Cosmetic Injectables

Facial Rejuvenation with Botox®, Fillers, & Kybella®

Dr. Shin has extensive experience injecting therapeutic Botox® and Botox® Cosmetic, as well as, Juvéderm® dermal fillers and Kybella®. These types of cosmetic injectables offer non-surgical solutions to wrinkles, volume loss, and submental fat with rapid results and minimal downtime.

Botox® Cosmetic

Botox® is a minimally invasive treatment that can treat existing facial wrinkles and help prevent more from forming by temporarily blocking nerve impulse transmission to the injected muscles and preventing their contraction, which results in a more relaxed and smooth appearance. An injection session takes 10-30 minutes. The effects of Botox® start to become evident in a couple of days and are fully appreciated 10-14 days post-treatment. Results typically last 3 months.

Botox® is commonly used to treat:

• Horizontal lines or wrinkles across the forehead
• Vertical lines between the eyebrows (glabellar region)
• Droopy/sagging eyebrows (to produce a mild eyebrow lift)
• Crow’s feet around the outer edge of the eyes
• Bunny lines (lines on the bridge of the nose)
• Downward-turned corners of the mouth and marionette lines
• Enlarged masseter for jaw contouring
• Chin dimpling that looks like the contour of an orange or golf ball
• Platysmal bands (vertical, cord-like structures in the front of the neck)

Botox® is best initiated before wrinkles are deep-set and maintained to prevent the progression of creases.

Please avoid Botox® if you have or are:

• Currently pregnant or breastfeeding
• Have neurological disorders such as myasthenia gravis, ALS, or Eaton Lambert syndrome
• Taking medications that block neuromuscular transmission (e.g. quinidine, polymyxins, aminoglycosides, anticholinesterases, clindamycin, magnesium sulfate, succinylcholine chloride, curare-like nondepolarizing blockers)
• Trouble breathing
• Hoarseness or dysarthria (a type of speech disorder)
• Difficulty swallowing

Potential side effects include bruising and swelling. In less than 2% of cases, Botox® can migrate and temporarily weaken nearby muscles, causing a droopy eyelid or asymmetrical facial expression, which resolves as the toxin wears off.

If you are interested in Botox® treatments to help you look less stressed and tired, please schedule a consultation with Dr. Shin. She would love to meet you to discuss your concerns and wishes. After we establish your goals and a plan, you can schedule an appointment during which we will take photographs, apply a topical anesthetic (some patients prefer not to have the anesthetic), and clean your face before Dr. Shin provides the Botox® treatment. Cool gel packs can be also be applied for comfort, although this is unnecessary for most patients. Dr. Shin helps rid you of your areas of concern to look refreshed and natural, not frozen.

Dermal Fillers

Fillers are cosmetic injectables designed to replace facial volume lost due to age or other circumstances. Restoring this lost volume can help you achieve a more youthful appearance and decrease fine lines and wrinkles. The most common fillers available are made of hyaluronic acid, a type of sugar naturally present between skin cells that can hold up to 1,000 times its weight in water, or calcium hydroxyapatite, a biocompatible material that stimulates your body to produce collagen. Most patients benefit from a combination of filler products.

Dermal Fillers (sometimes in conjunction with Botox®) can:

• Provide the “Liquid Lift” by providing support for the skin in some areas and sculpting the face
• Plumping depressed horizontal wrinkles along the forehead or vertical lines between the brows
• Volumize deflated temple areas
• Softening crow’s feet/smile lines around the eyes.
• Improve undereye appearance if sunken or has bags
• Add volume to the mid face.
• Turn downward corners of the mouth upward
• Help reverse aging parentheses or creases around the mouth
• Add fullness to the lips and smooth smoker/straw pout lines
• Reduce marionette lines
• Improve dimpled chin
• Fill in depressed scars

Dr. Shin currently offers fillers of different thicknesses and weights in the Juvedérm® family :

• Juvéderm® Hylacross products: Ultra XC and Ultra Plus XC
  The Hylacross products crosslink hyaluronic acid molecules of uniform molecular weights.
  • Ultra XC (last 6 to 12 months)
    Indicated for the nasolabial folds. Also smooths smile lines around the mouth and the marionette lines. This best addresses finer lines and wrinkles.
  • Ultra Plus XC
    A thicker version of Ultra XC, Ultra Plus XC softens deeper lines and folds.

• Juvéderm® Vycross products: Voluma XC, Vollure XC, and Volbella XC
  The Vycross products crosslink hyaluronic acid molecules of higher and lower molecular weights.
  • Voluma XC (lasts up to 2 years)
    As the thickest, strongest member of the family, it is ideal for injecting deep into the cheekbone area to lift and add volume.
  • Vollure XC (lasts up to 18 months)
    Like Ultra XC, it is indicated for nasolabial folds, smile lines, and marionette lines, but because of its high-low HA crosslinking, it can be injected more deeply for more severe folds, lasts longer, but spreads a little less readily.
  • Volbella XC (lasts about 12 months)
    As the thinnest, most spreadable Juvedérm® family member, it is the filler of choice for filling fine lip lines or the delicate under-eye area.

It is best not to wait until the products are depleted to retreat. Patients who receive treatment approximately halfway through the retention period (or more often if volume loss accelerates), tend to maintain a more balanced look.

