Question:

I just read the question from someone else about tear trough implants. If they don`t help with tear trough hollowness, then what are they used for? I`ve been considering them myself. Have you ever used them, Dr. Garcia? What are the relative advantages and disadvantages in your view and experience? What is the risk of extrusion? And how often are the edges visible?

Answer:

I do think they help but in that patients case I did not think that would help in their case. I prefer fillers most of the time over implants. The problem with implants is they are rarely the right shape or size. That area needs more variability.JG 8.15.13

Question:

What is your opinion of tear trough implants? Had an overly aggressive bleph 12 years ago that left my R lower lid hollow; the surgeon also cut the arcus marginalis on that side, for some unknown reason. So the hollowness of the lid is made worse by the marked descent of the malar pad. It looks like an orbital fracture. I`ve had to have 2-3 ml of Restalyne injected there every 6 months or so just to hold the lid up. A different surgeon is now recommending 1) elevating the malar pad, 2) tear trough implant, 3) continued use of Restalyne, but less than I have been needing, since the surgery should help with the volume there. What do you think of this plan? Will the implant be visible through the thin skin of the eyelid? Will there be a marked step-off that will be detectable? Thank you!

Answer:

I can see how lifting the malar fat pad will help but not sure why the need for the tear trough implant. It will not fix the hollow created by the loss of orbital fat. Hard to say more without seeing pictures. I wish you the best. JG 8.15.13

Question:

I had a botched laser surgery years ago that resulted in a chunk of fat missing in my lower cheek area by my mouth folds... I have tried various hydroaluic based fillers like Restylane and Voluma in decent sized amounts before and they really didn`t even make a dent in fixing its appearance... I kind of gave up on it for a while but I`m looking to try and repair it somewhat, it`s mostly noticable when I smile, left side of my face, giving my face an asymetical look. What do you suggest to fix this concavity? I will enclose a pic. Thanks. http://i41.tinypic.com/2gt7ok7.jpg

Answer:

I might use Sculptra in that are as I think it will replace the fat in a better area than the other HA fillers. Having said that, the appearance while relaxed should improve but when you smile, no matter how it is filled, there will remain some degree of asymmetry, sorry. JG 7.4.13

Question:

Thank you for the answer about the MedPor implants. But you didn`t say if you concur with my surgeon that replacing it is dangerous. He keeps talking about nerve damage, but if he routinely replaces other surgeons` implants, why should replacing his own be any more dangerous than others?

Answer:

I do not think it is dangerous per se, but it will be difficult to remove and in that process tissues and nerves can be damaged if one is not experienced in dealing with MedPor implants. Silicone implants are much easier and therefore safer to remove as they are flexible and do not adhere to the tissue the way that MedPor implants do as they are rigid and allow the tissue to grow into the implant. JG 5.13.13

Question:

Hi, Dr. Garcia. I had medpor cheek implants placed four years ago and loved them. Foolishly, I let the PS who placed them talk me into letting him trim the lateral edge of the R implant because he thought it was too projected. Unfortunately, it left that side of my face distinctly flat, so I`ve spent more than $10,000 on fillers trying to correct it, but it never gets it right. I`ve used a dermatologist for this rather than my surgeon because I fear, perhaps irrationally, that he did it deliberately to create a revenue stream. Anyway, he won`t replace it because he says it`s too risky. Is that right? I`ve gone to other surgeons who all agree that it should be replaced but they don`t use medpor and they don`t replace cheek implants. They all send me back to the guy who did it because he`s renowned for his ability to revise other surgeons` cheek implants. But he won`t revise his own. What should I do? Thanks,

Answer:

Highly unusual that the original surgeon will not revise his own work, all I can suggest is to contact MedPor and ask them for a list of surgeons that use their cheek implants. Wish I had more. JG 5.12.13

Question:

What do you think of the soft temporal shell implant designed by Barry Eppley and marketed by Implantech? Sculptra needs to be repeated too often as I age and I`m looking for a more permanent solution. I am concerned about visible margins, but it`s made of soft pliable (and trim-able) silicone. Where would the incisions be placed for this implant? Thank you for your opinion.

Answer:

when placed at the correct depth the edges will likely not be visible. The incisions are placed in the hair-bearing scalp, so they would not be seen. It is an option if you are willing to have surgery. JG 2.11.13

Question:

I had Medpor malar implants placed 4 years ago. I like them but they don`t project laterally enough for me. Removing them is very difficult, as you know. Would you think it a safer option to have tiny, individually carved additions placed along the lateral cheekbones rather than to try to remove them and replace them entirely with larger ones? (Alternatively, could small silastic implants be hand-carved and placed along the lateral cheek bones?) My surgeon is reluctant to try either adding tiny new implants or removing them entirely and starting over. What do you think? A complicating factor: my surgeon transected the right buccal branch of my facial nerve when he implanted the first round. I have only about 20% of motion on the right side of my face now. Thank you.

Answer:

I think it might be better to use longer term fillers to achieve the effect you desire rather than having more surgery as you already have had some issues and more surgery would be more difficult than the first. I wish you the best. JG 2.10.13

Question:

Sounds good, but would it be a problem to use bone matrix substitute, or other custom made materials on the jaw and side areas, if i already have a chin implant of silicone? I hope i don´t have to remove the chin-implant? And is the bone matrix substitute, or other custom made implants of porous material?

Answer:

Not a problem and they are rigid and in some cases are porous, it depends on what the surgeon orders. JG 12.20.12

Question:

Well then, do you think that fastening silicone implants with screws increases the chances for infection? (for all bacterias) Thank you on advance.

Answer:

I do not think that would affect infection rate. JG 12.2.12

Question:

Medpor cheek implants 3.5 yrs old. They look terrible. They`ve hardened my face and given me a strangely masculine rather than more feminine look, which was the original intent. I look like one of those plastic surgery disasters that the media ridicule. Honestly, as bad as Michael Jackson, minus the pigment changes. The surgeon who placed them says if they`re removed, my midface will comopletely collapse and I`ll be left with dents on my cheeks in the exact shape of implants. That would be far worse than what I have now. Do you agree with him? Wouldn`t the scar tissue hold up my midface and also fill in the dents? I feel as stupid as I as I look. I guess I deserve this fate for choosing to put them in in the first place. Do you have any suggestions at all? I`m sorry to take up your valuable time with my selfishness.

Answer:

I do not think you would be left with dents as long as they reattach the tissue back down to the bone, but you will look like you did before, maybe some looser skin. You could consider some Sculptra to the lower face, below the implants on the cheek to give you a rounder look and take the overly sculpted appearance and soften it, that might work and would avoid the surgery to remove them. I wish you the best. JG 10.26.12

Question:

I mean: What made bacteria suddenly develop there then? If the implant itself is not the issue.

Answer:

It ocurred during the implant insertion. JG 10.9.12

Question:

Sorry to ask again Doctor. But i will have it removed in approximately 2 weeks. I should have treated the infection immediatly 4 months ago, but it was hard to understand that it was an infection when it occured. You said the faster i remove it the faster i can do something to achieve the look i want. But since i suddenly had a small reaction to the medpor implant. Will it be a problem having medpor jaw-chin implants in the future(in 1-2 years)? I have a chin implant which i didnt react to at all. Thank you very much for you time and patience.

Answer:

implants in the nose are at high risk for infections, the other areas are much less, so you can likely use the MedPor implants there. Best of luck. JG 10.8.12

Question:

Ps. The liquid is also more clear-looking. The amount the liquid is decreased, but it still leeks out.

Answer:

I think it will not heal as long as the implant is in there. JG 10.7.12

Question:

Hello again Dr.Garcia. The bacteria results of the white-like liquid just arrived, but they showed no sign of bacteria! Have you any idea of what they can be? The doctor would not give me any more antibiotics, and told me to wait and see. He had no idea of what it could be. The red scar-lump is lighter now, but some liquid is still come out. But the liquid contains blood and is now much more yellow looking.

Answer:

it could be a sterile abcess, but it also could be somehting they did not look for, something like an anaerobic infection, and they should also have looked for an acid-fast bacterium and that can take up to one month to grow in culture. I am afraid you will need to have the implant removed for the problem to stop and the area to heal on its own. Sorry. JG 10.7.12

Question:

Sorry to ask again Dr. But i am still waiting for the bacteria test results. I am on antibiotics for 12 more days. But the red lump is actually a small pit where the white-like liquid comes out. My surgeon had no idea why there was a pit in the skin, but is it because the infection is serious there? The small pit sort of syncopates the skin and makes it red. Out of it comes white liquid. Is it a good sign if the liquid bisects?

Answer:

there is a pit because the pressure from the infected material thinned the skin out some and likely you also lost a little bit of the tissue beneath the skin, that usually fixes itself in time.It is good if the liquid comes out, yes, but that will not make it certain that the implant will not still need to be removed for the infection to totally clear. JG 9.23.12

Question:

Well i have just started a long-time well known antibiotic-cure.Is the chances good on becoming well by the cure? Because it did not seem to my that my surgeon had seen this type of small infection before. He was also really surprised of the infection evolving over a long period of time, and that it was not painful for me at all.

Answer:

It is possible, yes, but when there is a foreign material in place, like an implant, the success rate is less compared to when there is no foreign body in place. Infections around implants are commonly seen to grow very slowly and many times they are not painful as the skin can stretch. JG 9.20.12

Question:

Thank you very much for a quick answer Doctor. But how long should i wait and how long does it take for the body to break the blood down and absorb it? Thank you again on advance.

Answer:

No way to tell, buy the blood should be gone in a couple of weeks or so. All depends on the amount of blood. JG 7.26.12

Question:

How long after implantation does it take for tissue ingrowth to be completed with ePTFE implants? After that time, is the risk of extrusion significantly diminished?

Answer:

6-12 months, and yes. JG 7.24.12

Question:

Morning. Would like to know if 15 mins in an Infrared Sauna is detrimental to a silicone Chin implant or Dermalive or Juvederm fillers. I read that no silicone implants should be subjected to it. Your opinion pls. Thank u from an appreciative Canadian...

Answer:

I see no problem with the infrared sauna and those issues. All the best. JG 6.26.12

Question:

Thank you very much for your prompt and informative reply to my question about nostril implants. I truly appreciate your opinion. You didn`t say if you think continuing to inject the nostrils is unsustainable in the long run. I`d MUCH rather keep doing this than undergo any more risky surgery. Do you believe that my surgeon correct -- that soon he won`t be able to inject any more filler due to scar tissue from repeated injections? If that were the case, then how is it possible that people keep having fillers injected for years and years? Sorry for two postings. Thank you again so much for your time and help, Dr. Garcia.

Answer:

Sorry, I do not think the repeat fillers will give you any long term sustained improvement. I do think that at some point in time that the fillers will become more difficult t place, but not any time soon. Some people cannot have surgery for medical issues and continue to have fillers for many years. JG 6.4.12

Question:

I`m having a facelift and my doctor recommends mandibular implants at the same time to augment my small native jaw. I think it will look better and might make the facelift sturdier as he says but I wonder about the long-term effects. With my jaw pushed out, even by a few centimeters, as I age, will I need fillers in my lower cheeks to make up for the inevitable soft tissue gap between the jaw and the cheekbones? I`m worried that we`ll be creating a scaffolding that will then need constant tenting over it. Does that make sense? Do you often do mandibular implants with your facelifts? Thank you for your opinion and your time, Dr. Garcia.

Answer:

Have never had to us a mandibular implant at the time of a facelift. It will not make the cheek itself look sunken, but you will look different as the boney proportions will change. All the best. JG 6.3.12

Question:

Hello there Dr.Garcia, does your office or the hospitals where you operate at have places and equipment to sterilize facial implants or silicone facial implants? typically dry heat sterilization equipment? thanks.

Answer:

They have autoclaves, yes. JG 5.29.12

Question:

Hi Dr. Garcia in july `11 I had a tummy tuck and chin implant mainly cause I thought I had no chin. one week later i got a heavy dizziness with tingling down both hands. endless doctors later they could not find anything. I started having ringing, clogging and popping in ears. Was told tmj i that chin implant made it worse. Can a chin implant make this worse. Would removing it help

Answer:

I cannot see how a chin implant would affect your TMJ, it would not change the motion of the TMJ. If you have run out of options, you can always remove it bu I doubt it would help. JG 5.9.12

Question:

hey dr garcia! i had a sliding genio about 6 weeks ago. soon rigth after surgery my bottom lip lower teeth and chin were all numb. now my right side is slowly returning but my left side of lip is still numb and so is my right side of chin..no sensation whatsoever. when i clench my teeth i feel a funny nerve feeling in that same nuumb left side of bottom lip. this started recently. will this go away and will my sensation come back with time?

Answer:

it will take time, maybe months, but it should all get. No way to tell how long though. JG 3.30.12

Question:

I have had my cheek bone silicone implants for 8 years now and have experienced some fat loss in that are due to age. Now, you can see a separation (shadow) between the bone and implant. To avoid another surgery, could I just get a little temporary filler placed on it? And if so, which one should I choose?

Answer:

I would use Sculptra, not an immediate fill, fills slowly over 6 months, but will last longer. JG 3.28.12

Question:

Ok thanks, so can you tell me all the various methods are there that you can use for temporal augmentation in my case where the hollowing is deepest about 1cm above the zygomatic arch? thnaks

Answer:

I would not use an implant, I would use fillers such as Sculptra in that location. JG 3.19.12

Question:

Ok thanks, but can you explain to me how the nerve will still be at risk?

Answer:

once you go above the superior edge of the zygoma, the nerve courses through that tissue on its way further up. Also, since the space between the arch and the temporal fossa is small in that area, an implant can also cause pressure on the temporal muscle which can cause atrophy and muscular imbalance leading to bite problems. JG 3.19.12

Question:

Ok, i have heard of doctor`s making implants specifically for the patient`s condition, so what if the implant is thicker closer to the bottom?

Answer:

might look fine, but you would still be putting the frontal nerve branch at risk, I would not perform that. JG 3.19.12

Question:

I`am sorry but i don`t understand, will putting the implant under the superficial temporal fascia put any nerves or veins ar risk?

Answer:

it should not, as long as the fusion line of the deep and superficial fascias is not split anteriorly going onto the forehead, if that occurs, then it could damage the nerve.JG 3.19.12

Question:

Ok thanks, but i have been told by plastic surgeons that placing the implant under the muscle is far more intence, and they told me the deep temporal fascia has no problem stretching to cover the implant, they told me ( There is no problem with the deep fascia stretching to cover it and the fascia often released along the lateral orbital rim and superior zygomatic arch to accomodate bigger implants . I now live in las vegas, so is it possible for you to put the implant under the deep temporal fascia for me if i come to see you? thnaks

Answer:

well, superior to the zygomatic arch is where the frontal nerve runs, so I would not put it way down there, not sure why you would need an implant that large anyway. I will not put it under the deep temporal fascia or into the muscle, there is no need to do that and it will damage the muscle for no good reason. I would need to see you in consultation to determine if I can do and achieve the correction you are looking for. JG 3.19.12

Question:

Ok, so where do you put the temporal implants under the temporal muscle?

Answer:

below the superficial and above the deep fascia, never going into the muscle nor under the muscle. JG 3.19.12

Question:

Thanks, so if its placed there does it reach down to the zygomatic arch? because my hollowing is deepest about 7 mm above the zygomatic arch

Answer:

hard to say 100% without seeing you, but if that is the problem area, thin I feel the temporal implant is likely not what I would do as the greatest thickness is much higher than that and you will get minimal fullness down there as the implants are tapered to thin out at the edges. JG 3.19.12

Question:

Ok, so can`t a temporal implant lets say silicone be placed under the temporal fascia instead?

Answer:

it can, but the deep temporal fascia cannot stretch to cover the implant if it were attempted. It can be placed below the superficial temporal fascia, but not the deep. The temporal implant should not go out further than the edge of the crest so the nerve should not be in danger. It should not be placed in a subcutaneous plane though. If you are trying to fill in the lateral forehead in front of the temporal crest, an implant will not fix that, it will need to be remedied with fillers.JG 3.19.12

Question:

Thank you very much Dr. so does it go under the temporalis fascia then?

Answer:

no, but the frontal nerve, although it goes to the forehead in the temple area, the temporal fossa, where the temporal muscle is and where the implant will go, is posterior to the track of the nerve. JG 3.19.12

Question:

Hello there Dr. can you put a temporal implant under the temporal fascia? because i read that putting it on top the fascia puts the frontal nerves at risk, thank you.

Answer:

the location where a temporal implant would go will not be anywhere near the frontal nerve.JG 3.19.12

Question:

Hello Dr.Julio, do you use bone cements or kryptonite bone cement especially for the temporal areas? thanks alot

Answer:

I have never had occasion to use it. JG 3.17.12

Question:

Hi. I had a chin implant put in when I was young, I didn`t really want it, but I was forced by my mother. It was when I was about 15 or 16, I am 22 now. I have been trying to get over it the flaws in my chin, however, it causes me many insecurities and I would like to look into getting it fixed. I was wondering, if I have it fixed, what exactly would a surgeon have to do? I do not have the money to pay him to fix it, I was hoping that since I did nothing to cause this myself, he would adjust it for free? Do you believe this would be the case? Also, I was wondering if it would be as simple as him just realigning the current implant? And if this would happen again after? The issues I am having are my chin appears wider from one side, and thin on the other. I LOVE how I look from one side, but hate it from the left because of how unbelievably unsymmetrical my chin is. On the left side, I can feel the end of the implant. Also, my smile is somewhat crooked, my lip on the left side does not go as far down on the right, and the left side of my chin isn`t completely numb, but definitely is somewhat numb compared to the right side. I assume that since it has been years since the surgery, I must have permanent nerve damage and this is irreversible. Is this correct? Please help me, any information would be greatly appreciated.

Answer:

hard to say what needs to be done to correct it without seeing you. I think most plastic surgeons would revise it for a nominal fee if done within a reasonable amount of time, but your case has been going on for quite a while. I do still think asking him and going to see him is a good idea. He might work out some type of payment plan for you or something. Repositioning the implant can be done but the problem with the lower lip might not get better with moving the implant. All the best. JG 3.16.12

Question:

thank you so much dr! also since ive had two implants before the sliding genio i have a hard spot on the side of my chin where the wing was supposed to be with the implant..i used to feel this even when there was no implant during the period between when i got in removed and right before the genio. could this be calcium deposit or scar tissue..can i ask my doctor to inject that 1/2 inch long hard lump with kenalog to break it down..is that possible?

Answer:

As if has been there for a long time, I am unsure the kenalog will help, might be too hard. KG 3.12.12

Question:

hey dr garcia, my post is down below..i wouldnt dare to do this myself! just wanted a second doctors opinion aand see if it matches with mine..steroids are risky to begin with just want to be certain what would be right according to your expertise

Answer:

Would use Kenalog 10, one half cc mixed with one half cc of saline. JG 3.12.12

Question:

hey dr garcia, i had asked about the swelling after removal of chin implant and genioplasty as the revision..and you said kenalog shot should be ok 6 weeks out.. you said in diluted amounts it should be ok.. can you tell me how mch strength and how much amount is safe to put in 3 spots on the chin (swelling areas)

Answer:

You doctor should know and do thay for you, it is not something you should do yourseelf. JG 3.13.12

Question:

hey dr garcia, my ques in the 4th one down about the chin surgery..so is it safe to start using steroid small dose shots 5 weeks out?

Answer:

I usualy wait 6 weeks. JG 3.3.12

Question:

hey dr garcia, i had a sliding genioplasty after 2 chin implants that failed..i had scarring (scar tissue). how safe are steroid shots in the chin after things have healed? also random ques, with dimpleplasty being so popular now i heard that some doctors also do venus dimples lower back dimples above buttocks on either side of the spine. would you perform this procedure? im having a hard time finding surgeons that have done this so far ive only come across two..

Answer:

in small volumes, and in diluted amounts, the steroid shots are safe. As to the dimpleplasty on the upper buttock, no, I do not perform it, I feel it is unreliable and will likely not last long. JG 3.2.12

Question:

ok, but dont you know the names? can`t you tell me?

Answer:

your board certified plastic surgeon is free to call me. JG 2.12.12

Question:

Yes, but the physician who has to perform the surgery for me needs to know where to get the silicone temporal implants, he can perform the surgery but its been a while since he`s done those, so he needs to familiarize himself with those companies thanks.

Answer:

He can ask the companies that sell him cheek and chin implants. JG 2.12.12

Question:

Hi Dr. Garcia, i was wondering can you tell me the name of the business or company where silicone temporal implants can be bought or odered? thanks alot.

Answer:

They can only be purchased by a physician and they should know the companies. JG 2.11.12

Question:

I have one cheek with a Gor Tex implant. I would like to have it removed. Will tissue stick to the Gor Tex? Will I end up with a hole? Will this be an easy operation? Also I want to get silicone implants in my top lip. Is that the way to go instead of Botox?

Answer:

there is some adherence but I have taken out Gortex implants before without a problem. The overlying tissues might have been stretched out some, all depends on the size implant and how long it was in place. I would not suggest silicone implants in the lips if you are trying to get rid of small wrinkles and I never use Botox around the mouth for fear of muscle weakness causing drooling and impaired speech. JG 1.18.12

Question:

I just posted the question about removing the chin implant and want to add that I am seven months post-surgery.

Answer:

It should still help to remove it. JG 1.19.12

Question:

I have written to you before about a painful chin implant and a problem opening and closing my mouth. The pain has extended into my front neck muscles and it causes pain when I eat. A neurologist said it is atypical facial pain and that I can take pain meds or chance that removal of the chin inplant may help. The original plastic surgeon told me if I did this I`d have the pain from hell, and two others said it is possible it may help. The neurologist wouldn` say one way or the other. As it stands, I must wear or chin bra or the pain is so severe,I end up bent over. I have feeling in the chin area. Do you have any comments?

Answer:

I see no reason why removing the implant would cause an increase in your pain. It would either not help at all, or it would feel better. I wish you the best. JG 1.10.12

Question:

Hello Dr Garcia, I have asked a lot of questions about the granuloma in my lip caused by dermalive, I was considering the perma lip implant and you had said you would be worried that if the granuloma is removed the implant may not stay in place. Well the doctor said we could take natural tissue form the other side of my lip once the granuloma is removed and then put the implant over it. What do you think? Im really upset and just want to get on with my life. If you dont agree do you have any other suggestions. So far this seems like the best option but id like your opinion. Thank you so much.

Answer:

placing a solid or semi solid implant over the tissues of the lips is easy to do, but if there is an uneven surface underneath the implant, it might not look or feel straight. You can certainly try it and if you do not like it, the implant can be removed later if it is not comfortable for you.JG 1.9.12

Question:

Feliz ano nuevo Dr Garcia,I trust 2012 will be a great for year for you! I have a question to ask, is it safe to get fillers on top of cheek implants and is there a risk of infection with doing this? I have medium malar ePTFE coated silicon implants (also my PS told me that they are easier to remove that Medpor?) and was wondering in your professional opinion what you thought? Thank you so much!

Answer:

Those implants are easier to remove, yest. I think it is safe to inject over the implants, and there is no difference in infection risk. All the best for the New Year. JG 1.3.12

Question:

Some years ago a dermatologist inject my cheek and lower lid with kenalog to dissolve scar tissue but it eroded most of the tissues of my midface. I`ve been getting by with Restalyne under the eye and Sculptra in the mid-face, but it never looks right. It`s always variable and often looks swollen after injection and then deflated (with an ectropion) when it`s time for another round of injections. I`ve consulted with a few plastic surgeons, and a famous facial reconstructive surgeon is recommending a spacer graft with hard palate. He considered an orbital rim implant but said he`d have to free up my entire midface to place it and that would be too dangerous in light of my histroy. Another surgeon told me that he thinks that a hard palate graft is completely crazy. Is this really an unusual (and unusually risky/ crazy ) surgery? While my face never looks right, I can sometimes have about a week or two each year between the waxing and waning injections when I at least don`t get stares on the street or questions from strangers about what happened to my face. Will the spacer graft make me look more normal or is it likely to make me look permanently distorted in the way that I do after being injected? I`m embarrassed to say that this whole situation has caused me to be depressed for years, which I never, ever was before this injury, It`s really hard to make these decisions when I`m getting conflicting medical opinions, since my physical health and my emotional health are on the line as much as my appearance. I want to make the best choice possible. I very much appreciate any wisdom you can give me. What would you do if you were in my situation? Or what would you advise a close friend or family member to do? Thank you so much for your help.

Answer:

Your scenario is hard to evaluate for what is needed. If you cand send me some photos to drgarcia@lvcosmeticsurgery.com I might be able to give you more info. JG 1.3.12

Question:

Hello, again. I am considering removing a multiple stitch chin implant that was done in conjunction with a deep necklift. Can it be done and ,if so,how long is the recovery?

Answer:

can be done and I think you should be back to full activity in 3-4 weeks, got to take it easy the first two weeks to avoid bleeding. JG 12.28.11

Question:

Sorry I meant ENT.

Answer:

Plastic surgeon would be best. JG 12.26.11

Question:

Happy New Year! I am the same person who had the chin implant and a neck lift. When I move my mouth, the muscles in the neck are being pulled. I now feel that I have rubber bands around my mouth and in my neck after seven months Who can treat people like me with SERIOUS problems ..a plastic surgeon,an EMT or a neurologist. Again, my PS has shown no interest in talking about it.

Answer:

I think it best to see a plastic surgeon, but you sound like you need to find a new one. All the best. JG 12.26.11

Question:

I forgot to ask if wearing a chin bra will make my condition worse. Merry Christmas and Happy New Year!

Answer:

no, it will not hurt. JG 12.23.11

Question:

Will wearing a chin bra make my condtion worse and whatis is the best medication for my condition pain-wise? I should have included these questions in my prior post. Thank you again! I have a close friend in Las Vegas, I`d love to . come out ot get a personal consultation. Merry Christmas and Happy New year.

Answer:

will not make it worse, and as to pain medicine, I ask the patients not to take any pain medications that can cause blood thinning for two weeks after surgery, then usually Advil or Motrin is what we try to use. Please feel free to come to the office for a consultation if you are in town. JG 12.23.11

Question:

I had a facelift, a necklift, a chin implant and fat grafting to my cheeks and mouth areas. I now have bumps and swelling on my inner cheeks and gums. I have trouble moving my mouth below the implant. This has gone for seven months. I must wear a chin bra to get some relief from pain and discomfort. My PS says he doesn`t have any idea why. Can you help? Margo

Answer:

well, the muscles of the chin need to be lifted off the bone to place the chin implant and their ability to reattach to the bones will influence their function. Also, injecting fat into the mouth area, if the muscles that help the function in that area are bruised or scarred from the fat injections, they could be the problem. Besides massage for the fat injections there is not much to do. If it were due to the chin implant, if it is bad enough you could consider removing the chin implant and reattaching the muscles to see if the function improves. Sorry to hear about the problems. I wish you the best. JG 12.23.11

Question:

No, my chin is not long, its just not square. I apologize for the misunderstanding. Its normal sized, but round. What type of chin-implant would you suggest? I`ve seen this implant called Terino square chin - style I. Could that be something? or do you suggest other?

Answer:

It will help but the center part will also be bigger, there is no implant that will square it without making the central part more prominent too. JG 12.18.11

Question:

How long does it take for the scar tissue capsule to form around a silicone premaxillary implant? Upon removal is it possible it would leave some augmentation( even if its only in for a short period), and if so can it be flattened with 5fu?

Answer:

there will be some minor amount after 6 weeks, and it will continue to grow for another 4-5 months. The degree of improvement it would leave is relatively small though, due to the thin tissue over it. It can be flattened with 5FU, yes.JG 11.7.11

Question:

Hi Again, I`m the one who had the implants submalar and premaxillary in for 3.5 weeks and removed 5 weeks ago...the swelling is starting to subside and I have very noticeable sagging n/f and marionette lines my cheeks seem to have dropped, I feel like this may be permanent and might require a mid face lift..I was told it was a reversible procedure..what do you think?

Answer:

I think it will take at least 6 months for things to settle in, I would not make any decisions until then, I think a lot of it is reversible. JG 11.1.11

Question:

Hi dr Garcia I have been posting on here with my concerns since I had my cheek implants placed and then removed and I appreciate all your answers and you Babying me through it. My most recent concern of many is that my incision scars above my gums are creating lumps in the left side when I animate. What can I do to make them go away?

Answer:

Massage and after 6 weeks, if very hard, you caan have your surgeon use some 5FU. Hang in there. JG 10.23.111

Question:

Thanks for your response regarding my nerves (lip twitch) and muscles in my face (after gortex cheek implant removal).Dr, do you think it could possibly be “Synkinesis” that has caused this whereby my nerves have happened to become mis-wired while regenerating and resulting in this lip twitch with closure of my eye. If so, will this be permanent, would botox help with the lip twitching when my right eye closes as it seems to come from the nasolabial region. Do you think I have not healed properly or as you mentioned it could just be nerve stretching and scarring as result of the removal? Would botox maybe help? It is only slight but does distress me a little. I am seeing my PS in 2 weeks time. Muchisimas gracias, agradezco su ayuda, usted es una estrella!

Answer:

Synkinesis is a very low probability, more likely is the tethering and scarring that will get better. Botox can help with the twitching, yes. I think the nerves are stretched and irritated but were not cut, so in time, it will get much better. Nerves are more easily cut during the placement rather than the removal. Give it time and all the best. Y es un placer ayudarle. JG 10.17.11

Question:

Hola Dr Garcia! You answered a question of mine a few months back telling me to hang in there regarding my face after having goretex implants removed with regards to the muscles etc. It has now been 3 months and my face has slowly improved, but now I can’t see much more improvement, I am still unable to lift my upper right lip and pull my lip up on the right, at the moment I can only do this by a couple millimeters. I feel as if my healing has now halted and the muscle is stuck. I think it is the Zygomatic muscle responsible for this, however, I have noticed this past month that when I blink my r.side lip automatically twitches/ lifts up in conjunction when I blink just for a second almost as if the blinking action is causing my lip to pull upwards. Is this nerve damage or are muscles still in the process of healing? I am worried and hope to get my lovely smile back and should I be worried about my twitching of my lip - what do you think? Thank you ever so much for your patience and kindness in replying!

Answer:

I think it is related to nerve stretching and scarring, but the fact there is twitching and some movement tells me the nerve is not cut. Progress will likely be slow form here on out, massage should help the muscles move better in time though. Its tough waiting but more intervention is not safe or warranted at this time. All the best. JG 10.16.11

Question:

I`m considering orbital rim implants to support my lower lids following severe ectropion from an aggressive bleph. I had a canthopexy and two canthoplasties and still have the problem. What are the pros and cons of the ORI from your perspective? Some surgeons say they will help by supporting the lower lids; others say they will make the ectropion worse by exerting a downward pull on the lids. Which is correct in your view? Thank you for your help.

Answer:

well, the problem is that it might give some structural support but at the same time as they will enlarge the area, they will pull on the skin and may potentially make the ectropion worse, although not in all cases. As your case is from an aggressive blepharoplasty, I would doubt you will get any benefit and the negatives outweigh the positives, in my opinion. JG 10.13.11

Question:

Hi Dr.Garcia, I had cheek implants about 8 months ago. They were sewn in and not screwed in. Within the first few weeks I noticed a slight indentation below my right eye and that the right implant appeared very slightly lower than the left. I had a bad infection on the left side - however it did resolve within a month (antibiotics etc). Now that it has been 8 months I have noticed that the right implant is not as pronounced as the left. No one else has noticed it, in fact I have to point it out to them. Should I have the implant repositioned? I am honestly afraid to redo the surgery because it cost me several weeks off work originally. The surgeon believes the difference is so subtle that it should not be redone. Is it possible that it shifted - even after 8 months? Thanks

Answer:

It might be best to leave it alone if other people do not notice it as the difference form right to left is likely more due to the scar tissue that developed on the left side from the infection and not from the right implant moving. After 6 weeks it is hard for them to move. Removing scar tissue on the left is risky and moving the implant on the right up could make it more visible yet not achieve the symmetry you desire. JG 10.14.11

Question:

Hi Dr. Garcia, recently I asked you about using a fibrin glue sealant to help prevent sagging after cheek implant removal and you noted that it would not provide any significant support. Aside from not being very effective, could the fibrin negatively effect the outcome by making the scar tissue capsule more visible and noticeable on my cheeks if I were to use it? I`m asking b/c I`ve read that the substance of fibrin plays a critical role in scar tissue formation. Thanks again!

Answer:

really no significant negatives, it might make it less swollen right after the surgery, which is good, but unpredictable. JG 10.13.11

Question:

Hi Dr Garcia, Im the one who had the cheek implants and premaxillary implant put in and removed 3.5 weeks later. I am almost 2 weeks post op removal and am still swollen (not badly) around the cheeks and nose and lower face. I have two concerns. 1) It looks like my face is sagging, I have jowls and smile lines that were not present before, Im wondering if this could be caused from the swelling making my tissues heavy and causing them to droop, and if this will resolve once the swelling does, normally I have very little fat on my face and no smile lines. 2) My nose is very swollen with wide upturned nostrils and is not back to my prep nose-hopefully this is due to the swelling aswell?

Answer:

All normal, the implants were not in that long, so as the swelling goes down, the skin will shrink and reattach. Things will continue to get better, but slowly. JG 10.11.11

Question:

I have been told that removing cheek implants or any implant for that matter can cause the skin to sag, not from the swelling, but from the muscle being lifted off the bone and not reattaching in the same position after removal. Do you agree with this? I had mid face implants in for 3.5 weeks.

Answer:

I would agree with that statement, that is why some sort of reaatachment should be done if possible. If there is an infection, one may just be able to remove them and then suspend them later. JG 10.6.11

Question:

Thank you for the rapid response about the fibrin glue sealant Dr. Garcia! I really appreciate it. Just a quick follow-up: The other option I was considering to prevent sagging following the cheek implant removal was fixing the inner lining of the implant capsule to the outer lining of the capsule that formed on the bone with several sutures at the zygomaticomaxillary junction. Do you think this would be effective? My surgeon has two reservations about this approach: (1)He is not convinced that this would help b/c whenever he has removed implants in the past there was no capsular layer on the bone itself to which the implant capsule could be sutured. - Has that been your experience as well? (2)He is concerned that this option could result in a dimpling of the tissues directly above the capsule. Do you think this would help and if not is there anything else that could be done intraorally at the time of removal to minimize any potential sagging? Thanks again...Have a great weekend

Answer:

I think suture are fine too, but the most reliable is for a small screw to be placed into the bone and then suture the capsule to the screw, that creates suspension and also closes the pocket of the capsule. JG 10.6.11

Question:

Hi Dr. Garcia, I am having my silicone malar implants removed (afer 9 years, now 32) soon and one option that I read about to help minimize sagging was a fibrin tissue adhesive which would be applied within the pocket to help keep the tissues suspended as they heal. Do you think that would help? I was concerned that it might keep the tissues which are attached to the implant capsule from naturally moving with the rest of the tissues. Would that be a problem? Thank you

Answer:

Do not think it will do much, good or bad. JG 10.6.11

Question:

Hi Dr Garcia, I`ve been looking through your older posts from some people that had there cheek implants removed. I had mine removed large malars in submalar area and small premaxillary implant in on sep 2nd out on sep28th. My healing is ok it`s only been 5 days, my cheeks have come down a little, I can smile and move my upper lip although movements feel tight around the incisions and swelling.My nose is causing me the greatest concern since it is still wide and snout like, not as bad as it was but not even close to pre op, is this only swelling or could scar tissue have already formed in 3 weeks? Is it possible there will be mounds left where the implants were, or sagging even in this short time? I read of one girl who still had swelling 5 months after removal...when can I truly expect to go back to my pre op look, this has been one of the worst times in my life, thankyou for your answers and support.

Answer:

well, there is tissue aggravation , but not true scar tissue. I think that the area where the premaxillary implant will settle down quite a bit, but because those muscles move so much while talking or chewing, it will take longer than other areas where there is not as much motion. I think having swelling still there 5 months after the removal is quite unusual. Give it some time for your case, it has been a short time and I think there will be lots of changes in the next few weeks. JG 10.3.11

Question:

Hola Dr Garcia, espero que estes bien! You have been a treasure with your advice re cheek implants - I have had a few issues regarding cheek implant size and infection. I have a few questions for you: 1) What do you think of goretex as an implant for cheeks, are they prone to infections even several years after implantation, what type would you use, what do you think of silastic instead as I don`t want to worry about infections in the future. 2) Will having a medium size instead of a large extended malar implant equate to less swelling as I had large previously and my swelling took an exceptionally long time do dissipate, my ps reckons that it could have been due to too much strain on my tissues and bruising (however I dont recall having bruising on my cheeks post op?). 3) Normally how long should swelling take to go down? Could it be that I swell more than average, is there anything I can do to prevent this pre-post op? Thanking you so much, your wisdom and kindness is so appreciated from the bottom of my heart! Sorry for all the questions but I really value and trust your opinion!!

Answer:

I normally use silastic silicone implants as there is a greater variety of shapes and size, but the infection rates short and long term are essentially the same. The size of the pocket required to place the implant influences the amount of swelling, but the difference between a large and a medium is very small and likely would not be visible externally as a difference. Most of the swelling on cheek implants the first go around is about 50-75% in 6 weeks and then the rest over the next few months, it would take longer on a second surgery. Besides ice afterwards and avoiding blood thinners, there is not much more you can do pre or post. All the best. JG 9.9.11

Question:

I am 72 hours post op large terino shell submalar augmentation and small premaxillary implant I know it is early but my surgeon is offering me little comfort to my concerns I can`t move my upper lip although I can feel it and I am very swollen like a pumpkin..can I expect 50% of the swelling to be improved within 3 weeks? And is it likely I can`t smile or move my face due to swelling rather than nerve damage? I realize I need to be patient it is just very scary.

Answer:

I think the swelling will be down at least that and the tissues should start moving better, remember that the implants are placed underneath the muscles, so that makes the muscles not work well for a bit, but it will get better. I do not think it is time to worry about nerve damage, that is rare. All the best. JG 9.6.11

Question:

I am a 48 year old female who had a chin implant and lipo done on 8/18. I was happy with my results until a couple of days ago when I noticed a dime size indention in my chin. When I felt around the indention I could feel something like the pointed end of the implant. It comes to a point at the bottom of my chin right by the indention so I don`t know if the indention is from the implant not fitting right or from too much lipo is this area. The pointed end sticks out at the bottom of my chin and feels exactly what I believe the implant would feel like and it is definitely noticeable. The other side of my chin is perfect and I can`t feel the implant at all. I realize that I still have swelling and that I am less than 2 weeks out of surgery but I am starting to get worried. My next follow-up with my ps is not for another 3 weeks. Is this something that I should be concerned about or maybe something that will get better or should I contact my ps and let him know now in case it is something that needs to be corrected now. I hope I don`t have to go back and have surgery again to fix anything :(

Answer:

I would call them and see if they want to see you sooner, I do think it might get better as things settle in, hang in there. All the best. JG 8.30.11

Question:

Hi Dr Garcia, you very kindly advised me with regards to my cheek implants and their removal. You were absolutely right, I had a slight amount of skin sag to the left side of my face where I had prolonged swelling for several months due to infection etc. The right side looks as it did before as in nice and taut however there is now a slight fold near my nasolabial region on my left side which I feels on the one side ages me when you compare to the other side. What would you suggest as the best course of action for me? I am soon to be getting fillers for the interim period but was wondering when I get my cheek implants replaced in approx 6 months time will this help to lift the area that got sretched and help lift the slight fold or would I need a minimal lift of the cheek tissues so it looks similar to the right side? Thank you, so much!!

Answer:

Fillers like Sculptra for now and I do think the new implant will lift and tighten things, hang in there. JG 8.21.11

Question:

Thank you so much for taking the time to answer my question about the malar implants. I am so grateful for your information and the hope you`ve offered me. Is this something that you could help me with -- i.e., possibly reattaching the muscle and/or repairing the nerve? If not, whom do you recommend? I know you have a (wise) policy of not referring posters on this blog to your colleagues, but I don`t have the money or disposable time to fly all over the country for consultations, especially if they will only yield the same kind of response I have received at the facial nerve center where I am currently seen -- i.e., there`s nothing that can be done and it`s not even worth ordering any studies to confirm that opinion. Thank you again, Dr. Garcia. And God bless you.

Answer:

I think you should go see someone who does this all the time, I might suggest seeking out a university based plastic surgeon that performs facial reanimation after strokes/paralysis, http://uwmedicine.washington.edu/Patient-Care/Our-Services/Medical-Servi... All the best. JG 5.23.11

Question:

Hi, Dr. Garcia. I notice that you frequently post here that you like to use Sculptra to build up the zygomatic arch. Several years ago, I had small cheek implants placed and have been using Sculptra to build up the zygoma and temples. I wish I had known when I had the cheek implants placed that I could have (and should have) had extended implants that covered the zygomatic arch (and, in fact, temple implants too), since those areas are quite deficient in me. I was presented only with one option: small malar shells. The surgeon who placed the implants now doesn`t want to remove them and replace them with differently shaped ones and with temple implants, though he is a craniofacial specialist and routinely places these. I don`t understand why, except that he obviously stands to make more money with repeated Sculptra injections than with a single surgery. Unfortunately, I`m working class and don`t have money to spare at all. I need to minimize my expenses, so I`d like to correct this problem surgically and decrease the need for soft tissue augmentation. Can you tell me if there`s a common reason from a surgical standpoint not to correct this particular deficiency (zygoma and temples) with implants rather than Sculptra? I`m frustrated and broke! Thanks so much for your help and honesty, Dr. Garcia. I wish I lived near you. I`d love to be your patient.

Answer:

I see no reason to not correct a problem that has been identified, in experienced hands those implants should do well. As a craniofacial surgeon he is likely able to do that for you. He may just not want to undertake it for purely cosmetic reasons and your only remaining solution is to seek out another surgeon in your area that feels comfortable with it. All the best. JG 4.22.11

Question:

Hello Doctor, I have a question, I bumped my chin pretty hard a few hours ago and i have a chin implant. Now my lower lip and the skin below my lips going toward my chin wont stop quivering. Im scared the implant moved and now its pressing on some nerves or something. it doesnt feel or look like it moved....do you think this will go away??

Answer:

I think the implant is fine, more likely is that the muscles or nerves were bruised and that will get better with time, might be a couple of days but it will slowly get better through that time. JG 4.17.11

Question:

Hi again, just to clarify, did you yes ori/ tear troph implants will make eyes look smaller? Would only getting a very small one avoid this?

Answer:

well, maybe a little recessed is more accurate, since they aperture of the eye opening will not change. The larger the implant, the greater the difference, yes. JG 3.4.11

Question:

I have naturally high cheekbones but am thinking of getting submalar cheek implant to give more fullness to my face, is it possible to place the implants in away so i still have high cheekbones? Is there a special submalar implant used with high cheekbones or size or placement technique?

Answer:

there are submalar implants that come in a few different sizes, all depends on what you need, there is no special one used in patients with high cheek bones to start with though. Placement is the same. JG 3.2.11

Question:

I am planning on getting silastic cheek implants and premaxillary implant, I have reacted to restylane injections in my lips with scar tissue formation, I`m wondering if I should not have facial implants since my body reacted to restylane as a foriegn body substance, should I be concerned about the facial implants being rejected or disfiguring scar tissue forming around them?

