NOTICE: Ask Dr. Garcia is intended for educational and discussion purposes only. It does not constitute a formal medical evaluation nor consultation. No doctor-patient relationship has been formalized by this communication. If you desire such, please feel free to call and schedule an appointment. Otherwise, please be advised that all information that has been given here should be cleared with your primary care physician before changing or instituting any therapy. Explanation of off-label use of substances may be discussed here in but does not reflect an endorsement nor promotion of such off-label use.

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• Hi Dr. Garcia, what is your opinion of the PCA oxygenating trio? Worth the time?

  Answer: 

• Hi Dr. Garcia, I got a v-beam treatment a week ago for a relatively light pink/brownish spot under my eye. Though it was slightly swollen for a day there was no purple bruising, but for the last week it has been a much darker reddish/brown color to the point where it looks like I have a black eye. Is this likely to fade to its original color, or does this sound like a hemosiderin stain? Thanks

  Answer: 

• I often see light chemical peels recommended in a series. Is there any benefit (pigment, pores, skin texture) to continuing to have a monthly light chemical peel indefinitely? Is all that peeling eventually harmful to the skin?

  Answer:  Continuous skin peeling can over irritate the skin and cause blemishes or abnormal skin growths, it should not be done unless needed. JG 2.4.11

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

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

• Hello Sir, I have had 3 rhinoplasties over the past 30 years, and the last on 7 years ago. The tip had a hole in it, that took forever to heal. The Dr. blamed the last Dr, said it was bad work, the worst he`d ever seen. Now, I am searching for a solution to fill in the dent, and small dent in bottom between nostrils. I can`t find a Dr. who will even tell me what to do. Can you advise? Would fat from my own body fill it in. He says my skin is thin, but I feel after 7 years, it is not. Thank you for any help, as I feel at a loss. Lin

  Answer:  Possibly a local skin rotation flap could repair the issue. JG 2.4.11

• Hi Dr. Garcia, I`m 37 years old and am starting to see fine lines appearing on my forehead and around my eyes. More noticable wrinkles around my neck and decollete. I have very fair skin. What treatment would you recommend? I`ve been trying to do my own research and it`s been very confusing with all the different methods of treatment. Thank you for your time.

  Answer:  At this point sunblock not sunscreen, no cologne on your neck or upper chest, Retin-A to the areas, start at night only and progress to twice daily as tolerated. Possibly a little Botox to weaken the muscle of the forehead and around the eyes to slow but not stop the aging process and lessen the degree of muscle and therefore skin flexion. Avoid smoke if possible and maybe in the future some light fractional lasers might be worth it. All the best. JG 2.3.12

• Dr. Garcia, I have thin and toned upper arms but due to age the skin is becoming crepey and I am becoming self-conscience in sleeveless tops. My dermatologist recommended the Thermage Body procedure on the upper arm area. Do you think this will help somewhat. Thank You.

  Answer:  I personally think the degree of improvement is small and not very long lasting.Sorry. JG 2.3.12

• I see that you recently answered a question about cortisone on your website. I know it`s not a plastic surgery matter, but I too have a simple question about cortisone. I had my first injection of it last week to my knee for arthritis. The doctor told me it would take 48-72 hours to kick in. I`m at day 7 now, and I do notice about a 10% improvement in the pain. My question: is the full anti-inflammatory effect experienced at that first 72 hour point, decreasing thereafter (that is, is the amount of pain reduction I currently feel as good as it will get), or will the anti-inflammatory effect increase with time (that is, can I reasonably hope for further reduction in pain the weeks ahead)? Also, when cortisone wears off (at about 3-4 months?), do its benefits drop off gradually or precipitously? Many thanks for your time and expertise. God bless you.

  Answer:  well, it depend son what type of cortisone shot was given, some are longer lasting than others. Whatever effect it will have will reach a maximum, which you already have, and then from then on will continue to help for the time relative to the type of cortisone, and then wear off. In your case what you have is the best you can expect and will go down from there. Cortisone can help, but it will not help in all cases. The decrease is gradual and not precipitous. I wish you the best. JG 2.3.12

• Hi Doctor.I hope you and yours are well and many thanks for your site and your advice.What are your thoughts on the use of skinoren(azelaic acid) for the reduction of thread veins on the face? Can it help?

