Question:

Hi Dr., now that I know you would use Restalyne in the upper cheek area, I must ask you...why oh why do these injectors differ so much in their practice? The question is why would Restalyne be better than Radiesse, and what would you use in the mouth area (marionette and those parenthesis lines). I don`t have the money to be ripped off, but will surely go with your advice, even of it means that I have to save a bit more. Thanks a million.

Answer:

I do not use Radiesse as the carrier sugar gel that the hard fragments are floated in is dissolved in 6 weeks leaving only about 30% of the amount injected and then you must hope for growth of tissue around the fragments. I find it therefore expensive and unpredictable. In the nasolabial fold area if superficial I use Restylane, if deeper I use Perlane. I wish you the best. JG 1.14.14

Question:

Would you use Restalyne, or Radiesse to fill the upper area of the face? Upper cheeks, underneath eyes, and to extend laterally towards the eyes. I`ve had great results with just the tear trough area from a dermatologist who used Restalyne. He was very, very expensive though, and so I sought a consult with another injector (who basically scoffed at the thought that I had Restalyne under the eyes). Can you advise?

Answer:

I would use Restylane, so I am scoffing at the scoffer. JG 1.12.14

Question:

thank you about my Mother.. she does not want to go thru a total laser over the full face. for one bag under the eye// can lumina help instead vs. laser all over the face? He apparently (the PS) does not do juvederm or restylane under the eyes... thank you again again she is 69. previous facelift 8 yrs ago

Answer:

no laser will help the puffiness I am afraid. May want to look for a different plastic surgeon or dermatologist .JG 1.12.14

 

Question:

What do you think of these PRP facials or so called vampire lifts ?

Answer:

I think they are a waste of money. JG 1.10.13

Question:

hi doctor. I had a tca chemical peel in December with doctor injecting shots inside my mouth jaw area as well as face to numb me I swelled very badly after peel so it was a deeper one.. but afterwards I broke out in a rash on body except not the facial area. then about a week later my ears started ringing and now a year later I still have ringing in both ears , do you think the peel or shots could have caused this also I need botox for glabeller area which I had done in past ,do you think it would make tinnitus worse or migrate down into auditory area???? thank you so very much!!!!

Answer:

I do not see how that would be related to the shots or the peel, sorry. I do not think the Botox will make anything worse and it will not migrate down, so safe to do. I wish you the best. JG 1.9.14

Question:

With few exceptiosn (you included) it seems to me that many PS in my area (Silicon Valley) operate at a different level than normal folks who actually have to save and budget for everything. They hand us over to their business person who coolly give us a tab for $5000, $8000, $15,000 for recommended procedures as if we were being offered shoes on sale for under $100! I believe many of these doctors recommend what they believe to work (or if not, why would they lease such expensive equipments) but often times, I feel they recommend what they have to offer, whether it works or not. Can you comment? I would truly like to understand. Thank you!

Answer:

I find that at times, the doctor is duped into buying technology that after actually doing it themselves does not render the results that they had been told. They are then faced with a scenario of how to pay the lease off. Many times they technology will be sold and the doctor writes it off as poor judgement, as I have had to do at times. In other scenarios, they go ahead and use it, trying to downplay the results somewhat and try to pay the machine off. Some doctors will use a technology as a marketing technique to get people into the office and then tell them they need something else. Doctor are just like all other people, they come in all different `flavors . so, as I have said before, buyer beware. JG 1.8.14

Question:

I hope the new year is off to a good start for you. I recently went to my PS to see about a filler for the undereye area. This seems to be so typical of many offices these days, but instead of getting what I asked (Juvederm), I was told instead that she recommends an aqualift - do you know what that is? Basically, she will use a machine to inject the filler (don`t know what filler), and also wants me to have a threadlift for the jawline, as well as a laser peel for removing wrinkles around the eyes. So instead of the advertised special on Juvederm (less than $1000), the tab for the recommended procedures is a cool $5000. First of all, as an Asian, I am very afraid of a peel that is so strong that it requires me to miss a few days of work ... hyper/hypopigmentation is not something I want to live with, and will take wrinkles any day. And I didn`t think any real PS would perform threadlift.

Answer:

I am not sure what they mean by the Aqualift but since I find thread lifts a scam in general, I tend not to be too enthusiastic about the aqualift. Ultimately the filler is the most important component, especially in the periorbital area. I agree that being apprehensive about a laser peel in Asian skin is a good thing. You might find that this person does plastic surgery but is not a true plastic surgeon when you ask for her credentials. I might suggest a visit to someone else from what you are telling me. JG 1.8.14

Question:

what is microdroplet botox and do you recommend/ Also, does filler work ok in temple area? Thank you!!

Answer:

microdroplet Botox is just the small dose injection of Botox, merely an attempt to make what they are doing different and newer, but it is how it has been done since the begining. As to filler s in the temple, they work well in experienced hands, yes.JG 1.3.14

Question:

Thanks so much for your always knowledgeable and candid responses! One more question for you....do you recommend doctors in other areas? I live in Phila/South Jersey area and would like to find the best dr for filler injections...word of mouth and online opinions really aren`t helping. Many thanks!

Answer:

Evan Sorokin MD 1734 Marlton Pike East, Cherry Hill, 08003 (856)310-4959 Gary Brownstein MD 102 Browning Ln, Cherry Hill, NJ 08003 (856) 795-7000 Happy Holidays. JG 12.17.13

Question:

I`m seeing info now about injecting filler with one needle and a cannula vs lots of separate injections? Am I getting that right? Your thoughts please? Thank you!

Answer:

I think the claims of less bruising are inflated as people who have liposuction with blunt cannulas get bruised. I also find that I frequently need to inject the filler from numerous slightly different angles and limiting oneself to just a single puncture may not allow the filler to be placed in an optimal fashion. I do not use the cannulas, it is more of a marketing thing in my opinion. JG 12.16.13

Question:

Is there an art to giving a Botox brow lift that doesn`t end up looking frozen or startled? Does it vary greatly on the person`s original depressed eye area, or is it just something every injector is taught to do the same on everyone. I have seen such perfect lifts on some, and some very startled and frozen looks on others (looking at before/afters online).

Answer:

the ability to predict how deep of a weakening of the muscles you get with Botox varies from patient to patient.Once a person has been injected once then better predictions of how much needs to be used to lift the brows can be done. It really is more patient difference than injector difference.I wish you the best. JG 11.26.13

Question:

Hi good Dr., can you give an opinion as to what filler you would use on the bony/upper cheek area (beneath eyes)? Also, what filler would not be advisable in this area? Also, what is best for some no too dramatic marionette lines. They really are just now becoming noticeable, but I fear looking over-inflated in that area. A million thanks, in advance!

Answer:

At the orbital rim I only use Restylane, I would not use Artefill or Radiesse for fear of developing granulomas.For the non dramatic marionette line I would use Restylane although in that area Radiesse can be used. I wish you the best. JG 11.24.13

Question:

hi dr.garcia, what do you think is the best treatment for wrinkles for a 63 year old woman with marionette lines. thanks so much! B

Answer:

well, fillers might work well as long as the line or fold is relatively mild, if it is deep then the filler will make you look fat, something I do not recommend. JG 11.24.13

Question:

What do you think about the newest filler voluma? If it goes in so deep can it still be removed and how difficult would that be? Thank u!

Answer:

It can still be dissolved where it is placed. JG 11.21.13

Question:

Fillers never last in my marionette lines as long as other areas of my face.Is this because of the location or the filler used? What do you recommend ?

Answer:

It is likely because the tissues of the cheeks have fallen and you are past the point where fillers are beneficial and you might now need surgery. Sorry. JG 11.19.13

Question:

First of all, let me say that I can`t thank you enough for this service. It has educated me immensely, and I have abstained from procedures that seem to good to be true! My question...I had a great experience with filler (Restalyne) to the tear trough area and along the upper bony part of the cheek. Sadly, it is dissipating and no way can I afford the Dr.`s prices who initially did it. A nurse injector has been highly recommended for quite a bit less $ than the Dr. I used. She states that she would only use Radiesse along the upper/outer cheek extending almost (not quite) to the temple area. She claims the reason she uses Radiesse is because it promotes collagen and does not attract water. What is your opinion?

Answer:

She is correct in that it does not attract water, but the amount of collagen produced is not visualized clinically, just in slides for presentations. Also remember that over 60% of the Radiesse will dissolve in the first 6 weeks, that is the sugar based carrier the fragments are floated in, and then it depends on the body growing collagen around small fragments of synthetic bone which is the `meat` of the Radiesse. I would not use that product in that area. In my experience, the Restylane in that are should last 8-10 months and in some patients significantly longer. I would stay with the Restylane and possibly just use a different injector. I wish you the best. JG 11.19.13

Question:

I am a young looking 69 yr old except for dark circles under my eyes.Is there any effective treatment,such as fillers or a laser that would safe to use in that area? Thank you

Answer:

If it is the rim of the orbital socket that leaves a dark line, then a filler in that area, but not on the eyelid itself might be a good option for you. JG 11.18.13

Question:

What is the best way to make those vertical lines above the lip disappear? I`m not a smoker,50 years old, and just started seeing these lines appear.

Answer:

Laser. Either fully ablative CO2 or for a lesser but quicker healing a Fraxel. JG 11.13.13

Question:

Hi Dr. G. I have 2 questions. (1) What do you think of Ultherapy skin firming and lifting. It seems everywhere I turn, I am being urged it`s the greatest thing. (2) What do you think of Strivectin skin firming cream? I have to admit their skin brightening EV has done wonders for my skin, and that`s why I`m even taking your time asking about the skin firming cream. Thank you.

Answer:

As to Ultherapy, I am not a huge fan, I think it works for a while, 6-9 months, there can be unexpected fat loss, and it hurts to have it done, it is not the best thing since sliced bread as advertised. As to Strivectin, good moisturizer that will smooth the skin but only the company knows what it means by firming, such a vague term that no matter what happens they can say your skin is firmer, and it is kind of pricey. Al the best to you.

Question:

Hi Dr.,what will Radiesse do when used near the highest part of the cheekbones, kind of toward the lateral brow area. I`m new at this, and the injector suggested using one syringe in this area in addition to some botox to lift an open the eye area. I don`t want to have that weird alien look (kind of like Kim Kardashian, sort of). What do you think?

Answer:

It will fill in the area if any hollowness is present, but you need to have it injected deeply to avoid any superficial lumps. Hard to say how much you need without seeing at least a picture of you. I wish you the best. JG 11.13.13

Question:

Hi Dr. G, Botox has never lasted in the crowsfeet area for me but it lasted well in the 11s area. Now neither area lasts at all. Does having Aretefill affect how long Botox last? My doctors says that for some people, over time, the body builds up immunity to the Botox so it no longer works/lasts. Is this true? If so, what other options are there?! Thank you.

Answer:

Artefill will not effect Botox in a positive or negative manner but I do not suggest Artefill in the crows feet area.I think the immunity is very very rare. The bottle of Botox clearly says single patient use, which means that bottle is for you and should never be shared. That being the case you can use a 50 or 100 unit bottle, I have patients, especially men or people in general with very strong muscles that need a higher dose. I have many patients that need 30 units or more for the 11`s. Crows feet are more variable as the area for injection is so broad and I think it does help the wrinkles but I use it more for lifting the lateral brow rather than wrinkle reduction of the crows feet as any muscle function in the cheek will cause crows feet to show even if you have complete weakness of the orbicularis from the Botox.I would first start by getting a larger dose and see how it goes. I wish you the best. JG 11.8.13

Question:

Hello Dr. Garcia, I had sculptra injected into my knee caps yesterday & within 12 hours my knees are swollen & very painful. I can`t bend my knees without much pain. Obviously I had a reaction to the sculptra. What do you think I can do about it? Will it just go away? I can barely walk :(

Answer:

I do not think its an adverse reaction, just the swelling from the amount of fluid injected and the tissues` response. Use ice and then starting tomorrow alternate warm and cold, a little massage and time, it will all get better soon.All the best.JG 11.2.13

Question:

Hi Dr., and thank you for this great service. I recently had two consultations to get something done without the expense of surgery. My goal is to open up the squinty eyes a bit, and just give myself a little more bright-eyed look. One practitioner suggested filler to the brow (since the botox eye lift seems not to work for me), and another suggested botox to the glabella and corners of the eye (only 25 units would do), combined with Radiesse along the upper/outer cheek area, creating a more lifted, balanced look around the entire eye area. What is your opinion?

Answer:

filler in the cheek will not make your eye look bigger, if anything it will appear smaller. I think the filler to the brow might help the outer portion of the eye and I think Botox does work well in most cases but it sounds like you do not respond well to it, could try a larger dose before moving on, otherwise I might just go with the filer on the eyebrow to lift the lateral aspect of the eyebrow. JG 10.29.13

Question:

i am considering filler in temples. Is this a place where hitting an artery is more prone to happen? I know the glabella is a place where this is more likely to occur. Thanks.

Answer:

arteries are not a problem and veins can be seen tough the skin as it is quite thin. Best of luck. JG 10.28.13

Question:

Hi, Dr. Garcia. I had Restalyne injected under my eyes yesterday to fill in some hollowing, and I am a MESS today. It`s all lumpy and I have such big bruises that it looks like I was punched hard in the eye. I`m icing, sleeping sitting up, taken Bromelain and Arnica and used topical Arnica. I didn`t take any anticoagulants for 2 weeks prior to the injection. Now that it`s so swollen -- and now that the injection has already happened -- would it be OK to take ibuprofen? The bleeding has already stopped, so I don`t think it should cause more bruising. Is that right? Gosh, I don`t think I`ll do this again! I had to put an eye patch on to go to work today. I took it off to show a colleague and she gasped aloud. Just terrible. Thanks for your help, Dr. Garcia. Have a good holiday weekend.

Answer:

OK for Motrin now but it will not affect that swelling much as it is due to the filer and likely blood. It will be a matter of time, might suggest alternating warm and cold packs and light massage to speed the resolution of the blood and hopefully the lumps will get better as the blood goes away. I wish you the best. JG 10.11.13

Question:

Fat grafting to jawline? In a so-called “necklift,” the surgeon lipoed my jawline, thus removing fat in an important area. Then another surgeon did 2 so-called “facelifts,” in which he pulled straight across and even downward instead of upward. My jawline now looks weaker than ever. (I already have a chin implant, and was told an extended chin implant might look unnatural since there`s been fat loss there.) I was told by 1 surgeon that fat grafting is too diffuse to use along the jawline, but another said it could help to strengthen the jawline. What do you think?

Answer:

I think the fat grafting for jaw line enhancement is unpredictable and I do not recommend it, sorry. JG 10.9.13

Question:

Hi Dr., back in March I had restalyne injected underneath the eyes to diminish the appearance of bags. It worked like magic, and I am so pleased with the result. In your experience, how long does it usually last? I`ve heard anywhere from 6 months to 12 months. I am assuming it dissipates slowly and not all at once.

Answer:

it dissolves slowly and in my practice I see 8-12 months of improvement. JG 10.7.13

Question:

Hi dr., can botox really improve droopy eye lids? I don`t like that startled look that seems to be the norm these days, but the outer corners seem to be droopy. I have no forehead lines, and have never made a scowl (my family thinks it`s funny), so I don`t know if there is a fix for my problem. I am light-eyed and seem to squint often...now it seems like a permanent squint!

Answer:

As long as only the glabella and crows feet are injected and not the forehead it should be fine. JG 10.5.13

Question:

I had Juvederm injected last week and am scheduled for laser this coming Friday. Will the heat from the laser expedite the resorption/dissolution of the HA? Thank you!

Answer:

should not interfere with the filler. JG 9.23.13

Question:

Dr. Garcia, I had injections of Sculptra 2 months ago. I just had to have oral surgery and the surgeon had me take Dexamethasone for inflammation. Will it have a negative affect on the Sculptra? I took 4mg, 2mg, 1mg.

Answer:

a short course like that will not make a difference on the Sculptra. JG 9.22.13

Question:

Dr., I have just started to notice the beginnings of some marrionette lines. They seem to make me look somewhere between sad/angry, unless I am sure to smile. I have noticed there have been some very disappointed people who have tried to use fillers in this area. Is it something that just gives you a more inflated look? I am scared to spend money and walk away disappointed. What is the best filler to use (if any)? How much (for slight folds), and how important is the injector?

Answer:

mild cases do well with filers, but once the marionette line is deep, fillers can make you look heavy and I prefer to stop before that. If they are slight I use Restylane for the marionette area. In this area, the injector is very very important, because they must understand what is causing the marionette to form and not just blindly inject. I wish you the best. JG 9.16.13

Question:

Dr. Garcia,do you recommend PRP injections for skin rejuvenation? Does it wok? Thank you.

Answer:

I do not and I think it does not work, I do use the technology when performing a facelift to allow less bruising and faster healing, but just injecting PRP alone does not work. JG 9.16.13

Question:

I am 43 years old and I had restylane injections to soften a marionette line. It created more of a jowel and I did not like the result at all. 2 months later I had vitrase injected, same dr, very reputable. It created a very hollow area and the skin looked very damaged, thinned, mottled and lumpy. It looked as if my own skin had atrophied. Is this possible with vitrase? I waited for over a year and there was no change. I went back to try and have the hollow and lumpy skin smoothed out and it is overfilled with a funny unnatural bulge. This time we used juvaderm. I want to use vitrase but I`m worried that it will affect my own skin even more. They say this isnt possible but it`s obvious my skin was damaged. Was that just a fluke the first time? I wish I had left it alone. Thank you for your time!

Answer:

I have not seen vitrase have that effect, it should bring you back to where you were and maybe a little less but your body makes its own hyaluronic acid and any small amount of native HA should be recreated by your body in a short period of time. I have not heard or read of it lasting as long as you describe.I think it is fine to use vitrase again but just make sure they have diluted it to the proper amount. Best of luck. JG 9.13.13

Question:

What is the reason heat helps bruise heal faster? Would IPL eliminate red/purple color? Thank u

Answer:

it helps to break down the blood into components that your body can further digest and then absorb faster. IPL might slow it as it will cause inflammation with the heat the color will absorb. JG 9.10.13

Question:

What do u think of using vibe am or any laser for post restalyne bruising-- 4 days after injection . Downside? Side effects ? Purple bruises Thank u

Answer:

U think it might cause some discoloration that will take linger to resolve than the bruise. JG 9.8.13

Question:

I had restalyne a day ago. Arnica 30x how many how often. Ice? Heat.? Ho often heat? Thank u

Answer:

start alternating the warm and cold, three times per day for another 3-4 days. Start with the warm, then massage some arnica gel in, then place the ice.Warm and cold for 3-5 minutes at most. JG 9.6.14

Question:

I had Radiesse injected into my temples on Wednesday. I have it done dozens of times over the years without any trouble, but I am unable to chew, yawn or even speak without significant pain, particularly on the left side. There are no visible bruises, but could this be a deep tissue bruise? Anything I should be concerned about or will it pass with warm compresses and time? Thank you so much for this amazingly generous service, Dr. Garcia. God bless you.

Answer:

most likely the temporalis muscle is swollen and bruised and that is the cause. Warm compresses and stretching by opening your mouth widely and slowly to stretch the muscle fibers will slowly help.Should get better soon. I wish you the best. JG 9/6/13

Question:

When can I use heat not ice on bruise and swelling from restalyne. I mean warm compresses. Thx

Answer:

after 24 hours you switch to warm. JG 9.6.13

Question:

Silly question. Sorry to take up your time. I had Juvederm injected into my lips yesterday. My lower lip now looks like a sausage. My dermatologist told me two things during the appointment that seem to conflict in my mind: 1) he told me that because hyaluronic acid is hydrophilic, it will attract water and get larger after the initial injection and 2) that it will be swollen after the injection and that it will get smaller fairly quickly. Which is it? Will my lip continue to expand? (Yikes!0 Will it decrease in size quickly after the swelling subsides? Or is this a what you see is what you get situation? Of course, I know it will resorb in 8-9 months, but in the meantime, it`s pretty scary looking! Thank you, Dr. Garcia.

Answer:

the HA fillers are slightly hydrophilic, but Restylane is more than Juvederm. There is a slight swelling with the Juvederm in the first 24 hours and anything there at 5-7 days is filler and not fluid.I wish you the best. JG 8.20.13

Question:

I had Restalyne injected beneath my eyes in Friday morning. It`s extremely lumpy...looks like I have a collection of small rocks at the top of my cheek. I called my surgeon`s office and they told me just to massage it, since the product is malleable just like Play Dough. This doesn`t seem to be working for me , I`ve tried warm compresses to get it to soften up but no luck. Is it your experience that this product is pliable?

Answer:

It appears that in your case either more filler to fill the gap between the small bumps might be needed or to dissolve the filler injected and start over. I will say that in many cases the lumps get better after a 7-10 day period on its own with the warm moist heat and massage so I would not run to get something done just yet. I will say that in my experience the product is minimally pliable and after 24-48 hours much less so. I wish you the best. JG 8.19.13

Question:

what dose of oral bromelain do u suggest for post filler bruising? also arnica? Does topical arnica really help? Thanks.

Answer:

For bromelain about 100-200mg in 2 doses. As to arnica 6x, 4 tabs 4 times per day and as to the topical I do believe it works. JG 8.16.13

Question:

Had nice job done with restalyne and boletero but 2 weeks later still yellowish bruise which doctor wants to laser. Would you recommend this or waiting and if so how long? Is there a downside to trying to laser at this pointZ? Thanks

Answer:

I would just wait, that is just old blood that is being broken down and will resolve on its own. Lasers are not very effective for yellow so I would just give it some time. JG 8.14.13

Question:

what do you think about Voluma and when will it be released? Will it be similar to sculptra and can it be removed? Thanks!

Answer:

not released yet but sounds promising.It can be removed and is different from Sculptra in two way, it is an immediate correction but it does not create new material so the aging process is not affected with Voluma. JG 8.14.13

Question:

I have skinny calves. Can fat injections be used in this area?

Answer:

can it be used, yes, would I recommend it, no. I feel it is too unpredictable. JG 8.12.13

Question:

I think my calves are too skinny. Do you think fat grafts would work in that area?

Answer:

Possibly but I find them unpredictable. JG 8.11.13

Question:

What is the best filler to use under the eyes to fill in the Hollowness? Thanks

Answer:

I prefer Restylane. JG 8.11.13

Question:

Hi Dr. Garcia - I am considering getting fillers for the corners of my mouth and marionette lines. I am 56 and have Hashimotos thyroid disease, an auto-immune disorder. Are people with auto-immune disease at an increased risk for problems with fillers?

Answer:

I have not seen people with auto-immune issues have any problems with the hyaluronic acid fillers. JG 8.9.13

Question:

If filler is injected into an artery by accident would the blanching, pain, etc occur within 24 hrs. Had restalyne down to bone under cheeks to lift and just nervous but no signs. Hurts to smile. Thank u!

Answer:

The pain would be immediate and unrelenting, do not think it went into the artery in your case but not sure why the injected down to the bone. JG 8.5.13

Question:

Yesterday I had filler touch up for under my eye with restalyne. With the extra I had I put in the nasal folds on both sides. Today in the area it is bright red and a feel a big lump on both sides. Is this just normal type swelling. I did ice off and on yesterday evening. Should I be trying to massage the lumps? Thanks :)

Answer:

Might be a hematoma, doubt an infection, I suggest alternating warm and cold and light massage. I would have your doctor take a look at it in a day or so. JG 7.28.13

Question:

Dr. GArcia, I had radiesse four months ago in my jowl area and the big line under my chin. I have developed a bumpy red rash all over my chin. A few of them have white on the tops so am thinking it is radiesse. I don`t even know what a granuloma looks like but know they are bad. I am using over the counter cortisone cream till I can get to my appt. next week. Is this what the beginning of a granuloma looks like? Thank you so much.

Answer:

It does not sound like a rash from the Radiesse nor does it sound like it is a granuloma starting. I sounds more like a bacterial based rash.I would see your dermatologist for an evaluation. All the best. JG 7.26.13

Question:

Hi Dr. G. I read in New Beauty (a magazine devoted entirely to anti-aging) that some doctors like Elixis (sorry if spelling is incorrect)for body skin tightening. What are your thoughts? Also, what do you recommend for lip filler that is more long lasting? Does fat transfer work better? Thank you.

Answer:

I personally do not think Exilis is worth the money. As to longer lasting fillers for the lips, although I understand the desire, the problem with them is the tendency to form lumps as the material is not meant to be injected superficially. As to fat injections to the lips, I would not recommend them and I do not perform them. Many if not most of the plastic surgeons I know personally that used to do that have stopped performing them. Sorry. JG 7.25.13

Question:

Hi Dr, I have mentioned before about Dermalive which I had injected around the eyes 15 yrs ago which migrated under the eye and lead me to 3 surgeries to remove all the product, the last surgery was 7 yrs ago. Thankfully I haven`t had any further granulomas as I think the surgeon successfully removed everything. However, now and again my whole right lower eyelid gets very irritated, almost like a prickly and stingey sensation. I usually take antihistamine and it passes by the next day. Any idea what could be going on here? I can only guess there must microscopic particles of Dermalive left which occasionally get irritated but I am just concerned that this could develop into an allergic reaction? Also, although the product has been removed, would it be safe to inject HA in this area given what keeps happening. Many thanks

Answer:

More likely small amount of scar tissue causing it. I doubt it being an allergy. JG 7.25.13

Question:

I had filler under the eyes. Most of it looks great, except I have this odd little dent that still remains. It almost looks like I have a horizontal line (wrinkle) under my right eye. The doctor said he could maybe try injecting a bit more filler to help. I had restalyne, but I don`t know do you think a thicker filler like perlane or juvaderm would be better. I won`t use belotero as I already had a bad experience with that filler. Thanks for your help :)

Answer:

I think a thicker filler is the worst thing to do and I also do not like to inject on the eyelid itself, just where the eyelid meets the bone. JG 7.24.13

Question:

Dr. Garcia, First, thank you so much for taking the time to read and answer questions. My Dermatologist suggested Radiesse (one vial for each) in my temples. First, what is your opinion on using Radiesse in that area? Secondly, would Sculptra be a nicer/better option?

Answer:

I personally prefer Sculptra but I have also used Radiesse in that area. The advantage to Radiesse is the immediate correction but it will not last as long as Sculptra. Either is good. JG 7.19.13

Question:

Hello again Dr, Sorry just one more question concerning permanent fillers. I heard there is a now a laser which can melt the permanent filler and draw them out using fibres. I have a small amount if argiform in my lips 1.5 cc, and although initially I had some problems, they have been fine for years and I actually now like the shape. I am only thinking of removal for the sake of health concerns, should a reaction occur some time in the future. What are the chances of reactions after say 10 years of no problems and am I best to leave it alone? Thanks

Answer:

I think that in your case the risk is low since so much time has passed. JG 7.18.13

Question:

Hello Dr, I read recently of a couple of cases where fillers have caused blurred vision and blindness. This worried me as I once has Dermalive injected around the eye which I had removed many yeras ago although I am not quite sure if all of it has gone. In what way do they cause blindness..I,e would this be immediately after injection if a blood vessel was injected by mistake or in the case of a permanent filler, would it leak into the bloodstream with time and cause progressive degradation? Thank you

Answer:

Correct, an injection into an artery and with a high pressure the filler goes retrograde and blocks the bloodflow leadung ti blindness.JG 7.18.13

Question:

I had ask you about the restalyne under the eye and even sent you a picture about if it was normal, the swelling. I am sorry to go on about this, but I do also have my pic on real self and doctor replied I might have cellulitis. What is that and do you think that is possible? http://i.realself.com/full/5e4434d6d50a8d80da94991bc4fabb23/1022849-1843...

Answer:

cellulitis is an infection, you have redness but the incidence of developing an infection from a filler is extremely rare. I do not think you have cellulitis. If you had not had the filler and the redness and swelling popped up on its own, it could be cellulitis, but cellulitis is usually ion only one side. JG 7.12.13

Question:

What is the best way to improve the look of hands;fat transfer fillers or a hand peel? How long would it last?

Answer:

well, they do different things so it depends on what it is you are trying to improve, the loss of fullness, which would require fillers, or spots which would require a chemical peel. From what I have seen I would not expect more than a few months on either one. JG 7.11.13

Question:

I had posted the question early about the having restalyne under the eye yesterday and that today the area looked huged. I did attached a picture to see if you could look and make sure that looks normal. Thanks for all your help :) http://i.realself.com/full/5e4434d6d50a8d80da94991bc4fabb23/1022849-1843...

Answer:

Restylane does attract water into it over the first 24 hours and will not be appreciated right away but it settles down. I think that what I see in the picture is common and will get better over the next few days, yes. JG 7.11.13

Question:

I had restalyne injected yesterday under the eye. When I left the office it looked great. This morning the area is huge. Is tnis swelling or product? I iced all evening and started to take arnica,

Answer:

yes, not uncommon for that area, I would continue to ice, avoid any blood thinning products and it should be better in 5-7 days. JG 7.10.13

Question:

I am not sure if this is something you can or will answer, but have you ever heard of Dr. C. Khorsandi of Las Vegas and what is your opinion of him as a dr. that can do fillers?

Answer:

I know him personally, have seen his work and he is a fine plastic surgeon and will do a good job for you. Please tell him hello from me when you see him. JG 7.4.13

Question:

I had filler dissolved with hyaluronidase yesterday. How long do I have to wait until I can redo filler. The blueish bag is now gone under my eye but the area looks very flat.

Answer:

I would wait a week or so to make sure any swelling or deep bruising is gone. J 7.4.13

Question:

This may sound silly, but does heat affect the metabolizing of Restalyne or other fillers? I had a friend tell me it does. What in fact does cause this filler to disintegrate and why does it seem to last longer in some people, and not so long in others? Thank you!

Answer:

heat does not affect the dissolving of hyaluronic acid fillers. The body is in a constant process of breaking down and reforming its own hyaluronic acid as it is a normal component of our bodies. As we age the recreation of the HA is less robust than the dissolving. It is the natural process of dissolving HA which dissolves the HA fillers. JG 7.3.13

Question:

How can you tell if there was excess filler injected or if it is swelling? I had some belotero under eyes. Looked great when I left. Now almost 2 weeks later there is a puffy blueish pillow under my eye. The blueness doesn`t look like bruising, now sure if maybe a vessel that is under the eye is now irritated too? Not sure what I should do now

Answer:

the swelling should be gone in a few days and if it is still there at this point and you are seeing a new bluish discoloration, it might be from a too superficial injection causing the hyaluronic acid to give a Tindall effect. It might need to either wear off or be dissolved if it really bothers you.JG 6.30.13

Question:

Hello Dr. Garcia: I had juvederm to my nasolabials, and while it is so perfectly done (I had it injected on Thursday),,, my smile is still very forced and hardly shows the upper teeth. The area feels very tight. I don`t want to use hyraulindase as it will take it away. Anything else I can do on this 2nd date to help it be less tight? I have been using warm compresses to the area which makes it remarkably feel looser, but is only temporary.

Answer:

Time and warm compresses is about all you can do, sorry. JG 6.29.13

Question:

In your experience. How long does restalyne last underneath the eyes? I had it injected in March, and I must say the best result was about six weeks later. It still looks great, but everyday seems to be less and less. I may be just paranoid. I can`t afford to do this every 3 or 4 months, but the results were amazing.

Answer:

In my patients it lasts 8-12 months. JG 6.9.13

Question:

Just read the question about the Juvederm in the knees. I had Sculptra injected just above my knees four years ago and loved it. It lasted two years. I had it done again two years later and it`s still there. Will definitely keep doing this as needed!

Answer:

Thanks for sharing. JG 6.8.13

Question:

Hello Dr. Garcia, I had juvederm injected on my knees... Since that is an area that moves so much - will it go away faster or should it last just as long as it would if injected any place else? I really like the result - would you recommend a longer lasting filler for that area?

Answer:

Unfortunately I do not think any filler will last long there, sorry. JG 6.8.13

Question:

What do you recommend - or at least not opposed to - for facial skin tightening and body tightening? What do you think of Venus Freeze? Thank you as always.

Answer:

At the present time I cannot recomend any and as to being opposed, I am opposed to all of them as I feel you would be wasting your money. Caveat emptor. JG 6.6.13

Question:

Hello Dr. G. An earlier posting indicates that you don`t use Botox for crowsfeet. Am I correct? If so, I am really confused. I thought that is the purpose of Botox, for the 11s , the brows and the crowsfeet, even if not FDA approved. Every doctor who has ever injected me with Botox has injected for crowsfeet. Thank you.

Answer:

I do inject it into the crows feet area but to lift the lateral brow, never to eliminate the wrinkles. JG 6.6.13

Question:

You`ve been calming a lot of our fears recently about arterial embolization of HA`s. I`ve never had a problem with it, mercifully. My dermatologist is recommending that my earlobes could be improved with HA-- and he`s right -- but I`m wondering if this is a risky area for him to inject for this reason. And about how much is usually needed to treat both ears? (.5 ml/ear?) I ask because this is an expensive proposition! Thanks so much for your help.

Answer:

earlobes are very safe for HA`s. I think about 0.5cc should be more than enough. Should last 8-12 months there. Best of luck. JG 5.24.13

Question:

Dr. G. What are your thoughts on Serol Vital and the claim that it helps the body produce HGH. How does more HGH help? Thank you.

Answer:

save your money. JG 5.24.13

Question:

I recently moved and have a new dermatologist. She uses Medicis HA, not Allergan. Is Perlane roughly equivalent to Juvederm Ultra Plus?

Answer:

yes it is. JG 5.22.13

Question:

Dr.G. Botox injections in the forehead and the 11s are effective and lasts as they should. But in the eye areas, they don`t last more than a couple of months and don`t appear to work as well on the wrinkles. What gives? Is it because of my big cheeks, which push on the skin? I have been to many doctors, all with the same result so I`m not sure it`s just skills and techniques. How many units on each side do you recommend for the crowsfeet? Thank you.

Answer:

what give sis that is the reason that the FDA never approved the use of Botox in that area, it is still used but since there are other muscles at work that cause the wrinkling, nothing more can be done.I use Botox in the crows feet to elevate the lateral eyebrow but I never do it for improving the wrinkles. How many units you need varies from patient to patient, but I would say 10-20 per side in some patients is required. JG 5.14.13

Question:

I had Restalyne injected under my eyes on Monday and it left some bad bruising. The office had me come in on Wed to use the 1064 laser on the bruises. It`s fading them more quickly than they would if left alone, but the laser seems to have made the product ball up so that I now have three large pea-sized lumps under my eyes. What happened? Will this go away or did the laser cause the product to coagulate and I`m stuck with this now? Thank you for your help.

Answer:

I am not surw what happened as I would never have used the laser because of the heat generated beneath the skin. I do not think any permanent damage has occurred. I think the brusing and the and the filler will go away soon. I do not see how the laser would cause the lump. The lump is either a small blood clot or inaccurate filler injection. JG 5.11.13

Question:

I meant to add that my right eye is tearing continually since the injection.

Answer:

That can happen too and is usually short lived. JG 5.8.13

Question:

I had Restalyne injected along my orbital rims two hours ago. The left side is OK but the right side is bruised, red and warm to the touch. Is this normal? I just read about arterial occlusion on your site and now I`m afraid. What signs should I watch for if that has occurred? Thank you.

Answer:

The arterial occlusion has pain, paleness and coolness. What you are seeing is normal, time and ice for now is all you need. JG 5.8.13

Question:

is there any area that has more risk of injecting an artery than another?

Answer:

not really but the problems arise the smaller the artery is as there is less collateral flow. JG 5.6.13

Question:

if i have botox in glabella and my forehead only where there is recruitment of lateral brow can bunny lines worsen? I feel like they did when that was done before. Could i have bunny lines done at the same time. Mine are ok now but wondering if the botox can accentuate? Thanks Sandi

Answer:

the bunny lines should not be affected by injections there as they are far away. The bunny lines can be injected if so desired, at the same, time.JG 5.6.13

Question:

Thank you for the quick response on the LaViv and Pacific Tropical Marine Treatment. You mentioned that there are other alternatives for less. Can you please let me know what those alternatives might be? Also, what are your thoughts on Ultherapy? Thank you so much.

Answer:

I think the results from Ultherapy show some fat loss and it does hurt to have done, they also really do not know how long the results last. As to the creams, I think for the money the best is Oil of Olay Pro Series and Regenerist, good products and good value. JG 5.3.13

Question:

Hello Dr. G., I have 2 Qs: (1) What are your thoughts on Laviv (the before and after pictures are pretty amazing) and (2) Pacific Topical Marine Treatment (product information is below.) Very expensive, at $375/bottle but it appears the bottle is used once, and 3 months later, you`re on a maintenance program. Testimonials on their website is overwhelmingly positive. Thank you for sharing your professional opinion and time. WHY Because every year you lose 1-3% of your fibrocytes—your skin`s factory workers who repair and renew your skin. As they die off, your skin gets thin, dull dry, wrinkled and blotchy. HOW Works from the inside out to increase the number of fibrocytes in your skin, stimulate blood vessel formation, and thus increase the production of collagen, elastin and hyaluronic acid. WOW Reverse the skin`s aging process after just three months of treatment and move forward with younger, thicker and healthier skin.

Answer:

Sorry, but I think the hype for both is almost as high as the price and there are products as good or better for a fraction of the price. JG 5.3.13

Question:

I have considered having artefill injected into my marionette lines but some advise against it because it is permanent and the face changes.I don`t understand what this means and what would happen should the face change. Thanks

Answer:

The filler will last but the skin that is falling will continue so the correction will not last. JG 4.30.13

Question:

Thanks. I`ll check back in with the injector, but I don`t think anything is particularly wrong. If the material was injected too superficially, why would it peel like that? That is, what actually causes the peeling?

Answer:

the peeling comes from pressure being applied to the blood vessels and then the superficial layers flake off as they need to be replaced with the deeper cells that are more resistant to the pressure. Not uncommon. JG 4.29.13

Question:

I had Restalyne injected into my nasolabial folds last week. This week, the skin there is peeling off in hard chunks -- not thin sheets as it would after a chemical peel. Why is it doing that? Thank you.

Answer:

might be just form the injections being injected superficially, might want to go back and see the injector to make sure you do not have anything else going on though. JG 4.29.13

Question:

Hello Dr. Garcia, I had juvederm injections, really loved the results and went back a couple of weeks later to tweak things a bit more, thinking I would then be all set and just get touch ups in 4 to 6 months, or It is almost a week out since my last visit and am hoping things are still just swollen and will resolve in the next few weeks. I look unnatural and not like me , distorted, my eyes now have bags that were not there originally. Every day the bags look more pronounced. This has me very concerned. I have been told I look tired lately. I am wondering if this is a common problem issue, if there could be any permanent damage from my skin being stretched out. Or if residual results could remain. Your advice is really a great help to many people:) Thank you~

Answer:

At this point it could still be swelling. I do not think there will be residual effects. Use a little ice and avoit salty foods. Give it another week or so. Best of luck. JG 4.28.13

Question:

Thank you for the reassurance about getting injected. Since vascularization, while somewhat standard, varies from patient to patient depending on their anatomy, how can a doctor be sure to avoid an artery? If she or he keeps all injections strictly superficial, will that avoid arterial embolization? Still a little scared! Thank you, Dr. Garcia.

Answer:

Correct, superficial injections avoit the artery and if done deeply the trick is to inject when advancing tobpush the artery out of the way, along with injecting only small aliquots and the redirecting so that there is not enough material in one pass to occlude the artery. JG 4.27.13

Question:

Hey Dr. so your not a fan of Reaction radio frequency, how about JUVÉDERM® XC does it have great results and does it last?? Looking for more bang for the buck so to speek. Thanks

Answer:

I like it and it does last longer but it is to be injected more deeply so it is not interchangeable with the fillers meant for more superficial use. JG 4.26.13

Question:

Good evening, Dr. Garcia. I just heard a terrible story from my aesthetician and I want to know if you believe it could be true. She works for a plastic surgeon, but one of her clients sought filler injections outside of their practice at a medi-spa in town. She had Juvederm injected by a dermatologist into her nasolabial folds and within a month, skin necrosis developed on one side of her nose, apparently from a vascular obstruction which she believes was caused by the injection. I saw a photo of her nose and it was horrifying. She has actually lost the right lower lateral side of her nose and now needs reconstructive surgery. Can this really have been caused by an injection of hyaluronic acid? Have you ever heard of anything like this? I`m asking because I have been thinking of trying Juvederm and now I`m terrified.

Answer:

Ir can happen with any filler if it is injected into an artery, it is very very rare, quick diagnosis can help the treatment and extent of the problem, left unrecognized it can lead to what happened to that person. Experience and the ability to see the doctor can help avoid or prevent it. I think it is safe for you to have the injection though. JG 4.26.13

Question:

Hi Dr, I posted many years ago after I made the silly mistake of having argiform injected into my lips almost 11 years. Apart from a few lumps and bumps which are thankfully not noticeable, which resulted from topping up with HA years later, they still seem ok. After such a long time what is the likelihood of reaction and granulomas getting bigger? I was hoping that should be ok after 11 years.. Thank you

Answer:

Low risk at this time, lucky you. JG 4.15.13

Question:

hey dr gacia! had jjuvederm injected under eyes 3 wks ago ever sinceleft eye shows a tiny bump crease onlyy when i smile. will this go away? its only one eye and very annoying

Answer:

massage and a little time will help. JG 4.14.13

Question:

Dr. Garcia, I am wondering if the following can case fillers to break down faster.... 1. Topical treatments, retin a, alpha hydroxy acids? 2. Exercising too much,(increasing metabolism, in essence, causing the body to metabolize the filler faster)? 3. Diet, not eating enough protein? Thanks for your help!

Answer:

Nope, no effect, keep enjoying life. JG 4.13.13

Question:

I know that Sculptra lasts much longer than Radiesse, but I`m finding that they do very different things. Radiesse seems to give my face more structural enhancement, making it look like I have a stronger bone structure, whereas Sculptra seems just to make me fuller. Would you agree with this assessment? I ask because my PS pushes Sculptra over Radiesse and HA`s, and while I like Sculptra, I don`t think it`s good for every need. What do you think? Thank you!

Answer:

it depends where it is used, but in general, the Sculptra is used to replace lost fullness not boney definition. Sculptra can enhance the shape but not the bone`s appearance. Radiesse or Artefill is better for that, but typically the amount of bone loss with age is very small so it typically does not need enhancement unless the bones were always smaller in size than desired. Fillers are not interchangeable. There is no one filler that works for everything, but fillers to enhance boney structure are not great options and in those case it is better to use implants. JG 4.7.13

Question:

Thanks for the quick answer about the Sculptra! I do think I`ll go ahead with it. Would you please clarify one thing, which I should have asked you more clearly: In your experience, when you inject most patients with just one vial (and inject the lateral aspects of the face), would you say that the effect is usually a) extremely subtle b) subtle but it looks like something was definitely done or c) not subtle, definnitely looks like something was done ? Thanks so much, Dr. Garcia. Have a great weekend when it comes around tomorrow night!

Answer:

subtle and leaves them guessing if something was done or just that the patient looks rested. Thanks for the wishes and same to you. JG 4.4.13

Question:

I`m considering Sculptra but am afraid of an an over-inflated and round look. I know that the effects vary from patient to patient and much depends on the individual`s facial structure and age too; but in general, would you say that one vial injected to the temples and pre-auricular area provides most people with a subtle, not overwhelming, additional volume? I know the inflammation response increases over time and then levels off. I just don`t want to wake up four months from now looking like I`m on Prednisone! Thank you.

Answer:

I think that is a reasonable way to start, then wait 4 months to see how it grows because you can always add more later. Best of luck. JG 4.4.13

Question:

What is the best filler for marionette lines?

Answer:

I like Perlane. JG 4.3.13

Question:

I wanted to have artefill in my marionette lines but the Dr. doesn`t like to inject it because the face changes with age. What is your opinion about this? Thanks

Answer:

I agree, the descent of the cheeks will continue and although the filler will last a long time, the correction won`t. JG 4.3.13

Question:

I had juviderm injected at the corners of my mouth for fine lines about 3months after a fraxel restore treatment and ended up with many broken blood vessels that I can`t seem to get rid of. Do you know why that happened and what I should do about it? I`ve had injections there before the fraxel with no problems. Thank you..

Answer:

Not sure why that would happen from the injections. you can have them treated with an Nd:YAG or VBeam laser though. JG 4.3.13

Question:

Good morning good dr. Well, it has been 4 days since I had restalyne injected to underneath eye area. Upon initial placement I looked like a hot mess ! Whitish area where injected and some minimal but noticeable swelling right at that rim where I guess, cheek meets eye socket. It has been day 4 and I still have some swelling in that area (right eye more). My husband is mortified that I even did this. I am 50, but I have always been told I look much younger (or so they say)...now I am looking a bit distorted . It is almost a shelf like effect. When I touch it or massage it is not lumpy. Shall I go back to dr. I was told he won`t address anything until a week has passed. Shall I ice it? I may add the dr., has impeccable credentials and I know a woman who sees him and looks great! She says, wait it out. What is your assessment of this? Help..I need to attend a wedding Saturday!

Answer:

All common and will get better in time, I would alternate moist heat and then ice a few times per day. Shoukd get better soon. JG 3.26.13

Question:

Very happy with restalyne under the eyes. It was done 2 days ago and I presume there is still some swelling, but I am hoping it stays the way it is now. My question...can I resume my cardio work out....(some running, some jumping). I do not want to disturb the settling process, and I am afraid the impact of running will disrupt things. Is it okay. And, while I`m asking...is there are any truth to the myth that runners show more facial aging, and if so...why.

Answer:

OK to resume normal activity, nothing will happen. As to running and aging, yes, it is true, As there is a bouncing of the facial tissues that tends to stretch the supporting components out and the tissues fall sooner. Look at someone`s face running in slow motion and you will see what I mean. The larger effect though is that of facial fat loss( a normal part of aging in all of use) as the for lack of a better term, `lets the air out of the balloon`, and when the fat/ air is let out, skin, balloon falls. I wish you the best. JG 3.24.13

Question:

I have blueness under my right eye where had I filler. How can I tell if this is the tindall effect or bruising? If it is because of the filler what can I do to lessen it?

Answer:

Bruise should be gone in 7-10 days, if it persists it can be disolved with hyaluronidase. All the beat. JG3.22.13

Question:

Well, I did it! Got Botox to lift brows as much as possible, without looking frozen or surprised, and had restalyne to the under cheek area. Really liked the dr and he has had some very good reviews. Now, since I like to Malle myself crazy...I ask you, how long before restalyne settles and the swelling subisides? I am looking at some kind of lumpy/swollen areas along with kind of a white color underneath the skin where I believe the product is. I am hoping and praying that this is normal. The office staff basically said not to touch or massage anything, just use the ice gel packs to reduce swelling. Looks like one side has swollen more than the other, though.

Answer:

It will take about 5-7 days for the swelling from the filler to settle down and about 10 days for the Botox to reach maximum effect. It is common for one side to get more swollen than another and since there are needles involved, bleeding below the surface where no bruises may show can affect things. I would give it some time and follow their instructions in the meantime.I wish you the best. JG 3.22.13

Question:

Well, this is it...after asking you many questions and going to two consults I`m going to take the plunge (financially and mentally) and have some botox to try to elevate brows slightly and filler underneath the eyes. I consulted with a dr today (who will do the injections) and here`s what he said...I have very weak forehead muscles so not hardly any lines caused by moving the eyebrows up and down, but I do have a bunny line from good squinting muscles, he would like to address, and possibly give a more relaxed expression to the eyes. Would you agree that this would do the trick? He will also use one syringe of Restalyne to fill the cheek area underneath the eyes to attempt to alleviate the look of some slight bags. Would you use this for that area.? I do not want to get that pillow cheek look, and am so anxious about this. Thank you for your generosity of knowledge and time.

Answer:

Sounds like what I would do and I would use the same products. JG 3.20.13

Question:

I written a day ago about the kenalog shot under the eye for the juvaderm. Now I also have a bit of an itchy rash it seems in that area. Anything that can help with that?

Answer:

oral antihistamines is about all at this point. JG 3.19.13

Question:

I had juvaderm for under they eyes. One eye looks great. The other had a :puffy pillow: underneath. I waited a week and it didn`t approve so I went back to ask for it to be dissolved. Instead they gave me a shot ( I think kenalog) saying that the fat pad was angry and that would fix it. The puffiness did go down but now right under my eye is very dark and the outer right corner is indented. It`s been 5 days, is it ok to try to have more filler put in or is there something eles I should try?

Answer:

I would wait at least ten days to 2 weeks from the kenalog injection before trying anything else, and then it would be more filler. JG 3.18.13

Question:

Dr. Garcia, did you see any results after PRP(plazma injections), beside bruising? Thank you.

Answer:

I do not perform PRP as part of a stand alone procedure as I feel there is no science behind it, I have used PRP during surgery to speed healing and decrease bruising though. JG 3.18.13

Question:

Follow up to last question I meant to say that restalyn injected 10 days ago and had sensation which could be trigeminal nerve yesterday and gone today and wondering if injection could have triggered the sensation 10 days later. Thanks

Answer:

Do no think the injection of Restylane had anything to do with the trigeninnal nerve irritation. JG 3.13.13

Question:

Once you have filler dissolved in an area, how long do you have to wait until you can replace the filler? Is restaylne the best filler for under eye hollows?

Answer:

I have the patient usually wait abut 10-14 days to let all the swelling and bruising go down.JG 3.12.13

Question:

Had botox in glabella and some bolotero a month ago(10 units) Is it too soon to use botox again when there is still movement when i grimace? Thanks

Answer:

Yes, normal does there is 20 units. JG 3.12.13

Question:

It`s been a week since I have juvaderm under my eyes. It is still a puffy pillow that looks horrible. I`ve done the massage, arnica, the 6 day pred pack and it is still the same. Isn`t this too much filler and not swelling?? I want to get it dissolved, do you think that`s best?

Answer:

I think after a week the swelling should be gone so it might be best to dissolve it and then wait a bit and start over. JG 3.12.13

Question:

Well, my question seems to be one of those that got lost and didn`t get answered. Here it is...please tell me if Botox for crows feet or filler to the cheeks is what causes the odd chipmunk cheeks when smiling. I can`t help but notice many of my friends (45-50) have acquired this look! It is especially obvious in photos....not sure why that would be. I am so afraid of this look, but am wanting to fix the tear troughs and nasolabial folds!

Answer:

No, Botox should not have that effect, the Botox weakens muscles so if anything it would flatten the cheeks more. That is more related to fillers being overdone or placed in the wrong area. JG 3.33.13

Question:

Dr., Garcia, can you explain what causes the effect of the chipmunk cheek? Recently, had an evening with some friends (ages 45-50). I noticed that in most of the pictures several of them have that look upon smiling. I have only had a very small amount of botox (15-20 units) , and am considering a filler under the eyes (tear trough) and possibly some to fill in marrionette lines. I don`t want this odd look....is this caused by filler or by botox? Too much, or placement, skill of injector? Any suggestions would be awesome. I`m a bit of a chicken little!

Answer:

it is a little of the too much, and the injector and where it is placed, but the injections are done slowly and you can always ask to see yourself in the mirror as they do ii to make sure they do not overfill you. I wish you the best. JG 3.11.13

Question:

Hey dr Garcia! I got some prevelle lip fillers and some juvederm as well.why does the filler end up in small balls towards the insides of the bottom lip. I was watching my doc fill my bottom lip in the mirror he was injecting it in the middle part of the lip but the material was clumping in a diff spot. Why does that happen? Is it cuz there`s too much filler being injected and it travels upward?

Answer:

the entry point of the needle is not where the filer goes as the pressure on the syringes pushes it to the tip of the needle which is likely a ways away from the puncture site. The clumping most commonly is form too much filler deposited in one area and with massage it usually will go down. I wish you the best. JG 3.11.13

Question:

I have dark spots where I had juverderm about three months ago. Do you know what could be causing this or will they ever go away? It was put in the marionette lines. Thank you

Answer:

Unusual unless it was injected too superficially, then the filler can look blue. If that is the case it can be dissolved. JG 3.9.13

Question:

Is there anything else I can do to help under eye swelling from filler (juvaderm) go away? I am taking arnica, but I am suppose to be in a wedding next week and this looks horrible.

Answer:

Ice and massage is about it. JG 3.9.13

Question:

I did juvaderm to fill under eye indents and hollow. How long will swelling last? How will I know if it is swellling or overfill? I do also have bruising right now too.

Answer:

swelling might last 10 days at most. I think as long as the bruise is there I would give it more time as that might be causing some appearance of overfill and the bruise might take 2 weeks to resolve. I wish you the best. JG 3.8.13

Question:

Hi Dr., I see Sculptra is about $700-800 per syringe, which fits my budget. Do you ever use one syringe with good results? I am 50, but my mid-face has not quite yet fallen, still pretty taut, but I feel it would take me back a few years to enhance the cheekbones directly under the eyes. I don`t feel the outer cheeks need anything, as they are still quite prominent and there is no sunken temple look, or gaunt look to my face. I would love to have the Sculptra, but can only afford one syringe...should I head out the door and empty my wallet, or will it be a very minimal improvement? A million thanks for your tireless effort in the education of so many of us!

Answer:

from what you are describing I think one vial will likely be enough in your case. I would say that in 75% or higher of my patients I only do one vial. Thanks for the kind words too! JG 3.7.13

Question:

Hello again Dr, After injections of hylauronic acid, if an allergic reaction is going to happen, does this usually occur within the first few days or can this still happen weeks later? I have to thank you for such an amazing site. You have answered many questions for me in the past and your help is invaluable...

Answer:

hours to a day for an allergic reaction.Anything weeks later is something else. Glad I have helped and I wish you the best. JG 3.6.13

Question:

I have a baby quasar (red). Do you think that would help with bruising and swelling from juvaderm that was injected under my eye? I did ice all day after and it`s starting to swell and bruise. Anything else you would recommend?

Answer:

Not sure it will help, might suggeat arnica tablets and gel. JG 3 6.13

Question:

Hi Dr., I do not have the $ to use the Sculptra, as you have recommended to try to alleviate some Nasolabial folds. So, besides the Sculptra, which filler would work best? I want to fill the cheek bones, not the folds directly. Any suggestions as to your opinion on the product, and procedure is greatly appreciated.

Answer:

Perlane, Juvederm Ultra Plus or Radiesse, but you should not expect anything more than a few months of fill. JG 3.5.13

Question:

Good evening doctor...is it risky to have a face/neck lift if you have Dermalive /artecoll in the NLF. It has been there for about 7 years... 2-3 vials.

Answer:

should not have nay effect. I wish you the best. JG 3.2.13

Question:

Hi Dr, When a granuloma is formed from HA, is there any chance it will grow in size overtime or does it stay the size it was when formed? I have developed a granuloma in my lip from a Perlane last week. It is only slightly visible unless I pull my lip tight but I am worried in case it does grow. If so can I do anything now to stop it? Thank you

Answer:

In the rare occurance of it forming, it will usually stay that size. Normally it takes 6 weeks or longer for a granuloma to form as it takes the creation of essentially scar tissue made up of collagen. If yo have a lump one week out it is likely not a granuloma but just a collection of the Perlane and it can be pushed out through a stab incision or dissolved with hyaluronidase. Not sure why Perlane was used in your lisp though, that product is intended for deeper dermal filling as it is thicker and in thin areas like the lips it is much better to use a thinner HA like Restylane. Just because a product can last longer in the proper place it should be injected does not make the HA fillers interchangeable, because they are not. Improper use of a filler by using it in an area not indicated has a higher problem rate that can be avoided by using the proper product.I wish you the best. JG 2.28.13

Question:

Hi Dr, What are the chances of Dermalive still being present 10 years after injection. It appears to have gone however I am worried about having Perlane injected over it in case some of the product is still there? Thank you

Answer:

I think it can happen as it would be scar tissue at that time though.I do not think with 10 years between that the Perlane would cause a problem. JG 2.26.13

Question:

Hi Dr. G., Thank you for recommending Fallene sunblock. I read the testimonials and it appears that while the sunblock is effective, it leaves a white sheen on the face (because it is a physical block?). I have medium Asian skin tone and was wondering if Fallene sunblock would leave this thick white sheen on my face. Do you find that it has this effect on your skin, and if so, how do you deal with it? Thank you.

Answer:

I find that people use too thick of a layer of the sunblock, no need to do that, and that will reduce the whitish cast. Once the sunblock absorbs, the cast reduces so just wait about 10-15 minutes between the sunblock and makeup. JG 2.24.13

Question:

Hi Dr., I am wondering if just one syringe of Sculptra is ever used? I have noticed in reading that I never see any one advertising just one. Why is that? I`m of the less is more school of thought. Also, I am old enough to remember when the cheeks that were attractive were those of Lauren Hutton and some others, seems like now it is almost "child like" pudgy cheeks. What has changed in the beauty industry that what was once considered attractive, no longer seems to be?

