan accordingly. To find out everything there is to know about nasolabial fold rejuvenation, we spoke to a board certified dermatologist and plastic surgeon to get their thoughts on the best treatments and procedures to revive the region.

## **What Are the Nasolabial Folds?**
Also known as laugh lines, the nasolabial folds are the creases that run from the outer corners of the nose to the corners of the mouths on both sides of the face. Depdneding on how you feel about them, the laugh lines may be no laughing matter. Some people are born with more pronounced folds than others, but, as the skin ages, everyone’s nasolabial folds become deeper and more noticeable. 

With age, the buccal fat in the cheeks starts to “lose volume and support from the surrounding structures in the skin,” explains [Rachel Ho, MD](https://www.drrachelho.com/), a board certified dermatologist. “These changes cause hollowing of the cheeks and deepening of the nasolabial folds.” But it’s not the just the cheeks that are to blame. The changes in the nasolabial fold region happen “when the tissues of the cheek start to descend and you lose volume of the upper lip,” notes Stafford Broumand, MD, a board certified plastic and reconstrucive surgeon and founder of [740 Park Plastic Surgery](https://plasticsurgeonsnyc.com/). “It looks like a deep fold or wrinkle.”

## **How Nasolabial Fold Treatments Work**
Whether you’ve always felt like you have prominent nasolabial folds or you just started to notice your laugh lines, don’t be discouraged. There are both non-surgical and surgical treatment options to rejuvenate the nasolabial folds (and surrounding features), and what works best will depend on your age, anatomy, and aesthetic goals. Below, a few of the most effective:

### **1. Dermal Filler**
Perhaps the most popular treatment for nasolabial fold concerns, hyaluronic acid (HA)-based dermal filler, like [Juvéderm®](https://aedit.com/procedure/juvederm), [Restylane®](https://aedit.com/procedure/restylane), and [Belotero®](https://aedit.com/procedure/belotero), can be artfully injected to lift and smooth the creases without simply plumping up the lines themselves. In some cases, filler is “injected in the piriform fossa — or inferior to the nasolabial fold — to gently lift it and soften the appearance of the laugh lines,” Dr. Ho explains. 

For other patients, cheek filler, like the new [Restylane® Contour](https://aedit.com/aedition/restylane-contour-cheek-filler), may be a better option. “When [cheek fillers](https://aedit.com/procedure/cheek-augmentation-with-fillers) are placed in a strategic manner, the filler can lift the cheeks and surrounding soft tissues and the nasolabial fold,” Dr. Ho shares. By restoring the appearance of a more sculpted cheekbone, the laugh lines will be less prominent. [Cheek enhancement](https://aedit.com/aedition/cosmetic-procedures-to-define-cheekbones) can be done alone or as part of a larger [liquid facelift](https://aedit.com/procedure/liquid-facelift). Regardless of the placement, HA filler gives instant — albeit temporary — results that lasts six to 12 months. 

### **2. Thread Lift**
[Thread lifts](https://aedit.com/procedure/thread-lift) in “the mid-face can reduce the prominence of nasolabial folds,” Dr. Ho says. The minimally invasive treatment is popular due to its ability to provide both short- and long-term effects. “In this procedure, fine, dissolvable threads are placed under the skin to mechanically pull up the skin and soft tissues such as the cheeks and nasolabial folds,” she explains. The suspension of the sutures in the skin offers a subtle lift immediately, but it’s how the threads work over time that makes them so desirable. 

Internally, a [thread lift](https://aedit.com/aedition/pdo-thread-lift-for-facial-rejuvenation) stimulates the body’s natural [collagen](https://aedit.com/aedition/guide-to-collagen-in-skincare-supplements-aesthetic-medicine) production. While the threads break down over the course of a few months (think: three to six) and get absorbed by the body, the collagen remains for a smoother and more youthful appearance.

### **3. Non-Surgical Skin Tightening**
For patients with mild to moderate skin laxity that is effecting the appearance of their nasolabial folds, non-surgical, engery-based skin tightening can help boost collagen production and rejuvenate the skin. Dr. Ho is a fan of high-intensity focused ultrasound (HIFU) treatments because they “transmit [HIFU] energy to the skin of the cheeks and nasolabial folds to remodel the collagen and build collagen in the skin.” [Ultherapy®](https://aedit.com/procedure/ultrasound-skin-tighteningultherapy), which is a micro-focused ultrasound (MFU) technology, is another skin tightening option, while radiofrequency-based skin tightening treatments, like [Morpheus8®](https://inmodemd.com/technologies/full-body-fractionated-anti-aging-morpheus8-technology/) and [Thermage®](https://www.thermage.com/), have also gained popularity in recent years.

Regardless of the technology employed, some swelling, bruising, and/or redness is common after non-surgical skin tightening procedures. Because the treatments stimulate collagen production, it takes three to six months to start seeing the effects. The number of treatments needed will depend on the device and the patient. 

### **4. Facelift**
Dermal fillers, thread lifts, and non-invasive skin tightening can be very effective nasolabial fold treatments, but, for some patients, a surgical facelift is the most efficacious option. Different techniques, including a [mid-facelift](https://aedit.com/procedure/midfacelift), can be employed to specifically target deep creases around the mouth by repositioning displaced fat and removing excess skin in the cheeks and lower face. After a facelift, [fat grafting or filler](https://aedit.com/aedition/guide-to-facial-fillers-fat-grafting-after-facelift) may be recommended to restore volume and further rejuvenate the face.

## **The Best Candidate for Nasolabial Fold Treatments**
If you are bothered by the prominence of your nasolabial folds, you are likely a candidate for at least one of the treatments we’ve discussed. “Patients with volume loss can benefit from the fillers, as fillers can restore volume loss in the face,” Dr. Ho notes. For those who are concerned about skin laxity, both thread lifts and non-invasive skin tightening treatments can boost collagen prodction for a smoothing and firming effect. If you are experiencing more significant signs of aging and sagging in the nasolabial region, a surgical facelift may be your best bet. Consulting with a [board certified](https://aedit.com/aedition/medical-board-certification-in-plastic-surgery-cosmetic-dermatology) dermatologist or plastic surgeon will help to determine the best treatment protocol for your anatomy and aesthetic goals.

Depending on how you feel about your laugh lines, they may be no laughing matter. From fillers to facelifts, we’re breaking down the best ways to rejuvenate nasolabial folds.

Best Nasolabial Fold Treatments: Filler, Thread Lift, Facelift

These Are The Best Ways To Treat Nasolabial Folds, According To The Experts

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Despite what pharmaceutical brands hope for, when a prospective injectables patient is looking in the mirror examining his or her face, they’re thinking ‘I want to try filler’ — not ‘I need Radiesse®’ or ‘I could use 10 cc of Sculptra®.’ Plastic surgeons and cosmetic dermatologists are there to fill in the gaps, and you certainly don’t need to walk into a doctor’s office with an exact treatment plan in mind. But it *can* be helpful to understand the basics of two major types of [dermal fillers](https://aedit.com/aedition/everything-you-need-to-know-about-dermal-fillers): hyaluronic acid (HA)-based and biostimulatory.

According to [John Burns, MD](https://aedit.com/provider/john-burns-md-1204), a board certified plastic and reconstructive surgeon in Dallas, hyaluronic acid-based fillers are “by far” the most popular choice in his practice (and that is [also true of the United States at large](https://www.plasticsurgery.org/documents/News/Statistics/2020/plastic-surgery-statistics-full-report-2020.pdf)). He estimates that about 95 percent of his patients opt for HA, with only around five percent preferring biostimulants. But that doesn’t mean that biostimulatory injectables aren’t right for you. 

Ahead, we break down the differences between HA filler and biostimulants — including a helpful guide to what to discuss with your provider.

## **How Hyaluronic Acid-Based Filler Works**
If the term ‘[hyaluronic acid](https://aedit.com/aedition/guide-to-hyaluronic-acid-in-skincare-dermal-filler)’ sounds familiar, it’s for good reason. The naturally occurring humectant holds 1,000-times its weight in water and is produced by the body to lubricate the joints and moisturize the skin and eyes. When synthetic formulations of HA are applied topically via skincare, they help attract water deeper into the skin for a hydrating effect. Synthetic HA can also be injected into the skin to temporarily add volume, contour, and smooth lines and wrinkles.

Hyaluronic acid-based fillers “are biocompatible, which means it’s made with a clear, gelatinous substance that’s essentially the same sugar molecule that surrounds the cells in your body,” Dr. Burns explains. Because it is made with a substance your body recognizes, the body perceives the filler as part of itself. That means there’s less chance for a negative reaction from the tissue into which you’re injecting the filler.

There are several brands of cosmetic HA filler on the market (each with a host of sub-products that target specific aesthetic concerns), and your provider will help you determine which is best for your needs. A few of common HA fillers are:

- [Juvéderm®](https://aedit.com/procedure/juvederm)
- [Restylane®](https://aedit.com/procedure/restylane)
- [RHA®](https://aedit.com/aedition/new-injectables-neurotoxins-fillers-for-face-body)
- [Belotero®](https://aedit.com/procedure/belotero)

As for those versions we mentioned, each has different viscosities and target areas. Juvéderm®, for example, has Juvéderm® XC for lines and wrinkles, Voluma for cheek augmentation, [Volbella for lips](https://aedit.com/aedition/what-to-know-before-getting-lip-filler-for-the-first-time) (to name a few). Restylane®, meanwhile, has [Contour](https://aedit.com/aedition/restylane-contour-cheek-filler), Refyne, Defyne, Kysse, Lyft, Silk, which are approved by the U.S. Food and Drug Administration (FDA) to treat different parts of the face and hands. The lightweight Kysse is designed to mimic the natural feel of your lips; the stronger Lyft is used for cheeks and jawline. 

Another reason HA fillers are so popular? They’re temporary and [reversible](https://aedit.com/aedition/hyaluronidase-to-dissolve-dermal-filler). Depending on the product, treatment area, and patient’s metabolism, hyaluronic acid-based fillers generally last six to 12 months. Over that timespan, the HA naturally degrades and gets absorbed by the body. That breakdown can be sped up with an injection of [hyaluronidase](https://aedit.com/procedure/hyaluronidase), an enzyme that dissolves HA. The ability to undo and/or refine results is especially helpful for patients who are new to filler, Dr. Burns says, and may be nervous about the effect. 

