Ask Dr. Garcia - The Archives

• Dear Dr. Garcia, I see the dysoport is now available. Is it ok to layer this over existing botox? It is basically the same correct? Do you think it is more powerful? I had some at rest 11`s and would like to see if this would work better? I don`t see them completely gone or do you think a filler as in resty would be work best? Thanks

  Answer:  I think it is likley safe to do so. I think Dysport starts working faster and likely lasts longer. No agent like Dysport or Botox will correct lines seen at rest though, migth need a filler in addition to them. JG 7.3.09

• during endoskopic midface lift would a plastic surgeon be able to diffrentiate between juvederm lump, a pocket, or a fastoon in under eye area. would he be able to fix it?

  Answer:  no, becasue all of the tissues are above the access plane and none of that would be able to be seen. No way to correct a festoon endoscopically. JG 7.1.09

• is it safe for my own tissues to administer hialorunidase to juvederm lumps and bumps under eyes almost 2 years old? if yes, what concentration? my doc has no clue. thank you

  Answer:  I do not think it will help the lumps if they have been there that long, they will likely need to be cut out. JG 7.1.09

• Hi Dr. Garcia: i love your site and have found you generous and helpful time and again. My question is regarding sculptra. I was interested in using it to plump up my cheeks - however I have read some very scary things about granulomas and such developing even years after injections - what are your thoughts regarding its relative safety, longevity etc?

  Answer:  I think the newer ways we are injecting Sculptra over the past 2 years has essentially removed the risks that were more common in the distant past. I use it frequently with no problems. In most cases the improvements last 1-2 years. Thank you also for the kind words. JG 7.1.09

• DR G::: 1. which filler is best for under cheek bones, the hollows? 2. which is best for under eyes? 3. which is best for temple area? thanks so much for your time.

  Answer:  for the orbital rim I prefer Restylane, for over the cheek bone or temple I prefer Sculptra. JG 6.30.09

• I`ve seen pics of botox jaw reduction that look similar to what buccal fat removal looks like. I know the two are completely different, but can they yield a simlar looking result?

  Answer:  from my view, no, they cannot because they affect different parts and locations of the face. JG 6.30.09

• is eye rim resurfacing a wright procedure to fix lumps and bumps under eyes after injecting and dissolving a juvederm 2 years ago?

  Answer:  there is no effect on lumps from fillers with skin resurfacing, especially ones present for that long. JG 6.29.09

• doc Garcia. what happens if you administer hialorunidase under eye, and there is no juvederm there left to be dissolved? thank you

  Answer:  it will dissolve a small piece of your own hyaluronic acid and usually it reforms it within a few days. JG 6.29.09

• dear doc. is it possible for juvederm to last almost 2 years under eye area, where there is almost no circulation, and juvederm has formed a lump?

  Answer:  I do not inject Juvederm there but I have had Restylane stay in place for longer than a year in a small percentage of patients. Now when a lump forms, it is very common for it to last long periods of time because the surface is smaller and usually encased in scar tissue making the dissolution of it by your own body`s enzymes slower and more difficult for it to work. JG 6.29.09

• after injecting hialorunidase to dissolve juvederm under my eye i got a deep regular line from the inner side of my eye arching toward the midline. the skin was pulled in very deep. what was it? hu put a juvederm inthere and created a lump.

  Answer:  likely just the skin where the Juvederm was injected that has to slowly shrink back to its normal appearance. JG 6.29.09

• Dear Dr. I had botox for the first time 2 weeks ago. I had it for crows feet and 11`s. The one side bruised on the eye. It is still visable. I return for a check up tomorrow. I am not toally happy with the results. It has softened the line but that is about it---is it possible it was to diluted? Is a bruise in the area of crows feet typical? do you see this often? thanks.

  Answer:  bruises are common and as to it being diluted it might have been but also, Botox does not always remove all the wrinkles, especiallly if there are wrinkles at rest. JG 7.1.09

• same person here that had the lower face done with erbrium laser in aprril how long do i wait before i can undergo the same treatment again?

  Answer:  I suggest 12 months. JG 7.1.09

• hi had erbrium laser to lower face ablative, and the highest most deepest amount that the doc could do... i had it done in April, how long does it take to see the collagen build back?

  Answer:  it will take about 6 months. JG 7.1.09

• Hi Dr, A doctor advised me only to inject hylauronic acid such as Judederm or Restylane over a polyacrylamide filler, however he said not to inject Perlane as this is different. I thought Perlane was hylauronic acid also ... what is the difference? Thank you

  Answer:  it is essentially the same but it is meant for deeper injections so when going more superficial, it should not be used. JG 6.28.09

• Hi Dr Garcia i had a lump on my cheekbone caused by a Radiesse filler. A year and a half ago i had the lump surgically removed which resulted in the cheekbone losing some of its tissue making the cheekbone look flatter and lose some of its definition. I want to regain the plumpness and augmentation of the cheekbone. What do you reccomend that i have to give my cheekbone its definition back a fat transfer or a filler? I understand that with a fat transfer about 60% of the fat goes.

  Answer:  I suggest using Sculptra at this point in time, all the best. JG 6.25.09

• Avon came out with this HIGH GRADE HYDROLIC ACID derma 3 X cream. What are your views on these products? Do they work?

  Answer:  hyaluronic acid cannot be absorbed through the skin so it is not better than what they had before, except they are hoping you do not know that the material cannot be absorbed. JG 6.25.09

• I heard on CNN that getting Botox/Fillers at a younger age late 20`s/Early 30th can help with future wrinkles in your 40-50`s? Is there any truth to that?

  Answer:  as to fillers, no, as it will not stop any naturally occuring process but using products like Botox or the newer, and I feel better, Dysport, that weaken the muscles so the skin cannot fold as much can. The reason thay can is because some of the wrinkles that form occur from the repeat folding of the skin and resultant skin damage, so if the skin does not fold as much, the development of the wrinkles will be less. Of course, if you just voluntarilly move the muscles less, that will also work, especially when trying to avoid squinting. JG 6.25.09

• Dear Dr. Garcia, Is there a filler that will help marionette lines? If so how long will it last. Do you have a favorite filler for nasolabial folds? Thank you, Annette

  Answer:  All commercially available fillers can be used there, I usually use Restylane or Perlane. JG 6.23.09

• Thanks for your recent answer about using fillers in knee wrinkles. Hypothetically speaking, if money and time were not an issue -- would you then consider using fillers for that same problem?

  Answer:  Perlane or Sculptra. JG 6.23.09

• Do you ever use fillers to fill thin, but fine wrinkles that can appear on the tops of the knees? I don`t have loose knee skin, or large wrinkles (I`m only 28) but I do have an extensive network of thin creases on the tops of my knees (especially the bulge of muscle and fat just above the kneecap on the inner portion of the knee) that makes the skin look rough when they are bent. Thanks for any input!

  Answer:  I have not as the effectiveness and length of improvement make it not a good option. JG 6.23.09

• dr Garcia. after injecting hialorunidase to dissolve juvederm under my eye my skin got pulled in and created a deep crease between eyelid and the cheek. my doc injected juvederm inthere again, and this time i got a lump in that space, that increases the size of my eye bag. it`s been 2 years and no improvement. i am tempted to try hialorunidase again to try to avoid surgery, but i am scared after those experiences. what happens if i use hialorunidase and juvedem is not there? what was that crease that i got after previous injection?

  Answer:  I think that after two years the hyaluronidase will not help, that is for the soon after time. You might have what is called a granuloma there and at the point might need to be cut out, sorry. JG 6.23.09

• Hi doc, many thanks for your wonderful site: Had botox 2x`s for 11`s and lateral lines: 1st was dermo & results were flawless xcept for 2 small bumps that disappeaed in 48hrs,couldn`t furrow brow at all, after 3mo I could feel my forehead `pucker` and `scrunch` as the botox wore off. 2nd time was diffrent place and med spa nurse, not as smooth, could furrow brow slightly but lasted about 5mos and no waring off feeling. Why the difference and who do you recommend for 3rd time? Lastly can botox be used to relax vertical lines on my chest & between the breasts from a nite`s sleep? If no then what do you suggest?

  Answer:  the difference can be due to placement and also the amount of Botox injected. I think the effects on the chest would not be worthwhile, sorry. Might suggest light chemical peels or IPL for that area. JG 6.23.09

• Hi Dr.Garcia, I am still puzzled about restylane, specifically if it is injected in one area of the face, can it move to another area? I had had restylane in my back jawline and then had botox to lift my jawline about a month later. The injection of botox was in the exact location of where I`d had the retylane injection, at the very back edge of the jaw. This may sound unbelievable, but truly, the very next day, my chin looked very much bigger. I have always had a small (not receding)chin. I actually could feel the the restylane material in my chin. The chin has gone down with hylauondaise. Have you ever heard of this kind of thing happening?

  Answer:  the amount of motion or movement is minimal, a millimeter would be alot, although it can flatten some. As to the effect you got, understand that it takes Botox on average 7-10 days to work so the change you saw was not the Botox, might have been the filler, but that you would have seen sooner after the injection. I see no way that the filler or Botox injected at the back of your jaw would have an effect on your chin, sorry. JG 6.21.09

• I am in my early 30`s. I seem to have developed a nasal fold in the last couple years on one side of my face only. Is there any possible reasons for this? Also, every time I have tried Restylane it has failed to make a visible difference. Artefill is still being used in the country I live in. Would it be pointless to try a permanent filler if the temporary one is not working?

  Answer:  could be from you sleeping with that side down. I think the Restylane not working is likely injector effect, and using a dfferent filler by the smae injector will likely lead to a repeat disappointment. Sorry, best of luck. JG 6.21.09

• what is the difference between juviderm and restalyn. i am going to have it injected in area above cheekbone and he plans to use juviderm. thanks

  Answer:  it is s doctor preferrence, I prefer Restylane for my injections. JG 6.21.09

• i do not understand when you say that restalyn, juviderm, etc attract water. Does this mean the water is gone in a few days and it is only temporary for a day or so. How does the attraction of water affect the eye of the injector as he tries to make things smooth? Where does the water come from?? thanks

  Answer:  more so the Restylane than the Juvederm, but they are gels and attract fluid that stays in the product, the swelling that occurs is not solely due to the the gel hydrating but from the inflamation from the injections themselves. The injector needs to be experienced to compensate for the fluid afterwards. The fluid comes from the surrounding tissues and the body replaces it. JG 6.21.09

• Dr. Garcia, I had restylane above the lip and on the vermillion border over three weeks ago. I am still feeling some bumps underneath the skin which he said would dissolve. The area above my right lip which has the filling in it has a darker color than the rest of my lip. It is not blue--almost like a bruise but very even in color. It is not real noticeable but there. Could this be permanent discoloration? Also should you still be able to feel the slight bumps under the skin at this point? Thank you so much.

  Answer:  the even discoloration is more likely just from the filler and as it dissolves it will get better. In most cases the lumps should be gone by now. JG 7.1.09

• i want to have filler put beteen top of chhk and under eye area tapering up to the trough on one eye and tapering down on the cheek. i have heard that radiesse can sometimes cause lumps so even the chance of this makes me quite hesitant to use it. Juviderm or restalyne--would you recommend trying that. I like the idea that if I am unhappy Wydase can remove it. Your opinion please?? Thanks so much. I assume the product would have to be injected pretty deep--is it to periosteum? THANKS!!!!!

  Answer:  I typically use Restylane for that area. The depth of injection varies form patient to patient depending on their needs.JG 6.10.09

• dear dr Garcia. i have a fluid filled sac under my eye bag after using juvederm and vitrase 2 years ago. you said there is no way to say for sure that this is a fastoon. what would you recommend? it looks to me that there is still some juvederm left which attracts water. thank you for your advise, i am so devastated i can not concentrate on anything else.

  Answer:  the ability for Juvederm to attract fluid is only a matter of days so I do not think that is the issue, maybe send me some pictures of your face and I can tell you a little more, send them to drgarcia@lvcosmeticsurgery.com JG 6.10.09

• Dear Dr. Garcia, Two months ago, I had an injection of hyaluronic acid (Juvederm) to my lower face with no complications. Two days ago, I had a long dental procedure that required a fair amount of novacaine. While I expected some localized edema following the procedure, I was not prepared for the extraordinary and persistent swelling I am experiencing. I feel and look like I am suffering from lock-jaw; I cannot move my lower jaw. Do you know of any reports of adverse reactions between local anesthetics and Juvederm like this? Do you think that the edema may be especially pronounced due to the molecular properties of hyaluronic acid, particularly its capacity to retain fluid? When do you think it might subside; that is, should I be concerned about long-term damage? What remedies might you suggest other than warm moist compresses? Thank you very much for your generous assistance, Dr. Garcia!

  Answer:  I do not think it is due to the Juvederm after this amount of time, it is likely due to what was done now, either the injection itself or the procedure that was done after the injection. The ability for Juvederm to absorb fluid is long passed. At this point I would suggest massage and alternating hot and cold packs. Best of luck. JG 6.8.09

• Dear Dr.Garcia, after HA filler in upper lip I got a small lump in the side. Will it disolve by itself? How long to wait before use hyaluronidase? And what will be with a lump if not to do anything? Thank you for your advice.

  Answer:  in most cases with massage and time it does dissolve. I think if it bothers you after a couple of weeks then hyaluronidase can be used. I think the lump will go down in most cases on its own. JG 6.7.09

• why would yu leave it alone the vertical crease from under nose to upper lip? do yu ever filll it? would it help to have juvederm in my upper lip then instead to help the crease not be seen ?

  Answer:  I think from what you have described, in your case I would not fill it, I have on some occasions on other patietns. JG 6.7.09

• hi 38 here, and perfect face no lines at all due to many many injections over the years with juvederm, laser etc. Today , I am noticing the philtral columns being quite pronounced.. as a PS , would you recomend injections to this vertical crease (from middle of nose to middle of upper lip) or leave alone, if whole face is perfectly flawless...? today i am noticing the

  Answer:  I would leave it alone. JG 6.7.09

• dear dr Garcia. i have seen plastic surgeon, but he did not see me before festoon, so he might think that is how i look. is there a way to tell for sure?

  Answer:  no, sorry. JG 6.5.09

• dear dr. thank you for previous answer. how do i make sure that swelling under eye bag that i have is a festoon. it is bigger in the morning, and smaller later. i thought that was juvederm left attracting water in the loose skin remained after dissolving juvederm 2 years ago. is there any way to distingwish?

  Answer:  a doctor that sees you in person should be able to tell. JG 6.5.09

• dear dr. reading your anwers to me and archives i think i have a festoon and musles athrophy - both - after juvederm and vitrase under my eyes. my face is a mess 2 years already. i am considering a face lift to even things out - what will happen with a festoon if they pull that skin out? will the water acumulation still continue? will it change its shape? i am thinking about a lift wnen they pull skin only, not musles. thank you for your advices.

  Answer:  a facelift can,if special attention is given to the muscles in that area, be improved.If the muslces are not tended to, then the festoon will remin. A skin only facelift will leave you with likely a more obvious festoon as the surrounding area will be smoother but not the festoon. JG 6.5.09

• Have you heard of the filler evolence? How is it different from other fillers or is it? does it do the same? Have you used it yet and what is your opinion? Thanks.

  Answer:  yes I have, it is different only in that it is a new form of collagen, no difference in its filling efects or longevity, we do not use it as the difference is none compared to what we already use. JG 6.4.09

• Dear Dr. Garcia, I just turned 60 and for the first time I have noticed the skin in the upper eyelid is beginning to droop--if I hold me eys wide open they are fine. Would botox in the brows correct this temporarily? I had a lower bleph years ago--just wondering. Thanks.

  Answer:  sorry, but Botox will not help that. Sounds like an upper eyelid surgery thing. JG 6.4.09

• Thank you for your answer to my question as to continued swelling under eyes after two vitrase injections to dissolve restylane - last vitrase was about 2 months ago. You indicated that you didn`t think it would be possible to have permanent swelling, which I was very glad to hear, but you did indicate it could be from something else. -- My question I guess is can the needles that go into your skin under your eyes, both restylane and vitrase needles, could they possibly have penetrated a vein or capillary that is causing my continued swelling, and if that MAY be the cause, will it eventually over time heal itself and I will become normal looking again?? I have been so distraught over this. Thank you so much for taking the time to listen and answer my questions. I appreciate it very much.

