A nicotinic hypothesis for Covid-19 with preventive and therapeutic implications


A nicotinic hypothesis for Covid-19 with preventive and therapeutic implications

121 jean-pierre CHANGEUX, Zahir Amoura , Felix Rey , Makoto Miyara

Author(s) details


SARS-CoV-2 epidemics raises a considerable issue of public health at the planetary scale. There is a pressing urgency to find treatments based upon currently available scientific knowledge. Therefore, we tentatively propose a hypothesis which hopefully might ultimately help saving lives. Based on the current scientific literature and on new epidemiological data which reveal that current smoking status appears to be a protective factor against the infection by SARS-CoV-2 [1], we hypothesize that the nicotinic acetylcholine receptor (nAChR) plays a key role in the pathophysiology of Covid-19 infection and might represent a target for the prevention and control of Covid- 19 infection.

Symptomatic Covid-19 disease (as caused by SARS-CoV-2 virus) is observed in 2.5 percent of infected individuals [2] indicating an individual variability in the clinical presentation. Among the epidemiological and clinical features of Covid-19, the following features are of special interest for understanding the patho-physiolology, namely: (1) in outpatients with favorable outcome : neurological/psychiatric disorders, especially loss of sense of smell which is specific of the disease and (2) in hospitalized older patients with a poor prognosis : systemic hyperinflammatory syndrome with increased levels of circulating cytokines and atypical acute respiratory distress syndrome with loss of


neurological control of lung perfusion regulation and hypoxic vasoconstriction [3]. This raises the issue of the basis of inter-individual variability for the susceptibility to


The nAChR appears as a hypothetical clue for the main clinical manifestations of Covid- 19. It is accepted that the angiotensin converting enzyme 2 (ACE2), represents the principal receptor molecule for SARS-CoV-2 [4-6]. ACE2 is expressed at the transcriptomic level in the lung, the small intestine and colon, in the kidney, in the testis, in the heart muscle and in the brain, yet the protein is not detected in the lung [7]. In the brain, ACE2 is expressed in both neurons and glia and particularly present in the brain stem and in the regions responsible for the regulation of cardiovascular functions, including the subfornical organ, paraventricular nucleus, nucleus of the tractus solitarius, and rostral ventrolateral medulla [8]. Additional receptors or co-receptors are, however, not excluded. The relationship between nicotine and ACE2 has been explored in the framework of cardiovascular and pulmonary diseases [9]. Accordingly, in the ACE/ANG II/AT1R arm, nicotine increases the expression and/or activity of renin, ACE and AT1R, whereas in the compensatory ACE2/ANG-(1–7)/MasR arm, nicotine down regulates the expression and/or activity of ACE2 and AT2R, thus suggesting a possible contribution of acetylcholine receptors in ACE2 regulation. This possibility has not yet been explored in the framework of viral neuroinfections.

There is strong evidence for a neurotropic action of SARS-CoV-2 infection. It has been demonstrated that β-coronaviruses to which the SARS- CoV-2 belongs, do not limit their presence to the respiratory tract and have been shown to frequently invade the CNS [10] . This propensity has been convincingly documented for the SARS-CoV-1, MERS- CoV and the coronavirus responsible for porcine hemagglutinating encephalomyelitis (HEV 67N). In light of the high similarity between SARS-CoV-1 and SARS-CoV-2, it is quite likely that SARS-CoV-2 also possesses a similar potential. Neuroinfection has


been proposed to potentially contribute to the pathophysiology and clinical manifestations of Covid-19 [10] with the neuroinvasive potential of SARS-CoV-2 suggested to play a role in the respiratory failure of Covid‐19 patients [11, 12]. Our nicotinic hypothesis proposes that the virus could enter the body through neurons of the olfactory system and/or through the lung leading to different clinical features with different outcome, and contrasts with the currently accepted view that ACE2 is the principal receptor of SARS-CoV-2 for its entry into cells.