## **How Biostimulatory Injectables Work**
Here’s where the term ‘filler’ becomes a bit of a misnomer. “Biostimulants do some volume filling, but really their primary focus is to stimulate the collagen that’s already in your skin,” explains [Esther Yoonah Kim, MD](https://www.aiplasticsurgery.com/esther-yoonah-kim-md/), a board certified plastic and reconstructive surgeon in southern California. The injection is designed to “produce a controlled inflammatory response” and “recruit the inflammatory cells … including those that make collagen,” she explains. That newly produced collagen is permanent.

Unlike HA-based fillers, which are absorbed into the body, the [collagen](https://aedit.com/aedition/guide-to-collagen-in-skincare-supplements-aesthetic-medicine) created by biostimulatory injectables remains. Instead of providing an instant plumping effect, these injections stimulate the body’s own processes for longer-term smoothing and volumizing. “By their nature, biostimulants are thicker,” Dr. Kim says. As such, “they’re not good for areas that require a super soft touch,” she adds. That includes the [lips](https://aedit.com/aedition/what-to-know-before-getting-lip-filler-for-the-first-time) and [under eyes](https://aedit.com/aedition/how-i-quit-crying-about-my-tear-troughs) — two areas of concern for many folks coming into her office. 

But that’s not to say biostimulants don’t serve a purpose. Some popular options include:

- **Sculptra®**: Made from poly-L-lactic acid (PLLA), a suture material used in surgical operations, [Sculptra®](https://aedit.com/procedure/sculptra) is most commonly injected into the temples, mid-face, nasolabial folds, and areas of the body (think: [knees](https://aedit.com/aedition/best-cosmetic-procedures-for-knees), buttocks).
- **Radiesse®**: This injectable is made of calcium hydroxyapatite (CaHa), which is “a mineral-like substance that’s one of the ingredients in your bones,” Dr. Kim says. [Radiesse®](https://aedit.com/procedure/radiesse) is often injected into areas that have become bony, like hands or cheeks.
- **Bellafill®**: Made from polymethylmethacrylate (PMMA) beads and cow collagen (requiring allergy testing before use), [Bellafill®](https://aedit.com/procedure/bellafill) can be injected into depressed acne scars and nasolabial folds.

No matter what they are made of, all biostimulants have similar response-inducing properties. Generally speaking, the visible results of biostimulatory injectables last 12 to 24 months, at which point they can be touched up. So, while they [require less maintenance](https://aedit.com/aedition/how-frequently-to-get-non-surgical-cosmetic-procedures-like-dermal-filler-botox-chemical-peel) than HA fillers, they do have a higher upfront [cost per syringe](https://aedit.com/procedure/sculptra/cost) and it can take six weeks or more to start seeing results.

Another key difference? Unlike HA fillers, biostimulants cannot be dissolved or reversed. Since the purpose and results of biostimulatory injectables are quite different, it is important to discuss your options with a provider who understands your desired results.

## **Which Injectable Is Best for Me?**
Now that you know the difference between HA filler and biostimulants, you may be wondering how to determine which type is right for you. “The area of concern will dictate the conversation quite a bit,” says Kim. As we mentioned, HA fillers are best for the [lips](https://aedit.com/procedure/temporary-lip-fillers) and [tear troughs](https://aedit.com/procedure/under-eye-filler), but location isn’t the only factor.

If you’re new to injectables, your provider will likely recommend starting with a hyaluronic acid-based filler. “The benefit of HA is that it’s so forgiving, flexible, good for anybody, and good for almost all parts of the face,” Dr. Kim notes. It also offers immediate results, whereas biostimulant patients may not notice a change for a month or more. With that said, if you’re seeking a semi-permanent anti-aging effect on “deeper areas” like the nasolabial folds, marionette lines, or chin, biostimulatory injections may be the best choice. 

As always, an open and honest consultation with a board certified provider about your aesthetic goals and concerns should be the best determinant.

Confused about the difference between hyaluronic acid-based fillers and biostimulatory injectables? We’re here to help.

The Difference Between Hyaluronic Acid-Based Filler And Biostimulatory Injectables In Aesthetic Medicine

Hyaluronic Acid Filler vs. Biostimulatory Injectables: Which One Is Right For Me?

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*Since 1985, October has served as Breast Cancer Awareness (BCA) Month — a period devoted to educating the public on the disease that, [according to the Centers for Disease Control and Prevention (CDC)](https://www.cdc.gov/cancer/breast/statistics/index.htm), is the second most common form of cancer in women, regardless of race or ethnicity. Men can also be diagnosed with breast cancer (albeit at a much lower rate), and The AEDITION is devoting much of its coverage this month to [BCA](https://aedit.com/aedition/category/breast-cancer-awareness), from expert guides to mastectomies and reconstructive breast surgery to powerful patient perspectives and roundups of products that give back.*

The physical and emotional toll a breast cancer diagnosis takes is considerable. In addition to the fear and confusion often associated with various treatment options, breast cancer patients  must also consider the [breast reconstruction process](https://aedit.com/aedition/post-mastectomy-breast-reconstruction-process-breast-cancer) and how that might impact their overall health and sense of identity. Fortunately, breast reconstruction techniques have come a long way in recent years, and one such example is the rising popularity of one-stage breast reconstruction. Here, we’re breaking down everything you need to know about the singular surgery — from who’s a candidate to what’s involved — with one its pioneers. 

## **What Is One-Stage Breast Reconstruction?**
Also known as direct-to-implant (DTI) breast reconstruction, [one-stage breast reconstruction](https://aedit.com/aedition/comprehensive-guide-to-breast-reconstruction-nipple-reconstruction-after-breast-cancer) refers to when a plastic surgeon places implants at the time of a mastectomy. “This is in contrast to tissue expander reconstruction, which is more commonly performed, where a special expansion device is put in the breast at the time of mastectomy,” explains  Lisa Cassileth, MD, a board certified plastic and reconstructive surgeon and founder of [Cassileth Plastic Surgery](https://www.drcassileth.com/surgeons/dr-lisa-cassileth.html) in Beverly Hills.

For women who are interested in breast implants [after a mastectomy](https://aedit.com/aedition/mastectomy-breast-cancer-experience-from-patient-perspective), the standard has long been to schedule a delayed breast reconstruction. Instead of putting the implants in during the mastectomy surgery, the patient would have tissue expanders sutured into the breast pocket. In the weeks and months that follow, the expanders are gradually inflated in a plastic surgeon’s office using air or saline. Once they reach the appropriate size, the expanders are swapped out for implants. 

The expansion process can be painful, but some surgeons believe it is a necessary evil. Dr. Cassileth and her team, however, have been refining what they consider to be a more desirable alternative. Back in 2012, Dr. Cassileth’s [original research](https://pubmed.ncbi.nlm.nih.gov/21734545/) on one-stage reconstructive surgery was published in the *Annals of Plastic Surgery*. The study found the procedure to have lower risks compared to traditional two-stage tissue expander reconstruction and highly satisfactory outcomes. The technique has only improved from there.

## **Ideal Candidates for One-Stage Breast Reconstruction** 
For many years, it was thought that only women with smaller, non-droopy breasts could be candidates for DTI, but that is no longer the case. “DTI is good for women who qualify for [nipple-sparing mastectomy](https://aedit.com/aedition/what-to-expect-before-during-after-mastectomy-breast-cancer), since no skin will be cut away during the mastectomy and the lost volume of the breast can immediately be replaced without worrying about skin tension,” Dr. Cassileth says. With that said, patients with cancers that grow into the skin and must have skin removed may not qualify.

## **How One-Stage Breast Reconstruction Works** 
At Cassileth Plastic Surgery, DTI is performed over the muscle for the most natural-looking results. “This is in contrast to the under-the-muscle procedure, which was pretty standard years ago and now is more rarely performed because it cuts the pectoralis muscle,” Dr. Cassileth notes. When the breast implant is placed above the pectoralis major muscle, you avoid the so-called ‘pec flex’ deformity some sub-pectoral implant patients see and also experience a less painful recovery because the muscle remains intact.

Rather than simply wrap the implant in an acellular dermal matrix and place it in the mastectomy flap, Dr. Cassileth creates an internal bra structure to support it. By using a dermal matrix to bridge the gap between the implant and the chest wall, she prevents drooping at the bottom of the breast pocket, softens the contour of the implant, and decreases the need for [fat grafting](https://aedit.com/procedure/breast-augmentation-with-fat-transfer). Additionally, Dr. Cassileth performs a nerve graft at the same time as the reconstruction to restore sensation to the breast. Sensation improves as you heal.

It is important to note that the success and safety of a DTI breast reconstruction is not just in the hands of the plastic surgeon. One-stage reconstruction should only be performed when a mastectomy surgeon has a low rate of flap necrosis. Dr. Cassileth says that the rate should be less than one percent or else it is not safe to go direct-to-implant because the breast skin may not survive.

Following a mastectomy and one-stage breast reconstruction, patients stay in aftercare for two to three days. Drains are typically removed one to two weeks after surgery. “They can have normal day-to-day activities, like driving, after two weeks, and are allowed to lift heavy objects and [exercise](https://aedit.com/aedition/when-to-start-exercising-again-after-cosmetic-surgery-procedures) after one month,” Dr. Cassileth says. 

## **A Non-Implant Alternative...**
For women who do not wish to have implants or are not a candidate for them, there is another innovative option to consider. Developed by Dr. Cassileth and mastectomy surgeon [Heather Richardson, MD](https://www.bedfordbreastcenter.com/mastectomy-surgeon-heather-richardson-md/), of the Bedford Breast Center in Beverly Hills, [SWIM breast reconstruction](https://aedit.com/aedition/swim-breast-reconstruction-for-breast-cancer-mastectomy-patients) combines a nipple-sparing mastectomy with a breast reduction (SWIM stands for skin-sparing wise-pattern internal mammary perforator). 

In this procedure, the mammary tissue is removed during the mastectomy portion of the surgery, but the skin and subcutaneous fat are preserved. During reconstruction, the extra fat is folded and placed to create the breast shape. Unlike traditional TRAM and DIEP flap surgeries, no muscle is sacrificed and no abdominal, back, or buttocks tissue is transferred. This provides an alternative for women who want to avoid the extensive surgery, incisions, and long recovery period involved with other flap procedures.

