What You Need To Know Before Getting Botox and Dermal Fillers

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Botox® and dermal fillers are two categories of injectables that are ideal for correcting signs of aging or achieving an aesthetically pleasing look. Our entire goal when using these products is to help our patients look like themselves, but better.

If you are new to this world and worried about the possibility of having your look transformed – and not in a good way – I always suggest doing research to understand the difference between good and great outcomes. Keep in mind that experience and knowledge are important factors for the best outcomes. Physicians who are well-versed in anatomy and facial aging – and take facial balancing into account – can produce better results.

Before we go on, let’s define some terms to avoid confusion. “Dermal fillers” actually refer to soft tissue fillers. The term “dermal fillers” is no longer used by physicians, because fillers are less commonly injected into the dermis (the upper layer of the skin); rather, they are injected into soft tissue below the dermis for volumization and contouring.

Botox and other muscle-relaxing drugs (there are now 5 of them on the market in the US) are generally referred to as “neuromodulators”. When injected, neuromodulators affect the communication between muscles and nerves, which leads to muscle relaxation. Both fillers and neuromodulators are injectables.

In this article, I will walk you through everything to know before you get anything injected into your face. Let’s start with the role that injectables play to achieve facial balancing.

What is facial balancing?

To achieve beauty in a person’s face, we can use the same mathematical ratios used by the ancient Greeks to create harmonious architecture. These ratios are found throughout nature, and they are even evident in DaVinci’s paintings. Facial balancing is one of the ways in which classic principles of beauty are applied to facial enhancement or rejuvenation

In my practice, I apply the principles that underlie classic beauty and harmony to optimize a patient’s overall aesthetic. However, I don’t apply the ratios in a rigid way, otherwise my patients would look the same. I always take a patient’s unique facial anatomy into consideration so their upper, middle, and lower face are in balance.

For example, if someone has a tall forehead but the distance between their bottom lip to their chin is short, I might use an injectable in their chin to help balance those two distances and make them appear aesthetically proportionate. I would do the same for someone with prominent cheekbones and a recessed chin; enhancing the chin’s projection will help create balance.

The facial balancing concept can also help counter the effects of aging. As we age, we lose fat in our faces, and prominent facial features can become even more prominent. In this case, I look to balance the surrounding facial structure to restore a more youthful appearance.

For example, maybe someone naturally has really strong cheekbones. If they are petite and lose even a little bit of fat, the soft part of their cheeks becomes hollowed and their cheekbones appear even more prominent. By adding a dermal filler to the hollow area, their face will look softer and less harsh. In this case, the procedure is both restorative and creates aesthetically pleasing balance.

Botox and dermal fillers are my go-to products for facial balancing. Cosmetic surgery can play a role as well, but injectables allow for finer adjustments noninvasively. At the end of the day, I want to create harmony and balance and help my patients achieve natural outcomes.

The differences between injectables is probably not what you think.

There are different ways to understand dermal fillers. One approach is to consider how long the effects last. Temporary products eventually fade away but they last longer than most people think – up to a few years in many cases. Semi-permanent also last a couple of years, while permanent ones last forever. (There is only one FDA-approved permanent filler on the market called Bellafill®, and I only use it to treat depressed scars.)

Another approach to help understand fillers is the effect they produce when injected. If I want to lift your entire face, I need a “stronger” product. If I want to treat the fine lines on your upper lip, I would use a softer product. And If I am treating the area around your mouth, I would use a product that has some stretch to ensure your smile looks natural.

Semi-permanent injectables are a really interesting group, because they may be used to either provide volume or structure or, when used in a very dilute solution, to enhance skin quality. They work by stimulating or activating our bodies to produce collagen and elastin, both of which are important structural “building blocks”. Biostimulatory fillers can enhance skin quality in ways that cannot be accomplished by other means. Common areas where these products are used include the neck, chest, abdomen, above the knees, arms, and other areas. Biostimulatory products are the future of fillers.

We match products to desired outcomes.

In my practice, we use Botox and dermal fillers to achieve three outcomes:

Reduce the appearance of wrinkles and fine lines.
Botox and the other neuromodulators (Xeomin®, Daxxify®, Dsyport®, Jeuveau®) are used to relax or eliminate lines produced by facial muscle contraction (like frown lines, “crow’s feet” lines, and some forehead lines).

Soft tissue fillers may be used to treat lines that are present when our faces are at rest, including some forehead lines, lines between our eyebrows, and “smoker’s” lines on the lips.

Correction of wrinkles is perhaps the best known application of fillers but, in my practice, is actually the least commonly performed. I typically focus on first helping patients look their best from a comfortable social distance, then come back to the fine lines that sometimes are only visible in a 10x makeup mirror.

Facial recontouring
When performing recontouring, my goal is to balance (or rebalance) a patient’s facial aesthetic. Botox and fillers can be used, often in combination, to achieve facial recontouring.

I might inject filler behind the hairline to lift the mid- and lower cheek or in the back of the jawline to support jowls that have come forward. I may also use fillers to strengthen a cheekbone or chin or change the place in which light is reflected from the face.

Similarly, Botox can enhance facial contouring when injected along the jawline, into the chin, and in other areas.

As I mentioned above, we lose volume in our face over time, a phenomenon that can lead to an aged appearance. Strategic replacement of volume with fillers can restore a more youthful contour to the eyebrows, temples, cheeks, jawline, lips, chin, and other areas.

