Dr. Neurohr is one of the first plastic surgeons to regularly use Botox to improve the effects of facial animation. In the early 1990’s, he had a patient whose face was partially paralyzed from Bell’s Palsy. She suffered from uncontrollable muscle twitches in her face which were treated by her neurologist with Botox to “freeze” the spastic muscles. The neurologist was moving out of town, so the patient asked Dr. Neurohr to assume the therapeutic responsibility because of his knowledge of facial anatomy. He complied with her request, and soon learned the fundamentals of Botox injections. While conversing with her in the office one day, he realized that he could help balance her facial expressions by using Botox to paralyze her forehead muscles on the “active” side of her face. Equalizing her eyebrow action resulted in much less attention being drawn to her facial abnormality, and as a result, she felt much more comfortable in social situations. Dr. Neurohr developed a niche, treating Bell’s Palsy patients. As people learned about his Botox skills, his cosmetic Botox practice grew very quickly.
Being a surgeon, Dr. Neurohr actually operates on many of the muscles that are treated with Botox. He understands where they are, how deep, or how wide, or how thick they are. He understands the power and the modulation of the facial muscles His great experience with the preparation and administration of Botox helps him to translate just how much to inject and where to inject it. This practical knowledge gives him a big advantage when treating difficult cases because it is the nuance in the muscle effects from Botox which makes for the best results. Dr. Neurohr believes that the best results look natural, not fake. Some muscle action is important for that. The balance is always between preventing or treating a frown line or wrinkle, verses freezing all facial expression. People empathize and communicate through facial expression. It is fundamental to being who we are. A lack of facial expression makes the impression of a vacant personality. It looks strange, and Dr. Neurohr avoids that ”look” like the plague.
Where Botox takes a few days to work by paralyzing the muscles that cause wrinkle formation in the face, injectable fillers work immediately upon injection by restoring volume under the skin where a collapse in the structural substance of the skin has caused a depression which is seen as a wrinkle, a fold, or a trough. The decline of tissue substance that comes with aging is called atrophy of aging, and it is the primary reason that people look old. That is why fillers have become so popular in the last several years, because they reverse many of the visual effects of facial aging without the need for invasive surgery.
Hyaluronic acid (HA) is a compound that normally resides in the tissues of the body. It is readily accepted by the body when injected, and it acts to take space where it is injected, thus, filling the space with volume. When strategically placed beneath wrinkles, it softens the lines of the face, making them less noticeable, and erases these signs of age. HA fillers are manufactured by various companies. They come in different thicknesses designed for different purposes. For instance, some are more fluid like and are better placed under very thin skin like around the eyes. Others are thicker and more viscous. They are best for deep placement on top of hard tissue to create a larger, more general volume expansion. Dr. Neurohr likes HA fillers, and has been using them for many years. HA’s are temporary, but the more times they are used, Dr. Neurohr has found, the longer they last. For example, in the lips, the first time they are injected, the result lasts about 4 months. The next time it might last 6 months, then 8 months, etc. So, it develops into a very long lasting result. The important thing about fillers is to recognize aesthetic proportion and not get carried away with over doing a treatment! Everyone is familiar with modern phenomenon of “duck lips” and “pillow cheeks” from overzealous injectors trying to do too much with their fillers. Like every aesthetic procedure, fillers have their limitations, but there is a real tendency to try to do too much with them because it is a non-surgical procedure. Dr. Neurohr understands the limitations of fillers, and strives to maintain natural looking results. He excels at restoring youthful appearing lips and cheeks by restoring volume and shape within the margins of what is appropriate for each patient’s individual features. Being a surgeon, he is acutely aware of the borders where filling volume to restore youthful facial shaping ends and where surgical intervention is needed to restore youthful facial shape. Injectable fat grafting is another technique Dr. Neurohr employs sometimes as an intermediary between the two. Good artistic and surgical judgement is the key to delivering consistently excellent results, and Dr. Neurohr incessantly does his best to set the highest standard in that regard.