Breast reconstruction techniques have come a long way in recent years, and one such example is the rising popularity of direct-to-implant surgery. Here’s what you need to know.

One-Stage Direct-to-Implant Breast Reconstruction For Breast Cancer Patients

What To Know About One-Stage Breast Reconstruction

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As the demand for temporary, volume-enhancing injectables has risen in recent years, so too have instances of ‘pillow face’ — a tell-tale sign of too much [filler](https://aedit.com/aedition/everything-you-need-to-know-about-dermal-fillers). “Overfilled faces – whether cheeks, under eyes, temples, lips, chins, or jawline – can distort the normal anatomic proportions leading to alien-like facial contours,” explains [Jessica Weiser, MD](https://aedit.com/provider/jessica-weiser-md-34640), a board certified dermatologist and founder of [Weiser Skin MD](https://www.weiserskin.com/) in New York City. But it’s not just the visual impact that can cause concern. Over filling a feature or area of the face can inhibit function. So, how much is too much? Below, we explore the impacts of too much filler and what it takes to correct it.

## **The Aesthetic Downsides of Too Much Filler**
For the majority of people keen on [enhancing volume](https://aedit.com/aedition/best-procedures-to-restore-facial-volume), hyaluronic acid (HA)-based dermal fillers, like [Juvéderm®](https://aedit.com/procedure/juvederm), [Restylane®](https://aedit.com/procedure/restylane), and [Belotero®](https://aedit.com/procedure/belotero), offer a simple solution: subtle plumpness and a hydrating boost. When performed by a skilled injector who understands [facial harmony](https://aedit.com/aedition/facial-harmony-in-aesthetic-medicine) and values [proportion](https://aedit.com/aedition/plastic-surgery-results-are-about-proportion-not-perfection), filler can work wonders. Where it takes a turn is when the filler placement goes past the point of looking appropriate for the face in question. “I think of overfilled features as looking uncanny, i.e. unsettling, not-quite-human, or realistic,” says [Daniel Belkin, MD](https://www.nydermatologygroup.com/doctors/dr-daniel-belkin/), a board certified dermatologist at New York Dermatology Group. 

In the search for perfection or even just stronger contours, facial features can cease to coexist naturally. “They might be [lips](https://aedit.com/procedure/temporary-lip-fillers) that lose the natural structure of human lips or are unnaturally enlarged, [cheeks](https://aedit.com/procedure/cheek-augmentation-with-fillers) that are overly round and puffy, or natural folds that are effaced by filler,” he explains. In the case of the latter, he says to imagine the [lower eyelid](https://aedit.com/procedure/under-eye-filler) “running right into the cheek instead of being separated by a normal lid-cheek junction.” The phenomenon, he explains, can actually make others “uncomfortable because of the way they distort a human face and make it something slightly unfamiliar.”  

The change doesn’t happen in a silo. Filler in one area can skew the appearance of other features. ”Cheek elevation that occurs with smiling, speech, chewing, and more can become unnatural with too much volume distorting the apple of the cheek and even sometimes pressing up above the orbital rim leading to smaller squinted eyes,” Dr. Weiser shares. And then there is the way in which the filler is injected. Superficially placed filler can create a rough appearance on the skin, adding to the other-worldly appearance of improper injections. 

## **The Funcional Downsides of Too Much Filler**
Apart from the aesthetic consequences, the function of overfilled treatment areas are at risk, too. Depending on the placement, “too much filler can impact speech, muscle movement, and lymphatic vessels,” Dr. Belkin cautions. An abundance of filler in the lip or around the mouth, for example, “can change the way speech is articulated,” he explains. This occurs because “excessive lip filler can prevent proper puckering and contraction of the orbicularis oris muscle, leading to unusual speech,” Dr. Weiser adds. 

When the under-eye or medial cheek area is overfilled, Dr. Belkin says patients may experience “impaired lymphatic drainage from filler placement.” Although an [artfully elevated cheek](https://aedit.com/aedition/restylane-contour-cheek-filler) is meant to restore a more youthful appearance, taking it too far can lead to a bloated look due to the constriction. “The face has two planes of lymphatic drainage: a superficial and a deep,” Dr. Weiser explains. “Large quantities (or sometimes even smaller volumes) of filler can obstruct these channels causing fluid accumulation and facial swelling that may be difficult to reverse or correct.”

If you are curious as to whether or not too much filler can stretch the skin, Dr. Belkin says that, in most cases, “filler cannot provide enough force to overstretch skin.” In extreme cases, however, it is possible. “Overfilling to a dramatic extent can stretch the skin, especially when done repeatedly in the same area,” Dr. Weiser warns. HA fillers naturally break down and get absorbed into the body over the course of six to 12 months. That process can also be sped up by injecting an enzyme called [hyaluronidase](https://aedit.com/aedition/hyaluronidase-to-dissolve-dermal-filler) (more on that below). Whether through natural degradation or synthetic dissolving, Dr. Weiser says “the skin can be left with laxity, redundancy, and crepiness.” 

A silver lining? The stretching can actually have a youth-boosting effect. “By stretching the tissue, it stimulates fibroblasts (collagen-producing cells) to produce more [collagen](https://aedit.com/aedition/guide-to-collagen-in-skincare-supplements-aesthetic-medicine),” Dr. Weiser notes. “Because of this, I will tell people who worry they will have to keep it up forever that even if you do filler once and stop, you are better off than never having done it at all.” 

## **Correction Options** 
When prevention is not an option, correction is the next best thing. As Dr. Belkin advises, there is no one-size-fits-all option. The methods used for tackling overfilled features are determined on a case-by-case basis, but below are the most common:
	
### **1. Dermal Filler** 
Filler to treat overfilled areas? Yes, you read that right. Because proportion plays a big role in facial nuance, a feature may look ‘too plump’ simply due to its juxtaposition to a sunken area. To aptly treat an area that appears overfilled, supplementing its surroundings with volume may balance out the face for a more harmonious result. The way Dr. Weiser sees it, an overfilled appearance may be due to an uneven distribution that “can be corrected by adding small droplets of product for balance.” 

For example, some patients who have their [tear trough filled](https://aedit.com/aedition/how-i-quit-crying-about-my-tear-troughs) lack volume in the cheek, which leads to an unnatural result. Instead of dissolving the filler under the eyes, Dr. Belkin would look at the face as a whole. “I would recommend conservatively re-volumizing the cheek to match the replaced volume in the tear trough,” he says. But, again, this is not the solution for everyone. If the under-eyes look puffy and the cheek has appropriate volume, “it is likely the tear trough has been overfilled,” he says. In that case, he will “partially dissolve” the product. Speaking of dissolving... 

### **2. Hyaluronidase** 
Hyaluronidase is an enzyme that is naturally occurring in the body. Just as synthetic forms of HA can be injected to augment or sculpt, synthetic [hyaluronidase](https://aedit.com/procedure/hyaluronidase) can be injected to dissolve it. In certain situations, Dr. Weiser says the best solution to treat an overfilled appearance may be to start over. Getting patients on board, however, is not always easy. “Some patients are very resistant to dissolving and starting again,” she says. The alternative? “In these cases, I will encourage them to wait six to 12 months to allow the product to naturally degrade before adding,” Dr. Weiser shares.

Depending on your condition, hyaluronidase can be a relatively quick fix. Results can start to show up in less than an hour, though temporary [swelling](https://aedit.com/aedition/how-to-treat-minimize-swelling-after-cosmetic-surgery) (like the kind experienced after filler injections) can keep the area looking puffy for a few days. In more severe cases, patients may need multiple sessions to fully dissolve their filler. It should also be noted that hyaluronidase degrades all HA (not just the synthetic kind), which means you can be left with even less volume than you started with until the body adjusts.

### **3. Prevent to Protect**
We’ve said it before, and we’ll say it again: The best course of action when it comes to any aesthetic decision is to always do your due diligence and [find a provider](https://aedit.com/aedition/dangers-of-doctor-hopping) who is skilled in your specific concern or treatment and understands your aesthetic goals. “Make sure you are seeing someone who injects filler the way you want yours to appear,” Dr. Weiser says. One way to confirm this? Ask to see [before and after photos](https://aedit.com/aedition/importance-of-before-and-after-photos-in-plastic-surgery) and look for patients who have similar features to yours. 

## **The Takeaway** 
There is a reason hyaluronic acid-based fillers are so popular — they offer a great way to temporarily augment, enhance, or contour an array of facial features. But too much of a good thing isn’t, well, good. “Beautifully placed filler can be wonderful, but poorly placed or excessive amounts can be a struggle to correct,” Dr. Wesier cautions. For those who feel that their filler has negatively impacted their appearance or the function of certain body parts, revision may be possible in the hands of a skilled provider. Be sure to consult with a [board certified](https://aedit.com/aedition/medical-board-certification-in-plastic-surgery-cosmetic-dermatology) plastic surgeon or dermatologist to understand your treatment options.

Dermal filler is a great tool for restoring volume, creating balance, and contouring, but too much of a good thing can lead to an overfilled look that may require its own treatment plan.

How To Correct Too Much Dermal Filler In The Face

How To Correct Overfilled Facial Features

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You’ve seen it before: a woman with a gorgeous jawline that is accompanied by a crepey, saggy neck that doesn’t match. This exact look is why many plastic surgeons perform a [facelift](https://aedit.com/procedure/facelift-rhytidectomy) with a [neck lift](https://aedit.com/procedure/neck-lift-lower-rhytidectomy). Together, the two procedures create a harmonious, well-balanced look. But, like everything in life, there are exceptions to the rule — be it few and far between — when one procedure is necessary and the other is not. Below, we’re breaking down everything you need to know about [combining face and neck lift surgeries](https://aedit.com/aedition/best-procedures-to-combine-with-a-facelift).

## **Why Does the Neck Age So Fast?** 
We all age at different rates, but you can count on one thing: the [neck](https://aedit.com/concern/neck-and-jawline-definition) tends to age faster than the face. Here’s why:

### **1. Weight Changes**
Gaining weight in the lower face is just one factor that speeds up aging in the neck. “Weight often shows in the neck, and those that lose weight may not see their skin shrink back down, which results in a ‘turkey neck’ appearance,” says [Peter Vila, MD](https://aedit.com/provider/peter-vila-md-16177), a board certified facial plastic and reconstructive surgeon in San Rafael, CA. However, thinner patients without extra fat in the chin and neck area face their own set of concerns. Dr. Vila reveals that loose skin has a tendency to sink into the most dependent point of the face and neck — the area right under the chin — again resulting in a turkey neck. His advice to patients whose weight fluctuates: try to lose as much weight as possible before surgery. “This way, the skin can be tailored when it is most ‘deflated,’ and I can remove any extra fat via liposuction,” he shares.

