When patients come to your clinic for non-surgical facial procedures, you need to individualize their treatment. Dr. Michael Godin maps out his directions for optimizing results with his filler techniques.

Practitioners need a sound knowledge of the anatomy with a good technique to produce the best results. When considering fillers, will you use hyaluronic acid (HA), a semi-permanent filler or both?

In the forehead area, I don’t tend to use much filler. If I do, it will be a very light HA. As with all injections and particularly in areas where you might be worried about vascularity, you want a slow injection while withdrawing, introducing the material in small amounts. The blood supply of the glabella tends to be axial, meaning that the skin is dependent on one vessel. If you occlude that vessel, you can kill the skin.

The periorbital area of the forehead is where neuromodulators shine. I use them quite aggressively in the corrugator and procerus muscle, and the lateral and superior orbicularis oculi. We have to be judicial in our use in the frontalis—we don’t want to over treat it and drop the brow. We also don’t want to under treat it and leave people with a surprised expression, particularly laterally. When patients come in, and want their glabella treated, I ask them to frown. We see the classic “11″ comprised of vertical lines, with the corrugator pulling in, and we can see how laterally based it is. We want to treat the whole corrugator or we will get some pulling in of the brow.

Some patients are more procerus dominant. They have a more vertical pull and consequently the lines are more horizontal. We would not treat these people with a neuromodulator the same way. We have to individualize treatment. We a natural-looking result with botulinum toxin. I like to see some movement—I don’t want to see the forehead frozen. But it can be very useful in getting rid of deep lines, yet permitting them some motion.