  Answer:  Likely will not help and could make them worse, sorry. Thank you for the kind words too. JG 2.2.12

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

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

• 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

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

  Answer:  Usually 3 months. JG 2.1.12

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

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

• Hi Dr. Garcia, I had two diluted kenalog injections into an acne cyst on my cheek last year. I now have a obvious 3 inch hypopigmented mark in the injection site area. Is there any treatment available to restore some of the melanin back in that area? Thanks,Al

  Answer:  Supposedly excimer lasers help but I have never personally seen it, sorry, but not much else I can offer besidea trying to go out in the sun. JG 2.1.11,

• Hello Dr. Garcia - here I am again, seeking your expert advice. I am planning a 25% TCA peel on my whole face which I will be doing myself. My questions are: how long for down time? what results should I expect? How close to the under eye area can I get? Can I apply to the upper lid? Can I apply to the upper lip line? Any other advice I did not address would be appreciated. I have had 2 Obagi peels but was not much impressed. I am 56 y/o, very thin skin. Thank you, it gives me much comfort to know you are just an email away instead of all the physical distance. I am sure you will be rewarded for all your kindness and generosity

  Answer:  well, first of all, I have to say that I do not condone doing it on yourself. Even on the occasions when i have had a chemical peel, I had someone do it for me. That being said, I would suspect the down time to be 4-7 days or so. I would not go too close to the eyelashes because if it gets in your eyes, there will be serious burns. It can be applied to the lip line, yes. I always degrease the skin with acetone, then wipe with alcohol and let it completely dry. I normally have my patients treat for 2-4 weeks with Retin-A 0.1% and 4% hydroquinone twice daily before,and once the skin is healed I start complete sunblock and restart the hydroquinone once tolerated to avoid post-inflammatory hyperpigmentation. Be careful! Thank you for the kind words too. JG 2.1.12

• Hi Dr. Garcia, Is it possible to get hyperpigmentation from v-beam in areas where there was no bruising?

  Answer:  potentially yes, but short lived if it happens and you use sunblock after the treatment. JG 2.1.12

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

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

• My ps used radiesse in my face and stored some to use later. Will it still be as potent next time it is injected? Thank you

  Answer:  Should have the same potency, yes. JG 1.31.12

• I know you`re not a cardiologist, but I wonder if you can offer a general medical opinion about a simple cardiac question. I have mild hypertension that has been successfully controlled with HCTZ for some years. Last year, I developed an orthopedic injurgy that has caused me to use NSAIDS (naproxen- Aleve, only in the recommended dosages). Predictably,as a result, I develped systems of mild heart failure which prompted me to stop the NSAIDS. Since doing that, I seem to have had some symptom relief from the CHF. What I can`t seem to get a clear answer about from my cardiologist is if the damage done to my heart by the NSAIDS is permanent or if it is generally reversable once the NSAIDs have been discontinued.Thanks very much for venturing a bit out of your field, Dr. Garcia, to proffer an opinion.

  Answer:  Although hypertension is more common with nsaids, the heart faure can be evaluated by getting an echocardiogram to check wall motiom and ejection fraction, should be reversible if it was short time of use. JG 1.31.12

• Is it OK to use Retin-A on lips to promote exfoliation? Thank you!

  Answer:  I have had patients use it, just don`t swallow it. JG 1.31.12

• 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

• Hello Dr. Garcia I have been up and down las vegas to look for a surgeon. It is for my daughter ruby hernandez, she was born with a hemangioma on her left cheeck and it is the size of a half dollar. I have gone to 2 plastic surgeons this year and none of them can do anything since it is to big for them, and also they say that there are too many veins around the hemangioma for them not to damage her facial nerves. I am covered by hpn hmo and I just want a sertified surgeon to take care of my daughter so she doesn`t have to be the child who gets thrown on the side because of what she has since she was born. So my question is... Can you treat her and take out her hermangioma or will it be difficult for you to do so?