### **2. Skin Quality**
But it’s not just fat that accelerates aging. The skin quality — or lack thereof — also affects the appearance of the neck. [Stafford Broumand, MD](https://plasticsurgeonsnyc.com/plastic-surgeon/dr-broumand/), a board certified plastic and reconstructive surgeon in New York City, notes that the neck tends to display early signs of aging because the skin is thinner. Plus, the neck lacks as many oil glands as the face does. Natural oils hydrate the skin, and hydration is essential for skin health, says [David Shafer, MD](https://aedit.com/provider/david-shafer-md-153), an NYC-based board certified plastic and reconstructive surgeon.  

Of course, [collagen](https://aedit.com/aedition/guide-to-collagen-in-skincare-supplements-aesthetic-medicine) plays an essential role in the skin on the neck, too. Thick, healthy collagen equates to plump, taut skin. But since there is less natural collagen in the neck than in the face (or elsewhere on the body), the skin is not nearly as elastic or resilient. For this reason, fine lines and banding surface early on. [Sun exposure](https://aedit.com/aedition/cosmetic-procedures-treatments-to-correct-sun-damage), which destroys collagen fibers, also takes its toll. 

Sadly, for most of us, the neck is not treated with the same TLC as the face, although it is best to treat it as an extension. While we are diligent about applying sunscreen to your visage, most of us are not as good at applying it to our necks. The result? More sun damage, says [Jacob Unger, MD](https://aedit.com/provider/jacob-unger-md-2649), a board certified plastic and reconstructive surgeon in Nashville. It is, however, never too late to take care of the delicate skin on the neck with [sunscreen](https://aedit.com/aedition/best-sunscreens-of-2021), [retinol](https://aedit.com/aedition/guide-to-vitamin-a-retinol-retinoids-in-skincare), [moisturizer](https://aedit.com/aedition/best-neck-creams-for-tech-neck-sagging-jowls), and even the occasional radiofrequency-based skin-tightening treatment. 

### **3. Muscle Tone**
Couple loose skin with neck bands and the neck can age you by up to 10 years. Dr. Shafer says that, with age, the platysma (read: neck) muscles loosen and separate in the midline (similar to what can happen with the [abdominal muscles post-pregnancy](https://aedit.com/aedition/diastasis-recti-repair-abdominal-separation-post-pregnancy-weight-loss)). As he explains, the loss of muscle and tissue support from the platysma leads to jowls, low-strung platysmal bands, and a blunted, obtuse neck angle. “Part of the goal of a [neck lift](https://aedit.com/procedure/platysmaplasty) is to sew the platysma back together to define the cervical mental angle,” he shares. “Additionally, in a [SMAS facelift](https://aedit.com/procedure/smas-facelift), the upper portion of the platysma, which extends onto the face, is tightened to restore youthful muscle position.”

### **4. Technology**
And then there is the fact that we are all glued to our phones. So-called [tech neck](https://aedit.com/aedition/how-to-treat-prevent-tech-neck) causes pain and wrinkling from bending our heads to look at computers, tablets, and smartphones, says [Mark M. Hamilton, MD](https://www.hamiltonfps.com/), a board certified facial plastic and reconstructive surgeon in Indianapolis. “This downward tilt of the face and neck leads to early and excess wrinkling in the lower neck and chest,” he adds. 

But that’s not the only way technology is affecting the area below the jaw. The '[Zoom effect](https://aedit.com/aedition/how-to-treat-prevent-tech-neck)' is alive and well, says [Adam Kolker, MD](https://www.drkolker.com/), a board certified plastic and reconstructive surgeon in NYC. People have spent the last 18 months seeing themselves on-screen with jowls, neck folds, and creases they may not have noticed IRL. “With cameras positioned too low, this often prompts emergency calls to a plastic surgeon, but these effects are not permanent,” he explains. So perhaps limiting screen time isn’t such a bad idea after all, especially if it has an anti-aging benefit. 

## **Combination Procedures: A One-Two Punch**
When rejuvenating the face and neck area, it’s hard to treat both features with just one procedure, especially if the face and the neck show evidence of loose skin, displaced or excess fat, and poor muscle and tissue support. On their own, a facelift surgically corrects signs of aging on the face from the jawline up to the lower or midface. A neck lift, meanwhile, tightens skin from the jawline down, while removing redundant fat and tissue.

Hands down, a neck lift is a tried-and-true method for achieving a super tight, smooth neck. Most surgeons incorporate a neck lift into every facelift they do. “The vast majority of patients that need neck correction also need lower facial rejuvenation,” Dr. Hamilton shares. “Thus it is rare for a surgeon to recommend for a patient to select a neck lift alone.”

Yet, the decision to pair a facelift into a neck lift comes down to the best approach for you and your concerns. “We often perform facelifts and neck lifts contemporaneously as the face and neck are married by the aging jawline," Dr. Kolker says. Whether the face and neck are aging at the same or different paces, addressing one without the other will distort the outcome. “If one area slightly outpaces the other but both areas show signs of aging, lifting only one can be like painting one room in an old house,” he cautions. “The room right next to it will look like it needs a fresh coat even more.”

Simply put, correcting just the face and not the neck (or vice versa) highlights any imperfections, and the signs of aging will start to become more noticeable than before. “For most patients, addressing the neck without addressing aging in the lower face creates a notable difference between the appearance of the two, which is why most surgeons typically recommend rejuvenating both the face and the neck,” states Dr. Hamilton.

The criteria for considering a neck lift with a facelift:

- Your neck and face both make you feel and look older than you are
- The neck doesn’t match the face in terms of tautness or vice versa
- You don’t want to undergo multiple procedures in the future
- There is sagging in the lower face, under the chin, and on the neck

Excess fullness and skin in the area under the chin and jaw is what Dr. Vila looks for in a neck lift patient. In the case of a facelift, “the signs are jowling and a deflated look to the face,” he adds. A lack of distinction between the jawline, chin, and neck area is usually the final determining factor to perform both procedures. “Though patients may consider the two procedures to be completely separate, I view them on the same spectrum,” he shares. “It’s just that different patients require different components, and some patients require all of them.”

Rarely are there instances when only a facelift is necessary — though they do exist. “If there is facial laxity and soft tissue descent to the jawline region with minimal cervical laxity or deformity, no neck lift is required,” Dr. Kolker explains. “Most often, by resuspending the SMAS and platysma, the muscle that covers the lower two-thirds of the face and most of the anterior neck, mild neck contour issues and laxity are often corrected.” But, if moderate or severe laxity is not corrected, chances are you'll be back in the operating room to fix the now more prominently aging neck.

Sometimes, a preventative approach to aging uses [Botox® to diminish](https://aedit.com/aedition/where-to-use-botox-from-head-to-toe) prevalent neck bands or [filler along the jawline](https://aedit.com/aedition/non-surgical-procedures-for-jawline-definition) to create definition (i.e. add more distinction between it and the neck). Even so, these areas still tend to require surgical intervention, albeit at a later date. “After a facelift, [Botox® and filler](https://aedit.com/aedition/guide-to-facial-fillers-fat-grafting-after-facelift) are useful in maintaining the surgical results,”  Dr. Shafer shares.

Like other surgical procedures, the facelift-neck lift combo has evolved. “Over the years, we have learned to do two important things,” Dr. Unger says. The first involves [facial volume](https://aedit.com/aedition/best-procedures-to-restore-facial-volume). “One is almost always to [add fat to the face](https://aedit.com/aedition/guide-to-facial-fillers-fat-grafting-after-facelift) to replace areas that have lost volume due to the aging process,” he explains. “By adding volume, we can re-elevate areas of the face that have fallen for a more balanced and harmonious look.” 

The second lesson has to do with technique. Surgeons now take what Dr. Unger calls “a more anatomic approach” to facial rejuvenation. “Instead of just pulling on the skin and trying to make things tighter, we now focus on re-creating the natural contours of a more useful face by rearranging the anatomy on a deeper level than the skin,” he explains. “This creates a more natural appearance for longer-lasting results.”

## **The Takeaway**
Chances are, if you are seeking surgery to [correct your aging face](https://aedit.com/procedure/facial-skin-firming-and-lifting-solutions), you’re going to want to [address your neck](https://aedit.com/procedure/neck-and-jawline-definition-solutions), too. Rarely do plastic surgeons restore one without the other (though that doesn’t mean it can’t happen). “If only the face is corrected and not the neck, then the patient can look older because the neck skin will continue to sag,” Dr. Shafer says. There will also be an evident disconnect between the neck and face. “If the neck is corrected and not the face, the patient can get a bobblehead appearance with a tight neck and a fat face,” he adds.


You'd be hard-pressed to find a plastic surgeon who performs a facelift without a neck lift. The reason: The combo creates a seamless look. Here’s what the experts have to say about the pairing.

Benefits Of Pairing A Facelift With A Neck Lift

Do You Need To Combine A Neck Lift With A Facelift?

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Linda Evangelista made headlines on social media this week when she candidly opened up about her experience with paradoxical adipose hyperplasia (PAH), which she says she developed after a series of cryolipolysis treatments five years ago. In an emotional [Instagram post](https://www.instagram.com/p/CUJZa40tWXC/), the supermodel alleges the CoolSculpting® procedures “increased, not decreased” her fat cells and left her “permanently deformed even after two painful, unsuccessful, corrective surgeries.”

<CaptionImg url={https://images.contentful.com/zw35sfestf1t/5tUYfh7YSiYd0xHs77qCwi/eb88a5821865ba0aef90405f401b176c/LindaEnvangelistaIG.png}>
  Linda Evangelista's Instagram post about her experience with PAH. (@lindaevangelista/ Instagram)
</CaptionImg>

By sharing her story, Evangelista (who filed a lawsuit against the device’s manufacturer, Zeltiq Aesthetics, which is a subsidiary of Allergan) has paved the way for a renewed conversation around one of the lesser known adverse effects of the popular [fat-freezing procedure](https://aedit.com/aedition/comparing-fat-melting-sculpsure-and-fat-freezing-coolsculpting). So, what is paradoxical adipose hyperplasia and how common is it? Here, a top dermatologist and plastic surgeon break down everything you need to know about PAH — including how to treat it.

