Laser, Filler, Neuromodulator: Togetherness is Beautiful

Every once in a while, I stand in front of the mirror and decide that I am ready for a little makeover. I’m told I look 10-15 years younger than my actual age…heck I should, I work at an Anti-Aging Clinic!

I see some crepey skin starting to form around my mouth, my eyes are getting heavier and hooded and there’s a crease across my cheeks where the fat pad continues to drop, making my nasolabial folds appear deeper. I have lost a lot of volume in my marionette area so it creases and bumps when I talk chew or express myself. These are areas that I need to address about once a year.

What I do know is that I can’t solve all of these issues with one fix; I’m going to need to attack these from all angles with different modalities. Combining treatments is the key!

I always like to start with skin improvements as there is no point in getting a new mattress and covering it with old wrinkled sheets!

How do I start?

If I’m going to do a deep laser I want to have it done first as there is a chance that it could affect the longevity of any filler I might have by decreasing filler water content and potentially decreasing filler volume.

Thicker fillers are usually placed deep in the dermal or subcutaneous tissue and won’t be affected by most energy devices. Even the heat generated by the lasers won’t be an issue as the shrinkage effect of collagen from laser treatments occurs at approximately 65°C but fillers are sterilized at temperatures of approximately 120°C so the laser heat won’t affect them.  

I love our new PicoWay which goes to a depth of 4mm on the 1064nm and could possibly reach some of the filler so I’m not taking any chances and will start with the laser.

(I had one skin rejuvenation treatment with the PicoWay and saw a smoothing in my face, neck and chest skin within about 3 weeks. I didn’t need numbing cream or pain medications—it truly was very comfortable and most of the redness was gone in a few hours. I’m going to have another next week and so far, along with my current skin regime which includes vitamin C serum, growth factors, retinol, and a zillion antioxidants, my crepey skin is already being improved but I’ll see more during the next 6 months as my collagen grows from each treatment. I will probably have 3 to 4 then do another in about 8 months.)

Dermal Filler

Next, I make some time with one of our excellent doctors and we devise a plan to pick these cheeks back up, raise my eyebrows and smooth my chin and jawline. Using very thick hyaluronic acid products such as Juvederm Voluma or Restylane Lyft, the filler is laid into the deepest layers of the skin to push the tissue up in my cheeks also taking the weight off my nasolabial folds. If this isn’t enough, some filler will be put beneath the folds as well.

Often, a lighter filler is placed on top of the thick filler to create a smoother coverage in areas where the skin is thinner (e.g. near tear trough) or has more movement (e.g. around the mouth).

This is a common plan for me to have and use for maintenance.


Last in the makeover is the browlift with neuromodulators such as Botox, Xeomin or Dysport. Why last? Because the fillers often need a brief massage right after they are injected but you don’t want to disturb the neuromodulator once it is placed.

The doctor is targeting specific muscles to relax and moving the neuromodulator can create an unwanted result such as a droop. Within 3-7 days I will see my eyebrows and my eyelids lift enough to make me feel refreshed. This I will need to repeat in 3 to 4 months.


1st laser, 4 weeks later, 2nd laser, repeat if needed. If you choose a Venus Viva, IPL, Fraxel Re:store or the PicoWay for pigmentation you can have your laser and wait 1-2 weeks and then do your injectables.

All in one appointment: Fillers and neuromodulator.

I always deal with my anti-aging concerns by combining treatments, as I know for myself and have seen in thousands of patients, the best and most natural-looking results come from improving all areas at once.  They also enhance each other’s efficacy.

Deep frown lines often need a neuromodulator and filler and when used together the muscle movement that creates wrinkles is inhibited so the filler lasts longer and looks smoother. Collagen stimulation is achieved through the laser, the needles entering the skin and of course, the doctor recommended skincare you are already using.

Give yourself the whole shebang at once, you so deserve it!

By M. Wally

Age is a state on mind. Aging is a treatable condition.

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