by Lawrence Janowski, MD
Patients come to me because they want to look more youthful, fresher, more vibrant and more positive. In short, they want the outside to match how they feel on the inside. The most important concern they voice is that they want to look natural.
They don’t want to look like someone who is trying to look as if they are in their twenties again. We all agree, that does not look natural. Maybe 5-10 years younger, not 20 or 25 years. We have all seen on TV what trying too hard looks like: Weird!
What patients believe needs to happen in order to achieve natural rejuvenation is often different than what I believe should be done. Patients tend to focus on a particular line or wrinkle, for example, the folds around the mouth (nasolabial folds) or the lines between the brows (glabellar lines). These are important areas to correct, but are insufficient if we are truly to achieve facial rejuvenation and a natural “wow” result.
When I look at a face, I am looking at overall volume loss, since this is the most important contributor to aging of the face. I am also looking at overall facial shape, which is, of course, dependent on facial volume. A heart-shaped face is ideal, whereby more volume should be in the middle third of the face vs. the upper and lower thirds, and should taper down toward the chin. As we age, we become squares. This is due to loss of volume in the cheeks, and an increase in jowling along the jawline, among other things. Achieving beauty and youth comes through re-proportioning facial areas to align with this heart shape. Care must be taken not to over-volumize, but to appropriately place fillers to achieve a better facial balance. Counterintuitively, facial shape is most positively impacted by treating the outer two- thirds of the face, rather than the middle third that most of us focus on when we look in the mirror.
My preferred tool for achieving this result is Sculptra. It is the closest thing I have to magic. It stimulates our bodies’ own natural collagen to regrow in all of the right places, simultaneously. This is possible because I am able to inject a little bit of it into many different places around the face, focusing more on the outer two-thirds. I am able to rebuild structure where it has been lost. Because it grows slowly, it goes through a natural and seamless evolution. Sculptra injection is performed three times, at least 6 weeks apart, allowing for collagen growth after each session. Results begin to show at the first follow up visit at 6 weeks, can improve out to 6 months and last for up to 4 years. After reading this, you may never look at your face the same way again! But this is a good thing. A three-dimensional approach is best, and it can produce magical results.
*Results may vary from patient to patient