The Art of the Needle: A Dermatologist's Personal Guide to Botox and Fillers
Every face tells a story, and the one I see in the mirror every morning is no exception. Over the years, through the lens of my own experience and the countless faces I've treated, I've learned that the most beautiful results come not from erasing every line, but from restoring balance and harmony. I've been navigating this world for nearly a decade, and my approach has evolved with time, experience, and the simple, profound shift of becoming a mother. What I do now is less about fighting age and more about maintaining a version of myself that feels refreshed, balanced, and authentically me.
Let's start with the foundation of my routine: Botox. I like to think of it not as a wrinkle eraser, but as a tool for facial choreography. It's not about freezing expression; it's about calming overactive muscles that, over time, can etch lines into the skin. The key is understanding that each face moves differently. My map is not your map, and a good injector knows this intimately.
My Upper Face: A Brow Lift and a Gentle Arch
I first started getting Botox in my upper face at 26, not for anti-aging, but for beautification. I have naturally deep-set eyes that can look a bit intense, so I used it to soften the area above my brows and lift them just a touch. For me, the goal is to open up the eyes and create a more approachable, awakened look. I inject about 18 to 20 units into the muscles between my brows—the corrugators and procerus. These muscles pull the brows down and in. By relaxing them, the brows are allowed to float upward and outward, creating a gentle lift. This also helps prevent the "11" lines from forming. I am very careful not to be formulaic; I always assess my face on the day of injection.
For my forehead, I use a lighter dose—around 8 to 9 units. I inject high, near the hairline, and I deliberately avoid overtreating because I still want some movement. The muscles in the forehead pull the brows up, and if I overdosed, I would risk dropping my brows, which is the opposite of my goal. I also use a tiny amount—just about half a unit—to calm a specific crease above one brow. I don't inject symmetrically because my face isn't symmetrical. The total for my upper face, including a small injection under the tail of each brow to further lift them, usually comes to about 30 to 35 units. I don't usually treat my crow's feet because I have high cheekbones, and relaxing that area can make my cheeks look shelf-like. I don't have many lines there yet, so I leave them be.
My Lower Face: Symmetry, Prevention, and the Subtle Art of Balance
This is where the real artistry comes in. I use Botox in my lower face not for wrinkles, but to fine-tune muscle movement. I inject about a week ago, so it's only half-kicked in, which is perfect for showing you the effect. I use approximately 1.5 units at the base of my nose to calm a sneer on one side of my smile. This helps create more symmetry when I grin. I also inject about 4 units along my upper lip—four tiny drops—to prevent the vertical lip lines that my mother developed and hates. This is purely preventative. It also gives me a "lip flip." When I smile, my lip used to curl inward, making my upper lip disappear. Now, with the muscle relaxed, the lip stays turned out, giving the appearance of a fuller lip without any filler.
I inject the depressor anguli oris (DAO) muscles at the corners of my mouth. This muscle pulls the corners down, and by relaxing it, I prevent a downturned, sad expression. I use 3 units on each side. I also add a single unit to the depressor labii inferioris on one side to correct an asymmetry from an old lip injury. For my chin, I inject 4 to 6 units into the mentalis muscle to prevent the "cottage cheese" or dimpling that can appear when I smile or purse my lips. All these small tweaks add up to a more balanced, harmonious lower face.
The Masseters and the Neck: Sculpting the Jawline
I also inject Botox into my masseter muscles—the large muscles used for chewing. I have a square face, and this helps slim the jawline. I do this only about once a year now, because I found that twice a year made my face too thin. I inject about 15 units per side, in a triangle pattern, being very careful to avoid the anterior portions that could affect my smile. The final area is my platysma bands, the vertical neck muscles. Botox along the jawline and these bands relaxes the muscle, pulling it away from the jaw and creating more definition. I use about 26 to 34 units combined for this area. When I do a full face and neck treatment, I use 100 to 120 units total. That sounds like a lot, but using more Botox in more locations can actually make someone look more balanced, as long as the injector understands how the muscles interact.
The Role of Fillers: Adding Support, Not Volume
I use fillers much more sparingly, and I think that's the key to a natural result. The biggest mistake I see is overfilling, often because people try to compensate for all signs of aging with filler alone, when they might need Botox, lasers, or even surgery. I use fillers either to beautify—to give a feature I never had—or to anti-age by restoring lost volume. My lips are the only area where I use hyaluronic acid filler. I started at 28 or 29 because my upper lip was very small compared to my naturally full cheeks. I've never put more than a quarter of a syringe in at a time, building the volume slowly over years. The last time I injected my lips was over a year ago, and the volume has sustained itself. I use a specific product, but I emphasize that the injector's skill is far more important than the product brand.
I also use a tiny amount of hyaluronic acid filler in my nasolabial folds and my mental crease (the line between my lower lip and chin). I inject it very superficially, in a threading technique, to support the skin and prevent those lines from becoming deep creases. I do this about every 18 months with a very small amount of product. Fillers last much longer than people think—often years—so it's crucial to have an injector who recognizes that your filler is still there and doesn't overfill you.
Finally, I use a collagen-stimulating filler called Sculptra. I am a "sinker" in terms of aging—my face hollows out rather than sags. Sculptra is ideal for this because it thickens the skin over time, restoring volume naturally. I have it in my temples, which can become hollow with age, and in the hollows of my cheeks. I use it about once a year to maintain a refreshed, full look without looking puffy or overdone.
The Most Important Advice: Finding Your Injector
If you're considering injectables, my best advice is to find someone based on a real-life recommendation. Look at a friend or family member whose results you love. Online photos can be retouched, but you can't retouch real life. Credentials matter—board certification in dermatology, plastics, or a related specialty is a good sign—but the most important thing is the consultation. You want an injector who looks at your face carefully, listens to your goals, and is not afraid to say "no" when something isn't a good idea. You want a partner who shares your aesthetic vision. If you don't feel that alignment, it's okay to try a different injector. The goal is harmony, not a checklist of procedures. It's your face, and it deserves to be treated with the same artistry and care that a master painter would give to a canvas.