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Elise Wilcox/Unsplash

Whether you're just starting to research neuromodulators or a seasoned injectables lover, chances are you'll have questions about the new kid on the block: [DAXXIFY®](https://daxxify.revanceaesthetics.com/ "https://daxxify.revanceaesthetics.com/"). The FDA has recently approved the injectable to address common signs of aging, but how does it compare to the classics like [Botox®](https://aedit.com/procedure/botox "https://aedit.com/procedure/botox"), [Dysport®](https://aedit.com/procedure/dysportr "https://aedit.com/procedure/dysportr"), or [Xeomin®](https://aedit.com/procedure/xeomin "https://aedit.com/procedure/xeomin")? What would make your injector prefer this new option over its tried-and-tested counterparts? And just how safe is it? Let’s unpack everything you need to know.

__WHAT IS DAXXIFY®?__

The [American Board of Cosmetic Surgery](https://www.americanboardcosmeticsurgery.org/ "https://www.americanboardcosmeticsurgery.org/") defines DAXXIFY® as "an injectable neurotoxin that is FDA-approved to treat glabellar lines (frown lines between the eyebrows—commonly referred to as the "11s")." While the active ingredient used in the injectable is the same as many of its predecessors, the main difference with DAXXIFY® is longer-lasting results. Depending on several lifestyle factors and your metabolism, DAXXIFY® can produce results that last six-to-nine months, compared to two-to-three months for other products. The injectable also uses a novel peptide stabilizer, making it suitable for vegans. 

__WHICH AGING CONCERNS CAN DAXXIFY® ADDRESS?__

Qualified injectors can use the product on the upper area of the face to treat concerns such as horizontal frown lines, crow's feet, and of course, those pesky 11s between your brows. It works similarly to Botox® by delivering a botulinum toxin to the injection site. Over a short period, the toxin blocks specific nerve signals to prevent muscles from moving, leaving the area looking smoother. 

__HOW DOES DAXXIFY® COMPARE TO BOTOX? __

The neuromodulator in DAXXIFY® is the same as the one used in Botox, but the real difference comes into play with the stabilizer we mentioned above. Firstly, DAXXIFY®'s stabilizer makes it the first vegan neuromodulator on the market, a massive advantage for those who may have been putting off getting injectables for ethical reasons. Secondly, this new and improved stabilizer appears to help prolong results by several months for some people. The main downside to DAXXIFY® compared to Botox is that, in rare cases,  some people have reported it takes longer for side effects to pass. This may be due to the stabilizer being longer lasting, but there isn't sufficient evidence to confirm why this might happen yet.

__HOW LONG DO DAXXIFY® RESULTS LAST?__

If you're used to getting injectables for signs of aging, you'll probably have regular appointments at your medspa every two or three months. But if you decide to switch to DAXXIFY®, you could be seeing a lot less of your favorite injector. Results from the new injectable can last up to six or even nine months. The length of time your results last will vary depending on your lifestyle (for example whether or not you smoke or drink alcohol), how quickly your body processes the product, and other factors, including your age, the location of the injections, and the injection technique used. Your injector will be able to discuss how long they expect results to last for your specific case. 

__HOW MUCH DOES DAXXIFY® COST?__

As with most procedures, fees vary depending on your provider's location and experience. The average cost per unit currently sits at $17 across all states. To give you an indication of how many units you will need, the standard measure is 20 units to treat the forehead and 40 units each for 11s and crow's feet. To get an accurate quote for your circumstances, it's always best to schedule a consultation with your injector to establish how many units they expect you will need. They will be able to discuss how long it may take to see results and whether you will need multiple treatments to achieve your desired outcome.

__IS DAXXIFY® SAFE FOR EVERYONE?__

DAXXIFY® is generally considered safe for healthy adults. It is not suitable for children or if you are pregnant. When you have a consultation, your practitioner will look at your medical history and ask about any allergies to ensure you're a good candidate for the procedure. As with any procedure, there are some potential risks and complications, including muscle weakness, blurred vision, and drooping eyelids. Allergic reactions are rare but possible, and your practitioner will be trained to respond to these if they were to occur. 


__PATIENT PERSPECTIVE__

We spoke to two patients who have opted to include DAXXIFY® as part of their rejuvenation treatments. These patients' names and locations have been modified to protect their privacy.

__Anna, 37, Los Angeles__

*__AEDIT:__* How was your DAXXIFY® injection experience?
*__Anna:__* I hadn't ever had any tweakments before going in for the treatment, so everything was new to me. I'd consulted a dermatologist my friends recommended, and initially didn't know which product I wanted – I didn't go in specifically looking for DAXXIFY®. My doctor discussed the pros and cons of different anti-aging injectables. Together, we decided that longer-lasting results would suit my lifestyle better because I travel a lot for work. 

*__AEDIT:__* Are you happy with the results of the procedure?
*__Anna:__* The injections achieved exactly what I had hoped they would, yes! My main concern was frown lines, and they have disappeared. So far, I'm four months post-injection, and I'm still as happy with the results.

__Josie, 54, Dallas__

*__AEDIT:__* How has DAXXIFY® compared to other injectables you’ve had in the past?
*__Josie:__* I've been getting Botox for a good few years now and was happy with the results it offered. My injector spoke to me about the possibility of switching to DAXXIFY® because, in her experience, people were getting even smoother results, which was very tempting. We went ahead, and I have to say I think my forehead is smoother than it was with Botox, and the results are certainly lasting well.

*__AEDIT:__* Do you have any advice for people considering having the procedure?
*__Josie:__* I found my experience after the injections slightly different compared to Botox, but it wasn't unpleasant. I would say the results took a little longer to take effect, and I was a little more tender for a couple of days following the injections – but that could have just been because I was hyperaware, knowing my injector had used a different product.


Aesthetics

Everything you need to know about DAXXIFY®

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You’ll be hard pressed to find someone who hasn’t experienced a breakout at some point in their life. According to the American Academy of Dermatology (AAD), acne is the [most common](https://www.aad.org/media/stats-numbers) skin condition in the United States, with upwards of 50 million Americans dealing with it annually. 

Some 85 percent of adolescents and young adults between the ages of 12 and 24 experience at least mild acne, and it’s not exactly like those pesky pimples magically disappear in adulthood. A [study](https://jamanetwork.com/journals/jamadermatology/fullarticle/479093) in the *Journal of the American Medical Association* found that 40 to 54 percent of adults over the age of 25 have some degree of facial acne. Adult acne is considered more common in women than [men](https://aedit.com/aedition/how-to-treat-adult-acne-in-men), though it is increasingly impacting people in their [thirties](https://aedit.com/aedition/best-skincare-routine-products-ingredients-for-30s), [forties](https://aedit.com/aedition/best-skincare-routine-products-ingredients-for-40s), and beyond. 

While there are an array of [professional treatments](https://aedit.com/aedition/best-professional-treatments-for-acne-and-acne-scars) and [at-home skincare](https://aedit.com/aedition/best-skincare-ingredients-to-treat-acne-blackheads-whiteheads) that can treat various aspects of breakouts, dermatologists and plastic surgeons haven’t had a singular [solution](https://aedit.com/procedure/acne-solutions) to offer patients that targets acne at the source without a laundry list of side effects – until now. In March, Cutera received clearance from the U.S. Food and Drug Administration for [AviClear™](https://www.cutera.com/solutions/aviclear/), a first-of-its-kind energy device for the treatment of mild to severe acne, and it is being hailed as the biggest acne breakthrough in decades. Here’s what you need to know.

## **What Is AviClear?**
[AviClear™](https://aviclear.com/) is the first and only FDA-cleared energy device for the treatment of mild to severe acne. “What’s amazing is that it works on all types of acne – whether it’s cystic acne, inflammatory acne, hormonal acne, mask acne,” says [Arash Moradzadeh, MD](https://aedit.com/provider/arash-moradzadeh-md-430), a board certified plastic and reconstructive surgeon in Beverly Hills, CA. “Regardless of what type of acne you have, it’s very effective.”

The laser treatment, which is safe for all [skin tones](https://aedit.com/aedition/guide-to-fitzpatrick-skin-types), uses a 1726-nanometer wavelength to address the source of breakouts. Acne forms when sebum (read: oil), dead skin cells, and bacteria on the skin get trapped in the pores. AviClear™ works by selectively targeting oil glands, so that they produce less oil and, over time, less acne without damaging the rest of the skin. “The laser is actually being absorbed by the sebaceous glands, causing them to be down regulated, or destroyed, so that you then have less acne,” Dr. Moradzadeh explains. 

## **Who Is the Ideal Candidate for AviClear?**
One of the most compelling things about AviClear™ is just how inclusive the treatment is. “Unlike other lasers that you can’t use on [dark skin](https://aedit.com/aedition/best-laser-skin-hair-removal-treatments-for-darker-skin-tones), you can do this on anyone,” Dr. Moradzadeh says. It also doesn’t discriminate against certain types of acne, which means it can treat patients from adolescence through adulthood. Unsurprisingly, “teenagers are one of the main groups that want this treatment,” he says – though it’s not just about short-term relief. Less acne for less periods of time will likely mean less scarring down the road. “They can get treated early and avoid getting acne scars that are then very difficult to treat and cover,” Dr. Moradzadeh shares. 

Additionally, AviClear™ is an in-office, energy-based procedure, which means it doesn’t require prescription or over-the-counter topicals, oral medications, or patients remembering to do anything at home. “You are avoiding chemicals, antibiotics, and difficult regimens that some people can’t stick to and abide by,” he says. “For example, a lot of women don’t want to be on birth control for their hormonal acne, so this is giving them a non-chemical, safe alternative.” 

## **How Does AviClear Treatment Work?**
The treatment protocol for AviClear™ is three sessions, spaced one month apart. Dr. Moradzadeh says each appointment treats the entire face – not just the areas you are prone to breakouts. “When you do the treatment, you are doing it over the whole face,” he shares. “Over the course of your three treatments, you are effectively treating all of the sebaceous glands.”

As Dr. Moradzadeh explains, patients are asked to wash their face upon arriving at the office, before the skin is “degreased” with acetone and “rehydrated” with water to improve contact. After the 15 to 30 minute treatment, he says most patients are “a little bit pink” for about 15 minutes. “There is really no downtime,” he shares. In fact, “most of my patients actually love the way they look after they leave because of that kind of micro-swelling glow in the skin,” Dr. Moradzadeh says. The effect “actually makes their acne look less visible when they walk out,” he adds. Patients can resume activities immediately after treatment.

![AviClear Before & After-2](//images.ctfassets.net/zw35sfestf1t/3iPwQlkdTBNgLWzVCIvgcT/952b4fca323e39b72051fed8e4385809/AviClearBA2.PNG)

If you’ve had a [laser treatment](https://aedit.com/aedition/guide-to-ablative-laser-skin-resurfacing) in the past, you may be wondering about the comfort level. The AviClear™ device features a built-in sapphire cooling technology and sensory controls that work to maintain the skin’s temperature throughout the session. As such, “the treatment itself is relatively comfortable,” Dr. Moradzadeh says. “It feels a little bit hot with a needle-like sensation, but you do not require any pain medication or [numbing cream](https://aedit.com/aedition/numbing-cream-breakouts) at all.”

During the three months of treatment (and the months that follow), Dr. Moradzadeh says patients can carry on with their existing breakout-busting routine – including prescriptions like [Accutane](https://aedit.com/procedure/accutane), [spironolactone](https://aedit.com/procedure/spironolactone-for-acne-treatment), and [tretinoin](https://aedit.com/procedure/tretinoin). “You are not limited like you normally would be,” he explains. “If someone is already on Accutane, they can actually still get this treatment and then transition off their Accutane; if someone is already on spironolactone or an antibiotic or a skincare regimen, they can continue that during this treatment and then taper off.” The net-net: “Nothing has to really change,” he says.

Even so, it’s important to share your current skincare regimen with your provider to ensure you are setting yourself up for success. “I usually just review their protocol and see if there is anything better they could be doing as they get through the first six months to their clearer skin,” Dr. Moradzadeh notes. One non-negotiable during treatment? [Sunscreen](https://aedit.com/aedition/best-sunscreens-of-2022). “In terms of photosensitivity, the only thing we recommend is that you must wear sunscreen every day,” he emphasizes.

## **What Are the Results of AviClear?**
If you are familiar with Accutane, you may know that it is a brand name for isotretinoin, a potent form of vitamin A that was approved by the FDA in 1982 for the treatment of severe, resistant, nodular acne that is unresponsive to conventional therapy. The orally prescribed medication treats acne by reducing the size of oil glands and the amount of oil they produce. The results can be life-changing ([read one patient’s experience here](https://aedit.com/aedition/what-its-like-to-take-accutane)) and lasting, but it is not without a litany of side effects that makes it a difficult choice for many.

What makes AviClear™ so unique is that it treats acne in the same way, but it does so without the additional quality of life impacts. We’re highlighting the similarities between the two because the results of AviClear™ are similar to those of Accutane. “The results that have been seen are equal to Accutane, and you are also avoiding Accutane and the side effects,” Dr. Moradzadeh says. It should be noted that, during clinical testing, no significant adverse effects were observed.

So, what does that mean in practice? “When you first start Accutane, there is this phenomenon called ‘the purge’ where you get a breakout,” he explains. “With AviClear™, it is very similar.” One to two weeks after your first treatment, you can expect to have a purge period. “After your second treatment, you see less of that,” he shares. “And then, three months after your third treatment, you notice a significant reduction in your acne.” About six months after your third treatment, “you will usually love your skin,” he notes.

![AviClear Before & After-1](//images.ctfassets.net/zw35sfestf1t/2rqiD6xjS9dcmiuiUwYV62/3bb0dfffc69bf0995e981e34cbab93b9/AviClearBA1.PNG)

In the clinical studies, 80 percent of patients saw at least half of their acne clear after three treatments, and 87 percent said they were “satisfied” or “very satisfied” at week 12. The results continued to improve over the course of six months. Furthermore, any breakouts patients experienced post-treatment were reported to be shorter with fewer and smaller flare-ups. 

While AviClear™ has not yet been studied for the improvement of [acne scars](https://aedit.com/concern/acne-scars), Dr. Moradzadeh says some patients with “reddish- or pink-colored scars” find that they go away during treatment, while appearance of the remainder of their acne scars is minimized. “We are seeing skin quality improvements as a whole, but we have other treatments that are very specific for [acne scar management](https://aedit.com/procedure/acne-scar-solutions),” he notes.

## **The Takeaway**
As Dr. Moradzadeh says, AviClear™ is a “game changer” because it’s the first true acne innovation in more than 30 years. But it’s not just about the aesthetics of clearer skin. [Research](https://onlinelibrary.wiley.com/doi/full/10.1111/bjd.16099) has found that those diagnosed with acne are at an increased risk (40 to 60 percent greater) of developing major depression, and Dr. Moradzadeh has treated patients who don’t want to leave the house or go to school because of their skin. “Acne has such a strong impact on people’s self esteem and how they feel about themselves, and it hurts to not be able to give them something that is amazing,” he says. “So, to have something now that gives them equal results to Accutane feels good.” For the first time in a long time – or maybe ever – “treating acne is a happy thing,” he notes.