Answer:

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Question:

Hello Dr., I hope you are enjoying today off. You had recommended the use of sunblock, not sunscreen. So are you saying that all the moisturizers that include SPF 15 or higher are not sufficient? If so, what is the difference between sunblock and sunscreen? What sunblock should I use since one of the terrible things about most sunscreen is the heavy, greasy feel that balls up when I apply a bit of foundation over it. The feeling is so horrible, it make me want to wash all of it off. Please, what sunblock do you recommend? Thank you.

Answer:

That is correct, in my opinion, sunblock is superior for slowing skin aging and spot prevention. If you want to use a moisturizer, I would apply the sunblock first, wait 10-15 minutes and then apply the moisturizer over it but in most cases it is not needed due to the carrier cream the sunblock comes in. Wait the same amount of time for the make up too.I like the sunblock by Fallene, sold online or in my shopping cart.I wish you the best. JG 2.18.13

Question:

I notice you use Sculptra for cheeks. I have researched and notice it is the more expensive of all fillers. If I can`t afford that, what would be my next option? Also, I am terrified of the cheeks looking like golf balls upon smiling. I have never had this, and feel it would distort my face. How does that happen, and what does a good injector do to avoid it?

Answer:

In the long run the Sculptra is cheaper because it lasts longer, the other fillers will give you maybe 2-4 months and have to be repeated, and typically require multiple syringes where Sculptra can last 18 months and at times more. The overfilled cheeks can happen with any filler. JG 2.18.13

Question:

In the case of cheek filler, what is your opinion on what product should be used and how much? I do not want that round (Hillary Clintonesque) golf ball appearance upon smiling, just more of a small lift.

Answer:

I use Sculptra for the cheeks. JG 2.17.13

Question:

I have horizontal lines that are static at top of nose. Can filler be used here? Also what is the name of the artery at glabella that my dr does not want to inject filler here in case filler gets in there?. Thank u so much.

Answer:

It is the nasal artery and the horizontal wrinkles should be able to be injected safely. JG 2.16.13

Question:

I walked in to Drs office ready to spend $ for injecting the nasolabial/marrionette lines. I have had this before using only one vial of Radiesse . This time, I was told that without 3 vials (some for tear trough/ a little for lifting the cheeks, and then the marrionette lines) it would basically be spending $ for a very tiny improvement. The woman was actually very complimentary said I had great skin tone, youthful eyes, and nobody was going to pay attention to a small insignificant pre-marrionette lines. She said to save my $ for the 3 vials, and she would take about 10 years off my face. I left a bit perplexed. Happy that someone didn`t just want to take my$, but kind of sad that one vial would basically give such small results. Do you agree at all?

Answer:

well, we all focus on different parts of the face and want to fix things. Firstly nasolabial folds can be decreased by filling the cheek and if you have lost cheek volume, that might be a good idea. In most cases the refilling of a cheek with Radiesse can take a number of syringes when needed and I prefer to use Sculptra in that region as it will last longer. But if your cheeks have not lost volume, then your cheeks will look too big, no mater what filler is used. Secondly, I would not use Radiesse near the eyes as the material has a propensity to develop lumps near circular muscles which are the kinds of muscles around your eyes. I also appreciate someone not jumping and taking your money as long as you feel that their recommendations are ones you want to follow. Remember this is cosmetic and beauty is in the eye of the beholder. If you don`t think you need something, don`t do it. JG 2.15.13

Question:

You wrote about depressing procerus muscle with Botox to raise medial brow and I appreciate this. My other question is whether this could cause lid droop and the number of units of Botox you might use to do this or is it totally dependent on the amount of hooding? Thank you so very much.

Answer:

Should not lead to a droop and it can take 20 Units or so, it depends on the amount of muscke, not the amount of hooding. JG 2.13.13

Question:

I have vertical lines around lips and have tried restalyn but i don`t like the waviness that often results. Would boletero be different or am i stuck as i dont want laser or chemical peel.My actual lips seem ok and i dont want more fulless. Thanks

Answer:

I think Boletero is a better choice for fine lines but it will not last more than a few months as it is thinner material. JG 2.12.13

Question:

what is meant by #11(lines around eyes?) thank you

Answer:

2 vertical lines between the eyebrows that look like the number 11. JG 2.12.13

Question:

I had botox in glabella and still have wrinkles. Don`t think more botox is the answer. Can a filler be used there or are there arteries to worry about and possible more problems(i.e. necrosis)? My dr is a skilled injector but i know things unforseen can happen and would like to always be safe. Thanks.

Answer:

If you had wrinkles at rest the most the Botox would do is stabilize the wrinkle, I think a filer is needed and it has to be done carefully and not deeply to avoid any problems. There have been a few issues with tissue necrosis with fillers there but there have likely been millions of injections performed at the same time so the risk is low. JG 2.12.13

Question:

Hello, Dr.Garcia.I thing you use belotero in your office. Tell me,please, do you see any better results when you use it under the eye area, than from restylane or juvederm? Thank you.

Answer:

I only use it for more superficial injections of fine lines, so I do not use it for the orbital rim, there I use Restylane about 95% of the time. JG 2.11.13

Question:

On Thurs I had a bit of restalyne for under my right eye. I previous had to dissolve the filler in this area and reinjected( the previous injection looked like there was too much and I had a bag under my eye). When I left the area looked perfect. Yesterday when I woke up it looked a little bruised but also puffy-- kinda like last time when there was too much filler. How can I tell if I have swelling or if it has been over filled? What can I do?

Answer:

All you can do it wait about 7-10 days until the swelling goes down or the bruise that might be there in the deeper tissues dissolves, the filler will last longer than those two. JG 2.3.13

Question:

Hi Dr. G, I hope you are enjoying your weekend. My smile used to be one of my best features but as I got older, it just doesn`t look the same anymore. Obviously, the fact that my lips have got thinner is contributing to the less appealing look but do you think my teeth have changed as well, therefore affecting the appearance of my smile. I`ve read that Kate Middleton had her teeth fixed, which helped tremendously with her smile. I know this may be outside of your area of expertise but who should I consult ... cosmetic dental surgeon? Or would filler (for me, especially in the upper lips) help? Thank you as always.

Answer:

Our teeth can certainly impact our smile. As we age and lose bone mass our teeth lose some slight degree of projection and make the lips look saggier. That is why you see many people after getting veneers on their teeth that their lips look different. Lips also lose mass or volume as we age and fillers would help there. What you need is difficult to gauge without seeing you but I think a consultation with both a plastic surgeon and a cosmetic dentist would assist you as they will likely have different approaches. I wish you the best. JG 2.2.13

Question:

Hi Dr Garcia !! My PS is having a $50.00 off for Dysport through April. Is this Botox? I have never had it. I am wondering if it would help with the inside corners of the upper lids ( the turtle look). My forehead is smooth and I had a forehead lift/face lift using endotines 8 years ago. I also had a upper bleph in 94` that had a bad outcome. My own stupidity, I let a dermatoligist perform the upper bleph. What do you normally charge for Botox? Is it safe to get botox for the upper lids/forehead and sculptra to the cheeks at the same time? As always, you are sooooo appreciated. My first `go to` man. I always follow your advice. Thank you so very much

Answer:

Not sure the Botox will help what ails you. The only way to offer Botox or Dysport legally is to use the whole bottle, if you look at the bottle carefully, it clearly states it is meant for one patient only, the doctors that share the bottle between patients are not doing it right. We sell the 50 unit bottle of Botox for $600 and the 300 unit of Dysport for $850.No problem doing Botox and Sculptra at the same time, as long as it is not the same area. I wish you the best! JG 1.28.12

Question:

Hello Dr. Garcia, I had fat injections to my cheeks 9 mo. ago. I also had a forehead lift, forehead lowering and lower eye lift (incision inside lower lid. The fat transfer has not decreased at all and the left cheek is slightly larger when I smile. My mother-in-law asked me why this cheek seems swollen when I smile. Of course I played dumb, not wanting to admit to any surgery! I think I need more fat injected into my hollow temple and upper cheek area to even everything out, but I am afraid to do it now. Do you think sculptra would be a good alternative. Also, I am confuse about the conflicting reports of fat injections never dissolving and reports it lasts a max of 18 months. Thank you for your anticipated advice.

Answer:

I do think Sculptra is an option but you must be aware that it will take 4-6 months for it to grow, that will make it improve gradually so it will not be as visible and dramatic right immediately after the injections so others might not notice. The fat injections are quite variable in their longevity as you have seen and is likely the biggest problem with them, so touch ups of some sort are almost a 100% thing. Best of luck. JG 1.18.13

Question:

Love to do sculptra. But terrified of a granuloma Can u comment please

Answer:

diluted properly and injected in small doses per pass, should be a very low risk. JG 1.25.13

Question:

Hi!! I had botox on thursday to the upper eyes to lift them. Today it is Sunday, and the upper eyes are WAY lifted, almost to a point of extreme egagerration. when will this side effect go away? Yes, I am happy regarding the extreme upper eye lift, but it also looks a bit unatural. Thank you

Answer:

It will last to some degree for as long as the Botox does but will lessen in time. JG 1.13.13

Question:

I had one fraxel restore treatment and when I had juviderm injected three months later around my mouth,I developed tiny broken blood vessels that I never had with previous injections. Do you know why that is and how should I treat these? Thanks for being there. Your very kind.

Answer:

It should not be related ti the laser, it can happen fron the needles, it can happen to anybody. I wish you the best. JG 12.16.12

Question:

My dermatologist uses both Restalyne and Perlane on me. The latter is more expensive. I know he prefers the Restalyne for my lips and beneath my eyes, but I don`t know why he uses Perlane elsewhere. What/where do you yourself use it for on your own patients?

Answer:

I will at times use Perlane for deep nasolabial/ marionette folds, but the products are not interchangeable, the Perlane is meant for deeper filling and the Restylane for more superficial filling, so it depends on what you are filling as to which product is used. I use Restylane and Juvederm in the lips but not Perlane in the lips. JG 12.12.12

Question:

What do you think of Belotero for tear troughs and for inside the orbital rim generally? I`ve had Restalyne injected beneath my eyes to raise the lower lid height for years with variable results. Often it works well, if only temporarily, but other times, it just ends up looking swollen. I am wondering if Belotero`s relatively lower viscosity would prevent that problem, but that consistency might prevent it from being strong enough to raise the lower lid at all. What has been your own experience with this product? Thank you.

Answer:

i do not think the Belotero will work any better than the other HA filers you have used.I love Belotero for fine lines and lips but not for places where you need a thicker filler. Sorry. JG 12.8.12

Question:

Hi Doctor. How long after a deep CO2 treatment to the cheeks, for acne scarring, can a person have fillers ( such as Juvederm, Restylane, Perlane, Voluma ) injected into the upper cheeks to add facial volume? Conversely, how long after these fillers are injected into the upper cheeks, can a person have a deep CO2 treatment? How long does it take for the skin to return to its normal color after a deep CO2 treatment?

Answer:

I would wait at least 6 week to let the swelling go down and be better able to evaluate where to place the filler. If the filler is to be injected into the skin itself, I think it could affect the filler and dissolve it faster if the laser is done afterwards.How long it takes to return to normal color will vary but usually 6-16 weeks or so. JG 11.30.12

Question:

I had juvederm ultra injected to the right nasolabial fold today and all I see now is a thin line maybe where the injection was done , and it is vertical (could be related to the needle) line... what can I do and when does this go away?

Answer:

Massage and ice, should go away soon. JG 11.16.12

Question:

hello i had hyraulindase injected on tuesday to my nasolabial folds for juvederm which was slightly overfilled. how long does the hyraulindase stay active to dissolve the filler? the reason I ask is because I had more juvederm added to the nasolabial fold as it really took it (the hyraulindase) completley away the first time. I was just wanting to make sure the juvederm i had injected today wont dissolve due to the hyraulindase that I had put in on tuesday to the fold. thank you

Answer:

The hyaluronidase stops workiing by 24 hours, so you are OK. JG 11.16.12

Question:

I have has sculptra injections about three months ago, and now have a pretty good size knot or lump on my jawbone.I can`t see it, but can feel it and it rolls around seems like. Can this be dissolved or should I be concerned about it or just leave it if not visible? Not for sure if it was already there before injections or not. Was resting kinda on my hand and felt it, and it feel pretty big to me.

Answer:

Attempts to break it up with saline injections directly into the nodule might help. JG 11.15.12

Question:

Dr. G, here again about no upper teeth show... do you think if I use warm compresses everyday to help loosen thetight orbicularius muscles and do more smiling and somem types of mouth stretchimg exercises it would help show my upper teeth?

Answer:

it certainly will not hurt to do it. JG 11.12.12

Question:

Hi Dr. G.. I wrote you 2 months ago, about juvederm being injected to bilater al nasolabial folds, and I did get my left upper guy line in pain after the injection. I told you my upper teeth dont show and it is a forced smile, It still is. Im wondering if this is nerve damage. The smile is not uneven. just upper teeth dont show. I did go back to the injector and she of course told me nothing could be done.. unless they want to take all the nasolabial work with the juverderm out with hyraundiase , to perhaps make smile more natural... and i opted not to.. I just want to be sure my upper tee th show smile will go back to normal if this and when it all disssovles.( the juvederm meaning) i notice even 2 months after the procedure, today using warm compresses helps the muscles of the smile be more loose and less forced.

Answer:

I think the chance of a bilateral nerve injury will be very low probability. I do think in time it should get better. JG 11.11.12

Question:

Hi Doctor. For filling the tear trough area, is Restylane a better product than Juvederm, because Restylane is more cohesive and tends to stay where it is placed. Whereas Juvederm tends to diffuse in the tissue, thus Juvederm, when placed in the tear trough area, can drift readily to the top of the cheek. Would you agree with that? What is the Restylane product equivalent to Juvederm Refine? For the cheek area, is there a Restylane product equivalent to Juvederm Voluma? In general would you agree that doctors can mold the face better with Restyane because it is more cohesive than Juvederm?

Answer:

I prefer Restylane for that area myself. I think it is more of feel that drift though, the Juvederm really cannot drift but it is stiffer and in that area, what you are trying to replace is firm and not soft, so I use Restylane. I do not think Restylane has anything like Juvederm Refine, in that case I uses Belotero or Prevelle. For the cheeks, Perlane is as close as Restylane can get to Voluma. I think there is really little molding capability once the material is done, so it is more technique controlled than after the fact. I wish you the best. JG 11.11.12

Question:

Hi, Dr. Garcia. I have a Sculptra question. Is it your experience that Sculptra can end up making a person`s face look fat rather than youthfully full? I suppose it is injector dependent to some degree, but I have had that experience myself occasionally (even with my very experienced surgeon) and notice even in the company`s printed advertisements that some of the models don`t look younger but simply heavier and bloated. I love the product but it seems so hard to get it right...and then as soon as you do, it starts eroding. Any tips you have found over your years of using it that we can suggest to our practitioners? Of course the less is more rule applies, but sometimes, less is less and one ends up without an adequate correction. Thanks for your kind help. And happy Election Day!

Answer:

Less is more, in my practice I decide when to do more, I do not let patients push me. JG 11.6.12

Question:

Hello Dr. G. I have some discoloration under my right eye (from Sculptra injection and subsequent efforts to remove bumps). What is the difference between IPL and Vbeam? My PS suggests Vbeam and has given me a complimentary treatment. My eye looks a little better but it`s hard to tell if it was the Vbeam that did it or many years of IPL treatments and skin lightening creams, as well as Retin A and hydroquinone. Should I spend more $ in the hope that Vbeam might finally remove the pigmentation? Than you.

Answer:

IPL is not a true laser so it is much weaker than the VBeam, that likely would work better and take less sessions to improve the discoloration. It usually is done in a series of sessions, not a single one time go. Without seeing you it is hard to tell what you got the most out of but the VBeam is effective for discoloration, more so than the creams and such. JG 11.5.12

Question:

Good eve. Am thinking of injecting Juvederm in the NLF which currently have been injected with Dermalive...roughly 7 years ago. So far, I have had no problems with the Dermalive...if I were your patient would you inject over the Dermalive?... Or is this too risky? Thank you. Jg 31 Oct

Answer:

well, I think after this much time that I would proceed with the Juvederm, yes. I wish you the best. JG 0.31.12

Question:

Hi Doctor, I am thinking of has fillers injected into my upper cheek to lift my drawn cheeks and improve my nasal labial folds. Would Voluma or Sculptra give better looking results for that? ( and in general which would be better ) How long does Voluma last and how long Sculptra last for that? Some doctors tell me the results from Sculptra are unpredictable and depend in the person. And have not had great experiences with Sculptra because the volumizing effect ( stimulating the collagen ) is not all that great, especially when compared to the volume created by voluma. Is that true?

Answer:

I prefer Sculptra for that.In my experience the Sculpta lasts about 12-24 months, the younger you are the longer it lasts. I do not sue Voluma. The main difference is that Sculptra creates new tissue where Voluma only hides what has happened. The Sculptra is more dependent on the patient due to age and speed of the aging process, but I think overall it is a better product because of the creation of new material. JG 10.28.12

Question:

Good evening, Dr. Garcia. I`ve been getting Juvederm and Restalyne injections for years without any problems. I had one last Friday that has left me red and quite itchy. Is this common (and if so, when will it resolve) -- or do you see pts develop an allergy to these products after a while? What do you recommend? Topical OTC cortisone? Ice? Thank you!

Answer:

oral antihistamines and ice might help, I think topical cortisone will do nothing.I wish you the best. JG 10.18.12

Question:

Why some of the PS use PRP foe skin rejuvenation or even instead of fillers. Thank you.

Answer:

because the are trying to capitalize on the `stem cell craze` to make money but they are not offering any stem cells of any appreciable amount. JG 10.12.12

Question:

Hello, Dr. Garcia. Does PRP therapy work? Do you do this kind of treatment in your office? Thank you.

Answer:

it helps tendon sprains heal faster and does help resolve swelling and bruising when placed at the time of surgery, otherwise, lots of hype, and certainly no facial enhancements. I do not provide it as a stand alone option. JG 10.12.12

Question:

I`m the woman with the horizontal lines below my nose. My derm wants to use juviderm ultra. My last derm used juviderm and injected perpendicular to the lines in the cupids bow area and it did very little and was extremely painful. I know you said you would try beletero. Would you inject at a horizontal angle? And if it doesn`t look the way you want,are you able to smooth it out? Thanks so much. I`m just a little scared.

Answer:

I would inject directly under the line, in parallel.It is technique dependent and the filler really cannot be pushed around much. Best of luck. JG 10.10.12

Question:

Hi Dr! I have posted in the past about my Dermalive problem which I had injected around my eyes 14 years ago. It migrated underneath the eyes causing lumps which I had surgically removed. As my natural fat is starting to disappear from that area I was hoping to have hylauronic fillers injected. If, for some reason there were small particles of Dermalive left over from before, would they react to the hylauronic acid and also do these permanent fillers eventually break down and disintegrate after such a long time? Thank you

Answer:

there is no way ot know 100% but I think the hyaluronic acid filler should be safe to use. JG 10.7.12

Question:

Hi Dr. How long does it take the swelling to go down after filler (Artefill and Restylane) in the cheek areas? Also, how many months does Aretefill last? Thank you!

Answer:

swelling should be gone in 3-5 days in most cases. Potentially the Artefill has been reported as lasting up to 7 years, but that means the filler lasts that long, not that what problem it was used to correct will stay improved for that long as whatever caused the need for the filler has not been stopped and aging will continue. JG 10.4.12

Question:

I have a fairly pronounced cupids bow with about 4 fine horizontal lines running across. Is that a hard area to inject with fillers? How do you approach this? One doctor doesn`t think she can help and the other seems willing to try. Thanks for your advice.

Answer:

It is not easy, but if I were going to do it for you I would use Belotero, the new HA filler, as it is thinner and easier to sue for fine lines such as those. JG 10.2.12

Question:

I also had botox and is already wearing off and it usuall lasts longer than this. I don`t want to be able to frown and pull the eyebrows down because I think I look either mad or tired. I need something to evevate the eyebrows and have read where botox if injected in the right places can help. Can u tell me what areas to be injected with the botox to paralyze the muscles to not let me be able to pull the eyebrows down? I probably need a forehead or brow lift, but don`t want to lose any hair because I have thin hair and know they have to make tiny incisions in the top of my hair line and will lose some hair and I have none to spare. Are there any other procedures to help with the forehead or eye area to lift it? I have also read about fillers being injected under the brow to lift and give the eyebrown a lift without surgery. What fillers are used for this and would that help? I know there are many questions I have asked and would appreciate ur input on all of them. Thanks.

Answer:

the person injecting you should know that, if they do not, you need to find someone new. For filling of the area right above the eyebrow I use Restylane. Best of luck. JG 10.1.12

Question:

I have had several fillers for the face and it looks quite good when I leave the office, but about three days after looks deflated and still like I need more or something. Not happy at all. I had restylane for the tear trough area and juvaderm for the nasal labial folds and sculptra in some areas as to which I can`t tell any difference now, but looked great when I left and full. I know it takes time, but not seeing any difference and is going on two months. The eye area looks hollow again and nasal labial folds look like I need more.

Answer:

the end result is dependent on the material injected and the skill of the injector, you might need to find a different person to inject because none of those fillers should dissolve after a few days except the Sculptra. In that case, the fluid from the Sculptra goes away in a few days but it takes 4-6 months to see the effects of the Sculptra as it is a biological filer that needs to grow over time. JG 10.1.12

Question:

Wouldn`t let me send all my questions at once, so had to type it in two parts. I aslo have concerns with my face. I have had several fillers injected. I had restylane about two months then but three days later not. I had some sculptra injections which made my face look full and nice then deflated and looks back the same now. I know it takes time, but not happy with the results. I would like instant results. I also had botox for the forehead for my eyebrow looking like I am mad or tired. I know there are places to inject around the brow to paralyze muscles to keep from pulling down and making them look elevated. Where do these injections need to be placed? Also I probably need a forehead lift or brow lift but have no hair to spare. Are there any other suggestions as to what will help with this area?

Answer:

If you want an immediate filling of the areas that Sculptra is used for you can use Radiesse, Juvederm Ultra Plus or Perlane but the results will not last too long as it is not meant to be an injection to replace Sculptra. JG 10.1.12

Question:

I need some help please as to what to do. I am 52yrs of age and not happy with several things. I am not a fat person and never have been. I am 5ft 6 and weigh 120 but to me look like someone that has been big and lost alot of weight and have lose and sagging skin, especially in the abdomen and legs are jiggly and have dents or dimpling in them. Also my butt cheeks have dimples or dents in them and are jiggly and arms have lose skin and wrinkly. I have read about the exilis and lipodissolve being good for this. Are these procedures good and if not are there any treatments to address these problems?

Answer:

I personally think the results from Exilis are very temporary and the lipodissolve will only make it worse, and that is if it works at all. If you have loose skin, the only reliable and reproducible option is surgery, but the scars can be long. I know of no non-invasive procedures that give any improvement past a couple of months at most. Sorry. JG 10.1.12

Question:

what are the best fillers for the face?

Answer:

no straight single answers, it depends on what you are trying to correct, deep lines, superficial line,s fat loss, folds, etc. JG 10.1.12

Question:

Hi Dr. Garcia... the no tooth (upper when smiling ) patient here. Today i got hyraulindase added to the sides only of the upper lip. she definitley aggreed.the sides of the upper lip needed to taken out to allow for smile.. So I am waiting this out. She seemed to think it was the upper lip that was heavy and not the nasolabials.. as she said they are very even. So if this doesnt work it would have to be the filler compressing both sides as i would have uneven smile if just one side were compressed-- same scenario if I had nerve damage.. I think that I would as you confirmed have an uneven smile with nervedamage or even an inability to smile. If this hyraulindase does not work what step should I take next? I am wondering about an upper lip lift... do you suggest I go back to the doctor not the injector if still not satisified? Thank you again so appreciated. Im also continuing to use warm compresses to relax the nasolabial filler and loosen up the smile muscles.

Answer:

well, if it is due to the filler, the hyaluronidase should remove the filler and the problem, if it is due to that, will resolve itself. A lip lift can be done, but if you did not need it before the filler, and you have it done, then it might look too high if whatever acutely cause the loss of tooth show to reverse itself. For that reason I think I would give it a few months to see what happens. I might suggest to remove all of the filler from the entire area that was recently injected. If the problem arose from that, it is best to remove it all, no matter what it looks like and see if it resolves. I wish you the best. JG 9.29.12

Question:

ok, i am aware of repose, where teeth don`t show due to gravity.. i am 41, but ive done this injection thing too much with juvederm and had lips done with it a year ago ... it was only this time where i got a no tooth show. i have absolutley not one line on my face anywhere due to all the work ive done and kept it this way... but this time my upper teeth dont show with smile.. maybe a tiny tiny bit, i thought if nerve was damaged, it would result in asymmetry of the smile,?? in my case the smile is very uniform and not one upper part of the lip is higher than the other so no asymettry.

Answer:

You are correct, bilateral nerve damage as a cause is quite rare. If you only had the NL fold injected, I am at a loss for what happened, sorry. Never seen a case like yours. JG 9.27.12

Question:

Hello, I had recently asked you about my situation where juvederm was filled to the nasolabials 3 weeks ago, and left me with my smile which doesn`t show my upper teeth,, as I have been used to before this particular injection to both nlbs. I did go back to the injector, and she said of course if you do hyraulindase it will absorb all the filler. So I did not. My question is...Do you see many people (women) who smile and their upper teeth don`t show? It is making me feel self conscious... and the filler isn`t puffy and looks perfectly leveled.. I wouldn`t want to get rid of it. So do I deal with no upper teeth showing when smiling? I know it will resorb with time.. but its a catch 22 =( just wanted your thoughts. thank you again.

Answer:

I have never seen a patient who showed teeth before and injection and then lost it after the filler unless there was nerve damage. In many cases, as women get older, the amount of tooth show lessens, so some women do not have much tooth show to begin with, even prior to the filler. In your case, since you like the effect on the nasolabial fold, I would say to just wait it out. I am not completely sure what has caused the loss of tooth show in your case, so waiting is a safe option. JG 9.27.12

Question:

hello from using warm compresses to nasolabial area the first week (3 wks ago from a juvederm injection) i still have dark redness to the nasolabial area where i applied the warm compresses (which may have been too hot) is it ok to use hydroquinone cream on the redness... ? thank you !!!!!!!!!!!!!

Answer:

nope, hydroquinone helps brown spots, it will not help the redness and can irritate the skin and make it more red. Sorry. JG 9.23.12

Question:

How much do you think a realistic budget for maintaining an aging well program should be? I include in this (1) Botox and (2) fillers - but not skincare, as unless people regularly spend $200 per ounce on the latest cream, I think there are good alternatives out there that are affordable. Also, I am wondering why Botox (not more than 2 months) and fillers (even Artefill last only a few months) don`t last very long on me. I have been told it`s my genetic makeup or metabolism, or it is because I work out. Is this true? Thank you.

Answer:

as to Botox and fillers, it will cost less the younger you are. In cases where there is mild to moderate aging I believe a round number for those two options would be anywhere from $750-$1,500 per year, and it will get more expensive the older one gets as you will need more.I agree on the alternatives to the pricey creams, in that area, more expensive does not always mean more effective. As to the Botox lasting shorter times, it is likely more of how many units they injected, the fewer the units, the shorter it lasts, metabolism has an effect, but small, it is more controlled by the amount you use the muscle. If you scowl, whether its when you work out or not, the muscles are stronger and will need more Botox.All the best.

Question:

Not a question...just a warning to those considering fat transfer to tear trough area. I had this done in 2008 by a physician famous for it. Three procedures over the course of 9 months. I looked years younger, for a short period of time. And it wasn`t because of the fat. It was because of the mild swelling from the procedure itself. The doctor`s assistant even admitted that they space the procedures out to leverage the benefits of the swelling! It is now 3 years later and I hide behind glasses because the lumps under my eyes look horrible. I`ve put on 10 lbs since I had this done and the fat added to my tear trough has gained weight, too, but not in proportion to the rest of my face. I`m taking off the weight and the area under my eyes is looking less distorted. Talk about motivation to stay thin! I know you`re not a fan of fat transfer to tear trough, Dr. Garcia. Just wanted to give your readers a real life story to think about. Best wishes.

Answer:

thank you so much for the story, it means more coming from a patient than a doctor sometimes. I hope things get better for you soon. JG 9.16.12

Question:

I had Juvederm Ultra Plus placed under my eyes almost 2 years ago. There is still some persistent swelling under 1 eye because it was inadvertently placed underneath the eye, not just up to the orbital bone. I am having a treatment with the Palomar 1540 fractional laser on Friday and was wondering (hoping) if the laser might have some effect on the final Juvederm that remains.

Answer:

sorry, the laser will likely have no effect on the Juvederm Ultra Plus. JG 9.12.12

Question:

patient here with the guymmy no upper teeth smile after juvederm tomy nasolabials and oralcommisures only. today i went in to see the injector, and shesays i just need to keep smiling as the filler at both sides ofnasolabils is filled up but symettical to both sides... but that if i smile more it will help my upper teeth show... the other alternative was to take out the filler with hyraulindase.. and since she did so good id rather not.... my proble m as i told u last week is that my upper teeth dont show when i smile, and it is tight when i smile, so she said the injector, if i keep smiling it will loosen the filler up that is the NBFolds... and using warm heat wouldnt hurt.. agree... ???? thank u

Answer:

well, I do agree that the more motion in the area, the faster the filler will dissolve and go away, so it is certainly worth trying, just not sure how fast the problem will get better that way, it could be months. JG 9.12.12

Question:

When I have filler in my marionette lines, it goes away very quickly. Do you have any suggestions on how to make it last longer? thanks

Answer:

it should last a few months, if they inject it too deeply it will last less time, also it depends on the fillers, maybe use Perlane or Juvederm Ultra Plus. JG 9.7.12

Question:

I had filler done under my eye. However on one side I think he must`ve hit a blood vessel because the whole underneath of my eye is very dark purple and reddish. I look very bruised. Anything I can do that make it go away faster? How long will something like that last?

Answer:

I might suggest warm moist heat, and some bromelain and arnica montana from the health food store.It might last 7-10 days in some case. all the best. JG 9.7.12

Question:

Good day, I was wondering what you think of the permanent filler for lips. For the non-permanent fillier, do you recommend Restylane or Juvederm? As to bruising, is it the lips themselves that get bruised or is it the skin above the lips (or sides of the mouth)? Thank you.

Answer:

I would never ever use a permanent filler in the lips. As for the non-permanent, ones, I use both Restylane and Juvederm. Depends on what part of the lip I need to augment. The bruise can happen anywhere the the needle is placed, in the pi or in the skin. JG 9.6.12

Question:

hello, upper teeth still arent showing with smile as mentioned previously , do you think the many injections /fillers that I have done to the nasolabials in the last 2 yrs can weaken the area involved with a proper smile? just wondering if you think that doing fillers too much can weaken the orbicularis musles involved with a smile (and or showing upper teeth) thank you..

Answer:

I do not think fillers in the nasolabial fold will make your mouth muscles work less, no matter how much time you have had the injections done for. The fillers can only weaken it if it has caused pressure of some kind on the nerves.JG 9.6.12

Question:

I had filler yesterday under my eyes and upper lip. I believe it was restalyne. Anyways I am very bruised under 1 eye which I guess is common. However this morning I woke up and my lip is huge. I look like I have ducky lips. Is this normal swelling? Anything I can do to help it? How long will it last?

Answer:

Just ice for now, hopefully will get better in a couple of days. JG 9.6.12

Question:

hello, the upper teeth not showing when smiling after juvederm to nasolabial folds only AND NOT lips. As mentioned I had it done on WEd. and still today smiling no upper teeth showing.. at what point to I get concerned here? I do remember how very sore my upper gum was and could barely chew, and the injector went only to the nasolabials and skipped the lips totally except for the oral comisures. thankyou again. The nasolabials turned out not enlarged at all and perfectly symetrical withno bulging... just redness to one in particular. so I don`t think this is result of too much filler.

Answer:

I cannot see how a nerve could be injured, but I do think there could be some compression on the nerve that can cause that.I suggest seeing the person that injected you to check it out in person. Worst comes to worst, you can have the filler dissolved, as that will be fast and if it is pressure from the filler, it would be relieved in a day or so. Not sure what else it could be, sorry. JG 9.4.12

Question:

Hello, on Wed. had juvederm to bilateral nasolabial folds , NOTHING to the lips, and only bottom oral commisures. When I smile my upper teeth aren`t showing. Will this resolve? and is this inflammation.? thank you

Answer:

it is likely just some tenderness of the muscles of the upper lip that course below the skin in the nasolabial fold, that should get better soon. All the best. JG 9.2.12

Question:

Hi, Dr. Garcia. How long after HA is injected is it still mold-able ? I was injected yesterday and it`s a bit lumpy. I`m trying to massage it down/smooth it out. Am I doing this in vain? If not, how much longer do I have? I hope you and your family are enjoying a lovely holiday weekend. Thank you for all your help!

Answer:

it really is not too moldable, I think at this point it might help some, especially if it is swelling rather than the true filler.There is not downside to massage, so just do it and see how it goes. Al the best. JG 9.2.12

Question:

hello Doctor, I had written you on Wed. that I had juvederm to nasolabial on Tuesday and left with horrible bruise... I used the warm compresses, and they may have been too warm and caused me to be very red on top of the bruise. I am using aquaphor and vitamin e. Anything else I can do,?? little blister like as well. taking advil too.. thank you so much in advance..

Answer:

ust leave it alone, nothing more than what you are doing, nature will win. JG 9.1.12,

Question:

Hello again Mr.Generous - I just had Jurederm injected in the lower lids and the corners of the mouth. The PS said it would last a year. Is this what you see in your patienst? As always, gratefully yours.

Answer:

corner of the mouth, 2-4 months, around the eyes 8-10 months is what I tell patients. All the best. JG 8.9.12

Question:

Hello i had juvederm put in my right nasolabial fold and near the outside of the nose diagonal to the right oral commisure. Being an expert long term patient of juverm and this injector who has always done it, I ended up with a black bruise,, as im sure a vein/artery was hit and what is so unusual is that my upper gum line is extremely sore. This has never happened to me.. Please advise on what to do... and also right nostril is in a lot of pain. I have been using warm compresses... anything else?

Answer:

I suggest warm moist heat to help dissolve the blood, it is the blood putting pressure on those small muscles that is causing your soreness, as the blood absorbs, it will get better. I wish you the best. JG 8.29.12

Question:

Dr. G. Do you recommend sculptra over Artefill? Thanks.

Answer:

no, but they are not interchangeable, they are used for different things. So it is not a matter of either or, sometimes it is OK it use both together and other times neither is a good choice. JG 8.27.12

Question:

Hello Dr. G, I bruise easily and when I had Restylane in the trough/undereye area, I was left with significant black eyes. The doctor stopped injection as he said he couldn`t see enough to continue around the bruises. Q: What should I take BEFORE any injection to minimize bruising, and what can I take after the injection to make the bruises last less than 2 weeks. Also, does icing the areas before and after the injection help with bruising? Thank you!

Answer:

before you can take arnica montana tablets and bromelain. Avoid aspirin containing products, vitamin E, omega 3 fish oils, all non-steroidal anti-inflammatories, essentially anything that can thin your blood. I would say to continue the arnica and bromleain until the bruises go away. I think the effect of ice before is small, but it won`t hurt. It is just a risk anytime a needle is introduced, and in that area, there are so many blood vessels, that even a small bruise becomes quite visible. All the best. JG 8.27.12

Question:

Hello and Happy Hump day ! What are all the areas of the face that you use Sculptra in? As always, thanks for being smart AND generous (and handsome)

Answer:

I have used it in the temples, the upper cheek, the lower cheek, the area right in front of the ear, the entire jawline, and on the chin. Thank you for the kind words, but I think I need to get you a referral for an eye doctor if you think I am handsome! JG 8.22.12

Question:

I have been having Cheeks filled with restalyn. I have very thin skin and very little fat. Dr wants to use per lane. I`m nervous it might feel lumpy or even show even if it is injected deep. Do I have a better chance of success with per lane or should I stick with restalyn. Thanks

Answer:

f they inject the Perlane deeper than the Restylane, it should be OK. JG 8.20.12

Question:

I had 2,400.00 of facial work done a week ago this past Saturday. I had some sculptra in the jowl area, not much though. I had restylane for tear trough area, and juvaderm in the nasal labial folds. Also had botox injections for forehead so I wouldn`t be able to frown and pull my eyebrows down, suppose to have given me a lifted brow, but didn`t. Actually makes me my eyes feel heavy. My face looked great when I left the office and eyes looked full and refreshed, and face looked full. Now the eyes don`t look full and face looks deflated and nasal labial folds actually looks worse. What happened? Is there anything I can do to make it better? Also, I keep reading about ulthera for browlifts with good results from dr`s. Is that something u would suggest to have done?

Answer:

I am not a fan of Ulthera as the procedure hurts to have done and likely will not last more than 6 months. There can also be associated fat loss. As to why you look different today, it could be swelling, and also the location where the Botox was injected,placement is very important in the use of neurotoxins. I might suggest letting everything dissolve or stop working and seek an evaluation by someone different for another opinion. I wish you the best. JG 8.20.12

Question:

Dr. G. Have you heard of Biopelle or Auriderm (post op gel)? I`ve heard they help improve duration of bruises better than Arnica. What are your thoughts? And if not, does taking Vitamin K help? Is it true that Vitamin K is only available by prescription? Thank you.

Answer:

That product is essentially Vitamin. Vitamin K is needed to make blood clot, but very few people have low Vitamin K. I think Vitamin K products before surgery or an injection in patients that have low Vitamin K levels in their blood might help, but not for those that have normal Vitamin K levels. The Vitamin K that is usually given to patients that have low levels is either injection or pill and is a prescription, but in creams at low doses, it has been able to be used, less effective as the dose is quite small.I do not use products such as that.

Question:

Hello Dr. G, I had Restylane in the trough of the eyes and wow ... I look like I got punched in the eyes. The Dr. also filled in a little of the 11 area (just above the inner eyebrow area). This area is now lumpy. When will the lumpiness get better? Will massage help. The Dr. told me that if I get the YAG 1640, it will help with the veins in the eye area. What are your thoughts?

Answer:

I would massage the 11`s and that should help. As to the bruising, it can happen, that skin is very thin, but it will get better. I feel using Arnica Montana and Bromelain, from the health food store, help the bruise resolve. As to the veins and the YAG, I think in general those veins are large enough that it is not effective, maybe for very small broken red vessels is about all. I wish you the best.JG 8.17.12

Question:

I have horizontal lines above my lip. My doctor uses beletero but only injects it into the border of the lip which he doesn`t think will help very much. Do you inject right under the line itself? Another doctor tried injecting juviderm in a vertical fashion but that didn`t work. Any thoughts? Thank you for your time.

Answer:

the fillers can be injected horizontally if needed, but I am afraid it will not last too long. Sorry. JG 8.15.12

Question:

Hello, Dr. Garcia. 2-3 times a year I do fillers in different parts of my face. Every time after these procedures I have a lot of bruising and swelling (may be because I have a thin and sensitive skin). In a couple of weeks I need to do touch ups, and again my skin has bruises after. I think I am doing bad things to my skin. My question is :Do fillers flush out with blood or they at least stay inside the skin? Does the skin on my face get any antiaging benefits from these injections or all what it`s getting just a damage from broken blood vessels? thank you.

Answer:

the filler will stay and not be flushed out. The skin does not get any age defying effects from fillers, except for Sculptra, as that creates new collagen material. Next time before the injections avoid all blood thinners, take some bromelain and arnica montana for 3 days before and for at least 3-5 days after, use ice as soon as you can after the injections. 2-4 times per day after the injections for 2-3 days. I wish you the best. JG 8.14.12

Question:

Hi Gr. Garcia, recently you told me that to treat the little lipstick lines above the lip that a 40% TCA a peel would last about 6 months? In that case would it not be better to just try a filler? Seems less invasive.

Answer:

totally agree, that is why I do not offer a TCA peel for perioral wrinkles. JG 8.9.12

Question:

Hi Dr. Garcia, How often does hyluronidase work to even out Juvederm under the eyes from over-fill? I`ve heard many times that it creates more of a problem with pockets, as the hyluronidase cannot not pick and choose where it dissolves the Juvederm. Also, can too much Juvederm leave a blue cast under the skin? My problem is I have too much product in my tear trough, a leftover blue hue and a bit of a shelf where the product is not meshing with my cheekbone. It`s been 11 days since the last try to correct the problem and 3 trys in all. I`m exasperated at this point...What are all my options? Thank you.

Answer:

hyaluronidase cannot pick in chose between the naturally existing hyaluronic acid and the injected HA, that is correct. HA is in a constant cycle in the body of formation and degradation, the process becomes less efficient with age. I have not seen any permanent loss when using hyaluronidase to a level of greater loss than existed prior to the injection of the filler. I have not seen it not work to dissolve the HA if it was a true HA used by the injector. If the Juvederm is injected in too superficial of a location, it can cause a bluish hue, it is called a Tyndall effect, from the light reflecting off of the filler in the skin. In time it dissolves, although slower than when injected more deeply. I can only suggest using a different doctor for the dissolving as the material should work if properly placed in order to dissolve it, if used at the correct strength. I wish you the best. JG 7.30.12

Question:

I recently had a series of sculptura injections to attempt to soften my nasal labial folds. Well, it did not turn out as anticipated. The doctor pumped so much sculptura into mu left fold that are that I now a large ridge and a lump on one of my face. To me I look deformed. He did put more on one than the other and that is why it is only one side, thank goodness. The (2) sides are quite visibly different. It has caused me so much grief and depression; I wish I had left my face alone. In any case, I have read many blogs and discussion since then looking for a potential solution. I am realizing there isn’t one except to may wait until it’s gone. I am currently at 1 year and it’s bigger than ever. I also learned through blogs, yours included, that he probably should’ve restored the volume in my cheeks instead of focusing so much on my nasal fold. I have (2) questions – will my face return to normal eventually or will I always have some residual & if I add volume to my cheeks, which I now know was the problem in the 1st place, will it offset the nasal labial fullness. Please, any advice would be appreciated.

Answer:

I think in time all of the growth from the Sculptra will go away, entirely. It is hard to say whether filling the cheek up will change much on the nasolabial fold without seeing you, but I would conjecture to say that if the cheeks did need plumping, better to have that look better and let the other go away slowly. At leas that way, one thing will look better and might distract from what is bothering you at present. JG 7.25.12

Question:

Hello Dr. For the undereye area, generally, how much Restylane is needed? I know it varies by individuals but a Dr.`s office is offering $579 for 2 cc of Restylane. If this doctor is as skillful as the one I usually go to, is this a good price? My regular doctor has a special for $450 (with a purchase of 2 syringes). How much is in a syringe? 1 cc? Thank you for all you do for us.

Answer:

every patient is different, some take less than 1cc for both, so more. I must say that it is real Restylane, that is a very good price for a doctor injector. The syringe has 1cc or 1 milliliter.JG 7.24.12

Question:

Thank you for that answer. Very helpful. If artefill, is white in color, how can injectors say it`s a natural looking filler? If it is injected deep enough does the white now show through the skin? Would the artefill not show in the approved injected area,the Nasolabial folds? Is it just because it was infected in an non indicated area, the chin? All I know, is that white blotch showing under the skin is not natural looking at all...Also, is the blood supply limited where the artefill is injeted? It seems as though it takes longer for the skin to heal where the artefill has been injected. I think cutting in this area would leave a big scar due to this. I had laser treatments to try to remove the white line, recommended by the dermatologist, and the affects of the laser took a long time to heal.

Answer:

injectors will say whatever they want to push a product, there are no controls over that type of marketing.When properly injected it should not show, like in the nasolabial fold area.I think your issue is one of the incorrect filler for the area you desired improved.The blood supply should not be affected by the filler unless it was injected into a vein or artery which is very rare. There is no way a laser will dissolve the white material.JG 7.24.12

Question:

Dr. Garcia, I had artefill injections in my chin area. In certain lighting, it appears as though I can actually see the artifill under the layer of skin, it is white in color. I also have a zig-zag shaped line down the middle of my chin and is also white in color. It almost looks like a scar of some sorts. I also see, and feel, small bumps that have a very rutty uneven skin tone. I believe that is due to the artefil granulating. I would like to know why there is the white line, and why does the white coloring show through my skin? (especially in bright lighting).. Was it injected incorrectly? I have never heard of it actually showing through the skin. I was told it would look natural! Being concerned, I went to the dermatologist office that injected it, and she (the doctor) suggested cutting it out. She thinks that would remove the white color and lump. However, she has never done this before. Would you suggest letting her do this or go to someone experienced with this?

Answer:

the white line might be that the Artefill granules have moved due to the function of the muscle and they have coalesced into that shape. The line appears white because the granules and the filler is that color. It is possible that it was injected too superficially and that has caused the problem. If you go on to develop granulomas around the Artefill, they might very well have to be cut out to correct the problem. Injections and lasers will not help. Before I let her cut it out, I think having her make a puncture wound over the white line and see if the material can be squeezed out is something I would try. Cutting it out might leave visible scars that are just as bad or worse than what you started off with. I might suggest seeing someone who has more experience with surgery though. I wish you the best. JG 7.23.12

Question:

Hello Dr., This is a follow up Q. Do you recommend Juvederm or Restylane for the undereye? What are some of the side effects I should expect? Also, do you also NOT recommend fat transfer? Thank you!

Answer:

I prefer Restylane, the side effects are temporary bruising, incomplete correction of the problem, over correction of the problem, Risk of bruising can be decreased by avoiding blood thinning agents before the injections, the under correction can be fixed by placing more filler at a different time. The over correction is rare and it can be treated by dissolving the filler. I do not recommend fat as a filler around the eye, correct. I feel the chances of bruising are greater, the swelling lasts a long time, the predictability is poor and removing over correction can be difficult. JG 7.23.12

Question:

Good morning, Dr. G, For the lower, inner eye area, you don`t recommend Artefill. Would you recommend Sculptra? Which of the longer lasting filler(s) would you recommend, if I don`t want to have to go through the process every few months, not just with the cost but with the swelling and bruising. Thank you so much.

Answer:

I would not recommend any long lasting fillers, especially not Artefill, Sculptra or Radiesse. In my experience the hyaluronic acid fillers there last 8-10 months. JG 7.23.12

Question:

I have fine lines all around my mouth that form whenever I purse my lips. Filler hasn`t helped. Do you ever use a small amount of botox? I`m only 56 and I`m feeling overwhelmed and depressed. Thanks so much.

Answer:

I would never use Botox myself, in that area, but some doctors do use it, I am afraid of weakness of the lips that make you drool and affect your speech. JG 7.23.12

Question:

hi my name is maria i turn 38 ive taken good care of my skin however im starting too see age spot by the corner top of my cheek what would be the best derma filler.

Answer:

age spots are not helped by fillers. JG 7.23.12

Question:

i hate my vertical lip lines but don`t want to laser them. do you have any other suggestions. i do not want to have the lines look wavy and don`t want a fatter lip so am i stuck?? Thanks!

Answer:

Prevelle is a thin filler that can help short term. JG 7.20.12

Question:

Hi Dr. I went in for Botox today, and the doctor suggested Artefill for the eye area (as well as touch ups in the cheek and mouth areas). He showed me pictures (from iPad) of patients with injections in eye areas and the results look truly impressive. I am unhappy with my eye areas because they always make me look tired, puffy, hollow, you name it. What are your thoughts on Artefill for the eye area? I don`t want to go with Restylane, etc. as they don`t last long, I find the shots painful and, since I usually end up with bruises, I would like an alternative that lasts longer than a 3-4 months (on me). Thank you!

Answer:

I strongly suggest not using Artefill near the eye due to chance of permanent lumps, just like around the lips. JG 7.19.12

Question:

Hi Dr! Is it possible to have fat transfer to the chest area. I have a very boney chest and really need to plump up this area.. Thank you

Answer:

It can be done, it likely will take more than one session and survivability is still somewhat unreliable. JG 7.18.12

Question:

Hello Dr, Would fat transfer to a thin crepey neck be advisable or fillers? Thank you

Answer:

my preference is to use Sculptra for that. JG 7.9.12

Question:

Hola Dr Garcia, I trust you are well. It is so re-assuring to know that you are so kind and at hand to answer people`s questions. I had cheek implants (large medpor) which got taken out to due to an infection, replaced last year with medium ePTFE coated silicon implants, they now look a lot better but unfortunatley as my skin stretched so much with infection, swelling etc this caused my skin on my cheeks to swell considerably which meant that I have beeen left with slight laxity in my cheek area while the medium implant doesn`t quite lift the skin where the skin has stretched as my new implants are smaller in size. I am in my early 30s but would like to get some sort of non surgical procedure that will help tighten my cheek area where it has sagged slightly. I have tried fillers for the nasolabial area which only lasted a few weeks so I would ideally prefer something long lasting. What would you recommend that would yield good results. Also, I would like to get fillers for my under eye area as I believe they last longer for tear trough but as my cheek implants come up quite high on my face (under my orbital area) I am scared to get fillers done as I feel if the implant gets injected it could cause an infection? Is this true? Thank you so much for your time and advice.

Answer:

the risks of filler near the eye in view of the implant are small. I think it would be fine to proceed with a filler such as Restylane to that area at any time. As to what I would suggest in order to take up some of the loose skin, I think Sculptra injections, possibly 2-3 vials might give you the fullness you lost and can be injected into areas where implants would not correct. I am sorry to hear about the problems. I wish you the best. J 7.8.12

Question:

Hi - I had vitrase injected to remove excess Restyllane. I now have a dent in the area where it worked too well. How long should I wait to have more filler injected (more conservately this time of course)? thanks!

Answer:

you can have it refilled after 5-7 days. JG 7.5.12

Question:

Hello, Dr. Garcia. I asked you about permanent makup after juvederm. So I did juvederm in cheek-bones. It was no swelling,and in 2 days after,I did permanent eyeliner makeup(on upper eyelid). I had a terrible swelling under eyes. It`s 3 days after. I have less swelling, but it looks like swelling vertical lines under my eyes. Will it go away? Will juvederm stay on it`s place? and will be the same way like it was before that makeup? Thank you very much.

Answer:

should go away with time, yes. The swelling will not make the Juvederm move. Once the swelling goes down it will go back to the way it was. JG 7.2.12

Question:

Dr. Garcia. I did juvederm in my cheeck-bone. How long to wait before to do permanent eyeliner makeup? Thank you.

Answer:

just a few days is all. JG 7.2.12

Question:

I like what Sculptra does to the texture of my skin as well as to the volume. I don`t need more volume in my mid-cheeks, but I would like to improve the texture there Can my surgeon inject a highly diluted amount of Sculptra into the skin itself rather than into the dermis of my cheeks to improve the texture without risking either puffiness or granulomas?

Answer:

It can be done buy I think the risk of lumps is still pretty high.I would not try it. JG 6.27.12

Question:

Hi, D Dr. Garcia. Welcome back! I hope you were on a vacation rather than working last week. Two questions for you today : 1) If Sculptra takes 5-6 months to reach its full benefit, and if it starts eroding at 12 months (my plastic surgeon insists that the promise of “up to”18-24 months is, in his experience, mostly a marketing ploy), then one can expect only about 6-7 months of maximum benefit. Is that right? If that’s the case, then is it only about as long-lasting as traditional HA fillers that don’t promote collagen growth as Sculptra does? I know that the two products aren’t comparable in how they work (one masks a soft tissue deficit while the other stimulates collagen), but in how they actually appear in the face, do they turn out to be about equal in terms of how long they really last? 2) Do glucosamine supplements really work – that is, do they relieve joint pain from arthritis or is this just another case of the placebo effect? I have a stiff hip but don’t want to throw my money away. Thank you so much, as ever!

Answer:

Yes, it was a vacation, thanks. The length of duration varies, the younger the patient is and the slower they are seeing the aging process the longer it will last. In my experience, I use the Sculptra to the point the patient is please, sometimes one or two vials. Then I tell them to come back at one year for a new vial so the new one grows while the olde stuff dissolves. I think it is superior to the HA as when injected into the same level as Sculptra, which is below the skin and not in the skin, the HA`s last only weeks. Sculptra is not meant to rival HA fillers as those fillers are for direct skin injections where the Sculptra is meant for fat loss. Totally different indications, they are not interchangeable. Glucosamine supplements help in many patients, but not all, just like the prescription meds, all people vary in their response. It will not help stiff joints though.I wish you the best. JG 6.27.12

Question:

my dr wants to dilute restalyne to fill in vertical lip lines. Sound reasonabler. Cannot stand seeing those wavy lines. thanks

Answer:

I think it will make little difference compared to the non-diluted filler, it does not change the size of the filler molecule. JG 6.27.12

Question:

Hi, I had restylane about 4 mos ago to tear trough area. The left side looks fine but the right looks over-corrected with puffiness under eye. I am scheduled to get this dissolved. What are the side effects or risks from getting this injection? Will all the filler be dissolved or can the dose of the dissolving agent be adjusted so that only the excess is dissolved? Thank you for your help.

Answer:

during the dissolving injections there can be some bruising from the needle that is required, and then once it has finished dissolving the filler, as there is no control what percentage of filler is dissolved, you would need more filler once again in the tear trough. It cannot be controlled to just remove the excess and nothing more. All the best. JG 6.27.12

Question:

Hello Dr. When does one usually see the best/most realistic result after filling n/l and frown lines on corner of mouth with Radiesse? I see quite a bit of swelling that has gone down today, but in some lighting I notice that it is as if nothing has changed except the slight swelling near the downturns of the mouth.

Answer:

well, the swelling should be gone in less than a week, so by that time, you should see the end result. Lighting always affects the visibility of wrinkles and one cannot eliminate all wrinkles or folds in all directions of lighting. JG 6.15.12

Question:

the lip plumper you sell interests me but i have tried several which give minimal plump. Does yours have something special in it to really make a fuller less wrinled lip? thanks

Answer:

the effect is mild and lasts a few hours at most, the desire to replace injectable fillers with a topical agent is not possible. I think mien is better than those sold OTC, but again, it is not the same effect as injections. JG 6.15.12

Question:

whats your opinion of oral arnica pre and post filler for a hx of bruising from procedures thanks

Answer:

I think it does help, along with the gel in addition. JG 6.15.12

Question:

Well, I did it....Got some Radiesse to the nasolabial area and the marrionette lines. Injector thought 2 syringes would be almost perfect, with a bit left over, but I (being over-cautious and watching the budget) opted for only one. Immediate results (with some very mild swelling) were perfect. Now, I wonder if a lot of the perfect was due to swelling. I must say, there is no bruising and she did massage the areas quite a bit. I feel like already, it looks different than 2 hours ago, but still much improved. Do you feel one vial for both sides is really too little product and most of my initial loomwas due to swelling?

Answer:

Hard to say how much you would need without seeing you before, but always best to get more as a second injection rather than having too much put in. JG 6.14.12

Question:

Once,when I had botox for forehead lines, I had a ridge all way across, right above my eyebrows. Can anything be done when injections are done to prevent this? Thank you

Answer:

the ridge might have been from a large amount of Botox being injected into the horizontal wrinkles, leaving the frontalis muscle weakened and therefore allowing the skin to fall down and cause what can look like a ridge. Short of injecting less Botox to lessen the degree of muscle weakness, there is not much more that can be done if one is only using Botox injections for the wrinkles, otherwise it is surgery or lasers. JG 6.14.12

Question:

Dr. Garcia, a couple days ago I had a sculptra injections. PS said I`ll see result in about 2 months. Do I need to have a couple session? And can I do juvederm injections on a top of sculptra to see result right away? Thank you.

Answer:

OK to use Juvederm on top for an immediate response and I have found that although you can see early signs of what the Sculptra will do in about 2 months, it takes 4-6 months to get to the full extent of growth of the Sculptra. JG 6.15.12

Question:

Dr. Garcia, a couple days ago I had a sculptra injections. PS said I`ll see result in about 2 months. Do I need to have a couple session? And can I do juvederm injections on a top of sculptra to see result right away? Thank you.

Answer:

Juvederm will give an immediate result, but only hides problems where Sculptra takes time to grow but creates new collagen. I think final results from the Sculptra take 4-6 months, but most patients see the begining of growth at 4-6 weeks and if you desire a larger correction, more Sculptra could be done now but it will take time to grow once again. JG 6.14.12

Question:

Will a spot dermabrasion get rid of some bluish color from hyaluronic acid fillers? It`s been over a year since filler was injected.