  Answer:  well, you might have something called a festoon that is a seperation between the muscles of the cheek and eyelid and it looks like a sac of fluid, it is not truly swelling and the correction is not easy, in severe cases it needs to be cut out directly and that leaves a curved scar in its place. If a needle had penetrated a vein and caused bleeding, by now the bruising and blood should have gone, so that is not a likely case. All the best. JG 6.4.09

• Hi Dr. Garcia; I am seriously considering an appointment with you to remove a bump caused by the filler evolence under my right eye. My husband said I should leave it alone. I notice it every day when I look in the mirror. Question: how is it removed from you? What is involved? How is the healing? Have you removed many bumps caused by fillers? Is it costly? What are the side effects? Many questions... Thank you, again.

  Answer:  it involves making a cut over the lump and that will leave a tiny permanent scar. Stitiches are removed in one weeek and it is done under local anesthesia. I have removed probabaly 25-30 lumps from fillers. It costs $500. The side effects are the permanent scar. Hope that helps. JG 6.4.09

• I have been doing alot of research on fat grafting for the face instead of doing a facelift and find it very interesting. The Dr. I watched talk about it explained why people don`t look the same after a facelift, verses the fat grafting. He said that when you raise the eyebrow area and pull the skin to tighten it, that the person takes on a new look that maybe doesn`t resemble what they looked like at all. He said when you do fat grafting it makes the face look more youthful like in younger years without altering the way the face looked and makes the person look refreshed and younger, more like they looked when they were indeed younger. He said without the fat grafting that alot of people that have facelifts look hollow looking and the face looks thinner. I am really thinking about having this procedure. What do you think about this procedure and do you offer this?

  Answer:  I think his comments are accurate, but not for all, there is no 100% correct solution for everybody as people all age differently. If you are pulled too tight with a facelift and there is not enough tissue to lift, you can look unnatural. If you have fat injections when all you have is loose skin and no tissue loss you will look sagging and full. So each has its advantages and detractors. What a person needs has to be individualized, and some people benefit from having both. Sorry but I likley did not give you the answer you were looking for. JG 6.3.09

• Can you have permanent swelling under eyes due to damage caused by restylane injections and then Vitrase twice to remove the restylane due to overfilling?? Or will any swelling eventually go away on its own. I am worried that it is permanent. My last Vitrase injection was two months ago and swelling is still visible. Is it possible that you can have permanent swelling?

  Answer:  I do not see how that would be possible. Vitrase injections will not cause that and the Vitrase is absorbed and gone in a few hours. Must be some other cause. JG 6.3.09

• Dear Dr. Garcia, Is there any way to treatment marionette lines with fillers? If not, what treatment can be done? Thank you. Pat

  Answer:  yes, they can be improved with fillers, our choice is Restylane or Perlane. JG 6.3.09

• Dear Dr. Garcia, Will botox help the look of turkey gobbler neck or platysma muscles? Also, which of the facial fillers is less likely to cause bruising in the nasolabial folds? I have read that juvederm, perlane, or evolence might be better for this. Thanks so much, Tricia

  Answer:  no, if anything it will make it worse as it loosens muscles, and you`rs are already loose. All facial fillers have about the same risk of bruising because it is not the filler, it is the needle and they all need the needle. JG 6.1.09

• I got juvaderm injected in the nasal labial fold area about two weeks ago and it appears to look overfilled around the nose area. My lines go up pretty far to the nose area and when he injected the juvaderm, it looks like he got more there then in the lines leading down to my mouth. It makes my eyes look sunk in or hollow. I have had several people ask me if my face is swollen. Is there anything I can do about this. If I massage and push down on it, will it move down to where the lines are in the labial fold area? Will massage do any good at all. I have been thinking about getting restlyne injected into the tear trough area. Would that make it more even looking? Please help.

  Answer:  I do not think massage will push the filler down at this point as it has set into place, it might be sweling although that is usually gone after 10 days or so. I think filling in the area above it will be more reliable than trying to dissolve the Juvederm. JG 6.1.09

• I dont have wrinkles or dry skin. My mother and father have no real wrinkles or much saqgging. We have great skin. Iam 32. I do have a crease (1) inbetween my brows and (2) folds that fade from my nose to my top lip. Are these wrinkles or folds? Whats the difference and causes these. Whats the best filler do you think?

  Answer:  the ones between the brows we call wrinkles and the ones between the nose and mouth are folds. My usual filler for those areas is Restylane. JG 5.31.09

• dear dr Garcia. my face is deformed after juvederm under eyes injected and dissolved 2 yars ago. i think i might have some of it left, why would other wise my face look asymetrical? should i try hialorunidase again before deciding for a surgery?

  Answer:  hard for me to say why there is asymmetry this far out, I think the filler by now has likely dissolved. I do not think more hyaluronidase will help. The asymmetry might be due to scar tissue or atrophy of the normal tissues from small hematomas resolving. JG 5.31.09

• I got juvederm injected into my lips exactly one week ago. she gave me a dental block as she always does and for some reason the upper and lower on my right side she was having a problem numbng. I think she injected numbing solution many times. Anyways, afterward I had this terrible pain in my jaw and a migraine for the rest of the day/night. The next day was also painful but not as bad. Now, a week later no pain but a strange feeling in my chin and spots that feel somewhat numb. What is this and will it go away? Thanks for any advice.

  Answer:  most likely some irritation of the nerve and should all go away in time. JG 5.27.09

• Assuming that surgery is out of the question right now, what can one do to significantly reduce the look of eye bags....they are not severe, but do notice they are making me look tired. Any non-surgical options?

  Answer:  fillers can be used on some patients to make the bags look less visible by filling in the area right below the bag. JG 5.27.09

• Why is it not a good idea to use the fat from your own body to inject in the tear trough area? It wouldn`t have any possibility of clumping or creating a nodule like the man made stuff would it? Would it be better then fillers for the cheecks for volume and the nasal labial fold area?

  Answer:  lumps and nodules are highest risk wise with fat compared to other off the shelf fillers and if there is a problem the fat is hard to correct. It is safer for nasolabial folds and cheeks but still not predictable. JG 5.27.09

• hey dr garcia! I am 23 I had my buccal fat pads removed when I was 19.. I dont see any hollowing of my cheeks infact I like the smaller face/V shape... but I have been reading now that removing buccal fat can be a negative thing for later on.. My mom is 50 and I dont see her cheeks hollowing out..should I be worried? and later on if my cheeks do get the sunken look or gaunt look what are my options? I was reading some scary stories about sculptra and dont want to try that...do you think fat transfer to the lower cheeks will be a good option then? I know its early for me to be thinking but I am just a little scared for getting the gaunt look and want to know if thats fixable if I do get it. Thank you!

  Answer:  I do not thin you need to do anything now but removal of facial fat will in time speed the visble changes seen with aging. JG 5.26.09

• Hi Dr, Is it ok to inject hylauronic acid over poyacrylamide fillers? Thanks

  Answer:  should be OK. JG 5.25.09

• I had perlane on sides of my chin and restylane on border of my lips three days ago. I feel several lumps on the side of the cheek and there is a large lump on the bottom of my lip. He told me not to massage any bumps and come back in two weeks if there was a problem. But isn`t that too long to wait? It seems everything I find on internet says to massage them after applying warm compresses. I intend to call on Tuesday, but want to know if I should go ahead and do something with them. Thank you.

  Answer:  I always have patiens massage for the 3-5 days after the injection to help smooth things out.JG 5.24.09

• Whenever you get a filler what causes it to leave a nodule sometimes? What causes this nodule and what is the nodule made of? What do you do if you have a nodule left after the filler injections????

  Answer:  if too much is injected in one area the body can at times cause scar tissue to form around the filler and create the lump. In most cases the lump will go away but in rare cases they need to be cut out. JG 5.23.09

• I want to get some filler to treat the tear trough area but am afraid of getting a filler that can leave a nodule or hard spot that will have to be surgically removed later. I have read that sometimes they shift after having them sometimes and leave nodules after the boday ages. Can you tell me some of the fillers, if there are any that will not leave any nodules. Is there any that do not have any history of doing that at all? Is juvaderm safe for that, or is it possible that it also could leave a nodule. I also don`t understand when they say that the body will eventually absorb it, why then does it sometimes leave a nodule. What is this nodule? I want something that has no risk of leaving any kind of nodule or lump under the skin.If the body doesn`t ever absorb some of these fillers then where do they go eventually. Like radiesse?

  Answer:  any filler can leave a nodule. I normally use Restylane for the tear trough area. If a nodule forms there is some scar tissue also and that is why it does not resorb totally. What you desire does not exist though. JG 5.22.09

• Is your own body`s fat that is used after lyposuction good for filling out the nasal labial fold area??

  Answer:  it can be used, yes how long it lasts is unpredictable. JG 5.22.09

• Dr. Garcia, Yesterday I had restylane for my upper lip lines. But he did something I still don`t understand. He said that because my upper lip had lost fat and that my cupid`s bow was flat, he would have to fill in the vermillion border in order for it too look right. He said the upper lip would protrude and look ridiculous if he didn`t do the borders. He did a good job and the result is very subtle. I don`t think anyone could even notice I had it done, but I didn`t want anything done but the lines above the lip. Also, I had one side with slight dynamic wrinkling. It isn`t there now so I am hoping that is swelling and not overfill. If he overfilled the upper lines, wouldn`t it look bumpy and obvious? I just don`t want to make the lines worse by using restylane. Thank you so much. I value your opinion a lot.

  Answer:  all sounds normal,just let it settle and I think all will be fine. JG 5.22.09

• dear dr Garcia. how can i find a doctor in chicago area that has hialorunidase. i am calling around and checking internet but nobody seems to know. thank you

  Answer:  might suggest calling Northwestern Medical School department of Plastic Surgery or Dematology, tell them you need treatment for a lump of hyaluronic acid filler. JG 5.20.09

• Dr.Garcia,how soon can I see the dentist for cleaning and dental work after juvederm injection in the lips and around the mouth(nb area & marionette lines)?Thank you very much.

  Answer:  7-10 days. JG 5.19.09

• The dr. I visited today suggested that I would be a good candidate for the mid facelift. He said he did it from inside the mouth and then anchored something in the hairline behing the ear, but up in the hairline and it dissolved over time. He said there was no skin to be cut off. How would he make the incision inside the mouth and where would it come out to anchor it in the hairline above the ear or behing it in the hairline?

  Answer:  the incision inside the mouth is made in the lining above the gum line and teeth and then the anchoring device is placed in the temple area through an incison and then a drill hole into your skull is made to set the anchor into place. JG 5.19.09

• I visited a plastic surgeon today and got my juvaderm injections and he mentioned that I might benefit form lipsdissolve for the loose skin under my chin on my neck. To me it just looks like loose skin and no fat, but he says that I can benefit from it and also my jowls. I have heard some horror stories from lipodissolve and I am hesitant about having it done and if it is safe. What is your opinion on it and do you also perfor this procedure??????

  Answer:  Run away as fast as you can. JG 5.18.09

• I had 1 cc of restylane injected into my oral commisures about 2 weeks ago.The filler is actually off to the side,(you can feel it) and the crease is still there, It is a little better than before. Why would it do that and not fill in the crease. Thanks!

  Answer:  it is technique related. JG 5.18.09

• What are your thoughts about a doctor injecting Artefill into NL folds and marionette lines during eye surgery, unbeknown to the patient? Having Juvederm during a facelift had been discussed previously, and a verbal agreement was made, but never ANY discussion about Artefill. And certainly not during eye surgery. This is cerntainly unethical, if not illegal I would imagine. I read that a skin test two weeks prior to Artefill was necessary also. I would have never agreed to any type of permanent filler. What do you think? Thank you, KP

  Answer:  highly unsual, especially with a filler that can last as long as Artefil, the company that used to make it has closed down so I think any issues are between you and the doctor. I am sorry to hear this has happened to you. JG 5.16.09

• I have had two separate vitrase injections under eyes for overfilled Restylane injections. Last vitrase injection was in January. I still have swollen areas under the eyes, right eye worse than left eye. In some light it really looks uneven and I see a slight bluish tinge. I went back to my dr last week regarding a 3rd vitrase inj. Dr told me that all the Restylane had been removed prev and what I was seeing now was the healing process of the damaged capallaries which is causing the swelling and the bluish tinge. He said in a few months the swelling will be gone and I will look normal again. Is this common? My Restylane inj was Dec 22. I have been traumatized by these inj under my eyes and feel like I will never look the same again. Please let me know if you have heard of this healing process. Thanks

  Answer:  what he says could be true, and also the tinge could be due to some Restylane that was injected too superficially and is giving you a Tyndal effect, hard to say without me seeing you in person. The Vitrase injections work almost immediately so it might be worth trying it again. Best of luck. JG 5.17.09

• hi dr. how much do you charge for a syringe of 1cc juvederm or restylane. thanks

  Answer:  for me to inject it is $635 and for my nurse it is $535. JG 5.17.09

• I am having restylane and perlane injections for upper lip lines, chin lines, and marionette lines on Wednesday. If I decide to have the Pearl laser treatment for brown spots and fine wrinkling, should I wait till injections are gone or will it hurt to have laser over fillers? Also, I am not sure if I have rosacea, but I do have very light sensitive skin. Is there a chance the Pearl could make this worse? Thank you so much.

  Answer:  research shows that the laser should not afffect the fillers. A Pearl laser might aggravate the Rosacea, at least temporarily. JG 5.15.09

• Hi again.I posted the last question in this category. My other question is: Should I massage the overfilled area, or is it best to leave it alone?Thanks again.

  Answer:  leave it alone. JG 5.15.09

• Hi Dr. Garcia: One week ago, I had small revision on my breast implants. One looked lower than the other on the top part. My PS filled it with fat. Everything looks good shape wise, except it looks overfilled in one area with a slight depression in between. Should I expect that to absorb and smooth out over time, and how long? Thanks in advance.

  Answer:  it will likely take 6 months for it to get to its final results, got to hang in there. JG 5.15.09

• Dr.Garcia, question,how soon after restylane or juvederm injections you can do touch up? Do you need to wait longer if injected site stiil bruised, especially under the eye area? And if not to wait, untill it`ll clear, could be any discoloration of that area? Thank you very much.

  Answer:  I would wait at least 10 days to let the swelling go down and be better able to estimate where it needs to be placed. JG 5.15.09

• im having a hard time finding someone that does the real co2 laser that yu keeps saying does so good, im in orlando florida, can yu help

  Answer:  might want to contact the local county medical society for a list of plastic surgeons or dermatologists, I personally do not know anyone there who could do it for you. JG 5.14.09

• didnt explain a previous question . my doctor injected me with juvederm in lips without freezing them. said he can see the lines better . i okayed it and it hurt ,but wasnt too bad. is that true, is it easier to see the lines that way? was wondering if this is true? thanks

  Answer:  yes, that is true, the numbing agent can distort the tissues in some cases. JG 5.13.09

• how long on average will black and blue mark last after botox on crowsfeet? thanks so much for this site.

  Answer:  4-10 days. Thanks for visiting. JG 5.13.09

• hi doctor garcia, i had 3 1cc`s in marionette lines, plus lip lines. i am in my late 50`s, and he does a great job, but after a couple wks some of the wrinkles come back, but still looks good for about 3 or 4 months. anyway, i was wondering why he does not fill in more of the outside of the ridge, as that seems it would puff it up more and keep the marionette from showing at all. do you know what i mean. dont know if i am explaining it well enough, but i was wondering what you would say on that. thanks so much. i am a fan of yours.