## **What Is Paradoxical Adipose Hyperplasia?**
To understand paradoxical adipose hyperplasia (PAH), it’s first important to understand cryolipolysis. Also known as ‘fat freezing’ or by its brand name, [CoolSculpting®](https://aedit.com/procedure/cool-sculpting), the non-invasive body contouring procedure is a controlled cooling technique that works by freezing fat cells at negative 11 degrees Celsius to permanently destroy them. “Cryolipolysis uses cooling to damage and destroy subcutaneous fat cells without damaging the skin to reduce the amount of fat in the treated area,” says [Paul Jarrod Frank, MD](https://pfrankmd.com/), a board certified dermatologist in New York City. 

Most patients experience a 20 to 25 percent reduction of fat in the treatment area, and CoolSculpting® is approved by the United States Food and Drug Administration (FDA) to address visible fat bulges on the back, buttocks, thighs, upper arms, flanks, and abdomen and under the chin and jawline. According to the [CoolSculpting® website](https://www.coolsculpting.com/index.html), post-treatment side effects include “temporary redness, swelling, blanching, bruising, firmness, tingling, stinging, tenderness, cramping, aching, itching, or skin sensitivity, and sensation of fullness in the back of the throat after submental or submandibular area treatment.” 

The site also notes that “rare side effects” may occur: “CoolSculpting® and CoolSculpting® Elite may cause a visible enlargement in the treated area, which may develop [two] to [five] months after treatment and requires surgical intervention for correction.” The paradoxical adipose hyperplasia Evangelista describes was [first reported in 2014](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4171727/). “It is a rare, previously unreported adverse effect of cryolipolysis,” Dr. Frank notes.

PAH refers to hardened areas of localized fat that develop after cryolipolysis. “PAH is the unintentional growth of adipose, or fat, after cryolipolysis,” explains [Melissa Doft, MD](https://doftplasticsurgery.com/), a double board certified plastic and reconstructive surgeon in NYC. “Patients complain of a thick layer of hard fat in a similar shape to the applicator used for CoolSculpting®, and it has been described as looking like a stick of butter.”

[Studies show](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4171727/) that less than one percent of patients (about 0.05 percent to 0.39 percent) experience the condition after cryolipolysis, though [more recent data](https://www.sciencedaily.com/releases/2018/06/180629182037.htm) indicates the figure may be as high as 0.72 percent. “It is unclear why some patients have the growth of fat cells instead of reduction, but what is known is that the incidence is higher than was previously expected,” Dr. Doft says. “Researchers estimated that it affects one in 138 patients who undergo cryolipolysis and is more common in male patients.”

As such, providers increasingly believe PAH does not get enough attention. “This complication is more common than we think, along the spectrum of mild to severe,” Dr. Frank shares. In her IG post, Evangelista laments that she was “not made aware” of the risk prior to undergoing treatment. 

While it is not life threatening, PAH can be physically and emotionally distressing — and it will not go away without treatment. “I do not have a CoolSculpting® machine, but I have seen several complications unfortunately,” Dr. Doft shares. “It is devastating to the patients.”

## **What Causes Paradoxical Adipose Hyperplasia?**
The tricky thing about paradoxical adipose hyperplasia? We don’t really know exactly what causes it. “We assume the cooling effect has some sort of stimulatory stem cell activation which causes multiplication of fat cells,” Dr. Frank explains, adding that it is “typically a localized phenomenon.” That means most patients who experience PAH do so in the area where the cryolipolysis applicator was placed, and it can happen anywhere on the body. 
 
Additionally, it can happen to anyone. “There is no data on why someone is more susceptible than others,” Dr. Frank says. “That makes it such a problem because it's unpredictable.” One potential factor? “People who get too many repetitive treatments in the same area may be more inclined to have PAH,” he adds. 

For example, there could be situations in which a patient is misdiagnosed after CoolSculpting®. “The most common cause is when a patient says they have a CoolSculpting® cycle, and they start noticing growth in the area,” Dr. Frank explains. Rather than recognize the growth as PAH, an untrained provider may blame it on weight gain and have the patient undergo another session. “It usually happens when you have too many CoolSculpting® treatments in a short period of time to the same area,” he says.

## **How to Treat Paradoxical Adipose Hyperplasia**
The most important thing to know about treating paradoxical adipose hyperplasia is that additional cryolipolysis treatments are not the answer. Instead, [liposuction](https://aedit.com/procedure/tumescent-liposuction) or, in more severe cases, [abdominoplasty](https://aedit.com/procedure/abdominoplasty) (read: tummy tuck) are the most effective ways to improve or completely correct PAH. Be aware that multiple surgeries may be needed.
 
The coldness of cryolipolysis creates inflammation that destroys fat cells, but it can also cause panniculitis, or the inflammation of fat. “That causes a rebound and exacerbation of scar tissue that comes from the inflammation,” Dr. Frank explains. As such, “it is necessary for patients to wait six to nine months after the [cryolipolysis] procedure to confirm that the inflammation and growth has plateaued,” Dr. Doft adds. During that time, “people who are experiencing the active stage of growth soon after CoolSculpting® treatment require systemic steroids,” Dr. Frank notes. 
 
At Dr. Frank’s practice, [vaser liposuction](https://pfrankmd.com/lipo/) is the “gold standard” of treating fat adipose hyperplasia. “[Most patients](https://www.instagram.com/p/CMUeHjRFm46/?utm_medium=copy_link) get enormous improvement after one treatment,” he explains, but many patients “will require two rounds of surgical intervention to really reduce the irregularities.” 
 
Dr. Doft agrees that liposuction often “works well to remove the excess fat tissue,” though it is not always enough. “Some patients not only have excess fat but also significant scar tissue and will need an abdominoplasty to correct the problem,” she says.
 
## **The Takeaway**
Even non-invasive treatments that are generally considered safe and effective, like CoolSculpting®, can have negative outcomes that require costly revision. “[PAH] is a more common than discussed complication, particularly in the hands of unlicensed professionals and med spas,” Dr. Frank cautions. While all aesthetic procedures carry the possibility of side effects and complications, visiting a [board certified provider](https://aedit.com/aedition/medical-board-certification-in-plastic-surgery-cosmetic-dermatology) who specializes in the treatment you are interested in can help mitigate risk and ensure you are in qualified hands should something go wrong.

Cryolipolysis is generally considered a safe and effective form of body contouring, but adverse effects (however rare) are possible. Here’s what you need to know about PAH.

What To Know About Paradoxical Adipose Hyperplasia (PAH) After Cryolipolysis, CoolSculpting

What You Need To Know About Paradoxical Adipose Hyperplasia

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Raise your hand if you’ve experienced buyer’s remorse. The feeling that is familiar to many is not just reserved for retail therapy — it can happen post-aesthetic treatment, too. Results don’t always live up to expectations, and, in certain cases — specifically minimally invasive injectable treatments that temporarily alter the appearance — waiting for the results to dissipate can feel like an eternity. 

Hyaluronic acid (HA)-based dermal fillers, like [Juvéderm®](https://aedit.com/procedure/juvederm), [Restylane®](https://aedit.com/procedure/restylane), and [Belotero®](https://aedit.com/procedure/belotero), naturally dissolve over time depending on the treatment area, the amount injected, and the patient’s metabolism (for men, [it will likely dissolve faster](https://aedit.com/aedition/guide-to-lip-filler-for-men)). Those who are left feeling dissatisfied with their results, however, will be relieved to know that turning back time is an option. Enter: [hyaluronidase](https://aedit.com/procedure/hyaluronidase). 

Whether it’s the [lips](https://aedit.com/procedure/temporary-lip-fillers), [under the eyes](https://aedit.com/procedure/under-eye-filler), [in the cheeks](https://aedit.com/procedure/cheek-augmentation-with-fillers), or any of the other areas where HA filler is placed, injecting hyaluronidase can speed up the degradation process and reduce plumpness and/or lumpiness in a matter of days. But is the revision really as simple as it sounds? We tapped two top dermatologists to break down everything you need to know about hyaluronidase. 

## **What Is Hyaluronidase?**
Like [hyaluronic acid](https://aedit.com/aedition/guide-to-hyaluronic-acid-in-skincare-dermal-filler), the human body naturally produces hyaluronidase. “Hyaluronidase is an enzyme that occurs naturally in the body to break down hyaluronic acid, which is a naturally occurring molecule that helps give turgor and support to our skin and joints,” explains [Daniel Belkin, MD](https://www.nydermatologygroup.com/doctors/dr-daniel-belkin/), a board certified dermatologist at New York Dermatology Group. 

Just as we can inject synthetic forms of hyaluronic acid to augment and contour the face and body, we can inject synthetic forms of hyaluronidase to undo the effects. “[It] can be synthetic and used deliberately for the non-surgical removal of unwanted effects of a HA filler treatment,” says [Jessica Weiser, MD](https://www.weiserskin.com/md-jessica-weiser.html), a board certified dermatologist and founder of [Weiser Skin MD](https://www.weiserskin.com/). “Beautifully placed filler can be wonderful, but poorly placed or excessive amounts can be a struggle to correct.”

## **How Hyaluronidase Is Used**
As you may have predicted, hyaluronidase is a way to revise HA filler procedures that go awry for any number of reasons. “Because HA is the essential component of HA-based fillers, hyaluronidase may be injected into the skin by a dermatologist or plastic surgeon to rapidly dissolve filler,” Dr. Belkin says. This correction may be due to “a poor cosmetic outcome” or 
“for a complication,” he adds.

Yes, hyaluronidase can help remove volume or soften contour for patients who are unhappy with the outcome of their injectables, but it can also address some of the possible side effects of HA filler — chiefly, lumps and nodules. “The same applies to hyaluronidase for small bumps and blebs,” Dr. Weiser shares. “I will often start with diluted hyaluronidase to see if I can reduce excess product or product placed too superficially without wiping out everything.” In other words, a skilled injector may be able to smooth lumpiness without compromising the rest of the result.


