Pretty Peaches By Nina

“My Botox doesn’t last?” I hear this often from new patients so let’s talk about Botox, doses, and expected duration.

Did you know the studied dose for Botox in the upper face is 64 units? Did you know the average US patient is receiving half this dose at just 32 units?!?

Lips are very personal. They are much like our clothing style or choice of hair color. We all have a preference of what we would like. The truth is regardless of what you would like, you are married to what you have.

Anatomy can not be modified and fillers are to enhance, not change your face. Understand the face is a whole canvas and lips are just a portion of the overall picture.

This is why my process in clinic is a bit different. I do require a thorough consultation prior to any treatment. I do not believe the face should be treated a la cart. More importantly I never want you to come with the expectation of a treatment to then only be disappointed because I do not believe it is in your benefit. That is a waste of your time.

Allow me to hear your concerns, make my professional recommendations, and set expectations of outcomes with you. This is when you are fully informed and should feel ready to commit to our journey together.

Are you ready for the best version of you?

The under eyes. A very challenging area in my opinion. There are many issues involved with the under eye:
1. Hollowing-The bone around the eye widens and muscles weaken. A separation in anatomy occurs. This can cause herniation or bulging of the fat pad.
2. Darkness/Pigment- The skin of the under eye is like tissue paper. Thinning more as we age. The area around the eye is very vascular. The thinner the skin becomes the more you can see these dark circles. Chronic dry eye worsens the dark appearance from constant friction and shearing of these fragile vessels as we rub our eyes b/c of bilirubin.
3. Wrinkles- Either wrinkles created by the muscles or by the thin skin that has just become creepy with age. It lacks collagen and elastin. This is exasperated further by sun exposure.
4. Support- The forehead, temple and cheeks have hollowed from lax skin, loss of bone, and layers of fat pads that thin as we age. The under eye no longer has its support beams.
5. Intrinsic factors- Internal health issues such as liver, kidney, autoimmune problems, iron deficiency, hormone imbalances, vitamin d deficiencies, chronic allergies, oral health, sinus infections…. the list is long.
6. Lashes- Extremely heavy and long eyelash extensions will cast a shadow over your eyes and will dry them out. Both will contribute to dark circles and cast shadows that will look like dark circles. (And not a lovely set of false lashes. I mean lashes that are extremely exaggerated in length)
7. Natural lashes: Are you washing your lashes daily? The oil/makeup buildup will cause dryness, irritation, and create dark circles.

This area is a puzzle piece. Work backwards and piece it back together. Think about all 7 contributing factors. Sometimes it’s an easy fix and sometimes it’s a longer journey.

I start with 3 simple home remedies. -Dehydration measures
-Occlusion with Vaseline and CBD anti-bruising oil or growth factor
-Diet changes and for my very committed: An easy celery juice protocol. It works to detox so many organs.

What’s your favorite tear-trough tip ?

This one is for all my ambitious women out there. All the mommas, the small business owners, the CEOs, the college students, the entrepreneurs, the innovators. There is no greater power like a woman on a mission.

What motivates you?
I personally love being told “No, it can not be done.”

The consultation!

My process is different but I promise it is created to place all the focus on you. The consultation is to educate, support, listen, but most importantly guide you on the whole picture; your skin, your Botox, and your injectable needs.

Our first meeting is a full consultation. We are together an hour or 2. If you are investing into your aesthetic goals I will be sure you are prepared! This is my chance to:
✨Know your goals
✨Assess your anatomy for realistic outcomes
✨Review a complete your health history for safe injections
✨Discuss a treatment plan that feels responsible to you personally, professionally and financially.

Consultation Tip: Bring a picture from 10+ years ago. Not because I want to make you look 10+ years younger but because it is a tool that allows me to see where your filler will be most impactful for your face. That’s how we inject, with intention!

See this lovely patient. She requested lip filler. She is young, at 30 years old. You must understand fillers are not for aging only they are for structural purposes too! I know at 30 I did not believe I needed any cheeks, chin, jawline or smile lines treated. I also thought a lip plump was the best for me.
However, if we just filled her lips without addressing the whole face she would have walked out with a weaker jawline, deeper under-eye hollows, and a shorter chin AND worst of all she would have a displaced lip that did not suit her.
Now I have failed her and she has spent her hard earned money to look “unlike” her self. That is a no win situation. If I feel it is wrong for you then I will explain myself and kindly say “no”.

