Dr. Jo Herzog on Injectables and Fillers

Last Tuesday, I shared my experience with injectables and fillers from a recent event held at Dr. Jo Herzog’s office. I shared my perspective on the pain, overall difference made, and degree of satisfaction of each procedure. Today, Dr. Herzog will speak to the process from a doctor’s perspective. She will use my experience to show how  she works with her patients to achieve the results they want. Finally, she will tell her opinion of which procedures made the most noticeable improvement on my face.

Dr. Jo Herzog, M.D.

I was so happy to have Jamie as my model for our last lunch event.  Her face was perfect to use as a demo, as she did have some considerable volume loss that would respond well to the treatment. I approached her almost as I would an office patient but had to make some modifications, as we were unable to use an exam room due to the large number of people in attendance.

I started as I do with all patients by asking Jamie what bothered HER about her face. She disliked the wrinkles on her forehead that occurred when she made certain facial expressions, as she felt that these made her look angry. She had also begun noticing stationary wrinkles around her eyes and lips. The tiny lines above her upper lip bothered her quite a bit, as she felt they looked like “smoker’s lips.”

One of Jamie’s biggest concerns was the area underneath her eyes. Her very fair skin has dark circles and volume loss underneath, and she can no longer go without makeup, or at least concealer.  She felt that her eyes were making her look tired and much older.

She did not really have a desire for larger lips and fuller cheeks,  but she was bothered by the thinning of her upper lip. She wanted to treat this, but she wanted to do so conservatively. She was not aware of any need for volume augmentation in the temple area. This was something that she, like most patients, had never noticed a need to address.

The next step, as it is with all patients, was for me to give my thoughts on what would best help Jamie’s face.  However, my thoughts are just that, my thoughts. I never tell a patients what to do, but I do tell them what I would do if I were them. Patients may not know exactly what they need or what about their facial appearance is making them unhappy with the way they look. They just know they look older, tired, and less vibrant.

Some patients, however, have a definite idea of what they want and have no trouble articulating it.  I respect their wishes unless I think that they are overdoing it. If this is the case, I tell them my opinion. For example, if a patient wants huge lips that I do not think would be flattering, I am not comfortable with this, as I don’t want the patient to do something that will reflect unfavorably on his/her appearance. After speaking honestly with my patients, there is almost always a resolution where they get the most aeshetically pleasing results that they want without risk of overcorrecting.

In consulting with Jamie, I agreed with her about filling lines and smoothing wrinkles but also pointed out to her that she would do well with more volume in her temples and cheeks. She had never thought about the need for volume in these areas, but when I showed her the areas and explained what I felt would offer improvement, she agreed to give it a try.

After assessing patients’ wants and needs,  I then discuss costs with them, as everyone has a budget they they would like to stay within. Sometimes cost will determine which specific drug we will use and how much of it we will inject. Although cost is a factor, patients must realize that if they do not use enough filler that they might not like the results, as the job cannot be properly finished. I often like to do procedures in stages so that the patient can have a natural-looking, progressive change and then several weeks later assess if they even want or need more. This is the safest way to approach cosmetic enhancement and greatly reduces the chance that a patient will get too much and then be unhappy with the results. However, some patients do not want to work in stages and like the treatment done all at once, especially those that have a long way to travel for their appointment.

In Jamie’s case, I decided to be conservative and do some basic work knowing that we might want to add some more volume later. She lives close to the office, so subsequent trips would not be a problem for her, and she preferred this conservative approach as well.

In summary (we will go into detail in later weeks), I used some Dysport (forehead, glabellar area and around eyes), Restylane (around lip area and in both lips), and Perlane (temples and cheeks). We chose these specific products because we were doing a luncheon to demo them. If Jamie were to walk in as a patient, I would have discussed other options, as there are many other excellent ones besides these.

Jamie was most pleased with the small corrections in the areas that bothered her most. However, I think that she also appreciated the significant changes to the areas that she was not bothered with before we started. This is where a physician’s expertise comes into play. He or she can suggest things that a patient might not be aware that could make a huge improvement.

I did agree with Jamie’s high satisfaction rating with the Dysport which lifted the brow and ironed out the wrinkles and with the filling of tear troughs (around eyes). However, I would rate adding volume to temples and mid-facial areas as a bigger improvement than the small amount of filler that I put in her lips. I do feel that she could might be pleased at some point with a bit more volume and shaping of the lips. As with all patients, I offer my opinion as to small changes that might be considered in future procedures.

Next week, we will go into a bit more detail about these specific procedures and will even discuss pricing and how to go about doing certain procedures and trying to stay within a budget. As always, feel free to send any questions my way, and I will be happy to answer them in future posts.

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