Question:

The incisions on a man for facelifts, should they be in front of the ear, or inside the ear? I hear different views on this as it regards the sideburns being pulled too close to the ear.

Answer:

Either way is fine, either one will need a strip of laser hair removal to revreat the normal hairless area that can be created. JG 1.7.14

Question:

If I had a facelift done 6 years ago, could nerve damage be showing up now. I`m having chronic headache pain behind my left ear. I have some bad scarring there and about a month ago I had something poking out behind my ear like a stitch? Could the headaches be nerve damage just showing up now?

Answer:

Anything relate4d to the surgery would arise in the first few months, so I doubt it with your case. Must be something else. Sorry. JG 1.6.14

Question:

From looking at pictures of mini facelifts, or for that matter full facelifts, it doesn`t seem to me that men have as good of results as women. Is this true or just my imagination?

Answer:

Mens face are more diffixult in some cases depending on what is going on with the underlying tissues, but more importantly they usually do not want to look too tight and have an obvious change. It can be patient choice in most cases. JG 1.5.14

Question:

I am 3 weeks post op after mini facelift and neck lipo. I had the surgery because of my sagging neck which was heavier on one my left side. Now, as I heal, I notice that the swelling on my right is almost gone, but the left side is still swollen and appears heavier. Could this mean that I am still left with an asymmetrical neck?

Answer:

Too early to tell as the side that had more work had more work done, have to give it some more time. JG 1.4.14

Question:

I am 10 days post op after a mini facelift and neck lipo. The mini lift was pretty much a facelift in that tissue and muscle were repositioned. Since the surgery I have blurry vision. It is normal for distance but anything up close appears blurred? I do have a great deal of facial and neck swelling. Is that the reason?

Answer:

not a normal thing, not related to the surgery so you should aee someone for it. JG 12.22.13

Question:

My sister had a facelift in July and developed two hematomas at the back of her scalp along the incision lines. Her surgeon worked quickly to evacuate them and to monitor her recovery. She got great results BUT her hair started to fall out in September, and not just along the incisions but all over her head. At this point, she`s lost about 70% of her hair and looks 20 years older than she did before the surgery. She is heartbroken and really worried. Her surgeon is stumped and says he`s never seen such a reaction before. Do you think her hair will grow back or did the hematomas separate the skin from the deeper layers of her scalp and permanently kill the hair follicles? If it does grow back, is it unlikely to come back along the incision lines? We are so relieved and grateful that we found you on the web. You are simply amazing to offer this service to stressed out people who aren`t your patients! Thank you.

Answer:

Her hair loss is likely associated with a phenomenon that occurs in a small number of patients due to the stress of surgery and anesthesia. The patients can have significant hair loss but it does grow back in time. The hair goes into a state of shock and can take 3-6 months to begin to grow again. I do not think that the hematomas caused it. I have seen patients with the problem and they seem to get back to normal faster by using Rogaine. In her case, even if a female, I would suggest the Men`s Rogaine as it is stronger. Don`t let her give up, it will get better. Thank you for the kind words and I wish her the best. JG 12.3.13

Question:

Hi Dr. Garcia, I have read various things about timing of suture removal after facelifts. I have read anywhere from Day 4 to Day 7 postop. I am referring to front of the ears only, post op day number what, is the best day to remove the sutures to avoid track marks? I understand the back ones have to be in longer, but I don`t want track marks in front. Thank you for your help and for being there

Answer:

We take ours out at 7 days and do not have any track marks. And we do not put any ointments on them either. JG 11.7.13

Question:

When asking about permanent tattoos or post facelift scars, I should have asked you about permanent pigmentation for scars that have turned white. I meant small, white ones. Are they easier to cover than red ones? Thank

Answer:

white ones are much easier to cover, yes. JG 10.16.13

Question:

Dr. Garcia, What is your opinion of getting a permanent cosmetic tattoo for facelift scars behind the ear? Are there good results with the right artist? Thanks

Answer:

should work well in experienced hands. JG 10.14.13

Question:

Macs lift: Since I’ve had 3 “lift” surgeries that were all done wrong, and face is now pulling downward (yes, you read that right), I’ve been told by surgeons in this area that they’re afraid to open up around the ears because of scar tissue and loss of tissue to correct vectors. It’s been recommended to me that a Macs lift might help pull upwards without involving the same incisions. Another surgeon said a Macs lift would have to involve at least the upper part of the old incisions, and so would still be difficult. My questions are: Could a Macs lift be done without involving the incisions around the ears? If so, could it give a more upward look to my face that is currently downward? Does a Macs lift have to include opening up the previous incisions around the ears? Thank you.

Answer:

The MACS lift relates more the the treatment of the issues below the skin and not the skin itself. Incisions would be needed in order to access the tissues in order to place the purse-string MACS suture, but the access point is usually done in the old incisions. You likely will not have any skin removed in your case. Sorry to hear about the difficulties. JG 10.9.13

Question:

Hi, Dr. G--I wrote recently about the ps who wants to do a DAO release with my facelift. You said that would not do much for the marionette lines. If not, what would be the purpose and what are the dangers? Also, what are your feelings about a small bit of onetime laser on eyelid? BTW, this Q&A service is so helpful to so many and so appreciated. Thanks so much!

Answer:

the purpose of cutting the DAO is to lessen the downward pull on the corner of the mouth, that causes a drop of the skin onto the lip over the corner of the mouth but will not correct the marionette line which runs form the corner of the mouth down to the edge of the jaw. As to the one time laser for the eyes, it is OK, I do it when patients request, but it is a little disappointing in terms of how long the degree of improvement will last is all. All the best and thank you for the kind words. JG 7.21.13

Question:

I recently saw a ps in dc who wants to do a lip lift through the inside of my mouth (my upper lip covers my upper teeth) and supposedly he is one of few surgeons in the country who performs this procedure this way. He also wants to do a corner lift (which I am not sure of b/c I think it may look unnatural). He also cuts a muscle that gets rid of the marionette lines (mine are bad), but could`t cutting this muscle cause more problems than it improves? He seems very knowledgeable and his before/after stills and videos look good, but what is your opinion on these procedures? Thanks so much!

Answer:

I think doing the internal approach rolls the edge of the lip inward and I would not do it that way. As to the corner lift, in some patients it works well but there is a small visible scar that will require make up. As to the cutting of the DAO muscle, it can be done easily and safely, the other alternative is Botox to that muscle. I will say that it will elevate the corner of the mouth but will not correct a marionette line seen at rest as the cause of the marionette line is falling skin and not strong muscle. JG 7.17.13

Question:

Dr. Garcia, I just accompanied a friend for her face lift surgery. She was in actual surgery for six hours--she had a neck lift, mid facelift, and fat transfer to lips, eyes, temples. Is that an extra long time? Also, here in the midwest it seems that everyone does fat grafting along with the facelift. This doctor told my friend he can give her a bigger top lip with fat grafting. As I understood it, fat transfer isn`t necessarily permanent, is it? Thanks for any info.

Answer:

correct, it is not permanent in all cases and can be variable in how may survives between one side and another. I would never do fat injections into the lips for fear if it does survive that they will grow in time. JG 7.13.13

Question:

Hi Dr. Garcia. You have done 3 procedures for me in the past and I have been very satisfied. I am thinking of having a lower facelift. I live in CA and want to consolidate my visit. Is it possible to have the pre-op done within a day or two before and stay for the procedure and follow up? I`m assuming I would not have to stay overnight at a medical facility. Thanks!

Answer:

We could send you all the paperwork and the blood test slip, the blood test can be done in Ca, that way just arriving the day before is enough. You can send pictures to me at drgarcia@lvcosmeticsuegery.cim so I can figure out what you need and fees. We can arrange the overnight stay. Woud you be coming in with someone that can drive you home? If all is well you could go home the next day and return a week later. Let me know. JG 7.11.13

Question:

Hi, Dr. Garcia. Welcome back! Hope your time away was restful. I had a mini neck lift (just lateral) office procedure 3 else ago. My ears are now markedly white. Could I have reduced circulation as a result of the surgery? Is this common at 3 wks out or is this something to be concerned about that I should bring to my surgeon`s attention? Thanks so much!

Answer:

Thanks for the vacation wishes, it was wonderful. As to the earlobe color difference, I do not think it is due to long term decreased blood flow as then the skin would not have healed and you would have scabbed. I think the earlobe has less blood supply that has likely not hampered healing but likely as much of a cause or an even greater cause is moving skin that was further forward on the cheek and neck up and back. This takes skin that over the years has had more sun damage closer to the skin of the earlobe that usually has less, making the color difference more dramatic. I think that will improve with time, but there might always be a slight color difference due to the sun damage issue. I wish you the best. JG 6.24.13

Question:

i`m a male age 34... 175 lbs about 15% bodyfat... i notice that i have a double chin in pics... it just seems to be in the center area of under my chin above my adams apple... if i pull the skin tight there with my finger it looks normal... not sure if its fat or loose muscle or something... what do u think would address this? thanks

Answer:

Hard to say without examining you in public. If it is just a small amount of fat above the platysma muscle, then liposuction would help. Some people have fat below the muscle or an obtuse angle to the muscle and in those cases a surgery needs to be performed to remove that fat and adjust the muscle. Liposuction alone would not correct the second issue. JG 6.12.13

Question:

I wrote to you last week after 2 hematomas were evacuated. I still have a great deal of swellling on both sides of my neck. I`m seeing my surgeon today. Would there be any benefit to him inserting drains at this point? Anything else he should try? Thank you so much for your help!

Answer:

If there is continued bleeding it would help, yes. The bleeding must be controlled first and then maybe some ultrasound massages to help soften the tissues would help. I wish you the best. JG 6.10.13

Question:

I wrote to you yesterday about the hematoma following facelift on Tuesday. I want to thank you for urging me to see my surgeon. I had a huge hematoma on the R and a small one on the L. He was able to aspirate the L one but he had to open the R incision to evacuate and cauterize it. He told me that in 30 years of practice I was only his third patient to have this problem. (I guess I should play the lottery!) So I`m wrapped up tight, have ice packs on my neck taking pain meds as well as HCTZ to keep my blood pressure as low as possible. My surgeon, of course, needed to seem confident and hopeful in my presence; he said everything should be fine now. But I`m writing to ask you if it`s likely that I`ll have poor wound healing and bad scarring from this? Thank you, as ever, for your insightful and compassionate help.

Answer:

A little slower tilo heal but all will be fine in time. All the best to you. JG6.6.13

Question:

Oh, that helps me a lot. I`m a male and have relatively little hair to begin with, so combing the hair over the scar isn`t really an option. I appreciate your help very much.

Answer:

you are welcome. JG 5.29.13

Question:

RE the incision for necklift: Do you mean you would make the incision along the edge of the hairline rather than behind the hairline? I don`t understand how that would be easier to hide. Wouldn`t that be visible (especially if it stretches and widens) whereas IN the hair would be hidden by the hair? Sorry for the second question.

Answer:

yes, but the hair would fall over the scar unless you always wear it pulled up. The scar can become wide, but not always, it depends on how much tension there was at the time of closing the incision. Less tension, better scar. JG 5.28.13

Question:

Oh, I meant to add this question about my upcoming facelift: The surgeon will be cutting behind my hairline in high post-auricular incisions. Of course, this will end up moving my hairline back. My question is, will the amount of skin removed from my neck determine the degree to which my hairline is moved back behind my ears? I`m a little nervous about this because I have a fair amount of redundant skin, and I obviously don`t want my hairline to be moved back to the middle of my scalp! Thank you.

Answer:

The more skn that needs ro be removwd, the more elevation. I would perform the excision at the hairline as that scar will be easier to hide than an irregular hairline. JG 5.27.13

Question:

I`m having a facelift and neck lift in June. I don`t really have jowls, but my lower face has become soft and round looking. I`ve lost the angles from my cheekbones to my jaw. I don`t need -- and don`t want -- my buccal fat removed because I don`t want to end up looking gaunt. But I wonder if, short of that, if it`s possible for the surgeon to sculpt my lower face a bit during the procedure so that its angles can be restored and I can look less rounded. If so, what specific technique do I need to ask him to employ? Thank you for time and help, Dr. Garcia.

Answer:

By elevating the tissues below the skin in the proper direction it should fill the flat areas and empty the full areas. JG 5.27.13

Question:

I`m having a facelift next month. I don`t take any anticoagulants; the only questionable thing is the bio-identical hormone creams I use (progesterone and estriol). Safe to keep using them prior to surgery?

Answer:

I have my patients continue their use without stopping. JG 5.25.13

Question:

Hi Dr. G., When I smile, my teeth don`t show like they used to, ie, they seem considerably shorter. This is confusing since I thought the saying getting long in the tooth refers to aging? I am seriously considering getting veneers. It is not possible, however, to get an image of what I will look like after the procedure. In order to get veneers, my teeth will have to be filed down - really scary - as there is no going back if I am not happy with the results. I know this is not really your area but if you can tell me what I might expect in terms of facial structure after the procedure, it will help me to decide whether to go ahead. The DDS told me there will be no change other than my teeth will be longer and whiter. That seems like an awful lot of money, discomfort, etc. for no real visible improvement. Thank you for your valued opinion.

Answer:

Getting veneers might not correct it either. In your case that would only work if your teeth had gotten shorter, and that likely did not happen. In some cases it is because the bone of your upper jaw has been lost and the upper lip has less support or that the skin of the upper lip between your lip and nose has stretched. That skin can be shortened by excising a small piece and the teeth will once again show. Building up the jaw bone is difficult but can be accomplished with something called the facelift denture, which is a good option if you are already wearing dentures. JG 5.24.13

Question:

I am having a lower facelift in two weeks. Is it possible in that procedure to plicate the pre-auricular tissue and the tissue over the posterior mandible to add volume? If so, how long does that volume typically last? I`ve grown gaunt in those areas. Sculptra helps some but not enough. Thank you so much for your time and help, Dr. Garcia.

Answer:

it is possible an should last a few years, but everyone ages at a different speed I am afraid. I think the effect will be relatively small though, so do not expect much more than you see from Sculptra. JG 5.20.13

Question:

Good morning Dr. G. I am Asian, and have been thinking about getting my nose fixed. My PS, who is also Asian, has advised me against this because she said Asian noses don`t do well and she sees a lot of botched jobs that she has to try to fix. She uses Artefill instead, which does help refine the bridge somewhat but does nothing for a nose that is more bulbous than I would like as I age. What are your thoughts and how much does a nose job generally cost? How old is too old for this kind of vanity? What are the risks and recovery time? Thank you ever so much.

Answer:

I do think that refining the tip on an Asian nose is difficult and many patients, even after multiple surgeries, do not get the appearance they are looking for. Artefill will not effectively refine the tip I am afraid. I must agree with your surgeon`s opinion. JG 5.14.13

Question:

Thanks for your prompt response..the surgeon that did the loop cheeklift also does it with an endotine and will do a revision using it if I needed, how long must I wait from initial loop lift until the tissues have settled enough for the revision with endotine? 3 months, 6 months or longer? It`s only been a few weeks and there is alot of swelling and bruising on one side, I think removing the suture won`t cause much swelling. But want to know when the tissue would be healed enough for endotine lift? Thanks kind regards

Answer:

3 months should be plenty as it did not work. All the best. JG 5.13.13

Question:

Hi Dr Garcia, When can a revision be performed on a percuntaneous suture loop cheek lift? It is a few weeks old with no lift on one side and many irregularities, would it be best to remove suture loops sooner than later and when would the tissues be settled enough to try again with endontine?

Answer:

the sooner it is removed the better as it is doing nothing. JG 5.13.13

Question:

What do you think of the Iguide neck lift? How many days to recover?

Answer:

Short recovery but don`t think it will last too long. JG 5.11.13

Question:

Hi, Dr. Garcia, I postponed a revision facelift surgery in Jan. because I got jittery & asked several questions via e-mail. (He`s in another city or I would have just asked the Qs in person.) (I have had 3 face surgeries that were bad so I tend to be afraid.) I asked the surgeon if I could see him this coming June when I`ll be in his city, but he said to wait until late summer & we`ll talk by phone first because it`s too early for a re-evaluation. Do you have any idea why he wants to wait this long, talk with me by phone first, and what he may be planning to ask me? I`d like to have succinct answers (& questions) ready so our phone conversation will be as satisfactory as possible. Thanks!

Answer:

that is hard to say. I assume he is the surgeon who did at least the last surgery and maybe he is waiting to see if some of the issues that bother you might settle down and then you might need a smaller procedure. That is a guess though. JG 4.29.13

Question:

I see from reading this site that you perform corset platysmaplasties. Do you go below the cervicomental angle all the way down the midline of the neck? I know that not many surgeons do and, while the limited procedures can significantly improve the upper neck and immediate submental area (particularly sharpening the angle), the lower neck is often left untouched and unimproved. Also do you remove sub-platysmal fat? I am beginning to develop two rolls of it a few inches above the clavicle. I know that Dr. Joel Feldman is highly regarded for his skill in inventing and perfecting these techniques, but if I understand the situation correctly, few other surgeons perform this operation as thoroughly/aggressively as he. Am I wrong about that? Is this something you routinely do? Thank you very much for your time.

Answer:

whether I do that or not depends entirely on the patient and their anatomy.The common issues of the lower neck are related to skin though and not muscle so tightening muscle all the way down will not correct all lower neck issues. I do remove sub-platysmal fat when indicated, yes, but typically just above the level of the hyoid, not at the level of the collar bone.I do agree with you that few surgeons perform the surgery as Dr Feldman has described.I rarely do the procedure that Dr Feldman does as most patients do not need that done.I wish you the best. JG 4.15.13

Question:

Wow! What a helpful and thorough answer you provided about the neck lift. I am so grateful to you for your time and help, Dr. Garcia. I agree that the extremely talented and dedicated surgeon who did my first surgery does seem a little impressed with himself. May I ask just one more question? I can see that I have small bit of redundant skin (which, by the way, looks to be completely horizontal and not at all vertical). I`m just wondering if you think it`s likely that I`ll need the muscle re-tightened or if, once that`s done, it`s done forever. I`ve heard of people have terrible results (lumpy, uneven, etc.) from corset platysmaplasties, and I don`t want to risk that. Are those complications, particularly with a minor revision to a previous surgery, common? He may have an inflated ego, but at least my first surgeon is renowned for getting this particular procedure right. You are an angel. Thank you!

Answer:

The muscle repair will in most cases come apart. The visibility of a second repair depends on the thickness of the skin, thin skin will show more. It might be that you only need a horizintal direction. Animating the muscle can show if the muscle has come apart. Secondary surgeries are more difficult and more complication prone. I wish you all the best. JG 3.7.13

Question:

Oh, NO inconvenience at all, Dr. Garcia! You are the one who is inconvenienced by all our endless questions! Here is what I posted: I had a corset platysmaplasty 12 years ago and it fabulous. Over the years of course the skin has loosened . Is it possible that the muscle might need to be slightly retightened too? I went to the surgeon who did it the first time but he doesn`t revise his work because he says it`s always perfect the first time. He also told me he`s one of the only surgeons in the world who does isolated neck lifts in which the incisions are only behind the ears and under the chin. This is what I want because I don`t want scars ins front of my ears. Is he right or is he suffering from an inflated ego? Do other board certified plastic surgeons perform this operation? Is it something you yourself do? By the way, I don`t need a lower face lift. Thank you.

Answer:

not all patients are candidates for a limited post-auricular incision alone. The reason is some people have excess skin of the neck only in the horizontal vector, which makes them a good candidate for the behind the ear only incision. This is common in younger patients. As they get older and the amount of skin ages in both horizontal and vertical directions, then skin needs to be removed in front of the ear too. You can usually tell by pulling on your skin of the neck and seeing what direction the makes neck looks best. If there is any vertical pulling required and you see a small pleat of skin in front of your ears when you pull with your fingers, you would need the incision in front also. From what you are describing, it appears that your surgeon`s ego is likely as big as his prices. I am sure he thinks the first time was perfect, but alas perfection is fleeting, but if his claim to be one of the few that only does the incision behind the ear, that explains why he will not do the revision, because doing that isolated incision may not be enough in your case now and he does not want to make his claims untrue. Most plastic surgeons do neck lifts and where the incisions are needed is determined by the patients needs and not the surgeons desires. I wish you the best. JG 3.7.13

Question:

Hi Dr, Just a question on behalf of a friend of mine who is 3 weeks post from a SMAS lift and neck lift. She is suffering from headaches that originate from the back of the neck and move forward to the crown. Is this normal due to muscle tension and swelling from the face lift and does this get easier with time? Also, realistically when do the results start to show? Many thanks

Answer:

the muscles treated during her facelift should not affect the muscles back there.It might be because of the position she is sleeping in, or even lack of sleep. You should see the improvements start to show after about a month or so. I wish her the best. JG 3.6.13

Question:

Hi, Dr. Garcia. About a week or so ago, I asked a question about a corset platysmaplasty, but for some reason, you didn`t answer it -- or several other questions posed to you that day. If you get a chance, can you please go back in your blog and offer a reply? Thanks so very much!

Answer:

I have to apologize but it seems the messages posted that day have been lost as I cannot even retrieve them from the server. I hate to ask you to do this but could you repost the question. I am truly sorry for the inconvenience. JG 3.6.13

Question:

Question in re: to my 67 yr old mother. She had a full facelift 5 yrs ago, and her PS said it is now time for a mini face lift and wondering if 7500 dollars is an out of a line price for a mini lift? thank you

Answer:

Prices vary from arwa to area, it is usually about 60-70% of the original fee in most cases. JG 3.5.13

Question:

PS I don`t need a lower facelift, just a neck lift. I don`t have mulch loose skin on my neck, just some. And a little growing horizontal roll of fat st the base of my neck. Just above the clavicle. Can this fat roll also be removed in a neck lift? Thank you

Answer:

' '

Question:

I had a corset platysmaplasty 12 years ago and it fabulous. Over the years of course the skin has loosened . Is it possible that the muscle might need to be slightly retightened too? I went to the surgeon who did it the first time but he doesn`t revise his work because he says it`s always perfect the first time. He also told me he`s one of the only surgeons in the world who does isolated neck lifts in which the incisions are only behind the ears and under the chin. This is what I want because I don`t want scars ins front of my ears. Is he right or is he suffering from an inflated ego? Do other board certified plastic surgeons perform this operation? Is it something you yourself do? Thank you.

Answer:

' '

Question:

You had said that a revision specialist would be preferable for a 3rd revision facelift. I had said that I knew a PS who is He is a very experienced, respected cosmetic surgeon and about 1/4 of his practice is facework. He said he has done 2nd facelifts (1st revisions). I believe he has good judgment, advanced skill, 30 yrs. experience, multiple techniques, and good hands. If you can, in general, please tell me what pitfalls a surgeon such as this might encounter. He is very kind to offer to help me, and I can`t tell if he`s over his head, or he could handle this. What bad things could happen if he were over his head? Thank you!

Answer:

' '

Question:

Dr. Garcia, doing exercise after face or neck lift, will make any bad effect on the result? Let say in a year after surgery. Thanks,

Answer:

after 6 weeks we allow the patient to return to their normal activity.After that the exercise should have no bad effects.JG 2.11.13

Question:

Dr. Garcia,I had a neck lift about 9 months ago, PS connected right and left sides of platisma together. But now, I started to see the cord in the middle of my neck more visible and longer every day. Also, when I talk you can see,like 2 holes or they are like 2 deep lines on each side on the top of platisma (under the chin). What can be done to fix these? Thank you.

Answer:

sounds like the muscle repair tore apart, those muscles are very difficult to get to stay together at times, might need more surgery to repair them I am afraid. JG 2.11.13

Question:

I am 54, wirh pretty good skin, mild jowling and a definite turkey neck. I really want to do something about it but am petrified that something will go wrong if i get a facelift- i have read ao many horror stories. Is ir possible to get a facelift that is effective without looking worked on?

Answer:

most well done facelifts look very natural, unfortunately you get a jaundiced view by what you see and read on the internet as happy patients don`t spend as much time sharing their results. JG 2.11.13

Question:

Thanks again - which surgery would it require? - it`s just the cheeks which I suppose have never been lifted so they look a bit unnatural. Everything else is fine. What kind of surgery would you recommend please? best wishes

Answer:

Just a cheek lift with lifting and support if the tissues below the skin. JG 2.4.13

Question:

Thanks for your answer on an eventual endoscopic subperiosteal mid facelift. I understand you are not optimistic about this - 1. what do you suggest for cheeks which have dropped after MACS facelift? 2. Is it possible to get something done which doesn`t include surgery or is that inevitable for me?

Answer:

`I am afraid it will take more surgery, sorry. JG 2.4.13

Question:

I have had two facelifts: one 12 years ago and a second last August. Neither one seems to have helped my principal problem, which is small pockets of fat, or more likely, visible muscle, beside my mouth. They seem to be most visible dynamically but are apparent even at rest. My mouth isn`t down-turned, by the way. These pockets aren`t officially jowls that normally appear along the mandible itself; they`re sort of mouth jowls beside the lips and above where the marionette lines would be. The surgeon who did the most recent facelift told me that no surgeon is able to correct this problem, but I know that`s not true. I don`t have an excessive amount of buccal fat, and I`m reluctant to have what little I have removed for fear of getting sunken cheeks which will only worsen with age. What is the procedure I need to correct this problem? Do you do it? How much do you charge for it? Thank you so very much, Dr. Garcia.

Answer:

Pkease send me some pictures in animation and relaxed poses for me to see at drgarcia@lvcosmeticsurgery.com. JG 1.29.13

Question:

Hi, Dr. Garcia, I have found a surgeon in my region who has proposed a 4th facelift surgery for me. (The 1st one was a necklift that did very little.) So this would be a 3rd revision of surgeries done by other surgeons. He is a very experienced, respected cosmetic surgeon with a teaching hospital, but he does not specialize in face work. He said he has done 2nd facelifts (1st revisions). Do you think he may not have enough experience to do a 3rd revision? Or could it be that judgment, skill, multiple possible techniques, and good hands could make up for lack of FL revision experience? I don`t want to look overdone, just more back to normal. Please share your frank opinions. Thank you!

Answer:

In cases such as yours where have needes so many revisions I think having someone with speific skill in the face would be best. JG 1.14.13

Question:

Where would the stitches from a cheek lift be placed? Thank you

Answer:

Where the cheek meets the ear, a little bit inside the ear. JG 12.15.12

Question:

Hello Dr, I am 45 with no sagging skin but simply sagging of the cheek muscles. I am slightly confused with the different procedures offered to correct this.. Silhouette, Endotine, thread lifts. Which is the most effective and what is the downtime in terms of going back to work? Thank you

Answer:

I think a cheeklift would be best, skip those others, should be at work in two weeks. JG 12.14.12

Question:

I`ve been on 2 consultations for a lower face and neck lift and see a third surgeon next week. My lower neck is getting saggy and soft, so I`ll need long incisions, not short ones only around the ears. The two surgeons I`ve seen have told me that they don`t like to do this surgery because it always leaves patients with really bad visible scars along the hairline. They told me that scars behind the ears never heal as well as those in front of the ears. I know that others with my problem have successful surgery to repair it, so I`m puzzled. Do surgeons not do traditional full facelifts any longer in favor of those that require only short incisions? Do you do long incisions and do they always heal poorly? In light of what I`ve learned, what do you recommend I ask the third surgeon at my appointment next week? I`m a little discouraged. I obviously don`t want big, obvious scars along my neck and hairline. I have very short hair and it doesn`t grow, so I can`t hide it with hair. Thank you.

Answer:

I do longer incisions when needed and some people do get wider scars, but not all, it depends greatly on the amount of tension placed on the wound at the time of closure, the tighter it is, from removing more skin, the wider they can get. That will at times limit the degree of tightness as an end result on the neck. Also, the further the area is away from the incision, the quicker the skin relaxes, so in doing the neck tightening with incision behind the ear, the first skin to get loose again is the skin right under the chin.If the scars are wider than desired, you might need to change the way you wear your hair. There will always be a trade off. I would suggest telling the third consultation what you have heard and explain your desires to him or here and see what they say. I wish you the best. JG 12.12.12

Question:

I have had a facelift and browlift. What do you suggest to extend the life of this surgery? I know I should avoid the sun, which I do. I have tried to use Retin A but I get very very dry, even when I only use it 3x per week. What do you recommend to your patients. Cosmetic, facials?? Thank you

Answer:

facials will not help, keep your weight stable and limit or eliminate impact sports like running or jogging. JG 12.8.12

Question:

I met today with a plastic surgeon about a lower face and neck lift. Because I have excess skin on my neck, he told me that he`ll need to make the incisions back into/along my hairline. He said he`d prefer to make the incision along the edge of my hairline and not involve any hair-bearing scalp. I am a male with thinning hair, so there`s not much to cover the scar. I know the quality of the scar depends on the tension and on the closure technique. If these are carefully attended to, is the scar usually fairly invisible?

Answer:

A good quality scar at the hairline would be better than in the scalp as it would leave a visible weird notch in the hairline there. JG 12.3.12

Question:

How long does Sculptra build after injection? For 4 months, 6 months? Is there then a peak, then a plateau, or does it immediately begin to dissipate after the peak? Or is this known -- or different with each person? At 7 months, I feel my Sculptra is still building -- but I may be wrong. Thanks!

Answer:

It grows for about 6 months but the dissolving can take 12-24 months, so what you are seeing is normal. JG 11.27.12

Question:

Hi, Dr. Garcia, You had said that Sculptra should not be a deterrent from performing a revision facelift. The dr. who will do my FL said he wished it wasn`t there because it sort of masks the true contours of the skin & tissue. Will 9 mos. since my final Sculptra injection be enough time to wait before surgery. Or perhaps I should wait another month or so - to make it 10-11 months since injection?

Answer:

that should be plenty of time to wait. The Sculptra would affect more the tissues below the skin than the skin itself. JG 11.27.12

Question:

Dr. Garcia, This is not a question, but wanted you to know that I finally had my midface/cheek and neck lift done this weekend and so far very pleased with the results. My surgery involved the underlying muscle lift not just life style thread. I discussed all the issues you brought up like problems with ectopion, etc. Three days out and I don`t have bruising and not too much swelling and not much pain. I sent you my pictures back in Sept. Thanks so much for all your advice after my numerous queries. God bless you for devoting so much of your time in educating and helping others like myself with so many concerns and apprehensions. D.

Answer:

I wish you the best and thank you for the follow up. JG 11.12.12

Question:

Good evening Dr. Garcia, I had a mini-facelift and necklift done 2 years ago. My face still looks good but my neck not so much. I have the neck bands and saggy midline skin. Is it possible to do a necklift without the long incisions of the facelift again? Where would the incisions be for just a necklift? Thanks so much for your time and willingness to answer.

Answer:

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Question:

Good evening Dr. Garcia, I had a mini-facelift and necklift done 2 years ago. My face still looks good but my neck not so much. I have the neck bands and saggy midline skin. Is it possible to do a necklift without the long incisions of the facelift again? Where would the incisions be for just a necklift? Thanks so much for your time and willingness to answer.

Answer:

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Question:

Good evening Dr. Garcia, I had a mini-facelift and necklift done 2 years ago. My face still looks good but my neck not so much. I have the neck bands and saggy midline skin. Is it possible to do a necklift without the long incisions of the facelift again? Where would the incisions be for just a necklift? Thanks so much for your time and willingness to answer.

Answer:

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Question:

How long does it take for the full results of a facelift? I have read that it might take close to a year. I was told by my PS that after 3 month I would see good results. It has been 6 months and I am not completely sure if I am happy with the results. I get very different reactions from people...from no comment at all to wow, you look great! When I look at pictures of myself I just dont feel I look the same. I had a facelift, lower bleph and a forehead lift. Your comments are greatly appreciated. Thank you

Answer:

Full healing is one year, that is for scar fading and return of sensation. As to looking better, that should be 6 weeks to 6 months, the more surgery, the longer it takes. What matters is how you feel you look, other people are suprisingly poor at remembering what you used to look like. I think at 6 months that speaking to your surgeon is a reasonable thing to do. I wish you the best. JG 10.25.12

Question:

Thank you for the answer about the CO2 resurfacing. So I thought the facelift would take care of the pouches beside my mouth, but it didn`t. Now you say that resurfacing won`t tighten that skin enough to make a difference. My surgeon didn`t want to remove the buccal fat because he believes (and I agree) that it would just sag more and give me a hollowed look. What do you recommend? It`s the thing that bothered me the most prior to surgery, so it`s extremely disappointing to still have the problem and to have spent all that money. I`m pretty much out of funds.

Answer:

The pouches will require surgery, the pouches can be repositioned, no need to remove them. Will need the cheek part redone. JG 10.23.12

Question:

Dr. Garcia, Thank you for taking the time to answer my question regarding the midface lift. Some of the physicians have called it a midface and others a cheek lift. So I take it that it is very different procedure. Now I am concerned about the eye area with the midface lift. I will definitely ask him about that. Thanks so much again!

Answer:

Yes, the cheeklift is just the cheek portion of a facelift, because the typical facelift involves the cheeks and the neck.Best of luck. JG 10.18.12

Question:

Dr. Garcia, Is it true that hypertropic scarring is unusual from S-lift incisions because of the vascularity around the face? With a cheek lift, isn`t there an incision somewhere near the mouth or in the gumline? Can this be done without these incisions? Is the cheek lift different from a midface lift? Thank you.

Answer:

no, it is either due to infection, excessive tension and in smaller percentages of cases, genetic predisposition to hypertrophic scarring. There is no incision in the gum line routinely. Some surgeons due a subperiosteal release of the tissue in order to get elevation of the tissues of the cheek, and in those cases an intra-oral incision is made, but that is not done in the usual cheeklift.A cheeklift and a midfacelift are operations on the same area but classically, a midfacelift is performed by releasing the tissues off of the bone in order to get them to move and in a cheeklift they are lifted directly on the tissue itself with no release off of the bone. The risks of prolonged swelling and excess traction pulling down on eyelid structures is much higher in midfacelifts than it is in cheeklifts. I do to perform midfacelifts for that reason and also because the tissues do not become detached from the bone with age so I see no reason to approach them in that manner. I am going to guess that the surgeon you are consulting with is promoting the mid facelift over the cheeklift, telling you that you will not have any visible scars with the mid facelift, and that is true if you are one of the rare patients that does not need any skin removed after the elevation of the tissues, if you do there will need to be a scar.You may want to ask him what the chances of ectropion or lower eyelid malposition after his mid facelift is, in general published reports it can be as high as 17%, not a good thing. JG 10.18.12

Question:

Dr. Garcia, I have gone for several consults for midface lifts. One physician says he can do a midface and S-lift/neck in 2 hours. I had another consult today where the physician says that to do both, it would take at least 5 hours. They are both very prominant surgeons in this area so I don`t know whether I am being mislead that both procedures can be done in only 2 hours. What is your opinion?

Answer:

Sounds like a lot to do in 2 hours. It woukd take me 3 1/2 or so. JG 10.16.12

Question:

Wow! What a thorough and helpful answer to the question about the longevity of facelifts. Thank you! You say that small tweaks might be needed to extend the life of a lift. What kinds of tweaks do you mean? I suppose that that too would vary from patient to patient, but I imagine that no matter how small the tweaks, the incisions from the first facelift would need to be opened again to accomplish any improvements. Is that so? That is, from a surgeon`s perspective, the amount of surgical adjusting might be limited but from a patient`s perspective, would it likely be about the same kind of experience as the first round of surgery -- with the months of healing for the scars to become less visible, etc.? healing for the scars to be less visible, etc.

Answer:

The incisions and how long they would be would depend on what needs to be done, but at 18 months it is usually something small that is done in the office under local anesthesia. Therefore much shorter and quucker. JG 10.11.12

Question:

Hello to everyone`s favorite doctor! Hope you`re well. I`m hoping you can share your experience with the longevity of facelifts. I`ve had several consultations and the standard answer, of course, is about 10 years, but then when I press the question, they all eventually say, Well, it falls pretty significantly at about 18 months. I do see that having it done will leave one looking a bit younger in the long run than if one hadn`t had the surgery, but I wonder if in your experience, 18 months is about as long as they usually last. I have a friend for whom this was noticeably so. Truly, she looked great at 17 months, but by month 19 or 20, she looked pretty much as she did before the surgery. Thanks for your honest opinion, as ever!

Answer:

well, once you have a facelift, you will always be better off than if you had never had it, but that aside. The longevity of the results will vary. It will last less time the older you are,less time the faster you are aging, it will last less if you run or jog, it will last less if your weight fluctuates, it will last less if you have poor skin elasticity, it will last less if you have a large amount of skin removed during the facelift, last less if you smoke, and then there is the genetic factor.There are some people that can benefit from a minor touch up after 18 months, in many cases since the facelift did not stop the aging process, the skin and tissues will continue to age and the patient will also get accustomed to their appearance at the 3-6 month range and they want to stay that way, but gravity slowly wins.It will take years for the appearance to return to the exact same look you had before the surgery, but parts of the face will age faster than others, prompting small touch ups at shorter intervals. I wish you the best. JG 10/11/12

Question:

Dr. Garcia, Can mid-face lifts be safely done under local anesthetic? Would it be too painful to have it done this way?

Answer:

I would not perform it that way. JG 10.3.12

Question:

Hi Dr. Garcia, I`m the one who sent you pictures a couple of weeks ago. I`m wondering if I should have the midface lift if it is going to just give me a rested look. From looking at a lot of before and after pictures, some look almost the same or minimal improvement. I guess what I`m looking for is something that would give me a more dramatic change. To spend money just to look rested doesn`t really see worth the money. What is your opinion?

Answer:

he trade off between looking rested and something dramatic is that in the dramatic choice, you might look different, not like yourself, and it might be obvious that you have had something surgical done to enhance your appearance. You will need to make that decision, on how visible you want it to be, before you decide on what to do. My personal preference is to have the patient look natural, I prefer not to over do a person as I feel, even if they want that look, if others that see that work performed by me will likely scare off potential patients who may think it was my choice.I am not saying that a dramatic change is not a good decision, but I like to get patients back to the way they used to look like when they were younger, if that requires something dramatic due to the changes that have occurred, so be it. If they are looking for an appearance they never had, that becomes a more difficult decision as it might never be dramatic enough of a change in the patient`s eye.JG 10.2.12

Question:

Hi Garcia, Another question regarding the step down question about the facelift. What also does the term notching mean? All I know is that it is to be avoided and has something to do with the hairline, but I don`t understand it. Please help. Thanks again

Answer:

similar, there would be a notch in the hairline, where it would not be a straight, continuous smooth line.It can be avoided with proper incision placement.JG 9.23.12

Question:

Dr. Garcia, My plastic surgeon who is going to be doing my surgery, said he is going to do his best to avoid a step up behind my ear when he does my surgery, What does that term mean? I am farily certain he said step up, not step down. I hope you can clarify that term for me. Thanks much as always. Your the best.

Answer:

It means that they will try to keep the hairline behind your ears as it is now, the step off would make the line look jagged, and that can be a tell-tale sign when you wear your hair up of a facelift, the easiest way to avoid it is to cut right at the hairline rather than going into the hair. JG 9.23.12

Question:

Just read your reply to someone about non-primary facelifts. Does your answer mean that to the surgeon, a third or subsequent lift is not significantly different from a secondary lift, since it`s all just scar tissue after a first lift? Thank you for your answer.

Answer:

no, not at all, it is significantly more difficult and potentially dangerous as structures like nerves are not as easily identified and the tissues that have scar are not as pliable, but the amount of scar tissue is not increased with each successive surgery.If the fist surgery goes well with no problems and little to no bleeding, then the next surgery is not as difficult. If there is a lot of bleeding and swelling after the surgery, then the amount of scar tissue is increased and it makes subsequent surgeries more challenging. Hope that is a little more clear. JG 9.18.12

Question:

Thank you Dr. Garcia. I am trying to decide whether to have my midface lift done with one surgeon who does it through the mouth versus another who does the S-lift. What is your opinion on the two techniques? Diana

Answer:

I think the swelling when the midface lift is done through is prolonged and there is no skin removal, so it is not something I suggest to many patients. JG 9.17.12

Question:

Dr. Garcia, I was wondering if my picture transmitted I sent an e-mail yesterday morning and noticed that my picture did not seem to be included in my e-mail. I sent my picture last night again, but without the message. Thank you. Diana

Answer:

your email went to my computer at home and I can only access it there, so I will respond once I get to my office. JG 9.17.12

Question:

Regarding repeated facelift surgery: I imagine that the key obstacle is largely scar tissue. If that can be successfully negotiated during a second lift, I am guessing that it could be successfully negotiated in subsequent lifts, if necessary. That is, scar tissue is scar tissue, and additional surgery doesn`t significantly add to the TOTAL of amount of it. Is that right?

Answer:

Exactly right. JG 9.16.12

Question:

Dr. Garcia, I am contemplating whether or not to have a midface lift. I don`t know whether it`s worth the expense of doing this if there is not going to be a significant improvement or perceptive difference. Could I send you my picture so I could have your opinion. I`ve tried Radiesse and it lasts several months for the nasolabial lines, but does not last more than 1 month on the cheek hollows. I have a depression on my cheeks that have developed over the last couple of years. Thank you.

Answer:

Certainly, please send them to drgarcia@lvcosmeticsurgery.com

Question:

Hi, Dr. Garcia! If a vector is the direction of pull, then does is term applied to both SMAS and skin? In other words, a surgeon might pull the SMAS in 1 direction, and the skin in another direction? Thank you.

Answer:

correct, to both SMAS and skin. Actually almost always the SMAS and skin are lifted at different vectors because they do not sag in the same direction as they both have different points of fixation upon which they fold and descend differently.If you pull them the same direction, one of them ends up where it does not belong. JG 9.14.12

Question:

You had said the skin vectors can be revised in a 3rd revision facelift. When a surgeon talks about vectors is he talking about the direction of lift? (Since a 2nd facelift, my whole face, & especially mouth area, is being pulled DOWNWARDS towards the tragus and jawline, with no upward lifting at all.) Can a surgeon do a revision and change the vectors so there is actual UPWARD lifting in the right directions? If so, would he lift skin, SMAS, or both in the new vectors? If this is too many questions at once, please let me know & I will separate them. Thank you so much!

Answer:

if the tissue are loose enough or can be separated from the scarring, they should be able to be redirected in a more upward direction. I think the SMAS for sure would need a vertical lift from what you are saying, and possibly the skin too. Sometimes it is just the SMAS that needs rearranging.Hard to say without seeing you and pulling on the tissues. All the best. JG 9.14.12

Question:

My sister had a facelift last year. Her surgeon did an excellent job -- visible scars, not overpulled, etc. But here`s the thing: while her jaw and neck are a bit smoother, she looks indeterminately but perceptibly older somehow. It`s hard to pinpoint what it is. Have you seen this happen after facelifts before? If so, is there a surgical common denominator that can be identified (and therefore perhaps avoided) among these outcomes? I`ve been thinking about doing this myself, but I`m hesitating now what I see my sister. If you can tell me what you think happened, maybe I could specifically ask a surgeon not to do that/use a certain suture technique/ etc. to me.

Answer:

it can be from facial fat loss that makes her face look more hollow, if fat was surgically removed at the time of surgery for some reason, that can do it also.Sutures placed would not make a difference, although not repositioning the tissues below the skin when doing the facelift can leave things looking less than ideal. Hard to say past that without seeing before and after photos, sorry. JG 9.13.12

Question:

You had said the "skin vectors" can be revised in a 3rd revision facelift. When a surgeon talks about vectors is he talking about the direction of lift? Since a 2nd facelift, my whole face, & especially mouth area, is being pulled DOWNWARDS towards the tragus and jawline, with no upward lifting at all. Can a surgeon do a revision and change the vectors so there is actual UPWARD lifting in the right directions? If so, would he lift skin, SMAS, or both in the new vectors? Thank you so much!

Answer:

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Question:

Hello ... I am 54 and considering a cheek lift to help improve my jawline and sagging corners of my mouth. The PS I`m considering calls it a z-lift. It is done with a small incision near the lower ears and from all accounts is fairly simple. I am not sure if he pulls just the skin or the skin and tissue beneath. Would you recommend against the procedure if it does not involve the tissue beneath?

Answer:

At your age, usually you need skin and tissue lifted. It will last longer if both are lifted as long as you need both, hard to say without seeing at leaat pictures. JG 9.11.12

Question:

Hi Dr. G., How long after a lower face lift does all swelling go away? Thank you.

Answer:

the more swollen you get immediately after the surgery, the longer it takes, but in general, most will be gone in 6-8 weeks, but scars or incision might take 8-12 months and the sensation can also take months to resolve. JG 9.6.12

Question:

I had a lower face lift on June 28th. How long does it take for swelling to go down, and for the real results to show. Thank you!

Answer:

Most of the swlling is gone in 6-8 weeks, scars will fade for 1year. JG 9.3.12

Question:

Hi, Dr. Garcia. I have seen a surgeon who offered an option to help me after 1 damaging necklift and 2 distorting facelifts. He offered a Transtemporal Subperiosteal Mid-face Lift. 1) I can see how this would lift cheeks, but how much can this typically lift the mouth area? (My mouth area is now too low on my face and unusually downturned.) 2) Also, he hesitated to revise the bad facelifts, but I was hoping he could revise that in order to improve the vectors. (He said the vectors were wrong.) Do surgeons ever revise a second facelift to improve the vectors? Thank you for your kind assistance.

Answer:

it can lift the mouth some as it will be pulling the muscles of the cheek, which are the muscles that move the mouth, into a higher position. I think being conservative at this point is a good idea. Maybe consider revising the skin vectors after the mid facelift has healed, it might then require less revision to the facelift part. I think surgeons often do revise vectors when doing a second facelift, yes. I wish you the best. JG 9.2.12

Question:

Dr. Garcia, Thank you for answering my earlier question regarding local anesthesia verus twilight. I have another question regarding the longevity of facelifts. I do not have jowling, but the fat has fallen to the nasolabial area and I have depressions in my cheeks from loss of fat or migration of fat. Which facelift would best address this problem? Life-style, miniface lift, S-lift, or SMAS? Which one lasts the longest? Thank you.

Answer:

SMAS will last the longest. JG 8.24.12

Question:

Dr. Garcia, I am trying to decide between two surgeons in my area to perform a facelift(S-lift or mid-face lift). One surgeon does this under local where I will be awake and the other will do it only under twilight. The surgeon who operates under twilight says that an effective lift must be done under this type of anesthesia and the other under local must be just a feather lift. I don`t know which to believe. Also do you know if the Fraxel Restore Dual is effective and safe on Asian skin? Thank you.

Answer:

I would not use the Fraxel on Asian skin, personally. As to the surgery, if they are both surgical procedures and not just a thread lift, it ultimately is a decision between the surgeon and the patient. Using twilight makes the injections of the local anesthesia much less uncomfortable and will keep you from begining to fidget or move as you will likely need to be in certain positions for long periods of time without moving. I prefer using general anesthesia or twilight. I would also ask what surigenters the doctor has privileges at to the do the same procedure. If he can only perform it in his office, I would seek out a different surgeon as he probably does not the appropriate training to be certified to perform it at a surgicenter. Certification is a must. Best of luck. JG 8.24.12

Question:

Dr. Gacia,chewing gum and doing exercise for the neck, will help to prevent or postpond a necklift surgery,especially I had one, already. Thank you.

Answer:

no, it will not help, and could possibly make the bands in the neck become more prominent as the exercise might split the bands sooner. JG 8.23.12

Question:

How long does it usually take for swelling from a facelift to resolve? My neck and jaw are still quite swollen 3 weeks post-op. Thanks very much for your help.

Answer:

Should be looking better after 2-3 weeks in most cases, although the final result will take a few months. Might want to see your surgeon to make sure all is coming along as expected. JG 8.21.12

Question:

Hi Dr. Garcia, I guess I spoke to soon saying I was asking my final question about the High SMAS, or any SMAS, and cheek pad/fat lifting. You stated the it would not affect the tear trough, and possibly below the trough. What would be the name of the area right below the trough that also might need a filler? I am finishing up all my research thanks to you,and I am extremely grateful for your help.

Answer:

just the upper medial cheek, no special name. JG 8.19.12

Question:

Hi Dr. Garcia, I previously posted about the facelift, and you asked me to repost. Regarding recent posts from others about facelift/lower facelift, I thought in a typical SMAS, the cheek pad and fat was not underminned and lifted, and that was only done in a high SMAS. I know different doctors use same terms, but mean different things to each doctor. Anyway, my questions are if the cheek pad and fat are lifted, would this result in more hollowing under the eyes toward the midface, and toward the nose? Would the same lift be the one that could cause more wrinkling under eyes, hence the need for a lower bleph? And finally, if a HIGH SMAS is performed, would fat injections in the hollows/ orbital rim area be needed to create a smooth transtion from cheek over to nose on the orbital rim? Thanks much, as always your help is invaluable.

Answer:

first let me apologize for your previous question being lost in my server somehow. As to the SMAS, there are variations. In most cases the SMAS is undermined, leaving the fat on top of it, it is then redraped and positioned in a higher location.That is done in a high SMAS but also in many other SMAS lifts. The SMAS can also be treated by not undermining it but actually imbricating it, or rolling it on itself. In that case the SMAS is not undermined, just folded over by using sutures. I do that most frequently as it reduces chances of nerve injury and bleeding. In my hands I feel it lasts as long as the undermined SMAS too. Any technique of the SMAS, or even if one gets fat injections to the upper cheek, will make the height of the cheek mound higher, therefore anything around it, like the lower lid can look more recessed, or hollow in some cases. The wrinkling of the lower eyelid skin can be a result with any cheek procedure where a large amount of vertical traction is placed on the skin, making the cheek skin push onto the lower lid, increasing the wrinkles. It is unusual for that to happen in experienced hands as that degree of lift is rarely needed. If it does occur, a small skin excision of the lower lid can be done at the same time or later.Fat injections or HA fillers can be injected to the lower lid area but will only work at the orbital rim. Once you go onto the lower lid itself, where the normal fat pockets of the eye normally live, injections should not be done there for fear of lumps and also of poor survival of what is injected.In a small percentage of cases a filler can be used to smooth the transition though. My preference is not to do the injections at the same time, but to wait and see how it all looks and then use a filler only if needed. I would wait a minimum of 6 weeks after the surgery to decide that. Hope that helps. JG 8.16.12

Question:

Hi, Dr. Garcia. I wrote to you earlier this week. I had a facelift last week and had a lot of swelling and bruising on the left side. I have a fairly large but soft collection of blood along the jaw and in front of the ear, which my surgeon didn`t think needed to be aspirated when I saw him 7 days post-op. I`m massaging it gently and using warm compresses a few times a day to get it to resorb. The swelling is coming down a bit but the blood is still prominently there after almost 2 weeks now. What are the risks of his attempting to aspirate this....or to leaving it to resorb on its own? Thank you so much.

Answer:

It is likely easier to aspirate it now as the blood has begun to liquify, and that will make aspiration probably a little easier. It is preferable to aspirate it rather than let it resorb on its own unless it is really small. I wish you the best. JG 8.15.12

Question:

Hi Dr. Garcia, I asked question about SMAS facelift, question posted, but no answer is posted. Did you receive it? Thank you.

Answer:

Ii saw it on my smartphone and was going to answer it when I got to work, but I cannot see it now, I am sorry, but can you repeat it. Again, I apologize. JG 8.14.12

Question:

Hi Dr. Garcia,
Regarding recent posts about facelift/lower facelift. I thought in a typical SMAS, the cheek pad and fat was not lifted or undermined, and that was only done in a high SMAS
I know different doctors use different interchangably.
Anyway, my question is, if the cheek pad and fat are lifted,
would this cause hollowing under the eyes, more in the central part of face, and toward the nose to become more pronounced? And would the same lift cause more wrinkles under the eyes, hence needing a lower bleph? Thank you.

Answer:

' '

Question:

dr.garcia, what is the cost of the quick lift or weekend lift . i dont think i need a full facelift, but would like to have a lower facelift. thanks. i am 62

Answer:

I do cheek lifts and neck lifts, but I cannot quote you for a Quicklift or Weekend lift as I do not perform, them. They are mostly marketing terms only though. JG 8.13.12

Question:

hello dr.garcia, i am a woman who is 61, but most people seem to believe i am in mid 50`s or so, so my wrinkles to me are moderate. i was wondering if a lower facelift would help my neck jowls, and marionette wrinkles. thanks.

Answer:

without photos it is hard to tell, but in general, I would say yes, a facelift to include your neck and cheeks are all you likely need. JG 8.13.12

Question:

Hi, Dr. Garcia. I had a facelift last month. My surgeon told me he did a SMAS transposition. What does that mean?

Answer:

At times, we lift and remove excess SMAS, sometimes we fold it upon itself to add bulk, and in other cases it is separated and then pulled in a new direction compared to how it lay before. The last one is what you had done. It is a standard way to treat the SMAS in some patients. JG 8.13.12

Question:

dr. garcia, please can you tell me the average cost of a midfacelift would be for a woman with moderate sagging, and wrinkles ? thanks so much! b.s

Answer:

I perform cheek lifts, but not a mid facelift as it is described on the internet. I feel the risks of a mid facelift are too high with a complication rate of over 15%. JG 8.12.12

Question:

Hi, Dr. Garcia. I had a facelift on Monday and the dressing came off yesterday. Both my surgeon and I were surprised by the amount of swelling and bruising on on side of my face. I don`t have any hematomas, thankfully. I know it`s early and that swelling distorts things greatly, but it looks like the mandibular angle has been completely obscured. I was always fortunate to have good bone structure and a sharply defined jaw, but it now looks like my upper neck and cheek are conjoined. Is it possible that the surgeon could inadvertently have bulked the tissues in my upper neck on that side? Rather than looking lifted, my face looks like it has fallen into my neck-- and I look like I`ve gained 20 pounds. Thanks for any information and reassurance you can give me.

Answer:

It can look like that at times, at this point, but will all get better. It would be almost impossible to raise the tissues of the neck that amount to blunt the area. It might take a few weeks though to get better. I wish you the best. JG 8.10.12

Question:

I had a facelift and lower bleph 4 months ago. I noticed broken capillaries around my eye area close to the lower edge of my eyebrow right after surgery. The PS said this should go away on its own but it has not. Now I am getting tiny red pin dots under my eye area. Is this normal and what can I do about this. Thank you

Answer:

it can be normal and if they are bothering you, you can have an Nd:YAG laser or a VBeam laser to help them go away. JG 8.8.12

Question:

Hi, Dr. Garcia. I had a facelift yesterday and am now wrapped up like a nun in the Order of Our Lady of Plastic Surgery! Quite a fashion statement. My face is, understandably, quite swollen. Do you have your own facelift patients use ice to diminish the swelling? Thanks so much.

Answer:

We elevate the head, use ice, 30 minutes on, 30 off but we dot not use dressings like that. I wish you the best. JG 8.7.12

Question:

I see that you recommend Mederma for scar treatment. My own surgeon says it`s a waste of money, that scars just mature in their own time and there`s little that can be done to improve them unless they`re keloid or hypertrophic. Before I plunk down my cash, would you please tell me why you think it`s beneficial? Also, I had a nonablative fractional treatment last Tuesday to my face. I`m not swollen, but of course will have rough texture for the next few days. I`m scheduled for a facelift tomorrow. That shouldn`t pose a problem, should it? Thank you for being there for all of us, Dr. Garcia!

Answer:

I think Meserma speeds the process with its ingrediemts, but in time they all look the same. As to the facelift after the laser, no problem there, but I usually do it in the opposite order. Best of luck. JG 8.5.12

Question:

Dr. Garcia, Is it possible to have a cheek lift without the procedure of having the incision inside the mouth? Can an upper lid lift be done from inside the lid so scars won`t be seen?Are there any new safe lasers for Asian skin? I want to smooth and refine the pores. Thank you.

Answer:

a cheek lift does not require an incision inside the mouth. As to the upper lid, it cannot be done from the inside. I think there are safe lasers for Asian skin but those arno effective, there a re none that I woild use that give a significant degree of improvent. For your pores you can try some microdermabrasions, but you will need them monthly. JG 8.4.12

Question:

Thank you again for your helpful replies. I had asked about how much stretching could help a neck that is too tight after 2 facelifts. Since heat helps the stretching, I have done this off and on since the last surgery 1.5 years ago, but I have not done it every day. How often do you think I should do this stretching to bring about less tightness long term? And -- could the fact that I have not been diligent about it for this last year mean that I may be stuck with more tightness permanently?