The 1726nm laser is being called the biggest acne breakthrough since Accutane.

The Benefits Of AviClear Laser Therapy For Treating Acne

Meet The Laser That Is Being Called The Biggest Acne Breakthrough In Decades

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Plastic surgery is a big business. The American Society of Plastic Surgeon’s (ASPS) [annual report](https://www.plasticsurgery.org/documents/News/Statistics/2020/plastic-surgery-statistics-full-report-2020.pdf) found that some $20 billion was spent in 2020, with 15.6 million cosmetic procedures and nearly 7 million reconstructive procedures performed. When we speak about the cosmetic end of the spectrum, we are usually dealing with out-of-pocket expenses because the treatments are generally considered elective and not medically necessary. When we talk about the reconstructive side of the industry, however, [health insurance coverage](https://aedit.com/aedition/insurance-coverage-for-plastic-surgery-cosmetic-procedures) may come into play.

In June 1989, the American Medical Association (AMA) adopted definitions of ‘cosmetic surgery’ and ‘reconstructive surgery’ that are used by insurance providers to determine coverage:

- **Cosmetic Surgery**: Performed to reshape normal structures of the body in order to improve the patient’s appearance and self-esteem.
- **Reconstructive Surgery**: Performed on abnormal structures of the body, caused by congenital defects, developmental abnormalities, trauma, infection, tumors, or disease.

If you clicked on this article, it’s probably because you are considering a breast surgery of some kind. So, what does the ‘cosmetic’ versus ‘reconstructive’ distinction mean to you? If you are simply looking to up your cup size, you can pretty much count on paying for your [breast augmentation](https://aedit.com/procedure/breast-augmentation-solutions) yourself. But there are certain reasons why breast implants and other enhancement procedures may fall into the ‘reconstructive’ category. Additionally, [breast reduction](https://aedit.com/procedure/breast-reduction-and-revision-solutions) is one of the most common procedures insurance might cover.

To better understand what factors into whether or not a [breast surgery](https://aedit.com/concern/breast-shape-and-size) is covered by insurance, we’re breaking down some of the key criteria you need to know to make your case.

## **Why Breast Surgery May Be Covered By Insurance**
The fact of the matter is that there are no guarantees when it comes to insurance coverage. “Nobody knows what will qualify, as there are no guidelines that say, ‘if you have this, you qualify,” says [Richard J. Brown, MD](https://www.richardjbrownmd.com/), a board certified plastic and reconstructive surgeon in Scottsdale, AZ. “It is totally at the discretion of the insurance company.” Even so, there are some circumstances that, with proper documentation, may mean a procedure is eligible for coverage.

### **1. Post-Mastectomy Reconstruction**
Perhaps the most straightforward situation on the list, the 1998 [Women’s Health and Cancer Rights Act](https://www.cancer.org/treatment/finding-and-paying-for-treatment/health-insurance-laws/womens-health-and-cancer-rights-act.html) mandated that group health plans that cover [mastectomy](https://aedit.com/aedition/what-to-expect-before-during-after-mastectomy-breast-cancer) (for both breast cancer prevention and treatment) must also cover [breast reconstruction](https://aedit.com/aedition/comprehensive-guide-to-breast-reconstruction-nipple-reconstruction-after-breast-cancer). It should be noted that Medicare covers bilateral breast reconstruction in post-mastectomy patients, too. Reconstruction can be performed in a variety of ways depending on the anatomy and aesthetic goals of the patient, and prostheses (i.e. [breast implants](https://aedit.com/procedure/breast-augmentation-with-implants)) are an option. Whether it is a unilateral or bilateral mastectomy, insurance providers must cover reconstruction for both breasts. 

In these cases, surgeons do not need to document symptoms or trials of alternative treatment. “For breast cancer, I do not have to document, as they already have a diagnosis,” Dr. Brown explains. “If it is for revision reconstruction, I document what I feel I can do to make the reconstruction better, if that is possible.”  

### **2. Shoulder, Neck, & Back Pain**
Anyone that suffers from back, neck, or shoulder pain knows just how debilitating it can be. Whether the pain is attributed to injury, [poor posture](https://aedit.com/aedition/how-to-improve-your-posture), or breast size, treating the pain can be a challenge. This is especially true if the discomfort is caused by a large chest. [Research](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3322448/) has found a correlation between breast size and chronic back pain, and it is believed it may have to do with the curvature of the spine due to the weight of the breasts. As a result, insurance companies may cover a breast reduction to improve quality of life. 

### **3. Inability to Exercise**
Exercising is challenging enough as is, but, for some women, it is made even more difficult by large breasts. As you move, so do your breasts and that can be very painful while doing high intensity – or even low intensity – workouts. Finding sports bras that are supportive and containing enough may not be possible, with some even doubling up on them. Some women with large breasts are not able to get the health benefits associated with fitness, which can help create the case for a medically necessary breast reduction.  

### **4. Significant Asymmetries**
From head to toe, [asymmetry](https://aedit.com/aedition/cosmetic-procedures-for-body-asymmetries) is inevitable. No body – literally or figuratively – is perfect, and most females find that their breasts are uneven. For the large majority of people, correcting breast asymmetry is not a medical necessity. But for certain cases of asymmetry as a result of trauma, disease, infection, tumors, or genetic conditions that cause large size discrepancies, there may be a conversation to be had with your insurance company. 

### **5. Rashes** 
Chronic rashes under the breasts can be a reason for insurance to cover a reduction surgery. Because large breasts often droop and cover other areas of the chest, it can cause skin-to-skin friction (intertrigo) and/or make it difficult for sweat to evaporate. In normal circumstances, sweat produced in the inframammary fold (i.e. the breast crease) evaporates on its own, but, for women with larger breasts, the damp environment can cause irritation and rashes. 

### **6. Bra Strap Grooves**
Ever notice indentations on your shoulders when taking off your bra at the end of the day? It’s usually a sign that the undergarment was overburdened or ill-fitting. While this nuisance is usually a once-in-a-while thing for most, some bigger-busted ladies have permanent grooves from their bra straps because the breasts are simply too heavy to be properly supported. Alone, these markings may not be enough of a reason to warrant a reduction, but they can be supporting evidence (pun intended) when building a case. 

### **7. Headaches**
Can large breasts be headache-inducing? According to [research](https://pubmed.ncbi.nlm.nih.gov/20048598/), the answer is yes. Studies show a link between chronic headaches and macromastia (large breasts), and women who previously suffered from headaches or migraines reported improved wellbeing post-breast reduction. The exact connection between the two isn’t fully understood, but it is believed that the weight of the breasts can be a stressor to the muscles in the head, just like in the back, neck, and shoulders. 

### **8. Faulty Breast Implants**
Just as insurance companies will cover breast implants for mastectomy patients, they may cover the removal of said implants if it is determined to be medically necessary to do so. ‘Medically necessary’ reasons can include: 

- Implant rupture
- Severe [capsular contracture](https://aedit.com/aedition/capsular-contracture-breast-implants)
- Infection
- Chronic breast pain
- Breast implant-associated anaplastic large cell lymphoma ([BIA-ALCL](https://aedit.com/aedition/heres-what-you-need-to-know-about-the-allergan-breast-implant-recall))

Even for reconstruction patients, coverage for [breast implant removal](https://aedit.com/procedure/breast-implant-removal) or [replacement](https://aedit.com/aedition/guide-to-replacing-breast-implants) is not a given. “Beyond initial reconstruction, insurance is not obligated to cover any breast reconstruction revisions,” Dr. Brown shares. But “the fact of the matter is they pretty much cover it all,” he adds. With that said, insurance companies rarely, if ever, cover revision if the primary surgery was for cosmetic purposes.

## **How to Build a Case for Insurance**
So, how do you get insurance to cover your breast surgery? The reality of the situation is that it takes time and patience. With the exception of post-mastectomy breast reconstruction patients, evidence must be submitted to your insurance provider and pre-authorization must be gained before moving forward with the procedure. Insurance companies aren’t going to just pay for anyone’s breast surgery. In the case of [reduction mammaplasty](https://aedit.com/aedition/best-questions-to-ask-before-a-breast-reduction) (a.k.a. breast reduction), you need documentation that demonstrates why you need the procedure, including some or all of the following:

- **Photography**: Standardized photography of the breasts taken by a medical professional is usually required to visualize the breast hypertrophy, or overgrowth of breast tissue.
- **Symptoms**: Chronic symptoms, like many of those listed above, must be experienced for at least six months (though usually a year or more) before building a case.
- **Alternative Treatment**: Proof of unsuccessful non-surgical treatments, including visits to a physical therapist, chiropractor, or orthopedist, supervised weight loss, or the inability for rashes or other skin conditions to be cleared up by a dermatologist, must be submitted.
- **Surgical Plan**: Your board certified plastic surgeon will need to share the approximate amount of tissue they plan to remove from each breast based on your weight and height. Insurance companies have specific parameters for how much needs to be excised in order for the reduction to be considered medically necessary.
- **Surgeon’s Statement**: Additionally, your medical team will need to share their opinion on why your symptoms are best treated with breast reduction surgery.

Not all health insurance companies will require all of these criteria be met, but, according to a [2020 paper](https://journals.lww.com/plasreconsurg/Abstract/2020/08000/Insurance_Denials_in_Reduction_Mammaplasty__How.6.aspx) published in *Plastic and Reconstructive Surgery*, pre-authorization denial rates for breast reduction surgery have increased steadily over the last five years. The researchers note that the factors for precertification “are used arbitrarily, without scientific evidence, and are inconsistent with clinical practice,” making it difficult for patients and providers alike. 

These discrepancies are why Dr. Brown always tries to manage expectations. As he explains, “neck pain, back pain, bra strap grooves, headaches, rashes under the breast, [and] inability to exercise because they need several bras” are all legitimate reasons to consider breast reduction surgery, but these symptoms “do not guarantee” coverage by insurance. “They still can be denied,” he shares. “And often insurance wants proof of PT [physical therapy] and OT [occupational therapy] to avoid surgery.”

Needless to say, building a case for preauthorization isn’t something you do on your own. Your primary care physician, PT or OT specialists, and board certified plastic and reconstructive surgeon will all be part of the process. Dr. Brown’s approach? “I just tell the story,” he notes. “I describe the symptoms, and what is going on, and make comments on whether I feel it is medically necessary or not.” 

In addition to the symptoms described above, insurance providers usually use the controversial [Schnur Sliding Scale](https://pubmed.ncbi.nlm.nih.gov/30557179/) to calculate how much breast tissue should be removed. “[It] is a formula that based on height, weight, and other factors predicts how much they should have removed, and it is so imperfect,” Dr. Brown cautions. “They use that against how much the surgeon says they think they can remove, and, if those numbers are off by too much, they may deny.”  Some insurance companies will also require the surgeon performing the procedure is in-network, so be sure to clear that up early on.

### **Next Steps**
If your breast reduction case gets approved, insurance will cover the cost of the surgery – with some stipulations. You will need a post-operative report that shows the procedure was carried out in accordance with the pre-authorized plan. That includes being operated on by an in-network surgeon at an accredited facility (usually a hospital) and having the mandatory amount of tissue removed. 

## **The Takeaway**
Unfortunately, there are no ‘sure things’ in insurance, but there are steps you can take to improve your chances of coverage. In addition to careful documentation, one of the best things prospective patients can do is work with a board certified plastic surgeon who specializes in the procedure they are interested in. They will likely have a lot of experience navigating the pre-authorization process, and they should also be expert in delivering the most medically and cosmetically pleasing result for your anatomy and aesthetic goals.

From breast reduction to post-mastectomy reconstruction, here’s what you need to know.

A Guide To Insurance Coverage For Breast Reduction And Breast Reconstruction

Thinking About Breast Surgery? Insurance Might Cover It

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Injectables are constantly evolving, and what was considered the gold standard yesterday may be passé by tomorrow’s standards. One class of injectables that has largely proven to be trend-proof: [Neuromodulators](https://aedit.com/aedition/comparing-neurotoxin-botulinum-type-a-injections-botox-dysport-jeuveau-xeomin) and their ability to limit muscle contraction and soften the look of fine lines, wrinkles, and other age-related concerns. In fact, [Botox® Cosmetic](https://aedit.com/procedure/botox) is celebrating the twentieth anniversary of its approval by the United States Food and Drug Administration (FDA) for the temporary improvement of the appearance of moderate to severe frown lines in adults. It was the first of its kind when it entered the market, and it’s since been joined by [Dysport®](https://aedit.com/procedure/dysportr), [Jeuveau®](https://aedit.com/procedure/jeuveau), and [Xeomin®](https://aedit.com/procedure/xeomin). 

Since no two faces are the same, no two dosages of these products are necessarily the same to achieve a desired result. That’s where so-called ‘Botox sprinkles’ – also known as ‘baby Botox’ – come into play. Not to be confused with [microbotox](https://aedit.com/aedition/aquagold-botox-microdosing-facial), the sprinkle technique is essentially just a smaller dose of a neuromodulator. A modest amount of Botox® and the like may produce a more natural result for younger patients or newbies who are just dipping their toe into the wrinkle-relaxing pool and concerned about appearing frozen.

So, what are the pros and cons of Botox sprinkles, and how can you tell if you are a candidate? We tapped top dermatologists and plastic surgeons for the scoop.

## **What Are Botox Sprinkles?**
A tongue-in-cheek reference for a smaller dose of a neuromodulator, the term ‘Botox sprinkles’ are injections of Botox®, Dysport®, Jeuveau®, or Xeomin® into a specific part of the face to soften the look of fine lines and wrinkles without eliminating all movement. “Botox sprinkles are great for smoothing fine lines and wrinkles on the face without completely removing muscle movement,” says [Michele Green, MD](https://aedit.com/provider/michele-green-md-34642), a NYC-based board certified dermatologist.

The trend of less-is-more shows no signs of slowing down, and some injectors and patients are preferring to use minimal amounts of neuromodulator to preserve expression. At his Arlington, VA, practice, double board certified facial plastic and reconstructive surgeon [Jonathan Cabin, MD](https://aedit.com/provider/jonathan-cabin-md-956), says a large percentage of his patients opt for these treatments to soften facial wrinkles and prevent traditional aging-related wrinkles while preserving natural movement. “It is the ideal option for [first-time Botox patients](https://aedit.com/aedition/everything-you-need-to-know-before-getting-botox-for-the-first-time) who are a bit nervous, younger patients interested in prevention, and patients who depend on powerful emotive facial expressions for their work,” he explains.