## **When Will You See Results from Hyaluronidase?** 
Depending on your condition, hyaluronidase can be a relatively quick fix. “It often works to dissolve or partially dissolve HA filler in less than an hour,” Dr. Belkin says. “It may take until the next day to see the effects, though typically not more than 24 hours.” Like the temporary swelling experienced after [dermal filler injections](https://aedit.com/aedition/everything-you-need-to-know-about-dermal-fillers), dissolving filler may cause the treatment area to initially look even more plump. “This is because injecting the hyaluronidase requires the injection of more fluid into the area, not to mention the potential to bruise, which may leave the area looking puffy or full despite the filler having been dissolved,” Dr. Belkin explains. 

Fear not: As the swelling goes down, the actual results will show in a matter of days. 

## **What If I Want To Get Filler Again?**
No matter your reasoning for dissolving your filler, a refill, if you will, is allowed in due time. After your first hyaluronidase treatment, an evaluation will be necessary to see if additional sessions are needed. All the while, you’ll want to make sure any swelling has fully resolved before going under the needle for HA filler again. “I typically would wait a week before putting new filler in to make sure swelling has resolved, and we can see the full effect of the dissolver,” Dr. Belkin says. 

To ensure a more desirable outcome moving forward, Dr. Weiser recommends taking things slow. “Placing numerous syringes of filler in the face in a single appointment may be appealing right away, but it often settles poorly or leads to unnatural cosmetic outcomes,” she cautions. So, rather than going all in at once, she suggests taking a modest approach of one to two syringes (max) to start, after which more can be added upon request. 

## **Potential Complications**
This wouldn’t be an article on The AEDITION if we glossed over the potential side effects and complications of hyaluronidase injections. Dr. Belkin notes that the primary side effects are [swelling](https://aedit.com/aedition/how-to-treat-minimize-swelling-after-cosmetic-surgery) and [bruising](https://aedit.com/aedition/how-to-treat-prevent-bruising-after-lasers-filler-botox) (a common occurrence post-filler, too) that tend to last a week.

It should also be noted that the dissolver may leave you with less volume than you started with because hyaluronidase can impact both synthetic and naturally occurring hyaluronic acid in the treatment area. While Dr. Belkin says that the body corrects this over time by producing more HA, it may take a few months for the atrophy to fully resolve. “To avoid this, assuming it is not an emergency, I will dilute hyaluronidase with saline to get just the right amount of activity that I want,” he shares.

Additionally, the use of hyaluronidase is not recommended in individuals who have experienced anaphylaxis, are on certain medications, or have an allergy to any component of hyaluronidase. Be sure to discuss your medical history with your provider to avoid complications.

## **The Takeaway** 
A plump lip or a fuller cheek may provide a more youthful appearance, but, when overfilled features become a point of contention, hyaluronidase may dissolve those concerns. While the enzyme provides peace of mind for patients who experience undesirable outcomes or complications, one of the best ways to avoid the need for a revision is to [take the time to find the right provider](https://aedit.com/aedition/how-i-found-my-plastic-surgeon-dont-rush-it) for your aesthetic goals. “Every doctor has a different technique and varying end goals,” Dr. Weiser says. “So, if your injector has a very full face, they are likely desiring to give you this same endpoint.” Her advice: “Do your research!” 

Not all aesthetic procedures can be reversed, but hyaluronic acid-based filler can be dissolved. Here’s what the experts have to say about hyaluronidase.

How To Dissolve Hyaluronic Acid-Based Filler With Hyaluronidase

So, You Regret Your Filler – Should You Dissolve It?

AEDITION rejuvenators-min

Medical Aesthetics Collection | The AEDITION

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The eyes are great communicators — able to evoke a range of emotions in the blink of, well, an eye. But what if the expression you’re presenting is not one you’re actually feeling? With age comes the loss of elasticity, and this may result in [droopy eyelids](https://aedit.com/aedition/guide-to-eyelid-ptosis-drooping), a lowered brow, and, for some, the appearance of fatigue or sternness. 

When age has taken its toll, a full eight hours of sleep isn’t enough, and/or you find your vision slightly strained, it may be time for surgical intervention. [Blepharoplasty](https://aedit.com/procedure/blepharoplasty-eyelid-surgery) (a.k.a. eyelid surgery or eyelid lift) and [browplasty](https://aedit.com/procedure/brow-lift-forehead-lift-browplasty) (a.k.a. brow lift or forehead lift) are both common treatment options for [aging and tired eyes](https://aedit.com/concern/aging-and-tired-eyes), but what happens when you combine the forces of these two upper face rejuvenators? We spoke with Minnesota-based double board certified facial plastic and reconstructive surgeon [Peter Hilger, MD](https://aedit.com/provider/peter-hilger-md-1608), to learn more about these procedures and why they’re even better when paired together. 

## **Blepharoplasty vs. Brow Lift**
Both [blepharoplasty](https://aedit.com/procedure/blepharoplasty-eyelid-surgery/cost) and [brow lift](https://aedit.com/procedure/brow-lift-forehead-lift-browplasty/cost) individually treat the upper third of the face to create a more taut, youthful appearance, but there’s more to these [eye rejuvenation solutions](https://aedit.com/procedure/eye-rejuvenation-solutions) than meets the eye. Here’s what you need to know: 

### **Blepharoplasty** 
Addressing the skin either above or below the lash lines, there are numerous types of blepharoplasty to treat an array of aesthetic and functional concerns (yes, this is one of the few cosmetic procedures that may be [covered by insurance](https://aedit.com/aedition/insurance-coverage-for-plastic-surgery-cosmetic-procedures)). An [upper eyelid blepharoplasty](https://aedit.com/procedure/upper-eyelid-blepharoplasty) specifically addresses sagging skin in the upper eye area, while a [lower eyelid blepharoplasty](https://aedit.com/procedure/lower-eyelid-blepharoplasty-transcutaneous-approach) can be used to treat under eye bags, excess skin, and more. For patients with a monolid who wish to add an eyelid crease, an [Asian blepharoplasty](https://aedit.com/procedure/asian-blepharoplasty) may be performed.

Regardless of the type, Dr. Hilger notes that blepharoplasty techniques have evolved over time to deliver more natural results. “In years past, upper and lower blepharoplasty focused on removing — by surgical excision — redundant skin that created hooding and an aged face,” he explains, adding that this often led to a gaunt or hollowed appearance. Today's approach is more comprehensive and “includes tightening the supportive structures of the eyelids, repositioning some of the lax skin to preserve youthful contours, excising excessive skin that can block vision, or repositioning bulging fat pads,” he shares. 

These below-the-brow procedures can, he says, “provide a smooth contour that starts at the lash line and continues across the eyelid-cheek junction.” Another benefit? The surgery also has the ability to “resurface the eyelid to reduce fine wrinkles that can not be corrected by skin excision,” Dr. Hilger notes. 

### **Brow Lift**
As its name suggests, a [brow lift](https://aedit.com/aedition/theres-more-to-a-brow-lift-than-meets-the-eye) lifts the brow. The primary impetus to undergo a brow lift is to correct the loss of elasticity that makes the forehead skin drape poorly. Done via small incisions hidden under the hairline, modern versions of the surgery create a natural lift as opposed to the ‘surprised’ appearance of brow lifts past. “A brow lift repositions the brow higher, which makes the eye aesthetic zone look larger, reduces wrinkles as the skin is tightened, and reduces some [eyelid hooding](https://aedit.com/concern/sagging-and-hooded-eyelids),” Dr. Hilger explains. It should be noted that the so-called ‘[chemical brow lift](https://aedit.com/procedure/chemical-brow-lift)’ performed with neurotoxins (read: Botox®) can provide a temporary (think: three to four month) lift, but surgery is the best bet for those looking for long-term correction. 

## **Benefits of Combining Blepharoplasty + Brow Lift**
As we’ve covered, maintaining [facial harmony](https://aedit.com/aedition/facial-harmony-in-aesthetic-medicine) is the main objective of any facial aesthetic treatment, and sometimes that means combining procedures for best results. So, how can this dynamic duo of blepharoplasty and brow lift be beneficial?

- **It’s Cost-Effective**: “Combining the procedures in one setting is more expensive than an isolated intervention, however, the cost is less than performing them individually,” Dr. Hilger explains. While he cautions that cost should not be the driving factor behind your decision, it will be more [budget-friendly](https://aedit.com/aedition/how-much-cosmetic-surgery-costs) than going back for a second procedure.  
- **It’s Time-Effective**: Surgery requires time for both the procedure and the recovery. According to Dr. Hilger, pairing the two together will take one to two hours and the [recovery process](https://aedit.com/aedition/preparing-for-a-smooth-recovery-from-plastic-surgery) will only be experienced once. 
- **It’s Less Painful**: Some level of [discomfort](https://aedit.com/aedition/how-much-plastic-surgery-really-hurts) is to be expected after surgery, but, as we mentioned, combining the healing processes will save you from dealing with two rounds of recovery. 
- **It Looks More Natural**: If both the brows and lids are heading south, correcting them at once may offer the most comprehensive result. “Addressing changes that span aesthetic zones provide a more natural result, as the transition from one aesthetic area to another is blended,” Dr. Hilger says.
- **It Cuts Down on Maintenance**: “The results are remarkably lasting and additional rejuvenation is rare for a decade,” Dr. Hilger shares. While the natural aging process will continue to be in play, the [lifespan of each procedure](https://aedit.com/aedition/how-long-do-cosmetic-surgery-plastic-surgery-results-last) is about 10 years.   

## **The Ideal Candidate for Blepharoplasty + Brow Lift** 
This paired approach is preferred for patients who want a “natural rejuvenation that focuses on harmony, more comprehensive correction, and a more sophisticated result,” Dr. Hilger says. “These combined procedures are ideal for patients who have aging changes that go beyond isolated lid laxity.” When searching for the [right provider](https://aedit.com/aedition/finding-the-right-plastic-surgeon-dermatologist-or-cosmetic-dentist), he recommends evaluating as many [before and after photos](https://aedit.com/aedition/importance-of-before-and-after-photos-in-plastic-surgery) as possible. “The results are best demonstrated with images rather than words, so study the before and after images attached,” he says. 

