Facial Contouring with Injectable Facial Fillers

The development of injectable fillers has revolutionized facial plastic surgery, and probably is rivaled only by the discovery of Botox®. These fillers were originally developed to allow for correction of moderate to severe facial wrinkles and folds, but their uses have expanded exponentially. They have also received FDA approval for lip augmentation, and are commonly used in many other areas to change the contour of the face.

Most fillers consist of hyaluronic acid, which is a substance that is naturally found in the skin. Each company has a different proprietary formula for cross linking this molecule, which gives each product a slightly different feel. Cross linking the molecule also allows it to avoid resorption for longer durations, as hyaluronic acid made by the body is replaced every few days. Each formulation obviously has different uses in different parts of the face based on its properties.

Patients interested in these products can be conveniently scheduled during a lunch break or a short appointment for great results that require little to no down time. Proper injection will give patients natural results that previously were only attainable with surgery.

These medications have become so popular in the United States that many different formulations of hyaluronic acid have been FDA approved. Dr. Asher has experience injecting Juvederm®, Juvederm Voluma®, Juvederm Vollure®, Juvederm Volbella®, Restylane®, Restylane® Silk, Restylane® Lyft, Restylane® Refyne, Restylane® Defyne, Belotero Balance®, as well as Radiesse®. Of note, the formulation of Radiesse is slightly different than the other aforementioned injectables in that it is composed of calcium hydroxyapatite rather than hyaluronic acid.

The FDA has very stringent safety requirements before granting U.S. approval of these type medications. Whereas in other parts of the world there are dozens and dozens of products available, here in the U.S. less than ten have completed the extensive set of clinical trials to prove their long term safety. These medications have a record of safety that continues to grow. In the U.S. alone, over 1.8 million of these treatments were performed last year.

Unfortunately, even with an extremely low percentage of complications, these like any other medication can still be used incorrectly or even abused. Dozens of pictures can be found on the internet where patients have been injected in the wrong places, with the wrong products, using the wrong techniques or the wrong doses. This can be easily avoided with treatment by a skilled clinician who is knowledgeable in the anatomy and physiology of the face.


The discovery that Botox® reduces wrinkles has revolutionized facial plastic surgery like no other discovery this century. Patients looking for improvement no longer have to plan weeks off to recover from surgery, but simply drop by the office on their lunch break for quick, easy procedures that often outperform their surgical counterparts.

Patients love the results they can get from Botox® because it can look so natural and the treatments are so quick and simple. The medicine works by weakening selective muscles of the face where repeated contraction has left the patient with wrinkles. It has become so popular that two other forms of botulinum toxin A have been developed, each with their own advantages.

Dysport® and Xeomin® have a similar mechanism of action, and there will be certain situations where one product might be indicated over another. Dr. Asher has experience with all three medications, and will be able to tailor a treatment plan specifically for your goals and your individual facial structure.

In the U.S. alone, over 3.8 million of these treatments were performed last year. The beauty of these medications is that they work well, and work in a predictable fashion. Unfortunately these products, like any other prescription medication, can be used incorrectly or even abused. Complications can be avoided by injection from a skilled and knowledgeable physician who understands the complex anatomy and physiology of the facial mimetic musculature. If the treatments are performed correctly, the risks are perhaps the lowest for any procedure we perform.

Lip Enhancement / Augmentation

Scientific studies on eye tracking show that the smile is second in importance only to the appearance of the eyes. Everyone can have beautiful lips, with a quick, simple procedure and minimal downtime. This procedure is a very popular with younger patients. Or may be considered by patients who have noticed that their lips are thinner, and lipstick seems to run into the lines around the lips that have developed with age. Proper injection gives patients natural results that not even surgery can boast.

Poorly performed lip augmentation is perhaps one of the most common mistakes we see made in plastic surgery, and one that tarnishes the minds of those who might be seeking it. Often emphasis of the inexperienced injector is placed on volume rather than shape, and the patient ends up with lips that look odd, misshapen, and out of proportion to the rest of the face. This is easily avoided with treatment by a skilled physician. The patient satisfaction achieved by lip augmentation at the Facial Plastic and Reconstructive Center are some of the most rewarding of the facial enhancement procedures.