Answer:

I think after 1.5 years neither stretching nor heat will help much, just a temporary effect.I think you are where you are going to be. JG 7.29.12

Question:

Thank you so much for answering my questions. I love your site.I had a face and brow lift almost 4 months ago. How long does it take to see the complete results of a facelift and brow lift? Do you think that a peel should be done on the neck for wrinkles and if so how long after a face lift? If so what type of peel? I have also read on your site that you think Neutrogena UltraSheer Sunblock is a good product. Do you recommend that or the Fallene Total Block. There is a big different in price. Are both just as effective? Thank you

Answer:

It will take about 10-12 months for final maturation of the results. I think peels can be done on the neck, but not deep enough to get improvements lasting more than a couple of months. Lasers are even riskier there with potential scarring. If you were going to do the peel I think I would use 35% TCA done by a physiican. I prefer Fallene but the Neutrgena is easier to find at stores. I think they are pretty equal, I think the Fallene blends in with a little less skin residue. JG 7.26.12

Question:

Dr. Garcia, I asked you a question about bumps under the chin and neck after a necklift ( because a have a thin skin). Will massage or any other procedure help to disolve them quicker? Thank you.

Answer:

massage will help some and a heating pad might help also, but it is mostly a matter of time. JG 7.20.12

Question:

My neck on the left is still too tight, 2 years after a second facelift, and it pulls down on my jawline. Heat and stretching or massage does make it feel better, but can this actually loosen it so it actually pulls less? In other words, could the heat and stretching be more than a bandaid, and actually be sort of a cure ? Thank you.

Answer:

The stretching can help long term, but not the heat. JG 7.19.12

Question:

Regarding a revision facelift after Sculptra, will the surgeon need photos of me before the Sculptra procedures??? [What I mainly need is vertical lifting of the sides, which were anchored LOW (twice) by previous surgeon.] Also, I would prefer to not lose volume -- is that possible ??? Thank you!

Answer:

No need to see the before pics and you should not lose the volume you got from the Sculptra. JG 7.19.12

Question:

Dr. Garcia,It`s 3 monthes after necklift surgery,I started to see and feel some bumps under the chin and neck. PS said because I have a thin skin, the inside stiches are visible. Will they desolve? When? Will anything can be done? Thank you.

Answer:

Give it time, they will likely go away. JG 7.19.12

Question:

I may have finally found a revision facelift surgeon. But I am concerned that I just received 3 Sculptra procedures 3 mos. ago. Will the Sculptra cause a problem for a surgeon in a revision facelift? Will I have to wait until the Sculptra dissipates, which could take years?

Answer:

no need to wait, the revision can be done now. JG 7.18.12

Question:

Hello Dr. G, This Q is totally off the subject matter of this website so I really apologize. One of my employees is really suffering from gall bladder and the only help she has been able to get is referrals for surgical removal. She feels surgery should be the last resort but doesn`t seem able to get any help from her doctor or our provider. Is there such a thing as a specialist in gall bladder? What is this specialty/specialist called? She has tried everything ... special diet, accupuncture, etc. but nothing has helped. She is desperate and it pains me to see her in such chronic pain. It is really affecting her mental health as she is afraid she is doomed to suffer this way the rest of her life. Thank you for your help, and for us who abuse your already wonderful generosity on matters of skin health to other medical conditions!

Answer:

There are no specialists in gall bladder surgery amd once you have gall stones, the only solution is surgery I am afraid, nothing else will fix the problem. JG 7.17.12

Question:

Hi there. Would the use of 3mhz portable ultrasound be of any use to help break down scar tissue and increase blood within the nose after rhinoplasty? thanks alot

Answer:

very temporary effect on blood flow and might soften scar tissue with time and a series of sessions, but will not break it down really. JG 7.12.12

Question:

What is the technical term for the little jowls that develop beside (not below) the mouth -- like Joe Lieberman`s? I want to know because I want to be as precise as possible about what bothers me when I go for a consult. Many thanks!

Answer:

Tbey are jowls caused by a herniatiom of the fat pad of Bichat. All the beat. JG 7.10.12

Question:

Dr.Garcia Is there a cut off age where a facelift will not give good results due to trouble healing due to age? I gave been told that after 65, it is a waste of money. What are your thoughts and how old is the oldest patient you have performed a facelift on with great results?

Answer:

no, there is not, although I will say that the older the person and tissues are, the less time the benefits last. The oldest facelift I have done was 82. Also, the slower the patient ages, the longer the results last. So if you have a relatively young person that has aged fast, their results might not last as long as the same age person that has aged slowly. JG 7.2.121

Question:

Thank you for your answer about fat loss during facelift surgery. If the fat and the fascia needs to be repositioned upward (which they do in my case), doesn`t the fat have to be dissected too? A skin-only facelift has very little long-term effect as I understand it; and it turns out that I have almost no excess skin, just descending fascia and fat. In fact, my surgeon tells me that he will not excise any skin at all, since I have non to spare; he`ll just redrape it. Thanks for clarifying.

Answer:

I can be lifted attached to the fascia, thereby maintaining the blood supply to the fat to avoid losing volume. All the best. JG 7.2.12

Question:

Hello Dr., I am sorry if this question has been asked before but can you please tell me the difference between a lifestyle lift (and various other names) and a face lift, the cost range of both, and how long the results of each can be expected to last. Thank you for sharing your knowledge.

Answer:

I cannot give you costs as that varies from surgeon to surgeon in the same city. As to the LifeStyle lift, there is some difficulty in explaining it to you as their surgeons are not allowed to speak about what is done. So I will base my points on what I have seen from the numerous patients that have has a LifeStyle lift and then have come to see me for a facelift just a year later. First thing is that the amount of skin undermined is less, the ability to lift the tissues below the skin is limited in its direction and the work on the neck is minimal. Many of the photos you see in their ads show people that have had additional things that are not included in the straight LifeStyle lift. That is the reason why they are now saying that a LifeStyle lift is any of a number of procedures that can be done in a short time in the office, thereby covering the fact that the patients they show have had multiple things done, rather than the original LifeStyle lift which was essentially a mini facelift.In my opinion, the more things you correct, the longer it lasts and that is why I believe the facelif tis superior. One can expect 7-10 years or more with a facelift. I wish you the best. JG 7.2.12

Question:

Hi, Dr. Garcia! Happy July! I`m wondering about fat loss during facelift surgery. My plastic surgeon says that the dissection for a face lift always damages the fat layer above the fascia, causing even more gauntness -- which is part of what I`m trying to correct with a facelift. Is that true? If so, doing facelifts seems counterproductive. Thank you!

Answer:

I think the fat loss can be mitigated by dissecting the skin alone, leaving the fat on the fascia where it can draw blood flow to survive. JG 7.1.12

Question:

Good morning Dr. G, I am interested to know how much Fraxel cost and what are the reasons that you don`t like it. My PS, universally loved by professionals in the cosmetic surgery industry (ie, they go to him for their own cosmetic surgeries) has written articles about combining face lift with Fraxel as a way to maintain the results. He recommends the Fraxel twice a year. What are your thoughts? Thank you!

Answer:

I do not like it because I feel that the results you get are very mild and short lived for the cost and risk. It heals faster than a fully ablative CO2 laser since you are only treating a fraction of the skin, but then you get less correction but still have the potential risks of hyperpigmentation during the healing phase. A laser of any kind does not do the same as a facelift, the facelift is for excess quantity of skin and the laser for poor quality of the skin, so they treat different things. A laser will not affect how long the results from a facelift lasts, but will keep the fine wrinkles away while the laser is done. I cannot give you the cost for a Fraxel as I do not use it. I wish you the best. JG 6.30.12

Question:

It has been almost 3 months since I had a brow lift and face lift. I am still feeling numbness on the sides of my cheeks and forehead. When should this tingling and numb feeling stop. Thank you

Answer:

it actually might take a full year to recover the sensation I am afraid. Hang in there a bit longer. JG 6.25.12

Question:

Hi Dr. Garcia, Happy Sunday. My doctor recommends Silhouette (thread lift) for my lower face. She does not recommend any more filler. I would like to see the clean jawline I used to have, although friends tell me I look fine. Is Silhouette just another name for Lifestyle Lift? What are your thoughts on this procedure, which my doctor tells me will last about 3 years, with minimal downtime of 5 days, which is not so minimal with my job. Is the procedure worth considering? What other alternatives do I have? Thank you as always for your time and for sharing your knowledge with all of us.

Answer:

It is the new version if thread lifts, even less effective than a lifestyle lift. The threads may be permanent, but the threads break and then things fall, usually uneven. I personally do not recommend it. JG 6.3.12

Question:

I have one more questions please. I had a facelift 6 weeks ago and I feel a lump on the left side of my neck and a smaller size lump on the rt side of my neck. The PS did cut the platsymal muscle. Is this normal after a face lift? My PS told me not to worry about it. Why would I get lumps in these area. I never had them there before the surgery. Thank you

Answer:

it can be normal if the platysma was cut in that location as the muscle can bleed more and cause a lump and the cutting of the muscles can allow some protrusion of the contents that were below the muscle to look like a bulge. Usually with time and massage that all flattens out. JG 5.23.12

Question:

Thank you so much for answering my questions. I had a facelift, browlift and lower bleph and fat injections in my lips a month ago. I am not happy with the results. When I look in the mirror I dont see the same person.I thought I would look the same but just younger and more refreshed. My eyes seem to be different and my overall look just seems off. I still have some residual bruises on the sides of my face and I can see the line on both sides of my face where the stitches are. Is it still too early for me to see the results?? I was told after 2-3 weeks I would be pleased. I am not.

Answer:

hard to say what is going on without seeing pictures from before he surgery and at present, but you had a lot of surgery and I would give it another couple of weeks to see how it goes. Of course, you should stay in contact with your plastic surgeon to see if there is anything that needs to be done at present to speed your healing period up. I wish you the best. JG 5.14.12

Question:

I had a facelift, browlift and lower bleph one month ago. I had planned to go back to my aerobics class 3x a week at my 8th week. The class is low impact but at times has some jumping motion. Will this be a problem for the results of my procedures? I do not want to do anything that will shorten my results. I read on your post that you do not recommend jogging. Please let me know what type of cardiovascular exercise you do recommend if an aerobics class is not a good option. Thank you so much for your time.

Answer:

should be OK after that period of time. I think what you do is much less than jogging with the impact that comes with it for a longer period of time. Otherwise I thing a stairmaster, elliptical, or a spin class would be other options. All the best. JG 5.11.12

Question:

Good afternoon, Dr. Is the suture technique referenced in one of the recent questions the same as the Lifestyle Lift? Thank you.

Answer:

no, the Lifestyle Lift has a limited amount to skin separation from the underlying tissues and skin removal whereas the suture lift is done through needle punctures with no skin removal. JG 5.10.12

Question:

I just had a facelift, brow lift and lower bleph. What type of cardiovascular exercise do you recommend and how soon can you start after surgery? What about use of free weights? Does any of these things compromise the surgery. Thank you for your time.

Answer:

we allow walking on a treadmill after two weeks, not lifting more than twenty pounds the first two weeks, and full activity after one month. Overdoing it can prolong swelling, cause bleeding and lengthen your recovery. JG 5.9.12

Question:

I had a face lift, brow lift and lower bleph almost a month ago. I still have a bruising (green color ) and some swelling on the sides of my face and cheek area. I have been using arnica cream and arnica tablets but still has not gone away. Is there anything else I can do to speed this along. I do use makeup but it has to be very thick to cover all the bruising. What creams do you recommend using after FL surgery. Thank you so much for your time.

Answer:

That is what we use, would suggest some warm moist heat packs and massage. We also use ultrasound massage. JG 5.8.12

Question:

Hi Dr., My doctor tells me I am far from needing a facelift but she suggested a suture lift (minimal cuts in hairline by the ears)to help with slight jowling. She said it should last 2-3 years. What are your thoughts? Thank you as always for your generosity in sharing your time and knowledge with us.

Answer:

I am not a fan of the suture techniques as the sutures break and the tissue fall, I have not seen it last as long as she is saying too, also you need to be willing to be happy wit a few months of improvement. Also understand that the sutures never break evenly so one side can break and sag sooner than the other. All the best. JG 5.8.12

Question:

Dr. Garcia, what is a better option to heal the cscars on a face and neck: use a scar gel or let the body does it work? Thank you.

Answer:

Mederma or ScarGuard is what we recommend. JG 5.8.12

Question:

I recently had a minor revision to my mini-lift and I have an infection near the incisions and am now on Cephelex. My PS says that it is an allergic reaction to the Bacitracin which I did not have the first time. I am concerned that the infection is not an allergy but it is based upon incisions being contaminated. During the surgery, his office manager came into the operating room (office based) in her street clothes and watched the surgery. Could this have caused an infection?

Answer:

Not likely due to the office manager, but an infection can happen due to other things, sutures or instruments becoming contaminated, skin not cleaned enough, etc. I doubt it was the bacitracin as that would not require antibiotics. The medication you are on should take care of things though. Best of luck. JG 5.3.12

Question:

I had a lower face lift 18 months ago. I had such severe bruising on the left side I had exterior wounds which scarred. I have spent the last year getting laser treatments on the area. It has improved a lot, but now I have hyper-pigmentation there. Once the swelling went down, I had what my PS said was a hematoma that would go away in time. It hasn`t and now he wants to go back in and do another surgery. I was told by a second PS not to have further surgery on my face for at least 5 years. The 2nd PS thinks the swelling that is still present in my left cheek is a parotid duct issue and referred me to an ENT specialist. Two ENT doctors indicated they had no idea what it was and referred me to a PS who specializes in the face. I will see him in two weeks. One of the ENT doctors said he thought it might me the remains of a severe hematoma. What do you suggest for treatment if this is a parotid duct issue? Another online patient referred me to your website and said she was using Botox to treat her Parotid issue and has had success with it. Do you recommend this? Is it possible for the remaining swelling to be residual from a severe hematoma?

Answer:

I doubt it is a parotid gland issue this far out, more likely is the residual scarring from the hematoma. Going in to remove scar tissue might make the surface of the cheek look more smooth. I think 18 months is enough time to wait for the repeat surgery as the tissues have softened at this point. Botox can be injected into the parotid gland to slow the saliva coming out of it, but if you did have a parotid injury 18 months ago, it should have sealed off long ago, making the Botox not needed. I wish you all the best. JG 5.2.12

Question:

I am concerned and puzzled after having a facelift I have a large firm marble sized knot under my chin and am worried what can be done for it. Have you seen this before and if so what should I or the ps do?

Answer:

Could be a cost, scar tissue, a fluid collection. Mist likely it can be fixed, but you need to see your surgeon to see what is the cause. JG 5.1.12

Question:

Dr. Garcia, When Can I start to go to JYM and can I do all type of exercise after a neck lift? And how to prevent stretching of skin and muscle on the neck? Thank you.

Answer:

Treadmill is OK after two weeks, weights or running after 4 weeks. JG 4.26.12

Question:

Oh, Dr. Garcia! I am 65 years old, recently had a full facelift, brow, mid and lower face. The brow and lower face are wonderful, BUT I am horrified to see that my Endotine device cheeks are huge with sunken hollows below both, but the right especially, and my surgery was three weeks ago on April 2. The cheeks appear to have balls that lie beneath the skin on the point of each cheek and distend the skin there spherically about 8-12 mm beyond a normal cheek bone position. I have seen no one with this problem and am so worried. The surgeon just smiles and says the cheeks will settle down and the devices will desolve. Dr. G, is this a guarantee? Is there anything I can do to hasten this desolving process? The surgeon and her staff seem to think my concerns silly, but none of them are saying that this situation is common and that I have nothing to worry about. I know you are very busy, a very successful surgeon, but I hope you have a moment to help me. I thank you, Sir, for any advice you can give me and for providing this fine site. Cheryl

Answer:

the device that is attached to the cheeks will in fact dissolve in time and because of the technique used to perform the endotine suspension, there is a greater amount of swelling than in a regular cheek tissue elevation from the skin surface. The device is deep so there is not much that can be done to speed up the dissolving of it, massage will cause potentially more swelling by tearing the tissue from the small little prongs in the device. I would not say that it is a common occurrence, but it can happen and is usually self limiting. Give it a bit more time and I think by the 6 week mark it will look much better. JG

Question:

Hello, Dr. Garcia, after a pl. surgery I`ll need to fix one of the ear lobe, because it looks different, but I don`t feel it yet. How long after surgery I`ll need to wait to fix this problem? Thank you.

Answer:

I would wait 6-12 months. All the beat. JG 4.22.12

Question:

You said that you hadn`t heard of a surgeon positioning the SMAS lower instead of higher in a facelift. Now, let me ask you -- have you heard of a surgeon being in a seething rage before a surgery, and intentionally harming the patient? I ask this for a very good reason. This surgeon (P. Gutek) unexpectedly acted as if he hated me before the facelift, and he positioned the SMAS LOWER! Within 3 weeks of this surgery, he looked at me and said with ALARM, You`re going to need another surgery -- in the office! I asked when, & he said in 4 months. (I knew this was not safe, so I waited 9 mos.) In the second facelift, he lifted some, but not back up to the location it was in when I went there. The skin is tight, but the structure is too low, and I look bad! I recently read about SURGEON RAGE. I know you can`t know, but is it POSSIBLE this could have happened to me?

Answer:

I have not heard of that happening and I really do not know why would happen. I think giving things time to soften up and maybe seeing a different surgeon is the best right now. I wish you the best. JG 4.15.12

Question:

Good evening Dr Garcia. I am Parotid patient. I am now 8 week post FL and still experiencing some parotid leaking and harsh lines/swelling on that side. I did have additional botox 4 days ago and back wearing scolpolamine patch, eating a bland diet, and applying pressure. The fistula is gone but the fluids leaking down into my neck are causing some redness and swelling. Considering your experience do you have a timeframe for this to resolve? I am concerned however I am still enjoying my FL. Thanks for your time.

Answer:

Keep it all going, no way to tell how much longer, but continud use of those things will make it heal faster. Wish I could tell you more. JG 4.14.12

Question:

I had 2 facelifts in 2010 (at surgeon`s proposal, since his first one was so bad, & 2nd one not much better. Now, other surgeons are reluctant to do a needed revision. Also, there`s not a lot of skin to work with right now. However, in a year or 2 after the scar tissue softens more, & as skin loosens, do you think other surgeons may feel more comfortable considering a revision?

Answer:

I do think that with further laxity, something might be undertaken by those surgeons. JG 4.14.12

Question:

Hi, Dr. Garcia, Have you heard of a surgeon who did not re-locate the SMAS as high on the sides of the face as it had been before his surgery? It appears this has happened to me, so that my lower face is now vertically downward, and I am now homely when I was previously pretty. Would it be relatively straightforward for another surgeon to revise this, and lift the SMAS on the sides vertically upward and redrape the skin?

Answer:

I have never heard of that and I see no reason why they would not position it higher after they went to the trouble of lifting it. Hard to say what might be needed to correct it but I would think that something could be done to correct it. JG 4.14.12

Question:

Thank you for answering my questions. I am the one after a neck lift surgery with problems on the side of the neck (slip of muscle) and under the chin (skin stuck to the underlying tissue). 1. When can I start to do a massage and heat after the surgery? 2. How long will it take to see a result? 3. How often after neck lift patients have these problems? Dear, Dr. Garcia I want to wish a Happy Easter for you and your family, and thank you very much for your time.

Answer:

we start doing the massage one week after the surgery. As to how long it will take, it varies, the harder the adherence, the longer it will take, no way to tell I am afraid. I would say that it happens maybe 5% of the time or so, all depends on whether and defatting was done or if there was lots of bleeding, the more of those, the higher the chances. JG 4.6.12

Question:

Dr. Garcia, it`s a first problem on a side of my neck, I just described. The second problem is under the chin, (under the scar), the skin from the middle to the one side is still swelling, but from the middle to another side more flat , but has a very deep wrinkle (which I never had before) and this wrinkle looks like an inside scar, which holding skin from inside. What is it? and what to do now? Thank you very much for your time.

Answer:

I thinnk it is the skin being stuck to the underlying tissues, time and a little massage will get the skin to break away from the muscle and make it look better, but it will take a little time. JG 4.5.12

Question:

Hello, Dr. Garcia. I am one week after neck lift surgery. On one of my neck ( from a bottom of the neck right to the back of my ear where the scar} I have a vertical thick cord inside the skin, I can touch it and it is visible and ugly. Other side of the neck (where drain was) is smooth. What is it? and what can be done now? Thank you.

Answer:

it can be a slip of muscle that has become stuck to the skin and with time and massage will loosen and get better. It can also be a vein near the skin that is not essential but has clotted and will in time soften and become less visible also. In the latter, a little moist heat and masssage will also help. JG 4.5.12

Question:

I had a partial facelift and neck lift three years ago. One staple was left in behind my left ear, continuing to cause pain, intermittently and when I sleep at night. I am avoiding calling my surgeon to take it out but am concerned that it continues to hurt. Is it risky to leave it in?

Answer:

it will just cause pain, but likely no other problems. Removing it under a little local anesthesia should not be a problem. JG 4.5.12

Question:

I have genetic malar bags. I am 23 years old and have had them my whole life. It is definitely not under eye bags as they are on my cheeks. What is the best route to correct this? I don`t feel as though I`d need a facelift at 23 yrs old.

Answer:

I would try and see if a filer around the area will hide them and postpone any surgery as long as you can. JG 4.4.12

Question:

I am having a facelift, lower bleph, and a brow lift in two weeks. The doctor does not recommend icing after the procedures except using cold compresses on my eyes for the lower bleph. No ice bags, frozen peas etc on the other surgical areas. I have read other blogs on sites and the majority of the PS recommend using ice after for swelling. I have had fraxel in the past and had a lot of swelling. What is your opinion. Thank you

Answer:

We use ice on all of them. JG 4.1.12

Question:

Dr. Garcia, Thank you for anwsering my questions below. I know it is common to experience overall facial numbness and numbness around the ears following a face/neck lift. I have lots of numbness overall, however, my left ear is almost completely numb. Does this mean the great auricular nerve has been cut and is there any test that determines this? Thank you.

Answer:

although it is a possibility, numbness is very common for months after the surgery and does get better with time. I think it is a matter of waiting a number of months to see what happens. All the best. JG 3.27.12

Question:

Dr. Garcia, I had a cheek/neck Lift (believe it was a SMAS with platysmaplasty) about 1.5 weeks ago. Initially, the area under my chin was smooth as I expected it would be. Around day six, I noticed indentations and what appears to be some platysma banding. The area is definately not smooth. In addition, there is some lumpiness/bumpiness on the right middle of my neck. (The day following the procedure, I had some fluid removed in the PS`s office on the right side - - not sure this has anything to do with the lumps/bumps or not). Could the platysma muscle separated so soon after surgery? If the Platysmaplasty did fail, would the entire lift need to be repeated or could a repeat platysmaplasty be done? Also, what could the lumps/bumps be on the right front of my neck. I asked my PS to look at the area during my one week follow up to have the first round of sutures removed, however, he said it`s too soon to tell what the result will be yet. Have you seen this happen and is there a period of time needed for things to settle out before knowing if there is a problem? If yes, what is an appropriate time period? Sorry for all the questions. I appreciated any advice/insight you can provide. Thank you in advance.

Answer:

the fluid accumulation can cause the lumps to form and it is not unusual for you not to see or feel others soon after surgery as the area is still swollen and hides the lumps. More likely than the muscle separating is that the muscle is stuck to the skin and it feels like a ridge. Usually with time and massage that will go away, for both issues. Sometimes the surgeon will inject dilute kenalog into the lumps where the fluid was removed though. If the platysma did separate, it could be repaired along through an incision bellow the chin and not affect the rest of the cheek area. The lumps should be better in 4-6 weeks. I wish you the best and sorry to hear about the problems. JG 3.27.12

Question:

Good evening Dr Garcia. I am the parotid patient. I have really come a long way. I found staying calm and focused to be important in my recovery and the avaiability of your library was helpful in that regard--as well it is very interesting: thank you. My question today is a new occurrence, same side. There is a ridge developing parallel and slightly above the jawline, nearly the length of the jaw from in front of lower ear to chin. It seems semi fluid but firm and not painful. Can a seroma be developing at this late date? I am nearly 6 weeks post op. I have found a great lymphatic massage therapist who helped move the fluid out of my neck but I do not want to proceed with massage therapy on my face without serious consideration. Is it normal to develop lumps and ridges at this late date. Thanks again

Answer:

might be some scar tissue that formed from the prior problem and will likely get better with time and massage. Glad to hear that you are making some progress. I wish you the best. JG 3.26.12

Question:

Hi Dr Garcia. I am parotid patient who has posted several times and received your excellent advise and encouragement. I am still going in the right direction but have to be very careful eating or chewing as the area under my ear and along jaw becomes inflamed. I also notice a bluish tint in the skin on that cheek and down my neck. It is not getting worse but also not better. Do you have any advice on how to encourage healing on that side. I am now 3.5 weeks post FL. As always thank you

Answer:

the bluish tint is likely just some of the saliva that is leaking out from the Parotid gland that has collected underneath the skin and is showing a Tyndall effect, all will go away in time. Glad things are better, and although I know it sounds impossible at this point, I think you will look much better soon, got to hang in there though, it can be a slow road. Best of luck.

Question:

Good morning. Today the fluids he removed were similar to yesterday and I can tell she was disappointed. I am wondering if you know of anyone in our area for a second opinion. My right side is progressing nicely but any sort of food seems to make the fluid accumulate on the left. She suggested a tube through my nose for nutients but I think I would just swallow more and be irritated, let alone scared. I am very healthy and at a good weight losing a little would not be a problem I know as I have always been a stable weight. I am in the hyper chamber twice daily and sipping water and milk and an ensure for diabetics. I know she would do anything necessary but she keeps saying this is a fluke. Have you ever experienced this? Do you think its time for 2nd opinion? There was a bit of this happening on my right in the beginning but it resolved itself very quickly. I am now a full week post op . I was very impressed at your immediate suggestion of what it might be. Thank you.

Answer:

the fact that the fluid accumulates when you eat points to a salivary fistula. Drugs such as atropine or glycopyrrolate will decrease saliva production and do help quite a bit.I think placing a feeding tube is overkill. A drain being placed will get the skin to stick down and scar over the puncture wound in the partotid gland, and along with the glycolpyrrolate, it will close. The combination works better than one of them alone.It is a rare occurrence, but can happen. I have helped patients that came to me with that problem with the protocol I have outlined above. I think if your surgeon does not wish to do those things, you might want to get a second opinion for your parotid fistula. The other resort is to use radiation therapy to close it, but it will likely leave some permanent damage to the saliva gland that can affect how your food is digested and it`s taste. All the best. JG 2.21.12

Question:

Hi dr Garcia. I went to the ps today and was pleased that finally the fluid was about half of what it was yesterday. I am using a motion sickness patch as well as benadryl, and very bland Liquid diet. The swelling us down. She was planning put in a drain today but did not because of reduced fluid. I feel much better and in no pain. My question goes to the healing timeframe for this injury to the salvary gland. Should it self heal? Everything else is really good and expertly executed as far as I can tell. I had a hyperbaric chamber session prior to surgery at her recommendation. It was very hard to clear my ears and even when I woke from surgery I told her my ears felt full of water. Could this have irritated the gland? My concern for healing is less stressful today but I am still in slight panic mode and don`t want to do anything to compromise my surgery. Thanks for this wonderful blog

Answer:

It should close on its own the hyperbaric will not hurt and may help it actually. Stay on bland foods and avoid tart things like lemons so the gland works less. All the best. JG 2.20.12

Question:

I had a FL/NL 4 years ago with good results except my PS did not fat graft. I have a tiny face and really needed volume. I recently had restylane (Jan 31st) and it looks awful-my jowls are back and the texture of my skin looks dry and saggy. Did the restylane ruin my facelift? Dr did a little vitrase to reduce some overfill but it still looks watery and saggy-he also gave me diuretics for 5 days-I am beside myself. All I wanted was a little volume. I look worse than I did BEFORE my fl. WIll the skin go back to normal? Fluid in the jowls dissipate? I also have a small spot of resty that migrated under my lip and I look like i have a lump. This was a reputable PS!!! Any suggestions?

Answer:

I do not think the Restylane ruined your facelift, it sounds like either you developed some swelling around it or it was injected into the wrong area. Diuretics will not help I am afraid. The filler needs to dissolve and the fluid absorbed. The skin will go back to normal in time, yes. The lump on the lip can also be injected with the hyaluronidase too. Hang in there.JG 2.20.12

Question:

Thank you dr Garcia. To clarify the aspirations has had no blood only serous fluid that appears clear with no infection. I am sorry I did not clarify that earlier. I wonder if warm compress would be better than ice? With this additional info should I consider asking about a drain?

Answer:

Unusial to be clear fluid with no blood, could be an injury to the saliva gland causing it. I do think more surgery might stlll be needed. I would warm at this point. JG 2.19.12

Question:

Hello Dr. Garcia, Thank you for answering my questions in advance. I was asking you if you know any rupetable sergeon the other day and you gave me the website of a VA dr. and when I looked it up it looks like he is does more liquid lift than a surgery. If you don`t mind can you tell me if you know any board certified faicial surgoen and also who does facial fillers. (around VA, MD or DC area). Thank you so much for your time.

Answer:

Call him at (757) 557-0300, he does facelifts, it was just the link went to his medispa and not his surgery office. JG 2.19.12

Question:

Dr. Garcia, are there any doctors in Colorado that you would recommend for neck and lower face lift? Thank you in advance!

Answer:

Stacy Folk in Denver, please tell her I said hello. JG 2.19.12

Question:

IS it possible to lift loose skin under the chin and turkey waddle with a liquid facelift? Thanks.

Answer:

most likely not as the amount of filling of the face to achieve that results would make your face look bloated, it sounds like surgery is the only option, sorry. JG 2.2.12

Question:

I had Ultherapy done in June. I am 59 years old. The doctor also injected two vials of Sculptra in my temples and side of my face. I still have the turkey waddle,and there is no lifting or tightening. When will the cosmetic industry stop hyping treatments that are a waste of money?? Also, I assume my age is the reason this was not successful, however I was not told this would be a problem. Besides a facelift what can I do now? My skin is not heavily wrinkled.

Answer:

well, it is not the entire industry, it is the particular company and then individual doctors. I have not been a supporter of Ulthera.I routinely use Sculptra on patients much older than you though and get good results with it. Recommendations are difficult without at least seeing photos of you, but it might be a facelift, yes. Sorry to hear things did not work for you, but next time, all I can suggest is do a little more research before spending your hard earned money. JG 1.31.12

Question:

I read on an earlier post that you can peform a procedure for a down turned mouth. What is it? How is it done? Thanks!

Answer:

In some people a corner lift is done by removing skin right above the corner of the mouth. There will be a permanent scar and the lift amount depends on the distance between the lip and the nasolabial fold. JG 1.28.12

Question:

Hi Dr. Garcia 5 months ago I had a facelift and upper and lower eye lids done.My face is still holding much water and I have severe dry eyes..Will this water retention EVER go away? My eye lids close but more of my eyes are exposed and everyday is a battle. On Resasis and going to get stem cell drops made next Surgeon wants to put a stich in eyes to give the eyes a rest...Can you give me your oppinion? Thanks

Answer:

not sure why there is fluid retention this far out, tissues softening up can take time but swelling should be mostly gone by now. If the eye lids close, especially when sleeping, then the eyelid surgery did not cause the problem. If your eyelids do not close when sleeping though, then possibly too much skin was removed and a skin graft to replace some of the skin removed might help. I think you need to continue the drops as suggested in the meantime too. All the best. JG 1.18.12

Question:

Dr. Garcia, I had a consultation with ps about a necklift. I have some sagging skin under the chin and not perfect jowls. I am 50 years old. My face not fat and I don,t have a lot of far under the chin, just loose skin. My cheeks are good, but ps said that I need to have incisions under the chin, around the ears, inside the ears and up to the hair line near the temple. I don`t understand why so high? What do you think, dear doctor? Thank you.

Answer:

hard to say whether the length of the incisions told to you are needed without seeing you. The length of the incision is more related to the amount of skin removed and not on what is performed below the skin. In some cases, the incisions you describe are required, but if there is minimal loose skin, then they might be able to be shorter. They might just be telling you what would be the worst case scenario in terms of the length of the scar so you would not be surprised. JG 1.16.12

Question:

The Plastic Surgeon did remove a scalp suture in my bridge lift, but this has left me with a lot of pain in my neck and chin area. I have trouble opening and closing my mouth where I also have a chin implant One ps said to go to a pain clinic, another to a neurologist and to physical therapy. I am getting confused on which direction to take and feel that no one really knows what to do or wants to get involved. I have written to you before about the chin implant problem and my mouth, and think it may be involved with my neck lift. It seems that everyone I see is telling me to see someone else. Any other thoughts on the matter?

Answer:

I would undo as much of the surgeries as you can and then see a pain specialist to see if they can start you on some physical therapy and pain management techniques to help you out. I wish you the best. JG 1.16.12

Question:

My plastic surgeon did a bridge neck lift by using a separate suture from the left temple underneath the scalp to the right side and behind the right ear into the neck area. I never heard of anyone doing this sort of procedure and it has caused me several problems: dizziness, neck pain and chin implant problems. Is this an acceptable procedure and is there anyway to get relief from the pulling and pain?

Answer:

one of these minimal invasive suspension techniques, only will help in a small percentage of patients, hopefully he is willing to go back and cut the sutures to hopefully reverse the problems. JG 1.15.12

Question:

My plastic surgeon did a bridge neck lift by using a separate suture from the left temple underneath the scalp to the right side and behind the right ear into the neck area. I never heard of anyone doing this sort of procedure and it has caused me several problems: dizziness, neck pain and chin implant problems. Is this an acceptable procedure and is there anyway to get relief from the pulling and pain?

Answer:

hopefully if he goes back in and cuts the suspension sutures, the problems will resolve. All the best. JG 1.15.121

Question:

What is and what do YOU think about a short scar facelift (my jaw line and neck are my problem) and what do you think about drs using `platelet gel` to help bruising? Thanks!

Answer:

I have used platelet gel for my facelifts for about 5 -6 years now and I find that it helps speed up the healing. As to a short scar facelift, it is only a marketing term. The length of the scar depends on how much skin has to be removed. After access is gained to the tissue below the skin, and whatever is needed is performed, like tightening muscle or removing fat, then the skin is redraped and the excess skin is removed. People that can get away with shorter scars are people that have minimal loose skin and more issues with the tissues below the skin. If someone needed more skin removed and opts for a short scar facelift, the appearance might not be what is desired. Better to have a longer but good quality scar and the desired results rather than less scar and less improvement. JG 1.11.2

Question:

Dr. Garcia, Is there an age cut off time where a mid face lift or neck lift is ineffective? I think I read somewhere that after 65 years old nor=thing will be too effective and ps is a waste of money. What are your thoughts? I am 62 with very good skin but kneed something done with my jowls. I am saving up. I hope you had a wonderful Christmas. Be blessed in 2012.

Answer:

There is no age cut off as all patients age differently and need different things. You might still be a candidate. JG 12.27.11

Question:

Hi Dr. G, Happy Holidays to you and your family. Thanks for helping all of us with our questions. Mine is regarding under my chin and neck area. As I age it gets less defined and more of an issue. I HATE pictures of myself now. It is becoming an issue as I don`t like my face as much anymore. I work out all the time (size 6) and it seems unless I do surgery I am stuck with excess fat under my chin and a wrinkled neck. What do you suggest and about how much will it cost? Are you available to do the surgery if needed? What is the down time? Are the results pretty dramatic? I really want to see my jaw bone defined again. Warm regards, LLQ

Answer:

we do perform the surgery that you appear to desire. In your case it would involve removing some of the excess fat in the neck region, possibly tightening the neck muscles and then removing excess skin. How dramatic the changes will be depends on how much needs to be done or can be done. Surgical fees vary depending on time so I would prefer to see you in person to estimate that. A range is about $6200, all inclusive except for your medications for after the surgery. All the best. JG 12.27.11

Question:

Hi, Dr. Garcia! I have had 3 facial surgeries, so I have scar tissue along the sides of my face, AND, unfortunately, also in a horizontal line under my cheekbones! Would this scar tissue make a fat transfer difficult -- or impossible? I have just learned that the cannula has to tunnel through the tissue, and this leads me to wonder if SCAR TISSUE could be an OBSTACLE to this process. Thank you!

Answer:

can still be done but the survival of the fat will likely be less due to the diminished blood supply form the scar tissue. All the best. JG 12.13.11

Question:

I had a second facelift 1 year ago, which seems to be healing well. I am now contemplating a facial-contouring fat transfer. My doctor has proposed some filling along the sides of my face, on cheeks, below cheek bones, and along jawline. Question: 1) Do you think there will be a good BLOOD SUPPLY for the fat in areas that are still a little, tight and sore, and have scar tissue? 2) Do you think the blood supply will be as good there as it would be in areas not affected by the FL? Thank you!

Answer:

the face has very robust blood supply , so you should be fine from that standpoint. Best of luck. JG 12.8.11

Question:

I understand some doctors are doing facial contouring -- using fillers or fat to achieve more filling for face reshaping than just working on micro areas. Do you do this? If not, who would you recommend?

Answer:

I frequently use fillers to replace lost fat and achieve more youthful contours. At times I also do small cannula liposuction or micro liposuction to remove excess fat in other areas. The options all depend on what the patient needs. JG 12.7.11

Question:

Have you heard of blacklisting? The surgeon who did 2 facelifts on me has lied TO me and ABOUT me. I am now having a hard time finding any help in my area. When other doctors learn he was the surgeon, they turn cold. Do you think my name could be on a blacklist? How can I find out and what can I do? Thank you.

Answer:

A surgeon should not talk to other surgeons and divulge names and medical issues without the patient`s consent. There are times when a patient gives that permission, but not in all. Some of the local surgeons in your area might not want to perform a revision on a colleague`s prior patient. The reasons for that can be many, at times they might feel uncomfortable commenting on a colleagues work, at other times they might not like to take over someone else`s difficult cases. I will say that in cases such as your, you might have to seek consultations elsewhere. There is not much you can do besides that though. Sorry. JG 12.7.11

Question:

Two weeks ago I have upper and lower blepharoplasties and a mid facelift. How long does it take for the suture ridge to soften? Also at the top of my left ear I have two little bumps that look like suture irritations... what is the best thing to do for those. no pus or drainage but red and very sore. How long for the facial swelling to resolve. I feel my face is still tight without much definition. Thanks for your insight. Have a great day. Oh.. my suture line on my eyes has some milia. How long before those will resolve.?

Answer:

the suture ridge can take 3-6 weeks to soften, but final results will take a few months for fading and softening. Light massage can help a bit. The selling form a mid-facelift can take months if the tissues were separated from the bones. Should start looking better after 4-6 weeks. A little warm moist heat on the suture line will allow the milia to open and drain. JG 12.4.11

Question:

Hi Dr Garcia, Thanks for answering all the question you are asked. If only all PS gave their patients this much time. Which you were closer, you would be my choice. Question, Have you ever heard a neck lift the involves a t or z cut under the chin to remove excess skin?

Answer:

yes, they did that surgery many years ago, but it has fallen out of use due to the visible scars. It is quicker and easier than a traditional neck lift, but the scars stay pink for a long time and can be hard to hide. The Z works better with greater tightening than the T one. All the best and thanks for the kind words. JG 11.18.11

Question:

I had a lower facelift and neck lift done 8 months ago and had more swelling and comfort issues with the left side of my face right after surgery. The surgeon said to wait and all would resolve...I had lymphatic massage and, again the left side did not respond as well as the right side. Most of the issues have resolved and my face looks good except that the left side has a line that goes along the lower cheek and I can feel a knot from the permanent suture at the start of this line starting approximately 1 in front of ear lobe on cheek and ending 1 1/2 from corner of mouth. The line disappears when I talk or smile but it is there when my face is still and I can see it as a shadow when I see my reflection in a mirror. The surgeon said he can remove the suture but he will have to cut through my cheek and, of course, that will leave a scar. I am not really afraid of getting a small scar if it would take this line away and would not cause my whole face on the left side to drop down. Should I just be happy that I like most of my lift or do you think the lift will hold if I have this permanent suture removed?

Answer:

well, he would know if it could be removed with a small scar, if that is the case, it might be better to have it removed. Otherwise, you could use a little filler to hide it and it might get better over time. If it has gotten better, albeit slowly, the conservative approach might be better. JG 11.14.11

Question:

Dr. Garcia, using a tissue glue during the face and neck lift will speed the healing process or prevent from infection? Thank you.

Answer:

quicker healing possibly, less swelling possibly, I use it many times. JG 11.10.11

Question:

Dr. Garcia, do you do corner of mouth lift procedure? What would the approximate cost be?

Answer:

yes we do, in the office, under local anesthesia, the cost is $1700. JG 11.10.11

Question:

Hi, Dr. Garcia! I hope things are going well for you. I had 2 facelifts, specifically asking for the mouth area to be lifted after damage, and my mouth area looks worse (lower) than ever. 1) My lower face looks tight & narrow now and 1 dr. said a lot of fillers & fat may lift the mouth area. 2) Another dr. does a Vertical type of facelift, which he said could lift the area under the mouth (which appears it would be helpful, and 3) another dr. was concerned about vascularity and suggested endoscopy. QUESTION: Off the top of your head, do any of these possible options sound possibly helpful or likely not very helpful? Thanks!

Answer:

well, they have some aspect that is reasonable, but I do not think any one will likely do anything dramatic done alone. The fact that three surgeons suggested three different things tells you that there is no one single correct answer to fix the issue in your case.It is hard to say what might be best without seeing at least pictures of you before and after to try to figure out what you had before and what was done during the two facelifts. Please feel free to send any picture, if you wish, to drgarcia@lvcosmeticsurgery.com for my review. JG 11.1.11

Question:

Hi Dr. Garcia I wrote you yesterday re my neck bands showing as a result of a neck lift. Thank you for your prompt response re the likelihood of a corset platysmaplasty not helping the situation. What would you recommend to correct this situation? A redo of the neck lift??? Or......?????? Also, you did not tell me if the corset platysmaplasty will leave a line or fold or other indentation or protrusion down the center of my neck where the bands have been tied together. I am as concerned about that possibility as I am about the visible neck bands. If that would be the case, I would be trading one problem for another and the procedure definitely would not be worth it for me. You provide a very fine service. because of your objectivity. It`s very hard to completely trust a surgeon who is recommending that a procedure be done. It seems highly unlikely they will say it won`t work. The possibility of the appearance of neck bands after neck lift and liposuction of the neck was NEVER mentioned by my surgeon. I have been quite unhappy with the result of the surgery for nineteen months now. It`s time to address the situation but I don`t want to simply make another mistake and be disappointed one more time. Thank you for your prompt response yesterday and I look forward to hearing from you re the above.

Answer:

well, actually it sounds like you need to put some fat back into the area to soften the appearance of the bands. The facelift did not cause the bands to form,they were already there but just hidden. The liposuction likely unveiled them. I am not saying to put all the fat back, but a layer to hide the muscle edges would be a good option. As to a corset platysmaplasty leaving a line or fold, normally it would not but if your neck has been thinned out where there is little to no fat underneath the skin, it certainly might. I wish you the best. JG 10.27.11

Question:

Nineteen months ago I had a neck lift performed with liposuction of the area under my chin. As a result, neck bands appeared and have not resolved. The surgeon is willing to correct the situation and is recommending a corset platysmaplasty. As I understand it, this involves an incision below the chin through which the neck bands are gathered together and tied in some way. Do you think this is an appropriate procedure to correct my problem? The rest of my neck is smooth and I consider that part of the former neck lift a success. The residual bands are my only problem. Will a corset platysmaplasty leave a ridge or fold of skin or a line of any kind down the center of my neck below my chin where the bands have been gathered together? I have seen several plastic surgeons re how to correct these neck bands. Some say the corset platysmaplasty will leave a line, others say no. So I don`t know what to do. I don`t want to trade one problem for another. I will appreciate your input very much. Thank you very much for your assistance.

Answer:

It might help, but I think part of the reason you have the visible bands now and not before is because the fat covering the muscle has been removed and now its just skin and then muscle. Tightening the muscle will change the angle of the muscle, but it might not change the visibility of the bands.I do not think it will be any worse, but I am not sure you will much better either. JG 10.27.11

Question:

Regarding proximal plane, (under the cheeks), I thought it might be harder to dissect in that area to loosen it again? But you think the real problem would be scar tissue? I got the impression that you don`t do 3rd FL revisions. Do you know anyone in the U.S. that does? Thank you.

Answer:

I am sorry, but you are correct, at this time in my professional career, I no longer do revisions on surgery performed elsewhere unless it is due to aging. There is no surgeon I know that specializes in revision facelift. JG 9.27.11

Question:

My doctor tightened under my cheek in a second facelift in a misguided attempt to lift my mouth. He says, the tightening of the SMAS was again done secondarily in a much more proximal plane with interrupted sutures of 4-0 PDS. Even though these have dissolved, it is still very tight there. If I were to have a revision facelift (3rd), could that area be safely undone so it could be lifted properly? Or do you think undoing would be a big extra problem (besides the usual scar tissue around the ears)? Thank you!

Answer:

whether it can be done and positioned into a better location will depend greatly on the degree of scar tissue and whether the SMAS is able to be safely released without causing an injury to nearby nerves.Best of luck. JG 9.26.11

Question:

I am the person who had 2 facelifts by Gutek, the 1st, in which my face was anchored downward, then in the 2nd, lifted, but not enough, particularly vertically. So, my lower face looks LOW on my face, narrow, and hollow. He has also tightened under the cheeks too much. I can`t find anyone in the Kansas City area who will revise it. They say they are afraid of the scar tissue and possible nerve damage in a 3rd facelift. Do you think it`s necessary to have to travel elsewhere to get a revision? Is this unusual? Have you done any 3rd revision facelifts, and if so, how many? Do you know anyone else who has? Thank you!

Answer:

well, at times, the surgeons in a location do not want to undertake surgeries for a myriad of reasons. They might be concerned abut risks of intraoperative injury and possibly of the inability of getting a significant improvement due to what has been done before. I have done facelift revisions after multiple surgeries on some people, but luckily the numbers are less than 25 as it is not required often. It might serve you well to have at least another opinion from someone in a nearby town that can give you their impression.All the best.JG 9.26.11

Question:

I`m talking with a doctor who says that an incision inside the hairline taken a few inches up above the ear can provide a lot more vertical lift than if the incision stops at the top of the ear. I`ve only heard about this recently. Is this true? More vertical lift is what I`ve needed the most because of a doctor pulling the skin downward on my face in an imitation necklift. Thank you very kindly.

Answer:

well, the higher the incision goes, potentially the more vertical the lift can be, as far as the skin is involved, but you also need to take into consideration that if the incision is within the haie, as that skin is pulled more vertically, it will likely displace the temple/sideburn hair higher, potentially into an unnatural position, leaving a place on your face that should have hair not having any and making it look abnormal. All the best. JG 9.21.11

Question:

My doctor tightened under my cheek in a second facelift in a misguided attempt to lift my mouth. He says, the tightening of the SMAS was again done secondarily in a much more proximal plane with interrupted sutures of 4-0 PDS. Will these types of sutures dissolve? If so, how long should they take to dissolve? My face look horribly hollow under my cheeks and am hoping this will improve somewhat. Thank you!

Answer:

yes, they will dissolve in about 3 months. All the best. JG 9.21.11

Question:

Regarding volume in a facelift, my surgeon did plicate at the sides of my face, but I still look tight & narrow. 1) Is plication the same as imbrication? 2)Would a revision surgery necessarily make face look even tighter and narrower, or could that be avoided? 3)In other words, is there a way to make face look wider in a 3rd facelift? Sorry for 3 questions, but they all seem to closely relate. Best and thank you so much.

Answer:

plication ddn imbrication are similar but not the same, in imbrication, the tissues are pulled in layers to create a folding over and over on itself to look like more volume, In plication, if the location of the sutures is too far apart, it will actually flatten the tissues rather than build them up.The only way a redo would make you look tighter is if the tissues are again pulled too tight and too much skin is removed. Releasing tissues might make the face look wider, but in the short term you could try using Sculptra to avoid surgery and get a volume increase where you need it. All the ebst to you too. JG 9.5.11

Question:

I was the one who said my neck is too tight after a FL, and you thought that perhaps too much fat had been removed. Is removing fat from the neck a standard part of a facelift? If so, is this typical? I had no idea this could or would be done in a FL. I was conscious during the surgery and don`t remember anything like that taking place. (I`ve had lipo in the past, so I`m sort of familiar with how it feels.) Thank you!

Answer:

The day can be removed by directly with scissors or with liposuction and syringe so there is no noise. Fat removal is done if there is fullness in the neck. JG 9.5.11

Question:

It appears that my surgeon tightened too much at the base of my neck (in a facelift). My neck looks weird and scrawny, with lots of bands. Previously, it had enough fat in it and did not look old and scrawny. Do you know how/why he would have tightened at the base of my neck? Do you think this could loosen with time? Thank you.

Answer:

It more likely is due to too much fat being removed rather than too much tightening. Fat injections might help smooth the contour out. I think it will likely improve only a small amount with time. All the best. JG 9.4.11

Question:

My surgeon, Philip Gutek, did extra tightening under my cheeks in a more proximal plane, in a misguided attempt to lift my mouth. It did not lift my mouth, but looks terrible -- too tightly hollow and bony. Do you think this could loosen from a revision facelift, with massage, or with time?

Answer:

depending on how aggressive you want to be, the sutures can be cut out to loosen things by opening everything up, massage might help some, and time will also allow things to sag, in time and slowly. JG 9.4.11

Question:

Thanks for you answer below about the need for a revision of my facelift to re-suspend the modiolus and adjacent tissues. Approximately how much do you charge for such a procedure? And how long would I need to stay in Las Vegas? Thank you very much for your time and help! Hope to meet you soon!

Answer:

I would need you here for about ten days, and the fee is about the same as a cheeklift due to the type of dissection required. Fees, all inclusive of everything except your medications, done under general anesthesia in the surgicenter are $6275. All the best.JG 7.22.11

Question:

Hello Dr, At 43, although I do not have excess skin to warrant a face lift, however I find my face is sagging due to my muscles or tissues ageing. What is the name of the procedure which lifts only the underlying muscles and what is the downtime on this procedure? Thank you

Answer:

Still a facelift, just not much skinin removed, otherwise might look into injectable Sculptra to refill your face. JH 7.19.11

Question:

Re: moist heat on bruising after a face/neck lift...If I use a heating pad with moist heat, how long can I leave it on at a time and how often can I use it? Thanks so much.

Answer:

Use it for 5 minutes or so.JG 7.10.11

Question:

You recommended warm moist heat for bruising 10 days after a face-lift....thank you...how do you keep the moist towels warm? Would it be ok to use heat therapy patches? They say do not use on sensitive skin and I am still very sore where the bruising is...thanks very much for your help.

Answer:

Warm a wet towl in the microwave, check it to make sure it is not too hot, then apply until it cools, can reapply it every 30minutes. JG 7.9.11

Question:

Is there anything to speed up bruising and swelling 10 days post-op after a facelift?

Answer:

Warm moist heat and arnica montana gel. JG 7.9.11

Question:

Hi Dr Garcia. I hope you had a great break and caught lots of trout! Could you please explain where the incision lines for a high extended SMAS are and what is involved regarding the surgery? Thanks and have a great evening

Answer:

they are the same as a regular facelift, the difference is all underneath the skin as the SMAS is elevated form a higher point, not a procedure that all surgeons feel is significantly better than a regular SMAS lift. And yes, lots of trout! JG 7.7.11

Question:

I was the one with 2 facelifts, the second one with much more proximal plane to mouth, that left me too tight under cheeks (at 6 mos.) and mouth area is still downward. My new dr. is considering a SLING, which I have now found out more about. It is a stratus that is used with various surgeries, and may help with sagging skin and lost volume (which I have). (He would use the same facelift incisions.) Have you heard of this and, if so, what is your opinion? Thank you!

Answer:

I do not think Stratice will add any volume and it will support the fallen tissues, but if you have no tissues to left, I am not sure the reason to use it. It will not help the skin be lifted anymore than it could be without it. All the best. JG 7.6.11.

Question:

Regarding my facelift in which the dr. said he did a subcutaneous facelift with SMAS plication: You said: it is a pretty standard type of facelift, the SMAS was not separated and lifted, it was just folded upon itself. QUESTION 1 - If he did extra tightening in a much more proximal plane, could this be extra difficult to loosen in a revision if it becomes necessary? I ask because there is too much tightness under my cheeks, which looks hollow and old. (I think he did this in a misguided attempt to lift my mouth, which it did not do.) QUESTION 2 - In this type of facelift, is there less tissue removed? I look narrow, bony, and drawn, and wonder if a revision could help my face look Rounder -- if the tissue is still there? Sorry about so many words and 2 questions, but I hope this is the most efficient way to ask. As always, thank you.

Answer:

possibly more difficult just because of the potential of more scar tissue. In this type of treatment, there is no tissue removed, just skin, all of the other tissue is just folded upon itself. As there was no tissue removed I am unsure whether more surgery could make you look for round or full, but if the tissue are loosened, you might go back to the way you looked, but not entirely as skin has been removed and that will cause some limitation as the reversal. JG 7.6.11.

Question:

In a facelift, my dr. said he tightened the SMAS done secondarily in a much more proximal plane with interrupted sutures of 4-0 PDS Could this more proximal plane explain why there is too much tightness under the cheeks from the mid ear? Was this traditionally done in the past in facelifts to lift the mouth?

Answer:

not really, the tightness is more due to how much tissues is placed between the sutures and how tight the sutures are tightened. As to tightening the mouth, maybe you can describe what you were trying to get as an effect because most facelift improvements stop at the nasolabial fold and at most redirect a downward line from the corner of the mouth to a more horizontal one. JG 7.5.11

Question:

I received additional surgery notes from my dr. who had previously refused them. He said he did a subcutaneous facelift with SMAS plication. 1) Is this different from other types of facelifts, and if so, how?

Answer:

it is a pretty standard type of facelift, the SMAS was not separated and lifted, it was just folded upon itself. JG 7.5.11

Question:

I just realized I had already asked you about a sling lift. Sorry about that duplicate question. I did find something about it by reading something by Julio Wilson Fernandes @ http://www.springerlink.com/content/q33522hl1651461t/. Perhaps you would use another term for it? Thank you.

Answer:

yes, but I am not sure that is what your doctor plans on doing and without seeing you and feeling your tissues in person, I cannot say whether that procedure you sent the link for will help you, sorry. JG 7.3.11

Question:

Would hgh help people who are getting cosmetic surgery to make them heal faster?

Answer:

in theory yes, but it is not FDA approved for that. JG 7.3.11

Question:

I recently had a facelift revision but the stitches burst after a few days and the wound opened, leaving a big hole which is now clearing up but the facelift has dropped Will my surgeon be able to do this again and how can I avoid the same thing happening?

Answer:

I think you will need to wait until the tissues have softened enough and there is enough laxity in order to revise the scar and close the wound with minimal tension. Tension is the biggest foe in these cases and avoiding is paramount. JG 6.29.11

Question:

I am the one who had 2 facelifts, mouth is still downturned and generally lower on face than originally, and tight & hollow under cheeks. I have found a facelift surgeon who says he MAY be able to help me. He wants to see me at 1 year to evaluate whether there will be enough loosening to do a revision. He talked about a sling approach to lift my mouth. Have you heard of a sling? Do you think it`s something different from a sort of cheek lift or mid-face lift? Thank you!

Answer:

hard to say what he is calling his sling, but I agree, there is no way to tell until the tissues soften and become as pliable as possible. JG 6.29.11

Question:

My surgeon pulled (the SMAS?) harder than normal from the mid-ear during a facelift in a misguided attempt to lift my mouth. The tightness there is making hollows under my cheeks, and somewhat distorting my face & I don`t look at all good. Will this abnormal tightness loosen with time? How much can massage help?

Answer:

massage and time will help, yes, could do some fillers in the short term to fill in the depressed area if desired. JG 6.29.11

Question:

Ok here goes. I am a thin white female and always been tiny. I am now 50 and have lose skin under my chin and on my neck. I would love to have this fixed. I am terrified of being put to sleep, and wonder if this procedure could be addressed with a small incision under the chin and fixinfg it that way with going behind the ears because of hair loss. I have fine thin hair and can`t really afford to lose anymore. I also have lose creepy skin on my knees on top of my thighs and would like to know if farxel laser repair would help with this or if ther is anythig that would? How about the Elexis or however it is spelt.I am also scheduled to have Sculptra injections for the cheek areas and to help with the nasal labial folds. Think with the filler it will lift cheeks and help the nasal labial folds.