  Answer:  I cannot say what I might be able to do without seeing here. I might suggest you see a dermatologist to see if they can shrink it with a laser such as a diode or VBeam in order to make the eventual cutting smaller. If the local plastic surgeons and dermatologists cannot or will not treat your child then it is within your rights as an HPN patient to get a referral out of the system, like to UCLA for example, to get the laser. When I was the plastic surgeon for HPN, that is how it worked I wish you both the best JG 1.31.12

• For how long do I need to use hydroquinone prior to a chemical peel or IPL in order to prevent PIH?

  Answer:  2-4 weeks. JG 1.31.12

• Prior to having tumescent lipo down on my thighs I did not have any cellulite on my legs. The lipo was done over 2 years ago. Anyhow, the front of my legs are bumpy and pitted and appear as though I have cellulite. Is there anyway to fix this? Thank you.

  Answer:  the fist thing I would try is fat injections if they are dents from uneven fat removal. JG 1.31.12

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

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

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

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

• Hi Dr Garcia. Had upper and lower eyelid surgery two weeks ago. I now have two pea sized lumps in the outside corner of one of my eyes. One on bottom and one on the top. I`m not sure if this is normal and what can I do for it. Would heat help it? Should I massage the area? That eye is also alot more swollen than the other eye. Feeling very stressed.

  Answer:  not uncommon, can be some swelling from the stitches placed beneath the skin, warm moist heat, light massage and time should help them go away. Not uncommon for one eye to be more swollen than the other at this point, should even out over the next 3-4 weeks though. Hang in there, it will get better with time. JG 1.31.12

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

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

• One last question about the liposuction under my eye. You say a small canula will be used. Will the suction be done only manually or will the canula need to be attached to a vacuum compressor? I ask because I fear too much may be removed if it`s done mechanically rather than manually. I don`t want to be left with a big depression where I know have a speedbump on my face! Thank you again and sorry for so many questions!

  Answer:  in most cases it is by hand pressure only. All the best. JG 1.30.12

• Good morning Dr Garcia. Does using hydrquinone twice per day (instead of only once) produce results that are twice as fast?

  Answer:  cannot say twice as fast, but it is more effective. JG 1.30.12

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

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

• Dr Garcia, is a temporal brow lift a lift that only lifts the outer corner of the eyes? I like the position of my brows, I just don`t like the corners starting to droop. I feel like a brow lift would give me a surprised look. I have tried Botox twice....once didn`t make hardly a difference (in fact I wondered if I`d been injected with water), and the other time I developed bags under my eyes and very, very slight lift. Would I benefit from a temporal brow lift, or any other suggestions.

  Answer:  A temporal brow lift will only lift the outer part and may be exactly what you are looking for. JG. 1.29.12

• Hallo Dr. Garcia ! I have developed rocasea and now I had my first IPL done. How long should I expect swelling.. I did it yesterday and I still have swelling. Many thanks;)

  Answer:  Depends on how strong a setting was used, can last 2-4 days in some patients. A liile ice will help. JG 1.29.12

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

  Answer:  Warm moist towels will help. JG 1.28.12

• Hi Dr. Garcia, I got a vbeam treatment earlier this week on the tip of my nose, and for the first few days after treatment, the pigment was the same color as beforehand. Then 4 days after the treatment, my nose became pink in the area where I got v-beam. Is this a common reaction to get delayed pinkness? And will the pinkness fade?

  Answer:  It is common, and yes, it will fade in time. All the best. JG 1.28.12

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

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

• 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

• I would apprecaite your thoughts on ultherapy. Is it a waste of time and money?

  Answer:  Painful to have done and results do not last as long as advertised. JG 1.28.11o

• Thank you for the quick answer to the question about micro-liposuction of the face. What gauge needle would typically be used for that procedure? I`m trying to estimate the amount of visible trauma the procedure willcreate--and so, the amount of time off I`ll need from work.Thank you again and have a great weekend!

