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There’s a lot of staring into mirrors that takes place around this time of year. Some of it should probably be attributed to cabin fever. But the vast majority, I believe, stems from a deep-down desire, prompted by the start of a new year, to change something about ourselves.

While much of the advice bogging down the internet at the moment about sticking to our resolutions tend to center on short-lived concerns—the five to 10 pounds gained since the end of the summer, the new urge to drink more often after a month of nightly holiday parties—it’s the ones that have plagued us for as long as we can remember that resonate most during those long stare-downs with ourselves. Things like a double chin.

The good news is, if your double chin and neck area is something that’s distracted you, tightening it up is a fairly painless process that can be done in as little as 15 minutes with a board-certified plastic surgeon. Here’s what you need to know about it.

Did someone say no downtime?

Kybella is an injectable that dissolves fat cells permanently. It was approved by the FDA in 2015 for use specifically in the submental region of the body, also known as the space between the chin and the neck. Its key ingredient is deoxycholic acid, which is a synthetic form of bile, the bodily fluid that plays an integral role in our digestion.

When it’s injected, the acid destroys fat cells in the area around the injection so that they can no longer accumulate or store fat.

Anyone over 18 who has a pinchable amount of fat in their submental area is considered a good candidate for Kybella. Effective as it is, the results aren’t immediate. Most require three to four noninvasive treatments, spaced about a month apart. You should, however, begin to notice a difference after the second session.

For a comparison, you’ll see immediate results with chin liposuction once the swelling subsides, after about three days, but it is a minimally-invasive procedure. The fat is suctioned out through a cannula that’s inserted through a small incision in the chin crease.

An overnight success story

Perhaps the best part about Kybella, in case you glossed over it toward the top of this post, is that it permanently removes fat cells. It’s worth noting that the remaining fat cells can expand over time, so it’s important to maintain your results with a healthy diet and a consistent exercise regimen.

But that shouldn’t be a problem now that you’re no longer losing big chunks of time staring into a mirror, trying to wish away that one feature that, in your eyes, has defined so much of your identity for all these years.

I’m continuing a conversation here that I started in my last post: While plastic surgery has always blended technical expertise and artistry, it’s maybe never been more evident than it is at this very moment with all the innovative ways surgeons are delicately sculpting the human face with precisely placed injections. These are a couple more examples for your consideration.

What you’re not seeing

In high school art classes, it’s one of the first lessons they teach us: What’s not there is every bit as essential as what is. It can seem like plastic surgery is constantly focused on creation, even in the cases of liposuction and breast reduction surgery, where we’re removing something, but also creating a new silhouette. However, much of what we’re able to accomplish through injectables involves the engineering of negative space.

To slenderize blocky jaws, for example, we can administer a neurotoxin to the chewing muscles, which tend to turn bulky after years of clenching and chewing. With the right dose, the muscles will shrink slightly, narrowing the lower third of the face into a softer heart shape.

A neurotoxin can also tighten the neckline when it’s administered in a series of small doses under the jawline and across the platysma muscle that runs up and down the neck. It will enable the face to lift upward, to a degree, and any folds in the neck to lie flat.

Aging produces both positive spaces—folds and fullness—and negative ones, like wrinkles, under-eye depressions, and sunken temples. Hyaluronic acids are commonly used to fill the voids, though it still requires a refined technique and wealth of experience because precise placement is crucial. As is using a gel with an appropriate viscosity. The skin under the eyes, in particular, is extremely delicate. If certain hyaluronic acids are injected in the wrong place, the natural contours can be dramatically upset.

A long-term perspective

Miraculous as much of this sounds (and is), there can be such a thing as too much of a good thing. (Though, much more often, it’s a good thing that’s been poorly administered.) In those instances, we can refresh the canvas by dissolving hyaluronic acid with an enzyme called hyaluronidase. (It doesn’t have the same effect on other types of filler, which generally have to degrade on their own or be surgically removed.)

With many of the treatments I’ve highlighted in this post and the last one, it’s important to consider them as part of an ongoing treatment plan that’s been designed by a board-certified plastic surgeon after an extended and thoughtful discussion about your short- and long-term expectations. Without the right guidance, it can be easy to lose perspective and begin adding volume beyond what’s been naturally lost.

Throughout these posts, I’ve emphasized the surgeon’s expertise in knowing where to place these injections and his or her ability to place them. But just as important is their vast knowledge of the human anatomy and the effect these subtle alterations will have, not only over the next several months, but over the course of a lifetime.

Maybe you hold an image in your head of the type of woman (or man) who gets Botox. Amanda Montell did: Ramona Singer, of “The Real Housewives of New York,” “who is known,” Montell writes, “for always having white wine in hand and managing to look more youthful with age.