Answer:

I think that will be different, there is 100% chance of a capsule forming around the implant, nothing that can be done to stop that, but it will hold the implant in position when properly done. JG 3.1.11

Question:

Hi Dr Gsrcia Just wondering if you are doing the perma-sil lip implants.My daughter had them done and she looks fantastic.

Answer:

we have just recently started, they are not for everyone though as they give the lip volume only, it will not give as much shape control as fillers can, and will not help small lipstick lines. JG 1.10.11

Question:

DR.Garcia. I read here previously that scar tissue never dissapears after 1 or 2 or 3 surgeries if they appear of the surgery results, but they soften and get smaller in time. But what if u had 6 chin implant surgeries with procedures such as chin implant removals, replacements and chingrinding? What happens with the scar tissue u develop in the 6 surgery? I mean will the scar tissue then most certain stay and be at the largest and not so much smaller and softer But to some little certain point? I would guess that the scar tissue after 6 surgeries are stronger that in the second? Thank u.

Answer:

the more surgeries you have, the less reduction in scar tissue in most cases I believe is the case. It will get softer and smaller over time, but it will likely be more than after the earlier ones. JG 12.15.10

Question:

Ok. So would 1 month of waiting after the chin surgery be enough then?

Answer:

probably. JG 12.12.10

Question:

Then what if the chin implants are placed with screws so its impossible for any future movements?

Answer:

no, if screwed in, they will not move. JG 12.12.10

Question:

Dr. Garcia. I am goint to have a extended chin implant with a 4mm projection and i have a picture of the desired profile i want. Can i e-mail u my pictures please so u can tell me if it is enough with 4mm ? I am a little insecure of the size in 4mm? will that be enough is my question? or is it better with 5 or 6 mm? Thank you very much on advance.

Answer:

please send them to drgarcia@lvcosmeticsurgery.com

Question:

Thank you very much for your answer, Dr Garcia. I had never heard about temporal implants, in your experience does a synthetic temporal implant have advantages over one made of processed sterile human skin ? Thank you again Paco

Answer:

yes, I have used silicone ones that are soft, feel like muscle and last permanently. JG 11.17.10

Question:

I had porous cheek and jaw implants placed about 18 months ago. It was a big mistake. They masculinized/hardened my face and completely altered my appearance. The surgeon who placed them tells me that he doesn`t remove implants because they are extremely difficult to extract due to the tissue growth into the implants and also because extracting them would leave imprints/dents on my face in the exact shape of the materials removed (due to bone resorption and tissue loss). So I would be left with big triangle-shaped dents on my cheeks and long dents along my jaw. I don`t doubt that these implants are very difficult to remove, but do you think he may be overstating the dent situation in terms of outcome in order to avoid having to undertake the surgery? I don`t want to make this situation worse, and he is claiming that extraction will absolutely disfigure me. I`m really depressed about this. I`m unrecognizable as my former self. To make matters worse, I`ve only recently learned that few surgeons use porous implants, so finding someone who is not only willing to remove them but also skilled in doing so would be a huge challenge. Any suggestions? Would an oral surgeon be able to do this if not a plastic surgeon? Or do you agree that taking them out will make this even worse? Thank you so very much for your help.

Answer:

I think they can be removed, the amount of time that has passed should not show much bone loss or tissue changes. There are many oral surgeons that place those types of implants, certainly a good idea to ask around. All the best. JG 11.15.10

Question:

Hi thkssss for the lift and sculptra answer. Just one more pls, Is sculptra measured the same way as fillers, e.g 1 or 2 vial be equavalent to 1 or 2 vials of scultptra? I know you would be guessing for me but approx. how much cials of scultpra will you use for one side of the cheek for sunken correction? many thanks for your replies it really helped me to clear things out for me! you rock!

Answer:

no, it does not work tha way because every patient has to react to the Sculptra and create new collagen, the older one is the less collagen creation they get. It is hard to say how many vials of Sculptra you would need. I would usually inject one vial and then a second at 6 weeks, even though it takes 4-6 months to get the final fill. If I see a good response I might inject the second vial, if the response is super strong I might wait. JG 10.27.10

Question:

thnx for replying back so quick for the sculptra question. Will it give a similar look to fillers? I really don`t like fillers in those lower half of face. I read somewhere fillers aren`t supposed to be used for lower face but on top of cheek bones. Im talking bout below the cheeks when I clench my teeth the sunken cheeks show up then. Im just worried with the ps here, they say they`ve got experience but there all talk. You use it and I just want to know what to expect. Will it look more natural with scupltra in those areas? like will it pull my face down looking heavy as there is no bone in those areas. Or will it plump up the skin like with more youthful look. Im scared of it leaving me a with a big face and dragging my lower face down. also is there anywhere you can direct me online to see any after shots of this treatment?

Answer:

Sculptra is made to be injected in that area, but there is nothing that says that fillers should only be placed over bone, not sure why they have told you that. I think Sculptra will look natural as it is used over a broader thinner area rather than a direct line or strip like other filers. Try this site for info, www.sculptraaesthetic.com. JG 10.27.10

Question:

My lower cheeks are sunken, you know the cheekbone going down towards the cheeks that part has the sunken look where its my teeth are and further up from the side. Im a female early 30`s. I`m not talking bout the upper cheeks apples. thats the tricky bit. I had fillers injected in those lower part that was sunken, like how men have that sunken look to there lower face, I have that problem. Well the fillers were a no no. It made my face big! I always had a slender face just except for the sunken lower cheeks. I waited and waited for them to die out, it left a stupid look on my face but my cheeks are still sunken(lower half). I`ve been to some surgeons and they started talking bout fillers I was like Oh my god not fillers again. Anyhow I heard of sculpture dermal filler sculptra. I heard it works different not like fillers and its ideal to what problem I have. I want to know if this is true from your experience? and can you tell me if it will give me the same result as fillers? because I don`t want the same result! Will you use sculptra for my condition and does it look more natural then fillers?

Answer:

I think Sculptra is a good choice for a filler type procedure on that location of your face, it works differently than other fillers as it has to have your own body grow the collagen rather than putting something in for an immediate fill. Not sure why the other fillers gave you and unnatural look though, properly done at reasonable amounts, that should not happen. Not realy sure what has caused that at your age either. JG 10.26.10

Question:

I`m reading plenty of people saying fillers left there skin saggy but you`re still saying you never heard of this to happen? but there saying it so it must be true... some ps`s also stated skin can be molded e.g stretched and so on with fillers... like women when there pregnant there skin becomes loose after giving birth. I think it is possible and it does happen. It also happened to me, I`m not imagining it , it did happen. And it stays like that forever unless maybe if you can suggest something?

Answer:

I think pictures would show the story. In most cases if people need a filler their skin is sagggy or loose already. Placing a filler wil only hide the sagging, not reverse it, so once the filler dissolves, since the cause of the sagging was not corrected, the skin will have continued its sagging process which necessitated the filler in the first place, so the face will, by nature, look worse. Genetics are also involved and potentially hormonal issues, most women should only gain 20 pounds with a pregnancy but if they gain more and then lose it, their skin could be stretched out. I know of no occassion where a filler was used on a patient where the skin was stretched past where it was already stretched. If filler was placed to that degree, I guess then the skin might be looser, but that would likely take an enormous amount of filler to be injected. JG 10.24.10

Question:

THANK YOU for the thorough, fantastic answer. You gave me a realistic answer on realistic expectations concerning the downtown time. It helped me make a decision. I will have it, but not now, my fat loss is not as relevant as to really need it desperately, I can wait to have vacations or some other situations where I could count with the amount of days off that you mention and then some more, to be on the safe side. I also realize it can be good or need touch-ups. Yet another reason to do it when I won`t be hurried or worried by time and having to go back to work looking fine. I am not sure if that form of Restylane is available here, yet I know there are many Restylane products (Hylaform, say, and others -maybe one is that one). I will ask a derm and probably, even if maybe as expensive or more, and temporary, invest on some form of Restylane until I am really read for a fat transfer. It is not anyway like I need a lot of filling, so it should not be outrageous in terms of cost. Expensive, sure, but not outrageous and I would not have to worry about the aftermath of looking too swollen or bruised. You ROCK with your advice. Hugsssssssssssssssssssssss.

Answer:

all the best. JG 10.20.10

Question:

hey dr garcia! I have a revision chin implant done about 6 months ago.. I still have swelling in my chin..is it taking so long because it was a revision? Its not hard swelling so its not scar tissue right? Also from the past 3 months there was been an artery right under my bottom lip on the left side that keeps pulsating and is very obvious if you look in that area.. why has this artery become so prominant?? will it go away or is there a treatment for this?? its quite annoying.. :

Answer:

revisions will always take longer for the swelling to go down as there is scar tissue already there and it does not absorb the fluid as quickly. The artery might be more prominent because of the swelling, not many other causes for that. It should get better in time on its own, yes. JG 10.13.10

Question:

Love to my fav doc!! So what would you think about cheek implants installed with the ulterior motive of reducing naso folds? Any chance in heaven? I come from a large Italian fam, with relatives galore sporting those beautiful Sophia Lauren cheeks. Me, you ask? The Italian cheek fairy passed me by...And since everything I suggest to you to reduce the folds is met (wisely, professionally) with adjuration, I throw myself at your mercy and beg Dr. Julio, what can I do?

Answer:

well, nasolabial folds migth get better, but since you are filling in the cheek to a larger height,they actually might make the fold appear deeper in certain lighting. Nasolabial folds are normal, even babies have them, albeit shorter. They occur from the skin of the cheek fallling forward as the fullness of th echeek disappears with age and since there are lots of companies out there that make fillers, and fillers can make the folds look less deep, everyone has gotten to the point where they think nasolabial folds are unsightly. Cheek implants are to be used when eithre one is born with small cheek bones or has lost the fullness of the cheek. Since the are augmenting the size of the bone, cheek implants in many cases wil make the patients look different than they ever have before, so beware. Having said that, a full round cheek is asign of youth, even if there is a nasolabial fold.The fold visibility depends greatly on the ligths that are used when taking aphoto, if the lights are from above, the fold looks deeper and if the flash hits the face directly from the front, the fold looks less deep, even without a cheek implant or filler. don`t fall prey to the marketing of the cosmetic companeis that lead you to beleive that folds make you look old, Think about an overly tight facelift, there is no fold seen, but they look bad, so take your pick. Best of luck. JG 10.5.10

Question:

I am 13 months post-op with Medpor cheek implants, secured with titanium screws, and I`m now experiencing sharp pain under the right implant any time I chew as well as a constant mild ache around my right eye. I don`t have any obvious symptoms of infection (no fever, swelling, erythema, etc.), but I`m nervous that this could be a sign that something ominous is brewing. Is my concern warranted? What do you think this could be, especially since it`s been more than a year since the surgery? Are there more problems like this with porous implants than with silicone material? Thank you for your incredibly generous help to all the people who write to you, Dr. Garcia. You are amazing.

Answer:

I think more likely is that the muscles are starting to move more and the scar tisue that forms normally after surgery is begining to stretch, just like when one comes out of a cast. I would not be concerend at this point. Medpor implants cause a more robust reaction to the muscles compared to smooth silicone ones, so you just have to hang in there. Without fever or redness I think the likelyhood of an infection is quite low. If in doubt, a CT scan can always be done to evaluate for any fluid collection. I wish you the best. Also, many thanks for the kind words. JG 9.28.10

Question:

How can i identify for sure that i have scar tissue inside my cheeks.

Answer:

100% of implants have scar tissue around them but they usually do not cause a problem. If there is scar tissue around the implant that scarred the muscles, it is likely from the surgery performed to place the implant and not the implant itself. JG 9.27.10

Question:

What treatments are best to help eliminate or reduce internal fibrosis scar tissue in the cheeks?

Answer:

I am afraid there is nothing great, maybe 5FU or kenalog, but it might be mild at best. JG 9.27.10

Question:

Hey Dr. Garcia! Would you use Radiesse to plump up cheek volume? Love ya! My doc only used a little in my marionette lines and I have a syringe left :) Should I just wait and let him plump up those lines later? Thanx, happy summer

Answer:

I think effects on the cheeks will not last very long so save it. Best of luck. JG 8.31.10

Question:

Hi Dr. Garcia, I have two questions: I was considering having my malar implants (small, 7yrs ago, intra-oral approach) removed and having a buccal lipectomy at the same time. However, my surgeon believes it would not be a good idea to remove the implants intra-orally at the same time as my buccal surgery and suggested that I have the implants removed through an incision at the lower eyelid if I want to combine the surgeries. (1)Is this a wise approach? I`m concerned that such an incision along the top of the periosteum might lead to greater sagging as the periosteum and surrounding soft tissues would be more susceptible to stretching from the downward pulling of my zygomaticus muscles post-op. (2)Do you normally prefer to remove implants intra-orally or through the eyelid? Thank you -

Answer:

well, since buccal fat removal done as a stnad alone procedure is usually done intra-orally, I do not see why that would be his method. I agree that seperating the supporting tissue around the lower eyelid would have a higher risk of problems. I remove malar implants, on the rare occasion that I perform one, through the mouth. I feel it is just as easy, less risky, and leaves no external scar. Best of luck. JG 8.19.10

Question:

oh my god thank you... this for the cheek implant removal... u said I might look like before the implant with a lift... I prefer it that wayyy.. thats so nice to hear. thankkkssssss sooo much.... your so great in answering things... thank youuu for always being honest

Answer:

best of luck with everything. JG 8.6.10

Question:

Hello dr. Garcia, I have a question about chin implants and wondered if i can have youre email adresse so i can send u pictures so u can evaluate what u think? Thank u. Sincerely

Answer:

certainly, send them to drgarcia@lvcosmeticsurgery.com

Question:

Thanks for your advice yesterday about my prematurely dissolved intraoral sutures following placement of cheek implants last week. I did call my surgeon today and he saw me right away. He found the wound wide open and was able to probe the pocket all the way up to the base of the orbital rim. He didn`t find it infected, so he put me on a prescription oral rinse and told me that it would close on its own. He didn`t want to close it again because while the pocket wasn`t infected it was, of course, contanimated. He wants to see me again on Friday. I am so concerned that food might get stuck in the pocket and then be healed over by the gingival tissue, causing an infection later, that I`ve put myself on a liquid diet, using a straw to bypass the incision. My surgeon told me I can eat solid food but to chew on the alternate side. I am writing to you because I was surprised by his decision. I thought he would irrigate the pocket and then suture it up again. I trust him completely, but I wanted to check with you to see if you think that his plan sounds reasonable; it seems risky to me. Thanks again for all your help and kindness, Dr. Garcia.

Answer:

no, I agree with him, suturing it up has a very high chance of infection, those wounds heal well without it and I do think the liquid diet is nto a bad way to go to add to the safety part of it. Best of luck. JG 7.26.10

Question:

I see that you often recommend warm packs to reduce swelling. What do you find are the most effective, temperate and long-lasting ways of doing that, especially for facial swelling? Obviously, heating pads are unwise due to their potential to burn the skin, and warm moist compresses with tap water require that one stay next to sink all day, changing the compress every 1-2 minutes as it cools down. Is there a particularly effective method you recommend to your patients? Also, last week, I had cheek implants placed. On one side the sutures dissolved too quickly (in 4 days), and the incision is wide open. Will this need to be sutured again or will it heal on its own? I am concerned about infection, despite the fact that I am continuing on Keflex, given the nature and location of the wound. I am only ingesting protein shakes through a straw to minimize the possibility of food migrating into the cheek tissue. I`m scheduled to see my surgeon next Friday. Do you recommend that I call him sooner? Thank you so much for you advice, Dr. Garcia.

Answer:

we usually suggest the moist warm packs to be used 3-4 times per day for a few minutes each time is all, no need for prolonged periods of application. If the sutures were placed in the skin I think it best to resuture them to get the best scar, if they are inside of your mouth, as long as the deeper tissues are intact, I would allow it to heal on its own. I think if the sutures broke you should see him as soon as you can to get checked out. All the best. JG 7.25.10

Question:

Hello Dr. Garcia, I am considering a chin implant and would like to know if you recommend a silicon or gortex implant. Also, what are the pros & cons associated with each material. Thanks.

Answer:

visually the differences are small, but silicone coems in a greater variety of shapes and sizes, I usually use silicone for that reason, to have a semi-customized option. Removal is relatively similar and placing them is essentially similar. JG 7.7.10

Question:

thanks dr garcia, so in order to put the wafer does the implant need to be removed or can it stay put while the wafer is being sutured to it? also will there be less healing time with it? what can i apply to the external scar under the chin for it to fade?

Answer:

it can be left in place and the wafer placed on top of the center of the existing implant. The healing times will be essentially the same, not much less. As to the scar I suggest ScarGuard or Mederma. JG 5.11.10

Question:

hey dr garcia, i have a medium sized anatomical silicone chin implant.. i like it except that i wish i had a little more projection not lenghtening the chin vertically but from the profile view i want it to stick out more...could adding a wafer be an option as I dont want a large implant i just want more projection forward. if so, how would they secure the wafer?

Answer:

A wafer could be use, yes.It can be sutured to the other implant if needed, or a small screw placed through bothimplants too. JG 5.11.10

Question:

DR. GARCIA,WHAT ARE YOUR THOUGHTS ON REMOVING A JOWL IMPLANT AFTER 6YRS? I HAVE NEVER LIKED IT AND I THINK IT HAS CHANGED MY SMILE. THANK YOU,JM

Answer:

ca be done but the muscles need to be reattached to avoid them not being in the proper place. JG 4.23.10

Question:

hi i`ve had bio alcamid injected a awhile back. the scarring or encapsulation around the implant swells when i take certain medicine for my condition, typically about 2 hours later and it makes my face very round and heavy. I currently take testosterone and oxandrin for weight management for a illness to manage my weight. My specialist for my illness doesn`t know what he should prescribe to reduce the swelling. Any sugggestions?

Answer:

they can try steroids bt uthat will have other untoward side effects, that`s one of the reasons that I shy away from using BioAlcamid for scenarios like yours. I understand the desire for long term or permanent improvements, but there are limitations to that too. JG 4.20.10

Question:

No, i just asked the surgeoun and he said the implant was put only on my bone entirely.

Answer:

OK.

Question:

I meant it feels sore and not swollen when i press on it. Thank u.

Answer:

swelling or maybe the pocket is not large enough for the implant so it is not sitting entireey on the bone. JG 4.4.10

Question:

Well would it then still be ok if i have a chin implant surgery in the beginning of july if my left jaw side is still a little swollen? I had the left jaw surgery in middle of november so i am probably going to be swollen 1 year after as u said. Because its my second time having a jaw implant placed there so it probably would take some time before it settles. Its very important i have the chin implant surgery in july so i just want to know if it is ok and right time? Thank u very much :)

Answer:

it can be done but if the implant proves too big or small on the chin then it will need to be revised. JG 3.31.10

Question:

sorry one last ques dr! with chin implants do i need to worry bout bone reabsorption over time?

Answer:

there can always be a small amount of bone resorption with a chin implant but it is nothing dramatic. JG 3.29.10

Question:

whats ur opinion about flowers mandibular glove implant for females? for maximum projection wud u recommed the extended anatomical silicone or the flowers? (in medium size)

Answer:

all depends on how small the chin is, if there is a significant size increase, needed the Flower`s might be useful, especially if a little vertical dimension increase is warranted, hard to advise without seeing at least pictures, sorry. JG 3.29.10

Question:

hey dr garcia, I had a chin implant inserted intraorally last year but had to have it removed despite the beautiful projection it gave me because the wing was placed under the jaw bone give a slight jowl appearance. So got that removed 3 months after and let it heal. Now a week ago I had the silicone medium sized implant( same as b4) inserted from under the chin crease. Now the wings are sitting right but the implant itself the middle piece seems like its sitting right under the protruberence bone. the point where it sticks out. so its jus adding bulk and no forward projection. I can tell because its clearly not the way it looked when I got the implant placed last time. What should I do? Can it be fixed back into position? and how long do i have to wait till ican get it fixed? the scar is healing very well btw.

Answer:

It migth be worth fixing it again, I do not think it needs to be removed and have to wait, speak with your surgeon and tell him your concerns and see when they would be willing to go in and readjust the placeemnt. All the best. JG 3.29.10

Question:

I have recently consulted with several surgeons about mid-face augmentation. It`s clear to all of them and to me that fillers will no longer be sufficient, so we considering fat transplant (which doesn`t seem to last), a mid-face lift (which probably won`t fix the situation, since I don`t have much tissue to lift), and/or implants. The surgeons I`ve consulted are evenly (and, oddly, strongly) divided on whether or not implants are in order. Half of the docs are recommending them; the rest are strongly advising against them. The surgeons in the latter group seem to be opposed to cheek implants on principle, feeling that they never look natural. I get the impression that they don`t want their names (understandably) to be associated with an artificial/surgical appearance in their patients. Of course, I don`t want an artificial/surgical look either, but I was not aware until these consultations that this particular procedure is as controversial as it seems to be. I am writing to learn if I have stumbled across an anomalous collection of surgeons who are opposed to cheek implants, or is this indeed among plastic surgeons as controversial (and, so, ill-advised) a procedure as it would appear be from my recent conversations? That is, in your industry, are small cheek implants almost universally considered to yield an artificial appearance? And in your opinion? I had thought that the result is, as with most surgeries, largely technique-dependent, but I may be wrong. Thanks, Dr. Garcia.

Answer:

well, implants of the cheek come in many shapes and sizes and if one picks something that does not fit correctly for the facial structure, you can look unnatural, that shoudl be rare in experienced hands. I think you just happened upon surgeons that do not like to place implants is all. Keep searchning as it sounds that is likely what you need to fil in the deficit you describe. JG 3.12.10

Question:

Hi, Dr. Garcia. I saw your recent reply to a post concerning the release of scar tissue to improve a post-surgical distortion of facial animation. Two years ago, I had cheek implants placed, which left the right side of my face with limited animation. We determined that there was no nerve damage and that the problem is scar tissue. My surgeon can easily palpate the scar tissue at the gingival sulcus but is reluctant to try to release it for fear it may reform. He keeps telling me that the situation will likely improve on its own, but it hasn`t changed at all since 8 weeks post-op. Frankly, after two years of being unable to smile or laugh, I`m ready to try a surgical release of the scar. Is this something you might consider doing? Thanks for taking the time for all of us, Dr. Garcia!

Answer:

at the present time I am not accepting patients that have had surgery elsewhere as my schedule is busy, but it sounds like a release is in order, it might entail a complete removal of the implants for a period of time and then maybe replacing them later. JG 3.8.10

Question:

Hello Doctor: What are the indicators of a chin implant? Thanks.

Answer:

profile view shows the chin to be further back than the lower lip, also making the nose look larger in relation to the chin. JG 3.2.10

Question:

Hi i have a short and narrow forehead. Is it possible to have a wider and longer forehead by plastic surgery?

Answer:

longer, yes, wider, likely not. JG 2.10.10

Question:

Hi Dr Garcia, I wanted to thank you for your answers to my questions on 12.3.09. They were a great help. I just have one follow-up question for you. Should I avoid using a facial moisturizer containing retinol before and after my silicone implant removal surgery? I`m asking because I`ve heard that retinol can thin out the skin and I was wondering if you thought that might increase the chances of depressions forming over the pocket that encased the implants. (I`m trying to give my skin the best chance of bouncing back and retaining its firmness and elasticity after the surgery.) Thanks again!

Answer:

I do not think that will be a problem to use. All the best. JG 2.6.10

Question:

hello doctor garcia. I had very small cheek implants placed about 3 years ago, they are medpore ones and were designed to augment the tear through deformaty. they never did anything for lifting cheeks or giving me any high cheek bone definition and shape change etc, my face is still flat and you wouldnt think there was anything there, although they did help with the tear trough problem. what i want to know is is it possible to have other cheek implants placed in withoiut removing the exsisting ones? or would i still need to have the others removed?

Answer:

I always suggest removing the small one and replacing it for fear that the new one would not sit properly or move after the surgery. JG 1.31.10

Question:

hi Dr Garcia.. well, I think I know the answer to this.. I have been doing juvederm/botox for 3 yrs now, for nasolabials/marionette lines.. i am 38 and look 28, done even laser resurfacing like 4 times for perioral area i have become highly obsessive compulsive with this.. although i am thrilled with how amazing and beautiful i look, i am constantly wanting more and more. and wondering if i should keep getting more to avoid depletion of the product even though i dont need it... it is like i want more before it diminishes out of my face.. i strive for perfection in my beauty and success constantly.. its definitley ocd.. and maybe i should be going to mental health counseling.. i have money to burn as well...which also give a viable excuse.. but ido have anxiety about the product like juvederm going away..and im constantly thinking about it and wanting to go back within a month of the injection for fear of of course aging, and product going away.. do yu see this alot ? ocd with beauty/aging/etc

Answer:

having money to burn is not an excuse. I think you have taken the first step and realized that you might be starting to obsess about things, overall that is a good thing, the realization I mean. I defintely think that doing things before they are needed with fillers or Botox are not something I would suggest, it will not help you look better, might make you look fake, and will feed the obsession. I honestly do not see it alot, maybe because once I see iT starting to happen to a patienT I back off and refrain from feeding their obsession. They probabaly just go find someone else at that point. The hardest part for a platic surgeon is saying enough is enough. JG 2.3.10

Question:

Hi, Dr. Garcia. I am 6 months pos- op bilateral cheek implants. I still have only about 25% movement in the right side of my face. My surgeon told me at three months that it was likely permanent and that there was nothing to be done about it. I fear he may be right, but I am concerned that he didn`t suggest any tissue studies to determine the extent of the damage or even consider any therapeutic options, as I understand that if any interventions can be successfully accomplished with nerve injury, the sooner they are undertaken the better. I realize that (and fully understand why) no physician wants to deal with the sequelae of poor outcomes, but his early, speedy dismissal of this extremely distressing--in fact, life-altering-- situation makes me wonder if was I was, um, dumped by my surgeon. At this point, is there anything you would recommend or am I beyond hope? Have you ever seen successful reversal of facial nerve damage? Thank you so much for your compassionate and generous practice of medicine, Dr. Garcia. God bless you.

Answer:

an EMG can be done to see if there is any electrical activity in the nerve. If there is, then the nerve was not cut and it should get better. Also, in some small percentage of patients, removing the implant might help if the probelem is persistent pressure on the nerve from the implant. If the nerve was cut and the ends of the nerve could be found, it could be repaired and in some cases it will grow back. The EMG test could likely give you alot of informtion. I wish you the best. JG 1.26.10

Question:

hey dr garcia! do you prefer going intraorally or from under the crease of the chin for a chin implant. and why? given a choice which approach would you take?

Answer:

crease of the chin for less risk of infection from the saliva and intraoral bacteria. JG 1.5.10

Question:

I have high cheekbones, and my cheeks have sunken due to aveolar boneloss from tooth removal. My maxillo facial surgeon has suggested submalar cheek implants, but said he may also be able to reposition the fat, is repositioning the fat a cheek lift, is it a separate surgery or could it be repositioned while the submalar implants are being placed? What holds it is its new position?

Answer:

I think repositioning the fat lower will be difficult and the submalar implants will likely be a better choice. They could both be done at the same time. Sutures hold them in the new position until they scar into place. JG 1.2.10

Question:

What is the difference between a paranasal implant and a premaxillary implant? I would like an implant that will rebuild the area between my nose and mouth. I want it to help with my top lip projection also. Do you perform these types of implants? Will my smile look different? I would like to use gortex. How much should I expect to pay approximately? What are the benefits of each?

Answer:

the paranasal is on the side of the nose and the premaxillary is below the nose. Sounds like you desire a premaxiallary one. The smile will look different as the muscles of the upper lip will be repositioned. Fees vary from surgeon to surgeon though. JG 1.2.10

Question:

Hi Dr Garcia, love your website, so much great information! I am undergoing a reconstruction to my face involving several procedures. I had premolar teeth removed for braces, creating a different bone structure in my face and premature aging. I am considering many procedures to bring me back to my former look. I am 31 years old female. I am interested in augmenting my temples and jaw with hydroxyapatite granuals, I would like to know is it risky to inject hydroxyapatite in these areas? Nerves? Also I don`t want to do just the angle on my mandible, but the body of the ramus from the ear down, I like the shape of my jaw I just want it to be wider. The tooth removal has given me a narrow face, before it was wide and square like Angelina Jolie. Does Hydroxyapatite have the abilty to be that custom as opposed to a typical jaw implant? I can send pics if that helps.

Answer:

as long as the injections are done right on the bone, the risks are small and the results, when done by an experienced injector, are quite good. No nerve damage should occur. I think the granules are a good option. Best of luck. JG 1.2.10

Question:

Ps. The implant is also stuck to the jawbone with 2 screws so it wouldnt move in the future.

Answer:

should not if there are screws in place. JG 12.28.09

Question:

Dr. Garcia: I am wondering what you think of the Perma Facial Impplant for lip augmentation. I had my upper lip lifted in 1990 - a slip of skin was taken out from under my nose which pulled my lip up. But from my profile there is now a flat appearance to my upper lip and it looks very unnatural. Plus, there was scar tissue left only in the left side, so I have to go through periodic, painful filler injections on the right to balance it out. I am looking for a more permanent solution to balance out my lip, and just recently heard about the Perma facial implant. The photos on the site look impressive. Your thoughts about it, please. Thanks - I love your site.

Answer:

I would strongly advise against using it. If there are problems, which is likely not a rare issue, it would take surgery to remove the material. Sorry. Thank you for the kind words too. Merry Christmas, Happy Channukah and a Prosperous New Year. JG 12.21.09

Question:

ps. If the implants cannot be near or coapparate with each other does that mean i cannot have a chin implant? Please explain to me, it is very important :) Thank u very much for youre answers.

Answer:

they can touch each other, not a problem. Merry Christmas, Happy Channukah and a Properous New Year. JG 12.20.09

Question:

Ps. What is the danger of the two implants being near each other and interacting? Could it cause infection or what is the certain problem? I am very confused because i was told something else. Thank u for youre explanation.

Answer:

the surgery causes the infection risk, otherwise they can touch. Merry Christmas, Happy Channukah and a Properous New Year. JG 12.20.09

Question:

I dont mean that both the implants are supposed to be exactly on top of each other, but next to each other. The chin implant will be 3-4mm over the jaw implant so it will be even. Thank u very much.

Answer:

should be OK. Merry Christmas, Happy Channukah and a Properous New Year. JG 12.20.09

Question:

Hello Dr. Garcia. I had an angle implant placed on my left side back in 2005 to correct facial asymmetry. I have noticed a lump thats formed along the inferior border of the md about 1cm wide about 2 inches from the ear. DO you think this may be scar tissue or something I should have checked? Also, I am interested in having the implant removed. Can you recommend someone in the northeast who has experience in removing angle implants? Thanks for your help, its greatly appreciated.

Answer:

get it checked ot make sure but it is likely nothing to worry about. You might want to contact the local univeristy hospital and ask for the plastic surgery department to have it removed. Best of luck. Merry Christmas, Happy Channukah and a Prosperous New Year. JG 12.19.09

Question:

Hi Dr.Garcia! I had posted a q earlier about granuales from sculptra and I am just wondering if they ever do go away on their own...eventually. If the sculptra wears off with 2yrs. would that also apply to the granuales...And is surgery the only option....I seem to developing more and more visual granuales...nasty! The worst part about it all is that it didn`t even fill out my face.... Can you please let me know what my options are...I am on the other side of the country from I had my sculpture done. Thanks so much

Answer:

in most case, eventually they do go away. It is rare that they need to be cut out. JG 12.4.09

Question:

Hi Dr. Garcia, I had malar implant surgery in 2003 using very small silicone implants to give my face a more angular appearance and improve my facial asymmetry. Although they improved my asymmetry, they made my face appear rounder and fuller than before and I therefore would like to have them removed without replacing them. But I`m worried that doing so would result in permanent sagging of the tissue and the possible development of indentations where the implant pocket was created. So I have five quick questions: 1)Given my age (31) and the size of my implants, Do you think implant removal will result in permanent sagging or will the tissue eventually bounce back and return to the way it was before my surgery? And if it normally bounces back, how long does it usually take for that to happen? 2)Do indentations normally develop over the area of the implant pocket? (The implants were not screwed directly onto the bone. BTW, would that make a difference?) 3)I`m also interested in having buccal fat pad removal surgery in addition to having my implants removed. Would that increase the risk of the cheek tissue sagging? 4)Could you recommend some surgeons who specialize in implant removal? Thank you so much for your time. This website has been a great help.

Answer:

I think the sagging will be minimal most likley. It might take 6 months for the tissues tt stabilize. Indentations are not common if the tissues over it are not too thin, so in your case it is likely not a large risk. Screwing the implants inot place initially will not change anything for the removal. I do not think buccal fat removal will affect cheek sagging as it is below the cheek mound. Probably the one with the most cheek implant experience is Dr Ed Torino in Thousand Oaks, Ca. Best of luck. JG 12.3.09

Question:

Is it possible to place cheek implants laterally, so that they start at the temple and descend over the cheekbone under the outside corners of the eyes? If so, are there any special problems with such a placement, other than the typical concerns of more standard cheek implants? Thanks!

Answer:

not that I am aware of.JG 11.3.09

Question:

Hi Dr.Garcia, I recently noticed a large lump on the side of my face from having fillers and I`m not sure if it`s from sculptra or restalyne. I`m not even sure if the second dr. used restalyne, because at the time of the filler he wanted to use juvederm, but I wanted restalyne...regardless I am wondering what can be done about it....I`ve read that with sculptra that there isn`nt much that can be done besides surgery...are there other solutions...and what about restalyne....can it cause lumps and can anything be done.... It really looks horrible.. and very obvious Thank you for your time,

Answer:

well,fillerrs like Restylane or Juvederm would give you an immediate lump, Sculptra, if it is the culprit, would take weeks to months to feel a lump. If it is recent after the injection, injecting saline into the Sculptra lump might speed it breakin up. I strongly suggest seeing the doctor that injected it to determine what is going on. JG 11.2.09

Question:

I know you`ve mentioned hydroxyapatite granules/injections. Is it possible to carve a jaw angle implant (similar to porex style) out of a solid block of hydroxyapatite? To your knowledge has it ever been done. I was jaw angle implants but do not want silicone or medpor

Answer:

I have not seen of that being car ved in that way, the difference between the Medpor implant would be essentially none. JG 9.27.09

Question:

I had microlipo along my jawline 5 mo`s ago &now need a lower face&neck lift. I feel that too much fat was removed along my jawline and have lost jawline projection and contour. I am entertaining the possibility of having mandibular implants placed. Could I e-mail you photo`s and get your opinion? Not sure if lateral jaw angles would be helpful?

Answer:

straight on, 3/4 view and then profile is OK, send them to drgarcia@lvcosmeticsurgery.com

Question:

Hi - Just had some radiesse injected into chin. I am a little worried because it looks too long. Could it be swelling? When can I expect to see final results? Is there any way to remove the radiesse? Thank you.

Answer:

it will take 6 weeks for the carrier gel to dissolve so it will change quite a bit during that time. JG 9.1.09

Question:

sorry forgot to mention the incisions were intraoral...and since they were gortex it was quite a struggle to remove but removable..

Answer:

should not make a difference. JG 8.12.09

Question:

hey dr garcia, i had asked u yesterday bout the swelling persisting from malar implant removal after 5 months..and u mentioned that it couuld take up to one year. what can I do to speeden up the process? walking..jogging..any cardio? to increase blood flow to the face? and can i also take ibuprofen? also is it normal to still be puffy from the middle of the cheeks down to the jawline area still? since there was no trauma or incisions under the lower cheek i dont understand why the swlling covers the mid and lower cheeks?..is it normal?

Answer:

anything that causes bouncing will likely prolong the recovery, there is little you can do besides massage. It can be normal, yes. JG 8.12.09

Question:

hello dr! I had a midium chin silicone implant placed intraorally in march and then had it removed in june because the wing has slid down under the jawbone and was placed crooked. Its been a month and a half now is it normal to still have swelling and hard scar tissue in the chin? how long does it take to resolve? and I want to get my chin back cuz i loved my profile with it..how long do i have to wait? and will the scar tissue cause crooked placement or any complications?

Answer:

yes, it can persist for a few months I am afraid. The scar tissue should not prevent a new implant from being placed, best of luck. JG 8.11.09

Question:

I had maxillofacial surgery and have grooves lateral to the nose from moving the maxilla and bringing forward bone in lieu of paranasal implants. This has left emphasized some flatness in the malar/submalar area. I previously had Porex cheek implants but had them removed because I didn`t like the prominence of the implants being placed so laterally. Do you think that given my case, custom implants would be a good idea? How does one go about getting these? CT scan? Is it extremely expensive? Thank you.

Answer:

Custom implants are a better solution and are a little more expensive than regular ones, but they require a 3D CT scan animation to decide on the size and that can be expensive. JG 8.10.09

Question:

Hi, Dr. Garcia. I read your recent post about replacing malar implants. I am wondering if the bone resorption worsens progressively over time. I am having my implants replaced with smaller ones after 11 months. Would you expect the bone loss beneath them to be about the same as it would be if I were having them replaced at 3 months ... or at 3 years? Like the person who wrote that question to you, I too am concerned that I will be left with a permanent outline/depression of the larger implant around the new smaller one. Is that a likely outcome in your opinion and experience? Thank you for your time and generosity, Dr Garcia. You help so many of us who are struggling with truly complex problems which, let`s face it, are of our own making because we elected these procedure. I suspect I am not alone in feeling more than a little shame about the very difficult and unanticipated problems which our vanity has unwittingly generated. That you offer your advice without a whiff of judgment is truly remarkable and kind.

Answer:

the bone resorption is not very much on malar implants, it is higher with chin implants and it typically takes a long time to develop. I think the bone resorption will likely be almost non-existent in your case. All the best. JG 7.19.09

Question:

Hi can facial exercises or any other treatments except steroid injections help in reducing internal scar tissue inside the cheek?

Answer:

sorry but no. JG 7.12.09

Question:

Hi ive heard that steroid injections, Kenalog can cause tissue atrophy, can tissue atrophy still occur after just a few injections or do you need many injections?

Answer:

it is usually from onge term use and high doses, but in thinner tissues it happens sooner than in thicker tissue. JG 7.11.09

Question:

Ive heard that Kenalog, 5fu, steroid injects can be used to reduce internal scar tissue. I have internal scar tissue inside the cheeks, is there any other way to reduce internal scar tissue inside the cheeks?

Answer:

I certainly think it is worth a try. JG 7.10.09

Question:

Dr. Garcia, I read your reply to a recent question from a person who had a chin implant 4 weeks ago and still can`t move the lower lip. I`m having the same problem, (5 weeks post-op)--next to no movement at all. Speaking and eating are incredibly laborious and tedious. Massage and warm compresses seem not to be helping. You said in your earlier reply that you`ve never seen this turn out to be permanent in your own practice and that at 6 weeks, it`s generally pretty good. Is that in fact the average amount of time this takes to resolve? What is the longest amount of time you`ve seen a patient taken to heal from this? And the shortest? (My own surgeon predicted today that it may be 6 month to a year (!), this after he had suggested pre-op that if it happened, it would take about a month. Finally, is this an inevitable side effect for chin augmentation; that is, what percentage of patients typically experience this problem? How kind you are to offer your expertise and time to so many of us who are left stewing on our own with major unforeseen post-op complications!I hope you know how much we all appreciate you, Dr. Garcia. Thanks so much.

Answer:

I have not seen it take longer than 6 weeks in my patients and the shortest time to resolve was 3 days. The prediction of the longer time means that the injury to the nerve was more extensive. An EMG test cna be done to measure the electrical impulse in the nerve to see if it was stretched or cut. If the nerve was stretched, it will eventually come back, if it was cut, then no, it would need to be repaired with more surgery if it can be found. The percentage of patients that have this happen I would say is less than 2% for the 6 week recovery and even less for the longer term recovery. Thanks for the kind words and I wish you the best. JG 7.9.09

Question:

Hi, Dr. Garcia. I`m 4 weeks post-op from a chin augmentation. The inevitable numbness has abated, but I am still left with an extremely malpositioned and dysfunctional lower lip. I realize that the trauma to the mentalis nerve is traumatized in this surgery and that this distressing side effect is common, but at 4 weeks, it is more distressing than I had expected. I look and speak like I`ve had a stroke. I can`t take any more time off from work. My surgeon maintains that I`ll begin to see some movement at 6-8 weeks and that the situation should improve after that. When I press him for a prognosis, he is appropriately clinically vague and says, Well, sometimes it takes 2 or 3 months, sometimes a year or more. What is your own experience with the average length of time that this takes to correct itself? In your own practice, has this damage ever turned out to be permanent? Thank you so much for your time and help!

Answer:

I have personally not had a permanent loss, and usually by 6 weeks things are epretty good, keeep massaging to help the swellling go down and that might help get the nerve functioning better faster, all the best. JG 7.2.09

Question:

Hi, Dr. Garcia--I had a chin implant in January 2007. I had a scar revision done about 9 months ago. I am now having pain under my chin on the left jawbone (at the point on my jawbone if you were to take a line and run it vertically from the corner of my lip straight down and underneath). The pain just started about three weeks ago. I hope it is nothing major, but maybe you can give me some insight. Thanks so much--I truly appreciate this site. BH

Answer:

most likely scar tissue, might want to see your surgeon to make sure though, nothing dangerous. JG 5.6.09

Question:

Hi, I`m about a month out from my custom porex implant surgery. They look great, but I realize now I was a little conservative (implant are about 4mm) in the design. The options I`m considering are simply adding radiesse or replacing them soon. My question is, if I add radiesse for a couple years to temporarily satisfy my aesthetic goal, do I drastically decrease my options for getting a permanent implant of a larger size later on? Is it feasible to add a small Porex implant under or on top of the current one more easily than replacing it?

Answer:

I think stabilizing another implant on top of what is in place is difficult and Radiesse injections should not affect surgery in the future. JG 4.21.09

Question:

hi dr garcia! I am 5 weeks post op from a silcone chin implant intraorally. Why dont my lower teeth show when I smile? Is this going to be permanant? and also how long will it take to heal completely..and what causes it?? I am very concerned about this..

