Fillers, Fat or Surgery: Which One should you choose?

Each option has its place when correcting the eyes.  Base your decision on what bothers you, your budget and the result you are looking to achieve.
Choose Fillers: to fix hollowing in the tear troughs if there is no loose skin.  Ideal patients are those who have a depression like a tear through in their lower lids, had too much fat removed during surgery, or are hollow under the eyes.  Fillers are reversible and no overcorrection is required.
Choose Fat: for longer lasting results.  Your plastic surgeon will remove fat from elsewhere on your body, clean it and then inject it under the eyes for volumizing effect.  Fat also blends the area between the lower lid and the cheeks.
Choose Surgery (Blepharoplasty): to correct loose skin or excessive muscle and/or fat in the lids.  Removing some of this volume and distributing the contours equally restores the look of the eyes.
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Rellenos, grasa o cirugía: ¿cuál debería elegir?
Cada opción tiene su lugar cuando la corrección de los ojos. Base su decisión en lo que te molesta, su presupuesto y el resultado que se busca alcanzar.
Elija Rellenos: fijar vaciamiento en los valles de lágrimas si no hay piel suelta. Pacientes ideales son aquellos que tienen una depresión como una lágrima a través de sus párpados inferiores, había eliminado el exceso de grasa durante la cirugía, o son huecos debajo de los ojos. Los rellenos son reversibles y no se requiere corrección excesiva.
Elija grasa: para obtener resultados más duraderos. Su cirujano plástico eliminar la grasa de otras partes de su cuerpo, limpiarlo y luego inyectarlo bajo los ojos por efecto de volumen. La grasa también combina el área entre el párpado inferior y las mejillas.
Elija Cirugía (Blefaroplastia): para corregir la piel floja o muscular excesivo y / o grasa en los párpados. Extracción de algunos de este volumen y la distribución de los contornos igualmente restaura el aspecto de los ojos.

What are they?
Denevervating agents (onabotulinumtoxina), available as Botox and Xeomin work by temporarily reducing muscle activity to inhibit wrinkle formation, specifically between-brow lines that resemble the number 11. By decreasing forehead furrowing, they eliminate wrinkles and fine lines that currently exist and also prevent new ones from forming, making them favorites of patients of all ages.
In addition to cosmetic applications, many of which are considered off-label (see below), Botox is also FDA-approved for hyperhidrosis (excessive sweating). Xeomin is approved to treat abnormal spasms of the eyelids (blepharospasm) in adults who have had prior treatment with Botox. Xeomin is considered a more purified version of botulinum toxin type A than Botox because it does not have any protein additives. Some say this may help lower the risk of allergy to the product, as they believe the allergy risk is associated with these proteins. Xeomin is also the first denervating agent that does not need to be refrigerated before use.
Denervating agents have played a major part in the age of injectables, and doctors continue to find new and novel uses for them, as well as innovative ways to use them in conjunction with fillers.

  • Eliminating wrinkles and lines caused by movement
  • Excessive sweating (hyperhidrosis)
  • Creating wider-looking eyes *
  • Fixing scars *
  • Reducing pore size *
  • Lifting the top of the nose *
  • Lessening a gummy smile *
  • Treating migraines and TMJ *
  • Eliminating neck bands and cleavage wrinkles *
  • Temporarily improving the appearance of frown lines and crow’s-feet
  • Treating chronic migraines, defined as 15 or more headache days a month, each lasting 4 or more hours
(*indicates an off-label use)
Treatments and ResultsJust like injectable fillers, a topical anesthetic may be applied to make treatment more comfortable. Then, over roughly 10 minutes (depending on how many areas are being treated), your doctor will strategically place several injections. 
Although the overall experience is the same as with Botox and Xeomin, the main difference is that Dysport kicks in quicker—the results can usually be seen in a day or two, whereas Botox and Xeomin typically take three to five days. The results of both are believed to last about the same amount of time: on average, three months. However, after a series of injections, Dysport may last up to six months.
Side Effects and RisksYou may be red or bruised at the injection site for up to a few days, and in rare instances, patients have reported mild flu-like symptoms after treatment. 
Please call The Paragon Plastic Surgery and Med Spa for more information on Botox and Xeomin at (817) 473-2120


We all have varying degrees of fat in our faces and a multitude of factors can cause changes to these fatty compartments. Volume loss occurs because of gradual changes in the appearance of the fat. There is a loss both superficially and at a deeper level that comes along with aging.