Answer:

no, sorry, it will not. JG 6.14.12

Question:

what filler can be used for vertical lip lines that won`t make the area look wavy or the lip full. i hate that fake lip look and i hate these lines but don`t want to laser. Thanks

Answer:

Prevelle, Restylane Fine Line or Boletero once it is available. JG 6.13.12

Question:

My plastic surgeon who i think does beautiful work wants to put restalyne(i only use fillers that can be removed) in the preauricular and temple area to pull the face so sides won`t appear so sunken. Have you ever done this and what is your opinion? thanks

Answer:

Yes, but Restylane will not last very long in those areas, few months or so. JG 6.13.12

Question:

Hi again Dear Dr. Is Perlane advised for the smile lines and slight marrionette lines? My injector said she can either use Juvederm Ultra, Radiesse, or Perlane. She gave me literature on all. Right now, the PerLane is looking like a good option, but which would you use?

Answer:

We actually use all three, but Perlane is my preference. JG 6.12.12

Question:

Hello Dr, Would Sculptra be advisable for the neck area where the skin is thin and crepey but not very loose? Thank you

Answer:

nothing dramatic thee with Sculptra I am afraid. JG 6.11.12

Question:

Hi, Dr. Garcia. I`m in my 50`s and have lost enough subcutaneous fat in the my shins that they are now bony. My plastic surgeon uses Sculptra (diluted far more than for my lower face) to treat my forehead. Can it be used on the shins (again, very diluted because the skin is thin) to the same effect?

Answer:

Worth a try as there is not much else. JG .6.9.12

Question:

Hi again Dr., when I see myself in the mirror, I notice shadows (tear trough area, and smile lines), when considering fillers are these the most obvious places that should be filled?

Answer:

those are the two most common areas where fillers are used for the tired appearance, yes. I think the tear troughs are more related to looking tired and the smile liens to looking sad. JG 6.8.12

Question:

I am 41 and received juvaderm injections under my eyes 3 months ago. I have a thin face and I believe too much was injected. My entire face is puffy looking. I have lumps under my eyes that are getting somewhat better, but now I have loose skin around my mouth maybe from the excess volume in the upper part of my face. Will I likely be left with loose stretched out skin after the juvaderm dissolves or will it possibly get better with more time? It seems like it is already starting to dissolve some how long will it take?

Answer:

It should all shrink down with a couple of weeks after the filler is gone. JG 6.7.12

Question:

My friend recently did some injectibles around the smile lines/marrionette lines and I think the upper lip area. It has been a week, and she looks bloated, almost like a planet of the apes look. I am terrified because I have scheduled the same area fillers....thankfully, with a different MedSpa. Please tell me what causes this....injector skills, product, or patient insistence to get more than they really need.

Answer:

injector skill and patient insistence are the most common causes of that look. They can show you how the injections are going in the mirror during the procedure so you can tell them when to stop. JG 6.6.12

Question:

if i had a touch of widase to get rid of a small lump of restalyne under my eye yesterday when can i have it refilled?

Answer:

I would give it at least two weeks. JG 6.6.12

Question:

Dr. Garcia, I am about a week away from getting some injectible fillers. I would really like to do what is most effective...in other words the less is more approach. My pocketbook allows either fixing the slight bags under eyes or fixing the beginning of some marionette lines. One makes me look tired, the other stern/angry. Some Botox will be done to lift corners of brows in addition. So which would you recommend would give me the most for my money....fixing lower lids or fixing marrionette lines?

Answer:

the lower eyes. JG 6.4.12

Question:

Hi there. I was wondering if you have heard of the vampire lift and if you have what is your opinion on it. Thank you!

Answer:

yes I have, and I feel it is a waste of money. JG 6.3.12

Question:

Thanks for your reply about Belotero. As I understand it, it`s a robust but thin HA that may blend even more seamlessly than Restalyne for difficult areas like tear troughs. Is that correct? Even though my plastic surgeon is a great injector, sometimes, the Restalyne ends leaving my eyes looking puffy. Does Belotero promise to be a better product for this kind of problem? Also, I avoid anti-coagulants before injection or any kind of procedure, but how long after injections or procedures should one wait to resume them? I hate to skip fish oil supplements longer than I need to. Thank you, Dr. Garcia. Hope you`re having a great weekend.

Answer:

You can resume the supplements the day after. As to the puffyness after the filler, that is more technique related rather than the product used. I think Beletero might be easier to inject, hard to say Iifit will last as long as Restylane though. JG 6.2.12

Question:

I do not necessarily have marrionette lines, but am noticing a slight downward droop on the corners of the mouth. It gives me a sad and somber appearance, very evident in pictures. What would be your choice of treatment for this?

Answer:

Fillets like Restylane is likely a good option at this point. JG 6.2.12

Question:

If a crystal from sculptra gets in the ear can this cause labyrinthits?

Answer:

I cannot see how that could move into the inner ear to cause that, labyrinthitis is usually a viral problem. JG 6.2.12

Question:

What are your thoughts on Belotero?

Answer:

anxious to use it once widely available here in the US. JG 6.1.12

Question:

I am thinking of having a bit of cheek filler done. I have gathered from your expertise that it can hide eye bags, as well as maybe pulling up the smile lines a bit. I know you use Scuptra, but I inquired and it is quite costly. What other filler is good for this area?

Answer:

I only use Sculptra for the cheek itself and for the rim of the eye to hide the puffy lower eyelids I use Restylane. JG 6.1.12

Question:

Would you say it would be more prudent to to use filler under the eyes for small bags, or spend a little more $ to do the frown lines, and some Botox for outer brow lift. I can`t really determine what is causing the sad, serious look. Sometimes, I think the eye bags are the root of all evil . The nurse seemed to think frown lines, and drooping outer brows.

Answer:

For looking tired the filler for the lower eyes is usury the best, for sad,use the Botox in the glabella and upper crows feet but not the mid forehead. JG 5.30.12

Question:

Dr. Garcia, supposing the FDA requires that Botox vials not be split , what happens to the unused portion. Last year, I went to a very well respected PS to attempt a bit a brow lift and walked away with. $500 cost, and I must say the lift was very minimal at best. This year I have been to 2 nurse injectors who both said I would not need more than 20 units and both said they would never inject the lower portion of the eye (which the PS did).At 9.99 per unit, I calculate $200. Can they use a portion, and then save it for the same patient, or do you think they are using it against FDA regulations?

Answer:

the Botox will only be good for 4 hours after mixing, so it cannot be saved.The bottle and the package insert clearly says single patient, single use, so if they are sharing, they are breaking the rules and potentially exposing you to cross contamination from another patient. JG 5.30.12

Question:

Dr.Garcia, is it possible for sculptra to set of an autoimmune reaction in your body?

Answer:

Have not heard or read if it happening, if there even a remote chance, they would require allergy testing. The material has been in use in surgery for many years. JG 5.29.12

Question:

i cannot have botox becauseof graves disease. venus machine was suggested to lift eyebrow. What is your opinion? thanks so much!

Answer:

honestly, unimpressed. JG 5.28.12

Question:

Is there any chance that the fluid from the sculptra dissolving could get in the ear? I am so worried about my sudden left ear problem. Thank you for taking the time to reply to me again. Fiona.

Answer:

Anatomically impossible. JG 5.28.12

Question:

I have been recommended by 2 separate injectors Perlane for the smile/marionette areas. When asked why would they use this, both responded that it is a longer lasting filler - almost 9 months to a year. I see some posts saying it lasts only 4 -5 months. What`s the real story on Perlane?

Answer:

it can last up to one year, in some individuals, and in fact the filler might last that long, but it is the correction that will not last past that, no matter what filler is used, as the filler does not stop the aging process which is what is allowing the tissues of the cheek to fall, creating the marionette and smile line. A permanent filler NEVER means a permanent correction.JG 5.28.12

Question:

Hi Dr. I hope you are well :)....I tried Perlane in my upper cheeks, on the bone, like by the zygomatic bone to enhance cheeks...I really liked it but it only lasted about 4 months...they want to use Raidesse for longer results, but I see you do not recommend that u recommend Sculptra....what other product would you recommend besides Sculptra?? Are there any like Perlane that last longer with no bad effects that you would approve of for that area??? I appreciate any advice :)

Answer:

In the US, that is the only product I would use and the Radiesse will last about the same as the Perlane. Sorry, wish we had some of the ones they have in Europe, but we don`t. JG 5.28.12

Question:

Dr., thank you for your quick responses to so many questions. I feel like I am quite educated and not going blindly into these consults. I am going today again to see about correcting smile and slight marionette lines. In a previous post you said that sometimes filler in the cheeks will address this, as well as helping the lower lids. This seems like a great idea to me. Does it take more product to achieve this, and what filler should be used?

Answer:

Not more filler, but a different filler in some cases, for the cheeks I use Sculptra, and for the dark line at the edge of the lower lid I usually use Restylane. All the best. JG 5.22.12

Question:

Hi Dr., I`ve had two consults for the marrionette lines and smile lines. One by an MD/plastic surgeon who said she would do 2 things to correct my serious appearance 1) some Botox to lift the outer brows, and 2.) Perlane for the smile, and marionette lines. Consult with Nurse said nothing really to correct with Botox since I have no furloughs or 11 and not much lift it will give brow, and only Radiesse for marionette and smile lines. Why is one so different from the otherr? Hard to make a wise choice. Prices of course are considerably higher with the dr.

Answer:

well, it all depends on their perception of what you need and there is no one single right answer, although there are wrong choices at times. Without seeing pictures of you, it is hard to say what I might suggest. I would talk to them and ask them why they are saying to do what they want to do, if they will not answer or it is an answer that does not make any sense, seek out someone else to care for you. JG 5.21.12

Question:

Hi Dr., I`ve had two consults for the marrionette lines and smile lines. One by an MD/plastic surgeon who said she would do 2 things to correct my serious appearance 1) some Botox to lift the outer brows, and 2.) Perlane for the smile, and marionette lines. Consult with Nurse said nothing really to correct with Botox since I have no furloughs or 11 and not much lift it will give brow, and only Radiesse for marionette and smile lines. Why is one so different from the otherr? Hard to make a wise choice. Prices of course are considerably higher with the dr.

Answer:

it is because there is no consensus on the proper option choice. Also, what one person sees as a problem, another might not, therefore one person may suggest more than another. I think it is certainly understandable to be confused and I think they should explain why they want to do what they say. if they are unwilling to explain the reasons why to you, find a different injector. Best of luck. JG 5.21.12

Question:

Hello Dr. I bruise easily but am confused about what Arnica to buy. There are a number of options, but it is confusing. Which is the strongest dose, how many tablets to take daily, how far in advance of a procedure they should be taken, and for how long after a procedure? Thank you as always for your guidance.

Answer:

for that just use the 6x,no need for more than that,4 tablets, under your tongue 4 times per day. I suggest taking it until the bruising is gone, and we like to start ti 3 days before any procedure or injection. JG 5.16.12

Question:

If it is illegal to use Botox and split it, so you really only pay for what you need, how do so many MedSpas get away with it. I recently saw a nurse injector at a MedSpa and she quoted me 200 for Botox. I know the entire vial is somewhere around 500. How do they do this, is this not actually regulated and enforced?

Answer:

they are breaking the law, it has been going on since Botox was released. Many states do not enforce issues unless someone reports the people doing it.There is a lawsuit that has been filed in California to try to get it enforced and to get the reps that work for the company to tell people that it is wrong. JG 5.14.12

Question:

Hi Dr., I have a consult tomorrow to inquire about restalyne for very minimal/starting to see some marionette lines. I was told the cost of the syringe was on sale for 365. What if I don`t need the entire syringe? Is it approved to use only what is needed, or is it like Botox where it needs to be used in full?

Answer:

it can be stored for your use later, but not shared with other patients. JG 5.14.12

Question:

I have Dermalive in my NLF ..previously I have had Juvederm injected over this with no adverse effects. However, I do not wish to chance this anymore, is there something else i can inject or inject at a different place on the face to perhaps elevate this area. Thank you dr Garcia...Canadian girl...

Answer:

I think the hyaluronic acid fillers like Juvederm are the safest to use as they should not react with the Dermalive where as Artefill or Radiesse might cross react. JG 5.14.12

Question:

What would you say is the best filler for marionette lines which are pretty pronounced? I have a consult with a nurse this week and would like to have a little education before I go. Thanks for all your time.

Answer:

I think Restylane, Juvederm or Radiesse are all pretty similar for your area of concern. JG 5.13.12

Question:

i am interested in a filler for my lower face and know that sculptra is probably the best option but i hesitate to use a filler that cannot be removed. Are any of the hyaluronics ok for this area ? don`t want somethng that shows through my very thin skin. thanks

Answer:

the hyaluronics can be used to hide the fat loss but will not last very long as they are not made to be used that way, although they are safe to use. JG 5.11.12

Question:

have you ever heard of myotech--some sort of facial that plumps you up--sounds fishy to me but just curious--- thanks

Answer:

I have not heard of a machine from Myotech for facial enhancements, sorry. JG 5.10.12

Question:

sculptra question1. how common are granulomas and can one actually see a granuloma or just feel it beneath the skin? I really need it in lower face. I have heard it looks good that day and then sort of goes away and builds over time. Is that true? When will I see any permanent volume?? thanks!!!

Answer:

They are rare and they are usually just felt and not seen. It is a product that builds over 4-6 months, do not expect an immediate correction. The maximum growth is at 6 months. JG 5.10.12

Question:

Hello Dr, My skin has lost its plumpness on the lower part of my face underneath the cheekbones. What is the best filler for this area and also, would fat transfer be successful in this part of the face? thank you

Answer:

My preference is Sculptra. JG 5.10.12

Question:

Dr. Garcia, I have been contemplating a brow lift with Botox, but recently my family tells me that it is not so much the upper eyes which are causing me to look older/tired but rather the area under the eyes. I wish I had the $ for both, but must choose one or the other. I don`t really have bags under the eyes, just that kind of dark shadow in the tear trough area (not dark circles). What are your thoughts and what filler gives best result without looking bubbly .....thanks a million for your time!

Answer:

I think the filler for the lower eyes to get the tired appearance will last longer, about 8-10 months, and cost about the same where the Botox brow lift might last 3-4 months. All the best. JG 5.9.12

Question:

I had a little more restlyne added around the under area of my eye a week ago. When I left the office it looked perfect and I was very happy. About 4days later it looks horrible. It looks puffy and I have a new groove under my eye. How can I tell if it`s swelling or too much product? Is it possible the product could`ve moved?

Answer:

it is very very difficult for the product to move, but it does get slightly larger once the fluid gets absorbed into the filler. I would give it another week or so and I think it will likely improve. If not, go back to see the doctor to see if anything more needs to be done. Use a little ice in the meantime too along with a little mild massage for a minute or two twice per day. JG 5.9.12

Question:

Dr. Garcia, I have one spot on my cheek that has a depression. This started about 2 years ago. I continually to have that spot filled with radiesse, but it seems to persistently come back and I`m retouching it about every 2 months. I`ve had my frown lines filled with radiesse and only need to have those retouched about once a year.What causes this and is there any alternative that may be more effective. Thank you.

Answer:

fillers will last different amounts of time depending on how deep it is injected and the amount of motion in the location. You might want to consider some fat injections to the depression to lift it. If the depression is due to acne scarring or a laceration, it will be difficult to correct with fillers alone, no mater which filler you use. JG 5.9.12

Question:

I have gathered that it is safe to have a MRI with artefill in, correct? Even so with a 3t magnet? Also, I know that while having a head MRI, if the pt. has a lot of dental work, artifact can occur, which darkens and blurs the pictures. Is there enough metal in artefill(pmma)that it will cause serious distortions in a brain MRI images? Will artefill show up in the MRI brain images as a distinct finding, or only as artifact distortion?

Answer:

Yes, an MRI can be performed with Artefill in place.There should not be any problems with scatter from what I have seen or read. It should not influence the brain MRI. JG 5.9.12

Question:

My p.s. wants to inject belotero in lateral part of tear trough. the restalyne that i had injected there previously showed and i had it taken out. What is your opinion of bolotero in general and specifically for that thin skinned area? can it be removed as easily with wydase as restalyne? thanks so much

Answer:

it is thinner and might work better, it can be dissolved also if required. JG 5.8.12

Question:

So I too have some questions about fillers. My PS has been injecting a small amount of Juvederm for years in my lips and nl folds (1 ml for both areas about every 10 months). In the past three years as I`ve aged, we`ve added Sculptra to the temples and zygomatic arch/pre-auricular areas (about a total of 2 or 2.5 vials every 18 months), since I`ve begun to have some rather deep hollowing those areas. I don`t think it`s overdone at all -- he`s very conservative -- but I definitely do look a bit different. In the past week, two different acquaintances have asked me if I`m feeling OK. One asked if I was taking steroids because my face looks so swollen. The other wondered aloud if I should go to an emergency room in the event that I was have an idiopathic anaphylactic reaction. You look like you`ve been stung by a swarm of bees, she said. I`m guessing that if two people are TELLING me this, about 2,000 are THINKING it. My husband, PS and I don`t see it, but of course we see me all the time. I fear I have inadvertently become one of those women about whom people whisper. It makes me ill. I`m mortified. I`m writing to ask if you think that seems like an excessive amount of Sculptra. Also in your experience, are there any areas of the face that when injected (even conservatively) tend to result more than other areas in that terrible, swollen look? Anything I can do other than just let all the Sculptra go down and live with the deep hollows in the lateral aspects of my face? Or do you think the HA in the nl folds and lips is more likely the culprit here than the Sculptra? I`m pretty disheartened by all this. I never wanted to look like one of those scary celebrities who overdo things, just rested and more like my natural self. I`m so sad and now really self-conscious (not to mention out of a fair amount of money to look, apparently, freakish). Thanks so much, Dr. Garcia.

Answer:

things that can make another person feel the person is taking corticosteroids or is having an allergic reaction are a more rounded full face and swollen lips. If your friends had not seen you in a long time, they may interpret your changes to be more dramatic than those people who frequently see you. If your face is truly rounder from the Sculptra or your lips are larger due to the filler, some people might mistake if for an allergic reaction. I would let everything dissolve on its own, as to whether the Sculptra or the lip filler is the main cause, I am afraid that without asking them what they see that makes them think that, we might never know.I think you can likely continue with the treatments, just use less than you are using now. I wish you the best. JG 5.3.12

Question:

Hello Dr. Garcia, I have a question about fillers that I`m hoping you can address. If someone has fillers regularly around the mouth, jowels, etc., would the fillers over time stretch out the skin making it more saggy or wrinkly than it would have been had fillers never been used? I am concerned that if I use fillers for a few years then decide to stop, my skin may be worse off than if I never started. Your honest, professional opinion would be greatly appreciated. Thanks!

Answer:

the fillers are injected normally into skin that has deflated for lack of a better term. The intent of the filler is to plump it up to where it once was, not to overinflate it, so there is no risk of stretching the skin unless it is overdone. Fillers hide the aging though, and do not stop the changes of aging, so if you take pictures of yourself before starting fillers and use them for say 5 years and quit and take a picture of yourself after the fillers have worn off, you will look older. That is not because the filler sped the aging up, it is just that you continued to age while using the fillers but did not appreciate the changes as you were hiding them with the use of the filler. Hope that helps. JG 5.3.12

Question:

sorry to bother you again but will hylase do any damage to my lips will skin eventually recover and not look so pruned. been told if to much is put in can have a permanent effect on your bodys ha is this true this is not helping my stress. thanks

Answer:

It is quite safe, OK to use it when needed. JG 5.1.12

Question:

thanks for your answer could my swelling each morning be due to the fact that I had fillers put in 4 weeks later dissolving. and have had needles in my lips for the last 3 weeks each time one week apart. could this cause an swelling response and will get better once product is fully dissolved and no more needles are needed.plus I have been very stressed out by the whole process. I have been told to take periactin each night before bed. what do you think?? and thank you for taking the time to answer my question.

Answer:

Not sure the Periactin will help much, you just need to let things heal by leaving things alone. JG 5.1.12

Question:

had juverdurm in lips 8 weeks ago my top lip doubles in size every morning and then goes down through the day. have had hylase done filler is going away but swelling is the same every morning. have you seen this and what can I do? know one I have seen seems to know. it hurts every morning when they swell do you have any advise??

Answer:

I have never seen that happen, especially after the product has been dissolved. I really do not have anything to offer besides seeing an allergist, and making sure you apply no creams or salves to your lips at bedtime. JG 4.30.12

Question:

Hi Dr. Garcia, On March 17th I had Perlane injected to treat bags under my eyes, since I am very self conscious about this hereditary problem. While she was injecting I felt immediate numbness wash over the top part of my cheek down to my upper lip. Including and most obvious to me on my right upper canine tooth and the one right next to it. I have been back and they have injected me with some form of dissolving agent, but still I have no sensation on my right upper lip,or teeth (2). They injected 2 syringes into my cheeks, now one side is flat because it`s been dissolved. One side of my face is flat, the other is numb. Now the worst part of this has happened, one of the 2 numb teeth is losing color - turning the slightest tinge of gray. The first time I brought the numbness to their attention I had to stop them in the middle of what seemed like an interrogation to defend myself. They were much nicer after that, but now that I called about the discoloration the first thing I was told was, I thought you had gotten feeling back in your tooth? I said the only bit of feeling that has returned is on my upper cheek, I have been saying all along that I cannot feel my teeth or gums in that area. Anyway, do you have any recommendations? I am scared and too vain to gave a discolored tooth in the front of my mouth. I have an appointment with their medical director who is an actual plastic surgeon. Is there anything I should ask?

Answer:

The numbness can be from the needle hitting a nerve and the tooth discolorationhas to be from an injection into an artery feeding the tooth. I think you need to see a good dentist to make sure they can save the tooth. The numbness should wear off In time. Best of luck. JG 4.25.12

Question:

Thanks doctor for your Prompt response!!!! Also one more question can the doctor just dissolve just that one spot on the lip that is clear and very annoying or should I just have it all taken out: dissolved?

Answer:

just dissolve the spot. JG 4.24.12

Question:

Hello, I had juvedrem injected into my lips 3 weeks ago and 2 hours after the provedure I noticed I had developed a clear like blister looking lump on my lip! Went back to the doctor 1 week post injection and he said to leave it alone ! Well it has been 3 weeks and although it is smaller in size it is still visible and when I smile it looks even worse ! Actually i forgot to say that the dr never massage lips right after procedure either, was he suppose to! My question is what should I do , should I have it dissolved?? It`s making me sick, I don`t look right at all . It`s weird because the lump is not felt its just seen and it looks clear not blue so im unsure if it`s the filler or not? Please help !!!!!!!

Answer:

I believe it is filler. I think it is best to either get it dissolved or to see if the doctor can make a small puncture and push it out. Immediate massage at the time of injection may not have prevented what has occurred.JG 4.24.12

Question:

Dr. Garcia,do you work with Belotero? Is it good, what is better for the lips. Thank you.

Answer:

It has not been sold to doctors to use yet, buy looks promising. JG 4.22.12

Question:

Hello dr gacia, i was unforturnately very nieve when i got free silicon injected into my buttocks. It was done out the country 2 months ago . Now i have painful lumps . One that was surgically removed. I have found a doctor who says they can remove via laser lipo. Its this something that can be done.

Answer:

I seriously doubt It will work. It will make you lose fat and likely little to no effect on the silicone. Sorry. JG 4.21.12

Question:

sorry to be a pest regarding lips but if the restalyne went into an artery would i be having problems 4 days later --if there even are arteries around this area and not just small blood vessels thanks again

Answer:

It would be an immediate problem, with excruciating pain and skin loss. After 4 days, its not an artery. JG 4.20.12

Question:

follow up to restalyne in lines outside lip--the broken blood vessel were under lower not upper lip if that affects your answer.thanks so much

Answer:

Still the same. JG 4.20.12

Question:

had restalyne put inlines around lips but not really in lips. got some broken blood vessels-result is nice but one area was bumpy and i had it removed. Looking much better but want to know if an artery can be hit doing this and if 4 days post injection i would have symptoms if that happened.?

Answer:

arteries or nerves can be injured, that can cause swelling and bruising, but they are able to heal, so no permanent damage. JG 4.20.12

Question:

you just answered that you would not do the LPG/endormologie on the face to reduce sculptra fibrotic tissue...why not? I have massive fibrotic tissue on my cheeks and jawline which makes hard to smile. the skin is soo thick if I squeeze it together i have a lof of hard flesh within my fingers.

Answer:

I think there are not easily accessible heads to perform it and the device might cause broken blood vessels on the skin. JG 4.18.12

Question:

hello I am 35 years and had 1/4 vial in each side of the face (had prior sculptra injected 1 year ago 1 vial whole face, temples, neck, cheeks). Its almost 2 weeks now, the swelling went down 2 days ago, but today I woke up with a huge square puffy face. The bottom of my face looks wide, fat and square (strong jaw angles which I hadn`t prior to treatment) whcih gives me a very masculine older look. I liked the original shape of my face (heartshape with small chin)) and didnt want to add volume or change my jaw and faceshape, I just wanted to add volume to the sides to lift my cheeks and create a more youthfull and young look, now I look worse than before. It seems that the derm injected everything in the jawline which makes me look square. I always had a very strong collagen response to sculptra and could see increased skin thickness by 2 weeks continuingo growing for the next couple of months. Considering this I am very scared How I will look in 1 month. Could you let me know if the 1/4 vial could create and overfill ( taken in account that I had sculptra already in that area). What can I do to soften this square look without adding more volume to the face. Does botox help to soften jawline?

Answer:

I really do not see how that small of an amount of Sculptra could cause that in such a short period of time, it must be something else. Botox will only help decrease the jaw muscles, so it works only is a very small number of patients and is likely not something that will help in your case. I think you should go back to see your doctor that did the injections for a check up all the best. JG 4.15.12

Question:

I had Radiesse injected under my eyes by the cheekbone. The injected didn`t hurt at all, but the Dr said he needed to go deeper for better results. After the procedure, I instantly started swelling, puffy under my eyes and redness. No bruising at all. Placed ice for 2 days, still very swollen went to the Dr after 1 week of looking like I had severe allergies, he placed me on a steroid for 7 days. It did get better but still have bags, puffiness and redness under my eye that I never had before. Is there anything I can do?? Thanks so much for your help!!

Answer:

It does sounf like some type of allergic reaction and with the injection being placed deeply, it might take a bit more time. You need to be in close contact with your Doctor. JG 4.14.

Question:

I just saw recent pictures of Lindsy Lohan, and am appalled to such a young woman looking so injected and just plain weird. In the world of injectibles, is there such a thing as less is more ? I am considering some facial filler around the cheeks, but am terrified of this bizarre look. What would you say went wrong, and is there something one can do to avoid this happening?

Answer:

well, the too much filler look can easily be avoided. As the filler is being injected, the procedure can be stopped and the patient can look and decide in conjunction with the doctor, what area needs more and what areas are OK. As to what happened to Lindsay, I will venture to say that either she wanted it that way or her doctor did whatever he wanted, although I do not think a doctor would fill her that much and then have her tell people who did her work. That is a sure fire way to lose patients. JG 4.13.12

Question:

Happy Friday Dr. Garcia, I have a quick question. Any tips for resolving bruising quicker? My last sculptra treatment resulted in more bruising. Any thing to make them fade sooner? thank you.

Answer:

arnica montana gel and tablets from the health food store, along with bromelain, pineapple juice, warm moist heat and light massage. All the best. JG 4.13.12

Question:

I had filler put in under my eyes yesterday- I believe it was Restylane. It looked great when I left, but this morning I am very puffy underneath my eye. I would assume it is probably swelling. How long will this last and is there anything I can do to help it go away faster? I did ice for quite awhile yesterday when I got home.

Answer:

Keep the ice going, will be better in 3-5 days. JG 4.12.12

Question:

I had a 1/2 vial sculptra injected 9 days ago in the lateral cheeks and Jawline. Actually I wanted to lift the jawline and achieve a rounder youthfull look or shape, but now my face looks totally square with broad heavy jaw (very masculine). I do not know if my derm injected too much in in the jawline but the edges of my jaw are sticking out on the sides (bootom face is now wider than my cheeks bone), while my cheeks above the jaw look even more hollow. I do not like the way it makes me look (older and more masculine). Is this going to be the result? Will I even grow more around the jaw? can I do something to still remodel results ( inject saline to make sculptra spread away from jaw area) Please let me know I am really concerned

Answer:

I think at this point what you are seeing is the fluid that was used to mix the Sculptra has moved downward due to gravity and it will continue to move down in order for it to absorb. I do not think you will look like this long term, but it might take a few more days to look better, all depends on how much fluid was used for the dilution of the Sculptra. I see no benefit to injecting saline as it will cause more swelling. I would leave ti all be and let nature correct the temporary issues. I wish you the best. JG 4.12.12

Question:

Hi - I have a wellbox (endermoogie) unit that I used at home several days/week on body and face. I must say the sessions feel good and the results have been great. Anyway, I had restylane to the tear trough areas - can I continue to do the endermologie on my face? Will it affect or break down the restylane? Thank you.

Answer:

There is no research to say if there is any effect from the wellbox. JG 4.11.12

Question:

I had teosyal kiss and fortelis extra injected 3.5 years ago and he didnt do a good job and the filler migrated to the area above my lip (philtrum)area. I had hyaloronidase mixed wth steroid injected in the upper lip are and that caused a dent in the surrounding area. I believe after all this time i have scar tissue there causing an unevenness especislly if theres shade, if i purse my lips....how can i even out this areawthout using steroid injections? Will laser cause fat atrophy? How abt ultrasound treatment to break up the internal scar tissue? Please help...im scared of making it worse

Answer:

besides the kenalog, it might be having to cut the scar tissue out, but that has its own downsides. I do not think ultrasound will help, sorry. JG 4.11.12

Question:

I have tried Radiesse and Juvaderm for nasal folds and they are still noticeable, also it seems like the fillers moved causing the nasal folds to be even more noticeable at times and also causing fullness next to the nasal folds, it just does not look better and worse if anything, is there anything else that can be done? I had a cheek lift once already but that only worked for nasal folds for about a year...

Answer:

I am afraid that I have no other solutions if all that has failed.JG 4.10.12

Question:

Thank you Dr. Garcia for your answers. When can I do botox near the eyes and filler around the mouth and on the lips after neck lift? About creams on a neck, when can I start to use it after surgery. I appreciate your help very much, dear Doctor.Thank you.

Answer:

Cream OK after all sutures are out. Botox and fillets after 2 weeks . JG 4.10.12

Question:

Hi, I asked earlier today about juvederm and botox under my eyes. After the CO2 6 weeks ago, that area is even worse. You said that the Botox was most likely the cause of the bags under my eyes right now as the muscles have been weaken and perhaps that`s why the fat pad is puffing out. Would the weaken muscles under my eyes also be responsible for not being able to get rid of fluid retention after the laser? Just wondering and trying not to panic thinking this is permanent. The upsetting part is I went to a Board Certified Plastic Surgeon who teaches other doctors in our area how to inject Botox. Why would he not know better than to inject in the lower lid???

Answer:

yes, the muscles flex and help push fluid out, think of sitting in a car for a long time and your legs and ankles swelling, then you walk, the calf muscle squeezes the fluid out. I think the laser caused more fluid to be formed after the prior treatments and it added to the problem. I personally would not want to inject a muscle that I need to function. There are doctors with huge reputations that inject around the lips and eyes and claim wonderful results, but when on the rare occasion it goes bad, it is not them with the problem. Sometimes it is best to tell the patient the truth, that we can only make it a little better for a short period of time with safe reliable reproducible treatments but it cannot be totally erased. I would rather disappoint the patient before them choosing a procedure by telling them the limitations rather than have them disappointed afterwards.Hope that helps. JG 4.5.12

Question:

Hi Dr., I feel like as I approach 50 I`m noticing the aging process more than ever! I can`t do everything I`d like, but would like to know...given some slight marionette lines down thru to jaw, or some slight bagginess under the eyes which would you say will have the most effect to looking less aging . I do recall on an earlier post you explained filling the cheeks may decrease the marrionette look while elevating the cheeks...is this what you meant or did I misunderstand?

Answer:

That is what I meant, filling the cheeks can lift the sagging skin if the sagging skin is from loss of volume. In terms of what I might suggest for you, sight unseen, maybe Restylane for the nasolabial fold and marionette lines and/or Sculptra for your cheeks. Hope that helps. JG 4.5.12

Question:

I have the Tyndall effect (grey hue) after perlane injections 6 months ago. I have read on forums that sometimes this can be permanant and doesnt go away. Is this correct? I dont want the injection to disolve it as had a bad reaction to perlane and dont want any more upset. Have you ever known anyone have permanant blue/grey hue?. I am worried! Thank you for your time and for running such an informative service.

Answer:

I have never heard of it being permanent, but as it is superficial, it can take a long time. I have heard of some doctors making a puncture hole with a needle and trying to push some of the material out as the effect is there becasue it is too superficial. Just as an aside, Perlane is meant for deeper injections, it is not to be used interchangeably with Restylane which is made for more superficial injections. I wish you the best. JG 4.5.12

Question:

I am 37 yrs old. Had juvederm injected into tear trough area 41/2 months ago. The ps was very conservative (not sure exactly how much). 2 1/2 weeks later, he injected a little more and also a little into my cheeks along with Botox under the eyes. About 10 days later, I stated noticing a good bit of puffy areas. He said it was from the trauma of the injections. I has co2 laser around my eyes and mouth area 6 weeks ago which made the areas that were puffy even worse. He injected kenalog but it didn`t do anything. Finally, I insisted that we dissolve the juvederm bc I thought I was over injected. He diluted it and said he was only putting a little bc we could always come back and do a little more. . that was two days ago and we onky did it under my eyes. It has gone down a good bit but I still have little bags under my eyes. I`m not sure if this is still juvederm, inflamed tissue from the co2 or both. What should I do? Any treatment that you would recommend to reduce the bags and tighten up that under eye area?

Answer:

I think it is more likely due to the Botox injected to the lower lids. It is not approved by the FDA to be injected in that area, and when it is, it can weaken the muscle allowing there to have the appearance of swelling or even bags. There is nothing that can be done I am afraid except wait for the Botox to wear off. I seriously doubt it is the filler.I wish you the best. JG 4.5.12

Question:

hello, i have had juvederm done last month or two, ive had it many times to keep things maintained to the nsolabials and oral comisures and under the eye. my question is.. i recently lost about 6 lbs in a week due to familial crisis. is it possible that the juvederm absorbed/resorbed as im looking at my face and it seems to be not as full as a month ago when i had the juvederm.. i know a dramatic weightt loss in a period of a week of 6-7 lbs can make face less laxity.. just wondering ur thoughts.. as it doesnt appear since i lost this weight that the juvederm is still holding especially the area below the eye.

Answer:

the recent weight loss has made you lose your own tissues and you need more filler to get to the appearance you desire. Weight loss does not affect the speed of the filler dissolving. JG 4.2.12

Question:

hello just had juvederm ultra for nasolabial, which didnt need it since im 30, and jufverm to the oral comisures I had it done a month ago, and just i n last 5 days lost about 7 lbs due to medical history... i just had juverderm added a mont h ago.. is it possible for the product to reduce wit h loss of weight... >>>?? let me knw

Answer:

Not the product, but losing weight will lose fat in those areas so the fill appearance you had will require more to make up for the lost fat. JG 4.1.12

Question:

Thanks for your quick response re: my Juvederm `jowls`. If I do nothing, in your opinion, will the lumps eventually dissolve - will I have to wait much longer, and when it does happen, will it be gradual or quick? Thanks, Carrie

Answer:

They should have dissolved by now, so waiting will likely not get rid of the lumps. You will need hyaluronidase or have them cut out I am afraid. JG 3.20.12

Question:

Hi Dr. thanks for your answer, how many mm in thickness can i get with sculptra? because my temporal hollowing has about 7mm in full depression hollowness, also how long will this sculptra last and if it can fill out a 7mm hollow area, can you give me an idea of how much this will cost for both temporal sides? thanks

Answer:

The growth of Sculptra varies due to the patient variables, maybe 12-18 months. A guess would be about 4 vials at about $600 per vial. JG 3.20.12

Question:

Hi - had Juvederm injected a year ago in my marionette lines. The doctor overfilled, and basically gave me jowls! I did not want to dissolve it as I was advised my skin would be left baggy. I decided to wait for it to dissolve, but a year later it is still there. I have been offered Pelleve to tighten my skin and make it the lumps less obvious. Is there anything alse I can do - e.g massage? I am also worried that I have now produced my own collagen in this area, and that the lumps will be permanent. Is this possible? If not, when Juvederm does start to dissolve, it is quickly or gradual? Thanks so much for your advice! CArrie

Answer:

At this point the massage will not help and I am not a believer of the effects of Pelleve. I seriously doubt you have produced any collagen there but you certainly will have had more cheek skin laxity occur, making the marionette lines worse.If you have lumps this far out I would still try the hyaluronidase, it will not make your skin sag. All the best. JG 3.19.12

Question:

Dr. Garcia, Do Ipl treatments adversely affect fillers?how long should I wait in between? Thank you.

Answer:

really no effect but they can cause some small amount of swelling so best to do the filler first and then follow with the IPL if you are having them done the same day. JG 3.19.12

Question:

Hello Dr, do you know or have you ever heard of bone cements becoming infected?

Answer:

It is possible early on, but I think the more time since the surgery, the less the risk. JG 3.17.12

Question:

Hi Dr...I am considering maybe some cheek filler, but am so frightened of those golf ball cheeks I see on some women. I have always had high cheek bones which framed the eyes very nicely, but never had that apple cheek and I think this would make me look odd, and injected. Can a dr use less to just lift the cheek area or does FDA require full use of the syringe, like Botox?

Answer:

No, the amount used is up to you and the physician, there is no set minimum amount. JG 3.12.12

Question:

I have had fillers done around my eyes to help with the hollows. It did look great fro awhile but now that are suddenly looks well pronounced, like I have big bags under my eyes. I went to see a new plastic surgeon today to ask if he could do more fillers to soften the area. He said that he thought I had swelling and presrcibed medrol. Does that sound right to you? Can you have swelling occurs months after fillers. Thanks.

Answer:

I have not seen it occur months down the line, the Medrol will help if there is swelling, but usually that would have have happened much sooner. All I can say is to take the Medrol and see what happens for now. JG 2.29.12

Question:

Hello doctor, i had wide burn on my right cheek about six months ago. It got so hard and very hard and my doctor injected kenalog 40 inj. thrice. Now d scar is like a baloon as my skin has become so light. It has become so soft and raised. Wil it ever go down flat from its light baloon self and wil my skin ever regain its structure and texture. Pls help me.

Answer:

I suggest stopping the kenalog injections as the dose is too high. Might also suggest a YAG laser to slowly improve the scar. JG 2.25.12

Question:

Hello doctor, i had wide burn on my right cheek about six months ago. It got so hard and very hard and my doctor injected kenalog 40 inj. thrice. Now d scar is like a baloon as my skin has become so light. It has become so soft and raised. Wil it ever go down flat from its light baloon self and wil my skin ever regain its structure and texture. Pls help me.

Answer:

that is a very strong dose of kenalog. I might suggest no further injections and could consider a YAG laser to the scar to attempt to flatten it. JG 2.25.12

Question:

Thank you for responding about the juvederm towards the jawline so fast... Are you still under the assumption that heat helps to help diminish this pouchy result..? as ice I know seems to help inflammation and helps alleviate the pain, so do you rec ice or heat? ive been doing the heat but seems to make it more inflammed. im not massaging it either.. how are you feeling about that these days? its been years two maybe so want to make sure you still feel as you did years ago re how to diminish the pouch y effect after the juvederm injection =) thank yyou

Answer:

heat will help the tissue absorb swelling by drawing more blood supply to the area is all, it will not speed the dissolving of the filler itself. I do like massage too, again only works for swelling, it will not move the filler and likely will not make it dissolve any faster. All the best. JG 2.22.12

Question:

hello had juvederm as i have had so many times to the oral comisures which i really barely needed, but like to do it for preventive.. this time she went down diagonally from the comisure, down to the jawline i believe to balance everything out, and i understand, but now when i smile i really look like i have marionette lines from the corner of the bottom of the mouth all the way down. i have been using heat. i had this treatment on tuesday. i remember my injector (who has always done the best job) did this long ago to balance out the oral comissures by filling in the jawline diagonally inferior on each side and i hate d it when i smile.. and had to have hyraulindase to remove it. She evidently forgot that this bothers me to go all the way down to the bottom jaw line... the smiling looks horrible as creases.. im understanding her need to balance out the effect.. but wondering if it will resolve with heat or if i should pay another 140 to have hyraulindase added. why does the injector feel the need to go to the bottom of the jaw line when i just want the corner of the bottom of the mouth just filled a little?

Answer:

I would give it about 10-14 days and if it is still there, then proceed with the hyaluronidase. It might be a little bit of swelling this soon after. As to why the injector went so far down, that is actually a very good question as hyaluronic acid fillers cannot prevent the descent of the tissues that cause the folds to appear. JG 2.22.12

Question:

Hi Dr., I hope you are enjoying the long weekend, if you actually get today off! What are your thoughts for Artefill or Sculptra for the hands? Thank you.

Answer:

Still at work,patients take advantage of the holidays to come into the office. I think the Sculptra is likely safer, but the correction is not super dramatic though and does not last as long as it doe sin the face. JG 2.20.12

Question:

Hello Dr, i read you use sculptra in the neck area,How would that work and where would it be injected at?

Answer:

It is injected diffusly into the skin to create new collagen. JG 2.14.12

Question:

Hi Dr. G. How long does Artefill last? I was told Radiesse would last 12-18 months, and Restylane 6 months. Turns out Radiesse only lasts about 3 months for me. Thank you.

Answer:

Artefill is intended to last for years but it depends on what you are using it for. The filler might happen to last for years, but as it is not stopping the aging process, there are areas, such as a nasolabial fold, which will continue to age regardless of the filler employed and more filler will be needed in the future and eventually surgery. The length of time a filler lasts does not mean that the correction for which it was used will last the same amount of time. JG 2.13.12

Question:

Hi Dr. How long does Radiesse last? Do you use Sculptra to fill in the undereye area? My doctor says he uses a method that does not leave bump. Thank you.

Answer:

in my experience it lasts about as long as Juvederm or Restylane, so it depends on where you inject it, but on average 2-4 months or so. I do not use Sculptra for the tear trough as the skin there is thin and you can be left with lumps. I am sure your doctor is trying his best, so ask him how will he fix the problem with the lump if it occurs and just as importantly, what will he do it the Sculptra does not adequately fill in that area. JG 2.13.12

Question:

Hello Dr., This is a follow up to the Qs on Artefill. How long does Aretefill last? Your answer that that the skin loosening that is causing the folds to be visible will progress and the folds will return although the filler is still there. So what does that mean? Will I just need more filler when this happens?

Answer:

correct, and at some point, no matter how much filler you use, it will not correct the fold and surgery will be required. JG 2.13.12

Question:

Hello. I had ArteFill injected into the cheeks and temples six months ago and did not achieve the desired fullness. You can`t even really tell anything was injected. My dermatologist wants to use Sculptra in the same area. Is that safe? I`m worried the Sculptra will clump around the ArteFill beads. Many thanks.

Answer:

I like Sculptra better for that area and properly diluted and injected, should be safe. JG 2.12.12

Question:

Hi Dr., I hope you are enjoying your weekend. I have been getting Radiesse but it, along with Botox, don`t seem to last very long for me at all. Botox no more than 2 months, and Radiesse maybe 3-4 months. A doctor is suggesting Artefill. Costs a lot more but is supposed to last much longer. Is it true it`s permanent? What areas would you use it for? What are the risks? This doctor says he has used it on the nose - with 100% satisfaction from his clients. He has also used it for the top of the cheeks, which helps with the undereye area. Again with the same results. Thank you for your opinion!

Answer:

it will take longer to dissolve but it also depends on the skill of the injector. Nasolabial fold and marionette lines are the places for Artefill. The risks are of lumps and that although the fillers will last, that the skin loosening that is causing the folds to be visible will progress and the folds will return although the filler is still there. I is clear that it should not be used for the tear trough or areas close to the eyelid. All the best. JG 2.12.12

Question:

Supposing you could only do one injectible procedure due to cost would you opt for cheek filler, or filler to camouflage under eye shadows, or something like Botox to lift the brows? Which of these would give the best result? I should add that the problem areas I mention are not dramatic, but still noticeable especially to me!

Answer:

I would use Restylane for the lower lids and the cheek. JG 2.10.12

Question:

Hi Dr. Garcia, I have very deep smile lines and was wondering if you recommend fat injections to help this. If not, what would you recommend???

Answer:

I am not a fan of fat injections as I feel they do not last any longer than off the shelf fillers and the patients are more swollen after the fat injections. I like Perlane for that fold area. JG 2.9.12

Question:

Dr. Garcia, I had Juvederm Plus injections into the tear trough area under my eyes 8 days ago. I seem to have significant and uneven swelling under my eyes that will not go away. I have been using arnica gel, drinking lots of water, sleeping propped up and using ice. The PS who did the injections assured me that it will go down. I have a follow up with him in 6 days at which time he said he could simply push on the Juvederm to make it go away if I didn`t like the look. Is it normal to be swollen this long or could it be over fill? Also, is pushing on the Juvederm going to make it go away or should I be asking about using Vitrase to dissolve it? Thanks!!!

Answer:

not usual to be swollen that far out, and firm massage might help, but cannot say 100%. It might be something you need Vitrase for, all the best. JG 2.9.12

Question:

I have found that some ps that were doing artefill have suddenly stopped. Do you think that is because of the complications it sometimes causes? Also, what do you think of the silikon 1000 filler?Thanks

Answer:

I would not use Silikon 1000 anywhere for any reason. As to the people stopping Artefill, it is hard for me to say why they stopped, could be a couple of reasons. JG 2.9.12

Question:

I have found that some ps that were doing artefill have suddenly stopped. Do you think that is because of the complications it sometimes causes? Also, what do you think of the silikon 1000 filler?Thanks

Answer:

hard for em to say why those peopel that were getting Artefill have sopped. As to Silikon 100, it is illegal in the state of Nevada where I practice to use injectable silicone for cosmetic purposes, I cannot recommend its use, even if it were legal.JG 2.9.12

Question:

I have a Dr. that offers a light laser peel. The skin will look similar to a sunburn for about four days and then begin to slough off. It is supposed to help with fine wrinkles and help make the skin firmer. The cost is $1000.00. Do you think it would really help in this way? Also, could you tell me about what percentage of artefill filler cause complications and if so can they be corrected? Thank you

Answer:

it will help, but for a few months, not much longer than that. The complications from the Artefill are dependent on the area injected and if there is a lump, they can try kenalog shots to dissolve it but sometimes they need to be cut out. JG 2.6.12

Question:

Hi Dr Garcia! Hoping you can help me...I suffer from chronic migraines. I have failed a coupled treatments. The most recent being Topamax. It is not controlling the severity of the migraines or the amount of them. The side effects of the medication are also horrific for me. I am coming off the medication now. The abortive meds do not help me either. I am very interested in knowing about BOTOX for migraines and your expertise on treating patients like myself with BOTOX and their outcomes. Thank you so much.

Answer:

It can be challenging finding the spot to inject on some patients but in most cases it works quite well, decreasing severity and frequency. JG 2.5.12

Question:

What filler would be best to fill deep forehead wrinkles? Would it last long enough to be worth the time and money? Thanks

Answer:

Most likely will last 2-3 months, I would use Restlane. JG 2.4.11

Question:

Thanks for your answer to my question about how long it takes for Sculptra to take effect. You mention that I should wait to see if I respond at all before proceeding. Is it common for this product not to work on some people? If so, whom? I was under the impression that it worked really, really well. (I`m 48 years old, by the way.) Thank you for your help, Dr. Garcia.

Answer:

no, it works on almost all, bu tif you see how much you got from one bottle, you can then guesstimate how much you might need and then make a decision whether the money is worth it for you.The younger you are the better it works, I have patients in their 70`s though who get great results. JG 2.2.12

Question:

When starting supplements, how many weeks should be given to the effort before results can be realistically expected? Thank you!

Answer:

Usually 3 months. JG 2.1.12

Question:

My PS told me that most of his patients begin to see the inflammatory response from Sculptra about 2 weeks after the injection. I`m a little past the two week point and see absolutely nothing yet. When do you think I`ll begin to see a bit of a change? I know it continues to develop for about 4-6 months and then starts to degrade, so he suggests overlapping the remaining two injections (for a total three injections of 6 vials) about every 10-12 weeks so that the final injection of the last 2 vials happens when the first two vials are beginning to degrade. He predicts that I`ll need to start all over again in about 16 months. Does this all seem right to you, Dr. Garcia? (Gosh, this is an expensive undertaking. Wish it lasted longer!) Thank you!

Answer:

Sounds like he wants you to buy some more, although some growth might start in two weeks, it will not become clinically visble for 4-6 weeks. I would wait two months to see what you have going on and then maybe consider more. If you do not see anything, I would wait 4-6 months to see if more is worth it. i would not buy more untill you know it is going to work for you. JG 2.1.12

Question:

Thank you for this website and thank you for your response to my question of 1/27. I was curious, though, as to why you felt message would not help dissolve Juvederm under the eyes. Isn`t movement the reason it doesn`t last in the nasio-labio fold and marrionette lines???

Answer:

It is the muscle contraction more than random massage, but no harm in trying. JG 1.31.12

Question:

Oh, one more question about the deflated lips: About how much product do you yourself usually inject into deflated lips to achieve moderate fullness? 1 ml? less? 2 ml? (I`m 55 and thin-skinned, white, non-smoker.) I ask because I wonder if I may not have been injected with enough last time. Thanks again!

Answer:

I rarely use more than 1cc of filler into the lips. JG 1.31.12

Question:

I have hyaluronic acid (usually Juvederm) injected into my lips every five months for many years. It has always seemed to degrade gradually, not precipitously, until this week. I`m due to be re-injected in late February. As recently as last week, my lips were still appropriately full (in fact, full enough that several women my age commented on how good my lips looked!), but on Monday morning when I awoke, it looked like 90% of the product had evaporated overnight. I`ve never had my lips over-injected, just moderately, but my goodness, they now look (and strangely feel) like two deflated balloons! So I have two questions for you, Dr. Garcia: 1) Is this sudden degradation of the product common? If so, why do you suppose it hasn`t happened to me before? 2) Anything I can do to prevent this from happening in the future? Thanks, as ever, for your help. Wish I lived near you! I`d book an appointmentthis week to get these floppy, crinkly, empty lips fixed!

Answer:

A sudden degradation is quite unusual, I have never seen it happen in my patients. I have no explanation as to why that would occur, sorry. I am not sure what you could do to prevent it as I am unsure what caused it. I might suggest you ask to see the box next time and look for the hologram on it to make sure it is legitimate real Juvederm. All the best and thank yo for the nice words. JG 1.31.12

Question:

Good afternoon, Dr., If I use Retin-A every 2/3 days, do I still need to use lotions which help remove dead cells? Thank you.

Answer:

just cleansing your face should remove the dead cells. JG 1.30.12

Question:

Dr. G., I hope you are enjoying your Sunday. What are your thoughts on bioidentical hormones? Also, you mentioned that Sculptra on the hands can cause bumps. What other fillers do you recommend? Thank you.

Answer:

For fiilers in hands, Juvederm is OK, just very short ilved, not really anything that works well. As to the bioidentical hormones, I have been a believer for many years. Best of luck. JG 1.29.12

Question:

I had juviderm injected yesterday all around my mouth and have a few pimple-like bumps.How do I treat these? Your help is greatly appreciated as always...

Answer:

Warm moist towels will help. JG 1.28.12

Question:

I had Juvederm under eyes(don`t know if it was J.Ultra) three months ago. Results were horrific bags. Then had hyaluronidase injected twice. I`m a little better but still not back to baseline...depressed by grayish discoloration, deep indentations, and festooning results. Giving eyes a rest now. Will messaging help to dissolve what remains a little more speedily?

Answer:

I am sorry but I do not think massage in this case will help, sorry. JG 1.28.12

Question:

Hello Doc, Before I spend buck bucks on creams I have a question. Iam turning 35...and Clinique has a line of anti wrinkle creams and lotions....are these a waste of money? I don`t necessarily want to erase aging because you really can`t but want to preserve and care for my aging skin. are these worth it? If not, whats your best bet? Good nutrition and water and take care naturally? My best to you in 2012~

Answer:

I think Clinique is a good line, not over priced, as is Oil of Olay. Water intake, avoiding sun and smoke also as you said. JG 1.27.12

Question:

My good doctor! Dr. garcia my doctor recomended Plasma treatment to correct lines around nose and mouth and other parts of my face which he said is ok and safe since it is my own blood. How truth is this? and is it worthy? thank you

Answer:

safe, yes, effective, lots of hype and no science behind it, no better than all other off the shelf fillers on the market, and likely less effective than those other fillers. Lots of marketing hype in order to charge more. JG 1.27.12

Question:

What is the best filler to use on those smile lines next to your mouth? Also, do you feel that getting fillers in your youth help with preventing future wrinkle damage than If not? Or are all these facial fillers just a mask for it? Thanks doctor :)

Answer:

I prefer Restylane or Perlane, myself.Fillers like that will have no effect on wrinkle prevention though, they are just wood putty and all they do is hide things. Best of luck.JG 1.26.12

Question:

Thank you for your answer yesterday about the swelling post Sculptra injection. Very comforting! I forgot to ask you how long the initial swelling typically takes to go down. My PS told me it would be gone by the next day, but I still look like a chipmunk with mumps.I thought one day was quite unrealistic, so I`m not panicking, just wondering. In the meantime, three people I see regularly didn`t even recognize me today because my face is so enlarged and distorted. I`ve lost all the natural planes of my face. My dentist took one look at me this afternoon and cried, Oh, honey, WHAT happened to you? She was instantly suspicious of some grave pathological process. All of which is to say that the look is rather alarming! I read the post below about people not looking younger -- just injected/done. I am definitely in that terrain at the moment. Thank you so much for all the time you donate to all of us with all these questions, Dr. Garcia.

Answer:

in my experience, it takes 3-5 days, but the more fluid they use to dilute, the longer it takes.The swelling will move downward over the days , so if you had your upper cheeks injected alone, in a couple of days that swelling would be at your jawline, not in your cheeks. Hang in there, it will gt better. JG 1.25.12

Question:

Hi, Dr. Garcia. Well, I took the leap. I was injected today with Sculptra for the first time -- 1 vial mostly in the lateral aspects of my face (temples, pre-auricular, zygomatic arch). I know that the initial swelling is due to the lidocaine and saline that are mixed with the product, but I`m wondering if you can say, from your years of experience with this product, if the initial swelling approximates what the end result will look like -- or instead if it tends to be more (or less swollen) immediately after injection than the endpoint 4-6 months out. I know that the amount of collagen we can generate decreases with age, so you can`t offer me a certain answer here, but maybe you can share your general experience with this matter. (I`m 54.) I look a wee bit, um, crazy right now and am wondering if this is where I`m headed! LOL. Thanks so much, Dr. Garcia. Have a great day!

Answer:

in my experience, and with the amount of fluid I put into the bottle, about8 cc`s, I see about 30-40% growth of what you see right after the injections. Best of luck. JG 1.24.12

Question:

Good morning Dr. G. Paula Begoun of the Cosmetics Cop and Paula`s Choice cosmetics line shared on her weekly radio show that she uses Rogaine`s 5% solution - for men - instead of the 2% for women. I am currently using the 2% for small areas (mostly the bangs area) but would like to try the 5% as it seems to work better for some women. What are your thoughts on safety/risk factors of women using the 5% solution. Also, is there a difference between Rogaine and the generic brands? Thank you.

Answer:

as long as you do not get pregnant, it is OK to try to 5% on women. JG 1.23.12

Question:

I was interested in getting Artefill injected around my nasalbifolds. I have been to another doctor and he has injected 7 syringes everywhere but there. I am still not happy with my nasalbifolds. He said that the nasalbifold area is best treated with Juvederm or Radiesse. All the research I have done shows that it is specifically for the nasalbifold area. Do you recommend injecting it there? I have had Juvederm injected there in the past with not long lasting results and would like a more permanent resolve for that area. Would you be willing to inject Artefill along my nasalbifolds, or do you concur with the other doctor. Thank you for your input and time answering my question.