Answer:

it can be from swelling and from the muscles that were detached in order to place the implant not being totally functional yet, I think it will continue to get better with time. I do not think it will be permanent. JG 4.18.09

Question:

i had a fat transfer about 5 years ago with horrible results trauma to my facial artery and uneven cheeck i have found with research that this can happened if the surgeon is unskilled who would you suggest in nyc to ct that can remove this bad fat tranfer to cheecks and even out my face ? I look swollen still after 5 years i tried massage i tried great makeup but its not working

Answer:

tough problems, the person with the largest fat transfer experience in NYC is Dr Syd Coleman. Sorry to hear about the troubles. Best of luck. JG 4.15.09

Question:

It`s good to hear that too-tight sutures may be pulling my face down and dissolving might fix that. Regarding the chin implant pulling my mouth down (when not smiling), is there a chance that may also resolve when muscles & nerves recover? Or is my mouth down for good ? Thank you. Lilac

Answer:

yes, give it some time, I think it will get better. JG 4.2.09

Question:

Hi, Dr. Garcia, I`m the one whose chin implant caused my mouth to pull down and now, at Week 5, my smile is better, but when not smiling, my mouth still looks pulled down. When he detached the muscles to put in the chin (submental incision), do you think it make the muscles tight, and they are still pulling down, or do you think they are too loose? I don`t see how this can resolve because, also, his necklift was so tight around the face that it also pulled my whole face down. When the sutures dissolve do you think there is any chance my face or mouth will return to its more uplifted, rounder appearance? As it is, Dr. Eugene Bortnick has made me look 20 years older. Thank you. Lilac

Answer:

likely too tight an should relax over the ensuing few weeks. Massage might help too. I think sutures dissolving should help. Hang in there and all the best. JG 4.2.09

Question:

Dr. Garcia, I had asked you about my mouth and lower lip being distorted after a necklift & chin implant. My mouth is pulled down, my lower mouth area is sunk in, and my smile is turned down instead of up. I had said that a band on my jawline seemed very tight, and it was at the time, but now there is more tightness coming from the ears. Could this condition be caused by tight muscles on outside of mouth, a hematoma, or as you mentioned, a possibility of overtight suturing. My dr. is considering Botox to weaken those muscles, but I don`t want to do anything as just a trial. I look bad, and wonder if I`ll ever have my smile back. The dr. even suggested removing everything if I didn`t like it and then my face would go back to the way it was before. Would this happen if everything was removed? Thanks, J

Answer:

with the progression you describe it sounds more like a nerve issue. Judicious Botox can help in some cases but without seeing you in person I cannot say whether you would. If sutures are removed before too much scar tissue forms it should go back to normal, yes, unless the tightness is due to the skin that was removed, in which case it would not. Best of luck. JG 3.11.09

Question:

Hello Dr. García and thank you very much. When a person has silicone cheek implants placed can one get fat injected to add volume to the areas not augmented by the implants? I would also like to augment the area close to the nose and below the eye. Is the effect similar with both materials?

Answer:

yes, you can have that done in addition, yes. I think fillers are better in the area you describe towards the nose and below the eyes. JG 3.3.09

Question:

I`m getting quite alarmed.. I had cheek augmentation with implants 2 weeks ago. the left side of my lower face, the lower cheeks and my LIPS are numb.. like the anesthesia is still there.. and it doesnt move as much as my right side. when i smile. my left lip stays relaxed.. anything i can do? are the nerves controlling my lips damaged. or is it early to tell.. how long should i wait. im nervous if it is damaged i`ll smile like this forever?

Answer:

it is not uncommon for the nerves that make those muscles move for it to be stretched and it can take a few wweks for it to come back to normal function, might be as long as 6 weeks but some movement can start sooner. Best of luck. JG 3.1.09

Question:

Ps. And can i use an implant on my chin area 6-7 months after having performed orthognathic surgery? Is that possible? In case the surgeoun doesnt want to take my chin/jawsides forward to extreme degrees? Could i use an implant (silicone or goretex) after having orthognathic surgery on my chin area to make it come more forward and be more marked? Thank you very much for youre answer.

Answer:

yes, it is possible, but that is usually not needed if the orthognathic surgery is properly done. JG 2.24.09

Question:

Hi Dr.Garcia, I`m just wondering what you suggest for all over facial volume? I had tried that and it didn`t really make much improvement. Is there another filler? Or should I just keep trying with sculptra? regards,

Answer:

I guess you can try fat injections, or use Restylane SubQ but it is not available in the US. JG 2.21.09

Question:

Will diuretics such as furosemide speed up my swelling from cheek implants.. it is so swollen - at the jowls

Answer:

not to any appreciable degree I am afraid. JG 2.20.09

Question:

hello, can I reverse my cheeklift surgery with some options if you have, cause my face is too narrow and flat and gaunt, and its been pulled too tight, any suggestions

Answer:

it all depends on what was done, if any tissue was removed, then no, it cannot be reversed. If no tissue was removed, some sutures that are holding the tissues up can be cut but if enough scar tissue has formed to hold it, it migth yield no change. JG 2.19.09

Question:

hi, does the skin graft of the face possible to correct the gaunt face with fat added. thanks or any side submalar implants. thanks

Answer:

no on the skin graft and maybe on the submalar, but it depends where the gaunt area is, if it is not submalar, then no. JG 2.19.09

Question:

hey dr garcia! will removal of gortex malar implants after 3 years leave my face disfigured/uneven/lumpy? I really want to have the inmplants removed and replaced with another shape/size that is suitable for my face. But gortex allows soft tissue growth through them I believe and so is there a high risk of tissue damage leading to uneveness lumpy and disfigured face? please offer your advice on this.

Answer:

should not be lumpy or uneven but it might look more saggy than it used to look like if no new ones are placed. I have taken Gortex implants out and although they do have tissue ingrowth compared to silicone, it is not that difficult to remove them. Best of luck. JG 2.18.09

Question:

just had my cheek implants yesterday, i didnt expect it to be this swollen. Im taking sinecch and bromelain. also menadione vitamin k. is there anything i can do to speed up the subsiding of this swelling.. no bruise though.. what are your thoughts on prednisone after surgery. i remember taking those after my lower blepharoplasty. im not so sure if it helped

Answer:

Ice, eat small bites, try not to open your mouth too widely. I do not think Prednisone helps much as most of the swelling is due to blood and not edema. Best of luck. JG 2.17.09

Question:

sorry, this is the last question, in time will I get my round shape back and the face will stretch after fat grafting, and who does it ,please

Answer:

I have no idea who can help you in Toronto and it is impossible to tell if you will get the face round again, all depends on how well it takes. JG 2.16.09

Question:

hello, can fat transfer in the whole face work to change the shape and the volume of a gaunt,narrow face? thanks

Answer:

it can, if it lasts. JG 2.16.09

Question:

hello, can an implant or fat transfer work to make the face round and full again. thanks

Answer:

fat might, I do not think the implant will fill in the correct areas though. JG 2.16.9

Question:

hello, can I get my face back like before , the cheeklift made my face narrow small, gaunt, flat, oval,and small, pls help me. I am in toronto

Answer:

might need some Sculptra injections to fil it in some. JG 2.16.9

Question:

hello,dr, I am in big trouble, I had a face lift a year agoand was very happy, then I went to another dr to get rid of the scars on the side of the ears, he gave me a cheeklift and I ruuin my bubbly face into a gaunt flat narrow face, can I reverse this surgery to get my round face bacK? I am in toronto, pls help me. thanks

Answer:

very difficult to say without seeing you in person, if there was tissue removed then regaining the previous appearance might not be possible. If you look gaunt they likely removed some fat and Sculptra injections might help fill out your face a bit. JG 2.16.9

Question:

im probably getting my cheek implants tomorrow, how true that it is very cruicial not to bump it so it wont shift while it is swollen. how long will it be good to sleep on my sideS? so while it is swollen, is it possible to shift. i have a ready bromelain, arnica, arnicare. took a lil of vitk, what antibiotic do u usually prefer after this type of surgery, last time i was given oral meds cephalexin 500, is that good enough? or do you recommend a better and stronger prophylactic antibiotic. for pain, mefenamic acid i think will be prescribed to be taken ever 4 hrs. ?

Answer:

it is true if you bump it with significant pressure. Shifting is easier when it is swollen. We use Keflex as an antibiotic. Best of luck. JG 2.15.09

Question:

I forgot to ask another Q. Why is it that some people have good results with sculptra and others don`t? I had three sessions (with 2 vials/visit) and there was not much visial difference that the dr. basically suggested using restalyne.Is it, because some people just can`t make collagen? And would that effect the outcome of doing Co2? Would a deficiency in vit.c and protein effect the outcome?as both are needed to make collagen. What gives?

Answer:

might be the amount injected or the depth injected. Also the response in older people is not as robust as in younger patients. No filler will adversely affect the CO2 laser. Vitamin C can affect collagen quality but it is very rare. JG 2.15.09

Question:

I had my lower blepharoplasty- fat repositioning.. Jan 23. I`m planning to get my cheek implants on Feb 18 since i dont have more time here. is that okay. the swelling and bruising has subsided.. there`s like 10% more.. i still have couple of days more.

Answer:

should be OK to do. JG 2.13.09

Question:

Hi Dr. Garcia, is it normal for my nose implant to be loose at the top because everytime I wash my face, I would accidentally rub across the implant and I would feel that it is loose and not held tight into place. Thank you.

Answer:

well, not normal but it happens and shoudl not cause any problems. JG 2.8.09

Question:

Im planning to get cheek implants. I know that silicone is the common, im also looking at medpor/goretex. what are the pros and cons for each. i want something to be fully permanent that wont move specially if i sleep on my one side of the face. One more thing, just had lower blepharoplasty, fat transpositioning. (2 weeks ago.) right side is healing well, but under the left eye there is a lump of hard(fat i think) its different from the swelling. When I had my lips injected with fat months ago.. i asked the doctore to inject some on my under the eye.same spot where I think theres a lump now. If im gonna get cheek implants. is it going to make my under eye hollow?

Answer:

I think Gortex is also a good choice. I find the Medpor implants more difficult to insert as they are not flexible, they are harder to get to lie as desired, require larger incisions, and I see no advantage to them over silicone or Gortex. All will be permanent and most of the time they will not move once healed. The lump after the fat transposition can be swelling and it can also be a lump where the fat was pulled over the rim and is sutured into place. Cheek implants should nto make the eye area look hollow. Best of luck. JG 2.3.09

Question:

Hey Dr Garcia! First off I wanna thank you for being so helpful and answering all our questions! My ques is.. do chin implants (for females) make your jaw or chin broad? I dont want to lengthen my chin or make it any broader.. just looking for projection. Will the implant avoid the whole broad or long look and give me the desired projection considering the different shapes and kinds they have out there?

Answer:

whether it makes it broad or not depends on the shape of the implant placed, it does not have to all the time. JG 1.26.09

Question:

Hey Dr Garcia, How often do chin implants cause bone erosion? Is it very common? and is it something that has to be worried about forever? or its just happens during the healing process?

Answer:

not to any appreciable amount in the vast majority of cases. Not common enought to worry about. JG 1.22.09

Question:

hey dr garcia! I emailed my pictures to you. Kindly go over my email and pix and tell me what you think. best regards, ttyms85

Answer:

will do. JG 1.22.09

Question:

Hello Dr Garcia, I read an interesting article about fat transfer recently. It mentioned that although most of the transferred fat may seem to disappear initially within the first few months, it can come back considerably from 4 months onwards and therefore it is best to wait before repeating the procedure. Is this true in your experience and does this mean that the fat that survives the 6 months period is most likely to remain permanently? Thank you

Answer:

unfortunately no, that is not my experience, the fat injections, more often than not, do not survive in my hands and in most surgeons hands. I od agree though taht whatever has survved at 6 months will likely last permanently. JG 1.20.09

Question:

My prblem is for 12 yrs i have a chin implant that caused nerve damage (like carol Burnett) and also cause my jaw to jutt out when I speak, I have since then developed tmj and sometimes it is very painful. All doctos say to leave implant in cause taking it out could really make things worse. the questions is, it`s time for a lower lift and neck. Do any of you think that these procedures could effect my chin implant and make it worse? Or are they both far enough away from the implant nerves and muscles. The doc says i dont have to worry, but I learned not to believe everything they say. Please help. thanks

Answer:

the lower face or neck lift will not hurt nor help the problems with the chin implant. Might be a good idea to have it removed and replaced with a new one and have it secured with a screw to allow it to stay in place. Best of luck. JG 1.19.09

Question:

Hi Dr. Garcia - I asked you about the feasibility of inserting an implant for my jaw area (between chin and jaw). You indicated an implant may not be the right shape. Is it possible to have custom implants made?

Answer:

yes, that can be done, but is difficult. JG 1.19.09

Question:

hey dr garcia! is it possible to remove gortex medium sized malar implants (after 3 years) and replace them with smaller (different material) implants as a combined procedure (all under one anesthesia)? also what is the best material to use to chin implants for females? and do the chin implants alter the smile or movement of mouth when talking? is it better to place them intraorally or from an incision under the chin?

Answer:

yes, it is possible, I prefer general anesthesia as the new implants will likely need to be fixed into position to avoid them moving, might need a screw placed. I typically use silicone implants for the chin but Gortex is a good option also. I prefer to use an external incision for the chin implants to avoid infection and they should not alter your smile. JG 1.18.09

Question:

Hello Dr. Garcia - I have hollowness below the cheek area to the jawline. If you make a diagonal line from the corner of my lips towards the back of my jaw, it is that area. Can you tell me the best remedy for this? Artefill, Implant, etc.? I would like something permanent. Thank you!

Answer:

I do not think Artefill would be good choice, and I think implants will likely not be of the corect shape, I do not think anything permanent will work, but my choice is Sculptra for a longer term effect. JG 1.18.09

Question:

Hello Dr.Garcia. Thank you for youre answer but can you please tell me how big the chance is in % that the calcification/scar tissue will just stay in my left jawside? I asked my doctor but she said it goes away by itself in some time and that i did not need to worry about that, i just had to wait at least one year or longer. Is that true, since you said that there is a chance they would just stay there? Is it something/anything i could do to make it better? Thank you.

Answer:

maybe 25% or so that there will be a lump there long term, very hard to say though. I am afraid there is not much that can dissolve the calcifications though. JG 1.18.09

Question:

Estimado Dr. Garcia, en primer lugar quisiera agradecerle su atención y paciencia en contestar a nuestras repetitivas preguntas. Mi pregunta concierne al uso de bio-alcamid para corregir las arrugas nasolabiales. Me inyecté una muy pequeña cantidad (la mitad de la dosis porque no aguanté el dolor) hace ya más de tres años y no me han dado ningún problema de momento. Lo cierto es que me inyecté tan poco que ni siquiera desaparecieron las arrugas. Después de leer tantos mensajes contrarios al uso de Bio-alcamid me pregunto si puede tener efectos secundarios para la salud del estilo cancerígeno, alérgico, etc, o si son mayoritariamente las posibles reacciones que ya ha comentado antes (bultitos etc) Mi segundo pregunta es: es posible que me de problemas en el futuro si en estos 3 años y medio no me ha dado? la verdad es que me he quedado con un poco de miedo. Mi tercera pregunta es: el Aquamid es lo mismo que el Bio-alcamid? si es asi, supongo que tampoco lo recomienda, verdad? Muchisimas gracias

Answer:

creo que con la cantidad pequena y el tiempo que ha pasado que no tiene que preocuparse de eso. El Bio-Alacamd es lo mismo del Aquamid. Buena suerte. JG 1.12

Question:

Hello Dr.Garcia. I just wonder if you get a chin implant of the material silicone, is it a big chance that the implant will move its place and position? Because i have told you about my jaw implants before that moved its position. Is it different with an implant on the chin? Or do you need to fasten it with a screw? Because i have heard surgeons who use a screw to fasten silicone implants on the jawside and the cheekbones. Thank you for your answer.

Answer:

it is rare for it to move once healed. If the pocket is made corectly it should not move much, I typically do not screw them in although I do use a few sutures to hold it in place until the wound heals. JG 1.7.09

Question:

Hello Dr. García, Please, I`d like to know if chin ptosis due to removal of a chin implant can have a permanent correction, maybe repositioning the chin higher or with a chin implant. I had a chin implant removed 5 years ago and my chin is now drastically lower, my lips are also lower I have lower teeth show. I want also to wish you a merry Christmas and an excellent new year especially with a lot of peace and love. Thank you very much for this site.

Answer:

I think a better option would be to tighten the muscle and fat pad back into position, it might require a small drill hole into the bone to help support it but a chin implant will likely not fix the lower lip problem. Best to you for the season and thanks for the kind words. JG 12.21.08

Question:

hi dr. garcia, Is it true that after removing a chin implant sometimes you get some augmentation due to the scar tissue? is bone erossion possible after 7 months of having the implant?and how do you reattach the tissues to the bone after removing the implant? thank you very much! haver a nice day

Answer:

the degree of scar tissue is small, and the amount of erosion after 7 months should be almost non-existent. I have reattached the tissues with sutures and at times drilled a hole in the bone to hold the tissue back down if the implant was large. All the best. JG 12.19.08

Question:

Hello Dr. Garcia I have asked this question before about my jaw implants. I had surgery 3 times because my jaw implants moved its position and i had surgrey the second time with only 6 weeks after the first surgery and the third time i had surgery i removed them. Now there has been almost 4 months after the third surgery and i have a lot of hard lumps on my left jaw side. I have asked the surgeon what it ( The hard lumps) could be but he said it could be many different things. He told me it was not dangerous and it was not a tumor but i had to wait for 1-2 months and take a x-ray and then see what it was. he also injected cortison to make the lumps more soften in time. I know you once said it could be just scar tissue, but my question is how long it can take for the scar tissue to heal in more exact time if it is just scar tissue? Can it be leftovers or a reaction from the implants because i did get an infection after the second surgery to move the implants on its right position. thank you for your answer.

Answer:

scar tissue will remodel and soften for up to one year after the surgery, so it takes a long time. The infection could have incited more scar tissue, but it will react the same as non-infection derived scar tissue over time. Might be helpful to get some ultrasound massages, done at physcial therapy clinics, to help the scar tissue soften and loosen up. All the best. JG 12.18.08

Question:

ok so the qtlift will not last for long? I`ve read and talked to some docs and they say the results are quite long lasting... but the normal aging process continues...

Answer:

buyer beware. I personally think the hype is not warranted and they make it sound that it is the same result no matter where you have it done, and the truth it depends greatly on the skill of the surgeon performing it. If you want, you are free to be a guinea pig and try it. JG 12.16.08

Question:

hey dr garcia! jus a quick ques. im about to have my medium sized gortex malar implants removed in about amonth. I also had buccal fat pads removed. Main reason why im removing the implants is because its giving my side profile a outward rounded look. I just want to know if it would be advisable to go thru a mini qt lift to lift sum of the musculature and skin and give a tighter more youthful appearance after the removal of the implants? even now when I lift my face towards my ears with my fingers vertically my face looks more defined and it gives my face a subtle angled V shape which was what I was going for in the first place. I dont want to have any implants in my face...jus want a tighter more defined youthful face. please give me your suggestions. btw I am 22 years old.

Answer:

I do not think repositoning of what you have left will be worthwhile nor will it last a significant amount of time to make it worth doing, sorry. JG 12.16.08

Question:

Dr. Gracia..one more thing about chin implant removal, is it an easy procedure?and how long is the recovery? Thak you!

Answer:

simpe procedure, recovery is about the same as the placing of the implant. JG 12.14.08

Question:

Hello Dr. Garcia, im 29 and it has been 6 months since I had my 3mm silicone chin implant, I don´t like it and I am thinking about removing it and not placing another one in.Will i get back the way I was before?I have herad there might be sagging or skin irregularities is tha true?? I hope you can help me because it is a difficult decision to make, and I don´t want to end up worse than am now... Thank you,

Answer:

I think if it is small and they suture the tissues back that in all liklihood it will go back. Best of luck. JG 12.14.08

Question:

would i have better results if i do chin augmentation and nasal surgery the same time? or is it ok to do the nose-job first and then after 4 months the chin augmentation? regards

Answer:

well, not really better but any proportional changes will be less and if you are thinking of them both, doing them together is best. Doing them split only proongs the downtime as they have to heal at different times is all. JG 12.7.08

Question:

hi dr garcia! is it true that removing medium sized gortex implants after 3 years will leave unusual bumps on face or scar tissue that will make the face look weird?

Answer:

I do not see how it would be any different than any other facial implant, they are usually placed under the muscles so that should not happen. JG 12.5.08

Question:

Hi Dr. I posted before about facial drooping early at age 28 and you said I was probably losing volume in my face and recommended Sculptra injections..your reccomendation was right cause I consulted with a PS and he said the same thing..he did say that I have a weak chin and that a chin implant may balance out my face though..so now I think Im going to get one (when you put a pencil straight down from my lips there is about a 1/2 width away from the pencil). My question is..the dr said hed use a medium size implant on me..it looked sooo small..how would this fill in the gap? (underneath my bottom lip my chin indents in to the horizontal line) so the implant wouldn`t fill that part in..just the bottom of the chin? wont that look weird?...Oh. and I understand how the implant changes the shape of my chin from the side...but what change should I expect from the front?? wider?? Sorry about all the questions

Answer:

better to go a little too small than too big, otherwise you get a Jay Leno appearance. The changes from the front are actually minimal. Best of luck. JG 12.3.08

Question:

Dr. Garcia, Do you prefer the Medpor 2-pc contoured chin implant (designed by Dr. Yaremchuck) or the other Medpor 2-pc chin implant? I need only minor enhancement and the new Medpor chin implant comes in the smallest size (3mm). At least on the skulls, the new implant`s design looks more natural to me.

Answer:

I personally do not use the MediPor implants as they require larger incisions and I do not see any distinct advantage over the other implants. JG 11.19.08

Question:

oh and btw i already had buccal fat pads removed when i had the implants placed in 3 years ago.. my face still looks full and youthful.

Answer:

th effects from the bucal fat pad and premature aging are not seen for years. JG 11.18.08

Question:

hi dr garcia! im the 22 year old female who had asked you bout the removal of the gortex implants along with buccal fat pad. you mentioned that this would cause sagging prematuralely? what do i do at that point? do you think QT mini lift would be an option?

Answer:

well, a minilift might help the sagging if present, but it will not regain the appearance you have with the implants as the implants were placed to augment size and a lift does not augment size. JG 11.18.08

Question:

hey dr garcia! i am a 22 year old female. I had medium sized gortex malar implants placed intraorally about 3 years ago along with buccal far pad removal. I dont like the look the implants are giving me and want to have them removed. Will my skin sag or anything after I get this removed? and also any nerves involved that help you smile or talk (movement of lips). please lemme know. thanks!

Answer:

I think there might be a small degree of sagging, it depends greatly on the size of the implants. Removing intra-oral fat will allow your skin to sag prematurely in the fuure though too. The risk to the nerves is the same as it was for placing the implants. Small risk overall. JG 11.17.08

Question:

Dr. Garcia, I am trying to find an oral-maxiollo/cranial surgeon that will use hydroxyapatite granuals/paste on the lower jaw. Do you know of someone? Also, in your archives dated 7/30/08 and 7/27/08 under facial implants, someone had inquired about HA vs. screws and already had a surgeon. Is it possible to contact that person to find out who their surgeon is?

Answer:

I cannot give out that information, sorry, I suggest you look into oral maxillo-facial surgoens affiliated with a university or a plastic surgeon who does craniofacial surgery, best of luck. JG 10.28.08

Question:

hello Dr.Garcia I really want to try gore-tex implants in my lips, however i have heard that it is not recommended and that many people have reacted to the material. Is this true? What is the danger by having the surgey? I have tried evolence (collagen)but that goes away after 1 and a half year so you need to continue to fill your lips and i wanted something permanent. can you please tell me all the negative and positive sides by having goretx lip surgery? What is youre experience with goretex in lips? Because i dont want to have the surgery if it is a big danger that my lips will be destroyed. Thank you for youre answer.

Answer:

the patietns do not react to the material, but it can extrude and come out along with looking unnatural at times. There is nothing safe and permanent for lip filling, we use Restylane on our patients. I tried the Gortex implants years ago and stopped due to the unnatural appearance and feel so I no longer do them. JG 10.24.08

Question:

Hi Doctor, thank you for this site. 21 days ago I had submalar implants and some fat grafting done and it looks great. For the first two days I wore a facial compression garment which caused a great deal of bruising under my eyes. The bruising has gone away but I`m left with dark circles under my eyes. I normally have dark circles there but this is now much worse. Is this something to be concerned about or will it go away by itself, and if so, after how much time? I am not scheduled to see my doctor for another two weeks and am getting worried about this. Thanks

Answer:

no, all should get better with time. Arnica gel topically and pills orally will help, sold at the health food store, all the best. JG 10.23.08

Question:

Hi doctor, thank you for your answers.It has been 3 1/2 months since my surgery.I still have a hole in my skin, o the right side between the implant and the lip,What did the surgeon do wrong? can he fix it? also I have a lump on that side, Its like the end of the implant is not in its place. DO you recomend getting a second surgery or is it possible to have a biiger hole in my skin or make it worse.ALso I feel my lip very stif from the sacer, is that normal?? thank you I hope you can answer all my doubts,have a nice day!

Answer:

maybe if you can send me some pictures to drgarcia@lvcosmeticsurgery.com so I can help a little more and please include as much of the medical iostory as you can. JG 10.20.08

Question:

Hi Dr. Garcia, Thanks for answering my prior to two questions regarding cheek implants. I genuinely appreciate it. My cheek implant surgery is coming fast upon me, and I`ve another question for you. Regarding medpor morales implants, what is the purpose of screwing the implant in? Is it necessary? Each of the surgeons I`ve seen prior to selecting my current doc used them. My current surgeon, who has tremendous skill, credentials, and most importantly, I have a great working relationship with, prefers not to use them. He feels there is a close to 0% migration rate due to tissue incorporation. From the Porex product inserts, I`ve learned screws are primarily used to prevent movement specifically during the healing phase. Do you concur? If so, at what point after the implantation can I begin to not worry about implant movement via sleeping, etc. Thanks again. Appreciative fan, David

Answer:

it is done so that the implant will not shift, that can happen more often with Medpore implants because they are not foldable so the pocket and incision needed to place them is larger and while healing they can shift if not secured. The issue is not one of migration weeks down the road, but that of shifting immediately after the surgery and then the tissue grows in and holds the implant in an incorrect location and then would need repeat surgery. They stop shifting after 2-4 weeks, the less the swelling the faster they get incorporated. JG 10.19.08

Question:

if you got artefill for marionette lines--would you also need to have any nasal labio folds also filled. Could the artefill cause the bottom lip to droop?

Answer:

you only need to fill the areas that bother you. Artefil should not cause the lower lip to droop, no. JG 10.16.08

Question:

I got a notice that my question may have not been delivered so here it goes again. I had orthognatic surgery (mandibular advancement of about 6-7mm) about two and a half years ago. Six months after surgery there was still significant swelling and the surgeon decided to remove all screws and plates. After this all of the swelling went down, however, I now have two VERY visible dents along each side of my jaw where the bone was cut and moved. I was wondering if the best way to fix this is with implants or if there would be a better way. If the best way is with implants, I would like to know which one you think would be best, porex or silicone? What are the complications I should be aware of with this type of procedure? I appreciate your input on this matter.

Answer:

I think injecting hydroxyappatite granules is the best option as it will allow the greatest degree of control whereas silicone implants would be hard to fashion into the correct size and shape.That is usually performed by oral surgeons. JG 10.10.08

Question:

I underwent orthognatic surgery about two and a half years ago (mandibular advancement of about 6-7mm). About six months after the surgery, the plates and screws were removed because there was still significant swelling. After all this remaining swelling went down I was left with two very visible dents along my jaw line where the bone was cut and moved. Should I get these fixed with implants or is there a better option? If implants are the best option, would silicone or porex be best for this area? I would also like to know which doctor I should go to for this type of procedure (specialty??).

Answer:

I think injectable hydroxyappatite by your oral surgoen is a much better and more customizable option for your issue. JG 10.9.08

Question:

Thanks so much for answering my other two questions about my gortex cheek implants and the recent facial trauma I suffered. I just want to say that I trust my surgeon, but I`m just frustrated and frightened. I will wait and watch too see what happens as far as if what I`m seeing looks to be more than swelling once I`ve had a bit more time to heal. Thank you for having this Q and A feature on your website. You are saving a lot of worried people a lot of grief by being kind enough to address our concerns. May GOD bless you.

Answer:

thnak you and all the best. JG 10.9.08

Question:

hello dr.garcia I had a jaw implant and chin implant surgery in may 2008, unfortenately the jaw implant moved so i had a second surgery just 6 weeks after the first surgery to put one of the jaw implants back on its place. I was still very sore when i had the second surgery. After 2 and a half month my left side jaw where i had two surgerys in just 6 weeks apart got very badly infected and it got the size of an orange because of the infection. I had all of the implants removed one month ago but when i feel my jaw and chin exactly were i had the implants i feel this very hard lump! I have no idea what it could be because the doctor said he removed all of the implants so its not the implants. It is a very hard lump, do you have any idea of what it could be? Or is it just leftovers from the infection? Do i need to have another surgery to remove the lump or will it go away by itself? Thank you for your answer.

Answer:

it is likley the scar tissue that had developed around the implant and that likely was not removed. In time it usually softens and flattens. I do not think you need more surgery at this time. JG 10.9.08

Question:

Dr. Garcia, I had posted a question about having been recently attacked (punched in the face many times) and if the blows to my face could have moved or damaged the gortex cheek implants that I`ve had for about a decade. I`ve now had a check up with the surgeon who put in my gortex cheek implants, and I`m still worried. He felt my face, put a little pressure on, and I think he looked at the CAT scan results I brought in. He told me he thinks it is swelling. He said that he actually removed the bone cover when putting my implants in place, sandwiching the gortex between the bone and bone cover. He said the implant can`t have moved and that it has blood vessels growing through it. I feel he is too confident. I have more questions than I did before I saw him today, and I`m rather frightened. I felt rushed and didn`t have time to process his responses before my time was up. The area where the implant is looks very, very prominent and lower, but the flesh around it doesn`t look nearly as swollen. It actually looks deformed. *My first question is, is it possible that the gortex itself is swollen due to being engorged with blood or could there be a big clot of blood somehow? *What could make it so much more prominent than the area around it? *Could the gortex or the bone cover have become detached from the underlying bone. Now, I`m worried about bone death and very serious issues. He said it could take 4-6 weeks for the swelling to go down. What can I do to speed up the healing and get the swelling down, so that I can see what`s going on? It`s been two weeks since I was punched. *Should I get another opinion in person, just in case my surgeon missed something serious? I`m concerned that this could be much worse than a displaced implant. Thank you for taking the time to answer my questions. I really appreciate your help.

Answer:

Gortex does not develop blood vessels into it, that is incorrect and the Gortex material itself cannot become swollen. I think if you have swelling it can cause the whole area to become larger too. The Gortex could become dislodged from the pocket it was placed into and healed but that would be seen on the CAT scan. There is no risk of bone death for the trauma you describe. I think 4-6 weeks for swelling to do down is very common, and sometimes longer. I think if you want to get a second opinion to ally your fears, it is a good idea. I think warm packs will help along with possibly ultrasound therapy done by a physical therapist. Best of luck. JG 10.8.08

Question:

I`m 47 years old female. Eversince I was a teenager, I`ve been wanting to refine my forehead but a surgeon in Taiwan (im from taipei) told me if i have forehead implant, it wouldn`t look good w/the rest of my profile which is perfect in his eyes. I hit my forehead to the ground alot when i was little so i got some `uneven` surface on the bone of the forehead which im not proud of when shown to people n i feel it`s a defect. Is there anything i can do?

Answer:

might be able to have the higher spots of the bone burred or sanded down rather than an implant. JG 10.5.8

Question:

Thank you Dr. Garcia for getting back to me about the clear fluid in the corner of my eye. Hopefully it clears up soon. I have one more question, I didn`t realize that my cheek implants were secured with screws five years ago. Five years ago I had small implants changed for slightly larger malar implants and at that time the dr used small screws. Can having a small screw in my implant cause problems down the road?

Answer:

no, should be no problems there. JG 10.5.8

Question:

Many years ago i had cheek implants. Since that time I`ve noticed difficulty in moving my top lip. It`s not numb but a tight sensation when I speak. I had a lip lift thinking it would help but it hasn`t. I`m concerned because it`s affecting my speech. I`ve consulted with a few plastic surgeons and dentist but no one seems to have an answer to the problem. Can you help?

Answer:

sounds like the cheek implant surgery caused the issue from not allowing the muscles that were lifted while putting it in to reattach to the correct position. I am afraid that after this much time, even if you were to remove the implant, it would not correct itself, not sure who told you the lip lift would help but as that is a static lift, it will not correct tightness or mobility, wish I had more to offer. JG 10.4.08

Question:

I`ve had gortex cheek implants for about a decade. Recently, I suffered trauma to the area as the result of being punched several times by an attacker. An ER doctor ordered a CAT scan. The radiologist didn`t find any facial fractures, but contusions. The area around the implant material is very swollen. I`m wondering how likely it is that the implant material could be damaged (or could have loosened from the bone) due to a direct blow or swelling of the bone. (My surgeon once told me that the Gortex implant material adheres to the bone so much after years of being in place that removal would require scraping the material from the bone.) My face is very swollen (my nose, too). I have felt around and pushed on the implant to see if it moves or feels loose. Now, I`m wondering if I could have made worse any damage or loosening of the Gortex from the bone. I`m very worried. My surgeon is in another city, and no one local knows anything about Gortex. I`m just wondering how likely any damage is, considering the recent facial trauma and the length of time the Gortex has been in place, and if there are any signs of damage that I might be able to feel for or spot. I don`t think the Gortex was secured with screws. I`d appreciate your input you have to offer. Thank you for your time.

Answer:

I do not think the implant would be damaged, it would also unlikley move as there is scar tissue that forms around it and is attached to all of the tissue next to it. The swelling will eventualy go down and the implant should be in the position it was originally. Be patient. I think it will all be OK and I am sorry to hear about the attack. JG 9.26.08

Question:

When I was 21 I had rhinoplasty and a silicone chin implant due to braces pulling my chin back. About the same time I was diagnosed with adult cystic acne. 21 years have passed, now 41 I still get huge cysts especially around the chin area. My questions: 1. Is it possible the silicone in the implant is causing excessive sebum production? 2. Should I have the implant removed? Thank you, Lorraine.

Answer:

I have never heard of the implant causing that and do not think removing it will help the problem. JG 9.24.08

Question:

hello, I had a chin implant 2 months ago(intraoral)and I feel a bump on the right side of my chin, my doctor finally agreed that maybe he didn´t make enough space for the implant, so the end of it is sticking out.He said he could do another procedure to improve it, but I have heard that if he takes it out, it´s better to wait for other 6 months to place it back in. Is if posible to have only one more sugery and get it all done without touble? thank you very much...

Answer:

the ony time you need to wait is if it was infected, in your case it is OK and I would sugest it not be taken out for 6 months and revising the pocket is what is indicated. JG 9.24.08

Question:

Hello Dr García: Please, I had a chin implant removed 4 years ago, and my chin and the corner of the mouth are sagging. Also, inside my mouth I have a horizontal scar in the gum which covers the six forward teeth by the level of my teeth roots, maybe the ps made another procedure to give shape to the mouth, or is that the normal size of the incision made to place the implant? Is there any procedure that can give shape to the lower lip by bringing a bit to the center of the chin the lip corners? THANK YOU VERY MUCH.

Answer:

hard to say without seeing you, fillers might be the least risky though. JG 9.18.08

Question:

Hi Dr. Garcia. I`m having a crooked silicone chin implant revised in 2 weeks with a well known surgeon who does lots of rhinoplasties and genios. The prob is this; the tails of the chin implant are overlapped by my jaw implants, so all incsions have to opened and implants taken out and realigned. Right now (at 10 years post-op) the implants are tightly in place - almost cemented to the bone by the scar tissue capsule. My fear is that by revising the pockets, I`ll have that terrible problem of the pockets never sealing and implants being slightly mobile. I`ve read about this frequently here and others I`ve corresponded with. The surgeon plans to use 3ccs of HA granules to seal where implants ovelap. I can deal with crookedness but not loose implants. Please share your thoughts. Thanks so much.

Answer:

well, all the have to do is trim the chin implant to make it shorter so it does not overlap. JG 9.18.08

Question:

Hi Dr. Garcia, I am getting custom Medpor malar cheek implants (Mostly laterally) and want to know how to best minimize the risk of assymetry? Are there any measures I can take (Either with or without the doctors assistance) to do this? Thank you. David

Answer:

there is nothing you can do to minimize the assymetry, that is in the surgeon`s hands and in the custom process. JG 9.12.08

Question:

Thank you very much for the anwer...Why are there irregularities in my skin , two months after the chin inmplant.Did the surgeon do somethin wrong? He says I should wait 4 more months, is tehre going to be any real difference?I think I can see now the final result and I don´t like it...

Answer:

it is irregularities due to the muscle trying to settle back in, the muscle is having some spasms, not uncommon. I do think time will show some improvement, yes. JG 9.10.08

Question:

Hello Doctor, I had a small chin ilpnat placed thru the mouth 2 months ago, and not very happy with the results...I have a bump on my right side, and some irregularities in my skin.I want to know if I take it out, are there any risks of having more bumps or holes in my skin, does it go back to normal? Also, if he corrects that bump (which he thinks is the end of the implant not in place)do I have a greater chance of getting worse, for having a second surgery. Thank you

Answer:

as it has been such a short period of time, it should all go back to normal once the tissues reattach to the bone. I do not think that adjusting the implant will have any chance of it getting worse though. Best of luck. JG 9.9.08

Question:

Thank you so much for your response to my question about my jaw implant / muscle issue. I just want to clarify - just so I`m sure... Why can`t the muscle be sutured to the implant? I believe that is what is done initially after jaw implant surgery anyway - the masseter has to be detached, and is then somehow reattached - sutured, i assume - to the implant. Wouldn`t the implant qualify as that hard piece you referred to? (I have a porex implant, btw). Atrophy? Yikes. So essentially I would lose augmentation, the worst possible outcome.

Answer:

muscle is made up of fibers and do not hold sutures well, the muscle just tears more when it it is attempted. Normally the entire muscle is not detached, just elevated off of the bone and some fibers are left attached to allow the muscle to scar in and work again. I do not think you would lose size of the implant with the atrophy, it is atrophy of the muscle mass over the implant. Not a significant size change. JG 9.7.08

Question:

I had jaw (left side only) and chin implant surgery to correct facial asymmetry in April 2007. I`ve had a few revisions for various revisions since then. Over the last several months I noticed that the jaw seemed to be wider some times and narrower other times. This became worse over time and now if I use my jaw with any force, such as chewing something like pizza crust, my jaw will often bulge outward and forward dramatically. Even without chewing something, my jaw simply changes shape day to day, moment to moment, becoming wider or narrower. I thought this was due to the implant coming off the bone. So I had a revision last month, in which the doctor inserted 2 more screws to ensure implant stability. After the surgery, the doctor said I had some masseter disinsertion, which he apparently ignored as the possible cause of the problem and did not attempt to correct. I asked him if that could have been the problem all along and he said possibly and that I would just have to live with it. Now I am still having the same problem with the bulging and narrowing as before the revision. I also often feel a fluttery feeling in my jaw. So my current assumption is that some of the muscle fibers are detached and causing the issue. But obviously I don`t know. The surgeon won`t do anymore surgeries for me, and 3 doctors (2 plastic surgeons and a maxillofacial) I have contacted since then have either refused to consult with me and/or not known what the heck I was talking about. Is my assumption about the problem likely accurate? If so, can the muscles reattach themselves? If not, where can I turn to for help? Maxillofacial surgeons do not seem to know anything about implants and how they relate to the muscle and tissue anatomy, etc. And there seem to be no plastic surgeons with enough knowledge or willingness to help me either.

Answer:

I think it is likley that the muscle has become disinserted and the problem is that suturing muscles to the bone is almost impossible unless a tendon or hard piece is there and in your case it would not. In time the muscle will atrophy to some degree and much of what you are feeling will get better as the muscle will essentially shrink and fibrose. I am afraid that more surgery is not the answer, just need to wait and see and that would mean at least one year, wish I had more. JG 9.7.08

Question:

Thank you very much for your previous answer, I just asked you if a chin implant would help make the chin look shorter. If it can`t be done, will it make the face look as if it has the same lenght or it will always make it look a bit longer, which I don`t want? If I have a bit of redundant skin below the chin , can an implant help to elevate it? I am very grateful for your answer.

Answer:

the chin implant fits in front of the chin, not below, so the face should not look any longer after placement. The chin implant can at times help the loose skin. Best of luck. JG 9.6.08

Question:

Please Dr. García,I`d like to know if it is posible to place a chin or extended chin implant, a bit higher up from the chin`s lowest level or end, so as to make the chin look a bit shorter. Maybe it can create a shadow below that can make a face look shorter. And that would be better achieved with a porex or a silicone implant? I`m a female, 35. Thank you very much.

Answer:

not really, it needs to be placed on the groove of the edge and placing it higher will not allow it to sit properly and could move. The best option is to cut the bone and remove a slice and then screw the edges together, oral surgeons do it all the time and it avoids a chin implant. JG 9.5.08

Question:

I wanted brow lift and mid facelift. surgeon explain he will deal with the eyelids to perform the surgery. Then I had a quatation letter sent to me stating the cost of brow lift bilateral uupper and lower blepharoplasty and mid facelift. Its all good but I didnt ask for Blepharoplasty... is it normal for this to be charged while i just wanted a midface and brow lift to start with.. I know he said he will do the lifting through the eyelid but i thought that expense should be covered with once procedures cost. ALso is bilat. upper and lower bleph. taking fat from the areas? Im confused why he will state this in the letter. can you pls explain the 2 q`s for me? what that particular procedure is and is it normal for it to be charged seperately? also the whole procedure is stated to cost $24, 000 .00(australia$) does this amount sound normal with all the expense included?

Answer:

I agree with your assessment, escpecially with the upper lid surgery. As to fat being removed, that is done only if needed, but not always. I am not sure of the conversion rate for the Aussie dollar but here in the states for a brow and midfacelift that would be on the high side, more like $15,000 here in most locations. JG 9.4.08

Question:

hello Dr. Garcia I had a jaw implant and chin implant surgery a few months ago, my left jaw side got badly infected where the silicone jaw implant were put, i started to take antibiotika when it got infected for a long time, it improved the infection a lot. I removed all of the implants one week ago but now i have small and hard lumps on my left side jaw were i had the infection. Is it leftovers after the infection? or is it something else? How long time does it take for it to go away? Thank you very much for your answer.

Answer:

just scar tissue that with massage twice per day and time will flatten out over the next few months, got to give it time though. JG 9.4.08

Question:

Hello and thank you Dr. García, I`d like to know if anterior projection in the cheeks, esp the front of the cheeks, or submalars, can be augmented with porex implants and achieve the same aesthetic result as with silicone implants. Thank you very much

Answer:

the Porex implants can give you anterior projection yes, they are just a little more difficult to position as they are not maleable. JG 9.3.08

Question:

Hello Dr. garcia I am going to have two surgeries, the first one is a chin implant and the second is my lips with goretex. How long should i wait after the first surgery before i do the second surgery? Thank you for your answer.

Answer:

I think they can be done at the same time, if not, a few weeks is all that would be needed. JG 9.2.08

Question:

Hello dr. Garcia I just wanted to know if you choose to have plastic surgery with silicone implants in your chin or gortex implants in your lips for instance, how long does it take before the danger of infection is gone? How long does it take after the surgery to say it is safe for infections? That the infection will not come, is it 3 or 6 months? I am going to do both of the operations but i just wonder how long the danger of infection lasts after the surgery? When is it safe for infections?

