Many of us see our lips getting thinner with age. This is due to a decrease in collagen and elastin formation in our lips just as it decreases in our faces. Many women would like to have fuller lips like they had when they were younger, but most do not want a fake or over-done look. Natural, fuller looking lips can be achieved when the right filler is selected, the right amount is injected and in the right way. Not ready for filler? Sometimes, fuller lips can be achieved with carefully placed, low dose Botox or Xeomin alone!

Volbella™️ vs Juvederm®️ Ultra XC
(Filler Options)

For those wanting a subtle increase in their lip size, Volbella may be the right choice. One of Allergan’s newest fillers, Volbella was specifically formulated to be a softer filler with a more natural look. Alternatively, Juvederm Ultra has been on the market much longer and is the single most popular lip filler. It adds volume. Being careful not to overfill the lips (one syringe is usually enough), a natural look can be achieved with either. Both are FDA approved for lips. Results are immediate and can last up to a year. The most common side effects are swelling and bruising in the first few days.

(Not Ready for Fillers)

Botox and Xeomin, both neuromodulators, are most commonly used in the upper face to reduce wrinkles by relaxing muscles of facial expression in the forehead, between the eyes and at the corners of the eyes. Additionally, they can be used in a low dose to relax or “flip” the upper lip creating a slightly fuller appearance. Also, Botox can be injected into muscles at the corners of the mouth to flip the down-turned corners up. The results of both of these treatments are subtle but can be enough to make a difference in your look. Care must be taken to place the neuromodulator in the right muscles and at the correct dose, so that eating and speaking are not affected.


Most of us do not want exaggerated, over-done lips. Most of us do want the slightly fuller lips of our youth. Whether you are ready to take the leap to filler or would rather try low dose Botox or Xeomin, you have options.

Do you have a special pair of earrings, maybe even a pair of diamond studs, that no longer sit well in your pierced earlobe? There is now a simple outpatient procedure you can do to fix that.

Do Earlobes Age?

Interestingly, just like the face, earlobes lose volume as we get older. The combination of sun damage, wrinkles, loss of collagen and elastic tissue changes the shape of the earlobe, causing the piercing to hang lower. Additionally, years of wearing heavy earrings, age, gravity and genetics can contribute to the development of saggy earlobes.

Can Stretched Earlobes Be Fixed?

Yes! The same hyaluronic acid fillers that are used to restore volume to the face can be used to restore structure, shape and volume to the earlobe. This includes the Allergan line of fillers including Juvéderm®️ Ultra, Juvéderm®️ Ultra Plus, or Vollure™️.

Is Filler in the Earlobe a Long Procedure?

Often referred to as a “lunch time procedure”, filler in the earlobe takes only a few minutes to complete. A single syringe is typically more than enough to fill both earlobes. The use of a topical anesthetic cream can make the brief procedure pain free. Most clients return to their daily activities immediately. There can be some mild swelling and bruising that can last a few days, but when that goes down, you can expect lobes that look and feel great. And now, your earrings will actually sit upright in their piercing!

How Can I Effectively Maintain the Results from my Earlobe Filler?

In order to get the best and longest results from your earlobe filler (which you can expect to last from 12-18 months depending on the filler used), follow these simple suggestions:

  1. Avoid the frequent use of heavy earrings as they drag on the piercing and elongate the hole.
  2. Earring support discs that adhere to the post can help support the earring or earrings relieving some of the pull.
  3. Take your earrings out before you go to bed, and before you hold the phone receiver up to your ear. Better yet, use ear buds or the speaker phone!

Let’s avoid extreme earlobe damage that could require surgical repair. A little filler to the earlobe can help restore volume. Following the three suggestions above can help you maintain the improvement. Get those pretty stud earrings out of the jewelry box and have fun wearing them, once again!