This patient had 7 syringes of dermal filler.
We treated midface, cheeks, undereyes, chin length/projection/shadows, and prejowl along the jawline. She won’t need any more treatments for 12-14 months. At that time I would recommend a small portion of her initial investment to keep up her results. However most of the maintenance will come from her skin program. Let’s showcase your beauty. Never augment it. Are you ready to start your journey?

Are you ready for National Botox Day?

Date: ✨Wednesday November 16,2022✨
Time: 9am to 6pm

Details:
-$10.99 per unit (45 unit minimum)
- Goody bags
-$2k in skincare giveaways!

Let’s play a game! I want you to scroll to the left and guess what age the patient is shown with her upper face Botox/skin treatments. Then I want you to scroll again and guess what age the patient shown is with her lower face. Then I want you to scroll again and take notice of something; Would you believe this is the same patient?

This is a result of treatment in isolation, where she has had continuous upper face treatment but the lower face was completely disregarded.

Why do we recommend treating the whole face? It is crucial for this very reason above. Treating in isolation is never aesthetically pleasing, because preserving half of the face without consideration to the second half is not beneficial to your outcomes.
A patients biggest fear: looking unnatural. To me the above is the most unnatural approach possible. Your face is in separate decades. It’s telling and clear what the patient has and has not had treated. It also draws attention to the face but this doesn’t not highlight her beautiful rejuvenated upper face, there is a true line of demarcation from upper to lower.

Full face regeneration is crucial and why we discuss the whole picture:
Skin
Wrinkles
Volume loss

I am not a provider who only treats the lips or 1 area with Botox. I am a steward of your hard earned money and I know Botox and fillers are not wrinkle and volume chasers. They are beautification tools. This is why I do require a full face consultation prior to treatment. I want to explain and recommend your needs before we commit to a treatment. My goal is to educate you and allow you to decide if I am the provider for you.

Also I must give credit to the most amazing Allergan BDM for sharing this type of visual with me recently. .liz you are so forward thinking and creative and I am so blessed to be able to work with you and grow from your knowledge❤️

Transitions are key. I do not think a single patient has ever sat in my chair and said “I need temple, submalar and pre auricular volume replacements” Why? Because we see ourselves in the 2D and we are drawn to the midline of the face. We see 11 lines, forehead wrinkles, under-eye changes, smile lines, and lips. An aesthetic injector sees the entire picture. They know the frame is changing.
One of our largest fat pads, the bichat fat pad, runs the length from our temples down the face to the jawline. This is the 3rd fat pad to atrophy and thin on us all. What happens then? You develop hills and valleys or lights and shadows. The temple becomes hollow and dark, which then over emphasizes the cheek bones to look over done and full (even if they are not treated) , the overemphasized cheek then causes the loss of the bichat pad of the lower face to look more hollow and exaggerated. We look gaunt. Aged. We look like we have been over treated like this before picture.
The tendency is to add more cheek to try to correct the smile lines and “resupport” the face. It is not always necessary. Often you can blend areas and change light reflections. Treating the perimeter of the face takes the harsh hollows and curves away, softens the face, blends the cheeks, and supports the under-eye hollows. This means less product is required to treat the patient overall.

My favorite is blending vollure or voluma, I think of this based on the patient’s skin. Blend with 0.3-0.5ml of saline. l also love biostimulators in this space to help both volume and skin integrity followed by a heat source like our aerolase yag laser to stimulate fibroblasts post treatment. RF would be a great resource as well. Timing is key here if you add in devices. We create a treatment plan based on alternating treatment and laser for 6-8 months for best outcomes.

Cannula tips below in comments✨✨✨

Happy injecting my friends!

Transitions are key. I do not think a single patient has ever sat in my chair and said “I need temple, submalar and pre auricular volume replacements”
Why? Because we see ourselves in the 2D and we are drawn to the midline of the face. We see 11 lines, forehead wrinkles, under-eye changes, smile lines, and lips.

An aesthetic injector sees the entire picture. They know the frame is changing

Ok here we go. This may not be popular opinion, but I personally do not endorse derma planning. Now do I think you have been wronged by a provider who has derma planned you? ABSOLUTELY NOT. If you have regular skincare in place I do believe a healthy skin barrier is more receptive to this procedure but allow me to explain why I do not prefer it:

Derma planing originated from Japanese facilities called kao sori (shaved face) that offered its clients full face shaving services to create the affects of smooth skin. It became popular in the US in the 70s and picked up popularity in recent decades as a means to exfoliate the vellous hairs (peach fuzz) of the face and its claims of removing dead skin without the use of “harsh chemicals”.