I always restore volume in a way to ensure the entire face stays in harmony and balance. If the entire face has lost volume and only one area is treated, the outcome will not be natural or balanced.

How much downtime to expect with Botox and dermal fillers?

Patients often ask about downtime after injections. Downtime is typically caused by swelling and/or bruising. Some people don’t swell or bruise at all, some may swell and bruise a little bit, and others may do a good bit of both. I always take precautions to try to minimize both bruising and swelling. I usually tell people that if they’re worried about what people think at work, have the procedure done on a Friday. It’s always a good idea to have a little bit of downtime, just in case.

We can help you look your best.

My staff and I are here to give advice and provide guidance to help you achieve outcomes that enhance your natural beauty. We simply want to help you look like the best version of you and for your appearance to reflect the way you feel inside. We pride ourselves on bringing integrity and honesty to every conversation so you have a wonderful experience.

If you value a practice that wants to give you the best possible experience and ensure you get superb results with Botox and dermal fillers, call us at (615) 329-1110 to schedule an appointment today.

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Laser Treatment for Acne Scars – Q&A with Dr. Biesman

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Many of us remember what it was like to battle acne in our teen years or early adulthood. Adding insult to injury, many people who experience acne are left with visible scarring. Dr. Biesman has been treating acne scarring for more than 25 years, often using advanced laser therapies. We asked Dr. Biesman to share some insights into the best laser treatments for acne scarring.


How do laser treatments correct the appearance of acne scarring on the face?

Lasers can play a very important role in the treatment of acne scarring

There are many different kinds of acne scars, and there are many different kinds of lasers. In order to determine which treatment is best for an individual patient, we need to examine the patient to see which type of scarring they have, then select the laser or device that is best suited to correct those acne scars.

We can correct acne scars that are depressed. We can correct acne scars that are elevated. We can correct acne scars that are discolored, either red or brown. We can correct acne scars that have irregular surface textures, such as a tissue paper-type surface texture. There are all types of acne scars we can treat, and we use an array of lasers. In some patients, we use several lasers, all in the same setting.


How do you determine laser treatments are right for someone struggling with acne scarring?

For patients who struggle with acne scarring, there can be lots of options available.

It’s important that the acne must be under control before we try to correct scarring. We look for the appearance of the scars, and the depth of the scars. Some acne scars need to be treated surgically. Other acne scars need to be treated with lasers for discoloration. Some acne scars that are treated with lasers will have a very short recovery time, and other types of acne scarring require a more aggressive type of treatment with lasers that have up to a week of recovery time.


What can a patient expect during laser treatment for acne scars?

Laser skin treatments themselves usually are done in the office. Typically they are performed with either topical anesthesia, which is just numbing cream, or for some of the deeper acne scars, we might inject a numbing agent, like when you go to the dentist or have something removed by the dermatologist. 

Once the area is numb, we’ll do the treatment. Depending on which treatment we do, there may or may not be some discomfort, but usually not very much.

After the treatment is done we’ll put some type of dressing on the skin. We’re big fans of using things like Aquaphor right afterward. Sometimes we’ll use PRP, which is platelet-rich plasma. We’ll take some of your blood, spin it in the centrifuge, and separate the platelet-rich area, which we apply onto the freshly-lasered skin to help it heal and to enhance the results.


Describe the pre and post-laser treatment procedure.

Doing a laser treatment is a team procedure. We need our patients to work with us, and we need to work with our patients.

What do I mean? It’s extremely important that our patients follow their instructions carefully, and that we do our treatments according to plan. With that lockstep cooperation, usually, we can get nice results.

For example, patients need to avoid the sun before most laser treatments. After laser treatments, it’s super important to follow instructions on how to take care of the skin. We’ll go over it with you in great detail, but the devil’s in the details when it comes to getting the best results. You want the skin to heal as quickly as possible following treatment with a laser. That will assure you of the best possible outcomes. We’ll tell you everything you need to know, and someone is available 24/7 if you ever have questions.


Are there any risks or side effects?

There are risks to every treatment. As we use such a wide variety of lasers, we will go over carefully with you, before your treatment, all the things you need to be aware of that could go wrong. We’ll tell you what to look out for so we can catch something early in the event it’s not going the way that we want.


What is recovery like after laser treatments?

Recovery after laser treatment will vary depending on the type of laser that was used. In some cases, people may have just a little bit of redness or swelling. In other cases, it may take up to a week to heal. Again, there tends to be very little discomfort after a laser treatment, but it’s super important to follow instructions.


Schedule a Consultation for Laser Treatment and Acne Scarring 

Are you ready to learn more about laser treatment for acne scars? Contact our practice to schedule a consultation with Dr. Biesman.

Do Facial Fillers Make You Look Older?

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Facial fillers are often used to restore a natural, youthful appearance to areas that appear older due to wrinkles, fine lines, or loss of volume. Dr. Biesman has decades of experience providing patients with minimally-invasive treatments, including facial fillers, to achieve their desired results. For this article, we asked Dr. Biesman to share some of his insights into the uses and potential misuses of facial fillers. Here are his responses.


Do facial fillers make you look older? 

Facial fillers, if not used appropriately, can have all kinds of effects that are undesirable, and one of them can be looking distorted or even older.

Like any other tool, if it’s used properly by someone who understands how to get the best outcomes, using facial fillers should make you look better— not older.