“I was 16 at the time and watched in pure contempt of Ramona’s superficiality. People who got Botox had their priorities all out of whack, I decided. Couldn’t people just let themselves age gracefully anymore? Shouldn’t the goal be feeling young instead of looking young,” Montell writes in her essay for the beauty site, Byrdie. “Now, looking back, I have to laugh at my young, wrinkle-free self. It’s easy to condemn procedures that eliminate wrinkles when you don’t have any of your own!”

‘How quickly your tune can change’

What she’s trying to say is that her perception changed when her reality changed. At 26, the woman who thought she was nothing like Ramona Singe sought her first preventative Botox treatment.

“Oh, how quickly your tune can change the moment you actually see yourself start to age,” Montell writes.

A photographer friend had taken some shots of Montell. Later, when she saw the prints, all she could see were the vertical lines between her eyebrows, her “angry 11s,” as she refers to them, and other lines across her forehead that she’d never really noticed before.

“It’s not as if the lines were extreme, but they were there, staring back at me, an undeniable physical symbol that one day I wasn’t going to look like—or be—a young person anymore,” Montell writes.

“I couldn’t help but think: If my goal is to feel young, but the way I look doesn’t match that, then one day I’m not going to recognize myself anymore. That’s what bothered me—I wanted my outside to match my inside. And my inside still felt so wrinkle-free.”

Preventative vs. corrective

It’s important to understand that our perceptions of the kind of people who get Botox, or any type of plastic surgery, for that matter, have been shaped by reality TV and pop culture sites, which rarely cast anyone in the best light. “Preventative Botox,” as the treatment’s come to be called, is quickly gaining traction in large part because millennials are dismissing outdated stigmas and becoming well-informed about the aging process and the options for slowing it down.

The benefit of beginning Botox, or any type of botulinum toxin, when fine lines are just beginning to form (preventative), rather than waiting until they become deeply etched (corrective), is that it retrains the muscles responsible for those lines, effectively stopping them in their tracks. And once that happens, even less Botox is needed to maintain the results.

“With all the information laid out in front of me, the taboos and judgements around this one small procedure seemed so senseless,” Montell writes.

As of when she wrote the essay, Montell had undergone two Botox treatments over the previous six months. Already, her “angry 11s” had completely disappeared, and her makeup, she writes, is going on smoother than ever.

The prospective cosmetic surgery patient is much better educated than they were even just a few years ago. They’re entering the initial consultation with a pretty clearly defined idea of the procedure they want and what it’s going to entail.

By that I mean they understand that there’s going to be a certain degree of bruising and swelling. That knowledge, however, doesn’t always soften the shock.

Even in the hands of a skilled, board-certified plastic surgeon, a cosmetic procedure is still a type of trauma from which the body must heal. Your body can’t distinguish between tripping and scraping your knee and a doctor taking a scalpel to your chin. Which is to say the bruising and swelling can be relatively intense in the initial aftermath. But there are a few things you can do to ensure a speedy recovery.

What to expect

Before we get into the recovery, let’s discuss what you can expect to see and feel following your cosmetic procedure. In the first few days following surgery, the bruising will be a dark black, purple, or blue—which can look even more traumatizing when it’s in a highly visible place, like the face. But it should begin to lighten up by the fifth or sixth day and subside completely within two weeks.

The swelling, similarly, is going to be its worst over the first few days after the surgery. It’ll begin to go down after a week, and within two weeks, the swelling should reduce by about 75 percent. Six weeks out, almost all of it should dissipate. Any lingering swelling will go down over the next few months.

Self-care after surgery

Let me preface the tips that follow by saying that the single-most effective thing you can do to ensure a complete recovery is to follow your doctor’s post-care recommendations. That means keeping dressings and compresses on until you’re told to remove them. If you had a procedure performed on your face or neck, you may be told to sleep with your held elevated for the first few weeks. Stop taking any blood-thinning medications or supplements. It also means, above all, being a diligent observer of what you’re seeing and feeling. Redness around the site of the procedure, for example, coupled with pain and fever could be sign of infection, which warrants immediate attention..

Beyond that, simply take care of yourself. Don’t smoke. Avoid alcohol for at least the first few days. Drink lots of water. Stay out of the sun (exposure can deepen the color of bruises). Avoid strenuous activity, including exercise, for the first few weeks after surgery. And get plenty of sleep. Again, your body believes it’s recovering from a trauma, so enable your immune system to work at its full capacity.

When to return to normal activity

You may have a ready-made excuse for avoiding the gym for a while, but you’ll want to get out of bed and at least walk around the house a bit as soon as you feel up to it. It’s essential to promote healthy circulation and discourage the development of clots.

If the bruising makes you self-conscious, you should be able to mask it with makeup after a few days, but clear it with your doctor first. And steer clear of open wounds and stitches.