As mentioned, loss of sense of smell frequently occurs in Covid‐19 patients [13]. Furthermore, several studies have reported that some patients infected with SARS‐ CoV‐2 show neurologic signs such as headache (about 8%), nausea and vomiting (1%) [11]. More recently, a study of 214 Covid‐19 patients [14] further found that about 88% (78/88) of the severe patients displayed neurologic manifestations including acute cerebrovascular diseases and impaired consciousness. Based on an epidemiological survey on Covid‐19, the median time from the first symptom to dyspnea was 5.0 days, to hospital admission was 7.0 days, and to the intensive care was 8.0 days [15]. Therefore, the latency period may be adequate for the virus to enter the nervous system, invade the brain stem and affect the medullary neurons of the respiratory centers. However, variability of the neurological signs was observed with patients having anosmia, showing in general a mild evolution without pulmonary attack, in contrast with those without anosmia suggesting a diversity in the mode of proliferation and /or progression of the virus.
More than 20 years ago, Mohammed, Norrby & Kristensson [16], in a pioneering
study, showed with a broad diversity of viruses (Poliovirus, Herpes simplex virus, West Nile virus , Vesicular Stomatitis Virus, influenza H1N1 virus [17]), that viruses enter the olfactory epithelium and progress first through the olfactory pathway in an anterograde direction and then in a retrograde manner to the reticular neurons projecting to the olfactory bulbs, the median raphe neurons (serotoninergic) and the ventral and


horizontal diagonal band (cholinergic) [16, 18]. This olfactory infection route scheme [18] has been recently extended to Covid-19 infection [2, 11]. To further investigate the molecular aspects of Covid-19 propagation in the brain and its pharmacology, we have been aided by abundant studies on rabies virus (RABV) a negative polarity, single- strand RNA virus that is distinct from the coronaviruses [18-20]. nAChRs were shown to be the first receptors for RABV [21]. Structural studies further revealed that a short region in the ectodomain of the rabies virus glycoprotein shows sequence similarity to some snake toxins [20, 22] that were initially used to isolate the nAChR from fish electric organs [23]). These snake toxins [24] are known to bind with high affinity and exquisite selectivity to the peripheral muscle receptor, while also to some brain receptors [25, 26]. The neurotoxin-like region of the rabies virus glycoprotein inhibited acetylcholine responses of α4β2 nAChRs in vitro, as did the full length ectodomain of the rabies virus glycoprotein [20]. The same peptides significantly altered a nAChR elicited behaviour in C. elegans and increased locomotor activity levels when injected into the CNS of mice [20]. The nAChR thus plays a critical role in the host-pathogen interaction in the case of the RABV. Furthermore, a broad variety of nAChR oligomers are distributed throughout the brain, including the reticular core neurons and the spinal cord, with the 𝛼𝛼4𝛽𝛽2 and 𝛼𝛼7 nAChR oligomers being the most frequent [27]. The hypothesis we wish to explore is to what implications these data may hold for SARS- CoV-2 infection and we suggest a strong role of nAChR in the disorder.
The nAChR pathway is hypothesized to be engaged in the Covid-19 inflammatory syndrome. The nervous system, through the vagus nerve, can significantly and rapidly inhibit the release of macrophage TNF, and attenuate systemic inflammatory responses [28]). This physiological mechanism, termed the ‘cholinergic anti-inflammatory pathway’ has major implications in immunology and in therapeutics. The cytokine production of macrophages – one of the main cell types found in the bronchoalveolar fluid – is under the physiological control of auto/paracrine acetylcholine through their nAChRs [29].