  Answer:  sometimes more filler will only make it look unatural. You just might need it injected more often is all. JG 5.13.09

• my doctor injected me with juvederm in my marionette lines and lip lines at my request as he told me he can better see the wrinkles when they are at rest normally. wasnt too bad, a little painful in the lips and lipline, but it looks good now. i am just curious as to if this is true or not. thanks so much for your opinion

  Answer:  I think that was OK to do. JG 5.13.09

• my doctor injected me with juvederm in my marionette lines and lip lines at my request as he told me he can better see the wrinkles when they are at rest normally. wasnt too bad, a little painful in the lips and lipline, but it looks good now. i am just curious as to if this is true or not. thanks so much for your opinion

  Answer:  yes, true.JG 5.17.09

• Dear Dr. Garcia What fillers would you recommend for nasolabial folds and marionette lines? I am thinking of evolance because it is not supposed to cause bruising. Also, is there any treatment for hand wrinkles? Thanks, Tricia

  Answer:  any filler since it is placed with needles can cause bruising, it is not the filler but the needle that causes the bruise. I usually use Perlane or Restylane for those areas. As to the hand wrinkles, nothing safe and effective at present sorry. JG 5.13.09

• dear dr. Garcia, Is that procedure something you do? if not, would you be able to recommend a competent plastic surgeon who has done it before, preferably in the LA area..let me know if I should call your office for more info..I`m willing to try anything at this point in time

  Answer:  I might suggest seeing Rollin Daniel in Newport Beack, Ca., he is an expert in revision rhinoplasties.JG 5.12.09

• hello again..how would radiesse be removed at this point in time....is that something you could detect on examination...it sure feels like the filler could very well still be under my skin

  Answer:  it would require surgery to lift the skin and scrape it out, you cannot see it from outside. JG 5.12.09

• I contacted you recently re: ongoing inflammation condition of my nose, 2 1/2 years post injections on the bridge of my nose with radiesse..I thought the thickened appearance was due to scar tissue formation that replaced the filler from treated areas. I now realize that what is going on is a chronic edema, which accounts for the swollen distended look..it has been this way since the injections were done..is there anything that can be done about reducing or eliminating the fluid retention beneath the skin on my nose..please advise..

  Answer:  the only thing would be to try to remove the Radiesse on the rare chance it is what is causing the edema, otherwise there is not much I have to offer. Sorry.JG 5.12.09

• Dear Dr.Garcia, if you used half of syringe of juvederm, then you`ll store another half for the same patient. For how long it will be good and usefull? Thank you.

  Answer:  most times it is used within one year if stored under sterile methods. JG 5.12.09

• What is the difference between Restylin and Perlane? Perlane is more expensive but wondering if one is preferred over the other? I hv Resty injected in my shallow n/l folds and lips. My lips seem to ge down in only a couple months, n/l seem ok but were never bad to begin with. Lat time my PS used i think either a syringe and a half or 2 and charged almost 1000! he is about 200 more per syringe than his nurse and always insists on doing it if he has done it before. Plus he charges 50 for dental block for lips! A medical spa where i used to go for resty in lips is offereing 2 for one on syringes of both Resty and perlane. 450 for a syringe of resty and 2nd free if you buy before a certain time(within few days) and can use within 6 months. And same for perlane but 100 more. I am tempted to go there again. I liked their work. Would perlane work in lips or last longer? and what about for n/l?

  Answer:  They are not interchangeable, the Perlane is for deeper injection, deeper folds, Restylane is for more superficial use. I would not use Perlane in the lips. I understand the desire to have things last longer but using the wrong product can lead to lumps and problems. Perlane is a good choice for nasolabial folds though. JG 5.12.09

• I would like to have a filler injected in the tear trough area but I have no idea what would be the best. I don`t want something that will be lumpy or leave a hard place like some people talk about and have to have it cut out. If fat from my own body a good thing to use under the eye area? What do you suggest and how do they get it smooth so it wont be lumpy? Also, I think my cheeks need something to fill them out and give them volume. What would you suggest?

  Answer:  I do not recommend fat for that area, and I personally only use Restylane for that aea. As to filling out your cheeks, my preference there is Sculptra. JG 5.12.09

• Hi Dr. Garcia; Could you please answer a few questions regarding removal of a lump caused by the filler evolence? The lumps appeared instantly after the injection under my right eye. I prone to scar badly, and wonder if more than 2 mm would be needed to scrap and squeeze out the lump. Does this cause a pit after it is removed? Does it cause a large keloid scar? Is this a costly procedure and how long does it take to perform? Is this a routine office visit for you to remove lumps caused by fillers? Thank you for your time and patience with everyone asking similar questions.

  Answer:  a 2mm cut should be enough if you can easily feel it and there should not be a pit after it is given time to heal. It should not cause a keloid as no skin is being removed. The cost varies depending on the surgeon and it is usually done in the office under local anesthesia. JG 5.11.09

• Have a follow up question to my last question yesterday: if what has created the pockets of fluid that once was the radiesse in and around the bridge of my nose, can that chronic edema be alleviated by extraction or treated with some antibiotics..how could fluid be scraped , as you suggested..thanks

  Answer:  it should as a new wound will be formed and that should scar down and heal in time. JG 5.11.09

• Hi dr Garcia. I have had radiesse put in my cheeks two months ago. The effect has faded already. I want to know can I get another filler such as juvederm in this area or even sculptra. Or is it bad to mix substances? Thankyou.

  Answer:  It is OK to mix them. JG 5.11.09

• I ocntacted you a few months ago regarding the ongoing condition of my nose..21/2 years ago (9/06) I regrettably had radiesse injected from the tip to the top of my bridge..the skin where the filler was injected is red and bulky, detailing the same area where the radiesse once was..although I previously assumed that the area was now scar tissue, it appears the affected tissues remain swollen with fluid..when I appy any pressure to my nose (ie, lying down on a pillow), the swelling seems to change from one side to the other..the tip area of my nose remains reddened..is there any possible treatment to resolve the swelling? could antibiotics help? I even tried a very low dose of kenalog by a dermatologist a week ago who gingerly injected me at the bulkiest area on each side of my upper nostril, but I see no difference..I feel like taking a pin and puncturing the skin hoping the fluid will come gushing out of my poor nose..guess thats just wishful thinking..please advise..thanks

  Answer:  might be able to be removed with surgery to scrape the material out, best done by a surgeon who does rhinoplasties. JG 5.11.09

• I am 44 years of age. If I have vitrase injected under my eyes to remove the last little remains of Restylane and it also removes some of my own acid will my own acid return even at my age, and if so, how long does it take for your body to build it back up?

  Answer:  yes, but the effect on your own hyaluroic acid only lasts 24-48 hours and your body makes it back. JG 5.9.09

• i just got juvederm done in my lips and marionette lines 2 days ago. it looks good and i am happy. how long does this last on average on most of your patients. thanks so much for your answer.

  Answer:  2-4 months or so, depends on how much motion there is in the area, the more motion the less time it lasts. JG 5.9.09

• Hi Dr.Garcia, i just asked you about the restylane moving to my chin. I know it can be removed with hylaurondaise. I am afraid my doctor won`t remove it. If he doesnt, will another doctors fix someone else`s work and remove it Restylane in my face lasts for a year. I dont know if I will have to live like this for a year. I hope someothing can be done.

  Answer:  I do not think there is any need for you to remove the Restylane, the problem was the Botox used inappropriately, not the Restylane. Not much to do now until the Botox wears off, sorry. JG 5.8.09

• Dear Dr. Garcia, I had restylance injected in my jawline (the back edge of the jaw ) to make it look more square. At my next appointment I was having Botox in my forehead and my d said that he could lift my face with botox. He injected the botox at the same site as where the restylane already was. The next morning my jawline looked much less square and (I know this sounds strange) my chin was/is puffed out and it looks unproportionately big. It is horrible. Is it possible that the injection of botox at the same site where there was restylane already, caused it to move to my chin? It looks so strange. I`m so upset I cant believe this happened. Thank you for your time and wisdom.

  Answer:  Botox will not make the Restylane move but weakening the muscle with Botox can alter the appearance, not sure what they were thinking because that will not work. All the best. JG 5.8.09

• I got botox injections in my forehead area this week. I have an uncontrollable tendancy to raise my forehead when I am talking and when I don`t even know I am doing it and really I don`t have to be talking. It raises my whole forehead and causes it to wrinkle all across and causes the lines to form. After the botox injections the lines seem to be gone and over all it looks pretty good except for the right eye over the eyebrow. It still looks like I am trying to raise my forehead and over at the end of the eyebrow it wants to raise and form a hood looking effect. It looks funny. The left side wont raise but the right one will over at the end. It looks like a hump whenever I look in the mirror because I have no control of whenever I am trying to raise my forehead. I have always been that way. Why is both sides not equal????????????? And if I went back could he give me another injection futher over on the right above the eyebrow, but higher up not to cause drooping??????????? I hate that it looks raised on one side of the face but not the other.

  Answer:  might not have taken effect equally, the only way to make it symmetrical now is more Botox. JG 5.8.09

• hi dr, i am having restylane and botox today in my marionette lines and crowsfeet. can i tell if its going to look better the more swollen it is. meaning if it doesnt stay looking wierd for very long does that mean the dr didnt put enough restylane or juvederm in the marionette lines.

  Answer:  it should not look weird after the injections. JG 5.7.09

• I think I need a filler under my eyes. I think it is called the trough area. Not sure though. It just looks like I have lost some fullness or maybe sunk in. If I get a filler, how will they keep it from being lumpy and how will they smooth it out. I know when I have juvaderm for the lines around my mouth, they inject and then put their fingers under my lip and massage it and try to smoothe it out and still sometimes it is lumpy. So I would like to know how they can keep it from being lumpy under the eye area?

  Answer:  the lumps come from the injection technique. We also recommend massage ater the injections. I use Restylane in that area. JG 5.7.09

• Yesterday I had restylane injected in my oral commisures, 1 syringe. I have a lot of swelling on the side of my face and under my lower lip. Is this normal and how long will it last? Thanks.

  Answer:  pretty normal, it can last 2-5 days in some cases, apply some ice and that should help some. JG 5.6.09

• dear doctor. have you ever seen a face that looked worse after restylane in nasofobial folds - unnatural looking? how to avoid that? thank you

  Answer:  I have seen that when the Restylane was not injected into the proper place. JG 5.6.09

• dear doc. what would you recommend for bumps and lumps under eyes after juvederm that was dissolved but it is still there after 2 years? thank you

  Answer:  will likely need to be cut out. JG 5.6.09

• dear dr Garcia. what is the difference between radiesse and restylane? why some doctors prefer radiesse?

  Answer:  Restylane is a hyaluronic acid while Radiesse is a sugar matrix into which synthetic coral particles are floated into it. The Radiesse claims longer results but that has not been proven out and the Radiesse should not be used around the lips or eyes. I use much more Restylane than Radiesse. JG 5.6.09

• I have some wrinkles under my eyes and I have tried retin aA for quiet awhile and several wrinkles creames from very expensive to inexpensive. None of these treatments works at all for me. I have read where co2 laser will help in that area. Do you think it would be beneficial. I aslo see on several plastick surgeons webpage where they offer different treatments and I read where rhytec whatever that is works for the wrinkles and the titan and thermage. What about any of these procedures. DO any of them work for this area????????

  Answer:  I think CO2 will offer the most, next would be the Rhytec Portrait, I do not think the Titan or Thermage will do much, and remember the results will be temporary, a few years likely no more. JG 5.6.09

• Hi Dr. G, I have been told that Radiesse can be used around the cheeks to help lift the bottom half of the face. Also, around the jawline to make it less jowly. What are your thoughts on this? I have had Radiesse for the nasolabial areas and have been pleased with the result. As always, so grateful for your time and generosity.

  Answer:  I do nto think it is a good choice for that, the amount needed to lift the cheeks by filling the cheeks makes the price very high and to fill in the jawline to hide a jowl will by definition make the jaw more broad as how it is done is by filling in the normal area to the level of the saggy area. Best of luck. JG 5.6.09

• I read where someone asked what caused the lines around the mouth to lips and you said the skin getting loose and falling forward. My question is why do some women never get that? If it is from aging and someone is in their forties and someone is in their fifties or sixties and have never had that problem, then why is that?

  Answer:  different people age differently, so everyone shows the aging process in different locations of the face. JG 5.5.09

• Hi Doctor, Is NewFill exactly the same product as Sculptra but just renamed? The reason I ask is because I had NewFill injected over 7 years ago and the product is still in my nasolabial folds and lumpy in areas. I wondered if this is because at the time the product was too concentrated and I was not advised to massage the area?

  Answer:  It is called New Fil all over the world and Sculptra here in the US. Now I will say that the prodcut has been changed as the particles are smaller now due to larger dilution so the risks of having lumps is less. Sounds like you got some lumps or granulomas and when that happens it will last longer than normal. It is more likely due to the technique used at that time for the injections, we inject smaller amounts now over larger areas. JG 5.5.09

• I have a question that probably is a stupid one, but if I don`t ask then I will never know. I have had juvaderm injections for the labial fold lines beside my nose to mouth and I need to go to the dentist. Will having my teeth worked on and holding my mouth open and them stretching it the way they do hurt the juvaderm or move it around any? Will it make the lines worse?

  Answer:  should not affect the filler. JG 5.4.09

• Hi Dr. Garcia. Did I read your earlier responses correctly....you would use Restalyne for the rim of the undereye area, but not for over-aggressive fat removal that leaves the undereye hollow? If I got that right, is there anything other than fat transfer that can correct hollowing from bleph? Thanks!

  Answer:  there are no fillers that I feel will safely and reliably correct the hollow of the eyelid itself and I do not inject that area. JG 5.3.09

• I have under eye hollowness . I just had Scupltra used last week and see not change Dr. said it takes several times, next injection is in 2 weeks, with a follow up in another 3 weeks( a gradual build up), then it should last for 8- 1o months. Questions : does this work?

  Answer:  well, I would never expect Sculptra to show much change for 4 months so it is way too early, but I think that is not a great place to use Sculptra in, it is intended for deeper injections. JG 5.3.09

• Please explain, Sculptra thickens skin to reduce the folding upon animation. I feel I need more cheek fullness when my face is in repose. I have enough cheek roundness when I smile. Would Sculptra help my cheeks look more full when I`m not smiling? Thank you.

  Answer:  well, it probably more accurately thickens the tissues below that support the skin, but it does help lessen the ability of ths skin to fold upon animation. Sounds like Sculptra would fit your needs. JG 5.3.09

• I`m wondering if anything can help the corners of the mouth turn up? I was told by a PS that Botox is too risky to use on the lower 1/3 of the face. Is this true? Can anything else help?

  Answer:  would never use Botox there, the only way is to surgically lift the cheek pads. JG 5.3.09

• what causes the creases (parenthesis lines) around the mouth from the nose to the lips? what best filler helps

  Answer:  caused by the cheek skin getting loose and falling foward, I normally use Restylane or Perlane there. JG 5.1.09

• What filler do you prefer for use under the eyes? I had a U/L bleph on 2/9, in which he said he removed some fat + repositioned the fat that he left. Is it usual to remove AND reposition? I think my undereyes look hollow. Thank you!

  Answer:  it is not usual to remove and reposition at the same time, no, and i usually use Restylane for the rim but that will not correct overresected fat, just the rim. JG 5.1.09

• Hi, Dr.Garcia, is it OK to share 1 syringe of filler with couple of patients(for touch up),just changing the needles. Is it safe for them? Thank you, you`re the best.

  Answer:  I would never do that. That is why there is a single identifier strip on the syringe that goes in the treated patient`s cahrt. JG 4.30.09

• What kind of results do you get from using your peptides and what are they used for? This is all new to me?

  Answer:  they are used to minimize fine lines and smooth the skin. JG 4.30.09

• Is there anything that can be done to help wrinkled skin on the legs and arms and stomach.

  Answer:  on the tummy maybe a tummy tuck,not much on the legs. JG 4.30.09

• Teh filler deo snt omake the liens get Hi Dr. Garcia, I have a couple of questions regarding fillers: Which one is the best (fills the most and is the longest lasting) for smile and marionette lines? If filler is injected a two to three times per year, can it cause the lines to become deeper over time (once it eventually is absorbed and disappears), as the skin stretches to accommodate the filler, creating more of a problem in the long run I think it is great that you are accessable to so many people and generously offer your expert advice. Thanks!!!! Anne

  Answer:  we use Restylane or Perlane there. The filler does not make the lines get deeper, but while using it the aging process proceeds and people forget that their lines without the fillers were going to get worse anyway. All the best. JG 4.30.09

• Does 1 syringe of restylane seem like too much to fill in marionette lines? You mentioned in an earlier post that this is a hard area to fill and you made need surgery to correct it. What kind of surgery? A face lift? Or is there a procerdure specific to that area. Thank you!

