Botox may be a very simple and suitable solution, but this depends on the severity of the lines and whether there are any related "problems" that you might want to address. For example, if you are bothered by brows that are too low and wanted to address this surgically, then a permanent surgical solution to your vertical frown lines could be achieved at the same time. As you probably know, Botox injections must be repeated periodically to maintain results. Only by evaluation of the actual condition by a qualified, ASAPS-member plastic surgeon can "the best solution" be ultimately determined, since there are several alternative treatments that might prove suitable.

Silicone is essentially an inert material, and as such "rejection" does not occur. For practical purposes, the true "rejection" phenomenon refers only to protein matter, such as organ transplants.


Silicone can, however, cause mild irritation to the tissue (breast) that it contacts. Within four days of insertion of a silicone breast implant, the body forms a shell of scar around the implant as an isolation mechanism - surgeons refer to this scar shell as a "breast capsule". The characteristic of this scar capsule is that it may contract (tighten) around the breast implant to varying degrees. So in those patients whose “implants have gotten hard,” the actual implant has not hardened. Rather, the scar capsule has tightened around the implant, so that the breast feels hard. This hardening is referred to as “capsular contracture.”.


The frequency and degree of capsular contracture varies from one individual to another. It is not predictable. In general, patients who are going to develop capsular contracture often do so in the first few months after insertion. However, contracture can occur at any time during the life of the implant.

Botox cosmetic is a highly purified neurotoxin injected into the muscle causing a decrease in the function of that muscle. It causes minimal discomfort and swelling. It takes three to four days up to two weeks to see the full effect and usually lasts for three-four months. It is unusual to have significant numbness of the area injected afterwards. If you did experience this, it might be related to the topical agent used to numb the skin or some swelling and should resolve in a day or two.

Yes, I would expect for your areola to increase in size some. This is variable depending on the size of the implants, and if placed under or over the muscle, and the properties of your own skin and elasticity of the skin. It is impossible to know exactly how much, but it would be wider.

I had a patient that had this exact question of me this last week. She was very thin, so we could feel her saline implant valve that was on the front of the implant. There was some small scar tissue imbedded in the valve that showed up on the ultrasound. You could feel it, only because she was so thin. There is no question, that sometimes this scar forms at the valve. There could be other reasons for this diagnosis that should not be ignored. I would suggest that you go see your surgeon with the ultrasound in hand, and have him also do a physical exam. This also is important, as you may have your implants over, or under the muscle. If yours are totally under the muscle, they would not be in contact with your breast tissue but with your muscle. If this is the case, I don’t think that you have to worry as much about the implants hiding breast cancer. This needs to be correlated with a physical exam.

Since you are happy with the Botox, I would suggest that for future injections, under the advice of your plastic surgeon, possibly minimizing the use of the Botox near the lower eyelid area to see if this can minimize accentuation of skin folds in this area. Although additional Restylane could be used, it may be better to try to prevent the concern in the first place. Once again, this advice needs to come from your plastic surgeon that is caring for you, as he or she can discuss specifics that pertain to your anatomy.

As far as the premature wrinkles, as young as you are, I would consider microdermabrasion and the use of moisturizing creams. If that does not solve the problem, then you may try Botox injections, however Botox lasts only 3-4, maximum 5 months. For the dark circles under the eyes, I know of nothing truly effective, but you may camouflage them with makeup.

My first question to you is “Have you always gone to the same practitioner” and the next is “whether or not the practitioner has changed their technique or the number of units of Botox in a given injection site.” If nothing has changed, then you may be developing a tolerance to the toxin. Interestingly, some people find that the effect of injections last longer with time; hopefully you are not one of those whose effects diminish with time.

I would wait six months before trying to conceive after Botox treatments. By then, the Botox will be out of your system.