Microneedling is a skin rejuvenating procedure that involves puncturing little holes into the skin with a medical-grade device or ‘pen’ which delivers tiny needles to a precise depth. The microneedle injuries promote collagen production by the skin which is further enhanced by the topical application of either polypeptides (the building blocks for collagen and elastin) or Platelet Rich Plasma (PRP) which is rich in growth factors. The result is smoother, healthier looking skin.

You may remember a picture of Kim Kardashian’s face that went viral a few years ago. Her face was covered in blood! Very dramatic! That was taken after she had a Vampire Facial®️. But what is a Vampire Facial®️ and does it have any true value?

Nuts and Bolts

Microneedling is a skin rejuvenating procedure that involves puncturing little holes into the skin using a professional device which delivers tiny needles to a precise depth. This is done after a topical numbing cream is applied so that the procedure is painless. The microneedle injuries promote collagen production by the skin which is further enhanced by the additional application of platelet-rich plasma. The PRP is obtained by spinning a vial of your blood in a centrifuge which separates the red and white cells leaving an amber colored serum which is rich in platelets and growth factors. This serum is then placed on the microneedled skin where it is efficiently absorbed.

How It Works

In addition to the collagen stimulating effect produced by microneedling, PRP further stimulates collagen production and brings other healing effects to the skin with its growth factors. PRP has been used in sports medicine for years because of its ability to speed up the healing process. It not only helps the skin produce new collagen, but also new blood vessels and new cells. The result is tighter skin with visibly improved texture and tone.


Although many people report seeing immediate improvement in the quality of their skin, a full month is usually needed for maximum PRP inducing collagen production. Your skin will look healthier with reduced lines, improved skin tone, less prominent scaring and firmer texture. Depending on your results, you may opt for one treatment or choose a series of 3 at one-month intervals.

Ideal Candidates

An ideal candidate is anyone looking to modify the appearance or texture of the surface of her skin. The only clear contraindication to the procedure is a patient with blood or bone disorders such as anemia, blood or bone cancers, those with clotting problems or on blood thinners. Clients should avoid any medications that reduce the body’s ability to clot such as aspirin or non-steroidal anti-inflammatory drugs for a few days before the procedure and a few days after.

What To Expect

Following a microneedling with PRP procedure, you can expect some side effects such as swelling, redness and bruising. You will be sent home with a post-care kit and instructions. Your kit will include a protective, healing mask, and a one-week supply of cleanser, moisturizer and peptides. You will be asked to take good care of your skin by using the products you have been given and by avoiding make-up, abrasive skin cleansers, pools, saunas and direct sun exposure. After a week, you will be able to resume your personal skincare regime while eliminating any Retin-A containing products.


If you want smoother, healthier looking skin and are ready to take the next step (BUT DON’T WANT SURGERY!) microneedling with PRP may be the right choice for you.

Botox®️ or Xeomin®️ are commonly injected into 3 main sites; the forehead to treat expressive lines, the outer sides of the eyes to treat “Crow’s Feet”, and between the eyebrows to eliminate frown lines sometimes referred to as “11s”. But did you know that botulinum can also be used to raise the eyebrows, eliminate horizontal “bunny” lines on the nose, turn up the corners of the mouth, reduce lines above the lip, get rid of chin dimpling and smooth out neck bands? Read the details below.

Eyebrow Lift

When an elevated brow is desired, botulinum injected into the upper lateral aspect of the circular eye muscle named the orbicularis oculi can achieve this. By slightly weakening this part of the muscle, the opposing muscle of the forehead literally lifts the eyebrow up. Simple!

Bunny Lines

People use their facial muscles differently. Some people develop vertical “11” lines when they frown while others also contract the muscles on the side of the nose creating a horizontal “bunny” line across the bridge of their nose. This can be easily treated with a single injection of botulinum to each side of the nose.

Mouth Frown

Do people think you look sad when you are not? Droopy mouth corners can be improved by reducing the activity of a muscle that pulls the corners of the mouth down, the depressor anguli oris. This allows the smile muscles that pull up on the corners of the mouth to function, unopposed. Easy as that.