  Answer:  no, in some people that have deep lines that is about right. The surgery to correct it is a cheek lift or a facelift. JG 4.28.09

• Hi Dr. Garcia. How satisfied are your patients with fillers under the eyes? And how long, in your experience, do they last there? Thanks.

  Answer:  in general very satisfied and it will last typically 8-10 months in most but not all cases. JG 4.28.09

• dr. garcia, what is your opinion on the best filler to use for a 58 year old womans for her marionette lines. i am going for the juvederm, but want your opinion on that. also how long does it last on average if done correctly, and how many syringes does it usually take. thanks so much for your opinion and your time.

  Answer:  I think Juvederm is fine, I usually use Restylane or Perlane. JG 4.27.09

• I am the one who recently found out that I may have a possible unknown permanent substance in my face and all the while believed it was Radiesse. I had been following instructions given to me by pc’s at 12 and 18 months to expedite the breakdown of two small areas that appeared in a couple of patches on the sides of my face around the nasal labial folds. The instructions were to try to expedite the Radiesse to breakdown by hand massage and hi speed vibration. In January I noticed a puffy, rounded lumps developing in the upper lip area under the nose between the upper lip and nose on each side, almost like product I wasn’t even aware was there anymore had migrated downward from up around the nose to this area. When I applied the vibration technique in that area and in the folds as usual, I experienced a zapping pain in my folds then swelling and ever since then it seems that the product expanded and I feel as if the area is swollen or inflamed or something, some days worse than others. On the right side it seemed as if a piece of the product that lay awkwardly in thin stripe in front of the fold toward the bottom in front of the laugh lines by the mouth tore away into a round elevation that was painful for a long while and still so at times. I am so afraid of what has happened in terms of trauma to my body not to mention the appearance is more awful than its original appearance that I had been try to patiently wait for to go away as promised for the last 2 ˝ years. Now the balance of my face is further thrown off with all the lost contour from the additional unnatural fullness in the folds and lower part of my face in front of the smile lines to the sides of my mouth. If you could, please help me with the following questions: 1)Does this sound like a reaction that Radiesse could have had or is this a bad sign that it is in fact some unknown permanent product? 2)Do you have a suggestion of what dynamics occurred or are occurring inside my face.3) What information would an MRI be able to provide about all this (permanent/radiesse filler, inflammation, etc.)? It’s killing me not knowing what is in my face, what happened and what continues to happen or will happen in the future as time passes. The Woodridge,IL Medispa where this injection was done by an RN that owned the facility closed and my records which I requested a couple of years ago were never sent to the pc’s I`ve consulted with since then because he claimed to them that they were lost. So I can not check the file for any information. Sorry this is so long but I thank you so much for any answers or suggestions you might be able to provide at your convenience.

  Answer:  sounds like a granuloma reaction to whatever filler was placed, I think at this point the vibration massage is past its point of helping and you might need to get the lumps cut out. An MRI will not give much information as the material is quite small and even if you have it cut out, it might not be able to be determined as to what the type of filler it was, wish I had more to offer you. JG 4.27.09

• A couple days ago I wrote asking about the permanence of Artifille. You suggested that I wait or have it cut out if it is easily accessible. What do you mean by easily accessible? Thanks again.

  Answer:  in a place whre the needed scar for excision will be acceptable to you and also where the lump is easily felt so the surgeon will not need to injure other normal tissues in order to get to the lump. JG 4.27.09

• What injection filler do you recommend for the naso-labial folds and marionette lines? Can a filler help lift the corners of the mouth or can the filler at least make a drawn down mouth not be so obvious?

  Answer:  I usually use Restylane or Perlane. Lifting the corner of the mouth with a filler can be difficult at best. JG 4.26.09

• Hello Dr, With regard to permanent fillers such as polyacrylamide, although they are called permanent, is it possible that over long period of time (10 years +) that some of the product will be broken down by the body if it has been injected in small doses? Thanks

  Answer:  it is possible, yes. JG 4.26.09

• I think I saw somewhere in the posts you mention that Artifille lasts about 5 years. I have and unknown substance in my face that turns out might be a permanent filler instead of what I thought was Radiesse injected two and a half years ago. I have been eagerly waiting for the product to go away since it was poorly place, but it has not since gone away and in fact has gotten worse due to recent migration. I only heard one other time that Artifille lasts 5 years and otherwise have heard it is permanent. Please let me know your experience with the length of this products effects. Thank you so much.

  Answer:  some studies have shown it to last 5 years, and if injected in a large amount in one place could last longer, in some cases when injected thinly it has been found to breakdown over less than 5 years. I think all you can do is wait, or have it cut out if easily accessable. JG 4.26.09

• A necklift 8 weeks ago left me with mouth pulled down and more gaunt looking cheeks than before. I have a new dr. who says I could have Sculptra injections at week 10 on cheeks, naso-lab folds and marionette lines. Would that be too soon after surgery to have injections? (My swelling is finally much diminished.) Thank you.

  Answer:  I think they could be injected at this time. JG 4.26.09

• I`m getting the impression that Sculptra is a very good selection for cheek injections. (But if a surgeon injected too much or in the wrong places, you`re stuck with it for about two years.) Would Sculptra also be good for nasolabial folds and marionette lines? Thank you!

  Answer:  it should be used for deeper injections only and nasolabial folds and marionette lines need superficial injections. JG 4.26.09

• Dear Dr.Garcia, one more question, please. If you use hyaluronidase to dissolve a lump how long you need to wait to see if it works? And if you use just a lit bit first time and it works, when can you repeat it? How long to wait after, to inject this area with a filler? Thank you so much for all your help and for your time.

  Answer:  it works within hours. It is not uncommon for it to be repeated in many cases. I would wait about a month or more to injected more, but it depends on what happens when you dissolve it, so it might vary on the patient and the problem. JG 4.23.09

• Hi Dr, my friend had juvederm injections. In a week she came for touch up and doctor did injection with cosmoderm, instead. Is it OK to do different fillers on the same site? with interval of one week? Is cosmoderm a good filler? Thanks.

  Answer:  it is not uncommon for differnt fillers to be layered, should not be a problem. JG 4.23.09

• Is Sculptra the best choice for a cheek filler? Are most doctors good at figuring out where and how much to inject so that your cheeks look good? I`ve been told that cheek filler can give your face sort of a lifted look. Do you agree? Thank you.

  Answer:  I do think it is the best but it is not cheap. I think you need to look for a surgeon who is comfortable in doing it, I rarely inject more than one vial on each cheek per time, and then I wait 4-6 weeks and re-evaluate to see how they are responding before injecting any more. If the sagging of thevface is due to loss of facial fat, it can appear to give a lift after the Sculptra injections. JG 4.21.09

• hi dr. garcia, i am the one who has had the ongoing problem with the under the chin scar that was made so very long that the end of the scar came into the jawline. i have had the scar revised, and it is a lot better, but i still have sort of a dent where the skin is lossening a bit. i had hylaform injected to fill out the dent, and it lasted about 4 months. last september i paid a lot of money to have artefil injected because it was supposed to be permenant. by december it was almost gone, and now in april it is dented again. i was told it would last for several years, but i am wondering if i should have had a top off of the filler to make sure it would last. the hylaform was about 400.00 and the artetil was 1200.00 and they both lasted about the same amount of time. have you ever heard of anything like this? i am going to ask my injector what his opinion is, but i doubt i will get any satisfaction. thanks, barb

  Answer:  I honestly have nto heard of it, sorry, and since they both lasted about the same, go with the less costly, I would likely use Perlane, best of luck. JG 4.21.09

• Hi Dr. Garcia, I have migraines and TMJ pain. Since you also deal with Botox, I was wondering where the Botox could be injected to numb those areas of pain? Also, is there a safety limit to the amount of Botox used in one session?

  Answer:  Botox is a muscle paralyzing agent and does not cause any numbness. The amount of Botox used for migraines is much lower than in other applications so certaily one bottle is very safe. The use for migraines is to help with muscle spasms that can trigger the migraine.JG 4.21.09

• hi dr. can you tell me what you think of artefill for marionette lines that are moderately deep and have wrinkles that dont go away even when pulling face back. how long would the artefill last. i have had restylane filled in those areas before, but it only seems to work for about a month . is this common. thanks so much. i am a 58 year old female

  Answer:  well, it is a good choice, whatever effect you get will not last as long as the Artefil as the tissue that are sagging will continue to fall regardless of the Artefil as it does not stop the sagging. Artefil can last as long as 5 years or more, but the company recently went bankrupt so I am not sure how much longer you will be able to get it here in the US. Marionette lines are not always able to be corrected with fillers, it many times takes surgery to correct, the fillers can only temporarily slow the need for surgery. JG 4.18.09

• dear dr Garcia. my face is deformed for almost 2 yars after multiple juvederm injections and dissolving under my eyes .all i want is my face back, but it does not seem to improve. i think i still might have some juvederm left. should i try hialorunidase one more time? how to find a doctor that i can trust? thank you

  Answer:  Wwll, by now all of the Juvederm should have dissolved if it was real, I do not think anymore hyaluronidase will help at this point. Might want to se a plastic surgeon who does facial surgery for an evaluation. Best of luck. JG 4.18.09

• i had restalyn under eyes last sept. not sure now if crescent area that sticks out is restalyn or fat. maybe most dissolved and this area remains or maybe it is fat but does fat appear that quicly? any way toknow for sure??? i don`t want surgery to remove fat and turns out to be filler--does filler usually dissolve at same time in all the areas? thanks

  Answer:  hard for me to tell without seeing you in person, if you press lightly on it, if it is fat, it should flatten where if it is a filler, it usually will not flatten. In most cases fillers in that area dissolve in 8-10 months so it sounds like your case is more one of fat if it has been this long. JG 4.18.09

• I had scupltra injected under eyes in December and still have bruising and darkness under on right eye. Is this common? What can I do to decrease the bruising? Will It go away? Thank-you

  Answer:  not common, no, but I also would not have used Sculptra in that area, it is meant for deep injections and the area around the eyes needs superifcial injections. I think at this point all you can do for the bruising is give it time, sorry. JG 4.17.09

• Hi Dr. Garcia, I am 53- have had Restylane twice to restore some lost volume. My question- does Restylane cause problems eventually by stretching skin out- face looks slightly deflated- like a balloon- when it wears off? Also- what is the best filler in your opinion? Thank you, Dee

  Answer:  I have not seen it cause anything faster than it would have happened without it. I feel different fillers are better for certain things so you need to tell me what area you are using the filler on. JG 4.17.09

• Dear Dr.Garcia Which filler last longer injected in the face? Juvederm or radiesse? Thank you

  Answer:  Radieese probably, but not much longer. JG 4.16.09

• last question re granuloma---or fat--or juviderm--this is a crescent shape area not like a nodule--any thoughs?thanksAGAIN!!!!

  Answer:  doubt granuloma, it is either fat or filler. JG 4.15.09

• last question re granuloma---or fat--or juviderm--this is a crescent shape area not like a nodule--any thoughs?thanksAGAIN!!!!

  Answer:  doubt granuloma, either fat or filler. JG 4.15.09

• is it unlikely then that a p.s. would mistake fat or juviderm for a granuloma? this is not hardfeeling like a pea you are always so great! thanks

  Answer:  well, if the granolma is really deep, then it might be hard to appreciate how hard it is, as to telling the difference between fat and a granuloma, that should be pretty straight forward unless there has been surgery done in the area before. Also, if there has not been surgery before, the fat around the eye is not a small ball, it is longer and more sausage shaped so that should be easier to distinguish from the others. JG 4.15.09

• can juviderm or restalyn cause a granulomma after 8 months??what does a granuloma look like? thanks

  Answer:  they can, unusual, but yes, the granuloma would feel like a hard lump. JG 4.15.09

• i had restalyn under my eyes in august and more in september. there is a crescent shape area under eye now and doc is not sure if it`s fat that was not visible when restalyn in the area or if it is still restalyn. I wonder is there is any harm in injecting some vitrase there to determine what is going on. If it is fat i know it won`t remove it but would any harm be done in making certain. thanks

  Answer:  I do not feel that injecting the Vitrase would harm anything. JG 4.15.09

• Dear Dr. Garcia, I consulted with a well known cosmetic physician yesterday. I need a quick fix for the end of april and of course time is running out. I am nearly 60, with slight sagging in lower face, marionette lines etc. He suggested 3 syringes of perlane and I would be amazed--some injected in sagging of face, apples of cheeks, and marionette lines .I recently had one syringe injected of resty in those lines but it is barely noticeable. he said he would choose perlane as it has more volume. How long would that last? Does it dissapate faster than resty or juvederm? 3 syringes is quite a lot of money--thanks for your thoughts.

  Answer:  well, Restylane is thinner than Perlane, does not have more volume as 1cc is 1cc, it lasts about the same, is meant for a deeper injections so there are subtle changes. If your time is short you really do not have many choices as other fillers like Sculptra will not build up in time. I think the Perlane can be used, I suggest sing it about two weeks before you need to look good as I think the effects, especially in the filling of the hollowed cheek will not last long. The marionettes will lood good for awhile though. With your age and time constraints, you need to understand this is a quick short fix and is a compromise due to the limitations. JG 4.15.09

• Does restylane dissapate slowly overtime, or do its effects wear off suddenly? Also, is it safe to get microdermabrasion, a facial with extraction, and a glycolic acid peel in the same sitting? thanks

  Answer:  it is a slow dissolution. I think if you are going to do all of that I would do the filler last. JG 4.15.09

• I am 29 years old and have some lines on my forehead and around my eyes. Doctor after doctor have told me that if I try botox the lines at rest will `heal` and go away since I`m young, but I`ve been reluctant to try it. Do you think retin A is more effective for that problem?

  Answer:  I think you can use both. JG 4.14.09

• I would like to get rid or help the area under my eye which looks like it has lost some volume. I think it is the trough area. If I get something like juvaderm is there a chance it will look lumpy and if so will it go away or would I have to have it removed? Would fat from your own body be better? Do you have any suggestions as what the best thing would be.

  Answer:  in most cases it does not get lumpy and if it does, again in most cases it goes away.I do not think fat is a good choice for that area as survivability is no longer and the needles required are larger. I use Restylane for that area. JG 4.14.09

• i had restalyne under my eyes about 8 months ago which seems to have all dissolved. There is one lump that I am pretty sure is the restalyne. If doc injects with vitrase and it`s not restalyne is there a problem or will it just do nothing. Have you seen any side effects with the vitrase? thanks

  Answer:  should not cause any long term problems, just maybe a bruise from the needle. I have not seen any bad side efects from Vitrase. Best of luck. JG 4.13.09

• Dear Dr.G,when you use hyaluronidase to dissolve bad restylane injection; is it not going dissolve your own HA, and you are not going to have a scar tissue after? Thank you very much.