Answer:

I don`t think a small incision under the chin will get the job done, you will need a more invasive procedure on the neck to redrape the skin in order to leave it looking natural. I do not think any laser or skin heating technology will be safe and effective in tightening the skin on your thighs above your knees. As to the Sculptra, it will certainly fill the cheek and it might shorten the nasolabial fold but will not eliminate it, and could make it look deeper in certain lighting.Sorry. JG 6.21.11

Question:

Hi again Dr Garcia Thank you for answering my question below about a repeat face lift. When you say the platysma muscle becomes weaker, what are the repercussions of this? Does this predispose one to further problems down the line? Also when the skin is freed completely from the underlying tissue from posterior hairline to hairline(for the neck lift part) is that in the front of the neck or the back? Is this the usual procedure? Thank you

Answer:

as long as it is not completely transected, there is no significant functional loss. Many years ago, the muscle was completely cut, but that is no longer done. In order to release the tissue, most likely it will require both front and back access. JG 6.8.11

Question:

My mouth was pulled down in a necklift, then anchored down in a bad facelift. The dr. refuses to treat me after 2 facelifts because I was unhappy that he still had not lifted my mouth as he had promised. I now know that a mouth is not usually lifted in a facelift, but he never told me that! My questions are: 1) Can another dr. do a revision to help lift one side to match the other? 2) Will another dr. need detailed surgery notes? (My dr. refuses to provide detailed notes, and in fact, his medical records are misleading & contain critical omissions!) Thank you, thank you!

Answer:

hard to say bu tin most cases that is due to a different directional pull of the tissue and releasing or moving the tissues might make it look and feel better. Notes of what exactly was done during the surgeries is helpful, but not essential to have a different surgeon perform a revision. Best of luck. JG 6.8.11

Question:

Hi Dr Garcia I had my third face lift last August and the surgeon and I are both unhappy with the result. He wishes to redo it gratis and in his letter to me states that I `need a complete redoing of the high extended SMAS lift, freeing of the neck skin from posterior hairline to posterior hairline.....the excision under the chin needs to be reopened and the lump there excised together with the anterior platysma band which you can fee. Thank you What does this all mean? Will my skin rejoin back to my neck and also if you cut the platysma muscle, can this also join back again later as it seemed to after the last surgery where I was left with a very painful hard band which was temporarily helped by botox

Answer:

the skin will reattach in time, yes. The platysma will heal itself by creating scar tissue, but it will be weaker. The Botox only help spasms in the muscle, sounds like a redo entire facelift, but it might be what you need done, sorry. Jg 6.7.11

Question:

Hi I have had thread lifts to lift my eyebrows in the past with no result. I was told by a doctor that Stich Lift would work is that right? Thank you Ruth

Answer:

Same scam, different name, save your money. JG 6.2.11

Question:

You suggested I get copy of operative reports, but I have done so, and other surgeons have said the notes are too minimal & general to be of any value to another surgeon. I asked my Dr. to add notes about his techniques and procedures specific to my surgery, but he refused. He said another dr. can just call him. (I found that my medical records also contained omissions and falsehoods.) Can I make a formal request for him to add more detailed operative notes? How critical is it that a future surgeon have this information? Thank you!

Answer:

a formal request will likely not provide anything more than has already been given, I think the operative report would help but is not absolutely essential. Best of luck. JG 6.1.11

Question:

One more question, please. You are an angel to be so kind. In the bad necklift I had, my facial skin was pulled and stretched Downward for several weeks, pulling my mouth down. Then, Dr. Gutek anchored my face downward in a bad facelift, for 9 months. By the end of 9 months, I could feel it pulling down under my eyes. Could the downward facelift have also stretched my skin downward, and made my mouth worse? It does look like it.

Answer:

I guess it is possible but not a usual occurance less there was a postoperative hematoma that created a large amount of scarring, the downward pull on the skin is hard to maintain.JG 6.11.11

Question:

Is it inevitable that a person`s face will look narrower after each facelift? Mine seems to be after 2, and since tissue has been removed (and plicated) on the sides, I`m afraid that each surgery will make me look narrower & older because there is less tissue to work with. I used to like my horizontal face, but now it is very vertical. But maybe it depends on the surgeon`s skill and vision? Thanks.

Answer:

if tissues is removed, that can happen, but in many cases, the tissues can be plicated, or folded upon themselves, and not removed, that can avoid the thinning or narrowing effect. Also, as one ages the fat loss in the face, which is part of the normal aging process can make the face look narrower too. All the best. JG 6.11.11

Question:

You suggested I get copy of operative reports, but I have done so, and surgeons have said the notes are too minimal & general to be of any value to another surgeon. I asked my Dr. to add notes about his techniques and procedures specific to my surgery, but he refused. He said the other dr. can just call him. (I found that my medical records also contained omissions and falsehoods.) Can I make a formal request for him to add more detailed operative notes? How critical is it that a future surgeon have this information? Thank you!

Answer:

he does not have to give you anything more than the copy, I am a afraid. It would be helpful but not absolutely critical.JG 6.11.11

Question:

I’m the one who had 2 facelifts that are unsatisfactory, and my mouth is still extremely turned down from the skin being pulled down in a previous necklift. Are there doctors who are competent to tackle revision multiple facelifts? What information do they need from the previous facelifts so they are more comfortable opening someone up again? I can`t return to my surgeon because apparently he was afraid of my distress after 2 surgeries from which he did not fulfill his promises, and blamed me for “unrealistic expectations,” when, in fact, I just believed his unrealistic promises. Is this a common ploy? Anyway, I have now lost continuum of care.

Answer:

yes, there are many surgeons that can help you, and the best thing is to get copies of your pictures before the surgeries and also a copy if the operative reports to share with the new surgeon. JG 6.11.11

Question:

I`m 31 and notice that my lower face is started to droop a lot more, around my mouth and under my chin epecially. I don`t look like an old person but I would definitely look much better to have my lower face lifted. I have seen the results of good lower facelifts and that seems to be what I need. Would a lower facelift not be appropriate fro someone my age, and if so are there any alternate, less extreme lifts that can be done?

Answer:

seems early to have that done, without seeing you and some pictures of you maybe 5 years ago, it is hard to tell. There might be other less invasive things that could be done rather than surgery. Usually at that age fillers in the face like Sculptra can do a good job to correct many of those issues. JG 5.25.11

Question:

will the hyaluronidase also dissolve your own collagene or skin tickness when using to dissolve fillers like restylane after a long time. They were injected very diffuse, meaning over a large area. It seems impossible to inject the whole face with this product. What will happen, the restylane is everywhere, from chin to forehead, eyebrows, mouth, uptill the nose and near the eyes and ears.

Answer:

to an imperceptable amount, if not, then you need to allow it to dissolve on its own. JG 5.23.11

Question:

What can be done about bulging mouth corners after a macslift. Where does this come from, what went wrong and how to correct. Thanks

Answer:

might be some buccal fat pocket that was left untreated, in many cases it can be removed through a small incision inside of the mouth. JG 5.23.11

Question:

When using restylane vittal in sagging skin, the skin will be ticker but the area seems to be much heavier then before as there is more skin just made ticker. Is there another solution to get rid of the heaviness created by the restylane vittal. It seems that fillers never completely leave the skin, always something is left ther, whatever i is, scar tissue _ more collagene _ Is there a way to completely get rid of what is left over after 2 or three years.

Answer:

it can be injected with hyaluronidase to dissolve it. JG 5.23.11

Question:

Hello Dr. Garcia, I have a two fold question: 1) Is it okay to use lots of different types of filler in a thin face (i.e. Perlane, Juvaderm, etc. - approximately 5 syringes different locations) I`ve have two syringes of Perlane (one in each cheek area) and only noticed a subtle difference. I want to add at least two syringes of Juvaderm to my lower face (one on each side). Second question: Do I need to wait for the fillers to wear off prior to face/neck lift surgery? I`m not sure if having filler in my face affects surgery or the outcome since things will be repositioned during surgery. Thanks in advance.

Answer:

different fillers are intended to be injected at different depths so it is not uncommon to mix and match. As to the fillers wearing off, not really, the surgery can still proceed, just make your surgeon aware of what and where the fillers were placed. Best of luck. JG 5.23.11

Question:

Thank you for the answer below, Dr. Garica. About the Clarisonic Opal, it`s not their cleansing brush about which I was inquiring ( which I use and like); it`s a different product that aims exclusively to promote infusion of topical products: http://www.clarisonic.com/shop/opal_sonic_infusion_system/index.php. What do you think? Hype or worth it? And as to the removal of the buccal fat, doesn`t that create more sunken/hollow lower cheeks, which is also a problem for me, despite the pooling of fat next to mouth? Sorry to ask two questions in one weekend! I so appreciate your help and time!

Answer:

More hype than anything. As to the buccal day pad, that is what is causing the fullness, can it be resussuspended but it does recur though. I think if only a small amount of fat is removed, it should not make huedifference . The fat is not in its proper position now., so if you do not have hollow cheeks now, then removing it will not cause a hollowness. JG 5..22.11

Question:

Hi, Dr. Garcia. I have two questions for you: 1) Is the Clarisonic Opal worth the investment in your opinion? It claims to increase products` penetration. 2) I saw my surgeon this week to discuss a surgical intervention for a problem that continues to worsen for me despite a facelift a few years ago. My buccal fat pad has descended and is causing the modiolus to pool on both sides of my mouth. We`ve been masquing the problem first with HA and later with Sculptra, but of course the underlying problem is not magically improving with time, only worsening. We`re at the point that adding more filler around the modiolus would just make whole area bulky and would square my lower face. He thinks that the best solution now is to do another facelift, focusing on either resuspending OR redistributing the buccal fat (not removing it so I don`t end up with hollowed cheeks), but he thinks it will be difficult because he doesn`t want to end up pull my mouth laterally. I`m writing to ask if you think his plan sounds reasonable and possible and, if you do, which you think is a better solution -- resuspending that fat pad or opening it and then redistributing/sliding its contents. Have you done this with your own patients? Has it been successful? Thanks ever so much for your kind help, Dr. Garcia. You are a beautiful person. We all appreciate your help more than you can imagine.

Answer:

good for cleansing, not sure about the penetration though. As to the fat pocket,unless you need the rest of the facelift redone, just excise it from inside the mouth to avoid the pulled look that would come from tugging on the skin. All the best. JG 5.22.11

Question:

Hi doc, I know you don`t like the idea of thread lifting but how long do they last if many threads were to be used to support the ..say the cheeks or eyebrows?...I`m 30. I don`t mind repeating the procedure over and over again if theres no problem to do so. Thanks your always great...Australia says HELLO:)

Answer:

That might break in just a couple of days. JG 5.19.11

Question:

Hello ! (again....) I have pretty significant `broken` veins on both sides of my face. Most likely from a 6 year old facelift. Can these be permanetly removed if ijected with saline, or whatever the process is thats used for the legs? Thank you so very very much. Have a great day

Answer:

The injections are not very effective, might be better treated with a YAG laser or VBeam laser. All the best. JG 5.16.11

Question:

Prior to a lower face/neck lift, do you advise clients to discontinue the use of Retin A or Tazorac? I`ve been using 0.1% Tazorac on my face and neck nightly for many years. Do you think discontinuing it a few days prior to surgery is sufficient?

Answer:

I see no need to discontinue either prior to surgery. JG 5.4.11

Question:

Prior to a lower face/neck lift, do you advise clients to discontinue the use of Retin A or Tazorac? I`ve been using 0.1% Tazorac on my face and neck nightly for many years. Do you think discontinuing it a few days prior to surgery is sufficient? Thanks.

Answer:

I see no need to do that, they will not negatively affect the surgery. JG 5.4.11

Question:

Dr. Garcia, Thank you for your response to my question yesterday regarding recovery time following lower face/neck lift. I did not mention this would be a SMAS/neck lift; does this make any difference and do you still feel three weeks is sufficient to travel? Also, this trip will involve lots of activity and socializing. Do you feel a three week recovery period following this type of procedure is enough time to be physically active including exercise? Thanks.

Answer:

OK to travel, exercise only after 4weeks, nothing excessive til then. JG 4.28.11

Question:

Dr. Garcia, In your opinion, is three weeks enough time to heal from a lower facelift/platysmaplasty? I would like to schedule the procedure, but will be going out of the country for about 10 days and don`t want to run into any problems. How long of a recovery time should be allowed for this type of procedure prior to a big event? Thank you.

Answer:

I think you would be healed enough in three weeks to travel after that type of surgery. All the best. 4.27.11

Question:

Dr. Garcia, I was reading the Platysmaplasty section in your library and noticed some people experience platysma banding following liposuction. Your responses seem to indicate this may be due to fat removal. If this is the case, if someone is very thin without much facial fat can adding a filler to the face such as Sculptra add enough volumn/lifting to the face to make platysma banding less noticeable? Thank you in advance for your response. Also, I like the set up of your website.

Answer:

the reason the banding occurs after liposuction of the neck in some people is because the bands were already here and the fat was obscuring them. The liposuction in and of itself does not truly cause the bands in a traditional way. To inject fillers, of any kind, to obscure bands would take a lot of filler and will make your neck look much fuller, not a good option I am afraid. 4.27.11

Question:

Due to assymetry of a prvious facelift, the doctor injected some restylane vittal on my left cheeck, however four days after the treatment the whole lkeft side of my face is pulling upwards, due to swelling and fluid collection of the filler. Not only the injected side looks swollen but my whole face is puffy and like a balloon. Is this possible that fluid is over the whole face. What can i do do to minimize the swelling and fluid retention ? Only 0.5 ml is used on that area of the face. Is it still usefull to put icepacks ? My lean face is a balloon now. Is it recommended to use my dermaroller twice a week or should i avoid this for the next few weeks. Thanks for reply.

Answer:

If it is just swelling, massage and warm packs migth help, if it a hematoma from bleeding, once a few days pass and it softens, then it might be able to be aspirated with a needle.If only 0.5cc was injected, it is likely fluid around trhe tissues injected. I would not use a dermaroller for fear it could seed bacteria into the fluid. You can restart once the swelling has resolved. I must say it is a very very rare occurrance. JG 4.26.11

Question:

It was suggested to me that having a midface lift to raise the fat under the checks to a higher elevation would help with the bad lower bleph I had. I said I have indentions or a vertical line at outer sides that don`t look natural and I was told that was because there was nothing to support my outer eyes anymore. I was told this procedure would take this unnatural look away and also make my eyes longer in length. It was pointed out too much whites show in my eyes now. Two incisions would be make at the top of my scalp. What is your opinion on this? Thank you for your time and help.

Answer:

it sounds like the mid facelift alone might not be enough, you will likely need more work on the lower lid also with additional relocation of the lateral eyelid canthus into a better place and lower lid support. Best of luck. JG 4.13.11

Question:

Is it possible that after 6 months i still feel the restylane subq under the skin when i push very deep, i feel a jelly bubble where the restylane was injected, i am sure it is not gone. Also swelling is still not completely gone, especially in the morning.

Answer:

yes, Restylane Sub Q can last up to 2 years.I will say that swelling the gets better and worse depending on the time of day is not normal, there mush be something else going on. Might suggest you see your doctor that injected you for an evaluation. JG 4.3.11

Question:

Hi Dr Garcia, You are such a trailblazer and generous person to provide all this information for us confused consumers!! I am 52, in very good shape and look younger but my face has fallen just a bit, enough for me to notice the slightest hint of jowls and neck laxity (I`ve lost my sharp jawline). I went to 3 different plastic surgeons and here is what was prescribed by each: 1) neck thermage (eek! snake oil alert!) and sculptra in the cheeks 2) mid face lift with lower bleph 3) limited incision face lift with fat transfer in the cheeks (or sculptra) and TCA peel (or matrix fractional laser) and restylane in the tear troughs. Can you see how Joe Average Consumer has a hard time figuring out what to do? Plus having worked in health care I am acutely aware that most doctors who have procedural based billings have an inherent conflict of interest that must be balanced with do no harm and do the right thing for that patient . It seems to me that you`ve found the balance...if I lived in Vegas you would be my guy!! :) Anyway, I want the shortest downtime and I don`t need the most dramatic results. In 5-10 years I can revisit plastic surgery and be more aggressive since I won`t have the demands on my time that I do now (I`ve got younger kids). So, I`m leaning toward the minimal incision lift and tear trough restylane and cheek sculptra right now and will forgo the lasers because of down time. What do you think? Is the minimal incision face lift a second dose of snake oil? Any opinion on fat graft vs sculptra? Muchos muchos gracias, you truly are a gem!

Answer:

I think your choice is what I would suggest, I would skip the fat injections as they are not as reliable as people think, lasting no more than 2 years. I use lots of Sculptra for that reason as the recovery is much less and results the same if not better. Hope that helps and I wish you the best. Buena Suerte! JG 4.2.11

Question:

Dr. Garcia, Do you ever do the facelift stitches inside the ear? I have seen pictures of celebrities with this done, and I somehow think it looks a bit strange. One newscaster has a perfect face, but this ear thing just kind of throws it off. Which way do you think is best and how do doctors decide which to use? Also, if you have skin creases in front of your ears, does that effect the facelift in any way? Thank you so much.

Answer:

almost always. The skin has to be defated to make it look right and then use minimal tension so as to not distort any part of the ear. The crease in front of the ear will not affect the surgery. Hope that helps. JG 4.2.11

Question:

Hi Doctor. Are there any other options for the neck area other than surgery (crepiness, some loss of firmness)? Thank you. jg canada

Answer:

besides surgery,I do not feel that the things that are marketed for the neck work well. JG 3.29.11

Question:

Regarding the fillers, what is left now after 5 months, is this the amount of restylane itself, is the volume there due to the product or due to the fibritic response inside the skin ? My face is defenitely still larger then before . What do you think of the titan procedure to shrink the skin on the face ? Can it be used for other areas. thanks

Answer:

I think by 5 months most of the original filler is gone, if it was legal and true Restylane, not sure what is there at this point and there should minimal fibrotic reaction to Restylane. As to the Titan, I would save your money. JG 3.22.11

Question:

I was the one who had a facelift 3 months ago whose upper cheeks don`t appear to have been lifted enough. (Plus mouth corners are still turned down.) Could just a revision facelift, that raised upper cheek area (between mid-ear and top-of-ear), be a a simple solution, at least for that problem? (There are very few drs. in my area who do cheek or mouth lifts.) Thank you!

Answer:

yes, essentially just the cheek pat of the facelift. Some doctors call it a mini facelift or an S-lift. Best of luck. JG 3.14.11

Question:

I had a facelift 3 months ago. My neck, below the jawbone, is extremely tight, especially on the left. I asked the Dr. (Philip Gutek) if he could loosen it, & he said it`s muscle and can`t be lengthened again. Will this relax with time, and if so, how long? Is there something I can do to hurry this process? It appears to be pulling my mouth downward more all the time, and this was the problem I asked him to solve in the first place! --- Thank you.

Answer:

it will relax in time, and stretching your neck will help, just like when we were kids in gym class, just rotate and turn from side to side, front to back, and all around. It is a matter of time though. All the best. JG 3.12.11

Question:

You mentioned the traditional cheek lift with skin removal, in contrast to doing the stitch inside the mouth, etc. Does this traditional cheek lift have a name or description that I could use to explain my preference in a consultation? (And to research on the web?) Thanks!

Answer:

Just tell the person what you want to have lifted, lots of surgeons use different names, but they are for marketing purposes only.(here are variations like an S lift or a MACS lift. JG 3.8.11

Question:

Regarding mini-lift, are you saying that you consider a mid-face lift and a mini-lift that includes tissue (in addition to skin), to be virtually the same things? Thank you so much.

Answer:

yes, the problem is that a few years ago some surgeons were doing a lifting of the cheeks using incisions inside the mouth, in the temple and on the lower lid with little skin being removed. That procedure has a relatively high complication rate and I have always felt it offered no advantage to the traditional cheek lift with skin removal. For that reason you need to ask the surgeon what they mean when they use that phrase and make sure the rose is still a rose . JG 3.7.11

Question:

I haven`t asked a question for a year and a half, and now several because of current situation. I hope that`s ok, and thank you. After 2 facelifts (because in first one Gutek pulled face DOWN instead of up!), my face is narrower on the sides and jaw looks a little too tight. As time goes by, will there be natural loosening and relaxing so my face has a softer, rounder appearance? If so, how long does that usually take?

Answer:

yes, loosening of the tissues will make the lower face look rounder. Might take a year or more though. Hang in there. JG 3.7.11

Question:

Hi, Dr. Garcia, I was the one asking about lifting upper cheek area (zygomatic malar) and corners of mouth, and you suggested a mid-face lift, which sounds like a good dual solution. In addition, would a MINI LIFT accomplish something similar -- lifting upper cheeks and mouth corners? I guess a mini-lift only involves skin, so doesn`t last as long? But maybe it would work for my 2 problems? (I`m trying to go less invasive if possible, since I`ve had 2 facelifts this last year.)

Answer:

yes, I do my mid facelifts through the cheek lift incision, not intra-orally like others might do. A mini-lift should involve skin and tissue both, although some doctors might do only skin as it is easier. I always lift tissues when I do a mini-lift. Best of luck. JG 3.7.11

Question:

I was the person who said that my doctor, Philip Gutek, did (actually 2) facelifts on me after promising he could lift the corners of my mouth, then after that, said it could not be done! You said I would probably need more surgery. What type of surgery would I probably need? The neck and jawline are good -- I just need more lifting at the upper cheek area (zygomatic malar region?), and, the corners of the mouth. So, would I mainly just need lifting from the top of the ears? Would that need to involve a full facelift or could it be more limited? Thank you, thank you!

Answer:

limited to a cheek lift to lift the malar fat pad, with adequate release of the tissue near the corner of the mouth. Should be able to be done through the previous incisions. Best of luck. JG 3.6.11

Question:

The dr. who did my facelift, Phillip Gutek, promised me 5 times before the surgery that he would lift my mouth, but it is still extremely turned down at the corners. Now, he says he can`t do it! He recommended Radiesse injections in the upper cheek, which could lift the corners of my mouth. What do you recommend? Thank you!

Answer:

I believe that more surgery will be required, a filler, done in large amounts might for a short period of time lift some skin, but will not last long, if it works at all, the older one is the lesser it works. JG 3.6.11

Question:

Dr. Garcia, What would a combination lift for jowl and a submentoplasty do for the neck and jowls? Also, where would the scar be located? Would a lower facelift make small eyebags look worse? Thank you so much.

Answer:

that is really just a face lift and it should correct the jowl and the neck area, but don`t pay for two procedures as it is really just a simple facelift. What you are calling a lower facelift, which is what is called a facelift in common parlance, will not affect the eyes at all if properly done. Although in the vernacular a face is a cheek and forehead and the neck is separate, in surgical names, a facelift is a cheek and neck lift, and that should correct the issues you are concerned about. All the best. JG 3.1.11

Question:

i posted my question yesterday about my facelift that had ALOT of problems (scabs, tissue loss, extensive swelling etc.) i forgot to mention that equally upsetting was the fact that my neck bands were not corrected which was what i wanted to address the most. the ps said that it is very difficult to consistently have good outcomes with protruding neck bands. i sure have alot of scars from it and am wondering whether i should go to someone else to see if it can be corrected with more certainty.....and how difficult will it be? also, on my upper right side of face where there was a long period of swelling and bruising, i get burning twinges infrequently but while sleeping it often feels like a beard burn if i lay on that side. any ideas what this may be? thankyou again for your time, patti

Answer:

hard to say how difficult it would be without examining you but seeing a different surgeon is likely a good idea for a different viewpoint. The burning is likely due to small nerves being injured or stretched and it will not get any better after 12 months post surgery, sorry. JG 2.28.11

Question:

hi dr. garcia! i had a botched facelift five years ago (i was 56). prior to the surgery, my complexion was fair and flawless. my main concern was my neck bands. the ps did a deep plane lower facelift. after the surgery, i ended up with excessive swelling and scabbing funning down left cheek and a bulge near my mouth on right that lasted about a year.(i never had any drains) i think my skin was stretched from swelling for months and months, possibly over a year. i am left with discoloration on my left cheek along with a line of tissue loss and lots of uneveness...right side has a deep line following the original bulge line. in the last two - three years i have noticed that my compexion has changed dramatically. i now have small red spots that eventually turn into small depressions....i am wondering whether my facelift has caused accelerated aging?....this has all been traumatic to say the least. is there anything that you can recommend i do? thankyou for your time, patti

Answer:

well, if there is scabbing, that can lead to some dilated veins on the skin and on some occasions, depressions. The depressions can be remedied with fillers and YAG laser should help the dilated veins. When there is enough laxity in the skin, those areas might be able to be cut out. A facelift, even if problems should occur, should not accelerate the aging process, but parts of the face may not hold as well due to the swelling post-operatively. Sorry to hear about the problem and I wish you the best. JG 2.28.11

Question:

I am 5 mo`s post face/neck lift. The Dr. repositioned the cheek pads too high for my taste. Can the cheek pads be lowered at all? I already had broad, flat cheeks & feel that i have a bit too much cheek now?...Love the new website!

Answer:

thanks for the comments on the new website updates,as to the cheek pads, it is a major thing to undo, but I think if in a couple of months they still bother you, he can do a little syringe liposuction to reduce them a bit, can be done in the office under local anesthesia, pretty simple and might be an option. All the best. JG 2.26.11

Question:

Hi Dr. Garcia, I had a mini-facelift with (mini) neck lift done on October 1, 2010. My face looks great but unfortunately I didn`t achieve the lift in my neck that I would have liked. I`m wondering if it`s possible to have a full neck lift done after previously having surgery and if so, is there anything else to consider? I hate to think of having another surgery but my neck was really the primary reason I wanted surgery in the first place. Where are the incisions placed for a full neck lift? Is the recovery the same as what I had this past fall? Thanks so much for giving your expert advice.

Answer:

yes, you can have a full neck lift done after that. The incisions are essentially the same, just a little longer most likely. Recovery is about the same and there are no non-invasive options worth trying. Best of luck. JG 2.22.11

Question:

I wouldl like to have a facelift, but would like to know I have picked someone that really knows what they are doing, and someone I trust and feel comfortable with. The plastic surgeon I went to was voted the number one top plastic surgeon in two years in a row either in the city he is is which is Louisville, Ky. or in the state. I am not sure. How can I know for sure I have picked someone that really is good? Also he wants to do some sculptra injections on me, and I know from reading that you should pick someone that specialized in them. I know he says he does alot of them, but how can I find someone that actually specializes in them and that would be good at them?

Answer:

best way is to ask him to speak to some of his patients. Best of luck. JG 2.14.11

Question:

some drs cauterize on a facelift and some don`t-what is your opinion?

Answer:

I think when they say they do not cauterize I would question them on how they seal off the numerous small blood vessels that ooze during and after surgery, I think they are likely saying that to make them sound unique and different but doubt they actually refrain from some method of cauterization, it is likely a marketing claim only. JG 2.10.11

Question:

some drs cauterize on a facelift and some don`t-what is your opinion?

Answer:

all doctors cauterize to some extent, it would be hard to imagine that a face, which has many blood vessels, could be cut open and tissues shifted and skin removed and no cauterization done to stop the small bleeding veins. That would lead to either immediate or delayed bleeding and hematomas. So the claims that they do not cauterize are probably inflated. JG 2.9.11

Question:

I have several questions I would like to ask. First of all I would like to know what a short scar facelift consists of and why is it different than the other type considered a full facelift? Is it less complicated? I would also like to know what u think about sculptra. I went yesterday to have fillers done, but the dr. said that he thought I would benefit more from a short scar surgery to get the results I wanted. He also said that it took alot of Juvaderm to make a difference in the face, so therefore suggested sculptra. I have had Juvaderm in the past for the nasal labial fold area and was very pleased with it. He didn`t really want to use it. He said he preferred sculptra even for the nasal labial folds. He said if he put filler in that it would probably make the nasal labial folds look worse. I have been to other plastic surgeons and they say right the opposite. They don`t have a problem using fillers. I don`t know how to know which one is the best and which one to believe and trust. I would also like to know if you think sagging eyelids can benefit from fraxel. I read on the interntet that it is very good for the eye area and is used as another source for sagging skin on the upper eyelids and good for underneath also. Also I would like to know what you think of thermage for tightening the skin on the abdomen or gentle wave or infared for the skin on the face being loose. I read and and see on tv that both of these procedured are good, but whenever I ask about them at the office they act like it isn`t good. Also, I am very interested in the wrinkle release which is called surgi wire procedure for releasing the wrinkles on the forehead and the nasal labial folds. From what I read it sounds like a very good thing. What do you think honestly. Are you familiar with it at all. And are you the one who really answres these questions or do you have someone that does it. A freind of mine says I am silly to believe that you would take time to answer all these questions being you don`t profit from them as busy a man you are.

Answer:

A short scar facelift is a marketing term, used only to describe the length of the scar and not what is done. In a regular facelift, the longer scar is at times required if there is a large excess of skin, but the handling and movement of the tissues below the skin is the same as a short scar facelift. Not all people are candidates for a short scar if they have too much skin that has to be removed. Trying to use a short scars on someone with a large skin excess will leave pleats of skin or not as much of a youthful redraping of the skin as if you had all the excess skin removed. I use Scualptra quite often to replace loss of facial fat that can make a face look gaunt, lifting a face that does not have curves below will lead to a wind blown look, the youthful face has curves and using Sculptra, which would last much longer that Juvederm would re-establish those curves of youth. Once the folds get deeper, further filling can make the folds look worse, so fillers for nasolabial folds work for a while, but as you age, it is not as effective. I think the effects from any laser on eyelids is short lived as the skin is very thin and cannot be treated aggressively with a laser, the Fraxel, which is a fractional portion of skin being treated, will yield even less, it will heal quickly and while swollen you will look better, but it will not last more than a few months. I think Thermage is a total waste of time, no matter where on the body it is used. Infrared likewise will yield little. The Surgiwire is just a method of releasing the attachment of the skin to the underlying tissues, in and of itself will not correct anything unless a filler is also injected, it is just a method of opening up a space. I answer all the questions personally posted here on this site.If you have any doubt, you are welcome to come to my office and watch me and me alone type. As to benefit from me typing, I am happy to say that I get patients from all over that come to see me because of my website, so there are benefits gained.I wish you the best.JG 2.1.11

Question:

how long should a face and neck lift operation take. on my consults, I`ve been told 2-5 hrs

Answer:

I agree 2-5 hours is a usual range. JG 1.29.11

Question:

Would you be able to estimate all the work Adrienne Maloof (Real Housewives of Beverly Hills) has had done? She looks nice, but obvious she`s had a number of procedures done.

Answer:

I have to apologize but I have never seen a picture of Adrienne Maloof nor have I ever watched Real Housewives of Beverly Hills in order to say. JG 1.24.11

Question:

Hi Dr.Garcia, I love your new website design. I have a lot of fat loss as well as sagging on my face. I never went in the sun so I have no wrinkles anywhere on my face. I m 60. I read that you said the best candidate for successful facelift has lass sagging and fat loss. My other question is this: Do facelifts look more stretched and masklike in relation to how loose the skin is? It makes sense to me that the more sagging, the tighter the facelift would look in the result. Am I on the right track? I realize you can only give a general anwser because everyone has different quality of skin. is different quality skin. I have had trauma after which my face aged significantly.

Answer:

If you have lost fat and the skin has sagged you might benefit from a filler like Sculptra to regain the fullness and lift the skin a modest amount. If skin is pulled too tightly during a facelift, that can flatten the curves of the face out leaving an unnatural appearance. So it is a matter of how hard the skin is pulled, and to a much smaller amount, how much fullness you have underneath the skin. even if someone had nice full cheeks and no fat loss, if the skin is pulled too tightly, it will flatten the cheeks and look unnatural. The looser the skin is, the more skin can be removed, though. Thank you for the kind words about the updated website and I wish you all the best. JG 1.23.11

Question:

Dr. Garcia, I am 60 with a thin face and neck and very obvious jowls since there is no fat to even begin to conceal them. My neck is not wrinkled or banded. When I pull up and horizontally with my hands, I have the perfect correction. The doctor I am to consult with shows his mini or lower lifts always with a submentoplasty. Is this to secure the lower facelift ? What if you are just concerned with jowls? Thanks a lot.

Answer:

the submental procedure is to correct neck bands if the platysma muscle has split leaving visble vertical cords. If it is just the jowl, tightening or suturing the platysma muscle together is not needed. Best of luck. JG 1.15.11

Question:

Hi, Dr. Garcia. Great revisions to your site! I have consulted with 3 plastic surgeons about a secondary facelift (9 years post). My chief dilemma is my lower face and neck, especially the skin lateral to my mouth, which is beginning to drop and pool beside my mouth. All three surgeons agree that I could benefit from a revision, but they`ve also all said that this is a particularly difficult area to improve surgically. I don`t fully understand why that is so. Can you explain the problem to me and also perhaps suggest a surgical technique that could be used to address it? Have you successfully repaired this problem for patients in your own practice? Thanks so very much for your time and help.

Answer:

it is difficult because the farther one is away from the incision, the faster the problem recurrs. There is also always concern about pulling too tight on the skin to alleviate the problem and then leaving an excessively pulled appearance. I think in general, most surgeons like to underpromise because so many factors out of their hands impact the eventual outcome.In my experience it takes the tissues of the mid cheek malar area to be adequately supported to correct the underlying tissues and then the skin is draped in an oblique fashion to avoid pulling directly on the corner of the mouth. Correction is possible, but how long it lasts is more of the problem. Hope that helps and thanks for the kind review of the new website updates. JG 1.10.11

Question:

Dr. Garcia, I asked about what kind of exercises and massaging I can do post mid facelift/necklift/browlift to releave some of the tension but I forgot to ask if it is safe at almost 3 month post op. Thanks for listening.. I love your website. Better than speaking to my PS

Answer:

very safe at this point, glad I can help some. JG 19.11

Question:

Luv the new site.. I had a full FL 3 years ago, eyes, neck ect. It was a great FL, but I have a very sharp chin and while the surgeon took as much fat as possible under the chin and pulled it up; I have a `turkey waddle`that gets worse, I`m 62. is there some follow on procedure? it is just skin really and there doesn`t seem anywhere to `pull it`. THANKS

Answer:

might need a tightening of the neck with a neck lift to get a little roe pull on that area. all the best and glad you like the website update. JG 19.11

Question:

What kind of massaging and stretching exercises can I do at almost 3 months post midfacelift neck lift and browlift to releave some of the tension? Thanks

Answer:

small circles and then massaging from the center to the sides of the eneck. JG 19.11

Question:

What do you think is the average complete time of recovery from mid facelift neck lift and brow lift when you dont feel anymore discomfort! I am at day 77 and stil have discomfort under my neck. Am i being to anxious? Thanks

Answer:

maximum softening of the scar will proceed for a full year. I will say that it is unusual for it to last as long as it has for you, might suggest massage and stretching exercises to see if that helps.Best of luck. JG 19.11

Question:

I had a mini tummy tuck 10 years ago, it did not do much, certainly not for the stomach area. As my skin is quit loose i consider a complete abdominoplasty. Can the same scar be used ? In that case the skin would be tight but it should loosen up a bit in a year maybe? Other solution to avoid another scar and tighten the complete area ? There is loose skin in both directions. Thanks.

Answer:

the location of the scar will be the same but likely longer, and there is always some loosening of the skin with time, the older one is, the faster the loosening of the skin can occur too. I am afraid there are not other viable and reliable options to tighten or remove abdominal skin, sorry. JG 1.7.11

Question:

Is it normal to still have on and off swelling and tingling at Day 75 under my neck after midface/necklift/browlift? Thank you so much.

Answer:

unfortunately, yes, it can happen. JG 1.7.11

Question:

Hello, thank you for responding so quickly. Hope you dont mind several questions as I recover. I am 2 1/2 month after mid facelift and browlift. Its been rough. Is it normal to have days where I feel like its getting better than I wake up like today abd feel really tight again? My PS says he`s never heard that. I dont think I feel much better than I did 3 weeks ago. Is this normal? Thanks so much

Answer:

yes, that is normal, it ca be form scar tissue that feels looser some days, especially when your body is warmer, ad also can be from muscle spasms, as the nerves are starting to come back to life, so to speak. Unfortunately, it is going to be a matter of time thing, sorry. JG 1.5.11

Question:

Hi Dr G. My question is if one had a FL/NL and the neck loosened up a lot after a year, what kind of revision is feasible? Would it involve cutting behind ears and pulling up loose skin again or just incision under chin and removing some skin? thanks!

Answer:

likely an incision in front and in back of the ears to position the skin properly. JG 1.3.11

Question:

Not exactly a question, Dr. Garcia, but I appreciate how you name every single procedure done under your befores and afters. I called a surgeon`s office today to ask about a woman`s befores and afters. All it said on website was she had a minifacelift. Come to find out--a neck lift as well as a lot of fillers. I know it isn`t exactly false advertising but disappointing nonetheless. Thanks again for keeping it real.

Answer:

my pleasure and thank you for the kind words, all the best for the New Year. JG 1.3.11

Question:

Dr. Garcia Many years ago I saw a picture of monks who had lived practically their whole lives in some cave. The article pointed out that their sun avoidance had kept their skin smoothe -just like a babies. I also remember their faces were very chubby and childlike. I get this, but IF they had been women and had gone through menopause, wouldn`t they have shown some sagging? I know my sagging coincided with menopause. I know there are lots of factors involved, but this seems to be a very big one. I really regret not taking hormones because of this. Thanks so much.

Answer:

loss of estrogens and progesterone do allow the skin to lose some elasticity, but sun, genetics, diet, along with stress likely have a much higher influence on the aging of the skin. The estrogens would likely affect the small fine wrinkles more than loose skin. JG 12.30.10

Question:

Hi Dr. Garcia, I had a mini-face and neck lift done on October 1st. I looked great for about 6 weeks and now I`m starting to notice the cords in my neck again as well as some nose to mouth lines. I expected some relaxing as I healed but I`m very depressed that I spent this much money and went through so much to see these return so soon. My question is how soon would I be able to have a revision, particularly of the neck lift? Thanks and Merry Christmas!

Answer:

I would wait at least 6 months and preferably 12 months to let the tissues soften and become more pliable. Merry Christmas and Happy New year to you too. JG 12.26.10

Question:

Hi Dr. Garcia, Can a necklift be done without general anaesthesia? I mean can it be done with twilight and local combined rather than anaesthesia with the tube where one isn`t breathing on their own? I ve heard that there is the risk of bleeding more without the tube anaesthesia. Thank you so much and Merry Xmas :)

Answer:

it can be done that way, but the risk of bleeding is all the same, the only people that make that claim are the surgeons that do not have privileges to perform it under general anesthesia and do it in their own facility without having the ability to perform it in a licensed surgical center. A Merry Christmas to you also. JG 12.12.10

Question:

Thank you so much Dr. Garcia :)for all your answers to my questions :) Blessings to you and your fmaily for a healthy and beautiful holiday! :) p.s. (Now I understand what the meaning of neck and face :)

Answer:

you are very welcome and blessing of the season to you. JG 12.19.10

Question:

Hi Dr. Garcia, I would like to know what you call the following area of the face; Is the skin surface directly underneath the jaw / called neck or face ? I`m trying to decide whether I need a necklift or a lower face lift. Thank you. i hope you understand what I`m trying to describe. Also what is the down time for a light CO 2 procedure? For personal reasons, I can`t do both.

Answer:

neck. The problem is the term that has become used known as a facelift. In common parlance, lay people refer to everything from the forehead down to the jawline as the face and everything below as the neck. But in plastic surgery a facelift refers to a surgery that lifts the cheeks and neck and the forehead is referred to separately. So a necklift would tighten just the skin below the jaw and not change anything above the jawline, as to what a lower facelift is, there is no generally accepted definition of that as it is a term that used more by lay people. I think the easiest is just to tell the surgeon what areas bother you and they can tell you what they need to do. Many surgeons have unique names for the operations they do to make themselves sound unique. For a light CO2 laser, expect no makeup for at least 2 weeks and then fairly presentable with makeup after that. Best of luck. JG 12.18.10

Question:

In most cases, when performing a midfacelift, is it advisable to have a lower bleph too , to avoid more wrinkles under the eyes from lifting the skin ? I noticed that almost every surgeon is afraid of doing such a procedure, out of fear for problems with the lower eyelids, unless there is a bunch of skin , a lot of woman seems to have problems with this procedure, what is the rate of complications ? Does this procedure always looks unnaturally and harsh ?

Answer:

in most cases, the person has aged enough if they need a mid facelift that a lower lid skin excision is done, but not always. Many times the lower lid incision is needed to perform the mid facelift even if no skin is removed. Complication rates in the hands of the surgeons who invented the procedure are about 15%. I do not think the procedure is warranted in most patients. JG 12.12.10

Question:

What is the difference between vaser lipo and liposuction ? Are the risks and complications the same. From what i heared, woman are very satisfied with vaser lipo procedure for localiased fat loss. Thanks

Answer:

Vaser uses ultrasonic energy to melt fat to allow the fat to be more easily removed, so it carries a small risk of skin burns form the heat generated but it should not happen in experienced hands. The fat is still removed with traditional liposuction after the Vaser machine liquifies the fat. I think good results can be achieved with both in experienced hands, it is more of a surgeon`s preference. JG 12.12.10

Question:

How does hgh work for fat loss, is it because carbs will not be stored as fat ? Is it advisable not to eat for at least two hours before injecting at bedtime ? When a woman is estrogen dominant, is progesterone supplementation sufficient for skin benefits. Is it trough too much estrogen in ratio to progesterone makes woman fat ?

Answer:

I suggest you pose these questions to my associate who practices age management, his website is agelessforever.net

Question:

Hi Dr. Garcia- I`m living in the Middle East and am interested in having a facelift laser procedure. I would travel likely travel to Las Vegas for the procedure. How long would I need to stay in LV before I could travel back to the US?

Answer:

I normally have the patients here after surgery for about 2 weeks before traveling so far away, that way I know they are healing well and also look presentable in public. The blood work and EKG could be done in your home country and we could forward to you our preoperative booklet with instructions prior to your arrival to make the days before the surgery a minimum. If you wish, you could send me pictures of your face and your concerns and I can offer some suggestions. Please send them to drgarcia@lvcosmeticsurgery.com. All the best and hope to answer any questions you might have. JG 12.9.10

Question:

Hello, Dr. Garcia. About 5 years ago, I had a facelift and it has begun, of course, to sag a bit. What`s particularly bothersome to me is the reason I elected to have the surgery in the first place: a sagging modiolus (bilaterally). It looks like my mouth has jowls, with extra skin beginning to gather at the corners of my mouth. (Picture Joe Lieberman....as a 53 year old woman! LOL) Is there a particular technique that can be used to address this problem in a secondary lift? Is this a common problem that can easily be corrected or is it a notoriously difficult correction to achieve, especially on a second try? Seems like it might be hard to trim the skin sufficiently without overpulling the cheeks temporally, since the excess skin is at the bottom of a triangle by the mouth. Thank you so much for your help! You`re terrific.

Answer:

it can be a little extension of the fat pad of Bichat or excess skin, or both, in a secondary facelift, if done aggressively enough to get to that point of the cheek, it can be repaired. Arlen Specter has one too. JG 12.7.10

Question:

Hello, Is it still necessary for incisions to entend into hair-bearing scalp when performing face/neck lift in a person in their 40s without a lot of excess skin? I thought most surgeons now try to place the incisions so there is no disruption to the hairline. Does placing incision in hair-bearing scalp greatly increase the risk of hair loss.

Answer:

it all depends on their skin stretches, it can be hard to predict before the lifting and separation is done in many patients. I place the incision in front of the hair so as to not lose the natural hairline. JG 12.6.10

Question:

yep true, canthopexy did go wrong I reckon but all the surgeons think not, but when they see the pics from before they go silent... I just thought what if I get a temple lift.. will it help at all with the slant? thanksss a million

Answer:

sorry, but it will not. JG 12.5.10

Question:

hey thanks for the reply with the midfacelift .... also will the temple lift or eyebrow lift slant the eyes slightly up fromt the corners? coz I get a slant up when I slightly pull from the temples with my fingers... I really dont want canthopexy.. thats what I had already it just left me with very bad round small eyes...when I had almond eyes.. I know im only 30 but that is the case:(... thanks heaps

Answer:

the midfacelift alone will not slant your eyes long term, just short term while swollen. If you end up with a rounded eye from the canthopexy, something went wrong as that should not happen, unless you did not need the canthopexy to begin with. JG 12.5.10

Question:

with midface lift, if it`s done through inside the mouth and temples will it still give nice results? Im 30. I had cheek implants removed leaving me horrible bags. Will the skin look stretched or pleated? Will this technique also touch the eye region? coz I don`t want it to hit a nerve or anything, I don`t mind it giving me a slanted look with the eyes but no nerve or lower eyes falling problem.. Also What technique will give a slanted look to the eyes? coz my eyes went really round from previous surgery, temple lift?, eyebrow lift?..will midface lift do? thnks heaps

Answer:

it can yield a nice results if that is what you need, at your age, it certainly can be an option, but hard to say without seeing you in person. A properly done midfacelift should not leave you looking abnormal.The more they lift the greater chance you will need something done around the eye to avoid a skin pleat. If your eyes are rounded from a previous eye surgery, it will likely need a canthopexy and possibly some skin rearrangement as that happens when too much skin is removed for the original surgery. JG 12.5.10

Question:

I am 9 weeks post lowerface/neck lift after microliposuction to my neck/chin left me with no fat. It looks like I may have a small central neck deformity as I was told they need a little fat to hide the corset platysmoplasty. I look greatly improved, but was wondering if alloderm could be placed above the platysma to soften the look of the harsh neck?.. Thanks in advance.

Answer:

yes, that can be done, best of luck. JG 12.5.10

Question:

Hi Dr G: I had FL/NL/chin implant 4 months ago. Am pretty pleased with results but area behind scar under chin is sagging a bit and i have 2 ridges running down neck. I had terribly loose neck skin pre-op fyi. Doc says he will know by 6 months if he can do minor revision on neck area. Says he will do a zig zag sort of incision into neck which won`t be very visible to pinch loose skin. I had SMAS and not deep plane as he doesn`t feel risk is worth it but acknowledged that often it requires this kind of fix. I expect I`ll need this. Does this sound ok to you?

Answer:

yes, in some cases there is a need for touch ups and I do not think a deep plane lift would have avoided this problem. JG 12.7.10

Question:

Hi dr. Garcia, Can i send you some pictures, regarding a facelift, before and afters and ask you for advice what is the best thing to do , redo the lift or continue mwith fillers. Thanks for letting me know.

Answer:

certainly, you can send them to drgarcia@lvcosmeticsurgery.com

Question:

Dr. Garcia...my top lip droops ever so slightly. In fact, if I take the top of a pencil eraser an press it under my nose gently, it lifts the lip to the point where when I smile, the bottom of my front teeth show. Side view pictures of myself reflect a flat and long upper lip. My question is : Can a lip lift be performed by making an incision inside each nostril and gently lifting? Thank you for your help. 11.30.10

Answer:

yes it can. JG 12.1.10

Question:

Regarding the hgh, due to severe stress last 3 years i have been diagnosed ghg deficient among others, i was in a catabolic state for several times, leading to muscle loss, bone loss, sagging skin. Under doctors supervision i took very low dose of hgh and after two months on extremely low dose, going up a bit, i suddenly expirienced a tremendous hunger , a lot of sleep and at the same time all the lost muscles came back, so that makes me gain weight of course, no fat loss yet, as i would like. I read on several forums (thats the place where you have to look to find more information then what is been told in books, press etc...) and it seems more woman have experienced the same isuue with hgh, hunger, weight gain and then after more time the fat loss starts. Also a lot of people also men, stated they have tremendous benefits of skin tightening with hgh. Just don�t give up after two months, it can take more then one year , till two years for the skin to tighten up. By the way, what is the right amount of hgh for someone, you can be in the lower of higher range, mine was even under the lowest for my age. If i take it untill being at the highest value for my age, is this considered bad ?

Answer:

the is no universal right amount, the dose need to be customized for each person, women take larger doses than men do, but in 12 years of treating patients with adult onset growth hormone deficiency, I have never seen what you describe happen, sorry. JG 11.30.10

Question:

Hi dr. Garcia, I noticed that injecting hgh makes me extremely hungry, cravings for carbs and sugar. Unable to resist. I tought hgh would help to loose fat, it seems the opposite is trough as the hunger is uncontrolable. Do i need hydrocortisone and insulin to make these stressed out symptoms disappaear. Also it seems i developed hypervolemia, high blood volume. Thanks for advice.

Answer:

I have never heard nor seen, and there is no physiological reason for the cravings. Using HGH to lose fat is an improper thing to do, people that are deficient in HGH and then replace their low levels to normal levels will be able to lose fat more easily if they diet and exercise, but normal levels of HGH that are raised by taking more exogenous HGH when not needed will only lead to fluid retention and not fat loss.I think you need to see a physician to help you regulate these issues, I trust you have not being trying to treat yourself with these medications on your own without a physician supervising and prescribing them for you. JG 11.29.10

Question:

Why does testosterone promote fat loss in deficient man, what if a woman is seriously testosterone deficient ? Does hgh metabolise carbs ? It seems to be the case ?

Answer:

in men it does as the testosterone helps the insulin work better, in females it is the estrogens that do that. Supplementing testosterone in a woman will not affect her insulin sensitivity or weight loss. HGH does not metabolize carbs, it modulates growth and cell repair. JG 11.19.10

Question:

Why does hgh causes fat loss ? Is it nessesary to combine hgh with a high protein diet ? Is there need for carb restriction, meaning carbs like bread, rice, pasta ? would that restrict the fat loss ?

Answer:

alone it will not cause fat loss, combined with a good diet and exercise you need to keep the muscle and lose the fat. I think anyone trying to lose fat should restrict carbs to only complex carbs. JG 11.19.10

Question:

Two months ago i had botox around my eyes, also fillers below and at the eyebrow, one eye is very different then the other, i tought it could be from the botox, but after two months i don�t think that could dtill be the case, as the doctor used restylane on the eyebrows, also near the eyes, could thsi be nerve damage from injecting too deep in this fragile area ? It is not getting any better. Is there another nerve involved as i also had injections on the checckbones, cheecks and near nose. Thanks for clarification

Answer:

without seeing you it is hard to say but I have not seen a filler injection or a Botox injection cause the nerve injury. If too much filler was injected, a rare case, it could cause the eyebrow to droop. More likely it is the Botox that has weakened the muscle due to location of injection and migration of the medication and that should weer off in time, but it can take 3-6 months, depending on how much was injected. The Botox is a likely culprit of causing the problem if what you are having is weakening of the lower lid after an injection there, that is why it is not approved for use on the eyelids. Best of luck. JG 11.18.10

Question:

Injecting fillers in my face is defenetely not the solution for lax skin in the midface. My face and jawline are grotesk now with lack of definition and my own contours are completely gone. A bit of filler could be ok, if the loose skin was gone. Is it really nessesary to let dissolve all the filler before a redo facelift, that would mean waiting more then one year ? Is there a possibility that you can dissolve the fillers before the redo ? and in case that it is needed, place a tiny bit after a correction facelift ? I don.t think i lost much of the underlying tissue, it is more subcutanous fat that is gone, the fat under the skin, muscles and bones are fine. Thanks for advice.

Answer:

well, a repeat facelift can be done but if any attention is paid to lifting the tissues below the skin versus just the skin alone, then not waiting for the fillers to dissolve can make the end result less than desired because as the filler dissolves the repositioning of the tissues will be potentially inaccurate. Dissolving the fillers depends greatly on how much filler is there. Not sure what you are trying to change with repeat surgery if the skin is already tight as moving muscle is not practical and changing bones is not a facelift, the reshaping depends almost entirely on the movement of subcutaneous fat, and if that is gone, there is not much to move then. JG 11.17.10

Question:

To have a midfacelift only, with skin removal under the eyes, can this be done endoscoppically, without skin dissection from the underlying tissues, meaning no scars near the ears and above like with complete facelifts or macslifts ? What if one only needs an elevated midface, how is this done ?

Answer:

in some cases, yes, but there might be pleated skin if enough tissue is repositioned. In cases where no skin needs to be removed, it can be done endoscopically and through the mouth, but those are rare cases. JG 11.13.10

Question:

How long after fillers can a facelift be redone ? As the fillers are placed different amounts on both sides to correct a previously done assymetrical facelift, do the fillers have to be out completely to redo the lift in order to adress the skin properly and avoid new assy,etry. What about sculptra, is this the same issue, as sculptra stays in the face for 2 years, maybe longer ? Does the injection of sculptra or HA fillers create a permanent different contour due to the stimulation of collagene or fibrotic tissue ? Can the HA filler be removed during a redo facelift ? It seems my face has more volume from the HA fillers then just the amount that was injected, why when there is no swelling any more ?

Answer:

I think after 4-6 weeks is OK. Most faces are not even so injecting more on one side versus another is common. I think it is best to let the filler dissolve before more surgery, yes. With Sculptra I think you would not need to wait as it works on a different level. Neither filler type will cause a permanent anything, sorry. It would be difficult to remove HA fillers during the surgery. I cannot say why the injected side is larger in terms of what was injected and what you see. Best of luck. JG 11.13.10

Question:

I noticed by injecting hgh in belly fat for some weeks, all of the fat there is gone completely, would it be ok to inject in other fat areas of the body, like stomach, tigh fat, arm fat ... any other place where there is fat ? Thanks

Answer:

yes, you can inject anywhere in the subcutaneous tissues. JG 11.13.10

Question:

Regarding the hgh. Was just asking the question if it could be used alone. I have other hormone supplements but according to my lab test some of these went up like testosterone but i don.t want it to go up too much, i am not a body builder, i am a female and don.t want to bulk up. I take dhea and thyroid amour as well. All under docters supervision. Started the hgh very low does to get used to it so not much benefits yet as i am under severe stress i consume a lot of hgh. I see the difference in the morning when i wake up, my skin seems nice and better, during the day from all the stress it is going down again. The docter does not want to give me cortisone for my stress as he thinks this will be to dangerous, bad for the skin, causing weight gain, etc... Female hormones are not right either but he wants to wait to see how i respond on the hgh first before adding more. I have a strange issue, i have wrinkled skin but when i pinch it it snaps back immedialtely, just lack a small subcutenous fat layer all over. What hormone could this be i am lacking ? Estrogen , progesterone ? My vitamins seems to be ok, some of them are high like vitamine E and omega 6 even too high altough i don�t supplement them. Other issue when i drink a lot of water i swell up . could this be due to caproic acid ? value 0.0 seems to have something to do with water balance ? Thanks for advice

Answer:

it can be used alone. I agree in trying to avoid the cortisone as much as possible. I think balancing your female hormones would take precedence over the HGH though. Female hormones are more difficult to balance but they should be fixed first. There is no hormone that will rebuild lost subcutaneous fat, sorry. Not sure what is going on with your water intake and welling though. All the best. JG 11.13.10

Question:

I was euthyroid according to my first lab tests, only the conversion from t3 to t4 was not sufficient. So they gave me thyroid medication amoour, now 2 months later i developed subclinical hyperthyoid, do i lower the dose of amout thyroid or just stop it all. I had some rapid heartbeat when i took 2 grains, so i cut it down to 1.5, , maybe i should lower to 1 grain ? Does the hyperthyroid goes into hypo when stopping medication ?

Answer:

lower it first to 1 grain and ses how it goes. Hyper does not turn into hypo like that. JG 11.12.10

Question:

dr. Garcia, ragarding the previous question about the huch amount of filler, it is injected because of a too tight facelift that flattened my face, the skin is too tight in certain areas and by injecting the filler trying to create my former facial shape, it is now even tighter then before making movemnets more difficult. As the facelift relaxed a bit over the past 3 years , the midface is sagging and by filling up the complete face, it makes my face bigger, puffier, tighter, and heavier, so basically, without the fillers i have a face with sagging in the midface,and the sides pulled up. Now the sides are a bit (not completely) like before the lift but the midface is hanging down, as it has too much skin in the middle. By filling that up and the sides also, well much too big. Do you think it is better to redo the complete facelift, including midface to get rid of the lax skin in the midface ? Instead of doing the fillers. My jawline is too wide now. Also i have kind of pixie ears which came up when the lift relaxed a bit. Is this a normal disturbance ? is it possible to do an isolated lower facelift and a midfacelift , skin only, i don´t see a reason to adress the underlying tissues now, as i pull up the midface, there is too much skin under my eyes, how can this be corrected. How long to wait for a redo with the fillers ? I don´t like the fulness , it is a skin issue, not much a volume issue.

Answer:

if there is enough tissue below the skin that can be lifted to give you a more natural appearance, surgery would be preferable. The pixie ears come from too much tension from excess skin being removed in that area, that can also be revised with surgery to round them out. If it is only skin that is loose, then that alone should be lifted, as to the skin of the lower eyelids, if it is in excess, than cutting some out there migth help. As to redoing the fillers, that is a matter of when they dissolve. If it is a skin issue alone, then the filler is not the answer. All the best. JG 11.12.10

Question:

Dr. Garcia, When injecting a lot of HA fillers , which are making the areas bigger and fuller, do they gradually leave, menaing that if the full amount would be gone in 10 months , does half of the volume will be gone in 5 months. Does the skin which was streched by the fillers, regain its original size or will it stay always a bit streched, in case that the skin was already tight before the injection. Thanks

Answer:

approximately, but not exactly. If you are having so much filler that the skin is stretched, it is being injected improperly, it should only be injected to achieve the prior skin volume. Not sure why they would inject an area that was tight. JG 11.12.10

Question:

Hi Dr. Garcia, I`m 6 weeks tomorrow post mini-facelift and necklift. While I`m healing well and pleased with my results, I still have some swelling along the sides of my face bilaterally, more so in the lower face. My husband says that no one notices it as much as I do but I thought by now the swelling would be gone. Is it normal to still have some swelling at 6 weeks postop? How long should this continue? Is there anything I can do to haste the resolution of the sweling? Thanks so much!