Skin Rejuvenation

Taking care of the skin is one of the easiest things we can do to help patients improve their appearance. We are quite aware, however, that understanding all of the varied treatment options and products for the skin can be overwhelming for the non-medical professional. The first thing to recognize is that all skin types are different: different in age, different in pigmentation, varying in the number of blemishes or lesions, varying in the density of hair, depth of scar, size of tattoo, etc. We will help you decide based on your skin and your goals which is the best approach for you.

Scientifically proven skin treatment technology can generally be divided into laser, chemical peel, dermabrasion, and micro needling. Lasers use energy with differing wavelengths to target specific areas of the skin to remove wrinkles, brown/red spots, hair, tattoos, etc. Certain lasers can also be used for many other purposes. Chemical peels involve applying certain molecules designed to penetrate the skin at precise depths to increase cell turnover and help boost rejuvenation by resurfacing the skin. They stimulate collagen formation and will also help remove wrinkles, as well as brown/red spots. Dermabrasion is a technique whereby your surgeon uses a precision instrument to remove the appropriate top layers of skin to incite regrowth of newer healthy skin, and can also be used for resurfacing in scar revision. Micro needling is essentially exactly what it says it is, using “micro-“ or needles much smaller than a patient would expect, to create microscopic holes in the skin to stimulate new skin growth and increase collagen and elastin levels. We offer all of these services at The Facial Plastic and Reconstructive Center, and will help design a treatment plan that is specifically tailored for your skin and your goals.

The topic of skin care products is slightly more complex. The great news is that there is excellent scientific data to prove that certain ingredients are very important to the health of your skin. The bad news, is that cosmeceuticals are a multi-billion dollar industry with lots of misleading marketing. Dozens of companies claim their topical formulations are “the best,” which can make it very confusing for patients to understand. We try to simplify for our patients what we know works, what we know is harmful, and what may be beneficial. We utilize the products of several professional skin care lines, and offer advice for our patients to help address their specific concerns.

Patients should know that certain products are simply not available without a prescription. One example is Latisse®, a topical medication that grows eyelashes longer, fuller, and darker. The results it offers are amazing, but unfortunately there are no over the counter alternatives.

Certain professional and prescription products may have technologically advanced delivery systems that are better tolerated by the skin, and allow for increased absorption of the active ingredients. They also are allowed to contain much higher concentrations of the key ingredients. No matter what your budget, it is feasible and extremely important to use the right products on your skin to protect against skin cancer, to optimize your results from other surgical/non-surgical treatments, to slow the aging process, and to treat certain dermatologic disease processes. We are always available to answer your questions regarding skin care.



Aging is unfortunately inevitable. Many patients look in the mirror and feel much younger than they look and decide it’s time to turn back the clock. You may have noticed that your lower cheeks seem to sag forming a jowl that distracts from a smooth jaw line. Perhaps the deep folds around the mouth are bothering you. Perhaps the sagging skin in the neck area has led to more collared shirts in your wardrobe or frequently wearing a scarf to “be fashionable” when really it’s secretly to cover up some of the first signs of aging.

Advancements in understanding the biology of the aging process, discovery of new technology, and development of state-of-the art techniques have allowed surgeons to revolutionize the treatment of these problems. The number of minimally invasive and non-surgical treatment options has increased dramatically, expanding the number of therapeutic options for the patient and the facial plastic surgeon. Still some patients would benefit most from a facelift, and the doctor may make this recommendation for you.

Facelift, or rhytidectomy, involves hiding incisions in front and behind the ears to access the sagging, excess tissue of the face and neck. Sometimes a tiny incision is also tucked underneath the chin. The surgeon will then reposition and tighten the deep structures and remove any excess that is needed. The operation is not designed to alter the appearance of the face, but simply return the face to what it looked like ten to fifteen years ago. If the patient would like to change a particular feature such as higher cheekbones, etc., then certainly this can be accomplished at the same time. Unfortunately a facelift does not stop the patient from aging. Although the changes are permanent, aging will continue at the same rate from that point forward.