  Answer:  yes, but your body makes it back as part of the body`s natural process, and since the lump is a larger spot, it is affected to a greater degree. It does not result in scar tissue though. JG 4.13.09

• Hi Dr. Pierce Eight years ago I had Articoll injected into my the nasal labia fold area of my face, I was 40 years old. Three years later I toped up with Derma alive once and Derma Deep te second time. I feel the Dr. who administered these two Derma products was unethical and convinced me to have more injections when I didn`t really need them and also they were not thinking of the future and how much the scar tissue would build. Now that I`m 50 years old that area appears raised as if I`m bloated and have no definition there. Also the area close to my mouth is pushing inward creating an unatural look to the corners of my mouth. My question is: Are there any treatments to break down the scar tissue caused by the fillers? I`ve heard that steroids have been used for Articoll and Cortizone for Derma Deep. Is there anything in your opinion I can do about this problem? Also I wondered if I have a face lift ( partial or full) in the next few years could it help to correct some of the problem? Thank you, Sincerely, Kayla

  Answer:  You can try steroid injections but the effects are mild at best and do have side effects. Steroids and cortisone are the same thing. A facelift would elevate the skin and tissue and possibly, if the filler is seen at that time, it could be removed. Best of luck. JG 4.12.09

• I just had radiesse fillings yesterday, from inside the mouth and labial folds. Unfortunately the doctor shoot the lower sides of my face by my lips, to, I guess bring up the corners of my lips up. He started to frantically massage my left side. I smelled trouble at that point and surly enough I look like the lower sides of my face by the chin are FAT!! It makes me look older like my face is falling and fat. I was able to reach him and he said to massage each area for 10/12 hours and it will go into my jaw ! I cannot function like this and go back to work on Monday as this procedure created exactly the opposite from what I was looking for. I am massaging away but am I going to stay like this? Thank you Doctor Pierce, BB

  Answer:  i$t shoudl get better but it takes 6-8 weeks for the carrier gel to dissolve. I fear you will be like that for a long time, I never inject through the mouth, it is very difficult to place the material in the location needed that way and the infection rate is higt due to the bacteria in your mouth that cannot be sterilized. JG 4.12.09

• I had restylane injections under my eyes in December and the results turned out awful due to overfill. I had vitrase injected on two different occasions and the dr advised that all the restylane is now gone; however, I still have a small swelling under my right eye and under certain light still see a small amt of bluish tinge beneath the skin. The left eye is not as bad, but still has a bit of swelling in the corner of my eye. Is this normal, to have Vitrase injections twice to dissolve the Restylane with this type of result? Also, can the Vitrase cause permanent swelling or do you think over time this will eventually all be dissolved. I want so much to look like my normal self again prior to the injections. This was such a bad experience for me that I don`t think I will ever have this done again.

  Answer:  Vitrase injections are not common, but are needed at times and it sounds like you might need a little more where the bump is. Vitrase is completely gone in less than one day and does not cause swelling. Sorry you had the bad experience, it usually is not like that. JG 4.12.09

• When injecting juvederm/resty in marionette lines is the it injected into the line or to the side of the line? Thank-you.

  Answer:  directly underneath the fold. JG 4.9.09

• dear dr Garcia. evolence - can it be dissolved like restylane if bad results? thank you

  Answer:  nope, it is a collagen and hyaluronidase will not dissolve it. JG 4.9.09

• dear dr Garcia. so is evolence the same thing as restylane? it is not pernament, and i don`t have to be affraid to do it? thank you

  Answer:  not exaactly the same, but they are used for the same purpose and last about the same, the evolence is a collagen product where the Restylane is a hyaluronic acid product. Neither is permanent and should not scare you. JG 4.8.09

• dear dr Garcia. what is the difference between evolence and restylane? i had resty done and it was great, but now they said they only do evolence at this place. i hope it is dissolving also. thank you.

  Answer:  I feel it offers no significant advanatge to the patient, it might hurt a little less as it has a numbing agent in it is about all. JG 4.8.09

• hi, how bad is it if u find out your pregnant and u have juverderm?

  Answer:  although it has not been tested, there should not be a problem. JG 4.7.09

• Dr.~ Iam 30...fairly young and want to take care of my skin now that Iam getting older. I dont want to end up resorting in fillers due to the upkeep but want to combat and take care of future wrinkles that i can control if so. I kow there are millions of creams on the marget. I know some are just bluff but what I want to know is for my age...what cream is BEST for me to keep my skin in tip top shape. What ingrediantsd should I look for to help with cell turn over or even in the creakm to keep the best me i can

  Answer:  Retin-A or my DMAE face crema or peptide cream, mine are on my shopping cart. JG 4.7.09

• I have an odd question. Some days I have deep folds (Parenthesis) line around my mouth and other days they are faint same with the lil line between my brows. Some days they are deep some days faint. Whats going on? Is there a way I can treat them with a cream

  Answer:  it is likely related to the position you slept in causing them to be worse on some days. Creams will have a small effect if they come and go lie that. JG 4.7.09

• Doctor G~ Im a very active atlete--24 hours a week I put in my activity.... I wanted to try fillers but was told that the more active you are the less time the fillers would stay. My question is wouldnt that be NOT worth it for me if I pay $999 dollars or more and it lasts 3 weeks due to my activity? Any suggestions

  Answer:  I do not think it will last three weeks, likely longer, but they will last less time than in more sedentary people. JG 4.7.09

• Hi Dr.Garcia - Hoping you can give some adivce.... 2 weeks ago I had injections of Radiesse. The dr suggested 3 syrniges. Now I have chipmunk cheeks and a large lump up the right side of my nose. He said wait 3 weeks and come back. Is there anything that can be done to reverse this? I also still have hard lumps in my cheeks. Thanks for any advise.

  Answer:  it takes 6-8 weeks and the carrier gel then dissolves which should decrease some of what is happening so give it some time, best of luck. JG 4.6.09

• Dr. Garcia, What is the longest latest dermal filler to fill in deep lines around the mouth and marionette lines? I have had Restaylne but there is no bang for the buck as it wears off relatively quickly. Thanks

  Answer:  could try Radiesse. JG 4.5.09

• doing co2 laser to lower half of face.. i have juvederm in my eye troughs, nasolabial and marioneete lines. will the laser diminish the restlylane product?

  Answer:  should not affect it. JG 4.3.09

• for co2 laser to wipe out the perioral area the marionette lines, chin wrinkles, etc, €how deep numbers wise should it be at(in microns or what ever numerical system is used

  Answer:  at least 150 micorns. JG 4.2.09

• I have dynamic wrinkles starting above my upper lip. I saw in another post that fillers aren`t a good option because you can look over filled or lumpy. What can I do? I am thinking of doing erbium laser for my skin, will this help?

  Answer:  I prefer a CO2 laser, but erbium will give you a mild degree of improvement. JG 4.2.09

• Dr.Garcia, 2 years ago I had fat injections in my lower eye lids. It gave me lumps. In 3 months PS fixed them with restylane. It was even worse. After, he tried to smooth this area with hyaluronidise, it was not a big improvement, at all. Even now( after 2 years), I have some small visible lumps and skin is streched and wrinkled. PS doesn`t know what`s still left under the skin :fat or restylane, or both. What is your advise, can anything be done to improve it: any peels or lazer, or injections will be helpfull? How long that fat and restylane will be there? Thanks.

  Answer:  sounds like scar tissue around the fat, might need surgery to remove it. JG 4.2.09

• Dr.Garcia, 2 years ago I had fat injections in my lower eye lids. It gave me lumps. In 3 months PS fixed them with restylane. It was even worth. After, he tried to smooth this area with hyaluronidise, it was not a big improvement, at all. Even now( after 2 years), I have some small visible lumps and skin is streched and wrinkled. PS doesn`t know what`s still left under the skin :fat or restylane, or both. What is your advise, can anything be done to improve it: any peels or lazer, or injections will be helpfull? How long that fat and restylane will be there? Thanks.

  Answer:  most likely lumps of scar tissue around the fat, might need surgery to cut them out I am afraid, hard for me to tell you more without seeing you in person. JG 4.2.09

• Dear Dr.Garcia, I have some fat and some loose skin under the chin , can I improve it without surgery just having fat dissolving injection(which one?) and after that mesotherapy with HA to tighten the skin. Thank you.

  Answer:  sorry, need surgery, liposuction would likely leave you even looser. Need to have fat removed and skin removed, both. JG 4.2.09

• hi doctor could you tell me i have had aquamid about 3 years ago and would like some more can aquamid be put on top of aquamid? thankyou for your time in answering everyones questions.very helpful to all who are considering cosmetic procedures.

  Answer:  I guess you could, but I think Aquamid is potentially a problem and I do not recommend its use. Thanks for the kind words and for visiting JG 4.2.09

• is there another name for total ablative co2 laser? how do i find someone in orlando?

  Answer:  not sure who does it there, might look in the yellow pages and then when you call ask them if it is a fractionated or pixelated laser, if it is it is not the open you want. JG 3.31.09

• any problem with having botox a week prior to facelift--i have had it in the past-glabella and forehead--thanks

  Answer:  not a problem. JG 3.31.09

• how about multi fractional laser by Mixto? is that deep laser co2

  Answer:  nothing fractional, no matter the company or the claims will compare to a traditional totally ablative CO2. JG 4.1.09

• when yu say deep laser for that diagnoal chin crease, does that mean fractional co2? thankyu

  Answer:  no, fractional lasers will not do it, you need a total ablative CO2. JG 4.1.09

• Dr. Garcia, I am thinking of trying fillers for my vertical upper lip lines before more drastic co2. When I speak, the dynamic wrinkles are only on one side. With the filler, would it take care of the dynamic wrinkles? Also, what if the injector wants to use Botox as they have suggested along with the fillers? I just wish I could go cross country to Las Vegas. Thank you once again.

  Answer:  fillers are for wrinkles at rest, not for dynamic lines, if you inject a filler for dynamic wrinkles it can look too full when in the relaxed position. I would never inject Botox around the mouth for fear of muscle weakness causing drooling that will need to allow the Botox to wear off before it gets better. JG 3.31.09

• have a diagnonal creas e or wrinkle going from the bottom of the mouth (chin area) about 1 inch long, it has been filled with juvederm but doesnt do to well in this area.. would yu recomend co2 laser? i did do it once, bu t it didnt seem to help? anything else i can do? i am assuming this can be caused by sleeping..?

  Answer:  I think regular deep CO2 is a reasonable option. JG 3.31.09

• Dr.Garcia as a tear trough filler you recomend restylane. What about juvederm or radiese? Thank you.

  Answer:  Juvederm, maybe, Radiesse, I would not use there personally. JG 3.31.09

• Dear Dr. I had one syringe of Restlyne put in marionette lines last week, by a PS. Although there is an improvement the line on my face which extends halfway down my chin is filled in, it is still visable. (on one side) Should he have used 2 syringes? Did he not use enough or is it just embedded into my face in which no filler will work? Thanks.

  Answer:  well, fillers help, but the amount it takes to fill the line in completely can be quite alot at times, I always start with one syringe and if the patient wants more, then I do more, but understand, there might never be complete effacement of the fold. JG 3.30.09

• Dear Dr. GArcia I went to a woman`s health showcase last weekend and was shocked and amazed at all the medi-spas that are springing up in Doctor and dentist`s offices now. They are all offering fillers and or Latisse. I am not sure who would do the injections as I would not go to one unless it was run by a derm or ps. My questions is Is this the wave of the future? Does this mean the fillers will go down in price? I wouldn`t think the physician`s charge for doing the injection would just what is used. I was shocked that so many doctors are getting into this such as ENT and Opthamologist to name a few. This was a showcase of over 75 representatives. I know you get what you oay for...but... By the way, your other site is still down so I posted my question here. Christine

  Answer:  it is the wave for right now, there have been many problems in these areas where there is no appropriate supervision, but the injuries and lawsuits take time to surface. I think as the spas are slowly closing down slowy, the price for fillers will not drop too much, it is lower in less experienced hands at present though. I think some doctors are getting into it not because that has always been their interest, but it is purely financial as reimbursment from insurance companies is not what it used to be so they are searching for things that they can make money with their medical license. JG 3.24.09

• Dr. Garcia can you tell me about the new derma-filler EVOLENCE® dermal fillers? I heard about it but there isnt much being used from who i talked to...are u using this or know about it? Is it better than the other fillers

  Answer:  really does not offer any improvement over what has been put there for a long time with a proven track record, we are not using it in our office. JG 3.16.09

• Dr. Garcia,I know people love botox but I am afraid of it--although I would love to smooth out 11s How often have you seen anyone have any bad reaction? I hear that the eyelids can droop--does that happen often? Have you seen it personally? I want to take the chance but--I have concerns. Thank-you.

  Answer:  I personally have not seen a bad reaction except I had one patient that laid face down afterwards after being instructed not to do that for at least 4 hours and her one eyelid drooped and I had to treat it with eye drops for two weeks until the effect wore off. JG 3.16.09

• I am 58 good nutrition sun damaged skin (I work outside and play golf dive have a boat) I went for a consultation recommended- effudex, retin a photodynamic therapy face and chest and radiesse(jawline juvaderm(chin) and perlane temples and cheeks I dont do botox I am worried about being outside after allof that and do you think liquid facelifts are worth it about 3200. Thanks MKJ

  Answer:  well, Liquid facelifts do replace lost facial fat, if you have that, then it is worth it. As to Effudex, your skin is going to get really irritated and unless you are willing to stop or decrease the sun exposure, I think they are likely not worth unles syou have skin cancers it as the damage will return. As to the fillers you mentioned, I see no problem with them. JG 3.16.09

• Dr. Garcia, if some of the skin`s natural hyaluronic acid is inadvertently dissolved along with Restylane during hyaluronidase treatments, will the natural hyaluronic acid be replenished? Thanks.

  Answer:  yes, it will. JG 3.15.09

• Dr Garcia, At my PS office, a syringe of Restylin contailns 1.00 either ccs or ml? the cost is 390. does that sound right? and would 1 be enough to do n/l (mine are not very deep and were done during sugery 3 months ago, along with a little in lips bur he used 1 and 3/4 syringes)?

  Answer:  well, firstly, I cannot tell how much product it will take to fill in your fold as it varies from patient to patient. As to the cost, that will vary from doctor to doctor but that is lower than most doctors charge that I know, if it is the doctor doing the injection. also to the size, the legal syringes we purchase have either 0.8 cc or 0.4cc, not 1 cc. JG 3.15.09

• I am getting my first treatment of sculptra (2 vials) next week. My doctor is diluting with 7cc`s water per vial, letting it sit 48 hours before injecting. Do you see any issues with this method? He says the greater dilution rate and waiting period is suppose to result in less risk of bumps.

  Answer:  no, that is a common way to do it. The waiting 48 hours makes for less lumps in the bottle and in the needle but not less lumps in the face. Best of luck. JG 3.12.09

• Dear Dr. realistically how long is juvaderm lasting for say the marionette lines? It is holding up any better then resty? I hear it is easier for most to work with--? Any thoughts? Can one hope for 6 months at best? Thanks.

  Answer:  2-4 months, I have not found it to last any longer than Restylane. It is thinner but the ease of working with it does not matter in experiecned hands nor in results. I don`t think 6 months is likely. JG 3.12.09

• Dr. Garcia, Is there anything other than botox to counteract crow`s feet? Botox is so short-lived for me - lasts a few weeks at best. Hardly seems worth it. Any possibility of using a filler in that area? Or is there anything else you would recommend? Thank you.

  Answer:  fillers do not work well in that area. JG 3.12.09

• Dr. Garcia, Is there anything other than botox to counteract crow`s feet? Botox is so short-lived for me - lasts a few weeks at best. Hardly seems worth it. Any possibility of using a filler in that area? Or is there anything else you would recommend? Thank you.

  Answer:  maybe lasers to thicken the skin, but will likely not last more than 18 months, even if you go deeply. JG 3.12.09

• Dr. Garcia, My doctor has suggested using a small amount of evolence to fill an indentation under my cheek. She said it would give a nice smooth fill. Do you agree. Thank you.

  Answer:  will likely fill it in yes, JG 3.11.09

• i have a small triangular area above cheekbone that i would like to fill. perlane was suggested. how does it differ from restalyne or juviderm. I amvery thin skinned. thanks

  Answer:  Perlane is intended for a deeper injection and it lasts longer than the others when injected deeply. JG 3.10.09

• Hi Dr. Garcia: I would like a slight more projection on my nasal tip. It is not enough to require surgery, That probably would be overkill. My Dr. suggested Radiesse. He says they have had good results with it in that area. He also suggested and has already given me a 10% kenalog shot just above the tip, but a little higher on the nose than the tip. It seems to have made a slight difference after three weeks. Do you suggest trying the kenalog again after six weeks, and if not sufficient, going with a little radiesse in the tip? What is your opinion? Thanks in advance.

  Answer:  I think that sounds reasonable but the Radiesse is not permanent. JG 3.9.09

• Hi Doc, I am thinking about tear trough filler. Exactly, where is the injections applied, and what results should I see?

  Answer:  it is injected rigth at the edge of the bone below the lower eyelid to fill in the dark crease that forms there, it is not injected to the eyelid itself. JG 3.7.09

• The temple area, to the side of my eyes and brows, has lost volume over the years. I notice loose skin and crinkling when I smile, like a deflated ballon. Can sculptra be used in this area effectivly?