Answer:

yes, still normal I am afraid, it will continue to get better, albeit slowly. There will be subtle difference in the swelling for another 4-8 weeks in some people. I am afraid all you can do is a little massage and time, all the best. JG 11.11.10

Question:

What do you think of the valentine lift? The one that removes a small amount of skin at the corners of the mouth to take away the sad look?

Answer:

OK to do, but you will have visible scars there that will likely need make up to cover. JG 11.9.10

Question:

Is there a way to reduce muscle in the overall body and face without having sagging skin.

Answer:

not that I am aware of. JG 11.8.10

Question:

Is saging skin from smoking reversable after you stop the bad habit. Will the mouth lines go away in time.

Answer:

nope, you bought them, unless you do surgery or lasers or fillers. JG 11.8.10

Question:

Hi again, I just asked you about if an necklift is done with an incision under the chin, did an incision have to made behind the ear? I should have said not just behind the ear, but cross over into the hairline? Would it depend on how much skin has to be removed? Thanks

Answer:

correct, the more skin that has to be removed, the longer the scar will be, otherwise you get pleats. JG 11.8.10

Question:

If a patient has a necklift, do incisions have to be made behind the ear, in addition to incision under chin? Or can the incision just be made in front of the ear? I appreciate your help.

Answer:

the only time that would not be needed behind the ear is if no skin is needed to be removed a rare circumstance. The incision in front of the ear alone will limit how the skin can be redraped in most cases. So it is likely a little in front and a little in back. JG 11.8.10

Question:

Hi Dr. Garcia, I hope you are having a good weekend! I am 5 weeks post mini-face and neck lift. Things are healing well but I`m having difficulty hiding the scars in the temple area and under my chin. I use concealer but the scars are still obvious. The scar under my chin is very red and the scars in the temple area almost appear brownish. Is there anything I can do to hasten their fading? Is it too early to use a hydroquinone product to bleach them or something else? Thanks so much for taking your time to answer this question.

Answer:

I think the efffect with hydroquinone at this point on the brown scars is small and it will not do anything for the red. I might suggest either Mederma or Scarguard until time passes. All the best. JG 11.7.10

Question:

Why does thre exist the possibility to get artritis or joint problems when taking hgh. Do these symtoms occur due to high doses and after how much time ? Is this condition reversable ?

Answer:

never seen nor read about you getting arthritis from taking HGH. JG 11.6.10

Question:

In addition to the neck lift, is there a specific lift (i.e. MACs, SMAS, etc.) that would be appropriate for the lower face? I`m not sure what the differences are between the lifts , but I`ve never seen any surgeon discuss customizing a lift procedure specifically for a patient. It seems they usually recommend the lift they are most comfortable doing... Thanks again.

Answer:

if your description of the lower face lift is cheeks and neck, my preference is a SMAS facelift. At our national meeting we have repeatedly seen that no matter what technique is used, at one year they all look about the same. The use of the names and new and improved procedures, in most cases, are more marketing than a large improvement. JG 11.6.10

Question:

There is vertical banding that would require a platsymaplasty. However, I don`t see sagging in the cheek area yet. I can see the beginning of some lower face sagging, but not much. Most surgeons have said that tightening the bands alone would not be the answer. Is there a lift designed to address the bands and lower face only?

Answer:

that would be a neck lift, which is the bottom part of a facelift, but that would not help the loose skin in the jowl region. Tightening the bands is needed, but then the skin also has to be pulled tighter and some removed. JG 11.5.10

Question:

So should the skin be atttached firmly to the muscle following a Platysmaplasty? Is a SMAS lift with a platysmaplasty a good facelift for someone 48 years old, thin (no fat), with the primary concern being vertical neck bands? Do you perform SMAS lifts on your patients or are there other lifts you use? Thanks again.

Answer:

it always is for a brief period of time, but if you pull on the skin of a young person, the skin is seperate form the muscle, they are loosely attached at best. If the tissues of the cheeks have dropped, then the SMAS might be a good idea, if there is no tissue that has fallen except the skin, then the SMAS might not be needed. If there are bands of the platysma muscle, then tightening those bands would be a good idea. JG 11.5.10

Question:

In regards to a face/neck lift - some surgeons recommend a SMAS (or similar procedure) with incisions going from the front of the ears, down and around the back of the ear. Some surgeons say they only need to place the incision from the top front of the ear, follow the natural crease down the ear and extend the incision only half way up the back of the ear. Other surgeons say they need to extend the incision all the way up the back of ear and extend it out along the hairline. Why do some plastic surgeons need to extend the incision all the way up the back of ear and along the hairline? Also, is the SMAS with Platsymasplasty with the incision extended approximately 1/2 way up the back of ear a reasonable approached for a neck/facelift? Finally, should someone who has undergone a SMAS/platsymaplasty feel tightness in their neck/throat for a period of time following the procdure and if they don`t have a tight feel to their neck, does that mean the platsymaplasty procedure was not stitched tight enough ? I hope this makes sense. Thanks in advance.

Answer:

the length of the incision has nothing at all to do with what we due to the tissues below the skin, whether SMAS or platysma, the length of the incision depends on how much skin you need to remove from the patient. A shorter incision, by definition, removes less skin, while a longer incision removes more skin. Think of a pleat on a skirt or shirt. If one attempts to cut less skin, there can be pleats of skin left and then the surgeon and patient can hope they will flaten out in time, maybe they do, maybe they don`t. The tight feeling relates more to the amount of attachment of the muscle to the skin, although tightening the muscle itself does feel snug, but that lasts for much less time. If the skin is attached firmly to the muscle, which is not the way skin was before the surgery, then it will feel tight for a longer period of time. Time and massaage will help that all go away. All the best. JG 11.5.10

Question:

Is the tickness that you get from filler , the same as the tickness of the gel after injecting, meaning 1cc in the cheeck is that the amount that tickens the area. Is that the result that stays after the swelling is gone ? Thanks again

Answer:

essentially, yes. JG 11.4.10

Question:

Is it possible to have headaches from botox in between the eyebrows, even after 4 weeks.

Answer:

I have not seen that occur. JG 11.4.10

Question:

What would be the best solution for an assymetrical done macslift, skin lifted in a different way, one side tighter and higher ? The other side looks better. What would be your solution for this ? Thanka so much for you wonderfull advice you give to woman , seems many have issues with cosmetic procedures. Do ypou ever have problems with your patients, you seem to know so much and it is like nothing can go wrong in your hands.

Answer:

migth need to let it relax because once the skin is removed, it cannot be replaced, the only option right now is to lift the good side higher and tighter, not likely what you want. I also have issues with results at times with my patients, maybe 2-3%, it happens to all of us, but it is good to keep communication open and if the issues are seen and agreed upon, most surgeons will strive to make it better, if at all possible. Best of luck. JG 11.2.10

Question:

How long does juvederm in the nose tip lasts ? Last time it was out in 7 months, now it seems to stay there forever ?

Answer:

varies, 2-10 months. Might have developed some scar tissue that fills the spot in. JG 11.1.10

Question:

When do fillers start to reduce ? Do they dissolve gradually, from what point of time would i notice this ?

Answer:

it depends on the filler used and the area, no way to make a general statement on it. JG 11.1.10

Question:

What makes woman store more overal fat (especially at the tighs ? Lack of Estrogen or progesteron ?

Answer:

genetics and low levels of localized epinephrine, that is what helps mobilize the fat.

Question:

What is the longetivity of restylane vittal light ? Seems that even after one session (several weeks ago) the area on the face where done is very full, I thought it had to be done three times to have some effect, seems that once is enough? Hope the skin will not stay streched as it attracts water too. Seems the skin is more hydrated but much too full either like all the other restylane injections. Feels spongy.

Answer:

maybe 6-12 weeks, depends where it is placed. Once is enough if enough of the filler is injected. JG 11.1.10

Question:

How long will HA fillers like restylane continue to attrct water ? Is it as long as the filler (I can feel the gel under my skin) is there ? When the gel is dissolved, does the area still continue to attract water ? Thanks

Answer:

they are done attracting after a few hours, up to 24 hours. Once it has filled up, it stops and does not attract any more. JG 11.1.10

Question:

What age do you usually performe a facelift?

Answer:

there is no age as everyone ages differently and when they begin to be concerned about the changes associated with aging. JG 11.1.10

Question:

Is the effect of a more plump skin while using hgh due to the water retention. It seems to make my face and body havier, at leat that what is what others are noticing. I increased a size in cloths instead of losing. Also more cravings for carbs. I thought it would be the opposite from what i experience. How long to get benefits out of it, 6 months, one year ?

Answer:

skin changes mostly due to water, yes. I have never seen it increase body fluid as much as you are describng though. Benefits will max out after about one year and then what it does is help maintain. I do not think it will decrease or increase cravings for carbs though. JG 10.31.10

Question:

Dr. Garcia, How long after a facelift should a person wait to have fillers done in tear troughs, around chin, etc? What do you think is the best filler for tear troughs in someone who has thin skin? Thanks much, you are so good to help so many. kp

Answer:

at least 6 weeks, if not a little more. I prefer Restylane for the tear troughs. All the best and thanks for the kind words. JG 10.29.10

Question:

how long does the fluid retention from hgh last ? Can it be prevented by lowering the dose ? Is it reversable ? Seems my fingers became ticker ? My whole body in fact probably by fluid retention? Does a diuretic helps with that ?

Answer:

if you stop the HGH it should go away in a few days, at least enough to alleviate most symptoms. Then when you restart, you start at a lower dose and work your way up once your body becomes accustomed to the lower dose and then increase slowly over time, doing it that way usually will avoid the swelling issues. A diurectic will help some yes. JG 10.28.10

Question:

Is it possible that after 2 months of growth hormone injections once a day dose of 0.1 ml i have side effects like artritis in fingers, bigger head ? Swollen pot belly ? Or is it just imagination and not possible.

Answer:

pain in finegrs cna be form th fluid retention, a pot belly not likely and a larger head would take years at high doses and it would be mostly jaw bone growth. JG 10.28.10

Question:

Thanks for the person for the information anout the subq in teh cheecks. I had much more filler in my face, cheeckbones, near nose, cheecks itself, nose to mouthlines, ... So everything is puffed up, with bags, swollen undereyes, .. Dr. Garcia, when you say to wait it out, how long do you mean, the time of the filler to dissolve, meaning 2 years ? As you stated , maybe the malar bags will not improve, in that case what can be done ? The surgeon who performed this procedure noticed that maybe i aged that much in this timeframe, creating these malar bags ? Maybe they were there but not noticable ? As i probably have to redo the facelift in one way or another, making everything loose , underlying tissues etc... would this orrect the malar bags ? How long to wait to do this after the fillers ? Thanks as always for your insight.

Answer:

the length of time a filler will last varies, and is influenced by the degree of motion in the area, the more motion, the faster it dissolves. If the malar bags do not improve, although many things have been tried, from small needle liposuction to lasers to radiofrequency skin heating to steroid injections, all of that remains unpredictable. There are ocassions where the malar bag or festoon has to be surgically removed, leaving a curved scar permanently on the cheek. In most cases, when a large volume of fillers is going to be used, the physician will take photographs, you might want to ask if they were taken so you can look back to see if the malar bags were already there and have just gotten worse due to temporary swelling. It would be unusual for you to go from no malar bags to new bags in just a year or two. Malar bags are typically not corrected during a facelift and can actually get more swollen after the facelift for awhile. As to the facelift and the fillers, I would wait as long as you can tolerate it to allow things to get as small as they will and allow the surgeon more control over what they will do with the facelift and the tissues that remain at that point. I wish you all the best. JG 10.27.10

Question:

I`m planning on getting a cheek lift and co2 performed. Which one goes first and how long should I wait

Answer:

laser second, wait at least 6 weeks. JG 10.27.10

Question:

Hello Dr. Garcia, I am 3 1/2 weeks post mini-facelift and neck lift. While I`m healing well, I still have what I consider a lot of swelling in my cheeks bilerally, as well as numbness and pulling sensation in that area. I was wondering what you thought about facial lymph drainage massage to help relieve facial swelling after facelift surgery and how long will the numbness last? Thanks so much for this wonderful website!

Answer:

I think it is a good option. As to the numbness, it should start getting better after about 6 weeks and continue after that for months. All the best and thanks for the kind words. JG 10.27.10

Question:

If the malar bags and swollen undereye do not disapear after 6 weeks since the restylane sub q was injected, what would be the solution for removing this issue. Does the fluid need to be drained out with a needle ? Thanks

Answer:

I woudl wait it out, after 6 weeks there is no sense in attmepting to dissolve the Restylane SubQ as any fluid it attracted is already in the filler, there is no way to remove te fluid with a needle, will likley just have to wait it out. JG 10.26.10

Question:

How long is retylane moveble under the skin after the injection time? I can still deplace small parts of the filler ? Is it not going to stay at a certain area at some point of time even when massaged hard or pressed ?

Answer:

it can be flattened for maybe a day is about all, it really cannot be moved to areas around it to any great degree once placed. JG 10.25.10

Question:

The shape of my eyes looks so much better without the botox, only more wrinkles aroung them. Is it possible to place botox, without distorting the shape and correct the wrinkles. I look more angry and droopier eyes.

Answer:

the look is controlled by where the injector places it, sounds like they have put too much in certain places. JG 10.25.10

Question:

How long does droopy eye . one side, from botox lasts. Anything that can be done to speed the process. Is it possible that when botox placed under the eye corner, more like a mesobotox, makes one eye more deep and smaller then the other one, when not done symetrically or placed maybe more or different on one side then the other. When does this wear off. Does it takes the full 5 to 6 months before it is out.

Answer:

it can last a few weeks to a couple of months, the Botox to the lower eyelid can cause that appearance, yes. That can take up to a few months also to go away. JG 10.25.10

Question:

What is the maximum amount of years sculptra stays in the skin, is the effect permanent, does it ever leave completely. Like when you have recountoured your face , does it ever go back to its previous state, after what amount of time. Is sculptra a calcium based product ? Thanks for you info.

Answer:

it last no more than 2 years I feel, it is not permanent, it does leave completely. Sculptra does not have calcium. JG 10.24.10

Question:

Hi I`m 30 and I am considering a midface lift. I`ve already seen my ps and he`s been evaluating and assessing so yep I will be getting it done soon. I know 30? well I had bad luck with fillers and cheek removal leaving me a pocket on each side of my face dragging down. I`ve shown photos of me only few years ago to the ps`s to get other opinions well they were shocked to see the difference and they`ve also decided adviced me to go through as it will help me with my so called mental stage . I have line going down from each nostril and saggy cheeks. I look deformed, honestly speaking. I used to be stopped and asked to do modelling and now people look at me in the weirdest way. I know too much info...:) My concern is I don`t want the strectched look so to speak. Why do most women get this streched look? and some looks natural? I was reading on David Rosenberg and he explains this ways of doing a lift where it leaves patients looking so natural. Can you tell me what the procedure is that leaves patients with stretched look?just so I can eliminate that method? and plsss tell me the procedure for the natural look: ? ...... another question is after filler and removing cheek implants and having this problem(saggy face) can I have that sculpture thing done instead of a facelift? or could u also advice me of the name of that natural facelift too pls?== I don`t want a strectched thinned out face, boney..noo... PLS help

Answer:

the stretched look comes from over tightening of the lift by the surgeon that can cause flattening of the normal curves of the face. It is not a method issue, it is a surgeon issue, any procedure performed unskillfully will look unnatural. The best procedure of a natural look is a surgeon that knows what he or she is doing. There is no reason why Sculptra could not be done. Best of luck. JG 10.24.10

Question:

What is your opinion on Stem Cell Facelift?

Answer:

glorified fat injectiosn that have no evidence that there are actually any beter than old fashioned fat injections, but hype sells. JG 10.23.10

Question:

I have a few subcutaneous small lumps from sculptra in the past, One is a bit vilible, the other not. Is it possible that these lumps grow in the future, it seems that they are not getting smaller after 1.5 year , i have the slight impression they are bigger , will they eventually absorb with time, seems like a buildup of the product that was not well spread or massaged. Thanks

Answer:

doubtful they will grow any bigger this far out unless they are in the lips, where the muscle can push residual material together. I think if they have formed a granuloma, which is what appears to have happened in your case, they will not disappear on their own. JG 10.20.10

Question:

Why do people look better when taking hgh _ What is the benefit, why do they look younger

Answer:

the appearance can be form many different things, the skin being more plump, they sleep better, they have less body fat, etc. JG 10.20.10

Question:

Hello Dr. Garcia :) What is your opinion of Biafine, Topical Emulsion? Thank you in advance.

Answer:

I am sorry but I have never used it on a wound. JG 10.19.10

Question:

I HAD A NECKLIFT AND MY NECK UNDER MY CHIN LOOKS TERRIBLE. THERE IS LOOSE SKIN HANGING. THE DR. SAID SHE WOULD CORRECT FOR FREE WITH A 2500.OO O.R. FEE. THAT`S NOT FREE ! WHAT CAN I DO ?

Answer:

not much besides more surgery, I would assume the fees are to cover operating room and anesthesia fees. JG 10.18.10

Question:

I HAD A NECKLIFT I YEAR AGO AND MY NECK LOOKS TERRIBLE. THE SKIN IS HANGING LOOSE. I HAVEN`T LOST OR GAINED WEIGHT.THE DR. SAID SHE WOULD CORRECT IT FOR FREE WITH A 2500.00 O.R. FEE. THAT`S NOT FREE! WHAT SHOULD I DO? THANKS, LINDA COFFMAN

Answer:

not really usre what options exist besides more surgery. I would assume the fees he is charging you are for the operatiig room and anesthesia costs. JG 10.18.10

Question:

dr. Gracia, do you mean that it is not possible to dissolve all of the restylane if i opted for that . How much could be dissolved ? Does it take mutltople treatments to dissolve ? How much does 1 cc of restylane thickens the face when injected at ex. nose to mouth lines, does this pushing the tissues op like for 0.5 mm. My face is very big and puffy after all those injections and quantities, it appears much to big for my body, What would be the best solution, i can not stay like this for over a year or more.

Answer:

it should able to be done, yes. In many cases, depending on how much was injected and over what area, it will take multiple sessions to dissolve it. There is no way to tell how much 1cc will elevate a particular area, sorry. Might need to have it dissolved with hyaluronidase. Best of luck. JG 10.17.10

Question:

Hi Dr. Garcia, I am 2 weeks post mini-facelift with lower lid bleph. I`m the one who had the small hematoma next to my right cheek, which is resolving slowly but surely. I still have some swelling in the cheek area and some bruising under each eye, sort of like a football bruise there. I have been using warm, moist packs on my cheeks and lower lids carefully to speed the healing but wonder if this contributing to the swelling? Is there anything I can do (short of heavy duty concealer) to hasten resolution of the bruising under my eyes. I have to return to work on Monday. Thanks so much for your time.

Answer:

I do not think the wram most heat is making it worse, it is just going to take time, everyone absorbs the blood at different speeds. I think ultrasound massage helps, we do it on all of our facelift patients, but it will not work by Monday I am afriad, sounds like concealer for now, sorry. JG 10.15.10

Question:

with the macslift i had, my face is now more squared instead of oval shape, no chin definition, havy bottom face, shortened, havy fat looking underchin, the jawline is puched upwards, the fulness instead of being at the jawline is above it jawbone definition gone, more bags around mouth more like big lumps, flettened sides, the more they are filled with fillers, the mor it pushes up vertically, and shortenes even more my face, i have the appearnace of loose skin which is actually not, but all comming from the lift creating folds and lines, bunching cheecks in the midface, with flattened glued sides. No surgean dare to isk to make everything loose and don´t know how to correct this issue. What would you do, are the fillers that they inject making things worse ? They try to put it between the skin and the underlying tissue, after the swelling, it gets flat again immediately, as the skin seems to be glued , nothing can get in between . Desperately want a normal face again when moving it or try to smile

Answer:

I think the best option is to undo the sutures that are holding the MACS and see if the tissues will regain a more normal shape. JG 10.15.10

Question:

sorry dr garcia, other question about HA fillers, is it normal your face feels jelly and mushy after the fillers, how long does this last, it feels completely differnt comparing to sculptra that i was used to in the past. I am cerfull now with sculptra as it does not leave fast if placed wrong and makes collagene or fibrosis and very difficult to get rid off. What do you think of restylane vittal for fine lines ? I had it around mouth and jaw area and it feels mushy. The areas were i had sculptra in the past are very smooth compared to the other areas of my face. thanks again

Answer:

I could see if large amounts of fillers are placed that it could feel jelly like for a short period of time. With Sculptra, since the diluent is absorbed in a few days, they are totally different in how they feel. I think the thinner Restylane is a good choice for the fine lines, but does not last very long. Hard to imagine that such a large amount of that product could have been injected to the fine lines to cause the jelly feeling. JG 10.14.10

Question:

dr. Garcia, I mistakenly asked you about the amount of restylane, it seems not to be CC but ML (mili leters) Is this the same, does 1 cc corresponds with 1 ml.

Answer:

yes, it is the same. JG 10.14.10

Question:

Hi dr. garcia, One month ago i had lip filler, a bit before the other restylane fillers in my face. Now today i went back to the dermatologist for touch ups my lips, he was very surprised, almost all gone, i really have the slight impression that sonce the chelation therapy with EDTA (removes calcium out of the blood and put it back into places were it belongs like the bones) also fillers leave in a record time. Normally i have lips done for at least four months , now one month almost gone. Also fibrosis improves a lot, the chelation is rapidely moving everthing for at least two days in your body, improving metabolism, you feel it running in your body for two days before it slows down. So maybe it could be that fillers disolve in quick time. When i have a cut, or wound and i do a chelation, it heals much quicker, normally it could take weeks for me to heal from a bruise or wound, now it takes a few days for the bruide to leave, i had bruises from fillers in the past , staying colored for months, now three days, gone... Also eyesight improves after two days following chelation, hair growth and nails also, teeth get stronger, .. Is all this possible with the chelation . Do you think i could get rid of teh scar tissue from the facelift a had ? other fibrosis from fillers , would sculptra residue improve, still have a lump under the skin from sculptra two years ago. Do fillers have some kind of calcium like substance ? I don´t understand, it must be something like that, otherwise no way to leave that fast. Three more sessions and probalby most of it is gone. I also take amour thyroid, also improving metabolism, could this also be due to this substitution ? Seems everything is growing and acting faster. Thanks for you insight. please let me know if fillers like restylane or perlane act like calcium substances or similar ? If so i wait for the redo of my lips untill i finish my chelation therapy.

Answer:

I do not think the chelation will have any positive effect on the scar tissue from your facelift. I have never heard of chelation affecting the longevity of fillers that I had heard or read of. If you are taking thyroid medication to bring you back to normal, I do not see how that would negatively impact the fillers either. I do not think Restylane or Perlane would be affected through a calcium link. If you feel there is a correlation, it certainly makes sense for you to wait for the chelation to be over. JG 10.14.10

Question:

Is the amount of 2cc restylane subq much, does it give a lot of volume such a quantity, what will stay from the 2cc ? I had 2cc on each checckbone, 1 cc under each checck, and 1 cc on each side of the jawline. The hollows where filled in with normal restylane ? I have the impression that my whole facial skin is streched, hope it will come back as i have bad skin elasticity.

Answer:

the 2cc will stay until it dissolves, small amounts will slowly dissolve over time. JG 10.14.10

Question:

Hi dr. Garcia, After some sessions of restylane subq and restylane on my face, my face seems to big for my body, it is 4 weeks ago, still appears puffy, but as the face has been widened at the cheeckbone area and the jawline bones plus the midface it is not very nice such a big face. Will it go down a bit more like when i have restylane on my lips, it is much less after 4 weeks, like almost nothing left. Will my face size come back to were it was before ? What about the skin, will it come back also ? As you said restylane subq takes years to dissolve ... I only had like 4 times 2cc of subq, and 6 x 1cc of normal restylane to fill in some contours. When will it start to improve ? Thanks.

Answer:

well, it will come down, but Restylane SubQ lasts a long time, so it is not going to go down as fast as your lips I am afraid. The skin and your face should come back to its prior state, yes. That is quite a bit of filler to have injected I must say. All the best. JG 10.14.10

Question:

Dr. Garcia. Is skin necrosis the same as scar tissue? Thank you.

Answer:

no, skin necrosis is dead skin, scar tissue is part of the body`s attempt to heal a wound or injury. JG 10.14.10

Question:

Hi Dr. Garcia, I had a macs lift 3 weeks ago. There is terrible scar tissue that has formed on the right side of my face where the drain was put in. I have been going for massages and the Dr. that did the surgery has given me 2 steriod shots. He has assured me that it will go away. That the body will dissolve the scar tissue. I am so scared that this is permanent. Please let me know if there is anything else I can do to elimate this terrible scar tissue. It is about 3 inches long that runs from my cheek all the way down to my chin. Thank you for your advise.

Answer:

might want to use some external ultra sound massage like they use in physical therapy too, all the best. JG 10.14.10

Question:

Why ddo fillers in some people dissolve faster then in other people. Is it due to the metabolism of someone, is it due to age, is it due to collagene production ? thanks for answer

Answer:

age, genetics, depth of injection,amount of motion in the area material used, lots of variables. No fillers, except Sculptra create new collagen, so it is not related to that for most fillers. JG 10.12.10

Question:

Dr. Garcia, When having a puffy relative fat midface compared to flattened sides after a facelift, with bunching up of the cheecks in the middle of the face, what can be done about it ? Would evision sugery with more skin dissecting and then make equal tention with the available skin ,without more removal of that skin, be an option. Other solution that you can advice ?

Answer:

not knowing what surgery was done to cause it makes it hard to say what coudl be undone to improve it, but I will say that pulling skin tighter will likely not flatten a full face, it would require debulking somehow of the area that is perceived as too full.Either removing tissue or releasing sutures that are holding things into a ball causing the increased fullness. JG 10.12.10

Question:

Will fibrosis from fillers ever go away ? How long will it take if it does. Is there a differenec in fibroses between different HA based fillers, does it depend on the amount of filler that was injected or the number of times ? Does fibrosis from sculptra ever leave completely. It seems that use of fillers do not produce collagene so much but tickens the area from the fibrosis. Thanks for your explanation

Answer:

fibrosis is scar tissue and although it can get softer, it never totally goes away. I do not think there is any difference in fibrosis between the different HA`s. It is more relative to the bleeding and needle injury than the product. The only filler I think that creates new collagen is Sculptra, all of the others just mask the depression. JG 10.12.10

Question:

What is the best treatment for under eye wrinkles ? What are the side effects if laser is used ? does it give a notiable improvent ?

Answer:

I think the best is a totally ablative CO2 laser, there will be redness for 2-3 weeks followed by pink skin for a couple of months and you will likely be back to what you had before in about 18 months. I think in general, when the patients understand the limitations, they are pleased. JG 10.10.10

Question:

When using fillers in one area , does it lifts another area or does it just ticken or make it bigger, wider,... Example, filling in the cheecks, does it lift teh jowls ? With sculptra that is the case in my experience, is this the same with HA fillers.

Answer:

if enough filler is injected, it can lift. When I use Sculptra to fill the cheeks in the jowls do get better. I think the amount of HA filler it would take, at least with the ones we have in the US, it would not be worth it as the HA fillers in the US are not made for deep long lasting injection and using the fillers we have will not last long. JG 10.9.10

Question:

dr. garcia, I had also restylane under the skin, hnot on bony stuctures but under weak structures, to fill in submalar area, it is still lumpy, i can not break the lumps, i can not massage them smooth like with sculptra, what can i do with these lumps, does it soften, Can it be used fro jawline contouring ? Thanks again

Answer:

might need to have it dissolved with hyaluronidase.It can be used for jaw contouring, yes. JG 10.9.10

Question:

Which will have more affect on the cheek area, SMAS or an extended SMAS? What really is the diffeence? Thank you. kp

Answer:

well, the extended SMAS will do more but if you do not need more, then it is not the better option. It is a more aggressive lifting and not all patients need it. JG 10.9.10

Question:

How to get rid of the bags that i did not have before, surgery together with a corrective facelift, an undo facelift at the sides is what i need combined with a midfacelift with skin removal on undereyes and as for the sides, after facelift undo, unplicate smas and sutures out, still needed some fillers for touch ups, too much went wrong. Are you scilled to do this in an almost perfect way.

Answer:

impossible for me to say what you need, or if I can perform it for you without seeing you in person and feeling your tissies. From what you describe, I must be honest with you, improvements are likely possible, but perfection will likely never happen if it as bad as you are saying. JG 10.9.10

Question:

how long does normal restulane stay, same as juverderm ultra used before on lips, eyes and nose, lips 4 months, eyes a bit longer , and nise 8 months, in my case.

Answer:

essentially same as Juvederm. JG 10.9.10

Question:

The eyes were done with normal restylane, should this dissolve in 6 months, the restylane subq in injected very deep, i read that this tnd to last less long, correct or not ?

Answer:

the SubQ is formulated to be injected deeply AND last longer. JG 10.8.10

Question:

What if i want to redo the facelift, what about the restylane subq, do i have to wait for years to wear off. Even in small doses does it really last years, that means longer then sculptra ? is there a way to get it out ?

Answer:

no need to wait, can proceed at any time. It does last longer than Sculptra, yes. It can be dissolved with hyaluronidase, or removed when re-doing the facelift. JG 10.8.10

Question:

Hello dr. garcia What do you think of the mixto laser for skin texture, does it improve, can it be used under the eyes also, fine wrinkles around mouth ? can it cause oedema ? and what is the downtime, how soon back to normal ? Risk of compliactions ? Thanks again

Answer:

it is a fractional C2o laser and I think the benefits are, in general, over-inflated. It will cause edema and the potential good effects will be short lived, weeks to a few months. The downtime depends on how strong of a setting they use, no way to tell. I think the biggest complication is spending money and not getting anything that lasts more than a few weeks. JG 10.8.10

Question:

Hi dr. garcia, It seems that after the restylane subq and normal restylane, i have folds of skin lumpyness all over my face, that does not improve. On one eye were the macslift created some scar tissue i have the impression that the big needle has loosened up the scar tissue created more loose skin next to one eye. The skin under this eye is looser also. Is it possible that the scar tissue near one eye caused this problem, or is it because the skin during the macslift was tighter on one side then the other. How long before teh restylane wears off, how long before teh lumpiness and folds under th skin improve, Tipically how much skin it dissected near the sideburns to lift the skin , next to the suture i mean, is that almost untill close to the eyecorner ? just try to figure out why i have this issue. Thanks

Answer:

more likely due to the surgical intervention. Restylane will last anywhere from 2-8 months, the greater the motion in the area, the faster it goes away. But Retylane SubQ last a couple of years. The amount of skin that is lifted varies from patient to patient, it rarely goes all the way to the corner of the eye. All the best. JG 10.8.10

Question:

Hi Dr. Garcia, I am one week out today from a mini-facelift and lower lid bleph. I saw my PS yesterday who felt I had a hematoma on the right cheek so he aspirated about 1 cc out. He said all the incision lines looked good and were healing well. He wants to see me next Tuesday for a recheck. I`m so upset to have this complication and am using moist heat packs and gentle massage. Is there anything else I can do to speed the healing of the hematoma? Thanks so much for your advise on this site.

Answer:

just what you are doig and make sure you are not taking anything that thins the blood, hang in there, a 1 cc hematoma is quite small. JG 10.8.10

Question:

is it tue that fat cells atropphy when they are under constant pressure, are they shrinking in that case, like the case when you see on peoples fingers when they wear a ring, the atrophy is permanent. When there is fat atrophy in one place, do fat cells grow in another place.

Answer:

typcially, the fat loss is permanent, yes. If there is fat atrophy in one spot, there is no direct cause for fat to accumulate in another area. Having said that, if one has liposuction and then continues to overeat after the surgery, they will gain weight in new ares where fat cells remain viable. JG 10.7.10

Question:

Hi Dr Garcia I have seen quite a few surgeons and each one has offered me a different kind of facelift - MACS facelift/Minimally Invasive facelift/Silouette lift/Deep Plane facelift. Some surgeons want to give me fat injections and others are against this saying this cause lumps etc. After much research and seeing a few surgeons I am more confused as ever. I think I must not be alone in this. Thank you for your advice on all this controversy in plastic surgery today.

Answer:

well, if you really nened a facelift, even if its a mini, I think the MACS lift, of the ones you listed, is the way to go. I think the minimally invasive facelift depends on which one they are talking about, if it is endoscopic, skip it. I understand the desire for the Silhouette technique but if the sutures break, the face falls. As to a deep plane lift, it has never made sense to me, why lift tissue up by seperating them off the bone if they never sag from the bone, and along with that, the swelling takes a long time to go away and after one year it looks just like a short downtime regular old-fashioned facelift. As to fat injections, my issue with them is not the lumps, they are easy to avoid if you are not in a hurry, it is the unpredicatability of how well the fat will survive. You might go through lots of swelling and have the fat be gone in a year or so, for that, just use a filler off the shelf that leaves much less swelling. Not sure I helped you much after all of this. JG 10.7.10

Question:

Hi Dr. Garcia, I had a mini facelift and necklift with lower lid bleph last Friday. Overall, I`m doing well with some slight bruising under my eyes, chin and ears. I had quite a bit of swelling, particularly in the upper cheek around (I`m assuming where the lifting sutures were placed) and was wondering how long before this swelling will subside? I used iced packs for the first 72 hours... should I continue ice packs while I still have swelling? Thanks!

Answer:

swelling might decrease in 10-14 days or so. Every patient is different though. At this point the ice will not do much more, all the best. JG 10.5.10

Question:

Second issue with restylane subq, near one eye, it is all lumpy at one side, like litte craters near my eye, very ugly,like the restylane is visible through the skin, should it be filled up more or does it improve by its own. The injector went trough a lot of skin with a tick needle and skin near the eye aera is very thin. What can i do ? The malar bags or not improving either. Thanks again for respons.

Answer:

either let is dissolve or you can also have the dissolved with hyaluronidase. JG 10.3.10

Question:

Hi dr. garcia, thank you so much for all the answers to my questions. I have another issue with the restylane subq: First, at the injection side at the cheeck , were the needle was put in the skin, there is a red bug bite lump, maybe there was a drop of restylane when taking out the needle and stayed to supperficially in the skin. It does not seem to go away, its 10 days now. What can be done to make it disappear.

Answer:

massage and warm packs, it will go away. JG 10.3.10

Question:

One more question as i try to figure out what to do to my misformed face. It seems my skin is loose enough , why then is it not possible to create volume and change the shape of my face with fillers at the sides. Fillers under the skin that was not dissected gives a full aspect, and when the fillers are just done, it is puffed also at the flettened areas, but 2 weeks later, the flettened area goes flat again and the other areas stay full, more disformation.

Answer:

in the US, there are no fillers except Sculptra that will last a long time in the deepr parts of the face as most of them are intended to be injected in a very superfical plane and injecting them deeper will just lead to quick dissolution.JG 10.3.10

Question:

I have seen the website of dr. Hayworth, he seems to adress every different part of the face seperately and does procedures to adress every single issue. Midface, facelift, fat transfer, implants, eyes, brows, lips, different techniques, do you think this is a better way to balance the face instead of adressing one area and trying to pull the other areas with it.

Answer:

if ther are multiple areas that can benefit from being addresse, the answer is yes, I certainly suggest that to my patients, but many times what the surgeon sees as needing to be fixed is not agreed upon by the patient and other times the patient does not have the funds to attetnd to all of the issues. JG 10.3.10

Question:

Is there a similar product like sculptra to ticken the skin and create volume with multiple sessions. Sculptra takes too long to get out in case it is wrong placed. Thanks, Martine.

Answer:

no other product that I am aware of that works that way. Sorry. JG 10.3.10

Question:

The skin at the sides of my face is glued one way or another, it is flattening the sides of my face, every filler put underneath seams to disappear due to the flattened area, too little skin and volume at the sides , too havy at the bottom, misformed face. Is a redo a possibility, when the lift should be redone, dissecting more skin then with a macslift to put equal tention , would it create more scar tissue over the whole dissected area , flattening the face even more. Nobody here seems to have a solution , suregeons in belgium are not specialist in faces, the only that they know of is the macslift, as Tonnard is promoting it.

Answer:

sounds like a redo facelift is needed, there should not be any improper or greater amount if scar tissue formation after a second operation. Best of luck. JG 10.3.10

Question:

Dr. Garcia, What is the difference between a SMAS and an extended SMAS facelift? Does the extended change the cheek area at all? Thanks. Hope you are having a good weekend.

Answer:

they both do, the extended SMAS claims to do just a little more than the regular SMAS does, but with that coems a slightly higher risk. JG 10.2.10

Question:

I read you previous answer about eh fluid bags after co2 laser, why does it cause this kind of bags after co2, does it not go away on its own, does the fluid needs to be extracted ? Would that be the case with my problem after the restylane subq?

Answer:

it usually does go away on its own, yes, in both case of laser or fillers, slowly over many weeks,but if there was an early festoon there which was not appreciated or seen as much, it can be made worse and then it may not go away after time passes.It migth be the case after yoru Restylane injection yes, so it is best to give it time and see what happens before trying anything else. Got to hang in there for a bit. JG 10.1.10

Question:

Hi dr. Garcia, Is it possible that under eyebags that came up after restylane subq was injected very deep at the cheeckbones and a bit in the cheeck itself caused sepearation of the muscles or could it be that the restylane traveled to another compartiment ? The bags are still there , one side worse then the other and when i press on them, no improvement. Is it possible that the tick needle broke down some scar tissue from my previous facelift , letting the fluid or restylane travel to the under eye, causing the bags. Also UNDER the cheeck it seems much havier then before altough there was noting injected, the nose to mouth area was injected to make it fuller, maybe this is creating the haviness under the cheeck since the skin is so much tightened with the facelift. I really have not any natural line in my face , looks very weird. I am worried about the bags, my eyes were the only natural and nice part of my face that was left after this terrible facelift.

Answer:

I do not think a filler can cause that type of muscle damage, no. Restylane does not easily migrate but does attract fluid and that is what can cause the puffyness, otherwise, and less likely is the filler was injected in not the desired location. I do not think it undid anything from the prior surgery either. The filler in the nasolabial area is what is likely causing the cheek fullness but not the festoon. Sorry to hear about the problems. JG 10.1.10

Question:

What happens if fillers or skin tickening products are used on loose skin and with therapy the skin starts tickening again as well as volume is restored, would the face look puffy ? I once started the therapy and i noticed the results of the volume and tickening of the skin, even change in skin tone and color, also pigmentation spots disappeared, i did not know what was going on, it was like going back in time, also hair color started to change. Then i quit the teraphy during a stressfull event and everything went down again. So i am planning to restart soon, but first wants to do the fillers and skin tickening as my real age is now 30 years more then i really am, have to turn it back, strong diet, hormones, exercises, air, very diciplined, not one candy or chocolate, not one glass of alcohol, no bread, no pasta.... only proteines and fat. As i have lack of several hormones like HGH and Testosterone which is not measurable any more, that low, i have to replace them all with injections, gels, pills, supplements, ... And then suddenly whn you are in a good mood, you discover the changes from one day to another, just like they came. The only thing i could not get rid of was the lines near mouth and chin, due to smoking i gyuess, any remedy fr that, maybe retinol but my skin is hypersensitive for the moment, All our anti aging doctors in Belgium, clain¡m that sagging skin is the rsult of HGH deficiency , they told me together with`a protein diet it would take two years to have resulkts, I just started with tiny doses, dont expect much first months.

Answer:

only would look puffy if over done, needs to proceed carefully and slowly. I am unsure though what product you had injected as I know of no product that could cause all of that. I am aware of the claims that sagging skin is due to low HGH and can be correctedd with HGH injections, but after treating patients with HGH for over 10 years, I have never seen that be corrected. JG 9.29.10

Question:

Dr. Garcia, What product can be used as a replacement for sculptra to thicken the skin, i have used it before with good results, only a few small lumps under the skin, but the problem is , when it is wrong placed it takes ages to get out. So i would like to try another product similar to sculptra. Thanks again.

Answer:

Restylane Sbb Q is a good option, gives an immediate fill, but not sold in the US. Otherwise, I know of no other similar products that are safe to use. JG 9.29.10

Question:

How can i remove the swelling in the malar bags under my eyes ? Is it not possible because the cheecks and cheeckbones are pushing the skin under the eyes upwards, creating excess skin and more wrinkling. How long does the swelling from restylane subq lasts ? How long does teh filler lasts ?

Answer:

can try massage and ice packs, I do not think it is caused by the skin being pushed up though. Normally the swelling should only last a couple of weeks at most. Best of luck. JG 9.29.10

Question:

Why do i have these undereyebags after fillers in my cheeckbones and a tiny bit in the cheeck itself ? The bags were not there before. I think most of the swelling is gone, it was over a week ago.

Answer:

might have gotten some swelling into a small malar bag, it can happen, more so the further on to the cheek the filler is injected. JG 9.29.10

Question:

is it possible that when someone start producing more collagene due to change in food habits, hormaonal terapy etc... the sculptra starts to work again and thickens the skin, is there another way to remove the sculptra or block the effect ? Do you perform midfacelifts with endotine and skin removal under the eye ? Could this be an option to balance my face, sagging midface ? Sorry for all these questions, just need to find someone to make a decent correction, not just some or half of the issues i have with my face . I feel sculptra is like a fat transfer, it stays in the face, and when the face is changing after a facelift it looks weird. At least in my case.

Answer:

no way that I am aware of to stop the Sculptra from forming collagen and in theory, a proper diet might help, but it is more genetically and age controlled than any diet effect. I do not perform mid facelifts due to the high incidence of eyelid distortion and malposition, with rates as high as 15% even in the surgeons` who invented the procedures hands.Whether it would help will depend on whether there is any tissue in the midface that can be lifted, if there is not enough tissue to lift, there might not be much improvement from a midfacelift done through the eyelid. I have not seen that effect you describe with Sculptra injections though. All the best. JG 9.29.10

Question:

Dr. Garcia, regarding my previous question, i look like e weasel because of the wromg performed facelift, can a redo with all the procedures you mentioned correct this problem, also one question, i had in the past several sculptra sessions, altough not much was used. Different amounts on both sides due to assymetry but never really solved the problem, how long does the sculptra stay in the face, i also had in in the jawline and now that my skin sagged and loosebed it looks weird, havy. Ot was one year ago, to have a redo is it nessasary to wait longer ? How long does it last before mostly gone. Thanks again.

Answer:

it will depend on how much the tissues and skin can be rearranged, very difficult for me to say without seeing and feeling your face. Sculptra can stay in your face 18-24 months in many cases. More Sculptra could be injected at this time if needed. JG 9.29.10

Question:

Hi dr garcia, Is the procedure about the skin lifting, removel of scar tissue and placing aloderm sheet a procedure that you can do ? Does it mean an equel procedure as a facelift, dessecting the skin etc... Is it possible during this operation to correct uneven skin tention and redraping ? Can it be combined with a midfacelift or jawline tightening as somewhere i have more skin that has to be redraped or removed to balance my face. What would be the cost of operation , what is the time needed to stay to be safe ? Thanks for answering all those questions.

Answer:

it is as invasive as a facelift, yes. I do perform that type of surgery when required. Uneven skin tension cannot always be changed if there is not enough skin present to alter the direction though. What can be altered will depend entiely on how mobile the tissues are, no way to tell without feeling your tissues personally. I would need you to be here for at least ten days after surgery and if the Alloderm is required, the approxiamte fee would be about $9700. All the best. JG 9.29.10

Question:

To remove the scar tissue between skin and smas can it be done with a needle without dissecting the skin that has been opened with the facelift ? When Aloderm is used, is it possible to use fillers afterwards to recontour the face or not ?

Answer:

no, it need to have the skin lifted so a careful and accurate removal can be performed. Fillers can be used on top of the Alloderm, yes. JG 9.28.10

Question:

What do you mean by a smoothing cover ? For doing this is it nessasary to reopen the skin that has been opened by the facelift ? Or maybe more skin. Is aloderm the same as used in breast lifts ? Will this stay in the face or will it dissolve in time ?

Answer:

basically what I mean is for the tissues below the skin to smoothed out, it would require lifting the skin once again, and tailoring the tissues to a smooother contour. The Alloderm that could be used is similar to that used in breast surgery, but it can be a thicker piece if needed. It will dissolve over time but new collagen should grow in its place to provide a smoother contour. JG 9.28.10

Question:

I spoke to a doctor about sissecting the skin again from the smas, removing the plication and close the skin again. He told me this would not be helpfull because new scar tissue will form and the same problem will occur. Still after 3 yeasr there is so much tention on the skin , the part that was overstreched. When i talked to the docor about desecting more skin towards mouth and nose and redrape the skin to create an even tention, he told me that the problem of scar tissue would be over the complete face and not only the sides as it is now. I have not much fat in my face and the fat that i had on the cheeckbones is lost with the facelift, dont know why, it was not cut out, it just disapeared. So my facial shape changed in a much smaller one with less curves and this for the worse. Result, flatened cheeckes at the sides (overstreched ) pointing forward as i have strong muscles, sagging jawline and sagging mouth. Nice shape , feel awfull !!!

Answer:

maybe could consider something like Scultpra to fill in the cheeks and slowly stretch the skin to make it look more natural with more curves. JG 9.28.10

Question:

How can a repete lifting of the skin from its underlying tissues be done ? Once it is lifted is it nessesary to put something like filler between both tissues in order too loosen them up.

Answer:

the tissues might be able to be smoothed out to a more level surface, some scar tissue could be removed,otherwise a sheet of Alloderm can be placed to increase the thickness and also place a smoothing cover betweeen the tissues and the skin. JG 9.28.10

Question:

last week i had a session of fillers. The dr. used restylane subq and went very deep to fill in. Now when the swelling is gone, i have all lumps especially were the scar tissue is from the previous facelift, 3 years ago. All my skin is lumpy, falling in folds and bags, also near my eyes, all folds and bags under one eye, he only filled up the sides and a bit under the outer corner from the eyes. All my face is folded, don´t know what to do. Please advice, thanks.

Answer:

sounds like fillers would at best be short term. You might benefit from repeat lifting of the skin off of the underlying tissues on your face to let it lay in a smoother fashion. I wish you the best. JG 9.28.10

Question:

Hi Dr. Garcia, I`m 45, caucasian female. I have good skin yet the skin on my neck is becoming lax, mostly in the center. I have scheduled a neck lift for later this year and the PS said the incision will start in front of my ear and go behind it into the hairline. Will the scars be very visible and if so, for how long?

Answer:

scars should be well hidden and the more skin that has to be removed the longer the scars will be. All the best. JG 9.26.10

Question:

Hi Dr. Julio!!! Happy Autumnal Equinox (although it`s still 94 degrees here). Alright, so do you know anyone who specializes in nasolabial excision- and could you point me to any *close-up* photos (I swear I keep seeing the same photo of one guy one EVERYBODY`s websites) so I can get an accurate idea of the scarring. You`ve made me a savvy consumer :) Be well!

Answer:

thanks for the best wishes. Direct nasolabial fold excisions are not commonly done as although the scar might be thinner than the fold, it is still a scar on a very visible place. Some feel it is best done on males as their skin is thicker and more easily hides the scar, but men do not commonly wear make up though. I have performed them on rare occasions, but when the fold is excised, it can leave a somewhat unnatural flatter apearance on the face. The face should have hills and valleys and a nasolabial fold excision will diminish that and can make the face look unnnatural, pulled or distorted. Showing a picture of a scar can also be misleading as all patients heal differently, and a great amount of that is dependant on how much skin is removed. The greater the tension on the wound upon closure, the less attractive the scar will be. In short caveat emptor! JG 9.24.10

Question:

How soon after the frost burn can i start with the retin a and hydroquinone ? Can face cream with alpha hydroxy be used ?

Answer:

can start once the skin is intact, and a glycolic acid product can be used in conjunction. JG 9.23.10

Question:

What is the best treatment to remove hyperpigmentation from a frost burn ?

Answer:

Hydroquinone and Retin-A mixed together applied topically. JG 9.23.10

Question:

Hi dr. garcia, Is it possible to undo or release the plication from the smas done by a previous facelift. Is there a way by removing the treads or by new surgery ? Thanks.

Answer:

yes, but if enough scar tissue has formed, the tissues will still be stuck together and it may require the SMAS to be elevated and seperated. JG 9.23.10

Question:

Hi doctor Re the question of Mesoplasty. I don`t think that it involves fat at all - only injections of vitamins, fillers (no fat), botox to areas of the face for rejuvenation. Here in Spain a lot of doctors seem to be doing it. But maybe it is only hype. But I am pretty sure that no fat is injected with this procedure. Have you heard of this and if so do you still think it is not worthwhile? thanks again

Answer:

yes, I am familiar with it, I think it is a waste of money and I have heard of patients losing fat with the injections eventhough that was not inteneded with this procedure. Other fillers can be placed at the same time to fill in area that have lost volume, but that is not mesoplasty. JG 9.22.10

Question:

Dr. Garcia, If a person gets a lower face and necklift, without any eye work, will I end up with bunching under my lower lids? Thanks. kp

Answer:

it should not. JG 9.14.10

Question:

I managed with the use of supplements and hormones to restore all of my bone loss in a matter of two months, even already partly muscle atrophy. I only do 10 minutes of exercises a day. These conditions i had for over 3 years restored in less then 2 months, i think it is amazing. It is justed something that happens very quick, suddenly a doctor told me , you have no bone loss, i looked suprised and saw in the mirror and i noticed he was right. Plastic surgeans always told me this could not be fixed, it is aging and thats it. Seems not true. So i suppose there could be a possibility to restore other physical problems too. All this in case of premature aging , i dont know if this is like that for normal aging. What is your experience ?

Answer:

with the proper hormones being used, along with good diet and weight bearing exercise, loss of bone cna be restored, yes, I have seen it happen myself on my patients. JG 9.1310

Question:

What do you think of the gosleeveless website, claiming that plastic surgeans are wrong, that all sagging can be fixed with good nutrition and the right exercises.

Answer:

I think the are not being honest. JG 9.1310

Question:

i ask again about the butt lift, is it a usefull procedure, does it give good results.

Answer:

I only do it on people afte massive weight loss because the scars are so wide, and in their case, the large excess skin is worse than the scars. JG 9.1310

Question:

Is a butt lift a riskfree procedure, when removing part of the skin, is the scar very visible ? Does it fade easily or does it produce unsightly scars. Can fat be used to fill up the butt, or implants, what are the risks. Could carboxytherapy provide good results for sagging butt or upper leggs. Thanks for answer.

Answer:

fat injections are unreliable at best and will last maybe a couple of years at best and the implants available for buttocks in the US are not that great. Carboxytherapy is a waste of money no matter where it is used. JG 9.1310

Question:

Hi dr Garcia, Can human growth hormone in combination with nutritional food and exercises, in a deficient aging adult improve the sagging skin that happened as the result of improper lifstyle due to stress. Or is plastic surgery the only remedy to get rid of the sagging skin which happened very fast like in two months time. All this happened when i found out nothing can be done to my failed overstreched facelift , i could barely move my face for over two years. Is supplementation of dhea , pregnenolone and testosterone usefull when also testosterone deficient. What to take when adosterone defiecient ? Thanks

Answer:

I have never seen it fix lax skin, fine wrinkles,in small number of patients. For the lax skin it is surgery. I almost never use aldoseterone, and if the hormones are deficient they will maybe slow the effects of aging but not reverse as much as some people claim. All the best. JG 9.1310

Question:

Dr. Garcia, I would like your thoughts on Ultherapy.

Answer:

waste of money. JG 9.12.10

Question:

Hi Dr. G. I was wondering why some doctors require one to wear a compression garment after a face lift and some do not. If the doc uses tissue glue, is the garment deemed less necessary? thank you!

Answer:

I do nto use one, and I use tissue glue, but even before I did, I did not use one, I think some doctors use it so the patients do not see any bloody drops, but in reality, they offer little help, do not prevent bleeding and can cause ridges or folds in the skin from too tight of a compression. JG 9.1.10

Question:

Thanks doctor Garcia for your response to my question referring to the SSF lift. Does this type of lift go deeper than say a traditional smas lift? Is it similar to the Hamra deep plane?

Answer:

no, it just breaks the procedure down into smaller customizable parts, but it is still a SMAS facelift like has been done, not a deep plane at all. JG 9.1.10

Question:

I am having a lower facelift/necklift. I have some bunching of loose skin at the sides of my mouth because of fat removal from microliposuction. The surgeon will release 1 of 2 ligaments to help flatten the area ( I am assuming DAO release.) What is your opinion of this procedure?

Answer:

I do not feel that releasing the DAO is needed to lift that skin, although the skin at that area does probably have to seperated from the underlying tissues and redraped. JG 8.24.10

Question:

Hello Dr. Garcia, What about a mid-facelift... Doesn`t it only have 2 tiny incisions on each side of the face in the hair line? I`m looking for the best results w the lowest invasion... Thanks again!

Answer:

no, a mid facelift will have a temple incision, an incision on the lower eyelid and many times an incision inside the mouth, and at times in front of the ear if there is enough loose skin. JG 8.22.10

Question:

Hello Dr. Garcia, I was wondering what procedure has the least amount of scarring or cuts to get the result of a mini lift? I want that upside down triangle look again... Is there a surgery that does it microscopicly??? or just tiny incisions somehow? Thank you

Answer:

short incisions only if you have absolutely no skin that needs to be removed and only tissues below the skin that need to be readjusted higher, that is a very rare occurrance though. JG 8.22.10

Question:

Hello Dr. Garcia, What would you suggest for slight jowls... looking for the upside down triangle look again along with skin tightening too! Thank you

Answer:

cheeklift or minilift is about all I can honestly say will reliabley do that. JG 8.19.10

Question:

Hello Dr. Garcia, Have you heard of the Natural Lift?? I understand it only leaves a small unnoticable scar/cut right under the chin & works on jowls & chin/neck area??? Thanks

Answer:

if you are speaking of the one doen in New York with micro ultrasound and then liposuction, it will give you not much more than a little liposuction effect and I think the skin tightening is minimal and the fat removal on the cheeks will lead to premature aging over time, I would not suggest you spend your money on it. JG 8.19.10

Question:

Hi dr. Garcia, First question, is it possible to remove the undisolvable treaths from a macs lift. Type prolene, it seems that they were tight up with some kind of hooks, if it would be possible to remove them surgically, would the underlying tissue relax quicker, meaning go down more fast ? To the point where it was before the lift. Will the skin strech again to the point where it was before ? Second question, i still haev some kind of fibrosis underneath the skin from sculptra injections 2 years ago, it is not very visible and very very slowly it gets better. I think is is some kind of scar tissue that has formed, how many years does it take to completely go away ? I thought sculptra and the effects were gone after two years. How long lasts juvederm in the cheecks and how long in the nose tip ? Thanks for answer.

Answer:

yes, the threads can be removed but it requires surgery and to undo the effect of the sutures at times some scar tissue that has formed also has to be removed to let the tissues go back to the way they were. The skin will not relax to the way it was before as some skin was likely cut out and now does not exist. The Sculptra forms new collagen and should be gone in two years but if there is scar tissue that formed that should not have, it can last longer, maybe another year or so. Juvederm in the cheeks might last just a few months and 2-12 months on the tip of the nose. JG 8.15.10

Question:

What is your opinion of a modified deep plane lift? I consulted with a dr in NY who said the down time would only be a week for my lower fl and neck. I wouldn`t have to have drains either. He does all kinds of lifts. Also what is your opinion of the fraxel Miix2? Thanks

Answer:

sorry, but I am not a fan of either and I do not believe the one week down time for a deep plane lift unless the modification is he barely does anything.JG 8.11.10

Question:

Hi again Dr Garcia Thanks for your advice on deep plane/fat injections eyes. 1.Which kind of facelift do you do the most ?and 2. What would you do for upper eyelid hollows? Is it better to leave well alone? best wishes

Answer:

I do a traditional SMAS facelift, as to the upper eyes, I wouls inject Restylane in whatever areas are possible for that filler, but I would not use fat. Depending on what it looks like, there might not be much that can be done. Best of luck. JG 8.11.10

Question:

Hi there. No question this time; just a comment. You answered a question for me on July 26 about getting restylane in the OR before FL. I just want to report some good news for a change :o) I had a face/neck lift/chin implant just one week ago and already I look great. sure i have some swelling and my neck is quite bruised but the waddle is gone, I have a defined jaw line. I am 58 and twice this week have been mistaken for someone in her 30`s and that is with post op swelling etc. I went out today to see doc and get staples out and wound up staying out and going shopping. The whole thing went so well I can`t even believe it. I want to say it was a piece of cake but am afraid I`ll jinx it! LOL. so many thanks to you guys who really know what you`re doing. :o)

Answer:

glad all went well, continued success and have a great rest of the summer and thanks for sharing. JG 8.9.10

Question:

hey doc garcia... I was reading your posts and read that after removing cheek implants you could have some sagging. Im 30, I had cheek implants removed 3 years ago, Your right it left some sagging. It looks terrible. Like a sad face. Can I do co2 to tighten some skin? oJG 8.6.10r a mini lift to improve this? or please give suggestions. thanks your v. good.