Can too much dermal filler age you?

Using too much dermal filler can distort your face, make it look asymmetric and aesthetically out of balance, and in some cases, it can even make you look older than you actually are.


Are fillers anti-aging?

Dermal fillers are not anti-aging from the standpoint of preventing changes from occurring in our face, but they are wonderful for helping to camouflage changes that have occurred already so that people look younger. So, they definitely correct some of the signs of aging to make us look more youthful when used properly, but they won’t prevent those changes from happening. Those are going to be genetically predetermined.


Describe your approach to facial filler treatments. 

My overall approach to facial fillers is a conservative one. 

First, I like people at a comfortable professional or social distance to just look good— not look a certain age, not have a certain “look,” just look good.

How do you do that? We use fillers in three ways. We use fillers to correct volume or to replace facial volume if there has been a loss or change. We use fillers to recontour the face, whether that’s the cheekbones, jawline, forehead, or nose. Finally, we use fillers to fill in fine wrinkles or lines. That’s the minority of the work we do, revising wrinkles. Most of what we do is contouring and volume.

So, we use injectable fillers to aesthetically balance the face, balance the upper face with the lower face, and make sure everything is harmonious in such a way that it doesn’t look like people have had something done… they just look good.


At what age should women start getting facial filler treatments?

There’s no absolute minimum age at which you should start getting facial filler treatments. We do see younger people who are born with, for example, hollow under-eyes get filler treatments as early as their twenties. The majority of the treatment we do in people who have started to see changes over time, or if they look back over photographs from when they were younger, tend to be for people who are in their thirties or even a little bit older.

A majority of our patients who use fillers regularly are probably between the ages of 30 and 80.


What age group do you typically see women consistently getting facial fillers?

It’s very common to start seeing people regularly, women and men, in their thirties. In many cases, we can use fillers as the best option to keep people looking youthful. It’s important to maintain skincare, to use sunblock, to take care of ourselves in terms of what we eat and drink, and to use fillers appropriately. 

For many patients who are in a younger age group, surgery isn’t an option for them. As people start to get older, sometimes fillers can be used in conjunction with cosmetic surgery, skincare, and injectables like Botox and other neuromodulators for a combination approach.


What do you want to share with women who have had a bad experience with facial fillers and are hesitant to try them again?

Unfortunately, we do see people regularly whose experience with fillers has not been the best.

Why does that happen? Usually, it’s because someone’s expectations weren’t met. In other words, they were hoping to get one thing and they got something else that they weren’t happy with.

Most often, we can fix that. We can get rid of filler that was put in the wrong place or the wrong quantity or was the wrong product, and replace it with something that gives a better result.

It’s disheartening to people when they’ve had a treatment and it doesn’t go the way they want, but do be reassured that in most cases we really can use fillers successfully, even in someone who’s had a bad experience to start with, to get a nice result.


Get More Information About Facial Fillers

To schedule a facial fillers consultation with Dr. Biesman, contact our office at your convenience.

Overview Of Surgical Brow Lift Vs. Botox Eyebrow Lift

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Sagging eyebrows may contribute to the appearance of heavy eyelids, something that many patients do not realize until they examine old photographs of themselves. For those who wish to lift their brows, there are many surgical and non-surgical options available. 

Dr. Biesman is an expert in providing these brow treatments. We asked him about some of the most common options, including the surgical brow lift and Botox brow lift.


What is an eyebrow lift?

An eyebrow lift refers to any procedure that, as you might guess, lifts the brows.

There are several different ways we can do that. Non-surgically, we can sometimes use Botox, which is an injection, to relax the muscles that pull down the eyebrows and let the muscle that pulls the eyebrows up act unopposed. In other words, we change the balance between the pull-up and pull-down muscles of the forehead. This way, you can get some degree of lifting for the eyebrows. It varies as to how much, and it’s not as much as with surgery, but you can in many cases get some degree of lifting from the brows with Botox.

If for whatever reason someone is not a good candidate for Botox brow lifting, because their brows are too heavy or they need more elevation than what Botox can give, then a surgical brow lift might be the best option.


What surgical and non-surgical options do you provide for eyebrow lifting?

Non-surgical options for eyebrow lifting involve, primarily, Botox to relax the muscles that pull the eyebrows down. We can also use fillers, which pick the eyebrow up. We can sometimes use devices, like non-invasive skin tightening devices, a couple of which have FDA indications for lifting the brow area.

When it comes to surgery, we need to make an incision that allows us to get access to the tissue around the eyebrows and lift the brows. In most cases, we try to do that from behind the hairline. In severe cases, we might have to make incisions right above the eyebrow itself, but that’s something we try to avoid.


What are some of the common issues you treat with an eyebrow lift?

Common issues we treat with eyebrow lifting include asymmetry of the eyebrows and hooding of the eyelids caused by eyebrows pushing down. We also contour the brows sometimes. The eyebrows can flatten over time. Sometimes we aren’t lifting the brow so much as reshaping the brow, so it depends on what the underlying anatomic concern is and what the goal is when it comes to adjusting eyebrow position.


What does an eyebrow lift do for a patient?

Eyebrow lift surgery can elevate the entire eyebrow. It can elevate just the outer part of the eyebrow. And, it can reshape and recontour the eyebrow to make it aesthetically more pleasing or more youthful.


What is a Botox eyebrow lift?