Answer:

well, any foreign body like that can always be infected, even years down the road. The risk goes down after 6 weeks but it is never zero. JG 9.1.08

Question:

Hello Dr.Garcia I had a jaw implant surgery a couple of months ago with silicone implants, unfortunately i had a very bad infection on the left side on my jaw where the implant were put. I just had both of the implants removed a few days ago but i just wonder if the infection goes away when you take the implants of? Or is the infection still there even if you remove the implants? How long will it take before all the infection are gone?

Answer:

it will take a while for it to go away once the implants are removed, but in time it does go away. JG 8.30.08

Question:

I have wanted to try the artefill, but am a little reluctant because I have heard it can cause granuolas that would have to be surgically removed. Can you give me some insight into this. Thanks

Answer:

it is possible, the more superficial the greater the need for removal I am afriad. Deeper injections might still result in lumps but they are felt and seen less. JG 8.18.08

Question:

Hi Dr.Garcia, I am a 48 year old female who had a facelift w/upper & lower blephs done two years ago and cheek implants about one year ago. I`ve been thrilled since, but lately, I have noticed that I have developed some major depressions (which have come on quite suddenly) which I was calling under eye hollows but which I have been told should actually be described as upper cheek hollows because you can feel bone when you place your finger on the spots. My questions are: Could this have developed from a change in diet & doing cardio? (recently lost 10 pounds) Would the cheek implants be contributing? (they are malar) & What could be done to alleviate it? Thanks so much. C.G. 16/08

Answer:

weight loss can commonly result in facial fat loss and make these look more hollow and bones look more promient, yes. I do not think the implants are causing it, on the contrary, you likely have aging fat loss changes that you have combated with the surgeries and now as the aging process continues you are seeing those effects. You would likely look worse if you had never had the surgeries done. Hard to say what can fix it, it is impossible to direct fat gain to the face, migth benefit from some Sculptra injections though. JG 8.16.08

Question:

Hi Dr. Garcia: Is the surgeon obligated to keep and provide records/and or photos of my chin aug? The doctor is not an ethical man-I will not waste your time with details but he referred me to a doctor in Manhattan would wrote some of the earliest books on maxiofacial surgery. When I tried to make an appointment with the doctor he refused to see me. I have a highly reputable oral surgeon willing to work on it. I have a feeling that my Doctor who did the initial surgery (Dr. Lovaas at Park Nicollet in St. Louis Park) will refuse to be helpful by providing documentation. Is there any chance of straightening my chin? I am very sceptic because of the nerve/muscle damage inside my mouth. Thanks, Mary

Answer:

the photos really belong to you but I cannot say what he will do, I am sorry. JG 8.12.08

Question:

Hello Dr. Garcia: I was 23 yrs old when I decided to have rhinoplasty but a maxiofacial specialist suggested chin aug. He cut across the lower jaw and added plates and screws to extend my jaw and bring it forward. Much scar tissue formed inside my mouth-under my lower lip. Th doctor was not successful in removing all the scar tissue -later I had an oral surgeon remove most of it. I thought my smile would be straight again-no. I was told by the oral surgeon that the other doctor cut too deep and damaged the nerves-muscle under my lower lip. I have asymetry in my smile, as well as my jaw. I am 37 yrs old so it has been 14 years since the procedure. What are the complications I face for having the plate removed and reset straight as well as REPAIRING the nerves that the doctor cut-damaged under my lower lip? I really just want to correct my crooked smile. Thanks, Mary

Answer:

I am sorry but I seriosuly doubt the nerves can be repaired at this point. JG 8.12.08

Question:

Is there any website I can go to see photos of the re-attachment of the chin muscles to the bone as far as where the suture placement should go? Do you think a capsule has formed around the chin implant by 8 weeks post-op? Thanks!

Answer:

none that I am aware of, it is not a commonly done thing. At 8 weeks some capsule has formed, yes. I usually use two sutures just to the side of the center to get a balanced repair. JG 8.12.08

Question:

Dr. Garcia - the chin impant girl again! Just wanted to make sure I told you that my chin implant is a medium - not a large. Thanks!

Answer:

still the same recommendation. JG 8.12.08

Question:

Dr. Garcia - I am VERY scared about having my chin implant removed that was inserted 8 weeks ago. Although I am 35, I have read on the web about severe chin deformities occuring as much as 6 to 32 months post removal. On www.pubmed.gov it states, 10 women, aged 23 to 62 reported severe soft tissue deformities after removal of their alloplastic chin implants. Deformities consisted of dimpling in repose, chin ptosis, pogonial bunching in 90% of them It also states that the bizarre soft-tissue chin deformities are virtually uncorrectable. On another site it states, when extrusion, displacement or capsular contracture following implant removal occurs, a revision operation may be required. Secondary chin surgery is challenging because implant removal alone may produce a disfigured chin. I am very upset because my surgeon suggested this implant - I never even knew such a thing existed & now I have witches chin where you can clearly see the indentation around the large implant that looks like a big ball! Now I am VERY afraid to remove it due to possible deformities & I really hate the way it looks & am angered my surgeon suggested the implant to start with. Is there anything he can do during the removal procedure to minimize the risk of deformity? Should he remove the capsule that formed over the implant or what exactly? I trust him to do a good job, but the deformities may be out fo his control & I may ultimately not see deformities until 6 months to 3 yrs from now long after he has been paid in full. By the way, my implant is sylastic. Is the alloplastic the same thing? I am really very scared about the best way to proceed at this point.

Answer:

alloplastic and silastic are essentially the same, silastic is one form of alloplastic. Your surgeon coudld try to re-attach the muscle to the bone by placing sutures to the bone to get the muscle to readhere, also at times removng the capsule helps the readherence. Best of luck. JG 8.12.08

Question:

I am considering either buccal lipectomy or cheek implants. My concern is whether, after a buccal lipectomy, years down the road, my face will be more saggy-for-the-wear. Are more people w/round cheeks/lack of cheekbone definintion better off w/cheek implants, for when they`re older and begin to sag?

Answer:

hard decision, fat removal will certainly prematurely age your face compared to how it would look without the fat removal, but cheek implants might make your face look too wide. JG 8.8.08

Question:

I am the 35 year old considering chin implant removal. Forgot the mention that these deformities appeared in 90% of the patients of that study as much as 6 months to 6 years after the chin implant removals! Does this sound accurate to you or has your experience been that younger women`s skin bounces back smoother after chin implant removal? Thank you!

Answer:

I personally have never seen that happen and do not think it wil cause any issue in your case. JG 8.4.08

Question:

Hello Dr. Garcia - I`ve read that chin implant removal can leave permanent deformity or dimpling of the chin as much as 90% of the time on a study of women ages 23 - 65. Is this correct to your knowledge? I am 35 & just had the implant inserted one month ago & now considering removal in about another month. My skin has good elasticity at this point. What do you think the probability is that I will have these deformities? Is it loose skin that causes the deformities or underlying scarring/tissues?

Answer:

I have not seen it happen and if it did it would be frm a very large implant being removed so that the tissue would have stretched out to a large degree. I tink in your case since it has been in fr such a short period of time that all of the tissues should go back to the way they were before. JG 8.4.08

Question:

Hi Dr. Garcia. I wrote to you the other day about revising a crooked pocket with my chin and jaw impants. The surgeon proposed realigning the where the implants overlap and using 2ccs of hydroxylapitite granules to cement them in place and prevent reversion to the crooked pocket. What do you think of this use of HA? HA vs. screws?? Please, your opinion on HA. thanks much!

Answer:

I think the screws are better to hold them in position and the HA can be used to fill in any cracks or deressions that the implants cannot fill in. JG 7.30.08

Question:

Hi Dr. Garcia. I had a chin implant with wings 11 years ago. A year later, I had jaw implants that slightly overlap the wings of the chin implant. In the early post-op peroid, the right jaw implant knocked the wing of the chin implant off the bone. The entire wing of the chin implant rest off the bone - for 10 years now. Fast forward today, I found an excellent craniofacial surgeon who is willing to go in and revise the entire pocket. Because everything overlaps, he needs to realign all the implants - meaning full lower mouth incisions. He said he will use 3ccs of hydroxyapatite granules to seal any gaps where implants overlap to prevent the implants from slipping back into the crooked pocket. What`s your opinion of this plan?? Thanks so much!

Answer:

sounds like the best option for you, all the best. JG 7.27.08

Question:

Good afternoon, Dear Doc!!! Have you done any implants on the lips? How are the results? Do you have any before and after pictures for me to see how it looks? When one kisses...can the other person tell you have implants? I had restilane before and it only lasted maybe a month... :(Do you have an approximated cost for that procedure? (range). Thank you!!!

Answer:

I have and in generla have not been impressed with the results due to them not being as mobile when one puckers. The person who had them done typically can always feel them and at times someone else while kissing can tell. JG 7.25.08

Question:

Hi Dr. Garcia - Thank you for your quick response. One other question. How long does chin implant removal typically take & could I go right back to work the same day or would you suggest waiting a day. Thanks!

Answer:

I do not think you should go back to work that day but it is pretty quick, maybe 30 minutes, to take it out. JG 7.21.08

Question:

Hi Dr. Garcia - Got a chin implant July 2nd by 21 yr experienced surgeon. At consult, I asked for only neck lipo & he suggested medium chin implant as well - an extra $2,000. I never had a receding chin, but trusted his expertise on facial symetry & agreed. Love the neck lipo, but hate the chin implant - it is way to large, creates a crooked smile when my mouth is open,& formed new crevices around the implant making the skin under my lip push down in a frown or pout. Overall, very unatural. I want it removed & feel some of the $$ should be refunded, as I did this at his suggestion. But I definitely want it removed at no cost. Based on the office manager & his personality types, this may be tough to achieve. I have a written note from the mgr saying that if Dr. Widder feels I need a 2nd correction surgery, it will be at no cost. But of course, this is why he is insisting that he thinks it looks great. An honest appraisal of this large unshapely chin definitely suggests otherwise. What do you think would be my best approach with this? Also, the surgoen said waiting awhile to remove the implant is better to get a smoother chin because the tissue will have healed a softened. Is there any truth to this? Is there a better time to have it removed or does it not matter at all when I do it? I want it done as soon as possible of course. Thank you!

Answer:

well, as to refunding the money, I do not think he will do it for you in most cases. I think if you express your dissatisfaction to him in terms of patient good will, he should see his way to removing it.I think all surgeons want their patients to be happy as they get new referrals from happy patients and lose referrals from unhappy ones. I think if you are having some smile changes it is likely due to some pressure or stretching on the nerves and it might get better, but it could be, on rare occasion from the implant lying on the nerve and that might be a way for you to prompt him to remove it sooner. I feel once one is convinced that they want it removed, the sooner the better, allowing a capsule to form if one is not going to replace it with a new implant is not needed. All the best. JG 7.21.08

Question:

Hello, I have a morphea on my right cheek, the color is disgraceful, but the main problem for me is the atrophy of the skin, the skin is more thin so i have an hollow on my face. Do you think that fat injection could help me ? And the laser is effective for the color ? thank you and sorry for my bad english

Answer:

for the laser I would suggest a YAG laser, as to the fat injections, I think that is an option or Scultpra injections. JG 7.20.08

Question:

Hello Dr. Garcia, I`m contemplating getting small cheek implants. I seek a little more fullness both laterally and projected forwardly in the malar region. Is it possible to get much forward projection? Also what kind of implants do you recommend? Lastly, I don`t have a lot of fat above the orbital rim (aggressive lower blepharoplasty some years ago), so do you think there will be a big problem with the edges of the implants being visible? Oh, also, what is the likelihood of infection over the years after implantation (I sometimes get sinus infections - don`t know what effect, if any, that might have on cheek implants). Thanks!

Answer:

there are all different sizes and shapes so your surgeen would need to advise you of what would fit in the space you have. I personally use silicone implants on the face most commonly. The implants are placed below the muscle so there should not be any problems with it being visible and they do not move much either, all the best. JG 7.19.08

Question:

hi dr. garcia, i had fat grafting to the orbital rims six months ago it was looking good, perhaps a bit had been lost since the beginning but not too much, but in the last few days it honestly looks like it has all gone away. is this possible after six months to have such a dramatic drop? is it possible that its just going through a dip and may improve again?

Answer:

unfortunately, yes, that is the most common scenario I am afraid. I do not thik new fat will grow back, sorry. JG 7.12.08

Question:

Hi Dr. Gsrcia - Thank you for responding so quickly about my crooked smile after the chin implant. Is it wise to wear a wide soft stretchy cotton strap around the front of my chin to get the muscles to re-attach to the bone quicker & perhaps in the proper place? Wearing this soft stretchy strap also provides some relief against the odd sensation of healing. Wearing this sort of strap (not too tight of course) wouldn`t cause damage to the surgery would it? Thanks again!

Answer:

I think the strap will help the swelling and the reattachment of the muscles to the bone, yes. It will not damage it, we use it for the first 2 weeks pretty much all the time and then weeks 3-4 for 8 hours per day. JG 7.10.08

Question:

Dr. Garcia - Just had chin implant inserted 6 days ago by surgeon with 21 years experience, highly recommended with great results photos for chin augmentation. He did not tell me not to move my chin around, talk, laugh, eat solids, etc. immediately following the procedure. Now 6 days after the procedure, the implant does not feel as though it has shifted. However, I noticed a pulling and minor pain sensation above the implant on the left side - like a tight or pulled muscle only when I laugh, eat or flex the muscle in that area. As a result, when I laugh, I have a crooked smile/lower lip. The left side relaxes more & pulls up high over top of my lower teeth while the right side of my lip stays well below my teeth like before the surgery. Did I inadvertantly rip some muscle here or do you think this problem can only arise through surgical error. Or perhaps is this crooked smile just a natural part of the healing process? There is no excessive numbness at this point. Thank you!

Answer:

that is all normal as the muslces were lifted off of the bone in order to place the implant and until they re-attach, there will be some muscluar dysfunction, and the muscle will heal at different speeds on one side versus the other. I do not think there is any evidence of surgical error at this point, just maybe poor communication with you prior to the surgery to alert you to the fact that what you are seeing is the normal and expected course of events. Give it time, it will al get better. JG 7.8.08

Question:

Hi Dr. Garcia, I have a weak chin and am having a tough time deciding between a medpor implant or aquamid injection. There are many positive feedback on both methods but hardly any detailed reviews on the cons of either procedure against the pros. For one, aquamid seems to have very little or zero downtime but I`m concerned if there would be any side effects in the long run. Could you share with us your thoughts on mephor implant vs aquamid injection please?

Answer:

no question about it, I would go with the implant because if there are problems in the future, although rare, it is easy to remove, while Aquamid injections are frought with problems and almost impossible to remove. JG 7.8.08

Question:

Dr. Garcia, I had cheek implants removed 4 months ago. I have what looks like round bumps on both cheek bones. One is more prominent than the other. Will this ever go away?

Answer:

massage should help but it might take up to one year I am afraid. JG 7.7.08

Question:

hi dr garcia i am 22 years old. I had medium sized gortex malar implats placed in about 3 years ago.. I was always unhappy with em because of the uneveness or unsymmetrical look it gave me upon looking closely and they are also placed lower that they really should be.. However he wouldnt remove them because I also had buccal fat pad removal as well. and he said if i took them out now then my skin would sag. I recently met this other doctor here who has removed many cheek implants and he says since im so young and my skin is like spandex it will just go back flat if i remove them and that would be the best option for me now. what would you suggest? Would my skin really sag if i went ahead and removed them now since i also had buccal fat removed? please give me your opinion on this.. thanks

Answer:

well, I think the skin will shrink at your age, but understand that removing the implants will not take you back to the way you looked before since the buccal fat pad was removed so that will lead to a more hollow appearance that you showed before. JG 6.29.08

Question:

dr. garcia, i am considering butt implants. From you extertise, what shape is better round or oval, i know they say oval size is more likely to move around is this true. I am 5`2 115 lbs. small frame. what size would you recommend for someone my size. Is it also true that a small incision size of an inch will be shown around my butt crease. Will they make other holes in my buttocks. I know one doctor said there would be one small hole on the bottom of the cheek, I believe he said something about avoiding internal bleeding? do you find this information accurate?

Answer:

the best shape depends on the patient, there is not one that is in general better than another. The incisions ar typically made in the crease between the buttocks and is much longer than one inch. As to internal bleeding, it depends more on the surgeon maintaining control of it during the surgery, the size of the incision does not help or hinder that. JG 6.24.08

Question:

Hi Dr.Pierce. I am 38 with high cheek bones and a rather thin face. Under my cheekbones, my face slighly caves in. I would like to round it out. It is not extreme, but has always bothered me and I am exploring options such as cheek implants, a threadlift/lifestylelift, fat transfer, or a long-lasting injectable. What do you suggest? Thanks, Sandra

Answer:

Of them, the only one that has a chance of improving that is the fat injections. The Threadlift or lifestyle lift, if they work, and that is a big if, would only exaggerate the problem, I think fat injections, or my preference, Scultpra injections are the best option. JG 6.9.08

Question:

Thanks very much for your answer yesterday to my question about submalar implants. I`m sorry to ask for a clarification, but I don`t understand why you prefer Sculptra. The implants themselves are soft and maleable, so I am assuming that they would correct a soft tissue deficit as well as the Sculptra; furthermore, they have the advantage of being permanent, which, of course, Sculptra is not, and so, they are less costly in the long-term than fillers. Is your objection to submalar implants based on your opinion that they simply don`t look natural (because they are harder once implanted or oddly shaped or...?) or because they can develop a visible step-off or because they may slip? If none of these issues are typical problems with these particular implants, what would you say is their chief disadvantage? Thanks so much for answering me twice! I truly appreciate your help and time, Dr. Garcia.

Answer:

implants are soft and pliable in your hand, but when placed under the muscle and on the bone as they should be, they will no longer be soft and pliable, you should replace things lost with things in the same location, and since what you lost was subcutaneous fat, replacing material there rather than under the muscle on the bone where nothing happened is a better choice. Implants when placed in an appropriate pocket should not have a step off or move.Implants should be used to improve boney contours not soft tissue contours. Hope that explains my feelings.JG 5.30.08

Question:

I have recessed and small chin . I was advised sliding genioplasty for horizontal advancement and vertical movement of chin . My surgeon is telling me that in order to increase the height of chin Autologous bone have to be used as filler . My question is Is there any synthetic bone filler available ? and if yes what is/are the most common fillers available ?

Answer:

there are synthetic bone fillers, called calcium hydroxy apatite that can be used. JG 5.28.08

Question:

Sorry, forgot to ask. One side, which required more tissue scraping, is more swollen, giving my chin an off-kilter appearance. Is there something that might help the swelling o abate faster? I do believe nothing has shifted, and the pocket was well made into the bone and the tissue. (I was kind of awake, so that`s what I heard anyway.) How would one know if it shifted, and the nurse said it would take someone pushing up on the implant to shift it. I guess it`s the extended, though he trimmed the ends. Thanks.

Answer:

just ice for now. Until the swelling goes down one cannot tell if the implant has shifted so just hang in there. JG 5.26.08

Question:

heyy doc.. If you have cheeks that are more to sag..and if you put fillers in will they appear high or will it just look more like a sag?? and also.. when i asked my ps that i wanted cheeks he showed me that he will be putting the fillers high into the corners of my eyes only.. but i want the cheeks just under my eyes too (apples of my cheeks) to look like its blending high ... mmmm.. i dont know how to describe this to my doc.. coz when i did he looked confused and said he will put 2 units each into each cheeks to get this result (juvederm) does this sound right..? i dont want big cheeks hanging down like as though im really old.. im 27.. i want high cheeks with full apples cheeks.. looking cute.. do you have any idea how to describe what i want in ps terminology?? so i can just say yep this is what i want..and so on.. and i had juvederm in my nasal folds 6 days ago.. i cant see any results.. ps massaged it.. but what the hell is wrong? am i not seeing well? but im sure it looks the way it was before.. it was my first time getting it done so i dont know what to expect.. thakyouuus)

Answer:

in the short term they will be lifted, in the long term they will sag again as the filler dissolves. I cannot say how much it will take to fill in the areas but you need to be clear with him on where you want the augmentation of the tissue so he puts it where you desire. As to the Juvederm not giving you a result, it might be because it was injected too deeply is all. At your age they should be easy to fill as they should not be too deep. JG 5.21.08

Question:

Hello Dr Garcia... I want to have permenant cheeks and n/folds to be done. My ps is saying he will do juvederm first and later aquamid... will aquamid work the same as juvederm? will it feel the same?e.g in regards to being having a soft texture or moving from one place to another? ... or anything-else?

Answer:

I will tell you that since the nasolabial fold forms from falling tissue and not loss of localized collagen, not even a permanent filler will correct the problem permanently. The cheek augmentation with a permanent filler is also something I would not advise due to potential long term problems. Aquamid will never feel as soft as Juvederm and I think the amount of Juvederm it will take to fill in the cheek is large, the nasolabial folds are reasonable to treat with Juvederm though. JG 5.21.08

Question:

Heyy Dr Garcia I had juvederm injected under my eyes 6 days ago... now both my under-eyes are swollen and bruised... i was reading and found out that these bruises can be permenant... is this true..? Im getting scared after reading this information.. It was my first time injecting under my eyes.. what should I expect? also The injected areas seemed to form bags under my eyes.. I dont know if its because of the swelling up because its still bruised.. will all this be ok in time?? GOSh tell me it willllll...

Answer:

I have never seen the bruises be permanent, no, it might take another few days to go down though, warm packs and light massage should help. The bags are likely just due to the swelling from the injections and will also get better and go away in time. JG 5.20.08

Question:

in response to your answer regarding filling in the gaps and ridges left from osteotomies. The doc that removed to titanium screw and all the HA (without my permission) tried to put bone in the areas. It did not take and I was pulling bone out from the left jaw line. Is there something else to fill in the jaw line ridges, and do you use the HA paste? I`m not a doctor, but I`m thinking it is easier to use in order to mold along the jaw line

Answer:

I do not use HA, but oral surgeons do, that is probably the specialist you should see. JG 5.16.08

Question:

I had upper and lower osteotomies in 1989, followed by HA to fill in the gaps and ridges. Another doc, without my permission removed almost all the HA, while he was supposed to be removing a titanium screw under right eye and addressing the left gonial angle. It has been about 15 years and now I would like to fill in the gaps, ridges, and asymetry. What would be the best permanant procedure for this? And also a permanent procedure to even up lips, as this doc also messed them up. Lastly, Do you know of anyone in Florida?

Answer:

could use your own bone to try to get it to fill in, I am not familiar with anyone in Florida I could refer you to, sorry. JG 5.16.08

Question:

Hi Dr Garcia, I was wondering which cheek implants are the best. Silicone, gortex or porex? I have malar implants that were put in without a screw. Should I be concerned about them moving? They are also silicone. I have read that silicone implants are not good and that the others are better. Is this true. My doctor prefers silicone because he feels it`s easier to remove them. I was also wondering what a infraorbital rim implant is? Thank you for your help.

Answer:

I think the differences are small, except that Porex implants require larger incisions as they are quite stiff. They all have the potential to move if not secured at the time of surgery, but that is routinely doen to avoid the motion. I use silicone almost always and as to the oribital rim implant, it fits right at the edge of the lower eye socket. JG 5.15.08

Question:

I`ve been exploring your archives, as I`m considering having cheek implants (malar). However, I can`t help but be concerned over the number of patients having them removed. Is this prevalent. I don`t want to go through the hassle & expense, only to be deformed in any way. I realize one can`t predict exact results, but why so many removals? Thank you.

Answer:

no, it is not, it is just that when people get on message boards, they usually do not if all went well, so you can get a slanted view of things. JG 5.8.08

Question:

revision of facelift caused more wrinkles (loose skin) under eys. Why would this happen. would you give it time or go right to oculoplastic dr i do not think i can have a lateral canthoplexy due to chance of ectropion thanks

Answer:

I would give it time to settle in, most if not all of that should get better with time. JG 4.29.08

Question:

Thank you so much for your rapid response to my question about fat grafts to my lower cheeks, Dr. Garcia. I`m sorry to post another question on the same topic, but I did not understand what you meant when you wrote, there are differences more so when you inject the lower face due to more dependent swelling and bruising at times. What is dependent swelling and why is it different in the lower face than in the upper face? (I did not have my lips injected, by the way, and I am most grateful for that.) Also, if the massages and warm compresses don`t work, do you think that some of the fact could be suctioned out? I understand it can be difficult to do with injected fat but not always impossible. Is that your experience? Thank you for your valuable time.

Answer:

dependent means that areas below, where the gravity pulls the swelling. The upper face is firmer and has more bands to hold the tissues up and since the lower face has less support and is also lower, it gets more swollen. In time, the fat could be removed with liposuction, yes. Best of luck. JG 4.27.08

Question:

My cheek implants were removed a week ago. The right side of my lip still doesn`t move and I have a crooked smile. Do I have facial paralysis? If I do can this be fixed to make me look totally normal again?

Answer:

it is not unsual for that to happen and will get better as the muscles reattach to the bone so they work again. JG 4.6.08

Question:

I had submalar cheek implants put in, and then taken out. I was left with some scar tissue in that area. I was wondering what could be done to reduce/remove that scar tissue?

Answer:

massage and time is about all. JG 3.30.08

Question:

Hi! Approximately 10 years ago, I had 2 different sized cheek implants put in that frankly have left me with a distorted, long, assymetrical look. One of them (the smaller) you can literally see the outline and as I age it is horrible. They are both literally touching the corners of my eyes. I want to replace them with custom implants that are placed horizontally across the mid cheek region to give it more natural volume instead of giving me a high cheekbone look but flat long face. What are the repercussions re rebuilding a new pocket without getting implants screwed down (don`t want goretex,etc) and can I get the look that I want without submalars which give a chipmunk look that I don`t want. How is recovery time and finally can you recommend someone in Florida or elsewhere that does custom (that is a primary issue) other than Flowers in Hawaii, Yaremchek in Boston, Palmer or Biden in LA, or Terino? I have found that the big name is not necessarily better. Thanks!!!!!!!!!!!!

Answer:

well, I think in your case a screw or other method to hold it in place will be a best bet to avoid it form moving due to the pocket now being larger than desired. Getting a 3-D cat scan of your facial bones might also help in order to determine the degreee of assymmetry before hand. Recovery will be longer than before and I think you will need to look around, maybe look at the local universities at places where they do birth defects such as craniofacial anomalies. Best of luck. JG 3.20.08

Question:

Hi Dr. Garcia, The Maxfac doc read my patient records from the plastic surgeon who placed my chin implant and the records stated the implant was place on top of the peristeum. Is there a risk to the peristeum by attaching the implant tight against it? Thank you.

Answer:

I have never seen it cause a problem being screwed over the periosteum, if anything, it might be better because the blood supply to the bone that comes from the periosteum, is still intact. JG 3.19.08

Question:

Hi Dr. Garcia, Recently I had a consultation with a oral and maxillofacial surgeon for my loose moving silicone chin implant. I asked him to attach the implant to the bone with a small screw. The doctor said no because my implant was placed between the peristeum and the muscle and not under the peristeum. He said screwing the implant down tight against the peristeum could kill it. What are your thoughts please?

Answer:

well, firstly I do not see how he could say that because there is no XRay or physical examine that can tell if it is above or below the periosteum, we always put them under the periosteum though. I think he just does not want to do what you need done and is coming up with excuses. Might need someone else to do it for you. JG 3.19.08

Question:

Some costmetic surgeons I have consulted have said it is bst not to use a chin augmentation with me because I am 66 and there can be bone loss with older patients. I just consulted with a very respected cosm. surgeon yesterday who said an augmentation would be fine for me. What do you think? Thanks, Judy

Answer:

I think it is fine to do it if you have solid bone mass, if you wear dentures I probably would not do it though. JG 3.18.08

Question:

I am considering malar cheek implants but have a few questions for you, Dr. Garcia: 1)I am 52, have a small face and close-set eyes. What size is recommended? I`d like to make a dramatic change in my appearance but don`t want to look like a chipmunk! I also don`t want to go through the procedure using small implants that nobody will notice a change. 2) Can this procedure be done in the office without having to use general anesthesia? 3) Can you recommend a surgeon in Portland, Maine or Boston? Thank you for all the help you provide to us beauty-seekers!

Answer:

might not be able to go much past a medum in small face patients. I would never try to do it in the office under local anesthesia myself. Due to potential legal issues, and some doctors wanting to know why I referred a patient to someone else and not them, I think you are best to go to this website and look for a plastic surgeon in the area you desire. I wish you all the best. JG 3.8.08 http://www.surgery.org/public/findasurgeon.php.

Question:

Hi Dr. Garica. I`m 10 years post-op silicone cheek implants. I like them very much but wonder will they last and hold-up through the decades should I not have injury or infection? I`m corresponding with someone whose implants float around their face. They can move them! Mine are not screwed to the bone, but by 2 weeks post-op, they felt firmly stuck in place. How can mine be stuck at 2 weeks another`s float . Also, my implants start at the base of my nose, run along the orbital rim. the edge wraps around my orbital bone then has tails that taper off near my hairline. Have you heard of such a implant. Sorry so many questions. thanks.

Answer:

she might have had alot of swelling and the pocket then ended up too big, yours sound like they healed they way they should. No need to change them if not causing a problem. That is just an extended malar, not common but they are out there for those people that need a little more. JG 3.5.08

Question:

Hi Dr. Garcia I need a facelift but am unable to finance the entire procedure now. I can manage a chin implant (I have a receding chin). Is it practical to do these procedures in stages? I need neck work as well. I have the `elephant` neck as opposed to the `turkey` neck. I was thinking I`d have the chin now and do the neck and face in a few years. What are your thoughts? Should I procede or wait until I can do it all?

Answer:

I think the chin can be done now, there will be some improvement, not as dramtic as a facelift, but the facelift later will yield a better result than if you had never had the chin implant, having said that, the facelift and chin implant can be both done at the same time too. JG 2.27.08

Question:

How long does hydroxyapatite injections last? I know radiesse lasts anywhere from 6-12 months

Answer:

in some areas hydroxyappatite can last years, in the soft tissues of the face it can last up to one year. JG 2.27.08

Question:

If you have porex implants when your young and then later in life develop cancer and need chemotherapy, will the implants then automatically get infected due to the immuno supression?

Answer:

no, they should be protected by the scar tissue. JG 2.21.08

Question:

I just got a rhinoplasty in Dec. I had an l shape implant. My surgeon shortened the short end. I like it but I am noticing that the tip is starting to have a circular color change. It is starting look lighter there - like a bubble but it is not raised or does not hurt. Can you tell what could be happening?

Answer:

might be just thin skin stretched over the implant, need to see your surgeon to make sure all is OK. JG 2.21.08

Question:

So does hydroxyapatite injections last longer? if so how long do they last? also how can i find a surgeon who uses hydroxyapatite blocks for jaw implants? I ask because i am a 24 year old male with a very weak brow and would love to bulk it out bu can`t undergo a coronal incision due to receeding hairline.Thank you

Answer:

I cannot tell you how to find someone to inject the hydroxyappatite besides calling around, sorry. JG 2.20.08

Question:

what is the difference between hydroxyapatite injections and radiesse?

Answer:

essentially the same thing, just the Radiesse has microspheres of the hydroxyapp floated in a carrier that is absorbed in 6-8 weeks. JG 2.20.08

Question:

Hi Doc. I can`t believe you take the time to read and reply EACH post. THANK YOU. I had hyaluronidase inyected to disolve some overfilled H.A. (Teosyal) and it did the trick, but then, I insisted in a second shot cause I thought there was still HA left to get rid of, and from this second shot I got a dent in the exact inyected area. The dent looks like a chicken pox marking, and in the begining was also a bit redish. I`m still glad I took the hyaluronidase, cause I looked awful, but I wished I had not insisted in getting more, cause it seems that it can leave a dent if not sufficient HA is present. The concentration used in my case was about 120 units of hyaluronidase disolved in 1 cc of saline solution, from wich he inyected 0.5cc. It`s been 6 months and the dent has not filled up but is not as obvious as before (no redness). I doubt it will go away on its own. Have you ever seen these dents from hyaluronidase inyections? is there any treatment that would help? Microdermoabrasion? Thanks so much. Vicky

Answer:

give it time, and let it fill in on its own, it might take some more time but it should get better, I do not think the microdermabrasion will help, sorry. JG 2.19.08

Question:

Hi Dr. Garcia. 12 years ago I had a mandible glove chin implant with wings. 1 year later (11 years ago) I had jaw implants. On my left side the jaw implant overlaps the wings of the chin implant - providing nice, streamline augmentation. The right side of the jaw implant pushed the tail of the chin implant down - making not as clean and a bit asymmetric. I plan to addresss this when I see the doctor in a few months. My question is: do you think the silicone chin implant warped into this position and cannot be straightened without replacing? Or, do you think it could be straightened easily? Thanks so much!

Answer:

silicone does not stay warped, it is in that shape because of the pressure from the other implant and the pocket that it sits in, revising the pocket will allow the implant to lay flatter like the other side. Best of luck. JG 2.13.08

Question:

Hi Dr. Garcia. Could a Porex cheek implant truly be removed without tissue damage years after it has been placed? I recently heard that someones cheek tissue grew into the implant. Thanks!

Answer:

the tissues can be peeled off like velcro in most cases. JG 2.12.08

Question:

Thanks for your answer to my last question. Are silastic chin implants risky in any way? I know they have been around for 40 years, but will it erode my bone? Will any bone erosion affect augmentation results over the long- term?

Answer:

I think they are generally the standard of care for chin implants, very safe. Any implant will potentially erode into bone, and sliding genioplasties can also lose bone too. The degree of bone erosion is minimal though. JG 1.29.08

Question:

Hi Dr Garcia,i have another question on dissolving sculptra.Do you think that hyaluronidase or an enzyme injection might do the trick? I know you said you heard about salain elswhere from other doctors, could you give me details of the site as i am currently unable to speak with the person or company who did my injections. Thank`s again for all your help.

Answer:

no, those enzymes will not work on Sculptra. I do not recall which site I read about the doctors using the slaine. There are some sites that are available only to doctors and I am not sure which one it was. JG 1.14.08

Question:

Hi Dr Garcia, I,ve asked you a couple of questions about dissolving sculptra and you said salain might work. Do you know of any successfull cases?

Answer:

I personally have not had to do it, only have heard about it from some other blogs where physicians answer questions. JG 1.12.08

Question:

Hi Dr Garcia, I have sculptra as a model for the third time in 1 year ,the first two times i had one vile but the 3rd time i had 2 although i didnt really need it. I did not realize it would make me look older and puffy faced. I am really depressed and upset and becoming very depressed. I s there anything I can do to have this stuff dissolved I am so desperate please help.

Answer:

well, some people report some benefit from injecting saline into the area to help speed up the dissolving but it is not very predictable I am afraid. JG 1.8.08

Question:

Hi Dr. Garcia. It`s me again. Is dog tongue the right terminalogy for the excess skin that grew along the stitches called? It`s inside my mouth (chin aug surgery was done inside mouth)and the size of a small swollen dime.

Answer:

dog ear , close though. JG 1.7.08

Question:

Hi Dr. Garcia. I had a chin implant Dec. 5 and since then they had to suction a blood clot and restitch (inside mouth surgery). I just noticed that there is excess skin that has grown from where the stitches are. It looks like a small tongue the size of a small dime. The nurse at my doctors office said it can be something called a dog tongue ... have you seen or heard anything like this. Also, I noticed that since my lower jaw was swollen for quite a while the skin is somewhat sagging. When I look in the mirror my face looks rectangle but when I pull my skin up near my ears it pulls the skin around my chin and jaw and it has a curved v shape. Will the skin tighten up to reveal the curved v shape? I am 39 years old.

Answer:

I think all of that will tighten up and smooth out in time. JG 1.7.08

Question:

Have you done any permanent lip implants? Do they look natural? Can that be done at your office and around how much are they? Thanks..you are wonderful.

Answer:

the newer ones called FulFill have recently been released and look promising, all of the older ones with strips of Gortex I felt did no give asupple feel or look. You can call the office and speak to one of my nurses about the Fulfil lip implants if you would like, it is an in office procedure under local anesthesia and you are swollen for about 10-12 days. JG 1.4.08

Question:

I have had a silicone chin implant for the last 6 years...at some point does it have to be removed or can i go to my grave with this... hopefully, permanent meant permanent. Thank you and God Bless. jg 03jan08

Answer:

nope, it is permanent, all the best. JG 1.2.08

Question:

Hi Dr Garcia, I was wondering what you thought of men and cheek implants. I have been told by a few Dr`s that Malar implants would be something I could benefit from. Also I have been told that 3 mm Terino Malar Shells are the most appropriate for men and anything larger would be too much, has this been your experience? One last thing, would a mini-facelift make acne scars less visible? I have had 2 plastic surgeons tell me that it would help and 2 others that said go see Dr Yarborough in New Orleans for dermabrasion so I am more confused than ever! Any advice would be greatly apprectaited! Happy New Year! Mark -

Answer:

I do think some men can look better with cheek implants, but I cannot see how anyone can make a general statement about a thickness as what is needed will vary from person to person, for some that will be too small and for others too big. I think mini lifts do help acne scars but as the skin loosens with age the scars become prominent again. I think dermabrasions are nowadays replaced with lasers due to more control and safety. JG 12.29.07

Question:

Hi Dr. Garcia, I would like to have mandibular angle implant from POREX. I want to know that screw must be put on POREX implants and that place? If not may it change place or slide? And another question; After surgery how much time am i on infection thread? Because solid silicone implants can cause an infection whatever time after surgery, isn`t it?? Thanks,

Answer:

In that area the implant is usually held in place with a screw due to the amount of muscle motion. Any foreign material can become infected at any time after the surgery but the initial risk is low after 6-8 weeks. JG 12.27.07

Question:

hello doc, what are the sizes of chin implants that exist?

Answer:

small, medium, large and extra large, their dimensions vary depending on the style chosen. JG 12.27.07

Question:

Is there anything permanent for repairing whistle lines (marionette lines) above your lips, not the lines on the sides of your lips.

Answer:

nothing permanent, no. JG 12.22.07

Question:

I just had a chin implant and nose implant. The nose implant is to lift the bridge. However, now it looks like the tip is short and looks like a snout. I see more of the inside of my nostrils. They used a l shaped implant. Is this swelling or an indicationg of how my nose will look like when the swelling goes down? For the chin, they used the extended arms for my chin implant and now my face looks rectangle. It used to be oval. Will this taper out so that it`s not so sharp looking? I just wanted my chin to protrude a little more to balance my new nose. Also, at the ends of my chin implants there are hard bumps on each side that hurt. It feels like my muscles are being pinched. My doctor said that it`s the nerves trying to reposition itself away from the implant? Is that possible?

Answer:

well, certainly swelling can cause that and it does take time for it to all go down, but if the short limb of the L shaped implant is too long it can cause the issue you are concerned about too. Final results can take 6-12 months at times. As to the chin, the extended anatomical implants do give a more squared off appearance as it extends laterally. As to the nerves, they cannot move to reposition themselves but it can be swelling, it can also be pressure from the ends of the implants too, hard for me to say without examining you, sorry. JG 12.18.07

Question:

Hi sorry one more question about the chin and i wont annoy you no more lol im just very nervous when it comes to permenent surgeries that you cant reverse. Okay lets say i get a chin reduction using the burring method and my face looks too round and my chin also too flat and squarish, are their chin implants that i can have implanted to the tip of my chin to make it look more longer and oval, is there such thing? Thankx

Answer:

yes, they come in many shapes and dimensions. JG 12.11.07

Question:

Hi i had the question about the chin reduction, both dr. Yaremchuk and Dr. zide are good doctors i heard but both told me that my chin shape wont remian the same and its going to be more round and i dont think Dr. zide does sliding genioplasty would you be able to refer another surgeon?

Answer:

Due to potential legal issues, and some doctors wanting to know why I referred a patient to someone else and not them, I think you are best to go to this website and look for a plastic surgeon in the area you desire. I wish you all the best. JG 12.11.07 http://www.surgery.org/public/findasurgeon.php.

Question:

had mini lift and one ear is pleated in several spots due towhat doc says is anchor stitch. he offered to put restalyne in lines til anchor stitch does something in around 3 months. Ever heard of this anchor stictch bit?? I assume i could wait for the 3 months and have him reopen to correct if necc. thanks!!!

Answer:

it is more likely from trying to keep the incision short, I doubt the anchor stitich is the cause. It might require a little more skin to be removed or redraped to allow it to lay flat. JG 12.11.07

Question:

Hi have you heard of Dr. Michael J. Yaremchuk in common wealth boston?

Answer:

yes, good surgeon. JG 12.9.07

Question:

Hi, I am very confused and would greatly appreciate your advice, im getting a chin reduction because of my long and pretruding chin,the 2 docs that i am thinking of want to use the burring method,my problem is i like very much the shape of my chin i dont want it changed and with burring i wa told theres going to be a definite change. I have a oval chin and by burring its going to make it rounder or who knows how im only doing 5mm is sliding genioplast alot more dangerous then burring regarding the nerve? thank you

Answer:

in experienced hands a sliding genioplasty is safe, as to burring it down, in experienced hands it can be burred and the shape maintained. JG 12.9.07

Question:

I had endoscopic brow lift and chin implant 2 years ago. However, I feel my face looks stretched out and too long. I`m not sure what to do about this. When i go to the doctor he just keeps saying you look great. Would image software help me determine if the implant was too long?

Answer:

well chin implants usually push the chin forward and not down but some can if placed that way, also the lifting of the brow will commonly stretch the forehead longer and give that illusion, it might actually take a revision of both. It might help to have the doctor print your before and after pictures next to one another so you both can compare them and see where the differences are. JG 12.6.07

Question:

Hi Dr. Garcia. have you heard of Dr. Flowers for facial implants? I`m trying to find a master implants doctors. Thanks

Answer:

good man, lots of experience. JG 12.4.07

Question:

Dr. Garcia, I had a chin implant done 4 days ago, The surgeon originally put in an XL implant, decided it was too big, then but in a Large. I can feel the arms of the implant in my lower gums- just the edges on each side of my lower gums. Is this normal? I feel like I can move the arms around. Is this actually the arms or fluid from something. I am concerned that I am going to have to have the implant repositioned. I like the size and shape, only concerned with the feeling in my lower gum. Thanks in advance

Answer:

not really, they should lie lower on the bone, might need to get it repositioned. JG 12.3.07

Question:

Hi iam from india my skin is normal colour and i have small pimples on my face and there is no glow on my face evn though i have tried lot many facials available in the market can you please advice me any creams or any treatments so that i can improve my colour and make my face look younger and better.

Answer:

I would start with Retin-A and see how it goes. JG 11.30.07

Question:

What is you opinion on direct incisions on sides of mouth to help with extra skin in lieu of facelift?

Answer:

well, a good option but there will be a permanent scar that you might need to cover with make up and the amount of lift is limited by the distance between the corner of the mouth and the nasolabial fold. JG 11.29.07

Question:

Hello Dr, G , I would like to find out how long it takes to have swelling diminish completely after a check implant surgery. I had the surgery done one week ago. The swelling has gone down, but my face (especially around the areas where the check implants were positioned) is bigger than I expected. Could you kindly let me know the progress of swelling going down (if any, after a week) will take place. Thank you so much for your opinion and assistance.