Lip Lines & “Lip Flip”

Nothing makes one feel older than the fine lines that develop above the lip. Often incorrectly referred to as “ Smoker’s Lines”, they can develop in smokers and non-smokers alike. When low dose botulinum is placed above the lip in the circular muscle that creates puckering, the muscle relaxes, and the lines are reduced creating a more youthful look. Some people even get the added effect of a slightly wider upper lip leading to its nickname, the “lip-flip” or the “ lip-pop”.

Dimpled Chin

Chin dimpling can occur with age if the mentalis muscles become overactive. Botulinum can be used to relax these muscles thereby reducing the dimpling, giving you a smoother chin.


Teeth clenching and teeth grinding can cause enlargement of the masseter muscle which adds fullness to the face and angulates the jaw. Botulinum into this muscle not only relieves the symptoms of teeth grinding but can have the added benefit of slimming the face.

Neck Bands

The platysma is a broad superficial muscle that spans the neck from the top of the chest to the jawline. With age, it can develop bands and cords. Botulinum into these bands relaxes them, making them less visible. The result is a smoother, more youthful neck.

So next time you are in for your Botox®️ or Xeomin®️ appointment, let me know if you are interested in treating one or more of these areas. I will evaluate your unique, expressive face, and we will decide if adding any of these sites would be a good choice for you.

(Botox®️, Xeomin®️, Dysport®️, Jeuveau®️)

Wrinkle smoothing Botulinum Toxin A injections are the most common non-invasive aesthetic procedure in the US, and while they are colloquially called “Botox”, there are actually four different FDA approved Botulinum Toxin A injectable products for cosmetic use. Each one is made by a different manufacturer and has different cost, potencies, formulas and trademarked names. Because Botox®️ was the first FDA approved neurotoxin on the market, for many people the name Botox®️ has become synonymous with Botulinum Toxin A just as Kleenex has with tissues.

All four contain the same active ingredient, a very small dose of the potent Botulinum Toxin A which has the ability to temporarily paralyze muscles for cosmetic effect thereby reducing the appearance of fine lines and wrinkles caused by facial expression.

How They Work

Botulinum Toxin A works by preventing muscle contraction. After injection into the target muscle (forehead, “elevens”, Crow’s Feet), the product travels to the junction of the motor nerve ending and the muscle. There, it attaches to the nerve ending and prevents the nerve from releasing the chemical messenger (acetyl choline) that normally travels to the muscle cell with the signal to contract or shorten. Without this signal to contract, the muscle remains relaxed, and wrinkle free.

Dosing, Duration and Side Effects

Each of the four neurotoxins have similar safety and efficacy profiles but subtle differences do exist. Dosing is similar for Botox®️, Xeomin®️, and Jeuveau®️ but Dysport®️ dosing is more than double the units per area. Onset for Botox®️and Jeuveau®️ is 3-5 days, 5-7 for Xeomin®️ and 24 hours for Dysport®️. Results last an average of 3-4 months for all four but vary for individuals. The most common side effects are redness or bruising at the injection site, headache, nausea, temporary facial weakness and, rarely botulism-type symptoms.



Botulinum Toxin in its natural form is considered one of the most lethal substances known to man. I marvel that scientists have been able to harness, purify and dilute Botulinum Toxin A to create a product that is both safe and aesthetically useful.

Ideal Facial Dimensions

The concept of ideal facial dimensions has existed for thousands of years and remains relevant in modern times. And although we all know a beautiful face when we see it, attempts to quantify the ideal facial proportions can be downright humorous. For example, did you know that the ideal face should be equal to the length of three noses, and that the space between the eyes should be the width of one eye? Additionally, according to BBC News, the distance between a woman’s eyes and her mouth should be over a third of the overall length of her face. Who knew?