Answer:

I think what you need to understand is that although Artefill is approved for injection into the nasolabial fold, the fold is not a static wrinkle as its cause is two fold, and for that reason, no long term filler will likely correct it any better than a short term filler. When a wrinkle exists because of loss of skin collagen, then using a filler is a good long lasting option. In the case of a nasolabial fold, it exist for two reasons, it is there because the skin has lost some collagen and because the tissues of the cheek have fallen and are causing the skin to fold or hang over. In essence, when that is the case, the filler is being injected into the normal skin below the fold to have it meet the fold and to make it look less visible. Because what is at least partially causing the fold to exist, the loss of tissue in the cheek, is not corrected by the filler into the fold, the fold will progress and continue to fall and the fold will once again be seen a few moths later. In short, I don`t think Artefill will be nay better than the other fillers because of the cause of the fold, not because the filler is any better or worse than any other. JG 1.23.12

Question:

I see that you only use Restalyne under the eyes. I`ve read of many complications from other products being injected under the eyes on your blog and elsewhere. My dermatologist says he uses Perlane, which he says is just a slightly thicker form of Restalyne. Before I allow him to inject me, I thought I should check to see if it is OK. I am incredibly cautious and don`t want to find myself in the same disastrous situations I`ve read about. Thank you for your time and help. You are unusually generous.

Answer:

Likely safe but I feel Restylane is better as it is a bit smoother. JG 1.22.12

Question:

Now 5 months after injections into glabellar,have severe burning headaches,vision is worsening,dizziness,loss of appetite and weight four and half stone in 4 months,all tests were normal mri pet scans.Severe tinnitus,ear pressure,depression,inability to take in food or water without severe nausea.Doctor thinks it;s not psychological.Burning above eyes.Also severe insomnia,memory loss,irritability,muscle weakness.Can juvederm migrate as hardly any in forehead.How long does juvederm ultra 2 last in glabellar? Thanks

Answer:

The Juvederm might last 4-12 months in that area, all depends on how much motion there is, but I have never heard of Juvederm causing a reaction like you describe. Juvederm does not migrate very well after injection. I wish I could tell you more. JG 1.20.12

Question:

Dr. Dr. Does radiesse really stimulate the collagen? I heard it enhance your own collagen and its sounds to good to be true. Just wanted to ask all there is about the filler from a professional.Thanks.

Answer:

that is what is believed to occur around the granules in Radiesse. I think any collagen formation from it is relatively short lived though, likely much less than 12 months in most patients. JG 1.20.12

Question:

i am going to have restalyne or some other filler in my cheek/tear trough area. i am very nervous about the possibility of hitting an artery and want to definitely tell dr to stay away from any area that has that potential. Please advise .I haver heard the area near the nose is most succeptible.Thanks. Also is botox in glabella(not filler) possible to strike an artery. Had it there before with no problem. thanks so much

Answer:

well, there are arteries and veins in the areas you are considering, all injectors always attempt to avoid any visible blood vessels, but there are always blood vessels that are unseen and any time a needle is used to puncture the skin, bleeding is a potential risk that is never 100% avoidable.The area near the nose is no more susceptible than others, but as the skin is quite thin, any minimal amount of blood is easier to see if it does occur. Botox is placed with a needle, so that risks exists there also. All the best. JG 1.18.12

Question:

Hi Dr. Garcia. I am 44 years old and have been getting botox injections for the past year and a half. I get the injections between my eyebrows and in my crows feet. The first time I got the botox injections it lasted for about 5 months, which was amazing. I noticed that each time I get it done, it doesn`t last as long and doesn`t work as well. The effect is only lasting about a 1 1/2 months to 2 months. I`ve been told botox is recommended no sooner than every 3 months. Is this common? I was also told that it should last longer and get a better effect over time because the muscle isn`t used as much. Should I try a different product such as Dysport to see if it works better? Also, I got Radiesse injections and haven`t gotten any granulomas as of yet (3 1/2 months), does this mean that I am safe to use Radiesse again without fear of granulomas, or could I get them with future injections? Thank you so much!

Answer:

I think the first thing to find out is if they injected the same dose reach time, I have seen patients get good results one time and then the next time the Botox was kept passed its recommended 4 hour window for mixing, was stored and used from a prior patient or was diluted more and then the injected dose was less and these issues lead to the Botox lasting less. There is nothing wrong with injecting Botox more frequently if it is wearing off, and trying Dysport might give you a different response, all things being equal. As to fillers with long term effects, I would say with Radiesse, it can happen for up to one year after the filler is placed, although the risks drop with time. Granulomas are also technique driven,not just product related, so there is no guarantee that future injections will always yield no granulomas. JG 1.17.12

Question:

I have had, Radiesse (Perlane) injected at the tip of my nose twice now & it doesn`t last but a month & I am scared of going under the knife... My question is what filler could be used as an alternative because obviously my body is metabolizing the Perlane quickly. I was thinking Radiesse but was told it would appear white under the skin & be too obvious. Would you suggest layering? Maybe the Radiesse first & them on top the Perlane? Or knowing my body metabolizes Perlane at a fast speed maybe trying another filler?

Answer:

If injected below the skin, the Radiesse should not look white, only if injected into the skin, could try Artefill, but it is also white. JG 1.17.12

Question:

How Dr...in order to reduce marionette lines from the corners of the mouth to jawline, would you recommend a filler (like restalyne) be injected directly to the lines/folds or would you recommend filler to the cheeks? I want to get the most bang for my buck !

Answer:

for quick fix, the filler directly into the fold is good, for a longer fix, but slower, then I suggest Sculptra if the cause for the fold is loss of cheek fat. JG 1.16.12

Question:

Dr. Garcia, I`m getting dark circles underneath my eyes and getting hollow spots on my cheeks which I`ve been treated with radiesse. Does Sculptura really last longer and worth the money? How long does it really work and does it produce more collagen? Can this be used under the eyes? Thank you.

Answer:

I believe Sculptra works better, but slower than Radiesse for the cheeks. It does produce much more collagen than Radiesse. It cannot be used under the eyes, but neither should Radiesse be used under the eyes. JG 1.16.12

Question:

I READ THAT BOTOX CAN AFFECT THE BLINK REFLEX WHEN PUT IN CROWS FEET. IS THIS TRUE? THANKS SANDI

Answer:

I have not seen nor heard of that happening. JG 1.16.12

Question:

My question regarding restylane fine line,was when will it be approved by the FDA? I was interested in having it injected into the horizontal fine lines above my upper lip. Is that what you use for that problem? Thanks as always...

Answer:

we use Prevelle Silk for the very fine lines, and I am not sure if and when Restylane Fine Line will be approved in the US. Sorry. JG 1.16.12

Question:

What is the best way to improve the marionette lines near the corners of the mouth? They are not remarkable, but definitely visible. My age is 47 and have never had anything done to my face except a few microderms. I am looking for something affordable with good results. Thanks for your time.

Answer:

if they are not deep, then fillers are the quickest. Might last 2-4 months. JG 1.12.12

Question:

What is the best way to improve the marionette lines near the corners of the mouth? They are not remarkable, but definitely visible. My age is 47 and have never had anything done to my face except a few microderms. I am looking for something affordable with good results. Thanks for your time.

Answer:

if they are no very deep, then fillers are the quickest way to hide them. Might last 2-4 months or so. JG 1.12.12

Question:

i want to reduce glabella wrinkles and i have upper lid ptosis. if i get botox in glabella and crows feet do you think this is a place where the risk of getting more droop is possible. What area should i definitely avoid? i have had botox in glabella before with no problem but not wanting to risk more droopiness. thanks so muxch

Answer:

properly injected Botox into the glabella and crows feet areas should not cause drooping, that can happen frequently when the forehead is injected though. Best of luck. JG 1.11.12

Question:

Dr., one of your suggestions to alleviate the sad look of a minimal fold between the lower corner of lip to chin area was to inject filler into the cheeks. I notice that when I slightly lift the cheek area it does quite dynamically erase that fold. How much would this procedure cost, how long will it last, and what filler would you recommend? A million thanks to you for all the education you provide us with!

Answer:

I would use Sculptra for that, but all patients are different and doctors charge differently, it might take 1-2 vials, so maybe $700-1400, should last a year or two. All the best. JG 1.7.112

Question:

Hi Dr Garcia, I had juvederm injected into my lips and I am very disappointed. I was told that it would dissolve in 6 months….Well, it has been a little over a year and a half and I still have two air pockets on my top lip and they won`t seem to go away! I hate my smile and have become very self conscious. I heard there was a product that could dissolve these air pockets or whatever it is….please help and tell me what I need to do. Thank You

Answer:

If it was real Juvederm, using hyaluronidase you dissole it will help. All the best. JG 1.7.12

Question:

what is your experience with cannula technique for injecting fillers? thanks

Answer:

minimal difference compared to traditional needles, might cause slightly less bruising but it also might be harder to place the filler in the desired area as the tip is blunt. OK to use in deeper injections, but not for superficial dermal injections for fine lines. JG 1.4.12

Question:

Hi Dr. G. I`ve had Radiesse on the bridge of the nose, with good results. My doctor thinks I can use more, and she recommends Artefill. What do you think? How far down the tip do you recommend? She tells me I can get good results going all the way down, making the nose looks higher and more refined but I am afraid the filler will make my already bulbous nose even more so. What do you recommend? (the doctor I am considering seems to be very good at what she does, knows how to handle the needs of Asian features and skin, and seems to have achieved that balance of art and science). Blessings to you!

Answer:

I think Artefill is a good option for the nasal dorsum, I would not go to the tip itself, but stop right above it. Any filler will make the nose look larger though, no way to add something and not make it larger.If you nasal tip is bulbous, then surgery is likely a much better option as a filler to the tip will make it larger. All the best. JG 1.4.12

Question:

Dr. Garcia, I am very desperate in looking for some help. I am only 38 & started getting lines above my lip at a young age. I got juvaderm last year and it worked pretty great for about a week. I then went back to my plastic surgeon just weeks later & bought another round (now $1200 later) it lasted about the same time. So some of my friends suggested that because mne are so deep on one side that I may need botox there. I can`t afford to keep trying so many different things & I was very thorough when I had my initial appt with my plastic surgeon when I was trying to ask what he thought would work best for me (laser, juvaderm, fillers,etc). Earlier this year I went to my dermo. & spoke with her & she recommended I speak with someone that comes into her office once a week and does some form of a lighter type laser treatment. This dr said after I filled out the questionaire, with my fair skin, I prob would have discoloring above my lip if I did the laser & that`s when she suggested this other type that`s not so strong. She said I would of course need to do all over & not just above my lip, but that I didn`t really have to do my forehead are but the remainder of my face she would def recommend. She said she would start less aggressive since I have no tolerance for pain but it would probably take about 3-4 treatments. I am now so scared because I don`t know what to believe from anyone. I don`t know of one person that has had my problem & had treatment to ask. My only option I feel is to make several appts with different surgeons around my town & one that is about 2 hrs away. But that doesnt mean I can still get the correct answer. Is there anything you suggest? I cry about this on a weekly basis. Thank You!

Answer:

well, at our age a laser might be a good idea, if you have fair skin and not much sun damage. It will likely have to be a series of peels as most doctors now only do fractional lasers. That is for quicker healing and less downtime. I think you also need to stop drinking out of straws and sports bottles, stop smoking, and cease as much activity where you purse your lips. All fillers will last a relatively short period of time due to the degree of motion and the need to use the filler in a superficial level. The series of lasers will also eventually have to be repeated. I wish you the best. JG 1.3.12

Question:

Is it possible for fat grafts to the cheek and mouth areas to migrate into the inner cheeks and gums if too much fat was injected? How long does fat grafting really last?

Answer:

well, they can cause swelling and maybe scar tissue, but the grafts do not move much if placed properly. I think that the fat grafts will typically last about 6-12 months from what I have observed. JG 12.23.11

Question:

Hi doc merry christmas to you and your staff I just had some hydraloise placed in an overfilled area above my lip and as soon as he placed it in it puffed up and is no bigger than before he said it will go down just checking if that seems right i have been iceing the area its been about 2 hours still puffy is this normal? thank you so much

Answer:

Normal to a little swollen, if it is working the excess filler should be decreased in 24 hours. Best of luck. JG 12.22.11

Question:

I had perlane injections in the marionette line area right below either side of my mouth 2 days ago. I had acne scar indentations there that I wanted filled. Today I have noticed a puffy lump above the lip on one side about an inch above the injection site that wasn`t there before. It feels hard and makes the moustache area look weird, making my lip look smaller on one side. Could it be that the perlane moved up? Is this possible? Thanking you in advance for your response.

Answer:

unlikely the Perlane moved, more likely is swelling or a deep bruise is causing it. Time and massage should help. Best of luck. JG 12.19.11

Question:

my friend has had radiesse she didnt know not to take ibruprofen it looks like she has a small birthmark on her right nasal labial fold and she has a cold this is 5 days after her injections is this normal and how long before it fades or will it be permanent?

Answer:

Bruise should be gone in a week or so. JG 12.18.11

Question:

Hi Dr. Garcia, I have hereditary hollow under eyes, they seem to be getting worse as time goes by.Iam 31 now. My skin is also very fine and pale. At a recent consultation a Dr. said she is very confident she can fix this problem. She would use Juvederm Voluma placed deeply.She said the voluma had no chance of lumps etc as she has a special device to dilute it first. It would be placed using a blunt cannula method through my cheeks which she said greatly reduced the chance of bruising. The second Dr. I saw said she would use Restylane injections. I am unsure as who to go with. I couldn`t find many reviews on Voluma used under the eyes, and none using the cannula technique.But given the Dr seemed confident I would have littlechance of bruising/lumps I am leaning towards her. What are your thoughts on the cannula technique on undereye fillers and also juvederm voluma placed deeply here? Thank you kindly

Answer:

any and all fillers can leave a lump, there is no 100% guarantee that can be made. The blunt cannula only potentially lessens bruising but it still needs a sharp needle to pierce the skin, so there is still a potential for a bruise and diluting the Voluma will also not avoid lumps.Place the blunt cannula through the mouth will pierce more tissues that do not need to be pierced and makes it no better than a direct injection through the skin. I only use Restylane for that area and I inject directly through the skin. due to the exaggerated claims by the first doctor, I would go with the Restylane choice. Best of luck. JG 12.18.11

Question:

Hi, Dr. Garcia. My plastic surgeon will often save my syringe of hyaluronic acid if I haven`t used it all at one appointment for future injections. I am getting Radiesse this week. After he mixes the product, do I need to use the whole syringe at one appointment or can it too be saved for another day if I don`t need the whole thing? A beautiful holiday season to you and your family -- and a healthy and peaceful new year. Thank you, thank you for all you do!

Answer:

As long as stored in a sterile fashion, it can be saved. Happy holidays to you too. JG 12.17.11

Question:

Good evening doctor. No questions tonight..just want you to know how useful and appreciated your Q&A`s are....a big heartfelt thank you and Merry Christmas to you and yours...from Not so snowy Ottawa, Canada..Yet. Jg

Answer:

Thank you very much and a Merry Christmas to you too. JG 12.17.11

Question:

If you use the enzyme to dissolve restalyn what will happen if it is not restalyne

Answer:

Momt much effect then, it will work on any hyaluronic acid. JG 12.15.11

Question:

Dr. Garcia, Since 18-20 units in total for my forehead and Inbetween by Eyes last less 3 months. How much is or should be used in those areas to last a bit longer? What do you usually use?

Answer:

20 units for the area between your eyebrows and then maybe 15-20 in the forehead, the forehead is harder to determine as it depends on how large of an area you are injecting. The forehead is an off-label area so there are no established treatment parameters. JG 12.13.11

Question:

Good evening Dr. Garcia and Happy Holidays, I have a BOTOX questions. I have been getting Botox in my forehead and between my brows for the last year, I am 33. Anyways, I get 18-20 units for all of that area total. I LOVE the results for the first month and a half then I notice the smoothness to fade and you can faintly see movement return. About 3 months there is some Botox left and I usually try to make it to 4 month before I get more but wish it would last longer. Do I need more in my frown lines and forehead to last or is this just how it is in general?? Many thanks!!!

Answer:

A higher dose should last longer, yes. JG 12.12.11

Question:

Since Sculptra takes so long to see results as opposed to radiasse, can you layer juvaderm on top of sculptra? i`ve lost of volume around my temples and want sculptra but want immediate results.thank you for your help. jc

Answer:

Certainly OK to do that. jG 12.11.11

Question:

Hi Dr...at nearly 49 years old I am seeing the aging taking place (especially looking at pictures!). My face in pictures always seems to look angry or sad, unless I am specifically smiling. I am attributing this to the beginning of seeing a fold between the corners of the lower lip to the chin (not sure what that area is called). What would you recommend to make this go away (except for the obvious surgery). It is really bothering me.

Answer:

could use fillers such as Restylane directly into the fold or Sculptra to replace the loss of volume in the cheeks that has allowed the skin to fall and create the fold. all the best. JG 12.9.11

Question:

If I get a filler under the brow to lift the skin on the eyelid like u said, what kind of filler is the best to be used and wouldn`t the filler make the brow stick out more and look bigger? Also, if the Sculptra makes the nasal labial fold look deeper but shorter, what need to be used and where to inject it?

Answer:

I usually use Restylane , and it has to be injected on the brow bone, directly above the eyebrow so as the tissue inflates, it elevates the eyebrow and then the eyelid skin secondarily. As to the nasolabial fold, people become obsessed with the fold, thinking they should not have one. If you look at a new born baby, they have a nasolabial fold but they do not look old, so when one wants to look more youthful, that does not mean eliminating the fold, just making it look shorter. JG 12.7.11

Question:

I am 51 years of age and in October had my first series of Sculptra for loss of collagen or volume in my cheeks. He said it would help my nasal labial folds and that I would need to more visits of the injections for a total of three. I usually got a instant filler or Radiesse or something like that.. I also use to get a tear trough filler for my eyes. This time he didn`t use anything but the sculptra. He said it would do everything I needed. He doesn`t believe in using fillers in the nasal labial folds. He says the volume that is lost causes the skin to fall causing them, and with the sculptra it would fill the cheeks out and pick up the skin. I haven`t been able to go back for my second series of injections, but really notice my face deflating. I wonder if I need to start all over again with the injections and the first one wouldn`t even count now, or if I still can pick back up with the sculptra like it is my second series of them? I have an appt the 17th of this month to continue. I think I look worse now then before. He likes to build up the temple area and another dr. I have been to doesn`t like the fact that he does that, but he specializes in the liquid facelift, so I would hope he knows what he is doing. Also one says I need a brow lift, the other says I just need an eye lift. How do I know which one is correct? I have read about a filler underneath the brow or eyebrows to lift the area, would that work?

Answer:

well, firstly Sculptra takes 4-6 months to grow to its maximum amount, so it is a little early to tell what the vial has achieved. Sculptra cannot be used in the tear trough and is really not intended for the nasolabial fold. Actually, if you inject the cheek to refill the lost fat it can in many cases make the nasolabial fold look shorter but also deeper as the cheek will be fuller and higher, making the level of the nasolabial fold appear deeper. Sculptra is a good choice for the temples but has to be injected by an experienced person as it is more tricky than the cheek. Fillers below the eyebrow can many times lift the brow and that can take up some degree of excess upper eyelid skin too. I wish you the best. JG 12.7.11

Question:

I had restalyne injections in the tear trough area 2 days ago. I still have a bruise under my left eye. How long does that take to go away? I also have a little lumpiness under my left eye where the bruise is (although not super bad). He did do more injections on that side. Overall, I don`t see much improvement (I guess I was expecting incredible results from what I had read). I went to a board certified plastic surgeon. He did do my upper lip line too and my laugh lines and I am pleased with that work. Thank you for your advice Doctor!

Answer:

the bruise might take 7-10 days to totally go away. The lumpiness can be smoothed out with some light stroking type motion over the area, in most cases, with that, it will get better in just a few days. As to the degree of improvement, it is a matter of how much filler was placed and in what layer. It might be that you just need more injected.Best of luck. JG 12.1.11

Question:

Hello, I have a granuloma in my upper lip caused by Dermalive, everyone is telling me it is not noticeable but it is really upsetting to me because I notice it when I smile. I have had 5 steroid injections and had more the half of it cut out once. The steroid injections did not make much of a difference, after cutting if out it grew back over 6 months. I don`t plan kn doing anymore of the steroid injections. The next plan is to cut it out again. Should I just learn to live with this ridge above my upper lip? Could you please tell me what the risk is to getting it cut out and at what point does getting it cut out stay permanent?does it take a few times. I am basically trying to weigh the risk here. Thank you so much.

Answer:

If it bothers you, then the only option is to have it cut out. It might leave a small depresssion and a little numbness too. Best of luck. JG 11.13.11

Question:

When hyaluronidase is used to dissolve synthetic HA, does it also dissolve the body`s own HA? And if so, will that native HA regenerate? I ask because after I was recently overfilled with Juvederm, I had it dissolved and was ASTONISHED at how deflated (and uncharacteristically wrinkled!) I was within 24 hours. I saw my doctor two days later to be reinjected. I`m just not sure if what I`m seeing now is due entirely to the product or if it is also due to the regeneration of my own hyaluronic acid. Could hyaluronidse also cause a localized acute dehydration that, even if I hadn`t had the area re-filled, would eventually correct itself? Honestly, the day after the hyaluronidase, I looked like I was 75 years old, and I`m only 47! I`ve only been using fillers for a couple of years, and I can`t believe that I`ve aged THAT much in such a short span of time. Is that really what I look like without filler? Dear God! Thank you for your help, Dr. Garcia.

Answer:

it can dissolve the body`s own HA but it reforms.When using the dissolving agent if there is a large overfill with the injected HA, it can stretch the skin temporarily and it can look like that right after the dissolving. I will say that when people get frequent fillers, since the filler does not slow the aging process, and the filler hides the effects of aging, when one stops using the fillers, their skin will look worse than it did when they started getting the fillers, that is the downside of hiding the effects of aging. Once they show through, it can be disheartening. JG 11.6.11

Question:

Thank you so very much for taking the time to read and answer my question. Earlier this summer (2011) I had a large acne cyst before a big event. I went to my general dermatologist to have it injected with cortisone. The cyst went away but now, months later, I have a shallow, saucer type depressed scar on my Left cheek(I assume from atrophy). My question is this; would a HA filler elevate the scar and make it less noticeable? I am a 46 yo female and this depressed scar is really affecting my self esteem. I appreciate any advise that you could give to me, as I have another public appearance coming up within the next 4 weeks. As always, I am grateful for your time and honesty. If a filler is not your first recommendation, what would you suggest? Again, many thanks! Kim

Answer:

I think the HA filler is certainly a reasonable thing to do, it should not interfere with the body`s own attempt to fill the depression in. I think either Restylane or Juvederm are good choices. Best of luck. JG 11.7.11

Question:

Hi Dr., what do you recommend as a filler for the upper lip area specifically the little smoker lines as well as some volume in that area, not looking to enhance lip size just smooth out fine lines and give some volume. It has been suggested I try laser but am very afraid of pigment discoloration. The lines are very fine but they bother me. Help!!!!

Answer:

I think you need to use a relatively thin filler so it will not look lump. Prevelle is one choice, otherwise Juvederm, but not Juvederm ultra or ultra plus.Laser help, but at most for a few years is about it as what is causing the lines, loss of collagen and frequent motion of the lip muscles cannot be stopped. JG 11.6.11

Question:

I had fat transfer to my face with fat harvested four months ago. I have terrible bruising and swelling....I am 3 days out...what can be done to speed up removal of bruises and swelling?

Answer:

Massage, arnica montana is about all. Best of luck. JG 11.6.11

Question:

Hi Dr, Is it ok to inject radiesse in the cheek area where HA was injected a couple of months ago, or is it best to wait until all the HA has gone? Thank you

Answer:

Should be OK to do. jG 11.5.11

Question:

How soon should I wait to have artefill injections if I have just had radiesse injections? Thank you

Answer:

I would wait 6-8 weeks for the carrier gel in the Radiesse to dissolve. JG 10.30.11

Question:

Hello Dr.Garcia. I am a 43 year old male that recently went to a doctor and got injected with silikon 1000 to fix an asymmetric nose (post revision rhinoplasty). Part of the bridge that was indented filled in very nicely but i regret getting it in the tip. Yes the tip looks straighter but it is regrettably bigger. The doctor acknowledged this and has treated me 3 x with kenalog 5 shots. It seems to have brought it down some but it is still too big. is it safe to continue treating this with kenalog? If i reach a desired result will it just built back up after time?

Answer:

I will say that there is no way to use a filler without making the area larger. The proportions may change and make things look better balanced, but it will be larger. Sadly, there is no way that Silikon 1000 will be dissolved by kenalog. In Nevada, it is illegal to use silikon 1000 for cosmetic purposes and it to be used only for retinal issues. I would not have any further kenalog or silikon injections. JG 10.27.11

Question:

To the person with the Botox eye bags. I will try to explain....I went in to have only the lateral part of the brows lifted. I do not have any horizontal lines, or any eleven on the forehead. Also, I have crows feet, only when I smile. I know at almost 50, I should feel blessed, BUT, we can always find something that needs to be improved, so off I went to lift the brows! The first nurse I went to explained that she would only use a very small amount because really, there was no need to use a full vial . I knew that Botox should not be split up, or used twice, so I chose to see a very reputable Dr. instead. He used the entire syringe/vial (however many units that is) and injected upper/lateral part of the brow, a crease between my eyes, where nose begins, and underneath the eyes...he said it would decrease wrinkling in that area....WRONG! By the 5th day,all I could see were the eye bags. My husband gave me the I told you not to mess with your face speech, and told me I looked like someone who had been crying and had no sleep for days. I really did. It started to wear off about 3 months later. It has been since June and I am still completely focused on the lower eye area. It has improved, but it seems I still have the tear trough line....which was barely noticeable before. Scared to have anything else done...but considering the good Dr`s advice on restalyne .

Answer:

thank you so much for sharing what has been a difficult scenario for you. JG 10.27.11

Question:

I see several posts on here about the dreadful eye bags after Botox. I too was a victim of the same. Why would a PS inject the lower lid area to begin with? What could the benefit be? I am terrified to have anything else done with Botox, as I looked worse, rather than better. Are there just some people that just do not respond well to it? I wanted the brows to lift, and they really never looked any different. It has finally worn off, and the bags have deflated, but now I am focused on tear trough issues!

Answer:

well, it is not approved by the FDA to use there, as to the why try to use it there, some patients and doctors are trying to smooth the wrinkles seen when you squint, but as you have read, it has some serious downsides.The whether someone responds well or not, it is a matter of how many units are injected and over what area it is injected. I never inject the lower lids. To lift the lateral brow you need to inject just the upper crows feet, the lower the injection is performed in that area, the less lift you will get. Glad all got better. For the tear troughs, I personally use Restylane. All the best. JG 10.26.11

Question:

Hi doc, thank you for this wonderful service. My question is, I have moderate malar mounds that make me feel very self conscious.I met a plastic surgeon who said that he could inject the area with lipo dissolve and that would get rid of the malar mounds.I have read about the side effects of lipodissolve and am dubious. Do you think it might work? if not what can I do to get rid of them? Thank you for answering in advance!ms hansi

Answer:

well, I think it likely will not work, and I think you could try it, I think the risks of something bad happening are low. I am afraid that most of the time for malar mounds or festoons lasers and injections do not work. They exist because there is a small separation between the muscles of the lower eyelid and of the cheek, and fluid will accumulate in this area. It is not responsive to injections or aspiration. Eventually, when they get bad enough, they can be cut out, leaving a small scar. I wish you the best. JG 10.24.11

Question:

Hi Dr. Garcia, Thanks for your service. I am 51 in good shape but have some thinning in my face. Today I went to my doctor certain that I was going to get Sculptra (I’ve spoken to him about it before) and it turns out he hasn`t been doing much of it in recent years and didn`t even have any in the office. Instead he is using radiesse for filling out the cheek area. He said that it too promotes collagen production and the results are better. I left the office very confused (and without doing any treatment). I know you are very pro Sculptra for the cheek area and I was surprised that my doc was pushing for radiesse. Now I feel stuck and am trying to figure out what to do with these conflicting views. Will both work and each doctor has a personal preference and comfort level with one or another? I look forward to your perspective on how to sort this out.

Answer:

I think the collagen growth from Radiesse is very small. I use it for cheeks only if someone needs a quick fix Otherwise it is Sculptra for me. JG 10.20.11

Question:

I would like to have my doctor inject 5fu into my fat graft lumps in my marionette line, but would like to fill the line and irregularities with a bit of resty or juvaderm. Will the 5fu dissolve the resty or juvaderm or make it difficult to target the lumps?

Answer:

I think doing it all together is not a good idea. You should get rid of the lumps first and do the fillers down the road. JG 10.19.11

Question:

Sorry Dr G, I meant could the fluid from the poly lactic acid powder mix affect the Dermalive? My apologies. merci encore. J

Answer:

no, the fluid is just saline and will not interact with the Dermalive. JG 10.17.11

Question:

So, can the poly acid powder from the Sculptra negatively affect the Dermalive if it made it`s way down from the cheeks to the NLF ? Based on your previous response, Sculptra wld b ok to put there. Thank u for your patience. I c by the post below mine that I am not the only one with Dermalive concerns. Mercy big much. J

Answer:

there is no way to tell 100% as it has never been tested. DermaLive is about the only filler that doctors are warned about potential interaction although the instances of problems are rare. I routinely inject Sculptra into the cheek to lift the nasolabial area, but I NEVER inject Sculptra directly into the nasolabial fold, it is not meant to be used as that superficial of a filler, it needs to be injected deeper.If in doubt, avoid injecting any filler in the same exact area as the DermaLive was injected, no matter how long ago, but the reported problems have been rare. JG 10.17.11

Question:

When injected does Sculptra migrate once injected. I am the paranoid Dermalive recipient in the NLF. Was thinking of Sculptra for the hollows of the cheek area. Thank u big much for all your help. J

Answer:

no, the Sculptra will not migrate, but the fluid that is mixed with the powder will move as it is absorbed, but not the actual poly lactic acid powder. JG 10.16.11

Question:

Hi Dr. I had a consult with a nurse yesterday regarding rejuvenating the eyes. She suggested I would need some minimal amount of filler in the tear trough, and then suggested that, because I have not had any good result lifting edges of the brow with Botox, she suggested that we could use a small amount of filler near the temples to lift the outer corners of the brow. Have you ever heard of such a thing? just curious.

Answer:

Yes I have , and on the right patient I commonly do that. JG 10.14.11

Question:

Subsequent to my Dermalive question. Could the Juvederm cause some sort of activation to the Dermalive...because if it started to cause granulomas, then the Hylaurondaise would be of no use as the bumps would have already commenced...? I hope u know what I am trying to convey. Thank you.

Answer:

I will say that there have been reports of lumps when other fillers are placed over Dermalive, so nothing is 100%. The risk of granulomas decreases with time after the Dermalive injections, so if they have not formed for a couple of years, it is doubtful they will. As long as the new filler is not injected directly into the Dermalive, it should be OK, but I cannot guarantee it. JG 10.14.11

Question:

I have a question about the nasal labial fold area. I got the sculptra for the first time Saturday and he had told me that it would help my nasal labiab folds and that he didn`t like to use filler for that area. He said it would lift my cheeks up because it was my cheeks that had lost collagen and that was causing my cheeks to fall and create this fold of skin. Seems like now they look worse. Looks like my cheeks are puffy causing them to look worse and didn`t think I would see any difference this fast from the sculptra being I just got it Saturday. I know u said it wouldn`t really help the nasal folds but might shorten them but wouldn`t help them the closer to the nose it got. What would help with it closer to the nose area?

Answer:

the larger the mound of the cheek, the deeper a nasolabial fold will look, the fuller cheek does help elevate the loose skin in the jowl region though. The more robust the growth of the Sculptra in the cheek, the deeper the nasolabial fold will get near the nose. For that you will need a filler directly into the nasolabial fold. I think the degree of fullness you have right now is due to swelling though, and not the growth of the Sculptra, that will take months. Best of luck. JG 10.14.11

Question:

Hi Dr Garcia, I am considering filler injections in the tear trough to reduce the shadows/eye bags. I have a wedding a week from this Friday. I do not want to look bruised or lumpy/swollen. Should I hold off and not do this right now? I`ve never had this done, so I have no idea what to expect for the few days afterwards.

Answer:

well, whenever one is trying to avoid a bruise, one usually gets one, and although you have a little time, I think it best to wait until after the wedding. JG 10.10.11

Question:

I have another question regarding the sculptra, if I got all the sculptra injections and my face was like I liked it, if I didn`t ever get anymore would my face look older because of the skin being stretched out from the new collagen or sculptra? I know I will continue to age but just wondering if it would stretch the skin out. Also u said I should give it four or five weeks, so are u saying I shouldn`t go back for anymore or to wait four or five until I go back for my second injection? Aslo should the dr. mark the places where they are going to be injected so to get it even? This dr. did not mark the spots at all. The injections are exactly even on both sides and that concerns me. On one side it it up higher on the cheek than the other one.

Answer:

Sculptra will not age the skin as all it is supposed to do is replace what was once there. I think since there is some concern whether the placement of the product was correct in your particular case, I would wait to see what you get after 4-6 months before putting more in, as it cannot be removed.I think that at this point, due to the swelling, one cannot say where the Sculptra will end up growing.Got to give it a little more time. JG 10.10.11

Question:

If I don`t have anymore more injections other than the one I had Saturday of the sculptra, should I not see that much of a difference in my face. After what I have seen so far just kinda scared of it now. Especially where he injected it in my cheek for the tear trough area instead of a filler like restalyne or something like before. My face already looks different and not likeing it. Will it go back to normal? Do u think it is just swollen?

Answer:

the smaller the area injected, the more the effect, but if the single vial is spread out over a wider area, the visible effects will be less. In you case, since it is so soon after the injections, just wait for the swelling to go down, and I think you will look much better. JG 10.9.11

Question:

I have another question about the sculptra and the nasal labial folds and the tear trough area. Since the dr. I went to injected me inot my cheek and said that was for the tear trough area which I thought was weird, and u said it could make it look worse, should I just not go for any more injections. This was my first one and he says I need two more times. I also use to get juvaderm for my nasal labial folds which he said I don`t need any filler there because he said what was causing them was where my cheeks had lost volume and it was letting them fall and was was letting the skin fall and creating a fold of skin and separate it from the rest of my face and all I needed was the volume restored to lift my cheeks back up and then the folds wouldn`t be there. He said if he injected it with filler for the nasal labial folds that it could make it look worse. Please help with this issue? And is it normal to see effects from the sculptra one day after? Will this go away?

Answer:

I would wait 4-6 months in your case to make sure it is growing and giving you the correct degree of correction you are seeking. If the nasolabial fold is present from the skin of the cheek falling, then a filler in the cheek will lift the skin up. It will make the nasolabial fold shorter but it will not make it less visible the closer you get to the nose. At the 1-4 day time period after Sculptra, it is all swelling, you will not see any growth for about 4-6 weeks at least. JG 10.9.11

Question:

Hi, Dr. Garcia. I had Restylane injected at the lateral corners of the orbital rim (.2 ml. on each side) yesterday afternoon. The L side looks great but the R is a mess. Raising the lateral portion of that lid instantly created a puffy, red sling from my nose to the outer corner of my eye at the bottom of the lid. My plastic surgeon saw it too as soon as he injected the area. Of course, he told me to ice it, sleep with my head elevated and that it would come down within a day. It`s now been about 30 hours, and it looks like I was punched in the eye -- or stung by bees. Is this common with such a tiny amount of product? If so, when should I realistically expect it to look normal? I know it can be dissolved and reinjected, but it is so incredibly expensive, I`d like to avoid that if I can; but I can`t go to work looking like this. Thanks for any advice you can give me.

Answer:

it is more likely due to bleeding than the product, bleeding is always a risk with any needle puncture, no way to avoid it 100%. It might take 7-14 days to get better, but massage and ice will help. I don`t think that small of an amount caused it and I would not think that dissolving it would help. It actually might make it worse as there would be more needle punctures. JG 10.9.11

Question:

Dr. Garcia, I went today to get sculprta injected for volume in my cheek area. The dr. I went to was suppose to be a specialist in liquid facelifts. Before he injected evolence inot the tear trough area for my eyes and was very pleased with it. The second time he injected my tear trough he injected it with parlene and didn`t like the results all that well. Now that I am losing volume in my cheeks I have read all about sculptra and decided to have it. I aslo wanted a filler for the tear trough area. He said he would just use sculptra. I asked him was he sure that he could use it for my tear trough area and he said yes. I thought that it couldn`t be used for the tear trough but he is a specialist, so I let him. He put the injection in my cheek and said it would work for the tear trough area. He then injected me several times in my temple area and jawline and on the sides of my cheeks. Is that a normal place to use it? And, have u ever heard of it being used for the tear trough area? He didn`t actually inject it in the tear trough area and don`t see how it can help when he injected in my cheek for the eye area. Is this possible. Really stressing out about this. Plus it is very sore in the lower jaw and lumps there, like knots and very tender and hurts and veay large on one side in the jawline at the bottom underneath my ear. Plus one side looks bigger than the other and makes my nasal fold line look worse. He said it would help the nasal labial folds because it would lift the skin up some and fill it out which would help the labial folds. I know I only had it done today and have two more times to get it and also know he said that it would take time. Please can u give me ur advice. Thank you very much...

Answer:

they are all normal places to inject Sculptra except the tear trough, the company is very clear that it should not be used in the tear trough.If you need a filler in the tear trough and all that was injected was into the cheek, the depression of the tear trough might actually look worse as the difference from one area to the other will be greater. Being uneven this soon is common as one side will always swell more than the other. I think Sculptra can help the jowl due to the lift effect, but as you make the cheek pad fuller, it might shorten the nasolabial fold but it will not make it less visible, especially close to the nose. Hang in there. JG 10.8.11

Question:

What do you make of this week`s news about an oral medication to reverse the graying hair? Promising? Will it be available only in 20 or 30 years? Also, I had Radiesse injected into my temples today, which I`ve had many times before without incident. It`s a little lumpy tonight. Is that just localized swelling that should go down or is it a sign of trouble? I`ve heard of people who`ve developed granulomas with this product. Thank you, Dr. Garica.

Answer:

Too soon to tell about the pills. As to the Radiesse, it is early, so a liitle massage for now and they should go away. JG.10.6.11

Question:

I had fat injections around my eyes, upper and lower, earlier this summer. The fat was taken from my thigh. It was alright for a while, but now four months later it all seems to have disappeared. Is that normal? The doctor said he was very aggressive so I am not sure why this happened.

Answer:

At best about 50% will survive but in many cases you lose it all. The eye region is notorious for poor fat injection survival. I only use Restylane in that area. JG 10.4.11

Question:

Good eve. First how do u update an email address on your site. Secondly, if I had derma live in my Nlf about sic years ago, would it be ok to put a different filler over top now?..so far no problems. Also could I have a lower facelift with this derma live still in there as that area is now looking like I need more filler there.

Answer:

I think the easiest for you would be to ask any prior questions again using the new email site to make sure it gets in. As to fillers over DermaLive, I would suggest only hyaluronic acid fillers and no Radiesse, Artefill or Sculptra to avoid any issues. A facelift would not be limited by any prior injections into the nasolabial folds. JG 10.3.11

Question:

What is the best treatment for laugh lines mid face? Fillers? Laser? If so, which filler and which laser do you prefer for each choice of treatment. Thank you.

Answer:

fillers would be much better than a laser for the laugh lines. I prefer Restylane or Perlane, but Juverderm Ultra Plus is also a good choice. JG 9.30.11

Question:

Due to your suggestion, I am considering getting some filler in the tear trough area to reduce the appearance of baggy/ tired eyes. I spoke to one nurse who said she would use a very small amount of juvederm. I then spoke to another nurse at a different place who told me the Dr. She works for will not allow a nurse to inject this delicate eye area. Of course, it would then cost more for Dr Vs. Nurse...and she said she thinks he would only use Restalyne. What is your opinion on all of this.

Answer:

Well, its a matter of experience. in my office I have a nurse injector with 24 years of experience with fillers,but I and only I do the tear trough. If the nurse is experienced with fillers in the tear trough, I guess it would be OK. There can be issues with docs injecting too, its not 100% for anyone. All the best. JG 9.29.11

Question:

Speaking of lumps under the eyes from filler, I would like to know what your thoughts are on implants. I have never put a foreign substance into my body. My form of plastic surgery is what I term maintenance . But my face has just gotten, well, boring. There is no real shape to it. Have you done implants? And what are your thoughts about them? Would you do a filler instead? And have you used any that DON`T produce any lumps. Thank you.

Answer:

Fillers are easier as the implants can be done, are permanent, but in most cases, you appearance will change more dramatically. You need to understand that we recognize one another mostly due to facial bone structure and an implant will only enlarge the boney structure, so implants will make you look different, they are not as customizable as a filler is. As to fillers, all can produce lumps, and implants have their risks too of malposition and infection. JG 9.29.11

Question:

Dr. Garcia, you mentioned you don`t do fillers in hands and about lumps which is exactly what I got - but under my EYES! I was trying to give a bit more volume to my upper cheekbones and all that happened was THREE years of a lump under each eye. I wish I could remember what product is was. I only know it wasn`t restylane. So would you do fat in the hands rather than a filler? I would just like to get rid of the bony-ness I`m seeing. Thank you!

Answer:

I think the lumps will require surgery to remove and I feel fat injections do not survive well in the hand. JG 9.29.11

Question:

Yesterday my ps injected me with Radiesse. He put some in my pre-jowl sulcus and...now I have jowls I never had before! I look terrible -- about 15 years older than I did when I walked into his office. I know there`s nothing to dissolve Radiesse, so I`ll have to live with this for about year, right? Sigh. Could this be temporary swelling? I doubt it but I thought I`d ask in the hope it might be! By the way, he used 1.5 syringes (of the larger size) on my face, putting most of it in my temples, zygomatic arch and pre-auricular tissue. He didn`t used much in the jowls, but a tiny bit seems to have made a HUGE and terrible difference there. Thank you, Dr. Garcia! Be careful wielding those syringes!! :-)

Answer:

well, the gel carrier that the Radiesse material is mixed with should dissolve in about 6 weeks, so you should see some improvement in that time The Radiesse is claimed to last up to one year, but in most cases, does not. I cannot see how swelling would go to just one side of the site injected, so likely not swelling. JG 9.29.11

Question:

Hi DR G: In your opinion what is the best procedure to tighten the skin under the eyes. I have these terrible deep wrinkles when I smile.

Answer:

Well, its a matter of thickening the skin with a laser or cream, nothing honestly, if it is there when you smile and not there at rest, nothing will work well. JG 9.18.11

Question:

Dr. Garcia, I had juvederm injected in my cheeks about 4 months ago. As the plastic surgeon was injecting he decided to do the tear trough area as well. I developed a small lump on my left tear trough that has now moved down slightly below the trough area. I have gone to see him several times about this and he says to wait and see and hopefully it will go away. I asked him about granulomas but he wouldn`t admit that that is what it is and to just wait it out. It has been very upsetting because I wanted to look more rested and this bump under my eye makes me look tired all the time not to mention...it shouldn`t be there at all! What are my options now 4 months later? Would the hyaluronidase/kennalog injections help at this time? Would that cause an indentation? Would having them surgically removed leave an indentation under my eye? This is such a mess and I truly regret ever having injections done at all especially since I did not ask him to inject there. Thanks so much for your help.

Answer:

I think hyaluronidase is a good idea but would not do the kenalog into that thin tissue. I do not think surgically remove it would leave a depression though. Sorry to hear about the problems. JG 9.16.11

Question:

Hi Dr G. Thanks for your time. I am stumped by this and I hope you can answer. I went to a Medispa and got Dysport for $8 a unit. I got 10 units on the forehead with great results. My next session I went to a Plastic surgeons office and got Dysport at $5 a unit and got 20 units on my forehead and did not get good results. I don`t understand this. Please help

Answer:

Well, that is a quandary, buy unless you see them mix it, you are just trusting them that you are getting what they say. Dysport, like Botox is intended and labeled that each bottle is for a single person and it is not to be shared, it also should be used within 4hours of mixing. The time it did not work, it could be they were using it past the 4 hours and it was weakened. Wish I had more to offer. JG 9.15.11

Question:

Hey Dr. Julio!!! Haven`t been to your site in a while, new intro had me cracking up (in a good way :) So... what are your thoughts on Silikon-1000? Have you ever used it? I have been receiving Radiesse injections into my rather deep nasolabial folds for the past year at a rate of nearly every 3 months... so needless to say it`s eating at the wallet. Would love to have a permanent filler. Does Silikon-1000 work? What are the drawbacks? Hope you and yours are fantastic!

Answer:

I understand the desire for permanent, but Silikon-1000 has too many problems, that it is why the FDA has never approved it for cosmetic injections.In Nevada, it is actually illegal to use. Remember too, filling the fold is fine but what is causing it, which is the descent of the cheek skin, will not be halted by the filler, so you will need continued injection over time, no matter what you inject. Sorry, and thanks for visiting the new site! JG 9.14.11

Question:

Dr., a million thanks for your answer on what ages eye area most. You have given me some hope for putting off surgery, at least for a while. If I go to you, what is your charge for injections to reduce the appearance of puffy lower lids? What would you use in this delicate area?

Answer:

I typically use Restylane, the fee is $635 for the syringe, many patients get more than one session form the syringe. Al the best. JG 9.12.11

Question:

Hi Dr. Garcia, I had sculptra injected in my cheeks. Is it possible for the fullness to actually make under your eyes to look more hollow?I have circles there that I never noticed before.thanks as always...

Answer:

the large the cheek pad is, the greater the difference between the eye socket and cheek, so it could happen, yes. All the best. JG 9.9.11

Question:

What happen if the sculptra is injected too deeply? Does that affect how long it lasts? I went to a derm for exploration and she said that from feeling where the nodules are ( within the mounth at cheekside) the sculptra was injected too deeply and not in the recomended layer. Clould this be the reason why I hot chipmunk cheeks and feel my face more stiff when smiling and talking?

Answer:

it will possibly not create as much new collagen if there is not enough blood supply to help that happen. If less collagen is made, the effect will not be as much and will not last as long. Injecting it into the muscle is well known to cause lumps and that can contribute to the fullness you have as the muscles have retained a lot of swelling and possible granulomas within the muscle. Those will take time to go away.All the best. JG 9.9.11

Question:

Hi Dr...maybe a bit long-winded here; in the past I have tried using Botox to lift the tails of the brows, by two separate injectors (one a plastic surgeon, the other a nurse). I really can`t say I noticed a bang for my buck with either. I did however notice that both times some very noticeable eye bags formed. These eventually disappeared but it took a long time (more than 8 weeks). Are there any options left for me to alleviate a tired look, besides surgery. Would plumping the area just above the cheeks and extending to the outer corners give any kind of lift at all? I guess Botox just doesn`t work well for me.

Answer:

if your skin above the eyebrow has thinned out as part of the aging process, then a filler above the eyebrows to replace the lost subcutaneous fat might help, otherwise there is a technology out there called Ulthera that helps to lift the brows, but the results might not last more than 6 months or so and is uncomfortable to have done. Otherwise, it is surgery. Sorry, wish there were more options. JG 9.7.11

Question:

Hi Dr. G., What can I expect prescription bio-identical hormones cream to do? Does it improve just the skin where it`s applied? If my doctor is not familiar with hormone replacement, what is this specialty area called? Are there articles/books you can recommend so I can educate myself? There are a lot of information on the Internet but I think much of it is not balanced, and Suzanne Sommers seems too sold on the benefits. I`d like to make an informed decision so I need to know what the risks are as well. Thank you as always.

Answer:

Check out worldhealth.net JG 9.1.11

Question:

Hi Dr., I will be seeing my doctor for my annual, and would like to get guidance/advice on hormone supplements. Can you tell me what is possible in terms of safety and effectiveness. Also, you had suggested prescription bio-identical hormones (cream) for skin. What does this do for the skin, and is it used for the face or the body as well? Lastly, you stressed use of sunblock, not sunscreen. Can you give examples of brand names? It seems everyone is selling sunscreen and moisturizer with 15 or 30 SPF (UVA and UVB). Why are these not enough protection? Thank you!

Answer:

Not all doctors do hormone replacement, so ask anfd see what they say. I prefer bio-identical as that is what the body makes. As to sunblock, as long as it is a block, they are all pretty similar. I use Total Block by Fallene, sold on the internet. All through best. JG 9.1.11

Question:

Hi Dr. G., I hope you had a good summer, and enjoying what`s left of it. Today`s Qs are: What is available out there today that helps tighten skin (body as well as face), other than surgery. Also, does Toki (packets of soluble collagen that one adds to water, etc. and drink a coupld of times a day) actually work? It sounds farfetched and very expensive but these folks seem to be able to line up people who claim it helps their skin. Thank you as always.

Answer:

I do not think there is any noninvasive technique that will work. As to the Toki, save your money, best of the season too. JG 8.31.11

Question:

Dr. G - what would you say the standard amount of Dysport a 52 year old female should get on the forehead and eye area, And why does some places charge $10 a unit (a Medispa) and a Plastic surgeons office charge $5 a unit?

Answer:

I think for those that charge bu the initialization, the spa is charging about 3 times too high, might be because it is one of their top end procedures while at the doc`s office, it can be just a way to get people in so they might come back for surgery. What I use for Dysport is 60 units for the glabella, about 30-60 for crows feet, and about 100-150 for the forehead. JG 8.30.11

Question:

Thanks for answering my questions Dr. G. I went to a different dr;s office to get Dysport (my first visit) and the injector did not inject in the right location so my results were not as good. Next time, should I go somewhere else or try again with the same one. (I like going there because they have good sales)

Answer:

Price is important, but experience is more important. Best of luck.JG 8.30.11

Question:

Hello Dr Garcia; A medispa charges $10 a unit for Dysport. A plastic surgeons office charges $5 a unit for Dysport. I went the the Medispa and got 10 units in forehead; 12 units by each eye. Had really good results. Went to the Plastic surgeons office and got 20 units of Dysport on forehead and 12 by each eye. Results are not as good as the Medispas. I call the Plastic surgeons office after 5 days and advise that I still have crows feet (not bad, but they are noticeable). I was told to give it 10 days. At the Medispa it got resuls in 3 -4 days. Whast is going on??

Answer:

I think it is where the Dysport was injected, small location differences can make a big difference. JG 8.29.11

Question:

Dr. Garcia, Quick question about Prevelle Silk. My dermatologist says it does not last long. I had some injected in lips (like it!) and smile lines. I know you can not say exactly, but about how long do you think it should last? So far I like it as it is subtle and soft. thank you for all your great answers to our many questions.

Answer:

They are correct, it does not last long, but can be used in very fine lines where the other fillers might be too bulky. As to how long it will last, the more the area moves, the less time it will last, but I would say a couple of months at most. Its a good product for certain things, but to keep it soft and subtle, you give up a little of the longer lasting effect. Best of luck. JG 8.26.11

Question:

Morning Dr. Jacquie from Canada again about the derma live. can I have sculptra injected in the cheeks...wld that lift enough to help with the marionette lines or wld I have to put a whole Ot in to make a difference. T.y.

Answer:

hard to say without seeing you in person, but it should help some, might not totally eliminate it though. JG 8.26.11

Question:

Hi doctor. Would you do a fl on someone who had derma live in the n/f and marionette lines...2 vials...also as I cannot have any fillers put in this area, is a cheek lift or implant an option? Don`t like those marionette lines...any suggestions? Thank you from Canada. Jg

Answer:

A facelift, cheek lift, or cheek implant are all OK to do. All the best. JG 8.25.11

Question:

I am in a major dilemma. I had an extremely strong response to two vials of Sculptra I received in June. I`ve been using Sculptra since 2008 and have been very pleased. By June, I had deflated significantly an needed to be reinjected. Now my face is swollen, literally, to 2 times its normal size. It looks like I`ve been stung by a swarm of bees. In fact, I cannot fully open my eyes because my cheeks are so full, and it`s only getting worse by the day. Would a course of Prednisone take this down a bit? I can`t live like this for two years, waiting for it to subside. I have a very public job. Thank you for any help you can offer.

Answer:

It is worth a try but not sure why you are having such a different response. JG 8.23.11

Question:

What do you think is the best filler for long lasting improvement in marionette lines? Thank you

Answer:

I like Restylane. JG 8.21.11

Question:

Hello Dr. G: What is the standard units of Dysport that a 52 year old woman requires on the forehead and around each eye?

Answer:

I am afraid there is no standard, each patient will need different amounts and doctors at times use variable doses. In the majority of my cases I use 300 units to treat the upper forehead, glabella and crows feet area. JG 8.21.11

Question:

Hello Dr, Welcome back! I hear different reports on whether or not fat can be stored for later use to be used as a facial filler. Some articles say that it does not survive so it must be injected immediately, others say when frozen it can last up to two years. What is your experience of this? Thank you

Answer:

Besides research labs, no one has the correct temperature freezer to store fat. Sorry, just docs making claims to greet patients to come in. JG 8.18.11

Question:

hi Dr. Garcia, I would like to treat the fine horizontal and vertical lines above my upper lip. My doctor wants to diagonally inject juviderm there. Is that how you would address the problem?

Answer:

Yes, its s common solution. JG 8.18.11

Question:

Whenever i receive Sculptra injections, I notice that they seem to peak, reaching their maximum fullness, at 2-3 weeks. My ps claims that this isn`t possible, that it takes 6-8 weeks. What do you think is going on? Also, do you like the Kinerase line of skincare products? And any thoughts on the Image line? Thank you for your time.

Answer:

well, I honestly disagree with both of you, it peaks at about 4-6 months. Some people see the start of growth at 4 weeks, but it continues from there. I do think Kinerase is a good product line. As to Image, no personal experience with it, but likely not significantly different than any other. JG 7.31.11

Question:

Hi Dr. Garcia, I just wanted to know if it`s normal to feel a line of restylane just behind the nasolabilal crease rather than directly in the crease. I had some injected on Friday and I was just wondering about the placement. Thank you...

Answer:

That can be normal, not to worry. JG 7.25.11

Question:

I seem to be a bit confused. If I get restalyne or another filler directly placed underneath eye bags/top of cheekbone will this do two things and give a lift to the bone structure while also reducing the appearance of the bags? Or, is one a completely different than the other?

Answer:

It will hife the fat pocket by raising the skin that has sunken from fat loss. It really does not do much for the cheek itself. JG 7. 24.11

Question:

Hello, I am getting restylane injection in a couple weeks. I currently take cod liver oil - is this known to thin the blood and should I stop taking this to decrease risk of bruising? Thanks.

Answer:

Might be a good idea. JG 7.21.11

Question:

I have a bruise the size of a quarter from a deep restalyne injection in lower part of face on the side. The bruise is 10 days old and is very green. Will this ever go away and is it mnormal to be green --what should I expect--more than another weekl?? I am using arnica orally 3x a day. THANKS!!!

Answer:

it can happen with any filler, if it is green, it will be gone soon, some warm moist heat should help some. Keep up the arnica too. JG 7.18.11

Question:

Dr. Does Botox have some strange reactivation in the sun/heat? I know that`s kind of a stupid question, but just the other day I wrote to you saying my Botox eye bags had deflated, and yesterday I was lounging by the pool (yes, using 45 sunblock on my face), and when I looked in the mirror the baggy eyes had returned. More on right side than left, and also I can actually see the divet where it looks like the place where the needle went in. Should I just stay away from the sun? I was wearing sunglasses and lots of sunscreen around eye area. Thanks so much for your answers.

Answer:

No sun effect on Botox, likely just sun effect swelling, ice wnd massage should make it better. JG 7.16.11

Question:

What do you think of ultherapy? Is it just hype? Also, which would you recommend for marionette lines; artefill or radiesse or other? Thank you

Answer:

expensive and painful to have preformed, for what appears to be 3-6 months of improvement. As to the fillers I recommend for marionette lines, between those two I would use Radiesse. JG 7.13.11

Question:

had restalyne today and when i open my mouth wide and shut it hurts--could a muscle be injured or a nerve? thanks

Answer:

highly doubt a muscle or nerve was injured, just probably some swelling in the tissues. Should get better with a little time. JG 7.13.11

Question:

Dr.Garcia, did you get the chance to see the photos I send you? Would you please let me know what do you think and if I will be getting even fuller as time goes by? At the moment it looks that i will be getting close to the look I had the day of injection. He overcorrected 300 % or even more I could barly open my mouth due to so much volume. When should i start to see some deccrease? Please let me know. Tnak you so much

Answer:

I am sorry but I cannot say when it will get better as I have never seen or heard of anything like this. JG 7.12.11

Question:

Hi Dr, due to the down time of having fat transfers and not having the time off from work, I had HA fillers injected into my cheeks about 3 months ago. I now have the possibility of getting time off. Can I just have the HA dissolved and then have the fat transfer done immediately after? Thank you

Answer:

Should be OK to do. JG 7.11.11

Question:

Hi I have very hollow cheeks. would you please let me know which is the best product. I have tried Scalpta (new feel) with no success. Thanks again Ruth

Answer:

That is the only product we have in the US that I would use, none of the other fillers will work well. Sorry. JG 7.11.11

Question:

Wow...I thought it was just me but saw another post about fluid and eye bags protruding after Botox to lift brows. This is horrible. I got a nice lift to the outer brow but the fluid/ bags are not worth it. It has been one month for me and it doesn`t seem to be getting better. Have you any suggestions on what can be done? Will this wear off sooner than the brows. Why did this happen and what can I say to the next injector (thinking of going elsewhere ) to make sure it never happens again. This is making me look so old and weary.