  Answer:  they are actually called cannulas and they are about an 18 gauge needle size. They are blunt in order to minimize bleeding. Figure about 5-7 days of swelling and bruising in that area though. JG 1.27.12

• I had fat grafted to my face 5 years ago. I was left with a raised deposit of fat at the lid-cheek junction (at the bottom of the tear trough) about 4-5 mm long x 3 mm wide. It`s not a distinct or hard lump, just a bit too much fat. Though it`s small, it causes quite a deformity; in fact, it has created the appearance of a deep bag beneath that eye, since the bottom of the lid is raised above the upper part of the lid. I don`t want the fat injected with a steroid because I`m afraid it will migrate and I`ll end up with tissue atrophyin the mid-face. So my PS is recommending micro liposuction. I`ve never heard of that being done to the face. Is it safe? Is it effective? Is it likely to cause more of a problem than it resolves? He can`t remove it transconjunctivally because it`s too low on the lid. Thank you for your opinion. Wow -- you seem to help out a LOT of people!

  Answer:  I think small needle liposuction is what I would suggest. Risks are small and is the best option for overgrafting in that area. All the best and thank you for the kind words. JG 1.27.12

• Hi Dr. Garcia, I`m 54 years old and need a neck lift. Can you please explain where the incisions are for a neck lift and healing time? Thank you!

  Answer:  healing time before you are out in public is about 10 days. The scars will be both in front and in back of the ear, and maybe a small one under the chin, the length of the scars around the ear depend on how much skin needs to be removed, the greater skin excess, the longer the scars will be. Best of luck. JG 1.27.12

• Good day! If you already have breast implants is there a way to tell if you can go bigger by looking at them for yourself? Is there a way you can tell the ons you have now are the limit by looking at your own anatomy? Any clues?

  Answer:  it really would take a surgeon to do the measurements I am afraid, sorry. JG 1.27.12

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

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

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

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

• I`ve read on this website of many people who have fat atrophy after steroid injections. I had to have cortisone injected directly into my shoulder capsule this week (under fluoroscopy, so we could confirm that it was placed in the capsule only). Because of that, am I protected from the possibility of tissue atrophy around the capsule? If not and I end up with a deformity, is the tissue likely to regenerate with time? Thank you. Enjoy your weekend!

  Answer:  the chances of steroid atrophy in your case is almost none as long as it is in the capsule only. Best of luck. JG 1.27.12

• Dear Dr. G. What are your thought on using Sculptra for the hands? And what would you suggest for tightening the skin of the fingers? Thank you.

  Answer:  some physicians are doing it but i have seen granulomas form in the hands, and I do not use it there. I am afraid I have nothing safe and reliable for the skin of the fingers either. Sorry. JG 1.27.12

• hi doctor, i am 45 and i wanted to use hyaluron fillers from eucerin. is it a good product. please advise, thanks.

  Answer:  not much better than all the other moisturizers out there, they are trying to capitalize on the popularity of hyaluronic acid fillers, while they are not a filler and the ability of topical hyaluron to push fluid into the cell is minimal to none. JG 1.27.12

• Hey Doc, I had Fractional Erbium Laser at the end of August last year. I still have this tingling in my face that comes at random times. Around the temples (mostly left side) and sometimes forehead. Usually more towards the end of the day. Or sometimes when I drink beer or work out or get hot...but definitely not always. My dermatologist explained that this was collagen production, but I have my doubts. Since it`s been this long, should I have any reason to worry. Is this possible nerve damage. I`d appreciate any help you can provide. Thank you.

  Answer:  more likely is nerve covering irritation from the deeper pixels, should get better with time, not a very common problem, but I would not worry, might take a year to totally go away. JG 1.26.12

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

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

• Good day Doctor! I was wondering if one was going to replace there implant size for a different size and the pockets are already made, is there Less bleeding occurring during a swamp in size then the original surgery?

  Answer:  Yes, unless you are going much bigger as the pocket needs to be made larger, but still likely less than the first time. JG 1.26.12

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