Following dysregulation of macrophage nAChRs, the profile of cytokines massively secreted include Il1, Il6, TNF et Il18. This cytokine profile shows striking analogies with the cytokine storm syndrome, leading to the hyperinflammatory syndrome described in a subgroup of Covid-19 patients [30]; Systemic coagulopathy with venous and arterial thrombosis is one of the critical aspects of the morbidity and mortality of Covid-19. In line with our hypothesis, one should note that hematopoietic 𝛼𝛼7-nAChR deficiency increases platelet reactive status, which could explain the thrombogenic presentation of Covid-19 [31].
Although selective cytokine blockers (eg, IL1-receptor antagonist anakinra or anti-IL6 tocilizumab) have been proposed for the control of Covid-19 cytokine storm, their efficacy is still to be explored. Interestingly, 𝛼𝛼7 agonists, including nicotine, have proven to be effective in reducing macrophage cytokine production and inflammation in animal models of pancreatitis [32] and peritonitis [33]. In this setting, a nicotinic treatment that might possibly antagonize the blocking action of SARS-CoV-2 on the AChR through a possible modulation of the ACE2 – nAChR interaction, would act earlier than anti- cytokine therapies. nAChR modulation by Covid-19 might tentatively account for the hyperinflammatory features observed in a subgroup of Covid-19 patients, mimicking bona fide the macrophage activation syndrome.
Of note, our hypothesis could explain the high prevalence of obesity and diabetes mellitus observed in severe forms of Covid19. The diminished vagus nerve activity previously described in these two illnesses could be potentiated by the Covid-19 elicited nicotinic receptor dysregulation, leading to a hyperinflammatory state often reported in obese patients [29].
nAChRs are present in the lung epithelium. The non-neuronal cholinergic system contributes to the regulation of cell functions such as cell-cell interaction, apoptosis, and proliferation and it is well established that human bronchial epithelial cells contain nAChRs. The airway epithelium expresses 𝛼𝛼3, 𝛼𝛼4, 𝛼𝛼5, 𝛼𝛼7, 𝛼𝛼9, 𝛽𝛽2, and 𝛽𝛽4-nAChRs


subunits [34-37] and their contribution has been discussed in the framework of airway epithelial basal cell proliferation-differentiation and their alteration in lung cancers [38]. These nAChRs are mentioned here as possible targets of Covid-19 infection of the lung, which would take place concomitantly with, and/or as a consequence of, the neuro- infection. Additionally, nAChRs are involved in lung perfusion regulation, which seems to be disrupted in the atypical acute respiratory distress syndrome reported in Covid-19 patients [3].

A potential protective effect of smoking and of nicotine on SARS-CoV-2 infection has been noted. Until recently [39], no firm conclusions could be drawn from studies evaluating the rates of current smokers in Covid-19. All these studies [40-48], although reporting low rates of current smokers, ranging from 1.4% to 12.5%, did not take into account the main potential confounders of smoking including age and sex. In the study that two of us are reporting [1], the rates of current smoking remain below 5 % even when main confounders for tobacco consumption, i.e. age and sex, in- or outpatient status, were considered. Compared to the French general population, the Covid-19 population exhibited a significantly weaker current daily smoker rate by 80.3 % for outpatients and by 75.4 % for inpatients. Thus, current smoking status appears to be a protective factor against the infection by SARS-CoV-2. Although the chemistry of tobacco smoke is complex, these data are consistent with the hypothesis that its protective role takes place through direct action on various types of nAChRs expressed in neurons, immune cells (including macrophages), cardiac tissue, lungs, and blood vessels.

Mechanisms engaged in Covid-19 as nAChR disease might be tentatively suggested. There is structural evidence supporting the hypothesis that SARS-CoV-2
virus is a nicotinic agent. The recently reported X-ray structure of the RABV glycoprotein (G) ectodomain [49] shows that the region corresponding to the neurotoxin-like peptide


is exposed at the G surface, in agreement with the fact that this region is part of the major antigenic region II of RABV [50]. The recently published cryo-EM structure of the trimeric SARS-CoV-2 spike (S) protein [51, 52] revealed an insertion with respect to that of SARS-CoV-1, in a loop that is disordered in the reported structure, and which has a polybasic sequence that corresponds to a furin site. Importantly, this exposed loop of the SARS-CoV-2 S protein also contains a motif that is homologous to that of snake neurotoxins and to the RABV neurotoxin-like region (Figure). This observation supports the hypothesis that SARS-CoV-2 virus itself is a nAChR blocker.