## **Recovering from Blepharoplasty + Brow Lift**
Post-op recovery of a combined blepharoplasty and brow lift will be similar to that of a solo eyelid or brow surgery. “After surgery, ice is your friend to reduce [swelling](https://aedit.com/aedition/how-to-treat-minimize-swelling-after-cosmetic-surgery),” Dr. Hilger says. [Sleeping](https://aedit.com/aedition/sleeping-better-after-cosmetic-surgery-aesthetic-procedures) must be done upright, and [physical mobility](https://aedit.com/aedition/when-to-start-exercising-again-after-cosmetic-surgery-procedures) (aside from light movement) may be limited for a few days. But, for those worried about the [length of recovery](https://aedit.com/aedition/how-long-does-it-takes-to-recover-from-cosmetic-surgery-procedures), Dr. Hilger says that “you will be back to your normal activities and social life in 10 to 14 days.” 

## **The Takeaway** 
When it comes to [eye rejuvenation](https://aedit.com/aedition/popularity-of-eyelid-surgery-cosmetic-eye-procedures-during-covid-19), many procedures can fit the bill, but, for those who are concerned about a lowered, droopy eyelid and sagging brow, pairing an upper eyelid blepharoplasty and brow lift may provide the most impactful result. “The combined approach is more comprehensive, provides greater visual field correction when lax skin blocks vision, provides more durable results, and generates a superior natural change,” Dr. Hilger concludes. Remember, genetics, lifestyle, and other external factors play a role in how your face ages, so be sure to consult with a [board certified plastic surgeon](https://aedit.com/aedition/medical-board-certification-in-plastic-surgery-cosmetic-dermatology) to ensure you receive the best treatment for your aesthetic concerns and goals.

Combining procedures is not only cost-effective but may achieve more natural and long-lasting results. If the concern is droopy lids, holistically looking at the eye and brow may offer the biggest benefit.

Combining Blepharoplasty And Brow Lift: Benefits, Candidates, Recovery

The Benefits Of Combining Blepharoplasty And Brow Lift

shutterstock 190955117 (1)

If you're a regular reader of The AEDITION, you know we always emphasize finding a 'board certified' provider to perform your preferred cosmetic procedure. But what does it mean to be a board certified plastic surgeon or dermatologist? How do doctors go about becoming certified? We're here to shed some light on the board certification process and why it matters.

## **Medical Licensure vs. Board Certification**
First things first, a licensed doctor is not the same as a board certified one. A medical license is required for all doctors who wish to legally practice medicine in the United States, and medical licensure is handled at the state level by state medical boards. Doctors must receive individual licenses in each state they wish to practice in, and they must be renewed periodically.

While the protocol varies from state to state, you can be sure that all licensed physicians (at the minimum) graduated medical school, underwent some level of postgraduate residency training, and passed a comprehensive national licensing exam (either the United States Medical Licensure Examinations [USMLE] for medical doctors or the Comprehensive Osteopathic Medical Licensing Examination for doctors of osteopathic medicine).

Board certification, meanwhile, signifies that the physician has successfully completed a residency in their chosen specialty. In order to become board certified, a doctor must have completed his or her undergraduate education, medical school, one-year internship, a residency in their chosen specialty, and passed the residency board exam.   
  
Unlike a medical license, board certification is not required to practice medicine in the U.S., but it is an important tool in distinguishing whether or not a provider has specialized in a particular area. Additionally, board certification does not last forever. Many medical specialty boards now require recertification every 10 years or so, ensuring doctors keep on top of their skills.

## **Why Board Certification Matters**
Board certification is important for all fields of medicine, but it is particularly necessary in the aesthetic space. While it cannot guarantee the quality of results, it can certainly point you in the direction of qualified doctors for the procedure you are interested in or care you need.

Titles like cosmetic surgeon, plastic surgeon, and cosmetic dermatologist have [seemingly become interchangeable](https://aedit.com/aedition/difference-between-plastic-surgeons-and-cosmetic-surgeons), but the qualifications of such doctors can vary greatly. Because there is very little regulation governing how doctors refer to themselves, understanding your provider's board certification(s) can ensure you are consulting with a doctor or surgeon who is actually trained in plastic and reconstructive surgery, otolaryngology, ophthalmology, or dermatology (i.e. the specialties that most relate to aesthetic medicine).

## **How Doctors Become Board Certified**
The [American Board of Medical Specialties](https://www.abms.org/member-boards/) (ABMS) is comprised of 24 certifying boards that are known as the Member Boards of ABMS. Specialties range from internal medicine to radiology, and while it's pretty straightforward that a pediatrician would be certified by the American Board of Pediatrics or a gynecologist would be certified by the American Board of Obstetrics and Gynecology, gaining certification in aesthetic medicine is less clear.

Sure, there is an American Board of Plastic Surgery (ABPS) and American Board of Dermatology (ABD) that offer subspecialties in hand surgery, dermatopathology, and pediatric dermatology, but there are no member boards for specialities like oculoplastic surgery or cosmetic dentistry. Further complicating matters is the fact that there are board certifying organizations that exist outside of ABMS. While some have standards that are as rigorous as the written and oral examinations Member Boards administer, not all do.

When choosing a provider to perform a cosmetic procedure or cosmetic surgery, look for a specialist in the following categories:

### **Plastic and Reconstructive Surgery**
General plastic and reconstructive surgeons complete three to five years of general surgery training followed by a two to three year cosmetic and reconstructive plastic surgery residency. Plastic and reconstructive surgeons can pursue board certification via the [American Board of Plastic Surgery](https://www.abplasticsurgery.org/), and they may be dual-certified by the [American Board of Surgery](http://www.absurgery.org/) (ABS). While they are board certified to perform cosmetic and reconstructive surgeries on the face and body, their work often focuses on the breasts and body.

### **Facial Plastic and Reconstructive Surgery**
After completing a five-year residency in otolaryngology (a.k.a. ears, nose, and throat), facial plastic and reconstructive surgeons pursue year-long fellowships in cosmetic and reconstructive procedures specifically related to the face and neck (think: rhinoplasties, facelifts, chin and jaw surgeries, etc.). While there is no ABMS Member Board specifically for facial plastic and reconstructive surgery, they should be board certified by the [American Board of Otolaryngology – Head and Neck Surgery](https://www.aboto.org/) (ABOTO). The [American Board of Facial Plastic and Reconstructive Surgery](https://www.abfprs.org/) (ABFPRS) is also an accreditation that many facial plastic surgeons seek.

### **Dermatology**
Medical dermatologists diagnose, treat, and prevent conditions affecting the skin, hair, and nails. While there are subspecialties within the field, all dermatologists board certified by the [American Board of Dermatology](https://www.abderm.org/) undergo non-surgical, cosmetic dermatology training during their residency program. Dermatologic surgeons (i.e. those qualified to perform liposuction, fat transfer, and Mohs surgery, in addition to non-invasive treatments) are often fellows of the [American Society for Dermatologic Surgery](https://www.asds.net/) (ASDS). Asking to see before-and-after photos and inquiring as to how often they perform certain cosmetic treatments and procedures will shed further light on their aesthetic expertise.

### **Oculoplastic Surgery**
While a facial plastic surgeon is able to perform eyelid surgeries (like [blepharoplasty](https://aedit.com/procedure/upper-eyelid-blepharoplasty)), oculoplastic or oculofacial surgeons are experts in procedures that reconstruct the eyelids, tear ducts, and orbital area. They should be board certified by the [American Board of Ophthalmology](https://abop.org/) (ABOP) and have additional fellowship training with the [American Society of Ophthalmic Plastic and Reconstructive Surgery](https://www.asoprs.org/) (ASOPRS).

## **Fellowships & Societies**
Doctors who wish to further specialize in a particular area of medicine may choose to continue their training and education via a fellowship. Fellowship programs are often highly competitive and last one to three years each. Due to the lack of ABMS Member Boards in certain subspecialties, fellowships may be used to denote expertise. An ophthalmologist who wishes to subspecialize in oculoplastic surgery, for instance, would complete a two-year fellowship through the aforementioned ASOPRS.

Society memberships, meanwhile, offer another way (separate from licensing, board certification, and fellowships) for providers to continue their education, in addition to offering mentoring and networking opportunities. Below are some of the academies and societies related to aesthetic medicine, cosmetic surgery, and dermatology:

- [American Academy of Aesthetic Medicine](https://www.aaamed.org/) (AAAM)
- [American Academy of Cosmetic Dentistry](https://aacd.com/) (AACD)
- [American Academy of Cosmetic Surgery](https://www.cosmeticsurgery.org/) (AACS)
- [American Academy of Dermatology](https://www.aad.org/) (AAD)
- [American Academy of Facial Plastic & Reconstructive Surgery](https://www.aafprs.org/) (AAFPRS)
- [American Society of Aesthetic Plastic Surgery](https://www.smartbeautyguide.com/) (ASAPS)
- [American Society of Cosmetic Laser Surgery](https://www.cosmeticsurgery.org/page/SubspecialtyOrganiz) (ASCLS)
- [American Society for Dental Aesthetics](http://www.asdatoday.com/) (ASDA)
- [American Society of Dermatologic Surgery](https://www.asds.net/) (ASDS)
- [American Society of Hair Restoration Surgery](https://www.cosmeticsurgery.org/page/SubspecialtyOrganiz) (ASHRS)
- [American Society of Liposuction Surgery](https://www.cosmeticsurgery.org/page/SubspecialtyOrganiz) (ASLS)
- [American Society of Ophthalmic Plastic & Reconstructive Surgery](https://www.asoprs.org/) (ASOPRS)
- [American Society of Plastic Surgeons](https://www.plasticsurgery.org/) (ASPS)

While these affiliations are voluntary, a doctor may display their memberships as an indicator of interest and engagement in their specialty. 

## **The Takeaway**
There is perhaps no more important task in your aesthetic journey than finding the right physician to perform your cosmetic surgery procedure, and understanding the board certification process is a key part of that. While all the certifications, licenses, and credentials in the world cannot guarantee results, knowing that your doctor specializes in the procedure you are interested in is the first step toward ensuring you get the best care for your needs.

If you’re interested in a cosmetic procedure, you’ve likely been told to find a board certified provider. But what does it mean to be a board certified plastic surgeon or dermatologist? The AEDITION breaks it down.

How Plastic Surgeons And Cosmetic Dermatologists Become Board Certified 

What Does Board Certification Really Mean?

