Top Plastic Surgeon Dr. Julius Few on Frown Lines, Face-Lifts, and His Famous (Noninvasive!) Techniques

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Top Plastic Surgeon Dr. Julius Few on Frown Lines, Face-Lifts, and His Famous (Noninvasive!) Techniques

Top Plastic Surgeon Dr. Julius Few on Frown Lines, Face-Lifts, and His Famous (Noninvasive!) Techniques

Actual Xeomin (incobotulinumtoxinA) patient. Individual results may vary.

Top Plastic Surgeon Dr. Julius Few on Frown
Lines, Face-Lifts, and His Famous (Noninvasive!) Techniques

In partnership with our friends at Merz Aesthetics. Please see Important Consumer Safety Information below and Full Prescribing Information here.

We’ve spent most of 2020 squinting ever more intently into our screens, and the evidence is piling up on our skin. Specifically, we’re looking worried. Or is it irritated? Pained? We talked to top plastic surgeon Julius Few, MD, famous for his nonsurgical treatments that freshen his patients’ appearance, about what to do for frown lines, why the eyes and the neck are the first to show age, and how to get ahead of age-related skin changes with skin care and in-office treatments.

Few says his innovations in less-invasive approaches grew out of his experiences treating his Black-skinned patients. “Skin of color is more prone to keloid scarring,” he says. “I was one of the few African American plastic surgeons going into training over thirty years ago, and people believed you couldn’t do plastic surgery on skin of color well because of the scarring. No one really did it, so it became a passion point for me. Out of necessity, I developed minimally invasive strategies to make my patients look better without causing scarring. And well, of course everyone—of every skin tone and type—wants less invasive! Nobody wants to have a lot of work done. So as I’ve focused on and developed these techniques, I sort of fell into this niche that appealed to a lot of people.”

A Q&A with Julius Few, MD

We’re looking very concerned. Or displeased. Even when we’re happy. Is that permanently-furrowed-brow look just part of getting older? And what’s the best strategy for addressing it? We’re staring at screens more than ever—could it be the blue light?

“It’s more the act of frowning at the screen than the light itself that causes the vertical lines between the brows sometimes known as the elevens. A neuromodulator like Xeomin can soften the look of them by preventing the repetitive motion that causes them to form. The skin is like a piece of paper: The more you fold it, the more wrinkled it gets. And in terms of wrinkles—almost all wrinkles—my goal is not to freeze them but to soften them. Say you have a favorite shirt—you don’t want to never wear it; instead, you treat it well, you take care of it, and you wear it. If you never wear it, what’s the point? So softer, not frozen, is the look we’re going for.

“As for the blue light, I don’t think there’s enough data to understand what blue light does to skin.”

Many people say they want to age gracefully. As you drill down, what does that end up meaning for people?

“For all things having to do with the face, I look at three things. One is movement—movement can cause wrinkles over time, but the total lack of movement looks unnatural. I modulate movement with neuromodulators.

“Two, I consider volume. In cases where there is too much volume, I may be more likely to choose surgical options—for example in people who are predisposed to bags under their eyes, and in almost the way that pregnancy can stretch the out skin on the stomach, something similar can happen under the eyes.

“Three, I look at skin quality—textural changes, sun damage, that sort of thing.

“Our skin is not our enemy. It’s definitely our friend and largest organ. We want inner health matching our outer health, so I love the idea of great holistic vitamin support combined with external products that play off of good nutrition.

“The way I think about it is, much as in health care and in wellness in general, we want to prevent as much as we can rather than treat after the fact. So I recommend starting with the areas where we know the skin is thinnest with creams, because they age first—eyelid skin and the skin on the neck. Those are the two spots on the body where the skin is thinnest skin, and that directly correlates to the places that show premature aging first.”

What are your favorite approaches to aging around the eyebrows?

“I have nonsurgical treatments that really work for many people. Xeomin has been a useful tool for me to treat moderate to severe wrinkles between the eyebrows. Xeomin is not for everyone. All treatments come with risks and may be serious. So people should first talk with their provider to see if it is right for them. And of course, individual results vary.”

Xeomin is considered a uniquely purified injectable, meaning that it does not contain any unnecessary proteins. What are the benefits of a uniquely purified injectable?

“I don’t see any decrease in Xeomin’s effects with repeat treatments with my clients—and botulinum toxins have had that reputation. It’s a technology that’s extremely predictable and consistent. Xeomin is a temporary treatment; for my patients, I recommend Xeomin should be administered once every three to four months.”

Dr. Julius Few, MD is a board-certified plastic surgeon and founder of The Few Institute for Aesthetic Plastic Surgery, LLC, in Chicago.

This article is for informational purposes only, even if and regardless of whether it features the advice of physicians and medical practitioners. This article is not, nor is it intended to be, a substitute for professional medical advice, diagnosis, or treatment and should never be relied upon for specific medical advice. The views expressed in this article are the views of the expert and do not necessarily represent the views of goop.

