What You Need to Know about Botox and Filler: Tips From a Dermatologist

My bathroom doesn’t have the best lighting which can be both a blessing and a curse. A blessing because I rarely see imperfections and a curse because I do have a quite a few. At age 37 to be exact, I entered the world of botox and have been a part of this sisterhood ever since. It all started as a way to prevent wrinkles which had slowly been creeping up on me and now at the ripe age of 43, there’s no turning back. I am very clear about keeping the injections to a minimum to avoid an overdone frozen look. As one thing leads to another, I segued into fillers at age 41. Again, I am extremely conservative but fillers do help to restore the fountain of youth. My husband David is not a big fan. It’s not fun for him to see me drooling while sipping from a straw nor is he comfortable with having botulism injected into my face. He also prefers the au natural look but alas this is my new au natural look. I don’t completely disagree with his reasoning as there is something to be said about simply aging gracefully.

I typically see my dermatologist and anti-aging guru, Dr. Jody Levine, three times a year for botox and twice a year for filler and am quite pleased with the results. I like that she listens to my preferences and I feel like she has my best interests in mind.
I’d like to share some of her wisdom with you. Below is a Q & A with Dr. Jody Levine.

I realize that one size doesn’t fit all but in general at what age do you recommend that one begin using botox?
All people get lines when they make facial expressions. That is normal. But overtime, when lines are made over and over again, they begin to get etched in our skin and are present even when not expressing. These lines then make the person look older. Many lines, if left alone, begin to scar down and then are very hard/virtually impossible, to erase. So, my rule of thumb is that if a person already has “the lines of expression” when that person is not even making an expression, then it is time to botox. If that person waits until the lines scar down, it is too late. Some people are super expressive or genetically have very strong muscles and already have lines in the their mid-late twenties. But, on average, the early 30’s is when most people begin to develop fine lines. Of course, there are exceptions to my general rule. Certain areas, such as the glabella, when botoxed, smooth out very nicely. So, in that area, even if a person doesn’t see lines, it does improve the appearance to botox the area. The “mouth angles” is the one area I like to botox prophylactically. Meaning I like to botox there before the lines really start to form, to prevent the marionette lines which are very hard to treat once they form.

For someone who is thinking about botox and filler, what are the dos and don’t’s?
In general I feel less is more. Using small amounts slowly allows one to maintain a youthful look that is spectacular and natural.
However when someone has waited a very long time to start botox and fillers, they will need a lot and putting too little may not even show a change.
Do go slowly but be reasonable with expectations. Do take a before picture because its easy to forget what you looked like before.
Don’t take aspirin, advil, Motrin or other ibuprofen products within the two weeks before to avoid brusing.
Don’t go to a doctor or person who is not properly trained in fillers or botox to save money. Fillers and botox, when placed incorrectly, can have negative results and you want to use someone who will know what to do if a problem occurs. There are certainly people who have learned how to administer the products but still don’t know the anatomy well enough to treat a problem.
Do take arnica-montana after for a week to limit bruising.
I have more dos and don’ts on my website if you want to check it out …

Besides botox and filler, what other anti-aging procedures do you recommend?
A good topical regimen is important. That includes cleansing, toning, treating, moisturizing and protecting. Some examples of topical products include a broad-spectrum sunscreen (not just in your makeup), an antioxidant moisturizer, peptide cream, retinoid, eye cream, neck cream,and lightening product when needed. Additionally there are outstanding laser options that create dramatic natural results with little to no downtime.

For people who don’t want to do botox or filler, what are some other anti aging procedures that do you recommend?
Chemical peels monthly (or even weekly in the case of acne) are great.
A wide array of Lasers and light based treatments.
PRP with either micro-needling or with laser or alone.

What are some good pre and post procedure tips?
Drink plenty of fluids after, limit sun exposure after, and hydrate the skin. Arnica and bromeline to limit bruising (more on my website).

What’s new on the horizon in the field of anti aging?
Lasers are constantly being updated . Pico lasers are hot. Radiofrequency lasers are new and amazing.
PRP for use alone or with devices is super successful. We do the fractura laser along with PRP for incredible results.
Fat injections is great not just for volume but also for stem cells and is being used more and more.
Vaginal rejuvenation is a hot area now as well. There has been some bad press lately but that was really aimed at the companies who are marketing the lasers for off-label use.
New ways to do liposuction are big. Dr Elie Levine has 7 different devices that he uses for fat removal and skin tightening combined, depending on the pateints’ needs .
Laser fat reduction is big
Building muscle while reducing fat at the same time is now growing in popularity.