Like traditional injections of neuromodulators, the ultra-light dose version still requires a medical professional to inject botulinum toxin type A under the skin to temporarily relax the underlying muscle. A sprinkling of a neuromodulator within a particular area may provide a reduction of wrinkles and lines and their formation but not to the same degree as a standard treatment, says [Brendan Camp, MD](https://aedit.com/provider/brendan-camp-md-34645), a board certified dermatologist in New York City. Striking this balance is dependent on the [skill of the provider](https://aedit.com/aedition/botox-neuromodulator-safety). “An experienced injector will be able to determine the right amount of Botox to inject based on how strong your facial muscles are and how deep the wrinkles are,” Dr. Green says. 

The just-right amount of product will soften the visible appearance of wrinkles while limiting – but not paralyzing – the movement that causes them in the first place. Botox sprinkles aren't the best route if you want very little to no movement in the treatment areas. Using less Botox is less likely to completely paralyze the muscle and, therefore, results in more expression, says [Marisa Garshick, MD](https://aedit.com/provider/marisa-garshick-md-313), a board certified dermatologist in NYC. “Ultimately, with Botox sprinkles, you retain some movement and some wrinkles but soften the overall appearance,” she notes. Most injectable patients eschew the fully frozen look (though some want it) and the overarched eyebrows and difficulty moving that accompany it. If you specifically request baby Botox, you are less likely to have that frozen appearance since your doctor injects smaller amounts of the product.

Even though the name ‘sprinkle’ implies injecting a dusting or smidgen of neuromodulator into any one area, it's a little more precise than that. While there is no set requirement for what a sprinkle treatment consists of since each patient requires a different dose, expect about half the unit use compared to complete treatment. “For Botox sprinkles, I use as little as five units of Botox in the forehead and glabella, whereas the official dosing is 20 units for each,” Dr. Cabin says. “For the crow's feet, I use about 2.5 units per side, whereas the official dosing is 12 units per side.” Again, a consultation with your injector will dictate the best approach for you.

It should be noted that a full dosage doesn’t necessarily mean an unnatural or immobile result. If your doctor recommends using the standard dose of a neuromodulator, it still can provide a refreshed look that allows for facial movement. “However, if a patient is interested in maintaining a lot of movement, a lighter treatment with neurotoxin can be a great option,” Dr. Camp says.

## **Where to ‘Sprinkle’**
It's safe to ‘sprinkle’ the same areas of the face that providers commonly treat with larger amounts of neuromodulators – like the glabellar lines (a.k.a. the elevens), [crow's feet](https://aedit.com/procedure/periorbital-botox), and even the horizontal lines on the forehead. For the most part, smaller areas don't require as much product to begin with to erase wrinkles and lines seamlessly. Dr. Green prefers to use the sprinkle technique on areas of the face with lighter lines or where the skin is just starting to develop them. “It also works wonders in reducing mild to moderate wrinkles while still looking natural, but it often fails to yield the desired results for deeper lines etched in the skin,” she says.

## **Who’s the Best Candidate for Botox Sprinkles?**
Botox sprinkles are suitable for anyone who doesn't have many lines yet or has lines that aren't very deep but wants to prevent further wrinkles, Dr. Garshick says. “It's also good for someone who prefers a very natural look with minimal correction but still wants a refreshed appearance,” she explains. “And it can be helpful for older patients with a low-set brow or those who rely on the muscle movement to keep the eyelids and brows open to soften the movement without causing the brow to drop.”

Not everyone will benefit from a smaller dose of neuromodulator injections. While Dr. Camp says it may be a “good option” for those with minimal wrinkling who don’t require a full dose, others may find that a smaller amount of neuromodulator does not produce their desired result. Dr. Green says some patients come in expecting to get baby Botox, but, upon consultation, find out they have strong facial muscles and need more product to achieve optimal cosmetic effects. “The key to getting the best results from a neuromodulator is to go to an experienced injector, like a board certified dermatologist, who can give you natural-looking results,” she notes.

Generally speaking, the deeper the line, the stronger the muscle, and the more product needed to create smoother skin. Dr. Green explains that, with baby Botox, such small quantities of Botox are added to the muscle that it is not entirely relaxed. For deep wrinkles that are the result of overly active or strong facial muscles that repeatedly crease in the same spot for years, too little of an amount won't effectively smooth the area. “It's difficult to undo years of wrinkles with small quantities of Botox, so a regular amount is better for deep lines,” Dr Green shares. “But always ask your doctor what is best for you.”

That’s not all. As Dr. Garshick explains, Botox improves dynamic wrinkles or wrinkles that form with expression as opposed to lines at rest. Regardless of the amount of neuromodulator used, if a line is deeply etched in while at rest, it may not go away with Botox alone. “For these types of deeply etched lines, it can be helpful to also use [laser resurfacing](https://aedit.com/aedition/guide-to-ablative-laser-skin-resurfacing) or [microneedling](https://aedit.com/procedure/microneedling) treatments, which can be helpful to improve the appearance of lines at rest,” she adds.

Skin health may also play a role in who Botox sprinkles do and do not work well for. As Dr. Cabin shares, patients with mild-to-moderately etched-in wrinkles but otherwise elastic skin with healthy levels of collagen can eliminate and prevent deepening with consistent sprinkles. “But, in people with poorer skin or those that have significantly deep etched-in lines, this treatment may improve their lines a bit but will not be powerful enough for significant improvement or reversal,” he notes.

## **Does Less Botox Mean Less of a Result?**
In a single word: no. Just because you choose to go lighter on the amount of neuromodulator that is injected doesn’t mean the results are suboptimal. “Botox sprinkles can help the forehead look smoother, the wrinkles around the eyes less pronounced, and the lines between the eyebrows less deep,” Dr. Camp says. “However, the results are more subtle than standard treatments.”

Generally speaking, Dr. Green says baby Botox will yield a similar result to regular Botox, just on a smaller scale. “It is great for younger patients in their [twenties](https://aedit.com/aedition/best-cosmetic-procedures-plastic-surgery-to-consider-in-your-20s) and [thirties](https://aedit.com/aedition/best-cosmetic-procedures-plastic-surgery-to-consider-in-your-30s) who are looking to prevent fine lines and wrinkles from developing and subtly reducing the appearance of mild to moderate frown lines,” she shares.

Patient response to neuromodulators varies, and what may equate to a ‘lesser dosage’ for one person may be the standard treatment for someone else. “A ‘sprinkle’ for one could significantly decrease muscular movement for another patient,” Dr. Cabin notes. This is why first-timers are usually encouraged to come back for a follow up. “This is why I recommend two appointments with every new Botox patient,” he explains. “The first appointment is a conservative treatment, and the second appointment – two weeks later – is to see the response and if touch-ups are needed for undertreated areas.”

Certain features, like the forehead, actually respond better to smaller amounts of product versus larger quantities. For example, too much neuromodulator in the forehead can weaken the muscle in the area and force the brows to drop. “Injecting too many units can give the impression of a heavy brow,” Dr. Camp cautions.
 
As far as longevity goes, the lesser dose holds just as much weight in terms of results. It shouldn't wear away any faster or slower, so you can expect, on average, to stay wrinkle-free for about three to four months. In some patients, however, fewer units may equate to a shorter duration of results. This is especially true if the muscles are strong. But, “if the muscles are weaker, you will still notice some benefits for the same duration as expected with a full course of treatment,” Dr. Garshick says.

## **The Takeaway**
Whether it’s a preventative treatment, gateway procedure, or aesthetic preference, Botox sprinkles can serve many purposes. By using less neurotoxin, the muscle will retain more movement than a standard dosage, which can lead to a more natural-looking result. Depending on the depth of your lines, the quality of your skin, and/or your goals for treatment, baby Botox may be all you need to enjoy a more refreshed appearance. Consulting with a board certified dermatologist or plastic surgeon is the best way to determine how much neurotoxin you’ll need to achieve your desired outcome.

Dermatologists and plastic surgeons weigh in on whether using a smaller dose of neurotoxin can still be effective.

The Pros And Cons Of Baby Botox (a.k.a. Botox Spinkles) For Fine Lines And Wrinkles

Are Botox Sprinkles The Way To Go?

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Dematologists and plastic surgeons break down the differences between Morpheus8, Vivace, Infini RF, and more.

Comparing The Best Microneedling With Radiofrequency Treatments

Here’s How The Most Popular RF Microneedling Treatments Measure Up

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The invasiveness and permanency of a surgical procedure are often big considerations for those interested in going under the knife – you’ll likely have some downtime and there’s no going back. The market is ripe with non-surgical treatment options ([we recently broke down some of the most exciting advancements](https://aedit.com/aedition/best-new-nonsurgical-aesthetic-procedures)), but few cosmetic surgeries have a non-surgical counterpart that can offer similar results, sans operation. One of those unicorn pairings, however, is the ever-popular [surgical rhinoplasty](https://aedit.com/aedition/difference-between-cosmetic-rhinoplasty-vs-functional-rhinoplasty) and its less invasive sister, the so-called [liquid rhinoplasty](https://aedit.com/procedure/liquid-rhinoplasty). 

You may already know that both procedures can enhance the [shape of the nose](https://aedit.com/concern/nose-shape) and address aesthetic concerns, but, as it turns out, their commonalities don’t stop there. In fact, a liquid rhinoplasty “is a great alternative to surgical rhinoplasty for those interested in improving the side view of their nose,” says [Usha Rajagopal, MD](https://aedit.com/provider/usha-rajagopal-md-1330), a board certified plastic and reconstructive surgeon and founder of [San Francisco Plastic Surgery & Laser Center](https://www.sfcosmeticsurgery.com/). As she explains, it can even “improve some function concerns, however, it’s mostly for those who want to contour the [profile view](https://aedit.com/concern/nose-angle).” This is especially true, she says, “if they have a hump or a nasal bump.” 

<a href="https://youtube.com/shorts/UwL56Kc7LrQ?feature=share" class="embedly-card" data-card-width="100%" data-card-controls="0">Embedded content: https://youtube.com/shorts/UwL56Kc7LrQ?feature=share</a>

Since you’ve undoubtedly seen transformative [before and afters](https://aedit.com/aedition/importance-of-before-and-after-photos-in-plastic-surgery) of liquid rhinoplasty on social media, it’s time to get to the bottom of what the procedure can and cannot do. Read on for the top five things you should know about the non-surgical nose enhancement solution.

## **1. It’s a Quick – But Temporary – Fix** 
The most obvious differences between a surgical rhinoplasty and a liquid rhinoplasty: [recovery and results](https://aedit.com/procedure/rhinoplasty-nose-job/recovery). “This is not a permanent procedure and not a substitute for a [surgical rhinoplasty](https://aedit.com/procedure/open-rhinoplasty),” Dr. Rajagopal says. But, unlike a traditional rhinoplasty that requires [anesthesia](https://aedit.com/aedition/everything-you-need-to-know-about-anesthesia) to perform, a couple months to [recover](https://aedit.com/aedition/rhinoplasty-recovery-healing-process), and a year or more for [full healing](https://aedit.com/aedition/how-long-does-it-takes-to-recover-from-cosmetic-surgery-procedures), it’s non-surgical counterpart “is only 10 minutes long and requires no downtime with minimal discomfort,” she notes. 

<CaptionImg url={https://images.ctfassets.net/zw35sfestf1t/73KFqQVXtqmJC9fNtOTlK9/8da13478592e7c853a81d8990bd93725/LiquidRhino3.jpg}>
  A before (*left*) and after (*right*) look at one of Dr. Rajagopal's liquid rhinoplasty patients.
</CaptionImg>

In her practice, Dr. Rajagopal uses a [Restylane®](https://aedit.com/procedure/restylane) product because “it’s hyaluronic acid and can give a nice lift to the area of treatment.” Like HA filler for other areas of the face, results last up to a year, at which point they need to be touched up. Should you experience buyer’s remorse, the filler is dissolvable via [hyaluronidase injections](https://aedit.com/aedition/hyaluronidase-to-dissolve-dermal-filler).

## **2. There Are an Array of Benefits** 
Strategically placed hyaluronic acid-based filler can shape and contour the nose. “The ideal candidate is a patient who only has one or two issues with their nose that they are unhappy with,” Dr. Rajagopal shares. For example, “if the tip plunges or dips affecting the smile,” they may be a candidate, she says. Others who may benefit from filler are those with petite sniffers. “A patient with a [smaller or shorter nose](https://aedit.com/concern/nose-size) can benefit, as the product can give them volume and elevating the nasal dorsum gives a nice aesthetic result,” she explains.

It can also work wonders for [nose bump](https://aedit.com/concern/nose-bump) concerns. “When I do a [liquid rhinoplasty](https://aedit.com/aedition/what-you-need-to-know-about-liquid-rhinoplasty), I’m actually adding product to camouflage a hump,” she explains. “I will go on either side of the bump to reduce its appearance, and, oftentimes, I will add to the tip of the nose to give it a little lift and give it a nice, smooth appearance.” 

<CaptionImg url={https://images.ctfassets.net/zw35sfestf1t/5Os1oMBPnUpi3PiuMqMPhY/d0d228eb363ffc4bc2ea160db5b69b7e/LiquidRhino2.jpg}>
  A before (*left*) and after (*right*) look at one of Dr. Rajagopal's liquid rhinoplasty patients.
</CaptionImg>

While it’s not the same as combining a [facelift and skin resurfacing](https://aedit.com/aedition/best-procedures-to-combine-with-a-facelift), [blepharoplasty and brow lift](https://aedit.com/aedition/combining-blepharoplasty-and-brow-lift), or [rhinoplasty and chin implant](https://aedit.com/aedition/combining-rhinoplasty-and-chin-augmentation), pairing a surgical and non-surgical rhinoplasty may be beneficial for those who feel prior surgery hasn’t achieved their desired look or for those who have experienced specific complications post-op – which leads us to…

## **3. It Can Address Certain Functional Concerns** 
Those who have undergone a surgical rhinoplasty may be aware of the potential complications, adverse effects, or suboptimal results. A liquid rhinoplasty may come into play for those not interested in a traditional [revision rhinoplasty](https://aedit.com/aedition/what-you-need-to-know-about-revision-rhinoplasty). “It can help some functional concerns, especially if patients have had a rhinoplasty done and have had a middle vault collapse or have the central part of the nose slightly depressed,” Dr. Rajagopal says. “This happens when some of the cartilage has been over-resected and the internal valve or the internal part of the nose hasn’t been opened up again.”

Candidates who experience [breathing problems](https://aedit.com/concern/breathing-issues) due to the projection of the nasal tip may find relief as well. “For those who have a [droopy tip](https://aedit.com/aedition/drooping-nose-from-aging), lifting it up can improve breathing function,” she shares. “Over-resected tips or nostrils can be improved.”