A Botox eyebrow lift refers to the use of Botox or other drugs that have a muscle-relaxing effect. 

There is a set of muscles that pull the eyebrows down. If you relax the muscles that pull the eyebrows down, and you let the muscles that pull the eyebrows up act against the weakened muscles, you can achieve the upward elevation of the eyebrows. That’s what we refer to as a Botox eyebrow lift.

A common misconception is that injection of Botox in the forehead lifts the brows. It does the opposite. There’s only one muscle that picks the eyebrows up, and if you relax that muscle, the eyebrows are going to come down.


What is the difference between a surgical eyebrow lift and a Botox eyebrow lift?

Surgery and Botox can both be used to recontour brows. 

Surgery is a much more dependable and reliable way to contour brows. For patients who require very little elevation of the brows, Botox can be a good option. For people who don’t need much correction and don’t want surgery, again, Botox can be a good option. 

You do have to keep up on Botox injections, usually three or four times a year to maintain results. Surgery, of course, provides a longer-lasting result. Surgery does have the relative downside of having to undergo a procedure. Even with brow lift surgery, though, once the brows are corrected, for someone with deep furrows between their eyebrows, they may still need to use Botox. This isn’t to lift their eyebrows, but to control the frowning lines.


Can dermal fillers lift eyebrows?

Dermal fillers can be used to lift eyebrows in some patients, but not in everyone. There’s a fat pad that lives underneath the eyebrow that becomes deflated over time. Sometimes just reinflating that fat pad with a little bit of filler does wonders for brow height, brow shape, and even brow projection. If you look at young people, their brow has a nice three-dimensional contour, but when you get older, the brows become flatter and tend to sag a little bit.

For the right patient, fillers can be nice for recontouring brows and making them look more youthful.


What are some of the best options for lifting the skin around the eye and especially the upper eyelid?

There are several options for lifting eyelid skin.

We can lift the eyebrows. If the eyebrows are pushing skin into the eyelids and you try to surgically remove that skin, you’re going to end up sewing the eyelid to the eyebrow, which isn’t good. So, to treat the eyelid skin, we sometimes need to lift the brows.

Sometimes, we can use procedures like laser resurfacing to tighten and lift the eyelid skin. Laser resurfacing does not do a good job lifting brows, but it can do a beautiful job of tightening eyelid skin.


Learn More About Eyebrow Lift Treatments

Do you have additional questions about brow lift procedures? Schedule a consultation with Dr. Biesman at your convenience.

What To Expect During Blepharoplasty Surgery

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When the excess tissue of the eyelids makes the eyes appear aged and tired, a procedure known as blepharoplasty may be an option to make the eyelids appear more youthful and awake. Dr. Biesman is an experienced Oculofacial Plastic Surgeon who has provided countless patients with outstanding blepharoplasty surgery results. We asked him a few questions about what to expect during blepharoplasty surgery and to describe the eyelid rejuvenation process, recovery time, and more.


What is blepharoplasty and eyelid rejuvenation surgery?

Blepharoplasty, or eyelid rejuvenation surgery, is a surgical procedure that we perform to help eyelids look less tired and more youthful. Blepharoplasty can also allow eyelids to have more definition, be tighter, and just look fresher.

Blepharoplasty can be performed on both the upper eyelids and the lower eyelids. One of the important pieces of information to keep in mind is that the upper eyelids and the eyebrows are closely related. When the brow is low, it may look like you just need a blepharoplasty when what you need is a brow lift as well. And if your upper eyelid is droopy, we may need to tighten the muscle in the eyelid. So, eyelid rejuvenation surgery can involve blepharoplasty in conjunction with brow lifting or other procedures.


How do you know if someone is a candidate for blepharoplasty eyelid surgery?

Almost anyone can be a candidate for blepharoplasty eyelid surgery if they are unhappy with the appearance of their eyelids. The vast majority of people who either have asymmetry of the eyes or just don’t like the way their eyelids look are good candidates for blepharoplasty surgery.

Note that there are certain degrees of limitation we have when doing cosmetic surgery. If the differences between the eyes are extraordinarily minute, it can be difficult to make them exactly perfect. Candidates with these very minute differences may not be the best candidates for blepharoplasty surgery.


How do you recommend a patient prepare for blepharoplasty eyelid surgery?

Blepharoplasty surgery is very easy for most patients to tolerate. It’s usually a very good experience. 

One of the most important things that we ask our patients to do before blepharoplasty surgery is to hold off on Aspirin, Motrin, Advil, Ibuprofen, or any blood-thinning products. Those can even include some vitamins, supplements, and things that you may not think about as blood thinners. We provide patients with a full list of what those products look like.

Aside from that, take care of yourself, get plenty of rest, and try to avoid alcohol for about 24 to 48 hours before surgery.

Describe the day-of surgery. What can a patient expect?

On the day of blepharoplasty surgery, people are typically a little bit nervous. That’s very normal. If you’re not nervous the day of surgery, that makes me a little bit nervous.

Usually, you’ll come to the outpatient surgery center, where we do many of our procedures, or straight into our office, where we do some as well. We’ll get you comfortable, and make sure all the paperwork is taken care of. I’ll begin to draw some lines on the eyelids indicating what I want to do surgically, where I want to make my incisions. We can take a few minutes to talk one more time about what we’re going to do, and if you need to ask any questions, you can.

Once we’re all ready to go, we’ll make sure that you’re comfortable and take you back to the operating room.