The Triangle of Youth

The youthful face has specific dimensions and proportions too, particularly when compared to the older face. Commonly referred to as the Triangle of Youth, the weight of the youthful face is at the top of the face, with full cheeks, high cheek bones, and full temples. These pleasing youthful proportions can change over the years leading to an Inverted Triangle with the weight of the face at the bottom rather than the top. Many factors contribute to this including the effects of gravity on muscle and skin, loss of collagen and elastin, and, what we will address below, loss of fat pads, particularly in the cheeks and temples. But what can be done?

Treating the Hollow

Dermal fillers can be used to add volume to the temples and midface and restore the Triangle of Youth. Restoring volume to these areas can eliminate hollow temples, accentuate cheek bones, and lift the face thereby reducing wrinkles and folds even in the lower face.

Safety Consideration

Dermal fillers can be safely added to the temples and cheeks in the office. The procedure can usually be performed with minimal discomfort after the application of a topical anesthetic and typically takes less than 30 minutes. Use of a blunt cannula in the temple region can reduce the risk of bleeding or bruising. Results are immediate and can last up to two years if a long-lasting hyaluronic acid filler such as Juvéderm Voluma®️ is used.

So, if you have lost volume in your cheeks, or your temples appear a bit hollow, a little dermal filler can help restore an attractive, aesthetic proportion to your face and help create a more youthful you!

1. Smile, Often!

Forget about aging gracefully! Age youthfully! Individuals in a study on the aging face were asked to guess the age of models with various facial expressions. Neutral expressions led to the most accurate estimates of age. Fearful expressions led to subjects being rated older than they were, and happy smiling faces were rated as younger than they really were. So, smile and take years off your appearance!

2. Take Care of Your Skin.

A simple skincare routine which includes a daily facial cleanser, toner, serum (particularly those with Vitamin A or C) and a hydrating cream is essential for healthy looking skin. Adding a weekly polish will help remove dead skin cells and promote skin cell turn-over. Taking time for a monthly HydraFacial©️ can help keep your skin radiant and bright. As always, drink plenty of water and keep fruits such as grapes, berries, plums and pears in your diet. They contain sorbitol which is a humectant, or substance that attracts water. And lastly, protect your skin from damaging UV rays. The best choice in sunscreens is one that is mineral based rather than chemical based. Mineral based sunscreens like Colorescience®️ provide a physical barrier to UV rays and are not absorbed by the skin.

3. Touch Up Your Hair.

As we age, our hair changes in color, texture and fullness. In addition to highlights and lowlights, consider the routine application of conditioner. If hair loss is a problem, Platelet Rich Plasma (PRP) is a non-surgical way to improve hair growth. It can be safely performed in a doctor’s office or medispa and can be highly effective.

4. Exercise Four Times per Week.

Pick something you like, whether it is walking the Galveston beach, jogging with friends, playing tennis or golf, or just keeping up with the grandchildren. Try combining cardiovascular for heart and lungs with resistance exercise for muscles and stretching for flexibility and healthy joints. Staying active will help you move more gracefully, fend off muscle loss, and help you sleep better.

5. Give Yourself Permission to Get a Little Help.

Often, I have clients who tell me that their significant others are opposed to them getting Botox or filler. Interestingly, these are often the same clients who are getting the occasional Botox or filler! The men don’t know, they just think their wife or girlfriend just looks great! If done well, Botox and filler should neither make you look fake nor over-done like a Hollywood actress or Washington politician.

What is exfoliation and why bother?

Let’s cut to the chase. Would you rather run your fingers over a smooth silk pillow or across a burlap sack? Exfoliate!
Exfoliation involves the removal of dead skin cells from the skin’s outer layers and is performed to promote healthy skin and to prevent breakouts. New skin cells are formed in the deeper layers, pushing the dead cells to the surface. If these dead cells are not removed, they can build up causing a dull appearance and rough texture. (Remember the burlap?) Adding exfoliation to your routine will not only brighten your face but will also improve tone and texture allowing products and makeup to go on “as smooth as silk”.

What are the different types of exfoliators?

