Las Vegas Restylane - Ask Dr. Garcia Library - Page 1

NOTICE: Las Vegas Restylane: 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. All responses regarding Las Vegas Restylane are done personally by Julio Garcia.

• can boletero be used for fine lines where cheek meets under eyesor is restalyne better? thanks

  Answer:  I would not use Belotero there and would use Restylane, they are not interchangeable as they do totally different things. JG 5.6.13

• How long do fat injections last in under eye hollows? Is it permanent? Also, if one is skinny and seems to have no fat can you still do the procedure? Or where do you take the fat from?

  Answer:  how long they last is variable and how well they work is variable, I for those reasons, I do not use fat injections around the eyes.I use Restylane for that area myself. JG 3.15.13

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

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

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

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

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

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

• Doctor Garcia: Three weeks ago I had some restylane injected into my nose, but now have broken blood vessels near the injection site. A week ago I visited a dermatologist to have the area lasered, but the redness and vessles are still there. What can I do to get rid of these? I know they occurred when the doctor punctured my skin with the needle.

  Answer:  Lasering those vessels usually take a series of treatments, not just one. JG 2.2.13

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

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

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

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

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

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

• dr garcia, 2 years after the injection of 12 cc in total of different fillers my face is still large, especially on the underside of the face, it is much wider and looks still very odd compared to by tiny frame. most if it was restylane subq. Especially at the back of my jawline it seems not to leave, my eyes are looking so tiny with this big face, completely disappearing in my face. Need a lot of make up to look a bit normal to bring out my eyes. i did recently a touch up with a tiny bit of filler in the nasolabial folds and under the mouth corner to lift the drooping mouth, now it looks like 2 tick bulges comming out of my face above and near my mouth, how long will this stay, the bulges seem to grow instead of dissapearing, it was one month ago. with the filler in the nasolabial my face looks even more wider and shapeless. I look older then before with the bulging. Thanks for advice.

  Answer:  very unusual for fillers to last that long and it might take more than 3-6 months for the recent filler to dissolve, unless you have some hyaluronidase injected to dissolve it. JG 11/4/12

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

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

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

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

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

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

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

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

• Dr. Garcia, Have you seen fat injected into the orbital rim cause lumps in any cases? Do you inject fat there, or because of potential lumps, prefer Restylane? Answers much appreciated.

  Answer:  I have seen that frequently actually.I never inject fat into the orbital rim for that reason, for the reason that if the fat survives the fat will grow if you gain weight, for that fact that removing it can be difficult and because it causes more swelling and bruising with longer recovery than Restylane. All the best. JG 9.7.12

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

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

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

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

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

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

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

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

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

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

• Dr.Garcia I am glad you agreed with me on the filler versus the 40% TCA peel for lipstick lines. The PS I consulted with did not do fillers at all so of course that is why he suggested the TCA. now which filler do you typically use for that area? Thanks for your thoughts.

  Answer:  for the lines I like Restylane, for the lip itself, Juvederm. All the best. JG 8.10.12

• Dr G: You say you use fillers frequently under the eye area for hollowness. Can a filler also fill in the under eye wrinkles as well? I want to go with a filler but am alittle leary, being the area is under the eye. Also, what filler is the safest?

  Answer:  no, it is meant to be used just at the rim, it should not get close to the eyelashes as it will lump up. It will not correct the fine lines. My preference is Restylane for that. JG 8.6.12

• My previous post may have been misleading concerning a lower lid skin pinch. I do have excess skin and I did not mean to imply that I was having a fat transfer, I left out the fact that the next appoinment is for more Sculptra. Also - I think it is natural for most of us to want to improve our looks but there are those that think we are vain and only idiots would be willing to take such chances

  Answer:  Well, that being the case, taking a little skin out of the lower lids might help the wrinkles some, for the fat pocket, you could also try some fillers like Restylane to hide it rather than having it cut out or repositioned, I would not use fat injections for that. I think the filler to hide the fat pocket can be done at the same time as the Sculptra, something I do frequently. As to adding the surgery to the Sculptra injections, in my practice I do Sculptra in the office and the eyelid surgery in the operatiing room at a suricenter so it would be at different times. as to vanity, thank God for that, otherwise my business would be much less! JG 7.30.12

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

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

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

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