What does recovery look like for blepharoplasty eyelid surgery?

Recovery after blepharoplasty surgery is very well-tolerated by almost all patients. Probably 90 percent or more of our patients take only extra-strength Tylenol for pain relief. 

There’s always going to be bruising and swelling after surgery. The better you can be about using cold compresses on your eyelids, the better you tend to do in terms of the amount of bruising and swelling that develops.

We had one patient who had almost no bruising or swelling, just three or four days after surgery, and we asked him: “What was the secret?” He said: “Ice and Netflix.” He used ice and watched Netflix, and he was very diligent. Just make sure you don’t put an ice cube on your skin. Always have a cloth or something in between. But, the more diligent you can be with ice, staying relaxed, and trying not to do much in the way of heavy exertion, the better you’ll do with recovery.


More Questions About Blepharoplasty and Eyelid Rejuvenation?

With any additional questions about eyelid surgery, we welcome you to schedule a consultation with Dr. Biesman. Contact our practice whenever you are ready to schedule an appointment.

Oculoplastic Surgeon Vs. Plastic Surgeon for Eyelid Surgery

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Reasons Why You Should Choose Oculoplastic Surgeon Vs. Plastic Surgeon for Eyelid Surgery

Plastic and reconstructive surgery can have a significant impact not only on your personal appearance, but also your level of self-esteem. Before having surgery, it is crucial to make a careful selection of who you will trust with your face. It is critically important to choose a highly trained doctor with the skill and experience needed to ensure the highest standards of safety, plus the desired clinical outcomes.

If you are considering eyelid surgery, you’ll face a fundamental choice: Oculoplastic surgeon vs. plastic surgeon. What’s the difference between these two types of doctors? And which one should you pick for your own eyelid surgery?


What’s the Difference Between an Oculoplastic Surgeon vs. Plastic Surgeon?

One of the most important distinctions between these two fields is that an oculoplastic surgeon has a practice that is more specialized to a particular part of the body, whereas a general plastic surgeon takes a more generalized approach, providing cosmetic and reconstructive procedures for the whole body.

To understand the importance of this distinction, it may be helpful to consider the specialized training that’s needed to become an oculoplastic surgeon. First, it’s necessary to become Board-certified in ophthalmology, then to gain membership to the American Society of Ophthalmic Plastic and Reconstructive Surgery. (Dr. Brian Biesman has been a member since 1993.)To qualify for membership in ASOPRS, it’s also necessary to complete a certified fellowship, to take a written examination and an oral examination, and to maintain continuing education moving forward. It’s a somewhat long road to go through, but it does ensure really strong expertise and excellence in the area of constructive and cosmetic eyelid surgery.

So, to become an oculoplastic surgeon, Dr. Biesman first trained in the field of ophthalmology. He then received specialized training in plastic and reconstructive surgery of the eyelids and the face. He does not do breast augmentation, tummy tucks, liposuction, or similar procedures that are commonly associated with general plastic surgery.

Given the more specialized nature of his practice, it is much easier for Dr. Biesman to be extremely familiar with the delicate anatomy of the eyelids and the eye sockets, and the complex relationship between the eyes and the rest of the face—because it does really all fit in together.

Someone who is a general plastic surgeon may do a variety of different procedures, whereas Dr. Biesman focuses on the eyelids, the upper face, the area around the eyes, and the mid-face.


Should You Choose an Oculofacial Surgeon for Your Eyelid Surgery?

Is this level of focus and specialization an advantage? There is a tremendous amount of variability from one patient to the next. Dr. Biesman has had patients come see him for cosmetic surgery, and he has diagnosed them with tumors behind the eye and even identified brain tumors. There are a lot of subtle changes that take place that are important to identify in order to ensure the patient’s overall health and safety, and in some cases to seek life-saving interventions. Dr. Biesman’s background as an oculofacial plastic surgeon really does help him identify these signs and subtle changes.

The eyelids are highly complex, and it’s important to find a surgeon who really understands the relationship between the eyelids, the bony eye socket, and the rest of the face to perform your surgery.

Does that mean that everyone who comes to see Dr. Biesman should have him do their surgery?  Not necessarily. It’s most important for you as a patient to feel comfortable with whoever is doing your surgery. You shouldn’t go to someone just because they have a great Instagram page. You shouldn’t go to someone because you heard they were good. You want to do your homework, but more importantly than anything else, you want to make sure you feel that that surgeon has a connection with you, listens to you, understands what your concerns are, and then has a plan that sounds like it should address your concerns in a reasonable way. 

You want expectations to be set realistically. You want someone to talk to you about what will happen if things don’t go as planned. Remember that in surgery, as in the rest of our lives, sometimes things don’t go just the way we want. It is necessary to know what happens if things don’t go well, and to feel confident that you made the right decision about the person who will take care of you even if things don’t go the way they want. Second guessing yourself or having regrets should be avoided at all costs. You want to feel like, no matter how things go, you made the best decision.

Dr. Biesman is extremely proud to be able to offer eyelid and facial surgery. He says it is very gratifying that patients do ask him to take care of them. It’s a fun part of his job to walk patients through their surgical journey from beginning to end.


What is Dr. Biesman’s Background as an Oculofacial Plastic Surgeon?