Answer:

Might take a few more weeks, it will not last as long as the other Botox effects. A stronger dilution and more careful placement should avoid it next time. JG 7.10.11

Question:

Hi Dr., I was wondering what you think of the supplements being sold by Dr. Lark for helping alleviate menopause symptoms. They are not cheap. 2 capsules include B6, B12, traditional chinese herbal blend (too long to list), para amino benzoic acid, hops extract, boron and melatonin. Are these Is there another way to prevent/get back some of the losses caused by an imbalance of hormones - safely - without spending hundreds of dollars a year. Thank you as always for your time and sharing of knowledge!

Answer:

overpriced, the things that are natural that help are not that pricey, things like fermented soy, black cohosh, and B vitamins. JG 7.8.11

Question:

Hi Dr. G., I hope you had a wonderful July 4th. I have been following your advice regarding progesterone, hair loss, post-menopause symptoms, etc. I am 55, had my last period when I was 47, and from all I`ve read and seen from friends and colleagues, I guess I`ve had an easy time of menopause. Perhaps because I`ve always worked out strenously since my mid-20s, I`ve had very infrequent and very brief hot flashes, and have not suffered too much of the symptoms I`ve read about. Nevertheless, I`m wondering if I should have my hormones level tested. If so, what medical specialty would this fall under since my GP is an internist. Where and what should I be asking for - when buying progesterone to inhibit hair losss? Are there side effects to taking progesterone? What can I take to improve on skin elasticity? I`ve noticed that the skin on my arms and legs are thinner now. Sorry for the many Qs. Thank you as always.

Answer:

typically I would suggest an age management doctor, you can find a list at www.worldhealth.org. As to the progesterone and hair loss, it can be bought at a weaker dose OTC at good health food stores, look for progesterone USP only. The side effects most commonly reported is feeling tired, but that is hard to do with topical creams applied to the skin, there is no need to apply it directly to the scalp. Estrogen replacement from a physician might also help with the thinning skin. All the best. JG 7.6.11.

Question:

Follow-up my question about a line on chin unresponsive to fillers. I assume that`s not a place botox could be used (without drooling or something). But just getting your thoughts.

Answer:

You can try a very low dose, but if you see it rest when the muscle is not flexing, it likely will not help. JG. 7.5.11

Question:

I have a couple of creases about an inch long on one side of my chin. They do not respond to fillers. Do you think a spot dermabrasion would help? Area would be about the size of quarter. Or is there a new filler that might lift them?

Answer:

maybe, but it will be short term, I think if there is flexion of the muscles causing the problem, fillers will likely not work well. JG 7.3.11

Question:

Dr. Garcia, its me again...its day 16 after sculptra in my cheek hollws and my face is morphing and growing every day...I cant even do a bright smile anymore, my eyes look tiny and sunken...i look weird ( we call it pillow face...like Meg Ryan, Cathrine zeta jones, madonna, Kylie Minogue etc.) with a stuffed unnatural face and huge cheeks. I am crying everyday.I had a nice natural shaped face with slight cheek hollows now I look like a plastic surgery disaster freak.please tell me if my face will become natural again with natural angles, shape and contours, now its just big round and flat, no nasolabial lines no expression, I used to have a soft, sweet and very young looking face now i look older, hard, it`s so horrible and I couldnt stand to stay like this for another year. I am hiding in my house, barley seeing anyone. Please tell me what to do to get rid of it an become back my old face???

Answer:

I am unsure as to what is happening, I cannot see that it is the Sculptra itself, I think you need to see your doctor that injected the product for them to figure it out. I am at a loss as I have never seen nor heard of that happening with Sculptra injections. JG 7.1.11

Question:

Here in Ottawa there is a lot of promo for a softlift - i think it is with fillers and botox..is this correct? ALSO, IF U HAVE HAD DERMALIVE IN THE NLF - how could u have a facelift..does not the dermalive adhere to the tissue/ thanx dr.

Answer:

yes, it is just the use of multiple non-surgical products, like Botox and fillers to improve one`s appearance. As to the Dermalive, a surgical dissection with scissors or scalpels will be able to separate the tissues, much like a second facelift is done. All the best. JG 6.27.11

Question:

Hi Dr. Garcia, its me again the one with the fat sculptra face...my question is if its really already sculptra results I am seeing after 12 days and fibrotic tissue already formed ( mys skin feels very thick almost to stiff where he injected) and it will grew even more in the next couple of months, or is it as my derm says rather swelling and product ( but no collagen formed yet) and it will settle in a couple of weeks and be more subtle. What do you think from your experience, Could it be possible to have already a strong response after 2 weeks bearing in mind that he overfilled me the day of injection???

Answer:

it takes at least 4-6 weeks for collagen to be deposited, for fibrosis to occur and the the PLLA to start building, I do not believe you are having a stronger than normal reaction. JG 6.27.11

Question:

If you have had Restylane done and it doesn`t look right, can it be dissolve? What about radaiesse?

Answer:

Restylane can be dissolved, Radiesse cannot. JG 6.26.11

Question:

Dr. Garcia- A dermatologist in Beverly Hills is performing a non-surgical face lift called stem-cell lift in which he injects fat and stem cells into the face for natural results that last 5-10 years. Have you heard of this and what do you think of this procedure. Thank you.

Answer:

At the present time that is hype and lies, he has no proof in his on experience nor in the scientific literature that he has viable stem cells in the fluid he is injecting nor of how long it will last. He is using a buzzword to take your money. Spend your money on something else. JG 6.25.11

Question:

Hello Dr. Garcia, It`s been a few years since I last spoke to you in regards to Artecoll. I had Artecoll injected into my lips about 5yrs ago and am now experiencing lumps; which have quite a sharp feeling to them like there is little bits of glass in my lips. Along the edge of my lips it`s rather hard but not even. There are spots that have artecoll and then spots that don`t. I know now that I shouldn`t have had this done, but it`s done and now I have to live with the consequences, or is there something that can be done to fix this problem so that I can feel more comfortable with how my lips feel and look?

Answer:

I think this far out trying to dissolve them or break them up will likely not work, it looks like you will need to have them cut out, that might leave small depressions in the lip that then have to be filled in preferably with an HA filler such as Restylane. I wish you the best. JG 6.24.11

Question:

hi dr. garcia. i had juvederm injected into my right nasal fold near the bottom - and i asked it to be filled very conservatively. i am fair skinned and thin and i have had some questionable results with things done on my face. immediately after the injection, i felt a large lump in one area which the dr. asked me to apply pressure to and the other injection site bled and (two days later) has a red mark that does not seem to be fading....the lump looks like it missed my crease area or migrated. i have tried massaging it but it is still very red by the way and has not smoothed out at all. i called the p.s. office and he said it is normal and may take a week or so but to try massaging it again........when i look in the mirror i realize that this lump that doesnt smooth out the crease also adds another shadow contour to my face (that i didnt need)....any suggestions? i have a big affair to attend this weekend. thankyou in advance for your help, pg

Answer:

migration is rare, but injection being off the mark or a hematoma are possible. The hematoma can be deep and can take a week or more to get better. Warm moist heat and masssage is about all you can do, so continue. The red mark form the needle can also happen and will go away on its own. There is not much you can do in the short to speed thing up though, just continue your present regimen. All the best. JG 6.22.11

Question:

I asked a question about getting sculptra injected in my cheeks. The plastic surgeon said it would help with my nasal labial folds because he said they were caused from collagen and fat being lost. He said when he injects the sculptra and it begins to work it will fill the cheeks back up and lift the skin that is falling down causing the nasal labial folds. He says u don`t need a filler to be injected underneath the folds because that isn`t what they need.He said the sculptra will take care of it. And I think he is right because when I had the filler injected underneath them they looked worse in some ways. Looked swollen and just didn`t look right.

Answer:

in most cases I agree, if the nasolabial fold is due to descent of the cheek skin, that will help the problem. In younger patients with full cheeks the Sculptra might not be the best choice. Every patient is different. JG 6.22.11

Question:

What is your opinion of artefill?I am thinking of using it for bmarionette lines as no other filler will last for long? Can it be dangerous or cause problems later on? Should it be done in layers over time? Is it really permanent? Thank you Dr. Garcia

Answer:

the longer any filler lasts, the longer an problems such as lumps can last. It potentially can be permanent, but count on 3 years or more, but remember, the filler you are using is to mask something else that is falling, the filler will not stop the falling, so the problem will recur, even with the filer, in time. JG 6.22.11

Question:

Sorry to ask these questions again, but u never did answer them before. It is posted where I asked them but it is skipped over and the others are answered, but not mine. I am a thin white female age 50. I don`t smoke but have loose skin under my chin and on my neck. I would like to have this fixed, but don`t like being put to sleep. I would like to know if this could be fixed with a small incision under the chin somehow and not have any cutting behind or in front of the ears because of hair loss? I have thin fine hair and can`t afford to lose any more. I also have baggy wrinkley knees and wrinkles on top of my legs. I would like to know if fraxel repair or anything could help this? Also I am scheduled to have sculptra injections for the cheek area. I would like to know if this could help in raising the cheeks to where it might help the nasal labial folds some?

Answer:

please look at the original posting, I answered the questions out of order as I was having problems with my smartphone. JG 6.21.11

Question:

Thanks for your time Dr. G. :What are your views on Sculptra vs. Juvederm vs Radiesse injections?

Answer:

I use them all, but they are not interchangeable , what I use dependants on what area is being injected. JG 6.21.11

Question:

Hi Dr! I have been having Sub Q or Teosyal for the past few years for cheek augmentation. I am now thinking of trying Radiesse as I like the idea of collagen production, however it seems people get more problems with this product. Are there more risks with this filler? Thank you

Answer:

I don`t think Radiesse will create enough collagen on a clinical level to warrant a change from what you are using now. JG 6.9.11

Question:

I had hyaluronidase a few days ago to dissolve an overfill of HA. Now the skin over that area is red, very dry and peeling off in huge chunks. Not infected. Why is it doing that? Creams don`t seem to be helping. Any suggestions? Thank you!

Answer:

just a normal inflammatory response to the speedy breakdown of the product, it is temporary, OK to use moisturizers over the area. It will get better with time, slowly. JG 6.9.11

Question:

I recently moved an my new dermatologist wants to use Perlane under my eye an in my oral commissures. My previous dermatologist used Restalyne, and it worked perfectly. I`ve read a lot of horror stories on this blog about the wrong product being placed in the wrong site. I thought I should check with you before I let him do it. Thank you!

Answer:

I think Perlane is fine for the oral commissures but I feel it is too stiff for around the eyes. All the best. JG 6.8.11

Question:

me again with juvederm done 24 hrs ago to oral comisure what will the moist heat do if i use it to the injection site?>

Answer:

help get any blood that is deep in the tissues form the needle stick to dissolve and be absorbed faster. JG 6.1.11

Question:

had juvederm to one oral comisurre yesterday. and it is a little pouchy. are u still recommended moist heat to bring the pouchiness down,???? to make more smooth and not so elevated.. also taking advil pm for inflammation that might be occuring

Answer:

ice for the fist 24 hours, then heat, yes. I try to avoid Advil after and before injections as that can cause more bleeding and swelling. JG 6.11.11

Question:

I had restalyn today and it looks great. As tht dr used the last bit of the vial it sounded like air going in the area but it looked fine and i didnot mention it. Wheni got home and put on foundation i noticed when i pressed on that area it sounded like water or air was in the area which after pushing on was gone, looks fine and feels fine. Should I be concerned. It is now 6 hrs later . Could it be air bubbles that would cause an embolism? Thanks so much.

Answer:

no, that air will be absorbed without any negative effects. No chance of any embolism. Best of luck. JG 5.26.11

Question:

Dr. Garcia, Is there any limit in the anount of filler (ie. Restylane, Perlane, Juvaderm, etc.) that can be injected in the face at one time. For example, if someone has several syringes of Perlane injected in the cheek area and a few days later feel they still need to address the lower face, is it fine to add several more syringes (possibly a different kind of filler)? I`m not aware if there is a limit on the amount of filler that can be injected at one time or spaced days apart. Thank you.

Answer:

No limit. JG 5.24.11

Question:

Thank you for answering all my questions. I had juverderm almost 1 week ago in my marriorette lines and lower jaw. On May 31 I am suppose to have my teeth cleaned. Will the teeth cleaning cause any problems. I am also having zoom teeth whitening on the same day.Zoom is not a laser, but rather a low-heat emitting blue light. You do have to put a guard around your mouth, which keeps your mouth wide open for 45 mins. Is all this work going to be counter productive to the juvederm injection. Should I wait on the cleaning and zoom treatment. Thanks you for your input.

Answer:

no worries with the teeth cleaning.Same for the use of a mouth guard for the required period of time. Best of luck. JG 5.22.11

Question:

Hi Doctor, I get Juvederm every 3-4 mos in my nasalfolds and lips for a few years now....it seems to go away fast in the nasalfolds, Im looking for something longer term to save money maybe once a year or 2years to inject there and look plumper in this area, I am 30 years old. what product would be the best for my money??? Radiesse??? Thank you :)

Answer:

Radiesse can be tried, might last a little longer, otherwise Artefill will last evn nlonger. Best of luck. JG 5.22.11

Question:

I received juvederm on Tuesday of this week. I feel lumps or bumps at the injection site. They are not visable. Is this normal or should I be concerned. I also took arnica tablets for a week before the injection and iced after for the first 24 hours. I still bruised. I have also applied Vit.K cream to the site. Which is better to use the Vit. K or the arnica gel. Thank you

Answer:

Nothing prevents bleeding entirely when needles are involved, you can use either cream, I prefer the arnica. Small lumps can happen time and a little massage should help. JG 5.21.11

Question:

One last question about Suzanne Somers Platinum Facemaster - can it actually stimulate the muscles or can it do more harm as you are shocking your muscles??? Think she may have had the stem cell Facelift...better before.

Answer:

Well, the more the muscle flexes, the greater skin wrinkles, that`s why Botox is popular. Muscles on the face do not weaken so they do nor need stimulation. As to what she has had done , hard to say. JG 5.19.11

Question:

Dr. Garcia, I am the one who developed two radiessse lumps inside my lower lip. He injected marionette, chin, naso lines, and cheeks with two syringes. After reading on here, he shouldn`t have used it all, I guess. He told me to leave the lumps alone as they aren`t bothering me or visible. He told me not to massage them--it might bother the looks of it on the outside. Do you think I should insist on him cutting them out if they don`t go away in a few months? Also, are you ever out of the woods with radiesse? I am going on five weeks--can you develop these lumps at any time. Thanks so much. Never again will I use this.

Answer:

What you have might get better in time on its own, but lumps can develop up to one year after the surgery . I think waiting a couple of months at least is a good idea to see what happens to them before doing any cutting. JG 5.19.11

Question:

How soon after you have juvederm can you have a facial or mild peel from a esthetician. Is it okay to use your skin products and makeup right after juvederm injections or should you wait a few days. Thank you

Answer:

a day or two I spent of time. OK to use your skin care products the same day. All the best. JG 5.18.11

Question:

I had juvederm today on my marionette lines and some fine lines in the triangle area by my mouth cheek area. She used 2 syringes. On my left side the marionette line is still visible, my right side looks great. Will this fill in or am I seeing the end results. She use 1 syringe and showed me the results and I decided to use one more syringe to do the other fine lines. When she showed me the areas she did with the first syringe the marionette lines were gone. Why did the one on my left side reappear. I did not notice this before I left the office. Do you think when I was putting pressure on the site ( she told me too) the juvederm dissipated? I have read that too much pressure right after the injection can cause a problem. Thank you for your time.

Answer:

Juvederm provides an instant result, the product will not enlarge to get any bigger, you might need more, although 2 syringes is a large amount I must say. The Juvederm would not disappear so all I can guess is that she injected more filler above the level of the marionette line and it recreated the original problem. It would be nearly impossible to push the Juvederm out of position, it might have not been appreciated at the completion due to the lighting in the room is about all I can guess. All the best. JG 5.17.11

Question:

My face is sagging...getting that square look. My neck is wrinkling inward so that I have about 6 folds in the center of my neck. Do I do something now? Wait until it gets worse? Would filler along the jaw line just make me look worse? Is filler ever done in the center of the neck? Also, my hands were always boney looking but now are looking skeletal! What do you think about filler in hands? Thanks very much.

Answer:

if it bothers you everyday, then proceeding with treatment is reasonable. I do not feel fillers in the neck work well enough to recommend them. Fillers in the hands can be done but do not last very long, sorry. JG 5.22.11

Question:

One more (or two more) questions. When I had filler injected into my cheeks I was bruised for almost three weeks,mostly on one side. On the side I wasn`t so bruised I had been icing up to the moment the dr began the injections. I`m thinking that for someone who bruises as badly as me, icing before injection is wise. What do you think? Does it interfere with the injection at all? Tx!

Answer:

it will help the pain and will help the bruising a small amount, it is more of where the blood vessels are and if they are injured by the injector needle. It will not interfere with the injection though. JG 5.17.11

Question:

My face is sagging...getting that square look. My neck is wrinkling inward so that I have about 6 folds in the center of my neck. Do I do something now? Wait until it gets worse? Would filler along the jaw line just make me look worse? Is filler ever done in the center of the neck? Also, my hands were always boney looking but now are looking skeletal! What do you think about filler in hands? Thanks very much.

Answer:

if it bothers you 7 days a week, then it is likely time to move forward. I think filler at the jawline will make your jaw look bigger and will not correct your issues, unless you inject enough to make you look like Jay Leno. Fillers in the hands work, but just for very short periods of time. JG 5.17.11

Question:

I have sought your assistance many times over the last 3 or more years and posted twice today but just want to say Thank you for your time and expertise. I hope you continue this site for many more years to come. It is comforting to know that you r there no matter where we go ..and the price is right too. Thank you again Dr....your Canadian admirer in Ottawa. jg

Answer:

I truly appreciate the kind words, and am glad I have helped. A big all the best to my neighbor to the North!

Question:

Is the Suzanne Somers Facemaster worth getting. Can u really stimulate muscles to sculpt the face. She claims to use it but i am not convinced that she does not use fillers or has not had surgery. Thx jg

Answer:

personally, although I really think Suzanne has lots of good ideas and beliefs, this is not one of them. JG 5.17.11

Question:

I have been using botox for about 7 yrs. I notice at the temple area around the eyes, sort of indented. Is this normal? What causes it and what can prevent or help it. thank you. jg

Answer:

That is not related to the Botox, it is part of the normal subcutaneous day loss that comes with aging. It can be improved with filler like Sculptra.. JG 5.17.11

Question:

Dr. Garcia, Thanks for answering myquestion on the radiesse injections which must have caused lumps inside my mouth. He did not inject through my mouth--just on the outside to the left and right where my marionette lines were. AT least I think he injected there because I can feel it a little when I press there on the outside. I know he did the chin area. So it is weird these lumps are on the inside?

Answer:

quite, the reason is that if it is injected underneath the skin, the material would need to migrate through the entire group of muscles around your mouth to get to the inside, not an easy thing to happen. JG 5.16.11

Question:

Dr. Garcia....I am considering Sculptra filler for hollow cheeks and am looking for an expert injector of Sculptra in Newport Beach, CA. Do you consider find a doctor on the Sculptra website to be a reliable source for a doctor referal and would the listed doctors all be a good choice. Thank you.

Answer:

yes, it is a good source. Best of luck. JG 5.16.11

Question:

Dr. Garcia, I had two syringes of radiesse about four weeks ago. He did my cheeks, jowl area, and unfortunately, my marionette lines. He did not get close to eyes cause he said lips and eyes were out. But now I have two lumps inside my mouth where marionette lines were filled, I guess. I have an appointment to see him in two days. After reading your opinions on radiesse, I am worried that these lumps will just get bigger and bigger because of collagen stimulation. Also worried about mouth cancer, etc. Anything to do or tell him not to do? Thanks so much. I know the horse is already out of the barn, but don`t want him to do anything else that might make it worse.

Answer:

I see no need to worry as to the cancer, and there is still some collagen carrier that has to dissolve so I would give the lumps inside your mouth time before doing anything. Not sure why you would have lumps unless he injected you through the mouth,I would never consider injecting through the mouth as it is further away form the area you are trying to fill and there is a higher risk of infection. All the best. JG 5.16.11

Question:

I asked you a question about restylane for marrionette lines and lines above my lips. I am concerned that I will not be healed (bruise, swelling) for my daughters wedding early June. I am scheduled for an appointment on May 17, which would give me 3 weeks before the wedding. I do easily bruise. How long do you recommend for recovering. I had fraxel done recently and I had swelling for 3 days. I am more concerned with the bruising. Is there anything I can do so I do not bruise or swell. I have heard that arnica homopathic tables and arnica gel is recommended. Thank you so much for your time.

Answer:

I think three weeks is more than enough time to have the fillers done and fully recover. Arnica, both tabs and gel, are a great option for before and after, we use it on our surgery patients. JG 5.13.11

Question:

I would like to have restylane for my laugh lines and marioneete lines. My daughter is getting married in one month and I am afraid of bruising or any other side effects. Do I have enough time for the healing? Thank you

Answer:

yes, planty of time do it this coming week. Congrarts to your daughter too! JG 5.7.11

Question:

Hi Dr. Garcia: I had my doctor inject a Kenalog 5FU combo in to my scar and it worked it flattened it out, but I have a traingle area above the scar which is right above my lip, under my nose to the right side. It has to be from the Kenalog. I had the shot 4 weeks ago. Will it grow back, it is aweful flat, can I do anything to reverse it. It is to thin to inject juvaderm or rastalyn because it turns blue or purplish. Do you have any suggestions. Thank you so much!!!

Answer:

should grow back, yes, in time. Just have to wait it out though. Hang in there. JG 5.7.11

Question:

What can you do for discoloration resulting from hyaluronic acid fillers being to superficially injected? Does it improve over time?

Answer:

best is to wait for it to dissolve and if it is due to the filler, it will go away on its own. JG 5.6.11

Question:

Hi wonderful Doc, I had restylane in the tear trough a month ago and am not too thrilled. I now have a puffy white line like a half-moon beneath each eye. 1) How long will this take to go down if I just leave it alone? 2) I want Botox now to reduce crowsfeet and lift the lateral brow. The Restylane circles extend almost up to the outer corner of the eye, could the Botox injections for crowfeet actually penetrate the filler and cause more problems? Thanks so much for your time.

Answer:

It might take a couple of months to get better int that area, might want to consider hyaluronidase to dissolve it. I don`t think the Botox would cause any negative effects with the Restylane, even if over filled. Best of luck. JG 5.4.11

Question:

Hello Doc Garcia, Quick Question. Is it okay to use my Retin-A cream if I have Juvederm? Any problem with that? Thanks... and have a great week.

Answer:

no problem, smear away! JG 5.4.11

Question:

Hi dr Garcia thanks for all your helpful advice on this forum I really respect your advice and opinion. Can you please tell me the worst case scenario of using 5fu to treat scar tissue in the lip border caused by restylane injection, likely the scar tissue has formed from the trauma of the needle. Could injecting these lumps of scar tissue with 5fu cause more problems? Like the needle used for the 5fu create more scar tissue, permanent hyper pigmentation, tissue atrophy. Does the 5fu need to be specifically only injected into the scar, it is difficult to see the lumps unless it`s in fluorescent lighting

Answer:

I have not seen any problems from the 5FU itself, but the needle used can cause bleeding, and if that is a large amount, some amount of scar could potentially form, but quite rare. It has to be injected directly into the scar tissue, but it can be done by feel. Best of luck. JG 5.3.11

Question:

Hi Doctor. I am the one who posted the dermalive question below. Just wanted to say thank you for answering on a weekend. U must have a very understanding wife. Thanks big much again.. you have made me feel better....your Canadian admirer. jg

Answer:

Glad I could help, and yes I have a wonderful wife. JG 5.1.11

Question:

Hi Dr. Garcia. Just wondering - had dermalive injected about 6 yrs ago with no problems - just the odd itch. Had Laser Genesis done and 4 weeks later an IPL. Is this all right as I went on the internet and have seen various complications and am totally scared now. Thank you.

Answer:

This long from the injections should be OK. JG 4.30.11

Question:

Dr. Garcia, I had juvederm yesterday in my marionette lines, the right side looks great, but the left is lumpy. Is there anything I should do? Also, since the right looks fine now, is it going to get any fuller? I have read where that happens over the next 10 days or so. Thanks for all your great advice.

Answer:

little massage and starting tomorrow some warm moist heat to get ti all to go down. I do not think it will get any larger. The swelling can take 10 days to go down but it does not get larger for the ten days, hang in there and best of luck. JG 4.29.11

Question:

If I have no crow`s feet, will it still be possible to get a Botox brow lift to the outer corners of the eyes?

Answer:

Certainly. JG 4.28.11

Question:

Hallo! I have post you before. Well, I am a person with Sub Q in my cheekbones 1 CC in each side. I had it done 22 m ago. I finally get my nerve and went to London and had Hyalase. The part that remained was shrinking down a lot in the beginning and I am almost back to baseline. I did this 6 days ago. How long does hyalase work. Days or weeks? Many thanks for your time.

Answer:

The Hydase works in 24 hours so you might need a bit more. JG 4.28.11

Question:

I`ve been told that fat can be transferred to overliposuctioned areas under chin/neck area (cobra neck deformity) I know that survival rates are variable, but can this be done, in your opinion? How about fillers?... Thanks in advance.

Answer:

it can be done, and since the amount needed is usually small, it can do fairly well, I think the other off the shelf fillers will not last long, maybe Sculptra is an option although I have not use it in that area. Best of luck. JG 4.27.11

Question:

i had restalyn injected weds on cheekbone. at first i had some pain on that bone which went away. now when i press temple area(none injected there) it hurts. could it be related . It is only 1 side and the restalyn looks good. thanks so much.

Answer:

Likely just swelling on the cheek muscles that are attached to the temple area, should resolve in time. JG 4.22.11

Question:

I have a question about filler for the eleven lines between the eyes. Can you have filler put there, and if so, which filler would u recommend to be the best. Also, is artecoll a good filler and what areas of the face would it be good for. Is it suppose to last a long time and does it have a tendenceny to have nodules from it? One more question, and u get filler put in behind the eyebrows or under them for lifting them some. I have read that,but seems it they injected filler underneath the eyebrows or behind them, looks like they would bulge out and look funny.

Answer:

You can have filler there and my preference is Restylane. Artecoll is a good filler but cannot be used in replacement of other fillers as it is meant for a deeper injection. Some people use it for scars or nasolabial folds. If it is injected too superficially or in areas with circular muscles, granules can form. Fillers to the brow are meant to replace the fullness that was lost form an earlier age, so it should just look like it did, assuming you needed fullness replaced. JG 4.22.11

Question:

I am 46 and very concerned about my marionette lines. What do you recommend? What are your thoughts on ultherapy?

Answer:

the research on Ultherapy is only for 3 months, so I am not sure it is worth the investment, as to your marionette lines, at your age maybe fillers such as Restylane are in order. JG 4.20.11

Question:

I asked a question earlier about needing a filler when having a facelift performed to take the place of the collagen and fat that is lost for volume. You responded by saying most usually the tissue is just sutured back up where it need to be. If a persone looses collagen and fat, then I have read so many times that a facelift also needs the filler put back in too, because it is lost as we age, and it only makes sense that if the skin is pulled up and snipped off and the underlying tissues and whatever else brought back up, it still seems that it would need filler to plump back up what has been lost over time to take the place of the fat and collagen. I have read if it is not replaced, that the face looks kinda thin and pulled. And u didn`t answer my other question about the filler Sephyl. I wanted to know if u thought it was a good filler to have for the eye area and nasal labial folds?

Answer:

that will vary from patient to patient, if the face is loose form fat loss, then fillers would be all that is needed, if the skin is loose, the skin only needs removal, in most cases where facial aging has occurred on the cheeks and neck, the tissues only need to be lifted to look more youthful. Unless one is extremely thing, the filler is not needed during a facelift, although some doctors do so they need to perform a lesser facelift and potentially charge more. As to the Sephyl Vampire facelift, I mentioned is it a scam, trying to capitlize on something that has never been shown to work.JG 4.20.11

Question:

I have noticed my cheecks, or many my jowls, when I pass the mirror and I am looking at my face kinda from the side, looks like sagging or excess skin. If I have a facelift, wouldn`t they need to put some filler in for the collagen and fat that has been lost? Looks like if they just tightened what is underneath or whatever they do, and then cut off the excess skin, that the volume would still be missing and it would be thinner looking and tight, maybe kinda sick looking without the volume that u had when u were younger. Also, I would like to have my brows lifted a bit by Botox, but when I told the dr. that it made me look more tired looking because it wouldn`t let me lift my eyebrows at all and it made me look tired and my eyelids look heavy or maybe it was my eyebrows, he said that Botox wasn`t for me because it would just make me have that tired look because of the extra skin on my eyelids or maybe it is my eyebrows. Can`t they inject it to where it will give the lifting effect a little but not let me pull down on my forehead? Where would the injections be given for this effect? Seems like everytime I get it, it won`t let me lift my eyebrows at all but right the opposite, like pulling down effect? Also what about injecting a filler to plump up the eyebrow to give a lifting effect. I have read about this, but wouldn`t it make the eyebrows bulge out if there were filler put behind the eyebrows? One more question. What do u think of the new filler Sephyl called the vampire lift that they use ur own blood? Is this something that u think is worth looking into for a filler for the nasal labial folds and the eye area? I have read that it is very good.

Answer:

if you have lost facial fat, fillers might be needed, but in the majority of cases, what is done is the tissues that have fallen to create the jowl are lifted and sutured into their original location to empty the jowl and refill the cheek pad. As to the Botox, if injected properly, it can lift the brow some, but only the outer part of the eybrow, not much to the rest. Properly injected the brows should not bulge, for it to work, the crows feet are inejcted to allow the forehead muscles to lift the outer brow. No injections directly to the forehead will ever lift the brow. JG 4.19.11

Question:

Hi Dr....if one desires to have the outer corners of the eye lifted, would you recommend doing that by HA injections under the brow, or by having Botox injected to lift only the corners of the eye. I feel like I have adequate space between brow and eye and am afraid that if I say I want a Botox brow lift, I will end up looking surprised which I don`t want.

Answer:

I think the lift from the filler is small, it is more of a more full look, rather than a lift. JG 4.17.11

Question:

I have two questions for you, Dr. Garcia. 1) I have been having HA placed beneath my eyebrow at the outer edge of my eyes for years and have liked it very much. In the past year, I`ve begun to develop hollowness at the INNER corner of my eyes, where my eyebrows meet the top of my nose. Have you successfully place HA there in your patients? If so, do you prefer Restalyne or Juvederm? 2) In your opinion, is the Clarisonic brush worth the price? Thank you for your help!

Answer:

I have used it there, just not as often as other areas.I prefer Restylane for the periorbital area. I also think the Clairsonic is also a nice product. All the best. JG 4.17.11

Question:

should arnica be continued when a bruise is yellow-bromelain also?? thanks

Answer:

it wil help some at that point still, but not as much as when it is still purple. JG 4.12.11

Question:

Dr. Garcia, 2 days ago I had juvederm injected into my cheeks and through same injection site, my plastic surgeon also injected it into my under eye area..where my dark circles were. I now have a hard lump that has formed under my left eye that doesn`t feel fluid filled..just hard. I noticed it the first day but he said this would go down. I`m a little worried since it`s still there. Is this fluid...scarring...?? What can I do about it?

Answer:

most likely a little blood accumulation, I suggest you go back and see them in about a week to make sure it is getting better, those things can happen. JG 4.11.11

Question:

will sauna or steam cause broken blood vessels to get worse thanks

Answer:

possibly. JG 4.8.11

Question:

where should botox be injdected to lift the brows and do you think injections for crows feet work? thanks

Answer:

your injector should know that and I think the effect on reducing crows feet is so low that it is the reason it has no FDA approval for that area. JG 4.7.11

Question:

i had restalyn injection deep right onto cheek bone-looks nice but i never had a purple or dark bruise--just a lot of yellow bruising. Is that wierd? Why yellow only?? thanks

Answer:

because by the time the blood that accumulated deep made it to the surface, it had started to degrade, all normal. JG 4.7.11

Question:

Had some filler removed from cheek and under eye area-broken capillaries and yellow bruiosing which i assume will go away or lighten but is it necessary to wait to put in more restalyn til this yellow bruising is gone? thanks.

Answer:

I would wait so any swelling goes away so the placement can be as accurate as possible. JG 4.6.11

Question:

my derm uses the diamondtone laser for broken blood vessels.Do you know it? Do you have a better recommmendation in terms of type of laser for this? I am also concerned that the area where the capillaries are around my niose will end up being brown instead of red lines. Help please! Thanks a ton!

Answer:

I prefer a YAG or a VBeam laser for broken blood vessels. Should not turn brown as long as you avoid the sun while healing. Best of luck. JG 4.6.11

Question:

what do you think of vitamin k cream for bruises and broken capillary healing? do you sell it?

Answer:

have personally not seen it be effective, sorry. JG 4.7.11

Question:

Hi Dr Garcia! I have been having Sub Q in the cheek area for the past few years. I had a problem with a reaction once but it never happened again. I was reading recently that patients are starting to notice tracking of the product causing scar tissue leading to swelling and bleeding later on when having top ups. I have read a few times that doctors prefer to use Teosyal or other HA products instead. Have you heard of this before? Thank you

Answer:

I have seen some blogs mention it but there have been no well documented reports in the medical literature of things like that. I think other HA fillers can be used in conjunction if desired with no adverse effects though. JG 4.6.11

Question:

I am going to have the procedure exilis done, but would like to ask a question first. I am having it on my face and neck and mostly for sagging skin so to tighten it up some. I know it is used to help eliminate fat and also skin firming. If ur body and face have fat, would it do away with the fat in ur face? I know that fat and collagen is what ur face needs, so what would keep it from dissolving it from the face or doing something to it? Also would it hurt the fillers in the face and dissolve them or make them less effective? I am going to have sculptra. Would it hurt the sculptra? Would I need to have the exilis done first before the sculptra?

Answer:

if it works, it might dissolve fat, not always a good thing. There are no studies on the effects of that therapy on fillers that I have read. I think it best to do the treatment first and fillers later. JG 4.5.11

Question:

Hello Dr Garcia! I am a women from Sweden and I have write to you before. I have Restylane Sub Q on my cheekbones and really true Restylane. In Sweden there is no fake restylane because Q-med is here and the fake restylane has not come to Sweden yet. I went to a very good clinic and I have my bath number. I had 1 cc in each cheekbone and it is almost gone I did it 2 years ago. But I have a spot that still remains, not hard like a granulom but rather jelly. I want to get rid of it. What do you think I should do Vitrase? The main problem is there is not so many here that have experience with Vitrase or Hyalase. Have you a lot of experience with Vitrase or Hyalase?? Your a very kind person and if I lived in US I would have come to you right away.

Answer:

I think Vitrase is a reasonable option. If the ball is soft, an attempt to aspirate the material out with a needle by your doctor can also be tried, I do not think making a large incision and cutting it out is worth it as it would leave a scar. Best of luck. JG 4.1.11

Question:

I was wondering how long after a TCA peel to the lips one could have filler? Also I have white forstyhe sopos on my lips would that affect the outcome of the filler?

Answer:

I would wait about a week or so, depends on what strength peel was done and the spots should not affect the filler. JG 3.31.11

Question:

Hi Dr...I have asked you so many questions, and I really don`t know how you have the time for this, but thankful for your patience with all of us. My question: supposing botox lifts only the lateral brow, which I presume is the tails , does it then decrease the appearance of the very slight hooding at the very end of the eye, near the end of the brow? I know what I really need would probably be a blepharoplasty of the upper lids, but can`t afford the downtime or the cost, so going through the options and respect your thoughts.

Answer:

if the hooding is slight, it will help, but the stronger the pull of your muscles, the less dramatic it will be. Just might need a good strong dose of the Dysport or Botox there. Best of luck. JG 3.29.11

Question:

Hi Dr. G. Can you tell me approx. how many Units of Botox are in a vial. The Dr. I am now going to only sells via this method..most still sell by the unit. Normally I would use apprx. 78 units and i was wondering if this exceeds one Vial. How do YOU deal with clients that require more - do they have to pay for two if they don`t use ALL of the second one. I just want to have some idea what this will cost me. I have read your Notice on Botox. Thank you.

Answer:

The only legal way in the US is to sell it by the bottle as it is a single patient single use vial, Botox is made in both 100 and 50 unit vials. Whatever is not used should be discarded to avoid contamination and the spread of blood borne disease. JG 3.28.11

Question:

Thanks for the answer below about the Sculptra and recommending implants. I already have Medpor cheek, mandibular and chin implants; maybe I should add templar implants too? (Gosh, I`m like a PBS TV series: This Old Face instead of This Old House ! I`ll have to run my own equivalent of a PBS fund-drive to pay for all of this.) You didn`t answer the question about the price of Sculptra. Any hope that Sanofi-Aventis might drop its price? Any competitors coming along in the market that might force it to do so? Thanks and have a great day, Dr. Garcia.

Answer:

I seriously doubt Sanofi will drop the price until a similar product comes out. None in the pipeline though due to expense in getting products approved through the FDA. All the best. JG 3.22.11

Question:

I had an excessive amount of Restalyne injected to one orbital rim 5 months ago and had it dissolved last week. Immediately, it deflated like a balloon. At one week post, the skin on that eyelid is, in addition to being wrinkly, now peeling and papery. Is this because it was over-inflated for a long time and is now, suddenly, dehydrated from within? I never had crepey eyelids before, only a little hollowness, so I`m hoping that this is just a temporary side effect of the hyauloronidase. Thanks for your advice. You`re the best!

Answer:

it is a short term effect from the deflation being done and the skin should snap back, you can use some Retin-A to speed it along if you wish, but the skin will likely get irritated by it. JG 3.22.11

Question:

Hi, Dr. Garcia. With Sculptra, do you find that it usually lives up to its advertised prospect of lasting up to 2 years (note, NOT lasting 2 years !)? I ask because HA manufacturers always advertise that their products last up to 1 year, and I never get more than 4-5 months out of them. It`s infuriatingly expensive. I`m one of those people whose facial atrophy is so advanced that without filler, I am actually disfigured -- looks like I`ve had facial trauma; and the atrophy also makes me look decades older than I am. (An occuloplastic surgeon stopped me on the street to ask if I`d had an orbital and cheek fracture that needed treatment.) All of which is to say, I need A LOT of this stuff! I started getting Sculptra just under two years ago, and about every three months, I need a touch-up of a few syringes as the older product dissolves. (I`m only 44, so I don`t think that this has to do with my especially advanced age.) I love Sculptra but I`m beginning to think it`s behaving like all the HA`s I`ve tried. What is your experience? And any hope that the price of this product might come down. It`s impoverishing me. Thanks, as ever, for your help!

Answer:

I would say that most of it will last one year with some small remaining amount to about 18 months. There is usually a need for a touch up at one year in most patients. As to it working, it does vary from person to person, in those that had accelerated aging or fat loss for some reason, they will not respond as well. Technique does make a difference, as does the initial amount injected too, but they are lesser factors. If you are facing those scenarios, you might want to see a plastic surgeon in person for an evaluation for permanent facial implants. They will never be able to do the same as the fillers, but possibly some of the issues can be improved and then the fillers used just for feathering. Wish I had more to offer. All the best. JG 3.21.11

Question:

Hi Dr. Garcia...I have been considering doing something for my eyes. I have asked plenty of questions to you, and you have most graciously educated me so here`s one more:...at 48, I notice the most obvious sign of aging to be the eyes. The upper eyelid skin is lax, and the lower eye area is a bit baggy with what seems to be very dry skin. I think this is mainly from using a combo product that contains glycolic and kojic acid (I am not doing that in that area anymore). My question: Do cheek fillers and botox (at the tails of the brows) address these eye areas? Will the filler smooth out the bagginess and fine, fine wrinkles under the eyes? I am so confused as to how fillers can help the undereye area. I do not have what I would consider hollows , but more of bags under the eyes, slight, but still noticeable. I know the best option is surgical, but I really can`t afford that right now so I`m exploring other options. Can you help?

Answer:

I do not think that cheek fillers nor Botox at the corners will have any positive effect on the eyelid skin itself, sorry. A filler at the rim of the orbit might lessen the visibility of the puffy bags but do nothing for the fine lines. You cannot inject the filler into the eyelid skin itself for fear of visible lumps, it is only for the dark line between the eyelid skin and the cheek skin. Hope that explains things a bit more. JG 3.20.11

Question:

I visited a Dr today for a consult on Restylane fillers in my under eye hollows.I was told my undereye skin is too fine, thin & pale under my eyes to have a natural effect with fillers.I also have visible veins under my eyes & was told I would likely get a black eye/s from the procedure due to the large amount of veins beneath my eyes. I feel quite sad,as was hoping this would be a good fix for my under eye hollows.Should I visit another Dr for another consultation,or are under eye fillers just not an option for this skin type?

Answer:

well, seeing another doctor might help you, yes. But not all patients are candidates for fillers around the eyes. It is commonly used for the dark circle at the edge of the eye and cheek but not for true hollows of the eyelid skin itself. JG 3.14.11

Question:

Hi, Dr. Garcia. I had my temple and zygomatic arch injected bilaterally yesterday with Sculptra. I have two questions for you. 1) My doctor injected 1.3 ml on my left and 1.6 ml on my right side respectively. Does this seem like an unusually small amount to correct a moderate atrophy or does this sound about right to you? 2) I awoke this morning with my lower cheeks/jowls extremely swollen. I assume that this is due to the fluid used in the injections, but my lower face wasn`t injected. Is this just because the fluid migrated due to gravity? If so, how long before it should resolve? If not, what should I do? Thanks, as ever, for your kind and generous help, Dr. Garcia. A restful weekend to you!

Answer:

well, I am going to have to guess because I am assuming he used one vial and just mixed it with 3cc of fluid. Injecting asymmetric amounts is not uncommon as we are all uneven to start with and the aging process is never even either. As to injecting about 1/2 vial on one side and a little less on the other, that is common. The swelling is also common form the fluid used to float the Sculptra powder in as it moves downward due to gravity, it all goes away in 2-5 days. All the best. JG 3.12.11

Question:

Dr. Garcia. Would you please kindly recommend a safe and good option for filling the smallest amount of a permanent filler on the bone of the jaw and sides next to the chin? Its not to make the jaw area wider or very larger, just some small definition. Like sort of this small stripe og filler will do. I have tried radiesse, but i would like something more permanent without a large surgery with implants and heavy narcosis. But the filler have to tolerate silicone implant without reacting in a dangerous or unflattering cosmetic way. Since i have a small extended chin implant screwed on the chin.Do you perform anything like that? Under local anestesia is fine in the office. i just dont want to undergo heavy narcosis.If you do something that i would be interested in, i would like to book a consultation some day. Thank you very much for your answer and time on advance. My best regards.

Answer:

might want to use Artefill for that. No anesthesia needed, its just injections. We do that type of work, it might take more than one syringe though, I always suggest to start slowly as more can always be added. The patient needs to be tested for allergies and then wait for 4 weeks before injections. JG 3.11.11

Question:

Hello again Dr Garcia, Sometime ago I asked your advice on granulomas which occured 8 years after dermalive injections. I have been reading about 5FU injections being effective. Do you know anything about this treatment and if it would be harmful to try it

Answer:

I use the 5FU injections on my patients and it is not harmful, but after 8 years, the efficacy might not be so good, all the best. JG 3.9.11

Question:

Thanks so much for your answer about the salmon below. I purchase 1/4 lb. 2x/week and eat just a few bites each day. My nutritionist advised this to augment my intake of protein, since the rest I get only from egg whites, tofu and (very few) beans. I am 5`6 and 100-102 pounds. Is that still too much salmon (about 1/2 lb/week) to consume? If so, in what way is it harmful? And is the problem with the amount (however miniscule) or the frequency (daily) of ingestion? I assume you are not concerned, as I was, about increasing the risk of bleeding with injections, which is what prompted my question. Thank you, as ever, for your kind guidance.

Answer:

as long as it is Pacific Wild Line caught, you are good to go. I think that amount should not cause any bleeding issues. AL the best. JG 3.9.11

Question:

Hi, Dr. Garcia. So...no fish oil (or any other supplements with anti-coagulant properties) for two weeks prior to any injections, but what about oily fish itself? I eat wild salmon at least once/day. Should I avoid that too when anticipating injections? Thanks so much. Your patients are very lucky to have you!

Answer:

eating oily fish is OK as long as you do not eat it every day.If you are eating wild salmon, might want to cut back a little. JG 3.8.11

Question:

What injectable do you recommend for the longest effect? Which gives the most bang for the buck if one is unable to have facelift surgery?

Answer:

Sculptra. JG 3.7.11

Question:

Which do you believe is a more natural looking and better filler for jawline and prejowl area--radiesse or perlane? Thanks as always.

Answer:

no difference in an experienced injectors hands. JG 3.7.11

Question:

Hello, hope all is well. I was wondering.....does the more you use Botox on an area does it weaken that muscle as time goes on so you don`t have to get it more often.....

Answer:

in theory, yes. All the best. JG 3.7.11

Question:

Dr. I had 22-25 units of Botox put between my brows and a little in my forehead! After 1 month the one placed between my brows wore off but my forehead is still perfect! Why is this and what can I do to make That last? Is it time to go back for More....

Answer:

that can happen if the muscles are stronger in one area versus another, can get some more yes. One more thing about Botox. It has come out that the education that injectors were given since the beginning of Botox release was incorrect. The bottle is to be used for a single patient. That means that a bottle should not be shared between multiple patients. The company that makes Botox has known about this but has never issued an alert to doctors or patients. The risk is that of the bottle becoming contaminated and passing a communicable disease like HIV or hepatitis from one patient to another. There are no known reports of disease transmission in the use of Botox, but it has not been looked at yet in order to determine that issue. For that reason I strongly urge you to demand that a new bottle be used when you are treated and then observe the injector destroy the remainder of the bottle. If that is not done I urge you to contact the local board of health for the violation. Ask to look at the box it comes in and you will see the single patient, single use wording. JG 3.6.11

Question:

Dr. Garcia....I would like to have botox to lift the tails of the eyebrows. When I explain this to the person doing it...should I make it clear that I would like only the tails lifted and not the entire brow? I don`t want that Kate Gosselin /over-arched brow look. My friend used that description when she had hers injected, and basically she got close to nothing. She looks no different and her eyes do not look any more open or less squinted. Your opinion is greatly appreciated.

Answer:

I think telling the injector what you desire is important, yes, and how much the lateral brow will be lifted will depend on how much Botox is injected and also how strong your muscles are. Best of luck. JG 3.6.11

Question:

My MAIN man !!! Hope you are well and excited about the arrival of Spring. OK - my question....2 days ago I had Sculptra injected in the folds on the right side of my mouth ( the 4th injection)and the P.S. decided that he would give me a freebie of Radiesse because `he couldnt stand` how the mouth corners were turned down. I know the Radiesse is immediately noticable but is there also some swelling involved with it? I now look I have a `chaw of tobaccy` in there ha ha . People will notice when I go back to work unless it goes down some.....sometimes I think I`m nutts. Thanks you so much as always

Answer:

80% of the filler Radiesse, will be gone in 6 weeks, so most likely it will get better soon. A little massage might help some, all the best and Happy Springtime to you. JG 3.6.11

Question:

Hello Dr. Garcia, I had sculptra 1cc in each cheek and 3cc in temples 10 days ago. The last time I had sculptra was 2 years ago. I noticed that the swelling went down after about 5 days and I swear I am getting collagen already, my skins looks pinker and soft, and my cheeks fuller. Is that possible? Or, is it more possible, I still have swelling that has not resolved?

Answer:

more likely just swelling still present, it takes at least 6 weeks for a significant amount of collagen to form. JG 3.4.11

Question:

I got an email today from a plastic surgeons office telling about artefill for a good filler for nasal labial folds. I wondered what ur opinion is about this filler. I also wanted to know if sculptra is used for the tear trough area or any under the eye area and also is it used for nasal labial folds?

Answer:

it can be used for the nasolabial fold and it can last a long time, takes an experienced injector though because it will not easily resolve, so you got to be sure it is placed properly. I have used it, but rarely. I would not use a filler like Sculptra for the tear trough myself for fear of developing lumps, I would only use Restylane in the actual tear trough. Sculptra is good for below the tear trough on the cheek though. I only use Sculptra to replace lost fat, so it is not meant to be injected directly into the nasolabial fold like other fillers. It should be injected into the cheek to lift the tissues that have fallen from fat loss. Fillers are not all interchangeable. Not all fillers can or should be use in the same areas. JG 3.1.11

Question:

I have several lumps in my lips from restylane injections 6 months ago, they are being treated with vitrase...but haven`t gone away, I am going to try 5fu but have been recommended 5fu diluted with cortisone, will using this combination create more lumps and irregularities from my tissue being dissolved?

Answer:

I would try to avoid the kenalog for fear of tissue atrophy. Best of luck. JG 3.1.11

Question:

Hi Dr Garcia I am thinking of having botox to lift eyebrow tails. My question is how long should I wait to have an IPL treatment for age spots/spider veins? AND Is this a good treatment for my problem taking into account that I only have a few age spots. thank you

Answer:

the IPL can be done the next day. I think it is a good option for the age spots, yes. JG 2.28.11

Question:

What is your opinion on the effectiveness and outcome of using Artfil for lines and deep wrinkles? Do you like using this product for long lasting results? Thanks so much! JH

Answer:

effective for nasolabial folds, I do not use it anywhere else. I do to use it too frequently though. JG 2.28.11

Question:

i cannot use latisse as my opthamologist says i am at risk of green eyes turning brown and i`m not willing to do this. Any other products that will help? Thanks

Answer:

Revitalash. JG 2.26.11

Question:

Have you heard of ultrathereapy by ulthera? Any merit?? Thanks!

Answer:

have heard of it and in my humble personal experience, I feel it is not worth the pain and expense. Very short term improvement. JG 2.26.11

Question:

Hi Again, One more series of questions regarding the scar tissue in my lips and 5-fu injections. My lips still look like they are augmented, but with the scar tissue I guess, I read in another post about a lady trying to treat her granulomas from newill, and you say that 5-u only softens the scar tissue, is that enough to bring me back to my pre restylane state or would steroids need to be used aswell? Where i have visable lumps is softening them enough to make them disappear. Also you said if it was product it would be everywhere, the lumps can be felt pretty much everywhere in my top lip, they are not really isolated, there are several at least 10. I will follow up with my surgeon with all this aswell, i appreciate your opinion.

Answer:

I would avoid the steroids for fear of tissue atrophy. All the best. JG 2.22.11

Question:

Thanks or your answer regarding scar tissue in lip after restylane injection,You said that you think it is the bleeding that may have caused the scar tissue, so is that technique dependent, should I avoid injecting this area with any products? Also is scar tissue the same as a granuloma? Can injecting the scar tissue with the 5-fu reduce the odd appearing ridge above my lipline? Are there any adverse side effects from the 5-fu. Sorry or so many questions, just so worried about this unusual response.

Answer:

yes, to some degree, but any needle can cause some bleeding, scar tissue is not a granuloma, the scar tissue will get softer with time where a granuloma will be there for a long period of time and may be permanent. If the ridge is due to scar tissue, the shots should help. Used in low doses, I have not seen nor heard of adverse events from the 5FU. I would not do any more injections until all is better. Best of luck. JG 2.22.11

Question:

I had restylane injected 5 months ago in my top lip, it bruised quite a bit and there was a small visible bump right in the middle where the needle went in. A couple of weeks later I noticed several lumps inside my lip, and a unnatural ridge above my lipline. I have been to two surgeons since one told me it was scar tissue and the other said it was restylane and injected vitrase, its been 3 days and no change, if it is scar tissue whats the safest treatment 5-fu or steroids, I`m afraid of making it look worse than it already does, does the 5-fu not damage surrounding tissues? Is scar tissue a granuloma? What filler should i use instead of ha after such a rare reaction? Collagen or should i avoid them all?

Answer:

I think 5-FU is safer as it does not cause surrounding tissue atrophy.It is more likely scar tissue in the case of Restylane. I think it was likely not the product and more due to the bleeding because if it was the product, it would have happened to all of the filler, not just in spots. Any filler can have lumps though. Best of luck. JG 2.22.11

Question:

Hi Dr. Garcia, I had botox above my nose (where it wrinkled when I smiled) and now the bridge of my nose looks different. My bridge looks like it`s swoops in a curve. Can you tell me what most likely happened?

Answer:

some of the bulk and appearance of that part of your nose was made up by the muscle there contracting o bulking up, and when the Botox relaxed the muscle, the bulk decreased in size. JG 2.21.11

Question:

Hi dr, I recently asked my doctor if I could have Sculptra in the temple region. He said he preferred not to use this product as it is permanent and causes too many problems and suggested HA instead. I have always thought that Sculptra is a temporary and safe product? Thank you

Answer:

he is wrong, it does take more skill to inject the temple in order to avoid lumps, so more experience is needed, but Sculptra is not a permanent filler. If he does inject Sculptra at all anywhere else, ask him why it is not permanent in the other areas.JG 2.20.11

Question:

You seem to prefer restylane over juviderm. Why? And do you ever use prevelle silk ? If so-where? Thanks as always...

Answer:

I use Prevelle Silk in the fine liens around the lips, Restylane everywhere else except into the lip itself where I use Juvederm. I feel it repairs the problem in those areas best that way. JG 2.19.11

Question:

Hi, I`m 32 years old and I showed you a pic of myself a while ago due to having what appears to be fatloss in the lower medial cheek on one side of my face. I had previously had restylane injected in the area a few times and it made no difference. I don`t think they ever injected the restylane in the right layer of skin or that the product was thick enough for fat loss. You suggested I try either a peripyriform implant or have Voluma injected in the area. I had half a vial of Voluma injected by a much more experienced injector (1 cc) and it probably looked better for a couple days when it was swollen (the restylane never looked better at any point) but after that the improvement was slim if anything. It`s difficult to tell. Not seeing much of a difference in pictures and with different lighting it makes it harder to tell. Overall right now I`ve probably had about 1 cc of restylane put into the area, which was over the span over 1 year and I assume is all gone now, and the 1 cc of Voluma about 6 months ago which should probably still be there. So in total I`ve gotten injections for a 2 year period, 2 cc`s of product altogether, but 1 cc of Voluma remaining if it is in fact all still there. I`m now beginning to wonder if the filler is just going underneath where the fat pad rests pushing it laterally outwards widening the gap and I`ve been making it look worse all this time by getting more injections, or if it is truly fatloss. Again it`s difficult to remember. I remember that area being less full that the other side of my face which prompted me to have treatments but I don`t remember it being to this extent. It`s possible that either the treatments made it more pronounced, I`m simply looking at it in different lighting, or I`ve lost more fat in the interim. I`m considering having either 2 cc`s more of Voluma injected, or having the implant put in, my one concern about the implant is that the volume loss goes down lower than where the implant will be placed, which is slightly above the nostrils on the bone. I don`t think it will adrress alot of the volume loss which in reality extends down the fold on the one side of my face all the way down to the right of where my moustash would start to grow if I didn`t shave. Does this simply look like it needs more product? I`m considering either the implant or 2cc`s more of Voluma. Which do you think is the better option? Does this look like fatloss or misplaced product to you? It`s difficult for me to remember what the area looked like before I started having injections. Thank you very much for your help. Here is my pic one more time for reference: http://i43.tinypic.com/rc4nfc.jpg

Answer:

from what you are describing and the location of the deficiency, the filler is a better and more customizable option for you. I think it is likely more fat loss and it is hard to imagine all of the injections of the fillers being misplaced. JG 2.17.11

Question:

What do u think about the filler aquamid? I read where it is a very good filler and long lasting with few side effects. I understand it isn`t available yet in the Untied States. Do u feel it will be soon?