Answer:

could be 3-6 months for it to totally go away, but most of it is gone in 6 weeks. JG 11.27.07

Question:

I recently had facial plastic surgery and implants, 1.5 months ago(male). Since then I experienced hair loss. Had hair transplant about 2 years ago. Could hair loss be attributed to the plastic surgery or it it coincidental? Have you heard of anyone with this situation? Thanks

Answer:

I think at times there can be short term not permanent hair loss from the stress of surgery, should all get back to normal in the near future in most cases. JG 11.26.07

Question:

hello dr. Garcia I just wondered if it is possible to have chin implants, if you have a unsymmetrical jaw/chin area and make it look more symmetrical and straight? I would really like a strong jaw and chin and dont know what is possible to do with it. Can you have jaw implants as well or is that just in USA? or is it enough with chin implants? I would like my face form to be more square and not so much round. Can you please give me some advice? Thank you. I live in Norway.

Answer:

well it cna be done but hte chin implant will either need to be custom made or modified during the surgery to change its shape. There are jaw implants for the angle of the mandible bones too, available in the US and worldwide. Best of luck. JG 11.25.07

Question:

Like to have dimple cration done on my cheeks and a cleft on my chin, I had a chin implant about a month ago would the cleft affect my chin implant. And do you don dimple creations.

Answer:

I am sorry but I do not do that type of surgery as it can be unreliable. JG 11.24.07

Question:

Hi Dr. Garcia, Thank you for your quick reply yesterday for securing my loose chin implant. When I wear a facial compression garment, the upwards pressure pulls the chin implant back up where it belongs. Would wearing the facial compression garment long term help hold the implant in place and allow the chin pocket to shrink in size to tighten up the implant?

Answer:

I think since the pocket exists that is larger than desired that it will keep moving unless it is secured or the pocket partially closed. JG 11.21.07

Question:

What do you mean probably? Should I look out for something else to be damaged?

Answer:

you are aksing questiosn that there are no real way to tell you the answers to. JG 11.19.07

Question:

What do you think of maxiallary spine grafts? What do they do exactly? Thanks!

Answer:

used to elevate a depressed area of the skin between the nose and the lip, some people do benefit from them. JG 11.19.07

Question:

so if scar doesn`t spread, I am in the clear?

Answer:

probably. JG 11.19.07

Question:

If the inner sutures are damaged, how would I know?

Answer:

the scar might spread out wider. JG 11.19.07

Question:

Hi Dr. Garcia, I am having problems with my 12mm silicone anatomical chin implant. The implant keeps sliding down and sits too low and looks like a witch`s chin. It seems to me that the pocket or envelope in my chin is too large allowing the implant to shift downwards. I can move it up and down. On revision surgery 7 weeks ago the doctor repositioned the implant and placed a temporary pin to hold the implant in place. He didn`t want to use a screw to permanently hold the implant in place saying that a screw could get infected. The pin is out now and the implant is still moving plus now I`ve got a scar/dent on the jaw line behind the implant on one side. I have lost confidence in this doctor. This is the 2nd chin implant from him thats caused me problems. His office says he does about one chin implant surgery a month for his patients. What do you think of placing a screw to hold the implant in place and could I use a oral surgeon to do this in his office instead of my doc? Is this a fairly simple procedure?

Answer:

I think that is the best option for what is going on, relatively simple procedure. JG 11.19.07

Question:

If I get the goretex implanted and open a suture line from my direct browlift when it is 4-5 weeks post op, is there a chance that the inner sutures sorrounding the new opening could me damaged, stretched, etc...due to swelling and manipulation?

Answer:

yes. JG 11.19.07

Question:

If I was to get the goretex, and there were complications such as migration or infection, how would most doctors charge for the remedy? Should I expect to be charged to remove the implant and replace it or to fix migration? Is there a standard practice for this? How is migration fixed?

Answer:

can`t say, will depend on the doctor. Migration can be fixed by fixating to to something. I think you are overly concerend about this migration thing. It is not a common occurrance. JG 11.19.07

Question:

Thank you so much for answering my questions! So this goretex sounds like it acts just like skin - is that true? You have given me so much confidence to make a well informed decision - thank you.

Answer:

not really, it acts to replace the muscle bulk or the fullness of the muscle that was removed. All the best, glad I could help. JG 11.19.07

Question:

So you don`t see the need for screws even if my skin may have a tendency to sag? If I have to get my skin lifted, will the gortex need adjustment or will it just lift with my skin back in place?

Answer:

yes, it wil get lifted with the skin the second go round if it has fallen. JG 11.19.07

Question:

The gortex sheets can be attached to the bone? Does it require more than a local procedure for that? Is there a chance it could come loose. What do you think is better to sag with the skin or to be attached to the bone and only have the skin sag? What is best: silicone, goretex, or medpor for that area & my concerns about sagging as far as what takes best, has less chance of infection, less chance of migration and lasts.

Answer:

need to have general anesthesia in order to put two screws into the Gortex or silicone and the bone. I do not think the Gortex or silicoen will cause the skin to sag any different than without it, it does not weigh that much. I would use Gortex. JG 11.19.07

Question:

Dr. Garcia, Thank you so much for your prompt response. If I may, I have two related questions regarding cheek implant. You mentioned in your response that regardless the size of the packet, it may still move due to swelling. My question is whether or not the size and the shape of an implant can have any affect. I need to place a long not a round one. Also, I am advised that for the few days after the surgery, I should not rest in horizontal position. Does not that positing contribute to prevent the implant from going downward in contrast to resting in the position like standing which, I assume, would contribute to the implant moving downward. Sorry to take your time again, but I am concerned about the movement of the implants. Best, Shahron

Answer:

well I do not feel the shape will affect the mobility, they both can move. As to horizontal positioning, we advise to not lie face down, and lying on your back just allows more swelling so we usually suggest sleeping in an upright or semi-recumbant position. JG 11.17.07

Question:

So, if there is a chance that my skin could sag b/c I may not have frontalis in the glabella, is there another implant for the glabella besides gortex that can be anchored? Mepor, Silicone with screws?

Answer:

the implant will not prevent the potential sagging, it just fills in the depression from the muscles being removed. JG 11.16.07

Question:

I mean approximately how many goretex implants have you done in the whole face, not just the glabella.

Answer:

maybe 50 or so. JG 11.15.07

Question:

so you have taken 1 out for infection out of many you have installed? Do you know about how many on the face in general that you have installed? Does one area tend to infect more than others?

Answer:

I think your questiosn are certianly valid but I have already answered that question before. JG 11.15.07

Question:

I have noticed that a lot docs like goretex and a lot don`t like it. I am scared it will be hard to find a doc for goretex service if I need it b/c not all like it and use it.

Answer:

well then use a different type of implant, things will always change and new things will come out and the old are usually changed if needed. JG 11.15.07

Question:

How many years since ¥ou did your first glabella implant and have any of the clients had to come back for the goretex issues of extrusion, movement, or infection(I know these wouldn`t be faults of yours, but I am just trying to get an idea how reliable goretex is).

Answer:

it has been at least ten years or more since my first Gortex implant and I had to take one out due to infection, it was on a severly scarred cleft lip correction on an adult. JG 11.15.07

Question:

u said that glabella implant of goretex isn`t common, butyou didn`t say what your experience is with it there: have you seen it there on patients or have you put it there before? Thank you.

Answer:

I have done it about half a dozen times and have seen probabaly 15 patients with it over the last 10 years. JG 11.15.07

Question:

What do you mean? I thought you needed two holes to place the goretex. Would I only need one hole to place the goretex?

Answer:

only need one, if you already have two open it is eaiser but can still be done through one. JG 11.15.07

Question:

would there be one or two cuts for implanting goretex in the glabella?

Answer:

depends on where the cuts were to begin with. JG 11.15.07

Question:

I already have direct incisions around my brow centrally and above, so if I was to get a Gore tex implant, and I asked for the incisions to be in that area, how big do you think the incisions would have to be to install an implant?

Answer:

same size, no need for anything longer. JG 11.15.07

Question:

How often have you seen infections with Gortex in the glabella? Do you see many people with it in the glabella? How much swelling/pain is there with implantation?

Answer:

not a common procedure to be doen but I have never seen it get infected, the only place I have seen Gortex get infected is in the lips. Swelling is mild and pain is small. JG 11.15.07

Question:

when the doc numbs you with lidocaine and you swell up, how does he know how much Gortex will fill the void correctly if you are all swollen from the lidocaine? My muscles were definitely resected - cautererized.

Answer:

it is estimated before the injections. JG 11.13.07

Question:

Is there a website I can go to and look at the Gortex sheets that you use for the glabella void? Can you describe it? What shape do you cut it in for the glabella? How does it fill out the void if it is a flat sheet? Have you seen many people get infected after insertion in the glabella area? Does it have more or less chance of migrating in the glabella? Does removal ever require scarring because of the tissue integration?

Answer:

I am not aware of one, sorry, it is not a usual thing, most people the sheets can be layered and trimmed to fill in the gap. I usually do not resect the muscle, just cut them to avoid the depression. Migration is a very small risk for the Gortex in the area. Removal is not too difficult in the rare instance it is needed. JG 11.13.07

Question:

One more question about the Gortex/Glabella. Have you see older people with these? Do they look good on older skin?

Answer:

yes, and they look fine. JG 11.12.07

Question:

Have you heard of subcutaneous dissection of soft tissue surgery by use of a diamond wire or wire scalpel. From what I understand, it removes extra skin without scarring. Is this correct? could excess glabella skin be removed this way?

Answer:

yes, but that alone will never remove skin, it just releases it from the underlying tissues, and then can be cut out or filled in if needed. JG 11.12.07

Question:

Had direct browlift and procerus and corrugator resected 2 years ago at 40. The muscle removal was successful(no movement in the area just like the affects of botox), but it left a deficit between brows that caused a large crease that I didn`t have before when I was using botox. 3 months ago, had another direct lift to remove the deficit through additional excision and lifting. That didn`t work, so a week ago, I had the direct lift incisions continued from above the brow to between the brows to remove the excess skin. So far, it appears to have worked, but I do have to wait on swelling to go down to be sure. Since I don`t have muscle there anymore, is my skin going to sag earlier than my other skin? This has got me greatly concerned - don`t feel like having browlifts every 2 years. If the excision I just had doesn`t work, are there any permanent fillers such as Advanta or Gortex that would work? I am concerned about using a Advanta because they only augment soft tissue with little support. Without the muscle structure, would the implant add weight and cause my tissues to sag as I age? What WILL this type of implant look like when I age? I am really not interested in any injectables because they are temporary and many of them are not recommended for the glabella due to migration. Is there any implant for this area that provides support, and is permanent? Nasal, skeletal, silicone set with titanium screws like cheek and chin implants, etc...? Anything? Help!

Answer:

the lack of muscle will not make the skin sag but it is the removal of the muscle that has caused the depression there, using a filler in usually the best option for it. The pocket made for the Gortex or other implant will not allow it to sag and it will stay in place. JG 11.12.07

Question:

If a person gets submalar implants and after awhile they want to remove them , after its removed does the facial skin sag where the implant was or does it return to normal after awhile and the skin tightens?

Answer:

I think the degree of sagging will be small if any. JG 11.12.07

Question:

Hi i saw Dr. posnick for a chin reduction and he said my face was flat and he refuses to do a chin reduction on me he rather bring my upper jaw foward for the flatness I have an underbite and only my teeth were corrected and not my jaw but i think i would benefit from just chin reduction, my question is for the flatness of my face instead of bringing my upper jaw foward which im too scared to do like dr. posnick suggested can i just get paranasal implants with dr. yarmchuk that is used to hide the flatness in the midface? Your website is a lifesaver thank you

Answer:

I think the paranasal implants will certianly help the area below the nose but not much for the cheek, may need a submalar implant oo for that, best of luck. JG 11.10.07

Question:

Hi i am interested in getting a chin reduction i was wondering which method you think works better the burring method which Dr. zide uses or the sliding mehtod that other doctors favor. Im worried with the burring it wont be so accurate i only want 5mm taking off and pushed back , which method do u think is safer and more accurate. Iv heard burring can leave the chin uneven. I appreciate your help. thanx

Answer:

in skilled hands the burring will do fine for that small amount and it can be left smooth with less swelling too. JG 11.10.07

Question:

Hi Dr. Garcia, I had a chin implant placed this past May. The swelling is gone and I am left with a disfiguring dimple/dent on the left side of my face along the jawline right next to the chin implant. How can this be corrected? Thank you. JoeN

Answer:

could try a filler like Restylane or Juviderm and if it looks good then inject with Radiesse or Artefil later on. JG 11.9.07

Question:

I have paranasal implants and I`m wondering if it`s possible to get cheek implants as well or if there is only room for one or the other?

Answer:

yes, they can both be done, they fall in different areas. JG 11.6.07

Question:

Hi Dr. Garcia, I wanted to treat the dynamic fine lines above my upper lip. What do you reccomend? I`m considering cosmoderm/cosmoplast- realizing I`m going to have to refresh every few months.Any risks I need to consider? Thank You,I appreciate your help.

Answer:

I think both those fillers yield extremely short correction, might want to go for a Restylane or Juvederm product. Risks are small lumps in the relaxed position since they are filling dynamic lines, the fillers do well for wrinkles seen at rest, but wrinkles seen only when moving are hard to fill and leave looking natural without lumps. I am not a fan of Botox there because of muscle weakness and speech distortion, best of luck. JG 11.3.07

Question:

Dr. Garcia .Thank You for your quick response.I have a rather odd question. I had facial cheek implants back in 1985-1986 in Las Vegas by a board cerified plastic surgeon whose name I cannot remember. How would I be able to track this Physician as I need to know the type Of implant? I only remember the implant was small, hard and it shifted within a few years of my surgery and now sits between my nose and top of my lips.Thank You again for your time...

Answer:

was either Dombrowski, Vinnick or Hetter likely and they are are long since retired and their charts are not available, the new surgeon might have to have a couple of different sizes in the OR and then decide after he takes yours out. I will say that the implants then did not have as wide of a range in shapes too. It is better now. JG 10.31.07

Question:

Hi Dr. Garcia I posted a question a few days ago concerning cheek implants I had 20 yrs ago. My face has hollowed under my cheeks and the hollows of my eyes. My derm. suggested Sculptra to fill in these areas. Can I still have a filler injected in those areas even if I decide to have my old cheek implants removed or replaced in the future( Implants were placed through an incision under lower lash line and not through mouth)? As I have a small, wide and rather flat face I am trying to add vertical length and contours to my face. Would replacing my small cheek implants and possibly adding a chin implant help to achieve this ? or would a sliding genoplasty be a better option ? Could you recommend a maxillofacial surgeon and a plastic suregeon that would specialize in this area in Los Angeles county...I tried to make an appt. with you to no avail...

Answer:

yes, Sculptra will not affect any old or future surgery decisions. I think changing the implant to a different shape might help, and I would need to see you to tell if the chin implant would enhance things. May want to see Ed Terino MD in the LA area for your issues. JG 10.31.07

Question:

i got juvederm injected into my lips a day ago and they are very firm and not natural feeling. will they feel natural?

Answer:

It will get better but it will take a week or more. JG 10.23.07

Question:

Hi my question is i have been to 4 maxillofacial surgeons consults for a chin reduction and all of them took an xray which i guess was to see where my nerve is.The last doctor i went to dr. barry zide which is known to be achin specialist didnt take an x-ray he just looked at my chin hes going to be goin threw under my chin.Why do u think he didnt take an x ray and the other 3 doctors did they said they were going to go threw the inside of my mouth is that why?

Answer:

yes, since Dr Zide is going form the outside it is a safer procedure, by the way, I think he is excellent. JG 10.20.07

Question:

Hi Dr. Garcia, I wrote you about Radiesse. Had injections in cheek and jaw on 8/31 to correct over microliposuction in facelift. Wanted you to know it was a very good choice and am happy with outcome. Nurse practioner took great care and time and I have good symmetry and feel comfortable with my appearance now. Thanks for all your help.

Answer:

I think it is a good option for your case, yes. JG 10.19.07

Question:

Hi Dr. Garcia, I recently had fat transfer from my hip to under my lower eyes. The doctor transferred the fat by inserting inside my lower eyelid; however, he stated he overstuffed to ensure I received enough fat transfer as 50% of the fat would disolve. I had the surgery two weeks ago and my eyes are still swollen, with light brown bruises and I have lumps of fat in certain areas. I went to see another plastic surgeon and he suggested cortisone shots into the puffy and bumpy area, as this would disolve the fat. Can you confirm if this statement is true, or do you have any other ideas on how I can fix this issu?

Answer:

I do think the cortisone will dissolve the fat but it will dissolve on its own without it just about as fast with less risk, just wait it out. JG 10.17.07

Question:

Hi Doctor, You have stated several times in e-mails that malar implants will make you look different. Is that the case with sub malar implants also? if yes, as different as malar implants? Thank you.

Answer:

less so with submalar implants at they are over the soft tissue and not really over the bones which are what makes you look different if altered. JG 10.9.07

Question:

Hi Dr. G.. Can surgery to remove artecoll lumps in the nasal labial folds be done from inside the mouth ? They are extremely visible. Thank you

Answer:

nope, it needs to be done from the outside. JG 10.3.07

Question:

Hi Dr. Garcia. 9 years ago (at age 20) I had hand carved chin, jaw and cheek/tear trough implants by Dr Flowers. They look great but I worry that I will have to replace them at some point because I had them at a young age. Will the silicone deteriorate over the years or will these hopefully last until old age? i always hear people and other docs playing devils advocate saying they`ll get imfected or have to be replaced. Thank you very much?

Answer:

no need to replace them, they will last many years. If they get infected, doubtful at this point they can be replaced with another carved implant. JG 10.2.07

Question:

Hi its me again,about the paransanal implants , lets say i dont like it in about 2 years and i want to have them removed will my face be the same after i have it removed like it is now before the implants or will it look deformed after i take it out or like will i have loose skin?Also which are the best type of implants that that are non allergetic

Answer:

they are not that big to cause loose skin so it should not be a problem I feel. I have never seen an allergy to these implants and I tend to use solid silicone for that area. JG 10.2.07

Question:

Hi its my first time on your site and am so happy to find a site like this. My question is i went to see a maxillofacial surgeon to have a chin reduction he also suggested Paranasal implants above my lip and near my nose because of my underbite it looks flat near the area, im afraid of him hitting a nerve are there alot of nerves in that area and if i decide to have the implant removed am i going to see a difference in my face after , will it look exactly like before after i have it removed?

Answer:

pretty safe area and I have done it and it makes a huge difference in terms of facial bone balance. JG 9.30.07

Question:

Hi Dr. Garcia. When cheek implants are placed and positioned under the periositum, do you still need titanium screws? Why don`t most surgeons place under the periositum? What do you prefer? Thanks so much!

Answer:

if the pocket is precise it is not needed. Most surgeons place it under the periosteum because it is less bloody and easier to avoid injuring blood vessels and nerves during the opening of the pocket. I place them under the periosteum and I do nto use screws typically.JG 9.27.07

Question:

Thank you for your answer. I am the same woman that asked about which surgery would reduce the vertical height from the lips to the chin. You told me that only maxillofacial surgery would correct this problem. Are you referrring to a sliding genioplasty. Would does a sliding genioplsaty do?

Answer:

well, it really is not a sliding genioplasty alone, that is done for only retrussive chins, in your case a slice of bone will need to be cut out to redue the vertical dimension and then if needed it can be slid forward too. JG 9.26.07

Question:

Hi Dr. Garcia, I am in need of your advice. I am a 32 year old woman with a very long face. I have alot of length between my lips and chin, which I detest and would like to shorten. At the same time, I also have a very weak chin and a bad profile. I do not wish to undergo the extreme maxillofacial surgery which requires that I wear braces for months. Which procedure would you recommend to decrease vertical length from lips to chin (at least 1 inch), yet build up the chin from the side? I appreciate your help. Thank you,Leila

Answer:

I am sorry but there is no surgery besides the maxillofacial one that will reduce that distance I am afraid. JG 9.26.07

Question:

Hi Dr. Garcia - I hope you`ve been well. I`m posting after a long time - I had submalars done and some sub-Q in my outer-cheek area but feel bothered by an area under my eyes which is still in need of a little lift. I`m wondering is there anything that can be done in this sensitive area that will be safe? Thanking you.

Answer:

hard to say without seeing you, might need more fillers there or some surgical intervention through the eyelid incision. JG 9.16.07

Question:

How long does it take for the skin to tighten back up following chin augmentation. I had a lot of swelling post op and as the swelling goes down some the skin seems loose and there is also some dimpling present. I`m twenty five years old and didn`t have any loose skin prior to the surgery.

Answer:

should be pretty much gone after 6 weeks. JG 9.16.07

Question:

Ps. I dont want big silicone lips but just a little fuller and bigger, especially my upper lip. Doesnt it depend how big implants you take that may cause infectio? Just see how many women who are taking silcone implants in their breasts, they also get infection, but that doesnt stop women having breast implants. Thank you so much.

Answer:

it is a risk, you can decide to do it and if it goes well, that is great, if they get infected they need to be removed and if they distort they will need to be removed. JG 9.6.07

Question:

hello dr. Garcia I have asked you yhis question about lip surgery with gortex, is that the best option for permanent lip surgery? i am desperate i really want to have bigger lips permanently, i know a doctor in my country who does it and i really want to do it but only if i know the % chances of if the procedure could go wrong. There are people who have permanent lip surgery and they look fine to me even after many years, what do they have then when they have permanent lip surgery? Please help me.

Answer:

well the infection rates alone from what I have heard with PTFE which is Gortex run about 7%. JG 9.6.07

Question:

thank you for youre answer, but i dont understand why you dont recommend gortex in lips? Is it just because you dont think it is natural looking? Because i have seen people having it and it looks nice to me. I just wanted to know how safe it is for allergic reactions and infections? Is it a big chance you can have an allergic reaction and infection in your lips after the surgery? Because if the procedure is ok and safe enough i REALLY want to have it. Thank you so much

Answer:

there are risks of infections and also a funny appearance when the person purses their lips as the Gortex cannot collapse, it just folds. JG 9.5.07

Question:

I`m currently 8 weeks post op following rhinoplasty and a chin implant prodedure. I still have swelling in the chin area and there is very little movement in my mouth area when I speak. Also, my lip on the right side is pushed up higher than the left side. My PS says that this is likely due to the swelling, which he is confident will subside over the next few weeks. I have two questions: Is it normal to have this level of swelling 2 months after this type of procedure. Also, will I regain normal movement in chin and lip area or is there a possibility that this will be permanent?

Answer:

well, swelling varies from person to person, more likely the reason for the lower lip difference is a strecthing if the nerve that affects the muscles on the side where the lip is lower but I do agree that it in time usually gets better. The return of function of the lower lip muscle usually gets better in 6-12 weeks if stretched to a good amount. JG 9.2.07

Question:

I had a silicon chin implant replaced 8 weeks ago. It is still to big, I have 6mm of projection. Are there smaller implants? What is the smallest? I am thinking of having it removed completely since I really didn`t need the implant to begin with. If dimpling occurs, are there fillers to smooth it out?

Answer:

yes, smallest is 2mm I believe. Fillers are avaialable if there are dimples, yes. JG 8.31.07

Question:

Hi, Dr. Garcia. I asked earlier about chin implants that elongate the face. Are there certain materials/types/names of implants that I should request from my plastic surgeon to get a more elongated look? Thanks, again!

Answer:

they should have them in their catalog at the office. JG 8.30.07

Question:

Greetings, Dr. Garcia. I have a question about chin implants: Are chin implants used only to help the profile in terms of the project (forward) and not to elongate the face? In other words, are there chin implants that would somehow allow a person to have a more angular or pointy chin? THANKS!!!

Answer:

some of them can elongate it too, just not all of them. JG 8.29.07

Question:

hello how are you? i just had 1 question do you recommend having a lip surgery and make them bigger with gore - tex? what can go wrong? How big chances are there that the procedure can go wrong? Is gore tex permanent? thank you?

Answer:

I do not think the Gortex commonly used looks natural when you purse your lips ands they can rarely get infected. Goretex is permanent, yes. JG 8.29.07

Question:

hello how are you? i just had 1 question do you recommend having a lip surgery and make them bigger with gore - tex? what can go wrong? How big chances are there that the procedure can go wrong? Is gore tex permanent? thank you?

Answer:

it is permanent and I do not recommend it. JG 8.29.07

Question:

Hi Dr.Garcia. What do you think about custom carving cheek implants from solid blocks of silicone? Not many surgeons do this. Thank you very much.

Answer:

if the surgeon is also a skilled sculptor it is fine but they are not easy to carve, silicone is not an easy matter to create subtle things with due to its rubbery nature. JG 8.25.07

Question:

Hi Dr. Garcia, Do you think it is okay to get a chin implant or sliding genioplasty if I have an over-bite? An oral/facial surgeon recommended a bi-lateral sagital split of the jaw, but it seems very intense and would require braces for two years. I`m thinking about just doing the genioplasty, because what really bothers me about my face is my recessed chin, not my overbite. Are there any additional complications or risks with genioplasty when the jaws are not in optimal alignment? Thank you.

Answer:

sliding genioplasty will give you a larger advancement but neither one will correct the overbite. Might be best to have that treated first. The overbite can affect your teeth long term. JG 8.15.07

Question:

HELLO DOCTOR.IS THERE A WAY TO REDUCE MY CHEEKBONES AND WHAT THIS SURGERY CALLED?

Answer:

not easy to break those bones and have them heal evenly I am afraid. JG 8.12.07

Question:

Dr. Garcia, I am sending this message to you to say thank you for helping many people, including me, with you knowledge and experience and advice. For many of us who are getting second opinion. I do not mean to take more of your valuable time which can be used to answer many other peoples` questions, I have to ask you one more question, once again regarding chin implant which I had it done but need to be removed and replaced. My doctor is suggesting to put reseolvable and permanent stitche to secure the new implant because the pocket is now bigger than usual and would creat the possiblity for the new implant to move if stitches are not placed to secure the implant. My question is whether permanent stitches are good ides in my case. Thank you so much. You are just remarkable. Shahron

Answer:

I certianly think placing permanent sutures is OK to do, I use long term absorbing sutures but either one is OK, one is not better than the other, best of luck. JG 8.10.07

Question:

Dr. Garcia, I have been interested in getting a chin implant for a long while. I consulted w/a few surgeons and both recommended sliding the lower jaw forward because of my mis-aligned jaws. Is it wrong to use a chin implant in a case where the jaws are mis-aligned (it seems so much easier than cutting the bone, etc.). Thanks!

Answer:

no, but you cna get a greater amount of projection if they move the bone. JG 8.10.07

Question:

Dr. Garcia, How much is the cost of cheek implants?

Answer:

you need to choose a surgeon as prices vary. JG 8.10.07

Question:

Twelve weeks ago I had a 12mm anatomical silicone chin implant placed. The swelling is now gone and the new implant is loose. I can take the implant between my fingers and move it up and down over my real chin bone. Plus the whole implant is crooked with the right side too high creating a dimple/dent in the skin below it. I have an appointment to see the PS in four weeks. How can this problem be corrected and what questions should I be asking the PS? Could the implant be pinned in place? Thank you so much.

Answer:

it might need to be opened and the implant sutured or positioned with a screw to get it stable. JG 8.7.07

Question:

PS to chin implant removal question. The implant replacement was done in conjunction with lower face/neck lift. There is one little band of neck muscle that is not smooth (raised up looking, seems like its sticking to the skin instead of tucked tight). This section is just to one side of neck midline and on the same side I fear the chin implant flange is outside the pocket -- so adding to icky look on that side. Is this part of the neck lift performed through the submental incision and, if so, when the PS removes the chin implant under local through that incision, can the platysmal suturing/lifting be touched up? Or would that require general? Otherwise becoming pretty happy so far with lift results but this is a lot of suffering/expense for a less-than-great result.

Answer:

they can cut the band a bit to see if it will relax some and improve the contour, all can be done under local, yes. JG 8.7.07

Question:

Hi Dr. Garcia. You kindly answered my question about a replaced chin implant (asymmetry, flange won`t lay down, fear its outside of pocket) and suggested maybe best to remove (which I want). The old implant was in place for 20+ years, this one for 6 weeks. My followup question: how great are the odds that I will have a serious deformity if the thing is yanked out? Neither implant real large but in place a long time. Will the skin droop? Redrape? (I`m 50 with good skin --- had lower face lift at the same time as implant switch). I want the pocket stitched closed but PS also says possible to just rough up the surfaces to readhere? Thanks so much.

Answer:

I agree with the roughing up and a few sutures to collapse the space are also nice. JG 8.7.07

Question:

Hello Dr i have very bad jawline one side it is projected out and other side is sunken deeply leaving out scar , in dark light my face look too uneven shape ,i`ve witnessed in photos and my colleagues ,others also say this. i`m regularly visiting doctors but no ray of hope... what step i should take for this, pls suggest me doctor it is spoiling my social life very much... thanx for any suggestion on this ..

Answer:

hard for me to say without actually at least seeing some pictures, sounds like you might need a plastic surgeon that deals with cranio-facial irregularities or an oral-maxillo-facial surgeon. JG 8.4.07

Question:

Hello again Dr. Garcia, thanks for answering my previous questions.. I am the 28 yr. old male with the cheek implant ordeal.. Well its turns out, after having the implants removed not only do i have scar tissue on the incision site(which is making my lower cheeks lumpy), but i also have scar tissue on the cheekbones themselves that make my face look wider than it really is( capsule formation?) My questions to you are: is my capsule formation gonna go away on its own? I don`t know if i can tolerate having a wider face because of them(its been 2 months and a week since i had the implants removed..) Are my Lumpy cheeks gonna flatten out? or do i need some treatment to help them along? Thanx again Dr. Garcia, You truly are a great doctor and a person..

Answer:

usually becasue of the motion of the muscle in the cheek area that all gets softer but it will take quite a bit of time. Some ultrasound massages might help. Physical therapy departments have the machines. Best of luck. JG 8.3.07

Question:

HELLO DOC, I HEARD ABOUT THESE FINANCIAL PROGRAMS(CARECREDITS, MEDICREDITS) WHICH HELPS YOU PAY A COSMETIC SURGERY, MONTHLY AND NOT INSTANTLY OR BY GETTING LOANS..WHAT DO YOU THINK? IS IT POSSIBLE FOR A 19 YEAR-OLD GUY TO TAKE SUCH A PROGRAM?

Answer:

all depends on your credit rating, we offer them to our patients here. JG 8.3.07

Question:

I have severe laugh lines around my mouth. I am only 44 years old. What is better Restalyne or Juvederm?

Answer:

pretty similar. JG 8.2.07

Question:

Hi Dr. Garcia: What a helpful and informative website. You are so kind to answer everyone`s questions during the really scary post-op period. I recently had an old-style wafer chin implant which had shifted removed and replaced with a newer Implantech style with the side flanges. During surgey, PS discovered old implant was gel-filled, had ruptured --- much digging ensued, much swelling followed. Post-op I was horrified by size of swelling and asymmetry on the right side and wanted it taken out right away. (wrote to you, helped to remain calm!) Dr. convinced me to wait six weeks. Swelling has subsided but right side still bows out and there is a divet below that bow on the soft tissue of the jaw line. Plus, muscle to pull mouth down/out on that side still not working as well. Is it remotely possible that the flange on that side could have been placed OVER the muscle and tissue --- somehow piercing through the pocket and keeping soft tissue trapped above it instead of rounding around jaw? Dr. encourages me to wait but I hate the way it looks (deformed) and I think swelling is no longer the culprit. Better to get it out now before it damages anything (further)? My own chin was not that weak, old implant kind of an add on with rhinoplasty. Thanks so much for your honest and helpful answers.

Answer:

it is possible and the muscle dysfunction could be from the nerve being bruised, that can take weeks to get better in some cases. Might be best to get it all out and let it all heal nad settle in for a while, best of luck. JG 8.1.07

Question:

HI DOCTOR, COULD YOU PLEASE INFORM ME HOW MUCH THE JAW IMPLANTS OR THE INJECTION FILLER COSTS?...THANK YOU

Answer:

I am not sure which previous question you are referring to, I also think an in person evaluation would be best to determine best options. JG 8.1.07

Question:

HI DOCTOR.. WHEN YOU SAY INCREASE DISTANCE BETWEEN LIP AND CHIN(GENIOPLASTY) , YOU MEAN AN INCREASE OF CHIN IN LENGTH(BY PROFILE) OR INCREASE OF THE SPACE BETWEEN THE LIPS AND CHIN BY BREAKING THE CHIN AND SETTLE IT DOWN AND INCREASING THE HEIGHT OF THE FACE?

Answer:

the genioplasty can increase vertical height between the lip and chin along with horizontal length seen on profile. JG 7.14.07

Question:

HI Doc.. I WAS WONDERING HOW MUCH DOES THE JAW-BRAKE (INCREASE DISTANCE BETWEEN LIP AND CHIN) COSTS(AVERAGE) AND HOW MUCH(AVERAGE) DOES A CHIN AUGMENTATION COSTS..THANK YOU!!

Answer:

a synthetic chin implant is about $4000 and I do not do the bone breaking sliding genioplasty so you will need to get that fee from an oral surgeon or a plastic surgeon who performs it. The genioplasty can give more than 10mm of advancement. JG 7.13.07

Question:

Hi Dr. Garcia, I just had Radiasse injected into smile lines around nose yesterday. My doctor used 2 vials ($900 each). Today, I am very bruised and swollen. I look like a chipmunk. Is this the look I will have for 2 years? Is this the Radiasse or just swelling. I am very concerned that perhaps my doctor suggested too much? What do you think. I hope it is just swelling (it is almost 24 hours later). Thank you for your time, Jeana

Answer:

no, it is swelling and that will go down a large amount in the first week or so. JG 7.13.07

Question:

Last questions, I promise. 1.Do large submalar implants seem unreasonable for a woman in your opinion? 2.It is really just the lower outer part of the implant on my left side that needs correcting(the implants are the same size). It basically juts too far out at the bottom. Can I just correct the one side with a med. implant and leave the other side alone(lare implant)? What would be the best coarse of action; I know it will get worse with age? Thank you very much!!!!!!!

Answer:

the size can be appropriate on a woman with a long large face. The implant might have shifted downwards and may just need to be pushed back up surgically. May not need to remove it, or it could be shaved down a bit too. JG 7.13.07

Question:

I had large Binder submalar implants put in 10 years ago in order to restore fullness from a botched buccal fat pad extraction. One side was dimpled. I have always thought they were large but something I could live with. However, as I age, they look more prononced, especially on my left side. I have consulted several doctors, all had different opinions. Do you thinks switching them to a medium submalar would be better? Please give me your opinion. Thank you so much! I love your website, by the way.

Answer:

well, I think you can do that but I am unsure hoew well the capsule that surrounds the larger implant will shrink, so it might have a funny result. Tough call on what to do. Thanks for visiting. JG 7.12.07

Question:

My daughter is 6 days post-op with a chin implant inserted thru her mouth. How long should she expect swelling and numbness? Also, it appears that one of her sutures have come out and there is minor bleeding. Is this a problem?

Answer:

swelling and numbness might take 6 weeks or more and a suture coming out at this point should not be a problem, just have her rinse her mouth out to keep it clean. JG 7.12.07

Question:

Thanks Doc...one other thing, when i had my cheek implants removed, i also noticed that my face has gotten wider than before i had them put in..especially near the outer cheek bone area.. Do you know the reason for that? I`m asking this because i also had Neck Sculpting done, and the skin appears to have gotten looser and worse than before i had the neck tightening...Thanks again Dr. Garcia...

Answer:

just the tissue stetching out, as the tissues contract that should get better but it might take a few months. JG 7.11.07

Question:

Hello Dr. Garcia. I am very stressed out about my cheek implant ordeal/removal and was wondering if you could help me.. I am male , 28 years old and in decent health i suppose... i had Cheek implants put in ,because my face was a little flat and there were small indents on my cheeks, so i wanted a little lift ... (that was done on 2/23/07) ..i waited 3 whole months before deciding to get them removed, because i felt the implants were way to big for my face...(i had them removed on 5/24/07).. well my cheeks aren`t huge anymore, but now there are lumps right underneath the cheeks where the incisions were made..scar tissue! Not to mention the indented grooves(the main reason why i had the surgery done in the first place) are more noticeable, making me look older! My questions to you Dr. Garcia are: 1)Will the lumpy scar tissue ever go away and flatten out?? its been over a month!.. 2) Will the indents ever go back to what they normally were?? i also have dark lines caused by the damned implants themselves and was wondering if you had any suggestions on how to fix any of these problems..Please help me doctor..i`m beside myself.. i don`t look like the guy i used to..everyone keeps telling me i look older and tired, and its just killing me the fact the i had this done in the first place...any suggestions will be fully appreciated. thank you.

Answer:

the scar tissue will in time soften and flatten, yes. I think the indentations will likely go back to the way they were as you had the implants in for a short period of time. The dark lines are likley due to the tissue being stretched and in most cases with time that also goes away. JG 7.11.07

Question:

Thanks for answering my previous question Dr. Garcia. Well then I was wondering whether or not the chin implant can help push out the lower lip to give more of a whole look to the lips (keep in mind the cleft between my lip and chin is decently long)? Also, because it seems that a genioplasty procedure is more complicated than a regular chin implantation procedure, what are some complications that are unique to this procedure that I should consider (e.g. higher risk of infection?)? And finally, you stated that the chin tends to stop growing at around 18-20, is there anything I can do during this time period that would help my chin grow larger? Excercise more? Eat more healthy? Intake more of a certain mineral or vitamin? And as you stated with age the chin tends to appear larger due to skin thickening and sagging of chin fad pad, will these cause the chin to look significantly more protrusive and whole or just mildly so? Thank you very much for your time!

Answer:

the chin implant will not impact the lip I am afraid. The genioplasty is more painful and yields more swelling but actually less risk of infection but it is also more expensive and performed by fewer surgeons, usually some plastic surgeons and then oral surgeons. There is nothing you can do to make the chin grow more than what is genetically determined I am afraid. The chin implant or genioplasty will not stop the sagging of the tissue in later life but might delay it some. JG 7.8.07

Question:

Hello Dr. Garcia, I have been considering for some time now whether or not to get a chin implant. I am curious about at which age male chin`s stop growing because I have noticed older men seem to have larger chins than when they were younger (comparing 40 yr olds to 20 yr olds) and whether or not the implant will feel like natural bone and whether or not the edges of the implant (an extended anatomic) cant be felt or seen once inserted? Also, I read one of your previous comments that these implants cannot increase chin length but from several before and after photos I have seen, chin length does seem to increase by a factor of a few mm`s or about 1/5th an inch which is exactly what I want in this case; is this a possible through chin implants? And my final question is would you happen to know about what percentage of patients develop infections and are there ways to prevent these infections from occurring by say taking antibiotics for the first few days after the surgery? Thank you for your time.

Answer:

the chin stops growing about age 18-20. The relative appearance of persistent growth of the chin is thickening of the skin and more so the drooping of the chin fad pad which then stretches the soft tissues and makes it look larger. The implants are realtively hard and do feel like bone. They are placed below the muscles to they are not easily felt, although there is an appearance of an extension in the vertical dimension, it is becasue of the pushing forward of the soft tissues. If what you require is a vertical height increase then a genipoplasty where the bone is cut and then repositioned with metal plates is a better option. Infections are less than 2% and usually treated easily with antibiotics. JG 7.8.07

Question:

Dr. Garcia, I had a size 2 implant put in about 8 months ago. From day 1 it was not symmetric. I recently got an opinion from another surgeon saying that he could reposition it. I am not really happy with the size and would like to have it removed. He told me that taking it out could cause the chin to sag and dimples in the skin. In reading some comments on your site you state that this could be avoided by placing stiches in the pocket. I had brought this up to him and he said that the capsule is too thin to hold sutures and they easily pull out. He stated that he has only removed 4 implants before and 50% of them did not look right afterwards. Have you ever performed this surgery before and if so have you ever seen the sutures not hold. Thanks

Answer:

in my expereince the sutures hold, at times you can even put small little holes in the bone and place a screw through the muscles to reattach it to the bone, all depends on what is going on. JG 7.2.07

Question:

Its me again , I am very sorry that I am asking you so many question , I need to know if you can recommend me a doctor for a cheek implants in state of Michigan , and I saw before that you recommend plasticsugery.org , I tried that but it did not help.

Answer:

may want to try Dr Lee Colony. JG 6.26.07

Question:

Hi again , but you didn`t tell me , since it been a week now for the cheek implants inserted thru my mouth , when is it safe to take them out , can I do the surgery again or remove them by this week or next week , please its very serious I need to know , if its safe or if its going to cause a injury , usually how soon the can cut the gum again.

Answer:

it is OK to remove them now if you desire. JG 6.26.07

Question:

Hi DR.GARCIA, I did a cheeks implants a one week ago exactly , last tuesday , they look huge and the left side is sticking out on the end , and higher then the right side , they look funny , I have under eyes now, I am 29 years old ,and I am very angry , that it cost me $5300 , to look like this , this is not my first time doing it , I did it back in december 19/2006 , but he used #3 and the size was fine but it didn`t look like I had a cheek implants surgery , I looked the same before surgery , and anyway he did the right side perfect and high bone cheek ,but the left side it was not pushed all the way , it was down from my cheek bone and it was pressuring my gum and giving me a tooth pain, so I went back to the doctor and he decide it to fix it , since he was going to do it anyway again , I decide it to go one size bigger but I want it from the same co. , he took them out and he tried to stick the bigger one in , but I couldn`t handle th pain , he said that he will do it only at surgery center because they will put me to sleep, so that`s what happened , I did it again , but I think he did not use the same co. he used before , it feels different , so now I don`t want to keep them , they look big and I look ugly, I know I am still swollen , but last time I was fine in one week , I am sorry I took so long with my story , but I want you to know the whole story, so my first time he inserted thru my mouth on 12/19/2006 and second time on 2/20/2007 and the third time on 6/19/2007 so now my question is , when can he be able to do it again or take them out, and if the implants out , will my skin be sagy and pluffy and not toned , please let me know .

Answer:

I think at your age your skin should shrink back down since they have not been in that long, I think going in through the mouth again is the best. Sorry to hear about all the problems. JG 6.26.07

Question:

oh, its me again , I need it to tell you about the doctor name , Jeffrey Colton , do you ever heard of him , and if you did , is he a good doctor or not, thanks.

Answer:

I do not know him, sorry. JG 6.26.07

Question:

Gortex in nasolabial folds; right side creased more than left; maybe due to swelling?

Answer:

more likely due to the pocket or space where the Gortex was placed not being as large and smooth as the other side, swelling might contribute but not cause what you see. JG 2.2.8.07

Question:

Wonder if you can advise. I am 47 year old female with significant facial asymmetry and lipodystrophy. Had a malar augmentation (unilateral)approximately 2 years ago which has now slipped with infection present. Obviously this has to be removed. I wonder if it will be possible to use either sculptra or bio alcamid to compensate for the cheek implant. Would the scar tissue from the implant exclude me from having either of these treatments. I believe that the implant is sub periosteal and the fillers would be injected subctaneously.

