Hx: The patient presented for improvement of her ‘gummy smile’ and nasolabial folds (lines that run from nose corners to corners of the mouth) which she felt had worsened since losing weight. 

Tx: We consulted extensively with the patient, explaining that the changes she had noted were definitely possible with weight loss due to a reduction in fat tissue volume of the face and resultant hyperactivity of muscles that are freed of compressive load. On examination we noted that despite her weight loss, the patient had maintained good volume through the midface, and that sag here was not significantly contributing to prominence of the nasolabial region. We advised against dermal filler into this area, as the patient did not really have a significant deficit in which to place additional volume, and instead recommended treatment with PDO mono threads. To combat the patient’s gummy smile we recommended some volume to the lips, predominately into the wet/dry border of the top lip to try and prevent loss of volume upon smiling. We also treated the circular muscle underlying the lips with muscle relaxants to provide increased evolution of the pink lip irrespective of mouth activity, and the muscles that control curl of the lip on smiling. At this stage the patient is only requiring maintenance treatment of her muscle relaxant ad hoc to maintain her results.