There could be several different causes of a "witch's chin" as it is known. It could be a hyperactivity of your chin muscle (the mentalis) which pulls down too hard as you're smiling causing the chin to elongate and stick out more. Botox or Dysport judiciously injected into the mentalis muscle can sometimes fix this problem.

Another reason for a seemingly protruding chin especially as you age is that the area just lateral to the chin slowly becomes depressed causing the central part of the chin to stick out more. Sometimes addressing this "pre jowl" area with a little filler can fix the problem.

I have also seen this problem in patients that either had a geneoplasty operation or a short chin implant placed. In those patients sometimes a combination of lateral filling and Dysport/Botox is needed, or the short chin implant can be changed for one that extends more laterally.

By Dr. Gal Aharonov

Assessing the best treatment to elevate a patient's brows is one of the main questions I get asked. Who needs surgery and who will benefit more from non surgical treatments?

My first question is whether or not a patient likes his or her brows when they were younger. If you had nice full brows that were at a good position and now they've deflated and are lower, in my opinion a surgical brow lift will not make you look better.

If you have always had a low brow, even when you were a teenager then surgery might be the best option for you, unless you have had a deficient volume to your brows even at a young age.

I believe that brow lifting surgery has been overperformed by many surgeons. Plastic surgeons get trained to surgically elevate the brows and when they encounter a patient with a "brow problem" they automatically assume a brow lift is needed. When I first got out of my training I was the same way.

Now the first thing I do is evaluate the volume of the brow and decide if the brow will be raised by added volume. If someone is hollow with a deflated brow a surgical browlift will make them look like a deer in the headlights and will make their eyes rounder! I have made this mistake in the past and regularly now see patients who have had endoscopic browlifts with the same issue. Over the last several years I have performed fewer and fewer endoscopic browlifts because of this.

If you are a good candidate for a surgical browlift, there are a few different procedures that can be performed. The most popular and common is the endoscopic browlift. I reserve this for patients with a relatively low hairline. If your hairline is already too high this procedure can make your hairline higher!

For patients with a high hairline, a hairline browlift can be performed. You can read more about this in the browlift section of the website.

By Dr. Gal Aharonov

I get many patients coming in for consultation desiring a facelift because they feel it is a permanent fix while fillers or volumization is a waste of money. Some have even gotten upset at me for trying to talk them out of having a facelift and refusing to perform a facelift on them.

On the flip side, I have had patients coming in for non surgical treatments with fillers who I have had to tell them that their issues are best addressed with surgery.

A facelift addresses a completely different issue than volumization with fillers!

I personally believe that a facelift should be reserved for patients with significant neck laxity, jowling, and sagging. It does not address hollowness and volume loss! I feel very strongly about this and will refuse to perform a facelift on someone if it will not address their issues.

The only way to naturally address a face that has lost a lot of volume is by adding volume back! This can be done with fillers, fat injections, or sometimes facial implants. A facelift does not address volume loss.

The reason some people look like they have had plastic surgery is because they were not treated in the best way for their face. Many doctors succumb to patient pressure or desires and will perform surgery that is not right for that patient. Some doctors are also greedy at times and will push patients to have unnecessary surgery.

Please understand that I am a surgeon and would love to operate on someone if it will help them. But I will not succumb to patient pressure when I feel strongly that it will not benefit them. That sometimes makes patients upset.

Endoscopic browlifts are well known for causing these effects you describe when done too aggressively. Browlifts, in my opinion, are overperformed and do not always give a very natural result. So what options do you have now to fix your issues?

It is possible to reverse the procedure. A reverse endoscopic brow lowering surgery can be performed to lower your brows back down. If you are nervous about surgery again and would prefer something less invasive, it is possible to reduce the hollowness in your eyes and make them less round with just filler. This will not lower your brows but injecting filler below your brow can take away the roundness and hollowness. This also reduces the "deer in the headlights" look BUT does not lower the brows.

Either restylane or juvederm can be used to inject into the brow and upper eyelid. I prefer restylane because it seems to not swell as much as juvederm. Filler into the upper eyelid and brow area lasts a very long time. I have patients where it has lasted well over 2 years!

Just like in the rest of our face, our earlobes lose fat as we age. The skin also gets thinner adding to the wrinkling effect. Some women start to feel self conscious about that. A quick and easy fix to earlobe wrinkles is to inject a little bit of filler into them. This immediately re inflates the earlobes to their more youthful appearance and shape.

Filler injections to the earlobes is also very long lasting compared, for example, to filler injections in the lips. Either Restylane or Juvederm can be used to quickly restore volume to the earlobes.

Are earlobe creases associated with heart disease?
For years it was thought that earlobe creasing or wrinkles are associated with heart disease. Actual scientific research has proven this to not be true. It was concluded that the incidence of earlobe creasing increases with age, as does the incidence of heart disease. The two were found to be independent of one another.

There are several possible reasons why your under eye area is puffy now.

1. It could be that too much juvederm was injected under your eyes causing there to be puffyness and bagging now.
2. Some people get a lot of swelling from juvederm under the eyes (that is the main reason I prefer Restylane under the eyes).
3. Even if the under eye filler was done perfectly, if you have a very flat sunken in cheek it could cause your under eyes to appear puffy until the cheek is filled a bit as well.

Your face needs to be evaluated as a whole. There are certain relationships that need to be maintained between different features of the face. If those relationships are compromised things look weird or off. For example, many women get their cheeks filled with filler. Even if the cheek filler was done perfectly the cheeks might now look out of balance with the rest of the face and hence look "artificial." For example, filling the cheeks alone might now make the under eye area look more hollow and sunken, and also might make the temple look more hollow and sunken.

Any idiot can take some filler and inject it into people's faces. The art is in anticipating how the filler will make your face look and where exactly should it go to make you look better and more natural, not artificial and puffy.

So what can you do regarding your under eye bags? Well, you need to be evaluated to see why it looks puffy. The filler might need to be dissolved if there is too much of it, or your cheeks might need to be addressed if it is because your cheeks are too sunken.

It is not typical for our brow bone itself to get bigger as we age, but it does tend to look bigger and more prominent in some people. Why is that? Usually the reason is loss of fat around the bone including in our temples and the fat under the brow bone in our upper eyelid. As the padding around the bone goes away with age, the bone seems more prominent.

Is it possible to shave down the brow bone? It might be but I would not recommend it. Instead the way to fix this is by adding padding back again around the brow bone. Either by using filler or fat injections. By giving more volume to the temple, forehead, and/or upper eyelid, the brow bone will appear less prominent.