Answer:

have heard of too many problems with it in a long experience in Europe, I would not use it. I am unsure of its release in the US. JG 2.15.11

Question:

Hi Dr, At the age of 42 I have started to notice the natural signs of fat loss and ageing around the orbital rims and temples but the cheek area is still quite plump. What would be the best filler to use for this upper area, or indeed fat transfer? thank you

Answer:

for the temples I would use Sculptra and for the area above the orbital rim, either Restylane, or maybe Sculptra. JG 2.15.11

Question:

Hi Dr.G. I asked you on the Feb 7 about injecting Sculptra over Dermalive and you replied . I would avoid anything over the Dermalive, if you get lumps there it will surely be from the Dermalive though, and not what you inject over it. - Is this because Juvederm or another filler would activate the Dermalive or what could cause the lump formation at this point in time...(Dermalive is approx. 7yrs in.) Thank you. jg Ottawa Canada

Answer:

there would not be any activation of the Dermalive, if it has been that long and you are without problems from the Dermalive, you are probably safe to proceed. JG 2.15.11

Question:

i have a large brown spot on my chest that got even bigger after tx with liquid nitrogen yrs ago. my doc suggested fraxel co2 but i know you are not a fan. what do you think about an ipl for that spot--it`s about the size of a quarter, perfectly flat -looking for lightening and not tightening thanks

Answer:

IPL is OK, I would progress to a YAG laser after that if still needed, it will likely require a series of sessions to be safely treated. Best of luck. JG 2.14.11

Question:

where should i not get botox if i want to be 99% sure i won`t get droopy eye?? thanks

Answer:

avoid the glabella area at the part of the eyebrow below and closest to the nose, and also the forehead directly above the eyebrow. JG 2.12.11

Question:

follow up to question re botox not sure i understand -botox in glabella will not lower medial brow botox high near scalp of mid forehead (2 injections) could lower medial brow?? thanks

Answer:

that is correct, the glabella muscles pull the brow down and if they are weakened, then the medial brow lifts. The mid forehead and higher elevates the brow and if that area is injected and no other area is, then the muscles of the glabella can pull the medial brow down. JG 2.11.11

Question:

Hi Dr....I am thinking of having injections to the cheeks...I am not looking for a full or apple-like cheek. I have never had that, and I don`t want to look diffferent , just more of a taut look, like it was many years ago. I am afraid of the look I see with so many women that almost creates a puppet-like fullness in the cheek area. Is this more due to the filler that is used or to the expertise of the person injecting? Thanks for your suggestion.

Answer:

it is more due to the amount, overfilling with any filler will give you that look. All the best. JG 2.10.11

Question:

I would like to know if someone that would be 64 could still really look good with no sagging skin whatsoever and no wrinkles around the eyes at all and no fat loss in the cheeks and not labial folds at all, and not have had any kind of work done at all? If the answer is yes, it is possible, then why does the plastic surgeon say that all women have collagen and fat loss the face starts to sag and u get jowls and nasal labial folds and wrinkles around the eyes? I see so many women on tv that say they have had absolutely nothing, and they look like they are 40 instead of 64. I just don`t understand it. I would also like to know that I I had sculptra injected and it lasted from 2 to five years, would I have to get the whole amount redone after that time, or just a touch up? And how many times would I have to go to see a difference that would last? How long does it take to make a difference?

Answer:

I think Sculptra can last up to 2 years, likely not 5, and would need to be either touched up in smaller amounts before then or the whole thing repeated in time. The older one is, the more frequent the touch ups will be as the amount of collagen that is created from Sculptra injections will diminish with age. As to how many times it would be required to see a difference, that varies form patient to patient, no way to tell 100%, but most people start seeing an improvement after about 6 weeks. As to some people being 64 and looking 40, it is either good genetics and habits or lying. JG 2.10.11

Question:

Good morning. I have recently lost some weight and notice the hollows of the cheek area (sucked in) - is Sculptra good for that area. I have had Juvederm at the cheekbone area injected in Nov. ..can i still go ahead with the Sculptra or do i have to wait. (1 vial in total and included NLF - so not a lot in the upper cheek area and only one side). Thank you. Last question - Dermalive over the NLF - i guess Sculptra cannot be used over it ?? Thanx big much. jg Canada

Answer:

I think Sculptra is the way to go and it is OK to do after he Juvederm from November. I would avoid anything over the Dermalive, if you get lumps there it will surely be from the Dermalive though, and not what you inject over it. Best of luck. JG 2.7.11

Question:

what is a good filler for the area lateral to crows feet--maybe it is the temple area--would restalyn work or be too seeable cause it can`t be injecterd deep enuf to look natural thanks

Answer:

for the temples my choice is Sculptra. Restylane would not last very long there. JG 2.6.11

Question:

how long after botox on forehead and glabella can i have a craniosacral massage?? thanks

Answer:

1-2 dates should be more than enough. JG 2.6.11

Question:

HI Doctor! A dermatologist I saw here (I wish I could see you but I am in another country) suggested something and I`d like your opinion on it - I know you are not here to see me, I only want to know if it sounds crazy or not. See, I have a long face to begin with and that plus ageing and the tendency to easily lose weight at my face makes me have frequent restylane injections. I even had some artefill so it would last more. This doctor suggested using tripolar radiofrequency, that has a tightening effects and pushes the skin taut and up , to be used in the lower area of my cheeks, near the buccal area, where I really have a bit of fat ( I am not fat, but she says I could use the fat that is there - comparatively I do not lose the fat there as I los the fat o the medial and upper cheeks) and use there the RF, so that it pushes the skin a bit up , which in turn should push a bit the fat I have above and the fillers a bit more up, creating a rounder appearance with the same fillers I already have, not adding more. I wonder if it makes any sense and also worry if what might be ok for restylane might not work for artefill. That is, tripolar radiofrequency could make the areas with artefill start developing granuloma? Hugssssssss

Answer:

I think what they are suggesting will not help your attempt to improve your appearance, and in some cases can even cause more fat loss. Artefill and Restylane are no affected by the body in terms of working or not, it is a matter of where it is injected and the amount used. I do not think the RF will cause any granulomas to form though. JG 2.6.11

Question:

Why won`t restylane subq ever be available in U.S.? Or will it? Thanks.

Answer:

the company has pulled its application so it will not be available, it is not due to any safety concerns, but for financial concerns. JG 2.6.11

Question:

Hi Dr. Garcia, I`m scheduled to have Restylane injections under the eyes (tear troughs) to get rid of dark circles next Friday. How long does the redness & swelling last under the eyes after Restylane injections? Thanks for taking the time to respond.

Answer:

swelling and any redness should be gone in 3-5 days in most cases, everyone is different. Avoid any aspirin like products before to help lessen the chances of bruising too. JG 2.6.11

Question:

i have granuloma annulare on both elbows--does this mean that i am prone to granulomas and should not have sculptra?? can a person have a patch test for sculptra?? thanks!

Answer:

no patch test and I do not believe you are at any higher risk of getting granulomas from Sculptra. Best of luck. JG 2.5.11

Question:

Thanks Dr Garcia for your answer about SUBQ You mention that it is not approved in the US - does that means there is something wrong with it? I would like to know if you would use it if you could? Third question : if I have had this done would it be possible to have fat injected in the same place 1 year later? thanks

Answer:

no, the company apparently now feels that the amount it would sell is not worth the expense to perform the studies needed to be submitted in the US for its approval. If available, I would use it, yes. Fat injections can be layered over the same area, yes. All the best. JG 2.4.11

Question:

my ps wants to inject 4 cc(maybe it was vials--whatever sounds reasonable) inthe area where i am gaunt around lower lateral cheeks--does this sound like a reasonable amount. Is there a great risk of granuloma? That is my biggest worry tho I think he is a well respected dr. He says restalyun would not work there. Please advise. Thanks a million

Answer:

when I dilute the vial of Sculptra, it is with 6-8 cc of fluid for the entire vial, so that sounds about right. With proper technique it should not form a granuloma. All the best. JG 2.4.11

Question:

Hi Dr Garcia What is the difference between Restylane SubQ and Sculptra? If SubQ was approved in US would you prefer it (if there is a difference)? Thanks

Answer:

Restylane SubQ is a hyaluronic acid filler and has an immediate effect of filling but does not create new collagen. Sculptra works by building up your own collagen, and does not give an immediate filling effect. If Restylane SubQ was available, and the patient could not wait a few months for their own collagen to grow, I would use Resty SubQ. JG 2.7.11

Question:

Hi Dr Garcia What is the difference between Restylane SubQ and Sculptra? If SubQ was approved in US would you prefer it (if there is a difference)? Thanks

Answer:

Well, the difference is Restylane SubQ will fill in right away, where Sculptra has to grow on its own. Sculptra though will create new collagen so as the aging process continues, you will start aging from a better point, where all Restylane and HA products just hide the aging.I have heard that the company that makes Restylane SubQ has stopped its FDA application in the US so I am afraid I will never get to use it. JG 2.3.11

Question:

My dermatologist has injected perlane in front of and back of my jowls for four years. I have a thin face and the jowls really stand out if not for fillers. He also injects one side of my chin which has more sagging in the nasolabial fold and chin crease that runs across it. The perlane doesn`t last much more than a couple of months there. Would radiesse be a better filler for this area as well as the jowling camouflage? Also, can radiesse be injected over the perlane when a touch up is necessary? As always, thanks a lot.

Answer:

I do not think that Radiesse, although touted as lasting longer, will give you any longer lasting results. One can be injected over the other, yes. All the best. JG 2.2.11

Question:

Morning. Your opinion pls on the Trampoline Lift neck and early jowling. I am 54 have few wrinkles but notice the beginnings of jowling and a bit of neck banding - would i be better off with Sculptra - have had Dermalive in the NLF so cannot use filler in there but maybe the Sculptra would help lift??? a bit?? Thank you greatly, JD Canada

Answer:

well, I would not do it as if the single suture breaks, it all falls down, and it will not do anything for your jowls either.The amount of Sculptra needed in your face to lift the neck skin would likely be quite a large amount, not something I would usually recommend. Sorry. JG 1.31.11

Question:

should the results from voluma and from a fat graft look identical in the lower cheek area?

Answer:

in theory yes, in practice, probably not due to the variability of the fat graft survival and the need for a larger needle to inject the fat and where the fat has to be injected, in terms of the level, compared to Voluma. JG 1.30.11

Question:

Hi Dr. Garcia, I had emailed you almost 3 years ago about the side of my face being numb due to having juvaderm injections on my laugh lines. It happened when I was getting the novicane. The left side of my face has been numb ever since. It has gotten a little better it started under my eye down to the top of my lip. Now it is just numb from the bottom of my nose to the top of my lip left side only. I guess it is safe to say after all this time the numbness will never go away? Also, can you tell me what would a good filler would be for the top of my lip just to fill in the lipstick bleed it`s not bad but I see it. I had perlane 1 cc injected paid $700 and it did nothing. Help. Really need a good surgeon in the Passaic/Essex County area of New Jersey. Can you recommend. Thank You. Barbara

Answer:

well, you have had some improvement, so one can continue to hope that it will still get somewhat better. I like Restylane for that area, having said that, vertical lines treated with fillers do not last very long no matter what filler is used as the filler has to be injected very superficially and also there is so much motion that that the fillers dissolve quickly. Sorry, but I do not know any plastic surgeons in that area. All the best. JG 1.28.11

Question:

I took the day off of work next tuesday to get my first botox treatment between my eyebrows, will I be able to go to work the net day without anyone knowing? Would anyone tell? Also, when is it safe to lift weights run and wash or rub or scrub my face like normal after treatment?

Answer:

you can go back right after the injection, there are no tell tale signs, the Botox will not really show effects for about 10 days and bruising and swelling is uncommon and minimal if it does occur. You can resume all normal activity the next day. JG 1.27.11

Question:

my dr wants to put botox around lip to get rid of lines -i wanted restalyn but her thinks that works better. what is your opinion? thanks

Answer:

I would NEVER inject Botox around the lips for lines, ask yourself, if it was as good or better than Restylane, why would it not be FDA approved for that area or promoted by the company for that. JG 1.25.11

Question:

my dr suggested sculptra--i do have flat gaunt cheekbones--i am worried about granuloma formation--is it possible or probaable in the hands of a good injector, is it just a matter of luck or what. I am pretty nervous about getting a granuloma and lastly can you look overfilled it it is put in the lower area of the face where i am hollow on one side?? thanks so much

Answer:

in experienced hands it is a very rare occurrence. If injected in the proper location, the lower area should not get any larger, although I will say that while the swelling is resolving over the first few days, there will be some temporary swelling there that will go away. Best of luck. JG 1.24.11

Question:

when i buy restalyn syringes from ps to inject are there 1 o2 2 syringes in package thanks

Answer:

it is illegal for you to do the injections yourself and illegal for them to sell them to you. But they come one per package. Sorry. JG 1.24.11

Question:

if restalyn attracts water how much and for how long? does it puff things more and then stop? i don`t get it!

Answer:

it does only for the fist day then stops, and it swells about 30% at most. JG 1.24.11

Question:

Hi Dr Gaarcia Thanks for your answer re needle sizes for fat/filler injections. The surgeon I saw says that in his surgery `Fat is injected into dozens of tiny channels about 1/20 of a millilitre per channel through one or more injections sites` What is your opinion on this? Is this viable or do you always prefer fillers such as Sculptra etc. thank you - I am so confused He would do a facelift.

Answer:

well, my personal feeling is that when fat is injected through that small of a needle, the fat cells are likely damaged and they are essentially injecting the oil within the fat cell that is acting like a filler. They will harvest the fat using much larger needles so as to not damage the fat, so injecting it subsequently through a smaller needle does not make sense In cases of fat loss of the face, I prefer Sculptra, yes. JG 1.24.11

Question:

hi again doc just asked below about the juvederm in my nasalabial, apparently she says it was injected in the mid dermis but iam still concerned with the color as to whether its bruising or not

Answer:

I am sure that is where she attempted to inject it but there is no way she can know for sure as the mid dermis is quite thin and the angle of the needle insertion can place it in a more superficial or deep layer, plus, every patient`s dermis is a different thickness.JG 1.23.11

Question:

hi doctor,i have just had juvederm ultra injected into my nasolabial fold, its been 24hrs now and i have a green colour and a deep purple line in some of the area where i was injected, could it have been done superficially? it looks terrible its only on one side aas the other side only had a small amount in and i dont have anything showing really there. please advice iam really upset.

Answer:

this soon after the injection it can be either an early bruise or a too superficial injection causing a Tindell phenomenon. I would suggest avoiding sun and applying alternating warm and cold packs to see if the bruise will go away. You can also use Arnica Montana from the Health food store to speed the resolution of the bruise. If it is from too superficial of an injection, then it can be dissolved with hyaluronidase injections by the doctor. Best of luck. JG 1.23.11

Question:

Dr. Garcia, I`m thinking of using scultra for filling in hollows in my face due to fat loss. I`ve heard so much about the granulas or lumps which can occur years after the sculptra is injected. From reading your website I ve heard they would have to be cut out. What if that happens? You just live with it? I trust you and know that you still use it. Please give me your thoughts.

Answer:

on the rare occasion they form, they at times have to be cut out, but they are rare in experienced injector hands and in properly placed techniques. If the lump starts to form and you recognize it early one, saline injections will many times break the granuloma up before it completely forms a hard mass. All the best. JG 1.23.11

Question:

is it ok to have liquid nitrogen on an ak that is in a place where restalyn may be under skin thanks

Answer:

yes, its OK. JG 1.23.11

Question:

Rumour goes that botox is dangerous as it may trigger ALzheimer, how far are the researches in this respect?

Answer:

I have not seen an evidence to that effect, lots of inuendos though. JG 1.22.11

Question:

Dr. Garcia, back in November I received Dysport injections in what I believed to be a lift of the brows. I have no idea how many units were used, all I know is that it took no more than maybe 6 injections, total (both sides). I never really could see any difference and I believe nobody else could either. Let me add that the nurse who worked for this particular doctor came highly recommended by several people as they have had great results with her. Can you speculate at all as to why I did not get these results? I look at before and after pictures that I myself took and there is seriously very, very little to no improvement...sometimes I think I even talk myself into seeing a change. I would like to try again, but would greatly value your opinion and may come see you and your staff instead.

Answer:

well, it depends on where the Dysport was injected, there should be some lift of the lateral eyebrow if the crows feet are injected but if any is injected into the forehead itself, it can erase any potential lifting effect. In some small number of cases, the amount needed to be injected might be more if the muscle pull is very strong. Wish I could add more. All the best and we would be happy to see you in consultation if you wish. JG 1.21.11

Question:

Hi Dr. Sounds like you believe the risks in using filler in the undereye (trough) don`t justify using filler. Are you saying that people with this problem just have to learn to live with it? I have read in magazines (Vogue, Allure) that people in the articles are thrilled with how they look are having filler in the undereye area. Can you please share with us the risks of using filler in this area? Thank you for sharing your time and knowledge.

Answer:

I do fillers in the trough frequently, but not with fat, I use Restylane. Many of the problems after fillers there can be treated by dissolving the filler or cutting and lumps out. Fillers can yield great results but they can also have prolonged swelling and bruising, a grayish tinge to the skin, limps and twitching of the eyelid muscles which is temporary. All the best.JG 1.21.11

Question:

Thanks for your answer about fat injected under my eyes (I`m the one who has had swelling for 3 months after this procedure and nose reconstruction). I forgot to mention/ask...underneath the injected fat (for both eyes), I still have some redness (like in a half moon shape) that has persisted, I guess from the bruising that occurred. I have never had bruises last this long (3 months). Do they eventually go away, or if not, how can they be treated? I also have a bruise near my chin, where fat was injected to my chin. Again, it`s a lighter color than the original black and blue after surgery, but it`s still a color that cannot be covered up w/ makeup. Thank you again for helping me!!!

Answer:

redness is not bruising, might be something else, might want to see your surgeon to see if there is any fluid there that could or needs to be aspirated. Might use Arnica Montana gel on the chin and in time that will also get better. JG 1.20.11

Question:

I had fat injections directly underneath my eyes to fill in hollowed-out areas from a bleph I had 10 yrs. ago. It looked great in the beginning (I`m 3 mo`s post op) but now it looks like most of it is sitting on the upper area of my cheek bone. The PS says it`s still just swelling. Even though most of the fat injected under my eyes looks better than before, this extra amount just below the eye socket makes it look like I have eye bags. Will this go down? BTW - this was in conjuction w/ a nose surgery. Thanks for all of your help and love your new website design!

Answer:

in cases of combined surgery, there can be prolonged swelling as you describe, give it a few more months, it should go down. JG 1.20.11

Question:

Hi! I`m getting 22 units of Botox for the first time ever between my brows for those 11 lines. Can you tell me what to expect after the injection. I`m scared. Also im very active! How long after the injection Can I lift and run and bend over? What will my face feel like and is there any aftercare I MuSt remember?

Answer:

minimal discomfort and some improvement in the motion in 7-10 days. I would limit activity until the next day and avoid pressure to the area for at least 4 hours.Your face will not feel any different. JG 1.19.11

Question:

Hi Dr., This is a follow up to the fat transfer. I was referring to a filler underneath the eye (not the eye itself), where, because of fat loss, there are shadows. I am confused about the lid you mentioned. Do you mean the upper lid? Is there a lid in the lower eye? Sorry for my ignorance. Also, thank you for the very clear, strong sentiment. Why do you use Restylane and stay away from fat transfer for the eye area?

Answer:

the lower eye also has a lid, it is the skin form the eyelash line to the edge of the bone. The ridge where the bone is felt is OK to inject, along with anything below that, but not over the soft part above the edge of the bone.I stay away from fat for many reasons. Firstly the needles used to inject the fat are larger, the droplets of fat are larger than the other fillers, the fat has to be injected into the muscle for it it survive, survival is poor at best, and in the event that it does survive, if you gain weight, the fat will grow and look lumpy. Fat injections do better in areas where it can be injected deeper, like the cheeks, but does extremely poorly around the eye as there is not much muscle for it to develop new blood supply in order for it to survive. Hope that helps. JG 1.18.11

Question:

Hi Dr., My doctor is a true believer in fat removal and transfer. I have read of its risks and anyway, can`t afford the downtime of going through the procedures 3 times. Still, she recommends that I have a fat transfer for the undereye area. What are your thoughts? What filler do you use or recommend for the undereye area? Thank you.

Answer:

I would NEVER EVER do a fat transfer for the undereye are. I only use Restylane, and then only for the rim, not the eyelid itself. JG 1.18.11

Question:

What do you think of the vampire facelift or serphyl?

Answer:

not sure what serphyl is but the Vampire facelift is a lot of hype with very little science or proof behind it, I would not perform or promote it. JG 1.17.11

Question:

Is it uncommon to lose volume unevenly on the face? My lower cheek seems to be hollowed out a lot more on one side of my face near my NL fold and I`m in my early 30`s over the last couple of years. I have a sneaking suspicion it has to do with a laser treatment I had in the area.

Answer:

actually, losing it unevenly is the most common way for it to happen as it is the boney structure underneath which is uneven and when the fat loss occurs, that difference is more easily appreciated. I doubt the laser treatment caused the fat loss. All the best. JG 1.17.11

Question:

Hi Dr. G, What are your thoughts on Radiesse for the hands? My fingers/knuckles as well need a filler. Would this be possible or is it just the back of the hands that can be filled? Thank you.

Answer:

I think it would have a high risk of getting lumps that will require surgery to remove, sorry. JG 1.13.11

Question:

I wish you can work on my face the way you did for the model in the intro. :) I like what you`ve done with the web update/remodelling! I am Asian, and unlike some caucasians, do not have a problem with gauntness. I have a full face, and I think if my cheeks weren`t so heavy/ were better supported, the bottom half of my face (sides of mouth and jaw line) would have cleaner lines. A doctor who had done fillers told me too much filler in these areas would make the lower half of my face heavier. She had suggested fat removal and transfer. Can you please share your thoughts on this, ie, how long does it last, how much down time, potential negative effects? Thank you.

Answer:

I agree that in many Asians, due to genetic fat distribution, they can have round faces and fat removal with or without transfer can attempt to obtain a more angular face. The fat removal is permanent, the fat transfer might last a couple of years. The potential negatives is that you might look older sooner compared to your family members as fat removal allows the skin to fall at a younger age. I too wish doing surgery was as easy as it is on the opening to the website. All the best. JG 1.10.11

Question:

Hi Dr, I had SubQ injected to the cheeks about four months ago. I am now considering having a top up but this time with Teosyal. Would there be a problem mixing the two products and do you know which of the two fillers gives better results? Love the new website by the way ! Thank you

Answer:

I have not read about any negative interactions between them, and thank you for the comments on the updated website. JG 1.10.11

Question:

I had a juvederm injection under the eyes almost 2 weeks ago. Due to bad swelling under 1 eye, I had vitrase to remove it last week. Now that more of the swelling has gone down, I can see that the injector placed the product too high. Is it still possible for him to move the filler into its proper location or do I have to have it removed and start over?

Answer:

need to remove it and start over, sorry. JG 1.10.11

Question:

Dr. Garcia, I am unable to be cut due to medication but am able to have injectables. I had Restalyne a few years ago, it did not last long. I want to know what you recommend for a filler that will last a reasonably long time. Artfil? Sculptra?,etc. I am 62 and look it. I would love to look younger as I work with high school students and they respond well to me but they naturely repond even better to younger teachers. I also want a new ,refreshed look. Thanks so much! J. H.

Answer:

hard to say which filler would be better for you without at least seeing pictures of you. I will say that longer term fillers though are not substitutes for the shorter term fillers. Long term fillers can often not be used in the same area as the shorter term ones due to potential complications. If you would like, you can send me some pictures to look at to my email, drgarcia@lvcosmeticsurgery.com and I can try giving you some options. All the best. JG 19.11

Question:

Hi Dr Garcia Love the new website! Just a wee question - is there any situation where you might do facial fat injections/grafting? best wishes

Answer:

thanks for the website comments, and as to the facial fat injections, yes, if am going to have access to some viable fat and am already operating on the face and the patient understands that the fat will likely not survive more than 1-2 years. JG 19.11

Question:

thank you for answer on permalip but you didnt tell me how the skin cancer could be fixed? or can it so filler will be even in lips?

Answer:

sorry,the only way would be to cut the scar tissue out and then suture it closed as letting the wound close on its won as was done creates more scar tissue. JG 19.11

Question:

hello Dr! been a very long time since i have posted! wouldnt have thought to if i hadnt gotten the email regarding the new website! thank you! my question is I have had a scar above one side of my mouth(invisible, maybe slightly white) from a basal cell skin cancer removal. ever since, when i get filler in my lips, that side is always lower(it is lower bc of the scar always anyway) and it seems more noticeable. my facial PS said once casually he could fix that. have never bothered but was wondering how it would be done? my injector says she can feel the toughness of scar tissue there when the needle goes in for filler. When it was removed, it was just scooped out, leaving a hole about the size of a tapioca bead, to heal opened on its own. also, what do you think about PermaLip implants? i have seen pictures and it seems that the shape is just straight across, not going up giving width or defining the cupids bow(vermillian). and if removed, wouldnt there be scar tissue built up, looking strange and lumpy afterward? thanks for your time!

Answer:

scar tissue form the previous skin cancer can cause tethering of the tissues so the skin does not stretch evenly after the filler inject. The Permalip implants do not have curves as you mention, so the downside to them is that it will give only volume, so you might need a filler on top of the implant to give you the localized prominences, but likely less total filler amount. I think the amount of scar tissue left after removal would be quite thin though as the capsule around it would flatten and be smooth. I wish you the best and thanks again for visiting to updated site. JG 1.8.11

Question:

I have granulomas caused by dermalive which was injected 10 years ago in Portugal where I was working at that time. I went back to the surgeon who injected and she was cagey about what she had injected although eventually whe said it was dermalive. She agreed to remove them surgically. That was a year ago, but they are still there only worse than before. They have spread and I now have scars as well. I don t want to go back to this woman and there is also a language barrier. Is there anything else I can do please.

Answer:

I am afraid all that can be done is more cutting, I am sorry. JG 1.6.11

Question:

Hello Dr...I was wondering what you thought of facial fillers for shaping the face...basically, im 30 and would like to give myself a more raised higher cheekbone look...i have chubby cheeks but sort of bottom heavy....It is the zygomatic bone I would like to accentuate I believe...which filler would you recommend to test it out??? can I achieve a higher cheekbone and not a chubbier face if filled in the zygomatic area??? Thank you so much :)

Answer:

I would suggest Sculptra for that area. I think if you have a full face, any filler or cheek implant will likely make you look like you have a more chubby face though. Might need some fat removed to sculpt the face more, maybe in the fat pad of Bichat. Best of luck. JG 1.5.11

Question:

Hi doc. I had juverderm in the temple area... it`s not very smooth looking. How long do I have to wait until I try sculptra?

Answer:

I suggest waiting until it dissolves and comes smoother to avoid problems. JG 1.1.11

Question:

Hi Doc. Merry Christmas. I had restylane injected into my nose on one side to help with asymmetry. I had is injected over two ago and my nose is still red. is this normal? will it go away?

Answer:

can happen, try not to rub it too much and give it some more time, the skin there is thin and it can stay red for awhile, all the best. JG 12.31.10

Question:

Hello Dr Garcia, I am 53 years old, in very good shape but have slight jawline sagging and my neck does not look great (to me it looks like I need lipo even though I`m not overweight). Just saw a ps and he said face lift is the best reliable fix but that I`m not at the end of the spectrum where it is really necessary. He recommended trying thermage on my neck (he did say it doesn`t always work) and sculptra on my face to fill in some lines, etc. I do like the fact that he didn`t push the surgery as the only option. What do you think about taking the approach of thermage/sculptra to stave off the inevitable face lift? Also I want to look as natural as possible and don`t mind a few wrinkles. You are a true gem for answering all these questions, hope you will turn off the computer for the holidays (but not until you answer my questions of course :-)

Answer:

I think Sculptra is a good idea but I would skip the Thermage, very disappointing results. I wish you the best for the holidays and a prosperous New Year. JG 12.22.10

Question:

What can I use instead of botox for my forhead lines and furrow between my eyes. My family has a history of Neurological disease (mom-ALS ). I also would like to use a filler for lines around my mouth. I had fraxel done about a year ago on my face and neck and the results are minmal to none.

Answer:

can use Restylane or do a totally ablative Co2 laser. Best of luck. JG 12.19.10

Question:

Hi, Dr. Garcia, Botox question--I have bad crow`s feet that extend from corners of my eyes down cheekbone--nearly two inches down. I also have them under my eyes, of course. I know this is from sagging skin because when I pull my face up (like a practice facelift), they are gone. Would botox injections be of any benefit when dynamic wrinkles are so severe? Also, would it help prevent these horrible lines from getting worse if I had botox and continued it? No static wrinkles, but sixty years old and trying to put off a facelift. Thanks a lot.

Answer:

if you have wrinkles at rest I think the amount of improvement with Botox will be quite small and I would not recommend it. I might help the progression of the wrinkles slow down some, but not entirely. Most likely I would not suggest you spend your money as its effects in the crows feet area are quite mild and that is why it has not been FDA approved for that area, only for the glabella. Best of luck. JG 12.18.10

Question:

Hello Dr, What would be the best filler to use in the area below the eyebrow in the upper eyelid area to re-create a more plump look? Thank you

Answer:

I use Restylane for that area.JG 12.6.10

Question:

Morning. If i have had Dermalive injected in my NLF can i still have Sculptra put in my cheeks or will it migrate down into my folds. I am aware that the Sculptra should not be placed in with the Dermalive.. correct?? Thanks from Snowy Canada. jg

Answer:

no, it can be injected and will not migrate.Just do not inject into the same place. Best of luck. JG 12.6.10

Question:

I asked you previously about treating diagonal lines around my chin area-I can see they are created when I speak.Can a little bit of botox in that area help? thanks as always..

Answer:

tricky to get it right with Botox and leave you looking or speaking strangely. JG 12.5.10

Question:

Ps. i mean fuller and larger from the scar tissue of course.

Answer:

unpredictable. JG 12.7.10

Question:

I want to have sculptra done to fill in fat loss in my cheeks and hope it will lift my jowels a little. I`m also trying to get pregnant but haven`t had any luck. My aesthetician says that they generally insert Scultra twice about 6 weeks apart. If I got one round of injections right now while I m not pregnant and then got pregnant before I got the second is there going to be a problem? I guess I`m asking if that second injection time is to fix any funny shaping or is just to add more volume.

Answer:

I do not think injecting Sculptra while pregnant will affect the pregnancy.Best of luck. JG 12.2.10

Question:

Hi Dr. I am a 20 year old college student and I have used artefill for my nasolabial folds after 1 year of using radiesse. After my last touch up (my fifth) for artefill, which was about 6 months ago with Dr. Rivkin in Los Angeles, I noticed that my nose tip was larger and felt and looked swollen, bulbous and uneven. Over the last 6 months it has very slowly improved slightly but still looks bad. The doctor keeps telling me swelling will go down eventually but this seems very abnormal. Im really worried and running out of options. I cannot meet with him because I am in school. Is it possible my nose will ever look right? My tip still feels hard and my research says that maybe a steroid injection or massaging may help? PLEASE ANY ADVICE WOULD BE REALLY HELPFUL

Answer:

Honestty, Arefill should not give long term swelling, but it is a long term filler that can last years, I have never found steroid injections to help in dissolving Artefill or Radiesse, and in the case of true swelling or edema, it can work, but transiently. sorry. JG 12.2.10

Question:

Hi Dr. G., I hope you had a great Thanksgiving. Your generosity with your time and knowledge is among the things I thanked over Thanksgiving. Have you heard anything about Zenora (laser that works on reducing fat) and what is your opinion of it? Thank you!

Answer:

thank you, my Thanksgiving with my family was great, I wish I could say the same about the laser fat reduction, it is minimally to not effective and I cannot recommend it, sorry. JG 12.1.10

Question:

hi again doctor garcia. thankyou for your answer regarding the filler disolver. i have found out that the name is not ilpac, it is called kinacort or (kenacort), this is what they are using to disolve the filler in dubai. they do use hyalaise too, but a few docs here say they use this other one as they dont stock the hyalaise. what do you know about it? is it safe? and are there any side effects? Maybe its not meant for dissolving filler i suspect, as i thought hyalaise was the the only solution.

Answer:

Kenacort will not dissolve any filler but it will dissolve the surrounding normal tissue, it can soften scar tissue. I have used hyaluronidase and it is very safe, safer than kenacort. All the best. JG 11.30.10

Question:

I have juvederm injected every 4 months in my frown lines and it causes bruises for a week and is expensive. Why not just inject my own fat? Would that be permanent?

Answer:

likely not permanent and will cause a lot more bruising as the needle needed to inject fat is much larger. JG 11.19.10

Question:

I had two vials of Sculptra last night. Is it OK to ride my recumbent bike this morning for about 30 minutes?

Answer:

yes, it is. JG 11.18.10

Question:

In your experience, Dr. Garcia, is it typical to have a significant amount of swelling for a week following injection of Juvederm? I expected a little post-injection swelling for a day or so, but it`s now been about four days, and I`m worried that what I thought was normal swelling may really be a result of too much product having been injected. If so, that will dissolve in about 4-5 months, I know, but in the meantime, I will look very, very odd. Is it too soon to assume that this is the problem, or after four days, is this a case of what you see is what you get, at least for the foreseeable future? Thank you very much for your valuable time and opinion.

Answer:

some people swell more than others, and ther might be some blood in the site that has to dissolve. If it is the product due to overinjection, you can have it dissolved if you wish and then start over. I think what you have at ten days is what you will have. I wish you the best. JG 11.18.10

Question:

hi doc, i asked you about ilpac? maybe thats a nick name for it, but do you know of any other substances other than hyaulaise that they would use to dissolve filler? i thought it was only the hyaulaise that they used.

Answer:

hyaluronidase is the only one that dissolve hyaluronic or HA fillers like Restylane and Juvederm, it is the generic name. JG 11.17.10

Question:

How long does the Tyndal effect last from HA that was injected too superficially? As long as the filler lasts (4-5 months) or does it fade before the filler resorbs? Can it last longer than the filler itself? I`ve read posts on your site from people who claim to have a blue shadow for a year or more, long after the filler would have been gone. If that is so, why? Would it stain the skin and last longer somehow? Thank you for your kindness! Have a beautiful day.

Answer:

it will last as long as the filler lasts, could be months. Cannot last past that point, as to people stating they have it for longer, unless the filler lasted longer for some reason, there is no physical reason for that to occur. It cannot stain the skin, but the dark circle might have been there to start with. All the best. JG 11.16.10

Question:

hi doctor, Have you heard of a substance called Ilpac? they are using it in dubai to dissolve hyaloronic acid fillers, is it safe?

Answer:

sorry, but I have not heard of it, does it go by another name perhaps? JG 11.15.10

Question:

Dr. Garcia, I`ve made an appointment with my dermatologist for restylane, and during this visit we will also discuss using Sculptra. Because I travel a long distance to see her, I was told that I can make back-to-back appointments--so that if we decide on Sculptra they can prepare and administer it the same day. I saw a comment somewhere in the netsphere that the Sculptra solution needs to be prepared the day before to properly dissolve. What is your procedure? Would an hour or two be too little time for proper dissolution? Thanks.

Answer:

I think if it is mixed less than one day before you have a significantly higher chance of lumps, we mix it at least two days ahead and warm it before injecting. Best of luck. JG 11.15.10

Question:

have u used selphyl? what do you think?

Answer:

sorry, have not used it. JG 11.13.10

Question:

what do you think of ultherapy to get rid of sagging under chi?? Even if it lasts a yr i would be thrilled thanks

Answer:

I would not use it personally, I think the fees for what you get are not worth it , but caveat emptor. JG 11.13.10

Question:

Hi Dr. Garcia. I am planning to get Sculptra for sunken cheeks and fat loss on cheekbones. My question is about the immediate swelling afterwards (which I know goes away until the collagen production begins). Will it be very noticeable? If I go into work the next day, will I look done ? If so, how long does the swelling tend to last? I`m thinking of timing the injections so I have a couple of days off. I don`t want to deceive people, but also don`t want to field questions about what happened to my face. Thanks as always for your kind advice.

Answer:

it is fairly noticeable for 2-4 days or so. The next day you will look puffy, yes. Best of luck. JG 11.13.10

Question:

Hi Dr.Garcia,I have some diagonal lines on both sides of my chin probably due to sun exposure and muscle contractions.What would you suggest for that area?-fillers,skin re-surfacing and what type? thank you as always for your time.

Answer:

I would start with Restylane and see how it goes,lasers will be hard to get a dramatic effect there. Best of luck. JG 11.11.10

Question:

Regarding the botox single bottle use issue, I read that one dr draws up 10 units per 1cc syringe and then refrigerates the 100 units or 10 syringes.... then the dr just pulls the number of needed syringes per patient, never having to do multiple draws from a single bottle of Botox. Would storing the reconstituted mixture in that way affect the potency? Thank you!

Answer:

well, if stored past 4 hours, it weakens it. As to the Botox use issue is that what he is doing is what is considered a willful and knowing violation. Although it is likely sterile, the bottle is labelled as a single use AND single patient. Knowing the box says that and then attempting to circumvent it by doing what has been described to you is not only wrong, but in a court of law, would show a premeditation to violate the established safety labeling induced purely for a profit motive and would be a slam dunk against his cause. It might seem cleaver, but it is a losing stand. JG 11.10.10

Question:

Thank you for your answer about the botox and it`s affect on my smile....I`m wondering if the amount that was injected has anything to do with the lenght of time it will last...am I still looking at 4-6 months even if very little was injected into the area...most of what I got was around my eye brows... as you can see I`m not being very patient...having my husband notice my slanted smile tonight was upsetting...I will never do botox below the eyes again. Thanks so much.

Answer:

it might last less, depending on the dose injected, yes. Hang in there. JG 11.8.10

Question:

I have a divet on my jawline caused by smartlipo, where the doctor took too much fat in one small area. It makes me look I have jowls on that side. The doctor that performed my revision said he could use the fat he was removing around the dent and do a fat transfer to that area to try and smooth it out. I was too scared to try fat injections because I am afraid of either it not working or gaining weight in just that area, and it looking odd. I had the revision a month ago but the dent is just as obvious as it was....looks a little worse but could be because of residual swelling. What is your opinion on some of the fillers used on the jawline? I have heard of fillers resulting in blobs under the skin or marks. It would probably only be a very small amount. What happens if you start using fillers in your early 30`s? Does the constant plumping and deflating result in saggy skin in the future, kind of like when people gain and lose weight? Also how long after smartlipo do you recommend waiting before filling dent? What type of filler do you recommend if any for this type of issue?

Answer:

if there is enough fat around the dent, then removing more fat alone might work by making the area more smooth and even, but if there is minimal fat around the dent, it will not work. In that case something has to be put in to replace the fat that was removed, if the revision was done with SmartLipo, then using that fat will not work as the fat has been damaged by the laser, so you need either fat from another area or an off the shelf filler. Fillers will not cause faster sagging if all you are doing is replacing what was lost. I think after 3-6 months it is safe to proceed with the filler as whatever was going to smooth out has done so. Hard to say which filler I would use without seeing you in person, but could be Sculptra or Radiesse,mayeb even Artefill. All the best. JG 11.3.10

Question:

Why is it that if restylane is not permanent. that I have had some injected approx. 5 years ago, and the area that I did not like before the injection still has not reappeared? In other words, is there some people that retain it permanently?

Answer:

it is biodegradeable, all I can say is that maybe scar tissue displaced the Restylane to allow it to continue looking good, or it was something that was going to get better on its own, or it was not real Restylane. JG 11.2.10

Question:

If I have hyluaronadase injected to get rid of restylane that looks like a worm under the skin, how long will it take to see the resty dissapating and will it possibly take more than one injection?

Answer:

it can take more than one injection in some cases, it should do its thing within hours, if you see no change by the next day it is OK to repeat it. JG 11.2.10

Question:

If fat has been injected in the wrong place, can it be removed with kenalog; Also can restylane injected in the wrong place be taken out with an 18 guage insertion needle and then squeezed out? Thanks in advance.

Answer:

It can be attempted to dissolve fat injections with the kenalog, but the kenalog can dissolve the normal fat too. I have never seen nor heard of aspiration of Restylane being successful, sorry. JG 11.1.10

Question:

hello doctor, i asked you before about dissolving teoysal in the jowls area, well i had it done yesterday and all what has happened is the area has gone larger and it looks worse, i cant see or feel that any filler has dissolved nor can i see any decreaese, only increase. she said she injected alot of hyalaise in that area too. Is teoysal deep lines hard to dissolve?I thought it was hyauloronic acid. it was injected deep over the bone. iam worried that i may need to have surgery to get this out,do you know anything about this? i also had my cheeks done with teoysal too, and have had a little hyalaise on one side to bring it down, but again cant see much improvement.

Answer:

it will take more sessions than regular type, and there is always swelling after the injection due to the hyaluronidase being diluted in order to inject it, and there is the risk of bleeding and bruising too.Might need it done more than once.JG 11.1.10

Question:

Hi, After receiving an ArteFill injection which left a lump, I had Kenalog, which also created an indent. I had the indent filled with some Jevederm. The indent filled in but does not look natural. I can still see the borders of the indent and it is a little lumpy. My question is, can the area be smoothed out if I had some Microdermabrasion treatments? What other alternatives could I possibly do?

Answer:

microdermabrasion will not do anything as the problem is below the skin, short of more fillers, there is not much I can suggest. JG 10.31.10

Question:

Hi, Dr. Garcia. I had Radiesse injected two weeks ago and had no bruising, but today, 6 distinct bruises have appeared at the injection sites. This has never happened to me before. Have you ever seen a delayed response like this? What do you think happened? (Just in time for Halloween -- my very own creepy costume!) Have a great weekend, Dr. Garcia!

Answer:

in some cases, it will take time for a deeper bruise to rise to the surface and be seen, not unheard of. It will go away on its own, use sunblock over them in the meantime. JG 10.30.10

Question:

In your practice, have you seen Sculptra improve pore size? I have some volume loss as well as texture problems lateral to my nose and on my chin and am wondering if this product would improve the texture -- particularly the pore size-- of the skin as well as improve the volume. Thank you.

Answer:

I have not seen that happen nor would I think it could cause it to happen.JG 10.28.10

Question:

Good Day Dr.G, How long will Sculpts last in a cheek augmentation? Thanks GFA

Answer:

up to 2 years. JG 10.26.10

Question:

hi doctor garcia, i had teoysal deep lines injected into my jowls area, and now my face has unwanted volume at the botom of my chin and underneath near the neck area, i look like i have a fatter face and its all uneven, it doesnt look nice at all.i didnt really have much of a problem there either. i want to get it disolved with hyalaise, is it possible to dissolve the filler in that area? please advice. thanks

Answer:

It certainly can be tried, all the best. JG 10.24.10

Question:

Hello Dr. Garcia: For about 3 months, I used a product named LipFusion about 4 years ago and shortly after using it, I developed small granulomas in my lips. Is there anything that my doctor can do to reverse this problem?

Answer:

cut the lumps out. JG 10.24.10

Question:

Good evening, Dr. Garcia. I had a series of Sculptra injections from last December through April of this year and have been very pleased with the results. I had thought that the end point after each injection was about 6-8 weeks, but in the last month or so (September-October), my face has noticeably widened again. Have you ever heard of such delayed collagen formation from Sculptra? I know it will eventually deflate, but I am surprised by this sudden development. I hope it won`t continue! Thanks for any insight you can offer. Sincere gratitude for your merciful and generous practice of medicine. (By the way, I think you should run a seminar for your colleagues at your next national meeting on the humane, dignified and non-defensive treatment of patients who suffer adverse events. It seems that many would do well to follow your example.) Peace be with you.

Answer:

it is not a delayed reaction, although we sometimes inject more Sculptra at the 6-8 week range for further augmentation, the maximum effect of the Sculptra is not seeen for 4-6 months. Best of luck and thank you for the kind words, they are greatly appreciated. JG 10.21.10

Question:

Dr. Garcia, My son is getting married in Feb, I would like to know when I should come in and get botox injections for the ultimate effect.

Answer:

2-4 weeks before should be good, and congratulations too. JG 10.20.10

Question:

I`m one of those unlucky people who developed granulomas from Sculptra in my hands. They appeared about 3 weeks after I was injected in May. My dermatologist has tried subcision 5 times and twice has injected some of the larger nodules with very diluted kenalog (mostly saline). They have decreased in size only about 15-20%. We can see approximately 10 large nodules in each hand and at least 20 smaller ones in each hand as well, most of which seem attached to the tendons. My dermatologist thinks I may well have upwards of 40 in each hand, taking into account the ones that are less visible. Obviously, my hands are now a mess. My question for you is, at what point would you suggest excision -- 6 more months, 1 year, 2 years? Honestly, at this point, it looks like the skin would have to be dissected off the entire dorsum of each hand to expose the tissue below to get all these things out. It`s surprisingly depressing. Do you think there may be a chance that these might resolve on their own? My dermatologist thinks not. My advice to your readers: skip this stuff in the hands! Thanks so much, Dr. Garcia.

Answer:

I think somewhere at 6-12 months it would be worth starting the excisions, the bigger they are the sooner I would take them out, maybe removing them in stages, large ones first, hoping the small ones get smaller with time and avoid having those cut out too. Small incisions over each one, unless they are very close to one another. The smaller ones might dissolve on their own, but not the larger ones. That is why Sculptra is not approved for use in the hands. JG 10.19.10

Question:

Hi Dr. Garcia. I appreciate all of the advice you have given me over the years. Last year I posted about my experience with mis-used hyaluralonidase and I thought I would follow up, since I think others might benefit from knowing what happened to me. Basically, a dermatologist used hyaluralonidase to try to correct some areas of overfill that were created by another doctor. After the injections, one side had a shallow, crescent-like trough running from nl folds to the marionette line. After much going back and forth about it, it became clear that she directly injected an area where she THOUGHT I had restalyne, but did not. She pretty much said this. Since then she has filled in much of the trough and folds with restalyne, and so far much of it has remained filled except for an odd depression along the nl fold that I have learned to live with. I do believe that this substance is harmless most of the time, but that a doctor should not use it unless they know EXACTLY where the filler is. Thanks for letting me post my experience.

Answer:

I truly appreciate your input, it is valuable for al of us. I do agree, putting it where it belongs is key. I wish you all the best. JG 10.17.10

Question:

i have had a sinus infection but feel fine-is it ok in your opinion to have restalyn injected into cheek area . i have had it done there before with good results but want to be sure that it will not be near sinuses. this may be adumb question but i am no dr!

Answer:

should be fine, yes. Not a dumb question at all. JG 10.17.10

Question:

What places on the face can restylane NOT be injected. Example; Can it be used to enhance a chin, the tip of the nose, upper eyelids right under the brow bone on the outside part of the eye?The columnellar, the philtrum.. Thanks

Answer:

I would not use it on the eyelid itself, and also some areas will just be absorbed faster than others. JG 10.17.10

Question:

hello, Iwant to my nasolaibial fold done with filler, and want to know how deep it should be injected? should it be superficial for this area? or how deep in the dermis? iam worried about having a grey or bluish line showing on my skin if its not done right. can you please advice and recomend the fillers most effective. many thanks

Answer:

into the mid to deep dermis. I use Restylane for that area. JG 10.16.10

Question:

Hi so if its not edema in the cheek after three years from surgery. How could scar tissue form in the cheek as no surgery was done on the actual cheek only the cheek bone area. I actually had a lot of swelling in the cheek after surgery to the cheek bone area is it possible that the swelling stretched the internal tissues of the cheek causing scar tissue?

Answer:

the scar tissue cna be on top of the bone pushing the cheek tissues up. Stretching the tissues would not make the tissues large, just possibly more saggy. JG 10.16.10

Question:

I recently had restylane injections in the naso labial folds. It lasted approximately 1 1/2 to 2 months. Is this the customary amount of time for this material to last? If so, I think the cost of maintaining could become prohibitive. I did inquire as to what I felt was a short lived injection and was told more would be injected with the next appoinment. If the smaller dosage first injection attained the desired result, why would I want a larger volume injected the next time around? Wouldn`t the material,regardless of the volume, have the same duration? Thank you!!

Answer:

it varies from patient to patient but I would expect at least 1-2 months more, the deeper it is injected, the less time it lasts, and also the greater the amount of motion, the less it lasts. I agree with your analysis of injecting more at the time not being the correct answer as it would make it look overfilled. JG 10.14.10

Question:

Hi sorry i meant that the actual cheek has become fatter like there is some fluid inside the cheek tissues. Could it be Edema?

Answer:

not after three years. JG 10.13.10

Question:

I had cheekbone surgery about 3 years ago to scrape out a lump on my cheekbone. Ever since my cheek has become fatter than usual and when i feel it seems to have something inside the cheek tissues. Is it possible that i could have long term swelling in my cheek? If so how can i prove what is still inside the cheek thats making it look fat and assymetrical compared to the normal cheek on the other side?

Answer:

more likely scar tissue that formed in the space where the lump was. An MRI scan can be done to give some information but it will not always be able to differentiate between tissue type. JG 10.13.10

Question:

Hi Dr G, I am in the process of having a serie of YAG, and filler touch ups (Radiesse). (1) What is the reason for waiting (and how long should I wait) after having Radiesse before having the YAG? (2) The reverse, after a YAG treatment, is it safe to have Radiesse the day after? Thank you!

Answer:

I see no reason to wait more than the next day for the YAG. If the YAG is done first, you could get the filler right afterwards. JG 10.12.10

Question:

What`s the latest estimate on when the FDA will approve Restalyne SubQ for use in the States? Any guesses as to the cost?

Answer:

no date for release yet in the offing, nor prices. JG 10.11.10

Question:

Restylane SubQ

Answer:

OK.

Question:

One of my NL folds is is in a higher up on my face and further out than the other by a few cm. I have tried filled to make it look less noticable but it never looks much better. Is there any kind of surgical procedure to pull it down or reposition the fat?

Answer:

might need a cheeklift to do that. JG 10.10.10

Question:

I was offered My cell as a substitute to Sculptra due to my risk which I was informed was high due to allergies. I could go down the route of a patch test but have read mixed reviews on Sculptra. Can I pick your brains on Sculptra, What do you think of it for a volume filler. The results of his did look fantastic. Hes done over 2500 patients with it . Two with allergic reactions. Thanks in advance you are a star!

Answer:

I think the risk of allergic reactions is never zero, but I have never seen an allergic reaction to the Sculptra myself, and it is the preferred choice of mine for a filler in the area of loss of facial fullness or fat. JG 10.8.10

Question:

Hi what are your opinions on My Cell, where they take stem cells form your plasma for facial rejuvenation ,rather than traditional fillers. Do you think there are any risks or complications other than the usual ones expected with HA fillers. I have few lines and little sag and have been advised this procedure instead of filler as he feels I do not yet need to go this far and the Doc thinks stem cell is the way to go with fewer risks. would much appreciate tour thought on it. Cheers

Answer:

same risk, but I don`t think it works, you already have stem cells there, why the stuff works in other cases is the growth factors that it contains and unless there is an injury, the growth factors do not matter much. JG 10.7.10

Question:

My doctor, who only does cosmetics work (as opposed to others who specialize in other specialties and have a beauty business on the side) suggests that I have a CO2. What are your thoughts on the CO2 for Asian skin, vs. the YAG, and the benefits/risks of each. Thank you!

Answer:

I personally feel the CO2 is risky in Asian skin, so to do it safely, you might not get much improvement in return. JG 10.3.10

Question:

Hi Dr. G., What are your thoughts on fat transfer for the face, vs. the various fillers - and what are the advantages/disadvantages for the fat transfer vs. fillers. Thank you for sharing your professional opinion.

Answer:

I think the fillers are easier, less down time and more predictable then fat injections. JG 10.3.10

Question:

Hello Dr. G. I bruise easily and was wondering if I should stop taking Omega 3/6 tablets before any procedure that might cause bruisng. These Omega 3/6 tablets look like Vitamin E, and I know I`m supposed to avoid it, in addition to aspirins and alcohol. Thank you as always for your generosity!

Answer:

there are reports that they can thin the blood so it is best to stop them for 10 days before and after the procedure. Best of luck. JG 9.28.10

Question:

Good morning. Dr.G have you heard of the Vampire Facelift-believe a Dr. here in Ottawa Cda. patented it..uses your own blood to be injected instead of traditional cutting method. Longevity could be a few years and of course the downtown time and costs are closer to those of injectables as that is really what this is. Your opinion please. Thx a zillionth time from one of your Cdn. fams. jg

Answer:

there is absolutley no proof to any of the doctor`s claims, he is making claims to profit off of patietns desires to have something non-surgical and have it be new . Save your money on this one. JG 9.27.10

Question:

Is bioplasty (bioplastia) safe?

Answer:

no longer able to be used in the US. JG 9.26.10

Question:

Is it possible for filler to be misplaced in NL folds where the filler is placed under the fold creating a spacer effect, widening the fold and causing the fold to drape over at an increased height and lateral projection? This is what I feel like happened to me through the course of filler injections and only on one side. I was only 28 then and I had pretty small, thin lines to begin with... even if I look back at pictures right before the injections. However, in pics a few weeks post-injections is when I noticed something was up with one of my smile lines. I originally got them both filled even though they really didn`t need it at all because I was sold on it and doing my eye area anyway. I started to notice after the injection that on one side, the line was wider, higher and (in retrospect) looked as though it was resting over the filler that was shoved into the triangle area. The line on that side was always a little more pronounced, but after I noticed a much more substantial difference in the pics a few week after the injections, I simply attributed it to the fact that I simply losing volume in that side faster (which in retrospect could have been due to the spacer effect I was referring to) and I began to get the one side filled frequently (probably about 3 cc of hydraulic acid products ranging from Restylane to Voluma in a course of the last 2 years). I think by continually putting filler in the area to fill it I am exacerbating the problem and what I`m essentially doing is filling a gap that was created by the filler in the first place. So even at best, when that gap is full, it still does not match the other side and gives that side of my face a different, more strange look with the fold pushed out and upward and the gap becoming increasing full and possibly even widened with injections. Does this sound within the realm of possibility to you??? I basically have three options: I can wait it out, keep filling it, or have it dissolved to see if my hunch was right... and if I`m wrong and dissolving actually makes the area looks less I`ll have thrown away all that money on injections which will be a tough pill to swallow. Thanks :)

Answer:

it can happen on a small number of cases. Exacerbating the problem with the filler would happen only if they kept injecting it into the incorrect area. I think waiting for it all to dissolve is the way to go. As to throwing away the money by dissolving it, I think that sounds like it has already happened as you do not have the correction you were hoping for years and multiple injections later. Best to let it all dissolve and then re-evaluate the situation. JG 9.24.10

Question:

Hello Dr. Garcia. I was wondering what filler you believe looks best in the lips? Previously, I had always used cosmoplast, but want to switch to something else.I have tried Jevederm in my smile lines, but did like the way it worked. Can you recommend a couple fillers that work well in others parts of the face. thanks for you time.

Answer:

Prevelle for the lips, or Restylane. JG 9.20.10

Question:

Hello Dr. Garcia, I got restylane injected in my tear troughs on August 3... Its kind of uneven & a medium lump on the one side. Its not terrible but I`d like to fix it if possible. Is massage able to flatten/smooth it at all at this point? Heat? Any suggestions?

Answer:

at this point it might be more effective to get it dissolved with hyaluronidase. Best of luck. JG 9.16.10

Question:

Dr. Garcia...when botox is used as a lift , what exactly is it lifting. I seem confused; I thought it was strictly for the wrinkles that animate the face. I have no crows feet, no lines above the forehead, and a very slight furrow between the brows. I was told I could use botox to lift the area under the brows and the tails of the brows. Will I be wasting my money?

Answer:

it will lift the outer part of the eyebrow, not a waste of time. JG 9.16.10

Question:

hi Dr Garcia I would like to know what you think of `Thermage` for under the eyes. I could use some tightening for my under eye skin and to get rid of the fine lines. Also how long does it last? if you don`t agree with Thermage - what would you recommend for skin tightening under my eyes.