## **4. There Are Risks** 
We always emphasize the importance of finding a skilled injector. While no HA fillers are indicated for use in the nose area, liquid rhinoplasty can be safe and effective in the hands of a pro. Experience is particularly important in this case, however, because the nose area is at an increased risk of [vascular occlusion](https://aedit.com/aedition/risk-of-vascular-occlusion-after-dermal-filler), which is one of the most serious filler complications. “The nose has a lot of vascular structures and those connect directly to the eye or the brain,” Dr. Rajagopal explains. If filler is accidentally injected near or into a blood vessel, it can become occluded due to the pressure. Too much pressure can limit blood flow, leading to skin necrosis (read: death) and, in the most severe cases, blindness. 

Promptly dissolving the filler with [hyaluronidase](https://aedit.com/procedure/hyaluronidase) can remedy the situation without damage, but the provider must know what to look for (including how to delineate between normal [post-injection bruising](https://aedit.com/aedition/how-to-treat-prevent-bruising-after-lasers-filler-botox) and the discoloration caused by vascular occlusion). “That’s why it’s important to find an expert who knows how to handle those complications if they do occur,” she emphasizes. 

## **5. Not Everyone Is a Candidate** 
While there is a lot a liquid rhinoplasty can do, it is not for everyone. “Someone who has multiple concerns they are unhappy with and want to change may not be a good candidate,” Dr. Rajagopal says. Filler can augment the nose, but it can’t reduce its size. “Those who have a [big nose](https://aedit.com/procedure/nose-augmentation-and-nose-reduction-solutions) but want a significantly smaller shape won’t be able to achieve it,” she explains. “[Similarly], those with a wide nose – whether it’s a wide bridge or wide nostrils – may not be a good candidate.”

For some, liquid rhinoplasty can serve as an alternative to a surgical revision, but this is not a hard and fast rule. “Someone who has had a rhinoplasty done where a cartilage or silicone implant has been used and there is no space to put the product in may not be a fit for a liquid rhinoplasty,” she shares. She makes these decisions on a “case-by-case basis.”

<CaptionImg url={https://images.ctfassets.net/zw35sfestf1t/1amKjyaVhwrMNRvrQaZg9w/712e68ec614820b115a7424b63b4d78d/LiquidRhino1.jpeg}>
  A before (*left*) and after (*right*) look at one of Dr. Rajagopal's liquid rhinoplasty patients.
</CaptionImg>

## **The Takeaway**
A liquid rhinoplasty may be a ‘lunchtime’ procedure, but there’s more to it than meets the eye. Like all injections, the provider should be thoroughly vetted and the patient should go in with realistic expectations. While it can improve nose shape and contour, not every aesthetic concern can be addressed sans surgery. A consultation with a board certified plastic surgeon will help determine if you are an ideal candidate for liquid rhinoplasty. 

Did you know that a liquid rhinoplasty can address certain functional concerns? And that’s not all this non-surgical treatment can offer.

What To Know About Non-Surgical Liquid Rhinoplasty, According To A Plastic Surgeon

5 Things You Should Know About Liquid Rhinoplasty

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A seemingly quick fix treatment that has caught on like wildfire, your social media feed may have you thinking that [under eye filler](https://aedit.com/procedure/under-eye-filler) is a universal solution for common aesthetic eye concerns. While the treatment can be very effective for the right candidate, it – like just about every other cosmetic procedure – is not for everyone. 

Until recently, under eye filler was an ‘off label’ (read: not approved by the United States Food and Drug Administration) use of hyaluronic acid-based dermal fillers. Earlier this year, the [FDA approved](https://aedit.com/aedition/fda-approves-juvederm-volbella-xc-under-eye-filler) Juvéderm® Volbella XC for the improvement of infraorbital hollows in adults over the age of 21. As part of this new indication, Allergan Aesthetics will be providing training programs, including how to assess facial anatomy holistically and the identification and management of [potential complications](https://aedit.com/aedition/guide-to-cosmetic-surgery-complications), to anyone who wishes to inject. This is because injecting the tear troughs and hollows beneath the orbital rim is not without risk.

Good under eye filler can be transformative, but it can be hard to get it right. Not everyone wielding a needle is well-versed in the procedure, and not everyone who thinks they want the procedure is actually a candidate. Here, we investigate the under eye filler craze and why it's not a singular solution for all under eye concerns.

## **How Under Eye Filler Works**
For some, under the eyes lives a slight depression in the skin that absorbs light rather than reflecting it. When darkness casts a shadow on this inner part of the eye, known as the tear trough, a crease between the upper cheek and the lower eyelid becomes evident. Most patients who desire under eye filler complain of a hollow, dark, tired-looking eye that does not seem to go away, no matter what [skincare they use](https://aedit.com/aedition/best-eye-serums-for-fine-lines-dark-circles-puffiness) or do or how much concealer they layer on.

Blame your genes and the natural aging process for the cause of shadowing under the eyes. “The tissue structures supporting the eyelids weaken from aging or genetics,” says [Michele Green, MD](https://aedit.com/provider/michele-green-md-34642), a board certified dermatologist in New York City. “This weakening causes a hollowness and sagging of the skin in the under eye area, but hyaluronic acid fillers replenish volume to the area.” Although remediation with fillers is a relatively quick process, the procedure relies on dermal fillers placed into the deep hollows to replenish lost volume. Putting HA filler into deep under eye creases plumps them up so that the skin is smoother and can reflect light properly.

That, in turn, addresses more than just the tear trough. Injections can also help alleviate dark circles, which sometimes develop from volume loss in the lower eyelid fat pads, creating hollows, explains [Snehal Amin, MD](https://aedit.com/provider/snehal-amin-md-308), an NYC-based  board certified dermatologist. “By correcting underlying volume loss, shadows under the eye reduce,” he shares. “Volbella is FDA-approved for this indication, but it is imperative to seek out an experienced, qualified provider.”

Well-injected filler under the thin skin of the eyes are a great way to brighten up the eyes and reduce hollowness and that tired appearance from some of the tissues underneath the eye, says [Usha Rajagopal, MD](https://aedit.com/provider/usha-rajagopal-md-1330), a board certified plastic and reconstructive surgeon in San Francisco. She adds that smoothing out the grooves under the eye helps to improve the overall contour of the lower eyelid and, secondarily, reduce discoloration.

Since not all discoloration is an effect of shadowing and hollowing, it is crucial to identify the cause of discoloration before jumping into the under eye filler pool. For example, Dr. Amin says discoloration under the eyes can also be caused by rubbing the skin in cases of [eczema](https://aedit.com/aedition/comparing-eczema-vs-psoriasis) or allergies. And, for this type of darkness, filler isn't the answer. “Instead, [chemical peels](https://aedit.com/aedition/guide-to-superficial-medium-deep-chemical-peels) or [lasers](https://aedit.com/aedition/guide-to-ablative-laser-skin-resurfacing) best address this discoloration,” he says. 

With no downtime, the effects of under eye injections using hyaluronic acid-based filler are immediate (save for some minimal and typical [bruising](https://aedit.com/aedition/how-to-treat-prevent-bruising-after-lasers-filler-botox) and swelling). Within minutes of injecting the under eyes, patients can see a smoothness to the area, less darkness, and no more shadowing. The results generally last about a year.

## **Choose Your Injector Wisely**
This is where it starts to get a little dicey. The array of providers offering under eye filler treatment ranges from board certified dermatologists and plastic surgeons to your strip mall med-spa injector. And because those who don't hold a medical degree or have years of experience don't know the pitfalls of injections around the eye or facial anatomy, you may be putting yourself in a dangerous position by not going to a qualified provider. “The success of under eye fillers is not solely dependent upon the product used, but also the skills of the injector, their experience, and their comfort level using the filler product,” Dr. Green says. “There is an increased risk for developing unwanted side effects when performing injections with an inexperienced or unqualified injector.” 

All filler should be injected by a highly trained provider, but the under eye presents its own unique set of challenges. “This is not a med-spa procedure,” Dr. Amin cautions. “This is a medical procedure because of the complexity of the anatomy and the dangers of complications.” Additionally, the injector must be able to suss out who is a candidate and [manage expectations](https://aedit.com/aedition/how-plastic-surgeons-balance-patients-cosmetic-surgery-desires-and-safety) accordingly. For example, filler is an acceptable treatment option when a patient has a bothersome hollowness without large under eye bags, says [Jonathan Cabin, MD](https://aedit.com/provider/jonathan-cabin-md-956), a double board certified facial plastic and reconstructive surgeon in Arlington, VA. However, the addition of filler to bulging under eye bags (caused by protruding or displaced fat pads) will not do much of anything to correct the hollowness. “Patients must have realistic expectations of what can and cannot be corrected with filler and understand that filler will not improve wrinkles or primary dark circles,” Dr. Cabin explains. 

In most cases, filler cannot correct excess skin or [pigmentation-related](https://aedit.com/aedition/under-eye-hyperpigmentation) color changes to the skin. Also, people with fluctuating lower lid and mid-cheek swelling (known as malar edema) are usually not fit for filler treatment since injections can exacerbate this condition.

## **The Issues with Under Eye Filler**
Under eye filler is tricky because, as Dr. Rajagopal explains, volume deficits under the eye exist in many layers. “It can be deep and right next to the bone, just above the bone, or in the muscle layer or the skin layer,” she shares. “All these areas may need to be addressed differently in different patients.” Generally, the deeper the injection, the less visible the product. Furthermore, doctors must use a very thin filler in patients who require more superficial placement. If not, lumps, bumps, and even discoloration (i.e. the infamous blue tint) can ensue.

The most important takeaway with under eye fillers is that less is more. “A tiny amount of filler goes a long way,” Dr. Rajagopal says. “And the result should be an improvement of the area and not full correction because full correction leads to overcorrection, [overfilling](https://aedit.com/aedition/how-to-correct-overfilled-facial-features), a lumpy look, and often swelling underneath the eye.” It is important to remember that it is entirely normal to have mild depressions and some lines under the eyes. Attempting to eradicate them with too much smoothness can lead to an unnatural look.  

Overcorrection is, unfortunately, a common mistake. It creates less distinction between the cheek and the tear trough, which causes the eye to get smaller from above, says [Doris Day, MD](https://dorisdaymd.com/), a board certified dermatologist in NYC. Too much filler makes the eyes appear small and squinty and, conversely, the cheeks look disproportionately big. “When you keep filling and adding layers, the eyes can look off-balance,” she explains. “Instead, the eyes may require opening and the skin may need some tightening, but the key is not to erase those points of distinction.” When you do, “the face looks distorted, and it's a look that everyone is walking around with,” she adds.

But the aesthetic concerns related to overfilling are just the half of it. There are also more serious issues to be aware of, including:

- **Swelling**: Mild swelling for 24 to 48 hours after treatment is to be expected, but long-term [swelling](https://aedit.com/aedition/how-to-treat-minimize-swelling-after-cosmetic-surgery) that never goes away can occur. Patients with poor lymphatic drainage tend to hold onto more water and fluid in the eye area, so the addition of HA filler (which attracts water to plump) causes lasting fluid retention. Since certain fillers are more hydrophilic (meaning it holds onto water) than others, this presents the potential for the filler to puff a bit. Dr. Green adds that patients who present with bulging from water retention or sagging skin due to loss of elasticity should avoid under eye filler. 
- **Filler Migration**: Filler that moves under the eyes isn't atypical. As Dr. Day explains, migration partially occurs because of constant movement in the area and ligaments that push the filler around a bit. When filler migrates, it can shift downwards or to the side and even take on a bumpy or lumpy appearance depending on the filler used and how much of it there is. “Sometimes, we don't see the effects for months or even years later,” she notes.
- **Visible Product**: Known as the Tyndall effect, a bluish tint to the skin can occur from placing the filler too close to the surface of the skin. Some fillers are more prone to this than others. “I prefer using [Belotero®](https://aedit.com/procedure/belotero) for the tear troughs because there is no Tyndall effect,” Dr. Amin says. Although this discoloration can technically happen in any area of filler used, Dr. Cabin says it is most commonly seen under the eyes because the skin is fragile. However, he adds that your provider can prevent the Tyndall effect by injecting filler in the deeper areas (over bone) and only injecting small amounts per injection while keeping the cannula moving.
- **Vascular Occlusion**: One of the more severe complications that can arise, [vascular occlusion](https://aedit.com/aedition/risk-of-vascular-occlusion-after-dermal-filler) refers to accidentally injecting into an artery. When not immediately corrected (via HA-dissolving [hyaluronidase injections](https://aedit.com/procedure/hyaluronidase)), an occlusion can result in skin necrosis or skin death. While vascular occlusion and necrosis are rare, they do happen. Injection techniques that involve a pulling-back effect are critical, as is the correct type of injection tool (more on that below).
- **Blindness**: Blindness from filler injections is the most serious byproduct of an occlusion or blood clot that arises and blocks the typical blood flow pattern throughout and around the eyes. It's crucial to understand facial anatomy when injecting this area because there are far more blood vessels around the eye than other areas in the face. Although blindness from under eye fillers is the rarest complication, it is nothing to take lightly. A 2015 [study](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6554164/) found 98 cases of blindness related to the use of filler.

Your injector should use only [hyaluronic acid-based filler](https://aedit.com/aedition/hyaluronic-acid-filler-vs-biostimulatory-injectables) under the eyes. “Non-hyaluronic acid fillers, like [Sculptra®](https://aedit.com/procedure/sculptra) and [Radiesse®](https://aedit.com/procedure/radiesse), are too thick for this area,” Dr. Cabin says. "Also, Sculptra® and Radiesse® work over time by stimulating the body's collagen creation mechanisms, and movement around the eye can create irregularities as these fillers settle in.” While lumpiness as a result of HA filler is dissolvable with hyaluronidase, biostimulatory injectables are not reversible.

## **The Right Way to Inject Under the Eyes**
When injecting under the eyes, your injector has the choice between two different tools to prevent less-than-ideal results and complications: a [blunt-tipped cannula](https://aedit.com/aedition/guide-to-injectable-techniques-needles-for-botox-filler) (a soft plastic catheter that cannot interrupt a vessel) or a [needle](https://aedit.com/aedition/guide-to-needles-used-for-cosmetic-injectables-botox-filler). Both have their place, and it's up to your provider to choose the best one.

“The use of a blunt-tipped cannula to access the treatment area from below and just to the side of the lower eyelid is the gold standard for under eye treatment,” Dr. Cabin says. It nearly eliminates the risk of [bruising](https://aedit.com/aedition/how-to-treat-prevent-bruising-after-lasers-filler-botox), significantly reduces post-injection swelling, and also dramatically lessens the chance of a rare complication by preventing entry into the veins or arteries around the eye. “With all filler injections, injecting small aliquots while actively withdrawing the cannula helps reduce the risk of lumping or clumping and vascular or lymphatic disruption,” he adds.

All you have to do is think of how many times a day you blink to know the under eyes are an area of movement. They're anatomically complex, thin, and delicate, with an intricate network of several blood vessels and lymphatic drainage pathways. This makes filler placement more taxing than other parts of the face. “Therefore, under eye filler needs to be placed deep, just over the bone (periosteal), to be in an area that corrects the hollowness without causing any injury or disruption to the delicate structures of the under eye,” Dr. Cabin explains. “Placing the filler in a deep plane, just under the bone, also minimizes the risk of filler migration over time and will lower the risk of the Tyndall effect.”