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It’s an undisputed fact that more men are getting cosmetic procedures. According to the American Society of Plastic Surgeons’ annual report, more than [1.3 million men in the United States went under the knife (or needle) in 2018](https://www.plasticsurgery.org/documents/News/Statistics/2018/plastic-surgery-statistics-full-report-2018.pdf) — a 29 percent increase since the year 2000. And while the majority of these procedures performed on men were minimally invasive, men still made up 13 percent of cosmetic procedures performed in the United States.

It’s not exactly surprising that men are increasingly seeking out the help of plastic surgeons to reach their aesthetic goals. Cosmetic surgery has never been gendered, but the divide can be traced back to our cultural misconceptions of what cosmetic surgery is and who gets it. Thanks to the internet and social media, both men and women have a greater understanding of just what these procedures entail and what they can do. “The conversation is a lot more sophisticated than it used to be,” says board certified plastic surgeon [Jacob Unger, MD](https://aedit.com/provider/jacob-unger-md-2649), of Maxwell Aesthetics in Nashville. He’s noticed an increase in male patients in his own practice in recent years.

Still, men who get cosmetic surgery are looking for different results and typically approach it differently than women. The biggest fear most men have when getting cosmetic surgery is that it is going being obvious that they got it. “They don’t want to look like they’ve had anything done,” says board certified plastic surgeon [Leif Rogers, MD](https://aedit.com/provider/leif-rogers-md-578), in Beverly Hills. They also want different results, particularly when it comes to common procedures like liposuction and rhinoplasty. Cosmetic surgery, after all, is not one size fits all, and men want the results to look masculine and blend with their existing features. 

Both Dr. Rogers and Dr. Unger’s patients reflect the current trends that the ASPS reports. “Men want a lot of body contouring, liposuction, and liposculpting,” says Dr. Unger. On the face, eye lifts and nose jobs reign supreme among men. “About a third of the rhinoplasties I do are on men,” notes Dr. Rogers.

The AEDITION asked the experts to break down the most common surgical and non-surgical cosmetic procedures for men, and what they have to say may surprise you.

## __1. Liposuction__
[Liposuction](https://aedit.com/procedure/liposuction) is consistently one of the top cosmetic procedures across the board, according to the ASPS, so it’s not surprising that it lands in the top spot for men as well. But that doesn’t mean that men and women are getting the same type of liposuction or looking for the same results. “Guys don’t want to be thin, they want to be defined,” says Dr. Unger. “They want to get rid of the pudge at their waist, but they also want obliques and the manly contours that make them look stronger.” For men, it’s not just about getting rid of unwanted fat, but augmenting and enhancing muscle. “They want broad shoulders, a narrow waist, and no hips,” agrees Dr. Rogers. 

To meet the desires of the male clients, Dr. Rogers, Dr. Unger, and many surgeons are using body contouring techniques with their liposuction. “I use the term lipo-sculpting or soft-definition liposuction,” says Dr. Unger. “The days of just removing fat and saying ‘job well done’ are over. What it really is now is definition liposuction.” That means not only removing fat, but doing it with the purpose of enhancing or creating muscle contours. 

In Dr. Rogers’ case, it also means sometimes redepositing the fat in other areas to further augment muscles. It’s particularly common, he says, in patients who want liposuction on their chest area. He often “puts some fat under the muscle or into the muscle to build the pectoral back up,” he says. “You actually still have volume, but it just looks like muscle versus fat.”

While there is no way of telling how many men are going to liposculpture or fat grafting for muscle augmentation since the ASPS does not differentiate between those procedures and liposuction, both doctors see in their own practices that it’s becoming the standard in male liposuction.

## __2. Gynecomastia (Male Breast Reduction)__
[Gynecomastia surgery](https://aedit.com/procedure/male-breast-reduction), or male breast reduction, is one of the other most common cosmetic procedures among men year over year. That’s partially because only men get it. Gynecomastia is the medical term for enlarged or feminized breasts in men and the surgical procedure usually involves removing the tissue in combination with liposuction to contour the area. Gynecomastia as a condition is common and affects about half of males at birth and one in four men age 50 to 69, [according to the Mayo Clinic](https://www.mayoclinic.org/diseases-conditions/gynecomastia/symptoms-causes/syc-20351793). 

As Dr. Rogers notes, however, getting a male breast reduction does not necessarily mean you’re getting a textbook gynecomastia procedure. “I have a lot of patients who are asking for liposuction or contour on their chest,” he says. “You could put them into the same category because I’m working on their chest, but they’re not there for gynecomastia specifically.” No matter how you slice it, whether these men are getting true gynecomastia surgery or not, it’s clear that procedures to augment and contour the chest are increasingly popular.

## __3. Blepharoplasty (a.k.a. Eyelid Surgery)__
“Men will come in and say, ‘I look tired and I look old’ but they don’t want a face lift,” says Dr. Rogers. The solution: an [eye lift](https://aedit.com/procedure/blepharoplasty-eyelid-surgery). Most men first notice signs of aging around their eyes and typically complain about eye bags or excess eyelid skin that they feel makes them look older. It’s expected, then, that blepharoplasty is consistently among the most popular procedures for men.

Eye lifts are performed on either the upper or lower lids (often both) and remove excess skin to smooth wrinkles and make the eye area appear smoother and more youthful. They’re popular among male patients, says Dr. Rogers, because they are relatively simple procedures that offer big results with little down time. “It’s a simple surgery,” he says. “The recovery is easy and there is little to no sign that you’ve had anything done.”

Dr. Unger notes that blepharoplasties among men are popular not only because, when performed properly, they aren’t obvious, but also because the results are subtle. “For men, it’s less about trying to be youthful and more about erasing the more obvious signs of aging around the eyes,” he says. 

## __4. Hair Transplant__
“Hair transplants are getting crazy popular,” says board certified plastic surgeon [Ben Paul, MD](https://aedit.com/provider/benjamin-paul-md-392), in New York City, who specializes in hair transplants and other hair-related procedures. [According to the American Hair Loss Association](https://www.americanhairloss.org/men_hair_loss/index.html), about two-thirds of men experience hair loss by the time they are 35 years old. That number climbs to 85 percent by the time they reach 50. The main culprit is androgenic alopecia (commonly referred to as male pattern baldness), and, as the name suggests, it is one of the issues men deal with most.

It’s understandable that hair transplants would be among the most popular cosmetic procedures for men, but one of the reasons that more men are seeking them out these days is that there have been technological advances that allow them to work better and leave less scarring. “In the past, the donor site was approached with a very big punch and many groups of hairs were transplanted together,” says Dr. Paul. That old way of doing it is what we call ‘hair plugs’ — and wasn’t very aesthetically pleasing.

“The average person has roughly 2.3 hairs per follicle,” he says. “Currently we do something called [follicular unit extraction](https://aedit.com/procedure/follicular-unit-extraction-fue) and that technique involves just taking the fundamental unit of hair (the follicle).” Individual donor follicles are taken from the back of the head and then transplanted into another area. “You can take up to half of the hair from the donor site before there is any visual decrease in density,” he says. The procedure has gotten so good, he says, that “we’re able to harvest through really small holes, so the healing is very rapid and the entire procedure is scalpel and suture free.”

While the procedure is time consuming (the average procedure takes six to eight hours), Dr. Paul says “the success rate is high with these techniques because you’re transplanting from your own body and you don’t have to worry that you’re going to reject yourself.” These new techniques are also effective treatments for facial hair and eyebrow hair.

## __5. Rhinoplasty (a.k.a. Nose Job)__
“A third of all the rhinoplasties I do are on men,” says Dr. Rogers, illustrating just how popular nose jobs are among men who get cosmetic surgery. “They’re great because they can completely change the way your face looks in one procedure and can make an enormous difference.”

Men, however, are usually looking for something different than women when it comes to their [rhinoplasty](https://aedit.com/procedure/rhinoplasty-nose-job). “In general men want a more masculine nose,” he says. “They usually want it a little straighter and less of what’s called a super tip break (when there is a little tip above the tip of the nose). They also usually want it a bit bigger.”

That’s because smaller noses tend to read more feminine, says Dr. Unger, as does an “overly-sculpted nose.” He’s noticed that his male rhinoplasty patients don’t want their noses to look too perfect. “They want to retain some flaws: not perfectly straight, not a perfectly refined tip, a little hint of a hub. It looks more natural and more masculine.”

## __6. Dermal Fillers__
Not all men who seek out cosmetic procedures are ready to go under the knife. [Dermal fillers](https://aedit.com/aedition/everything-you-need-to-know-about-dermal-fillers) are more common among men than surgical procedures that could address the same issues. Hyaluronic fillers like Juvederm® and Voluma® are typically used to replenish lost volume in areas like the cheeks, while poly-L-lactic acid (PLLA) and calcium hydroxyapatite (CaHA) fillers like Sculptra® and Radiesse® (respectively) are used because one of the most common places men want filler is along the jawline. 

“Men ask for filler along the jawline more than women,” says Dr. Rogers. “It can help with jowls because when you start getting them, you can make them go away with filler.” For many men, a sharp chin and strong jawline are signs of masculinity and youth, so using filler to keep the skin around the jaw from sagging is a common request.

## __7. Neurotoxin Injections__
Let’s just agree to stop calling it Brotox. [Neurotoxins](https://aedit.com/aedition/comparing-neurotoxin-botulinum-type-a-injections-botox-dysport-jeuveau-xeomin) like Botox®, Dysport®, Jeuveau®, and Xeomin® are by far the most common cosmetic procedure for men. These injectable toxins smooth wrinkles on the forehead, between the eyebrows, and around the eyes, which makes them an easy way for men to combat visible signs of aging. 

Men, however, are not always looking for the same results as women. “Men can get away with some lines,” says Dr. Rogers. “Frankly, sometimes it looks better for them to have some.” His male patients are usually looking to smooth very deep wrinkles, but not completely erase lines altogether. The biggest thing men should consider when getting Botox®, he says, is who is administering it. “A lot of people have a ton of experience treating women, but not necessarily with men,” he warns. “You don’t want to get treated exactly the same way because you may get a frozen look.” Men usually need less neurotoxin to get the results they want.

More than 1.3 million men went under the knife (or needle!) in 2018 — a 29 percent increase since the year 2000 — and The AEDITION asked the experts about the most popular invasive and non-invasive cosmetic procedures. 