Did you enter the new year determined to make more of an investment in yourself? Rewarding as that will ultimately be, it can be difficult trying to figure out exactly where and how to begin. A positive return on those first few steps will likely give you all the momentum you’ll need to stick with it. But stumble just a bit and you may fall back to your old ways.

Worth your consideration is a small but effective act that’s come to be described as a “tweakment.” It’s a new category of quick, minimally-invasive cosmetic procedures that are meant to provide a dramatic refresher and stave off the early phases of the aging process. Think injectables, microneedling, and lasers. Here’s a closer look at a couple of the most popular tweakment procedures.

Concern: Double Chin

You may have heard about the growing wave of body-contouring technology that’s capable of removing unwanted fat without a single incision or any downtime. Lesser known is just how versatile many of those treatments are. CoolSculpting, the best-known brand among the fat-freezing devices, has a treatment head that can be used under the chin to tackle jowls, for example.

Through a process called cryolipolysis, the fatty tissue in the treated area is cooled and up to 25% of the affected fat cells are ultimately destroyed. And because the body only produces a certain number of them, those particular fat cells are never coming back. Basically, as long as you maintain a healthy lifestyle, you can expect to never again be plagued by that pocket of stubborn fat.

Concern: Dark Circles

Dark circles really have more to do with genetics than anything else, but they will become more prominent if you’re not staying sufficiently hydrated or getting enough sleep. They also worsen with age. The upside: A well-placed, subtle hyaluronic acid filler can have a pretty dramatic effect simply by creating a plumper under-eye.

Hyaluronic acid is a natural part of the skin’s dermis, but we store less of it as we age, which causes the undesired hollowing effect under the eyes. The hyaluronic acid in fillers helps pull water to the site of the injection, stimulating the appearance of thicker fat pads under the skin.

Another tweakment option is platelet-rich plasma injections, which have the same effect. A small amount of blood will be drawn from your arm (about two to four tablespoons). Then, it’ll be placed into a centrifuge, which separates the blood into layers. The layer with the highest concentration of platelets will then be injected into your under-eye areas.

Each of the procedures outlined here takes less than an hour and requires little to not downtime. In other words, it’s a fairly minimal investment, time-wise, but you’re likely to reap the sort of rewards that’ll inspire you to make this your best year yet.

Already the most widely performed minimally-invasive cosmetic procedure in the United States, botulinum toxin (Botox, Jeuveau, Dysport, Xeomin) is forecast by industry insiders to become even more popular in the year ahead as more twentysomethings turn to it as a preventative treatment.

“Preventative Botox,” as it’s come to be known on beauty sites and across social media, may sound like overkill at first. Someone in their twenties who regularly thinks about their whispers of wrinkles is obsessed, not concerned, right? We are the harshest critics of ourselves. In other words, we’ve all been there, whether we choose to remember it and relate or not.

How it works

Personal motivations aside, there’s plenty of merit to preventative Botox. Frown lines, crow’s feet, and expression wrinkles result from the repetitive folding of the skin. It doesn’t happen overnight, but it does happen a lot sooner than many of us think it will.

We’ve come to realize that by injecting these areas earlier, we can keep these wrinkles from developing in the first place, instead of trying to diminish and delete them after they’ve developed. It’s a cumulative effect. With each subsequent treatment, we’re training these muscles—and, in turn, preventing the lines from developing until much later than they normally would.

One of the clearest examples of this are the downturned lines on the sides of the mouth, often referred to marionette lines. Once they form, they can be very difficult to treat. But by injecting the muscles at the mouth angles with botulinum toxin, we’re able to keep them from appearing in the first place.

When to start

Since the goal is prevention, when should treatment start? There is such a thing, of course, as being too young for preventative treatments. Botox is FDA-approved for patients 18 and older. Most begin around age 30. Some start as early as 25. Any younger than that and you likely haven’t developed enough lines to worry about.

When you start to notice frown or forehead lines, it’s reasonable to consult with a board-certified plastic surgeon about starting preventative treatments. Ideally, we want to prevent those lines from turning into larger folds.

It’s worth mentioning that while preventative Botox has been shown to be quite effective at staving off wrinkles, it’s also one part of a healthy skin-care regimen. Applying sunscreen on a daily basis, getting plenty of sleep, and keeping stress to a minimum with activities like yoga and meditation will all contribute to maintaining a youthful radiance.

As cosmetic injections have penetrated the mainstream in recent years, there’s been an increasing tendency by media outlets, bloggers, social media influencers, even some board-certified* plastic surgeons to use certain cosmetic-injection terms as though they’ve been part of our vocabulary all along. By doing so, the best-case scenario is you’re left in the dark. Worst-case, you’re misled. Whether you’re preparing for your next treatment or your first, think about taking a moment to brush up on your cosmetic-injection terms.