Answer:

I would sugggest you not do Thermage on the eyes or anywhere else, I find it at best non-effective and at worst a potential burn. I do not endorse it, had a machine and got rid of it as the vast majority of patients wee dissapointed with the results. JG 9.3.10

Question:

Hello Dr Garica, I posted several months ago when having problems following injections of Teosyal in an area in my upper cheek lower eyelid where I had previously had Dermalive surgically removed. The problem settled down after a month of steroids and antibiotics. However, three months on, whenever I have any form of treatment to my face, facials, massage etc, it causes the same area to swell up and get irritated. I don`t understand why this happens and it only goes down after several days of steroids and antihistamine. Does this mean I will have this problem for life? and is this a reaction of the Teosyal to the Dermalive residue?..... Thank you so much

Answer:

I cannot say, I doubt it will last for the remainder of your life, but until the product somehow breaks down, it likley will continue. Wish I had more to offer you. JG 9.3.10

Question:

Hi, In the last three months I have received 3 shots of Kenalog with Lidocaine (5mg. - 5mg. - 2.5 mg.) for the lump on my chin from overfill of ArteFill. The lump has gone down but now I have an indent. What options do I have now? Is there any other filler that I can get to fill in this indent, or hope possibly that it will fill in again? The area is also a little uneven. Is there possibly some kind of laser treatment that would even out this area and indent? Thanks for your help -- this is been ongoing for the last six months.

Answer:

it might fill in on its own, but it will take time, whatever remains after 6 months will likely be permanent. I think chasing it with new fillers now is just asking for trouble. I think fillers after 6 months are OK, and lasers will do absolutely nothing for it, sorry to hear about the issue. JG 9.1.10

Question:

Hi DR. Garcia, I always seem to get at least one large bruise that lasts 2-3 weeks when I have juviderm. I know not to take any blood thinners before hand - Is it also a good idea to not drink any alcohol the day before and after? The bruise usually takes 1 or 2 days to appear and I get them around my mouth and chin area.Any other advice-I`m getting frustrated-they can be as big as a quarter in size. Is maybe the dr.doing something wrong? thanks as always...

Answer:

I do not think the alcohol will make any difference if you have a healthy liver. Ice after might help, but it is an unavoidable risk whenever a needle is used with any product, sorry. Could consider taking Arnica pills for 3 days before and then continue after until the bruise resolves, we use it for such cases, sold at health food stores. Al the best. JG 8.30.10

Question:

How do you feel about Radiesse. Is it better than the other fillers? Thank youu

Answer:

for some things it might work better than others in certain areas, but it is not interchangeable with other fillers. JG 8.23.10

Question:

Thanks for the answer below about the HA`s. I`m sure that this varies from practice to practice and rep to rep, but on average, what do doctors pay wholesale per syringe of Juvederm and Restylane?

Answer:

sorry, I cannot say. JG 8.22.10

Question:

I know you use different fillers to correct different deficiencies. What are your preferred uses for Juvederm and Restylane, respectively? Since they are both HA`s, aren`t they fairly interchangeable? I ask because my surgeon seems to prefer one product over the other for different areas, and I`m still unclear about why. Thank you, Dr. Garcia. Hope you`re having a great weekend.

Answer:

I use Juvederm only for the lip area, otherwise I use Restylane for all of the areas where I like HA`s.Some surgeons use one product rather than another based soley on the price they get it for as the company that sells Juverm also sells breast implants and Botox and will offer those doctor`s a discount, a nice thing if the savings are passed on to the patients, but they usually are nto, and I also personally like to decide on what is the beter filler based on the filler characteristics and not on price. JG 8.22.10

Question:

Hi Dr Garcia. I have a question about restylane filling in the folds from my nose to my mouth. They are not very deep at all, and i`m wondering about the recovery time . When can i realistically think about being seen in public? Should i have less restylane put in so that the down time is minimilized? Thanks so very much for all your answers to questions. It`s very generous.

Answer:

should be out in a day or two. The downtime is for potential bruising and injecting less will likely not change that. All the best and thanks for the kind words. JG 8.19.10

Question:

HELLO DR. GARCIA.What are your thoughts on the platelet rich plasma skin regeneration therapy? thank you

Answer:

I think it is likely a huge waste of time, lots of hype with no science behind it, lots of hype and inuendo. Maybe if you spray it on skin that has had a deep chemical peel or deep laser it might heal a little faster, maybe. JG 8.17.10

Question:

Hi Dr. Garcia,I have horizontal fine lines above the middle of my upper lip. How do you treat those?

Answer:

difficult, fillers are the best option but do not last very long, 2-3 months. JG 8.17.10

Question:

Oops - just posted the restylane question and forgot to ask is it ok to resume exercise tomorrow? Thanks again!!

Answer:

OK to exercise, yes. JG 8.17.10

Question:

Hello, I got some restylane to the tear trough and cheek area today. It looks really good and I only have one very small bruise so I am not worried about that...but it feels very hard where she injected - is that normal and will it soften? Thank you.

Answer:

all normal and will soften up over the next few days. JG 8.17.10

Question:

Hello, I had precise injected into my upper cheek and tear trough area 4 months ago and the area is too full now. Will 5FU/Kenalog be effective at treating this overcorrection and breaking up the collagen/scar tissue that is forming around the PMMA, or is it too late for this? I know that Kenalog/5FU or excision are pretty much my only options here, and I`m hoping that the former will help. What do you think? Thank you

Answer:

I think the kenalog and 5FU might help but no way to say 100%. Worth a ry thoughy. Precise filler should NEVER be used in the tear trough area, the fact that it was shows the lack of understanding of what certain fillers can result in with improper site selection. JG 8.16.10

Question:

i want to have botox in between my brows. i have one droopy upper lid from graves disease (not too bad but a little droopy) and want to know whether botox injection in this area has a good chance of causing droopiness in the hands of good opthamalogist. I think he said 25 units(4 injections in the area) thanks--can i exercise the next day if i do it-yoga?

Answer:

the chances of the droop in experienced hands is very small. All activities are back to normal the next day, best of luck. JG 8.13.10

Question:

how do you feel about taking hyraulonic acid supplemennts?? im 39 and get laser resuracing every year and juvederm every 3 monts to keep nasolabials and marionete lines filled also use retin a and obagi

Answer:

expensive and will never get to your skin, no matter what the seller says that they have coated it with. JG 8.11.10

Question:

Hi Dr. G. What is the reason for waiting up to a week between radiesse/botox and IPL treatment. I have heard that IPL can dissolve the radiesse. And also something about needles/puncture sites. Thank you.

Answer:

there have been medical studies published that have shown no affect on the Radiesse with IPL, I suggest waiting the little bit of time to make sure there is no bruising that can make the IPL hurt more. JG 8.11.10

Question:

Hello, I am scheduled to get some restylane next week. She is a very experienced injector working under a very experienced plastic surgeon. In fact, she was featured in New Beauty magazines as one of the best in my state. However, after reading these posts and all the problems people have had, I am getting nervous. Do you know of any research/percentages of people that have had problems with restylane or weren`t satisfied? Thank you for your help.

Answer:

the percentages of problems with expereicned injectors is very small, best of luck to you. JG 8.11.10

Question:

hi dr. garcia, i had restylane injected in lips last year, and there is a blue little bubble on the bottom lip, right at the corner. what will happen if i poke at this like a blister, will i be able to draw it out? do you charge to have it taken out? thanks

Answer:

if it is filler it might be able to be squeezed out, but if it is a small vein it can bleed quite a bit. I think you should not try to do it yourslef and see a doctor that does injections, like myself, for an evaluation. All the best. JG 8.11.10

Question:

Hi Dr. I had sculptra for the 1st time in my cheeks recently. On day 2 I developed a rash along my cheekbones. Kind of looked like a windburn. Not sure if it was result of too much massage or the sculptra itself. Day 4 rash is healing and getting much better. What do you think caused the rash and should I be concerned? Should this prevent me from getting 2nd round of injections in 8 weeks? What is proper way to massage after Scultpra? Thanks.

Answer:

I would not be concerned, most likely it was just the massage is all. We ask our patients to massage very lightly using a facial cream, and the pressure is just like smoothing the cream out, no need for deep massage. I think it is OK to proceed with the next injection. Best of luck. JG 8.11.10

Question:

Hi Dr, How long should I wait after Botox and Radiesse to have an IPL? Thank you. You are a godsend!

Answer:

few days to a week should be enough. JG 8.11.10

Question:

Hello. I have had only great experience with the filler evolence thoug i heard that it was removed in The USA. And i wonder why?? Because they use it in Europe where i live. I have had Evolence in my lips twice, i hade it the second time because i wanted them to be larger, and im so happy because they are still there after over 3 years!! It looks also really nice as well. And people have commented that they are beautiful! I dont understand why they removed it? Can you explain why? Also i wonder, do you know if the filler dont get as good result when u are old since the filler binds with the body’s natural collagen to achieve more natural effects? Thank you very much. Best regards.

Answer:

it was removed for reasons not totally clear but there were frequent reports of granuloma and chronic infections. The older one is the faster any filler will go away I am afraid as the aging process breaks it down. JG 8.10.10

Question:

had restalyn under eye today--good job but one lump where it is bruised--is this a pocket of blood or a lump of restalyne or maybe both? if i massaged it 10 hrs post injection could i spread it out to look not so lumpy? really doesn`t seem like swelling--heat help?? thanks SO much!

Answer:

more likely just swelling from some blood that will get better with some time. Ice for the first 24 hours along with massage and then warm moist heat with continued soft massage will help. JG 8.3.10

Question:

i had restalyn under eye this a.m. and have a small dark purple bruise about 1/2 inch wide. do you think i can do light yoga today--if not when?? thanks so much

Answer:

I would wait at least until tomorrow or the day after. JG 8.3.10

Question:

Hi, I have read from other peoples posts asking about filler in the brow to lift it up and make the excess skin look not so noticible. Wouldn`t that make the eyebrow area look swollen and puffy looking and funny? Looks like it woul make it heavy looking. How does this help with the sagging skin on the eyelids or the brow dropping?

Answer:

if overdone yes, but in many cases with aging, the brow loses some fullness and replacing the fullness in an appropriate amount will fill it and lift the tissues that fell. It is filled more on the brow, over the bone than on the upper eyelid itself. JG 8.2.10

Question:

I have been reading a lot about facial exercising. There is one called CFF standing for Carolyns Facial Fitness program. It shows videos of her exercising the facial muscles for the neck and hooded eyelids and drooping eyebrows and even the cheek to give back fullness and lift it up. It doesn`t cost anything, so it isn`t like they are trying to sell anything. It has a dr`s opionion as to what he thinks, and he agrees that if done right, that it can help alot, and some people wouldn`t need to have fillers and facelifts. I know you are a plastic surgeon, but I wondered if you would give you honest input on facial exercising and if you think that you can build up the muscles in the face to help the skin on the face and if they are beneficial at all.

Answer:

well, since we know that facial exercises cause skin folding and as we age and lose certain elements in our skin, those folds from animation become more visible as wrinkles, I see no way that more motion in the face would make one look younger. In over 25 years of doing facial surgery on older patietns, I have never seen that their muscles are any smaller than in younger patietns, it is the other tissues that change, so in short, I am not a believer in facial muscle toning. Sorry. JG 8.2.10

Question:

Which is the better filler to replenish volume around the chin- perlane or sculptra?

Answer:

probably Sculptra. JG 8.1.10

Question:

My PS says that my own fat transfered to my face will be a permanent better solution for hollow area under my cheeks, nose to mouth lines, etc. than fillers. What do you think and if you prefer fillers, which do you recommend?

Answer:

I am not a believer in fat injections for permanent correction of all of that, if that were the case, then why did the fat dissolve in the first place. For the cheeks I use Sculptra and for the nasolabial folds I use Perlane. All the best. JG 7.31.10

Question:

I have some other questions. I have been reading about different procedures to put volume back in the face, and I came across this procedure called the young volumizer procedure for the face. A plastic surgeon in Washington invented this procedure and shows how it is done with the own persons fat and they are put to sleep and he injects the whole face with it even the upper eyes and the forehead. He said it is better than a facelift. Are you familiar with this procedure and what do you think of it? He also talks about facelifts and what he does that is different than most plastic surgeons. He said most don`t know how to do the facelifts correctly to achieve the results that are good. He talks about a deep plane facelift and how he works with the muscles underneath and separates the ligaments and how it takes a very skilled plastic surgeon to do this. This makes me wonder if I go to a plastic surgeon if I would get a good job. Can you please tell me what you think? His name is Dr. Philip Young. Could you please go to his website and check out some of his procedures and tell me what you think of some of the things he says. Makes it sound like he is one of the best in the world. Thanks!

Answer:

I think it is an unreliable and unpredictable procedure and if the face looks older because of fat loss it might help, but if the issue is loose skin it will not replace a facelift. As to deep plane facelifts, in our national plastic surgery meeting it has been shown over and over that the deep plane technique has longer healing and at one and five years, there is no differnce than other techniques. I am not saying he is not a good surgoen, but I can unequivically say that his reputation rests more in his mind than in the mind of others around the world.I think what is inflated is his impression of himself and not the patient`s face. JG 7.31.10

Question:

I am so angry and upset. I absolutely hate myself the way I look. Just a year ago, I looked pretty good. My face had some fillers and my face looked good. I turned 50 this April and now every day my face looks worse and worse. I just have perland injected for the tear trough area and the dr. put perlane also in the cheek are around the temples and some actually in the cheeks. It was done the first of June and already it seems to be gone. My eyes look more hollow now then when I went for the tear trough filler. Is it possible that I am aging that fast and that the fillers just wont help. I paid $2000.00 for the injections and now nothing. If I keep getting fillers are they just going to keep disappearing like this because I am aging that fast? If I had a facelift would that help any? Or would I still keep looking so hollow or sunken in around the underneath of my eyes? Is there anything that will stop collagen loss and fat loss in the face or slow it down? Is it possible to get too much filler in the cheek area and make the eyes look more hollow because they don`t have enough filler to bring them up even with the cheek to make it look full? Can you have too much filler in the cheek and make the face too heavy and pull down? Please help with these questions?

Answer:

I think I would have used a difffernt filler like Perlane for the cheek sand temple and Restylane for the tear trough. Facelifts do not replace loss fat, they do different things so that might not be the answer. It is hard to suggest things without seeing you and observing what is causing you to look different than you did before. Over inflation of the cheek can make the eye look deeper in some cases, yes. ALl the best. JG 7.31.10

Question:

Hi ~ This is a follow up Q. If neither Sculptra nor filler will help with sagging, jowliness, what will? Laser? If so, what kind. I am so confused by all the seeming options out there ... and yet none seems to work (according to your great advice - thank you!) as promised.

Answer:

a cheek or facelift are about the only options. JG 7.30.10

Question:

Hi, I turned 50 in April, and it is the most awful age to me yet. Everything seems to happen at this awful age. It seems over night things tend to fall and get saggy and dents appear. Every day I notice something different in my face that wasn`t there the day before. Is this normal? Does a womans face age that fast when she hits 50. I don`t smoke, I am not overweight, I take care of the skin on my face. I use retin A every night and never tan my face. My cheeks have lost volume and I have had fillers injected back the first of June, but since then it seems like every day there seems to be a new indention or sunk in place in my cheeks. Especiall one of them. Can you please inlighten me as to what is happening or what I can do? Please help! :(

Answer:

well, once things start to fall, they do seem to accelerate, its like a run in your nylon, once the elastic and collagen fibers begin to fail, they start progressing faster than before. Unfortunately it is controlled by genetics and now all that there is will be fillers, lasers, etc. Sorry. JG 7.29.10

Question:

Hi Dr., I had Sculptra injected in the eye trough 5 years ago ... and there are still hyperpigmentation in the undereye area. I have been using Neocutis, and it has helped in lightening the hyperpigmentation all over my face but the eye areas are resistant, partly because the discoloration was so dark. Would IPL help for the eye area? If not, what would? Also, what would you recommend for overall skin firmness, including the neck? Would any laser help? How about growth hormone? Thank you!

Answer:

I would start with IPL and then progress to a Q switched Nd:YAG from there. Best of luck. JG 7.29.10

Question:

I have some questions regarding the tear trough area and the cheek areas. I have had fillers injected under the eye last year with excellent results with evolence. This year when I went back, the dr. said they can no longer use this product. He used perlane instead and the results didn`t look as good and definitely haven`t lasted as long . I just got it the first of June and now most of it looks gone. The eyes look kinda hollow underneath them like they need plumping up and also the cheek are looks already like it is going down. On one side of my cheek I have a dip place that looks like it needs to be filled in or plumped up with something. Maybe the outter jaws or outter cheeks. What would you suggest to be the best filler. I read a lot about restalyne and also sculptra for the cheek area. What would you suggest. I really don`t want to keep going back as many times as it requires for the sculptra because it quite a distance for me to travel, and I wouldn`t be the one driving there. Thanks for your advice.

Answer:

I use Restylane for the orbital rim and Sculptra for everything below that. The Sculptra takes time to build up and a series of two injections is likely enough on the Sculptra for average fat loss. JG 7.29.10

Question:

Dr. Garcia, Could you please tell me what you think the best and lasting dermal filler is for the lines at the edge of the mouth that give that kind of downturned look where those lines age the face in a 58 yr. old? Thankyou for your recommendation.

Answer:

I might use Perlane for those, I think options such as Radiesse and Artefill are risky there as it is so close to the lips that lumps can occur. All the best. JG 7.28.10

Question:

I had sculptra last week in my face and temple area and it looks like a blood vessel bump on my eye lid formed within a day or so. Will that go down?

Answer:

yes, a little moist heat and a little massage along with time will allow it to go away. Best of luck. JG 7.28.10

Question:

Hello Dr.Garcia - What percentage of your patients are satisfied with the use of Sculptra to the face? I would like to try it and even discussed it with a p/s last March. He was really tempting me and saying that his distributor was offering a deal, buy 2 vials at $800 and get the third for free. At the time I was also scheduled for laser resurfacing. I had to cancel at the last minute and was charged a 20% fee from the whole amount. Think I had to pay about 859 bucks for that. Now - I want to go back and ask for the same Scrulptra deal considering I paid him for his time and my loss. have you ever had this happen? Where the patient had to cancel and pay? And do they return and do you offer any kind of discount in that situation? Beleive me, I would have never cancelled but I could not walk at the time. Your website and your expert advise is always my first stop before considering any procedure. I appreciate your advice vey much, you`re a great guy : ) Oh - one other thing, I beleive you do not recommend Sculptra as a filler for the hands? What would you recommend? My hands are ghastly and thats putting it mildly Thanks again

Answer:

the younger they are the more satisfaction there is with Sculptra as when one is older the Sculptra is not able to create as much collagen due to the advanced age and loss of reparative process. We have a process where surgery is canceled that is different from his. I understand the loss of time and the inablility to put another patient in your place but as long as you eventually have the procedure, I think most surgeons will not charge you a fee like that. As to the hands, I really do not ahve a good filler, lots of peopel use Scultpra but I have not been impressed with the results of any filler in the hands. Thanks for the kind words and I wish you the best. JG 7.27.10

Question:

Dr. Garcia, Thankyou for your wonderful site. I have a question. I have quite significant dents on the front of my upper legs,about halfway between my knees to my upper thighs, of which i have always been very self conscious of. It is scar tissue from when i was a very young child.My mother told me it was from when i was hospitilased, and had numerous injections there, because i was very ill. I can`t remember now exactly what was wrong, but i did have Diptheria, and also Pyloric Stenosis. She died in 1999, so i can no longer ask her about this. Do you think a permanent filler, (ie), Artefill, would be a good way to make my legs look more natural to fill the dents and give a smoother look? Thankyou for your response.

Answer:

Artefill can be used but more likely the better option would be injecting your own fat, it might take more than one session but as the dents are probably from fat loss, your own fat in that area would be a better option. All the best and thanks for the kind words. JG 7.26.10

Question:

i have a huge prominent blood vessel in an area in the tear trough that i am having injected with restalyn this week. the dr said he wants to inject under the vessel--does that sound possible. Also will icing constrict the vessel so it is less likely to bleed if it is poked

Answer:

yes. it is possible to do that.Icing will help a very small amount I am afraid. Best of luck. JG 7.26.10

Question:

Hi Dr. Garcia. Is it ok to put retin a/hydroquinone on face 6 hrs after botox injections in forehead?

Answer:

yes, OK to do. JG 7.24.10

Question:

Hi Yesterday I had Sculpta on my face. On previous occassions my face was very swollen but not this time. My concern is that I did not receive enough product as my face is almost the same as before the procedure. Many thanks as always Ruth

Answer:

the swelling the next day is more due to the amount of fluid that the Scultprsa is dissolved in and not the maount of Sculptra itself, so you might just have had less fluid injected. JG 7.24.10

Question:

I go to a highly reputable PS and they open the Restylane right infront of me so I know that the product is infact restylane, plus I`ve requested my forms just to make sure. Anyway... I had 2 vials of restylane done under my eyes 1.5 years ago, and I kid you not just about all of it is still there. I can see it in my tearthrough and in my upper cheekbones where it was placed. I don`t mind it, but honestly I kind of want to go back to the way I looked before. I`m 32 but look many years younger than my age. Most people think I`m about 21-22. Do you think it could be lasting longer with me due to my physiological makeup?

Answer:

The dissolving of fillers varies from patient to patient and I have many patients that have fillers like Restylane injected and it lasts much longer, especially in areas where there is not alot of motion such as the areas you had treated.Not a bad thing. JG 7.24.10

Question:

Hi Dr. Garcia. I have a question regarding juvederm in the lips. I had 1/2 of syringe put in part of my upper lip to even the lip out. For a few hours after I left the dr`s office I really liked the results. I then had severe swelling in and above the lip. It has now been two weeks and while the swelling above the lip has gone down the lips are still too puffy and big. Do you believe that if I wait longer the lips will eventually go back to how it looked when I left the dr`s office or after two weeks is this final result? Luv your site...thanks so much!

Answer:

yes, they will go down but it will take time I am afraid, maybe a few more weeks. Go to hang in there for a bit, thanks for the kind words and all the best. JG 7.22.10

Question:

hi, ive just had some hyalaise in the front and tip part of my nose to dissolve juvederm which has stayed almost a year after i had it in. the hyalaise was injected 3 times in 3 areas and alot was injected. however the next day i dont see any difference i till have the same lot of undesired volume on my nose, it just looks like nothing has changed. what else can i do? i thought it would have gone with the hyalaise but it seems ive waisted my time and money again.

Answer:

I would have thought the Juvederm should have dissolved away on its own by now, and if thehyaluronidase did not work, it might be because the fullness you now have is due to scar tissue and not any residual filler. JG 7.22.10

Question:

Thank you for your answer. So does IPL help lessen hyperpigmentation? Your response said it helps with red spots ... does red spots refer to rosacea? Thank you for your patience!

Answer:

yes, works well for Rosacea, but it needs a series and then continued sessions to control it. JG 7.20.10

Question:

Hi Dr. G., What does IPL do beside help with hyperpigmentation? And is fotofacial another name for IPL? Sorry - I am sure you have answered these Qs before but I am confused by what`s out there, the claims, the different names by different manufacturers. Thank you for sharing your time and expertise. You are wonderful and unique.

Answer:

help red spots and helps to shrink pores short term. Fotofacial, Photofacial and IPL are all the same. Different companies make the similar machines and use different names, they are all intense pulsed light, thereby the name IPL. JG 7.20.10

Question:

I know this is not your area so please forgive me for asking more than you`re already giving. I have not been able to find any information on this matter anywhere, and my own doctor is unable to help. I get frequent cramps in my feet ever since I had surgery for bunions, and I was wondering if there is any supplement I can take that would help lessen the frequency/intensity. Thank you for your generosity.

Answer:

you can try potassium and magnesium, maybe 1000mg of the magnesium per day and potassium 99mg as potassium gluconate per day. JG 7.16.10

Question:

Hi Dr. G, What do you think of Sculptra for the hands? I don`t have age spots and my hands are not too veiny but noticing the skin is getting thin. Thank you!

Answer:

can be done, not as robust of a filler as it is on the face though. JG 7.16.10

Question:

i am having restalyne in tear troughs next week-want to avoid bruising. Do you recommend arnica and bromelain and if so do i start them before or after? Should i ice before injection or is it true that if you hit a blood vessel icing before won`t do anything? thanks so much

Answer:

I do recommend them, start at least 48 hours before and avoid all blood thinning products like aspirin, Motrin, Ibuprofen, Alleve for ten days before. I think icing before the injection helps with the discomfort but not with the bruise prevention. All the best. JG 7.16.10

Question:

what do you think of hirudoid cream for bruising??thanks so much

Answer:

might work to some degree. JG 7.16.10

Question:

Hello Dr, I once had fat transfer to the upper eyelids to give a more plump effect and really liked the results. Obviously it does not last long so I am wondering if there is a filler that will give the same effect? Thank you

Answer:

Restylane or Perlane could be used there also. JG 7.7.10

Question:

Hi Dr, What is the treatment for an allergic reaction to a HA filler and would hylauronidaise to dissolve the product stop the swelling/itchy symptoms? Thank you

Answer:

dissolving might help, the allergic raction is very very rare and would include, a surrounding rash, itching, diffuse swellin past the are of injection and if it is sever enough there will be itching and swelling far away form the injection site. JG 7.4.10

Question:

Hi Dr. Garcia, my question is...will botox really lift the eyebrow area. I am 47 years old have no horisontal lines on my forehead, and no 11 between the brows. I do notice very slight horizontal lines in the upper nose area, probably from pulling the eyebrows down in the sun. Would botox work to create a very subtle lift of the brow, or would I just be wasting my money?

Answer:

it will lift the outer part of the eye brow in most patients, the amount of lift varies though. The lift between the eyebrows is less but will work too. Best of luck. JG 7.3.10

Question:

Hello Dr Garcia, I am still battling with the ongoing problem of swelling on one side of my cheek from Teosyal injections 4 weeks ago. I saw a dermatlogist as I am travelling and he prescribed antibiotics and 40mg of Prednisolone for a week. The problem is some days it just a small area which is red and inflamed and some days I wake up and my whole cheek is entirely hard and swollen and hot then settles down the next day. How can I know if this is a cyst or an allergic reaction?. There is one small area in particular that has started to sting. Do you think I should have hylaurondise to dissolve the Teosyal or have an intralesional injection? Thank you so much

Answer:

an allergic reaction is uncommon to get better and worse like that from day to day, and a cyst would nto go up on down. It is an unusual thing to say the least. Might want to try avoid sleeping on that side of your face to begin with, and I would certainly tak ethe pills prescribed just in case. Without a discrete mass in one single area that does not go up and down I do not think intralesional steroids or hyaluronidase will work. You might want to contact the company that makes Teosyl and they might have something else to offer. All the best. JG 7.2.10

Question:

Hi; I have asked a MD if he could remove a lump caused by a collagen filler evolence. He stated he would not want to remove it since he has never performed this. He is a plastic surgeon. What does the results of removal typically look like if it is removed from the skin under the eye? Have your results shown much success or does it leave large scars after the removal? I know that you have said it could not be dissolved. Thanks for the answers as you are helpful to all.

Answer:

there will be a scar where the incision is made, it is no different than removing a cyst or other mass below the surface of the skin, he likely does not want to get involved with something that went bad. The scar should be relatively small, no longer than the size of the lump. Best of luck. JG 6.30.10

Question:

Hi, sorry to bother you again. You said an injection of Kenalog could last up to 6 weeks or even 6 months. Even a small dosage of Kenalog-10 (like 5 mg) mixed with lidocaine into an ArteFill lump? Does this mean that I should wait until six weeks before I get another shot if I don`t see any results? Should I also get the same dosage?

Answer:

if it is going to work you will start to see that within 6 weeks and that is the point a repeat injection could be done, in terms of negative effects like soft tissue atrophy or loss,and dilated skin blood vessels and skin thinning, that can continue for up to 6 months. JG 6.30.10

Question:

What is your opinion on the Selphyl System? Is it just as good as the other fillers out on the market and does it last reasonably as long as the others do?

Answer:

it will nto last as long as the other fillers out there, sorry. JG 6.28.10

Question:

hello again, my name is samantha and i just posted a question regarding advice about my nose, and the unwanted filler. you replied: i need to know what filler so i can help you . I beleive the filler was juvederm as i remember, and it is suposed to be only temporary as i was told.

Answer:

if it was Juvederm, it shoudl all dissolve in about one year on its own in that area, you can always have more dissolved though with the hyaluronidase too. Best of luck. JG 6.28.10

Question:

Hi Dr, You kindly answered by question a few weeks ago, I had swelling on one side ten days following Teosyal injections in the cheeks which took the form of a grape almost like an abscess in the upper cheek, lower eye region. Thanks to the antibiotics and hot/cold packs as you suggested, this has now reduced in size. However there is still a small lump under the skin which is noticeable as well as a permanent pigmentation colour around that area. Whenever I massage this - even lightly, it swells up immediately and the skin around it turns red/bluish looking. It takes several hours to return back to normal. Could this be a small cyst under the skin. It is now 4 weeks since the injections so would have thought it would settle by now .. Thank you

Answer:

yes, could be a small cyst, might need to be drained with a needle by the doctor, all the best. JG 6.28.10

Question:

Hi Dr Garcia, Thank you for the previous answers regarding my botox questions. Can you tell me how long after a botox injection (Glabella) should you not lift anything heavy? And is it important not to bend your head or put your head down. Thanks again.

Answer:

I let patients return to full activity the next day. I have them avoid putting their head down and most importantly not lay face down for 4 hours. Best of luck. JG 6.28.10

Question:

hello, i need advice regarding my nose. a year ago i had a filler injected to my nose as i had some indentations (although not very serious) these were due to after effects from rhinoplasty. well too much filler was placed in and gave me a rather bullbous parrot looking tip. ive been 3 wks ago to have it dissolved with the enzyme called hyalaise. but it still looks the same and i still feel the volume from the filler in my nose. doctor said he only put a bit in buit doesnt seem to have had an effect. is it difficult to dissolve a filler in this particular area? and there any risks of scar tissue formation? also the needle was agony it really hurt me. the doctor also said that you cant put a needle deep in the nose as there is ony cartlige and bone there, so iam assuming that this filler i have in my nose must have been placed in superficially is that correct? iam eager to get rid of this as its been a year and i cant beleive its still there, i just want my tip back to how it was before but iam so worried that iam going to be stuck like this. any advice would be most appreciated. regards, samantha.

Answer:

I would need to know what filler was injected in order to help you. JG 6.28.10

Question:

Hi, Regarding ArteFill lump for the question below -- the Kenalog injection, forgot to mention that I had 5mg.

Answer:

will likely not help. JG 6.27.10

Question:

Hello, Can you tell me what you which filler you would recommend for cheek augmentation? I just want more defined cheek bones - not dealing with any sort of fat loss etc. Thanks!

Answer:

I normally use Sculptra. JG 6.27.10

Question:

Hi, I had an injection of Kenalog-10 mixed with lidocaine a couple of days ago into lump from ArteFill overfill. How long does Kenalog stay in one`s system and when can I expect to start seeing some results, if any? This was a very low dose and understand that I may need another.

Answer:

maybe 6 weeks but effects can last 6 months. If it is going to work you should see something in 6 weeks. JG 6.27.10

Question:

Hi Dr Garcia, Can you tell me if it is ok to have a botox injection if you have heart arrythymias and take medication for it? I just read that you should not get a botox injection if you have cardiovascular disease. I have a botox appointment scheduled on Tuesday for the Glabella. I think they are injecting 24 units. I had a previous botox injection two years ago before the heart issues started. At that time I had two side effects from the botox. One was my eyes were extremely dry and i felt extremely tired. It lasted a couple of weeks then went away. The second was about 3 months after the injection by right eyebrow would arch up and move on its own. I would have to massage it to get to go back down. Have you heard of this happening before? The place I have the botox scheduled said they never heard of that happening before. Also can you tell me the time period that you cannot lift anything or put your head down after the botox injection. Thank you

Answer:

should not affect your heart. The issues you describe from the previous injections are due to location of the injection, and not the medication per se. The feeling tired occurs from the brows dropping in some cases and the one brow arching more is because as the motor end plates that were affected by the Botox are slowly replaced the replacement rates are not always even side to side. Usually it is a subtle difference but in some people, if the effect from the Botox was more profound, it can be more evident as it wears off. Best of luck. JG 6.25.10

Question:

I had my third round of Sculptra (over the course of 4 months) injected into my hands on June 3. I have massaged as instructed each time. A week ago, 8 or 9 lumps appeared in both hands. I understand that it may be possible to break them up with saline, but if that`s not successful, they are permanent, right? They don`t dissolved on their own over time? I am seeing my doctor next Wednesday. Is that too long to wait, or should I try to see him sooner? Unfortunately, it`s now Friday afternoon, so it`s unlikely that I could get an appointment even if you advised one. Thank you for your advice, Dr. Garcia.

Answer:

if the saline does not work they can dissolve on their own in some cases, but if a true granuloma has formed, then they might need to be cut out, yes. Waiting a few days for the saline injections is oK but the sooner they are injected the greater the chance of them dissolving with the saline. JG 6.25.10

Question:

Hi Dr. Garcia, I recently had juvaderm injected into my cheek area. I also need to get a vbeam laser treatment done to reduce redness in the same area. Will the vbeam laser affect the juvaderm in any way and/or will it cause the juvaderm to diminish. Also, should I wait a certain amount of time after having the juvaderm injected to have the vbeam treatment. Thanks so much for your help and advice.

Answer:

shoul be Ok ot do the laser 3 days after the injection, minimal to no effect on the filler. JG 6.25.10

Question:

i have a strip of juviderm from the side of my eye to under my eye left from last january. i have been waiting for it to go down as i have a big vein in part of the overfilled area and STILL have discoloration(hemisiderin or discoloration) not sure. I used the enzyme in April--strip 2 inches by 1/2 inch still there. Should i dissolve again--think it won`t go away if i don`t but trying to avoid another bruise. just hoping for your best shot re an answer thanks

Answer:

I think if it is still there your only option is to try to dissolve it once more, all the best. JG 6.24.10

Question:

I have been looking for a Dr who does fillers (restylane) for the under the eye area, I have seen 3 so far, and all three tell me the same; that fillers in that area do not work well due to the skin being so thin, and that the filler can be seen through it, sometimes forming little bags. Is this correct? In your opinion can this procedure been done with good results? since it seems that injections can no go deep in that area. Best regards Paco

Answer:

it varies, we have been using it there for a few years and in general the results are quite good, but it takes a lot of experience and the learning curve is steep. JG 6.22.10

Question:

hello, thankyou for your reply about the perlane and discoloration problem. you said that the colour can result from bleeding when hitting a blood vessel causing the purple greenish colour, do you mean that it is permenant thing when this occurs? its just its been more than 6 wks and i was pretty sure it wasnt bruising. it does seem less after the hyauloronidase shot. iam quite fair skinned too. i live in south australia, and the doctor iam going to for the new fillers is offering resty sub Q and juvederm range, ultra and voluma etc. iam told injecting deep under the muscle or along on top of the bone is the best result as filler will not leave discoloration effects. but i wasnt aware that it will not last very long, how do you inject these fillers or how deep is your teqnique required for good results? regards sarah.

Answer:

no, it is just a bruise that is slowly breaking down and being absorbed, should not be permanent. A deeper injection might leave a less visible bruise, but if it is large enough, you will eventually see it too. The depth the filler is injected depends on what you are injecting and for what you are injecting for. I rarely feel that injecting on the bone is needed or yields a good result. It is best to inject in the same layer as the material you are trying to replace. Best of luck. JG 6.22.10

Question:

hi doctor garcia. i had perlane for cheek augmentation with dissapointing results, i had purple /green patches showing through becouse it was put in too near the skin surface, ive since had it dissolved with hyauloronidase, it has gone down alot but i still can a slight tinge of discoloration as their may still be a bit left in there. now iam going for juvederm and want it done under the muscle this time so it wont be visible. however iam not sure whether i should have a last shot of the hyauloronidase to completley dissolve the perlane. if i have new filler done now under the muscle will it make the slight bit of colouring that i have left from perlane any worse or better? or effect the result? should i make sure all the perlane is out first before proceding with the new filler? thankyou, sarah.

Answer:

It is always a good idea to let all the material be gone beofre starting over to have a clean slate to build upon. Having said that, I think the green and purple patches were from bleeding and not the material being injected too superficially.Bleeding is a risk with all fillers, even if injected deeper as the needle still has to go through the skin and can injure a blod vessel and cause it. I fear that injecting Juvederm deepely, where it is not meant to be injected, will last a very short period of time. Best of luck. JG 6.21.10

Question:

Hello again Doctor, You very kindly answered my question a short while ago about my Teosyal problem. You have eased my mind a lot and will contact my doc on my return if the problem has not settled. I hope you dont mind if I ask just one more question, the area which is swelling the most, is an area where I had Dermalive once surgically removed. I believed most of this had been taken away. Could the swelling be a reaction of the Teosyal to possible remnants of the Dermalive, or just the possible infection/blood culmination you suggested. Thank you so much. I am away from home and this is such a help.

Answer:

doubtful there is any relation to the old Dermalive or interaction to the Teosyl, just due to the removal there is more scar tissue there and scar tissue bleeds more easily than normal non-scarred tissue. Hang in there for a bit, it will get better. JG 6.10.10

Question:

Hi Dr, I had Teosyal injected into the cheek area about ten days ago. On the right side of my face everything is fine and the swelling has gone, however on the left hand side, there is significant swelling still and there is one area in particular which is the size of a grape and feels hot and sore to touch and seems to be getting bigger. Could this be an infection? I am currently travelling so unable to see the doc who injected me. FortunatelyI had some Co-amoxiclav antibiotics and anti-inflammatory tablets with me which I have just started to take to be on the safe side. I would really appreciate your advice doctor. Thank you

Answer:

could be an infection but more likely it is some blood from the injection that is deep and your body is trying to break it down. I think the antibiotics and anti-inflammatories are fine, along with alternating warm and cold packs too. Best of luck. JG 6.10.10

Question:

It`s me once again. When you say it depends on the amount injected at the site, does that mean that I have paid a certain amount, but maybe the amount injected was less? I usually pay for a syring and it is distributed amongst my forehead several places and above my eyes and between my eyes until it is all gone. This dr. stuck me five times. Four times straight across my forehead all in a row and once between the eyes. How come sometimes I get stuck more places and it works better? Shouldn`t they use all of the syringe if you are paying for it? The reason I know that it matters if you frown or not is because it lets the dr. see where you are having the problems and lets him know where to inject the botox. Last year the dr. said the dr. before had focused more on the inner part of the eyes and between the eyes and not injected it out to the outter parts of the forehead and the eyes. Therefore it still let me raise the outter part of the eyebrows, but not the inner parts. After he injected it differently to correct it, it worked fine and it stopped letting me raise the outter part of the eyebrow, which was causing another wrinkle to form. This dr. this time did not do that and did not inject it in the right places to let it not do that.

Answer:

I cannot say without knowing the amount of units that were injected, typically for the glabella where the lines that form an 11 are, it takes at least 20 units, I use 30 units there. The number of needle sticks is immaterial because it depends on what amount is injected. The end results depend on where it is injected and the dose injected.JG 6.10.10

Question:

Tindall vs.bruise again under eye.. day 2 still very black right at the inner corner of the eye and slants down diagonally about 3/4 inch. what should i do, im taking arnica and dissolving in my mouth.. should i go out and buy vitamin k topical? anything else i can do? isnt it true that tindall effect doesnt show up immediatleey after the injection, as this bruise appeared immediatley.. thank yu

Answer:

warm moist heat, can also apply Arnica gel topically, it is too late for the Vitamin K, that helps the bruise from happening, but it already has. I think you have a bruise and not a Tindall effect. Hang in there. JG 6.10.10

Question:

Thanks for your input. But, why would you never use perlane for the tear trough area? What will it do that you don`t like? And back to the botox. If you frown and they can see the frown lines and where they are and how bad or deep they are they place the injections at different places. You can even make the eyebrowns look lifted depending where the injection is. And some dr focur more aroung the inner part of the forehead and not out towards the edge which allows the inner part not move but the outter eyelids will raise and it creates another crease on the outside obove the outter eyelid. I have had that happen and had another dr. who knew where to place the botox injections to where it would stop letting the outside part of the eyebrow to raise up and actually made the eyelid look lifted and when you go up near the top it wont let you lift it at all causing the crikle at the tip top. Also if you inject it right between the eyes it will correct the eleven lines. This dr. did not and it still lets me frown and still causes it. I have had enough of these injections to definitely know it does matter and been told by several d`s. that it matters and they have proved it to me.

Answer:

because Pearlane is meant for a deeper injection and the skin in the tear trough is too thin and Perlane might leave lumps. I agree that Botox can lift he brows but the injection site does not vary, I know thati s what you believe and what you have seen but as a plastic surgeon that has seen the actual muslces that are injected thousands of times during surgery and in view that the Botox migrates after injection as it disperses, there is no need to frown. You are free to believe what you want, but it is not needed. If you understand the function of Botox, you woudl understand that injecting the muslces that depress the brow and leave the muscles that elevate the brow unjected, it is common and expected that the area not injected will rise and will also show wrinkles where the unopposed muscle is continuing to work. Where the Dr focuses depends on what is being attemtpted to be acheived. Whether the injection works depends not only on location but on the dose of medicine injected. If the correct place is injectd with too low of a dose, it will not work and I think that is likely what happened in your case. 6.10.10

Question:

It`s me again. You still didn`t answer my question. What do you suggest is the best filler for the tear trough area and the nasal labial fold area. And yes, I am going to disagree with you saying I might not be a good candidate for fillers. I have had success with the juvaderm and the radiesse and the evolence for the tear trough areas. It was just last Saturday that I really wasnt satisfied with the perlane and where he gave the injections of botox. I have been getting botox for over 10 years and I have never been injected like this dr. did. I do think it matters when you frown for the dr. The dr. has told me that before.

Answer:

you are certainly free to hold your opinion but I respectfully disagree as to the Botox and needing to frown. As it is a chemodernervation agent and not a filler, the location of the wrinkle is absolutely inconsequential, as the muscles are in the same place in all patients and the Botox has to diffuse. For fillers I agree it is nice to see the wrinkle to see where you need to inject. As to the tear trough, the only filler I use is Restylane. As to the nasolabil fold I use Restylane and on rare occasiosn Perlane. I would never use Perlane for the tear trough. All the best. JG 6.9.10

Question:

I am so, so upset and disappointed. I have really bad nasal labial folds and have been getting injections for about three years for them. At first I had Cemetra, which at first for a day really looked good and then by the next day they were back again. I had it again and still the same thing. Finally the dr. I was going to said that Juvaderm was really good for that area and was new at the time and he injected me with that and it made a big improvement. I have been getting it ever since. Last year in May I think was when I had the last touchup for the juvaderm which I think he overfilled it or where mine go up all the way to the sides of my nose, I think he got too much there and made it look puffy and almost worse in that area. I went to another dr. and he injected my cheeks with Radiesse and the tear trough area with evolence which both worked really well. It didn`t last as long as he said it would, so last Saturday I went back to him for more filler in the tear trough area and more filler in the cheeks. This time he said that they had pulled evolence from being used even though he still liked it better. He said perlane was good for the tear trough area and he didn`t want to use Radiesse in the cheek area because he said he could still see I had some and he though I needed it more in the temple area and futher over in the cheek area more towards my ears. I injected a little in the nasal labial area but I cant even tell it. I am not satisfied with any of what he did. He also injected my forehead area with Botox, but did it very fast all the way across my forehead in a row and once between my eyes. He didn`t even have me raise my forehead or frown like all the other dr`s. have in the past. It lets me raise on eye but not the other one and at the top of my forehead right at the hairline, it lets it raise and caused a crinkle to be there and looks funny. My question to you is, how do I go and get the nasal labial folds injected and know that it is the best stuff and be satisfied and also with the botox? How can I be sure that the dr. is doing the best job. This dr. is suppose to be the best in the state where I live, but he didn`t seem to take very much time with the botox and the filler he used looks like there is more on one side than the other. On one of my eyes it still looks hollow and looks like it needs more filler and the other looks better but not like last year when he used evolence. What filler do you suggest to be the best for the tear trough area and how to inject it and what is best for the nasal labial fold area? Can my problem be corrected and should I go to another dr. or go back to him and let him know I am not satisfied with his work?

Answer:

I do not think it is necessary to flex the muscles to know where to inject the Botox. As to what effect the Botox is having in terms of where it was injected, you got exactly what is expected, the inability to raise the eyebrows as the forehead muscles have been weakened. Having said that, not all patients are good candidates for fillers, they do not give everyone the desired look and you might just not be a good candidate for fillers I am afraid. It seems you have tried multiple fillers and multiple doctors to no avail, might need to accept things as they are and await until things get bad enough to warrant surgery. JG 6.9.10

Question:

i had eye done for hollowness w/ juvederm yesterday.... major bruise under eye.... using arnica .. what is difference btwn tindall effect and just bruise???

Answer:

Tindall is blue and will not fade whereas the bruise will turn green yellow and fade over time. JG 6.9.10

Question:

So then would a an actual implant in the pyriform apeture have less potentially serious side effects than the Voluma? I know the chance of the necrosis is low but from what I`ve read injections in the subdermal plane in the superior nasal labial folds is one of the most dangerous areas on the face to inject due to the angular artery and it`s branches. I`m not seeing any side effects like this listed for the implant and it`s permanent.

Answer:

I think so, yes, the implant would not have that risk, but it would have other risks. I know you have read about necrosis and the angular artery but it is almost unheard of when comapred to the many injections with no problems. Bad occurances get magnified because people like to hear and write about disasters, normal outcomes do not get reported on as much. JG 6.9.10

Question:

Whoops and I forgot to say the chances of this with a good injector with good understanding of the anatomy.

Answer:

less of a risk, but I think in general, the risks are small, even in inexperienced hands. When you compare the number of injections performed versus the reported adverse events, the numbers are incredibly small. JG 6.8.10

Question:

Interesting, So in your estimation, what percent chance would there be of necrosis if one were to have 1-1.5 CC of Voluma subcutaneosly in the pyriform aperture?

Answer:

I am sorry, btu there is no way to tell because it depends over what size area and vertical height it is injected, you are asking for an answer that is impossible to calcualte. JG 6.8.10

Question:

Sorry to keep bothering you. Regarding ArteFill lump, what would be a safe dosage of Kenalog/5FU to inject without hopefully causing atrophy? And, if I did do this, how many weeks should I space them apart? Thank you.

Answer:

there is no such thing as a safe dose I am afraid, atrophy can happen at any dose, but the risks increases the greater the amount of kenalog injected. If there is going to be Kenalog in it, it should not be done more than every 6 weeks, if it is 5FU alone, it can likely be re-injected every two weeks. JG 6.7.10

Question:

It`s me again. I am the one asking about putting in fillers in the face instead of having a facelift. You said I might could avoid the surgery, or opt for a lighter or smaller surgery. What kind of smaller surgery than a facelift were you talking about for loose skin due to fat and collagen loss. And why cant you just have fillers put back in until the loose skin inst loose anymore?

Answer:

impossible to tell what smaller procedure you would need until the filler has been injected and we see what effect and where it has made a difference. It might just be a smaller type of facelift with less lifting and less skin excised. Injecting fillers when not needed can make you face look distorted and unnatural, more is not always better though. JG 6.6.10

Question:

Thank you. I was not aware that the angular artery lies in the sub q. This concerns me because I have an apt this week to have 4 cc`s of Voluma (2 cc`s in each side) injected in bulk fashion subcutaneously in the pyriform aperture to give contour back to the area due to a loss of fat directly in the area. I understand that Necrosis can be caused by occlusion or compression of the artery, and to me it seems viscious filler injected in bulk fashion into the same layer seems like I could be asking for trouble. Is this a real concern? If so it is simply not worth the risk to me. My injector is very experienced and extremely reputable. are there any injecting techniques that will eliminate the risk? Like injecting below the subq onto the bone to simulate an implant? Last question on this. God bless.

Answer:

it is technically possible for it to happen, but the skin stretches quite a bit so it would be hard to get it to happen. I think that is quite a bit to have injected, why not start with 2 cc and then wait a wek or two before getting more. All the best. JG 6.6.10

Question:

My question is concerning volume loss or fat loss in the face. I am 50 years old and seem to have a lot of volume loss due to the loss of collagen and fat. Now I have excess skin the plastic surgeon tells me due to the volume loss. If he injects my face with liquid fillers to put back the volume, will I still need a facelift for the excess skin. If you have excess due to the loss of collagen and fat, cant you just put it back wih some sculptra or juvaderm or radiesse or pearlene or something to fill back up the space.If he just does a face lift and doesnt put back the loss of volume due to collagen and fat, then wouldn`t the skin just be pulled tight and I know the muscles are tightenend back up, although I don`t know what makes the muscles get lose.The dr says the only reason you have nasal labial folds are because the skin lost fat and collagen and starts to sag so if you fill it all the way back up with filler, then you wouldnt need the facelift anymore, would you? Please explain this to me.He also said I had weak eye muscles under the bottom part of my eye. What did he mean by this?

Answer:

you might be able to either avoid the facial surgery entirely or opt for a smaller procedure. All the best. JG 6.6.10

Question:

Would the physician aspirating the syringe completely eliminate the risk of necrosis with filler injections?

Answer:

nope. JG 6.6.10

Question:

Hi dr garcia. i live in dubai Uae, and iam interested in restylane for under eye area. iam going to appointment/consultation with a doctor Ashok govila, who i beleive is an indian plastic surgeon in dubai. was recomended to me, but actually iam concerned after visiting his website: plasticsurgeonashok.com i clicked on the procedures then fillers, and i saw the before and after pictures from his practice, there is three or four pics of a lady who has had restylane under the eyes, and i was suprised at how awful it looked, it seems worse than the before pictures purple and the skin texture looked poor. i wounder is that how its supposed to look? i would appreciate if you could check out the pics on the website i wrote for you and give me your opinion, is that how your patients would look with under eye filler? i cant beleive they would post such awful pictures, the other pics of other facial corrections look fine. obviously this is putting me off now from having it done.

Answer:

seems that he uses the same picture a number of times and I agree, they are not the greatest. You can consider finding someone else, or at least have him do it in small amounts over a series of treatments. Best of luck. JG 6.5.10

Question:

Sorry, me again, asking about the necrosis. I`m using Voluma in the folds because I actually lost fat in the area due to rapid weight loss.. it`s not a skin thing, all lost fat. Is there more of a chance of necrosis with the Voluma? The doctor said he was going to inject onto the bone like an implant. Is this depth safe? The thing that concerned me about the necrosis was that on the online thing I read it said a lot of filler in one area can cause it and I need a lot in this area.

Answer:

again, there is no increase risk of necrosis with Voluma than other fillers, and it likely needs ot be injected into the check to correct fat loss allowing the nasolabial fold to be more visible, and not directly into the nasolabial fold so the risk of necrosis shoudl be essentially nonexistent. Best of luck. JG 6.4.10

Question:

would u recommend juvederm voluma for a 28year old? i have slight loss of volume is which i use restylne and it looks good. i used the juverderm before and i looked unnatural; too thick for the little fat loss i havei think...what do u think? how about sub-q? looking for something that will look good and last longer but not bad...

Answer:

depends on what you are having injected, hard to believe a 28 yo has volume loss though unless you lost a large amount of weight. Unnatural appearance from a filler is likely more due to injection technique than the filler. JG 6.4.10

Question:

Dr. Garcia, What do you think of Radiesse as an option for a longer lasting facial filler? I have only ever had Restylene and Botox. Thankyou for your answer.

Answer:

in some areas, it might be warranted, but it does not have the versatility that Restylane has and Botox is not a filler, but a neurotoxin so its effects on wrinkles are secondary and not primary. JG 6.3.10

Question:

Thank you for your response. Will the fluid ever go away? Is there anything I can do? I am worried that this might develop into an infection.

Answer:

in most cases it should be gone on 6 weeks, rare for it to last longer than that unless something is causing it to reaccumulate, like a tearing of the tissues. JG 6.3.10

Question:

Hi, Regarding the ArteFill lump I have on my chin area -- everytime I press on it, it makes a squeaky noise. Is this normal? Is the noise coming from the PMMA or could it be still collagen? How long does collagen take to dissipate? Someone told me it could take up to six months.

Answer:

the noise if from fluid around it. Solid materal like collagen or PMMA do not make noises. JG 6.3.10

Question:

Dr. Garcia, Thankyou for answering my question about injecting filler into the eyebrow region. Is it normally a hyaluronic acid filler from what i read, as i would be interested in this procedure. Your site is great, and wish i lived closer to where it would be easier for me to have a consult with you. I would be very confident of your expertise. You must be a wonderful Dr. to do this here for so many, as i`m sure you are a very busy practitioner.

Answer:

yes, most commonly it is a hyaluronic acid product. Thank you for the very kind words, and I am glad I have helped. JG 6.3.10

Question:

hello doctor garcia, i have a question regarding facial fillers. iam going to have fillers done on my cheeks. i had a consultation last week with a doctor and we discussed the filler. he sai he would do perlane but would not go over the bone and that it would go medium depth to superficial and would give a nice result.ive read online that fillers are injected deep over the bone to give a natural look avoiding tyndall effects which occur when fillers are not placed deep enough. iam thinking twice about going to this doc incase i get the wrong result. how should cheek augmentation (upper)be performed? and what about under eyes how deep should filler go in this area? kind regards, sandra. Devon(UK)

Answer:

I would use Sculptra for cheek augmetnation, and I inject deeply with that, at the deep surface of the skin. The Tyndall effect is when it is really superficial, and there is usually enough tissue on the cheek to avoid that. As to the under the eyes, I use Restylane there and I inject under the muscle. Could use Voluma for the cheeks in the UK.All the best. JG 6.2.10

Question:

Dr. Garcia. I read recently where similar results to a blepheraplasty can be obtained by injecting filler into the eyebrow, have you heard of this?

Answer:

I think the result of fillers in the brow can lift the brow and therefore make the eyelid look like it has less excess skin, especially in patients that have the skin in excess due to fat atrophy from aging in the periorbital area. I have heard of it, seen it, and performed it. JG 6.1.10

Question:

Hi Dr. Garcia. I had a small amount of resty put in the tear trough on one eye about 4 weeks ago. It swelled up and bruised quite a bit. But, now at 4 weeks, I find there is still a small amount of bruising and swelling just below where the filler was injected. Is that normal, and how long should it take for all the swelling and bruising to dissipate.Thanks in advance for your prompt response.

Answer:

it can be normal in a small number of patients, bruising is always a risk, especially in that area as there are lots of small blood vessels and not alot of thick tissue to hide the bruise with. I think it might take a few more weeks, massage and warm packs will likely still help, although it is mostly a matter of time. All the best. JG 6.1.10

Question:

How far apart do you typically space Sculptra injections in your practice? 4 weeks? 6 weeks? 8 weeks? By the way, I agree with the poster below. What you do here is not only amazing, it is the work of a rare degree of love and compassion. Thank you.

Answer:

6-8 weeks. Thank for the kind words too. JG 5.26.10

Question:

my options for acne scarring seem to be limited as I am olive. Are there any fillers that encourage natural collagen growth in the skin? How long does Radiesse or Radiance last in scars? Also, you talk a lot about subcising the scar before injecting with anything? Even if the filler is gone, does that subcision have any lasting effect on the scar appearance? Does it hurt to have it done? I have a few ice pick and some rolling scars.

Answer:

no fillers that will do that in a scar and as to how long the Radiesse will last will depend entirely on how deep they injected it, my guess is nto too long. Subcision will help some on its own, yes, but only mild. It is done under local anesthesia and should not hurt.The ice pick scars can be cut out and stitched closed. JG 5.25.10

Question:

Thanks for your answer below concerning the depth of Sculptra injections, but I am confused about your answer. You advise a deep or sub-dermal injection, but then say you think it is OK to proceed with the surgeon whose technique is to inject it into the superficial dermis, just below the epidermis. Is that right? He places it there, he says, because it can`t produce much collagen when it`s placed in the lower dermis or below it entirely. But it sounds like you disagree with him, so would you advise that I seek someone other than him? Sorry for asking you this twice, Dr. Garcia, but I want to be sure I understand your answer. Thanks again!