  Answer:  yes, good option for that problem. JG 3.8.09

• Dr. Garcia, I had cosmoplast in lips yesterday. My upper lip seems a bit more than I would like. Might it take a couple days for all the swelling to subside? If it does not go down is there anything besides time I might do to bring them down a bit? thanks in advance

  Answer:  I think it will take 3-7 days for the swelling to go down so give it some time. Massage will help and Cosmoplast does not last very long either. JG 3.6.09

• I just turned 30 years old. I`m a little confused because in the last year I`ve put on about 15 pounds and my cheeks look alot chubbier, yet I began to develop NL folds. I thought they were typically caused by losing weight?

  Answer:  weight loss allows the skin to sag or loosen and that can make the nasolabial folds be more easily seen, but in patients that gain weight and their cheeks get larger, since there is no weight gain medial to the nasolabial fold, the fold will look deeper because the cheek lateral to it is now even higher, therefore causing the fold to be more easily seen. JG 3.6.09

• Hi, I have heard of people getting botox in the smokers lines above the lip. I thought botox would paralyze. How could you have it above your lip?

  Answer:  well, some people will try anything, including doctors, it is being done, and it might help relax the wrinkle a small amount, along with the possibility your speech will be altered and you might drool as your muscles will not tighten as much as they normally can. JG 3.5.09

• I have slightly puffy cheeks and my Dr. says it is muscle, not fat. I have heard recently that botox is being used to slim the cheeks by injecting the muscles so they atrophy and shrink, thereby creating a slimmer facial look. I have seen before and after photos and like what I see. Are there any risks that I should know of if I have this done?

  Answer:  where the Botox helps with large muscles is over the back part of the jawbone, not the cheek. The risks if the injections are weakness on chewing and asymmetry of the result, along with the fact that is needs to be redone every few months. JG 3.5.09

• Hello Dr. Garcia; I have a question regarding evolence filler. I have posted a question before. I still have two small lumps under my eye from the filler. It has been present for almost 1.5 years. Will it disappear on its own as I do not want to get it cut out due the most probable scar formation on the skin which would be worse off. Is there anything that will speed up the removal or am I stuck with it possibly forever? Thank you for your time and answer.

  Answer:  well, since Evolence is supposed to not even last one year, I fear you might have a granuloma that might need to be cut out if it is stil there at this point. I do nor think there is anything safe and effective that will dissolve it this far out. Sorry. JG 3.3.09

• hi 37 yrs old with slight oral commisures... always getting them filled with juvederm question is: do you think it will help me to use a night guard or mouth piece while i sleep to help prevent these lines from becoming marionette lines? it just may be that i am clenching or frowning in my sleep.. i just thin k it may help to prevent more lines..

  Answer:  I do not think a mouth guard will do anything beneficial. Certainly no harm in trying it though. JG 3.3.09

• I had wrongfully injected argiform in my fine lines by my mouth,without consulting anything about it...can I get it out? And how? I see myself and my smile diferent and let me know if this product is safe and approved in Houston,Tx.?

  Answer:  interesting because it is illegal to use in the US. I am afraid there is nothing that will dissolve it and it might need to be cut out to remove it. JG 3.2.09

• I had radiesse injected into my cheek about 4 1/2 weeks ago. I now have a lump at the injection site. I read one of your posts that said if done recently the Radiesse can be pushed out through a needle hole site. In what timeframe can this be done without surgical removal?

  Answer:  I think it is past the pushing out phase as most of the carrier has dissolved, I fear that if it persists it will need to be removed surgically. JG 3.2.09

• Thank you for your response about the invisalign> That it will not move my filler> Mine are very tightly placed U Guess. However I was very concerned bout part 2 of my question which was about the lines that form in removal process plus the stretching of my skin. Can some become permanent lines & will the stretching make my skin?....... I would appreciate what your take is on this.

  Answer:  the few times per day you do that should not cause a problem, especially because you will only use the Invisalign until the teeth are straighter and then you will likely not need something as difficult to place. Stretching the skin in general does not cause wrinkles, it is the contraction and folding that does. JG 3.1.09

• what do you think of radiesse for filling area of upper cheek where it meets under eye -is it possible to remove if i am unhappy-i know restalyn and juviderm are dissolvable

  Answer:  I would not use it as the chances of lumps are higher than with hyaluronic acid fillers. JG 3.1.09

• DR Garcia A year ago I had the eyelid droop from botox & well a year later I still have a slight droop. Not real noticable unless I point it out but it is there & very visible to me EVERYDAY>>>> The skin never moved back up completely. IS there anything i can do to undo that damage? Why do you think this happened (the incomplete resolution)?? Thank you!

  Answer:  I am sorry but I have never heard of the Botox effect lasting that long, might be something else that has caused it to stay that way, in addition to the Botox effect. JG 3.1.09

• Hello> Thi smay sound like a really bizarre question but I thought YOU would have a solid truthful answer. I have had filler placed in smiles lines I use invisalign will the removal on & off cause product to move? ALSO another BIG concern I have> the removal of my invisalign is quite difficult & i have to do this 3-4 times a day in order to eat> ok so when I remove them I completely tweek my face out of wack pull stretch fold bend & I can literally see the lines & folds linger for a few moments after my torture can these now become additonal lines on my face.. hmm really concerns me! Thank you very much. Its repetitive facial movements for a year or so??? What do you say? Thanx again!

  Answer:  no, the removal of the Invisalign will not move the filler. I was not aware that the Invisalign was that difficult to remove. JG 3.1.09

• On Dec 22 I had restylane injections under both eyes. He used an entire syringe for both eyes. They were overfilled and had significant swelling and brusing that lasted 6 weeks. After still having significant puffiness due to overfilling and having the tindle effect showing through skin, two weeks ago I insisted on getting the Restylane dissolved. It has now been two weeks and about 80% of it has dissolved but there still remains small bag/swelling under each eye with a bluish color. I called him a week ago about it and he said I need to give it more time to dissolve and said if he did it one more time it would dissolve my natural acids. Is that correct? Can`t I have one more small injections over the existing lumps to dissolve the remaining restylane down without it affecting my own natural acids? please help. I am so desperate to look like my old self again.

  Answer:  the hyaluronidase will dissolve it in a day, so it can be repeated again, I think the effect on the normal hyaluronic acid is small, I think he is just trying to get you to give it time to dissolve on its own. JG 2.28.09

• I am also a confused one...how does botox lift the brow area? I thought what botox did was to paralyze a muscle/area...how does it lift without using muscle? Does this kind of brow lift really work?

  Answer:  it lifts it by weakening the muscles that pull the brow down, allowing the muscles that lift to work unopposed. It works, but is subtle and shortlived. JG 2.26.09

• Hi Dr. Garcia, im 20 yrs old female and have a really dark under eye, im just wondering if theres any filler that can help diminish my dark under eye permanently? and if how long that filler last? surgery is not my option, that is why i wanna know if there is a way to remove dark eyebags. thankyou

  Answer:  nothing wil be permanently correct or improve it. Fillers can last 8-10 months in some circumstances but it will not correct many patients` dark circles if the ksin is discolored, it will just elevate depressed or recessed areas and then those areas might look better if they approach the level of the surrounding skin. Surgery rarely helps. JG 2.26.09

• I had Evolence Breeze collagen injected in my lips three weeks ago to give them a little more volume. The top lip turned out great but for some reason the bottom one developed a big lump in the middle. I`ve been back to see the doctor who tried to break the bubble, unsuccessfully. He then injected some steroid into the lump to try and dissolve it, and that has also not worked. Is there anything I can do? How long will this last if I do nothing? Thanks for your help.

  Answer:  might see if they can push out out through a small needle hole. JG 2.25.09

• I had Evolence Breeze collagen injected in my lips three weeks ago to give them a little more volume. The top lip turned out great but for some reason the bottom one developed a big lump in the middle. I`ve been back to see the doctor who tried to break the bubble, unsuccessfully. He then injected some steroid into the lump to try and dissolve it, and that has also not worked. Is there anything I can do? How long will this last if I do nothing? Thanks for your help.

  Answer:  they might try a small needle hole to see if they can push it out, steroids will not work. JG 2.25.09

• Hi Dr. Garcia, I`ve been seeing a pretty experienced dermatologist for scarring that I have primarily from acne. After trying a variety of treatments, we are now onto fillers. The problem is, he says that the scarring is superficial and that collagen is the appropriate filler for this type of scarring. I know that collagen lasts the shortest period and the idea of getting injections every month or so is not what I had hoped for. Is there any other filler you might recommend for superficial scars that might last a little longer? Thanks!

  Answer:  sorry, but no. JG 2.24.09

• Do you sell or can you offer any suggestions as far as camouflaging under eye hollowness? I tried the filler route, but it turned out to be a nightmare (radiesse was used). I am so thankful that it seems to have dissolved (5 months ago). From what I understand there isn’t a whole lot that can be done in that area except for fillers. When I look in the mirror all I see is the hollowness

  Answer:  nothing topical will work, it is only fillers, sorry. JG 2.23.09

• I have a few questions: 1. What is the best filler/treatment for lip volume, which is pretty safe and long lasting (at least a year)? Is there something which also encourages natural collagen production in the lips? 2. What is your take on botox used to soften the jaw line? The results seems good enough? Is it possible to get some permanent or very long lasting effects even after the botox is gone? Thanks

  Answer:  there is no filler pretty safe for lips that will last one year. I think Botox to soften the jaw can take a large amount and can have some unwanted side efects of muscle weakness. If you are talking about the masseter muscle, it can be reduced by cutting some out but getting it even can be difficult. JG 2.23.09

• What is the best procedure to get rid of fine lines? Pixel Laser Skin Resurfacing?

  Answer:  old-fashioned totally ablative CO2 laser. I do not think pixelated or fractional lasers will do the job. JG 2.19.09

• hello dr. garcia. i was wondering if you could help me with this question. i am a 58 year old female, blond, light skin, and i have marionette lines that go away with restylane for about 2 months but come back. the lines have zig zaggy wrinkles. is there something that will eliminate them longer. thanks so much.

  Answer:  maybe Radiesse JG 2.19.09

• DEAR DOC. GARCIA I`M 46 YEARS OLD AND MY FACE HAS LOST VOLUME IN IT WHICH MAKES MY FACE LOOK TO THIN AND MY JOWLS WERE SAGGING A LITTLE.I WENT TO A DOC. THAT HAS DONE SOME OTHER THINGS FOR ME AND ALWAYS DID A GOOD,HE SAID HE COULD INJECT ONE TWO SYRINGES COSTING $1,600.00 A SYRINGE OF ARTEFILL AND THIS WOULD TAKE CARE OF THE PROBLEM!AT THE TIME I WEIGHED 122 AND I ALWAYS LOOK TO THIN,SO I KNEW I SHOULD TRY TO PUT WEIGHT ON TO, THIS WOULD HELP IN MY FACE AREA TOO.NOW I WEIGH 133 AND I HAVE HAD TO HAVE 4 SYRINGES OF ARTEFILL BECAUSE THE LEFT SIDE THERE WASN`T MUCH IMPROVEMENT AND THE RIGHT SIDE WAS BIGGER SO HE INJECTED THE FOURTH ONE WHICH I PAID $2,000.00 FOR MORE ONLY IN THE LEFT AREA THIS WAS FEB.2ND AND IT`S ALREADY BACK DOWN AGAIN I STILL HAVE THE SAGGING SKIN BY MY MOUTH,THIS WAS THE MAIN REASON I WENT TO GET THIS DONE BECAUSE THIS REALLY BOTHERED ME!WHAT WOULD BE THE REASON THIS IS NOT WORKING ON ME DO YOU HAVE ANY SUGGESTIONS ON WHAT TO DO? I`VE ALREADY SPENT OVER $6,000.00 DOLLARS AND I DON`T SEE HARDLY ANY IMPROVEMENT AND ALSO I`VE PUT ON 11 POUNDS WHICH HAS ALWAYS MADE MY FACE LOOK BETTER SO IF I LOSE DOWN TO 122 THERE MAYBE NO IMPROVEMENT AT ALL I DON`T KNOW IF THE LITTLE IMPROVEMENT I SEE IS THE WEIGHT GAIN,I KNOW THE RIGHT SIDE YOU CAN SEE SOME IMPROVEMENT CAUSE IT`S FULLER THEN THE LEFT SIDE PLEASE LET ME KNOW YOUR OPINION ON WHY THIS DID NOT WORK?THANK YOU SO MUCH PEGGY

  Answer:  Well, Artefill is really for deeper skin injections but it is not a good choice for loss of facial fat restoration, for that Sculptra would be better. Wish I had moree to offer. JG 2.19.09

• Hello dr Garcia,I am very interested to know if hyaluronadise used to dissolve juviderm in the upper lip area can destroy the natural collagen in the skin in this area. I had hyaluronadise injected in my upper lip area 4 months ago and I noticed fine lines and crinkly skin in this area immediately afterwards,which is still the case. I had juviderm injection put the same area to augment my upper lip a few days later but there are deeper lines going upwards where the juviderm ends. can you please tell me what you think this was caused by the hyaluronadise.thankyou.

  Answer:  I thinnk the amount of natural hyaluroic acid digested by the hyaluronidase is minimal but can happen, I do not think the degree of natrual hyaluronidase dissolving though would cause wrinkles to form that were not already there. It might be from the swelling of the ill-positioned filler or from the repeat injections causing swelling. I would give it time and see what happens. JG 2.19.09

• I HAVE A QUESTION. IAM FAIRLY YOUNG. 32...I DNT HAVE WRINKLES PERSAY , just expression lines on my forehead which been there since i ws born and the lil line from frowning inbetween my brows. IThey are faint and you cant see them but osme days you can/ Anyways I want to keep my foread ones cuz they arent really that deep but want to rid the lil line between my brow. JUST ONE LINE. HOw much would that cost with botox? I dont want to spend hundreads on one line and maybe think its just not worth the vainity in it? But if its $100-$200 maybe?

  Answer:  it will be hundreds because you need to buy a whole small bottle as it is illegal to share bottles between patients, eventhough you will use only 30 units of the 50 it contains. JG 2.17.09

• Dr. Garcia, I have gotten Perlane injections twice for a prominent chin crease--they said mental crease. It only lasts about two months. I have always been an open mouth breather and was told this was the reason it is not lasting. Does this make sense? I smoked many years but gave it up 8 years ago. My lower lip has always protruded and drooped downward. Will I need Botox in this area in addition to the fillers? Thank you so much.

  Answer:  I do not think Botox will help and in some cases, like yours, that is about all the filler will last. I think past smoking is not the issue. JG 2.16.09

• It`s now 2 months with a very light bluish color left over from a bruise from juvederm injection....dr wanted to laser it but you said to give it more time...it`s still there...am I stuck with this? What is --and is it-- ashy dermatosis? (thank you internet for more panic...) The area still needs more filler because in addition to the bluish-ness, it`s still indented making it really shadowy...can I do more filler yet? (You are wonderful!)

  Answer:  in time it should all go away, it is from the filler being injected too superficially. Could try also making a nick in the skin and having it pushed out. It is called a Tyndall effect. I think it is OK to inject more filler in a deeper layer. JG 2.16.09

• Hi Dr Garcia i want to have some filler for cheekbone aumentation but i had a scar on my cheekbone which i had excised out and the skin was slightly pulled about 3-4 mm to stitch the scar up and make a new less noticable scar. If i have some filler on the cheekbones underneath the new scar can there be any other problems that can come about since a bit of the skin was excised and the skin on that area pulls a bit more?

  Answer:  should not present a problem, but the area right under the scar can be difficult to lift up with the filler in some cases. JG 2.16.09

• Dear Dr. Garcia, I wrote to you over a year ago about restylane injected into my nasolabial lines, in 2006, too superficially that never went away and looks bad. I have been to 3 or 4 ps and derm. in my area and no one really has had a good explanation for why it is still there, until my last visit to a derm. in a nearby city. She said that restylane can synthesize with the collagen and she thinks that`s what happened to me, and said she didn`t think it would go away, or that it would take a long time to. If this is true, is there anything at all I can do about it? She didn`t have any other answers for me. It still looks messed up and my face looks asymmetrical as the overfill is just on one side of my face. Thank you for any advice you can give me.