Figure: The neurotoxin motifs. Amino acid sequence alignment of the motifs found in toxins from snakes of the Ophiophagus (cobra) and Bungarus genera, in G from three RABV strains and in S from SARS-CoV-2

Nicotine may be suggested as a potential preventive agent against Covid-19 infection. Both the epidemiological/clinical evidence and the in silico findings may suggest that Covid-19 infection is a nAChR disease that could be prevented and may be controlled by nicotine. Nicotine would then sterically or allosterically compete with the SARS-CoV- 2 binding to the nAChR. This legitimates the use of nicotine as a protective agent against SARS-CoV-2 infection and the subsequent deficits it causes in the CNS. Thus,


in order to prevent the infection and the retro-propagation of the virus through the CNS, we plan a therapeutic assay against Covid-19 with nicotine (and other nicotinic agents) patches or other delivery methods (like sniffing/chewing) in hospitalized patients and in the general population

In conclusion, we propose, and try to justify, the hypothesis that nAChRs play a critical role in the pathophysiology of SARS-CoV-2 infection and as a consequence propose nicotine and nicotinic orthosteric and/or allosteric agents as a possible therapy for SARS-CoV-2 infection. Interestingly, ivermectin, which has been recently shown to inhibit the replication of SARS-CoV-2 in cells in vitro [53], is a positive allosteric modulator of a7 nAChR [54]. The nicotinic hypothesis might be further challenged by additional clinical studies and by experimental observations determining whether SARS- CoV-2 physically interacts with the nAChR in vitro, for instance by electrophysiological recordings, high resolution EM and by animal model studies. Further work should also specify the still enigmatic relationships between ACE2 and nAChRs in the nervous system.

One should not forget that nicotine is a drug of abuse (53) responsible for smoking addiction. Smoking has severe pathological consequences and remains a serious danger for health. Yet under controlled settings, Nicotinic agents could provide an efficient treatment for an acute infection such as Covid-19.


Golden Milk


Golden Milk is beautiful, easy, and a delicious introduction to the ancient philosophy of Ayurveda. A taste-bud-tingling alternative to coffee, this comforting drink is perfect for any time of day.



Golden Milk Recipe

1 cup organic whole milk (preferably unhomogenized) or almond, oat, coconut, hemp milk, etc.

½ cup water

½ teaspoon ground cinnamon

½ teaspoon ground turmeric

2 to 3 cardamom pods, cracked, or ⅛ teaspoon ground cardamom

pinch of ground nutmeg

a good grind of black pepper

1 date or 1 teaspoon jaggery to sweeten

1 teaspoon grated fresh ginger or ½ teaspoon ground ginger

1 teaspoon organic ghee (good for vata)


1. Add the milk, water, spices, and the date, if using, to a pan and season with black pepper and whisk well.

2. Bring to the boil and then reduce to a simmer for 10 minutes, being careful not to let it burn or let it bubble over! Add ghee and jaggery if using, mix well, and remove from heat.

3. Allow to cool a little, strain and serve.

Recipe excerpted from East by West. Copyright © 2017 by Jasmine Hemsley. Published by Bluebird Books, an imprint of Pan Macmillan.

Don’t just lose weight, choose a healthy lifestyle

Deciding to lose weight is not just about starting a diet; it’s about choosing to live a healthy lifestyle. The key to successful and maintainable weight loss is all about controlling cellular inflammation. And while controlling cellular inflammation will drastically show physical changes, what we don’t realize is that we are also making positive changes to our biochemistry.

Approaching weight loss by targeting visceral fat, aka “belly fat,” will help reduce your waistline and improve your body’s chemistry. Visceral fat is a dense and highly toxic type of fat that is responsible for the release of inflammatory proteins and hormones, increasing your risk for developing certain diseases such as high blood pressure, type 2 diabetes, and elevated cholesterol levels.