Chin Augmentation

Scientific evidence has proven that a balanced face is a key to what our brains consider attractive. Often the nose and midface, the upper face, and the lower third of the face can be out of proportion to one another. Augmenting (adding to) or reducing the size of the chin and jawline can often be a very powerful change to one’s appearance. Thorough biometric analysis may reveal that what appears at first glance to be a prominent forehead or large nose, might actually be an underdeveloped mandible.

Depending on the patient’s individual anatomy, sometimes non-surgical treatments such as fillers and injectable neuromodulators can offer quick, non-invasive, yet amazing results. Altering the shape of the frame of the face can make an older patient look younger, a woman look more feminine, or a man look more masculine. If surgery is necessary, and a tiny incision underneath the chin or inside the mouth will allow the surgeon to remove or add bone, or place an implant to alter facial contour. Patients are often surprised how big a difference even small changes can make to their appearance.


Many patients get frustrated that the skin and soft tissue under the chin has begun to sag and distract from a youthful appearing neckline. They look in the mirror while leaning their head back, grab the extra tissue and say “I just wish this would go away.” They often aren’t bothered by any of the other signs of aging on the face, and actually are quite afraid to change the way their faces look.

Although some non-surgical treatment options have expanded the number of procedures available for patients not interested in surgery, a neck lift is many times an excellent choice. A patient’s specific anatomy, gender, and age will typically determine how the procedure will be performed. Incisions can be tucked under the chin, can be hidden in front and behind the ears, or sometimes placed in the midline of the neck and disguised utilizing running z-plasty or other scar camouflage techniques. Unfortunately a neck lift does not stop the patient from aging. Although the changes are permanent, aging will continue at the same rate from that point forward.

In the age of the “selfie” many younger patients have noticed they have a “double chin” that they find it unappealing. After altering the camera angle and the position of their jaw over and over again to get the best picture, often patients will choose instead to have a quick procedure to help improve their appearance (and, of course, their photo sessions).

Cheek Lift

Beautiful high cheeks are a sign of youth, and many patients loose volume in this area of the face as they age. When this happens the soft tissue of the cheeks can sag and certain smile lines, like the nasolabial folds become more prominent. The bags underneath the eyes become more accentuated, and patients feel like they look “tired.” Other patients are simply born with smaller cheekbones, and lack the attractive facial contours we see every day in actors and models on television.

For some time, surgeons relied on techniques such as alloplastic cheek implants and midface lifts that sometimes resulted in unnatural augmentation or required prolonged healing. Fortunately, the development of newer techniques and a greater understanding of the ideal contours in this region of the face have changed the way we are able to treat patients with these problems. Restoring or adding volume with non-surgical treatments such as fillers can be performed even in the office with essentially no down time. If the patients is planning to undergo an operation on another part of the face, the doctor can use the patient’s own adipose tissue harvested from other parts of the face or body to appropriately contour the shape of the cheek and midface.

Facial Fat Liposuction/Grafting/Transfer

Scientific research has shown that the face loses volume as we age. Often the patient’s own adipose tissue (fat) can be harvested from other parts of the body to appropriately restore this volume in the face. This enables the surgeon to more naturally restore contour and shape, filling in the folds and wrinkles rather than “pulling” skin aggressively with surgery (which can result in an undesirable “wind-swept” look). Typically the fat is harvested from the abdomen or thighs, it is commonly placed in the cheeks, midface, and around the mouth to smooth out “smokers lines,” “parenthesis lines” or nasolabial folds, thin lips and “marionette lines.” Fat grafting can also be used to revise scars. It can be performed alone, or combined with other procedures like a facelift.  Sometimes liposuction is necessary in the double-chin or cheeks, and this tissue can be discarded or placed into more desirable locations depending on the preference of the patient. Often patients who have enjoyed the benefit of temporary fillers look to fat grafting for a more long-lasting solution to the aging problem.


