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Bliss Life

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This Can’t Possibly Be Me

Nov 17, 2017 02:46PM

by Dr. Joseph L. Kiener, M.D., F.A.C.S.


Your best friend just sent you pictures from one of the many holiday galas you have on  your schedule. Your reaction is, “That can’t possibly be me!” The camera can lie, but not when the setting is at 100 megapixels. So you can either check the camera resolution prior to having your photo taken, or you can do something about  it. Also, since your next engagement is a week away, whatever you need to do should produce a noticeable result with minimal collateral damage.

To decide on corrective measures, it is important to understand the processes behind making you look older. Simplistically, facial aging can be summed up by the 3 “D”s: deflation, descent, and dynamic compensation. As we age we lose volume in the face by loss of bone, muscle. and most importantly, fat. The loss of fat is both superficial—just under the skin—as well as in deeper compartments. This also contributes to descent, as the overlying tissues have lost the underlying support. Descent can also be attributed to the action of certain depressor muscles, which I will touch on further.

In correcting these losses, it is important to understand this anatomy to produce elegant results. The hyaluronic fillers have been a game changer in this regard. They are effective in correcting deep volume loss, as well as superficial loss, and do not require a procedure, such as fat grafting. They are, unfortunately, not permanent and can be expensive.   Although Mae West said, “Too much of a good thing can wonderful,” that does not apply to the over enthusiastic use of fillers. It is always better to under treat than to produce an appearance suggesting another species of humanoid. Expertly administered treatment with fillers is usually money well spent.

Although the aforementioned fillers can produce some lift, it is usually minimal. Descent is most predicatively performed by surgical procedures. Although “minimal lift” procedures are available, they are not recommended when time is of the essence. Other non-invasive modalities such as radiofrequency, ultrasound, intense pulsed light, and lasers can tighten and lift tissue; this effect is usually not seen for months.   Again, this is not something to recommend as a relatively quick fix.

Last but not least is the process of dynamic compensation, the body’s response to both deflation and descent. The lines around the mouth, forehead, and lips are largely due to this phenomenon. Neuro-modulators, like Botox, Dysport, or Xeomin, are the treatment of choice for these areas and an effect is usually seen within three to five days. Neuro-modulators can also be effective in weakening depressor muscles that pull tissue inferiorly, such as the low lateral brow and down-turned corner of the mouth. This allows the elevator muscles to act unimpeded.  Remember, fillers and neuro-modulators complement one another and the best results are seen by using both. When all else fails, rely on a good facial, good make-up, your best smile, and lower camera resolutions.  Happy holidays!


Dr. Kiener has been in practice in Reno, Nevada, since 1991. He received his M.D. from the University of Cincinnati in 1981. His general surgery training was at Cook County Hospital in Chicago, and his plastic surgery training was at the University of California, San Francisco. He has been certified by the American Board of Plastic Surgery since 1993. Dr. Kiener is a member of the American Society of Plastic Surgeons, the American Society for Aesthetic Plastic Surgeons and the American College of Surgeons. For more information, visit or call 775-825-1234.