The procedure uses a surgical blade which shaves the surface of your skin in short strokes. The blade is held at an angle to glide over the skin, shaving away the hair & skin cells.
The reason I don’t agree with this process:
A surgical blade is used just for that, as a scalpel to get inside of the body. The blade is sharp. It’s held at a different angle but it is cutting away hair and skin cells without any control of depth. No one really knows if it’s taking only the top layer of skin, even in the most skilled of hands. You would need a mega microscope to determine the depth of exfoliation here.

Why do I care?The concern for me is you are no longer just removing hair and redundant cells but you are also microscopically removing the first 3 lines of skin barrier defense.
1. The microbiome, our first layer of protection, is scraped off. You just removed the roof of your house. This leads to bacterial disruption, congestions, skin irritation, and breakouts.
2. Stratum Corneum is the surface layer of our skin called the epidermis. It has natural moisturizing abilities and multilamellar lipids that sit between our cells. Once removed our skin is unable to retain moisture and it becomes dehydrated. I know a serum is applied over the skin after treatment but you are applying a bandaid over a cut. Why mess with a system that already self regulates?

Continued below ⬇️ in comments

Time: 1 year 2 months
Sessions: 3
Total syringes: 2.3 of juvederm ultra

Please remember it takes time to build a lip. Also the frustrating truth is that a full lip is not in everyone’s future. Your anatomy dictates your lips. We can not force a product into a space when it does not fit.
We also can not just fill your lips without giving thought to the rest of your face.

My analogy: you buy a beautiful Victorian home and you only renovate the kitchen to be a modern space. Now the beautiful home looks distorted and mismatched. The beauty has been taken away from the home and the expensive and new kitchen is an eye sore. An augmented lip with no consideration to the whole face is the same situation. It takes away from your beauty. We never just fill your lips ❌❌❌

Once the face is in proportion and the lips are supported then we look at the lip :
-what type of lip tissue do you have?
-we assess the width of your smile.
-are the proportions of your brows/eyes/lips/chin appropriate?
-we assess dentition because teeth have a big impact on lip filler.
-we measure the distance between your nose and the peak of the lips.
-we assess how thick the border of your lip is naturally; ie is there a natural ledge already?
-what is the color of the lip and has it’s border faded?

Then we pick the correct filler which will work best with your assessment and to work towards our goal. The wrong selection can detour the whole plan!

Some of you may already know this sweet patient. Carolina worked with us at Forma and she moved back home earlier this year. She flew all the way back down to Atlanta to have me continue working on her lips, which is the biggest compliment. She is very missed!

If your words inspire others to learn more, dream more, do more, be more…..well then keep on talking.

I like my ladies head strong and heavily opinionated.

“The eyes are the windows to the soul”
Thank you to Adrienne for sharing her with me yesterday.

The tear trough, in my opinion, is the most complicated area to approach. The skin is thin, like tissue paper. The bone takes a unique path of absorption. The vascular anatomy is high risk. The muscles change, especially for those who have had long term Botox treatments. There are skin concerns. The list is long. The approach is very complex.

I appreciated your approach, the anatomical discussion, and technique guidance Adrianne.
Thank you and for hosting us in your space. Also for providing the most amazing, cool, calm & collected models I have ever worked with. Your staff is so kind and so accommodating in every way ❤️

Patients: We will have a model call this week for 3 models to work with to receive treatment for tear troughs. We will be posting all the information this Monday with details of dates and discount pricing!

Dear patient,

This letter is for you, because I want you to know that I am incredibly grateful for you. With all the talent and practices to select from in our Atlanta market, I want you to know how thankful I am that you continue to choose me.
Your trust in my care means a great deal. Please know you are valued and you are very appreciated. Thank you for allowing me to live this dream and to practice medicine the only way my heart knows best.

Xoxo,

Nurse Nina

Dear patient,

This letter is for you because I want you to know that I am incredibly grateful for you. With all the talent and practices to select from in our Atlanta market, I want you to know how thankful I am that you continue to choose me.
Your trust in my care means a great deal. Please know you are valued and you are very appreciated. Thank you for allowing me to live this dream.