  Answer:  if it was real Restylane and is superficial a small nick in the skin and it might be able to be pushed out. Not much more I can offer, sorry. JG 2.15.09

• Hi Dr. Garcia: I see that you responded on 11.9.08 to someone about Sculptra that asked if it is approved. You said it is. I`m confused, can you clarify whether it is approved for cosmetic use? As far as I know it is NOT approved by the FDA for cosmetic use bc it has not been tested properly and I found out that 50% of the people in HIV studies got lumps and granuales. Can you clarify this fact for all so noone is confused. Thank you!

  Answer:  it is apporved for facial fat atrophy in HIV patients, is used off label legally for non-HIV patients, the resutls of the lumps in the older trial pateints was mostly due to the technique which with it was injected and the amounts injected also. JG 2.15.09

• HiDr.Garcia. I had radiasse injected on my smile lines and nasalobial folds . I had three treatments of radiasse. I had some improvement. I also had sculptra on my cheeks. will juverderm improve the appearance of my smile lines and nasalobial folds ? Terri

  Answer:  additional filler might improve it, no matter which filler is used, yes. JG 2.13.09

• wierd question. Is there any way filler can affect your breathing, like migrate into sinuses or airways (throat, lung) and affect your breathing?

  Answer:  no, there is not. JG 2.12.09

• Hi Dr. Garcia...I am getting filler touchup tommorrow for my nasalobial folds and I can`t decide which one to get...I had Radiesse in 11/07 and Juvederm Ultra Plus in 5/08...there is still some filler left in the folds...in your experience which of the two do you feel might be still there?...Thanks for your insight?

  Answer:  I don` think there will be much difference between them but the Juvederm likely has a greater safety margin as you can dissolve it if too much is put in. JG 2.10.09

• Hi Dr.Pierce: Was wondering what you think of sculptra? Can it be done in just one area, I have indentation lines across my cheeks, fillers or fat injection were recommended but if sculptra produces a swelling for three years, wouldn`t this fill the indentation in? Also just wanted to mention I got scared out of my vbeam appointment because it really sounds 50/50 of it going right or going wrong.

  Answer:  Sculptra would be a good option for that. JG 2.10.09

• I am young and have a little bit of an NL fold line on one side. Im becoming increasingly frustrated as Ive tried having it filled in twice with Restylane, once deeper and the next time more superficially and both times it failed to make a visible difference. Can this be due to my anatomy? What product gives the most lift in your opinion?

  Answer:  very likley due to you anantomy and the way the muslces, fat and bones on that side of your face are stuctured. I am afraid there is likely nothing that will be worth doing at this point, maybe in the future. Nasolabial folds are normal and they are supposed to be there, trying to change that can leave new problems that might be worse. JG 2.8.09

• I have always had smile lines appear on my upper, outer cheeks, underneath the eyes everytime I smile. I would say right below the crows feet area. Does botox work in this area?

  Answer:  no, because that is due to the cheek muscles lifting the tissues of the cheek and causing the skin to fold, not much you can do there. JG 2.8.09

• Hi Dr. Garcia. I`m considering subcision and a filler for a rolling scar on cheek. What filler do you suggest with subcision? Do you reccommend CO2 or Rytec with this? If so which one and is done at the same time? Can you refer anybody in Pittsburgh area? Thnaks for time.

  Answer:  usually use Restylane or Juvederm Ultra Pluse. I prefer to use the CO2 if possible. I usually do the resurfacing 6 weeks later. Do not know anyone personally in Pittsburgh, sorry. JG 2.6.09

• Hi Dr Garcia please can you answer these questions to the best of your knowlesge and expertise, thanks can radiesse be used into cheekbones so i could i get an exact match as the other cheekbone, could this lead to further problems? If i was to get fat grafts to build up parts of scraped away cheekbone due to surgery would it be a surgical operation or can that be injected? Could bone graft be done to a good standard to make a cheekbone look symmetrical compared to the other? Regarding the pufiness in cheek due to surgery could this be liquid (edema) trapped in the cheek and muscles? If it is scar tissue (i cant understand how scar tissue could have come about since the incision was made on the cheekbone), would it be ideal to get an mri scan could you see the scar tissue with this scan? By injecting steroids directly onto the scar tissue in small doses could this lead to further problems, is there any other ways of reducing the scar tissue and pufiness in the cheek? thanks

  Answer:  get it closer, yes, exact, no, nohting can do that. Could it lead to further problems, yes, could lead to lumps. Fat injections need a surgery to harvest the fat and then it is injected, all at the same time. Bone grafts are going to be difficult to shape it accurately to match something like your case. As to the puffiness, I think after this much time it is not fluid trapped in the muscle, that would not last this long. It is more likely the scar tissue that pushed or herniates up. The MRI scan can tell you what is there but the visible difference between normal tissue and scar tissue is not great. Injecting scar tissue can, at times, cause tissue atrophy or thinning that can cause an even bigger depresssions. JG 2.5.09

• Does resty or juvederm just mask the need for a lower face lift when addressing marionette lines? I am approaching 60, and those are really my only wrinkles or concerns. Would using fillers be just a waste of money in the long run? Would a lower face lift be best in the long run? How long do those last? Thank-you.

  Answer:  yes, fillers just lift the normal skin so the folds are less visible in some lighting. The exchange though is the lower face will look larger with the fillers in place. I think if one has marionette lines, I would only use fillers for a short term fix, in anticipation of surgery. Some people do not want surgery and then, there are no other options. I think it is likely better to have the lower face lifted and then you look better and thinner. JG 2.4.09

• Hi i think i may have edema in my cheek area due to cheekbone surgery making my cheek look slightly puffy, how may i reduce the puffiness in the cheek, note that i had the surgery over a year ago, thanks

  Answer:  hard to fix that problem with anything this far out. Swelling this far out should not exist. If what has occured is the creation of festoons, then they might respond to lasers, but doubtful. In some rare cases, the festoon needs to be cut out. Hard for me to say whether what you have are festoons though without seeing you. JG 2.4.09

• I saw Dr Ordon perform injections for wrinkles in the chest area on TV. What do you think about this? Does it work?

  Answer:  I think it is certainly doable, I think the chances for lumps are higher than on the face, and I think the amount of time it lasts is also less than on the face. I would not waste the patient`s money and time on that. JG 2.4.09

• Hi Dr..I have 2 questions...1) My PS showed me a chin implant and it looked like a U. He said they come in 4 sizes small med large and x large...he didn`t tell me they come in different shapes too...i have another consult with him soon..i was wondering if there are other kinds... 2.) I get botox to get the effect of a browlift...i think it helps some..but my injector puts it in the glabella and like right underneath the outside of each eyebrow...(I saw here you said the injector has to put it in the crowsfeet area to get the browlift) Can I get a better effect if she puts it there too?? Or is she doing that already?? Im confused...(she never puts it anywhere on my forehead and luckily Ive never had a problem w/ forehead wrinkles) Thanks Dr!!

  Answer:  different companies have different shapes and sizes of chin implants. I think as to the Botox, the more muscle that is weakened by the lateral eye injections, the greater the lift. Best of luck. JG 2.3.09

• What do you recommend for the treatment of somewhat prominent horizontal necklace bands on the neck? I had a physician recommend filling them with Radiesse, but I had her stop shortly after beginning treatment, and the half inch line that was filled is still a raised lump 2 months later, so I do not believe this was an appropriate treatment. Thank you!

  Answer:  I think fillers on the neck are unreliable and do lead to lumps, I think lasers and chemical peels are also not very effective due to the inability to perform the procedure deeply enough to manifest a change. I am afraid the solutions are limited in scope and effectiveness. JG 2.2.09

• Dr. Garcia, What is your opinion of Sculptra in the eye area also the upper cheek area? I want some added volume in both those areas. Is it possible to get a good result with it in those areas or should I look at another product instead? Thx!

  Answer:  good for cheeks but not for the eyelids. JG 2.1.09

• sorry for all the typos in my post, but i think the gist is clear, nevertheless, Looking forward to your answers!!

  Answer:  no worries. JG 2.1.09

• Dr. Garcia, I am in the process of geting about 6 cc`s (3 under each eye). It was so much and so close to the surface that I liiked like I had pronounced ,alar bags, tyndall effects, some rednedd, and also lumpy/uneven . As you can imagine, it`s a mess. It has come doen about half way thus far and is does, mthe skin thye restylane was supporting looks wrinkly and crepey (as in excess or stretched out). It`s kind of hanging in folds that are easily mistaken as wrinkles. The REAL QUESTION ARE: (1) Can I expect some redraping and also skin shrinkage in the area (or am I permamrntly stuck with all this excess skin that now looks wrinkly - never had wrinkles prior to the restylane which has been about 14 months? (2) If the skin does eventually both redrape and shrink, how long will it take to shrink/redrape, and (3) if the skin doesn`t go back to completely normal over the next few months, would you advise either a CO2 peel or dirext surgical removal of any residual excess - keeoing in mind, i had a blepharoplasty 9 yrs ago which left me on the very (not quite) of an ectropion. Since that time, I had a very heavy 35% TCA peel with no problems and it did remove lines at the time, so I`m not worried with the ectropion issue if chemical peel is used. Do you; howecer; feel it might be safe to go deeper with a CO2 peel or direct insision (the copncern is scar contracture that might push a slight ectropion into a worse ectropion - can this be judiciously done without risking more ectropion?) if it`s still needed in a few months? Thanks much! BTW, the bruised makar bag effect from the restyalne is diminishing as the restylane is being slowly dissolved over a series of hyaluronidase tx`s, so that`s the good news!) Thanks for your opinions and for this board!

  Answer:  I think the skin will likely get back to the way it looked long ago. It might take a few months after the material is totally dissolved. Hard to say what will make it better, but a light CO2 laser might be best. JG 2.1.09

• THank you for your answer about storing juvederm. Could you please tell me how long it can be stored? I just don`t want waste it. Thanks again.

  Answer:  I have seen it being stored as long as 6 months. JG 2.1.09

• PS told me that he could store unused juvederm. Do you do that? Under what conditions? Thanks!

  Answer:  it is not an uncommon practice to store the unused part under sterile conditions for a short period of time. JG 1.31.09

• Hi Dr. Garcia. Is it possible to have fat injected for the fine undereye wrinkles? I have very fine lines (I`m 31)and I just want something that will help with these lines. Would just a tiny bit of fat help with that? If not what do you suggest as the best form of treatment? I have had botox and use renova. Thank you

  Answer:  no, I do not think it is possible, the needles needed to inject the fat to get it to survive are too big for that. Might need a laser to help them. JG 1.31.09

• If you have to tighten neck skin, not muscle, via non-invasive procedures, which would you recommend? Refirm, Thermage, SkinTyte, etc. What about Profractional? What kind of surgery could I have for removal of necklace lines on an otherwise tight neck with a little skin under the chin? I really need some sage advice!

  Answer:  well, I honestly would not have to because I would not offer an non-invasive option for tightening the neck skin. Surgery will remove skin exess but will not treat the fine lines, the treatments that can be done on the neck for the fine lines yield subtle effects if any because the skin there cannot be treated aggessively enough due to scarring potential.JG 1.29.09

• I have used Refirm ST and Thermage in the past five years a couple times each. I am 44 years old. I have good skin and a bit of a saggy neck. I thought I couldn`t tell much the result of the treatments till I looked back five years. Nasoblastial fold, marionette lines, slight eye-lifting, etc. I can tell it also defines my jawline somewhat. I think the situation with these non-invasive procedures is that the result is subtle. It may help curtail the signs of aging, but will not do what a CO-2 or a facelife/necklift will do. Please don`t debunk the collagen builders--there are some such as refirme st specifically which are effective for thos who do not want the downtime of a resurfacing/peel. Thanks, Angie

  Answer:  I render here my opinion, I hear from my patients more stories of dissatisfaction than happiness with these procedures. I am glad to hear that you are one of the less than 15% that has responded well. One is certainly free to disagree with my opinion, but that is all it is, my opinion, so Caveat Emptor.JG 1.29.09

• Dear Dr. Garcia, Thank you for answering my questions re my cheeks looking very balloon like when I smile from restylane I would still like to know what the word buckling means. I know that it is a natural phenomena that cheeks always look bigger when one smiles, but would my cheeks look less ( only look less like a water balloon with Sculptra. Thank you very much for clarifying my question from yesterday.

  Answer:  no, any filler will make them look fuller both when smiling and relaxed. I think Sculptra would likely do less as it is injected deeper though than Restylane. JG 1.29.08

• Hi Dr.Garcia, I wrote a few days ago re my cheeks looking like a balloon when I smile fully with restylane. You answered that sculptra might give less of a buckling look. I just want to make sure I understand the word buckling . I want to make sure you and I are thinking of the same thing, The cheeks become very balloon like when I smile. Is it the same thing? 2.Also it seems that many people have problems with Sculptra and end up with lumps under the skin and some which are also visible. What is the percentage of people who get lumps? 3. What is sub q restylane? I read in another letter on your wite that it is not approved here. Once approved, do you think it would be a good alternative to sculptra without the risk of lumps?

  Answer:  I think if your concern is that the cheeks look too full when you smile, then anything you put into the cheek area will potentially exaggerate that appearance. I think when you search for Sculptra, or any other filler on the internet you get a slanted view as to thinking there are lots of compications, but realize that the complications are rare, it is just that people that do not have problems are not on the internet talking about it. I think any filler, I repeat any filler, can have lumps, whether Restylane subQ or any other. JG 1.28.09

• A highly reputable plastic surgeon who is known for being an award winning injector is still offering Artesense in my area. I am considering getting it for my NL folds, but I am 30, and they are not very deep. Given my age, and the fact that my anatomy will change with aging, is it a risky long term decision to make? Or are complications such as migration and nodules rare with a good injector in the NL fold area? Thank you

  Answer:  I think complications and migration are rare, but I will say, at least in the US, there are no awards given out, at least legitimate ones, for being an injector. He must have gotten the award for soemthing else. Artesense is illegal to be injected in the US. Best of luck. JG 1.28.09

• My doctor says that he uses botox for neck wrinkling. Do you recommend or not? Thanks.

  Answer:  do not use it, would not use it, I do not feel it makes much of a difference, it might help some of the bands seen only when tightening your neck but will never help wrinkles in the neck seen at rest. Have him explain the potential bad side effects to you also, if he does not tell you what thay are, I would not let him treat you as the negative side effects have been published in the medical literature. JG 1.27.09

• Dr, Garcia, I lost all collagen in my cheeks because of accelerated aging from trauma.I have high cheekbones but otherwise my cheeks are completely flat( partially because of accelerated aging due to trauma.) I had had restylane to make muy cheeks look fuller, and it looked amazing except....when I smiled. As soon as I smiled fully, my cheeks puffed up and out and looked like balloons filled with water. I am wondering if sculptra would be more natural looking If yes, can you explain why? Thank you!

  Answer:  I think sculptra tends to be better as it is meant for a deeper injection so should not give the buckling that the more superficially injected Restylane would. JG 1.27.09

• I had a very dark bruise from juvederm. After a month, I still see the shadow of a bruise. Dr. said it might be veins that got plumped up from the juv. He said he could laser the area. I think (and hope) it`s the bruise still fading...it`s the same shape as the bruise was a month ago just very light.Your thoughts please? Thanks!

  Answer:  I woudl avoid the laser and just let the staining from the bruise get better on its own, and avoid sun exposure to make it get better faster. JG 1.26.09

• I am a male who has always had a thin, angular face with somewhat hollow eyes and high cheekbones. I recently had some restylane added in my tearthrough and inner upper cheek area and honestly I think it detracts from the chisled look I previously had and makes my face look more round and pudgy. What places on the face can filler be added to enhance a chisled look rather than detract from it? Thanks!

  Answer:  you would need to get the filler injected over the boney area only.JG 1.26.09

• will thermage help with slight oral commisures ? i did C02 laser once about 2months ago, and thinking of going back to the Co2 laser in 2 more months..i think id rather do thermage.. what do you think?