Answer:

nothing done to the skin alone like a laser will ever help. The tissues that have fallen are the tissues below the skin, so a lift of those tissues is required. There are lots of different names for the procedures on the cheek, but essentially you need those tissues repositioned. The issue might be though, in your case, since you had cheek implants before, that lifting you will, at best, take you to the way you looked before the implants and no better. Best of luck. JG 8.6.10

Question:

Hi DR Garcia; About two years ago my wife had a SMAS mid face lift and 13 hours after surgery her iv was changed and she became so swollen from receiving to much fluids it compromised the surgery. The imbrication of the SMAS came undone, can this make the face fall over time? and she still has burning and pulling feelings and her cheeks get hot will this stop? thanks

Answer:

I personally do nto see how an IV can cause that, only generalized swelling. I can see swelling localized ot the face from post-operative bleeding though or just swelling from tissue trauma. If the imbrication of the SMAS was comprimised, it will certainly allow the tissues that were meant to be supported by the imbrication to fall sooner than desired. The burning and pulling feelings can occur even without the swelling though, as that can be due to scar tissue and/or nerve irritation. That part should get better with time though. JG 8.6.10

Question:

Hi again. I read a post on another site from a woman who said after her lower FL, she had terrible wrinkles under her eyes when she smiled that she did not have before the lift. Is that a possible outcome of a FL when they don`t really go near your eyes? Was skin pulled too tight? Am very curious to know. Thank you!

Answer:

sounds like the skin was pulled over aggressively and caused some plication or folding of the upper cheek skin, that should not happen under normal circumstances. JG 7.27.10

Question:

Hi. Would having Dermalive & Artecoll injected in the NL folds (nose to lower chin) affect having a facelift. Would you not do one on someone who has had these injections. Thank you.

Answer:

neither should affect the facelift. OK to proceed. JG 7.27.10

Question:

Hi. It`s been a while since I last posted! I am finally having lower FL/NL next week. I had asked about getting some Restylane in tear troughs. I don`t need bleph. My doctor says he can do it right before we go into OR and it will not interfere with surgery as he does not go near my eyes. Is this normally done?

Answer:

commonly done, yes. Best of luck with the facelift too. JG 7.26.10

Question:

I have a question concerning having a facelift. I have turned 50 and have really been thinking about having a facelift. I have had fillers for the cheek area and the nasal labial fold areas, and the tear trough area, only for it to be expensive and not to last as long as the dr`s assure me it will last. It usually only last about 2 months or shorter with me. I have done a lot of research on facelift and what to expect and the pain from the facelift and the recovery. What I read, and what I am being told from the dr. that I went to are different things. The dr. told me that having a facelift isnt painful at all and that his patients do very well. He said there would be some bruising and some swelling but as far as pain there wouldn`t really be any. When I do research on the internet I have read where they say the dr`s don`t really tell you what you need to know and if they had known, they would not have chosen to have one. They say it is very painful and that there is a lot of pulling in the cheek area and the mouth feels like it is being pulled and that it feels like the face is stapled to the head and that it pulls so tight. One woman could`t even talk to where her family could understand her and that her mouth was numb and her cheeks and her ears burned and ached and that the swelling really didn`t go away for 6 months to a year. How much of this is really true? I would like to have one, but not if it is going to be this much trouble. Please helpe me with this.

Answer:

I think what you hear from patients on the internet is usually the results that are not doing well, the vast majority of patients do well and they unfortuantely do not go on the internet to talk about their good experiences. Slow healing and pain can occur but in most cases a facelift is not an unusually painful procedure and most patients are out in public with a little make up in a couple of weeks. Best of luck. JG 7.25.10

Question:

What about the plication leaving the diagonal lines, will this ever relax or diappear without a redo, Second question , what about the underlying tissue, will it eventually come down and equalize with the midface. Would a separate midfacelift be advisable to balance all regions of the face, it seems to be a major and difficult surgery and not many surgeons are specialist in this kind of lift, only a few are well known for this.

Answer:

most likely will need more surgery after this amount of time to allow the skin to lay down in a direction with more normal tension lines. It is impossible to predict if the tissue will come down and equalize with the midface. My guess is likely not as the upper tissue might fall, but the lower tissue will also fall, so there will likely be a gap between them unless they are reapproximated. In view that you have had these issues, certainly another cheeklift wil be needed, one can call that a mid facelift if desired. A MACS lift is not what was once called a mid facelift years ago, that is where the tissue were detached from the bones and lifted but that has its own set of risks and I do nto think it would help your secenario, sorry. JG 7.22.10

Question:

The scar tissue from the macs lift is gone, a had several treatments to release the scar tissue, so it is not that which is causing me the hanged up feeling, could it be that the underlying tissues are causing the hang up. Thanks for being so kind to reply.

Answer:

scar tissue never leaves 100%, the only thing that can hold the tissue in position are sutures that have not dissolved or residual scar tissue.JG 7.22.10

Question:

Sorry again, question about the macs lift. When a part of the skin at the sides is dissected, and lifted too high and too lateral, creating a plication that results in two diagonal lines, will this relax with more time? Other question, after the skin is dissected, and the underlying tissues are lifted and sutured, what happens with the fad pads, do they stay on the underlying tissue, are they adherent to the skin and eventually cme down together with the skin ? Thanks again.

Answer:

it can in many cases, but not all if there is scar tissue holding it or there is excessive tension in a certain direction from the skin being laid back down in a slightly angled direction. The fat pads are normally left attached to the tissues lifted and are seperated from the skin. JG 7.22.10

Question:

What are the benefits of infecting HG on an adult HGH deficiency woman. Is it possible to develop this syndrome as the result of the waste syndrome, not absorbing any nutrients any more, and the body is consuming now the bones as fuel ?

Answer:

HGH does help in cases of wasting, yes. JG 7.22.10

Question:

Sorry to ask again about the macs lift, What can cause the hanged up feeling, is it the skin which does not strech together with the perhaps fallen underlying tissues ? It really feels very tight, is that possible after all those time, thanks for respons, trying to find out what is causing this terrible feeling not to speak about the misformed appearance.

Answer:

usually that sensation is from the tissue that were tightened below the skin that are being held by scar tissue now. JG 7.22.10

Question:

Hi dr. garcia, is it possible that i still suffer from a too tight macs lift done almost 3 years ago or is it the undisolvable treths causing the hamged up feeling at the sides and the sagging midface. Can you suggest a solution, thanks again.

Answer:

Some of the tissue originally held in the MACS suture might have torn free and allowed it to fall. JG 7.22.10

Question:

Hi dr. Garcia, What is your opinion on supplementing human growth hormone trough injections when an adult suffers of HGH deficienty ? What about oral taken HG releasers ? Thanks for reply.

Answer:

I think in cases of adult-onset human gorwth hormone deficiency, the treatment with injections is FDA approved and worthwhile. I have never found an oral secretogogue that works past the I feel it working phase. Blood tests do not reliabley show oral secretogogues to produce measurable results by themselves. JG 7.22.10

Question:

I had a facelift 14 months ago and I am very happy with the results with the exception of two small areas, on either side of my face, in front of my temples. The areas look puffy, with or without smiling, and are very noticeable. My PS said that the areas are not puckers, but rather areas that remain swollen. He said I could try fillers to camoflauge the areas, drain the area with a syringe which concerns him because of the nerves in the area, or I might consider scar revision (ugh). He also said that he has never seen this and the swelling might reduce in time. Fortunately, I wear glasses and they conceal the areas, but one side larger than the other and without my glasses, I am very self-conscious. What do you recommend? Also, I never discussed fees during my visit, but should he charge for a scar revision?

Answer:

I cannot say but many times the surgeon will do something small like that at no charge, it sounds like there is some bulky appearance there from the tissues below the skin that was lifted, debulking them surgically is likely the best option, it can be swelling but unlikely due to the amount of time that has passed. All the best. JG 7.22.10

Question:

Dr. Garcia, In your opinion is it possible to tighten the neck muscle without making an incision under the chin? I was told by someone the doctor did it under the skin. Does that even seem possible? Would it be more likely it was tightened when skin and all was rolled away and then tightened behind the ears? Hope you can help. Thanks, KP

Answer:

well you can tighten by making incisions at the ear region, but no way to tighten the muslces reliably without incisions, there are string methods but I think they are very unpredictable and the sutures break with muslcular action. JG 7.19.10

Question:

Hello Dr Garcia, You are a saint to answer all these questions, it is all so helpful. Thank you! I am 53, in very good physical shape, no real problems with my body, but I had a hysterectomy 3 years ago and had surgical menopause and since then I`ve developed a sort of double chin with the slightest jowling. The rest of my face looks pretty good if you ask me, it doesn`t look like an obvious face lift need. Is there something I can do just for the neck to get my tight jawline back? Are there options with less downtime? Also, what is the best way to remove wrinkles and light bags under the eyes? Thank you again for all you do.

Answer:

well a pure necklift will not fix the jowl region as it only pulls horizontally but a mini facelift might be able to tigthen the neck enough and lift the jowl region superiorly into a better position to give you the desired improvement. As to the eyes, if you have both of those issues it might be a lower lid blepharoplasty with skin excision and fat removal or repositioning. Best of luck. JG 7.18.10

Question:

I just turned 50 back in April, and am thinking seriously about a facelift to make me look more youthful and rested. I do have to admit, I am afraid. Is having a facelift dangerous? I would also like to know when you wake up if you have a lot of pain from the facelit and how long it would take to be able to go out in public again?

Answer:

I do not think it is dangerous in experienced surgeon`s hands. I find that patients are very comfortable when they wake up and take few pain pills after the surgery. My patients are usually able to go out in public after 10-12 days. JG 7.13.10

Question:

I understand that Dr Garcia does a great job with facelifts. Do you charge for your consultations??? I would love to have one with you

Answer:

there is a $50 consultation fee that is applied towards your surgery if you proceed. I woudl welcome you to call us and schedule consultation so we can disclose your personal issues. Looking forward to see you whenever you have time. JG 7.7.10

Question:

Thanks again Dr Garcia The last question regarding fat injections: I am really curious as to why many surgeons want to give fat injections when there seems to be so many problems with it. You are so patient with us all

Answer:

as to why they use them, I am not sure, it seems like they feel the patient is already asleep for something else so its not a big additional thing. JG 7.7.10

Question:

Thanks Dr Garcia Re my question regarding fat injections : Do you think I should refuse the fat injections and ask for another kind of filler. 1. Is it the same filler for cheek, lips, tear troughs or different kinds. 2. Should this be done during the facelift or is it better to do this after. Thank you once more

Answer:

I like to do the fillers after myself, in order to see exactly where it needs to be placed when there is no swelling, you can use Restylane for all of those areas is you wish. JG 7.7.10

Question:

Hi Dr. Garcia - I just read about a plastic sling surgically implanted that can be tightened as the neck continues to fall - the chin sling - as one of the new ways of dealing with turkey neck. Is it still in the testing stages or is this a viable alternative now? Thank you kindly for your site, it is enormously helpful

Answer:

it is out, but what attaches the sling to the tissues up higher can break and allow it to loosen once again, also, usually the aging neck is looser muscles and skin and if the skin is not treated, the results are not good. All the best and thanks for the kind words. JG 7.7.10

Question:

Hi, Dr. G--I plan on having a cheek lift and upper bleph in mid-August. I am planning to get botox tomorrow in my forehead and around crow`s feet. Will this in any way affect what my ps is going to be doing? I don`t want to affect the outcome of my surgery in any way because the muscles may be acting differently. Thnaks. B

Answer:

no, it will not alter anything that is planned. Best of luck. JG 6.30.10

Question:

Hey Dr Garcia, thanks for quickly answering my question about temple hollowing and mini facelifts. Would Sculptra be good to fill in the temple area? What do you think is the best filler for that area? I am scheduled for a rhinoplasty and mini facelift on July 7th, but I am going in for another consult on Monday to tell him that I don`t think I want a mini-facelift because I don`t want my temples to look more hollow. Is fat injections good for that area? Thanks again for your time and for all you do - pv

Answer:

that is my first choice for that area, fat would be my second choice, but causes more swelling I feel, and does not last any longer. Best of luck. JG 6.27.10

Question:

Hey Dr Garcia, just a few quick questions. Will a mini facelift help hollowing temples? Can an incision be made right in front of the hairline at the temple and skin excised? Is there a procedure that is just for the upper face that would help the temple area and top of the cheeks that is not (fillers)? Thanks so much for your time - pv

Answer:

minifacelift will do nothing for the temple hollows. If there is fat atropy in the upper face and temple, the only thing that will help is fillers, pulling the skin tighter will not give a more natural appearance in that scenario, if anything, it will accentuate the hollowness by pulling the skin over the boney prominences tighter. JG 6.25.10

Question:

Dr. Garcia, Are you familiar with the new procedure Vampire Facelift ? This procedures technical name is Selphyl which uses ones own blood spun down to the platelets and is injected in the facial wrinkles. This process tricks the body into a healing process generating new cell growth.

Answer:

sorry, but the effect is not very effective, migth help fat injections survive better and does decrease swelling and speeds heaing during open surgery, that is how I use products like that, but just injecting parts of blood taken from one`s body in the hope of long term wrinkle reduction is hype and fallacy.JG 6.23.10

Question:

Good day Dr. Is the nefertiti neck lift of much benefit and if not - why not. Thank you. jg june 21

Answer:

I think it is a scam as Botox or other neurotoxins cannot tighten muscles as the purpose of the toxin is to weakedn or partially parlayze the muslce, I would not perfrom or nor recommend it. JG 6.21.10

Question:

Hiya Doc! OK, so this is what went down... Radiesse in the folds and a touch of Juvaderm in the trough/upper apex of my cheek. I questioned him on everything, told him from what I had read Restylane was a better product, he said he would do whatever I wanted but that he strongly suggested Radiesse- so I went with it (I`m a terrible control freak, so I figured, eh he`s the head of the US Board of Facial Plastic & Reconstructive Surgery, so wtf!) OK, so I originally freaked out because it looked like a caterpillar had crawled under my right cheek/fold area and was basically crying. He`s assured me not to worry, that it is temporary swelling. Even just 2 hours later it looks a little better. The eye area looks fab- what am I, 16?!! BUt still, I guess I always thought I was pretty, so I`m a little conflicted about the overall result. Agghhhh, why are humans so complex! Love to you and yours, thanks for the years (and future years) of advice!

Answer:

all the best to you. JG 6.10.10

Question:

Last question, I promise! Do you use the restylane in the nasal fold area because more patients prefer immediate results, or do you use it because you find it yeilds better results than Sculptra? Would Sculptra be more beneficial down the road with someone with deep lines such as myself? And what about eye trough area? Restylane? Thank you so so so much, and I will be certain to let you know what I choose and how I feel about it, because I feel you have really been a helpful guide. Rock on Dr. Julio!

Answer:

I do not use Sculptra in the nasolabial fold itself, I use it only to fill in areas where fat has dissolved and that is not what causes a nasolabial fold to become visible. I have on a small number of cases injected Restyalne into the fold and Sculptra into the cheek at the same time to give some effacement of the fold while waiting for the fullnes of the Sculptra to kick in.The only product I use in the tear trough is Restylane. And how did you know I like Rock Music?! Best of luck. JG 6.10.10

Question:

Real quick doc, Ok so I`m going in for Sculptra for nasal folds tomorrow! Nervous to put stuff in my face! Here`s the thing though, since Sculptra may take 6-18 weeks to show anything, I started thinking about Restylane again (instead) Now I know it doesn`t last as long, but effects are immediate and it also has the side benefit of increasing collagen production. Also, I found reports that Sculptra doesn`t work as well in patients under 50, have you found that to be accurate? SO I just want to make the best darn decision as I can, and of course, I have you to thank for it!!!!!! Have a wonderful day! OH WAIT...AND... I was wondering, should I consider getting just a little in my cheeks to plump them, would that also affect my deep nasal folds? Or will I start to look done which is a huge fear of mine.

Answer:

I know the company says it increases collagen production but after years of injecting it personally into hundreds of patients, I think the amount of collagen produced in not visible clinically. As to Sculptra, since it depends on the body creating new collagen and the ability to produce collagen is better in younger rather than older patients, I think the answer is the reverse of what you have read, it works better the younger you are. Filling in the cheeks can make the folds appear deeper in certain lighting. All the best. JG 6.9.10

Question:

Hi Dr. Garcia: I had a FL/NL in 2008, with extremely poor results, hematoma, seroma in neck. I had loose hanging skin with banding four months after surgery. No result on neck. Had full face and neck revision six weeks ago, face looks great , neck failed within three weeks after surgery and I am back to waddle and banding. Any ideas as to why this might happen besides poor skin elasticity ? Thank you .

Answer:

well, if the skin was too stiff from the previous insults, it might not have been elastic enough to pull tight, or the surgeon pulled as tight as they felt was possible and not too much in order to avoid increased tension at the incision that could lead to poor healing. I think those two are likely the most common causes.At times when there is alot of scar tissue after previous surgery the tissues are difficult to separate from the muscles and that can limit the degree of improvemnet in some cases. Sorry to hear about the problems and I wish you the best. JG 6.9.10

Question:

Hey Dr. Julio. I am reposting b/c I think you accidentally missed my question (or you didn`t feel like answering, ha!) I have very deep nasal labial folds and I`m only 32. So, I`m going to try Sculptra next week (I`ve held off on doing anything for years thanks to you :) But what I really want to talk about is excision and/or Surgiwire. My folds are sooooo bad already, and filler of course is only temporary. You have been relatively anti mid-facelift, and I am not crazy about injectables anyway. I`m Italian Irish, I don`t smoke or drink regularly and heal pretty well (ok, I don`t sleep though!) So what do you think doc? I am single now and don`t want to look at these things forever. Excision would create a scar, who knows how bad right? What would the surgiwire do, just slice the muscle underneath and release the fold? How will that look? What is your biggest fan to do??? As usual, I thank you and think you are wonderful!!!!!

Answer:

just answered it, sorry. JG 6.8.10

Question:

Hey Doc, I`ve been coming to your website for 4 years!! I`m always complaining about my nasal folds. They are bad (think 55 year old golfer) and I`m only 32. So, I`m going to try Sculptra next week (I`ve held off on doing anything for years thanks to you :) But what I really want to talk about is excision and/or Surgiwire. My folds are sooooo bad already, I would be putting filler in constantly, pricey, pricey. You have been relatively anti mid-facelift, and I am not crazy about injectables anyway. I`m Italian Irish, I don`t smoke or drink regularly and help pretty well (ok, I don`t sleep though, 2 young kids getting my masters) So what do you think doc? I am single now and don`t want to look at these things forever. Excision would create a scar, who knows how bad right? What would the surgiwire do, just slice the muscle underneath and release the fold? How will that look? What is your biggest fan to do??? As usual, I thank you and think you are wonderful!!!!!

Answer:

I think the scar from the excision can heal well, and at other times can be seen easily, at your age, not something I would recommend. As to the Surgiwire, it still needs a filler to be interposed to avoid the tissues from reattaching. I think it is a short term fix in most cases. At your age I cannot imagine that the skin is in excess so cutting skin out with a minilift would leave you looking pulled. I do think Sculptra, to try to refill the fullness or rounded appearance of the cheeks is a good option. The younger one is the more robust the creation of your own collagen is with Sculptra. Just remember the Sculptra takes 4 to 6 months to show its final effects and you might need more than one vial and then a touch up down the road, so be patient. Sculptra is likely what I would suggest to you. All the best and thanks for the kind words. JG 6.8.10

Question:

Hi Dr Garcia I have been thinking of having a facelift for a while now. But I also have some problems with my skin (eg. red spider veins, a few little acne scars). Should I deal with the aspect of improving these skin problems before or after the facelift. Thanks

Answer:

well, I think the red spots can wait until after as transiently the red spots will get worse from the facelift. As to the acne scars, there will be some improvement of the scars from the facelift, so no need to do anything for them before. JG 6.2.10

Question:

would a cheeklift effect or damage the result of co2 laser if the lift was done after the laser?

Answer:

no, it would not have a negative effect. JG 6.1.10

Question:

ptosis surgery is reccomended for my eyes. If its performed can it be redone without any serious problems or effecting the look of the eyes?

Answer:

in most cases it can be done that way, yes. JG 5.26.10

Question:

if co2 is performed for the cheeks will it lift abit?

Answer:

not much. JG 5.24.10

Question:

thnx for the eyebrow and lift answer. you agreed less invasive eyebrow lift is better. What will the name of the technique be? or how will you describe it?

Answer:

there are lots of names out there, very misleading as they are more marketing terms than descriptions. I think it best to choose a couple of surgeons and see them in person and tell them what you are looking for. JG 5.24.10

Question:

how will co2 work in comparison to a face lift? Can learn the similarities? will it lift certain parts or tighten certain parts of face? can you please explain some? thankyou

Answer:

there are no true similarities, the faclift takes away excess quantity of skin and the laser imporves skin quality, they are not interchangeable. JG 5.24.10

Question:

I need to fix the assymetry with my upper eyelids by using eyebrow lift. Still young patient 29. Some say get a lesser invasive lift with different ways of doing the surgery. some say it doesnt matter. Im not familiar with the ways and terminology. Some say the lesser invasive way is better because in the future when its needed to be redone surgeons can work with more ways to correcting the same problem by pulling further up the lift. therefore if more invasive way is used there wont be anymore room to pull much further up. is this correct? and what will u suggest?

Answer:

less invasive might be possible, as long as it is able to correct the problem, having said that, small incisions do not mean less invasiveness underneath the skin, so small incisions can cary with them longer healing times in some cases. I am always of the belief that if you can get away with something smaller, it is always best. JG 5.24.10

Question:

Hi Dr. Garcia - Approximately how long does it take to recover from a neck lift? How long to not look beat up, how long to be able to sing a 4 hour event, how long to be able to go on -camera? thank you so much for your thoughtfull-ness in answering these questions!

Answer:

in 10-14 days you should look pretty presentabel. As to singing, due to the activity the nck muscle I would say 4 weeks, maybe a little more. Best of luck. JG 5.24.10

Question:

I have some twitching one eye and round the cheeks. had canthopexy 10 months ago. Looks like i need cheek lift. can this performed with twitch problem? will it make it worse? how will the lift effect the twitching?

Answer:

OK to perform it with the twitching problem. The twitching will likely not be affected, good or bad, that is from a nerve irritation. JG 5.23.10

Question:

hello dr. garcia If i would a breast lift with new implants and they have to make an incion under the breast very large and my breasts are very close together, so that means the incision would be large, would it be possible the rmove a bit of the skin to lift the loose stomach skin up. Like tummy tuck but under the breasts and lifting upwards. I would like also to have the breasts a bit lower . Thanks for reply.

Answer:

It can be done but the scars from that will typically widen and it could make the scars form the breast lift more visible I am afraid. JG 5.21.10

Question:

What is your opinion of the short scar incisions? I heard they may have a `rolled` or pushed out effect. Thanks

Answer:

only works in a small subset of patients that have minimal to no skin excess. Overmarketed I feel. JG 5.16.10

Question:

I recently had a lower/mid facelift. I now have large skin puckers on both temples and a large green bump on my right cheek and stitches poking through in different areas. I had surgery on March 17, 2010. Any ideas of how this can be addressed? Do you do revision surgery? Thank you, Carol Paquette

Answer:

well the green thing is old blood that is being broken down and slowly absorbed, might be able to be sucked out by the surgeon, the stitches poking out can happen and they should be cut or trimmed, as to the pucker, it is from an incision being not made longer and the skin is puckered. Many times the puckering gets better with time and massage, otherwise it might need a little scar revision in the future. All the best. JG 5.16.10

Question:

hi dr ,please could you give me some advice,5wks ago i had a facelift, mid face,and upper and lower bleph,i told my ps iwas unhappy with my malar bags/festoons he said they would be improved,well you can guess the rest, they are much worse, i have since found out what i had done can do this,so.now i am stuck with baggy pouches near my nose and puffy pillows on my upper cheek,i am really down about this it is making me mentally ill,i really want these bags cutting out even though i know there is a scar i would prefer that to seeing these bulges which i cant hide,do you know of anyone in the uk who performs this procedure i have trawled all cosmetic surgery sites and cant come up with anything.my ps wants to try steroid injections or maybe co2 laser on them but i feel it wouldmake them worse,and would only be a temporary measure.what would you advise from what ihave described sorry have no photos ,thank you j.

Answer:

I would suggest you give it at least 6 months and then proceed to have them cut out, all the other stuff will consume your money, make you swollen and not let things heal and settle down. Patience is the best thing right now, sorry to hear about the problems. JG 5.16.10

Question:

You answered a question for me this morning. In regards to the leaking parotid, I had 20u of Botox injected into it and I think this is what finally got it to stop leaking. Will it start leaking again when the Botox wears off? My PS has no idea, he googled how to treat this.

Answer:

usually there is enough scar tissue that will develop that it will stop, there are also pills, anti-sialogogues they can give you to slow the parotid fluid output too. Best of luck. JG 5.13.10

Question:

I had a facelift and lower blephs ( also repositioned fat) in late February. My parotid ended up leaking and I had an drain in for over 2 months. I have swelling under my left eye which is not decreasing and the area under my eyes looks purple.My right cheek area has a horizonal deep crease that runs along my cheek bone and is very noticeable. Do you have any suggestions?

Answer:

I htink massage and a little tiem to see how much it softens and settles down is in order, after about 6 months the evaluation of what, if anything, can be done will be more accurate. Sorry ot hear about the problems. Jumping in too soon to try to correct things is not a wise idea. JG 5.13.10

Question:

Thank you, thank you, for answering questions. One more, please. When I said dr. was supposed to lift the mouth, I meant the CORNERS of the mouth only. (In a previous bad surgery by another dr., my mouth was pulled downward to a drooped, downward shape.) This dr. said he could lift the corners so my mouth looked straight across instead of downward. 1) Is this often accomplished as part of a face lift? 2)Is it done by giving extra lift to the front portion of the side SMAS? 3) And do you still think this could be done in the office?

Answer:

not commonly accomplished with a facelift.Depending on the casue, it might not be able to be corrected. I cannot say whether it can be done in the office without seeing what the proble is that is causing the droop, sorry. JG 5.9.10

Question:

I had a facelift 7 weeks ago. My Dr. said that if my mouth was not lifted enough, he can lift it in the office with local anasthesia. If he does this, how long should he wait after the facelift? And will lifting my mouth this way be as effective and last as long as it would have if it had been done during surgery? Thank you.

Answer:

not sure what part of the mouth you are referring to as the lips are never lifted during a facelift, if it is the nasolabial fold, they might look better with a little more skin being removed. I would give it at least 6 months for the swelling to go down and the scar tissue to soften to allow better ability to lift the tissues. A delayed lifting should not affect the longevity of the total lift done togetehr, should be similar. All the best. JG 5.8.10

Question:

Hi, Dr. Garcia, I had a facelift 7 weeks ago. I am still having strong pulling downward towards my neck under the jaw. It pulls so strong that it is pulling my mouth downward, which looks bad. I suspect the dr. did not lift my mouth enough, anyway, and this just strengthens my fears. So, 2 questions: 1) Is it normal for face to be pulled down to neck, and how long can this last? 2) If face is pulled down like this, how much does it typically effect the mouth? A lot? Thank you.

Answer:

sounds like what might be happening is that an aggressive tightening of the neck muscles is what is causing the senasation, that should loosen up with time though. The platysma muscle which is tightened in some facelifts can cause a very srong pull on the mouth, just like a very stronng grimace. I would try stretching and massaging the neck and see you doctor in follow up to make sure that is what it is. Best of luck. JG 5.8.10

Question:

Every time i have a filler like juvederm injected, in the forehead, sides of the face, eye region, brow to reverse the hollowness and fat loss under the skin, it seems fine for three weeks and then the filler goes down a bit and sagging brow comes back. I doubt the swelling takes as long as three weeks , any other filler recommended. The same happens with sculptra, three weeks seems to be ok after initial swelling, and then the next week it goes down. Is there any supplement i can take for cronic stress to balance the whole body, as for the moment the stressfull period will last for a couple of months. Thanks for reply.

Answer:

not really much I can offer, not all patients can have all areas corrected with fillers, sorry. JG 5.5.10

Question:

Is a lip lift a solution for wet mouth corners due to volume loss and skin sagging ? Upper mouth is draping at the sides over the lower lip and the problem is worse after the macs lift that was done 2.5 years ago and now has come down. The lift was done assymetrical so the draping is worse on one side then the other ? What are other possible remedies ? Thanks again for answer.

Answer:

it can help that scenario in many cases,yes. I think that is the best way to treat it, fillers might be able to evert the lip if injected properly in a small percentage of cases. JG 5.5.10

Question:

Hi dr garcia, Is it ok to have an ipl session two weeks after sculptra injections? Does it affect the sculptra or any other filler like juvederm ? Thanks for answer.

Answer:

yes, its OK. JG 5.4.10

Question:

Hi Dr Garcia - I`m 51 with great skin. However under my chin I have the beginnings of a turkey neck. To me it is almost worse that my face is so youthful, my face and neck just don`t match. Is it wasteful to have a neck lift if the neck is only semi-slack, not completely? will I need more work in just a couple of years because I just did a little nip and tuck? thank you for your kindness in taking the time to answer all of these questions

Answer:

well, if it bothers you it is likely worth correcting with an isolated neck lift. Your face will continue to age though and in time the cheeks might need to be done. It is certainly reasonable to do it piecemeal though, no need to operate on an area that does not have a significant amount of sagging yet. JG 5.4.10

Question:

I have these little pouches at each of the corners of my mouth that seem to be becoming more pronounced as I age and put on weight, but I`ve always had them. Is that fat or muscle? Is there anything that can be done about them surgically or with fillers? Could losing overall weight help?

Answer:

it is a little fat and a little loose skin too. Surgically lifting the cheek can improve them and at times fillers around the area can make them less obvious, but the fillers do not always work for that as it makes the areas fuller or rounder. All the best. JG 4.16.10

Question:

Evg. Dr. Just wondered if you have heard of or been exposed to this type of facelift - volumetric. Richard Ellenbogen, MD, FACS, developed the volumetric facelift, a technique that focuses on treating both skin laxity and volume loss.1 I was pleased to contribute to this development. The technique involves replacing fat in areas where it has been lost, removing fat below the mandible, and conservative skin tightening and redraping to effectively reverse the signs of aging and produce a natural, younger appearance. We believe that this approach provides a simpler surgical technique that gives durable, natural results, as well as a smoother, less painful, and more rapid recovery. Your opinion please. Thank you. jg.

Answer:

if the fat stays, it is a good option, but the fat transplanted will behave like the fat from the area it was taeken, so if it is taken from your stomach and you gain weight in your stomach areas easily, then whatever fat survives, the transplantation, will grow like belly fat. I think the results are not as reliable as regular surgery or implants though, lots of variables as to how well the fat survives. JG 4.14.10

Question:

Hi Dr. I`ve been hearing alot about dimple surgery. Is anyone doing anything like coupling a mid-face lift with a dimple for a longer lasting effect? Thanks, and happy spring.

Answer:

I have not seen any procedure that shows consistent and reproducable resutls. All the best to you also. JG 3.31.10

Question:

im 32 and i would like a heart shaped faced . When i was 25 i had a mask lift as my face shape was round. I know feel it has dropped. How can i achieve the heart shaped look?? What type of face lift would i need? what is it called? i heard that madonna has this silhoutte lift where theres no visible scarring. Its my lower face thats sagged and id like everything pushed up. please advise.thanks

Answer:

it might be more of a question of fillers such as Sculptra to get that appearance rather than more surgery. JG 3.15.10

Question:

Hello Doctor: Is it better to have the frown muscle cut between the brows that forms the 11 or are botox treatments better for that concern?

Answer:

I feel it is better to use Botox. JG 3.15.10

Question:

Dr. Garcia, I have recently seen a segment on The Doctor`s TV show about a threaded neck lift that can be done in an hour or so and is basically painless. The results looked great. I am a 56 y.o. woman and have sagging skin. Do you do the procedure and do you think it would work on someone my age?

Answer:

the threads break in a relatively short amount of time and I think it is playing to hype and hope. JG 3.14.10

Question:

while grooming eye brows ,nipped some of my eye lashes.Will they grow back ,if so how long would it take? thank you for an answer dr Garcia . Its very gracious and generas of you

Answer:

yes, but slowly, might take a few months. Products like Revitalash would help them grow faster. All the best. JG 3.13.10

Question:

Hi dr. garcia, due to sagging, skin laxity and fat loss of my face , I have a problem with my mouth, drooping mouth , no lines or wrinkles, just droopy skin all over. My mouth corners are constantly wet for this reason and I have difficulties in talking and eating. Can there be something done to correct this problem, Maybe some filler , but in which regions of the face. My previous macs lift did nothing for this. This problem with my nouth makes me very stressed also socialy . I read on some message boards about other people with the same problem but nowhere i find a solution. Thanks for your advice.

Answer:

well, fillers such as Sculptra to reinflate the cheeks could be done, otherwise it is a facelift to reposition the skin and tissues into a higher position. Sounds like you need a lot of skin removed and MACS lifts try to lift the tissues more than remove skin, that is its marketing ploy since people want shorter scars. Your issues sounds like the skin is sagging due to loss of the fat and the macs lift would not correct that problme as the macs lift elevates the sagging tissue mainly but you do not have much tissue to lift any longer. I think the macs lift was the wrong choice and you need a more traditional facelift with significat skin resection. I wish you the best. JG 3.13.10

Question:

Dr. Garcia, MD. On around Sept 1st, 2009, I had a neck life. At that time the Cosmetic Surgeon also did some tightening around my mouth which made the lines to the side of my mouth almost invisible. The lines above my mouth were also decreased. On Jan. 1, 2010, he did an Acculift. After the acculift, I could not tell any difference. In fact the lines to the side of my mouth looked worse and also it left a kind of what looked like a pocket of fat around the edges of the mouth. That was about 2 1/2 months ago and the fat pockets are still there. These pockets were not there even before any surgery. After the first surgery, my face looked good. No lines or wrinkles around my mouth. Now fat pockets to the the side of my mouth that will not go away. The surgeon says that they will go away. If they do not he will do some more tightening again around my mouth, like he did before. Do you think that I will regain the look that I had after the first surgery? Or should he do more tightening? Thank you for your answer. I really appreciate reading all of your answers to questions that you have received. mlratl@yahoo.com

Answer:

I think they will have to undo the sutures from the Acculift to allow the tension being placed on the underlying tissue to relax and stop the bulging of the fat pad of Bichat at the corners of your mouth. I am not sure why he did the Acculift if all looked good. All the best. JG 3.9.10

Question:

Hi dr. Garcia. I had a macs lift 2.5 years ago and it was done assymetrially (dr. tried to fix assymetrical face with bad result) and i want to do a revision facelift now. Also when I smile i have a freakish face, cheecks too high and pointing foreward. Also too much skin was removed during the macs lift. Can this cheeck problem be fixed. When I laugh , accidentely, people look at me, like what has happened to her face. I am very depressed about it. Can a lower eyebrow be corrected during a facelift ? I had some sculptra during the past 1.5 year trying to correct somewhat, can this be a problem for a revision facelift? On one side i have lateral sweep, much more then the other side. I jnow these are a lot of questions but it is very important to me not to make a second mistake. Thanks for answer.

Answer:

if it is due to scar tissue, and if the scar tissue can be released, it might ge better in terms of the distortion on animation. It can be difficult to remove the scar tisue and leave no residual though. As to the eyebrow, if it is swept up, there was likely too much skin removed and that will be quite difficult to improve and not leave new scars that are visible. JG 3.6.10

Question:

Dr. Garcia, Hypothetically, What would you say, if a patient asked you to do as minimal a procedure as possible, for example if a patient wanted just a neck and chin lift would you do it even if you felt they needed more?

Answer:

as long as they are willing to accept the limtitions, in many cases but not in all cases I would, but if it is going to make them look strange in some way, I might decline. JG 3.3.10

Question:

Hi Dr. Garcia Ive heard that going under local anaesthesia with twilight makes the patient bleed significantly more than with general anaesthesia. (I mean in terms of a neck lift.) Thank you !

Answer:

it happens at times as the blood pressure is usually a little higher, especially if the local anesthesia has not worked in all the areas. JG 3.2.10

Question:

Hi Dr.Garcia, Which has a better result to restore cheeks,, an smas or a cheeklift. You`ve mentioned previously that they are different ways of lifting. I have very high cheekbones but I`ve lost a lot of volume in my cheeks. My second question is, what is your opinion of the Y lift? I imagine it would not last as long as a facelift. I wonder if this procedure (depending on the doctor of course) can help at all in lifting a my jawline which has now has jowels.

Answer:

in most cases, tightening the SMAS is agood idea to allow the tissues to hold up longer. The Y-lift is just an attempt to do a smaller procedure and make it sound new, but actually it is nothing new. It will likley lift the jawline but not the jowls as much, hard to say. JG 2.28.10

Question:

Hi Dr.Garcia, There s a doctor here in NYC who is associated Mt.Sinai Hospital who does a procedure called a Y lift. I imagine it wouldnt hold up the way face lift does. I cannot have a normal face lift because of my health. Do you know if the procedure has a nice effect?

Answer:

well, I think you need to find out what exactly he is going to do, there are many doctors out there that like to use fancy terms for the surgeries to make them sound unique, but they are essentially the same that others are doing.Best of luck. JG 2.28.10

Question:

Dr. Garcia, I m know I sound panicked. I should have known the dermatologist had really no concern for my well being.And I became one of those people who kept going back for more. If I sound panicked its because I am. Thank you agian.

Answer:

see above. JG 2.24.10

Question:

Dr. Garcia, Is there any procedure to lift a chin? My chin has dropped drastically from being overfilled with perlane. I wish I knew how many syringes he used. The perlane removed with hulaurondaise over a period of two years. I had many injections of hylaurondaise. I know I sound crazy but it`s true. I dont understand why the derm did this to me,however I take full responsiblity even though he did it without telling me first. Anyway, for whatever reason, my chin (the skin) which was originally in perfect proportion to the rest of my face,makes me look completely different. and because of it, my face looks different, I dont recognize myself.

Answer:

the chin pad can be lifted and attached to the bone in a higher location in cases where it has dropped. I have never seen the skin, and the skin alone, of the chin pad sag though. If it is just the skin, the procedure I mention is likely overkill. All the best. JG 2.24.10

Question:

hello dr. garcia, do you think there is a general perfect age to get a mid-facelift or a cheek-lift? 30 - 40 - 50??? And how bad is the recovery and scaring? Thanks

Answer:

unfortunatley, no, I do not, it depends more on the person`s speed of aging, not all 40 year old have aged at the same speed due to genetics and lifestyle habits. Scarring should be minimal and recovery is 10-14 days before looking good enough to be seen in public and 4-5 weeks before full activity. JG 2.21.10

Question:

Hi Dr.Garcia, I`ve been reading some of the questions on your site regarding face lifts. Many of the comments/questions are about numbness or lumps after a face lift. It seems like numbness lasts well after the facelift is done. I understand that each case is different. I am considering a face lift and worry about lumps or haemomotoma complications. (I dont know if haemotoma is the correct term.) Are older or fair skinned people generally at more risk for this outcome? a common occurance post operation.Thank you so much.

Answer:

age and skin thickness does not affect the hematoma or nerve injury risk. Males have a higher risk of hematomas and taking certain blood thinning medications also contribute as does elevated blood pressure. The risk of a hematoma is between 1-2%, most are able to be treated without furhter surgery. JG 2.21.10

Question:

Hi Dr. Garcia, When getting a facelift, must all filler be dissolved before the procedure? The perlane that I have now might last up to one year, and I don`t want to wait that long, unless you say it is necessary.

Answer:

no need to wait for that to be dissolved or worn out prior to the surgery.JG 2.20.10

Question:

Hi Dr.Garcia, I have been to a few consulations of well respected plastic surgeons here in NY. On two separate occasions I asked the office coordinator to see photographs ofbefore and after, they brushed me off, or perhaps showed me two photographs when I wanted to see more. The two plastic surgeons where quite well known but not just that, also with excellent long time reputations. (I`m well aware that famous has nothing to do with how good a surgeon is, I realize there are always PR firms to get a name in a magazine>) But about the photographs. Is the patient coordinator so snobby it is not necessary for a patient to ask to see photos? How do you feel about a potential patient asking to see photographs. Finally,how do you feel about a potential patient who is a bit anxious about a procedure? Thank you :) to get them in magazines!)

Answer:

I think photos are helpful, over time though, the number of photos being shown has decreased because patients see a result and then think they are guaranteed the same result, and that is not always possible. I do think a number of patient photos is a reasonable request though. I think you are also right, at times, peopel with a reputation can be snobby in some small number of cases. I personally feel some degree of being anxious is normal, but if I feel it is too much, I will postpone things until the patient is sure you want to proceed. Some patients are anxious because of the risk, but others are anxious because they are afraid what their friends and family will say and think, or maybe they are stretching their finances. Apprehension about the risk is normal and can be explained by the staff and those fears allayed, the others might not be able to be talked away I am afraid. All the best. JG 2.20.10

Question:

Thank you very much for all your answers and for alleviating my anxiety in the past. :)Thank you so much! :)

Answer:

glad I help and continued best wishes. JG 2.20.10

Question:

Hi Dr.Garcia, I`m 63 years old and in the last year my face has aged. I had a well structured squarish jawline and now I actually have jowels. It looks as if I aged 20 years in one year. My question is regarding the difference between a natural and pulled face lift. Does the age of the patient have an impact on how tight the end result will be? I have understood that the worse the quality of the skin, the more the skin needs to be pulled, thus causing the mask kind of look. I understand that there are people who look that way because of multiple surgerie and bad surgeons, but I m asking in general, is what I m asking correct? I would consider a lower face lift but worry about the result. My second question is would you do plastic surgery on a 63 year old healthy woman?

Answer:

no, age does not mater, that is a matter of how tight the surgeon pulls and lifts, the natural or unnatural look is in his hands, not in yours. What your age does affect is how long it will look. In more aged skin, there might be a need for more skin to be removed, but the natural appearance can still be acheived. I have done facelifts on patients 20 years older than you, as long as they are in good health. JG 2.20.10

Question:

hello, i have a full face, cheek lift, upper eye, neck lift last feb. when i woke up in the recovery, there was no pain IV in my arm. I had been in surgery 6 hours. the dr stated i should not be in pain when i woke up. i had over eighty staples in my head and face. due to the immense pain, my blood pressure shot to 200/80. they then gave my benedryl and oral vicodan/ is this what should of happened???????

Answer:

well, we like to keep an IV in until such time that the patient is doing well and taking oral liquids. A blood pressure of 200/80 is quite high, can lead to excessive bleeding and in most cases, if we had an IV still in place, we would have given you a medication to lower the blood pressure and not a pain pill like Vicodan nor an antihistamine like Benadryl, their effects on blood pressure would not be too strong and would take a longer time to take effect. JG 2.18.10

Question:

HI Dr. Julio, you know I love you! So, do you not so mid-face lifts? Just got divorced, back on the market, only 32, but UGH the marionette lines!! Skin is good otherwise. Do I just wait to get older, full face lift, or what? I am not doing any injections or implants so... whaddya think. Love you!!!!

Answer:

maybe just a cheeklift is all, hard to say without seeing you, all the best. JG 2.12.10

Question:

who invented the midface lift that lifts off the bone...just curious. is it dr nigro?

Answer:

nope, Dr Rod Hester in Atlanta. JG 2.10.10

Question:

heyy doc, how is midface & cheeklift different? I don`t get it. I`ve been reading into it. One removes skin or something? and which one does that? and what does the other do? please explain abit?

Answer:

they both lift tissues of the cheek but the cheeklift does it from on top of the muscles and the midfacelift seperates it off the bone and the suspension is harder to get to hold in a midfacelift.JG 2.10.10

Question:

you added that endescopic cheek or eyebrow lift doesn`t last very long, compare to the other techniques how long does it last on average?

Answer:

18 months. JG 2.10.10

Question:

HI, you stated midface lift has highter complication rate then a facelift..how so? I thought midface would be easier and safer..?

Answer:

in most cases the issue is the degree of traction placed around the eye and the degree of support needed as in most cases the tissues are lifted off of the bone and require a greater degree of support. Complication risks of a midfacelift in the surgeon`s hands that invented the procedure is up to 17%. Not sure who told you it is safer, but that is not true, easier is relative. JG 2.10.10

Question:

I am 30 years old female. I`ve been having problems with my cheeks sagging along with my eyebrows falling down giving my face a sad pulled down look. I`ve been adviced that cheek lift and lateral eyebrow lift will be a good option for myself. I know being 30 might be younger then some to do this procedure. Thats why I need to know what to really expect. Will I need this procedure every 5 to 7 years? how often will i need to perform these procedures ? and when needed to redo this surgery will it have more serious complications? and will the scars be worse?

Answer:

highly unusual for someone your age, if indeed you do have it happening, you likely will need it redone much more frequently than others, yes. The complications should not be any higher or worse. JG 2.10.10

Question:

Hi Dr Garcia Can I ask you what you think of the Lateral Smasectomy facelift? Is it similar to the Extended MACS lift? It`s getting so complicated with all these different names and different types of facelift. Thank you

Answer:

I personally like it better than the MACS lift. The names are complicated but at the end of the day, or I should say, end of the first year after the surgery, the differences are really hard to see between all the techniques, it is more marketing hype than anything. The MACS lift is actually based upon an operation that was described in 1908 by a Russian surgeon with minimal changes! JG 2.8.10

Question:

I am two weeks post op fl/chemial pee and still swollen under my right eye and left cheek. When I try to smile my right side is difficult and below my swollen cheekbone I have a horizontal line that is present when I try to smile or drink something. Will this go away? Also my right eye is slower to blink then the left eye....will this get better?

Answer:

swelling and creases should all get better with a bit more time. Not sure why the eyelid is blinking slower though if no eye surgery was done, I suggest seeing your surgeon to ascertain what is the cause for the eyelid discrepency. JG 2.5.10

Question:

hi dr. garcia, long time , no post. i had a full face and neck lift in 2000. then in 2007 i had a macs lift. which did very well. i am now almost 67, and you know the skin does crazy things at this age. my dr. says he will do a skin tightening, since the muscles have already been done. he plans to do a cut in front of the ear and pull the loose skin up, it is very minimal. my concern is that i am taking a drug called plavix due to a heart sten being inserted 3 years ago. i went off it for 5 days to have a partial knee done and had no problem. my dr. is hesitant to do this skin tightening when i am on plavix. he said he will but it will be a mess since i have always trusted your opinion, i was wondering what you think. is it a big risk to be off it for a few days as compared to the mess that my dr. is referrring to. i have had no problems at all with the stent or the meds. in fact, i didn`t even know i had a problem. i went to the dr because my husband made me. i am glad now, of course. there was no heart damage from the blockage. thanks for you help once again, barb

Answer:

well, I do not think it will be a mess, I think he is being careful and preparing you for a potential slow helaing and lots of bruising. I think if you can get off the Plavix for a few days, it would decrease the risk, but there is always a risk of a hematoma, even without the Plavix. In cases like yours I think a minimal undermining of the skin will be less risky,the proposed amount of skin can many times be pre-marked and then no further lifting of the skin past that is done to limit the potential severity or size of the hematoma. It might decrease the degree of improvement but there will be a comensurate decrease in the risk. Will likely have to compromise a little is all, I wish you the best and glad the ticker is stil ticking well. JG 2.3.10

Question:

Hi Dr. Garcia, Hope you are having a good weekend! I have a question about a necklift. Is it possible to have a minimal incision necklift with good results? By this, I mean a small incision under the chin for a corset platysmaplasty and then small incisions behind the ears to tighten the skin? I`m not ready for a full facelift yet but would like to be able to have a smooth look on my neck.

Answer:

it is possible in some cases where the degree of deformity is minimal. Minimal deformities can benefit from minimal procedures, but, if you have more than a minimal problem and you have a minimal procedure, then it might not fix it as much as you need. JG 1.24.10

Question:

Hi Dr. Garcia, Thanks for your response concerning the platysmaplasty and cervicoplasty. To clarify, do you ever do a platysmaplasty where you just tighten the muscle in the neck with just a small incision under the chin and NOT remove excess skin through incisions in front of and/or behind the ears? Will this help to smooth the turkey neck or do you always have to remove excess skin? Thanks again for taking your time to respond.

Answer:

yes, in a small percentage of patients, that is all that is required. I doubt it would fix a turkey neck though, it would only fix the bands one can see upon muscle contraction is all, once the turkey is there the skin usually needs to be cut out. JG 1.21.10

Question:

Hi Dr. Garcia, Just wondering if you ever do a platysmaplasty without a cervicoplasty? I saw a PS who said I didn`t need a facelift yet but I would like to improve the appearance of my neck. If I`m going to have a cervicoplasty, I might as well go ahead and do the MACS lift since the incision is the same? I would appreciate your opinion on this. Thanks!

Answer:

well, terminiology sometimes is confusing and some surgeons like it that way. A platysmaplasty is a procedure where the main intent is to tighten the loose muscles of the neck and in many cases there is also some skin removed. A cevicoplasty is a procedure intended to improve the neck in general, that can include removoing fat and or skin along with tightening neck muscles if required. So, a cervicoplasty can at times include a platysmaplasty, but not the other way around. As to the MACS lift, that is more the for cheek pad elevation, so although the incisions are similar, what is done under the skin is quite different. All the best. JG 1.21.10

Question:

Hello, Dr. Garcia I am grateful for your consideration of answering all of the questions. Do you recommend a mini facelift/smartlift laser for a second facelift nine year later. Would a full facelift result in a less than natural look? THanks, Sue

Answer:

it all depends on what has changed, in many cases it is a smaller procedure than the first, but in some people, a repeat full facelift is needed, no way to tell without seeing you and feeling the tissues. A full facelift should not look unnatural if proper tension and positioning is employed. JG 1.19.10

Question:

I am in my early 30`s, my skin quality is good and fairly tight, I have good bone structure, but I am at the age where there is a change in my appearance. I notice that if I put my fingers about an inch under my temples and push up about an inch to my temples, it gives my cheeks and cheekbones, and even a little of my lower face a very nice subtle lift that restores my faces former projection. What kind of lift would best replicate the lift I`m giving myself? Thank you.

Answer:

it would likely be a midfacelift or a cheek lift. JG 1.19.10

Question:

if i were to show you the result..if you hold the area under your ear on the jawline and pull towards the ears..thats the look im trying to achieve..hope this helps

Answer:

if there is a pleat of skin in front of your ear as you do that, you will need the incision in front also. JG 1.15.10

Question:

hey dr garcia is it possible to make an incision behind the ears and lift the fullness in the middle of the jawline in lower face from both the left and right sidestowards the ear to make the jaw line sharper and smoother without pulling or giving a pulled appearance in the lips area? i hope my ques makes sense..

Answer:

difficult as it most likely would leave a pleat of skin in front of the ear that would look funnny. The pulled appearance on the lip is all a matter of how hard and in what direction you pull, that should not persist past a couple of days as the swelling goes down. The jowl needs a vertical lift more than a straight back lift anyway. JG 1.15.10

Question:

Hi Dr. Garcia, During the cheek lift, my surgeon used some SMAS to fill in my n/b folds. The right side came out nice but the left side has a lump. Will SMAS dissolve? If so, how long does it take? Or should I just have it removed?

Answer:

it might, all depends on if it develops scar tissue, no way to tell except to wait it out. JG 1.15.10

Question:

I agree experience is great but i`ve heard some negatives and wondered if age plays a part in surgery. The younger dr has had many postive ratings which he needs for his career. Anymore input would be appreciated. Thanks again

Answer:

well, certaily there are negatives, since he has taken care of more patients, there are likely more issues, the less experienced one has not treated as many people so the numbers are smaller, but if you are concerned, the younger might be fine, there is no way to tell l00%. I will say taht a younger doctor likely has a different subset of patients, maybe more that are willing to post things in readable places. We were all younge surgeons once, hopefully we will all also be older experienced surgeons too. JG 1.11.10

Question:

Dt Garcia I`m going to consults for a fl and the two that I liked so far- 1. a big name NY dr who`s 68 and a dr who`s been in practice for 3-4 yrs and seems great. in your opinion which is better? Thanks

Answer:

well, experience does help I believe. JG 1.11.10

Question:

Hello Dr. Garcia, A highly regarded P.S. suggested smartlift facelift, He has hundreds of photographs of patients some look great and some results are not real impressive. He suggests this procedure over a traditional facelift,and commonly for second facelifts. He charges more for the surgical facelift by about $1,000. I just do not his understand his preference for this procedure. Any insight? Thanks, Sue

Answer:

the Smartlift is just a mini facelift, so it is a smaller procedure than a regular facelift, healing is shorter, as less is done. In many cases, if one has had a facelift before, they only need a mini facelift the next time. I think the only smart thing is what he is charging you, as it is much smaller than a facelift and the price difference is not larger. JG 1.11.10

Question:

will you perform a cheek lift for a patient that has some neurology problem.. like twiches with eye and cheeks.. little lips and chin..? will it make the condition worse? is it safe to do so?

Answer:

well, it can be done, the twitching will likely not change, no better nor worse. JG 1.10.10

Question:

I am planning facelift and have been researching docs in Bay Area. Do you know anything about Delgaldo, Eshima or Aycock?

Answer:

do not know about any of them, sorry. Happy New Year. JG 12.30.09

Question:

Hi Dr. Garcia, quick questions: 1.Is a suspension necklift better than, worse than, or just different than a conventional necklift? 2. Is adult stem cell fat transfer-with both donor and recipient sites treated with growth hormone-more likely to allow fat transfers to survive? IS an adult stem cell facelift as effective as a conventional facelift? This is the quote from the doctor`s website: Although fat grafting to the face has been known and utilized for over a decade with a varying amount of success, this new approach, of transplanting “Adult Stem Cells” and fat from the lower abdominal area, and awakening them as well as the local stem cells within the face with specific stem cell growth factors, is a revolutionary technique to facial rejuvenation. Thanks for your help, and I must say that it`s unique to find a doctor like you. Merry Christmas and all the best in the New Year.

Answer:

well, if it is just a percutaneous suture technique it is worse, if it is part of the traditional neck lift, it migth last a little longer. Thre is no evidence that human growth hormone injections enhance fat transfer survival. Stem cells with fat injection do not replace a facelift, they do different things, the facelift lifts the tissue that are there and the injection enlarge the fullness and only by secondary effect lift the skin. There are new machines sold that claim to have stem cells in the supernatant but although it is used in other countries around the globe, it is legally not able to be claimed here in the US. The survival should be better if there are truly stem cells present though, but that is a big if as it depends on the tehcnology used to harvest and process the fat. Merry Christmas and a Prosperous New Year. JG 12.22.09

Question:

hello dr garcia merry xmas & happy new yrs 2 u 2:D.... Im the one with the cheek question, you said 1/2 is not enough to fill up a cheek and to give a roundness. How much of the filler will be normally enough to get this effect with juvederm? I know its hard to say without seeing me but approx. what would you say?

Answer:

hard to say as it depends on how much loss of fat you have in the cheeks but in most cases for someone who has lost tissue it will be 3-5 syringes.Merry Christmas, Happy Channukah and Happy New Year. JG 12.17.09

Question:

hi doc, I just had half a ml of juvederm injected to each cheek area. I wanted to have high cheeks with a aesthetic roundness just below the eye rim like a apple cheek but high. However my ps injeted it just near the the eyes not so much high enough to reach the temples or to give any roundness., My question is when using juvederm what is the proper way to explain to someone what I just described to want? Im not familiar with the terms . He said he knows what I want but I didn`t end up getting much. Im scheduling another appointment for a top up but Im affraid he might just use the same approach. The result he gave me was a wide face, as he injected just at the side of the eyes without any extension. please adviced.

Answer:

it is always proper to express your desires and to be honest, the amount injected is OK for the tear trough but it would not be anywhere near enough to fill a cheek area for roundedness. I think assuming that there is good communication is never good, take an eyeliner pencil and draw the area of yor cheek you want filled when you go in. Best of luck. Merry Christmas, Happy Channukah and Happy New Year. JG 12.17.09

Question:

i posted about being 1 yr post with some numbness still on one side after u.l bleph, and lower face/neck lift and about a friend who was referred to an opthamologist few weeks after bleph. wonder if you didnt see it as it wasnt answered. thanks!