It can be fun to find an exfoliation process that you enjoy and that works for you and your skin type. Some can be done at home and some require specialized equipment like the HydraFacial©️.

Physical exfoliation often involves the use of a granular scrub that abrades or buffs the skin’s surface removing dead cells. Common granules include salt, sugar, magnesium crystals, grains, jojoba beads and even ground nuts. For daily use, the ZO®️ Exfoliating Cleanser with jojoba beads is gentle and effective. A more aggressive product that is great for a weekly buff is the ZO®️ Exfoliating Polish with its abrasive magnesium crystals.

Chemical exfoliators usually involve gentle acids and enzymes that dissolve the protein bonds that exist between dead skin cells allowing for cell removal.

Mechanical exfoliation employs a product or tool that rubs, scrubs or vacuums. This includes brushes, loofahs, abrasive tips and others.

Can I use more than one of the different exfoliating techniques?

Combining various options can be fun and can lead to healthy, vibrant looking skin as long as you are careful not to over-exfoliate. Treat yourself to a monthly facial with the patented HydraFacial©️ machine! It provides a gentle chemical exfoliation (with glycolic acid and salicylic acid) and physical exfoliation with its specifically designed HydraFacial tip and fluid enhanced suction. Your skin will glow! In between facials, enjoy your home skincare regime.

If you are not already exfoliating, try adding it to your skin care regime and say good-bye to rough uneven skin and hello to smooth silky skin you will love!

What can Retinoids do for me? 

Vitamin A derivatives (commonly referred to as retinoids) can do wonders for your skin. Naturally abundant in carrots, eggs and sweet potatoes, synthetic retinoids are a gold standard ingredient in skin care because they alter the behavior of aging cells to act more youthful. They improve the appearance of the skin by reducing fine lines and wrinkles, increasing exfoliation, improving skin tone and texture, and reducing hyperpigmentation. They accomplish all this by first causing the outer layer of keratinocytes to shed off, leaving the skin smoother and more evenly pigmented. Next, Vitamin A derivatives effect the epidermal cells which start replicating faster, causing the skin to look and feel softer and healthier. This amazing vitamin also shrinks dilated pores and improves cell turnover within the pores so that they are less likely to clog and become blackheads or whiteheads.

How often can I use Vitamin-A products on my face and how soon will I see results?

Most people will notice improvement in their skin after 2-3 weeks of using a product with Vitamin A, but sometimes it can be as long as 6 weeks, depending on the skin type and concentration. Retinoids can be strong and often cause peeling and redness as well as irritation. It is best to apply the product sparingly all over the face, skipping days or adhering to a schedule of application every three days. After your skin gets acclimated to the product, you can increase the frequency of use.

Are Retinoid, Retinol and Retin-A all names for the same thing, and which ZO® Skin Health Products contain them?

Retinoid is the general category of synthetic Vitamin A derivatives. The over-the-counter version is called Retinol and is milder than the prescription version known as Retin-A or Tretinoin. Retinol is a powerful ingredient in Dr. Obagi’s ZO® Skin Health ‘Prevent and Correct’ line. A partial list of products that contain it are Wrinkle and Texture RepairRetinol Skin BrightenerRenewal Crème and Daily Power Defense. If you decide to add Retinol to your skincare regime, we will look at your specific skin type and needs to select the best corrective ZO® Skin Health product for you.

Are there any down-sides to using Vitamin-A derivatives in my face care regime? 

While using a Vitamin-A product, it may be best to avoid certain irritating skin care products such as those containing lactic acid, salicylic acid, or glycolic acid. On the other hand, using fragrance-free moisturizers and hydrating creams is encouraged and can sooth the Vitamin-A treated skin. Allow the Retinol product to absorb into the skin for 10-15 minutes before applying a moisturizer. Additionally, it is imperative that you use sunscreen daily while using Retinol as your skin will become very sensitive to the sun.A Fountain of Youth? Probably not, but Retinoids are the gold standard skincare ingredient that help the aging skin cells act young again.

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