Along with reducing belly fat, healing the gut microbiome is an essential component required to promote a surge in metabolism and allow better absorption of nutrients which will kick start to your metabolic rate. A typical Western diet, one of which we’ve all been accustom to, one of which is high in refined carbohydrates and processed foods, will create gut inflammation resulting in what’s known as, Leaky gut. Leaky gut is one of the leading causes of cellular inflammation, making it difficult to lose weight, and ultimately sustained weight gain.

This disruption in the gut microbiome allows trace amounts of toxins into the bloodstream forming an attack on the cells. To protect themselves, the cell slows itself down and creates a barrier of inflammation to keep toxic elements out. You feel this in many different ways such as, chronic fatigue, brain fog, slow metabolism, and nutrient deficiencies. In extreme cases, a prolonged leaky gut can lead to a variety of autoimmune diseases such as Irritable Bowel Syndrome and Chron’s disease.

By working with Essentials Medispa and Salon’s Nutritionist, you will receive the education and advice necessary to be becoming a happy, healthier person. Our nutritionist is here to educate and guide you into becoming a healthier version of you. She understands weight loss can be an intimidating and challenging task for many and is dedicated to delivering personalized care to each one of her clients by providing a non-judgmental and caring service.

Weight loss and wellness, a race not a marathon

Our amazing Nutritionist, Samantha, is dedicated to delivering personalized care to every one of her clients by providing a non-judgmental and caring service. She understands weight loss can be an intimidating and challenging task for many. Samantha is here to educate and guide you into becoming a healthier version of yourself. Whether you want to lose a significant amount of weight, fit back into your favorite dress, or snap back into shape. She has a solution to help transform yourself. 

Deciding to lose weight is not just about starting a diet; it’s about choosing to embark onwards to a healthy lifestyle. While many of us focus on the physical changes during the time we lose weight, we are also making an impact on our physiology. We change not only the way we manage our weight; we also reduce our risk of developing (or even resolving) illness and disease at the same time.

At Essentials Medispa and Salon, our Nutritionist will assist you through your weight loss progression. Samantha specializes in an alternative approach to weight loss by targeting visceral fat “belly fat.” This dense and highly toxic type of fat causes the release of inflammatory proteins and hormones that put you at risk for developing certain diseases such as high blood pressure, type 2 diabetes, and increased cholesterol levels. 

Along with reducing belly fat, healing the gut microbiome is essential to promote better absorption of nutrients and increasing metabolism. A poor diet high in carbohydrates, sugar, and processed foods, like the Western Diet we’ve become accustomed to, will cause the leaky gut syndrome. The leaky gut syndrome is another leading cause of inflammation throughout our entire body, which can make it difficult to lose weight. This disruption in the gut microbiome allows trace amounts of toxins to get into the bloodstream and attacks our cells. This can cause a decrease in energy, memory, metabolism, and malabsorption of nutrients. In extreme cases, an unhealed leaky gut can lead to a variety of autoimmune diseases such as Irritable Bowel Syndrome and Chron’s disease. 

By working with Essentials Medispa and Salon’s Nutritionist, you will receive the education and guidance necessary to become a happy and healthier person. Samantha will develop and devise a personalized weight loss and wellness plan to lose weight and live a healthy lifestyle. 

Essentials Medispa and Salon offer additional tools to help promote weight loss. 

Appetite Suppressant – Clinically proven to reduce weight, it decreases your appetite by increasing your metabolism. Therefore it’s easier to choose healthier foods and control portion size.

Lipotropic Injections – Lipotropic injections contain nutrients that contain fat-burning compounds, amino acids, and vitamin B12 as methylcobalamin. This injection aids in increasing your metabolism, reducing appetite, increasing energy, and helping your body to burn fat.

B12 Injections – B12 is an essential vitamin, improving mood, energy, and cognitive function. It has also been shown to reduce the risk of heart disease and stroke by promoting an increased red blood cell count. 