Answer:

sorry, but I did not see the question, if it is still numb after one year the loss of sensation might be permanent, there are always small nerves cut during surgery and spots of numbness are not unusual, but they usually shrink over time in size. At this point in time there is likely little that can be done to correct the issue I am afraid. JG 12.7.09

Question:

i am almost 1 year post upper/lower bleph, rhino, lower extended SMAS face/neck lift. I am still numb at the hinge of one jaw and up to same side outer cheek bone and eye. the eye on that side still gets lazy about closing al the way sometimes. is this normal? Also, hv you ever heard of a PS injecting botox on a patients outer eye/forehead area few days before upper lower blepg and brow lift? Not me, but some one i know get a droopy eyelid at 11 days post op and she says her PS is already referring her to an opthamoligist? Dont you think the PS should be responsible?

Answer:

well, not normal and although numbness can happen, the eyelid closing problem is not normal, sounds like there was some type of muscular nerve damage or too much skin being removed. The purpose of injecting the areas with Botox before the surgery is to get the muscle to be weaker so it tends to stay where you put it after lifting and the muscle do not work to pull the brow back down until it has healed. I do not routinely do it, but some surgeons feel it is a good idea. The drooping of the eyelid after Botox can happen and will wear off though, although if the eyelid sagging is due to the surgery or skin removal, that will not wear off and might need something totally different. JG 12.7.09

Question:

Dr. Garcia: I`ve been noticing that certain celebs who`ve apparently received lower face lifts, such as Meg Ryan, end up with very pointy chins. Is this outcome usual for a lower face lift or chin & neck lift? Or is this dependent on other factors? Thank you for all you do. :)

Answer:

it can be,especailly if they get a chin implant placed to enhace their jawline more. Thanks for the kind words too. JG 12.5.09

Question:

Hi Dr. Garcia, How long after a TCA peel can a patient have a facelift? Thanks for your time, and happy Thanksgiving.

Answer:

after 4-6 weeks should be OK. All the best. JG 11.22.09

Question:

Hi Dr. garcia, I have been seeing alot of cosmetic surgens and doing my homework so I will choose the right surgen when I am ready to have my procedures done., however , most of the doctors are gentle with my skin as they study my face to see what needs to be corrected, yet a few of the doctors that I have seen are really rough when they examine my face , such as pulling and tugging my face , eyes and neck, which bothers me because I know the skin tears easier as we get older and I am 56.,If i did not have saggy eyes and a turkey neck, well then after going though this tugging thing with these doctors, i feel that They most likly made things worst, does this really cause dammage or am I just worrried for nothing, thank you doctor garcia, you are the best.

Answer:

I think although it is rough, there is no damage being done to your skin with that examination, best of luck. JG 11.22.09

Question:

I asked you a question recently regarding neck bands and a MACs lift. Your advise was to go with a plastysmalplasty if neck bands were my primary concern. I consulted with another PS that has recommended a Plastysmalplasty/Cervicoplasty (no lipo as I`m very thin). He indicated there will be small incisions behind the ear with the possibility of small lumps behind the ear that could be worked out with massage. Does this sound like a reasonable approproach and is there anything that you can think of that I should be concerned about?

Answer:

very reasonable and I would have said the same. JG 11.17.09

Question:

Hi Dr. Garcia, I`m 52 years old. I`m wondering if a neck lift is always done with a face lift or can it be done on it`s own? I don`t think I need the face lift part just yet but would really like to get rid of the beginnings of a turkey neck. I would probably also consider a lower lid blephoraplasty at the same time. Thanks for taking the time to answer my question.

Answer:

it can be done on its own if indicated. I will say though that in many cases the amount of skin in the neck region cannot be draped in a soley horizontal direction, thereby requiring a vertical lift which then needs to employ scars onto the cheek. In theses cases the surgeon will just go ahead and do something on the cheeks to complete the facelift as a facelift is a cheek lift and a necklift together. JG 11.15.09

Question:

Hi Dr. Garcia I had cheek implant replacement (original implants were placed in 1994)22 days ago. I also had a facelift and rhinoplasty. The incisions of the facelift are along the front of the ear into the earlobe and wrap behind the ear, I have a jagged appearance on the inside of the ear and the incisions are very visible. My face is very swollen still. What will be a typical outcome of the scars. WHat would work best on the scars. Thank-you in advance for your time.

Answer:

in time as the swelling goes down, the scars will usually shift into a better hidden place and they will also fade in terms of color, but that will take weeks to months, got to give it some more time. You could use ScarGuard or Mederma on the scars at this point. JG 11.12.09

Question:

Hi Doctor Thank you for your answer re bumps in MACS. Do these bumps occur even when they use dissolvable sutures.

Answer:

yes because it is not the sutures that cause the bump, it is the tissue that has been tightened like the top of a purse with a pursestring. JG 11.11.09

Question:

What is the difference between a MACS lift and a SMAS lift? Is one superior over the other especially in regards to the lower face/neck? Also, is one less invasive with a shorter recover period? Thank you. I really value and appreciate your website and the information you provide.

Answer:

they both lift and tighten the SMAS, but the MACS lift is where rather than multiple points of suturing, a purse string approach is used where the SMAS is gathered together in 1-3 places to lift and reposition. The limitation is that there can be a bump where it all comes together and that you lose the ability to lift in various directions. It is not less invasive if the elevation of the skin is similar, but it has been marketed that way though to make it sound less invasive and less scary to the patient. JG 11.9.09

Question:

I consulted with a Plastic Surgeon regarding a plastysmaplasty. My primary concern is neck banding. This is a PS with all the right credentials/certifications. He suggested a MACS lift. He said this would addres the neck banding. He felt I did not need a plastysmaplasty and I could eliminate my banding with the MACS lift. He also said some of the information gleaned from the current PS conference is a shift away from surgery which opens the neck. He said this is an old fashion approach. He said most people are born without their plastysma muscles attached and by attaching mine, it would make them anatomically incorrect. My research indicates that a platysmaplasty is the most important element of lifting the neck and eliminating neck bands. My questions are: 1. Can a MACS lift address banding of the neck? If no, what do you recommend to a patient who presents with neck bands being their primary concern? I don`t want to endure a procedure that does not address the problem and 2. Is there a paradigm shift in Plastic Surgery moving away from opening the neck? Thank you in advance.

Answer:

A MACS lift cannot reliably correct neck banding. I think if that is your main concern, have a traditional platysmaplasty, like that which has bene done for many years. Joel Feldma MD has popularized it many years ago and it stands the test of time. I think when doing facelifts there is a move away from large neck incions but not when it comes to a primary neck problem. JG 11.9.09

Question:

Hi Dr G: You mentioned that some types of facelift have more risk of nerve damage than others and are really no more effective. What kind has lower risk yet yields good results? thank you

Answer:

well, imbricating the SMAS instead of seperately lifting it is safer. JG 11.6.09

Question:

I am thinking about having a facelift, but as I read I read that several people have nerve damage. Is this a common thing that can happen? The dr. that was telling me about having a facelift made it sound like a simple pain free procedure that I would benefit from and that it was no big deal. He said that a lot of people had numbness on the side of their face because of cutting into nerves and that it would probably come back in about a year, but he didn`t mention nerve damage that you couldnt move part of your face and that you would look funny. Please help me with this issue. Thanks. Also, is it a dangerous procedure with lots of complications usually?

Answer:

nerve damage occurs in less than 1% or even less. Nerve damage is always a risk but the risk is higher or lower depending on the technique used, there are good ways to perform the lift and avoid the areas where the nerves can be injured as still yield a very good result. Long term studies have never shown a superior result long term in the types of surgeries where the risks are higher. Total complication rate, including minor and major problems with a facelift is about 2%. Best of luck. JG 11.3.09

Question:

Dr. Garcia, Are jowl ligaments ever cut to improve the outcome of a facelift? If so, in what situations is it appropriate? Thank you for your time.

Answer:

no, they are not as we do not want to injure the underlying muscles. JG 11.1.09

Question:

Hi, Dr. Garcia. I`m 13 weeks post op with a mid facelift. I experienced some facial nerve trauma and was unable to animate the right side of my face for the first week. At 3 weeks, I had regained about 30% function. Since then, there`s been no real appreciable improvement. I purchased a TENS unit, which I`ve been using 3 times each day, but it doesn`t seem to be ameliorating the situation. In your clinical experience, would you say that at this point, I have just about all the improvement that I am going to see and that I cannot expect a full recovery (or even significant continued improvement)? Thanks so much for your time and encouragement.

Answer:

The TENS unit does not help the nerve regenerate, what its intent is is to maintain the muscle size and not allow it to atrophy while the nerve regenrates on its own.The degree of return of function will depend greatly on the type of injury to the nerve. If someone has come back, then the nerve was not cut entirely through which is a good sign but it can take months in some cases for the final return, or degree of return, to be determined. Hang in there and best of luck. JG 10.31.09

Question:

Hi Doc, Just wondering about something. We are hearing more and more about the MACS Extended JG 10.30.09Lift. 1. Do you think that this is gaining more popularity with many plastic surgeons just because it is an easy surgery to do? thank you

Answer:

personally I think most surgeosn are adopting it so they can say they are doing the latest version of a facelift, it is not dramatically better than other techniques that have been around for many years but have lost their advertising sizzle. JG 10.30.09

Question:

Dr. Garcia, I trust you answers and your judgment about different procedures I a have asked you about. I am kinda thinking about a mid face lift for not wrinkles but loose slacking skin causing the jowls and uder the neck thing. The plastic surgeon says I have taken very good care of my skin and that I have nice smooth skin without wrinkles.But there is still the extra thing and upper eyelid extra skin.My question to you is that I had radiesse put in the cheek area about 6 weeks ago and before that radiesse and some evolence for the tear trough and a little juvaderm for the nasal labial folds. Will I have to wait for these to dissolve before I can have a facelift so he will know how much skin to pull up and take off. Will the filler take up some of the skin that it is filling out and then after the facelift it gos down and then I still have loose skin? Please tell me what will happen in this case. I know that sometimes when you have lost some fat a collagen and just had your cheeks fall down that just a facelift will pull th skin tight but wont fill out the cheeks or face for the young youthful plum look we want.

Answer:

I think you can proceed with the facial procedure without waiting for the fillers to totally dissolve, they will not hinder the performance or outcome. Best of luck. JG 10.30.09

Question:

Hi Dr, Garcia, Before I had my facelift a nurse told me that a facelift is really a neck lift, my facelift looked good for a while , It has been almost 4 years and now my neck is really loose, more than ever before., So my question is that Is a facelift the same thing as a neck lift? thanks you are the best.

Answer:

a facelift is a combination of a neck lift and a cheek lift. Necks generally loosen up faster than the cheeks though. JG 10.25.09

Question:

Dr. Garcia, Three years ago I had three different consultations with plastic surgeons regarding a face lift. I was 56 at the time and had slight jowling. My problem is that I have a very thin face--apparently not very good cheekbones because I never had any apples on the cheeks except when I smiled and then they were fine. All three suggested a skin only lift--these were not lifestyle lift doctors. What do you do with an already thin face? I don`t want to get into fillers and cheek implants because I never had that fullness to begin with, but I don`t want the surgery to make me look thinner. Have you had patients with this problem and what do you do? Thank you so much.

Answer:

well, I will be honest, although you never had a full face, with aging, some facial fat is always lost, so your face is likely less full now than 10 years ago, so a skin only facelift would likely make you look thinner because it would unmask the lost fat. I think some type of bulk producing product will need to be added to make the face look more youthful. This might be injectable fillers like Sculptra, or fat, or in some cases cheek implants, hard to say what would be best without seeing you in person. Best of luck! JG 10.22.09

Question:

I have search your site and found the answers to my inquiries; however, my question is more about the scheduling of the procedure. I think I am interested in a cheek lift, but I feel I should wait to schedule the cheek lift until I loose the 20Lbs I am in the process of working on loosing. As a result of wanting to wait, when should I schedule the consultation and surgery if I want to have this procedure to look unnoticable by 10 Oct 2010.

Answer:

I think if you have the procedue in early to Mid August, that would be optimal, we are booked about 6-8 weeks in advance for surgeries at present so a consultation about June would be a good idea. All the best. JG 10.21.09

Question:

Hi Dr. Garcia, Hope you are having a good weekend. I`m 52 years old with some lower facial sagging and turkey neck developing.I`m seriously considering a local plastic surgery consult for a MACS lift and neck lift with lower lid pinch blepharoplasty. I`ve read opinions both ways - that the MACS procedure can be effective for a younger person with less aging and then I`ve read that the mini facelifts are just marketing hype... everyone should just have a regular facelift. Or should a good surgeon be able to tell you which one is going to be best based on my face? I would appreciate your opinion on this topic.

Answer:

well, the MACS is just a way to suspend the tissues, most people think that shorter scars are mini-lifts, but lots can be done below a short scar. Ultimately, if you need a good amount of neck skin removed, then it will require a longer incision to remove it, no matter whether a MAC suspension was employed. An experienced surgeon should be able to predict the length of the scars required. All the best. JG 10.18.09

Question:

Hi Dr. Garcia: I would really like to have a lower face lift but am afraid to. My neck has a lot of loose skin and I hate it but the possibility of permanent nerve damage is just too scary. What advice can you offer? Thank you.

Answer:

I have to say that you will likely need to get over your fears because it will probably take surgery to correct. JG 10.18.09

Question:

What is it about the serdev suture procedure that would keep you from recommending it? Are you familiar with this procedure at all?

Answer:

yes, the sutures will break and then the lift will fail and you will look lopsided until the other side breaks. JG 10.16.09

Question:

What do you think about the serdev suture procedure for a brow lift and face lift. It promises no incisions and no scars and it says the brow lift is permanent and also the facelift has same results as the one with scars. Sever videos about it and all over the internet. Please tell me what you think.

Answer:

I would not endorse it. JG 10.16.09

Question:

What do you think about the serdev suture procedure for a brow lift and face lift. It promises no incisions and no scars and it says the brow lift is permanent and also the facelift has same results as the one with scars. Sever videos about it and all over the internet. Please tell me what you think.

Answer:

I would not endorse it, sorry. JG 10.16.09

Question:

I have very fine thin hair and wanting to have a facelift done. The dr I went to specializes in this and says the way he performs facelifts that I wouldnt be abel to see the scars. He goes behind the ear and not in the hair and says he goes in the ear somehow in from into the lower earlobe and showed me several pictures of people that had short hair and said the scars wouldnt be able to be seen. He said they would fade and you wouldnt even be able to tell. Is this possible to have no hair loss from the facelift and not visible scars?

Answer:

well placed scars so that they are not easily seen is possible, but the limiting factor will be how much skin needs to be removed, the greater the amount of skin that needs to be removed the greater the chance the scars will not be hidden as well, so there is a trade off. JG 10.15.09

Question:

I am wanting to have a facelift done, but I am scared to death of the pain of it and the being put to sleep and the scars. I wanted to ask you if I did have one done, how long would it be before I could go out in public and look norman and will the scars ever look normal?

Answer:

most people are out in public in two weeks with a little make up. The scars will fade in time but in some people that can be harder to hide. JG 10.15.09

Question:

Would a facelift typically improve the skin above and below the mouth? In other words, would naso folds & mario lines be improved because of the general lifting of the face (cheeks & neckline)? Thank you!

Answer:

yes, they should also be improved. JG 10.11.09

Question:

You had said that before a second surgery, you liked to wait until the area was loose, not tight. (I had a bad necklift and now will need a facelift.) It is now 7 months since the necklift and the area in around my ears is still tight, but getting better. I am hoping I can have the facelift 1 year after the necklift. Have you ever heard of anyone who had to wait longer than 1 year after the first surgery? One and 1/2 years? Two years? Thank you for your thoughts!

Answer:

I like a year but 18 months might be better if you can wait. JG 10.11.09

Question:

hi doctor garcia is Skin Doctors Capillary Clear Cream 50ml good for the capillaries? or rosehip oil or any suggestions?

Answer:

I know of no topical creams that help broken facial capillaries, I suggest a YAG laser or an IPL treatment as a series, and no matter what is done, they will come back in time. JG 10.10.09

Question:

Thanks - they both said they`d do the same procedure-one dr general and over night and the other general and out patient.

Answer:

well, it is always nice to have skilled and experienced people take care of you if possible and if the price is reasonable, a family member or friend can do it but they will not sleep much that first night while taking care of you. JG 10.9.09

Question:

On my consults for fl surgwey, one dr said i`d have general and stay overnight in the hospital and the other said I`d be out and back in my hotel in 3 plus hours. what`s your opinion? Thanks

Answer:

quite a difference, some doctors operate just as well but slower, and some doctors do less as part of a facelift, might want to get a third or fourth opinion until you get consistent answers. JG 10.8.09

Question:

Hi, Dr. Garcia. I have experienced facial nerve trauma secondary to a mid-face lift 11 weeks ago. While I regained some function within the first few weeks post-op, I have had no measurable improvement in the past 8 weeks. I can barely animate the right side of my face. I believe I have read in one of your posts that you sometimes supply your patients with an electrical stimulation device to prevent muscular atrophy in cases like this. My own surgeon has never used this but feels it can`t hurt. Where would I obtain such a device? What is it called? How much does it typically cost? What is the longest amount of time you have seen for full function to return? Finally, in your opinion, is the fact that I do have some neural activity at this point indicative of a possible full recovery, or is this state of affairs likely to be permanent? Thanks! You`re terrific to offer your time and expertise to strangers.

Answer:

in most cases a local physical therapy office cna help you get one,they are used to avoid atrophy in larger muscles but all you do is turn down the strength on the face, they work well and are easy to use for even the unexperienced. They can be rented at some clinics or they run about $250. I have seen and heard of the nerve taking 12 months in some cases although they typically see partial and slow return way before that. It is hard to tell about a full recovery, it can still happen, they could do an EMG of the facial muscles to check for nerve integrity but it can be pretty uncomfortable. I wish you the best, and there are no strangers here, just people I have not met yet! JG 10.7.09

Question:

hey doc im the one who used ragain for hair loss and made more hair fall off! you said you never heard of regain make hair fall but earlier when i asked you said it does make the hair fall off at the start and then it grows... i just wanted to know if i discontinue to use it as it made my hair fall off heaps will i have my own hair grow back again without using the regain. and there is nothing that changed with me that can cause it except that i was using the product for almost 2 months now.

Answer:

the effects of Rogaine are not immediate as it only affects the hair that are going into the growth phase, so normal hair loss will continue for awhile after starting before any positive effects are seen. If the hair loss was due to DHT and you continue to use the Rogaine it might help, if you had some unusual allergic reaction to the Rogaine, it should grow back if you stop, but that allergy is quite rare. JG 10.6.09

Question:

Dr. Garcia, To what do deep tissues of the face refer? Is is basically everthing below the skin/fat? Finally, do the deep tissues sag along with the skin (e.g., if deep tissues includes glands, do the glands sag)? Thank you.

Answer:

yes, the fat and muscles in most cases. JG 10.5.09

Question:

my doctor told me i dont need a facelift, but i am 59 years old and my neck is somewhat loose. can he tighten that without doing a facelift, and what would you recommendd?

Answer:

yes, you could do a necklift which is just the bottom half of a facelift. JG 10.1.09

Question:

hi dr garcia, what do you suggest for skin that looks yellow on some areas of the face? like under the eyes and spotty looking yellow marks?

Answer:

I would start with some Retin-A and see what happens. JG 9.28.09

Question:

hello doctor, what are some good chemical peels for fine lines, face?

Answer:

I feel chemical peels are good for spots but not for wrinkles unless you use phenol, and that is rarely used anymore. JG 9.28.09

Question:

Dr. Garcia I had a fl and necklift 15 yrs ago and then just a necklift approx 5 yrs ago. I`m considering another fl but my neck is saggy ( I have a long thin neck) so can it be lifted again? Thanks so much !!! ps when I had just the neck lift last time it only did so much because the face wasn`t addressed.

Answer:

yes it can be lifted again if needed. Best of luck. JG 9.27.09

Question:

hi doc, i will be having eye surgery to elevate lower eyelids. What will be the best thing to use to decrease the brusing and all? arnica? hirudoid cream? what can you suggest?

Answer:

we use arnica in our office, both orally and topically, best of luck. JG 9.22.09

Question:

im using regain for hair loss. while using this product will the rest of my hair grow quiker then usual?

Answer:

yes, it might. JG 9.21.09

Question:

I just read you suggest starting Arnica 2-3 days before surgery. What about Bromelain? When should that be started? Thanks

Answer:

same way. JG 9.16.09

Question:

Hi Dr. As i have severe dry eyes, a bleph is not an option for me until absolutely necessary (met w my Ophthamalic PS) Question, I am considering a FL or LFL with NL which i was told was ok. (A mid FL was questionable if they were to go in thru the eyelid-a no, no.) Will a FL or LFL/necklift get rid of the marionette lines as I have been told that my eyes are fine and no need for a browlift. Am 53 with good skin..lower face beginning mild jowling-currently have juvederm in folds and cheek area and Btox for frown lines..My best option.??? jg Canada

Answer:

yes, the cheek procedure, whichever you choose should correct the marionettee lines, all the best. JG 9.15.09

Question:

I have a little whitehead like thing under my eyes. But its not a zit. Its been there for about a year and a half. I tried poping it but it wont pop. It just hurt and turned red abit. Its actually really tiny but it looks like it has white stuff in it but nothing is getting out of it. What do you think it is? and how am i supposed to get rid of it? thank you)

Answer:

likely an inclusion cyst and you should have a dermatologist take care of it for you. JG 9.11.09

Question:

hey doc garcia, im using regain here product. I was wondering, how do you know if its working for you? I`m not totally bald so its hard for me to tell if its working in few months. Would the first sign of hair growth be little spikes of hair showing its first stage of growth? What kind of hair should i expect to see and how soon?

Answer:

small little soft spikes of hair, yes. It usually works in the first 3 months if it is going to work. JG 9.10.09

Question:

hey doc if 1 mls of fillers is used for cheeks... would you say 1ml of sculptra will do the job? im trying to figure out how to know how much scultpra will be right. So if 1ml of restylane is enough would it mean that 1 ml of of sculptra will be right?

Answer:

there is no conversion like that, and Sculptra does not come in cc`s, it is vials. JG 9.6.09

Question:

Like so many others, I`m in awe of your ability (and generosity) to inform us, what with your busy practice. You`re a rarity, for sure. Are you familiar of the Y-lift? It`s a new technique employed at the Yan Center for a lunch time face lift.

Answer:

it is just an attempt to make something that has been around for many years sound new and unique to that doctor, beware of operations that make claims that appear to be too good to be true, it usually is. JG 9.3.09

Question:

I will need a facelift as a second surgery after a bad necklift by Eugene Bortnick. It has been 6 months since the necklift, but I still feel tightness and some soreness around the ears. Do I have to wait until I feel no tightness or soreness before I can have a facelift?

Answer:

I think it best to have the tissues as soft as possible to allow the manipulation of the tissues to be the best. JG 9.3.09

Question:

which would you suggest for a fl-general or local anesthesia? I had hair loss from a prior fl procedure. Will it happen again? Is there anything I can do to preveny that? Thanks

Answer:

I do all of my facelifts under general anesthesia, and hairloss can happen after a facelift, depends greatly on the type of facelift done and where the incisions are. The only way to prevent it if it was due to the surgery is to limit tension on the skin flaps so the blood supply stays as robust as possible. JG 9.2.09

Question:

hello dr garcia i have a weird question... Everytime i eat junk food the next morning and days after my face looks different dramatically. One eye looks smaller then the other eye the upper eyelid looks puffy .. this goes on for even weeks sometimes.. why do you think this happens?

Answer:

well for a day or two it is likely the sodium, but if it is just a one time junk food night, it should not lasts weeks. JG 9.1.09

Question:

if I plan on having a fl in june, should I not have any botox, fillers during the year+ Thanks

Answer:

not a problem having that done while waiting, best of luck. JG 9.1.09

Question:

Thank you for your quick reply. If I am asking you it is because I really value your opinion on this and also because I do have some hesitations. My doc does say that in his hands there will be no lumps etc. with this procedure. My question therefore would be even in the `best` hands could there still be complications regarding this fat transfer procedure? Can i post a picture to see if you think I need this done. Once again thank you

Answer:

yes, complications can happen even in the most skilled hands, also, there is no guarantee that the fat will survive or how long it will last. You can send the photos to drgarcia@lvcosmeticsurgery.com if you wish. JG 8.26.09

Question:

What surgical procedure can be done for the marionette lines? Mine are actual creases at both corners of my mouth and make me look like I am frowning. I tried fillers but that didn`t work. Thanks for your advise!

Answer:

cheek lift should help them. JG 8.26.09

Question:

Hi Dr. Garcia, Hope you are having a great weekend! I was recently at my docs office having Botox and asked for a referral for a mini-face lift somewhere in IA. I was referred to a plastic surgeon in Des Moines who does the Euro-mini facelift, along with neck lift and mini lower lid lift. What do you know about the Euro-mini facelift? I`m 52 with some laxity in the lower face, slight bags under the eyes and starting to see the dreaded turkey neck. I`m all for a mini-version of this type of surgery with less downtime and subtle results vs. the windblown look . I would appreciate your opinion on this? Thanks!

Answer:

it is most likley what is called a MACS lift which is a good option for many younger patients. It should not give you a wind-blown effect. Best of luck. JG 8.16.09

Question:

when using regaine hair product it says (in the instructions) to use 1ml for the area being treated. so if i was using it for two spots of my head can i use double the dose or is that the dose for the whole head? thank you

Answer:

that should be enough for the two area. JG 8.6.09

Question:

Ive lost hair from my temple front hair line.. will regaine product help for this condition? im a female

Answer:

Yes, Rogaine should help there. JG 8.2.09

Question:

hello doc, Im a sort that uses hair products like, hair spray, fizz free products daily. I have a question with the use of medscalp. It says to use it every day 2 times , mornings and night times on clean scalp. Does this mean i will have to wash my hair every night before applying for night time?

Answer:

you can apply it on a dry scalp, no need to wash yoru hair before application. JG 8.1.09

Question:

sorry about that, i was supposed to say selsun shampoo not senson.. i just wanted to know if i can use this shampoo all the time even if i dont have dandruf anymore? because i like the way it feels with my hair... thanks

Answer:

I figured. JG 7.31.09

Question:

ok, what happens if i miss only one day of using regaine hair productt? will it dramatically effect the process?

Answer:

no, you would need to stop for a longer time, week or more. JG 7.30.09

Question:

which one is better? ScalpMed or regaine? and why? thnxxx

Answer:

I feel ScalpMed is better as it is less irritating to the scalp. JG 7.30.09

Question:

hi doc garcia... I was wondering ... can a women use regaine hair product without having a bald patch? My hair is fine and i will like more hair... Will it have any bad effects for someone that doesnt have a major hair loss if used?? and will this help a person like myself?

Answer:

Rogaine will potentially slow hair loss and might get some small hairs that stopped growing to restart but it will not necessarilly make a thin hair thicker. It should not have any negative effect though, besides the rare ones listed on the box. JG 7.30.09

Question:

Hi Dr Garcia I saw a well-known surgeon Dr Javier de Benito and he does sillouette lifts? I never in the past though much of these kind of lifts but he is so well though of that now I wonder. What do you think of these lifts?

Answer:

I would not perform one, no matter what surgeon vowed they are wonderful, the threads break, can be difficult to remove, and if one side breaks and the other does not then you look like you had a stroke, and since it does not remove skin, it would only be indicated to help a small percentage of patients for a short period of time, sorry. JG 7.29.09

Question:

If one is doing a browlift, and then lower face and neck at separate times, which should be completed first? Without much of your time, could you elaborate very briefly? Thanks much, hope you are well.

Answer:

there is no one correct answer, I suggest doing the area that bothers you the most first. JG 7.28.09

Question:

I had a rhytidectomy 8 days ago. Stitches are now out from around my ears altho my ears became very angry and swollen. It appears that my skin did not like the sutures and reacted. Now the lower jaw and neck areas are still very swollen and not only feel so very tight but feel as tho the areas are rock hard. Like muscle contractions that are not relaxing at all. So very tight when I swallow. Do you think this is normal and is there anything to be done for spasms like this?

Answer:

I think you should see the surgeon to make sure there is no hematoma that needs to be drained, best of luck. JG 7.28.09

Question:

If the hair has become finer after electrolysis and say i decide to pluck them will the hair become worse again and darker? or will it stay the same?

Answer:

stay the same. JG 7.27.09

Question:

hey doc, while using retina (first week) is it ok to workout and sweat from face?? will it effect the skin ?

Answer:

OK to do, no problem. JG 7.27.09

Question:

is there any supplements to get rid of adrenaline flushes?? aNYthing??

Answer:

sorry, no. JG 7.27.09

Question:

i was reading bad results and suggestion to fix nose jobs.. from your experience what are are the common mistakes made with nose jobs that gives bad results in the future..?? thank you doc.

Answer:

the most common problem is not enough change and that can be fixed by more surgery, touch ups or revisions occur about 5-7% of the cases. JG 7.26.09

Question:

nswer: well, the entire opening of the eyelid will be smaller, both vertically and horizontally, so the shape of the opening between the upper and lower eyelid will be smaller, narrower. JG 7.24.09-----------------by this do you mean my eyes will be shortened horizontally??? because the ocuplasty said he wont shorten either eyes and that it will only mean the lower eyes lifting up with tarsal.strip. I understand if you saying the opening will be narrow because thats what the procedure is for i think, coz the lower eyelids are falling down causing dry eyes but i dont want it to be shortened horizontally... does this sound right for this problem.. and what i want?

Answer:

well, I beg to differ, although the lateral canthus is not changing, since the canthal ligament in your case is being brought up vetrically, in so doing there will be a small amount of horizontal shortening too although nowhere near as much as the vertical shortening, having said that I think the horizontal width will be closer to normal, in your case the horizontal width is excessive and he will normalize it so it will shorten a small amount, but only to approach the normal width. JG 7.24.09

Question:

hi dr garcia, with the tarsal eye surgery to correct the lower eyes hanging down you said apeture of the eye will need to be made smaller and that i should be aware of this. I dont understand what you mean with saying the aperature . Does this mean my eyes will be vertically more closed , while the lower eyelids raise up? Because my eye surgeon said he wont remove any skin or shorten it horizontally... Can you please explain as you have much skills... thanksss

Answer:

well, the entire opening of the eyelid will be smaller, both vertically and horizontally, so the shape of the opening between the upper and lower eyelid will be smaller, narrower. JG 7.24.09

Question:

hello dr garcia, I just wanted to let you know. I was concerned about my upper eyelids being hollow. My eye doctor injected restylane. I am 29 years old / female. My eyes actually look great. My eye doctor said the improvement is very slight and that i shouldnt get it done but that slight improvement actually has put my eyes and face back into balance. Just wanted to share a happy story on your site:)))... your great and a beautifuL doctoRRR)) take care

Answer:

well now I am blushing and thanks for the positive story posting. JG 7.24.09

Question:

how many sessions of electrolysis would normally be needed for hair to be permenantly or almost permenantly, to be gone?? i know it will depend on each individual but from your experience can you give me some idea, would you say 5 or 10 sessions?? or more?

Answer:

impossible to tell, too many variables, it might never be permanent. JG 7.24.09

Question:

I had electrolysis for hair removal. Is it possible for the treated black thick hairs to grow back finer??? The lady who treated me told me it wouldnt that all the hair thats been treated is permenantly gone.

Answer:

yes, it is possible. she is incorrect. JG 7.24.09

Question:

hi dr garcia when i asked, if females can use men face cream it was of a cream called MenScience Pigmentation Repair Formula (Retinol 1%, Glycolic and Kojic Acid)... would this cream give the same effects to a female face? or would it be harmful for the female skin.? and would you think this cream is a decent as a face cream?? Thank you for always helping with questionssss... I always value your opinions...

Answer:

it should work the same way. I cannot comment on effectiveness without knowing the concentrations of all the ingredients. JG 7.20.09

Question:

to spread eyebrows apart my p.s. wanted to puit 5 injections of botox -one over medial aspect of each brow and 3 in between brows. does this sound logical with minimal risk of ptosis. thanks!

Answer:

it can allow some minimal spreading of the skin between the brows but injections in that area are the ones that can lead to a droopy lid, although it is quite rare in experienced hands. JG 7.14.09

Question:

I had a short-scar f/l 2 weeks ago. Initially all even-now right side feels significantly tighter (from temple on down) and one eyeball sits appr.1 mm HIGHER than the other. Even husband can see, but consoles me that it`s prob.due to swelling, residual tightness. Have you ever seen such in any case? Thank you!

Answer:

I agree, it might look worse due to swelling, give it another 4 weeks and see what happens. JG 7.13.09

Question:

hey doc you just said fillers wont be worth it for upper eyelids, my eye specialised suggested this procedure to me though... do you think its ok to go through it.. or what will be the worst thing that could happen?

Answer:

I guess the worst thing that can happen is it leaves your eyelid droopy due to the weight and you waste your money. It helps if injected right under the brow to plump the area but injecting the upper lid skin itself is very difficult to get right. JG 7.11.09

Question:

for protuding eyes , will fillers be ok to fix the lower eye hollowness and upper eyelids. and will you say fillers be better if performed on the bone. And when the fillers waste in one spot will the skin become a bit saggy? and lastly what filler will you suggest? your the BEST

Answer:

it can be much more difficult in protruding eyes for that to be effective. Might not be worth it. JG 7.10.09

Question:

what is kenalog and why is it used?

Answer:

it is a glucocorticoid steroid used for allergies and to try to soften scars. JG 7.10.09

Question:

hi doc, I want to get just the tip of my nose looking nice. I thought this procedure will be easier then the bridge is that correct? and what are the possible complications with the tip??? and.. when fixing the tip do the nostrils get smaller or change in form??

Answer:

not really any easier, but the end results will take more time to see as the tip can stay swollen for months after the surgery. Nostril size should not change but the shape can change from oval to round at times. JG 7.10.09

Question:

is retinol cream better then retina? and is it true that retinol A cream doesnt cause the skin to dry up and better for the sensitive skin then the retinA cream?

Answer:

Retin-A is stronger. The retinol does not cause the skin to dry up becasue it is weaker and less effective. JG 7.7.09

Question:

hey dr garcia I have ReTrieve cream 0.05% is this the same as retina?

Answer:

same thing. JG 7.8.09

Question:

hi dr garcia, i wanted to ask a female question but i dont know if this is the correct forum. Anyways , I wanted to know if a female hits menopause can she still maintain her toned body e.g. abs...etc.. if she was to be working out as usual or does it go when its menopause timE? THnk you

Answer:

it can still be maintained, yes. JG 7.6.09

Question:

DrGarcia, Happy Fourth! I would like to have a neck lift only because of a fragile lip tissue and precarious dental work I am afraid of general anaesthesia (the tube in my mouth , it moving etc)Can a neck lift can be done safely with local and twilight?

Answer:

in some indiduals it can be, yes, but not all, depends on the patient. Happy Independence Day! JG 7.3.09

Question:

Hello Dr Garcia I had a face lift 4 weeks ago and recently saw my plastic surgeon for the first time. I questioned him about my top left lip nerve damage and he said it was the bucccal nerve that was weak and he predicted approx. 5 weeks more for it to get better. He suggested I see a facial nerve physiotherapist if it had not improved by the end of the week and wanted to give me a referral. My question is do you think this will help at all ? (He did give me 3 exercises to do) and said she would give me more..this is more money though and a long drive to see her. My scars are also widening and his office gave me silicone gel strips to place on them. How long do you think it will take for these to reduce the redness? My main concern at the moment is my mouth and I cannot make an O properly and when I say Bs and Ps and Ms my mouth pulls down to the right. This is very distressing and I feel that my surgeon has not given me much time at all since the op. 10 mins tops! Any reassurance or advice you can give me is so very much appreciated. Thank you for your time and expertise. Best wishes to you.

Answer:

well the nerve stimualtion while the nerve is coming back will help prevent the muscle from atrophing and I think it is worthwhile, we use home units the patient can use a few times every day to make it more convenient. The casues of the scars widening are myriad and silicone sheeting migth help some at this point. The redness should improve over 6-8 weeks though. I will say that not seeing the surgeon for one month after the procedure is unusual, usually I see the patient the next day, at one week and then 2-3 other times during the first month and the pateitns are having ultrasound massage in the office twice a week during that time so if there is a concern I can see them more frequently. I think it will all get better but it will not be overnight, hang in there. JG 6.29.09

Question:

thanks, I dont know if you know people with there ID here, but you really helped me with your knowledge. Plenty of times, Thank You alot.

Answer:

the ID is used just for access to prevent bots from entering, I never see the patietn`s name. I am glad I could help out, continued best of luck. JG 6.25.09

Question:

when can i apply your petite cream if i want to use vinegar wash on my face? I put cream before i sleep... after i clean face and right before petite cream?

Answer:

let the vinegar wash dry completely then apply the peptide cream. JG 6.25.09

Question:

Hello Doctor Garcia: How does a mini neck lift compare to a regular neck lift? Do you perform this surgery? Thank you for all you do.

Answer:

it is just a lesser procedure with less actally perforemed,less draamtic efect as less is needed. We do it when patients only need a small improvement. Yes, we perform it although in most cases patients think they need something small when in reality, in order to make it look natura, something much larger is typically required. JG 6.24.09

Question:

What in your opinion would be the best type of facelift for someone with mild jowl problem. 1. Extended MACS (third suture) with lower eye pinch and no scar behind the ear or 2. Traditional facelift thank you Yvonne 2. Traditional

Answer:

between those two,a traditional facelift most likely, but hard to say without seeing you in person. JG 6.23.09

Question:

hello dr garcia, I had canthopexy done 2 years back. My eyelids feel bad and apparently dont close all the way down for blinking and sleep time. one of my eyelid is twitching at frequently and looks smaller then the other eye. both eyes are not well but one of them feels worse with a severe headache constantly, I am 30. The more painful eye feels tight i guess it also looks smaller. I dont like the way it feel or the way it looks. I dont know what to do. What do you think is wrong? and how can it be fixed? please give me your help.

Answer:

hard to say without seeing you in person, there might be something that can be done to improve things, I suggest seeing an occuloplastic surgeon for an evaluation. JG 6.21.09

Question:

hey doc my skin has this yellowish look to it with a pale tone. When i pull my skin, with two fingers, i can see tiny brownish spots and also pale yellow look. overall when i look at my face it also looks like it has large pores and when i get closer i can see small red vessels on cheeks, corners of my nose and even running down to my cheek and neck ( they look like purple but mostly redish veins) .and when i make a expression my whole forehead and eyebrows looks really wrinkly with pores shinning more with yellowish/brownish look. I am still late 20`s. I dont think i am sick to have this happening for any reason. What do you think is wrong with my skin?? and how can it be treated? I quit smoking 5 years ago but because of this problem i just started to smoke again! im so stressed! Im scared to look at my face in the mirror!

Answer:

hard to say the cause, migth suggest some microdermabrasions or IPL sessions and see how it goes. JG 6.21.09

Question:

Dr. Garcia, some two months ago i started to have severe pain on both of my arms, it feels like my arms are inflamed , it gets worse when i come outside and when it is warm and the sun shines, even with sunblock, also at the same time that the pain started, my arms seems to get thinner and wrinkled, like a dried prune. i moisture two times a day, avoid as much as possible to come outside and avoid the sun completely. What can cause this imflamed feeling, my skin is not red or anything. I have had some bloodanalyse done and everything is normal except my blood serum iron is too high 289 ug/dl, also saturation transferrine is too high 129 % and ferritine is very low 13.3 mg/ml, i am loosing hair. I you have any solution or possible solution for treating my inflamed arms and for making ferritine levels higher, please let me know. One doctor here is telling me to do some DPL treatments (LED light therapy) for the arms, could this make any improvement? Thanks for letting me know of all this.

Answer:

could be cutaneous porphyria or a type of hemachromoatosis, you need to see a blood specialist. JG 6.12.09

Question:

ok,:) im really sorry, but i just searched croton oil.. im lost... how do you use it? is it a normal oil you can put on your face bedtime? who sells it? how can I get it? do you have it as a cream?

Answer:

it is a peel performed by doctors, it should never be done on one`s self. JG 6.10.09

Question:

we dont have phenol peel here, no rhytec no co2 and no croton oil! thats why we are the uglier people in the world! :) can you suggest maybe something next best :D

Answer:

well, although I am not a fan, maybe an erbium laser. JG 6.10.09

Question:

In your opinion what is the best chemical peel for firming skin? if you had to pick? other then phenol..

Answer:

if you eliminate phenol, then I woudl say croton oil. JG 6.9.09

Question:

If a patient wants/needs a second surgery and their tissues are not virgin, do you hesitate or avoid doing surgery on them? Do other drs. avoid doing surgery on them?

Answer:

I avoid doing surgery on them if I think the tissues are not soft enougth to get the desired result. JG 6.9.09

Question:

Hi, Dr. Garcia, How long should I wait after a bad necklift before I can get a facelift to fix it? The necklift was done with anchors above, below and inside the ears. I was told by one dr. that I can get a facelift 6 months after the necklift, & another dr. advised waiting a year. Does the wait time primarily depend on how much swelling remains? Thank you!

Answer:

6-12 months or so I would say. Once the tissues have softened, then it is OK to proceed, doing surgery when the tissues are stiff can lead to less than good results. JG 6.9.09

Question:

would tca peel and Ipl treatment give the same result? how are they different? thankyou so much

Answer:

about the same, not much difference, but the TCA peel can be done strongly and then there is more downtime. JG 6.8.09

Question:

hey dr garcia, you explained erbium laser doesnt last too long. Does that mean it lasts only for few months? or 12 months? or more? I just want to know what you mean when you say it gives effects for short period of time. XXXthnks

Answer:

few months, depending on how deep they perform it to.

Question:

how far apart can erbium laser be repeated again to get desired effect? as it is temporary

Answer:

you can likely repeat it every 12 months or so. JG 6.9.09

Question:

what do you think about VI peel for fine lines, sun spots? pores? capilaries..?

Answer:

sun spots likey good, pores, good but very temporary for fine lines only good while swollen and for capillaries, nothing. JG 6.8.09

Question:

Hello Dr. thank you in advance for your time and service that you provide us with it is so very much appreciated. I contacted you before regarding pain after a facelift. It is now day 12 and my left ear pain is not easing at all. It settles on rest and as the day goes on it throbs and aches and I cannot walk or move my head without pain...getting me down now. It seems to be the bone to the right of ear hole which is slightly swollen compared to the other side. My dr is on holidays but said on the phone to try olive oil and take pain killers...I see the nurse tomorrow. Also on that side my upper lip in the top left corner does not work properly. When I form an O shape or say an M or B it pulls down to the right and the dr. has told me to do exercises. Also I have more puckering behind the left ear so I am wondering if all these problems on the left side is caused by too much tightness? or an infection? Would appreciate any feedback...I do have photos of the left and right ear where you can see the slight swelling of this bone if interested I can send otherwise your advice would be plenty. thanks again from one worried and in pain lady :-(

Answer:

the weakness of te muslces in msot cases is due ot the nerves going ot the muscle being stretched and in 6 weeks in the vast majority of cases goes away. As to the pain that gets worse as they day goes on, it can be due to swelling that increase throughout the day or due to muscle spasms, so a muscle relaxant might help, along with massage or ultrasound therapy. The puckeing in most cases is due to an attempt to keep the scar shorter and trying to sew a longer side to a shorter side, that also in time will smooth out, but that takes months, not weeks. I know you are frustrated but the things I suggest here at this time are what I would do at this point in time if you were in my office. All the best. JG 6.8.09

Question:

Hello Dr. Garcia, What is your opinion on facial fat grafting to add fullnes to face for lift rather than a `face lift`. I have been seeing a lot about it recently and so far it looks quite interesting. Thank you

Answer:

they are not the same thing, if you have tissues that have fallen and need to be lifted, then the facelift is the best choice, if you have lost fat in your face and that is what makes the skin sag, then fat injections might be the better choice. Fat injections into a face where there is plenty of tissue but it has sagged will look just like a fatter face. JG 6.7.09

Question:

how do you reattach tissues after a cheek implant removal? is that another procedure?? my surgeon just said .. a removal is enough/... your saying the surgeon had to attach the tissue back to the bone... confused... wouldnt the tissue be attached normally to the bone>>?

Answer:

while removing it it can be sutured down to the periosteum, or in difficult cases a small screw can be placed into the bone and the tissue sewn to the small screw. If the implant has been in there for more than a coupe of weeks a capsule so scar tissue around the implant that if not taken out, will not allow the tissues to readhere to the bone. JG 6.6.09

Question:

whats a festoon ?

Answer:

a split between the muscles of the eyelid and cheek where fluid accumulates to make it look swollen or like a baggy pocket. JG 6.5.09

Question:

hey doc, you said my tissue is no good coz my face sagged after a cheek implant removal... Mmmm.. Interesting.. so then what do you suggest for this problem? supplements? special diet? if I get a cheek lift will it also give me a bad effect? yet again..seems though fillers and implants are out of the question..

Answer:

no, what I said was that if your tissues did not reattach on their own or were not reattached by the surgeon at the time of the cheek removal it can cause sagging. I also said that if you needed cheek implants at your age due to tissue loss, then yes your tissues are not good. There are no special diets or supplements besides a normal healthy one that will influence it, in most cases it is a genetic thing that you cannnot change. A cheek lift for what you have told me will not fix the problem as you needed cheek implants due to loss of tissue or due to poor bone structure and neither one of those is improved with a cheeklift. JG 6.5.09

Question:

what makes a facelift bad? is it because p.s`s pull everything too high and then cut off skin? will it be better to not cut off skin if not needed? I want my midface lifted but through temple way. Not by cutting under eyes, as i have medical eye problems, dry eyes... what is the most natural lift? and will midface lift intere with orbital nerves? if so how?

Answer:

that is too broad a question as there can be many causes, having said that, if you do not have excess skin then there is no need to remove skin. The natural results can be achieved through many different techniques, there is no one that is better than any other. A midfacelift shoudl not interfere with any intra-orbital nerves. JG 6.5.09

Question:

is it normal for electrolysis to hurt while being performed? and what percent of hair will it really remove? 20 50 90%?

Answer:

yes, it hurts. As to the percentage, that depends on the location of the hair and the skill of the technician, no way to tell. JG 6.4.09

Question:

Hi doctor, I have two questions, today i had a sculptra treatment 2 months after the previous one, and on the contrary as the before sessions (first two sessons i had a lot of swelling lasted for a long time) and today by the evening i have almost no swelling at all, 2/3 th of a vial is used, same as the last time, how is it possible no swelling, also i had juvederm in mu upper lip border, no swelling by the evening, last time 4 amonths ago al lot more swelling, same amount of product was used. Is it possible that the doctoe was not honest about the amount of product she has used this time ? Second question, I have hair loss and brittle hair, blood analysis came back, ferritine is only 13 so they have put me on Losferron to increase iron. Pogesterone was 0.2 ng/ml last time i had this checked. Will do new test next week. Do i need to take also additional progesterone to have my hair regrow. Thank you for your advice on this.

Answer:

as to the Sculptra and swelling, they might have pierced the skin fewer times with the needle, they might have injected it a little deeper or they migth hav emixed it into less solution so there were fewer shots, lots of variables that can contribute to that. All you need is one puncture into one vein and the swelling increase, same goes for the Juvederm. As to the second question, they need to look at your thyroid and progesterone level both to see if they are deficient. Best of luck. JG 6.3.09

Question:

ok, I read some responses for fillers and cheek implants and people asking certain questions... I had fillers for cheeks and implants.. and Had the implants removed few years ago. Im in my late 20`s. Let me tell ya something if you inject a part of your face with fillers I believe it will in some cases give a baggy look to that area even when the fillers burn out. I had this happen to me and other friends and I read people asking here but not sure .. no I agree with those it does... Docs that say I never really heard of one having this problem// mm... well everyone is saying it ask if it can happen put 2 + 2 together... and with implants (cheeks that is) after removing them.. yep it does make your own cheeks sag... and nooo maybeeesss it does happen. It happened to me and I read people asking if it can happen... well so many people are asking again if this can happen... so yes, it can happen.. And nooo its not in your heads... your not going crazy. I`ve been observing my face closely, mirror, photos, videos, Im pretty sure there is biiig changes... and I have given long healing time so no way it will change and heal more... I even had few docs telling me this is normal after filler and implant job.. and its been 2 years now... filler hasnt left one side of my cheeks.. so the other half is smaller.. yes i could put more filler into the other side to match it up BUT I want the bigger cheek to fade instead coz it looks so weird that people walking past stare at me! and noooo the fillers hasnt burnt out over 2 years-juvederm. and docs say i havent heard of temp fillers lasting any longer than that time.. well it has.. and again i read plenty of poeple asking about the same filler problem... .. when will it fade away ..(fillers that is).. and response is again ,,.. I never heard of this happening.. well im not a doctor but I even heard this happening.. how? real people who had the filler job done are stating it... this should mean something~ shouldnt it?

Answer:

well, first, the removal of implants can make you look more saggy if they are taken out if the tissues do not readhere to the bones. In your case, although it is hard to say without seeing you in person, and unless you had some boney issue where your facial bones were underdeveloped, I cannot really see where a person your age would require the degree of intervention that you describe. In cases where someone does need that series of interventions to begin with, as in yours, you need to understnad that for whatever reason, your tissues are not good, will age at a significnatly faster rate than other people and you will likely be saddled with a lifetime of short term resutls. People with bad genetics do not get the results from interventions that others do. The resutls from all interventions certainly depends greatly on what and how it is done, but it also depends greatly on who your are performing it on, the same procedure on two different people can yield dramatically different results. JG 6.3.09

Question:

hey doc, you`ve been saying running ages you but then how else you supposed to keep fit and healthy? what exercise will you suggest for cardio sweat? So those researches about exercising keeps you young is all incorrect?? Wouldnt you age faster if you never exercised?

Answer:

stairmaster, eliptical trainer, swimming are other optiosn where there is little impact to cause the faster decent of facial tissues. As to exercise keeping you young, that refers only to heart and lungs, nothing else. JG 6.3.09

Question:

I have been doing electrolysis for my body hair, chest. Its been 4 session with and 4 hours altogether. I still have some hair growing, a little finer but they are there... The electrolysis lady explained that the hair I can see are the ones still growing and that the ones she treats are permenantly removed. Its been 4 months. doing it for once a month. Is the electrolysis lady correct? I know you said electrolysis is not permenant but how much percentage of the hair is normally permenantly removed with elec.? thanks

Answer:

I think it is difficult to get all of the hair to die off so many treatments will likely need to be done, and even then, occasionally some hair will grow.JG 6.3.09

Question:

I`m in late 20`s. Ive used retina for about 5 years. I had light olive tan. However now my skin is very pale. I stopped using retina for about 2years because it was also drying out my skin with no good effects. My question is I look sick now from being pale on face while my body is still olive tanned. is there anyway of regaining my normal complexion? is there anything i can do? even if its a temporary thing i don`t mind. i can be consistent with it and maintain it. treatment? supplements? can you help please?......

Answer:

the only way will be to get sun exposure on your facial skin which will likey replace the color and but then progress with accelerating the aging process of your skin. JG 5.31.09

Question:

would yag laser help with restoring melanin? or any other laser or treatments?

Answer:

no laser will do that, it might cause some temporary redness is all. JG 5.31.09

Question:

would chemical peels, or erbium laser give good results for a 29 year old with fine lines?

Answer:

not in my opinion. JG 5.31.09

Question:

I have so much hollowness in my upper eyelids that makes people stare at me. I look really creepy. My eyeballs are basically sticking out. I did have bleph surgery for upper eyelids few years back. What do you suggest for this problem? I now nothing is permenant but is there anything I can do with this problem? thnx.

Answer:

might want to get your thyroid checked out as bulging eyes can be a sign of an overactive thyroid that needs to be controlled. JG 5.27.09

Question:

hey doc, are the bad risks (like hardening, leaking..etc) with breast implants as same as other implants like calf implants and so on..? I thought both implants are from the same silicone substance... will same problems occur? if not whats the difference?

Answer:

same issues can occur with the body implants except they cannot rupture as they are solid. JG 5.27.09

Question:

ok, im the one with the co2 and tarsal strip(correcting the lower eye) question.. you said i should get the co2 after correcting the lower eyelids... but if i get it after wouldnt co2 pull the eyelids back down again? coz it will shrink the skin?... thats why i was asking if i can do co2 first then the surgery.. thnksss alot

Answer:

you need to worry about the medical issue first and foremost. If I remember correctly, you said you were in your early 20`s and I cannot see why you would consider a CO2 laser at this point in your life. JG 5.27.09

Question:

hi doc, you said i will need something more lighter then co2 what will you suggest? rhytec? (29 yr old female) they dont have it here.. what is something similar to co2? or lighter as you said// that will give good results

Answer:

impossible for me to tell without seeing you to detemine what your skin is like and what it would need, sorry. JG 5.25.09

Question:

Im getting tarsal strip surgery for eyelid pulling down (3mm).. you know the storyy.. but also my skin is horrible. 29 yrs old. can I have co2 performed (whole face+under eyes) before the surgery ? .. i was thinking this because if the eyelids fall extra down after the co2 atleast surgeon can fix it while doing the tarsal strip surgery as he wills still be performing it coz my eyes need `em... ORRR should i get co2 after the tarsal strip surgery? BUT -- with this idea i was thinking co2 will wreck what the surgeon has done... so then i might need another surgery, if i have co2 after the lower eyelid correction... help help help

Answer:

I have to say that I find it unlikley that you would need a full CO2 laser. Maybe something lighter. I think it would be best to do it seperately too to avoid the strip surgery being pulled down from the swelling. JG 5.24.09

Question:

would yag laser treat the red capalaries, sun spot damage and pigmentation change? is it similar or same as IPL laser?

Answer:

yes, it is much more effective than IPL.JG 5.24.09

Question:

Hi, Dr. Garcia, What is a Demand Letter and what does it consist of? I was the one who had a necklift that pulled face down and did not lift neck. Do you know where I might find a description of the tone and contents of a letter like this? Thank you, thank you!

Answer:

a demand letter is usually written by an attorney and is essentially demanding that a refund of money for services rendered is what it contains, wording will vary. Not sure where you would find one to look at. JG 5.23.09

Question:

hi dr garci... 3 -4 years ago i had cheek implants done. Im 28 yrs old... surgeon told me i lost alot of fat from my face due to exercise.. anyways i hated the cheek implant. it made my face so big- especially my lower face. It didnt give me a high cheek effect it just gave me fat fat from the mouth and above. I normally have a very thin small face. anyways-- just 2 years ago i had the implant removed. the problem is that i still have my face looking big! people look suprised to see my face so big still! im only 5`1 so i look like i have a big head for a short girl!-------- so what can i do to fix this? it has been 2yrs now so its not going away infact it is looking like its aged me alot! when i tell surgeon what effect i want they say its a cheek lift. the problem is before i had the implant done surgeons said i dont have enough cheeks to have the lift but after the removal they are saying im suitable for the lift... whats going onnn... does this mean that my cheeks grew due to the implants? or is it skin? if it is skin im pretty sure its not like a old person skin as i am 28 still but whats your opinion? what do you think i need? coz when i pull my cheeks up it does look better-or atleast closer to the way my face looked before--- i wish you were working in this countryyyyyyy!!!! come to australia-sydney pleasssssssse! thnkyou_

Answer:

that is very unsual, the cheek pad would not grow from the implants, All I an surmise is that either scar tissue formed there or you have a fluid collection in the area where the implant was that cannot be absorbed. If they are still big at this point then maybe a conservative cheeklift is what is needed. I do plan on going to Austrailia in the future but not to work, just to play! JG 5.23.09

Question:

If the silicone breast implant break and leak, will the leak damage your own breast tissue?

Answer:

no,but they can develop lumps where the silicone goes. JG 5.23.09

Question:

hello dr garcia, I hope you won`t think I`m crazy but Can a breast implant be implanted ontop of the head (on the skull) just to have a more taller appearance. If you cant do that can you recomend anything else for height? - it was just a crazy ideaaaa. would this be safe?

Answer:

not safe, there is not enough loose skin to accomplish what you desire and could make your face look funny in terms of proportion. JG 5.22.09

Question:

How long should travel by plane be avoided following a neck lift (platysmaplasty) and lower face lift? (i.e. thinking lifting luggage, lots of walking in airport and flying - - frequently, my ears hurt for a day after flying)

Answer:

14 days if possible. JG 5.20.09

Question:

Your opinion please on the Acculift or accusculpt procedure. I think it was developed by Dr Mann in FL. thanks!!