Dr. Biesman has an advanced level of education and experience in the field of oculofacial plastic surgery. He earned his undergraduate and medical degrees from the University of Michigan, graduating with high honors. He completed his Ophthalmology residency at the Illinois Eye and Ear Infirmary and then went on to fellowship training in Ophthalmic Plastic and Reconstructive Surgery at the prestigious Manhattan Eye, Ear, and Throat Hospital in New York, NY. 

Dr. Biesman ultimately spent some time in Boston, MA, assuming the Directorship of the Eye Plastics and Orbit Service and the Center for Aesthetic Eyelid and Facial Surgery at the New England Medical Center. During this time, he served as an Assistant Professor of Ophthalmology at Tufts University School of Medicine.

He has had his own busy practice in Nashville, TN since 2002, and also remains active in clinical research. He has been named one of America’s Best Doctors every year from 2004 to the present day.


Find Out More About Eyelid Surgery

To schedule a consultation appointment with Dr. Biesman, or to learn more about eyelid surgery, we welcome you to contact our practice (615)329.1110.


What Is A Liquid Facelift? – Overview by Oculofacial Surgeon

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What is a Liquid Facelift And Is It Right For You?

As we get older, we all begin noticing unwanted signs and symptoms of the aging process, including fine lines and wrinkles, lost volume, and more. There are a number of options available for facial rejuvenation, though these different treatments vary both in what they can accomplish, and how extensive their results can be. One treatment that patients should be aware of is what’s commonly known as the liquid facelift.

“Liquid facelift” is a term that physicians didn’t come up with so much as patients did… but nevertheless, it has become a huge term on social media, and it’s a procedure that more and more patients are aware of. As such, it’s worth pausing to consider these questions: What is a liquid facelift, what does it do, and are you a candidate for it?


What is a Liquid Facelift?

To start with, it’s crucial to understand that facelifting surgery is surgery that’s performed to rejuvenate the lower face and neck, the jawline, and the area under the chin. It is particularly useful when there is a lot of excess skin and a lot of sagging.

A liquid facelift does not accomplish the same thing as a surgical facelift. There are lots of changes that occur to the face over time that surgery won’t fix. For example, over time, our faces tend to lose volume. We get hollow in the temples, under the eyebrows, and under the eyes. The soft tissue in our cheeks begins to deflate, which can lead to deeper wrinkles and lines. We also see changes along the jawline, changes in the chin, even changes in the lips. Almost every part of the face will be affected over time by changes to natural volume.

That brings us back to the liquid facelift, which is a way to rejuvenate the face both by recontouring (meaning to pick things back up and reposition them) and by restoring the volume that’s been lost with age. Note that a liquid facelift cannot reposition as effectively as surgery can, but it can still offer some very positive results.


How Does the Liquid Facelift Work?

How does all of this happen? Liquid facelifts are performed with the use of soft tissue fillers to address those changes that occur as a result of deflation, and to some degree the sagging of tissue for patients who really aren’t great surgical candidates.

Liquid facelifts are performed in our office without the need for sedation or anesthesia, though many patients opt to receive a topical anesthetic (or “numbing cream”) before their treatment begins.

Once the patient is comfortable, soft tissue fillers are used strategically to produce a more relaxed and natural facial appearance. Click here to get your guide to facial fillers and learn more about Dr. Biesman’s approach to facial contouring with injectables. 

What is the Recovery from a Liquid Facelift?

One of the reasons why patients are drawn to the liquid facelift is that the recovery is much less extensive than what you’d experience with a surgical facelift.

After their liquid facelift, most patients experience very little discomfort. However, some swelling or bruising may occur. Dr. Biesman’s patients who experience bruising are invited to contact the practice to arrange for a complimentary laser treatment which can help to resolve the bruising more quickly.


What’s the Difference Between a Surgical Facelift and a Liquid Facelift?

One thing that patients should know about these two procedures is that they can often be complementary. A liquid facelift may be performed to restore lost volume and to improve the facial contour, while a surgical lift can be more effective at re-suspending tissue that has succumbed to time and gravity, or is simply present in an excess quantity. 

In other words, these procedures are intended to accomplish different goals, and as such, it’s inaccurate to say that one is superior to the other.


How Long Do Liquid Facelift Results Last?

Patients often want to know for how long their liquid facelift results will last. The timeline can vary depending on the type of injectable fillers used. Some fillers last for only a few months, while others may last for up to two years.

During your consultation with Dr. Biesman, he will be happy to speak to the type of filler he recommends, as well as to the potential advantages of “maintenance” fillers to extend your initial results.


Is the Liquid Facelift Right for You?

How do you know if you are a good candidate for a liquid facelift? First and foremost, it is important to meet with an experienced oculofacial plastic surgeon, like Dr. Biesman, who can assess the changes to your face and inform you as to which type of intervention is right for you. Always seek the expertise of a facial or oculofacial plastic surgeon to determine the path of facial rejuvenation that’s best suited to your anatomy and your aesthetic goals.

Generally speaking, if your biggest concern is fullness of your neck, heavy jowls, your eyebrows dropping below the bony eye socket, or your lower eyelids being really puffy, surgery really is going to be the best option for you. But for those patients who don’t have changes that are so advanced, particularly those who have been relatively thin and fit their whole life but notice that they are looking older, liquid facelifts can be ideal.

Often, Dr. Biesman will ask patients to pull up their social medial to show him some old photographs, allowing him to look and see what’s changed and then use injectable fillers in various parts of the face, starting at the top and working down to help restore a more natural, youthful appearance, without it looking like the patient has had any work done.