Facial Trauma Repair

Facial trauma can be one of the most emotionally devastating events our patients can experience. It often happens so suddenly with no time for you or your loved ones to mentally prepare for the cosmetic and/or functional impact these injuries can have on your life.

Obviously most patients just want to get back to the way they looked before, and we will do all in our power to get you as close as we can to that. These injuries can impact the patient’s ability to breathe, chew, swallow, and speak. They can affect vision, movement and sensation of the muscles, nerves, and bones of the face. They can affect the sense of smell, hearing, and balance. Sometimes the complete restoration of function to pre-injury levels is not possible, and aesthetic perfection is not attainable. Close follow up with your surgeon will optimize your results, and often a series of surgeries or smaller touchup procedures will be required.

Skin Cancer Reconstruction

Skin cancer is the most common type of cancer, and estimated to affect approximately one in every five Americans during their lifetime. A majority of these are found on the face, head, and neck.

Facial plastic surgeons will often work in conjunction with a dermatologic surgeon that is trained in a technique called “Mohs” surgery. Mohs surgery was developed by Dr. Frederic Mohs nearly a hundred years ago to allow the highest rate of preservation of surrounding normal tissue and the lowest rate of recurrence by ensuring all of the margins of the cancer have been removed. After the cancer has been removed, often the areas on the face where the cancer defect exists must be reconstructed. The face is a complex three-dimensional structure that can be challenging to reconstruct. Often a combination of techniques including local and regional tissue flaps and grafts must be utilized to make the scar as invisible as possible, and avoid distortion of nearby structures such as the nose, eyelids, and lips.

Scar Revision

Whether you have a scar from a trauma, surgical incision, dog bite, keloid from ear piercing, or any other etiology, it is almost always the case that this scar can be made more invisible. Complex surgical techniques to re-orient and narrow scars can be combined with preoperative and postoperative strategies to improve healing, taking advantage of the latest technology and research in respect to wound healing. If you are self conscious of the way a scar appears, consideration should be made in undergoing a procedure to improve upon that scar.



Our eyes are the focal point of our faces when we interact with each other every day. We commonly see the “frame” of the eye begin to change as one of the first signs of aging. Often patients notice they can’t open their eyes as wide as they used to or feel a heavy weight on their upper eyelids. You may have difficulty applying eye makeup or might feel you look “tired” in the mirror though you feel quite rested. Maybe the bags underneath the eyes have begun to draw attention away from the beauty of eyes themselves. Sometimes patients may wish the smile lines or crow’s feet just beside the eyes were a little less prominent. Perhaps the lines in between the eyes on the brow give one a constant “angry” look that does not portray how you really feel.

Most patients are very happy to hear that newer non-surgical procedures can correct many of these changes. A few minutes in the office with no downtime is usually more appealing than having to do surgery. Of course certain findings may require a surgery for complete correction. In fact, aging changes around the eye can sometimes be so severe that they can inhibit normal vision. In some cases the upper eyelids would be completely fine if simply the brow were slightly lifted. Often younger patients may look to blepharoplasty to change the appearance of their eye in respect to ethnicity.

Blepharoplasty, or eyelid surgery, can be one of the most rewarding procedures. Incisions are very inconspicuously placed in natural creases around the eye that already exist, or sometimes on the inside of the eyelid itself. These heal extremely well and are almost always imperceptible. Small amounts of skin are sometimes removed, and fat can be either removed, added, or repositioned. Patients rave that the clock has been turned back and their friends can’t tell how they did it!


The forehead should never distract from the most beautiful parts of the face like the eyes and the smile. Many patients complain their brow feels heavy, or at the end of the day their forehead is tired from constantly pulling the eyebrows up into a favorable position. They dislike the wrinkles that have formed both horizontally on the forehead as well as vertically down between the eyes. These frown lines, or “eleven lines” can give the patient a constant scowl though they feel quite happy. Some patients notice the smile lines, or crow’s feet over time pull the tail of the brow down the more they smile.