Answer:

just a diffferent laser company that makes a laser that tries to injure the fat to make it easier to remove with liposuction, lots of hype with little to no improvement over older tried and true techniques. JG 5.20.09

Question:

hey doc normally would you have to - have to - almost necessary to have a second surgery - for removal of implant or replacement or for any reason atleast once , once you get a breast implant? or will it be ok just with the implant surgery and off you go for the rest of your life?

Answer:

you have on average a 20-24% chance or need for a second surgery. JG 5.20.09

Question:

How long will the results from a face lift last? After the results are gone, will you be back to your before face lift look, or does it slow it down? I hope that question makes sense...I am contemplating this, but wonder if I will have to repeat the process every couple of years and that can get mighty expensive!

Answer:

well, it depends on the age of the patient and their level of activity, for example smoking, excess sun, weight fluctuations and running will shorten the length of time it lasts, in general we tell patients 5-10 years before it is worth repeating, but if you have it done you will always look better than if you had never done it at all. JG 5.20.09

Question:

Dr.Garcia, Regarding my midface furrow: when I smile the defect is not noticeable.It seems to get hidden.Thanks.

Answer:

seems that when you smile the tissues that were tightened move closer together and to make the crease less visible, therefore the easier fix woudl be a filler into the crease, otherwise you would need more surgery to pull the tissues smoothly together as they seem to not be in as good approximation as desired. JG 5.20.09

Question:

hi dr. thankyou for such a valuble site. 2 questions i would like to ask you. 1st question is it normal to have a slight lump at the top of my ear where i have been stitched 6 days after a mini lift?.2nd question when could i start to use retin a cream again? i think i speak for everyone who visits your site thankyou for taking your precious time in answering all our questions.

Answer:

yes, it normally will go down in 3-6 weeks. I usually advise patients to wait 6 weeks before exfoliating creams like Retin-A are re-started. Glad I could be of service and thanks for visiting. JG 5.19.09

Question:

Dr.Garcia, I apologize for being so persistent about the furrow in my check lift .The surgery was done 8 mo ago and the furrow has gotten worse in the last two months.It was not there for the first few months after the surgery.Thank you.

Answer:

in that case it might be some atrophy of the fat due to pressure that was not appreciated sooner due to swelling, might consider a filler to smooth the surface out, fat or Sculptra. Does the crease move or flex when you animate the face? JG 5.19.09

Question:

Dr.Garcia, I asked you the other day about what I thought was a suture line from the cheek bone to my lateral rim but it looks more like a deep gouge or deep furrow.I had a midface lift through the eyelid incisions.Thank you for your advice.

Answer:

might be either the suspension sutures used or a crease in the tissue from the tension placed on them to lift them, it might all get better in time, no way to tell at this point though and without seeing you in person. JG 5.19.09

Question:

I have orbicularic myokymia ..(tic on eye) and i can sometimes feel some tic on my left cheek... my doc will still some exams but its a nerve problem as you will know... having all this as a problem will it be ok for me to have a cheeklift? will it intefere with the nerve and some complications?

Answer:

well, if the muscles in that area are lifted or tightened the tic might get worse or might cause a different type of muscle contraction. JG 5.19.09

Question:

is erbium laser good for a 28 year old female?

Answer:

maybe to remove some recent sun spots is about all. JG 5.19.09

Question:

forgive me...i have asked you so many questions over the past three years....i am thin and fair skinned. prior to facelift (which i had to improve appearance of my neck) i had flawless complexion....after, discoloration, loss of tissue....now in last two months i am noticing a more visible line going down one side of cheek and on the upper portion of my face near top of my cheekbone i have been developing black and blue spots.....i originally had one which was where there was a scab and bruising but now all of the sudden the bruising is growing and it is uncomfortable to sleep on at night. i am very aware of it. it feels almost like a beard burn.............any ideas on what this is? and what i can do about it? thankyou!!!!!!! patti

Answer:

this far out, hard for me to say, blood suppply should not be changing anymore. Might suugest seeing a different plastic surgeon for an opinion. JG 5.16.09

Question:

Hi, Dr. Garcia, I had a necklift that left my face dropped downward and the neck not improved. Is there a preferred way to ask the surgeon for a refund? I know it may be unlikely, but I must try with everything I can think of because now I will need a facelift. Thank you.

Answer:

I would just say that you did not get the degree of improvement and you are going to require more surgery due to the results and see what they say, all the best. JG 5.17.09

Question:

I s there anything that can be done for the puckering of skin over the cheek bone towards the mid face lift incisions lateral to the canthus and the webing at the corner of the eye.Surgery done 8 mos.ago.Must wear glases to help hide the both sided problem.Thanks.

Answer:

more surgery is the only thing, the skin needs to be redraped and likley some type of canthoplasty on the eyelid too. JG 5.17.09

Question:

when having a Platysmaplasty (necklift) is it necessary to have to have skin removed both in front and behind the ears? I know a platysmaplasty alone will eliminate neck bands, but does it tighten the skin at all. What will this procedure alone accomplish? In addition to aplatysmaplasty, can skin be remove from behind the ear only? PRIOR to the procedure, does Retin A/Tazorac need to be discontinued - if yes, for how may days. I have used Tazorac since it became available; therefore, I don`t have any sensitivity to it. How long is it necessary to wait to safely travel by plane following the procedure? What is the primary complaint you see following this type of surgery (i.e. swelling, bruising, pain, etc.)? Thank you in advance.

Answer:

it depends on what the paeeint needs, in the vast majority of the cases some skin is removed, and the location is usually around the ears. Tightening the muslces alone will only do it in very young patients. The incision in most cases needs to be carried a short distance in front of the ear to avoid a pleating of the skin at the earlobe. JG 5.16.09

Question:

Is it possible that the use of the loreal self tanning body milk with slimming effect dries out the skin and make it more wrinkly ? Second question, is it normal when having several sculptra treatments spaced one month , 1 vial per session, does fade already after 2 months since the latest treatment ? Is it worth to have another session or does it simply not gives the desired fulness longer term in some people ? Is the fulness affected by emotional stress ? Thansk for reply.

Answer:

very possible. The Sculptra takes 4 months to build up so the swelling goes down in between the sesssions but not the new tissue that the Sculptra is causing to be formed. JG 5.14.09

Question:

Dr. Garcia, Does a mid-face lift move skin upwards or does it only reposition the malar pad? Many thanks.

Answer:

it is mostly a repositioning of the malar mound. JG 5.12.09

Question:

hey doc, what in your petite cream? Im supposed to having vitamin D- direct sunlight... for about 20 minutes a day or two... will the ingredients in the cream make it a problem????? you know some creams dont like sun....??? yet vitamin D is so important for young skin.

Answer:

the ingredients are 5 different pepetides that are proprietary. They will not counteract with sunlight although if you have no intestinal absorption problems it is likey safer to take oral Vitamin D and get it through a supplement. Vitamin D might and might not have food effects for the skin but sunlight will do nothing good for your ski, only bad. JG 5.10.09

Question:

Hi Garcia, Two questions for you. I had a browlift 4 months ago, endoscopically. One brow has fallen, outer 1/2 of upper lid does not show. Other brow and eye okay, frown lines still gone. Do doctors do just a slight revision to one brow in usually the same manner they used previously? Going to have lower facelift. Incision placement and scars extremely important. Does extending the incision from the top of the ear upwards, versus straight out towards the face make a difference in terms of visibility later on? Thanks for your help.

Answer:

they will likely need to repeat the whole endoscopic lift on that side to obtain symmetry. I think placing the incisions for the lower facelift at the front of the hairline leaves less stigma of having had a facelift. Best of luck. JG 5.8.09

Question:

Good morning Doctor. Two questions - we are told to ask many questions during a consult for PS ie. how many of these procedures (facelift /browlift-whatever) do you do in a month - and the PS will answer - i want to know how do I determine that the number he gives me is sufficient. Looking at before and afters I find of little use at the doctors only give you the best and only a couple. Next question, with all due respect - I have noticed that asking some of these questions seems to annoy some doctors - as if how dare I question their ability - what`s with that? thanks for your time.

Answer:

well, the average plastic surgeon in the counrty does between 25-50 facelifts per year according to the national data. As to their attitude, my personal advice is if they have that attitude, you should go somewhere else. JG 5.7.09

Question:

hey doc you said the new and old petite creams have the same name so how can we ask for one when the name is same? how would one ask for the new one when the old one has the same name... I hope you got it:)

Answer:

call the office and ask for the new one,we still have some of the old ones and will sell those at 50% off, but you need to call to get the old ones at half off. JG 5.7.09

Question:

I`m the one who has Maxon 3.0 monofilament polyglyconate synthetic absorbable sutures. It`s been two months since the surgery and the sutures still hurt and tissues in front of them are still tight (sutures are in the ears). I had a ton of inflammation for 6 weeks but I put ice on it, then in last 2 weeks inflammation has been minimal and I`ve stopped using ice. Could using ice have slowed down the dissolving of sutures? Should I use warm cloths now? Thank you.

Answer:

no, but the purpose of the sutures is to be in place until scar tissue forms to hold the tissues, so likely the sutures are gone and it is the scar tissue causing the tethering. Warm packs now and stretching. All the best. JG 5.4.09

Question:

My doctor used the following deep sutures in my necklift: Maxon 3.0 monofilament polyglyconate synthetic absorbable suture. Do you know if this suture dissolves by body heat or by body chemistry? Do you happen to know how long it may take to dissolve? Thank you for your wonderful site!

Answer:

they dissolve by a low grade inflammatory response in the body. It is about 50% dissolved in 4-6 weeks. Thanks for visiting. JG 5.3.09

Question:

if you put on the petite cream only before you sleep is ok to wash your face in the morning? will the ingredients work still?

Answer:

yes, the are absorbed in about 15 minutes or so. JG 4.30.09

Question:

hi doc againnn... thankyou for answering the questions... just want to know if the petite also works for pores?

Answer:

no, that is due to the oil trapped deeper in the pores, Retin-A helps that along with IPL treatments, but all is very temporary. JG 4.29.09

Question:

hey doc. does your petite cream help pores? and how long does it take for th cream to work? and how do you use it? do you wash face and wait 30min...etc? and can i use other creams in the morning like moisturiser and others? does the petite cream moisturise? im waiting to read all the answers...

Answer:

the peptide cream helps by assisting the body to make new collagen and also stabilize cell walls so degeneration is slower, most people feel a difference within 4 weeks and many see the difference after 4-6 weeks. One washes their face first and then applies it, ideally twice per day but once at night in younger patients is likely OK. There is no need to apply a moisturizer over it but if you skip the peptide in the morning, the use a moisturizer in the AM. JG 4.29.09

Question:

I had electrolysis done for hair removal. just after the treatment the area treated looks like pimples with irritation and then for about a week or 2 two i get scabs and then when it heals (the treated spot) I get red pinky looking spots.... is this normal?

Answer:

all normal, yes. JG 4.28.09

Question:

hello dr garcia, How many grams, mls do you put in for your petite cream? because i just ordered few for my friends as presents but they told me theres little amount in the container...???

Answer:

the new stronger peptide cream has 7ml and should last at least one month, it is put on very lightly, small spot on forehead and one on each cheek is more than enough, the older peptide was a larger amount but this is stronger and more concentrated and you need much less, it smooths out more easily than the older cream and has a new penetrator that make is absorb faster and better. JG 4.27.09

Question:

hi dr. garcia. i apologize in advance for asking you more questions...i am the person with the disastrous facelift that wrote to you yesterday (and in the past 3 three years - (b.b. mugs)....is it possible that the manipulation of my muscles,skin etc. have changed the tissues of my outer skin? prior to surgery, i had a flawless, unlined complexion....over these past three and a quarter years, slowly small depressions have been forming, lines where areas were swollen and generally not having my same smooth appearance prior to the surgery...granted i am getting older but it does seem apparent that all of this started after the surgery.......you didnt comment on abdominal stem cell transfer....do you feel that it helps the regain the quality of the skin? and lastly, since my skin does seem compromised in some way from the surgery, will fat transfers be riskier? THANKYOU AGAIN!!!!!!!! patti (i forgot to mention that i am turning 60 this year)

Answer:

some of the smoothness that existed prior to the surgery was likely due to the smooth contours of the tissues beneath the skin at that time. When complications occur, especially with scar tissue and fat loss, the smoothness of the underlying tissue is lost and undulations of the skin can become apparent. I think in many cases small amounts of fat can be injected to regain the prior smoothness, and the abdomen is a good source for that fat. Although some doctors are claiming they are also injecting stem cells with the fat, that is a theory, a stretch, and is not substantiated at present. But the fat injections do help a large percentage of the people, albeit having to be done more than once at times. Fat transfer should not harm the skin in anyway, and in some cases can improve the texture due to increased support and blood flow from the transfered fat. Congrats on turning 60, I am not far behind, best of luck and thanks once more for the mugs, they have been enjoyed many times. JG 4.27.09

Question:

i dont think my previous post came through....i had a disastrous facelift over three years ago....scabs, tissue loss and discoloration.......now i am experiencing tingling, sensitivity in one localized area on upper cheek where there had been alot of swelling for over a year....seems that depressions are forming. have you ever heard of facelift surgery accelerating the aging process? should i have been advised about having a problem with healing since i am thin and fair skinned? what do you think about fat transfers with stem cells from abdomen? should i even attempt to correct all of this or could i risk even MORE unsightly problems? thanks for your time, patti

Answer:

the facelift alone will not accelerate aging but some complications that can occur after a facelift can make a face look older. Facelifts on thin and fair skinned people are done many times and they do not always have a complication, complications can happen for many different reasons. I do think in some patients that fat transfers can help. Sorry to hear about all the issues, I wish you the best. JG 4.26.09

Question:

My nasolabial folds continues down to my jaw (I don`t have a separation or definition of the cheek area and the lower face). Is it probable that a facelift will not help the loosening of the lower face because of this extended nasolabial fold? Thank you Dr. Garcia.

Answer:

no, actually, the facelift should do quite well for that. Best of luck. JG 4.26.09

Question:

Some doctors perform face and necklifts with incisions techniques commonly done? Which techniques do you perform and/or recommend? Thank you!

Answer:

There is no routine incision that I use as it is taylor made for the patient, some need shorter or longer incisions and where they fall depends greatly on what the patient needs and wants improved. JG 4.24.09

Question:

I was the one who had a necklift and then myo-fascial release (2 sessions at 2 weeks post surgery and 4 sessions at 6 weeks post surgery). I was uncomfortable with tightness and swelling and a dr. suggested physical therapy (ultra sound, retro-grade massage) to me. The therapist then started doing myo-fascial release, which I was never completely comfortable with. Could he have stretched the fascia so that the surgery was undone ? The dr. and therapist swear that couldn`t have happened but now I feel a little too loose instead of uncomfortably tight. I`m also afraid when the stitches dissolve the whole thing will be looser than before. I think dr. and therapist were very wrong to put this situation and worry on me but they both say I`m silly to worry about it. What do you think? THANK YOU!

Answer:

well, it is possible, not sure why the therapist would do that. Most stitches are meant to dissolve after a period of time, during which scar tissues should have formed in order to hold the tissues in their new position. Things always feel a little looser as the swelling goes down and the tissues soften, so I suggest giving it time, by that I mean months not weeks and see how it all goes. Hang in there. JG 4.22.09

Question:

hi dr.. i am having a mini face lift in a few weeks time. i have researched the internet to try get some idea of how long this procedure lasts.i have had a full face lift a number of years ago so do not have huge jowls and was told that a mini lift is all i needed.could you tell me in all your experience how long does one last? i do not smoke or drink or sunbake.thankyou for your time in answering all the questions on your site.

Answer:

well, it varies from patient to patient. The more damaged your skin is the less time it will last, in most cases I tell the patient that smaller procedures will last 5 years or so. JG 4.22.09

Question:

Since one year and a half i started drastically to loose skin elasticity. My arms begun to have a chicken skin appearance and now lately it is getting worse. The flabiness is not that worse only the skin texture on the arms. I started to tale omega 3 capsules, vitamine E, hyarulonic acid pills, pills with lycopeen for sun damage, i use moisturizers and oils every day. When i come ouside and the sun is shining , my arms feel inflamed. What can i do to reverse or cure this appearance and inflamation feeling ? I am 47 years old.

Answer:

there is nothing topical or oral that will help, that is how your skin is responding to the aging process and ultimately might require surgery, there are no safe laser skin tightening procedures for the arms, sorry. JG 4.22.09

Question:

dr. garcia, Which creme that is sold in Europe contains copper peptides and DMAE. Can not seems to find any brand sold here in spain. I can not order produkts from out of USA, taxes will cost me the double of the price. Thanks, for letting me know.

Answer:

I am sorry but I do not have a list of products sold in Spain that I can help you with, you will need to search via the internet for that information. JG 4.22.09

Question:

My surgeon did a necklift that pulled from the ears and pulled fascia tight in front of the ears. At week 2 and week 5 after surgery, my physical therapist did forceful myo-fascial release (6 times total) and my face went from feeling too tight to sort of loose. Why is it that myo-fascia release won`t loosen the fascia that was tightened by the surgery? I just want to understand it and can`t find anyone to explain it to me. Thank you.

Answer:

well becasue typicall there are sutures that were placed into the muscle that make it harder to do the myofascial release and also there is scar tissue that makes it more difficult on top of that. I am not sure why you would have surgey to tighten the skin and muscles and then get myofascial release. Now if it was too tight to begin with, massage will help but until the scar tissue softens and the sutures dissolve, it can be difficult to stretch the myofascial unit and you could cause bleeding and cause the muscle you wanted tight to loosen. The sutures that were placed into the muscle to tighten it were into the fascia but also into the muscle fiber, that likely contributes to the problem, along with the hard scar tissue. JG 4.21.09.

Question:

hey doc, i used retina .05% for over years... when i first started using it , it worked well after the dry skin and all... but now when i use it my skin is just dry all the time without any good effects at the end. so i stopped using it altogether, it just made my skin sensitive and made me lose my light tan. Thats what i was trying to tell you before when you said you couldnt understand why it will lose its effect. so now i thought of using your peptite cream... if i use it will it work on my skin well to rejuvenate and all. im 30 now. thanks

Answer:

the peptide cream should work, but I thik if you are truly concerned about your skin and the effects of aging, you should not be tanning at all. JG 4.20.09

Question:

why would the jowl come back if I had it tightened from the front and back? From normal aging as the years go on? By cheekbones are good as is my forehead That is discouraging to say the least..but why do you say that?

Answer:

correct, the aging is reveresed with the surgery but aging will start immediately after the surgery so return of the jowls is a matter of time, no matter good the correction is initially. Since there is no wya to stop the aging process, the correction acheived will not be permanent, how long it will last will vary from patient to patient. JG 4.19.09

Question:

why would the jowl come back if I had it tightened from the front and back? From normal aging as the years go on? By cheekbones are good as is my forehead That is discouraging to say the least..but why do you say that?

Answer:

the truth is often discouraging, but the truth is the truth. JG 4.19.09

Question:

hey doc... ive been using retina.05% too. but it lost its effect on me therefore will the neuropet.cream be a good option now for me?

Answer:

not sure what you mean by losing its effect. The first 12 months is where the result of the Retin-A will happen, after that, there will be a slowing down but not a vibile reversal of damage that you saw before. No cream will indefinitley reverse the damage. Changing over to the peptide is a good option, and you could always go back to the Retin-A again at some future time. JG 4.19.09

Question:

is retina .05% stronger then the neurope. cream thats on your cart doc? or is it the other way around?

Answer:

they are different, the Retin-A causes irritation and the peptide cream does not, they have very similar effects I feel. I pesonally feel the peptide cream is easier to use and moisturizes while Retin-A does not. JG 4.18.09

Question:

hi dr garcia, i will be using neurope.cream from you... you said as you age you will need another cream, stronger... im the 30 yr old. how will i need when to change the cream to a stronger one? should i change the cream every year ? 10 years? 30?

Answer:

there is no way to predict that as it will depend on how you age, that is a multifactorial issue and there is nottway to predict that. JG 4.18.09

Question:

Hello Dr. Garcia- I read about this treatment but want to obtain your opinion before I make a consultation with the Guylaine Lanctot Cliniques- Dr. Thank you. Ladybird Suture Suspension: The replacement for traditional facelifts The Serdev Technique lifts the deep moveable subcutaneous tissue by anchoring it to non-moveable fibrous tissue. Employing this technique results in a more natural and youthful appearance. The Serdev Technique is ideal for lifting the face, chin, eyebrow, buttocks and abdomen.

Answer:

has been tried for years and the sutures break, it does not last, and if one side breaks and the other side does not you look like you had a stroke. JG 4.18.09

Question:

im 29 yrs old. will erbium laser be good for a skin rejuvenation?

Answer:

I personally do not feel erbium offers much, but if you do not need much, it might be of some slight benefit. JG 4.18.09

Question:

whats are the ingredients of neuropeptide cream? and how much %? active ingredients?

Answer:

I am sory but the mixture is of five peptides in a liposomal delivery complex and it is a proprietary compound that I cannot divulge, unlike my other creams. JG 4.18.09

Question:

hello dr garcia, i asked you before if i can use the neurope. cream and that im 30 or dmae. you said its good and wont have any side effects and that neurope.cream will give more results. therefore i ordered the neuropet. cream but as i was reading your posts.. quoted this to one other person in her 30 : ... I think the peptide cream will also work, it is stronger than the DMAE cream so I would start with the DMAE and then proceed to the peptide. It is not that it is wrong to use the peptide cream, it is just you want to use the weakest on so you have something stronger available as you get older .------- so my question is now, if i use the neurope. cream what happens to my skin when i get older? im puzzled. i already ordered this product and thinking maybe you shouldve adviced to me to purchase dmae cream instead too. im actually turning 30 next year... so now i dont know if this cream ideal for me. i was sure of it when i was reading the good post before. tell me please what to do now? if i use the neuro cream from your shopping list will my skin be more volnerable at a older age? and what you said to me before contradict what you quoted to me before... please explainnnn...

Answer:

nothing negative will happen to your skin if you use the peptide cream versus the DMAE cream. You will still age, I would expect the signs of skin aging on yoru face would be less. In the future, as no cream will 100% stop the aging, you might need a different cream. New creams are being developed all the time and I am sure in 3-5 years we will have even better products. I am actually work on new mixtures that will likely replace the peptide cream I presently sell, I expect release of that in 12 months or less. In short, if you are concerned about your skin aging the peptide will certainly help, if you are not too worried, then the DMAE might be enough. Nothing negative will happen from the use of a product intended for older more damaged skin on younger patients. JG 4.18.09

Question:

hi doc i just ordered 3 petite creams im from australia. 18.4.09 date. how long will it take for it to normally arrive to australia?

Answer:

normally 5-7 days. JG 4.18.09

Question:

I just had a jowl lift yesterday (and it sorta cleaned up the wrinkles on my neck but did not contour ir)...my face looks weird..my chin goes too much to a V and narrow while my cheekbones are so wide ..will this even out after the swelling by my ears settles down... and will my jowls area loosen up to look more normaL ..or always have that V look? How long does it take to resolve? (lots of questions!)

Answer:

I think much of the distortion you have at presetn is the swelling in one area and none in the other, it should balance out in a couple of weeks. The jowl, unfortunately, will eventually come back.JG 4.18.09

Question:

Hi Dr. Garcia, I`m a 52 year old Caucasian female with some mild lower face and neck sagging. I`m considering a mini-face lift to improve this area. Are there different types and what are the advantages of each? Can this be done with local anesthesia instead of general? What type of mini-face lift do you recommend and why? Thanks!

Answer:

lots of different names but all essentially the same. In some small subsection of people, it can be done under local anesthesia. I do not use any fancy terms for my procedure, I just tighten the SMAS and remove the excess skin in front of the cheek for my mini lift. JG 4.17.09

Question:

hey doc how are the petite cream and all different from retina? how does it work? does it renew the skin?

Answer:

the peptide cream also helps promote the creation of new collagen, but with no skin irritation, in that sense it does renew skin in a similar way. JG 4.16.09

Question:

hi doc, Im a male 30 years old. I have some problems with my upper eyelids. Ps told me i will need fillers to hide the hollow look. Will this give me a good result?

Answer:

can`t imagine how a 30 year old woudl have hollowness there and I do not perform fillers in the upper eyelids due to the high chance of lumps,sorry. JG 4.16.09

Question:

I am looking for something to rejuvenate my entire face and to reduce some fine lines. Im close to thirty now. what can you recommend? other then co2?

Answer:

Rhytec Portrait, Retin-A maybe. JG 4.15.09

Question:

hello You said i can use neuropeptide alhough its for more mature skin... if i do will it cause any bad effects? `coz you explained it has better effects ... but will it be ok for a younger person to use it for the long run?

Answer:

it is safe to use on young skin, yes, no negative effects. JG 4.15.09

Question:

hi doc, with your dmae and neauropeptide creams im confused please help. i want to purchase one and im 29 and buy one for a friend who is 36... which one will you recommend for a 30 and 37 year old female??? i know the neauropeptide is for mature skin but will it damage the skin if it over works the skin when its more ideal for say 60 year olds or older>>?? in other words will it be more suitable to use the dmae cream over nearopeptide cream if its less aggressive to the skin? we will like it to work with the fine lines and make the skin looking more younger... please recommend... can we use the nearopeptide without any permenant skin damage?? what will be the worst side effects>>?? and will it be permeanant>? tnaks

Answer:

the more damaged the skin is the better it is with the peptide cream, there is no negative effect form using the peptide cream on your skin though. JG 4.15.09

Question:

Is there a non surgical, non-invasive way to remove or reduce neck jowels? I am male, 73, excellent health, 5`9.5 , 160# Thank You, Elvin Erickson

Answer:

sorry, but no, there is not. JG 4.6.09

Question:

Just one more question regarding necklift that did not pull skin under jaw, so no definition. The necklift did pull my face tight from sutures in ears, but not under the jawline. In other words, I thought a necklift meant it would add definition from below the jawline. Instead it pulled my face so tight my face has been sort of pulled down from tightness at ears and at top of jawline. But under jawline -- no effect. Just the opposite of what I thought I was getting. So I have unattached sort of LOOSE skin on neck under jawline and TIGHT face. Does that sound backwards to you? Thanks so much.

Answer:

I understand what you are describing and I can understand why you are confused and disappointed, I think speaking frankly with your surgeon should be done and go over with him what your desires were and how it has turned out, sounds like it will involve more surgery. JG 4.6.09

Question:

Hello Dr Pierce. I`m 10 days post Lower face and neck lift. I went into this surgery in the hope of rejuvinating my jaw line and slight loose neck. I now look at myself and it appears that I have the pulled back look. My scars run front of ear and temple....NONE at the back. My question is ...Will I loosen up or is this the look I am left with? Thanks in advance, Janis

Answer:

it will loosen and the appearance will change over the next 4-6 weeks. Give it some time. JG 4.5.09

Question:

Regarding the necklift that did not result in good jawline, my glands are fine, but the skin under the jawline was not tightened by this necklift. He pulled up at 45 angle at top of ears, and horizontally from mid ear to lower ear. It pulled muscle tight but not skin. It appears ineffective to me. Any thoughts?

Answer:

in many cases a necklift is inadequate to give a good jawline and a full facelift with cheek tissues being lifted and then a horoizontal and a vertical pull on the skin leaving scars in front and behind the ears both. JG 4.5.09

Question:

Hi, Dr. Garcia, Regarding myo-fascial release phys therapy, the muscles the phys therapist is stretching are on the face in front of the ears (the Masseter muscles). (The sutures are in front of the ears.) Do you think this may help?

Answer:

the masseters will no be the cause of the chin and jaw pulling down as the masseter pulls the jaw up, it would need to be the neck muscles. JG 4.5.09

Question:

When sutures are too tight and pulling face down, what do you think of myo-fascial release physical therapy about 1 month after surgery? Would this help release the overtightness sooner so don`t have to wait for all sutures to dissolve to get some relief? thank you.

Answer:

I think it is worth a try, those muscles are smaller and it has not been studied though. JG 4.4.09

Question:

Hi, Dr. Garcia, Regarding my question about a necklift pulling my whole face down, and a chin implant pulling my mouth down, I`m afraid I`ll need a cheek lift to correct all this, even though I did not want any more surgery. What do you think of cheek lifts, do they work well, and how do you do them? How much recovery time is there, compared to a facelift? Or do you think injectables might be able to fix these complications?

Answer:

well, possibly, but I would not entertain the idea until the tissues are soft and pliabel as you do not want the tethered tissues of the neck to limit the ability to lift the cheeks up ot correct the problem. The cheek lift has a couple of weeks of downtime and is about half of a facelift.I do not think injectables will lift the tissue enough, sorry. JG 4.2.09

Question:

Is it true that for some people sculptra does not work, left with no results after 4 months. Or is this deu to the injection technique that was used. Thanks.

Answer:

no, it is true, it does not work as well on all patients as their own body has to respond to the material and create the fullness, older people respond less well. JG 3.16.09

Question:

During a sculptra session, the dermatologist has filled a crease in my cheeck , i think a sparse amount of sculptra but not that deep. Now i see on this area that the kin a a bit like small graines, not smooth at all, is this normal, what can be done to improve the skin texture , before the skin was fine. Thanks fr reply.

Answer:

If the Sculptra was injected too superficially it can leave some lumps, they can at times be improved with saline injections to disperse the material if done relatively soon after the Sculptra injections. JG 3.16.09

Question:

I am scheduled for a mini-lift - in office/local only. - primarily for jowls and to `clean up` sagging neck ... I ma concerned about how swollen or tight my neck will feel after...that choking sensation will freak me out...(and I don`t do zanax etc..) What might I expect to feel along my neck and for how long?( I will be ok with tight jowl feeling) Many Thanks

Answer:

if you do feel it, that typically only lasts a few days. JG 3.16.09

Question:

Hi Dr Garcia, Regarding a MACS lift. As I understand it, with that type of f/l the underlying tissues are not separated from the skin and lifted separately, but lifted along with the skin. It seems like this would make for a more pulled look. Do you do MACS lifts? Otherwise, I like the idea of a faster recovery. What`s your opinion on this lift? thanks

Answer:

no, they are lifted seperately from the skin, it is just that the skin elevation is less. I do a modification of the MACS lift, something many of us have been doing for many years, we just did not give it a fancy name. I think recovery is not always faster and swelling can vary also. JG 3.16.09

Question:

I had a macs lift 1.5 years ago, the sides were lifted so high and the skin so tight that my face still looks unnatural with severe hollows, i tried sculptra for the hollows but filling the hollows creates more tick bags at the sides of my mouth and besides i have the feeling that the sculptra wont last for more then 3 months in my face. A midfacelift would give me a puffy appearance i think and also would shorten my face even more. As i do not need to pull up or ad more volume in the cheecks ( i also have no hollows under the eyes at all, more like a bit too much skin after the lift) what could be done to make this sagging tick bags on both sides of my mouth less appearant. thank you if you could give me any advice, as my injector seems not to know how to improve this issue.

Answer:

maybe a sparse amount of Sculptra in very thin layers to almost thicken the skin rather than fill in hollows might help, hard to say. JG 3.13.09

Question:

Hi Dr. which of the 2 procedures would you recommend - A face lift or CO2 Laser ? Thank you

Answer:

they do totally different things, some people need them both, so it is not an either or scenario. JG 3.13.09

Question:

I had a facelift 5 weeks ago that included liposuction & silicone injections in the nasal labia area. The results are asthetically excellent however in one cheek near the nasal labia where there were injections I feel two lumps under the skin. Is this common? How long will the lumps be there? My dr. says he can inject steroids to dissolve them at sometime but this may cause indentations. What do you think about my situation? Do you have any recommendations? I am worried. Thank you

Answer:

lumps at this time are not uncommon and might get better with time but Silicone injections do not smooth out the way other fillers do. Steroids soften scar tissue but does nothing to dissolve silicone injections. At 5 weeks I doubt there is any significant scar tissue there yet as the body has not had enough time to have create it yet. I am not sure if you are in the US, but if you are, since silcione injections in many states ar illegal to perform for cosmetic issues, I suggest you seek care by a different surgeon, as one that is willing to break the law is likely not someone that will look out for your best interest. JG 3.10.09

Question:

Dr.Garcia, I still can`t decide which type of neck lift I need: mini neck lift, weekend neck lift,mesh, corset or trampoline platysmaplasty? I have some loose skin and a little bit of fat under my chin, but it makes vertical wrinkles just in the middle of my neck. The sides of the neck look good, no loose skin. If ps will do incision under the chin, liposuction and will tighten the platysma muscle, will I get rid of these wrinkles or I`ll need a neck lift with incisions behind the ears to pull muscles there. All I want to make these wrinkles disappear, a nice neckline, to have as less incisions as possible and scars less visible after. Yhank you.

Answer:

I thik you will need both the incision under the leck and then also behind and possibly a short one in front of the ear to remnove the skin that will likely be in excess. I prefer not to put mesh in the neck as it can scar in and show.Best of luck. JG 3.9.09

Question:

I had a necklift a week ago and my face is being pulled downward. My lower lip is pulled down, lower mouth is sunk in and my smile is a grimace. There is an extremely tight band around my jawbone. This is a catastrophe! What has happened and can this be corrected?

Answer:

hard to say, if the lower lip can still move then it might be too tight of a series of sutures and the muscle being over tight, if the lip does not move it migth be a nerve injury and that might get better over the next few weeks. All the best. JG 3.8.09

Question:

Dr.Garcia,if I have loose skin under my chin and some fat [not too much],will platysmaplasty with one incision under the chin help or I will need a neck lift with incisins near the ears?

Answer:

the more fat you have the more likely you will need skin incisions behind the ears to tighten the skin. JG 3.7.09

Question:

Is it true that when massaging very firm after sculptra injections , that the product moves deeper into the skin, into the muscles and not giving the desired result. My docs assistant said this when i came out of the office. She said i would only need to massage very gently like you do when putting on cream. Now I have a lump on my cheeck seems to be some excess of product and my doc does not want to do anything about it. She says it will go away on its own. Thanks, for reply

Answer:

I think that will be a minimal to nonexistent issue, the fluid that the material is floated in might go deeper but not the small fragments of the poly lactic acid that will eventually create the fullness. The lump is not do to anything you did, it is more injection related, but I cannot say why he will not do anything about it. In most cases it does get better though, with time, JG 3.6.09

Question:

Dr. Garcia, please bear with me as I ask one more question about the lower facelift and tip (of the nose) reduction (42 y.o. female again :). I have VERY minimal droop in my face and in my jaw. And my nose everyone thinks is just fine (many ex-boyfriends have labeled it cute and told me not to touch it). It really isn`t bad (the nose) just slightly bulbous at the end, but I always thought if it was refined just a bit, it would look better. Frankly, people think I`m nuts for considering a lower facelift and tip reduction. This all started with my wanting to get my lower eyes done - mostly caused by another botched procedure. 2 years ago, I went to a substitute PS (when my regular PS was out of town for 3 weeks) and it was a HUGE mistake. He injected Radiesse right into my face (bridge of the lower tear trough, I believe it is called) rather than how I believe it is done (injected up through the mouth) and it was the worst thing I could have done. Not only did it NOT give me the extra lift (more cheekbone) I was looking for, but my under eye skin got bags, and fluid pools around where these injections were - AND, of course, there are the noticeable lumps (that are CLEARLY visible under makeup) - all still there TWO YEARS LATER. My PS says there is still a chance it will get better (is this true after so much time has past?) but his biggest issue is just not messing with something that someone ELSE messed up. So that`s how the lower facelift came up. We had been talking about tightening my jaw (for a very minimal sag) and then he said if I tightened my midface, it would somewhat improve the eyes. Again, I have very MINIMAL sag, and though I would look a bit fresher I just wonder if it is worth the pain and potential problems. I do like how it looks when my PS shows me the lift the cheek and neck would get with the facelift, but by no means do I look bad or old for my age. Many people think I`m about 35. I just don`t like that bit of droop I`m getting. Any thoughts? THANK YOU!

Answer:

firstly I doubt the lumps will go away without them being cut out. As to the lower facelift, it might help the jawline some but I seriously doubt it will do much to help the eye region, sorry. JG 3.6.09

Question:

Dr.Garcia,can I do botox injection into platysma muscle instead of platysmaplasty surgery? Will it help, at least temporaly? And after botox, muscle and the skin wiil be even more loose and saggy?

Answer:

well, lets think about this, Botox weakens muscles, that makes muscles look looser and potentially sag, a platysmaplasty tightens muscles, which is in general the desired effect, so I think if you have loose skin and muscle you need the neck lift, and if you have lots of extra money and want to do something that will not help and likely make you look worse, then use the Botox. JG 3.5.09

Question:

Thank you for your answer regarding the pros and cons of a facelift at an early age (42 y.o. female). Honestly, there is not one person who would say I needed one. I just like to stay on top of things and I started noticing a bit of droop under my neck and a little sag in the cheek area (hence just a lower facelift). I`m worried about looking old before my time as some women get tightened and look worse. I have a VERY small face (thin) and I worry it might age me if I tighten up the skin, potentially making my face look even thinner. Any thoughts? THANK YOU!

Answer:

well, the looking done depends on how aggressive it is performed, so a subtle procedure might keep you looking natural yet refreshed so to speak. Best of luck. JG 3.5.09

Question:

Dr. Garcia, are you for or against younger people (42 y.o. female here) getting facelifts? (A lower facelift in my case). And there pros and cons? Thank you.

Answer:

well, chronological age is really not something that I go by, it is the amount of sag and damage that needs to be looked at, some people at younger ages can beefit from a facelift and there are some people in their 60`s that still do not need it. JG 3.4.09

Question:

One week post sculptra and one area still feels bumpy. I masaged very well and still two raised bumps under the skin. Should I be concerned, I keep masaging, but this part of the face is not smooth. Does it take more time ? Is this becaue of the injector did not a good job? Also 6 weeks ago in teh previous sculptra session, she used the product at some wrong places, will it go down more, or stay like that. Untill how many weeks i will see the definite result? Thanks for reply on all those questions. You are very helpfull, when I call the doctoe , she always says, it will be fine.

Answer:

I would keep massaging and might suggest seeing the doctor in person to make sure there is nothing else that can be done. At times it is the way it is injected, but it can happen even in good injectors` hands. The Sculptra typcially builds up for a period of about 4 months and then slowly degrades so the other area that was injected at this point might stay that way for awhile. JG 3.3.09

Question:

okay, i was reading the posted questions... the lady with the canthopexy causing one eye to be a different shape i can say....your in trouble... it will never be the same again.. ever.... and you will probably have eye problems too to make it worse... so go see someone who knows what there doing before it becomes medical .///...:( sorry to say... just wanted to say this doc.. coz i know this and its the truth....otherwise she might get other surgeries and make it worse..

Answer:

as I have said, there are small things like cutting the canthopexy scars that can be done but if the small safe things do not work, she might be stuck. JG 3.3.09

Question:

hi doc, if canthoplasty is performed can it be undone after one year.? my eyes look small. Can eyes be cut open and made wide again? or what can be done to make my eyes large again?

Answer:

although the sutures can be cut, at times scar tissue will still hold it in place. If the scar tissue is aggressively removed in some cases it will help but not in all as new scar tissue will typically form. You might not be able to regain the appearance you had previously in some cases. JG 3.3.09

Question:

im the 63 year old with still a severe headache. after my facelift last week the 17th.. staples are out, i still have swelling... cheeks huge.. i woke up this morning with severe headache it is in the temples.. temporal headache,, it is so horrific ive never had a headache like this before and ive had migraines when i was in my 20`s.. this is where the headache imminates from... please help me, my doctor tells me that this shouldnt be happening... and that i am the only one with this serious headache. it comes on from 3 pm mostly and worst at night, but this am it happened when i woke. my question is shouldnt the headache get better each day not worse? valium does help.. im very scared

Answer:

not uncommon for this to occur in some individuals, we use Robaxin but Valium is also a good choice, might suggest 10mg twice per day and warm packs to help get the swelling down. JG 3.2.09

Question:

I`ve had a facelift and facelipo about 6month ago and I still feel puffy and itchy on my cheek, neck and around my ears. Is it normal? How long would this last? Is it really normal to feel swollen at long after the surgery??

Answer:

the puffyness should have resolved by now but the itching is usually the nerves coming back.JG 3.2.09

Question:

Hi, had a facelift 6 months ago, but scars behind my ears healed badly and ugly and need scar revision, is it possible that the incisions can help smooth out some lines at sideof mouth , fillers have been used,but there are some stubborn lines that dont go away, when i gently and very slightly pull where the linesare they smooth out. what do you think...

Answer:

scar revision will not do anything for the lines at the side of the mouth, no. Those might take a laser or somethinbg else. JG 3.1.09

Question:

what is midface lift with spacer?

Answer:

sounds like you are reading about repairing a lower lid problem where there is either scar tissue or excess skin removed and the lower lid needs to be lifted, so they cheek tissues are lifted using the midfacelift and then a spacer is placed with either donor tissue or tissue from your own body to fil in the hole made by the stretching and proper positioning of the lower lid. JG 3.1.09

Question:

is canthopexy the same as tarssorrhaphy surger? whats the difference if not.>>

Answer:

no, the canthopexy raises the outer part of the lid and a tarsorrhapy sutures the eylids closed. JG 3.1.09

Question:

why is precilla presley`s cheeks big but not high as she had them before? i think she she still looks pretty especially for her age..but what did she do? was her fillers too much? did she need a lift instead of fillers? or does it look like she got a lift too? and also why does her upper eyelids look like they are too heavy for her? .. im just asking because i think i have similar eye problem as hers.. my eyes are opening and shutting normal but when i look at the mirror it seems like im struggling.. like the photos of her too i think i look similar in my photos.. and what can i do to fix it ?

Answer:

hard to say without seeing pictures where she is not smiling. I think you will need to be seen by a surgeon in person to determine what would benefit your particular case. JG 3.1.09

Question:

Dr. Garcia, how long does it usually takes for the sensibility of ears and face come back to te same as before otoplasty and facelift? When should I start worring that the numbness became permanent? It´s 46 days now and my sensibility in one ear is much better than in the other.

Answer:

it can take up to one year. Hang in there. JG 2.28.09

Question:

what does lagophthalmos bilaterally mean for eyes?

Answer:

Lagophthalmos is defined as the inability to close the eyelids completely.Blinking covers the eye with a thin layer of tear fluid, thereby promoting a moist environment necessary for the cells of the exterior part of the eye. The tears also flush out foreign bodies and wash them away. This is crucial to maintain lubrication and proper eye health. If this process is impaired, as in lagophthalmos, the eye can suffer abrasions and infections. Lagopthalmos leads to corneal drying and ulceration. JG 2.27.09

Question:

Hi doctor I asked something about this question before but I just want to be clear... can botox cause temporary eye blinking problems if its injected to lateral canthi for crows feet rhytids? MY eye twitches abit ... doc told me botox is the cause.. im waiting for botox to wear out.. is this a possiility?????

Answer:

it would lessen the blinking in most cases. If it is injected, there are cases where weeks to months later as it wears off, the muscles can twitch as they start to regain their function, but if that is the cause, it is short lived. There are times where right after the Botox is injected that there is some twitching from the needle causing irritation, but that normally wears off in a few days. JG 2.27.09

Question:

I`m a male. I have read alot about how the face loses fat as one ages but I don`t find that to be at all in my case. In my 20`s I had a very thin angular face, and now in my 30`s it looks a little softer, rounder and pudgier. I have probably only put on 10 to 15 pounds since. Is this typical for an aging male and would simply losing weight bring my appearance closer to where I was when I was in my 20`s?

Answer:

it is not typical and I cannot say that losing weight can cause a certain change as where the fat is lost from is unpredictable. JG 2.26.09

Question:

Hi dr, garcia, Yesterday I had my tirth sculptra treatment, spaced 5 weeks from the previous one, some doctors say that more time should be needed between treatments. My face looks bumpy at some places altough i massage 5 times a day. Is this common or is it overfilled at those places. Can it cause problems like a later reaction of the sculptra causing granulomas. Have you seen in your experience long term adverse effects of the sculptra like years later. The bumps from the second treatment is still there, it is not visible but i feel it under the skin .

Answer:

common, keep massaging, it can take a few days for it to smooth out. They should flatten with time and in some cases they can be broken up at the 6 week mark with a small needle and some saline fluid, should not cause long temr issues. JG 2.25.09

Question:

Hi Dr Garcia How long should I wait for a facelift after having had botox? I had botox injections beginning of this month. Thank you Yvonne

Answer:

no need to wait, it will not affect anything that needs or could be done. JG 2.24.09

Question:

hi, i m the 63 yr old again that had the mid face lift and lower facelift that i had last tuesday... with major headache still going on, can you give me an idea of how long the headache will last.. it is unrelenting...

Answer:

I have seen it last 2-3 weeks in some cases. All the best. JG 2.23.09

Question:

hello, sorry to bother you again, can you recommend to me the dr who does fat grafting on the face in toronto, thanks a lot. I am confused

Answer:

sorry, not aware who does that in Toronto. JG 2.23.09

Question:

i have two capilarries under my eyes.... what do you suggest? what kind of laser? chemical peeel? ipl? they say ipl is risky close to eyes... so then laser? but then they also say laser will make the caps worse.. then what the hell am i supposee to do? its red and can see the veins spreading..

Answer:

no chemical peel will help, I suggest a YAG lser or a VBeam laser. Lasers that make capillaries worse are ablative lasers, not the ones I just mentioned. JG 2.22.09

Question:

hi you said if i have the whites of my eyes showing i should get that fixed before doing thelaser... cant i not touch the area instead? will that still effect the eye area? because docs here tried correcting it and made my eyes so small! they did canthopexy and it still didnt fix the problem but lessened it tiny bit... im 28.... i dont have a sag... maybe i can use laser..facial rejuvenation and wiill chemical peel work for under eyes?... and what procedure do you use to correct the whites of the eyes showing?

Answer:

if a laser is done to the cheeks that will pull your lids down still. I think anything you do to your lower eyelids will make the scleral show worse until the lower lid position is corrected, you woudl go from bad to worse. You need a canthopexy, the one you had done obviously did not correc the problem so you need to have done again and more aggressively, maybe by a different doctor. JG 2.22.09

Question:

hi im 63 yrs old, female had lower facelift and midfacelift and lower eyelids, and laser under the eyes for the hollows, i have had a horrific headache for the last 5 days worse than a migraine. nothing touches it.. is this normal?

Answer:

can be from the suspension of the mid facelift, might suggest getting some Valium for the muslce spasms that are probably casuing the problem. JG 2.22.09

Question:

i have noticedd with my full facelift my skin is supple and looks like a baby`s, its very refreshed looking, is a ffacelift actually good for the skin of the face itself? ie..production of more collagen, etc..

Answer:

no, it does nothing for the skin itself. JG 2.22.09

Question:

hell dr, in my cheeklift the excess skin was removed and that made my face gaun,flat and narrow, what is the option to get the full round face back.and my cheeks which was flattenned and narrowed any reverse, I just went for scar revision, on the side of my face, not the cheeklift, thanks any options

Answer:

you know I have answered your questions multiple times over the last few days, please go back and read the answers. JG 2.22.09

Question:

encore co2 laser.. is this the same co2 laser you know? and whats LightSheer Diode Laser? is this a good laser for skin rejuvenation?

Answer:

I believe the Encore is a fractional treatment and I do not use that, I use a complete abaltion, as to LightSheer Diode laser, that is for hear removal and will likley do nothing for skin rejuvenation. JG 2.21.09

Question:

sorry if erbium laser good?///...

Answer:

nope.JG 2.21.09

Question:

hey doc, i want to get co2 laser but i was informed that i may have my lower eyelids pulling down... as i have some whites of my eyelids showing from previous surgery.. im 30. will this happen? is it true? and if so.. what will be the next good thing for good rejuvenation for the eye area??? with the rest of the face?

Answer:

if you have scleral show already, which is the whites of your eyes showing from previous surgery, doing a laser could pull the lid down even more, at least for a period of time. I think you need to get the scleral show corrected before you attempt anything on your eyelids besides creams. JG 2.21.09

Question:

is urbian laser good for a 30 year old patient...with fine lines happening and. i want rejuvenation with more attractive tight skin... surgeon wont perform co2 or rhytec saying its too much for my skin.. i dont know why..

Answer:

I personally do not feel taking the risk of an erbium laser is worth it as the degree of improvement is too small for the risk involved. JG 2.21.09

Question:

what is the differece between I1PL, I2PL?... are they both good? does both do the same thing like a typical IPL treatment?

Answer:

sorry but I am not familiar with that terminology for IPL machines. JG 2.21.09

Question:

how much do you charge for portrait normally for cheeks.. and rhytec? and is there any need to say over night at hospital for this and fees? coz i will be making a trip from overseas for this... i just want to be prepared...

Answer:

I rarely do one single areas like that, usually we do the whole face if we are going deep to get the best effect. We do it at a surgicenter so you go home the same day and I would need you to stay in town for at least 7-10 days. Fees are about $4500, all inclusive. JG 2.21.09

Question:

hi doc, can a nurse perform IPL treatment? I had the nurse telling me over the phone that IPL will be done once every month for maybe 3 times or 6.. and then i wont need any maintenance... thats all apparently.. Does this sound normal for open pores, capilaries, redness,... ? I thought you adviced that you will need to do IPL every month to maintain the good result all the time... im getting cofused.. when i argued about this on the phone she said i can get IPL done maybe every 6 months if needed... help me with this?

Answer:

a nurse can perfrom it but I think she is not being truthful about not needing it anymore after a number of treatments as the issues that cause the problems are never permanently stopped. If she is telling you that I suggest you seee someone else. JG 2.21.09

Question:

is skin photo rejuvenation, IPL photofocail, photorejuventaion are the same thing? are they they all IPL? and ......... when asking for IPL i noticed the person in charge asks why The treatment is needed and what the concern is...I understand that IPL treats pores caps red areas, brown spots.. therefore, if i say one of the concerns and not the others wouldnt the other problem areas be treated? I just thought IPL would just cover the whole lot without mentioning everything... and is IPL used to treat one concern at a time? e.g one treatment for pores...one treatment for caps...so on..? because when i told the lady the list of my concerns she didnt sound pleased...mmm

Answer:

essentially, yes, all the same thing. At times they might offer other treatments that might work as well for some issues and not as well for others is probabaly what is going on. JG 2.20.09

Question:

hi doc, is there any remedies that can be used at home or anthing... to maintain better caps and pores..? maybe steaming? exercise? anything? cream? tea on face or something?...

Answer:

the thing is that the exfoliating creams that help the pores will possibly aggravate the capillaries, there are not many home remedies that help the capillaries I am afraid. JG 2.20.09

Question:

my one doctor told me i need to wait for my botox to wear off. Its been 3 months now he told me to wait for another month. But the doctor who performed it told me to go back to seeing him after 6 months! does this mean that he has injected alot of botox therefore he`s predicting it to last for that long?????????? and if so would it last for 6 months...its only been my 2nd treatment..----------- and then... my other doctor told me i have been injected with it where it gave me bad results and effects... eye upper eyelids look flat and raised with a very boney look. he explained when the eyebrows calm down they will look more natural and better..is this right? he thinks the eyebrows falling down abit will give more padding to my upper eyelids.. thnx

Answer:

I usually suggest that one waits until they see some motion return to the area before injection, but you do not have to wait until it is all back. I will say that the more Botox that is injected, the longer it lasts. I cannot really comment on the eyebrows falling or not without seeing you, sorry. JG 2.20.09

Question:

hello dr. when the skin is pulled to tight in cheeklift, does the fat grafting still works to plump up the fae, for a gaunt look into round shape. thanks.

Answer:

it can still work in some cases. JG 2.20.09

Question:

hi doc, you said squalene oil will be good for sensitive skin... i cant find anything like that here.. but i found capsules to take orally... and the shopkeeper told me it will be the same as the oil it self... my question.. is this correct? and if it is its really smelly and i did try it.. im actually writing this while its on my face.. and it stinks.. does the oil smell the same way.. it has fishy smell...:)

Answer:

it is smelly, especially that in capsules, might want to buy the oil in a bottle from the internet, it smells much less fishy. JG 2.20.09

Question:

hi, is chemical peel better then IPL for pores, caps, blemishes... thats what a doc told me...

Answer:

no, it might work faster for the brown spots, will work about equally for the pores and will make the broken capillaries worse or leave them the same.JG 2.20.09

Question:

hey doc, about IPL... When i asked about IPL i was asked which one i was after.. IPL or IPL laser...~ ~ uh? whats the difference?

Answer:

there is no IPL laser, it is called that in comon discussions since its effects work due to the pulsed light but it is not as strong as a laser and the ony way you change the light emitted is by filters instead of a differnt wavelength emanated as a laser does. JG 2.20.09

Question:

hi doc, can a nurse perform IPL treatment? I had the nurse telling me over the phone that IPL will be done once every month for maybe 3 times or 6.. and then i wont need any maintenance... thats all apparently.. Does this sound normal for open pores, capilaries, redness,... ? I thought you adviced that you will need to do IPL every month to maintain the good result all the time... im getting cofused.. when i argued about this on the phone she said i can get IPL done maybe every 6 months if needed... help me with this?

Answer:

a nurse can do it but the procedure needs continued use, I think she is trying to sell you something and not being honest about the long term, I suggest you go see someone else. JG 2.23.09

Question:

I can`t believe your 51! I thought you were max late 30`s! ... i think you look very good especially for a 51 year old... you look younger then 30 year olds that i know! Do you ever come down to australia ?? for cosmetic reasons:)

Answer:

I have never been Down Under but am lookin forward to traveling there in the future. Thank you for the kinds words too. JG 2.20.09

Question:

sorry last question, face is pulled too tight, will it loosen by itself in time, I can feel tightness. and willit be narrow more or will it remain same. thanks for your help

Answer:

yes, in time the aging process will allow it to loosen. JG 2.20.09

Question:

I had juvederm done for my cheeks 7 months ago... i had 2 mls each side... my face didnt look like a bubble but it took a very different shape... :( the ps injected the fillers above my lips,, really low.. causing my cheeks too look like a W shape you know what i mean.. ? like a bra shape on my face without smiling.. but it didnt make me look young.. it made me look old.. im 30. now i have these effects still... i think maybe the juvederm is worn out but i feel as though it made a pocket on my cheeks leaving that flat shape... is this possible.. well it did happen to me soo... and when asking for a high cheek with fillers... are the surgeons sopposed to ask the patients exactly where we want it... or when asking for the high ceeks are they supposed to just know where to put inject without asking the patient??

Answer:

well, I think showing the injector where you desire it is a good idea and I think the filler he chose to use is not a very long lasting one for that problem so I think in a little while it will all go away. Hang in there. JG 2.19.09

Question:

with the DMAE cream ... doe the eyecream have different ingredients? would it be wiser to buy product seperatly or can the facecream be used for under eyes too?

Answer:

most people tolerate the DAME cream under the eye, but if you have sensitive skin, then I suggest the eye booster there and the DMAE on the face. JG 2.19.09

Question:

would DMAE cream cause side effects like retina? e.g dry skin. so on.. itchyness ?? for sensitive skin?

Answer:

it does not cause any redness or dry skin, and if your skin was not sensitive before, it will not make it sensitive. But it does not calm sensitive skin that was sensitive to begin with. JG 2.19.09

Question:

would DMAE cream be suitable for sensitive skin? with red patch skin? how does the cream work?

Answer:

In most cases it is safe for sensitive skin, but I would not apply it to an area that is irritated from something. DMAE is a short for dimethylaminoethanol, a naturally occurring substance that facilitates the synthesis of a neurotransmitter acetylcholine. DMAE is a compound found in high levels in anchovies and sardines. Small amounts of it are also naturally produced in the human brain. An intriguing finding in some DMAE studies was that it reduced the accumulation of lipofuscin deposits inside cells. Lipofuscin is a cellular pigment consisting of aggregated chunks of molecular waste. It tends to occur in the cells of older people. It is likely that lipofuscin is not simply a byproduct of aging but also contributes to the aging process. Neurons, heart and skin of older people usually contain particularly large amounts of lipofuscin. It has been demonstrated that DMAE causes some degree of skin tightening. However, despite speculation it remains unclear how DMAE firms the skin -- whether by stabilizing the membranes, boosting acetylcholine, reducing lipofuscin deposits or none of the above. Whatever the mechanism, the effect of DMAE is often noticeable. Besides, even though DMAE can`t fully reverse the existing facial sag, it may reduce its further progression. Some people report a cumulative effect with continued use of DMAE. JG 2.19.09

Question:

whats the difference between Neuropeptide Cream and DMAE? im 30 with sensitive skin.. have some lines showing, skin looks uneven with dull colour.. i used to have a olive tan naturally but after using retina for long time i lost the tan. i have pores, dry skin.... my skin turns red after work outs...