Schedule a Liquid Facelift Consultation Today

Dr. Biesman has been performing facial rejuvenation procedures since the early 1990s, and has a wealth of knowledge and expertise regarding the use of soft tissue fillers to address wrinkles, lost volume, and related changes. To find out more about this procedure and your candidacy for it, click here to view Dr. Biesman’s injectable filler before and after photos then schedule a consultation with Dr. Biesman at your convenience.

Benefits of Masseter Botox – Jawline Contouring

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All About The Benefits of Masseter Botox

Botox is a popular injectable treatment, well-known for its effects relaxing the muscles and smoothing certain types of wrinkles and fine lines. In addition to its applications for facial rejuvenation, Botox can also be injected into the masseter muscles, which is one of the muscles that control the jaw.

For some patients, this application of Botox may sound a little odd. Many years ago, Dr. Biesman remembers being in a meeting with senior leaders from the company Allergan, who were looking down the road for potentially new and useful applications of Botox. There was a small group of physicians, Dr. Biesman among them, who were in agreement that using Botox in the jaw muscles was a really promising idea that needed to be explored. The scientists at Allergan felt there was no way this application of Botox would ever become popular; they simply couldn’t imagine it. 

Several years later, Dr. Biesman and his team have performed two clinical trials on masseter Botox injections and studied the benefits of masseter Botox injections. Soon, Allergan will be able to begin advertising this particular use of Botox. When it comes to jaw injections, things have truly come full circle. But what exactly are the benefits of masseter Botox, and for what issues is it an effective treatment?


What are the Benefits of Masseter Botox?

There are two main reasons for injecting the jaw muscles with Botox. One reason is for facial shaping. The jaw muscle can be very prominent in some people. For example, when you bite your teeth together, you can sometimes see the jaw muscle pop out. Some people even have a square type of jaw because their jaw muscle is so prominent.

Some people like that contour, and that’s okay. By the same token, some people would like their jaw to look more slim. As such, one of the reasons Dr. Biesman uses Botox in the jaw muscles is for slimming the face.

The other main reason to use Botox in the jaw muscles is to relieve the symptoms of clenching and grinding the teeth. People who don’t clench or grind may not be able to relate to this, but for those who do, it can really be an issue. People who clench and grind their teeth will often break their teeth. They may also grind their teeth together at night so loudly that their partner stays awake or cannot sleep in the same bed. There are other times when people are so sore, or have so much pain from grinding, that they really have a tough time getting through the day. 

Dr. Biesman often sees patients who have seen dentists, gotten mouth guards, and chewed right through their mouth guard, without experiencing any relief. Other patients try acupuncture and a range of other treatments, none of which have proven successful. Botox is a great treatment for relieving the discomfort associated with people who clench and grind their teeth.


Is Masseter Botox a Good Treatment for TMJ?

One point that’s really important concerns TMJ, or temporomandibular joint syndrome, and its relation to the jaw muscle. It’s true that people who clench and grind their teeth may experience symptoms like those associated with TMJ. However, TMJ is a complex disorder that has multiple different causes, of which the jaw muscles may be one. Dr. Biesman likes to be clear with patients that he is not a TMJ specialist. If someone comes to Dr. Biesman saying their primary issue is that they have TMJ, he will typically advise them to seek a specialist first, whether that means an oral surgeon or a dentist. If the specialist recommends Botox as a form of treatment, that’s certainly something Dr. Biesman can provide.

The vast majority of the patients Dr. Biesman treats with Botox for their masseter muscles are either trying to pursue slimming of their face to get a more feminine appearance, or they clench and grind their teeth.


What to Expect from Masseter Botox Treatment

Botox is a minimally invasive, in-office treatment that is FDA approved and, assuming a skilled injector, generally very safe. Anesthesia and sedation are not required for Botox treatment. Botox injections are performed with a small needle, used to administer Botox into muscles along the lower face, the jaw, and the upper part of the neck.

While some patients may begin to see some positive effects right away, it usually takes up to two weeks before patients experience the full results of their Botox treatment. The effects of Botox are not permanent, and many patients return for “maintenance” injections every three or four months, allowing them to extend the positive effects and benefits of their masseter Botox treatments.

There is very little recovery time associated with Botox, and the side effects tend to be very mild. These effects can include some bruising or soreness around the injection site. Side effects of Botox usually resolve on their own within a matter of days. Click here to learn more and view Dr. Biesman’s Botox before and after photos.


Finding the Right Injector for Masseter Botox

Another important point to be aware of is that injection of Botox in the jaw muscles is actually fairly tricky. When performed well, the results can be truly outstanding. However, it is truly important to find an injector who is very experienced. With inexperienced injectors, you can get the smile being affected, you can get ineffective treatments of the jaw muscle, and you can get incomplete treatment for your clenching and grinding symptoms. The results can be suboptimal overall.

Patients are encouraged to do their homework, and find somebody who is really experienced and understands the anatomy of the jaw muscles. With that said, definitely think about jawline contouring with Botox for the jaw muscles if you are interested in either slimming your face or treating symptoms for clenching and grinding your teeth.


Learn More About the Benefits of Masseter Botox

If you have any further questions about getting masseter Botox, or believe you may be a good candidate for this treatment, the next step is to schedule a consultation. Make an appointment to speak with Dr. Biesman at your convenience.

