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06-28-09 | Posted by



The flagship Elizabeth Arden Red Door Spa on New York’s Fifth Avenue is host to a long list of chic New York women, celebrities, and beauty experts.  Since 2003, they have also added a very special Medical Director. Board Certified Manhattan Plastic Surgeon Dr Bryan Forley.

 What do Elizabeth Arden clients  ask for most?

The most common request is for Botox Cosmetic.  I frequently will do this procedure as part of a “day of beauty” package to complement the expert facials performed by the aestheticians at the Red Door.

Who seems to have gone overboard with fillers?

A good example of what not to do is Priscilla Presley.  She fell victim to both over-filling and use of an unapproved substance.  Unfortunately, celebrities frequently are susceptible to bad advice.

What is your favorite area to inject and why?

Botox injected into the crow’s feet area next to the outer corner of the eye can have a very nice effect on elevation of the brow in addition to smoothing the skin wrinkles.  The muscle in this area pulls the brow down creating a hooded effect.  By injecting Botox Cosmetic, the downward force is diminished and the elevator muscle of the forehead will be dominant.  The lifting effect on the brow can be quite dramatic in some patients and it is all done without surgery.

When does Botox leave off and fillers take over?

Botox Cosmetic is used to selectively diminish wrinkle producing muscle activity.  Folds produced by sagging or redundant skin and fat in the face, skin wrinkles, and the loss of volume in the face with the aging process are all suitable for treatment with dermal fillers.  The effect produced by dermal fillers essentially camouflages the contour changes in the face that otherwise would require a surgical procedure, such as a facelift, to improve.

What fillers produce the most natural looking results?

The hyaluronic acid fillers, such as Juvederm, Restylane, and Perlane, are my favorite fillers because they are safe, effective, and relatively long-lasting for up to 12 months.  They are very versatile and can be used in the cheeks and the nasolabial folds to counter from above and below the thickening that occurs with the descent of the cheek fat pad towards the lip and jawline.  Sculptra is another personal favorite for longer term (up to 3 years) improvement in facial volume.  It is a bio-compatible injectable that stimulates the production of collagen by the skin over a 3 month period thereby enhancing volume.  This material differs significantly from the hyaluronic acid fillers in that the onset of effect from the injected material is not immediate and achieving the desired outcome will require a commitment to a series of treatments over a 4-6 month period.

How do skin care, peels, and laser fit in with injectable beauty?

All of the non-surgical modalities available today can be used in a complementary way.  Each one addresses a different aspect of the aging changes we recognize in our faces.  Skin care products, with active ingredients such as anti-oxidants and tretinoin, peels, and laser treatments all handle the qualitative aspects of the skin.  Botox will prolong the benefits of a treatment that improves skin quality and wrinkles, such as Fraxel laser,  by preventing the repetitive wrinkling of the skin from contraction of the facial muscles.  Dermal fillers, in combination with a chemical peel or laser treatment,  will restore volume and soften folds to enhance the appearance of the laser-treated skin by the restoration of facial contours.

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