Additional weight loss can be supported by BHRT, Bioidentical Hormone Replacement Therapy

Hormones are the basis for all system regulations in our bodies. As we age, hormones start to decline, wreaking havoc on our body’s natural messaging system. A decline in hormones for both men and women start as early as age 30. Symptoms in women are experiencing energy loss, hot flashes, night sweats, memory loss, mood swings, weight gain, and low libido (sex drive). Hormones also affect men who want to lose weight, lost libido, fatigue, stress, energy, muscle mass, and body fat.

BHRT will bring hormones back into balance and improve overall wellness, sense of wellbeing, and increase metabolism. The difference between bioidentical hormones and synthetic hormones is unmatched. While synthetic hormones can mimic the effects of endogenous hormones on specific biological pathways, they rarely offer the same effectiveness at a more in-depth, molecular level. Bioidentical hormones mimic the similarity of human endogenous hormones; therefore, they are more effective in a wider variety of biological pathways. The added benefit of bioidentical hormones is that each dose is tailored specifically to your needs, not merely what doses the pharmaceutical company offers. 

At Essentials Medispa and Salon, we offer Bioidentical Hormone Replacement Therapy (BHRT). If you have any of these symptoms, you can feel better. Our physician is board-certified in anti-aging and bioidentical hormone replacement and will tailor a prescription based on your specific needs.

Medical Marijuana and CBD Oil

The cannabis plant has been around for centuries. All around the world, societies consume cannabis, and their reasoning is mostly the same: it makes them feel better. Humans have cannabinoid receptors housed inside the body that bind with cannabinoids found in the cannabis plant to provide therapeutic benefits for a variety of ailments. Medical Marijuana may be the solution to coping with chronic and debilitating conditions through what is considered “compassionate care.”

Many individuals are seeking to learn more about medical marijuana to determine if it is the right choice for themselves or a loved one. There is a variety of medical marijuana pharmaceuticals that treat several conditions from post-traumatic stress disorder (PTSD) and chronic pain to cancer and terminal illness. Based on the medical expertise of Dr. Lesser and his exclusive training, he can prescribe a medical marijuana strength and route that is unique to each patient. 

At Essentials Medispa and Salon, it is our mission to educate and empower our patients to our highest ability, so that each person can make the best decision for themselves and their future. 

IV Drip Therapy

IV Therapy in Melbourne, FL

Here at Essentials Medispa and Salon, we offer customized IV drop therapy, designed to optimize your health and wellness. Our IV nutrient therapy has helped a range of patients with concerns from asthma to immune disorders to heavy metal toxicity and cancer.

IV Nutrient Therapy is the fastest, most effective way to optimize your vitamin, nutrient, and mineral levels to replenish your health and revitalize your entire body rapidly. IV nutrient therapy offers a new path to treatment for many patients, whether they have difficulty with oral dosing or suffer from malabsorption of vitamins and minerals. Or they need a quick and large dose of vitamins and nutrients to boost immunity and increase levels of energy. IV nutrient therapy offers improved absorption and bioavailability by increasing nutrient absorption rates from 18% (when taken orally) to 100% (when taken intravenously). This type of treatment has been shown to improve the quality of life and elevate most symptoms in patients struggling with inflammatory responses to allergies, food intolerances, gastric bypass, and gastritis. 

Choosing Massage Therapy for Self-Care

Daily we hear all the buzz about “self-care” and the importance of health and wellness, but what about massage therapy? The constant scroll on social media viewing the hottest fitness trends, green drinks, and beauty treatments with the promise of a better you. We are inundated with tips and tricks on how to be well. How is that going for you? Are you taking the time to incorporate self-care activities into your routine?

Perhaps it is time to consider massage therapy.

What was once considered a luxury experience by many is now accepted as a basic need for wellbeing. More people are choosing to add it to their monthly maintenance health plan as research proves the positive impact. According to experts at the Mayo clinic “massage is generally considered part of complementary and integrative medicine. It’s increasingly being offered along with standard treatment for a wide range of medical conditions and situations.”