Side effects include bruising and swelling. Some patients notice redness or tenderness for a few days.

If you are interested in fillers to help you regain a more youthful version of yourself or to enhance your features, please schedule a facial analysis with Dr. Shin. After discussing what bothers you or the facial result you would like to achieve, you can schedule an appointment. To minimize bruising and swelling, please avoid taking nonsteroidal anti-inflammatories (NSAIDS including ibuprofen and aspirin) two weeks prior to the treatment. During your visit, we take photographs, apply a topical anesthetic (some patients prefer not to have the anesthetic), and clean your face before Dr. Shin treats you. The filler syringes contain lidocaine anesthetic for your comfort, and cool gel packs can be also be applied. After the approximately 30-minute treatment, you can return to work or your daily activities except for strenuous exercise or alcohol for 24 hours. You will see results right away although Voluma, for example, may look more natural after it softens into the surrounding tissue. Dr. Shin wants to rejuvenate you and bolster your confidence.

Kybella®

Kybella® is the only FDA-approved injectable treatment for submental fat, commonly referred to as a double chin, and is a less invasive alternative to liposuction. The active ingredient in Kybella® is deoxycholic acid, a naturally occurring molecule in the digestive tract that disrupts the cell membranes and thus destroys fat cells, which are then filtered out of the body through the normal metabolic process.

Kybella® is used to treat:

• Submental fat or a double chin
• Jowls

If you are bothered by a double chin or jowls, please allow Dr. Shin to see if you are a candidate for Kybella®. If Kybella® is appropriate for you, a series of treatments (usually two to four but possibly up to six) will likely be necessary to provide your best-enhanced profile. Nonsteroidal anti-inflammatory drugs should be avoided two weeks prior to injections. After taking photos, we will numb and clean the treatment area, select your injection sites, and with a tiny needle, Dr. Shin will deliver the medication in 15-20 minutes. Most patients see 80% of results within two treatment sessions. Treatments may cause bruising and swelling is proportionate to the amount of medication injected and fat to be dissolved. Although you may feel self-conscious because of swelling, Kybella® will not hamper your activities of daily living. If you want to avoid liposuction with incisions, general anesthesia, and possible scarring, ask about Kybella®!

Combination Treatments

Botox®, fillers, and Kybella® can be combined with PicoSure® laser, Lumenis Intense Pulsed Light (IPL), Sylfirm X, and TempSure® Envi technologies for augmented results. If you are interested in a package, we will customize a plan for you!

What are your concerns and how can they be addressed with Botox and fillers?

“I am bothered by my forehead wrinkles.”

• Botox can reduce your forehead wrinkles by inhibiting the muscles which create them. If they are deep, dermal fillers such as Juvederm® Ultra XC can plump up the depressed lines. Care is taken not to create a frozen forehead or droopy eyebrows.

“The lines between my eyebrows make me look angry.”

• Botox® Cosmetic can relax the muscles used to scowl and reduce the angry frown otherwise known as “Resting <Blank> Face.”

“My temples look sunken in or indented.”

• Volume loss from aging can create a sunken appearance in your temples. Juvederm Voluma™ XC can instantly replace lost volume and improve your appearance.

“The wrinkles around my eyes when I smile are now present even when I don’t smile.”

• Small amounts of Botox® Cosmetic can be injected to weaken the muscles around your eyes, thereby softening the smile lines around eyes.

“I hate the bags under my eyes/the areas below my eyes look sunken in.”

• Juvederm® Volbella™ XC is a lightweight filler with hyaluronic acid that can add subtle volume to the tear trough area and improve the appearance of undereye “bags.”

“I’d like the bridge of my nose to be straighter and higher.”

• Dermal fillers can be injected under the skin to change the alignment of the nose. This non-surgical procedure is often referred to as a “liquid rhinoplasty.”

“My face looks droopy and sunken in.”

• Replacing volume loss from aging can be achieved using a combination of Juvederm® fillers and skin texture and elasticity can also be enhanced with radio-frequency treatments.

“The folds by my nose/mouth look deep.”

• Nasolabial folds often deepen as we age but can be addressed with various Juvederm® products including Vollure™ XC, Ultra XC, and Ultra Plus XC.

“I am self conscious about the vertical lines around my lips.”

• Small amounts of Botox® Cosmetic can be injected to weaken the muscles around your mouth, to soften the appearance of perioral lines. Depending on the depth of the lines, Volbella™ XC or Juvederm® Ultra XC may be used to reduce perioral lines.

“I would like fuller lips.”

• Lip augmentation is performed using Volbella™ XC, Juvederm® Ultra XC, or a combination of fillers.

“My marionette lines are really noticeable.”

• A combination of fillers can be used in conjunction with Botox® Cosmetic to plump the lines and weaken the muscles that cause your mouth to turn downward.

“I hate my jowls.”

• Fillers are used to replace lost volume and lift the cheeks, creating a sleeker jawline and minimizing the look of jowls. Kybella®, deoxycholic acid, can also reduce jowls by dissolving submental/jawline fat.

“I have a dimpled chin.”

• Chin dimpling is commonly caused by a hyperactive mentalis muscle and can be addressed with injections of Botox® Cosmetic. Dermal fillers can also help smooth skin’s appearance.