Answer:

the peptide cream is for older more damaged skin, you likely do not need it at your age but certainly can use it if you wish. Red skin after work outs is normal and not much that can be done for that, stay out of the sun too. JG 2.19.09

Question:

HI doc... you said about my friend that her injection under the eyes should not show any swelling after a week or so and you think something else going on, either an allergic reaction or an over-injection of the filler. What can we do about this? i told her not to go back to the same doctor because he doesnt even listen to her and he tries to send her away... she is also limited with her english so he kind of pushes her away... we are in australia...sydney... what can she do? go to her gp? get a eye specialist doctor? what can fix this for her? shes really upset... please help...

Answer:

I would see someone who does those filler injections to see her, like a dermatologist or a palstic surgeon. Best of luck. JG 2.19.09

Question:

i have problems with my eye, twitching abit, from previous surgery going wrong with cantho. can i still get cheeklift surgery? will that effect my eyes/nerves? will fillers to the high cheekbones effect the area too?

Answer:

I think you can have the cheeklift as it likely will do nothing for the twitching of the eyelid. Fillers should likewise have no effect on the twitching. JG 2.19.09

Question:

hi, can anyone perform ipl treatment? where will i have to go to get the treatment done? doctors?dermo? ps?

Answer:

derms and plastic surgery offices have it, I think many are also done in a MediSpa whcih is OK as long as they have a physician on staff to make sure it is done properly. JG 2.19.09

Question:

hi doc, my friend had juvederm put under her eyes, shes really thin and has thin skin. shes 35. after that her under eyes were swollen for some time the doc said it should be ok in time. well now its been 6 months and she still has things like lumps and swolleness.. can she get rid of these? or is it permenant? what can she do? and what do yhou think they are caused from?

Answer:

that is not normal, the expected swelling is gone in most cases in 7-10 days. I think there is likely something else going on, either an allergic reaction which should be reported to the FDA or an over-injection of the filler. The lumps might be able to be dissolved using injections of hyaluronidase. JG 2.19.09

Question:

hi, dr,is fat transfer possible in the whole face and will my skin stretch ou on my face to give me the volume instead of a gaunt face. thank you once again

Answer:

it can work in the cheeks but it should not stretch the skin out. If it survives it can improve the gaunt appearance. JG 2.19.09

Question:

i used retina for years in early 20`s im 30 now. It worked so well to smoothen out my skin, and make my skin shine crazy! but in late 20`s it dried out my skin and my skin is very sensitive to everything... i cant put any ordinary cream.. so i dont use anything on it.. i gave up.. i just wash and pat dry.. my skin has capilaries on cheeks .. i also have brown little tiny spots when looked at closely... my pores make it worse.. Do you think IPL will be a good idea for my skin? and what else will you recommend as a cream? Can you also be clear with the options..with the recommendations i always think i have to try all it in one go:) so maybe tell me you can do this OR that... thankyou Doc:) I just want to start with something and be consistent with it as a lifetime routine... but i want to choose something right for me..

Answer:

I think IPL woudl be a good idea, avoiding sun exposure, using a complete sunblock and then consider something like DMAE cream that will not irritate your skin yet help with some of the damage that has occurred. I would stay away from products with any acids in them for fear of aggravating the blood vessels. JG 2.19.09

Question:

what is Ipl used for exactly??? and is there a setting that its supposed to be set at? is it something like IPL 200 :D or just IPL? and how does it work? ... Does it take away the top dead skin... what does the intense light do? how for of the skin does it go to....thkxxxxx

Answer:

it is used for reed and brown spots, settings will vary on skin type though. It will not remove the top layer of skin, or at laast it is not intended to. JG 2.19.09

Question:

hello will IPL be a good option for dry skin with big pores reddy patch spots, dull, with little lines happening... and would you use microdemabrasion together with ipl or only one will be enough? and how often is ipl needed normally?? im looking to maintain the skin ..... im really sensitive to retina though... and can ipl be used on eyelids without causing any problems? thnakyou waiting to read all the answers..:)

Answer:

I would use a combination of the two and understand the improvements will be short-lived. I do not think IPL is good for the eyelids themselves though. JG 2.19.09

Question:

hello.dr my face is too pulled up on the side with cheek lift and it hurts. can it be fixed by midface lift or any other procedure. thanks. My eyes hurts and as well my ears. thanks. Its been 3 months

Answer:

I think the safest and best option is massage and time, I would not suggest any surgery in an attempt op reverse it. JG 2.19.09

Question:

hello, i have pores, skin that used to have nice olive tan ages ago now is dull, sensitive, little lines abit pimple spots, dry, skin... what do you suggest? can i do co2 and after that ipl to maintain good results for ongoing ?? im 30

Answer:

pores are recurring problems so no matter what you do, it is temporary. I think IPL and microdermabrasions are a good place for you to start and maybe some Retin-A or glycolic acid creams. JG 2.17.09

Question:

hi doc, I had botox done in december 2008 so now we are in feb 2009.. how long more for the botox to wear off? You were right again about botox causing complicaitons with crows feet... i had it done for the first time.. and between my brows and forhead... so during that time.. and till now.. i have experienced twitching on my left eye.. and i wrote about that to you before but didnt mention the botox... i thought the reason wouldnt due to botox.. i had eye doctor examine it yesterday and he told me it can be due to botox so he is waiting for it to wear out... and my plastic surgeon told me ptosis surgery will be what i need.. but my eye doctor told me ptosis will worsen my eyes giving me a owl look so he told me he will reffer me to a surgeon who does fillers ontop of my eyelids ...this will replace the lost fat from bleph surgery (from 4 years back)... can you tell me if normally twitching happens to eyes from botox ? and if fillers are good ideas for upper eyelid..? and what kind of fillers are suggested normally? and how long it will last for normally??? thanks.. im the 28 year old female.. so sowie for the headache..:)

Answer:

as to how long it will last it depends greatly on how active your muscles are and how much was injected so it is hard for me to say. In terms of the twitching, I guess that can happen once the nerves start coming back and some muscles are working and others do not, but actually Botox was first developed to treat eye twitches and spasms. Ptosis surgery should not give you an owl look if done properly so I am not sure why that doctor said that. As to fillers around the eyes, they work over the bone but I think the correction of lost eyelid fat is not reliable. The most common fillers used there are Restylane and fat. Hope that helps. JG 2.17.09

Question:

dr. garcia can dr carlsen help me in this situation, as I had som e procedure done with him. thanks

Answer:

certainly worth contacting him, he is a very reputable surgeon. JG 2.17.09

Question:

Hi Dr Garcia I am undecided on two different kinds of facelift. One is an Extended MACS facelift with the inventor Dr Tonnard in Belgium or a SMAS facelift with Dr Jesus Benito here in Barcelona. I`ve visited both and would really appreciate your opinion. Thanks in advance Yours sincerely Yvonne

Answer:

to be honest, although I think Tonnard is an excellent surgeon and has a great operation, there is really not much difference between them and suggest you stay closer to home. JG 2.17.09

Question:

Dr. Garcia, with subperiosteal midface lift, some doctors say that 90% of the swelling is gone in 3 weeks. I cannot believe that is the case most of the time. It`s been about that long since my surgery, but I look really distorted and swollen. What is the real average time swelling diminished in the main? Also, I notice that the area next to the nose is extremely swollen. I hope it`s not actual fat and muscle. Do surgeons usually move tissue toward the nose during this procedure, or is it a vertical lift only in the area lateral to the nose? Thank you. Thank you for answering these questions!

Answer:

real time is about 6-8 weeks for about 50-60% to be down and at times 6 months for all of it to be gone. Tissues around the nose are not normally shifted during that surgery. All the best and hang in there. JG 2.12.09

Question:

Hello Dr Garcia You have helped me in the past with questions and I am firstly thanking you once again for your time, it is so much appreciated. I have recently seen a plastic surgeon regarding the MACS Short Scar Face Lift and Extended one. Research on the internet explains this normally takes 2-3 hrs. On consultation we discussed the extended MACS face lift which involves the malar cheek pad as well as jowls being lifted. When I asked how long it would take he said it would take 5 hours. I was taken aback at the length of time it would be and he said he does all the work himself and sometimes surgeons have assistants that sew up one side which makes the op. a shorter time. Could you please advise if this sounds correct or not? I am 50 yrs old and have good skin elasticity but cheeks have somewhat dropped and jowls are just forming. I have another appointment scheduled with him as he gave me a lot of scary forms to read through and sign which was a disclaimer which I understands covers him if anything goes wrong...assuming this is normal tho. The cost of his services is $6,500 but with hospital and anaesthsia costs it takes it to $14,000 australian dollars. Does this seem right? Would appreciate an answer as close as you can get to give me some idea. Thanking you once again so much, your answer will either reassure or make me seek another opinion. All the very best. :-D

Answer:

surgica time varies but a facelift can at times take 5 hours, no matter what technique is used to elevate the underlying sagging tissues. It seesm a little high on the price, but that varies from location to location and also with the doctor`s experience, certainly in parts of the US, it can cost that much. If you feel he understands your desires and you feel you can communicate with him, then I would go ahead with it. All the best. JG 2.9.08

Question:

With a subperiosteal midface lift, how long does it take for the periosteum to readhere to the bone in its new, elevated position? And, in your opinion, does using paper tape help secure the new position during the phase during which readhesion takes place, or, generally, if at all, how long should paper tape be used after subperiosteal midface lift? Thank you!

Answer:

well, there are different opinions on that but somewhere between 2-6 weeks or so. I do not think paper tape will cause or speed the re-adherence. I think that is pressure to a greater degree, limiting the swelling, and in some cases, fixation of the tissues to the bone in a variety of different ways can be done, screws, sutures, etc. JG 2.2.09

Question:

Dr. Garcia, I had a facelift & chin implant about a year and a half ago. About three months after the surgery, I began to notice a soft lump or bulge on one side of my face about the size of a quarter between my mouth & ear lobe but closer to my mouth; it protrudes noticeably whenever I am not smiling & isn`t so obvious when I am smiling fully. I`ve even had people ask me what I`m eating because it looks as if I have something in my mouth bulging out on that side. I showed the area to my plastic surgeon, who at first said it would take up to a year for all the swelling to go down but recently told me the lump is probably fatty tissue that was always there & just wasn`t noticeable until I had the facelift. But I have never had a lump there before in my entire life. Do you know what this might be & if it can be fixed? Also, I do feel that I must have had some nerve damage on hat side of my face as a result of the surgery because my smile has been crooked ever since I had the surgery although that seems to be improving. Not sure if the nerve damage might be related to the lump or not. Thanks for any help you can offer.

Answer:

hard for me to tell what the bump is without seeing you in person I am afraid. As to the nerve damage, I do not think it is causing the lump, but as long as it is getting better, that is all good then. JG 2.2.09

Question:

hey doc, i had fat removed from upper eyelids.. my eyelids look droopy and thin, boney... i hate them... some say i have ptosis.. so it will mean lifting the upper eyelids.. when i lift them up tiny bit with my fingers i can see the whites of my eyes.. im affraid if they lift them(with ptosis surgery)my eyeballs will standing out with whites showing at the top too.. i can open up my eyelids very wide when i want to (the upper lids do open too) but when im doing normal things during the day they look droopy,, 1)Does is sound look have ptosis? 2) do you think i can put fillers (and are fillers workable in that area???) to give it some fullness...??? thanxxx

Answer:

I think fillers can help the brow region but not the eyelid. If you have ptosis, then the upper lid would partially cover the upper part of the colored portion of your eye. Tise can be determined by your surgeon. If it is symmetrical, I doubt it is ptosis. Best of luck. JG 2.2.09

Question:

hi dr garcia... i have a sergeon i will be seeing. in his profile it writes he`s a subspecialist for the areas i will be seeing him for.. What does it mean by subspcialist? it sounds like he`s not all qualified but just did some parts of studies... what is your opinion? i`ve been searching it up but i dont know what it means...

Answer:

it likely means that he does a high percentage of his work in that particular area. It is a self-claimed interest, nothing more. JG 2.1.09

Question:

is Diathermy or Thermolysis good for capillaries and veins showing ?

Answer:

I have not seen it be effective. JG 2.1.09

Question:

you know those little dimples on the chin that usually only happen while thrusting out the lower jaw? well, i dont know if mine hv always been there and i am just now noticing them after my lower face/neck lift. or if they are new, but mine are there now even when my face is relaxed. not horrible, but wonderingn if anything can be done to smooth these out? retin A? or is it possible it is temporary? i am 5 weeks post op.

Answer:

likley seen due to loss of subcutaneous fat and you did not notice them before as you were loooking at other things. They can be injected with fillers or a laser done but they will come back. I do not think it is swellig from the facial surgery though. JG 1.28.09

Question:

Dr.Garcia, how would I know if I need a neck lift or lower face lift? Which is more expensive? Which one has more down time? I always appreciate you sharing your knowledge and expertise while always maintaing the dignity and feelings of the questionaires...even when the questions have been asked a million times. BLESS YOU

Answer:

well, if there is anything loose on the cheek or even a little jowling, then the neck lift will not correct it, also at times the excess skin of the neck is in excess both horizontally and vertically and a neck lift will only improve the horizontal excess and not the vertical, so in that case of both horizontal and vertical excess you need the lower facelift. Hope that helps and thanks for the kind words and encouragement, I appreciate it. JG 1.28.09

Question:

hello doc what is the difference between ipl and electrolysis? which one is better? can have some info?

Answer:

there is absolutely no similarity between them, IPL is a pulsed light source used to treat brown and red spots and electrolysis is for hair removal. JG 1.28.09

Question:

hello doctor garcia, Me and my friend both want to get into electrolysis hair removal field. but we dont know where to start from.. we have no qualification in medicine, dermatology, nothing like that in our background. infact im into childcare and shes a office manager.:) is there a uni degree or tech degree for this service? we are located in australia sydney.. would you know what to attend to? how do we become fully qualified electrolysis people? we are planning on opening our own service for this field.. please if you can supply us with all the knowledgeeee you haveee:)))

Answer:

I am not sure, you are best to call around and speak to a local electolysis person and they might be able to direct you. JG 1.28.09

Question:

Dr. Garcia. 1. Is fraxel useless, meaning no result for sun damaged skin, causing diagonal lines on chin and above mouth. Is there something better with not too much downtime? 2. What is the best way to treat lines around eyes, no hollows, a bit of exess skin. What can be used to plump up upper eyelids with a bit excess skin due to loss of fat in upper part. If there is excess skin and use fillers to plump up, will this cause sagging of the eyelid? Can you advice the best remedy. Thanks for answering those questions.

Answer:

there will be nothing effective without downtime. I think for the lines and excess skin around the eyes it might be a completely ablative CO2 with possibly some surgical skin excision in some cases. Restylane can be used in some cases to plump up a deflated lateral brow. A filler there should not cause more or faster skin loosening. JG 1.28.09

Question:

with electrolysis hair removal you said it will take months to grow back, hair that is. Is that when in the process when having the first sessions of electrolysis or when you achieve the desired effect say after getting it done every few months for over a 12 or 18 months period of time.... would you still need to get the treatment done for the rest of your life..? or will it bee needed once every 12 months??? because if you need to get the treatment done every few months forever.. wouldnt be like waxing?...can you please help me??

Answer:

after it has been done for awhile. How often it will need to be redone varies from person to person. It would be much less often than waxing. JG 1.28.09

Question:

hi, i want breast implants . will i need to change them every once a decade, year?.. and will i need other surgerys with this ... I dont want any other surgerys or other maintenance.. i just want to get them and thats all.. i hear some implants shift and become one or B shape, some harden in 3 years, some go crazyyy,,, it will be really embarrassing for a female to have all these problems... are they normal problems for this surgery.?? does the risks matter from size? and shape? and what i heard titanium coated ones or good.. you heard about them??? any info????

Answer:

you only need to change them if there is something wrong with them, no need to just change them out. Due to potential known side effects though, about 24% of the time there will be more surgery required later for a variety of different reasons. Risks are slightly higher with larger implants but not$ with shape. The titanium covered implants are not out yet, no one knows if they will be released and no one knows if it will cut down on re-operation rates. JG 1.28.09

Question:

i have weird arolae... i feel that they are bumpy and swollen and large.... i think maybe its called a areolae disorder... now ... i saw what they did to make the areolae small on you tube.. that looked bad...ok... what diameter should a normal areolae have??? so i can measure my one..lol gosh..:) funny question but it will help alot... i have sml breast with big arolae! really weird looking...

Answer:

average diameter for an areola is 4 centimeters. JG 1.28.09

Question:

i want to make only the tip of my nose softer and smaller.. like those hollywood:) i have a nose that ok shape.. just the tip bothers me... what is the surgery called and is it safe? and some people say... i will have to re operate for this surgery as the tip grows.. aparently... is this true.. what is involved.. and is the cost the same as a whole nose job?

Answer:

it is called a tip rhinoplasty. In general it is safe. Usually the nose might get larger with time but it is due to the skin getting thicker and more surgery will not help that. Cost will vary from surgeon to surgeon so you need to choose a surgeon and see. JG 1.28.09

Question:

i saw this girl she had hot lips.. but i know it wasnt fillers.. her lips were rolled up i think.. what is this method called? how do they do it? and how long does it take for a surgeon to do and healing time? and risks involved? does plastic surgeons all do this ??

Answer:

it is a lip lift or vermillion roll. Not all patients are candidates and there are limitations with it. Most plastic surgoesn will do it if it is indicated. Healing time is a few weeks. Risks depend on which technique is used so I think after you meet your plastic surgeon those issues can be addressed.JG 1.28.09

Question:

hey doc, you said before that with permanent hair removal tecnique hair will still grow back... how long will it take for hair to grow back? one year? two years?.. and will it be the same colour and thickness??? because i have hair growing from my chest! and im a female! if hair grows back will it be less obvious after treatments ...??? do i need to get the treatment done every once a year to maintain the good result??? would you need to go to a demertologist for this kind of problem or plastic surgeon or cosmetic or beautician?? thankyou

Answer:

months to grow back, not years. It will likely be softer and maybe a little lighter. It is done by specialists in electrolysis that are not doctrors. JG 1.28.09

Question:

hi doc, i have flat chest... and i want breasts... any method.. i heard about macrolane now am interested... do you perform this? and i`ve seen on tv , internet and media guys using hormone tablets to change into women!... they actually grow breast to be like women... i bet you know what my next question is... If guys can grow breast with the hormone tablets (like really big oneee that i`ve seen!) can females take them too to have some or bigger breast? if not why not? if it works for men why cant it work for women?

Answer:

Macrolane is not legal in the US. Hormones tablets also do not work and are potentially not safe due to potential issues with breast cancer. Most men that have grown breasts in terms of the transsexuals have had other injections or sugery to enlarge them. Sorry. JG 1.28.09

Question:

you are the smartest doctor:) what kind of hair removal would be best for permenant result? I am light olive skin.. I have pretty much dark hair growing from weird places.... hate to say but trueeee.. yukieee... and my doc did test and said its just from my good old genes...isnt that great... my doc didnt suggest anything.. she just said find a hair removalist from where ever you want to and so on... so please helpppp.. and how does it help? if i decide to go with one therapy how long does it normally take to get rid of the whole hairrrr.... how many sessions...?? please give me some info... thanksss

Answer:

well, the truth is there is nothing permanent in hair removal, electrolysis is likely the longest lasting though. It will take many sessions though I am afraid. Best of luck and thank you for the kind words. JG 1.28.09

Question:

thankyouuu so much for this information... after getting ptosis done if it overcorrected or under... as you said that can happen...can the surgery be reversed? and if it is will the eye go back to its same place? is there any muscle cutting involved in he surgery? are there different methodss? im 28yrs old so i just want to know this kind of thingsss so im not stuck with one eye bigger then the other and with other probsss... but you are so right! i described you the problem and said i needed the ptosis surgery instead of the eyebrowlift... i`ve been seeing that is the problem! i never realised i had ptosis and i`ve been living with this face..:)) i sound so stupid... but now that i know the surgery (ptosis) im affraid of getting it done incase it goess bad... please can you asnwer my questionsss... thankyou thankyou thankyou.. your one doc i will listen to :)))

Answer:

In most cases the ptosis repair can be undone if not too much time has passed. Ideally if it has to be revised they can fix it to the desired correction at that time. There usually is no muscle cutting, instead it is suturing of the muscle to the tarsal plate or cartilage of the eyelid. I think if you see an experienced surgeon that you should not be scared to have it fixed. Best of luck. JG 1.27.09

Question:

hello, is it true that you cannot ever completely close your eyes after ptosis eye surgery? while blinking, sleeping and so on...? you said ptosis is a different surgery,, you were right , its a really different surgery.. what are the main risks? can a ps perform this surgery or does it have to be a eye doctor?

Answer:

that is not correct if it is done properly. At first you will likely not be able to close but the lid should be able to close when relaxed afer a few weeks. The risks of ptosis surgery are under or overcorrection, so it is best to have someone do it that does alot of it to make sure the very thin muscles are adequately treated. Both plastic surgeons and eye specialists can do it if they are well trained. JG 1.27.09

Question:

How much time is needed to wait to have fraxel repair after sculptra session. Some say 2 months, some say it can be done immediatly. Thansk again.

Answer:

I would wait at least 2-4 weeks to let the fluid from the injections be absorbed. JG 1.27.09

Question:

Sorry other question about disolving sculptra. Is it true that injecting saline in the area where too much sculptra has been injected, could disolve the product when the saline is injected within a time frame of 2 weeks ? Can it be done also alter ? From what time on the sculptra is going to begin to work and then not possible any more to disolve? Thanks again for answer.

Answer:

it will not dissolve it but will disperse it so it would be thinner. I think after that time it will likely not be as effective. I think after 4-6 weeks any saline inejctions will be difficult to use. JG 1.27.09

Question:

Dr. Garcia: Will a neck lift improve the appearance of a depressed scar on my neck left as the result of surgery to my back? If not, what might I consider? This scar is approximately 3 inches long but when looking at my neck in the mirror it looks like someone punched a hole in it about the size of a walnut. It actually looks worse since my Dr. performed (almost a year ago now)a facelift (vertically pulling the skin upward) but he did not touch the neck area. Thank you. 1/16/09

Answer:

It might, yes. The problem is there is likely some loss of tissue and that will not be repaired with lifting it. JG 1.26.09

Question:

Gid day from up North..I am 52 and have fillers stuffed in me to help with the marionette look I do not want..and nose to mouth. I have some fat under the chin i would like lipoed and was thinking of a lower facelift - would a lower f/l address my under the chin issue...as well as my grooves from the nose to the chin. Is it better to wait until my Perlane/Restylane has migrated wherever before I embark on this adventure or does it matter. I do not require a full facelift and do not have many lines - eventually in the next few years I may look at a browlift but for the lower part of the face I would like something sooner. Thx...signed freezing in Ottawa.

Answer:

well, a cheek lift and neck lift would help, if that is what a lower facelift is to you, then that would do the job, it would just not improve the forehead or eyes is all. I do not think the fillers being in place would make the operation any different. Best of luck and bundle up. JG 1.26.09

Question:

My doctor says that radio frequency on a specific part of the face should let the sculptra in that area disolve quicker. is that true? could it cause any other additional harm to the tissu besides disolving the sculptra ? thanks for answer. you are very kind.

Answer:

well, if he has proof that it works he should publish it in a medical journal because I see no way that he can claim that. Likely no harm though. JG 1.26.09

Question:

hey doc you said There is no maintanence unless you get a silicone implant for breast 180cc does that mean they last longer and safer then bigger implants.. and what is the safest implants? im not familiar with terms..

Answer:

no, there is no maintanence for all of them regardless of size. I think both silicone and saline implants are both safe. JG 1.25.09

Question:

hello, my question: i have hallow look ontop of my eyelids some ps say i also have ptosis... ps said i need a eyebrow lift for this.. but when the area is elevated it looks more skelentonic.. boney... not attractive... so then i heard about fillers like juvederm elevating eyebrows by injecting it to the eyelids... will this do the trick for me? will injecting fillers to the eyelid lift the eyebrow area and help with the ptosis look? i had fat removed from this area before.. about 4 years ago... what do you think?

Answer:

it sounds more like you need a ptosis repair of the upper eyelid and not a brow lift. Juvederm will not elevate the lid but might fill in the hollowness. Best of luck. JG 1.24.09

Question:

is it safe to have macrolane fillers to enlarge breast? i will like my breast to slightly filled not to bee big..but just filled up. im size aacup.

Answer:

not approved in the US, it appears to be an option but no word on how long it lasts though. JG 1.24.09

Question:

hi doc, i dont want to be a pain but its me again with the twitch on the left eye (28 yrs old). Just wanted to describe the twitch to you if you can help and tell me if botox can help. Its the lid of my left eye, not the eyebrow skin its directly the lid , the line of the eyelash. That part feels like is moving at times. its not visible all the time but i can see it when im widening my eyes to yawn or talking making expressions while talking. . so does that sound like a spasm? and the does it sound like botox will help? and you said if i get it undone the twitching wont stop then really whats the use of doing that then? coz im affraid of the unpredictable result...! if i dont get it undone (if its not going to help the twitching) in you preofessional opinion will this twitching get worse...? i know your not a eye doctor but say in general with people with my condition.. what do you think of it?

Answer:

yes, it does sound like a spasm. I think a low dose of Botox is OK to try. I will also say that stress can make spasms better. JG 1.24.09

Question:

What means hydrosissection ? Is it succesfully used to get rid of lumps. Can it be done within two weeks after the injection that has caused the lump? Thansk for answer, martine.

Answer:

hydrodissection is the process of lifting or seperating tissues with the injection of fluid. The sooner after the injection the better the chance for it to work. JG 1.24.09

Question:

Last health insurance today. Long story. Before i run out wanted to get 3 month worth of med`s blood pressure med Thyroids and so on. Just got back from Europe. Suitcase got stolen Med`s where in that suit case.My doctor only wanted to do one month I needed 3 month pronto Found Dr who gave me 3 month prescriptions. Yet he turned out to be a flake He also sold me samples $20 a prescription. later i found out that is illegal Guess i am dumn.Ok he told me my face looked real good for being 50+ . well yet had a face lift way back. Then he started on my lips make me look older down ward mouth and so on. He could fix it for little money. Oh he does weight control . Pills for hunger and so on .He said i did not need to lose much weight though. told him hubby lost job no money . Still he capped at it. Doctors like that scare the sh.... out of me. Will never allow the persons like that put a needle in me . Oh He does not excepts credit card Or even debit. Cash he said was the best. The girl at the desk first said the machine did not work . Told her I don`t carry that much cash on me. I was aloud to use debit. Wonder if it was because of paper trail.. Thank you for filling out the prescription for the 2 creams. Will see you as soon as finances look better. Still sending people your way . Not to many Dr like you around ,who still believe in honesty and honor . Thanks again . God bless. Sorry for so many spelling errors Regards Lainie

Answer:

all the best,see you soon. JG 1.24.09

Question:

Dr. Garcia, Thanks you for all your help on my previous questions. I am a bit concerned about the two lumps I developed under the skin one week after sculptra injection, they are deep under the skin and you said to massage daily, which I do, but there seems no improvemnet, can this cause problems later when the collagene starts to form, and get bigger and sticking out of the skin, I keep massagine, is there need for other treatment, as it is still early now, 11 days after injection, maybe there is something that can be done to prevent overgrowth, I have seen the doctor and since they can not be seen, she does nothing, but I dont know this is the right thing , just doing nothing. Thanks again for your advice. I am really worried it might get worse after a few months.

Answer:

well if it is a clump of the Sculptra powder, in theory it could get large in time, I would sugggest you see your injector for a possible injection of saline into the lump to attempt to break it up to prevent future issues. I think after this amount of time you can stop the massaging as benefits will be very small now. Best of luck. JG 1.23.09

Question:

Thanks dr. Garcia for your quick answer on my previous sculptra question. But I think way too much sculptra is injected in those areas, so is it not partly possible that it is from overfilling, so that the contour of my face is changed to squared. It makes my face sagging on the jawline part instead of lifting. So much thanks for your reply.

Answer:

best of luck. JG 1.22.09

Question:

I forgot to ask an important question in my post below (re: lower face lift). I intend to stop ALL of my vitamins tomorrow. However, I also take diet pills (why, I don`t know, as they do nothing). Do I have to stop taking these, too? Or can I just forgo them on the day of surgery? Thanks!

Answer:

yes stop those too. JG 1.22.09

Question:

Same person about the scukptra question earlier today, the sculptra injected on the bottom of my face, around chin and jawline makes my face more squared and thus older, and flattened because there is less definition in the lower aera and the chin is also less defined. It is making my face bigger and lower, not a nice result, jawline bulging out a bit. When the sculptra wears off, is the sin going to be streched and lax from the volume augmentation that is there, or should it shrink back? I have very poor elasticity in my skin. Thanks again for help.

Answer:

the skin will not stretch out on a permanent basis from the injections. JG 1.22.09

Question:

I had an overfill of sculptra on the bottom of my face one week ado, the swelling is mostly gone, but the area is much fuller then before giving me a monkey look Does this means they have filled too much, is it still possible to massage and move to higher area on the face, I tought scuptra did not give that much fulness after this second treatment as the first did almost nothing an was as good as gone after three months now the second treatment is awfull, will it shrink a bit more and give some natural contours back, are will it stay as puffy as it is now? Some say it takes two years to wear of, others say it takes one year. One docot told me it was possible in this early stage to inject some sterile water in that area, used to dilute the filler and then massage to make the product move to other part of the face. Thanks for any help. Thanks for any help.

Answer:

I would not make that assumption for another 3-4 weeks, most likely it will all get better.JG 1.22.09

Question:

hi doc, i had canthopexy done to both eyes about 2 years ago. and i thought both my eyes look smaller then before! i hated it and the left eye looked more smaller but the surgeon said it wasnt. now my left eye keeps twitching once in a while. im wondering what can i get done to solve the problem? i feel as though the shape and all looks different from the right. i feel like a freak. the ps said he wont undo it coz then i will have a owl look. what will happen if the canthopexy gets undone? or maybe if it gets a bit losen up will that solve the problem? im not going to see the ps anymore i seeing a eye specialist soon. I have also developed Dry eye syndrome.. and i am only 28! tell me what can i get done???

Answer:

it is common and almost expected to have a smaller eye aperture after a canthopexy unless it is so mild that it almost was not needed to be performed, it has to happen, it is not a matter of sometimes, it geometrically happens. About all that can be attemtped is to cut the canthopexy sutures and release the scar tissue to hopefully allow the tisseus to go back to where they used to be before. You should not have an owl look unless too much skin was removed at the same time as the canthopexy. Hard for me to say more without seeing the before pictures and understanding why they did the canthopexy to begin with, but it is very rare to do on a person your age I must say. All the best. JG 1.20.09

Question:

Is it possibe to do a sculptra touch up in an underfilled area to balance the face five days after the first treatment. Can it cause problems? The doctor said no problem, do I have to expect problems with that? Thanks again for answer.

Answer:

I likely would not do it for at least 4-6 weeks as at five days it is usually due to swelling and not uneven Sculptra. The issue with problems can arise anytime it is injected, with any filler for that matter. JG 1.19.09

Question:

I just noticed a medium size lump after 5 days of my sculptra treatment. The docotor also used juvederm in some areas. The lump is on the right side from my chin , can only be felt not seen. I dont know if it is from the sculptra or the juvederm, dont know where she injected what. It is kind of a hard lump and can not be massaged away. Will it grow with time? Should I do something? It seems deep under the skin as far as i can feel. Thanks for your respons.

Answer:

I would go see the doctor and see what was injected thre, in either case, massage should help make it smaller or go away in most cases. JG 1.19.09

Question:

Hi dr. garcia, Today I had a touch up of sculptra to correct underfilling at the sides under my cheeckbones , this was this afternoon, I dont have bruising, never had before , a little swelling, but now by the evening, the swelling is almost gone, is that normal, The first time I had it done by another doctoe I has swelling for more tehn five days, does this other docotor use more diluted sculptra or what is the cause I have nearly no swelling. Maybe she did not inject sculptra but something else ? It was monday today and I called her just this morning to come over and do the touch up, so she said she has always prepared sculptra as she uses it every day. Maybe it was old sculptra from last week or maybe something else, i am nearly as before and had quit a lot of injections. What do you think? Thanks for anszer, seems that my previous question has gone.

Answer:

could be they did not dilute it as much, could be they injected it deeper. Hard to say. Having it diluted from last week does not make a difference with what you are speaking about though. Best of luck. JG 1.19.09

Question:

Where on the face after face/neck lift, is the last place to get feeling back and swelling to go away? for me, the fronts of ears, and actual ears, are still very numb, and skin feels thick in front of ears. And one side of jaw is stil squishy with a little swelling, and under jaw, chin area is totally numb. I also have a what looks like, tracheal ring, on my throat that kind of sticks out to one side. Assuming this is weird swelling? so basic question, what part of face takes the longest to heal? I am 4 weeks out. Thank you

Answer:

the area right in front and behind the ears is usualy the last. I think at 4 weeks there is still lots of swelling that seeing it uneven is normal but will get better with time and some light massaging. All the best. JG 1.18.09

Question:

If I were to have a browlift first, how long should I wait before having a facelift? Also, what do you think is the best product to use for scars from the surgery, and how soon can I use it? Thanks KL

Answer:

if you are going to seperate them maybe 3 months or so. As to scar reduction creams, we use ScarGuard, and start it 48 hours after the sutures are out. Best of luck. JG 1.18.09

Question:

how long after lower face/neck lift, rhino, upper/lower bleph do i need to wait to get a massage? The face down part is what i am concerned about. i would of course tell the therapist about the surgery. I am about 3 1/2 weeks post op. Thank you

Answer:

at least 6 weeks. JG 1.15.09

Question:

thank you for answering so quickly. if they do face lift just pulling the skin, can this be done with local anesthesia?

Answer:

it can but it can also be uncomfortable to get the injections and also uncomfortable if they get to an area during the surgery where you are not nnumb. JG 1.14.09

Question:

You mention you have completed facelift procedures with IV sedation and local anesthetic. Approximately, how long were the procedures in terms of hours? Thank you.

Answer:

about 31/2 to 4 hours, it takes longer to do under local anesthesia because if you get to any area where the local anesthesia is not adequate, you need to stop, inject and then wait. JG 1.12

Question:

Is it true that when you use things like retin A that thin the skin and old acne scars make the blood supply more compromised during a face lift, and you are more prone to hematomas? A lady stated she had hematomas from face lift from these prior problems? If this is true, how much more of a risk is this than a person who never used products that thin the skin? I know a doctor told me they usually happen to people who don`t follow the aftercare instructions?

Answer:

no, that is not true. The risks of hematoma are not affected by those issues, but the risk of hematoma is there for all surgeries, it is about 1-2% in facelifts, a little higher in males. JG 1.12

Question:

Thank you for your response regarding the LifeStyle lift. It is not that I feel the results of the procedure would be better if the procedure is done with a local versus another form of anesthetic. For me personally, I do not want general anesthesia. I had it once and reacted very poorly. I`m fine with IV sedation and local anesthetic. I was not aware there was a safe maximum limit of local anesthetic that could be administered during a period of time. When consulting with Plastic Surgeons, I was explicit that any procedure I have done NOT require general anesthetic. I was told the procedure I`m planning - neck/lower face lift; the surgery time is 3.5 hours and could be done with IV sedation and local anesthesia. I was assured the procedure could be completed this way. Does the use of IV sedation make it possible to use less local anesthetic? I would hate to get to the OR and find out this is not the case. Thank you.

Answer:

no, sedation does not make it require less local anesthetic but you are more comfortable while it is being done and the injections hurt much less. I have doen facelifts under local with sedation. Also, the end result is up to the surgeon. The LifeStyle lift is a procedure that is marketed as something unique when in reality it is not, it is all marketing, any surgeon can do similar things and just not call it that. Also the name of the procedure is no guarantee as to the result, results vary between surgeons, so just because the results look impressive from the examples they show does not mean the surgeon you are going to use will give you those types of resutls. Best of luck. JG 1.11.09

Question:

I am a 46 year old female with neck bands (not much loose skin). Would correction of the Platysma Muscle be enough to address neck bands or would there need to be incisions starting on the inside of each ear that wraps entirely around the outside of the ear? If some skin tightening is required, does it need to be so extensive? I have consulted with several Plastic surgeons - - one thought correction of the platysma muscle would be enough, the other said he could correct the platysma muscle; however, I would be back in a couple of years for him to finish the job. Is there some procedure inbetween that addresses the platysma muscle and slight loose skin without going all the way around the ear? Thank you.

Answer:

the degree of skin tightening is impossible to tell without examining you, if it is just the bands, then the skin might not need to be removed but the looser the skin is to start then the greater the length of the scar required to fix it. I think the vast majority of the time some skin removal will be needed in a few years if not done now. JG 1.11.09

Question:

I have seen a lot advertised about the LifeStyle Lift in television, magazines, etc. When looking at the before and after picitures, all the people profiled look great following the procedure. They claim the procedure can be done in about an hour under local anesthesia. What is the difference between this procedure and a traditional face/neck lift that appears to require up to four hours to complete? If the results shown in the advertisements are typical, it would seem to make sense to go with a procedure that does not require a lot of the risk that accompanies a longer surgery (primarily anesthesia). Do you feel the LifeStyle lift or other mini lifts are inferior procedures and if so why? Thank you in advance.

Answer:

I will comment on the Lifestyle Lift but I will do so carefully as I have a received threatening letter from the company for some comments I have posted here previously, so lets’ look at what everyone can see and read. Let’s look at what the site says. This relates to what was on the site a few months ago, so they may have changed it. They claim 60,000 clients, that sounds great, but is like saying there were over 300,000 liposuction clients in the US alone last year. You want the surgeon to have the experience, not the procedure itself. Procedures do not have experience themselves, it is the people performing the procedure that glean experience. It is a procedure done maybe that many times in its existence but not by a single surgeon. I see no documentation that a single surgeon has done that many it appears and the results of any surgical procedure will vary from surgeon to surgeon. The pictures shown reveal the before pictures with the patient in many pictures pulling their chins back which makes their skin more loose and then in the after pictures they are showing pushing their chins forward which makes the skin look tighter. Also when a patient is smiling, like in the after pictures, that lifts the tissue and skin higher and when you do not smile, like in the before pictures, the skin and tissue look looser. This lends itself to making the results look more dramatic than they are in real life. The pictures also do not say how long after the procedure they were taken so we have no idea as to how long the results last for. Local anesthetic, OK, can be true, but what happens when you feel pain and they have already used the maximum safe amount of local anesthetic. The statement that some people do not look like yourself for months or years has nothing to do with the anesthetic but with how tight your surgeon pulls the skin, not on the individual procedure performed, it’s more on how the surgeon performs the procedure. All medical offices also have to abide by OSHA so that is nothing unique to them. There are national organizations that certify and accredit office operating rooms but OSHA is not one of them. The non-use of sedation or general anesthesia also allows other issues, for example in some states if you have a complication from a surgical procedure performed under sedation or general anesthesia you have to report it to the state medical board, but if the complication happens when done under local anesthesia it does not have to be reported. Also, at times doctors perform procedures in their offices under local because in some cases they are not granted privileges to perform the same procedure in the hospital or surgicenter due to their lack of training or background. Sure, doing it in the office is less expensive for the patient, and it is also less expensive for the surgeon too. Awake and relaxed, maybe for some but what about the people who are nervous and fidget or move when the feel something that hurts, all while the surgeon is cutting tissues. Immediate results, well any plastic surgery procedure has immediate results but you are not presentable immediately in terms of what you look like because of swelling and bruising. There is no documented advantage to local anesthesia over general anesthesia in terms of how fast you look presentable. Certainly the less surgery you do in terms of lifting and supporting tissues leads to less swelling and bruising, but it also leads to less effect and less long lasting improvements. Overall, I think you will need to make you own decision but I cannot endorse or recommend the procedure as being anything different than what has been out there for a long time, just not referred to by a catchy marketing term. Caveat Emptor. JG 1.11.09

Question:

Hi Dr. Garcia, Are you familiar with the Simple Lift procedure (described as an 1 1/2 hour long S lift procedure for lower face/neck)? What are your thoughts on its effectiveness (short and long term)? My neck and lower face is aging faster than the rest of my face I am a fair skinned 50 yr old)and wanted something to improve these areas. THANKS for your website!

Answer:

for a fraction of the people that have minimal sagging, it might work, but I will tell you, it is nothing new, it was first done in 1921 and the guys now are trying to make it sound like it is something revolutionary. I think though, since it is a smaller procedure, not only is the degree of improvment less, but it wil therefore last less time too. Best of luck. JG 1.10.09

Question:

How much pain on a scale of 1 to 10 is the usual after face/neck forehead lift? When does itching normally begin and for how long? How long does it take before a patient seems to begin to deal with the after recovery? What is the usual recovery like?

Answer:

no way to tell becasue pain tolerance is individual, typically the forehead hurts more than the face and neck and both are easily controlled with pain pills. Most patients are back to full activity in 4-6 weeks. During that time there is some swelling and bruising but you look fairly presentable after two weeks. JG 1.8.09

Question:

Is it true that after a face/neck lift you are not supposed to turn your head/neck so that the stitches behind the ears don`t get pulled and greater scars for about four weeks?

Answer:

well, it is a good idea and most people will not do it anyway as they are stiff. JG 1.7.09

Question:

I went to PS today about ridge along jaw line from face lift. Hi DID inject cortisone all along it, said it was unusual for something like that to stick around unchange but assured me that it will go away. The eye that is still not quite closing he said to start massaging on top(even tho it feels swollen on bottom), and asked if i had been using cortisone cream around my mouth(co2 laser). I said yes but i have actually been inconsistent with it. Does it really help fade the pinkness? He also said that part of the mouth pulling feeling/look is the CO2 around the mouth. said nose swelling looked better, yada yada. Didnt really have much to say, just that swelling and distortion was normal at this stage(2 weeks from yesterday) and asked if i have tried make up. Answer, yes, helps but doesnt cover ridge. So i guess only positive thing will be if cortisone truely helps speed up the disapearance of the ridge. I have my sons 13th bday party this saturday, that as his mother, would like to attend. I will keep my fingers crossed. It is at our club and i told him i will not go if this ridge isnt gone. He doesnt care. Typical. (i am the one who emailed you my photobucket pictre site yesterday, freaking out). Thanks for your time. JR

Answer:

the eye not closing is usually due to the upper lid so that sounds rigth. As to the cortisone improving redness after a laser, sorry, will not help and might actually create new visible red blood vessels from thinning the skin and wil slow the healing. I think the ridge will likely get better, but localized shots of cortisone do not help localized swelling, I fear it is an attempt to just do something to pacify you. Best of luck. JG 1.6.09

Question:

Hi Dr. I just posted about the cortisone shots for swelling. Anoter patient of my PS s who had lower f/l recently had the cortisone shots in her swollen area at about the same stage of healing where i am now. and she said it helped with in a day. My main concern is a line along the jaw line that is raised, but i csn fel general squishy type swelling along both lower sides. Now granted i am only 2 weeks post op, but i am generally freaking out over this part of my surgery(the main part) Eyes are great, nose is great, Co2 around mouth is great, but the facial distortion at this point has me a basket case. I am 49 years old, have had many body surgeries, and decided to go for the face before the big 50. I cannot be seen by people i know yet because of the face, To ME it looks like i had a facelift, and i was youthful looking to begin with. I know it takes time yada yada but I am running out of excuses for not seeing anyone. I go to PS tomorrow, he hasnt seen me for week, was hoping the cortisone shots would help speed things up. I still have barely yellowish bruising, can cover that with make up, but the one ridge on the side of my face screams facelift over vacation . school starts back tomorrow and i am already working on rides for my kids various activities because i cant go into the school blding like this. I am planning on hiding out another week making a total of 3 weeks before going public. Sorry to vent but i am generally a super fast healer and expected to at least be presentable by now. most people would say i am but i feel i am not. does massage really help swelling? i would think it would aggravate it. Thanks for listening, any advice?

Answer:

I do feel massage helps, yes. You are probably more critical of yourself than others too. Wait and see your surgeon tomorrow and see what can be done. Best of luck. JG 1.5.09

Question:

What does a person look for in choosing a plastic surgeon beside board certified? What are good questions to ask?

Answer:

ask to speak to his patients, ask other doctors in the city to see about what they think, ask to see pictures, those are good ways to find out a little more. JG 1.4.09

Question:

Have you ever heard of removing the cheek pad during a facelift procedure? thanks doc

Answer:

sorry, but no, never. JG 1.2.09

Question:

Hello doc and happy new year.I am 10 days post op lower face/neck lift, rhino, upper/lower bleph, co2 around mouth.. only have one small dark bruise on a cheek bone, assuming from nose job, al other bruising, mostly mid face and neck, has always been pale greenish yellow, but never changing. I was religious with the arnica, but wondering if the cream would help this bruising go away.I just srarted it today but never been a believer in the topical arnica. also, is now a good time to start with a white vinegar/water solution on the co2 areas to help the pinkness fade? also, about how long for one eye to close completely after bleph? PS says i cant wear contacts till this resolves, he seems to think it will, eventually. anything to do to speed up. And how long after splint removed from nose can glasses be worn normally, without plastic clips to keep from resting on nose? PS told me but i forget. I had splint off Monday. I am just a mess! haha

Answer:

I think the cream is good to start and the vinegar slution is OK if it is OK with your doctor. The vinegar only helps remove the dead skin though, it will do nothing to fade the pinkness, that only comes with time. I am sorry but it is impossible for me to tell when your eyelid will close completely, it all depends on swelling and the amount of skin removed. Usually once the splint is off we allow the glasses to be worn. Best of luck. JG 1.2.09

Question:

Thank you for the answers regarding jowls and facelifts. Lower facelift is the term that I usually see for the traditional facelift and necklift but the b/a photos seem to only show that the tissue below the jawline is addressed. Best regards.

Answer:

well, typically that area is where the most dramatic changes are seen in most traditional facelifts. JG 12.31.08

Question:

From a plastic surgery perspective, are jowls only defined as cheek tissue that is hanging below the jawline? Does a lower facelift address loose jowls above the jawline? It is difficult to tell from before/after photos. Wishing you a blessed New Year. Thank you.

Answer:

well, I am not sure what you are calling a lower facelift, a jowl is made of cheek tissue that has fallen and hit a watershed ligament that casues a fold and allows the skin to fall onto the jawline. In some cases a cheeklift will fix that, in others it might take a necklift and cheeklift together, which is a traditional facelift.This is most commonly what is needs to be doen to leave a balanced and harmonious result. A traditional facelift does not include the forehead though. Hope that helps. Pictures can help decide, yes. All the best for the New Year to you also. JG 12.31.08

Question:

wondering if maybe you didnt see my face lift question? it wasnt answered and all the others above and below were. about the placement of stitches/staples and ridges on sides of cheeks? pls anwer if you can. thank you.

Answer:

did not sre the question but those ridges are normal and they will usually flatten out in about 4-6 weeks after the surgery. JG 12.29.08

Question:

Intraoral midface question: what would the recovery be like? Besides the fact of the postential for the sutures not holding it seems like a lower risk way to go because there is not cutting involved (skin removal)

Answer:

4, maybe 6 weeks of cheek swelling that is visible. I think the risks are actually higher though, cutting skin is low risk, in this case they are lifting all of the tissue off of the bones of your cheek and repositioning them, they will be right by the infra-orbital nerve which is never exposed during the regular procedure, also the lifting and re-securement of the tissues can lead to uneven smiling and lip closure in some patients on a temporary basis. JG 12.29.08

Question:

Regarding the intra-oral midfacelift. I believe the lift is anchored to the orbital bone with screws. can u comment on recoveryand effectivelness. Dr Nigro in Encinitas recommended it. thanks

Answer:

I stil think the failure potential is there because of the need to use sutures to attach it to the screws. JG 12.29.08

Question:

i had what was supposedly a lower face/neck lift 6 days ago, if it was truely just lower why then do my stitches/staples start all the way at tops of my ears, temple area, and go down the backs and inside my ears? i am not complaining ut seems extensive for lower lift. also, i have a thick visable ridge running down one side just above myjaw line and a shorter one and another longer one on other side, at a 4 day check up PS said they were the muscles he tightened and would go away as swelling diminished, i admit i havent been icing it much, paying more attention to other things i had done o face(eyes,nose, co2). does this sound right to you? i go for my one week tomorrow and will ask again. once i hv all my other stuff out/off i will be able to treat the face swelling more> thank you so much.

Answer:

not sure what you are describing as a lower facelift but if it is a face and neck lift, those incisions are typical, it just does not lift the forehead. Not uncommon for a ridge to be felt where the sutures were placed into the muscle, that goes away in time though. Best of luck. JG 12.31.08

Question:

Hi Dr. Garcia,I`m 51 years old with some sagging in my lower face and neck. I`m considering a MACS lift instead of a full facelift. Can you please give your opinion on the results from this type of lift or other mini-facelift options? Other pros & cons to consider? Thanks!

Answer:

they only thing is that in mild sagging the smaller procedures work well, and in severe sagging they do not, so if the patient is a candidate for the smaller procedure, it should be fine. Merry Christmas and Happy New Year. JG 12.27.08

Question:

Hi Doc, thanks for your reply below to my question regarding midface. I misspoke and said endoscopic midface but meant intra-oral midface, where the only incision is inside the mouth. Any opinions on that one? About how big of an incision? Longevity? Is that one where it can fall in a day if something breaks loose? thanks! Happy New Year too.

Answer:

not sure how they will support it unless a higher incision outside of the mouth is made. Merry Christmas and Happy New Year. JG 12.27.08

Question:

Hi Doc.....regarding an endoscopic midface done from inside the mouth. I had a consult for one a few years ago with a doc here in North County San Diego that said he pioneered/invented it and that it was the perfect solution for me. Anway, I`m now revisiting the idea and it`appealing b/c there is no skin cutting. How does the healing compare to say a lower facelift; will it address undereye hollows; how long will it last or I`ve heard you say before that a midface can just fall in one day b/c the sutures come undone. He said he anchors to the orbital rim I believe with screws (ooh, that sounds archaic and brutal but I think I remember him saying that). One more...how big does the incision need to be for something like that? thanks a lot for your time!

Answer:

I think the helaing is just as long as a facelift as the tissues need to be lifted off of the bone, there is a possibility that it might help the hollows but the chances are slim, I have been unimpressed with the longevity of midfaclifts too. I know some people use screws, but is is not the screws that fail, it is how you attach the tissues to the screws, that is with sutures, and they are what fails. The incisions are typically about 4 inches in your scalp hair. Best of luck, but remember I warned you. Merry Christmas and Happy New Year. JG 12.27.08

Question:

I am having a browlift and facelift as separate procedures. Which one do you suggest to have done first, and why? Thanks much. Merry Christmas, you have been a big help to me.

Answer:

I do not think it will make much of a difference if you are set on having both, might suggest the facelift though because you might find that it has given you enough and you might not want to proceed with the browlift. Merry Christmas and Happy New Year. JG 12.27.08

Question:

hey doc Garcia, with the eyebrow lift you said its the same as a forehead lift. So, when you ask to get your eyebrows lifted does the ps automatically assume to fix up the forehead too or do i have to tell him to do that area in addition with the eyebrow?? just want to know so if the forehead can get fixed up in the process i will like it to be done too!

Answer:

no, it is all done together. JG 12.18.08

Question:

Hi Dr. Garcia, I am thinking about having a browlift and a facelift at two different times, the browlift being first. Do you see in any way that this could compromise the asethic outcome and make it any less successful than if both were done together? Thanks

Answer:

no difference, together or alone. JG 12.16.08

Question:

Hi Dr. Garcia, I`m wondering whether a neck lift improves the look of the far edges of the jawline? Is there any procedure that lifts to the jawline or does that mean a full lower face lift? Thank you and happy holidays! Bonnie

Answer:

well, a neck lift only pulls back so in most cases there needs to be a vertical pull which means extension onto the cheek, and a cheek lift and a neck lift together is a facelift. JG 12.15.08

Question:

I recently removed a forehead lipoma (about the size of a marble), so far there has been almost zero scaring. However my concern is that at the area (the centre of my forehead) where lipoma was removed, the forehead skin seems permanently fixed. Normal facial expressions (such as laughing) that results in my forehead skin being stretched (left, right, up and/or down) all seem to be tugging on the area of the lipoma removal. It has been 2 weeks since the surgery. It is like the skin/tissue at the area of the removal is permanently glued or stapled to my forehead bone. The incision was approximately 2cm in length. Is this normal? What could be causing this? How do I fix this? Can you refer me to anywhere online where I might be able to find additional information?

Answer:

all normal, with time and masage it will all loosen up, but it can take weeks to release itself from the underlying tissues. It is adherent because the initial scar connects all the tissues from which the lipoma was removed, as the scar tisue matures it releases into seperate layers and all should return with time and patience. JG 12.14.08

Question:

Many thanks for your reply.Sorry to ask for more clarification,but i am a bit confused.You refer to the smas pilcation results as looking simalar to the more traditional facelift after one year,but in the next reply,you say the pilcation is a mini lift and wont be as dramtic as the traditional lift?sorry to ask again,for further clarification.I have minimal jowls and turkey neck,but if i am going to have the surgery,and scars,i don`t want a subtle change,as i want it to be long lasting?

Answer:

OK, lets try again. There are two ways to treat the SMAS, it can be lifted seperately and sutured, or it can be imbricated. Either technique can be done when doing a regular facelift or a mini facelift. When I said that an imbrication is similar to a traditional facelift, I was referring to the SMAS seperation versus an imbrication. A mini facelift with treatment of the SMAS will last longer than a mini facelift with no treatment of the SMAS, but a mini lift with SMAS treatment will not improve as much or last as long as a regular full facelift with a SMAS treatment. JG 12.14.08

Question:

Hello, I had a mid facelift w/lower eyelid surgery 9 weeks ago and though I do see a little improvement on the sides of my face, I am somewhat disappointed that I still have significant crows` feet. My surgeon gave me a little botox to smooth out some of the wrinkles. I have a lot of expression in my face when I speak, etc., so I`m thinking that the wrinkles are just a permanent part of my facial expression and I should just embrace them! Are there products or procedures that would help with the crows` feet? I have been using Renova and wondered if I should switch to a stronger Retin-A. I also use Skinceuticals C, E, & Ferulic acid serum. I`m very healthy, have a good diet, and exercise. (By the way, I am the one who wrote about the swelling of the submental lymph node..very mysterious.) Thank you for your time.

Answer:

Retin-a and laser might help, but I would never had expected a mid facelift and lower eyelid surgery to fix any crows feet issues. Not usre about the lymph nodes though. JG 12.14.08

Question:

From past questions I see you are not in favour of the Threadlift procedure. What would you recommend for lower face/jowel tightening? I have tried fillers but the results were not effective and I`m not ready for a full facelift. What is a mini-lift? Thanks

Answer:

minilift will help the cheeks but not the neck, so you might be able to get away with just a minilift if the neck is in good shape. JG 12.13.08

Question:

I had a mid-facelift two months ago and last week I developed some swelling of the submental lymph nodes -- center right under my chin and a little on the left heading back to the neck. Since I am not sick at all - had CBC and it was normal - I am thinking that this could be reactive nodes due to the surgery. My surgeon thinks this is unlikely. Do you think there could be some drainage or infection from the surgery? I had a hematomo on the left side of my face right after my surgery so I am thinking that the left side probably suffered some trauma. Thank you.

Answer:

I think it is unrelated to the surgery due to time. JG 12.13.08

Question:

The full name i think is platysma smas pilcation,is that of any help?i think it may be a mini lift with extra neck work?..a lift more extensive than the macs lift,in his opinion.Apparantely the psp surgeons modified the macs lift? is that of any help?

Answer:

well, a minilift will not give you the same result as a full facelift, your PSP at the time of a minilift will last longer than a skin only minilift though, but do not expect full facelift results with a minilift using the psp. Whether you are ready for a full facelift or just a minilift is the question I guess, no way for me to tell without seeing you in person I am afraid. JG 12.13.08

Question:

You asked what the psp lift my surgeon said he would perform..I think it is the extended smas pilcation,with neck tightening?...do you think this is as longlasting as other lifts?and would the results look simalar?

Answer:

well, I get the SMAS plication from the sp, but what does he mean by the first p? If no skin is being lifted or removed and the first p stands for percutaneous, I would recommend you find a different surgeon. Any treatment of the SMAS will last longer than a procedure with no treatment of the SMAS, but the skin removal is key and I am not sure what he has planmned. I will say that the term psp in not a common term used in our profession of plastic surgery so he might be trying to use it to make it sound like soemthing unique. The only psp I know of is made by Sony Play Station! JG 12.13.08

Question:

Is it true that jowls can reappear just a cuople years after a lower face/neck lift? i know a few women to whom this has happened. they r older than i and had more jowling to begin with. Pls say it aint so. i am getting mine done in a week, lots of money. i am not yet 50 with very little jowling and neck skin. Can i hope for a longer lasting result? And do PS s geerally pull tighter, kowing that it will relax a tad? I had a butt lift and this was the case. It has been about 6 months and it has softened and dropped into a more natural look.

Answer:

yes, the aging process is not halted and in people with poor tissue quality, since the jowl is the f