Xoxo,

Nurse Nina

We all have our own insecurities right? My biggest aesthetic concerns have always been:

1. My upper eyelids and the excess skin sitting on my lash line. The heaviness has overtime caused my brows to experience some frontalis hyper-compensation. This is a protective mechanism where the forehead muscles, which are responsible for lifting the brows up, are being signaled by the brain to lift the brows up even more in order to relieve some of the heaviness caused by excess skin on the lash line. Truthfully as my brows climbed up my forehead I was starting to look a little like I was put in a wind tunnel. Wind blown. Shocked. Def not cute. PSA: Elevated eyebrows can be a sign of aging and this is why it’s not always best to lift them more!

2. The dreaded accordion lines that have formed in the lower half of my face. This has happened over time due to a combination of overall skin, fat and bone loss in the upper and lower jaw.

I managed it with what I have available to me. Regular ZO skincare, retinols at variable depths, annual chemical peels, Botox in the cheeks and lower face, dermal filler, PRP injections into the lines and skin to boost collagen, micro-needling with Vivace and RF for skin tightening.

I was happy with the outcomes of my lower face and accordion lines but the one thing I could not manage was the excess skin above my eyelids. A Botox brow lift will never resolve this issue. The only solution is surgical. So I did the same thing I tell all of my patients to do, go book an appointment with

In May he removed the skin of the upper eyelids of both eyes and I had a full face treatment of C02 which I can say has helped improve the accordion lines and the creepy skin of my under eyes tremendously. I think the combination of all the things I have already done and continue to do has supported these outcomes. Also patience is critical. It takes time to heal the skin after C02.
I can not say enough wonderful things about and his staff. Thank you again for your expertise and giving me the gift of eyeliner back in my life😉

We all have our own insecurities right? To be honest my biggest aesthetic concerns have always been:
1. My upper eyelids and the excess skin sitting on my lash line. The heaviness has overtime caused my brows to experience some frontalis hyper-compensation. It is a protective mechanism where my forehead muscles, which are responsible for lifting the brows up, are being signaled by the brain to lift my brows up even more in order to relieve some of the heaviness on my lash line. This also allows my eyes to open a little wider. Truthfully as my brows climbed up my forehead I was starting to look a little like I got put in a wind tunnel. Wind blown and not cute. Elevated eyebrows can be a sign of aging and this is why it’s not always best to lift them more!

2. The dreaded accordion lines that have formed in the lower half of my face. This has happened over time due to a combination of skin, fat and bone loss in my jawline.

I managed it all with what I have available to me. Regular skincare, retinol, chemical peels, Botox through the cheeks and lower face, small amounts of a thin dermal filler, support in the peripheral of the face with thicker dermal fillers, PRP injections into the lines and skin to boost collagen, and micro-needling with Vivace and RF for skin tightening.
I was happy with the outcomes of my lower face and accordion lines but the one thing I could not manage was the excess skin above my eyelids. A Botox brow lift will never resolve this issue. The only solution is surgical. So I did the same thing I tell all of my patients to do…go book an appointment with
He removed the skin of the upper eyelids and we focused on doing a full face treatment of C02 which I can say has helped improve the accordion lines and the creepy skin of my under eyes tremendously, in combination with all the things I have already done and continue with.
I can not say enough wonderful things about and his staff. Thank you again for your expertise, guidance and giving me the gift of eyeliner back in my life🤣

Ideally my plan is to treat in sessions. It takes time for fillers, Botox, and skincare to take affect. I do not mean the average 2 weeks for your toxin to kick in and your filler to settle. I am referencing the whole picture. Macro changes in the face take time because treating aging happens in layers from the deep loss to the surface skin loss. I plan your treatments based on 2 major things:
1. your skin cycles and skin quality
2. your quarterly Botox
If we have worked together then you know about my skin cycle charts. It takes at least 3-4 skin cycles to see large changes. Those cycles vary based on your age. The younger you are the faster skin turns over. Your results are more evident. The older you are, the slower the turn over is and the results take more time and more commitment.

This patient is an example of how quickly you can see changes in a young patient! She has skin health, supportive tissue and is receiving regular Botox treatments for prevention.
She wanted all in so we added 7 syringes in this appointment, just over a teaspoon in volume.
A combination of deep and superficial filler was used with Voluma, vollure and Ultra plus. Now we will maintain this. I will likely not inject her for another 14-18 months.