Perhaps the best way to ensure good results (in addition to seeing a board certified dermatologist or plastic surgeon) is to make sure your injector has a deep understanding of facial anatomy, especially the periorbital area. “Many doctors inject filler as they withdraw the needle out of the skin; in other words, they push the plunger on the syringe as they pull the syringe backward,” Dr. Amin says. This technique prevents cannulation of blood vessels and limits the risk of intravascular filler injections.

## **Taking a Holistic Approach**
The features of the face live in [harmony](https://aedit.com/aedition/facial-harmony-in-aesthetic-medicine), not isolation. To ensure that the under eyes look natural and not artificially augmented, Dr. Rajagopal says to look at the face as a whole. “When you look at a beautiful face, it's the entire face,” she shares. “Generally, not just one area makes someone beautiful, but rather a complement of how one area flatters the other.” Selectively filling the under eye and failing to treat the surrounding areas, like the [cheeks](https://aedit.com/aedition/cosmetic-procedures-to-define-cheekbones), isn't usually the best approach. “Often, the eyelid-cheek conjunction is in continuity,” she shares. “So, to give the best results, it's important to inject part of the cheek along with the lower lid.”

A higher cheekbone or zygoma will pull the skin taught under the eyes. “Your doctor can inject filler into the cheek area to improve the under eye area,” Dr. Amin says. Plus, injecting directly into the cheeks instead of under the eyelids is safer. “Filler placement in the cheeks lasts a lot longer than the fillers used in the periorbital area,” he adds. Beyond the cheeks, the [temples](https://aedit.com/aedition/cosmetic-forehead-procedures) also need to be considered. 

Sometimes, addressing the neighboring features is all it takes to create the effect of more refreshed eyes. “That’s why I address everywhere around the eyes before correcting them because it may just be an adjustment to the cheeks or brows that a patient needs instead,” Dr. Day says.

## **Does the Recent FDA Approval Change Anything?**
As we mentioned, under eye filler was an off-label use (meaning it did not hold an FDA-approved indication) until the recent approval of Juvéderm® Volbella XC. “Volbella is a hyaluronic acid dermal filler with an innovative combination of low and high molecular weight technology, which improves the cross-linking efficiency of the hyaluronic acid chains,” Dr. Green explains. “In addition, this new Vycross technology delivers an ultra-smooth gel that is malleable, which results in a natural look and feel to improve the appearance of under eye bags.”

However, just because there’s now an FDA-approved filler for use under the eyes doesn’t equate to every dermatologist and plastic surgeon jumping on the Juvéderm® Volbella XC bandwagon. Some physicians, including Dr. Day, do not use like to use it under the eyes. “In general, I think it’s a problematic product,” she explains. “It can be somewhat unpredictable, and Juvéderm® tends to swell under the eyes.” While she concedes that the data from Juvéderm® Volbella XC “doesn’t show issues with it,” she prefers [Restylane®](https://aedit.com/procedure/restylane) and Belotero® for correcting under eye hollows.

So, does a new FDA indication mean that everything we know about under eye filler and its safety go entirely out the window? No. Like all aesthetic treatments, patients must weigh risk and reward. Dr. Cabin says whether a treatment or specific product is categorized as on-label or off-label has very little to do with safety and efficacy. “Receiving FDA approval is a very complicated and expensive process that can take years, so some filler manufacturers have to decide which on-label indications to pursue given these constraints,” he explains. “When a filler (or other aesthetic treatments) is not on-label, it doesn't mean they are less effective or more dangerous.”

Dermatologists and plastic surgeons weigh in on why the popular procedure isn’t for everyone.

The Pros And Cons Of Under Eye Filler

The Truth About Under Eye Filler

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The [non-surgical aesthetics sector](https://aedit.com/aedition/biggest-non-surgical-aesthetics-trends-of-2022) continues to grow with no signs of slowing down. Patients and providers alike love minimally invasive procedures for their scarless results, in-and-out nature, and often downtime-free convenience. The flipside is the rate at which technology advances. While cosmetic surgery techniques evolve over time, it’s nowhere near as quickly as how fast non-surgical procedures wax and wane. Treatments that were once popular go-tos basically become obsolete as cutting-edge, of-the-moment tech that works faster, better, and more comfortably than before replaces those former favorites.

This can also make it tough to keep up with what’s new and next in non-surgical aesthetic medicine, which is why we’re doing the homework for you. The following up-and-coming non-invasive and minimally invasive procedures for face, skin, and body are headed for star status, and we’ve tapped top experts to learn more about why they are gaining buzz. Perhaps you'll discover a new favorite treatment that you've been waiting years to arrive.

## **1. For Next-Level Skin Tightening & Lifting**
- **The Treatment**: [Emface](https://bodybybtl.com/)
- **The Technology**: Muscle contraction & skin tissue heating
- **Best For**: Non-invasive skin tightening & lifting

**How It Works**: The BTL Aesthetics family of noninvasive technologies — you may recognize the brand by it's award-winning high-intensity focused electromagnetic muscle (HIFEM)-building treatments like [Emsculpt Neo®](https://aedit.com/aedition/what-its-like-to-get-emsculpt-neo) and Emsella® — has a new face-focused treatment to add to the group. Enter Emface. Although details about the procedure are still very much under wraps, we know that the device uses proprietary energy to tighten and lift facial muscles. 

Injectables and fillers have their place, but there's also only so much they can do to lift the face. With filler comes the tendency for [over injecting](https://aedit.com/aedition/how-to-correct-overfilled-facial-features), starting them too young, and aesthetic and [medical complications](https://aedit.com/aedition/risk-of-vascular-occlusion-after-dermal-filler), says [Paul Jarrod Frank, MD](https://www.instagram.com/drpauljarrodfrank/?hl=en), a board certified cosmetic dermatologist and founder of [PFRANKMD](https://pfrankmd.com/) in New York City. “The technology will target non-invasive [skin tightening](https://aedit.com/aedition/best-nonsurgical-skin-tightening-procedures) to help people limit the amount of injectables they get,” he shares.

The goal is to create the lift that patients desire without being as dependent on filler or needing it as frequently. “Emface is an answer to the demand that the market is calling for right now and the reason why non-invasive treatments – like [microneedling](https://aedit.com/procedure/microneedling), energy-based devices, and [lasers](https://aedit.com/procedure/nonablative-fractional-lasers) – are increasingly popular,” Dr. Frank explains. “I think Emface will add to that ethos of what technologies have done for the body in terms of being able to affect several aspects of the skin to minimize the need for other types of more invasive procedures.” For now, that’s all we know, so stay tuned for more.

## **2. For More Even Skin Tone**
- **The Treatment**: [Glacial® RX](https://glacialskin.com/)
- **The Technology**: Cryomodulation
- **Best For**: Improving melasma, rosacea, acne, uneven skin tone

**How It Works**: Cold temperatures have been used in body contouring for the past decade (think: [CoolSculpting®](https://aedit.com/procedure/cool-sculpting)), so the concept of harnessing the cold to improve a specific concern or condition is nothing new. However, what is innovative is the idea of cryomodulation – a proprietary cooling technology that normalizes melanin production while reducing inflammation. Glacial® RX is the first device to use the method, which temporarily freezes melanocytes to suspend melanin production and treat pigmented lesions, redness, and inflammation, says Bruce Katz, MD, a board certified dermatologist and the founder of [JUVA Skin and Laser Center](https://www.juvaskin.com/) in NYC. “It is also the first to use a cold probe to treat the skin,” he adds. 

If you are wondering how cryomodulation differs from a procedure like CoolSculpting®, they are targeting different things. CoolSculpting® freezes fat cells to permanently destroy them and reduce stubborn fatty areas like the stomach, thighs, and buttocks. Glacial® Rx, meanwhile “temporarily freezes melanocytes to suspend melanin production,” Dr. Katz shares. “When melanin production pauses, new cells form without new pigment, resulting in a [more evenly toned appearance](https://aedit.com/procedure/even-skin-tone-solutions) on the skin's surface.”

The downtime-free Glacial® Rx treatment takes 10 minutes or less and feels akin to a cooling facial, though it provides a long-term, anti-pigmentation effect that can last upwards of one year (with diligent sun protection). During treatment, a cold plate is manually applied to each area that needs to be addressed. The chill also takes down any puffiness and redness in the skin. Some minor side effects include erythema (redness), micro-crusting, and temporary darkening, all of which resolve independently. However, after two to three treatments over a few months, the full results are seen.

Speaking of results, Dr. Katz says the cooling technology immediately clears up congestion and skin dullness anywhere on the body. Over time, the benefits become more pronounced. “This new technology is the first FDA-approved dermatologic treatment to use cryomodulation to treat [dark spots](https://aedit.com/aedition/guide-to-hyperpigmentation-dark-spots-melasma),” he explains. “According to studies, physicians saw an improvement in 92 percent of patients at one-month follow-up.”

So far, patients receiving Glacial® Rx like the results they see. “The feedback is positive, and the results are pretty quick,” he says. Plus, because there's no downtime, he reports that those who have experienced the treatment like that they don't have to take time off of work or interrupt their lives to recover.

## **3. For Smoothing Out Dimples & Puckers**
- **The Treatment**: [Endosphères® Therapy](https://www.endospheres.com/)
- **The Technology**: Compressive microvibration 
- **Best For**: Tackling cellulite

**How It Works**: With the exception of [Qwo™](https://aedit.com/procedure/qwo) injections, cellulite treatment often calls for the septae bands that fat bulges out of to be severed or cut in some fashion. Now, there is another technology on the scene to offer an alternative. Instead of clipping said bands, the Italian-developed Endosphères® Therapy relies on stimulating blood flow while providing oxygenation and improving lymphatic drainage to smooth [cellulite](https://aedit.com/concern/cellulite).
 
This 100 percent non-invasive procedure tackles the underlying cause of cellulite dimples below the skin (rather than just the surface) via a so-called compressive microvibration method, which involves a roller device containing 55 silicon spheres that generate low-frequency mechanical vibrations. Pressure is a key component of the treatment, which helps to eliminate toxins and activate the lymphatic system. Together, the combination equates to longer-lasting smoothness.
 
But it's not just microvibration that targets cellulite. The technology simultaneously addresses organ function to treat the root cause of the issue. According to the company, a clinical observation of 656 patients improved cellulite by 39 percent – though there is a time commitment involved. One dozen 45-minute treatments are recommended to get smoother, dimple-free skin.

## **4. For a Snatched Jawline**
- **The Treatment**: [MyEllevate®](https://myellevate.com/)
- **The Technology**: ICLED® Surgical Suture System
- **Best For**: Defining & enhancing the jawline

**How It Works**: If a tauter neck and jawline are what you're after, then MyEllevate® – a minimally invasive treatment that targets a poorly defined jaw due to sagging skin and tissue  – may be for you. Created by board certified plastic and reconstructive surgeon [Gregory Mueller, MD](https://drgregmueller.com/), the hour-long procedure is different from other non-surgical under-the-chin solutions because it targets more than fat. Instead, MyEllevate® addresses platysmal banding *and* all of the fat under the chin (not a portion).

Historically, plastic surgeons have to ‘open the neck’ to address the bands surgically, says [Olivia MaDan, MD](https://aedit.com/provider/olivia-madan-md-34660), a board eligible plastic and reconstructive surgeon in Nashville. “With MyEllevate®, these bands can be released or cut without opening the neck since we suspend the skin and muscle as a composite around the mastoid fascia behind the ears,” she explains. While the treatment may sound somewhat similar to a [mini-facelift](https://aedit.com/procedure/minifacelift), it's not. Unlike a mini-facelift or any variation, MyEllevate® – which is best for patients in their forties with visible platysmal banding and skin laxity around the [neck and jawline](https://aedit.com/procedure/neck-and-jawline-definition-solutions) – does not require incisions or cuts on the skin, so there's no scarring. 

A fiber optic illuminated blunt probe is used via a small entry and exit point to pass a permanent suture at the precise depth below the skin to restore a youthful jawline and lower face and improve the profile. “This technology allows for the permanent percutaneous placement of sutures using a light guide to transilluminate beneath the skin,” Dr. MaDan explains. “The color of the light-guide shows the surgeon the plane which the suture passes.” For example, red indicates if the suture is too deep, while amber specifies that the sutures are in the correct placement plane. 

[Local anesthesia](https://aedit.com/aedition/awake-surgeries-without-general-anesthesia) is administered before the treatment to make it as comfortable as possible for the patient. “Eight one-millimeter incisions are made at key points through which the suspension suture passes to address the skin and platysma muscle," Dr. MaDan shares. “However, none of the access incisions require a closure, so there is normal scarring after the procedure just like other minimally invasive procedures like liposuction or skin tightening.” Speaking of lipo, it’s used to remove unwanted fat and facilitate suture placement. “It's much like drawing blood, which requires a small poke but not an incision,” says [Philip J. Miller, MD](https://www.drphilipmiller.com/), a double board certified facial plastic and reconstructive surgeon in NYC.
 
After the procedure, there may be a feeling of tightness around the neck that settles over time. “There is also a [compressive dressing](https://aedit.com/aedition/benefits-of-compression-garments-after-cosmetic-surgery) we apply after the procedure, and we request patients to wear a soft cervical collar to dissuade them from looking down,” Dr. Miller says. “The dressing is removed on day three and the collar after 10 days.” Bruising and [swelling](https://aedit.com/aedition/how-to-treat-minimize-swelling-after-cosmetic-surgery) are also typical.

As far as maintenance goes, it's pretty much the same guidelines as most other rejuvenation procedures: take good care of the skin, stay out of the sun, maintain a healthy weight, and refrain from stretching the skin. “Supplementing the original MyEllevate® procedure with a skin-tightening procedure can also prolong the results,” Dr. Miller shares. The results from MyEllevate® should last about five years. “Of course, no procedure can stop natural aging and effects of gravity, and this procedure does not exclude someone from needing a [facelift](https://aedit.com/procedure/facelift-rhytidectomy) or [neck lift](https://aedit.com/procedure/neck-lift-lower-rhytidectomy) in the future,” Dr. MaDan says. 

## **5. For Breaking Up With Your Breakouts**
- **The Treatment**: [Plason](https://artemis.co/aesthetic-devices/plason)
- **The Technology**: Plasma energy & ultrasound 
- **Best For**: Treating acne-prone & oily skin

**How It Works**: We haven't seen a new in-office device that treats [acne](https://aedit.com/procedure/acne-solutions) in a minute, so this one brings lots of excitement. Plason by Artemis is an FDA-registered device that relies on an advanced version of [plasma technology](https://aedit.com/procedure/plasma-skin-resurfacing) to combat breakouts. 