Answer:

I think either one can be done once the implant is removed and the infection controlled because injecting it at the same time I fear will not work and potentially can get infected. JG 2.27.07

Question:

Hi Dr. Garcia, I was wondering how long tear trough implants (or fat injected from another area of the body) last? If I were to get blepharoplasty with arcus marginalis release and tear trough implants, can I expect lasting results? The dr. wants to charge me $7500 for all of this plus a laser peel in the eye area; is that reasonable? Also, how often do complications arise from restalyne injections for non-surgical blepharoplasty? thanks so much

Answer:

implants are permanent, fillers like Restylane might last 6-9 months, I do not use fat there for fear of lumping as it requires larger needles to be placed. I cannot comment on the fees as they vary from region to region and doctor to doctor.I think complications from fillers occur less than 5% of the time in general but it might be a little higher at the arcus marginalis due to the thin skin.JG 2.21.07

Question:

Dr. Garcia--First of all, thank you so much for your quick responses. You provide such a great service. Should I ever consider surgery ever again (I am still traumatized with current issue), I am coming to Las Vegas. In follow-up to my alloderm removal question. Is that tight rubberband feeling ridge from tissue or from some tunnel created to put the alloderm in? How does that heal or does the tunnel always remain? Why is it so tight and making it so hard to open my mouth or smile? Should I expect (with massage, etc.) to see improvement in another month or will it be longer---it has already been five weeks since removal and I still look disfigured when trying to force a smile that only shows a few teeth. When is a ballpark for complete healing (when I can smile normally again). Thanks so much. I truly appreciate your help.

Answer:

there is a small amount of scar tissue surrounding the tunnel and that is what you are feeling. It will heal and flatten and stretch in time. A month should show marked improvement, it is tight as the scar tissue is new and there is swelling making it feel tighter. In 4-6 weeks it will be lots better, full maturation may take 3-6 months but you will be much better in a few weeks. JG 2.14.07

Question:

Hello. I just had a chin reduction on Friday, February 2nd, with the doctors burring the bone. It is now about day 9 and I still look very swollen in the jaw and chin area. I have to go back to work soon and they told me I wouldn`t be as swollen as I thought around this time. Also, the inside of my mouth behind my bottom lip feels like I went through a meat grinder from the incision made there. Could this be the cause of more swelling? Is this all normal? I still feel very huge around the chin....I went in for a chin reduction? could any of the bigness be permanent?

Answer:

I do not think it will be permanent but I am afraid there will possibly be some visible swelling for at least another 7-10 days if you have that much at this point. The incision is not the cause of the swelling, it is the pocket that is made to gain access in order to burr the bone down that is the culprit. JG 2.19.07

Question:

I had a chin implant done almost 2 weeks ago. Most of the swelling is gone but I`m left with a lump of fat on each side of the implant, it looks like jowels, I look like Richard Nixon! I spoke to my doctor about it and he said I may need a cheak lift (at my expense). If these 2 lumps of fat are due to something with the chin implant shouldn`t the doctor fix it at his own expense? How can this be fixed? Also, my cheaks are now completely sunken into my face, I had a thin face before the surgery but not like this. Is that normal?

Answer:

well I would give it some time, if there was no fat there before there is no way the chin implant would have caused it. It might be swelling and in rare instances it can be the implant has slipped down over the edge of the jawbone to give you that appearance, in that case he should revise it for free. A chin implant also will not casue any changes in your cheeks. JG 2.11.07

Question:

hello hello:) I had tried restylane injected on my upper cheeks. later put a implant for a longer effect. the result is nothing like what the filler gave. The implant result is horrible. Why? The implant gave more of a hard dramatic looking result where the filler gave more of a softer look. Also can we use aquamid for smile fold? and on forehead lines?

Answer:

I do not recommend Aquamid as a filler and as to the difference between the implant and the injectable filler, it is because the implant is beow the muscle and lifts the existing muscle and fat where the filler is injected more superficially and can be shaped to a much greater extent, they are similar but not interchangeable. JG 2.10.07

Question:

hello what happens if i remove the cheek implants. i had them for about ten months now. i dont like them. my face is longer and i had a almond eye shape before now my face looks round and round eyes. can you please tell me what will happen if i remove the implants? will my lower face have saggy skin. because rather then havin a high cheek with the implants i now i have a midface that looks like a pull.. will this get worse if i remove the implant?

Answer:

In most cases it will go back to the way it looked but cheek implants should not make the eye look round so there must be something else going on there. JG 2.10.07

Question:

Will caffeine make my swelling better or worse? (During my 1st week post-op chin implant) Because I take about 2 cups of brewed coffee daily on top of antibiotics and mefanamic...

Answer:

no effect. JG 11.28.06

Question:

Hi my doctor prescribed diuretics today (4th day post-op)for my chin implant swelling. 3x a day for four days. Will this help the swelling? Any precautionaries or any thoughts on this? Besides possible potassium loss... Thanks doctor

Answer:

I do not think it will work I am afraid. JG 11.28.06

Question:

Hi Dr. Garcia. I had restylane injected into the hallow area under my eyes about 1 month ago. I recently had a mid facelift . Under my left eye is quite swollen, could it be the restylane product? thanks you in advance

Answer:

most likely from the surgery and not the filler. JG 11.27.06

Question:

Hi Dr. Garcia. I had submalars done in June. Since around July I`ve been having blood noses & last night coughed up a little blood. Should I mention this to my plastic surgeon & can he fix it or will he be offended? Also would a gp be able to fix it like maybe cauterise the area or something?

Answer:

the submalars should not be causing anything with your nose so I suggest you go see him or her to find out what is going n.JG 11.23.06

Question:

I am a 44 year old female. Four months ago, I had a 22 year old chin implant removed and genioplasty performed. The old implant had shifted and deflated over the years. I am somewhat disapointed in the result. Though, I gained a little more vertical height, which I needed, the projection is not as much as I want. Also the shape is not that pleasing from the side. It is too sloped backward, much like before I had the orginal implant. My question is, how long do I need to wait before placing a small implant over the genioplasty. Thanks.

Answer:

I would wait 3-6 months. JG 11.20.06

Question:

Hello. My name is Yasemin and im 26. I have cheek implants done. its been 6 months now. i dont like them. it gave my face a very different look. my face just looks fat and big when i tell this to my surgean he looks upset so i told him that i think he did a great job but its not for me. before my face had lost volume but my face was always naturally slim. it even looks like im developing a double chin.. anyhow before having the implant i had filler just directly under my eyes and cheek.. 1 ml each side.. it looked great!i was happy with that/// but it all vanished in only 1 week.. why???? it was suppose to last for six months according do research. anyways because of this i was told to have a perm... cheek implant... that will last forever. and i did. but it didnt give the same effect.(IM SORRY ITs A LONG STORY)so now im getting them taken out because my face looks big and different. my surgean told me that there is a new filler called SUB Q that will give a longer lasting result around the eye and cheek area... what do you think of this idea??? and later i was adviced that if the filler dies from the area in short time again he will try aquamid (cheek and just below the orbital area... on the bone) is this safe? You know its probably not a big deal for large wage owners.. but i lost so much money.. i have to pay another $3000... to take them out just after i paid $8000. anyhow.. if you think those fillers are not the correct types can you make an suggestion...?

Answer:

fillers can last varying times in different parts of the face I am afraid. There are longer term fillers and that might be an option for you. I think hyaluronic fillers are OK but I am not a fan of aquamid. JG 11.19.06

Question:

Dr. Garcia, I had cheek implants 7 weeks ago and the edges extend over my orbital rim and into my eyes and are certainly palpable. Also, the left side is slightly higher than the right. I understand from reading your feedback that you recommend revision be done after about six months. However, if it is just to trim the edges and move the right side up a bit, would it be okay to do now? What exactly is required to shift an implant upwards and keep it in position once they have already been placed and healed?

Answer:

It can be done sooner and the approach in terms of what incision to use needs to be discussed with your surgeon. Many times sutures are placed temporarily through the skin to hold the implant in position while swollen. JG 11.13.06

Question:

Hello Doctor, I sent u a pic asking about facial procedures such as cheek implants. Just wondering if you got it and what you think. Thanks

Answer:

have not had time to look at them yet but will email you as soon as I do. JG 11.7.06

Question:

Hello Doctor, I had botox about a year ago under my eyes for crows feet. It has effected my cheekbones and made my face seem to drop in the lower half.I seen a surgoen where i lives and he said he had never heard of that and looked at me weird. Anyway the botox made my lower eyes very lax when it was ineffect and has caused some permanent effects I am afraid. I am interested in getting something to biuld back up my cheeksbones and hopefully get rid of undereye tear trough issues. I had restylane injected under my eyes about 3 months ago. Its didnt really cause any bad effects but when i smile i still have the tear troughs which makes bags under my eyes and wrinkles on the outside. The indentions are stil;l there under my bags when i smile. Anyways I am 25 years old and shouldnt be having this concern so im not sure which approach would be best. I have heard bad things about the facial implants moving or dev capsular contraction, which I know full well about because I`m having breast imp revision in dec. When I asked the local dr about sculptra he said that it would take many syringes (at $1000 each) to receive any kind of improvement. Is this true? What do u think of facial implants or other procedures for cheeks? Thanks

Answer:

well Sculptra might help the cheek and maybe more aggressive Restylane for the tear trough. It is hard for me to comment on any other facial procedures without seeing you and that price sounds like the usual for the Sculptra, yes. JG 11.6.06

Question:

Hi Dr Garcia, im trying to decide which procedure to choose from cuz i only have cheeks when i smile and i want high cheekbones and some definition. I dont have a very narrow face so i want something that wouldnt make my face wider. Im 23 today(today is my birthday) and im also a student so pls can you tell me what is appropriate for me? Thank you.

Answer:

sounds like cheek impalnts are the way to go in your case. And Happy Birthday! JG 11.3.06

Question:

Dr. Garcia, Many people talk about having Radiance injections and how it lumps. If you do have a lump from the injection, will it eventually dissolve or does it need to be cut out. If it eventually does dissolve, how long does it take? Thanks.

Answer:

in many if not most cases it needs to be cut out, it greatly depends on where it is injected though, for example on the lips, it usually ends up being surgically removed. In terms of dissolving, I have heard of some cases taking up to 7 years. JG 10.24.06

Question:

Hi Doctor - great site! What do you think about Radiesse ? Thank you.

Answer:

thanks for the kind words, as to Radiesse for depressions or scars I like it, but not for fine wrinkles, lip augmentation, nor superfiial folds. JG 10.24.06

Question:

Hello Dr. Garcia, I had tear trough implants placed by a lower eyelid incision a few months ago. I know I still have some swelling, but they are crooked and far too large for my small face. As the swelling resolves, you can actually see the implant through the skin on both sides of my undereye It looks like ripples and you can feel the edges easily). My original surgeon thinks they look great. I want them removed. Is it better to remove them now so there is less scarring and stretching, or should I wait for a year for them to encapsulate as he recommends (I think he feels I will grow to like them,too). Thank you!

Answer:

if you are convinced you want them out then take them out now, if you are not sure, then give it some more time. JG 10.20.06

Question:

Hi Dr. Garcia, I am considering a chin implant or genioplasty and live in Las Vegas. Do you do chin implants and if so, how often do you do them? Thank you.

Answer:

I do perform chin implants maybe 5-8 per year, not a big calling for them here. JG 10.19.06

Question:

Dr. Garcia, I had Radiance injections in my nose about 1 year ago. I know it isn`t approved. I still have a lump where the injection was given. It has been one year, but I didn`t want to get a steroid to take it down. Sometimes it settles and other times when I rub it, it swells up. What is this from. My main question is that it says it last from 1.5 to 2 years. Will the lump eventually dissolve. Even if it takes another year, will the Radiance eventually break up. Thanks.

Answer:

eventually but it might take up to 7 years to do so. JG 10.18.06

Question:

Hi Dr Garcia, I sent a question earlier when I was 8 days post genioplasty. I am now 25 days post sliding genioplasty and I`m fairly certain that the advancement was too far forward. I had cephalometric measurements done for upcoming orthodontic work and according to that, my chin was 6.9 mm behind where it should be. The advancement done by the surgeon was 10 mm (even though he told me at my consult that I needed about 7mm of advancement.) Most of the visible swelling is gone although the chin is still numb and tight, and my chin just appears really prominent now. After everything settles, if it still appears too far forward, can a reduction genioplasty be done after an advancement genioplasty or is chin burring a better option? Also, I`m concerned as to whether or not nerve damage risks increase if additional surgery would be needed. I did the genioplasty in conjuction with a nasal septoplasty and was expecting a subtle change in the chin, however everyone says that my appearance has changed dramatically, and it`s not for the better. Thank you SO MUCH for providing this service. You are a very generous person! LC

Answer:

I thinking burring it down will be safe and effective for a small reduction of 2-3 mm, but give it some time as the tissues are stil healing. No additional risks compared to the previous surgery.All the best. JG 10.16.06

Question:

Dr. Garcia, Thank you so much for answering my post on genioplasty vs. chin implant. Do you do both procedures? I don`t see them listed on your website menu, but a friend of mine recommended you who had body work done (she looks great).

Answer:

I refer the genioplasties to oral surgeons as they do more of them, and thanks to your friend for the referral. JG 10.12.06

Question:

Dr. Garcia, Thank you so much for answering my post on genioplasty vs. chin implant. Do you do both procedures? I don`t see them listed on your website menu, but a friend of mine recommended you who had body work done (she looks great).

Answer:

I refer the genioplasties to oral surgeons as they do them more often. And thanks to your friend for the referral. JG 10.12.06

Question:

Dr. Garcia: I had rhino 5 years ago, and my surgeon at the time recommended a chin implant, but I didn`t do it. Now I regret not having it done. Can you tell me what the benefits are to getting genioplasty as opposed to a chin implant? Are there less complications with genioplasty? How do the costs compare? Thank you!

Answer:

the genioplasty is able to give you more forward projection, and avoids an implant so it lessens the chances of infection, which are small. The genioplasty is at least 50% more though. JG 10.12.06

Question:

Hi Dr. Garcia, it is just me, the alloderm to the lips girls again. I just have a quick question, I was trying to schedule how many days I would need off from work. If I have the alloderm removed on Thurs would the swelling be down enough to return to work on Monday or Tuesday? Is the swelling going to be the same as putting them in or will it be less? Thank you so much. See ya soon!

Answer:

swelling will be less than the placement and I think your proposed days off are about right. See you soon. JG 10.9.06

Question:

Hi again Dr. Garcia it is alloderm lip girl. Sandie called me and handled everything actually and I feel so much better, she is so sweet. Thanks for all of your help, I look forward to seeing you for my appt :) Thanks again!

Answer:

keep a stiff upper lip! Just kidding, see you soon. JG 10.3.06

Question:

Hi Dr. Garcia It is the alloderm to the lips girl again and I am just so upset I cant stand it any longer, I know it sounds crazy, but I just can`t. I hate the way I look, I am trying so hard to be strong, but I need help I am so sorry. I called your office and they said that you were going to answer me, but I thought maybe I could talk sooner this way. I just talked to the LifeCell corp, who make alloderm and they said that if I take it out that I will for sure have scars and I shouldn`t do it, but I really believe you and I really need to take this out, I hate it so much. Also, your staff wanted to set up a consult with you, but I live in Mich and I know that I won`t be able to afford to fly twice to see you, is there some way to set things up for patients who live far? I only trust you at this point as a dr. I am so sorry to write again, but I am so upset is there any way that if I gave you my email address you could write so we could speak, I understand if not I know that you are very busy. I didn`t mean to take up space on this site. My email is LeahZoran21@hotmail.com Any help you can give would be so much appreciated.

Answer:

well, the only scars you will have are the scars you already have from having it placed, no new ones. Someone from my office will call you and we will see you and do the procedure the same day, not to worry. JG 10.3.06

Question:

HI,WHATS THE COST OF A NOSE-JOB, A CHIN IMPLANT,A LIP AUGMENTATION AND A JAW IM PLANT?

Answer:

I would need to see you to give you an accurate quote. JG 9.30.06

Question:

Hi again Dr. Garcia, thank you so much for your help and I appreciate that you would help me (alloderm lip girl again). I am going to call Sandie as you suggessted. I am just so concerned that if I get the implants taken out that they have grown into my skin and I won`t get my regular lips back, I know that you said before that that isn`t the way it really works, but I read so much info about that online that it terrifies me. I guess I just wanted to know what the chances are that my lips will look like before becuase right now I feel so ugly but I just don`t want to look worse. I wish I would have never done this so badly. Thank you for your patience

Answer:

Alloderm does not grow into the tissue, it is not living tissue nor is it textured enough to allow ingrowth to happen. The lips will be swollen after the removal as the space where the alloderm is now will need to heal back down but that will be better in a relatively short period of time. Don`t beat yoruself up about it, hang in there. JG 10.1.06

Question:

Dr. Garcia...I had a chin implant (small implant) and neck lipo 2 weeks ago...I am a little nervous.....I am not sure if I am happy with the cosmetic results....is that normal with most patients at this stage? And a lot of the swelling and bruising has gone down..however, my chin and jaw is sooo tight that it is very difficult to put my head back, smile (showing lower teeth)....it feels like I have duck tap on my chin and jaw.....is this normal and how long will it last? And i just read something that a chin implant can cause bone erosion and damge to your bottom teeth/roots...how true is that and what are the chances? I am starting to think that the chin implant was a mistake.....what are the side effects...potential risks if I wanted to take it out? Thank you for your advise!

Answer:

that is very normal, changing ones appearance can take time for the brain to become accustomed to the newness. In time all of that will soften and loosen and feel more normal. By the end of the first month, all will be lots better. The amount of bone erosion after a chin implant is minimal and in most cases never becomes and issue. Give it all a few months before undoing anything. JG 10.1.06

Question:

Hi Dr. Garcia, it is me again, the alloderm to the lips girl. I posted a question yesterday, but I didn`t see it on there, but anyway I need your help if possible. I went to the PS to take the alloderm out and when I got there for my surgery the lady at the front desk said that the Dr. had a message for me that he didn`t advise taking it out . I asked why and she didn`t know, but she said there could be risks . I told her that the dr didn`t say anything about risks when we scheduled the appt. Then she went on to tell me that my lips could be permanently stretched out or lumpy. I waited 90 minutes for the dr to ask him the truth and he came up to me and said no more discussion, in or out, you have one minute to decide. But he wouln`t even discuss the risks with me, and I asked if I would be able to have my old lips back and he walked away and said one minute to decide. I am horrified! I didn`t end up getting them out b/c I didn`t want to look worse but I still don`t like the alloderm and I am afraid I am going to be stuck like this for a long time, for my wedding. My question is, I have called around to several other PS in Michigan and they won`t take it out. I am seriously considering coming to you b/c I think you are honest. Would you be willing to take it out, I am at 7weeks yesterday. Sorry to tell you so much about my problem, but I am just so upset. Thanks so much.

Answer:

I would certainly be willing to remove it, yes. I am so sorry to hear that happened, part of performing surgey is discussing risks. Please call my office at 888-FACES-89 and speak with Sandie and she will take care of things. JG 9.30.06

Question:

Hi Dr. Garcia, I had sliding genioplasty 8 days ago and wanted to get an opinion on how long my appearance will continue to change. Right now, my chin appears very prominent, and even though I know I need to wait a little longer, I am beginning to panic. I am a 48 year old female, and right now, I and my family feel that my face looks longer and chin much wider and almost bulbous. In profile, my chin is even with or possibly a little in front of my lower lip. My chin doesn`t appear to have a lot of swelling to the touch, although there is a of lip and chin numbness and along with a tightness deep within my chin. On a July reply, you mentioned that relapse can occur. I guess I`m just wondering if overcorrection is a common problem with sliding genio, or if I am reacting too soon, and there are still big changes to come. Thanks. LC

Answer:

overcorrection can happen but I think recession is more common. The majority of the swelling will be down after 6 weeks but you will see subtle changes for 6 months or so, hang in there a little while longer. JG 9.29.06

Question:

I had one cc of restylane injected for nasolabial folds on friday, and it left big red marks/ splotches.. what can i do to get rid of the redness, how long will it take to go away, and what is it from, ? did the injector go too deep or something? thank you

Answer:

it is just irritation from the shots, a light massage and a few days should make it all better, not technique depedent. JG 9.24.06

Question:

Hi Dr Garcia, It is the same alloderm lip girl again. I did some research online and I read that removal of the alloderm after a month can cause scarring and that it is difficult to remove, is there any truth at all to that? I guess I am just nervous to go through surgery again. My PS said that I can`t use local anethesia this time b/c it is going to be painful. I am wondering what I should do. I was hoping it would`ve gotten less puffy by now, is this normal for a patient to not like the alloderm after 6wks or do most people like it? I am just trying to decide what I should do. Thanks so much for any info you can help with.

Answer:

That has not been my finding in the cases where I needed to remove the alloderm, on the contrary, it slipped out very easily. As to not using local, I must say, that is preposterous, it is most certainly possible. As to not liking it after 6 weeks, I think most people do like it but it depends on how much was put in, tough decision, sorry. JG 9.24.06

Question:

Hi Doc , I m same person who inquired about medpor for mandibular retrusion, doc u didn`t tell me about the complications and side effects of medpor and another better alternatives present . kindly inform

Answer:

well the side effects are that it is more difficult to get it to settle against the bone since it is rigid so it sometimes will reveal underlying bone assymetries, the scar for placement is usually longer, infection rates are about the same with other implants but it grows into the tissues so it does not move after placement, as to options, there are silicone and Gortex which are more flexible and need smaller incisions, but are not as rigid and do not provide as much tissue ingrowth. I personally use silicone implants as the available shapes and sizes are the greatest. JG 9.23.06

Question:

Hi again Dr. Garcia, It is the same girl with the alloderm to the lips again. I actually saw my PS today and I scheduled an appt to take out the alloderm next week b/c I just didn`t think it was looking natural on me. I just have a question, will my lips be exactly as they were before the surgery??? They won`t be like saggy or distorted or anything because they were stretched out will they? Thanks you!

Answer:

they wil be puffy but since you had them for such a short period of time they should all go back soon, best of luck. JG 9.21.06

Question:

Hi Dr .Garcia I Have a small chin , is medpore going to help me ,any complications associated with it , side effects . kindly help and oblige .

Answer:

I think Medpore chin implants are good implants, a littel tougher to place as they are not collapsable but very sturdy. JG 9.20.06

Question:

Hi, Dr. Garcija, I want to augment muy upper lip with same of parmanent fillers I know that you are against permanent fillers but I want to do it so much so, my question is which one is more safe Aquamid or Bio alcamid? Thanks. All Regards, Monica

Answer:

I do not think that one is any safer than the other. JG 9.20.06

Question:

Hi Dr. Garcia, It is the alloderm to the lips again and I have just one more question for you (thanks again for all of your time and help). I know that you said that the alloderm would go down above the lip but I also am not happy with the shape of the upper lip, it seems puffy in the center and I think that is what makes it look so odd. They told me at my PS that the reason for that is that the middle is the last part to heal and that it won`t look so ducky after it is healed. Is that true??? Is the middle really the last part to heal or is the shape of the lip pretty much going to be like this until the alloderm dissolves? I am just curious b/c I am almost at 6 weeks and I am pretty sure all of the swelling is gone. Thanks so much!

Answer:

I do not agree with that statement. I think it heals slowly where the incisons are made but the difference is minimal. JG 9.20.06

Question:

Hi Dr. Garcia. I am considering a chin implant. I have a very slight cleft chin that shows when I smile though and I want to have this emphasized. Will the implant hide this or make it more obvious? Can you tell me Doctor what my options are to emphasize it more? (An implant with a dent perhaps?) Also, I believe dimple creations turn out a bit too exaggerated right?

Answer:

the implant will likely diminish or eliminate the cleft. I think emphasizing it is difficult and in many cases does not last. Dimple creations can also be unreliable too, I agree. JG 9.19.06

Question:

If someone wanted to increase the distance between the lip and chin you said that the jaw would have to be broken. Then what? What kind of scar and where would it be?

Answer:

done from inside the mouth, the jaw is cut with a bone saw and then moved down, held in place with screws and plates and bone dust placed in the gap to build new bone. JG 5.6.06

Question:

Dr. Garcia, I had a chin implant 29 days ago. During my 2 wk follow up visit my entire lower lip was still numb. The Dr called last week to see how I was progressing. I told him that the right lower lip was making some progress but the lower left lip is still dead with the exception of some very mild tingling in one spot. The Dr. suggested doing another surgery to either put in a smaller size (I had a size 2 silicone implant)or move the existing one, as he thinks that it might be too close to a nerve. I have another surgery scheduled for next week, which will be app 5 weeks post-op. Needless to say I am scared to death that I have permanent nerve damage. I want to have it removed completely. My question is how complicated is it to remove the implant? Would I be better off to wait a while longer or have it removed now? Thanks, CH 5-5-06

Answer:

well it is not hard to remove it, and a bilateral injury to the nerve is rare. If the nerve was cut it would not come back as it has been doing and removing the implant will do nothing if the nerve has been cut. I would say see how it goes the next week or so and if it is getting better, you may want to just sit and wait a little. JG 5.5.06

Question:

DR. I HAD TINY SCREWS PUT INTO MY CHHEKS TO PULL UP THE CHEEK TO YOUNGER POSITION. I HATE IT! I LOOK LIKE A CHIPMONK! CAN I GET RID OF THIS LOOK? HOW? I ALSO HAD MY UPPER AND LOWER EYES DONE. THEY LOOK BAD AS WELL. WAY TO ALMOND SHAPED. WHAT CAN I DO TO GET THEM BACK TO THE WAY THEY WERE? OR CAN'T I? I HAD ALL THIS DONE 7 WEEKS AGO. AND I'M STILL VERY SWOLLON.PLEASE HELP I LOOK AND FEEL AWFUL. THANK YOU. 10-18-48 WI.

Answer:

I imagine if the screw can be removed, most likely the tissues will relax again, but it is hard for me to say totally as placing a single screw into a cheek to lift it is not a usual procedure. The eyes may change quite a bit when the cheek tissue relaxes so that area may not need anything else done. JG 5.5.06

Question:

will you feel anything before movement comes back to areas of eye that are not moving right now because of endotine cheek lift. My left eyebrow will not move and lower lid is being pulled down still 3 weeks later. This does not have anything to do with the tarsel stips in my eye does it. Is the endotine cheek lift alright to get if you have tarsel stips in your eyes.

Answer:

endothine cheek lift is OK if you have tarsal strips, yes. As to the motion, it wil come back slowly but you may not feel anything as it returns. JG 5.4.06

Question:

i had tarsel stips done on corner of eyes to pull up because of scar tissue year ago would cheek implants pull them down. Would endotine cheeklift pull them down.

Answer:

if properly done the cheek implants should not affect them and the endotine should pull them up. JG 5.3.06

Question:

I have tarsel strips in corner of my eyes because of scar tissue under eye. I got endotine cheek lift. would endotine cheek lift be pulling my tarsel strips down. Or be having any effect on them at all. Thank you

Answer:

if anything they should be pulled up.JG 5.2.06

Question:

My gumline on the bottom of the mouth is very bony and ridged. My lower mouth looks like it is caving in due to the protruding gumline. Would a chin implant help to balance this? or maybe jaw augmentation. Have you ever heard of enlarged tori on the bottom gumline doing this?

Answer:

Chin implant will not help and a jaw augmentation will not either, it is probably because of weakness of the lower lip and allowing it to expose the gumline. Would suggest seeing an oral surgeon. JG 5.1.06

Question:

I got endotine cheek implants 2.5 weeks ago and still have swelling of course. My left eyebrow doesn't move and my lower eyelid is down.It was fine after surgery, but started doing this a few days after. Please tell me what it may be. Thank you, Connie My doctor says it is swelling and nothing more. And that all movement will restore after swelling goes down. I am wondering how long that will be. Thank you for your time

Answer:

not uncommon from the swelling and should get better in time. JG 4.30.06

Question:

Hi Doc. In your experience how safe are chin implants? Are there any side effects which can develop, and how long does the healing process usually take? Are your patients usually happy with the results and how long does it typically take to see the final resutls, thank you.

Answer:

I feel they are safe but they can become infected or they can shift. Patients are usually happy and patients look good after 2-4 weeks. JG 4.30.06

Question:

I had cheek implants 2.5 weeks ago. I am still running a temperature, is that normal. I am still swollen. How long before I will actually look good again.

Answer:

not normal, should see your doctor to make sure there is no infection. JG 4.30.06

Question:

In one of your previous posts about sub malar cheek implants you state It fills in the area below the highest point of your cheek only and some people that have it done do not like the appearance, there is no guarantee . What about their appearance do they not like, do they look overweight, or alien, or what?

Answer:

they look like chipmunk like cheeks. JG 4.30.06

Question:

Hello Dr., I'm scheduled to have chin implant surgery and lipo of the neck/under chin area in 9 days. I've been hearing a lot of horror stories about the implants being too big. My doctor only had 5 sizes to choose from and only #'s 4 and 5 had any wrap/wings. I chose the 4 because of the wrap that I feel I need. I have no idea of the size or millimeters of the implant. Is it very common that chin implants are too big? Also I've heard many different things about recovery and that too is scary. How long should I expect to be at my worst? KK 4/24/06

Answer:

there are smaller ones with wings and most patients with the chin implants do quite well. You will get very swollen from the chin implant, looking like Jay Leno for about one week, and by two to three weeks it looks good and continues to get better with more time. The lower lip is numb for a while and sometimes the lower lip does not move normally for a couple of days. Best of luck. JG 4.23.06

Question:

Hi Doctor Garcia, Been reading this site for a couple of years. I have read several questions over this time about people having cheek and chin implants removed for varies reasons. I had cheeks and chin done back in 1990. I honestly don't know what kind, (material) etc. was used. They were done by Dr. Ed Terino in CA. They are not big, very subtle. I wanted a natural look not over done. I have never had a problem. Healed very quickly. No shifting or scar tissue that I know of. I have no sensations of even knowing they are there. Can't be felt from the inside or out. The cheeks were inserted from inside the eye and the chin from inside the mouth. No external scars like I have heard about chins. I am just starting to wonder if I will ever have a problem. I was under the impression that these were for life. Do they wear out or have to be replaced? Just curious. Thanks for your opinion.

Answer:

Most likely it was silicone. If you are out that far, I think the chances of something happening are slim, and I feel that Dr Terino is a very good surgeon and you were in great hands. They will not wear out, just enjoy them. JG 4.19.06

Question:

Is it normal 5 months after removing sub-malar cheek implants to have residual swelling/puffiness? Could it be scar tissue? Are you supposed to massage the scar tissue?

Answer:

it can be due to fluid collecting in the old pocket. Massage may help. JG 4.19.06

Question:

I want to firm my lower jaw.I am 29 years old .I would like to know the cost of surgery? MUBEENA

Answer:

very hard for me to say without seeing you in person I am afraid. JG 4.12.06

Question:

Hi Dr Garcia: I had a chin implant last month and they inserted it in the inside of my mouth with the dissolvable stitches. On the left side INSIDE of my mouth, I have developed red bumps, it looks like cold sores and it's extremely painful. I can't talk and it's so sore. What is this? Is it an infection possibly? Have you encountered this before? I still have some stitches that have not dissolved as well, like it's small knots still in there. Can you please give me your thoughts? THANK YOU!!!

Answer:

may very well be oral herpes or apthous ulcers. May need to see your surgeon to determine which and then treat them. JG 4.9.06

Question:

Hello. 7 months ago I had a chin implant revision. The surgeon replaced a 10 year old, small implant with a longer mittleman pre-jowl implant. One side of the implant is loose & wiggles freely around under the skin. Also, I believe there may be some nerve damage also, because the area around the loose side of the implant is numb, tinlgy & tender, & a portion of my bottom lip is numb? What options are there for correction of this? Can the implant be fastened so it will no longer be loose? What can cause an implant to be loose? I would appreciate any information. Thanks so much!

Answer:

The implant can be secured, it can happen because if there is a lot of swelling after the surgery and then the pocket into which the implant is placed expands to a larger size allowing the implant to float around some but the numb feeling from a potential stretching of the nerve may not return, if it does it might take a year or more.JG 4.8.06

Question:

Hi! Thank you very much for answering my earlier question. I'm the one who had the question about my 2 year old hitting my chin and waking up in the morning with pain. Anyway, I had another question. Since my chin has hurt pretty much every morning since my surgery. For the past couple/few weeks I have been pressing from the bottom tip of my chin upward. Basically trying to see if it moved and if it did possibly pushing it back into place. I haven't been doing it really hard or anything just a tiny bit of pressure. Do you think I'm moving it and making it hard to heal? For some reason I'm just really worried my implant isn't going to heal correctly. For a while I was nervous it was going to move from my pillow, but now I'm freaking out that I'm the one pushing on it too much. What do you think? Do you think I'm hurting my healing process by touching my chin too much? Thank you!!!

Answer:

I would not push it up. If it has been dislodged there is not much you an do from the outside to fix it but if you rub too hard you can loosen it from where it is supposed to be, so I would just stop, maybe a little light massage from the center out towards the sides only. The pain is very normal as all of the muscles are lifted off the jaw bone and take time to re-attach, give it some time. JG 4.5.06

Question:

Hi! I had chin implant/lipo surgery 5 weeks ago. My 2 year old hit her head into my chin really hard today. Could that have moved my implant? I've been touching my chin pushing up from the bottom and I can't tell if it's moving. I feel pressure. Do you think this is something I should worry about? Also, when I wake up in the morning sometimes my chin hurts. Like too much pressure from my pillow. Could this be moving my implant? One more question, with my chin/neck lipo my chin doesn't come back very far because of the muscle. I had never heard of tightening the muscle. I saw 4 different Plastic Surgeons before I made my choice. Why didn't any of them offer it to me? Do you think it would have made more of a difference? FYI - I'm 33 and female. Thank You!!

Answer:

usually that will be OK, although I don't recommend doing it again. The pain in the morning is from the tissues getting stiff over night and is normal. As to tightening the muscle, it might have helped, but then it is a neck lift and not liposuction alone. Price would then be higher and a longer incision.That can be done later too. JG 4.5.06

Question:

Dear Dr. Garcia: Now you got me going on the size of my chin implant. I mentioned that I'm petite, 5'1 ,115lbs. What sizes do you use for an implant?? I'm very curious about this. If the Doctor put in a 9mm does that mean it will go down to a 9mm? I assume it's bigger NOW not due to the swellingness. I hope my chin isn't like Reese Witherspoon, great actress but wiht a big chin. : ) Any info you can give about sizing would be GREAT...again BG

Answer:

yes, it will at most be a 9mm increase, no more than that once the swelling is down. JG 4.3.06

Question:

Hello! Dr. Garcia; I'm 35 yrs old and had a chin,cheek(right only)inplant& lower face-lift on 03/15/06. So, far the chin and face-lift heal fine and improved cheek folds, just after two weeks. But my cheek inplant to correct asymmetry to right side of face is still remains swollen(getting better,but swollen)but I am having the following side effects:numbness to right cheek, diminished movement to right side of upper-lip, and droopy/watery eye. I look like I had a mild stroke! My dr. suggested that I'm still swollen and that I need to wait at least two months to see final results? I'm very self-conscious about my looks, does my surgery rehabilitation sound normal? what do you suggest? Thank You!!! for your time Patricia :{

Answer:

the numbness and lip part is not unusual but the watery eye is not usual, it may be that you have a thing called Bell's Palsy, caused by a virus that weakens the facial nerve. May want to talk to him as in those cases I use steroids and muscle stimulation to keep the muscles from shrinking. JG 4.3.06

Question:

Dear Dr. G What an amazing site you have. You seem really caring and it's much appreciated. I have a few questions. I had a chin implant with lipo under my chin/neck area 3 weeks ago. 1.I'm a petite girl 5'1 , 115lbs and I got a 9mm implant, is that considered a small implant, and will it go down? 2. When I touch my chin it's very very hard, like I feel the implant, will my skin stretch over it? 3. Does taking advil help the swelling? 4. What does lumps from the lipo subside? 5. Oh, and he out a dimple in my chin and I can't see nor feel it, is it because it's still so swollen? Thank you Kindly for your answers in advance. BG-Santa Monica, CA Email: santamonicabg@yahoo.com

Answer:

it is considered a little on the larger size, as to what it looks like right now, it will take another few weeks for the majority of the swelling to go down and start to look like it should. Clear it with your surgeon but advil should be OK now. The lumps from the lipo will take a few weeks for your body to break down the swelling and soften the scar tissue. As to the dimple, just give it some time too. All the best. JG 4.3.06

Question:

Hello. I had a genioplasty procedure and am very happy with the results. However, I may have my doctor go back in and sand down the bone on the left side because when it fused back together it ended up having a little bit of a bump. And, the right side of my chin seems to protrude a bit more than the left (it wasn't perfectly symetrical to begin with) so I was going to ask him if theres anything he could do to improve the symetry. Could he sand: it in any place to change the contour a bit? Or would the bones have to be cut and moved again? Thank you.

Answer:

sanding it is possible if you had an osteotomy. JG 4.1.06

Question:

If you have lost volume in the cheek area and you are flat and you get sub malar cheek implants what is the change you will see. Is it that you just look younger? How specifically does it change your appearance and is it always for the best?

Answer:

it wil fill in the area below your cheek bone, whether you will look younger is not guaranteed. It fills in the area below the highest point of your cheek only and some peopel that have it done do not like the appearance, there is no guarantee. JG 3.29.06

Question:

Dr. Garcia, you are so kind to answer all these questions so carefully. Twice I've posted a question about which I was truly worried and you always have an informed answer. I've told several of my friends about your site! Anyway, 3.5 weeks ago I had a chin implant, neck lipo and cheek buccal fat removal. I love how the chin implant looks--it really changes everything. However, and I knew this was a risk and I had spoken to my surgeon about it beforehand, my neck skin didnt bounce back the way we had hoped and I feel self conscious about it being a little droopy. Is there anything to be done for this beside a neck lift? I kind of knew that ultimately I'd be headed toward that surgery but wanted to do things little by little. After all I went through with this surgery, though, I d love to feel confident about how I look. Is there a short term solution to the loose skin? If not, is the recovery any worse than what I've just been through? I had a tough two weeks but then everything was fine. Thank you once again!

Answer:

glad I have been able to help. As to your present scenario, I am afriad that the neck lift will be the most reliable option. There are many companies out there with non-invasive techniques that make lots of promises but the results are unreliable. Recovery from a neck lift will be similar to what you have just been through. I will say though that it might still tighten up in time as the swelling has just recently been reduced and your skin may still tighten some. Hoping ofr the best for you. JG 3.28.06

Question:

In one of your posts you said Cheek implants also will change your appearance from anything you used to look like so you need to be ready to look different if you go that route . What did you mean because i got Cheek implants and i have been having hard time adjusting to my new face and after reading what you said I guess this really changes your appearance....?? More so then brow lifts, eyes and face lifts?? Also do you insert them through the mouth? And you mention many times about fat transfer under the eye causing lumps, does that happen more often then not?

Answer:

I insert them through the mouth typically and they can certainly change your look, much more than the procedures you mention. I would say as to the fat injections that lumps are at least 30-50%. JG 3.26.06

Question:

I went back to my surgeon for my 3 week post-op. I told hin I didn'y think yhr chin implant he used was large enough. Basically he told me to come back in 3 months because it is still early and if HE thinks he needs to go larger he will, but what about what I think. I know he's the expert but I'm the customer who paid the money. Don't I have a say

Answer:

you certainly do have a say, and waiting will not make it look larger, but keep him happy and go back again in time and express your desires. JG 3.25.06

Question:

Hi Dr. Garcia. Thanks in advance for your time. I am about 2.5 weeks from a chin implant, neck lipo and buccal surgery on my cheeks. Since the procedure I have run a steady low grade (99.1 - 100.5) fever that only bothers me now and then. It never goes higher than this. My dr. put me on a 10 day course of antibiotics (which was in addition to the first 5 day course) that ended today. My swelling is going down nicely and the bruising is almost gone. Does this mean the implant might be infected? The dr. and I were hoping it is the bruising reabsorbing and the swelling going down. I'm really hoping it won't mean the implant has to be removed because I love how it looks! What do you think the next move should be?

Answer:

more likely due to some blood in the cheek causing the fever as it dissolve, not uncommon. Warm moist heat to the cheeks to speed up the dissolving and a little time should make it all go away. JG 3.22.06

Question:

Hi, I had a chin implant and lipo under chin done on march 3rd. It's now March 22 and I liked it better from the side when it was swollen. It seems he didn't use a large enough implant. Also my right profile looks better than my left. There seems to be more fat left over on the left side and the chin implant seems not to flow as nicely. I go for my 2 week post-op Friday(2 weeks since bandages were removed, 3 weeks since surgery)Should I ask Dr. if he could lipo more fat or replace the implant with a larger one. I;m 32 years old and thin, my double chin was hereditary so I don't even know if there's even any fat left to lipo. He also said he tightened the muscles. Could it be that he tightened the muscles more and took more fat out on one side? How long do I have to wait to get a revision? Do Dr's. usually charge for this? Thanks,J 3-22-06

Answer:

I think at this time it is more likely due to uneven swelling which is normal. I would not consider any revision surgery for a few months at least. As to whether he will charge you, it varies from surgeon to surgeon. JG 3.22.06

Question:

my plastic surgeon told me that a cheeklift can actually make the nasoolabial fols more prominent. True or false? Brittany

Answer:

it can but depends on the technique. JG 3.15.06

Question:

Hi Dr. Garcia. During my recovery period I have been reading your site quite a bit; it's very impressive. Here's the thing: on 3/3/06 I had a chin implant, buccal fat removal, and neck liposuction. I also had Restylane injected in my lips and in the creases around my mouth. Since about a week ago I have almost no ability to move my upper lip, in fact, the entirety of my upper jaw. I can't suck on a straw, for intance, or chew food well. My lower jaw is staring to come back but its almost as if the upper lip/cheek area is paralyzed. My doctor has been great, says this will be okay, but I can't find any info that backs that up . I can't kiss, for instance, or whistle. What do you think? Will it come back in time?

Answer:

Most likely cause is a temporary bruising of the buccal branch of the facial nerve during the buccal fat removal, usually is temporary and can at times take 6 weeks to get markedly better. More common for it to be unilateral but it can happen on both sides. Give it a little time. JG 3.15.06

Question:

7 week ago I got submalar cheek implants, upper eyes and brow lift. Iam 47. Now I am very hollow under my eyes and black circles 100 times worse then before my surgery. Also there is a much more severe line on nasial fold and it looks like instead of the cheek implant lifting that area on the left it seems to be pulling downward. I don't see my pretty face anymore. I can't find a place for the implants when i look at myself. Could they be too low? My cheek area was very flat so it seemed like a good idea. The hollowness is very upetting and i am wondering if it's from the implant or the upper eye or the brow lift surgery?

Answer:

any effect on the lower would not be from the upper eye lid surgery or brow lift. Submalar implants are placed below the cheek prominenece so I suggest you see your surgeon to determine what is going on that is aggravating the scenario. JG 3.15.06

Question:

what is the cost of chin implant?how long does it take for the swelling to go away?

