The Rise of ‘Tweakments’

The last time I got Botox, my dermatologist, Melissa Levin, M.D., asked me, "So you still want to have movement, right?" I nodded. I don't want my muscles to be frozen in place. I would just like to look the way I did in college, when I still got carded on Monday nights at the local Chili's. These days, I can order a margarita and they'll just…bring it to me.

I'm not alone in my desire to keep my face looking like my face. Tweakments, a word often used to describe super-small injections of neuromodulators and filler in order to create a natural result, are gaining in popularity. "A tweakment is not different from an injectables treatment per se, but I think of it as a minimal refinement to your existing anatomy," says New York plastic surgeon Lara Devgan, M.D., whose Instagram is full of patients who sought her out for her skilled craft in what the aesthetics industry calls facial optimization. "It's designed to be a subtle improvement rather than a major change."

Tweakments are especially gaining ground in the age of coronavirus—or, at least, the curiosity around them is. Blame your daily stand-up meeting. "Unflattering Zoom angles are the new awkward selfie," says Devgan. Her practice just re-opened following shelter in place orders, and it currently has a waiting list in the thousands for appointments. "In terms of cosmetic treatments, people are spending more time looking at their own faces, and this has led to an increase in first-time patients seeking out tweakments," she says.

https://www.instagram.com/p/CBYBONYpLKK” data-instgrm-version=”8″>There are a number of factors behind the appeal of tweakments. Your serum can only go so far, for one. "Skin care is skin care, but it only does so much," says Sapna Palep, M.D., dermatologist and founder of Spring Street Dermatology in New York City. "It doesn't get past the epidermal layer of your skin." Injectables, on the other hand, go into the dermis and beyond.

Another big contributor is that the people now pursuing injectables for the first time have learned from the mistakes of the past—namely, the duck lips, inflated skin, and freakishly smooth foreheads. Now, "most people want to feel like the best version of themselves, rather than look like someone else," says Devgan. "This is the essence of tiny tweakments: They allow us to preserve the feeling of facial identity while optimizing global facial beauty."

When done right, a tweakment strikes the perfect balance between fulfilling the desire to enhance or correct and the need to look natural while doing it. "I still wanted movement in my face and to look like a normal person," says Louise Molony, 31, a publicist in New York City who first got Botox several months ago. "But I wanted to make sure that I was getting enough to see a difference in my problem areas."

That balance is often what appeals to younger women and first-timers alike. "The results are subtle, but effective enough to yield the desired effect," says Lauren Davis, 32, a stay-at-home mom in Cummings, GA, who got both Dysport (a neuromodulator brand similar to Botox) for lines and Restylane (a brand of filler) to address undereye bags. "People look at me and say, 'I can tell the baby has been sleeping through the night! You look great!'"

To achieve this, tweakments are largely corrective. For instance, if you're beginning to see the first signs of volume loss around your face—the result of fat breaking down over time—then super-small amounts of filler can be used to tighten your jawline, lightly plump your cheeks, and generally restore what's missing. Enhancing with tweakments is still doable in most areas, but only to a certain extent. "You can enhance lips with lip injections, but you never want to enhance past your natural state," Palep says.

The sign of a good tweakment is when you're one of few people to notice the results—if any. For instance, a former colleague of mine requested injectables so subtle that her husband wouldn't notice. "If you appreciate the paradoxical notion of wanting to look the same but better, or the idea of a subtle change that you’ll see but others won’t notice, then you may be a good candidate for a tweakment," says Devgan.

That was important for Ashley Abell, 29, a hearing instruments specialist in St. Louis, MO. When she sought out Dysport for fine lines on her forehead, she says, "I didn't want it to look like I had anything done. So I just asked that it look natural."