Answer:

I am sorry, I must have misread what you wrote as I thought you said he injected into the deepr dermis, if I was incorrect, I apologize. A deep dermal injection, where the dermis essentially meets the subcutaneous fat is OK, anythimg more superifical than that I would not do, no matter how much experience. Actually collagen is produced in the deep dermis, by the time the skin cells get to the more superficial dermis they have lost their ability to create collagen as they are too far from the basal layer.If that is what he said, then I disagree with his statement. If injected into the subcutaneous tissue it can indeed create collagen, but as the subcutnaeous tissue is quite giving, the new collagen that can be formed does not have much localized shape that can replace lost bulk. I typically inject right at the border between the dermis and subQ, many times penetrating into the deep dermis, but it is practically impossible to inject into the deep dermis and only the deep dermis with a filler using that amount of fluid, the dermis will not stretch enough to take it all in. Injecting Sculptra into the muscle is also inefficient. Hope that clears it up some. JG 5.24.10

Question:

I had asked about silicone for acne scars. What filler(s) do you suggest for mild or pitted acne scarring with long lasting (even permanent) results with reasonable safety? As always, thank you so much for taking the time to answer these questions.

Answer:

I think subcision needs to be done and then I might suggest Radiesse. I think long term fillers can have long term complications though, so although desirable, not always a good idea. JG 5.24.10

Question:

I am interested in silicone injections (done in moderation) for acne scarring, also very mild. More pit like than anything else. What is your take on silicone for acne scars? Can I still use IPL after to correct redness?

Answer:

I do not use silicone as it is illegal here in Nevada and in many other states to use for cosmetic reasons, as to having an IPL after silicone injections, as long as they are deep, the IPL should not cause a problem, but if the silicone is too superficial it could cause a burn. JG 5.24.10

Question:

I am 33, and want fuller lips. I am afraid of silicone implants because of the hardening but want something more permanent than fillers like juvederm. How do you feel about fat injections (done in two sessions 6 months apart) or saline injection in the lips? Do they last long and pose less risk?

Answer:

saline will last a few hours and I feel that since fat needs to be injected with larger needles, that the control and fine detail is gone with that technique. I think the fillers that dissolve need frequent injections but they are what I would suggest you stick with. JG 5.24.10

Question:

Hello Dr, I am still indecisive about having fat transfer/fillers for my cheek area. I am 42 and losing volume as part of natural ageing I suppose. I have been to see several doctors, some say fat transfer is better as it has a lifting effect due to the fact that it is made up of the body`s own tissue, and although a lot does not survive it is still better for the skin, as well as the fact that fat blends in whereas fillers just sit . Other docs say, fillers will give exactly the same result. I would really appreciate your guidance?. Thank you

Answer:

I think fat is more unpredictable than fillers, my preference is Sculptra as it creates collagen and therefore works to re-establish more tissue where the other fillers just hide the loss. JG 5.24.10

Question:

Hi, Dr. Garcia. I recently moved and am consequently changing plastic surgeons. I have been using Sculptra for the past four years with great results. I`m interviewing new surgeons now and have found someone who is very experienced with the product. He`s been using it for four or five years and has not had a single problem with it. Before I allow him to inject me, I wanted to check something with you. I believe that my previous plastic surgeon injected the product very deeply, beneath the dermis. The person I`ve just interviewed finds that injecting it in small amounts into the top layer of the dermis is best, since that is where the collagen is produced. Putting it in deeper really just wastes the product, in his experience. Of course, he constitutes it days in advance and dilutes it properly(with 8-10 cc`s of sterile water). He has a great reputation, and I`ve seen other patients of his who have had Sculptra treatments with him; but I am understandably frightened of the potentially dire consequences of making a mistake with this material. (I need to use Sculptra because I had to have granulomas from Radiesse cut out of my face and was horribly disfigured by the process. I was left with enormous depressions in my face. You can see why I`m extremely nervous.) Before I schedule an appointment with this man, I want to ask if you agree with him about the depth of injections? Does your experience comport with his -- i.e., that injecting it too deeply prevents the product from effectively stimulating the production of collagen as much as it might? Thank you so, so much for your help. What would we all do without you, Dr. Garcia?

Answer:

A deep dermal or immediately below the dermis is acceptable. Properly diluted and injected with the proper technique should lead to good results and low risk of lumps. I think you are likely OK to proceed and I wish you the best. JG 5.24.10

Question:

Hi Dr. Garcia; I had Voluma last week and now I find on the outer upper cheek area I have a lump - about 2cm and it`s lifting the area and looking obviously higher than the other side. I`m wondering can my injector dissolve that lump somehow or is there anything else he can do to fix it? Thanks very much for your help.

Answer:

if the difference was not there right from the begining it is likely some blood collection that most likely will go away with time, massage and moist heat, I think you should see your injector so they can examine you and see what is happening. JG 5.23.10

Question:

Hi, If I came to see you regarding my ArteFill lump what procedure could you do to help me?

Answer:

If I can help, I will certainly try, but without seeing you first I cannot say what I can do and I most likely cannnot do it during the first consultation either. JG 5.23.10

Question:

Dr. Garcia, I had Juvederm injected around 8 months ago into the NL folds around my mouth. After the swelling went down on the 2nd day I noticed odd smile lines when I smiled, almost Joker-like, which I never had before. I asked at the doctor`s office, and they said it would go away after all the swelling was gone. Fast forward 8 months, and I still don`t smile completely because it looks so odd. Will this eventually go away, or am I stuck with these lines forever? Can I get the filler dissolved at this late date? I have a very hectic life and didn`t make the time to go back sooner because I was really just hoping it would eventually get better. Thanks in advance.

Answer:

very unusual, if the filler had been injected above the fold to cause that, it should have dissolved by now. I guess you could try the dissolving, little risk, not sure how much it will do as the filler really should be gone by now, if it was real Juvederm. JG 5.23.10

Question:

hello doctor garcia. i have recently had perlane and restylane injected to the upper cheeks to give augmentation. however, now the swelling and bruising has subsided, i can see i have like a greyish /greenish colour where the filler was placed in like a cresent shape, it is especially apperent in floresent lighting, when i put makeup on it looks uneven due to the colour. does this mean it was placed superficially? i thought filler was suposed to be put in deep below the muscle. also i had som just under my eye and that has made the skin texture look more aged i guess that must be superficial too. how do you place filler for cheek augmentation? what about under eyes are they suposed to go under the muscle in this area? iam now going for dissolving as iam not pleased, i paid £800 for it and iam gutted. i had juvederm in the past on the cheeks and it looked natural with no signs of colour, i dont no why its gone wrong this time.

Answer:

could be from a too superficial injection, yes, or some slight bruising. Neither one of those fillers are meant to be injected below muscle though, they will not last long time periods if that is done. For cheek augmentation is is placed deeply, right on top of the muscle and I use Sculptra and not Restylane or Perlane for facial fat loss of the cheek. For the rim of bone below the eye I use Restylane and I inject a little below and a little above the muscle of the eyelid. All the best. JG 5.21.10

Question:

I am 28 and use restylne for marinette lines and lips. What would the differnce be if i used the sub-q?? are they same price generally??

Answer:

at your age,if injected like the Restylane you are using now, it might get lumpy as it needs to be injected much deeper than regular Restylane. JG 5.20.10

Question:

This is a follow up to my question regarding the continued appearance of n/l folds after 2 cc of Juvederm Ultra Plus. When I lift up very slightly on my cheeks the folds go away. I had planned to try scuptra to add lost volume to my cheek area. Could this improve the n/l fold area?

Answer:

hard for me to say but the amount of lift one gets with fillers like Sculptra will likely not be to the same degree as you see when pulling on your skin in an upward direction. It sounds like what you need is surgery, if you are willing. JG 5.19.10

Question:

hi, thanks for replying to my question regarding the nose filler. you said you havent heard of dents from hyalaise, but what i wanted to know is that becouse its the nose, would injecting hyalaise into it cause any tissue damage or misshape it? one doctor i approached said they wouldnt like to risk injecting there. would you personaly dissolve filler in this area? its around my nose tip and i can feel where it is. thanks again.

Answer:

I do not think the hyaluronidase will cause any internal damage to your pre existing nasal structures or tissues. I would likely use it if needed to dissolve a filler if I thought that was the problem. JG 5.19.10

Question:

Last week I had Juvederm Ultra Plus injected into my nasal labial folds (2 cc total) while lying flat on the exam table. The results looked fantastic in the mirror while I lay prone on my back. When I looked in the mirror upon arriving home the n/l folds appeared unchanged. (Gravity had played a cruel trick!) Is it common to need more than 1 cc per fold for a 62-year old female with a small frame and thin skin? Your input is invaluable. Thank you

Answer:

If 2 cc`s cannot correct the problem, then you are not a candidate for fillers and need surgery I am afraid. Not all folds can be corrected with fillers. JG 5.19.10

Question:

Hi Dr. Garcia, I hope you are well. I am writing to ask about some voluma I had done on Monday. Well it`s still turgid and swollen and only now just starting to bruise today and I`m wondering how long will it take for the swelling to go down as I don`t want to leave the house like this. Thanks,

Answer:

might take 3-7 days until it feels better, a little less before it looks better. JG 5.18.10

Question:

Regarding ArteFill overfill, if someone used kenalog-10 very dilated would that be safe enough as to not cause any indents? Then if more injections were necessary, one could get to create the desired results.

Answer:

the dents can still happen, I cannot say 100% whether you could eventually get the desired results. JG 5.18.10

Question:

Hi, I spoke with the nurse who injected the ArteFill on the side of my chin -- which is overfilled creating slight bump. She suggested getting an injection of kenalog. Do you think that this will dissipate ArteFill bump. I am afraid that this might make it worse by creating a huge indent. What do you think the safety rate of injecting kenalog into the face is?

Answer:

I see no way how Kenalog will dissolve the Artefill, personally. I agree with you that the negative potential side effects far and above outweigh any positive from the injection. I only inject Kenalog into a scar, and then it is mixed with 5FU too, never Kenalog alone. JG 5.17.10

Question:

I had juvederm injected into the side of my nose and tip to correct dents after nose surgery. the filler placed in the side of my tip has gone to the front of my tip making it larger and misshaped and droopy, i csn see and feel where the unwanted volume is, its been 8 months now and it is still there and no signs of it going down. iam tempted to get it dissolved with hyalaise, but someone told me there is a risk of dents occuring is this true? what do you advise me to do in this case? as it looks like its never going to dissolve on its own. thanks.

Answer:

I have not seen dents occur from hyaluronidase injections. JG 5.17.10

Question:

I was wondering if you have any experience in cutting out ArteFill lumps.

Answer:

I have had occassion to cut it out, yes. JG 5.17.10

Question:

I just heard from various places that Restylane Sub Q has been discontinued so that pretty much rules out any chance of it coming stateside. Have you heard anything about this as to why? I was quite looking forward to it as a replacement for Sculptra.

Answer:

I have not heard that myself but will look into it. JG 5.13.10

Question:

Hi, Thank you for the referral. I called Dr. Stacy Folk but there is nothing she can do for me. I guess I am just stuck with this situation. I just have one more question, do you think by massaging the area where the ArteFill was injected I could be making it worse. I was told that by massaging I could possibly break the granules up, thereby leading that the lump might flatten. Or could this lead to increased scar tissue in that area?

Answer:

do not think massage will make it worse, no. I think after the first couple of months that massage will not do much to flatten the granules I am afraid. JG 5.13.10

Question:

Hi Dr, I would like a filler to plump up the cheek area. I am looking at either Sub Q, Sculptra or Radiesse. I don`t really understand the difference in the final result of each. What is the best choice and the longer lasting? Thank u

Answer:

if you have access to all of those I would suggest Restylane Sub Q and it will be an immediate fill, second choice would be Sculptra but it takes a few months to build up, I personally would not use Radiesse for filling in fat loss in the cheeks. Best of luck. JG 5.13.10

Question:

Your site is amazing and I have found it very informative. My situation is that I am 35 and had dark circles under my eyes. I went to the PS and he said he has used jeuvderm a lot and that was what he recommended. ( I later found out from his nurse that he has used it very little under the eyes)I had severe bruising under my eyes and lumps.My PS did not have a follow up appt so I stopped in to see nurse. She said my skin had stained and there was nothing I could do. It is May 12th and i had the Injection in December so it has been 6 months. The bruising has decreased but i still have lumps and some b&B that I cover with makeup. I went to my derm and she is recommending laser treatment to get rid of the bruising and lumps. I now have some lose skin under my eyes that i never had before as well. I was wondering if you recommend the laser treatment and and side effects that are associated,

Answer:

the laser will likely help with the elements left over from the bruising but will not do anything for the lumps. If they are still there they will likely need to be injected with hyaluronidase to remove them. JG 5.13.10

Question:

I want to thank you for taking the time to answer my questions. In regard to ArteFill being cut out, how would they do this? Is there a possiblitiy of a huge scar or indent? Someone told me that the ArteFill granules are very fine -- like grain. So not sure how this can be taken out? Not even sure who to go to. Do you have any recommendations for the Colorado area?

Answer:

the scar would be over the lump, should be relatively small, should not leave an indentation. The small granules are not able to be felt until they congeal into a larger lump that is easier to remove. Might suggest Dr Stacy Folk in Denver. Best of luck. JG 5.11.10

Question:

What`s the best filler for males who want to avoid that bloated estrogen look? I tried hydraulic acid and it gives me a chubby womanly water retention looking face. I want more of the chisled look.

Answer:

it is not the filler, it is how much they inject and where they place it. JG 5.10.10

Question:

Dr. Garcia you and your expertise has been a tremendous help to me as you seem more knowledgable than any doctor I`ve spoken to. I showed you a photo of what is fat loss in the peripyriform area of my face in which I have had prior restylane and juvederm treatments that did not amount to anything and you recommended either a peripyriform implant or hydroxyappatite injected by an oral surgeon. I went to see doctors who performed this procedure, and also Dr. Stephen Mulholland in Toronto who knows of you and he agreed but also said that Juvederm Voluma would also be a good alternative, that I simply did not have enough filler injected before (they never did more than 1/5 vial or regular restylane or juvederm), and the right filler was not used. What do you think of the Voluma in my case as opposed to implant or hydorxyappatite, and will it lead to a less dramatic result? Thank you again. I`ll leave my pic for reference: http://i43.tinypic.com/rc4nfc.jpg

Answer:

we do not have Voluma here in the US but that would be a good option. I am likewise surprised at how small of an amount they injected, no way that small amount would have helped. I think the Voluma is worth a try first, yes. Best of luck and you are in good hands with Mulholland.All the best. JG 5.10.10

Question:

Sorry. I copied the entire post. Just posting again so the question is a little clearer. Regarding the ArteFill question, it has already been two months. When you say carrier, are you talking about the bovine collagen or the ArteFill granules? I am hoping you mean the ArteFill granules. I don`t think I can handle having a lump for the rest of my life. Is there any other alternative besides massaging. Is it possible that a steroid injection -- like 5FU -- might help break it up. I am just worried that this might be scar tissue that has formed. Please Help!!!!

Answer:

if it does not flatten on its own, it might need to be cut out, there are no injections that will dissolve the granules. JG 5.9.10

Question:

Hi, I recently had an ArteFill injection about two months ago. The nurse injected too much ArteFill in my left chin area creating a slight bump. I spoke with the plastic surgeon at the office and they told me that I could massage the area every day for ten to fifteen minutes and the bump would flatten out eventually. I really don`t know what to believe. Can ArteFill dissipate if you massage it enough. I thought this filler was permanent. I am hoping this is all just a marketing scheme (about being permanent) and that this will really disappear. This is really making me so depressed. Answer: well the filler that carries the long standing granules will dissipate over 6-8 weeks and massage will help that too. Hang in there. JG 5.9.10 Regarding ArteFill it has already been two months. When you say carrier, are you talking about the bovine collagen or the ArteFill granules? I am hoping you mean the ArteFill granules. I don`t think I can handle having a lump for the rest of my life. Is there any other alternative besides massaging. Is it possible that a steroid injection -- like 5FU -- might help break it up. I am just worried that this might be scar tissue that has formed. Please Help!!!!

Answer:

the collagn,n the granules will be there for a long period of time I am afraid. There is no injection that will dissolve it I am afraid, if it does not flatten on its own it might need to be surgically cut out. JG 5.9.10

Question:

hi doc,abo hi dr about 9 weeks ago I had my first sculpta injections to my check area alittle in lower jaw and temples when I went back 6 weeks fro 2 nd tx the derm felt I did not need any more in cheeck area is it possible for one tx to be effective in that area? It does appear fuller do you think it will last normal time?she said next visit she will add some restalyne under my eyes do you think thats a good idea Ive heard its a tricky area she is supposedly very experienced with cosmetic derm what do you think?

Answer:

the younger one is and the less fat atrophy they have the less Sculptra one will need so it can be possible. As long as they have experience with the filler around the eye it is OK, I do it all the time. JG 5.9.10

Question:

Hi, I recently had an ArteFill injection about two months ago. The nurse injected too much ArteFill in my left chin area creating a slight bump. I spoke with the plastic surgeon at the office and they told me that I could massage the area every day for ten to fifteen minutes and the bump would flatten out eventually. I really don`t know what to believe. Can ArteFill dissipate if you massage it enough. I thought this filler was permanent. I am hoping this is all just a marketing scheme (about being permanent) and that this will really disappear. This is really making me so depressed.

Answer:

well the filler that carries the long standing granules will dissipate over 6-8 weeks and massage will help that too. Hang in there. JG 5.9.10

Question:

Which filler is more firm or viscious between radiesse and SubQ?

Answer:

not much difference. JG 5.7.10

Question:

Thank you for your reply regarding Juvederm as a cheek filler and whether it would help with malar bags. What do you suggest for a filler that would put some fullness back into my rapidly sinking cheeks? I will visit a local Plastic Surgery Clinic in Toronto that also does fillers and would like to be prepared. Again, I appreciate that you would take your valuable time to answer questions from clients who can`t even visit you to repay your kindness with business!

Answer:

My choice for fat loss in teh face is Sculptra, that is much longer lasting than the hyaluronic acid fillers I feel. Best of luck and thanks for the kind words. JG 5.7.10

Question:

I had juvederm in my n/l folds and botox in the forehead a few months ago at a medical spa and loved the results. The nurse suggested filler in my cheeks as well (volume loss now at age 50)I have malar bags which I shrink down with an OTC serum every day. The suggestion was made in an online consult with the spa Dr. that Juvederm in my cheeks would draw some of the fluid from the undereye area as well as filling out the cheeks. I have always looked young for my age and these puffy bags are really aging me. I am paranoid about doing anything that will cause more fluid in the area and wonder what you think? I don`t want surgery.Thank you for any advice you can provide.

Answer:

I personally feel Juvederm is very short lasting as a cheek filler and to believe or suggest, as the doctor did, that the filler will draw the fluid out of the malar bag is ridiculous, absurd and an out an out lie in order to get you to spend money on something that will not work. I strongly suggest you go to a new more ethical place. Best of luck. JG 5.7.10

Question:

Good afternoon. Have read many posts on Sculptra forming granulomas - is this frequent. Had Dermalive injected in NL folds but am aware that Sculptra overtop would be a bad idea as it produces collagen which i do not want happening around the Dermalive. (So far no problems with the Dermalive). My question is, if Sculptra is injected into my cheeks could the collagen forming processing migrate to my NL folds which could potentially cause a problem to my Dermalive. thx Dr.

Answer:

it is infrequent, peopel that have Sculptra and have no problems do not post I am afraid. The Sculptra does not migrate very easily, so as long as it is not injected in that area, it shoudl be fine. JG 5.6.10

Question:

is there a specific way to dilute the enzyme to dissove restalyn so that it will spread less? last time i had it done it dissolved all the product when i only wanted 1 lump. thanks

Answer:

sorry, but theer is no way to get it to dissolve only the lump. JG 5.6.10

Question:

Thank you for your response regarding the dog bite on my face. What would you suggest as treatment to improve the indented scar if you think the fraxel will not improve it much? thanks.

Answer:

likely the most reliable thing will be to wait a full year after the injury, allowing the scar to contract and then have it electively surgically cut out and reclosed with appropriate plastic surgery techniques in multiple layers, bringing the surrounding tissue in to fill in the depression. All else will be less effective. All the best. JG 5.5.10

Question:

Hi Doctor! I was perusing the answers to questions on fillers and noticed someone brought up the issue of the Argentinian model who died after a procedure where a filler was injected to her buttocks. When the news spread, it was said that it was due to the PMMA. For work reasons (research for a dermatologist), I had to do a follow up of the case and the autopsy revealed, if I recall it right, that she died of pulmonary embolism and that the substance that was injected was not PMMA but probably liquid silicone. The autopsy revealed an oily substance that was not PMMA and it is believed was liquid silicone. The news that it was PMMA spread because she was *told* by the doctor that in her clinic PMMA was used, as it is quite used in Brazil already for that purpose, even though its use in large amounts causes controversy. But in Brazil it is put with a cannula, to avoid getting into blood vessels. The model instead had two injection points in the glutes. Anyway, I did not find the full results of the autopsy and further studies were needed to make sure of what substance was injected and to be certain of the cause of the pulmonary embolism. It was clear, anyway, since the info of that first autopsy was released that it was not PMMA that was injected, though, and that it was a case of mala praxis and not an accident as the family was told at first and believed at first (I think now it has resulted in a lawsuit, but not sure). Hugs

Answer:

well, I have not seen the autopsy report either, the pulmonary embolism can happen due to the position the patient was in, just from her only blood not flowing. This is especially a higher risk in paients on oral contraceptives and those that smoke. Injections into a vein can be missed at times and any filler, PMMA, silicone, or any other filler, if injected in a large enough amount into a vein can migrate to the lungs and have the same exact effect as a pulmonary embolism. Fat injection have also been found to potentially cause embolisms that can result in the same problem. JG 5.5.10

Question:

Dr. Garcia, I`m a 48 yr old female and received a bite from a dog on my left cheek 7 months ago. I have been undergoing fraxel(5 treatments) on the indented scar. Will the fraxel restore ever stimulate the collagen enough for it to fill back in to it`s mormal level? The dermatologist suggested restylane filler once the laser has softened the scar tissue underneath. Your thoughts? thank you.

Answer:

I have to say that is wishful thinking. I do not think the Fraxel will give you much improvement to speak of once the swelling has gone. The Fraxel also will not softten the scar tissue, that will happen with time even without the laser. JG 5.5.10

Question:

i had juviderm ultra under eyes and i hate one part -it`s been 4 mos now and there seems to be no change. i was hoping it would go down. some one told me it could last years in this area. do you agree? is there a usual time for dissolving in this area?? thanks

Answer:

I have never seen it last more than one year personally, you could consider having hyaluronidase injections to dissolve it. JG 5.5.10

Question:

i have a big black bruise uner eye from filleris it possible that the blood gets trapped in the filler and never dissolves. it has been 7 days with very little change thanks

Answer:

the blood will, with time, dissolve, it cannot get trapped. JG 5.4.10

Question:

how precise is the enzyme to dissolve restalyn? there are a couple of lumps which i hate but like the rest.does it spread a lot? the last time i had it it was diluted which i guess is the correct thing to do and the fluid tracked down my cheek which gave the appearance that things were swollen but it was gone the next day. is that normal for the fluid to do that?? thanks for everything!

Answer:

it will spread a little, yes. The fluid itself can cause swellling when injected. JG 5.4.10

Question:

I have an appointment with an excellent injector for radiesse in my cheeks but I am having second thoughts because you do not seem to be a fan of the product and I really respect and trust your opinion. Is it that you don`t think it is right for that area of the face or that it is dangerous because of granuloma? and why do so many plastic surgeons suggest radiesse if it is not a smart choice? thank you as always for your time-you are such a generous person

Answer:

I just think that it takes an enormous amount of material to be injected to get a long lasting effect, it is intended for more superficial use and when injected deeper it is not as efffective. Radiesse for nasolabial folds is OK but not for volume loss. Best of luck. JG 5.4.10

Question:

Thanks Dr Garcia, I have enclosed a side by side comparison pic below where you can see where the fat loss happened. The damaged side of my face vs the undamaged side. Again I tried Restylane and Juvederm and it didn`t work AT ALL. Which part of my face is this called? Which filler would you choose to fill the assymetry and how much filler? or perhaps an implant or a permanent filler? Pic is here: http://i43.tinypic.com/rc4nfc.jpg

Answer:

there are silicone implants that fit into that area, called the peripiriform area that might help, it is an implant that goes underneath the base of the nose to both sides but it can be trimmed, that will be your best bet. Otherwise using hydroxyappatite mixed with your own blood can help, it is a material used by oral/maxillofacial surgeons. Best of luck.JG 4.24.10

Question:

Hate to ask any more questions, but now I`m confused, doesn`t Artefill work similar to Sculptra in that it creates collagen and also requires a good blood supply too? I would ask my PS at the next consult but it usually seems like he`s just trying to sell me the most expensive treatment. I truly appreciate your help.

Answer:

Artefil will get a little collagen production but most of its effect is by the PMMA it has, that is why it is not approved nor shoudd be used for tissue loss.Best of luck. JG 4.24.10

Question:

Really? Wow thanks for the heads up on that. I can`t thank you enough. I was very close to getting Sculpra or Artefill for that area, but I had no idea those fillers to stimulate collagen relied on blood supply. Actually, I think the reason I`m missing fat in that area is due to a weak blood supply there due to a prior procedure and that`s why I`m not going with a fat graft because I doubt it will take as a result of needing a good blood supply. So, maybe I`d be better off with Raidesse, Voluma, Sub Q, Bio Alcamid? God bless.

Answer:

or a silicone implant made for that,need to see a surgeon to se what can be done for it besides fillers. As to the other fillers, likely Artefill would be best. All the best to you. JG 4.23.10

Question:

Sorry, did you mean that the Sculptra would not be too effective and I would need 3-6 vials to fill in the area? Or the Restylane? Thank you.

Answer:

3-6 for the Restylane and in that area Sculpra does not work as well as it does in the cheek as it needs to be injected into tissue with good blood supply for it to create the new collagen. JG 4.23.10

Question:

Interesting, thanks. Well I`ve had up to half a vial of restylane injected into my fat depleted canine fossa injected in one sitting before with a good injector but with no success as I mentioned. Do you think this means that Sculptra will not work there either?

Answer:

probabaly not too effective and if it were would take a few vials on each side, and also when filling in tissue loss, it takes very large amounts of filler, not the usual one or one and a half syringe like when injecting into the folds or lip lines, it takes lots of volume.In severe cases it can takes 3-6 syringes to fill in each cheek on someone with a significant amount of wasting or tissue loss. JG 4.23.10

Question:

I have always got Restylane with no complications, but the last time I had it, I got this little red pimple looking thing at one of the injection sites. It was generally soft, felt like maybe it had a little fluid in it just like a pimple. It stayed for a month, the fluid came to the surface like a pimple and it went away. But since then it`s like it comes and goes in the same spot, sometimes with a other pimples close to the same area. I know for a fact it`s the restylane because I never get pimples otherwise, and keeps coming right at the injection site in the same spot. The main one in the exact same spot. Anyway I read on the Restylane site that pimple type reactions are a potential side effect. It almost seems like some of the product was injected too superficially and it`s becoming inflamed and coming out a little at a time. It definitely does not seem like what people are describing when they speak of granualoma`s. It`s been coming and going for 5 months now. How long will this last and what do you think is causing it?

Answer:

if that is the case it might continue until all the Restylane that is in direct contact or communication with the puncture site has all come out. It is a very rare occurrance. Best of luck. JG 4.23.10

Question:

What is the difference in how Artefill and Sculpra work to create volume and which one creates more?

Answer:

Artefil counts on your body encasing the permanent PMMA particles in collagen and the Sculptra works by getting the collagne to form around the dissolvabel L-poly-lactic acid material, there is no way to compare which one creates more. JG 4.22.10

Question:

Over the last couple of years, I`ve gotten the impression that I was losing fat in the canine fossa area due to a prior procedure. It seemed like a little fat was missing at first and gradually, as a couple years past (I`m now 31) and I got more and more injections the transition between the cheek fat pad and NL line (which was very small at first) has become wider and wider making a wide unnatural looking line or gap. Over that period I`ve been getting more and more filler put into that area but it never seems to work. Actually it keeps on looking worse as the gap looks wider. I could be losing more fat which has been my thought all along, but I also came upon another theory. The last time I saw my derm he said that the filler could be just pushing it to the side? I`m not familiar with the anatomy of the face but is it possible that by continually putting filler in this area that I could have created this problem? Can the fat pad be pushed to the side creating a much wider looking smile line if too much filler is placed in one area? I seem to hold onto filler for a while and it to me it seems to be possible that my initial paranioa of losing fat in my face may have lead me to get and accumulation of injections I didn`t need in the first place which have created this problem. Last night after thinking about this, I tried massaging the filler inwards from the lower cheek in the direction towards the base of my nose and after doing this for 20 minutes to my amazement it looked much better and almost perfectly symetrical to the other side making the transition a much thinner nl line. It stayed looking better for a couple hours but today it`s gone back to normal but still looks a little better. Whether or not this is because I caused and accumulation of fluid by administering the massage making the area puff out and briefly look better or briefly jarred the filler in a better location I don`t know.

Answer:

fillers will not displace facial fat to any visible degree. Fillers are not that mobile after being injected where you can displace them to any appreciable degree I am afraid, more likely swelling was caused making it look like that. Sounds more like you are losing facial fat, could be genetics, stress, weight loss, aerobic impact activities, lots of variables. JG 4.21.10

Question:

hi dr. garcia, i am having fillers tomorrow. i am going out with the gang from work tonite and i was wondering if one rum and coke can affect bruising tomorrow. also how long should i ice the area where i am getting the fillers injected before and after. thankyou so much.

Answer:

I think that will be fine, as to the ice, we suggest 3-4 times per day after the injections for 5 minutes each time for a couple of days. The ice before is just immediately before for a few minutes while waiting for the injection. Best of luck. JG 4.21.10

Question:

how can i avoid bruising with juvederm. am having liplines and marionette lines filled . is there anythng to use before the injections to minimize bruising. thanks

Answer:

well avoiding OTC blood thinning products like aspirin and Motrin, along with the use of Arnica for 2 days before and a few days after, ice before and after might also help, but there is nothing that will avoid it 100%. JG 4.21.10

Question:

is there another nurse in the room with you when you are injecting fillers? i was just wondering what is normal . my doctor has nobody else in the room when doing fillers. is this normal?

Answer:

I always have a nurse in the room with me, I am never alone in an examing room with a patient.Being alone saves the doctor money though. JG 4.21.10

Question:

Since products like sculptra and artefill rely on creating scar tissue collagen to build up areas would it be reasonable to assume that darker skinned races would get even more of an effect due to having skin that develops scar tissue more easily? Also, which product between Artefill and Scluptra is more prone to lumps and skin reactions? Thanks

Answer:

I cannot say that it an absolute, and if it were in fact true, it would not be so in all darker skinned individuals as the issue with thicker scar tissue is due to many factors along with race. I personally feel the potential for lumps is higher with Artefill. JG 4.21.10

Question:

Regarding an earlier post, is that accurate that restylane can be stored for up to a year? I`m really surprised as my derm has only let me re-use within a 6-wk period. And of course I can never get in that quickly so I always need a new one....

Answer:

I know of many doctors that store it for up to one year using sterile technique. JG 4.21.10

Question:

hi doctor garcia, i would like to know if it is normal to reuse the same restylane when it has been in the fridge more than 4 weeks? i have recently had it around my eyes with good results, iam going for more,and its been 5 weeks now since the the first lot was injected as i had to give time for swelling and bruising to subside. the doc told me that there is still some left from before and we can use that.he said it can be stored over a year and used as long as it has not gone thick or anything. But ive heard it can only be stored a month and then they dispose of it. what do you think? do some docs really reuse it when its over a month gone? iam not sure if i should tell him to open a new one as iam worried it wont be any good for me.

Answer:

as long as it is stored in a sterile fashion, it can be used for the same patient, many doctors do that. JG 4.20.10

Question:

Thanks for your prompt reply re Radiesse and Sculptra in the hands. You say you`ve been unimpressed by both, but you didn`t say why. Did the products not take in the hands? Did they simply not last very long due to the high degree of motion in the hands? Or did they just look odd? I have seen hands treated with both products which looked great but others that just appeared swollen/weirdly over-filled for months on end, which I suspect may be injector-dependent. My PS has encouraged me to try Sculptra in my hands, and I`m trying to learn what the specific drawbacks may be before I proceed. Thanks again for your help and for clarifying your earlier answer!

Answer:

the issues are lumps and not lasting from the Radiesse, and not lasting with the Sculptra. I think it is not the motion as much as there is not enougth tissue there to incite a reaction to create newer collagen and cause the filling in to occur. For the first few weeks, and especially right after, they look great, but it is how they look at 3 months and after that counts and that is when the disappointment is seen. I think Sculptra is the better choice between the two. Best of luck. Julio Garcia MD 4.19.10

Question:

What do you think of Artefill for localized areas of fatloss? I know that a lot of people are getting PMMA fillers like Precise done in larger volumes but I don`t hear many people doing this with Artefill... what`s the difference?

Answer:

I think when you start injecting large volumes of any product like Artefill or Precise, the risks of lumps goes up. When injected in smalll amoutns over a large area the risks are much less. I would not use Artefill for fat loss myself. Julio Garcia MD 4.19.10

Question:

Have you ever treated hands with Radiesse or Sculptra? If so, have you been pleased with the results? How long have they lasted? If not, why not? Thank you for your advice.

Answer:

yes to both and unimpressed with both to be honest. I do not use it there anymore. JG 4.18.10

Question:

how long would juvederm last on average on smoker lip lines and marionette wrinkles that are somewhat crisscrossed on a 59 year old female. thanks.

Answer:

2-3 months at most. JG 4.17.10

Question:

What do you think of the filler Beautical. It`s available in my country. It is said to be like bio alcamid but not permanent, so would it be safer?

Answer:

I would not use it myself on a patient. JG 4.16.10

Question:

My dermatologist and my plastic surgeon are giving me conflicting advice about avoiding fish oil supplements prior to injections. One says that they have anti-coagulant properties and should be avoided; the other disagrees. What`s your opinion and experience with this? I don`t like skipping them to avoid purpura for a week before any injection if doing so isn`t necessary or benefecial. Thanks so much!

Answer:

I think the evidence for increased bleeding is small, but taking a few days off before and after might help and certainly will have no adverse health effects for a short period of time. JG 4.15.10

Question:

What is the differnce of Restyln, Juvederm, Radessie? Im so confued on which does what or is longer or better? Also....is it true that an active runner/lifter, that these fillers wont last as long as a sedetary person becuase they metabolsize? Also, any downtime?

Answer:

Restyalne and Juvederm have a natural hyaluronic acid component where Radiesse has a collagen gel in which are floated small pieces of essentially artificial bone. They should not be used interchangeably, it is not just a matter of using what lasts longer, they should be used in different areas and for differnt problems. Lifting weights has no affect on the fillers but running can do to repeat impact, but people that are aggressive athletes tend to lose facial fat more quickly and their tissues fall more quickly so fillers are needed more often. The downtime is essentially the same for all, a few days of swelling and maybe some bruising. I suggest seeing a plastic surgeon or a dermatologist for your fillers rather than a less experienced injector that will sell you something without taking other issues into account. I wish you the best. JG 4.12.10

Question:

Hi Dr! I wondered what your preference is with regard to fat transfer or restylane sub q for the cheek area since the fat transfer procedure techiniques seemed to have improved recently, and which is the longer lasting option? Thanks

Answer:

I would still use the Restylane SubQ, I think the advances in fat injections are over estimated by those claiming they get them. JG 4.11.10

Question:

I had Botox 2 weeks ago and after 3 days my brow dropped and I had puffiness and dark circles under my eyes. My cheeks look like chipmunks and I can`t smile like I used to. The cheek line in my right side is worse and it doesn`t rise like it did before so on top of the puffiness, small eyes and dark circles, I have a strange bunching, particularly under my left eye. It s awful and I have hidden for 2 weeks, I have been back to my practitioner who said sorry, it was her fault. She injected too far under my eye and paralysed my cheek muscles. She also said she injected too much and too low in my brow. She said all I can do is wait for this to wear off. I have never had Botox before. I went to see her to improve lines around my mouth, but she persuaded me to have botox to the upper half of my face as she said I would look silly otherwise. Well I look silly now, thats for sure and am so depressed. I have been tapping around my eyes to try and reduce the puffiness. I never had bags, fluid retention or dark circles before Botox. is there anything I can do to help the dissipation of Botox? Please help. I am at my wits end. For note. She is recommended by Allergan 3 times on their site

Answer:

I am sorry but there is nothing you can do except waiting to allow it to wear off. Some improvements should start in a few weeks so it will not look like that for too many months. Ice and keeping your head elevated might help with the swelling in the meantime. As to being recommended by Allergan, all that means is that they purchase the products from them and have atteneded training seminars. The presence on the Allergan website does nto necessarilly mean that she is any better than others. I wish you the best. JG 4.10.10

Question:

thanks for your quick response re PIH that I just asked. Would retin a help to use along with the lustra or is the lower eyelid skin too sensitive?? thanks

Answer:

I usually use them in combination, it is more irritating, yes, but more efective also. JG 4.9.10

Question:

if i have discoloration(brown) from PIH(filler) but it is in the dermis(according to dr-not the dr who did restalyn injection) would lustra or any hydroquinone work? one dr. said it won`t work in the dermis and another said that the skin is so thin in this area(uner eye) that it could work. What do u think?? thanks.

Answer:

yes, it will work, if it was only in the epidermis,which does not happen in PHI, all you would need is a single microdermabrasion and it would be gone. The thin skin will respond to the bleaching creams as well as other areas, but that skin can become more irritated from the cream too. JG 4.9.10

Question:

ever heard of lipoic-acid-dmae-cream_?? comments?? also any at home devices that may help with firming, jowls, etc?? i already use fillers and im 28...

Answer:

no devices that help, and back when we sold our DMAE cream, we had DMAE and lipoic acid in it, it works if the concentrationa are high enough. JG 4.8.10

Question:

I have what may be either some permanent bruising under eye from juviderm or PIH(it has been 10 wks since injection) and when I went to a different doc than the one that injected it he told me that the discoloration was in the dermis and lustra would not help. Another doc sais the skin was so thin there that is might. What do u think?? thanks!!

Answer:

if it is brown PIH the Lustra should help, worth a try. Best of luck. JG 4.2.10

Question:

My friend has been getting fillers for years and she recently opted to go permanent and got some bio alcamid where it`s available in Canada. I understand that what she did was potentially dangerous long term, but I did notice that her results seemed much more dramatic with the bio alcamid. It look a lot more filled out. Why do you think this is?

Answer:

the amount of fill appearance is not from the type of filler, it is the amount of filler injected. JG 4.2.10

Question:

Hello Dr Garcia I had botox on Saturday to my brow and crows feet.I look like a vulcan or Jack Nicholas....and to boot my eyebrow has dropped over my eye and my cheaks look swollen leaving my eye sockets sunken in my head. I just look awful and tired. I went to see the practioner again today as I was very worried and she said she was sorry. She said it was best to wait another week as various muscles kick in at different times but she could do nothing for the cheaks that look swollen and make my eyes look sunken. She said becasue she has relaxed the side muscles, these don`t scrunch up when I smile and thats how I look like I have 2 low hung apples for cheaks and this in turn pushes up caausing my eyes to look sunken. She saidthat it can take 2 weeks to get the full effect, god help me if it gets worse!! I am hiding in the house because I just don`t look like me. Is what she says correct or is there something that can be done so that I look normal? By the way, I only went to see her as I ws concerned about lines to my mouth but she persuaded me to have botox tooor I would look silly. Couldn`t look much siller and just want to cry all the time. Please help? PS, the lines around my mouth look no better and I have a swelling to the side of my mouth which looks ierd too.

Answer:

I never use Botox around the mouth and as the to the cheeks, it would have taken a large amount of Botox to have that effect, so not quite sure what has caused that except lots of swelling. You can have some Botox injected into the lateral brow forehead region though and that will drop the lateral elevation of the eyebrow that is giving you the Vulcan appearance. All the best. JG 4.1.10

Question:

i have lines in between brows and dr wants to give 4 shots of botox-5 units each spot-does this sound right and is it a place that could cause a droopy eye?? thanks

Answer:

it is the method used to diminish those lines and a droopy eyelid is possible but rare. JG 3.31.10

Question:

Hello, how long does it take for everything to settle down after restylane injections to the tear trough/cheek area? Thanks.

Answer:

usually 7-10 days.JG 3.30.10

Question:

hi, i have a problem under one eye. the skin is a bit crinkly and thin lacking in fat. i have had fillers but it cant reach the area of concern right inside the orbit area. can sculptra be injected in this area? and is it more natural looking than other fillers? also what do you think about titan? is it good?can you recomend anything that would solve it? thanks.

Answer:

I would not inject Sculptra around the eye. Not all scenarios can be remedied with fillers and some issues can never be made better no matter what is done I am afraid. I am not a fan of the Titan and without seeing you in person I am afraid I cannot say what it would take to make it look better. JG 3.30.10

Question:

THe 11 lines between the eyes are normally filled with botox but are there any other fillers u can use to smooth thise lines without freezing ur face? THanks =)

Answer:

Botox is not a filler, it is a muscle weakening agent. Botox or Dysport both weaken muslces so if you use a filler, like Restylane or Perlane, the lines should be better with no frozen appearance. JG 3.29.10

Question:

What is the best filler to fill the folds from your nose to mouth.....what causes those anyway. Iam 30 and can start to see them. If I get a filler will it help?

Answer:

it is caused by the cheek tissue falling from the aging process and I typically use Restylane or Perlane for that. The fillers should help, yes. JG 3.29.10

Question:

I had Dysport Feb. 19th, 2010..and about 12 days after the fact I started to have Right Eye problems. Now it looks as if my right eye has sunken into the eye socket. When I close my eyes, I can feel with my fingers that my right eye is now lower in the eye socket compaired to my Left eye. I don`t know what to do, can this be corrected in time. My plastic surgeon recommended Visine Get the Red Out, but so far no luck. My eye actually hurts, as if I`m straining it. Will this permenant? I`m very scared...I love my eyes. Will I need surgery to repair this bothched job? Thank you, Heidi Moore

Answer:

I will be honest with you, I see no way that a chemoparalyitc agent Like Dysport ot Botox could cause that. Muscle weakness, no matter how profound, would not allow the eye to fall deeper into the socket as you describe, there is something else going on and I think it is a mere coincidence that it has occured after the Dysport. I think your doctor needs to look for some other cause. I wish you the best. JG 3.29.10

Question:

Hi Dr, What is the best filler to have in the upper eyelid area below the eyebrow to create a more plump effect? Thanks

Answer:

I use Restylane for that area. JG 3.29.10

Question:

I meant to ask if you would consider posting some photos on your website of patients whom you have injected with Sculptra (with their consent, of course), since this subject seems to be of great interest to your readers. The company`s website features fabulous photos, of course, but many of us would like to see how average patients in a busy practice like yours actually appear. Thanks for considering this.

Answer:

I have patient permission to show pictures in my office to individual people but not to post on the internet, not many people agree to that when faces are involved. Sorry. Also, unlike many other surgeries, the results from Sculptra are much more variable in degree from patient to patient along with the amounts injected, time internal, etc. It is hard to show a picture and have it be representative of what another individual could achieve with the exact same procedure. JG 3.26.10

Question:

With Sculptra, each syringe is mostly water. How long does it take for the water to resorb and the initial swelling to abate (1 week? 2 weeks?)? When it does go down, the appearance of the injected area is the same as it looked pre-treatment, right? When can one typically see the inflammatory reaction begin (2 weeks post injection? 4 weeks post injection?)? The inflammation peaks at 6 months after the first injection and then begins to deflate? I know that the rate of deflation is age-related, but how long does it take on average for a patient to reach pre-treatment de-flation? Thanks for your time! Have a great weekend, Dr. Garcia.

Answer:

the initial fluid is usually absorbed in 4-7 days in most instances. At that point it is very typical for the appearance to be just like before the injections. The begining of the new collagen formation starts right after the injections but usually does not become visually perceptible for 6 weeks and continues from there for 4-6 months. It is not inflammation but new collagen that forms. The aging process is never stopped so any new collagen that is created will dissolve with time, the speed of that depends on your own personal genetics and speed of aging. Going back to the pre-injection appearance can take 1-2 years, the older one is the quicker the collagen loss occurs and the less dramatic the foramtion of the new collagen is. Hope that helps. JG 3.26.10

Question:

Hello, I received some restylane injections to the cheek area today. A friend told me I should not exercise for at least 24 hrs. Is this true? (I do a fairly intense circuit training routine). Thanks!

Answer:

I have not found that to make any difference. JG 3.25.10

Question:

Hi Dr. Garcia, I had under eye hollows/circles filled with Juvederm when I underwent a dental bone graft, extraction and implant surgery. I had HUGE shiners immediately. They didn`t ice it or numb it before because I was going under. I avoided aspirin for a week and cut back on my wine. I am also hugely puffy. It is two weeks today and my black eyes are fading but I am still puffy. My doctor said at my week post op to warm compress, light massage and it would be great settled. When will it settle? Is this swelling from surgery/bruising or overcorrection? I believe they used two .8 ml vials. One message board said wait until bruises are totally gone because it causes swelling before judging results of the filler. What do you think? Please advise and thanks!!

Answer:

might take a few more weeks, most of the swelling is from the dental work and not the filler though. Give it some time. JG 3.22.10

Question:

My daughter, late 40`s is beautiful & looks years younger than her age except for melasma cheeks /forehead etc. She is 1/2 Causcasian-German/French/Scot,1/2 Japanese. Retin-a/Hydroquinone has been ineffective. She is considering making appointment with you in NV. In meantime Q is this-If peels/lasers and other tx exacerbate asian skin, what about fillers such as radiesse/juvederm/restylane?Are they safe for asian/mixed skin as procedures for marionette lines etc? Or is there a dark side (pun intended) for those of these skin types as well?

Answer:

I think lighter (pun also inteneded) lasers like a YAG might help but it would be a series of them done every 4-6 weeks, anything stronger has the potential of making it worse. Fillers are safe though. All the best. JG 3.22.10

Question:

I read where a lady really liked your peptide cream. What is it for and what does it do? Is it better than Retin A?

Answer:

it is for fine lines and texture, it does not irritate the skin or sensistize it to the sun like Retin-A does. JG 3.22.10

Question:

hi, i want to know if pregnancy and child birth can effect the fillers in your face? can they dissolve quicker in your body? or it doesnt make any difference? thankyou

Answer:

no known effect. JG 3.22.10

Question:

Hi, Dr. Garcia. First, I want to thank you for your peptide cream. I have tried EVERY proecdure (really, EVERY laster invented) and product imaginable for more than a decade -- from Retin A to Prevage to the Obagi line to SkinCeuticals and NOTHING has improved my skin so measurably or dramatically as your amazing potion. Really, it`s GREAT stuff. Thank you! Secondly, I notice that you are using Artefill again now that it`s back on the market as well as Scultpra. What prompts you to use one product as opposed to the other with a given patient? I ask because I am trying to choose between them. The drawback to Artefill seems to be its greatest attribute -- i.e., that it is indeed permanent. Once it`s placed, the tissue around it inveitably ages, does one end up with islands of product in the middle of an aging face? It seems like a dermal equivalent of the epidermal tatoo problem; that is, it looks good until the skin wrinkles! Thanks for your guidance.

Answer:

I use Sculptra for replensihing the loss of fat in the face and I use Artefill only for its approved use in the nasolabial fold area, and that is really rare, as I use mostly Restylane in that area. I do not find Sculptra and Artefill are interchangeable, they are to be used in different areas for different things. I am so glad the cream is helping and I wish you the best. JG 3.22.10

Question:

Hi-I am planning on vacationing in Vegas and was wondering if I made an appointment with you if anything can be done with some lumps caused by a filler evolence. I would prefer to not walk around with a scar since it is under my eye. Can it be squeezed out or if this probably impossible? Thanks so much.

Answer:

I am sorry but in most cases the material cannot be squeezed out, if it does not dissolves on its own it might need to be cut out. JG 3.22.10

Question:

Hi Dr. Garcia, I scheduled an appt. to get Radiesse injected into my marionette lines next month. There are so many different types of fillers... which is the best to use and why? Are there complications I should be aware of? Thanks for taking your time to respond.

Answer:

I always suggest using something like Restylane as it is easier to remove if you do not like it. JG 3.20.10

Question:

Hi Dr. G, I was wondering if you have heard of the skincream called Lifecell that is supposed to do wonders for your skin, and if you can comment on it. Any truth to its claims or more hype? Thank you as always!

Answer:

save your money. JG 3.15.10

Question:

Hi Doc - 2 questions: I understand that artefill is back on the market again -is this correct? If so, do you offer it? (I had it done 2 years ago and was amazed at the results - would like to know it`s still available) also- why do you prefer Dysport over Botox? Thanks!!

Answer:

yes, it is and we are using it. JG 3.15.10

Question:

i asked a previous question about having a lump on my lip that is blue, it actually looks like a black and blue mark and is small in size. i had restylane or juvederm injected in my lips only once about a year ago. can i attempt to take it out myself like i would a sliver with a needle? also can restylane or juvederm to that to lips thankyou.

Answer:

I suggest you see the doctor that injected it. Any hyaluronic acid filler injected to close to the surface can cause it. JG 3.15.10

Question:

hello dr. garcia. i have gotten restylane and perlane in my lips in the past. its been a year since i have had that done to my lips. i have a tiny ,almost looks like a small bubble that is blue, on the end of my bottom lip. do you know what that could be, and why would it not go away after so many months to a year? hope you can answer my question. i can hide it with lipstick, but its annoying not knowing what it is. thanks so much for your wisdom !D

Answer:

most likely some of the Perlane that was injected into the area. Perlane is not indicated for lip injections, it is meant to be used for deeper injections on the face. Might need to have it cut out or a needle hole made and the material attemtpted to be squeezed out. Best of luck. JG 3.14.10

Question:

Hi again Dr. Garcia. I only wrote a few weeks ago. Well it`s almost 2 weeks since I had restylane vital under my eyes in the upper mid-cheek section. One side is really good and yet still has a bruise that is now purplish. The other side has a raised line and is not sitting flat so I`m pretty disappointed. Will you tell me what I should do? Do I wait some more until my next appointment in mid-April or do I go in earlier and ask for it to be fixed? Thanks a lot Dr. Garcia. Take care.

Answer:

if it is bothering you I think going in earlier is a good idea. JG 3.14.10

Question:

i bought a product called rapid lash at bed bath and beyond to use on my brows---any danger re pigmentation problems that u know of??

Answer:

I have not heard of any problems with it. JG 3.12.10

Question:

heydr garcia, what filler is best for moderate marionette lines? radiesse, juvederm, or restylance? and which is best for mild nasiolabial folds? and how long do the results last

Answer:

I use Restylane for the milder ones and for deep ones I use Perlane, I have not found there to be much difference between Radiesse, Restylane or Juvederm in terms of how long they last. In that area it might be 2-6 months, the more you move, and the older one is the less time it lasts. JG 3.10.10

Question:

HI DR. GARCIA,I JUST GOT BOTOX , AND AM USING RETIN A ON SAME AREA, WILL IT INTERFERE WITH THE BOTOX??? THANKS!!

Answer:

no, OK to use both. JG 3.10.10

Question:

Dr. G. could you pls tell me why i would use Sculptra vs say Perlane if Sculptra is $1000/syringe and Perlane is $550/syr. The longevity of Sculptra is approx. 18 mos. vs Perlane about 8 mos. Why would i not use Perlane 2 syringes 8 mos apart as this would keep the cheek area fuller vs the sculptra which would start to dissipate after a few months and by 18 mos. would have signifcantly lost its configuration. I hope u understand what i am trying to say...(cost wise it would work out to the same)or am i totally misinformed and sculptra would be the better option. Thank you.

Answer:

well, typically you cannot equate one syringe of one product with one syringe of another, so to get the effect of filling one gets with vial Sculptra will usually take more than one or two syringes of Perlane.JG 3.8.10

Question:

Hi Dr, I would like to try Radiesse in the cheek area but had Sub Q injected about 5 months ago so it may still be there. Is it OK to do this? Thanks

Answer:

OK to do, just that as the one filler dissolves the cheek will not look as full. JG 3.7.10

Question:

I had restylane placed in my upper lip a couple of years ago. I then had hyaluronidaise injected into a small area due to a lump. Now I have an indentation there. Why did this happen?

Answer:

should not happen again and should not have happened the last time either. JG 3.7.10

Question:

HELP! I have very hollow tear troughs the skin there is very thin and because of this I also have dark circles. I went to a dermatologist to inquire about a filler in that area and was told my skin is too thin and I would end up seeing the product. Is there anything that can be done topically? Do you agree with not putting a filler there?

Answer:

nothing topcial sorry, I think a filler is worth a try though. JG 3.7.10

Question:

HI, I LIVE IN DUBAI, AND I HAVE BEEN HAVING HYULORONIDASE INJECTIONS TO DISSOLVE JUVEDERM ULTRA, FROM MY CHEEKS. AFTER HAVING 1CC INJECTED INTO MY MIDDLE CHEEK, IT STILL DOES NOT LOOK ANY DIFFERENT, AFTER THE SWELLING WENT AWAY I STILL LOOK AND FEEL LIKE I HAVE SAME AMOUNT THERE. HOW COULD THAT BE? IS THERE ANY SECRET TEQNIQUE TO INJECTING THIS STUFF? I THOUGHT IT WAS SUPOSED TO BE VERY POTENT, THE DOCTOR MIXED POWDER WITH WATER AS IT SAYS YOU ARE SUPPOSED TO DO. IAM GETTING VERY CONCERNED NOW, IF YOU HAVE INFORMATION ABOUT THIS I WOULD LIKE TO KNOW PLEASE. THANKYOU.

Answer:

it has to be injected directly into the mass of the filler, so if they are close but no exactly into it, it will not be as effective. JG 3.7.10

Question:

i had juviderm under eyes 5 wks ago and now have what i think is hyperpigmentation . is there any harm in starting hydroquinone 4% at this time. I can quit if it is too irritating but I don`t want to risk more PIH from the hydroquinone. Also can it fade on its own? thanks

Answer:

might fade on its own but it is OK to use the hyrdoquinone at this point, and don`t forget the sunblock. JG 3.6.10

Question:

Good evg from Canada Dr. Had CO2 Jan 29 upper lip and chin still reddish but yes, i am being patient. Want 2 have Sculptra in cheek area have Dermalive in nlf - the Sculptra will not migrate to the nfl area - will it (as this could potentially cause me serious problems - as i am sure u r well aware. Am i good to go. Bless u big much and grateful to have u. jg Ottawa

Answer:

you are good to go, no problems like that should occur, all the best. JG 3.6.10

Question:

Well that makes perfect sense....tissue loss. But then a filler should help? Maybe I should go visit another MD as my derm saw it as a muscle issue not a tissue...issue. lol. Thanks for your help Dr. Garcia :)

Answer:

best of luck. JG 3.5.10

Question:

Hi again...regarding the lip question below...there are no indents to fill. When you purse your lips the sucking muscles pertrude...mine are pertruding even at rest. Uusally high muscle tone is a good thing...in this case, not so much. So there`s nothing to fill in per se. Maybe if I stop talking the muscles will atrophy...*sigh*

Answer:

the tone of your muscles is not high, what you have is some loss of tissue below the skin and that makes the muscle more visible and when the muscle flexes, it folds the skin and creates localized damage in the valley of the fold, so it is seen at rest. I don`t think induced muslce atrophy, as hard as it is to acheive, is worth it. JG 3.5.10

Question:

Just came back from derm and feeling a little discouraged...went to talk about the purse string muscles over top lip -- mine are starting to become prominent. I thought maybe fillers could help but he said only botox for muscle issues. He doesn`t administer botox to that area and wasn`t recommending it, btw. But he didn`t feel fillers would be the solution. Thoughts?

Answer:

if there are no lines at rest when the muscles are not moving I would not use a filler, otherwise if you fill in the area that is depressed upon animation, it might look lumpy when you stop animating. JG 3.5.10

Question:

Hi Dr. Garcia, I hope you`ve been well. I`m just writing to ask about some restylane vital I had injected into my upper middle cheeks just under the orbital area. I have a submalar implant under it. It is swollen and I`m wondering how long after the injection does it usually take to go down so I can get an idea what it`s going to look like. Thanks very much once again.

Answer:

I have seen it stay swollen for up to two weeks in some patients. Ice and a little massage should help. All the best. JG 3.4.10

Question:

I had radiesse injected directly into my cheeks 2 years ago and bruised and was swollen for weeks very badly. I am now ready to be injected again but this time I will do it intraoral. My question is will I bruise and swell with intraoral? thank you

Answer:

the same swelling and bruising can occur, yes. JG 3.3.10

Question:

I had evolence injected in a horizontal line above my lip almost a year ago. It made the area look worse. How long, if ever, does it take for evolence to go away?