*Board Certification

Indicates that the injector has not only graduated from medical school and is a licensed physician but they’ve also completed a three-year residency program in plastic surgery. When you’re considering any sort of cosmetic injection, you want a board-certified plastic surgeon because they have extensive knowledge of the musculature of the face.

Botulinum Toxin

A drug made from a purified protein derived from a strain of protein called Clostridium botulinum. With 7.4 million procedures performed last year, it’s the most popular type of injectable by far. It works by preventing nerves from releasing the neurotransmitter acetylcholine, which triggers muscles to contract. In doing so, overactive, wrinkle-causing muscles become relaxed and lines they’ve etched become less pronounced. In 2002, Botox became the first brand under which botulinum toxin was available for cosmetic injections. Jeuveau, Dysport, and Xeomin are newer versions of the drug.

Filler

Refers to any substance that can be injected into the skin or underneath it to create a physical change. There are currently 15 different kinds of fillers approved by the Food and Drug Administration (FDA) for cosmetic use. In recent years, plastic surgeons have gradually drifted away from permanent and semi-permanent fillers, which can last up to five years, in favor of hyaluronic acid fillers, whose results can last up to two years but are reversible.

Hyaluronidase

Used to reverse poorly done procedures (overly plumped lips) or the bumps that can occur as a side effect of bad injection technique or when an injection is too shallow. Hyaluronidase is comprised of a group of enzymes that break down hyaluronic acid fillers within hours without compromising the hyaluronic acid that’s found naturally in your skin. (It cannot be used on permanent or semi-permanent fillers.)

Poly-L-Lactic Acid

A sugar with medical and cosmetic applications—it’s in the filler Sculptra, which is approved by the FDA to plump nasolabial folds for up to two years. But unlike the sugar that makes up hyaluronic acid fillers, this one doesn’t occur naturally in the body, and it can’t be reversed.

Hyaluronic Acid

A naturally-occurring sugar that plumps the skin by holding 1,000 times its weight in water. With more than 2.1 million injections done in 2018, hyaluronic acid-based fillers are the most popular types of fillers today. Different brands and types offer the sugar in different concentrations and particle sizes. Small particles, such as those in Juvéderm Volbella and Restylane Silk, are often used to fill in shallow lines and delicate areas, like the lips, while larger ones, such as those in Juvéderm Voluma XC and Restylane Lyft, are most appropriate for adding volume to the cheeks and smoothing nasolabial folds.

Until recently, many plastic surgeons didn’t hesitate to prescribe the likes of Vicodin, Percocet, and oxycodone to address a patient’s discomfort that could follow a procedure. But an opioid epidemic that claimed tens of thousands of lives last year alone has prompted the field to take a closer look at pain management.

Narcotics are often necessary for controlling pain after major operations, like large-volume liposuction and tummy tucks. But more and more plastic surgeons are finding alternatives and using anti-inflammatories, local anesthetics, and numbing medications to attack different pain pathways.

And, increasingly, patients are asking their surgeons not to prescribe them any pain medication.

Redefining recovery with Experal & Celebrex

As reducing narcotics use becomes a greater priority, innovations like Experal are becoming commonplace and changing the recovery experience. Experal is a drug that contains bupivacaine, a longer-acting numbing agent. Injected at the site of the incision, it binds to fat molecules in a microscopic honeycomb. In some cases, an ultrasound is used to place it precisely where the nerves are.

Experal dissolves over the course of 72 hours, which enables plastic surgeons to significantly decrease the narcotic requirements for a number of procedures and get patients off of them a lot sooner.

Similarly, some doctors are incorporating Celebrex, an anti-inflammatory arthritis medication and pain reliever, and a nerve medication called Lyrica into their pre-surgery pain-management plan. The first is taken the day before surgery, the second, several hours before and four to five days afterward. The combination is able to cover a lot of a patient’s discomfort for certain cosmetic procedures.

And, believe it or not, Tylenol has garnered some renewed interest as an alternative. It’s been found to be particularly effective at blunting pain when it’s taken in frequent doses.

Voice your concern

Well before that point, doctors are also being more vigilant about screening patients for a history of substance use disorder. But medical records aren’t always a reliable reference for such a condition. Not to mention, there’s no way to take into account those who have a genetic predisposition for addiction.

Plenty of people are able to take opioids as they were prescribed and never use them again. But then there are others who aren’t able to stop taking them. Until you’re in that position, you can’t know for sure what you’ll be inclined to do.

If you have any concern about being prescribed a narcotic before or after your procedure, discuss it with your board-certified plastic surgeon. If an alternative isn’t readily available, your surgeon may be able to refer you to a pain management therapist, who can at least monitor your behavior when taking a small, controlled prescription.