Massage helps to loosen the muscles allowing increased blood flow, improvement of circulation and lymphatic system, as well as improve sleep, decrease pain, and increased flexibility, to name a few. When pressure is applied to the body, the skin’s nerve cells signal the brain to release endorphins, our “feel-good happy” chemicals that boost a natural high and positive mindset.

Studies of the benefits of massage demonstrate that it is an effective treatment for:

  • reducing stress, anxiety, and depression
  • minimizing fatigue
  • improving flexibility
  • releasing toxins
  • improved circulation
  • rebuilding immunities
  • decreasing inflammation
  • alleviating symptoms of chronic pain

Here are a couple of examples of massage therapy treatments and benefits:

Essentials Fusion Experience

Experienced as one of the world’s best massage techniques. Essential Fusion serves as a detox using herbal infused poultices and select Thai stretches. It provides relaxation with the warmth of heated stones and the rocking and rolling of Lomi Lomi techniques. Then hydrate with a warm cocooning wrap while receiving a scalp massage with Shirodhara oils.


An Ayurvedic treatment to balance and stabilize the mind and induce extreme relaxation. A soothing, steady stream of warmed herbal-infused oil is poured over the forehead and sixth chakra. This purifying treatment melts tension and calms the nervous system.

Want to learn more? 

At Essentials Medispa & Salon, in our state-of-the-art facility, we have licensed massage therapists that are well-trained, specialized, and experienced in a wide assortment of massage services. With contemporary and ancient techniques, from prenatal massage, aromatherapy, deep tissue, athletic rubs, to couple’s massage, we have something for everyone.

If you are ready to experience the benefits of massage, engage in your self-care journey, or simply want to indulge in a luxuriating and relaxing experience, consider a massage treatment at Essentials Medispa & Salon.

“We don’t fix a flat or line chase”

It happens to everyone…loss of facial fat pads in middle age. “I hear it all the time,” says Brian Whaley, ARNP-BC and Director of Rejuvenation at Essentials Medispa & Salon. Our patients “suddenly” notice that the firmness and lift in their faces have greatly diminished. It is normal in middle age for facial fat to decrease, which in turn has a hollowing and sagging effect. Indicators that most people notice are the deepening of the nasolabial folds and deepening of the tear troughs. These are both caused by a shrinking of the malar fat pads that lie just below the orbital bones of the eye. These are often called the apples of the cheek. Decreasing fullness here has a distinct elderly appearance and will continue unless corrected. “Filling in lines” is ineffective and amateurish – instead, an expert professional will treat the cause, not symptoms.

One may not be surprised at the treatments patients have undergone to address this problem, especially in this day and age. For some reason, providers are still injecting into the nasolabial folds. Whaley states, “This is a poor treatment choice that wastes money and does not improve the underlying problem of volume loss. The first thing I have taught my students is that A LINE IS A SYMPTOM, NOT A CAUSE. Fillers belong below the skin, not in the skin. The nasolabial fold is the medial margin of the flap over our oral cavities. This flap hangs under our eye which can cause tear troughs and flatten over the cheekbone, which can cause drooping of the corners of the mouth and marionette lines and the lowest tip of the flap is the jowl. The skin is a highly multifunctional organ system which renews every 60 to 90 days. Products injected into the skin are rapidly eliminated and also add weight, therefore dragging the skin downward even further. It is a mediocre cover-up and adds nothing to the improvement of contour. The line filling technique is antiquated and average; it is like using caulk in the bathtub!

Facial fillers that are properly injected deeply, just above the periosteum, replaces lost volume and adds the beautiful contours of youth. It can last up to two years, depending on the quality of the product. It is safer, more beautiful and less expensive than any “caulking approach” to a contour issue. Artistically placed filler, safely and meticulously performed, can bring back years of contour and make you appear younger, more attractive, and boost self-confidence! Interested or want to hear more? Schedule a free consult with Brian Whaley, ARNP-BC. You can age gracefully and modernly, subtle yet dramatic. Making Faces for 20 years.