Plason sterilizes the skin to eliminate acne-causing bacteria and germs while stimulating the skin's collagen-producing capabilities for firmer, clearer skin. It uses two different technologies – one is plasma energy (atmospheric low-temperature plasma) and the other is ultrasound technology, says Delaney Allen-Mills, director of partner training and quality at Artemis Distribution. “The real differentiation is the plasma,” she says. The device harvests plasma and then releases plasma radicals and ions into the skin, which attach to bacteria to kill it and create cleaner skin.
 
The quick five-minute, downtime-free treatment is most effective on [acne-prone skin](https://aedit.com/aedition/difference-between-oily-and-acne-prone-skin) and requires a series of treatments. It is also ideal for oily skin types who want less oil production and fewer breakouts. One to two treatments (on average) is all it takes to improve the skin.
 
The treatment also significantly increases skin absorption rate, so you'll absorb 60 to 120 times more transdermal product to the depth of the dermis than you would from topical application alone, Allen-Mills says. Plus, it's safe to use Plason in conjunction with oral medications. While acne is the device's primary target, the treatment is also helpful for [wrinkles](https://aedit.com/concern/fine-lineswrinkles), [scars](https://aedit.com/procedure/acne-scar-solutions), and [pigmentation](https://aedit.com/aedition/guide-to-hyperpigmentation-dark-spots-melasma).
 
## **6. For Removing Loose Skin – Sans Surgery**
- **The Treatment**: [Ellacor™](https://www.ellacor.com/)
- **The Technology**: Micro-coring
- **Best For**: Minor skin laxity in the lower face

**How It Works**: Yes, it is now possible to remove unwanted skin sans surgery. The Ellacor™ procedure uses the proprietary technology of [micro-coring](https://aedit.com/aedition/dermal-micro-coring-benefits) to remove loose skin via hollow needles to improve wrinkles without evidence of scarring and with faster healing time than many energy-based treatments, says [Siamak Agha, MD](https://aedit.com/provider/siamak-agha-md-34668), a board certified plastic and reconstructive surgeon in Newport Beach, CA. 

While micro-coring sounds like it could produce results similar to a facelift, Dr. Agha says that what you'll see afterward is much subtler. “Each session (three in total are needed) removes a small amount of skin – about eight percent,” he explains. “So, even though we are removing less skin than a facelift, that skin removal can be increased substantially without any scars.” Additionally, micro-coring doesn't address the underlying muscles or fat like a surgical facelift. 

To date, the procedure has not been validated on darker skin types. It is currently only FDA cleared for patients who have minimal sagging and are [Fitzpatrick skin types](https://aedit.com/aedition/guide-to-fitzpatrick-skin-types) I to IV. “Ellacor™ is designed for smaller areas of skin removal,” Dr. Agha shares. “But, with more research and development, we may extend this technology to larger areas in the future.”

## **7. For a Brighter, Tighter Face & Body**
- **The Treatment**: [Zaffiro](https://neauvia.com/product/zaffiro/)
- **The Technology**: Hydroexfoliation & near-infrared thermo-lifting
- **Best For**: Improving skin texture & firmness

**How It Works**: Energy-based tightening is nothing new and neither is the widely beloved [HydraFacial®](https://aedit.com/procedure/hydrafacial). But a device that combines the technology of [near-infrared (NIR) energy](https://aedit.com/procedure/infrared-skin-tightening) and hydroexfoliation into a single treatment is one for the books. Enter Zaffiro, which is a the first of its kind to incorporate thermal energy for skin tightening with hydroexfoliation (a.k.a. water peeling). “The hydro technology hydrates and exfoliates to blast the skin and give it a luminosity that improves tone and texture, which my patients love — they say their skin feels more rejuvenated from using it,” says [Jeanine Downie, MD](https://www.imagedermatology.com/), a board certified dermatologist in Montclair, NJ. “And near-infrared technology helps for skin tightening.” Suitable for all skin tones and types, a single session of Zaffiro is relatively comfortable and not too hot.

One of the most effective areas to treat with Zaffiro are the tiny lines around the mouth that appear when smiling and smokers' lines. But providers are already finding additional benefits. “Although I tend to use it more on the face, it can also be used off the face,” Dr. Downie says. This includes on the “soft part of the underarms” and for “tightening on the stomach, thighs, above the knees,” she notes. On the face, a series of four treatments are necessary for optimal results. Six sessions are recommended for the body, with regular maintenance for each.

By delivering a steady dose of gradual heating to the deeper layers of skin, the downtime-free treatment works to thicken collagen fibers, which encourages a tightening and lifting effect while improving skin elasticity and texture. In addition, dead skin cells are instantly removed for better penetration of topical ingredients, providing an immediate improvement in skin texture, clarity, hydration, and glow.

Coming soon to a doctor’s office near you.

Best New Non-Surgical Procedures In Aesthetic Medicine For Face, Body, Skin

7 New Non-Surgical Treatments You Need To Know About

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The idea of a perfectly round, smooth, and sculpted backside has propelled significant demand for the [Brazilian butt lift (BBL)](https://aedit.com/procedure/brazilian-butt-lift). Despite the fact that the infamous procedure has had its time in the spotlight for a myriad of reasons — celebrities who embrace the bigger-is-better booty push the surgery to the top of many women's surgery wishlists, while the dangerous links to embolisms and even death make the BBL front-page chatter — its popularity has hardly waned. New and improved versions, as well as plenty of [safety regulations](https://aedit.com/aedition/brazilian-butt-lift-procedure-safety), keep the butt-boosting surgery in the public eye.

Aesthetic trends and beauty ideals are ever-changing. For some, a larger-than-life posterior remains the goal. But that level of curvaceousness isn't on everyone's agenda. If a tweak is more your speed, then you'll be happy to meet the so-called skinny BBL. The traditional BBL isn't going anywhere (it's still a much-requested option for those with enough fat to achieve the voluminous look), but the toned-down skinny BBL is better suited for those with a limited amount of donor fat who are desiring a subtler enhancement. 

This time around, it's less about volume and more about contour, says [Alexander Earle, MD](https://www.pureplasticsurgery.com/about-us/dr-earle/), a board certified plastic and reconstructive surgeon in Miami. “Typically, the skinny BBL patient wants a curvier look – not an exaggerated one – that from the front has more of an hourglass shape and looks like an upside-down heart from the back," he says. So, who is a candidate for this slimmed down version and how does it differ from the original? We’re breaking down everything you need to know about the skinny BBL.

## **The BBL Basics**
The popular BBL brings to life the notion of taking fat from where it's unwanted and putting it where it is. First, your plastic surgeon performs [liposuction](https://aedit.com/procedure/liposuction) to remove unwanted fat from the lower back, waist, stomach, or other areas. Then, the donor fat is purified and transferred to the hips and butt to create a [lifted, shapelier buttocks](https://aedit.com/procedure/buttocks-enhancement-solutions) with a dramatic difference between the waist and hips.

In order to achieve this result, a decent amount of fat is needed. As such, “it is not uncommon for traditional BBL patients to be a little overweight by medical standards,” says [Zachary Filip, MD](https://www.aiplasticsurgery.com/zachary-filip-md/), a board certified plastic and reconstructive surgeon in Temecula, CA. This usually means there is enough excess fat for harvesting purposes, especially when a significant increase in volume is the ultimate desire.

## **The Skinny on the Skinny**
A skinny BBL is a modified version of its big sister, the traditional BBL. Its name stems from the lesser amount of fat used and that the procedure accommodates leaner and smaller-framed patients who may not have as much donor fat. The skinny BBL is similar to a traditional BBL in just about every way except for the outcome. It is designed for those who want a more natural, athletic-looking result. 

Another key difference between the two BBLs is the amount of fat harvested and injected, says [Kevin Tehrani, MD](https://aedit.com/provider/kevin-tehrani-md-91), a board certified plastic and reconstructive surgeon in New York City. Less fat leads to more emphasis on shape rather than size. “Similarly to patients who [pick smaller breast implants](https://aedit.com/aedition/how-to-choose-the-right-breast-implants), those who choose skinny BBL are interested in minor buttock enhancement,” he shares. Rather than completely overhauling the backside and taking it from small and flat to large and voluptuous, the skinny BBL creates more of a ‘booty pop,’ similar to the results of a diligent yet intense workout routine. It also corrects stubborn hip dips.

A standard BBL removes up to 5,000 cubic centimeters (CCs) of fat via liposuction and places 1,000 to 2,000 CCs into each butt cheek. The remaining fat can be used elsewhere, like under the eyes, or discarded. Since there's less fat removal with the modified technique (think 500 to 1,000 CCs), about 500 to 700 CCs or slightly more per cheek is put into the butt to create its new shape. Keep in mind that, in either case, a percentage of this fat will be reabsorbed by the body (more on that below).

Another plus to the skinny BBL is that the added fat addresses [hip dips](https://aedit.com/aedition/cosmetic-procedures-for-hip-dips) (a.k.a. trochanteric depressions). These indentations or inward-facing curves are hard to correct with exercise and diet. In fact, Dr. Earle says that the more you work out, the worse they can get. One thing to note: this area does not ‘hold’ fat like the buttocks, so there is a chance that the hip dips may return at some point.

## **Who Is the Skinny BBL Best For?**
A skinny BBL makes the BBL a viable option for leaner patients who do not necessarily have stubborn or problem areas of extra fat but want to improve the shape of their butt. “Patients usually weigh in the lower half of ‘normal’ for their height,” Dr. Filip says. Most patients have a BMI of about 20 to 24. In the past, plastic surgeons often rejected these patients for BBLs because they were ‘too skinny’ with too little fat for harvesting purposes. However, the procedure is now safe and effective for lower-BMI patients thanks to improved fat harvesting techniques and [cannulas](https://aedit.com/aedition/guide-to-injectable-techniques-needles-for-botox-filler).
 
So, can someone be too thin for even the skinny version? It is possible (particularly if a patient has a BMI under 20), but plastic surgeons can perform a skinny BBL on thinner patients because the fat removal is from more unconventional areas like the inner knees, arms, calves, and back of the armpits. “We are almost always able to harvest enough fat,” Dr. Tehrani says. “[Water-assisted liposuction](https://aedit.com/procedure/water-jet-assisted-liposuction) is a great option since studies show that the technique allows us to harvest more fat compared to other liposuction techniques.” Another benefit? “There is also better take of the fat, so more of it survives," he adds.
 
Besides fat, other options for thinner patients who want to enhance their rear end are biostimulatory [Sculptra®](https://aedit.com/procedure/sculptra) injections. The downside is that these injections last two years (at most) and require a lot of product, so it gets expensive quickly. There are also [silicone buttock implants](https://aedit.com/procedure/butt-augmentation-with-implants), which work well in thinner patients but are less common today due to their high complication rate. “For these reasons, the best option is to gain weight and reach the appropriate BMI before skinny BBL surgery,” Dr. Earle says. Anyone who is medically underweight for any reason will not be cleared to undergo cosmetic surgery (of any kind) until they can maintain a healthy weight.
 
## **Skinny BBL Recovery**
In terms of [recovery](https://aedit.com/procedure/brazilian-butt-lift-fat-grafting/recovery), the surgery is considered one of the more difficult procedures to recoup from due to the extent of [commitment, protocol, and length](https://aedit.com/aedition/brazilian-butt-lift-bbl-recovery-healing-process). And there's not much difference between the two types of BBLs. “Patients still need to avoid pressure to the buttocks and hips for six weeks, use [compression garments](https://aedit.com/aedition/benefits-of-compression-garments-after-cosmetic-surgery) for at least three months, and undergo post-liposuction lymphatic massages,” Dr. Earle says. “The biggest difference is that skinny BBL patients require more [post-surgery lymphatic massages](https://aedit.com/aedition/benefits-of-lymphatic-drainage-massages-after-cosmetic-surgery) — about 25 to optimize the results — than the traditional BBL patient.” 

In addition, your plastic surgeon may also place a surgical drain to assist in emptying any [tumescent](https://aedit.com/procedure/tumescent-liposuction) solution used during liposuction, says [Martin Benjamin, MD](https://aedit.com/provider/martin-benjamin-md-34666), a board certified plastic and reconstructive surgeon in Scottsdale, AZ. And, of course, all patients should maintain a [healthy diet](https://aedit.com/aedition/meal-plans-diet-before-after-cosmetic-surgery) and [exercise program](https://aedit.com/aedition/when-to-start-exercising-again-after-cosmetic-surgery-procedures) (when given the all-clear to do so) post-op to keep up their results.
 
## **Less Fat Does Not Equal Lesser Results**
Just because there's less volume added to the butt during a skinny BBL doesn't mean the results are less striking or short-lived by any stretch of the imagination. Still, there are some nuances to be aware of. According to Dr. Tehrani, the survival rate of a typical fat transfer is about 60 percent. “That means if we inject 1,000 CCs per side, 600 CCs, on average, will survive,” he explains. Fat absorption is one reason why plastic surgeons prefer to over-inject fat. “However, this approach is not always an option for skinny patients, as they may not have enough fat for overcorrection,” he says. “So, we use ACell MicroMatrix®, which contains stem cells that have special growth factors that improve fat survival by 20 to 30 percent.”
 
Regardless of how much fat your plastic surgeon transfers, the outcome should ultimately be permanent. As Dr. Filip shares, “once a patient heals, the results should be stable and long-lasting if they maintain a healthy weight.”

This slimmed down version of the infamous butt enhancement surgery is making the BBL a viable option for patients who previously weren't candidates.

Skinny Brazilian Butt Lift (BBL): Procedure, Ideal Candidate, Recovery, Results

The Popular BBL Is Getting A Major Makeover

altin-ferreira-TSFmAgJoDoM-unsplash

Every feature plays a role in [facial harmony](https://aedit.com/aedition/facial-harmony-in-aesthetic-medicine). When it comes to the upper third of the face, we often devote our time and attention to [the eyes and the brows](https://aedit.com/aedition/brow-lift-vs-blepharoplasty-vs-both) – but what about the forehead? The area from the hairline to the brow bone holds a lot of prominence and conveys a lot of emotion, which is why it can have such an impact on the overall proportion of the face. And, like so many other facial features, there is no singular forehead concern or procedure to treat it. From a forehead reduction to Botox, there are both surgical and non-surgical solutions to address a myriad of [forehead-related aesthetic concerns](https://aedit.com/concern/forehead-shape-and-size). Here’s what you need to know.

## **Forehead Proportions**
Based on its size alone, the forehead has always been at the forefront of the face. But nearly two years of wearing pandemic-related face coverings has put a spotlight on it in a new way. “With the COVID-era and [mask use](https://aedit.com/aedition/influence-of-covid-19-face-masks-on-medical-aesthetics-trends), the upper face is more noticeable than ever,” says [Samer Jaber, MD](https://aedit.com/provider/samer-jaber-md-3882), a board certified dermatologist and founder of Washington Square Dermatology in New York City. 