Answer:

swelling should be considerably be down in 2-4 weeks. I could quote you fees but that varies greatly form doctor to doctor. I suggest you get a fee quote from the doctor you are considering perform the procedure. I can only quote fees for people that are going to have me do their surgery. If you desire that fee quote, contact us via email at drgarcia@lvcosmeticsurgery.com rather than the message board. Thank you. JG 3.1.06

Question:

Hi, awhile back I asked if a forehead could be made flatter and not curve back as much to the sides, and you said it could be built up on the sides. Would it be built up with an implant on each side or injections? Thanks so much!

Answer:

either way is possible but the implant will last longer. JG 2.25.06

Question:

Dr. Garcia, I had a chin implant in Thailand two months ago. I have some pain when I try to stretch my muscles around my chin. For example, if I puch my lip into my mouth, I feel the pain. Sometimes, if I open my mouth big, I feel the pain. There is no much pain at this point. However, I feel sore on the muscle arount the implant. I am now in the US and cannot really contact the doctor in Thailand. Will this pain go away? When I push the muscle, I dont feel the pain but when I stretch it, I feel the pain. I dont know if it infected. I dont see any visible swelling. Please advise.

Answer:

Yes, in time it should all go away as the tissues soften. Not uncommon. JG 2.21.06

Question:

Hi, thank u for ur patience! Q1: i had a lower transconj.blepharo 3 weeks ago! i have black circles on my tearthrough and a hollow look! Do u think too much fat was removed? Q2: after my blepharo, my upper cheeks look like ther is some kind of hollowness on it! could it be because of the fat removal and could a cheek implant correct it? Q3: do u know any sunblock for the eyelids? Thank you so much Dr Garcia ! This is the best site ever!

Answer:

it is a possiblity if it looks that way so soon after the procedure. You may want to think about a tear trough implant for the upper cheek area rather than a regular cheek implant, bu tthta wil nto fix the hollow of the yelids. As to sunblock for eyelids, just be careful not to get it into the eyes themselves, I like Total Block by Fallene. JG 2.17.06

Question:

Dr.Garcia, I have been researching different procedures for the face and was wanting your opinion of what to do. I am thin (5'10 132 lbs) but my face and cheeks and chin area are fat, I also have high cheek bones. I was wondering if you thought facial liposuction would be the best. I am only 22 yrs old but the fat face look runs on my dad's side of the family even as they age. Also I wanted to see what your opinion of a chin implant and thinning out the tip of the nose are...and what is the process of thinning out the tip of the nose? Thanks for any help you can give!

Answer:

I think thinning of the nose and a chin implant may be good procedures for you but I am not a fan of facial liposuction in most cases as it will prematurely age you. Could be hard to change it without significant downside. The nose surgery would take an in person exam to tell you what can be done. JG 2.14.06

Question:

Thank you for answering my question. I had sliding genioplasty 7 weeks ago enhancing 8 mm. My lowr right lip is completely numb, and drooping. I have extremely stiff muscle that doesnt seems is getting better. I have difficulty eating and sometimes speaking. I also have saliva running from my chin when I talk or sleep. MY lower left lip is partially numb. I also have a big dimple in my chin on the right side. Please tell me if any of these get better since I am very worried. Thank you so much for your time.

Answer:

most of that should go away in time but it is getting a little long from the surgery so I would suggest you return to see your surgeon to see if they can give you any anti-inflammatories to help you along. Best of luck. JG 2.14.06

Question:

Hi Dr. Garcia, I had cheek implants in Sept of this year and since the surgery I can barely open my mouth- there's some tenderness there but... my main concern is opening my mouth. Is this a common problem ? thanks so much for all your help Megan :)

Answer:

unusual after this much time. I would go back and see the doctor to see what can be done. JG 2.13.06

Question:

I am the guy with the vintage 1987 chin implant. Have been a bit worried (probably more than I should be) about some mild swelling/redness/mild tenderness that appeared about 3 weeks ago. Its right below the labiomental fold midline on the chin and shaped like a cresent, approx 1 inch side to side and 1/8 to 1/4 inch top to bottom. It is most visible when I tighten my chin by pulling my lower lip into my mouth. My worry is that this might be caused by the implant, and that if so over time my lower lip function could be comprmised if something is going on with the muscle in that area(how is that for anxiety??) Is this likely to be related to the implant, and what should be checked? Thank you for serving others in this website, and God bless you for your help! JS

Answer:

I doubt the muscle will be affected by the implant, even if it has ruptured . Motion of the implant or dislodgement alone can cause what you are describing though. A Panorex X-ray may yield some info on the implant. This can be obtained at a dentist's office. Keep me posted. JG 2.9.06

Question:

Hi Dr Garcia, Kate here with response for Sue. The name of the Sydney doctor is Fabian Baez. He's in Macquarie Street. Apparently he's been doing Sculptra for years - ever since it was first trialled here in Oz. Moreover, he injects on a regular basis (anything up to a dozen a week - alot here considering our relatively small population). Dr Baez charges $880.00AUD per vial. I'm ducking up to Sydney next Friday for a consult, if you want some feedback email me on charlielass007@yahoo.com.au. All the best, Kate

Answer:

thanks for the exchange ladies, keep us all posted. JG 2.9.06

Question:

I forgot to ask you about a filler for the jaw & cheek. I had cheek implants years ago, but want a little more fullness. I also would like my jaw line fuller, but don't necessarily want to go through getting jaw implants, any suggestions?? Thanks so much for your input!

Answer:

you may wnat to see a maxillo-facial surgeon and ask them about injecting hydroxyapatite to the areas. JG 2.9.06

Question:

Dear Dr. Garcia, can you please tell me if a cheek implant is the same as a jaw implant?

Answer:

no, they can be made of similar material but a cheek implant is in the middle of your face so it has a different shape than something that lies over your jaw bone. JG 2.9.06

Question:

Hello! What do you think solid hydroxyapatite implants for mandibular angle augmentation is a good option? If not then why? Thank you! 2/9/2006 Edgars

Answer:

it is an option that has a little more variablity over solid implants. Should be done by someone who does a lot of it though. JG 2.9.06

Question:

In 1987 I had Dow Corning Silastic Gel Chin Implant, which I still have. Should I be concerned about leakage or the useful life of this type of implant? JS

Answer:

I think the risks are small but if you are concerned it can always be exchanged for a solid silicone or a Gortex implant. JG 2.8.06

Question:

Hi Dr Garcia, its Kate re the Sculptra and possible steroid injection. In terms of measurement, what do you regard as a 'tiny amount'? Its the column of tissue that has developed on the left side that concerns me, and if I were to go ahead with a steroid shot, I'd have it there. But I'd like to know what is a small amount. Thanks again, can I just say that finding this site and being able to ask questions got me through a really upsetting time in my life. All the best, Kate.

Answer:

I would prefer none, but if needed, maybe 10mg or so, can be diluted and then can be repeated in 4-6 weeks. All my best. JG 2.8.06

Question:

Hi Dr. Garcia. My mom recently posted a question about having a plate removed from by genioplasty procedure. I had another question having to do with that somewhat. I am very happy with the genioplasty results, however, on the left side of my jaw there is a bit of a ledge where the bones are fused together. My doctor told me a couple months ago that he could sand it down if it bothered me but it wasn't necessary because you can't really see the ledge its just something that I can feel when I touch my jaw. I'm wondering if he could sand down the bone to make it smooth at the same time he is removing the plate on the other side? Will there be a noticable amount of swelling from doing so..or not because theres no cutting of the bone? I'm trying to decide how important it is to me to have that bone smoothed out.. I can't afford to miss alot of school or work so if it's going to be really swollen from doing so then I will just forget about it. I plan on asking him these questions but I don't see him for another 2 weeks so I thought I'd see what you thought because so far you've been very helpful and accurate in answering my questions! Thank you!

Answer:

yes, that would be OK to do. As to swelling from either the plate removal or sanding, yes there will be some. All the best. JG 2.8.06

Question:

Dr. Garcia - my daughter, aged 19, had sliding genipolasty about 6 months ago. The results have been awesome with no problems noted until now. She had a routine dental exam the other day and it was discovered that a front lower right tooth, #26, may have root resorption or is otherwise infected. An antibiotic was perscribed but does not appear to have cleared up the infection. One other thing to note is that this is occurring in the exact spot where one of her stitches popped about midway through her initial recovery. She was treated at that time also with an antibiotic that did appear to work (not sure if that is important or not). Based on an xray that was taken, her dentist believes she may need a root canal. It is unknown if this is something that just occured with her tooth or if it was possibly caused by the metal plate placed at the time of her surgery. When looking at the xray it does appeat that the very tip of the metal plate may be touching or very close to touching the tooth root. We were referred back to her surgeon for consultation. The surgeon suggested removing the metal plate altogether as one possible solution for clearing up any infection. We are aware that doing so may still require a root canal. We have a consultation with an Endodontist about that next week. Upon hearing the surgeons suggestion, our dentist became concerned....the dentist admitted no real experience with genioplasty but fears the long term results from the genioplasty may be compromised if the metal plate is removed. We would like to know what you think. Have you ever heard of a metal plate being removed after genipolasty? Is the plate needed long term for support and reinforcement? And, what are the possible affects from removing it? Is there something else we should be considering here? We have consulted you several times during the course of my daughters surgery and healing and your advice/information has always been 100% on track. One more thing, what you are doing here is GREAT! We think you are pretty awesome :)

Answer:

once the bone is healed the plates are not needed. Removing the plate may make clearing the infection up easier. As long as it is healed there should be no long term adverse results from the plate removal. They will have to be careful though during the root canal as if they drill too close to the old bone cut, the jaw bone could crack, but they should know that. All my best and thanks for the kind words. JG 2.7.06

Question:

The last post was from JS

Answer:

thank you. JG 2.6.06

Question:

Had appt today with the PS that put my chin implant in back in 1987. Learned it is a Dow Corning Silastic Gel implant...hard on the outside with gel on the inside. The PS thought some of these implants have disintegrated after 10 years. Suggests he check it every two years. Also prescribed 6 days of a steriod for some mild unexplained swelling just below where the chin creases to the lip. What are your thoughts on this? Thanks much!

Answer:

May be best to have it exchanged to alleviate any fears. JG 2.6.06

Question:

Dr.Garcia, i would like to get an opinion about a chin implant.I also would like to know if im good for a chin implant. i have a pictures of my profile, tell me please,how could i send them to you. thank you

Answer:

please forward them to drgarcia@lvcosmeticsurgery.com JG 2.5.06

Question:

Hi Dr. Garcia and thank you for your time. Two years ago I had cheek implants inserted. the results aesthetically were not only terrible, but apparently the Dr. punctured my sinus cavity. Likewise I had intense pain on the same side, and when i blew or moved my mouth in a certain fashion I would be in intense pain. So, five months later, hoping to alleviate the pain, I had them removed (they were very assymetrical as well, making them look fake). So, here I am two years later with a small depression, hardly noticeable thank goodness, and yet, persistent pain on one side of my face particularly when i make certain facial expressions like blowing out a candle for example. I was wondering if you had any inclination as far as what is going on? Is it possible that a muscle was severed? Or could it be simply scar tissue? The thing is I still would like more of a cheek. But, until this issue is resoled, I dont see me having anything inserted again. Also, what would you suggest I use a s a filler or any other method to correct the small depression? Obviously, the pain and discomfort is something I can live with, but, undoubtedly do not enjoy. Id say the sensation is both a burning, pressure-type related pain and when i smile or blow it feels like there is a stretch feeling that is consistent from my upper corner of my lip to my lower cheek. Thank you.

Answer:

more likely is that the muslce underwhich the implant was placed got at least partially caught in the hole that was made into your sinus caivity and is now tethered and stuck there. It could also be soem scar tissue in the muscle too. As to a filler, I think Sculptra may be a good option for you. Best of luck. JG 2.1.06

Question:

Hi Dr. Garcia, Thanks for the prompt response to my query regarding th pain from cheek implants. What then should be my next course of action in regard to resolving the pain? Also, if I desired to get cheek implants again, would I be in greater risk for even more pain or could the issue be resolved once a Dr. decides whether it is just scar tissue or a tethered muscle? Again thank you.

Answer:

I think any further surgery will not affect the pain, for better or worse and I don't know of any reliable way to rid you of the pain. Sorry. JG 2.2.06

Question:

Hello Doctor, I am a 19-year-old male who had a genioplasty performed this past August along with upper jaw surgery (the upper jaw was moved forward) to correct a bite and the chin for cosmetic reasons. My chin was moved forward (I’m unsure of how much) and reshaped bone. I’m not satisfied with the results. It’s more defined, yes, but I want a really defined chin when I talk, as well, and although defined when my mouth is closed, it’s not as defined as when I talk. Would a chin implant be a good option? And would it even be an option? Thanks a lot.

Answer:

hard to say without examining you but your desire may and may not be helped with a further chin enhancement. JG 2.2.06

Question:

I HAD A FACE LIFT, CHIN IMPLANT and LIPOSUCTION ON THE NECK NEARLY 8 WEEKS AGO. My neck is still a little swollen, my chin seems to be bigger than expected but may be still swollen as it is still numb, there are dimples appearing in one side of the chin when I move it, is this normal? lower lip is still slightly numb.

Answer:

all sounds normal for what you had and should get better in time. JG 1.30.06

Question:

For a typical chin implant patient with no complications, do you advise your patients to see you for long term checkups...say after the first year or two? If so, what would you check for? Thanks! JS

Answer:

I see them once per year. I check for position ad patient satisfaction. JG 1.29.06

Question:

Dr. Garcia This is Shenna again about my cheek implants. You are the most wonderful person to respond so quickly and be there for people. I have been a wreck over my one cheek. My whole implant on that side of my face seams to bulge out somewhat whereas the other side pretty much looks normal. I did have a small infection in one spot on the bulging cheek whih clered right up with atibiotics. Could I be having capsular contraction? If I have the implants removed will a mid face lift be an option. My skin in the lower cheek area started to sag slightly and I have large pores. My previous string cheek lift was awesome but only lasted 8 months. I'm not sure I even like the look of the implants although they do help my skin and the lower eye area. I wanted amore permanent solution and my PS recommended the imploants versus a mid face traditional lift. He said it can change the shape of the eyes and look pulled. If my current puckering is caused by the cheek lift how can that be fixed? How can the PS tell if it is that or muscle contracture or whatever else. What makes you think it won't be permanent? Sory I have so many questions, but I won't relax til I know all the possibilities. I,m going to write to Oprah and tell her about your site and see if you can get on the show, you are a truly wonderful person to do this for people.

Answer:

Could have a fluid collection around the implant or a malpositioning of the implant too. Capsular contracture is rare in cheek implants. Removing the implants with a mid facelift may alleviate some of the issues, yes. The puckering should be improved by releasing the tissues some and letting the skin redrape. If it is due to muscle contraction then when you move the muscles it should move more. Thanks for the note to Oprah, but I am sure she has better things to do than talk to me, all my best. JG 1.29.06

Question:

Dr. do you do chin implants and if so approx. what is the average cost around? Also, what do you think about Tazaroc (I think that is the spelling) for acne or do you like retin A better? What do you sell for acne cream at your office? Thank you have a great night

Answer:

my fee for a chin implnat is about $3600, all depends on the type implant chosen and the time I need to perform it. I think Tazorac and Retin-A are similar in their effects. For acne we give Retin-A prescriptions. JG 1.28.06

Question:

Dear Dr. Garcia, I had cheek implants and a cheek lift 4 weeks ago. A few days ago I developed an indentation directly where the cheek lift incision was on one side. The doctor says this is a muscle contracture from the implant and will resolve in about 4 months. Does this sound reasonable? He also said I could massage the area. Is there a faster fix. I look deformed in certain lighting and I notice people staring which bothers me. shenna

Answer:

It is possible but almost impossibe for me to say without examining you in person. Massage may help if it is the muscle. If it is really bad you could have some collagen injected into the depression so it fills in the area while it resolves on its own. JG 1.28.06

Question:

It's me again about my cheek implants and thread lift. Could the dent on my lower cheek be caused by the cheek lift rather than by the muscle contracture around the implant where it was inserted? I believe the PS did a string lift. There is a tiny incision on my lower outside part of my cheek by the nasolabial fold and one in my hair near the upper part of my scalp. The cheek implants were inserted through my mouth. Could this be permanent? It bacame visible 3 and a half weeks after the surgery. Prior to that I had a lot of swelling. If I have the implants removed, would this still be there? Thank you so much for your time. Shenna

Answer:

It could be the Threadlift puckering the skin. I doubt it will be permanent and if it was a Threadlift, it for sure will not be permanent. If it is due to the threads, removing the implant will not help. JG 1.28.06

Question:

Dr. Garcia, I have two questions. First, can you feel cheek or chin implants? Lastly, how long will alloderm last when used to enhance lips? Thanks

Answer:

typically no, you cannot feel them. As to Alloderm, in my experience it lasts 1-2 years or so. JG 1.27.06

Question:

Hi Doctor, I'm considering cheek implants to augment my small face. Do you think it's best to use silicone or fat injections? Can you recommend a ps in the Boston area? Thanks so much! NM

Answer:

I personally like the silicone implants as they are permanent and more predictable. I would suggest looking for a surgeon on the website, www.plasticsurgery.org. All my best. JG 1.25.06

Question:

I am a 48 year old male. I had a silicone chin implant put in 18 years ago. Immediately after surgury, the implant shifted slightly laterally and down, but PS did not think enough to redo. Trouble free for 18 years. Thought I should make appointment to check for bone erosion or other durability issues. How does a PS check for bone erosion? Is this done with an X ray? If the implant is removed but not replaced, how frequent and severe are problems related to chin deformitites after the implant is removed? I have begun to wear an oral snore guard which keeps the lower jaw extended to stop my snoring. The month guard goes on my upper teeth, and there is a prong that goes behing my lower teeth. Is this an issue because I have the implant? Thanks! JS

Answer:

for bone erosion you need X rays or a Panorex xray your dentist can do. If removed the tissue needs to be re-attached or it will look saggy. The oral implant should not be a problem. JG 1.25.06

Question:

Dear Dr. Garcia, we took our daughter to a oral surgeon because she has a very snall chin. He said he could only move it 1/4 of an inch. This seems like a little improvement with a lot of risks. Would an implant be better for her. She's only 15 and very unhappy with her chin. Thank you.

Answer:

No, implants will give no more than that. You may want to wait until she is older and maybe they can move it further forward. JG 1.21.06

Question:

Greetings, in July I had jaw implants removed due to sufficient pain on one side that hurt significantly when i chewed. Unfortunately, now on the other side, I have a depression, and some lasting soreness which creates an assymmetric jaw some 5 months later. Is it possible to augment this tissue (I imagine the tissue is still there, just not where it is supposed to be) in order to create what was once a fairly symmetrical jawline. What would you recommend? Thank you for your time.

Answer:

you could consider a filler like Hydroxyappatite to even it out. JG 1.18.06

Question:

Hello Dr. Garcia - I was wondering about having cheek implants as a way to help diminish my Nasal-labial folds and marionette lines. Have you used this as a method? pj jan17

Answer:

it might help the nasolabial folds if you have lost cheek fat but I think the results are none if you have not and you will look different too. JG 1.17.06

Question:

Hi Dr. Garcia, I had chin implant surgery 4 weeks ago and the results are great! The only problem is that I am experiencing muscle spasms in the left side of my chin- the spasms are constant. Is this normal and will this go away? Thank you, AC

Answer:

all normal and will all go away. JG 1.16.06

Question:

Hello Dr Garcia...First let me Thank you for your time in advance I love your web site. Nov 3,2k5, I had face/neck lift w/lippo, upper and lower eyes...all seems well other than and here inlies my concern. On the left side below my ear and jawbone to my chin area is still puffy and numb, but more of a concern is what feels to me like a swollen gland about the size of my thumb in my neck area very odd feeling. Im trying to be patient but I don't think its getting better. My PS said that it can take up to four months to heal completely, but this seems really bizarre to me. What's your opinion? Will it go away with time?

Answer:

It could be a cyst full of blood or a lymph node. If it is old blood, placing a needle into it to draw it out will help,if it is a lymph node, it needs to go away on its own. Best of luck.JG 1.11.06

Question:

Thirty five years ago I had a button type chin implant surgery. It has always looked like a ball sitting on the front of my face. There is a variance in opinion regarding how much bone errosion I have at the roots of my front teeth. Do you have any experience removing these old implant and replacing them with a more anatomical shape?

Answer:

it is fairly straightforward to exchange them and as you are going to have a larger implant it can be secured more easily than going to a smaller one. JG 1.11.06

Question:

I had a chin implant done from under my chin 2 years ago. It was never quite even underneath and hung down slightly. Can this be fixed? How? SB

Answer:

yes, it needs to be removed and repositioned using the same old incision. JG 1.10.06

Question:

Dear Dr. Garcia, I had cheek implants two weeks ago--medium gortex. One side is up slightly higher into my eye socket and my eye looks smaller on that side. Also my eyebrow on that side is lower now at the end. How much time before I can tell the final results? The swelling seems to be gone already, but I'm not really sure. I had big cheeks to begin with as well as high cheekbones and did this to help with my nasolabial folds. It has helped that, but boy my cheekbones seem huge now and I have big round cheeks. I also had a cheek lift at the same time. How long does that last? And I had radiance injected into the folds. SB

Answer:

It might take a few months to settle in. Cheek implants can help with nasolabial folds in the tissues have loosened prior to the cheek implants. Cheek lifts should last 3-7 years or so. I hope it all goes well. JG 1.10.06

Question:

Dr. Garcia, I had deterioration of the jawbone 6 years ago. My surgeon put in jaw implants on both sides. One side took but the tissue around the other one became infected. After many antibiotics and removal and reinsertion of the implant he decided it was time to take it out. I now have a lopsided face. He would like to insert an implant that is nonporous but has said that there is not one out there yet like this. Do you have any knowledge of a nonporous implant? I have very little bone on that side to attach an implant to. Thank you for your time.

Answer:

Silicone implants are non-porous and are available now. JG 12.28.05

Question:

Dear Dr Garica, I was wondering if you perform sliding genioplasties or do you just choose to do implants? I have heard that bone deterioration can occur due to the screws used to fix the bone, is this a common occurence? Thanks Dr!!

Answer:

I just do the implants, if they need a sliding genioplasty I refer them to an oral surgeon. The amount of bone deterioration is minimal but can happen. JG 12.1.2.05

Question:

Dr. Garcia, How successful are jaw implants in providing a more sculpted look and is there a minimum age that you are able to have it done? Thank you for answering. CM

Answer:

They can do a pretty good job and I would wait until you are done growing, so late teens early twenties. JG 12.01.05

Question:

how is a facial dimple created surgically?

Answer:

not reliable I am afraid. JG 11.29.05

Question:

Dr Garcia, Can a tip plasty and sliding genioplasty be peformed under local w/ sedation instead of general anethesia? I would like to get both done at the same time but do not want general anesthesia. If this is not possible could you please explain why not? Thank you and I appreciate you taking time to answer my question.

Answer:

I guess some people would try it but I would not feel comfortable doing so. I think the level of sedation needed to be able to saw into your jaw and have you keep a patent airway makes it difficult. JG 11.29.05

Question:

Dr Garcia, I am interested in getting a sliding genioplasty done to correct my weak chin. Is this procedure safe and is the satisfaction rate high? The thought of cutting bone make's me a little weary. Also, i have invisalign braces and was wondering if this procedure can be performed while receiving treatment? Thank you Dr. and I look forward to your response.

Answer:

It is safe in experienced hands with good satisfaction rates. The braces should not present a problem as the sliding genioplasty is way down from the teeth. JG 11.28.05

Question:

My 18 year old daughter underwent a sliding genioplasty (4mm vertical reduction and about the same move forward) 8 days ago.This was done to help alleviate a TMJ problem and not for cosmetic reasons.It was done alongside wisdom teeth removal and bi-lateral lysis and lavage.Her face now looks a bit spoon shaped and long.She has some swelling aong the jaw line and just underneath the jaw which seems to feel quite quite firm (almost hard).Will the shape of her face improve much from now(8 days since surgery) and if the look remains odd how soon could it be put right??Please respond asap as she looks in the mirror and cries. Thank you for your kind help.

Answer:

Very hard for me to believe that a pure sliding genioplasty will help TMJ, but I guess it might. I think as the swelling goes down much of her appearance alteration will normalize in the next couple of weeks. She had big surgery and it takes time. JG 11.26.05

Question:

I am one week post-op for cheek implants. One did beautifully but the other swelled so much it caused vertigo, dental pain and shut that eye. The swelling is much reduced and I have 2 drains in that cheek which should come out tomorrow. There is crepitation when I press below the implant and blood/fluid comes out. Alot in the morning, less during the day. I have to know when I will be back to normal so I can go to work. Will removal of the drains accelerate the healing and reduce the swelling? Is there anything at all that I can do to reduce the swelling? thank you for your kindness in responding

Answer:

I think I might take another week or so for you to look presentable. The drains being in place help the swelling to go down, not the other way around. At this point I would suggest some warm packs and time. JG 11.26.05

Question:

Like everyone who writes, I am so grateful to you for taking the time to answer these troubling questions. Nearly 10 months ago, I had a reduction genioplasty. From the first, I worried that it hadn't been done correctly: the vertical height has never seemed less than it was before. I have compared photographs, and I cannot see any difference. It has taken forever for the swelling to resolve, and I can still feel pockets of puffiness in my chin. What has happened now is that I have what is almost like dimpling, meaning there are indentions in my jawline, puffed up skin, and nowhere near the smooth, rounded chin I had prayed for. I don't mind the wrinkles -- I have earned them -- but my jawline is very saggy and uneven, and it looks totally abnormal. Also -- after more than 10 months, should it still be so tender? Should I see a plastic surgeon or an oral surgeon? Please know how very grateful I am for your advice. BF 11/15

Answer:

Well, it is my pleasure to help. The tenderness should be gone by now.I think at this time, if not back to the original surgeon, where I can see you have some concerns, I would see an oral surgeon or a plastic surgeon that does maxillo-facial surgery. It appears that something should be able to be re-adjusted. Best of luck, JG 11.15.05

Question:

Hello Dr Garcia! Thank you so much for your time. I had Cheek Impalnts and a Midface Suspension Lift 4 weeks ago. My right endotine came loose and moved up creating a large bump on my cheek. My PS went back in and repostioned it 2 weeks later. Within 5 days the Endotine had slipped again and the bump was back on my cheek. It is very sore and makes my face look uneven. I went back to my DR today which is about 4 wks from my original surgery. He said there was nothing we could do but wait for the Endotine to dissolve. He said this could take 6-12 months to disolve. I feel I shouldn't have to go around with an uneven face for 6-12 months after paying all of this money to try to look better and improve my apperance. Can I get your opion from a Dr's view? Thanks! Cari PS I have been sleeping in a recliner since my 1st surgery making sure not to hurt the impants or device besides the fact I am still very sore.

Answer:

I think maybe the endotine should be removed and an alternate method of suspension utilized. Sorry to hear about your problems. JG 11.14.05

Question:

hello - I am an almost-50-yr-old woman who plans to have a complete face/necklift sometime next year. I am wondering how cheek implants compare to sculptra and how do you decide which to use? I am looking for just a little fullness/roundness to the cheeks - nothing dramatic,and I don;t feel compforatble about fat injections as they don't last long. How long does sculptra last and what exactly is it? do cheek implants last permanently or can they move around or drop? how are they anchored or fixed? which do you use the most? thank you so much.

Answer:

Cheek implants are longer lasting but have a set size and location whereas Sculptra can be injected with a little more discretion as to the location, but it lasts one to two years only. Cheek implants are permanent and a small implant may be the best and long term most economical. They are usually sutured to the underlying tissue next to the bone. I think cheek implants are used more since they have been round for a longer period of time. JG 11.14.05

Question:

what effect will cheek implants and browlift have on undereye area and/or crowsfeet area?

Answer:

Nothing on the under eye and it will pull the skin in the crow's feet tighter but there will stil be wrinkles in the quality of the skin. JG 11.13.05

Question:

Dr. Garcia, I'm only 28 years old, ... in 2004 I lost about 10 Kg (from 60 to 50 kg) in 5 months...later the same year I noticed I didn't look the same, there was something wrong with my face, that I looked like tired... later I realised that my cheeks had sagged and that this was causing me a horrible hollow appereance under my eyes, and a line that stretches from the lower eye lids to the side of the cheeks. Also the corners of my mouth are uglily turned down. I was always told by my friends that i was so pretty, but now i look so bad and aged when i am only 28. I think that the fact that I never had a good bony structure (i mean big cheekbones) has helped the cheeks to droop at such young age (only for a 5-month diet!!). Next month I am returning to my country (Peru) and I have arranged to have a midface lift with the best plastic surgeon there. He's going to perform two incisions (inside the mouth and in the temple area) at each side. My question is this: how long do you think the results will last if i dont go on diets anymore?, would cheek implants help the results to last longer? Thanks a lot for your time Ursula, Ireland.

Answer:

I think a midface lift will not help because you have lost fat in the face that maintained the shape and pulling the skin will not re-create the look you had. I think cheek implants may be better for your case, or fat inejctions or Sculptra injection to regain the fullnesss, sort of like putting the air back into the ballon to lift the tissues. Pulling skin tighter will not give you the youthful curves you once had. JG 11.05.05

Question:

I emailed you a while ago about a chin implant I had done and my chin seems to have developed an orange peel like texture. I neglected to mention that this implant is 4 yrs old as your response that it could be muscle spasms probably is reflective to a recent implant. Any suggestions what may have caused this-you indicated to increase botox to help? Also, noticed you recommend TNS - my derm has recommended this for me - i am a 49 y.o. female with fair complexion...why do you find TNS better than other products. It is $200 Cdn. here that is why i am asking. Thanks again for your time. Jacquie 31oct2005

Answer:

I think TNS is one of many good products, I personally do not carry it in our office but it is a good product. As to the the orange peel skin, the fact that it is so long ago makes it more difficult to figure out the cause. I really don't have much more to add without examining you in person and feeling the skin. The skin on our chin though has many oil glands that can get larger as we age and gives us that orange peel/large pore appearance at times. JG 10.31.05

Question:

What is the difference in a submalar implant and an orbital rim implant? What effects do they have on appearance? How does the heal time differ? Thank you for your kindness in responding.

Answer:

Submalar implants are on the lower cheek towards the corner of the mouth where an orbital rim implant is higher, right where you feel the lower edge of your eye socket. Healing time is about the same. JG 10.26.05

Question:

Dr. Garcia, I am considering a chin implant but I am worried about the implant breaking or shifting if I hit it too hard. With a goretex implant, bone tissue grows into the interstices of the implant to keep it in place, right? After it has completely healed, how strong will it be? Will my chin be as strong as it used to be? Would I be able to dislodge it by applying (hard) pressure to it with my fingers? I tend to lean my chin on my fist when I work, will years of doing that be ok? Will I be able to play sports where I might get hit in the face, like boxing without fear of dislodging the implant? Would sliding genioplasty be stronger? Thank you, Eric. 10.26.2005.

Answer:

It will never be as strong a bone but tissue ingrowth with Gortex is a little more stable than silicone, it can also be screwed into place. Leaning on your chin will not be a problem. You can play contact sports after 6 weeks. A sliding genioplasty would be stronger, yes, but more involved. JG 10.26.05

Question:

Hello Dr. Garcia, I got a chin last year in April and it was placed slightly crooked on the right side, it bothered me so much that I wanted to get it removed and put back in correctly. This past August, I went in for surgery to correct it but it got infected 10 days later and they had to completly remove the implant! I was told they couldn't replace it for six months. Now my chin has visible dimples and it hangs a bit. Will the dimples go away when they put the implant back in? What is the dimpling caused from? What other complication can I expect from having them go in for a third time? This has been a horrifying experience. I just want to know what I can expect. Thank you for your help.

Answer:

The dimples should improve when it is replaced, yes. The dimpling is the muscle over the chin having some spasms. The complications that are possible are the ones you have already had along with injury to a nerve causing sensation or motion abnormalities. JG 10.26.05

Question:

Oct. 24th Dear Dr. Garcia, I had jaw and chin implant surgery 2.5 years ago. In July, I had a really deep gum cleaning at the dentist and apprx. 2 days later, I noticed that a small bump had appeared on the right hand side of my face. You can't really see the bump, but you can feel it.My surgeon gave me antibiotics in case it was an infection back in July, but the bump has not gone away. It's now been almost 4 months and it's still there. My doctor says that it could be an infection or that the implant is too long on the right hand side of my face. What do you think? Is it possible to have an infection for almost 4 months without any other signs other then the bump? My surgeon said the only way to find out what is wrong is to operate on my chin again - which I obviously want to avoid doing. What do you think is the best way to proceed? Do you think I should continue waiting and see if the bump disappears? I really appreciate your advise.

Answer:

If the lump is not red and hot and tender I don't think it is infected, certainly nothing that is an emergency. I would wait and see. JG 10.24.05

Question:

Dear Dr. I had a chin implant a month and a half ago. When do i expect to see the final shape of the chin. what i mean is, will the bone around the chin get more changes and get more visable?? many thanks to you doc. :)

Answer:

It may take 3 months to get close to that due to swelling. JG 10.23.05

Question:

Dr. Garcia, I had a chin implant put in about 15 months ago. The implant has migrated down creating a ridge beneath my chin. Can this problem be fixed? What are the chances of it happening again? Thanks.

Answer:

Yes, it cna be fixed, a new operation needs to be doen and the implant repositioned and then screwed into place with small screws to the jaw bone. JG 10.21.05

Question:

Dear Dr. Garcia, few days ago I asked you about my jaw that after chin removal has lumps and under the lump the skin seems tuck to the bone. You suggest ultra sound. What will it do? Does it have any side effect? Is there special physical therapist who does this? Did you see good result with this treatment? Could you please answer my question. I am deeply obliged for your kind help.

Answer:

It helps with any fluid or swelling. No down sides to it. Most physical therapists have the ultrasound machines. JG 10.19.05

Question:

Hi, I'm writing from Ottawa, Canada. Glad I found your site. I had a chin implant 4 years ago and the skin on my chin seems to have developed a sort of orange peel texture. The PS says he does not know why the skin went like that. My derm has tried injecting Botox into it - but the results were minimal. I am now having Genesis Photofacial treatments - a series of 3 - I have had one. Do not know if it will make a difference on that area. I am a 49 yr old female with pretty good fair skin. I use Cellex C- 10% on my face, and SPF15. May I ask one more question. I have noticed many have mentioned IPL but what do you know about the success of the Gensis Laser. I have not seen much mention of it on your Q&A's. My setting for photofacial lasering is 18. My derm is new at this. I do have large pores, minor sun damage, minor wrinkling and minor redness (roseaca) - have noticed a slight improvement after two Genesis IPL sessions and one Genesis photofacial. thanks for your time. jacquie. October 18/05

Answer:

I think what the derm tried is what I would have done, the cause is usually muscle spasms, it might just take a little bigger dose of the Botox Cosmetic to get it better. I think the Genesis is minimally better to about the same a the IPL. JG 10.18.05

Question:

Hello. I posted the question a while back about there being sort of a ledge after having sliding genioplasty. You said it may be the implant. But an implant wasn't used. Any idea if it is the bone or if it maybe still be swollen? The procedure was 3 months ago. Thanks.

Answer:

Oh,sorry, read it too fast. If it was a sliding genioplasty then you may be feeling the edge of the bone that was moved and may be permanent. JG 10.18.05

Question:

Dr. Garcia- I had a genioplasty procedure a little over 3 months ago. I am not unhappy with the results, however it seems as though the sides of my jaw aren't symetrical. There's a bone on the left side that sticks out and feels like a small ledge. It's only noticable when pointed out or touched. Is this something that may subside with more time or something that requires a second procedure of some kind? Thank you!

Answer:

It could be the edge of the implant and if it is it will need to be revised, I don't think it will go away on its own. JG 10.17.05

Question:

Dr. Garcia sorry for the spelling mistakes. I am the one with problem after the removal of chin implant. I meant on one side of my jaw there is a LUMP and under it the skin looks shrunk and stuck to the bone not letting the lump relax and go downward. What would you recommand to solve this problem?

Answer:

the needle is OK to do along with ultrasound massage available at a physical therapist's office. JG 10.13.05

Question:

Dear Dr. Garcia, I had my chin implant removed 6 weeks ago. The inplant was long and went along my jaw. On one side of my jaw there is a big limp and just under it the skin seem shrinked and as if stuck to the bone. I have been messaging it and putting warm pads, but I see not a big difference. My uncle who heart surgeon told me may he has to detaach the skin with a needle or something. What would you reccomand? Thanks for your patient. Gratefully yours.

Answer:

It can be done to speed the process up. JG 10.13.05

Question:

Dear Dr. Garcia, I had chin implant 9 weaks ago but it was more like Jaw implany so I had to removed after a month. Now it has been 5 weaks but my Jaw line is still messed up. There pumps and close to the cut under the chin on my right side there a two inches depression the skin look as if it stuck to my jaw bone, and it is difficult to message it as the skin seems to be stuck to the bone. As far for the look it look hideous with the pump at it side. What do think it is? What did my PS did to have this happen? is there a remedy please let me know? My Ps say he will inject something for the muscle above to relax and fill the depression? Could you tell me what is he talking about and if it will really solve the problem? I am sacred that he may cause another problem for me, as he showed very little concern when he put the hideous Jaw implant which not necessary without tell me what he was planning to do my face. Please help me. Thank you.

Answer:

I think it is swelling in the pocket where the implant used to be causing all of this. I would hold off on any injections to relax the muscle and fillers may be needed but I would wait at least 6 weeks after the last surgery. I don't have a good idea of what he has planned, maybe you should seek a second opinion. JG 10.10.05

Question:

Hello! I had a genioplasty prodcedure at the beginning of July. My doctor said my chin would look longer for about 6 months. I was just wondering what the reason for this is and if it's a sure thing that it wont look so long after 6 months. Thank you!

Answer:

It is because the muscles have to be lifted off the bone and it takes a long time for that swelling to resolve. It might go away faster though. JG 10.2.05

Question:

Doc Garcia,well its me again ,I was sad to read I have to do the surgery to correct my problem, its like the jaws is abit wide 10mm on one side and abit less on the other side in the end of the mouth and its making the end teeth not fit well and due to this at times my lower jaw at night touches upper jaw and it gives me headaches and feel dull in my face when get up in the morning,so now if surgery has to be done ,what are the outcomes and healing process? or I can not do surgery now and wait? or wear a plate and see on how I feel and take surgery as my last option??or is it a possibility even if do the surgery I will feel better? please help me again or can go for a second opinion? salima0204@yahoo.com

Answer:

I think your jaw will be sore for a while but it will be worth it. JG 10.1.05

Question:

Hi doc its me again ,well its not the teeth its my jaws? I guess he was saying there is a gap difference of max 10 mm and is why my last tooth does not align well and may be I grind at night so what is the best thing to do as I dont want to do any surgery and as far as I know my jaws were like this since I was 16 ot 17 yrs old and it never gave me a problem,so all this I noticed when recently did lots of chewing ,so again the orthodontist was not sure to why I was having some pain on my facial areas like side and side of head as well so its salima0204@yahoo.com,the question follows what I send already in the 1st one where instead of jaws I mentioned teeth? help me please am so worried and dont want any surgery please Thanks so much

Answer:

The pain at times takes lots of time to come out as it is due to muscle spasms that takes time to develop. JG 10.1.05

Question:

DR GARCIA, I HAVE HAD CHEEK IMPLANTS REMOVED 9 MO. AGO DUE TO INFECTION, I HAVE NOTICED THE TISSUE IN MY JAW AREA IS PUFFY AND PREVIOUSLY THOUGHT IT WAS INFLAMMATION. I HAVE BEEN ADVISED BY A PS THAT'S IT'S TISSUE THAT HAS MIGRATED. HE ADVISED TAKING IT OUT AND PUTTING IT BACK IN THE CHEEKS. HAVE YOU EVER HEARD OF THIS AND DO YOU APPROVE OF HIS SOLUTION? HE SAYS FACIAL FAT WORKS BETTER WHEN PUT IN THE FACE RATHER THAN BODY FAT (DIFFERENT COMPOSITION). CAN YOU ADVISE. THANKS!

Answer:

I think the source of the fat is of little difference. I don't see how tissue will move after removal of a cheek implant but the tissues may sag a little for a while due to the stretching although most times it comes back. The lumps can be scar tissue and may take months to soften up. Best of luck. JG 01.1.05

Question:

I had sub-malar cheek implants put in a couple years ago. I was wondering if they can be taken out? Also, how will that effect the overall look of my face? Will my cheeks sag, and is there anything I can do to fix that? Laser-resurfacing?I'm in my early 20s, but people say the cheek implants make me look old. I just don't want to take them out and look older.

Answer:

They can be removed and if they are the skin of the lower cheek may sag or be a little loose. Laser will not do much, a cheek lift or face lift may be required in certain cases, all depends on how large the implants were. Best of luck, but at your age it may not need anything. JG 9.28.05

Question:

Dear Dr. Garcia, I just had a chin implant, 2 weeks ago, and I cannot really see a big difference yet. Is that normal? I have some stitches inside the mouth and 2 from the outside, on the jaw itself. The area still feels a little bit tight. I also feel an on- and-off burning sensation on the left side of my chin. The doctor said that it is normal. Is that correct? I would also like to know something about the final results of the chin implants. How long does it normally take before I can get the full result/ final look(e.g final changes) Thanks a lot for your time and answer. Amy!

Answer:

You should see a difference at this point since there should be some swelling present. The final results take a few months to see, all depends on how swollen you get. You may want to ask your doctor what size he used. JG 9.28.05

Question:

Dear Dr. Garcia, Thank you for your answer. I had chin implant 2 months ago, and removed a month ago and did not put one again. When the chin implant was put in I started to have this puffiness from the corner of mouth going down to where the corners of chin implant was sticking out. I was furious with the shape of implant, and to tell you the truth I did not one at all. But PS said it would help me to look younger. Anyway, I asked him to removed it immediately which he did. I do not want to put another in me. But when he removed the implant the puffiness got even more than the time he put the implant. You aid it may be fluid collection, if it is, will it go away by it self or it needs to be taken out with a needle? If PS take it out with a needle will there be a risk of any kind such as depression.Thank you for helping us. I wish we had a doctor like you in our area.

Answer:

It should go away in time, in very rare cases it can be drained. The implant is placed below the muscle and causes a lot of swelling so give it some time. If there is a localized area of fluid he thinks he can remove I would let him do it though. JG 9.27.05

Question:

Dr. Garcia, Im interested in getting a sliding genioplasty to correct my weak chin. I've read about something called a step-off that can occur with this procedure. Can you please explain to me what this exactly is and can it be prevented or corrected in any way?

