frontalis to lift the lower and sagging side. This side with the stronger frontalis from overuse will cause that brow to be higher. In some cases, patients are best served by a referral to an oculoplastic surgeon before proceeding because treating the frontalis will sometimes drop the brow and impede visual field. It is always important to verbally discuss the asymmetry, as well as document and photograph it, so that you are not blamed after injection for the imperfection if it is not corrected. In general, a small amount of 2-3 units above the stronger brow corrects the irregularity.
In certain ethnic groups, the injection of 1-3 units into a hypertrophic inferior orbicularis oculi muscle can open the eye and make it look more round. In general, this injection should never be done in older Caucasian females as it can result in accentuation of any laxity in the delicate skin in this area.
Lips, Chin, Nose, Jawline, and Beyond
There is nothing more unattractive than sausage or duck lips. Often, inexperience and/or the desire to please the female
wishing to have larger lips prevent a doctor from stopping and actually looking at the patient. Ask them to smile. No good artist works on the dynamic and three dimensions that is the human face without first carefully observing and assessing it. If the upper lip rolls under and the red show diminishes with smiling, injection of filler alone will give you the duck or sausage look. Over active orbicularis oris must be treated prior to injecting volumizing fillers. Often when toxin is done first, there is more red lip “show†and the lips look larger without filler but at the very least, the filler result looks more natural with less material. This injection must be done deep into the upper orbicularis oris. 4-6 units are my usual starting dose. Here, it is so much easier to add than to subtract (Figures 7 and 8).
And if the duck isn’t bad enough, who among us has not been horrified by the monkey roll? This occurs when injectors attempt to eradicate bar code lines with hyaluronic acid filler. Laser resurfacing or dermabrasion is often a