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👄 Lips are one of the most feared treatments in my practice due to the massive rise in people with over filled lips 🦆 So how can we gauge how much lip filler will restore lost volume as you age but also keep your lips looking like yours?! 🤔 ————————————————— As we age we lose up to half our lip volume ⬇️ A small amount of lip filler can transform the lower face but also still look natural if done in a way that is proportional to the rest of your facial features 📐👌🏼 ————————————————— In the 1950’s Dr Rickett devised a line called the E-Line which is a line drawn from nose to chin in the profile view as seen in yellow in the picture above 〽️The top lip should sit 4mm away from the line whilst the lower lip should sit 2mm from the line📏Originally suggested to be one of the ideal proportions of facial beauty we now use this as one of the guides of how much lip projection can be given whilst still looking natural 🍃 As with everything around beauty everyone is unique and as you can see above even the most beautiful faces fall from this ideal! ————————————————— How many of you now have a pen against your nose & chin trying to measure yourself?! 😂📏 ————————————————— I am a big believer of not changing someones look but enhancing and redefining key areas to harmonise the whole face. The result should be one that makes you feel refreshed and well slept rather than completely different!

A post shared by D R. M A R C U S M E H T A (@dr_marcus_mehta) on

Another bonus is that tweakments are versatile. They can be used to address a variety of aesthetic concerns. "A tweakment can address anything where millimeters matter—asymmetry of your eyebrows, unwanted fine lines around your eyes, a bump on your nose, thinning of your lips, dull skin quality, or even a combination of all of those things," Devgan says. The key is addressing these things on a micro scale, with small changes that add up to a more youthful appearance without any single part attracting attention.

Tweakments are also fair game for anyone and everyone, even those in their twenties. Palep files preventative procedures, such as “baby Botox,” in the tweakments category, as its benefits aren't really seen until years after the injection. "It’s not about age when you start with Botox," she says. "It has to do with the strength of your muscles."

If you're expressive and tend to use your facial muscles more—whether to glare at a passive-aggressive email or smile at a random dog on the street—they can create grooves and lines where you use them most often. (Think of folding a piece of paper repeatedly in the same spot…but with skin.) A micro-dose of Botox can go a long way by relaxing those muscles.

https://www.instagram.com/p/CAgxqJkJilL” data-instgrm-version=”8″>Plus, tweakments are just a good place to start if you've never gotten injectables before. "When I went in, my dermatologist asked if I wanted to get my problem areas around my eyes done, which I declined because I wanted to still look natural," Molony says. "But now that I've done other parts of my face, I feel more confident in getting just a little bit more." And the beauty of injectables is that if you start small, you can always scale up. "Injectables layer very well, which allows a subtle transformation and improvement over time," says Devgan.

There's no right time to level up your injectables, so to speak—since it primarily depends on genetics, sun damage, and other factors in how your skin ages. "I don’t plan on changing my routine visits anytime soon, but time will determine that," says Davis. "As I age and my skin loses elasticity, I may alter my approach."

Injectables are only the beginning when it comes to tweakments. Similarly subtle, natural results are possible with a number of procedures, even those that are more invasive. "For example, a resurfacing laser can be done at a milder setting to reduce downtime; a breast augmentation can be performed with a small implant to achieve a more subtle contour; and eyelid surgery can involve a conservative excision in order to maintain the natural character of your eyes," says Devgan. As cosmetic procedures move towards bespoke outcomes, tweakments will naturally follow.

However, it may be some time before you can get your tweakment. "The spa I go to has been closed for the last few months because of the coronavirus, but I’m hoping to get into a dermatologist office for some Botox before the end of the summer," says Abell. Molony feels similarly. "When I look in the mirror, I miss my Botox," she says.

Unfortunately, the one thing that isn't a given with tweakments is a gentler hit to your wallet, since the price of injectables largely depends on your concerns, your location, and your provider. Still, it could potentially be more budget-friendly, as some doctors charge by syringe. "I just need one syringe to cover multiple areas," says Palep. In general, that can cost anywhere from $400 to $1,000. (To put it better perspective, the “Insta look” for lip filler usually consists of two or three syringes.)

Last but not least, temper your expectations accordingly. If you're looking for a life-changing transformation in any way, a tweakment probably isn't for you. "That’s the whole point of this," Palep explains. "If my patient looks like they did something, then I did a bad job."

Deanna Pai is a writer in New York City. Follow her on Twitter @deannapai.

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