Do you have to add in 7 syringes? Absolutely not. I am here to discuss and respect your budget but also to set expectations for you based on what you feel comfortable commuting to. Remember even if we start small we can build over time too. It’s not a sprint to the finish line…. unless you tell me it is 😉

It is important to understand Botox treatments will evolve with you as you age.
What does that mean? It means your Botox is only as good as the quality of your skin and the volume of your face. The common myth is that Botox stopped suddenly working. Botox does not stop working suddenly after years of success (this is very unlikely and very rare). At some point in the aging process near our mid to late 30s the muscle is no longer the only cause of the lines and wrinkles we see on the skins surface.
1. Photoaging -Sun damage. The number one cause of aging. In our youth our skin is full of collagen and elastin. It is far more forgiving to environmental impacts like free radical, pollutants, UVA and UVB exposure. We begin to loss collagen slowly in our late 20s and this process accelerates further in our mid 30s. Picking up speed as we age. The affects of the sun and environment become visible on the skins surface. These deep lines at rest, discolorations, uneven tone/texture can not be managed with neurotoxins because Botox’s job is to relax muscles, and not to restore the skin. We need to add a combination of home skin care with professional services such as facials, peels, laser, or microneedling.

2. Fat Pads- In our youth the fat pads under the skin are still full and in tact. The skin does not sag. As we age facial fat pads thin out causing a flattening affect or they enlarge and sag. The lines that extend from the crows feet across the cheeks are no longer just the contraction of muscles previously treated with Botox. These extended lines are sign of volume loss of fats pads in the face and the thinning skin above. We need dermal filler and biostimulators at various depths in the skin to support these changes.

Continued in comments below……

If there is one thing I take great pride in it is taking care of my fellow nurses. They have truly earned every bit of a self care day!

We met in 2020 just 3 days before quarantine. Since that time we have done it all:
-Skin
-Botox every 3 months (she never misses her quarterly Botox and you can tell with her beautiful skin)
-Lips
-Lips
-Then I got greedy with her lips. I sacrificed shape for volume. I overfilled her lips so I had to dissolve my work in 2 areas of her upper lip and I retreated her lips. Now I know better then to push those limitations but I promise if I ever cause an issue I will own it and correct it.
-Cheeks: lateral and medial
-Under-eyes
-Cheeks: lateral
-Chin: projection/width/apex
-The lateral chin to blend to the pre jowl
-Jawline
-Piriform (smile lines)

The initial investment is the biggest investment that you make. This includes your first year of consistent Botox, skincare, facials, Microneedling, fillers, and biostimulators.
I create the plan and you tell me where you feel financially and personally comfortable investing. If it’s all in then we go all in. If it’s small treatments over the course of the year then we plan based on your needs!
The time line is yours to dictate.
The order of treatment is mine to guide you on to keep everything looking natural, refreshed, and balanced.
At this point we do quarterly Botox to the full face and every 7-9 months we evaluate and plan for what we need to maintain with 1-2 syringes on average. Remember the face is always aging so we have to maintain our outcomes.

The C Curve and loss of fat pads:

The fat pad of the eyes are the first 2 fats pads to thin and are often the # 1 area of concern to our patients. The second fat pad to thin is from the temple down to the jawline along the hairline, this is your buccal fat pad and temporal extension. (See next slides for visual). This is never an area of patient concern because it is not visible in the 2D (or straight on). These specific fat pads give our face support and a youthful fullness. They are also behind the line of ligaments and therefore can be considered as a supportive point. If you replace them you can also support the concerns of smile lines, marionette, jowls, and jawline.
The outcomes of replacing the loss of volume in these areas lead to a rejuvenated, youthful face with soft curves; free of shadows and hollows, which ultimately age us.

As injectors we are always drawn to start with a cheek correction but honestly I rarely begin here. Most of my patients are bothered by under eye hollows, smile lines, jowls, and a sagging face. This tells me we have bone and fat pad loss. My assessment starts with the hollows above and below the cheek bones. If you have two valleys or hollows around the cheek I know you have atrophy (or thinning out) of the fat pad. Adding a cheek at this point will make my patient look oddly overdone and will create bigger hollows around the cheek. It will make them look more aged.

This is a lovely patient from my recent private training. She was bothered by her tear troughs so we focused on the C curve and restoring loss in order of what she required:
1. Temple with blended Voluma
2. Lateral cheek for support and light reflection with Voluma
3. Medial cheek to support the ZCL ligament but instead of being on bone we focused on landing in the deep fat. The fat pads have hydrogen ions and if you hydrate them with an HA which loves water you will support their loss!
4. Vobella to the tear trough. We blended with saline to give our filler an affinity for water. We placed deep on bone with needle and glazed the skin in the tear trough.