Answer:

Whne the bone is moved an extreme amount there can be a step off or a small ledge, but that can be filled in with a bone substitute at the time of surgery. JG 9.27.05

Question:

Dear Dr. Garcia, I had a facelift and chin implant 2 months ago. And I had the implant removed a month ago, but I still have puffiness at the corner of my mouth. Is this fluid collection? What could it be?. Before the facelift I didn't have this puffiness. What do think it is? Thank you for your time. Eve

Answer:

It sure sounds like fluid collection from the shifting of the implant. I would give it some time and see where the implant settles and see if it wil need to be repositioned. JG 9.25.05

Question:

Dr. Garcia, I'm 30 years old and I was suggested to have a Silastic implant as filler for my nasolabial fold, which is very visible for someone of my age. Restilane may function for a while, but I want a permanent result. What are the pros and cons of the procedure? Do you suggest it? Thank you :o)

Answer:

There is nothing permanent and safe, the deepening of the fold there is a natural process and the safest way is to inject temporary fillers there as they fade. Permanent fillers cause permanent problems. Silicone liquid injections are to be condemned and silicone solid implants placed into the nasolabial fold look OK when relaxed but look strange when your face moves. JG 9.25.05

Question:

Hi, I had a chin implant 10mths ago and it has never looked right it makes me look like an older lady, a witches bulbus chin almost, now i caN feel it on the edge.underneath of my chin which must be what is making it look rounded, I thought chin implants sat on the front of the chin. I have an appoint with my surgeon on monday and since I am not happy with how it looks will he correct it for me, I can feel it underneath my chin, surley thats not right,? thankyou. DONNA.

Answer:

It sounds like it slipped too far down and needs to be repositioned. Best of luck. JG 9.23.05

Question:

Dear dr. Garcia, I had chim implant put 2 months ago, and after a month I had it remove because it not only a jaw implant instead of chin, but also because it was so crooked that deform my jaw line. Now it has been 3 weeks that the implant is out, but the scare tissue is still shows like bump on the side of my jaw and between the chin and the bump there is depression, it look as if the bone goes in and the skin is darker in this area. My question is: Do you think the scare tissue will go away? What is this depression and darker skin color? Will this depression and darker skin go away too? If the scare tissue will not go away by itself what is necessary to correct it? Thank you for your time.

Answer:

The depression is from swelling and the darkness is blood under the tissue from the recent surgery. It may take a few months but it should all go away on its own in time with nothing else done. JG 9.22.05

Question:

Dr. Garcia, I was wondering if it is possible to get a tipplasty and genioplasty done at the same time under local with sedation? My experiences with general anesthesia have been bad and would like to avoid it if at all possible. Thanks. Jon

Answer:

It can although some patients feel some discomfort having it done that way as the genioplasty requires lifting the muscles off the jawbone. jG 9.17.05

Question:

hi, my name is tina and i am 22yrs old. i always wantes to have dimple on my cheeks. i have searched your web for that couldnt find anything on it so i am woudering if you do that kind of surgurey. if yes plez give me an estimate. i really want them. I always wanted to have dimple... thank you..

Answer:

I am sorry but I do not perform that surgery as it is unreliable. JG 9.17.05

Question:

I had meninjites three years ago, I'm not sure if it caused the problme with my check but I wondered if you could help or know if someone who can. I need a cheek implant on the left side of my face. I have seen medical doctor to try to figure out what happened but they said it attrafy of the face and I need to see a plastic surgen for an implant. Basically, the left side of my face has no fat pocket, but the right side does. I doesn't bother me phyically but it is not pretty to look at. thank you

Answer:

A plastic surgeon is who you should see.Due to potential legal issues, and some doctors wanting to know why I referred a patient to someone else and not them, I think you are best to go to this website and look for a plastic surgeon in the area you desire. I wish you all the best. JG 9.15.05 www.surgery.org/public/findasurgeon.

Question:

About what is the cost for a jaw angle implant? Would this also help with covering up the slight 'pull' on my neck from a previous mini-lift? Thanks!

Answer:

Sorry, but I do not perform that surgery. I refer them to an oral surgeon. It might tighten your neck a little. JG 9.11.05

Question:

Hi Dr. Garcia, I had a chin implant put in about 3 months ago. It was inserted via an external incision under my chin. Now I have to some dental work done, my wisdom teeth are getting pulled. Do I have to worry about the implant getting infected? Should I take antibiotics before hand? Thanks and I appreciate all your help.

Answer:

I would suggest some antibiotics for 5 days around the proposed oral surgery. JG 9.11.05

Question:

Dr Garcia....again thank you so much for your dedication to this board...I had a reduction genioplasty 8 weeks ago.. before surgery I had had silicone injections in my chin....we used cortisone hoping that it would reduce some scar tissue which it did slightly but I can see that its assemtrical in terms of volume from side to side......is there a way of trying to remove the silicone without causing too much more scar tissue in tern have more volume.....thank you

Answer:

the removal of the silicone could cause more problems than it would be worth and I would avoid the cortisone injections as it could dissolve the normal tissue and make the whole thing worse. JG 9.7.05

Question:

Dear Dr. Garcia, I had a chin implant put and after a month I had noticed it was crooked and I ask my doctor to remove it and he did. Now it is only my 4th day after the removal of the implant, I still have slightly the crooked look that I had with the implant. I want to know if there has been any bone erosion and if this light crooked look will be corrected with time by it self. Beside can I use warm and cold compresses on my chin now for the swelling to fade faster? Thank you Please send your answer to zey@georgetown.edu. thanks

Answer:

bone erosion would take months. What is probably happening is the pocket where the implant was still has some fluid and as it was uneven, then the swelling will be uneven until it absorbs. Just give it some time and it should balance out. JG 9.4.05

Question:

I am considering a chin implant and a fat transfer to fill out my face but have an immune disorder called sarcoidosis. I have never been on medication for this problem but sometimes it can appear in your skin and I do have a spot on my nose. I recently had a hernia fixed on my belly button and when they tested the fat tissue they had removed it showed up with signs of sarcoidosis in it. Was are your thoughts on a fat transfer or chin implant for myself with having this type of disease. em 9/1/05

Answer:

I think the survival of the fat will not be very good in your case. JG 9.3.05

Question:

Dear Dr. Garcia Two weeks ago I had sliding genioplasty to advance the chin. I would like to know if the movement of the jaw and/or the bottom teeth can effect the position of the cut/bone/chin? I have been stupidly straining the jaw (as i have tmj) and cracking the teeth, the chin seems to appear smaller, and the bottom teeth which were straight are now crooked. Could I have repositioned the chin? Thanks for your time and response. C.E.

Answer:

It all depends on how the sliding genioplasty was fixed, with screws, plates, wires. The less stable the fixation, the greater the possiblity of a shift. The chin would look smaller after a while because the swelling goes down but it should not affect the teeth. JG 8.30.05

Question:

Dr. Garcia, I am interested in getting a tipplasty done and also a sliding genioplasty to correct my weak chin. I plan on having each procedure done by a different doctor. My question is should I get the tipplasty done first or the genioplasty? The tipplasty is to correct a bulbous tip and hanging columella. Also I have invisalign braces, will the genioplasty affect the teeth in any way? Thanks for taking time to read this and I look forward to your response.

Answer:

The genioplasty should not affect the teeth. As to which I would suggest to have done first, I think the tip. The chin can then be altered to bring it into proportion with the tip. Best of luck. JG 8.29.05

Question:

I had a genioplasty procedure about a month ago. The numbness in my bottom lip and chin is gone but my bottom gums are numb still. Is this normal? Thank you!

Answer:

Yup, it will come back in the next few weeks. JG 8.17.05

Question:

Dear Dr. Garcia, I recently had sliding genioplasty in order to bring my chin forward. It's been a week since the surgery and i've discovered that the tip of the chin (jaw) seems to be shifting (very slightly) from side to side (feels loose), I also seem to be having major discomfort in the bottom teeth and am noticing simple creaking sounds attributed to jaw movement. Is this normal and if so how long approximately would this take to heal (stabilize), if not what should I do? Thank you for your time and patience. - L.R. 8/17/2005

Answer:

It can be normal,deepnding on how they stabilized the bone during the surgery. It takes about 6 weeks for the bone to start to get solid. I would make sure that you keep your follow up appointments and tell your doctor what is going on. JG 8.17.05

Question:

Dr. Garcia, I am having sliding genioplasty to fix a weak chin. The surgeon said that the amount they can bring the chin forward is dependant on how much bone there is. I am worried that there will be no noticable differance in the chin and jaw. How far forward do you generally go with a sliding genioplasty and has it made a difference in the patients you have seen? Thank-you in advance for your answer.

Answer:

There will be more advancement from a sliding genioplasty than from an implant typically. JG 8.8.05

Question:

Dear Dr. Garcia, I've recently had a chin implant inserted. I was wondering what the effects were if years down the road I decided to have the implant removed. Would I look just like I used to (taking age into account of course)? Or are the chances of bone deterioration so great that my chin would look different? Thank you for all your help!

Answer:

If you decide to remove it there just must be care taken to reattach the muscles to the bone so that the muscle works well. You would pretty muck look like you did before. I think the bone resorption should be minimal and probably not seen. JG 8.6.05

Question:

Hello Dr. Garcia, I think your willingness to answer questions is awesome! I'm a 28 year old that just had a chin implant with 2 screws. I was wondering what the chances were of bone resorption and infection throughout my life. Are there any things that I can do to minimize the chances of these two problems? I'm just worried that being fairly young I might suffer significant problems down the road. Thank you very much!

Answer:

There is a small amount of bone resorption but it is minimal. Infection is rare. There is not anything that can be done to minimize any of this. It should be very safe for you long term. JG 8.6.05

Question:

Dear Dr. Garcia I'm a 22yr old male with a narrow face and have been looking in to jaw and chin augmentation to give my face more of a wider look. However, my forehead would still look narrow and round, so I was wondering if granular Hydroxyapatite, implants or fat could be used to make the sides of the frontal bone/forehead look more wider and masculine. Thanks for your time. BW 8/04/05

Answer:

I think the hydroxyapatite injections would be the best as it would be the closest to bone. JG 8.4.05

Question:

Hi Dr. Garcia, about how much does chin-reduction surgery usually cost? Thank you for your time. 8/3

Answer:

I do not perform that surgery so you will need to ask an oral-maxillo-facial surgeon. JG 8.3.05

Question:

hello Dr garcia .. i had a chin implant done one week ago .. with some chin liposuction .. my problen is my lower left side of my lip is droping will this go away ?

Answer:

Yes, it is not uncommon from the swelling around the nerves in your neck for that to happen. Give it some time and it should come back. JG 8.2.05

Question:

DR Garcia- I just need some reassurance. I had implant replacement surgery three weeks ago, we put in slightly larger implants,500cc, smooth silicone,under the muscle and my Dr. removed all the old scar tissue. Now I have ridges on the outside and flat on the top of my right breast. My Dr. says these will fill in when I form new scar tissue and I want to belive him. Should I? Sincerely skk 8-2-05

Answer:

I think he is right, just give it some time, those ridges are where the scar tissue removal ending and they will soften. JG 8.2.05

Question:

Dr. Garcia, I have sutures in my mouth from a genioplasty procedure. It's been a little over 3 weeks. How much longer until they dissolve? Is it different for everyone?

Answer:

They may need to be cut out if they have not dissolved yet. JG 7.31.05

Question:

Dr.Garcia: I am considering having a chin implant. Will this do anything to my bite, teeth? Also, what is the recovery time as far as eating. I am a diabetic.

Answer:

A chin implant should not effect either. You would be on a soft diet for a couple of days only, then solid food with small bites for a week or so. JG 7.29.05

Question:

Dear Dr. Garcia: I asked you yesterday if their where any alternatives to using implants to widen the jawline. You said that the mandible could be broken then plated into a new shape. I was wondering though, if that procedure would affect the bite. Thanks again. MA 07/29/05

Answer:

it would affect the bite, yes. You could possibly have injectable hydroxyappatite placed also, it will get hard like bone a few hours after an injection. JG 7.29.05

Question:

Dear Dr. Garcia: I was looking in to getting a sliding genioplasty to extend my chin, however I was wondering what happens to the gap in the mandible. I've read articles that said the bones fuse together and others that said they don't. So what really happens. Thanks! CW /26/05.

Answer:

It has to be filled with something to create new bone or with hydroxyapatite, like a coral substance if the gap is too big. JG 7.26.05

Question:

I had a reduction genioplasty.....i am 8 days post op and can start to feel the bone work....on the lft side of the lower side of the chin I can feel the bone come off of track and is causing the sligghtest protrusion...very slight....i would be able to live with this however what do you think that can be from.... everything else is so great.....

Answer:

I would go back and see your doctor to make sure the fixation of the one is stil alright. JG 7.25.05

Question:

After having my reduction genioplasty done the surgeon injected the surgical site with 40cc of a cortisone/steriod...the objective was to decrease the amount of scar tissue that I had in my chin from silicone injections...therefore decrease the volume...I have been in slight pain and rather swollen for he past 5 days post op....mostly at night and in the morning....Do you think that this was a good idea to treat with the cortisone?....Can this be part of the reason for my discomfort?...Thank you DR.....You are faboulous!!!!

Answer:

It is not unusual to use cortisone injections into a surgical site to diminish the swelling, but it does not take it all away. I doubt it has caused any more pain than you would have had without it though. Jg 7.24.05

Question:

I recently asked about my genioplasty and the longness of my face. I understand this will go away but I was wondering how long I can expect for it to look this way and is there anything extra I can do to speed up the healing time?

Answer:

Massage and hot packs may help, but mostly it will be time. JG 7.24.05

Question:

i just sent that last question about the genioplasty etc etc.......do you think that it is bad to continue icing after 2 days post op

Answer:

after 2 days an alternating warm and cold will be better. JG 7.24.05

Question:

Dear Dr Garcia-On Tuesday I had a sliding genioplasty,facial and submental liposuction,a reduction rhinoplasty and a lip reduction....a revising procedure due to too much silicone in my lower lip. The surgeon cut it off and reattached my lower lip.....It is very swollen at this time of course I am only 3 days post op......My chin is also very swollen.......How long would you expect this swelling to carry on for.....

Answer:

The swelling will subside to a great degree in a week to ten days. JG 7.24.05

Question:

I just had sliding genioplasty done to bring my chin forward. It's only been a week so I am still swollen, but it looks like my chin is longer as well as brought forward. Is this part of the swelling and will it subside or is my chin going to look longer forever?

Answer:

It is normal and will all go down in time, its just gravity pulling some of the swelling into the dependent area. JG 7.13.05

Question:

Dear Dr Garcia, I am very impressed with your web-site. My compliments to you and your thoughtfulness. I had tiplasty, a chin implant and my ears tucked on June 30th, 2005. We have a trip planned to Hawaii (grand wyallaya) with our two boys. I am feeling like terrible mommy because I'm not sure if I'll be able to go swimming with them. Our trip is on July 23rd. What do you think? Is the Ocean out of the question aswell? Thanks for your time

Answer:

As long as you are careful and do not get hit directly on the areas I think you will be fine to go in the ocean. Have a wonderful time. Aloha! JG 7.13.05

Question:

I had cheek implants put in 11 months ago. The right one is higher than the left one & looks strange. Is it safe to take the right cheek implant out now & put another one in that looks like the left one?

Answer:

I think the removal and readjustment of the implant certainly would be warranted. JG 7.10.05

Question:

Hi Dr. Garcia, Is a nerve being damaged during a chin implant an inherent risk with surgery (I wrote you a question yesterday about this)? How responsible do you feel a surgeon is making amends? How long will restalyne in general last in the chin area?

Answer:

It is a risk, a small risk, but a risk. The probelem is that it may not be able to be fixed, so there is no repeat surgery that can be done to repair the nerve as usually they are so small they cannot be seen. I think expecting a Restylane treatment or two would seem fair, but all doctors are different. Restylane should last a number of months. JG 7.8.05

Question:

Hi Dr. Garcia, thank you so much for taking the time to answer questions like this. I'm 35y/o and would like to correct the nasolabial folds beginning to form, lift the middle/outer corners of my brows and correct a recessive chin. I'm not ready for a conventional brow lift and have been considering the Contour Threads for that area, and also for my cheeks. My concern is the 12-18 mos longevity for the threads. Maybe it's not worth it for a pretty temporary solution. What do you see as the pros and cons of the contour lift compared to cheek implants, and as a solution for brows in general? My cheekbones are slightly flat and never have been very pronounced. Is there a possiblity my thread lift wouldn't be as lasting in the cheeks because of the lack of structure to hold the tissues? What should I consider when thinking of a chin implant. I've heard some use screws, some don't, some insert under the chin, some through the mouth. Thanks again!

Answer:

The pros are that it is quick and little down time for someone in a hurry, otherwise, for the cost, I think the surgery is better than the threads. Cheek implants also will change your appearance from anything you used to look like so you need to be ready to look different if you go that route. Threadlifts are for sagging skin, not sagging tissue below the skin. As to the chin, I prefer the outside incision due to less infection and as long as the pocket is made of the right size, no screw is needed. JG 7.6.05

Question:

Hi Dr. Garcia, I had a chin implant 10 months ago. It looks good when I smile or talk. However, if I make certain types of facial expressions (e.g. suck through a straw or make a funny/dramatic face), my chin only moves on the right side. The left side does not get a weird dentation? Would a filler such as restalyne help this situation? What do you suggest? Redoing the implant?

Answer:

It appears that a small nerve may have been injured. A filler like Restylane will not make the nerve come back but will fill in the depression. Re-doing the implant will not help either. In severe cases I will inject very small amounts of Botox Cosmetic into the normal side to slightly weaken it to make it look more even. JG 7.6.05

Question:

I am having a reduction genioplasty and am scared to death about awful pain....have you heard of this procedure being very painful...?....

Answer:

I do not think that the pain will be all that bad. JG 7.3.05

Question:

I am sorry to bother you again for advice. I had the sliding genioplasty exactly five months ago to correct a very long and unattractive chin. The chinline itself looks better, but the vertical height of the chin is exactly the same as before -- and the result is that there is no appreciable difference. The crease in the submental fold is much, much lower than it was before, and the whole area is still swollen. How can this be right after five months? My surgeon is willing to give me an injection of something called Restalyne, but that will only remove the wrinkle (which is now in the wrong place). The chin will still be very long below my bottom lip. Can you think of a solution? How much longer should I expect to be swollen? Even my lips still feel like they are being stretched.

Answer:

At this point in time you should be seeing some reduction in a vertical height, you may need more bone reduction of the jaw bone. Swelling should be markedly down by now. JG 6.30.05

Question:

I had a chin implant about 10 months ago. Unfortunately I was in an accident and my chin split open. The xrays determined that there was not acute fracture or soft tissue swelling. My doctor also said the implant was stable. What are the chances of my chin implant atrophying?

Answer:

I have never heard of the chin implant if it survived the accident, having any atrophy afterwards. JG 6.29.05

Question:

iv lost all kilo on face.i had fat injections about 10 months ago which mostly have gone now. i could of had more fat injections but i dont have enough fat on my body.it has been sugested to have cheek inplants and to have inplants at the bottom of my jaw to push the skin back up and to make it rounder .what do you sugguest as i carnt live looking like this .also i have to have pre op tests can you explain what these are for thanks allison

Answer:

I think the implants are certainly an option for you. As to what tests you may need to find out what is happening , I think you need to see an internal medicine doctor to find out why this has happened. JG 6.15.05

Question:

Hello Dr Garcia- I am a 23 year old male and will shortly be having a sliding genioplasty to feminize the lower third of my face. I have lyme disease (im from CT) and have had TMJ related symptoms with ear pain as a result of the Lyme Disease. Do you think that by having the Sliding Genioplasty that this will aggrivate my symptoms. Also in this procedure do they use screws in your chin and jaw or just the chin......Thank you sooooo much for your expert advice.....Matthew

Answer:

I don't think a sliding genioplasty will have any major effects on your TMJ, if they were moving the whole jaw it would be different. They typically use screws from the chin into the jaw bone to stabilize it. Best of luck. JG 6.11.05

Question:

Dear surgeon, Please kindly guide me to find answers about my cosmetic surgery. I am a lady at age 36 who would like to have which of these cheek implants is better according to my face who has a flat sunken,narrow and long face? I WOULD LIKE TO KNOW WHICH OF THESE CHEEK IMPLANTS are better (Nagor)or Gore-tex(EPTFE).?because one of the surgeon is advised me this and other the next one.I think Nagor is also a solid silicone type.for more information you can go to www.nagor.com it is made in uk tooHas nagor been approved by FDA?Is that true using Gore-tex cheek implant harder for the doctor to use and the final and ultimate result will show itself months later (around 1 year later but for nagor is a sudden change?if yes .why?and which of those 2 you are prefeing for me?what is your idea about Aquamid (Contura) for permanent lip enhancement. It consist of 2.5 % polyacrylamide and 97.5% water.I want to know which part of my upper and lower lips it must be injected to make it more matched and sexier to me? I have a long,narrow, protruded chin ,thus my last question is that can it be shorten and retrogress by the same Plastic surgeon and that can be done at the same time.along nose job,cheek and lip augmentation?or it must be done by Genioplast surgeon and in a separate surgery and later on?what is the best way for removing dark circle and hollow look under eyes?and is that true by cheek implant hollow look will be improved or I must use another way?If you let me I will send you some of my photos to make your decision easier and precise. With warmest wishes Elham Madani

Answer:

The change and the healing are about the same. GoreTex implants are a little more flexible than silicone implants and are no more difficult or easier to position. One thing is that the variety of sizes and shapes available are less for Gortex over the silicone. Nagor does not distribute solid silicone implants in the US but there are many other companies that sell basically the same product. My preference will depend on what shape the patient needs, if they need the same shape, I prefer GorTex. I would strongly advise against any permanent filler for lips, they are not meant to be filled with these types of materials, my preference is Restylane for lip augmentation. As to what portion of your lips needs to be injected will vary from patient to patient and also on their interpretation of what makes them look sexy. You can see many celebrities that have had them done and I feel look worse after the lip augmentation. The genioplasty or chin repositioning I feel can be done at the same time as the other procedures. As to the dark circles, it can be difficult. Some doctors are injecting materials there, others reposition the eyelid fat into the area, but it may be difficult to totally remove them. JG 5.27.05

Question:

I had Sliding Genioplasty (chin), and now I can't control my lower lip very well. Is there something that can be done for this? Thanks for your time and God Bless. STeve

Answer:

Well, it depends on how much time has gone on. That is very common for a few weeks after until the nerves and muscles adapt. If it has been more then a couple of months, you may need to get the muscles examined and see if the have come unattached and need to be repaired back onto the bone. It could also be some stretching of the nerves and at times it can take a number of weeks to start coming back. Please see your surgeon though and make sure what is going on. JG 5.5.05

Question:

Hello Dr. Garcia. I had a silicone chin implant(size small, without screws) done in 1996. Two weeks ago I fell on pavement while running and landed very hard on my chin. There was severe brusing. I just shaved off my beard and there is a bump under one side of my chin as if the implant shifted at an angle. It clearly looks different than recent photos. I'm hoping it is just residual swell even though it doesn't appear to be. What are the chances that a nine year old implant would shift under such severe impact? Thanks

Answer:

well, it is a possibility under that kind of force. If it does not get better in a couple of weeks you may need to see your plastic surgeon to see if it has shifted and then have them reposition it. It may need some stronger fixation this time as now the pocket is bigger. JG 5.5.06

Question:

Can you recommend anyone in the northeast for sliding genioplasty surgery, preferably pennsylvania?

Answer:

I AM NOT SURE OF WHO IN THAT ARA IS DOING THE SURGERY. I WOULD SUGGEST YOU CONTACT A NEAR BY UNIVERSITY AND I AM SURE THEY WOULD HAVE SOMEONE WHO DOES THAT TYPE OF SURGERY. JG 4.30.05

Question:

You were very gracious to answer my question a few weeks ago regarding some residual unresolved swelling three months following a reduction genioplasty. The swelling is in the area of the sublabial crease (or submental fold). You said to ask my surgeon if there could be infection or if the implant could have shifted. He said no, that I was healing normally, and that the swelling should go away -- and if not, he could take a few stitches inside my mouth that would make the swelling not so noticeable. Does this sound right? I had the surgery (at great pain and expense) to correct a very long and unattractive chin. The result would be fine if the swelling would go down, but for now, it is worse than when I went in. I am feeling both desperate and foolish, and wonder if you have any words of advice -- particularly about his suggested solution? Thank you for any encouragement you can give me.

Answer:

Yes, a suture could be placed but I think most likely it will go away in time, its just that there is a lot of motion there and it keeps it swollen. I would massage the area and try to push the fluid to the sides and it should get better in time. JG 4.29.05

Question:

I had cheek implants several (about 11) years ago. Do you ever need these re-done?? Also, I am considering laser or IPL for age/sun spots. Can these treatments be done without harming the cheek implants?? thanks

Answer:

No, its a one time deal. IPL and regular lasers can be done with no damage to the implants. JG 4.29.05

Question:

Hi. I'm a 30 y/o female with exopthalmus and droopy, sleepy looking lower eye lids. When evaluated by my plastic surgeon, he initially refused to do eye surgery (blepharoplasty), but later said I might benefit from fat redistribution. Your thoughts?

Answer:

A possibility, along with cheek implants to support the tissues of your cheek better and negate the negative downward vector of pull from aging and bone shape. JG 4.25.05.

Question:

Hi Dr. Garcia, When I was a child, I had a pretty bad fall on my head and it required some sort of procedure, I'm not really sure what it was, but I think it was something akin to a premature closing of a suture or something. It was not until about a year ago that I began to notice that my forehead is not quite as symmetrical as I would like it to be. In effect, there is a 'dent' on the right frontal side of my forehead, whereas the left side is rather round. It's not extremely noticeable, but can be obvious in certain lighting conditions when I cut my hair short. I have made the decision that I do want to get this fixed surgically in the near future, I was just wondering what sort of procedure would be performed. Any help would be appreciated, thank you!

Answer:

It may require an implant to be placed over the skull to simulate the shape of the other side, this can be custom made so that it matches the other side fairly close. It would require a surgical procedure to place it though. JG 4.18.05

Question:

Hi again Dr. Garcia, thanks for your quick reply. This is in regards to the forehead 'dent'. Just out of curiousity, what would the price range on a procedure like that be?

Answer:

It would depend on the size of the dent as that will dictate the cost of the custom implant, after which I could give you an estimate. A rough ballpark figure would be about $2000-$4000, depending on the time involved. JG 4.18.05

Question:

I'm a healthy 58-year old caucasian woman, 3 months post reduction genioplasty. My concern is swelling: I resemble the chimps in the Planet of the Apes movies because of so much puffiness in the area of my sublabial crease. Is three months long enough for this to have resolved? Many thanks for your guidance!

Answer:

I think three months is long enough for most of that to be gone. I would go back to your doctor and make sure the implant has not shifted or has an infection. JG 4.17.05

Question:

I was wondering how long cheek implants last? I was also wondering about jaw implants. Are implants the answer or can you get a similar look with injections? Also, what about side effects. Thanks for your help.

Answer:

Injections will give you a smaller and very temporary look. Implants are permanent and are made of either solid silicone, Gortex, or a Coral like material called Porex. Side effects of the implants are a malpositioned implant or an infection, and in rare cases a litttle erosion of the bone. JG 4.17.05

Question:

Dear Dr Garcia, Greetings from the United Kingdom. Dr I would like to know if you carry out facial chin dimple creation surgery or if you can reccomend any professional who does so? Thank you for looking into my question. Regard, Stella Khan

Answer:

It can be very difficult to create a dimple as it requires the tethering of the skin to underlying muscles. I don't know of anyone that does it with a reproducible result. JG 4.15.05

Question:

I had a genioplasty and am very unhappy with the result. Can I get this reversed?

Answer:

it depends on whether you had a bone advancement or an implant. If it was an implant, it can be removed and the muscles re-attached. If the bone was worked on, it will depend greatly on what was done to it. JG 4.14.05

Question:

Dr Garcia, Is there any way the screws/plate could come loose after a genioplasty, if so is this common? Also, when the chin is felt will there be any noticeable gap or will the chin feel normal?

Answer:

possible but not very common at all. There should not be any gaps or palpable step offs. The chin should feel normal. JG 4.5.05

Question:

Will there be any bone regrowth for a sliding genioplasty that involves bring the chin bone down as well as out? I wanted a little more vertical heighth to lengthen my face but am worried that no bone regrowth will occur because chin bone wont be in contact with any other bone. I've seen the plate used for fixation and it seems like it would prevent the bone that was cut off from coming in any contact with the jaw bone. Also, have you heard anything about resorbable plates?

Answer:

Resorbable plates are used but are not as strong as the permanent ones. If there there is a gap between the bones when advanced, typically a bone graft is placed to induce bone to grow in that area and make it stable. JG 4.3.05

Question:

dr garcia, I plan on getting a sliding genioplasty done in a few weeks. In my free time I like to go to the gym and do some boxing. My question is after my genioplasty is completed will the chin be strong enough to suffer a blow such as in boxing???

Answer:

I think you should avoid it for at least 6-8 weeks, but eventually should be OK to do if it is approximated with screws or plates. JG 3.15.05

Question:

Dr Garcia, Is it possible that a sliding genioplasty can not be done due to the bone structure of the chin. For example if you feel my chin bone you can feel a bump that extends from the bottom of my chin to the top near the roots of the teeth. My chin is not perfectly smooth when felt and is somewhat rough. Is a sliding genioplasty still possible because of this and if so will if be harder for the surgeon to perform this? Thanks!

Answer:

A sliding genioplasty would still be possible in your case from what you are describing. The cuts into the bone are done much further back and the point of the jaw bone will not affect that. JG 3.10.05

Question:

Why don't you do genioplasties? Why would a doctor do a genioplasty instead of a chin implant? Do you do all your own surgery or do you have someone else help you, i.e. with closures? About how many rhytidectomies do you perform each year? Can you give me an approximate price for a rhytidectomy and an upper & lower blepharoplasty? Thank you. 3-2-05

Answer:

well, technially a chin implant is a genipoplasty, what I do not perform is sliding osteotomy genioplasties where the bone is cut and then slid forward and then screwed together. I do not do them as I don't do them frequently enough to stay comfortable in the process. Years ago I did them but when it got to be that I was doing less then 5 per year, I felt it was better to let other more experienced people do them. I think they are good procedures though. In terms of my surgeries I do the entire surgery form start to finish, I put in all the sutures. As to facelifts, I do about 100 of them per year ( average plastic surgeon does about 12 per year), a facelift with upper and lower eyes, all inclusive with an overnight stay in the hospital, all fees including anesthesia and operating room and all ultrasound massages after is $12,925. JG 3.2.05

Question:

Dr. Garcia. I saw the previos question about porex jaw implants. I am looking into a chin imlant and I was told there are two options -silicone and porex. I was told that silcone would probably cause bone resorption, but that with porex, your own tisse actually grew into the bone, and after a few years you wouldn´t be able to tell the difference between the bone and the implant. Therefore there would be no bone resorption. What type of implant would you suggest? Thank you A.B. 2/23

Answer:

There will be some erosion with any implant. Your tissue does grow into the Porex but it takes a larger incision to put it in. Gortex implants are also available and have tissue ingrowth. I think the amount of bone erosion is not clinically evident for most patients. JG 2.23.05

Question:

Dr. Garcia, I am considering getting porex jaw angle implants. I have done some research and some suggest that porex implants cause bone resorption/bone thinning. Other studies aren´t conclusive. If I get the implants will they wear away the bone? This is a wonderful service, thank you. JM 2/21/05

Answer:

There is a potential for any implant of any kind to wear the bone away although it is minor, and unsual at the angle of the mandible where you are considering it. Porex is a good choice for that. JG 2.22.05

Question:

Is there any way a sliding genioplasty could affect the roots of the teeth? If so, would it be something that would occur soon after the surgery or could it happen years after the surgery? I was planning on getting braces to correct my bottom teeth and was wondering if I could do it after the genioplasty.

Answer:

If done properly no, if done improperly, the roots could be damaged and the nerves could be injured also. That is why you need an experienced surgeon, it is not a diffcult operation for someone with good experience. All of those things if they happened will happen right at the time of surgery and woud be evident right away, not later. The braces should be done after as the genioplasty although it should not change your dentition there could be swelling during the time of sugery making the adjustmnet of the braces moreedifficult. JG 2.19.05

Question:

I have a chin implant, but I want to enhance my jaw line. I have a small chin and a lot of fatty tissue under my jaw, that gives the appearance of a double chin but I am a very skinny and petite person. How can I achieve that movie star jaw line? My Plastic surgeon suggested a sliding ostomey, but I would hope maybe neck lift or a wrap around implant of some sort to reduce the invasiveness of the surgery.

Answer:

Well, besides the genioplasty, you can have a longer chin implant placed, there are also implants that go by the angle of the jaw bone, you could do liposuction of the neck and then inject fat onto the bone edge to enhance the area, some neck tightenting may also be beneficial but I would need to examine you to determine that. Hope this helps. JG 2.17.05

Question:

Is their a lot of deterioration with metal plates and screws used for a genioplasty? I'm young and worried that over time it will deteriorate the bone a lot and I will have to get them replaced. Also after the bone has regrown is it just as strong as it was before the genioplasty? Thanks for the help! Jaymie

Answer:

There should be minimal to no breakdown of the plates and screws for genioplasty. Once the bone has healed with the screws it is essentially just as strong as before, correct. JG 2.16.05

Question:

Dr Garcia, I've read a few posts on here about genioplasty, I know you dont perform that kind of surgery but I was wondering if you could answer a few questions for me. After the bone is moved forward and screwed into place, does the bone ever regrow back and if so how long does it take?? Also would the bone growing around the screws/plates be of any concern? Are their any high risk problems that occur with this type of augmentation such as bone infection or jaw fracture. If so, what are the most common? Sorry for all the questions. Thanks! ~Danielle

Answer:

The bone will heal like a fracture, it usually takes about 4-6 weeks to get bone ingrowth. There will be no bone growing over the screws, they prevent it as for bone to grow it has to be in direct contact with other bone and will not grow over an implant of any kind. Other risks are the bone not healing evenly, possible nerve injury also exists. Those riske mentioned are the most common, along with infection. JG 2.3.05

Question:

Dr. Garcia, I'm 20 years old and I've heard that a lot of plastic surgeons recommend a genioplasty instead of an implant for younger patients who want a chin augmentation. The reason for this is because the implant can erode away the bone over time causing problems later on down the road. Whats your take on this??

Answer:

Well, a chin advancement is more secure, and can give a more dramatic result as the jaw can be advanced a greater amount, but the amount of erosion from the chin implant, even over years, is milimeters only, very small amounts. Also you need to know that at times the sliding genioplasty can fail to heal solidly, and the jaw can fracture during the procedure, so nothing is without risk. JG 1.28.05

Question:

Dr Garcia, If I were to email you a profile and front facial pic of myself and tell what I would like to achieve, would you be able to tell me what size chin implant would suit me best, such as a small medium or large implant?? Also, do you perform sliding genioplastys and what is your take on them? Better than an implant?? ~Craig

Answer:

Yes, a 3/4 view will also help with the others. If you can have a ruler or something with a measurement near your face so I can have a perspective, that would help also. I do not perform sliding genioplasties, but other plastic surgeons and oral surgeons do. If the desired increase in frontal projection needs to be greater then 1 cm, then a sliding genioplasty is the way to go. They are more stable than an implnat, do not have erosion problems, but it is a bigger surgery, fractures of the jaw can occur, and injury to the nerves in the area are slightly higher than a chin implant. If you are coming from out of town I would want you here for about 5 days. We could have you get the required blood work done in your home town and send you all the permission papers in the mail before your arrival. JG 1.25.05

Question:

Dr Garcia, I am very interested in chin implantation. One main concern I have is the implant shifting out of place. Would you recommend having the implant fixed to the bone by the way of screws? If needed, would this make the implant a lot harder to remove? I plan on having a medium silicone implant, will this cause a lot of bone resporption, if any? Any suggestions on other materials? Thanks Craig

Answer:

If the pocket is made well, the implant should not move. Usually we suture it to the surrounding tissue. We can place a screw to maintian its position but not necessary on a routine basis. If it is screwed in it would not affect the ability to remove it. Any implant can cause some minimal bone erosion, but it is almost imperceptable. I think silicone is a good option, as well as Gortex. Best of luck! JG 1.24.05

Question:

Dr Garcia, The reason why I am interested in fixing my chin implant with screws is because im very active in sports. My main concern is getting hit in the chin area and having the implant move. Would the pocket created be strong enough to hold it in place? I've also heard that their is a chance of bone deterioration if screws are used. Is this something to be highly concerned about? Also, I've read that gore-tex promotes tissue ingrowth and, if needed, makes it a little harder to remove, is this true? I've heard that scar tissue is another thing to watch out for, especially with silicone implants, should i be worried? Do you perform chin augmentations and if so have you done a lot? I'm still looking for a PS and you seem like a highly qualified PS. Thanks again for taking time to answer my questions. ~Craig

Answer:

After about 6 weeks, that pocket should be very stable. Can you fix it with a screw, yes, but the implants are firm, not bone and they can tear through a screw, rare, but possible. Bone deterioration is possible with or without a screw being placed. This is of a very small degree and concern. Gortex can be a bit more challenging to remove, but not like a Porex implant which is hard and very difficult to remove. That ingrowth allows less movement potential afterwards. There is no difference in scar tissue formation between the implants mentioned. We do many of them and we would be honored to take care of you if you decide. JG 1.25.05

Question:

what would you charge for a full far transfer to the face. what parts of the face does the fat take well and which parts not?

Answer:

The only place I do fat transfers to the face are in the cheek region. I have found all the other areas not too receptive and do not survive. The fees are about $3200 for the procedure. JG 11.27.04

Question:

Dr. Garcia what would you do as a plastic surgeon for someone who is unhappy with dimple in chin and indentures in face under cheeks, cheeks look hollow, almost masculine? Would you do implants or fillers, if so, what?

Answer:

I think fillers would be the better choice and depending on how deep they are, I would consider Restylane or Radiesse. JG 10.22.04

Question:

i've emailed you a couple times about alloderm implants in the eye orbital. can you supply any pictures or experiences via your wesite from your patients. i am finding that the procedure is not so commonplace.

Answer:

It is not a commonplace procedure by any means and I have no patients that have given their consent for us to use their pictures. We cannot post photos without the patient's consent and many patients do not want their pictures shown, especially if they have had something go wrong before and their appearance was unpleasant. I must stress to you also that although alloderm may help, it will not last forever, so you may need repeat procedures done every few years. JG 10.18.04

Question:

how much do you charge for cheek implants and chin implants respectively. how much together?

Answer:

The chin augmentation is $4000 and the cheek implants the same, when done together, they are $7200. JG 9.20.04

Question:

This may be a silly question. I have read in previous posts that dimple creation is not guaranteed and that you prefer not to do them, but do you have an opinion on chin implants with a cleft? Thank you.

Answer:

You may have some slight depression from a cleft chin implant, but a dimple is formed by a connection between the skin and the underlying tissue whereas the chin implant is placed UNDER the chin muscle, far deeper than the area where a dimple would be, so I seriously doubt a cleft chin would result. JG 8.4.04

Question:

Hello Dr. Garcia. It is so neat to see a doctor so willing to answer everyone's questions! I am 27, and I was wondering what kind of anesthesia is generally used for chin implant and CO2 procedures. I was also wondering if you could give an idea of the cost of those procedures. Thank you so much!

Answer:

Chin implants can be done under local with sedation or general anesthesia. For CO2 laser of the entire face, I prefer general anesthesia as I do not want the patient moving when the laser is firing. Before I can give you a quote I need to know if you were planning on them together, and also, what you wanted treated with the CO2 as it will affect the fees. Also, what were you wanting the CO2 laser to be done for. JG 8.1.04

Question:

How much for cheek implants? How long do you need patient for follow up?

Answer:

Cheek Implants are $3950. That includes the operating room, anesthesia, implants, surgical fee, all blood work and all follow up visits. I normally have patients stay in town for about one week after this procedure. JG 7.31.04

Question:

hello, I have pock marks from acne above my beard line, not to much, I was wondering the best procedure to reduce/remove and the cost.

Answer:

The best option with the least down time and risk would be the injection of Radiance which is a long term subdermal implant. You would back to normal the next day, and the improvement should last a few years. Laser is another option for acne scars but has prolonged redness, and cutting the scars out will leave a permanent scar that may be visible. Jg 5.18.04

Question:

I had softform implants removed from my lips several years ago. But due to having them removed, my skin under my lips are bumpy, especially my bottom lip. Is there anything I can do about this. My mouth looks awful now. Thank you very much for your help.

Answer:

It is probably a small amount of scar tissue that will be difficult to remove. Probably the best thing is to have a filler injected into the lip, with less in the area where the bumps are. Once they are plumper, you should feel the lumps less. Cutting them out surgically would create just new scar. JG 3.16.04

Question:

Can you change a person who looks like a north eastern person of india to a northern person

Answer:

Certain things could be done with facial implants to alter the boney structure, but there would probably be still some sense of ethnicity, although, the more the person is willing to undergo, the greater the amount of change could be made. Skin tones will prevail though

Question:

hello sir, i am about to get plastic surgery done' i am thin and yet i have chubby cheeks, as a result my jawline is not noticeable . i am about to get johnny depp's jawline as well as liposuction on my face to remove the excess fat on my cheeks. i am supposed to leave for america on jan 4 2004 for my under graduate studies that leaves just over a month! my doctor here tells me that is enough time to recover from the surgery . i would like to know whether that is true ? is one month enough to recover from such a surgery? i would also like to know whether the fat that i will remove will that ever come back on my face again in the near future?

Answer:

Well any fat that is removed will be permanently gone. As to costs, I am sure it will be less expensive where you are than in the US. As to the recovery, I agree that one month should be enough to look quite presentable, although you probabably will continue to improve for a few months after that. Good luck and I hope you get the look you desire

Question:

Hi Dr. Garcia, I was wondering how much putting a dimple in my left cheek would cost and does it look natural?

Answer:

the creation of a dimple can be difficult and at times only temporary, I would be hesitant in attempting it for you as at times, the scarring can look unnatural, sorry

Question:

I have a thin face and very high cheekbones which make me look gaunt. My surgeon said my facial skin in very thin and implants would not work under the cheekbone because there is no place to adhere them to and they might cause a bulge inside my mouth. Is he right? I would like this hollow, sunken look in my face corrected. Would injections work? surgeon says I would need wya too much. Any suggestions from you? Please do not tell me to gain weight. I have a nice shape and do not want to get fat.

Answer:

I agree with what has been told to you. The other option is to do autologous fat injections into your cheeks, it may have to be repeated in 6 months, but it will allow the placement of fat and fullness where you want it instead of where the implant could be placed.

Question:

How is the procedure for creating dimples in the cheek area of the face done?

Answer:

The procedure is done by creating some retraction or scarring of the skin to the underlying tissue, approaching it from the mouth. Unfortunately, it can be hard to get even and to get it to be permanent

Question:

what is the average cost of dimple/ chin cleft cosmetic surgery?

Answer:

I cannot give you a fee because I will be honest, it is an unrelaible procedure to do. The chin skin needs to be scarred or held down to the underlying muscle, and that can be unrelaible in terms of it staying. Some doctors put a chin implant with a cleft in it, but that will not always show through to the skin level. At times it can shift out of the center, or the suture will not hold.

Question:

I am interested in having my lips enhanced. I there a non surgical procedure that would enhance them permanently? KC
6-14-03

Answer:

Unfortunately, the only procedures available to enhance your lips permananetly are not very good. They can leave them lumpy and hard in places, it can distort the shape of your lip when you purse your lips, and there is about a 6-8% infection rate, so I would not advise them, sorry.