1. Yo-Yo Dieting And Extreme Exercising
Keeping fat off your body is no easy task since the body can’t be told where to lose weight from and where to keep it. So even if you want to “spot-treat” a specific part of the body, you may end up reducing the amount of fat in your face as well. The ups and downs of recurrent dieting cause a stretching of the ligaments that support the tissues of the face. This can result in a loss of elasticity and volume, which promotes an aging effect.
2. Excessive Sun Exposure
Although fat loss is not directly dependent on UV rays, it is important to protect your skin from the sun. If you don’t wear SPF daily, the sun will accelerate the breakdown of collagen and elastin in the skin. When collagen and elastin levels are of poor quality, the condition of the skin is affected and the loss of fat can be accentuated.
3. Hormonal Changes
Female hormones, especially estrogen, are partially responsible for changes in the amount and quality of fat. As hormone levels begin to dip, fat can start to thin out.
4. Too Thin Of A Frame
It is possible to be too skinny. When that’s the case, the aging process will become even more of your enemy than your friend. The reason: A naturally thin face has little natural fat to begin with and over time the inherent amounts of fat begin to diminish, causing an extremely haggard look.
5. Receding Bones
With age, we naturally lose bone mass in the face. The muscles also begin to atrophy to some degree. These changes alter the underlying structure of the face and can cause the cheekbones and midface to look collapsed (the effects usually don’t take hold until later in life). It’s noticeable in the 70- to 80-year-old patient and while it’s highly variable, the majority of resorption happens around the nose and in the central face.
At the office of Dr. Mark Bishara and The Paragon Plastic Surgery & Med Spa we provide a wide range of cosmetic procedures to help patients look and feel their best, including injectables and fillers. These procedures are designed to improve the appearance of volume loss through minimally invasive techniques. Minimally invasive procedures offer patients the results they desire without the hassle and lengthy downtime often associated with cosmetic surgery procedures. We offer patients Botox, Xeomin, Radiesse, Juvederm Ultra Plus XC and the NEW Juvederm Voluma to help reduce or eliminate the signs of aging on their face.  Please call our office to see which product would be best for you at (817) 473-2120 or visit our website at for more information on these.


What is Juvederm Ultra Plus?
Juvederm Ultra Plus is hyaluronic acid which is a complex sugar that is identical to the hyaluronic acid your body makes. Because the Juvederm Ultra Plus is identical to the hyaluronic acid in your own body, it breaks down naturally.
How does Juvederm Ultra Plus work?
When Juvederm Ultra Plus is injected into or below the skin it lifts wrinkles, depressions, or scars, so that they are level to the surrounding skin.
Where is Juvederm Ultra Plus used?
Juvederm Ultra Plus can be used anywhere in the face (except for the hollows under the eyes (tear troughs), but it is best suited for deep wrinkles and to replace the facial volume lost due to the aging process. The ideal locations for Juvederm Ultra Plus are the smile lines or parentheses lines (nasolabial or melolabial folds), the marionette lines, to hide the jowls by replacing the volume lost just in front of the jowl (prejowl depression) and for lip augmentation (plumper lips).
Are there different types of hyaluronic acid?
Currently, there are two companies that make injectable hyaluronic acid. Medicis makes Restylane and Perlane, and Allergan makes Juvederm Ultra, Juvederm Ultra Plus and Juvederm Voluma XC.
Does Juvederm Ultra Plus work instantly?
Juvederm Ultra Plus works instantly to lift wrinkles, depressions, scars, and to restore the volume lost during the aging process.
How long does Juvederm Ultra Plus last?
The duration of Juvederm Ultra Plus varies from person to person, from injection site to injection site, and from visit to visit. There are three general rules with Juvederm Ultra Plus: 1. The closer you inject Juvederm Ultra Plus to the mouth, the faster the Juvederm Ultra Plus breaks down. 2. The more superficial you inject Juvederm Ultra Plus the longer it lasts. 3. There are no guarantees of duration when it comes to Juvederm Ultra Plus.
How many visits are there for a Juvederm Ultra Plus injection?
Unless you have had injectable fillers before, and know exactly what you want, there is usually a consultation to discuss your concerns and to educate you about your treatment options. Once the appropriate injectable filler has been determined for your concern we can do treatment at the time of the consultation.
Dr. Bishara provides a wide range of cosmetic procedures to help patients look and feel their best, including Botox and Juvederm. Many of these procedures can be combined in order to achieve your desired appearance. Please call our office at (817) 473-2120 to schedule your Juvederm appointment and ask about our weekly Botox specials.  Please also visit our website at and “LIKE” us on our Facebook Page- Paragon Plastic Surgery and Med Spa.