Deep creases will respond beautifully to Botox. However, if your primary problem is brows that are too low, which can be determined by your plastic surgeon at the time of your consultation, then you may want to consider surgery. A brow lift will smooth the creases on your forehead while also elevating your brows. By examining your face and forehead, your plastic surgeon will be able to determine which treatment is appropriate in your specific case.

For appropriately selected patients, adding a chin implant at the time of facelift can significantly improve the postoperative neck contour and overall facial appearance. Many surgeons routinely make a small, inconspicuous incision under the chin to recontour the neck. Through the same incision, a chin implant can be placed directly on the mandible (chin bone) to further enhance the appearance of the neck and face. Chin implants come in a variety of sizes and shapes and can be made of different materials. The most popular type of implant is made of solid silicone and wraps around the lower jaw, avoiding the "button" look. These implants have been successfully used for more than 20 years. Infection or implant rejection is very uncommon, but if this occurs, the implant can easily be removed. Usually it can be replaced after suitable healing takes place. Exceptionally large implants are not recommended because of the increased pressure on the mandible as well as a greater chance of malposition. Most implants, if placed without initial problems, can last indefinitely. Chin augmentation with an implant can add subtle, but noticeable improvement in the results of a facelift without adding significant cost, surgical time or recovery.

Since BTX does not produce atrophy of the muscle, merely inactivity/weakness of the muscle, it should not interfere with proceeding with either a facelift or blepharoplasty (eyelid surgery). Obviously, as BTX wears off, those muscles will become active and the wrinkles will reappear. The exception is if a brow lift is performed in which case the frown lines may remain less prominent.

While Botox is FDA-approved for cosmetic use only in glabellar "frown lines" between the eyebrows, it is used off-label for many other purposes. Nlite® may be effective but results can vary. A lot depends on skin type, extent of wrinkles and underlying muscle activity. It's best to have an ASAPS-member plastic surgeon evaluate these areas for more specific recommendations.

Botox injection for crow's feet should not interfere with a facelift. A patient would not need to wait at all and could have Botox injected before, during, or after the procedure.

Botox, when administered by a qualified physician who has evaluated you for this treatment, is very safe. However, if you are pregnant, suspect you might be pregnant or are trying to become pregnant, then treatment with Botox would be contraindicated.

Your concern about the need for an upper eyelid lift or brow lift after receiving Botox injections to decrease forehead wrinkling is a common occurrence. As we age, the brow falls or becomes ptotic (sags), affecting the appearance of the upper eyelid. The eye appears smaller and you lose a highlight area lateral and below the eyebrow; this area is called the "frontal bar." The Botox probably helped get rid of the wrinkles on your forehead but caused your brow to fall due to paralysis of the frontalis muscle. As you probably know, this condition will not last since the effects of Botox are temporary. However, it is not too soon to discuss the options regarding cosmetic surgery, even though you have recently received Botox injections. Brow lifts are commonly performed today with endoscopic equipment requiring much smaller incisions than in the past. The eyelid area may require surgery due to too much skin or excessive fat. This operation is referred to as a blepharoplasty (cosmetic eyelid surgery). A laser is sometimes utilized in this procedure. It allegedly decrease tissue trauma and therefore should decrease postoperative swelling and bruising. Lasers are expensive and may slightly increase the cost of the procedure. The long term results are quite similar whether a laser or scalpel is utilized for this procedure. To find out what options would be most effective in your case, you should consult with a local plastic surgeon who is a member of the American Society for Aesthetic Plastic Surgery.

Although Botox is growing in popularity for its ability to temporarily diminish the appearance of wrinkles, there are some real albeit uncommon risks. Some of these associated risks are bleeding/bruising, dry eye problems, drooping of the eyelid (ptosis), double vision, or allergic type reactions. Side effects, like other results of Botox, are temporary. Botox use in cosmetic plastic surgery is largely to treat dynamic wrinkles (those caused by excessive muscle contraction) around the eyes, and in the forehead and neck. It can be used alone or in conjunction with a surgical procedure.