Unlike [lip volume](https://aedit.com/aedition/what-to-know-before-getting-lip-filler-for-the-first-time) or [brow fullness](https://aedit.com/aedition/guide-to-surgical-and-non-invasive-brow-lift-procedures), there aren’t really aesthetic ‘trends’ related to the appearance of the forehead. Instead, patients and providers alike are looking at it relative to the face as a whole. “While there is no universal perfect forehead size, having a forehead that is [proportional](https://aedit.com/aedition/plastic-surgery-results-are-about-proportion-not-perfection) to the rest of your face can make you feel more attractive,” Dr. Jaber says. Generally speaking, “in an ideal appearance, the forehead should make up one-third of the face and should be approximately equal in size to the midface and the lower face,” explains [Rebecca Marcus, MD](https://northdallasderm.com/rebecca-marcus-md/), a board certified dermatologist in Dallas, TX. “This rule of ideal proportions is called the Golden Ratio.”

## **Aesthetic Forehead Concerns**
Now that you have a better sense of how the forehead relates to the rest of the face, it’s time to talk about the specific aesthetic concerns that people often have about the feature. “The most common general concerns are related to volume loss seen in the temporal region,” says [Amir Karam, MD](https://www.drkaram.com/about/meet-dr-karam/), a board certified facial plastic and reconstructive surgeon and founder of [KaramMD Skin](https://go.skimresources.com?id=170670X1638612&xs=1&url=https%3A%2F%2Fkarammdskin.com%2F). “Volume loss can cause the temples to sink in to give it a more hollow look making the face look bonier.” Dr. Marcus, meanwhile, regularly sees patients who believe their forehead “may be too wide, too narrow, too short, or too long.” Additionally, the [hairline](https://aedit.com/aedition/surgical-and-non-surgical-procedures-to-reshape-the-hairline) may be encroaching, receding, or uneven. 

And then there is the skin of the forehead. You’ll be hard pressed to find someone who doesn’t have any [horizontal forehead lines](https://aedit.com/concern/fine-lineswrinkles) (unless, of course, they’ve long been a neurotoxin devotee). These expression lines are caused by the constant movement of the frontalis muscles, the pair of vertically oriented muscles that lift the eyebrows. Furthermore, “the skin on the forehead can also overproduce oil or possess enlarged oil glands, known as sebaceous hyperplasia, which would manifest as small bumps in the skin,” Dr. Marcus adds. 

Regardless of what’s bothering you about your forehead, there are both [surgical and non-surgical solutions](https://aedit.com/procedure/forehead-reduction-solutions) that can address the shape, size, and skin. 

## **Surgical Forehead Procedures** 
In general, surgical procedures yield the most dramatic and lasting results. Depending on your forehead concern, they may be the best option. Below are three of the most common:

### **1. Browplasty**
A [browplasty](https://aedit.com/procedure/brow-lift-forehead-lift-browplasty) (a.k.a. forehead lift or brow lift) is a cosmetic surgery that can address the positioning of the eyebrow, which, in turn, enhances the forehead. While there are different types of brow lifts that each carry varying degrees of invasiveness and scarring, surgical brow lifts can reposition the brow, remove excess skin and fat, and tighten the muscles in the forehead area. This combination can minimize the appearance of forehead lines, soften frown lines, and restore a more youthful brow. It can be performed alone or to complement a [blepharoplasty](https://aedit.com/aedition/combining-blepharoplasty-and-brow-lift), [facelift](https://aedit.com/aedition/best-procedures-to-combine-with-a-facelift), or other facial procedure. For patients who have exhausted the so-called [Botox brow lift](https://aedit.com/procedure/chemical-brow-lift), Dr. Jaber says “a surgical brow lift with a plastic surgeon could be pursued for a more dramatic effect.” 

### **2. Hair Transplant**
Whether you realize it or not, your forehead and hair are inextricably linked. After all, the shape of your hairline directly affects the shape and size of your forehead. If you are concerned about a receding or uneven hairline, a [hair transplant](https://aedit.com/procedure/hair-transplant) may be for you. “Hair transplants, when done well, look wonderful and make a huge impact on one's confidence,” Dr. Marcus shares. 

[Follicular unit extraction (FUE)](https://aedit.com/procedure/follicular-unit-extraction-fue) involves transplanting individual hair follicles from the back of the head to the front to create a new hairline. This technique generally works best for people with short hair. [Follicular unit transplantation](https://aedit.com/procedure/strip-harvesting) (i.e. strip harvesting), meanwhile, is usually the preferred method for those with longer locks. Rather than explanting one at a time, a strip of follicles is taken from the rear of the head and then distributed to thinning or balding areas. 

In either case, you’ll need to be patient as the transplanted follicles establish themselves and start to grow. You’ll see initial results in about six months, with the full effect visible 12 to 18 months post-op.

### **3. Forehead Reduction**
While celebrities like Naomi Campbell and Vanessa Paradis are known for their larger foreheads that perfectly complement their facial features, not everyone is comfortable with the size of theirs. If your forehead is larger than you’d like, a [forehead reduction](https://aedit.com/procedure/forehead-reduction) may be in order for the right candidate. “With a forehead lowering procedure, an incision is made at the hairline from ear to ear,” Dr. Karam says. As he explains, one to two centimeters of skin are removed and the entire scalp is advanced forward. “The downside is that it’s surgery and will have a [scar](https://aedit.com/aedition/scarring-after-facial-plastic-surgery) at the hairline, but, otherwise, it is effective in creating the right proportions,” he adds. It can be a solution for those with a naturally strong hairline that needs to be lowered, but it’s not applicable for those who have had a [coronal brow lift](https://aedit.com/procedure/coronal-brow-lift) or strip harvesting. 

## **Non-Surgical Forehead Treatment Options** 
Whether you’re not quite ready to go under the knife or you want to treat something that doesn't require cutting, here are some of the best non-surgical procedures to address aesthetic forehead concerns.

### **1. Laser Hair Removal**
We talk a lot about receding hairlines, but [hair loss](https://aedit.com/concern/hair-loss) isn’t always the issue when it comes to the appearance of the forehead. “If the hairline is too low, removing hair at the hairline could help the forehead to appear larger,” Dr. Marcus explains. [Laser hair removal](https://aedit.com/procedure/laser-hair-removal) can provide the necessary reprieve, and celebrities like Kim Kardashian have admitted to seeking this solution. The process is virtually painless, though it does require [multiple sessions](https://aedit.com/aedition/laser-hair-removal-for-men) before the final result is achieved. While the technology has come a long way, it’s not an option for everyone. Those with [darker skin tones](https://aedit.com/aedition/best-laser-skin-hair-removal-treatments-for-darker-skin-tones) or lighter hair colors may not be candidates. [Electrolysis](https://aedit.com/procedure/electrolysis) may be an alternative.

### **2. Neurotoxins**
We’re all familiar with wrinkle-smoothing benefits of [Botox®](https://aedit.com/procedure/botox), [Dysport®](https://aedit.com/procedure/dysportr), [Jeuveau®](https://aedit.com/procedure/jeuveau), and [Xeomin®](https://aedit.com/procedure/xeomin), and one of their most beloved applications is for horizontal forehead lines. While neurotoxins can be injected directly into said wrinkles, strategic placement can yield an even more rejuvenating effect. “Botox® can be strategically injected to lift the medial and lateral portions of the eyebrows and help the forehead to appear more open and lifted,” Dr. Marcus says. “This is one of my favorite ways to provide a patient with a quick freshening up.” The minimally invasive solution not only softens the appearance of existing lines by temporarily ‘freezing’ the underlying muscles, but it also helps prevent further deepening. 

### **3. Non-Surgical Skin Tightening & Resurfacing** 
If [skin tone](https://aedit.com/concern/uneven-skin-tone), [skin texture](https://aedit.com/concern/uneven-skin-texture), or skin quality are a concern, there are additional non-surgical [skin tightening](https://aedit.com/aedition/best-nonsurgical-skin-tightening-procedures) and [skin resurfacing](https://aedit.com/aedition/ultimate-guide-to-skin-resurfacing-procedures) treatment options that can address the forehead and beyond. “Procedures such as [radiofrequency](https://aedit.com/aedition/radiofrequency-skin-tighening-fat-reduction), [microneedling](https://aedit.com/procedure/microneedling), and [Ultherapy®](https://aedit.com/procedure/ultrasound-skin-tighteningultherapy) can be used to stimulate collagen production,” Dr. Jaber says. “If the concern is to smooth out forehead wrinkles, resurfacing lasers such as [Fraxel®](https://aedit.com/aedition/guide-to-fraxel-laser-skin-resurfacing-treatments) or [CO2](https://aedit.com/procedure/pixel-co2) can be considered.” 

### **4. Dermal Filler**
When it comes to restoring [lost volume](https://aedit.com/aedition/best-procedures-to-restore-facial-volume), dermal filler is often viewed as a time machine. As it relates to the forehead, however, you’ll want to proceed with caution. Dr. Karam does not recommend filler in the region because of how expressive it is. “This is an area where the muscles move, so putting filler into this area can be ineffective and lead to clumping or irregularities,” he cautions. Dr. Jaber agrees. “If you are going to do forehead filler, make sure to discuss [potential risks](https://aedit.com/aedition/risk-of-vascular-occlusion-after-dermal-filler) with the injector prior to the procedure,” he says. “To soften forehead wrinkles, I recommend regular use of Botox®.”

What you may not realize, however, is that injecting [filler](https://aedit.com/aedition/hyaluronic-acid-filler-vs-biostimulatory-injectables) into other areas can have a big impact on the face as a whole. “If you feel like you have a large forehead, then defining your lower face with procedures like [chin filler](https://aedit.com/procedure/chin-augmentation-with-soft-tissue-fillers) or [jaw filler](https://aedit.com/procedure/neck-and-jawline-definition-solutions) can improve your facial proportions, making you feel more attractive,” Dr. Jaber explains. This holistic approach is why it is so important to visit a board certified dermatologist or plastic surgeon. They will be able to give you a complete assessment of what’s possible based on your anatomy and aesthetic goals.

### **One last tip...**
Fellas take note: [facial hair](https://aedit.com/aedition/facial-hair-care-products-grooming-tools) can be one of the quickest and cheapest ways to refresh your look. “If you don't want to do any procedures, then a simple option for men is growing a beard,” Dr. Jaber notes.

## **The Takeaway** 
Aesthetic goals and perceptions of beauty are as unique as fingerprints. “Even if a feature falls outside of these classic definitions of facial harmony and beauty, it doesn’t equate to an objective lack of beauty,” Dr. Karam emphasizes. But, if you are interested in addressing the upper third of the face, it’s helpful to remember that the region is more than the eyes and brows. Consulting with a board certified dermatologist or plastic surgeon will allow you to learn more about what treatment options may be best for you.

*All products featured are independently selected by our editors, however, AEDIT may receive a commission on items purchased through our links.*

Whether you think it’s too big, too small, or too wrinkled, there are an array of surgical and non-surgical solutions to address one of our most prominent facial features.

Best Procedures For Forehead Shape, Size, Wrinkles

How Familiar Are You With These Forehead Treatment Options?

jonathan-borba-5rQG1mib90I-unsplash

There are plenty of non-surgical procedures that get billed as facelift alternatives. And, while some have the ability to firm and smooth the skin sans scalpel, none have been able *remove* skin without surgery – until now. Since it received clearance from the United States Food and Drug Administration (FDA) last year, there has been a lot of buzz around [Cytrellis’s Ellacor™](https://www.cytrellis.com/technology/) and its micro-coring technology. 

Since we all know that trendy treatments have a tendency to come and go, you may be wondering if this one lives up to the hype. The short answer is that, in many ways, it does – though it’s not exactly a substitute for a [facelift](https://aedit.com/procedure/facelift-rhytidectomy). To break down everything you need to know about Ellacor™ and micro-coring, we tapped top dermatologists and plastic surgeons for their honest assessment. Here’s the scoop.

## **What Is Micro-Coring?**
Although some may be calling micro-coring the next best thing to a facelift, it's significantly different. For starters, it isn't surgery at all. Instead, micro-coring or fractional micro-coring is a new category of cosmetic treatment that involves the excisional removal of tiny columns of skin over a larger surface without cutting, thermal energy, or scarring.

Micro-injuries are made in the skin using a tiny, hollow needle while simultaneously removing small tissue areas to address mild laxity. “During a facelift, surgeons trim the skin from the sides,” says [Paul Jarrod Frank, MD](https://www.instagram.com/drpauljarrodfrank/?hl=en), a board certified celebrity cosmetic dermatologist in New York City. “With micro-coring, we inject local anesthesia and remove eight to 10 percent of the total skin surface.” As he explains, the idea of micro-coring originally came from the concept of skin tightening and wrinkle removal in studies showing [follicular unit extraction (FUE)](https://aedit.com/procedure/follicular-unit-extraction-fue), which involves removing individual hair follicles from the scalp before transplant. “When the tissue heals, the skin is much tighter,” he notes. 

To date, there’s only one micro-coring device on the market, Ellacor™, which has positioned itself as a minimally invasive facelift alternative thanks to its ability to remove skin without surgery. The first-of-its-kind treatment is [cleared by the FDA](https://www.prnewswire.com/news-releases/cytrellis-announces-fda-clearance-for-breakthrough-ellacor-micro-coring-technology-301341572.html) to treat moderate to severe wrinkles in the mid- to lower-face in patients with Fitzpatrick skin types I to IV. 

Ellacor™ removes micro-portions of excess skin improve the appearance of wrinkles, says [Jill Waibel, MD](https://www.miamidermlaser.com/dermatologist-miami-dr-jill-s-waibel/), a board certified dermatologist in Miami. “Whereas other skin revitalization devices use heat generated by a [laser](https://aedit.com/aedition/guide-to-ablative-laser-skin-resurfacing), [radiofrequency](https://aedit.com/aedition/radiofrequency-skin-tighening-fat-reduction), or [ultrasound](https://aedit.com/aedition/sofwave-for-skin-tightening-collagen-production) energy to induce intentional thermal injury to the skin, Ellacor™ uses patented micro-coring technology to reduce wrinkles,” she says.

## **Who Is an Ideal Candidate for Micro-Coring?**
Not everyone is an ideal candidate for micro-coring. “It's for someone who wants to take a more minimally invasive and natural-looking route to obtain tighter, younger-looking skin,” says [Dendy Engelman, MD](https://aedit.com/provider/dendy-engelman-md-312), a board certified dermatologist in New York City. This can appeal to people at [different stages of life](https://aedit.com/aedition/can-you-be-too-young-for-a-facelift) (and aging). “I sometimes recommend micro-coring to younger patients who are starting to notice changes in their skin and want to nip it in the bud,” she shares. And she also suggests it to “patients with more mature skin who do not want to undergo a full facelift and the [associated recovery](https://aedit.com/procedure/facelift-rhytidectomy/recovery).”