Many patients are quite excited that these changes can often be treated with newer non-surgical techniques. In fact, over 9.5 million patients in the U.S. opted for these non-surgical therapies in the last year alone. Younger patients are happy to learn that they may be able to change the shape of their eyebrows without surgery or altering patterns of plucking the hair with use of cosmetic fillers.

Brow lift, or forehead lift, must be tailored for each individual patient’s specific needs if surgery is required. Most can benefit from the minimally invasive endoscopic technique, which utilizes much smaller incisions hidden completely in the hairline. Other patients may need a combination of other techniques depending on their hairline height, forehead contour, and baldness patterns. Brow lift essentially involves repositioning the tissues of the forehead into a more favorable position.


Rhinoplasty (Nose Job)

No matter how elegant or cute a patient’s nose may appear, it is rarely the most attractive feature on one’s face. The eyes and the smile should dominate what others see when they look at you. If a patient dislikes the appearance of their nose or feels like it distracts from the other features of the face, it can be addressed by their doctor. Patients may have had their nose damaged by a trauma, affecting the function of the nose and decreasing the ability to get enough air during exercise or sleep.

Whereas, many parts of the face can be altered with non-surgical techniques, changing the shape and/or function of the nose typically requires a surgery deemed “rhinoplasty.” Rhinoplasty essentially involves changes to the cartilage and boney structure of the nose through reshaping, repositioning, adding, and subtracting. These changes can be accomplished through a tiny incision underneath the nose or sometimes through incisions hidden completely inside the nostrils. These incisions heal extremely well and are usually imperceptible after a few months.

It is important for the surgeon to always consider both form and function when performing rhinoplasty. Certain changes may look nice but not function well, and conversely some maneuvers that will improve breathing may not be aesthetically pleasing. Because the changes can be so dramatic, rhinoplasty is one of the most gratifying procedures. At the same time, the procedure is complex and requires some recovery time, so should not be undertaken without significant consideration. You and the doctor should have a sincere conversation about your goals and concerns before making the decision to pursue rhinoplasty.


Septoplasty is a procedure performed on a commonly described condition known as a “deviated septum.” The septum is simply the cartilage and bone that divides the left nasal passage from the right. The septum can be pushed more to the left, or more to the right, or most commonly is shaped like an accordion where deviations to the left and right at different levels can block both sides of the nose.

Many times a deviated septum affects only breathing, but if the front portions of the septum are deviated they can cause the nose to be crooked and/or the nostril openings to be asymmetric. Often the appearance of the nose must be altered in order to fully correct the function. These changes can usually be performed through incisions completely inside the nose, but can require a tiny incision underneath the nose that heals to become imperceptible after only a few months.



Ears are an important feature to any face, but the natural position and shape should blend in to the sides of head and never be a focal point. Our eyes are naturally attracted to ears that stick out too far or are misshapen. Unfortunately, these differences are easy for even children to spot, and often become a theme for continual “bullying” as many times kids can be quite cruel to one another. Some kids can even be born without one ear in a condition termed microtia.

Otoplasty is a procedure where the cartilage of the ear is molded to allow a more natural appearing shape and position. It can be accomplished through a small incision on the back of the ear that is easily hidden and heals very well. Although adults commonly undergo otoplasty, this procedure is most frequently performed in children. The procedure is quite safe, and the recovery is rather minimal. The psychological changes and the boost to self confidence we see after otoplasty is remarkable, and parents often question why they didn’t pursue it sooner.

Earlobe Repair

Ears age as do our faces. Although they are important features, ears should never be a focal point of our appearance. While ears are great place to wear jewelry and add flair to an outfit, often tearing of an ear piercing can occur. Simple constant wear of earrings and gravity can cause a once circular piercing to take on a long oval shape.

Many procedures such as ear lobe repair and otoplasty for the aging ear can be performed under minor or local anesthesia. They require very little recovery and the incisions heal to an almost imperceptible level within a few weeks. A common theme we hear is “wow that was easy, I don’t know why I didn’t do that sooner.”