1. in fair skinned irish or nordic patients with some sun damage, infrequent (like 1 to 2 x a year) could even be started in the late twenties. for people with bad habits and extensive sun damage even earlier. for those with olive skin and very little sun damage, one could start in the 40s or 50s and still be fine. it all depends. my mom is 71 and does not even need it. however, i did do a fat transfer for her.
2. restylane in the forehead does not work for two reasons. the forehead skin is too thin and does not tolerate a filler. a filler in the forehead does not make sense anyway since the forehead wrinkles are the product of motion. if you try to fill in a fine line, it will either be lumpy or be gone in a second. it is always better to treat the cause (movement that causes a wrinkle) rather than the effect, i.e., break the habit, slow down the movement, that is the trick. for between the eyes, fillers can be quite dangerous in terms of injecting areas of sensitive blood supply. again it is also a cause and effect issue as mentioned above. accordingly, for the area between the eyes, if i do a filler (which is rare), i only use restylane which is reversible in case a 1:10,000 chance of a blood supply issue arises and you and i cannot leave town the night after injection to minimize that risk. unfortunately, most doctors are unaware of safety with fillers and do not carry equipment to handle a problem should it arise.
3. if you include my hair transplant patients, my ratio is 50:50. if you take them out of the equation it is about 85:15 women to men. don't worry about stigma. the fact that you worry about stigma is actually a good sign. to me it means that you will not go overboard. that is a good thing.
best,
sml
Samuel M. Lam, M.D., F.A.C.S.
Diplomate, American Board of Facial Plastic & Reconstructive Surgery
Diplomate, American Board of Otolaryngology Head & Neck Surgery
Diplomate, American Board of Hair Restoration Surgery
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