To see success with Ellacor™, the degree of [skin laxity](https://aedit.com/concern/facial-skin-laxity) – which should be on the mild to moderate side – is imperative. “Someone with excessive hanging skin is going to do better with a more invasive surgery,” Dr. Frank notes. In addition, the treatment works best on the [cheeks](https://aedit.com/concern/cheek-volume), around the mouth, and [under the chin](https://aedit.com/concern/neck-and-jawline-definition), since these areas are where loose skin tends to accumulate. 

As we mentioned, the procedure is currently only FDA cleared for [Fitzpatrick skin types I to IV](https://aedit.com/aedition/guide-to-fitzpatrick-skin-types). “A separate clinical study is needed to evaluate the proper protocols for using Ellacor™ on darker skin types,” Dr. Waibel notes.

## **How Micro-Coring Works**
It may seem unfathomable, but, in 2022, we are at the point where doctors can remove minimal amounts of loose skin without the need to cut with a scalpel. 

Before an Ellacor™ treatment starts, [local anesthesia](https://aedit.com/aedition/everything-you-need-to-know-about-anesthesia) is injected into the area (topical anesthetic may also be used) to make the procedure more comfortable. Next, a small handpiece is placed over the desired location, creating cores in a grid formation (similar to energy-based treatments). The hollow needles within the handpiece quickly go to work and pierce out microscopic amounts of skin (less than half a millimeter). “With each excision, the tissue is removed from the needles through an integrated suction system, treating a 10 millimeter square area in less than three seconds,” Dr. Waibel says. 

Your doctor can adjust the depth of the treatment depending on your needs. There is pinpoint bleeding at each core site, which quickly resolves. Not all skin that falls within the coring square is removed. “After removing the excess skin, the body's natural healing response goes into effect as the dermal tissue quickly realigns to close the cores, resulting in improved skin architecture,” Dr. Waibel shares. As Dr. Engelman explains, removing the skin in this controlled fashion stimulates the wound-healing response that increases collagen production, ultimately promoting younger, healthier-looking skin.

## **Micro-Coring Recovery & Results**
A series of three 30-minute treatments are usually recommended to achieve optimal results, though many patients report seeing benefits after the first appointment. “Micro-coring results are more subtle than facelift surgery since each session of Ellacor™ only removes up to eight percent of the treated skin area,” says [Siamak Agha, MD](https://aedit.com/provider/siamak-agha-md-34668), a board certified plastic and reconstructive surgeon in Newport Beach, CA. “Less skin is removed than what a facelift can offer, but, with Ellacor™, that skin removal can be increased substantially without any scars.”

According to the clinical trials, each column of skin is selectively targeted and heals within an average of three days. But, of course, expect some scabbing, redness, slight [bruising](https://aedit.com/aedition/how-to-treat-prevent-bruising-after-lasers-filler-botox), and mild [swelling](https://aedit.com/aedition/how-to-treat-minimize-swelling-after-cosmetic-surgery). “The redness of the treated areas may last 30 days or more, signifying deeper tissue healing and tightening,” Dr. Agha says. Because the skin is sensitive and somewhat compromised after treatment, [a simple, bland skincare routine](https://aedit.com/aedition/post-procedure-skincare-makeup-product-guide) (similar to what is used post-laser or surgery) is often best. Once the skin is fully healed and the resulting holes from the cores are closed up, you should be safe to resume wearing makeup and following your regular skincare regimen.
 
One of the significant advantages of a micro-coring treatment over something like a facelift is the low risk of [scarring](https://aedit.com/aedition/how-to-treat-every-type-of-scar). “Due to the tiny needle used in micro-coring (22 gauge), the scars are microscopic and therefore not visible to the naked eye,” Dr. Engelman says. For reference, [needles](https://aedit.com/aedition/guide-to-needles-used-for-cosmetic-injectables-botox-filler) used to administer neurotoxins (read: Botox®) are usually 30 or 32 gauge. A [filler syringe](https://aedit.com/aedition/guide-to-injectable-techniques-needles-for-botox-filler) is 27 or 30 gauge. Higher numbers indicate smaller needles.  

## **FAQs: Micro-Coring Edition**
Now that you have a better understanding of how micro-coring technology and Ellacor™ treatments work, it’s time to get to some of the questions you no doubt have about what it’s truly capable of. We answer a few of the most common below:

### **1. Is Micro-Coring Anything Like Microneedling?**
We’d understand if, at this point, you are wondering what (if any) relation micro-coring has to microneedling. As it turns out, the only similarity between the two is that both modalities have the prefix ‘micro’ in their names, and both employ needles to some degree. As Dr. Waibel explains, [microneedling](https://aedit.com/procedure/microneedling) uses tiny needles to injure the skin, and there's no tissue removal — the tissue is only temporarily displaced — during the procedure.

The needle depth of a professional microneedling treatment is anywhere from 0.25 millimeters to 2.5 millimeters. The hollow needles used for micro-coring can penetrate up to 4 millimeters to remove the microscopic columns of skin. While microneedling safely creates micro-injuries in the skin to incite collagen production and decrease the appearance of acne scars, fine lines and wrinkles, and sun damage, it does not excise any tissue.

### **2. Is Micro-Coring a Replacement for a Facelift?**
A [traditional facelift](https://aedit.com/aedition/popularity-of-facelift-cosmetic-surgery-for-aging-sagging-neck) does more than just remove loose skin. It also addresses the underlying muscles and repositions fat and tissue for more significant support and a fully rejuvenated yet (hopefully) natural look. Every doctor we spoke to for this story agreed that micro-coring is not a substitute for a facelift, though it may be a suitable alternative for those who are not ready for surgery but desire some skin tightening and wrinkle reduction on the lower face.

Micro-coring acts on the skin alone. So, while the results of the minimally invasive procedure can be significant, it does not address the fundamental structure of the face and cannot provide a facelift-like result. But that’s not to say it doesn’t have value. “I think micro-coring is going to offer a lot more than other minimally to non-invasive treatments like [Ultherapy®](https://aedit.com/procedure/ultrasound-skin-tighteningultherapy), Thermage®, and other forms of [energy-based microneedling](https://aedit.com/procedure/microneedling-with-radiofrequency),” Dr. Frank says. “With micro-coring, we are going to fill that niche between non-invasive and invasive plastic surgery.”

### **THE SIMILARITIES**
- **Skin Removal**: Both a facelift and micro-coring can remove loose skin, however, the amount of skin laxity addressed through a non-surgical treatment is less than surgery.
- **Smoothing**: Micro-coring and facelifts improve wrinkling on the lower part of the face. Of course, what can be achieved with surgery is always greater than less invasive options.
- **Patience**: The results can take time to settle and fully reveal themselves after both a facelift and micro-coring, though there's more of a noticeable improvement right away post-facelift. 

### **THE DIFFERENCES**
- **Comprehensiveness**: Micro-coring does not correct or address anything below the skin like fat, tissue, and muscle. Only a facelift can target those underlying structures of the face.
- **Lift**: Whereas a facelift physically lifts the skin and requires tension, micro-coring induces collagen remodeling and firming through micro-injuries. The chances of having an unnatural result are lessened.
- **Scarring**: The tradeoff for a facelift is the [scarring](https://aedit.com/aedition/scarring-after-facial-plastic-surgery), though board certified plastic surgeons are trained to conceal the incision. There are no cuts, incisions, stitches, or scars with micro-coring.
- **Timing**: Two to three sessions of micro-coring are necessary to achieve full results. Dr. Engelman says patients typically start to see results of 60 to 90 days after the procedure, and there is usually significant improvement after just one treatment. A facelift is one and done, with results lasting a decade or more. 

Micro-coring is far less invasive than a sugical facial rejuvenation procedure such as a facelift. But, just because it's less invasive, doesn't mean it is fool-proof. As with all aesthetic procedures, a full consultation before the treatment is necessary and there is always the [risk of adverse effects](https://aedit.com/aedition/guide-to-cosmetic-surgery-complications).

### 3. **Micro-Coring vs. Facelift: Which One Is Better?**
There's no right or wrong treatment here. What checks of all your [skin-tightening](https://aedit.com/aedition/best-nonsurgical-skin-tightening-procedures) and rejuvenating boxes may not do the same for someone else. For patients who don't have the time – or, should we say, downtime – for surgery or don’t want it (for whatever reasons), micro-coring is perhaps one of the most promising alternatives available. 

With that said, Dr. Engelman reminds us that no procedure (surgical or non-surgical) is without strings. There is still anesthesia involved, your skin will require a few days to recuperate, and there is no instant gratification. “Downtime is minimal, but it will take some time for the results to be visible,” she shares. And be sure to keep your expectations in check. The results “will be more subtle,” she adds.

### **4. Can Micro-Coring Delay the Need for Surgery?**
Given the array of non-surgical modalities available today, it may be possible to delay the need for facial surgery with the right combination of treatments. But will Ellacor™ alone allow you to sidestep a facelift in the future? Probably not. “Micro-coring does not offer the same results as more invasive techniques, like facelifts,” Dr. Engleman says. “So, in that regard, it cannot replace these more dramatic techniques.” That’s not to say it doesn’t have it’s place though. “It is a great alternative for people seeking more natural-looking results with less invasive methods,” she shares.

## **The Takeaway**
Micro-coring is a new skin-eliminating treatment that is the first of its kind, which means there is still a lot to learn. Will it replace the standard facelift? Probably not – at least not right now – but it gives both patients and providers a lot to be excited about. “There is absolutely no doubt that it is going to offer a new category of treatment in between totally non-invasive and totally invasive procedures,” Dr. Frank says. “It will help fulfill that growing niche of patients that want to do something significant in terms of wrinkling and skin tightening but are not yet ready or willing to go through more invasive techniques.”

Everything you need to know about the minimally invasive procedure that removes skin – sans scalpel.

Dermal Micro-Coring: A Non-Surgical Facelift Alternative For Skin Laxity

Does Non-Surgical Micro-Coring Rival A Surgical Facelift?

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We’ve heard of [lip filler](https://aedit.com/procedure/temporary-lip-fillers), [cheek filler](https://aedit.com/procedure/cheek-augmentation-with-fillers), and even [hand filler](https://aedit.com/procedure/hand-rejuvenation-with-dermal-fillers), but it wasn’t until recently that the notion of foot filler crossed our desks. Just because it may not enjoy the same notoriety, however, does not mean it lacks a fan base. “A fair number of people do it,” says [Darren Smith, MD](https://www.darrensmithmd.com/), a board certified plastic and reconstructive surgeon in New York City. “It just doesn’t come up in conversation.” 

To change that, we spoke to two physicians familiar with foot injections — which, keep in mind, isn’t necessarily all dermatologists or plastic surgeons — to learn more about the benefits of injecting filler into the feet for both cosmetic and functional benefits.

## **The Aesthetic Benefits of Foot Filler**
[Dermal fillers](https://aedit.com/procedure/dermal-filler-and-injectable-solutions) can be used to shape features from head to toe – quite literally. The same fillers you put in your face to restore lost volume and contour can be injected into your feet for both cosmetic and functional purposes, Dr. Smith says.

If aesthetics are your concern, you’re likely going to be treating the [tops of the feet](https://aedit.com/aedition/cosmetic-treatments-procedures-for-feet-nails-toes). “Loss of volume in many different parts of the body connotes aging, and the feet are no different,” Dr. Smith explains. “Some people think their veins are too visible or their tendons are too visible.” While this is a natural part of the aging process for many, it can also be exacerbated by certain otherwise healthy lifestyle habits. It’s fairly common for people who work out regularly to lose fat on their feet (sadly, your running regimen doesn’t just make you choose between your ass and your face), which can make tendons appear more visible over time. 

Similar to using filler to rejuvenate [aging hands](https://aedit.com/aedition/aesthetic-treatments-for-aging-hands), injecting hyaluronic acid (HA)-based fillers, such as [Juvéderm®](https://aedit.com/procedure/juvederm) or [Belotero®](https://aedit.com/procedure/belotero), into the top of the foot can camouflage bulging veins or tendons and add volume. As with most HA filler injections, the results last six to nine months before it’s time for a touch up.

## **The Functional Benefits of Foot Filler**
Sure, cosmetic foot filler can be a confidence-booster for those of us who are insecure about our feet. But the real game-changing use of injectables is functional. [Neil Sadick, MD](https://sadickdermatology.com/), a board certified cosmetic dermatologist in NYC and the founder of [Stride](https://getmystride.com/), recommends foot filler for patients — typically ones who’ve been referred by a podiatrist — who have pain when they walk. Think of the filler as an in-sole that you just so happen to be inserting into your own foot.

For patients who come to Dr. Sadick with plantar fasciitis, calluses around the foot, or thickening of the heels, filler can act as a cushion to the area and lead to less mechanical trauma from the regular act of walking on two feet. Dr. Smith agrees. “If you look at a cross section of a foot, you should have a nice little pillow of fat at the soul of your forefoot and the soul of your hind foot,” he shares. “There are people with genetic reasons or repetitive use reasons — some people think if you spend a lot of time walking around barefoot, for example — where those fat pads, which should serve as shock absorbers, atrophy or shrink over time.” 

In such cases, it becomes very painful to walk, and that’s where your injector can come in and help you recreate the natural cushion that has been lost. HA fillers can be employed for this purpose ([studies show](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6039379/) HA filler injections under the metatarsal heads can provide a “significant and long-lasting improvement” in treating metatarsalgia – a condition in which the ball of the foot becomes painful and inflamed – caused by wearing high heels), Dr. Smith likes biostimulatory injectables, like [Radiesse®](https://aedit.com/procedure/radiesse) and [Sculptra®](https://aedit.com/procedure/sculptra), for functional improvement. The former is made of calcium hydroxylapatite (CAHA) and the latter of poly-L-lactic acid (PLLA), which both stimulate natural collagen production in the body for a longer-term effect.

Depending on the patient, fat grafting may also be an option. Dr. Smith says he works closely with podiatrists to address functional foot issues with [fat transfer](https://aedit.com/aedition/why-everyone-is-talking-about-fat-grafting), which involves liposuctioning fat from a donor site (think: the flanks or thighs), purifying it, and injecting it into the feet. After an initial reabsorption period, the transferred fat is permanent. 

## **The Takeaway**
The feet may not be the flashiest place to inject filler, but strategic placement of [HA and biostimulatory injectables](https://aedit.com/aedition/hyaluronic-acid-filler-vs-biostimulatory-injectables) can be transformative for those who experience certain kinds of foot pain or those with aesthetic concerns about their trotters. If you’re interested in foot filler, start with a visit to a board certified cosmetic dermatologist or plastic surgeon who has experience injecting in this area. “There’s lots of important stuff in the foot,” Dr. Smith cautions. A slip of the needle could lead to nerve problems, blown veins, or damaged tendons, all issues a practiced injector will know how to avoid. 

Hyaluronic acid-based filler and biostimulatory injectables can be used to treat foot pain and minimize aesthetic concerns on the tops of the feet.

The Functional And Cosmetic Benefits Of Foot Filler

Is Foot Filler Really A Thing?

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. 