It is very common to have a slowly developing asymmetry to certain parts of the face. The upper eyelid is a very common place to see asymmetries that were not present at a younger age. Patients always ask me why one side is aging faster or losing more volume than the other. A few theories might be that the left side of the face in our country is exposed to more sun while driving. I have had patients that had severe burns on one side of the face when they were younger which sped up the volume loss on that side.

The best way to deal with upper eyelid asymmetries due to volume loss is with filler. Filler is way more accurate than fat or anything else that is currently available. To correct an asymmetry of the upper eyelids usually only a small amount of filler is needed. This can usually be done with just one treatment, but occasionally a touch up might be needed once the swelling settles to get it as perfect as possible.

There sometimes is an asymmetry in the actual amount of upper eyelid skin. If this is the case filler can be used to make the creases appear more symmetric, but the eyes will never be entirely symmetrical unless the superfluous skin is removed surgically.

The biggest indicator of upper eyelid symmetry is the position of the crease, more so than actual volume or amount of skin. The amount of eyelid that is seen is the most critical element. Usually even if there is an asymmetry in the amount of eyelid skin, or even mild ptosis of the eyelid on one side, the eyes can be made to look more symmetrical by adjusting the amount of eyelid show.

To learn more about upper eyelid fillers you can visit our upper eyelid filler page.

There is really no such thing as a perfect sized forehead. A forehead must fit your face. A forehead that might be a good size for your face might be too large for someone with a smaller face or too small for someone with a bigger face. A forehead can also be used to provide a short face with some length or a long face with a reduction in length.

To decide how much I lower a hairline or reduce the size of the forehead I try to make the forehead match the rest of the facial features. This is not a cookie cutter approach. The resulting forehead should just fit your face and it should not be obvious that anything was done. If your forehead is too big for your face it is leading to an imbalance in facial features. When the facial features are rebalanced by lowering the hairline the face should just look in greater balance.

To learn more about Forehead Reduction of Hairline Lowering follow this link

It would be extremely unsafe to shave down your cheek bones so your face is less wide. There are many crucial nerves that would be in danger in that area. If you have hollow temples the safest thing would be to fill in your temples. This will bring your cheeks into greater balance and your cheeks will not appear to be as wide.

The easiest way to add volume to the temples is with filler. Juvederm can be used to fill the temples in quickly and easily with minimal downtime or bruising. Sculptra can also be used in the temple but tends to take months and months to show a noticeable difference. Fat injections can also be used in the temples but are only cost effective if a large amount of volume is needed for the entire face.

In general I can give patients a very good idea of how much filler around the eyes they will need before starting. That is why a consultation is so important. I can give most patients a reasonable idea based on a good quality photograph. Determining how much volume will be needed also depends on your aesthetic goals for what you want your eyes to look like. Some patients desire a very full look while others would just like to fill in some of the hollowness around the eyes.

As a rough starting point, an average patient will need anywhere from 1/2 a cc to 1cc of filler in each upper eyelid. Same goes for the lower eyelid or under eye area. If there is a considerable degree of hollowness you might need as much as 2 cc in each upper eyelid or under eye. This will be discussed during your consultation.

To learn more about fillers around the eyes click here for the eyelid procedures page

Belotero is a new hyaluronic acid based filler sold by Merz. The advantages that I have seen using it is that it is fully hydrated, which means it should not cause as much swelling as the other HA fillers. It also seems to be more liquidy which means it it much less likely to cause any sort of lumps. The disadvantage of that quality is that it is not a good filler for building volume. The other advantage is that it seems, so far, to not cause the tindel effect--the bluish tinge that other HA can cause when injected superficially. This means that Belotero can be safely injected into fine lines, acne scars, and under the eyes without worrying about the bluish tinge.

Disadvantages of Belotero are that it is not a good filler for volumization. The longevity of it in different areas is still not well known.

In my practice I use Belotero for superficial fine lines and acne scars as well as superficial injection under the eye.