Read the Medication Guide before you start receiving XEOMIN (Zeo-min) and each time XEOMIN is given to you as there may be new information. The risk information provided here is not comprehensive. To learn more:

  1. Talk to your health care provider or pharmacist

  2. Visit to obtain the FDA-approved product labeling

  3. Call 1-866-862-1211

USES: XEOMIN is a prescription medicine that is injected into muscles and used to improve the look of moderate to severe frown lines between the eyebrows (glabellar lines) in adults for a short period of time (temporary). It is not known if XEOMIN is safe and effective in children under 18 years of age.

WARNINGS: XEOMIN may cause serious side effects that can be life threatening. Call your doctor or get medical help right away if you have any of these problems anytime (hours to weeks) after treatment with XEOMIN:

  1. Problems with swallowing, speaking, or breathing can happen within hours to weeks after an injection of XEOMIN if the muscles that you use to breathe and swallow become weak. Death can happen as a complication if you have severe problems with swallowing or breathing after treatment with XEOMIN.

  2. People with certain breathing problems may need to use muscles in their neck to help them breathe and may be at greater risk for serious breathing problems with XEOMIN.

  3. Swallowing problems may last for several months, and during that time you may need a feeding tube to receive food and water.If swallowing problems are severe, food or liquids may go into your lungs. People who already have swallowing or breathing problems before receiving XEOMIN have the highest risk of getting these problems.

  4. Spread of toxin effects. In some cases, the effect of botulinum toxin may affect areas of the body away from the injection site and cause symptoms of a serious condition called botulism. The symptoms of botulism include: loss of strength and muscle weakness all over the body, double vision, blurred vision and drooping eyelids, hoarseness or change or loss of voice, trouble saying words clearly, loss of bladder control, trouble breathing, trouble swallowing.

These symptoms can happen hours to weeks after you receive an injection of XEOMIN. These problems could make it unsafe for you to drive a car or do other dangerous activities.

Do not use XEOMIN if you are allergic to XEOMIN or any of the ingredients in XEOMIN (see the end of this Guide for a list of ingredients in XEOMIN), had an allergic reaction to any other botulinum toxin products such as rimabotulinumtoxinB (MYOBLOC®), onabotulinumtoxinA (BOTOX®, BOTOX® COSMETIC), or abobotulinumtoxinA (DYSPORT®) or have a skin infection at the planned injection site.

Before receiving XEOMIN, tell your doctor about all of your medical conditions, including if you:

  1. have a disease that affects your muscles and nerves (such as amyotrophic lateral sclerosis [ALS or Lou Gehrig’s disease], myasthenia gravis or Lambert-Eaton syndrome)

  2. have had any side effect from any other botulinum toxin in the past

  3. have a breathing problem such as asthma or emphysema

  4. have a history of swallowing problems or inhaling food or fluid into your lungs (aspiration)

  5. have bleeding problems

  6. have drooping eyelids

  7. have plans to have surgery

  8. have had surgery on your face

  9. are pregnant or plan to become pregnant. It is not known if XEOMIN can harm your unborn baby.

  10. are breastfeeding or plan to breastfeed. It is not known if XEOMIN passes into breast milk.

Tell your doctor about all of the medicines you take, including prescription and over-the-counter medicines, vitamins and herbal supplements. Talk to your doctor before you take any new medicines after you receive XEOMIN. Using XEOMIN with certain other medicines may cause serious side effects. Do not start any new medicines until you have told your doctor that you have received XEOMIN in the past. Especially tell your doctor if you

  1. have received any other botulinum toxin product in the last four months

  2. have received injections of botulinum toxin such as rimabotulinumtoxinB (MYOBLOC®), onabotulinumtoxinA (BOTOX®, BOTOX® COSMETIC) and abobotulinumtoxinA (DYSPORT®) in the past. Be sure your doctor knows exactly which product you received. The dose of XEOMIN may be different from other botulinum toxin products that you have received.

  3. have recently received an antibiotic by injection

  4. take muscle relaxants

  5. take an allergy or cold medicine

  6. take a sleep medicine

Ask your doctor if you are not sure if your medicine is one that is listed above.
Know the medicines you take. Keep a list of your medicines with you to show your doctor and pharmacist each time you get a new medicine.

POSSIBLE SIDE EFFECTS: XEOMIN can cause serious side effects that can be life threatening including allergic reactions. Symptoms of an allergic reaction to XEOMIN may include: itching, rash, redness, swelling, wheezing, asthma symptoms, or dizziness or feeling faint. Tell your doctor or get medical help right away if you get wheezing or asthma symptoms, or if you get dizzy or faint. See “Warnings.”
The most common side effect of XEOMIN in people with glabellar lines includes:

  1. headache

These are not all the possible side effects of XEOMIN. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

GENERAL INFORMATION ABOUT THE SAFE AND EFFECTIVE USE OF XEOMIN: Medicines are sometimes prescribed for purposes other than those listed in a Medication Guide. You can ask your pharmacist or doctor for information about XEOMIN that is written for health professionals.
Active Ingredient: botulinum toxin type A
Inactive Ingredients: human albumin and sucrose
Copyright © 2020 Merz North America, Inc. All rights reserved. Merz Aesthetics and Xeomin are registered trademarks of Merz Pharma GmbH & Co. KGaA. Botox®, Dysport® and Myobloc® are registered trademarks of their respective owners. US-XEA-2000008

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