Benefits of Laser Skin Resurfacing and The Types of Lasers

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Many patients come to Dr. Brian Biesman with specific questions about the
benefits of laser skin resurfacing, the types of lasers available today,  and about its appropriateness for addressing their particular skin concerns.

Dr. Biesman has been performing laser skin resurfacing since the early 1990s. And, he has been fortunate to play a significant role in the development of several new technologies over the years, as well as techniques. This article will provide some basic guidelines as to what laser skin resurfacing is, why it is used, and when it is or is not recommended.

To begin with, what is laser skin resurfacing? Laser skin resurfacing is a procedure in which a qualified doctor, like Dr. Biesman, uses lasers to cause a controlled injury to the skin. As the skin heals, you will often see a remarkable transformation.

Dr. Biesman’s background as an oculofacial plastic surgeon leaves him to be especially interested in resurfacing the eyelids. His many years of experience and his expertise as a laser surgeon make him uniquely qualified to perform laser resurfacing of the face, neck, chest, arms, and more. Lasers can be used all over the body to achieve a wide range of beneficial outcomes.

The Benefits of Laser Skin Resurfacing

There are a number of things resurfacing doesn’t do, but there is also a ton of stuff that laser resurfacing does do. Laser skin resurfacing is great for treatment of:


  • Sun damage
  • Photoaging
  • Aging changes in your skin
  • Fine wrinkles
  • Deep wrinkles
  • Superficial discoloration
  • Deeper changes in the skin
  • Treatment of surgical scars
  • Treatment of traumatic scars
  • Treatment of acne scars
  • Treatment of burn scars


A lot of patients ask specifically about laser skin resurfacing as a treatment for melasma or hyperpigmentation. Melasma is the brown discoloration that many patients get; it is an extremely common problem, and it is also very tough. It’s not something you can cure with laser resurfacing. Sometimes lasers or other energy-based devices, like IPL, can be used to help manage it, but for the most part melasma is a condition that’s best managed medically. 

For example, laser resurfacing does not treat spider veins, it doesn’t treat blue veins under the eye, it doesn’t remove tattoos, and it doesn’t treat vascular birthmarks, all of which can be treated with other types of laser therapy.

Types of Lasers Used for Resurfacing Treatments

The spectrum of laser resurfacing devices is broad. If you have very mild changes in your skin, you just need a light resurfacing treatment. Dr. Biesman and his team also perform laser skin treatments on a maintenance basis to keep your skin looking fresh and beautiful.

If you happen to be someone who hasn’t kept up with skincare over the years, and if you have a lot of sun damage, deep wrinkles and lines, or discoloration, there are types of lasers that can address that, as well. 

Some lasers are more aggressive in their treatments, and some are more superficial. It is crucial to note that aggressive lasers aren’t always better. Dr. Biesman’s job as a leading expert in laser surgery is to match the aggressiveness of the treatment with your condition. 

Superficial conditions that are very mild can be addressed with very light treatments, where there may be just a day or so where your skin is pink, but with no real downtime. More advanced changes may take a couple of weeks to heal, but you get long-lasting results if you’re willing to put in that investment. More aggressive treatments can give you years, if not decades, of outstanding results. By contrast, a very superficial treatment with minimal downtime is something that you’ll probably need to keep up with on a regular basis. 


Specific Types of Lasers

A lot of patients ask for treatment with certain, specific types of lasers. As you consider your own aesthetic objectives, it may be helpful to have some background knowledge about the different lasers that are available for skin resurfacing. 

One very popular, well-known brand name is Fraxel. Fraxel is just that: A brand name, like Mercedes, BMW, or Chevrolet. Under that umbrella, there are actually a number of different devices. There is no such thing as a generic “Fraxel treatment.”

Some Fraxel laser treatments are associated with a little bit of pinkness of the skin, but very little in the way of healing. Others come with a bit more downtime, and some can actually have a full one to two weeks of downtime.

Some laser resurfacing treatments, such as the UltraPulse (which is the original gold-standard device), can have anywhere from three days of recovery time to a full two weeks. 

When treating scars, and especially acne scars, Dr. Biesman may do something called fractional skin resurfacing. This usually involves three to six days of recovery time. It will probably take more than one fractional skin resurfacing treatment to get best outcomes, because by definition these treatments only affect a fraction of the skin’s surface. After two or three treatments, most patients see great results.

In general, the more aggressive the treatment, the longer the recovery, the better the results, and the longer those results last. The less aggressive the treatment, the faster the recovery, the lower the risk, and the greater number of treatments required. Additionally, you will probably need to keep up with these less-aggressive treatments on a more regular basis.


The Risks of Laser Skin Resurfacing

There are risks associated with any medical procedure, and laser skin resurfacing is no exception. It’s really important to understand the relative level of risk involved with the treatment that is recommended for you.

In most cases, the risks are minimal. If your treatment is performed by someone who is extremely experienced and knowledgeable, then even if something starts to go sideways, it can be recognized and treated. It is very uncommon for there to be anything that doesn’t go well with a laser resurfacing treatment.

Learn More About the Benefits of Laser Skin Resurfacing

Overall, this is a phenomenal procedure, and Dr. Biesman encourages patients to find out more about all of the benefits of laser skin resurfacing and its potential applicability. Click here to view Dr. Biesman’s  laser skin resurfacing before and after photos and contact our office to schedule a consultation appointment.