Dr. Vivian Bucay

To date collagen has disappeared so there is no FDA-approved filler for the lips right now. Which is not to say that a doctor can't make the decision to use something like Juvederm or Restylane for lip enhancement because they are FDA-approved products but they were not studied in the lip. Restylane is close it should have already been approved for the lips. That's the one that's about to be approved at any moment for the lips. I think that the thing to make sure with the lips is to maintain facial proportions. The ideal lip, typically the upper lip should be about one-third of the volume of the total lip.

Without a photograph that allows me to evaluate your skin and overall facial volume, I can only give you general advice. If the dimpling on the chin is due to an overactive muscle, then treatment with Botox or Dysport to weaken that muscle can work beautifully. If you have volume loss, for example, you see shadowing or marionette lines that run from the corners of the mouth to the chin and jawline, then a filler may be the way to go to replace a volume deficit and smooth out the skin. Laser resurfacing would not be my choice to treat this problem because causes of a dimpled chin include overactive muscles, volume loss, or, very commonly, both.

Let's talk about the pores around your nose and on your cheeks. The first thing you must understand is that pore size is determined by genetics and pore diameter is a fixed size and cannot be changed. All we can do is improve the appearance of pores.You state that you have enlarged pores, not acne scars. The fact that you took Accutane 30 years ago works in your favor because Accutane reduces the size and activity of sebaceous glands, which makes pores look smaller. As we age, we lose collagen - the main source of support in our skin - causing the skin to lose its firmness. We also lose overall facial volume, around 1 teaspoon a year starting at age 30, so overtime, our skin just isn't stretched as tightly over our faces. The loss of firmness and "loose" skin makes pores look larger. Any treatment aimed at increasing collagen production and increasing skin thickness can work to improve the appearance of pores. Options include fractional laser resurfacing, intense pulsed light (IPL), and medium depth or deep chemical peels. Any treatment must be maintained with a good home care regimen. A good sunscreen and a topical retinoid (over-the-counter retinol or prescription strength, such as Retin-A, Renova, Tazorac, or generic tretinoin or adapalene) are the two nonnegotiable elements of an effective skin care regimen.

First, I am sorry to hear that your CO2 laser resurfacing did not give you the results you had hoped for. Without a photograph, it is difficult for me to give you specific advice because i cannot see your complexion. I suggest that you obtain a second opinion from a dermatologist who specializes in laser procedures, Possible options to improve your skin may include lasers that can reduce redness as well as certain topical compounds that can stimulate pigment production to improve the white lines on your face. The redness and flares at night will eventually disappear, but the white lines may represent a permanent loss of color in those areas.Of course, any further treatment should be performed by the physician only. Lasers are powerful devices that can produce highly satisfactory results, but like so many treatments, the most important part is the knowledge and experience needed to match the right laser to the right patient.