  Answer:  well a regular CO2 laser might give some, but a fractionated CO2 will not, I think Thermage will be a waste of time. JG 1.24.09

• I had some Radiesse injectable filler injected on my right cheekbone to hide a small scar i had about three years ago. The Radiesse caused a lump to appear and seemed quite apparant which made me self concious. I wanted to make the lump dissapear and i was going to have some steroids injected to help reduce the lump. After hearing it was potentially dangerous i decided to approach my gp who forwarded me onto an nhs surgeon. The nhs surgeon cut around the initial scar which was about 2 cm in length and 3 mm in width running vertically on my cheekbone. He then scraped away the lump which was a lump of tissue formed by the radiesse. The lump was directly above my cheekbone and the surgeon scraped away the top part of my cheekbone as he was scraping the lump. If i feel the left side cheekbone, the untouched cheekbone i can feel the cheekbone curves smoothly upwards onto the corner of my eye socket. But on the right cheekbone where the surgeon scraped away the lump i can feel that the top part of my cheekbone doesnt have that curve because the top part of my cheekbone which runs to the corner of my eye socket feels more flat and i cant feel the plumpness of the bone, as its been scraped.away. Also the surgery made my cheek muscles swell up and that puffy look hasnt gone my gp said it may be scar tissue in the cheek. I was wondering is there any way i can build up the curve of the top part of my cheekbone as it doesnt look symmetrical is there any procedure out there that could give the top part of my cheekbone that slight curve? Also how can i reduce the puffy look of the cheek muscles from the surgery? Thankyou

  Answer:  might be hard to take the puffiness away and I am afraid that fillers will be the only answer, I find it hard to believe though that he removed the surface of the cheek bone, that is very hard bone and almost impossible unless it is done with a drill. JG 1.24.09

• I plan on being pregnant end of March (using a donor egg) and wondered if it was safe to take either Botox or restaylane 2 months prior to pregnancy. I know during pregnancy, all is forbidden but what about 2 months prior. I cannot find any answers - my doctor says to ask my dermatologist and dermatologist says to ask my doctor. Help!

  Answer:  It has never been studied so there is no 100% answer to that. JG 1.24.09

• Someone told me its GOOD to get Botox and Fillers at a younger age to save the effects of aging down the line so in the future a need for a facelift would be LESS than if you didnt do any botox n fillers? Do you find truth in this? Also....does getting botox or fillers, once run off make your lines andcreases worse?

  Answer:  well, I think Botox has some preventive effects on the small fine lines that develop from repetitive skin folding, but fillers will not stop the loss of facial fat and other tissue loss, so it is a no for fillers and a preventative maybe for Botox. The use of the products does not make anything look worse, but they do not stop the aging process, so aging and tissue damage continues but you do not see it as you are hiding it with the fillers and Botox, so in people who stop using those prodcuts after a period of time and look at themselves in the mirror, they will look older than they did when they started because they are in truth older and less youthful,but that has nothing to do with the filler, it is just they could not see the aging process as it continued to occur. JG 1.22.09

• I have little fatty pouches at the corners of my lips that looked cute when I was younger but seem to be becoming more pronounced with age - Im guesing because the rest of my face is thinning out. What is the best thing I can do about this?

  Answer:  short term, it would be fillers to hide it, long term you will need at least a cheeklift to elevate the sagging tissues. JG 1.20.09

• Thanks i agree i will never try to get the scar tissue to be cut out like you said this will just cause more. What strikes me is that i cannot feel the scar tissue all i feel when i touch the cheek is that the muscles around the cheek area seem to feel inflammed and thus making the cheek look not as symmetrical as the other one, i wish i ultimately never had the radiesse injected and offcourse made it worse by having it surgically removed, not only does the cheek look puffed out a bit of my cheek bone has also been scraped when the dr scraped out the radiesse lump and the smoothness and roundness of the upper part of my cheek bone has gone, i wish never had it done

  Answer:  I am sorry to hear about all of the hassles, hopefully in time it will get better. Best of luck. JG 1.20.09

• I had juvadrm put in about 2 weeks ago and for the last week every 2 days or so they have been administering hyalaronidase to correct 2 areas that were not supposed to be targeted. It is slowly disappating. How long is it ok to remove the juvaderm? Will it still come out up to a certain time? What is that length of time? I`m scared.

  Answer:  no way to tell I am afraid, I find it hard to believe that they have not been able to dissolve the two lumps after two weeks though. JG 1.20.09

• Hi i posted a question regarding puffy cheek muscles caused by having a radiesse lump surgically removed from my right cheek bone earlier. Ive been advised that the puffy cheeks are due to scar tissue. But when i touch the cheek muscles (adjacent to my cheek bone) they seem enlarged and bigger than the other cheek (where i didnt have the surgery done) which is giving the appearence that my cheek looks swollen. I doubth it could still be trapped swelling a year after the surgery so it could be scar tissue. You advised in my last question posted about a month ago that the muscle cannot have scar tissue inside so it could be scar tissue underneath or above the cheek muscles to make the cheek look swollen. You also advised that a scar revision could help the appearence but im afraid that this could cause more cheek puffyness. Can you advise me if the puffyness could deflate in time and where the scar tissue could have formed if its not in the cheek muscles? thanks

  Answer:  it might get better with time, yes. As to removing scar tissue, most of the time it does not work as the action of cutting it out then requires the tissues to heal and they will form new scar tissue once again. JG 1.20.09

• hi dr garcia. I have two questions. I had juvederm dissolved in my lips with hyuronadise and i have crinkly marks like tissue loss above my lips as if my own collagen was dissolved as a result. Is this possible? Also do you like radiesse as a cheek filler? I got it 4 months ago and it has deflated already.Can I get another filler in same area or will cause problems mixing fillers? Thankyou/

  Answer:  it is the skin trying to shrink down to its old state, shoudl get better with time. I do not use Radiesse as a cheek filler as it is not financially a reasonable choice, we use Sculptra. I think you can treat over the Radiesse if it has dissolved, yes. JG 1.20.09

• Hi Dr. G., What do you think of sculptra for adding some volume to the neck and hands? Thanks.

  Answer:  good for the hands, not sure where on the neck though, might be a tricky area to get smooth reliable results. JG 1.20.09

• hi dr. what about lumps caused by retalyne,is steroids going to replace the normal tissue as well?

  Answer:  steroids will not dissolve the lumps and will cause loss of normal tissue, not replace it. JG 1.19.09

• hello.I got botox 4 months ago and my upper eyelids have never been the same. they are more puffy and drooped. Have you ever heard of this reaction?Do you think that I need to have a brow lift or upper bleph to remove fat that has came as a result? Or do you recommend any type of laser surgery to tighten eyelids such as fraxel?Thankyou.

  Answer:  well when Botox is injected into the forehead it can cause drooping that can result in what you are describing, yes. I think just leaving it alone and letting is wear off should allow it all to return to normal without anything further. JG 1.18.09

• hi dr.garcia,remmber me i came to your office with lumps in my lips(caused by newfill) and cheeks(caused by restalyne),you told me to try ultrasound.is there any other option that might dissolve it,i heared about steroids?if not steroids is there anything else that could work?thank you

  Answer:  I am sorry but I think steroids will displace the normal tissue and not the Newfill, sorry. JG 1.18.09

• Dr.Garcia, year and ˝ ago I had 2 and 1/2 syringes of artrfille injections in my nl folds with no result. Can I have Hyaluronic acid fillers over of previous injections?

  Answer:  yes, OK to proceed. JG 1.18.09

• Hi Dr. Garcia, I had a consultation with a dermatologist today, and she recommended getting radiesse along my jaw line to soften my jowls, and also near my temple area I believe which she said would give my face a lifting effect. She has a very good reputation in the area and even teaches how to inject botox, but I never heard of getting radiesse on the upper half of your face. What`s your opinion about this? Thanks!!

  Answer:  I prefer to use Sculptra there and any injection in the temples can create lumps, it needs to be injected deeply, it will fill in the area but the degree of lifting is minimal to none. JG 1.18.09

• I had fat grafting performed on only 1 cheek and jawline. Only one side of my face was sunken in and now the cheek that was sunken in looks fat after the fat graft. The surgery was performed 2.5 years ago and I still have overcorrection and it isn`t going away. What can be done to help remove/ dissolve some of the fat that was injected?

  Answer:  I am sorry but I think dissolving the fat is unreliable, as much as I hate to say it, you might need some minimal liposuction to improve it. JG 1.13.09

• Which is better for the tear trough to resolve fine wrinkles, dark circles and orange peel skin, Teosyal Meso or Restylane?

  Answer:  I think Restylane will help with the tear trough, but it will not fix orange peel skin, fine lines, and the only dark circle that will improve is the single one over the tear trough. JG 1.13.09

• Dear Dr Pierce I have fine wrinkles, dark circles and orange peel skin under my eyes and am thinking of having either Restylane or Teosyal Meso. Which would you recommend to get rid of the above or would you suggest something else? What about Co2 laser?

  Answer:  I think the CO2 should help but I think fillers will not help at all for what your issues are. JG 1.13.09

• if hyaluronidase is injected into the undereye area (tear trough) in the absence of any filler (there is only scar tissue n some fat there), will it dissolve some of the scar tissue, connective tissue? can it cause any damage to the other tissues/nerves?

  Answer:  no, it will not dissolve scar tissue or affect the nerves, there would be no reason to do that. JG 1.13.09

• Hi, I have smoker lines above my lips. Can I get a filler that will NOT make my lips bigger, just fill the lines in? I`m scared I will look like a duck. Also, will Retin A help soften or get rid of wrinkles? What strength is best for wrinkles? Thanks, Lynn

  Answer:  yes, the lines can be filled in without the lips and I usually suggest starting out with weaker Retin-A and then builiding up to 0.1% twice per day when tolerated. JG 1.12.09

• Hi Dr, You kindly answered my question some time ago regarding my fears over argiform which I had injected in my lips many years ago and my fears of this causing cancer. I managed to track down the original injector with a view to having it removed. He assured me that no late reaction/infection would happen with regard to infection later on as a very small amount was used (1ml) and Argiform contains silver ions which repels bacteria. He made me believe I was worrying over nothing. I would really appreciate your views doctor as unfortunately I am still concerned about leaving it in my body ? Thank you

  Answer:  not sure it will ever leave and lumps can stil form years later. JG 1.12.09

• Hi i had surgery done to scrape our a radiesse lump on my right cheek bone about a year ago. The dr scraped out the radiesse lump but this has caused my cheek muscles to swell up and they look enlarged. Now my right cheek looks puffed out and when i feel it with my hand i can feel that the cheek muscle is larger. I went to my gp and he said that it could be that scar tissue has formed behind or in the muscle this could be a possibility. Is there anyway i can reduce the enlarged cheek muscle so it stops looks puffed out so it looks symetrical to my face?

  Answer:  might need to have the scar tissue revised, the muscle cannot get bigger like you describe though. JG 1.11.09

• What do you prefer as filler for n/l folds and any other area on face? I hear so many conflicting things about which is better, Juvederm or Restylin. My PS did resty in my n/l during lower face lift and a little in my lips. Am wondering to maintain, what i should use. Does one last longer thsn the other and is Juve thicker or thinner than Resty and which is best for little bit of vlume in lips? what about Radiesse? is it also a Hyloronic acid? I want something long lasting and dont mind paying extra for it, since the injections HURT!

  Answer:  I usually use Restylane and rarely use Juvederm. I do not think the length of them lasting is clinically significant. JG 1.11.09

• Dr.Garcia, I have diagonal type lines on my chin area due to sun damage. What filler do you recommend to help smooth out this area and how long would it last? Thank You.

  Answer:  I usually use Restylane, might last 3-6 months. Best of luck. JG 1.10.09

• I had Radiesse in the lower half of the face and was pleased with the result. However, I need some touch up but in smaller areas, also in the lower face. Would you recommend using Radiesse again or it is more difficult to get it right injecting into smaller areas? Is there any other filler you would recommend over Radiesse, both as to how long it last and less likelihood of bumps? Thanks.

  Answer:  I think Radiesse again is a good choice. I think when injected correctly it will lead to good long lasting results with nothing significantly better out there. JG 1.10.09

• Hi Dr., I have been hearing about NeoCutis`Bio Serum that is supposed to give the face a lift in 7 days because of high concentration of protein. Another expensive product with BS claim or ??? Have you heard about this product? Thanks.

  Answer:  helps small fine lines over time, nothing dramatic in 7 days ad certainly not a facelift type result. It is a good product but it sounds like over-hyping from the marketing folk. JG 1.9.09

• Happy New Year, Dr. G! Congratulations on your marriage. You deserve all the happiness you can get for your generous contribution of time and knowledge. Selfishly, I hope your wife doesn`t curtail the time you devote to this site but I sure would understand if she did!:) I had Radiesse in the lower half of the face and was pleased with the result. However, I can see I need some touch up but in smaller areas. Would you recommend using Radiesse again or it is more difficult to get it right injecting into smaller areas (still lower face)? Restylane is good but it doesn`t last as long.

  Answer:  thank you kindly for the good wishes, luckily she understands what I do and lets me type away. JG 1.9.09

• Why do you reccomend Artefill over other PMMA based fillers? Is there something about its composition that makes it better?

  Answer:  smaller annd more uniform particle size which has been proven to be safer. JG 1.9.09

• Hello Dr. Garcia; I look at your site all the time. I have noticed that many people post the same problems about lumps with fillers. You have answered a question for me in the past. I have a lump from evolence under my right eye. The dermatologist who injected the filler said it will go away in time. It has now been 14 months. Can a needle with syringe be placed into the lump to aspirate the material, or would the lump still be present after the procedure? I have seen that you have posted that the material may need to be cut out. What does this involve? Thank you.

  Answer:  I do not think placing a needle to try to remove it will work at this point, as to cuting it out, it involves a small incision over the lump and then stitiches to close it afterwards, it will leave a small scar though.JG 1.9.09

• I had Restylane injected into my NL folds a couple months ago and it looks fine but since it was injected its felt hard under my skin when I touch it. Almost like a rock hard line from top to bottom of the fold. Is this normal?

  Answer:  it can be normal if the area required a large amount of the filler in one spot, it will all go away in time though. JG 1.9.09

• I read that you use Artefill for the NL folds. I`m in Canada and its getting tough to find around here because Artefill is out of business, but there are other permanent options available in this country. I`ve heard some bad things about Dermalive and Dermadeep, but do you think any of the other permanent fillers like Aquamid, Bio Alcamid or other PMMA fillers would be just as safe for the NL folds as Artefill and do you recommend any one in particular? Thanks.

  Answer:  I am sorry but I have heard about too many problems with the other fillers you suggest and advise you do not use them. JG 1.9.09

• The hylaronaise? to dissolve those types of fillers - do they dissolve normal fat or tissue or just the filler? What types of fillers can be dissolved by the hylaronaise? Would juvederm and restalyne be one?

  Answer:  just the fillers. Only hyaluronic acid fillers can be dissolved by hyaluronidase, things like Restylane and Juvederm. JG 1.8.09

• Hello Dr. Garcia...I have a question about the non-surgical nose job. I am asian and about 8 months ago decided to heighten the bridge of my nose using Juvederm. It definitely heightened the nose but at the same time it is too wide. The doctor did not use a splint or anything to hold it in place. He simply squeezed the area, injected (one syringe) over a period of 4 weeks because he didn`t think we should do it all at once, and molded/shaped it a little. Do you think it is technique related? Or is it just impossible to build up a flat bridge without some of the filler migrating a little and causing it to be wide? I have a fairly high nose but a weak bridge therefore a whole syringe was needed. I am not completely happy with the result but would be willing to try it again if it was technique related and not the nature of the juvederm to spread or flatten out like that. Thanks so much in advance!!

  Answer:  it is technique related, it has to be injected into a very narrow line to keep it form looking wide and usually a splint is not needed. I think Radiesse is a better product for that with less migration. Best of luck. JG 1.7.09

• Does kenalog injections cause loss of fat in normal tissue or fat or just the fillers? What dissolves filler should you have a problem? Does alot of the outcome of your filler have to do with how it was injected or technique?

  Answer:  it will dissolve normal fat and I know of no filler that is dissolved by kenalog. What is used to dissolves fillers depends on what is injected, hyaluronic acid fillers can be dissolved with hyaluronidase, the others cannot be dissolved. JG 1.7.09

• Dr. Garcia, Thank you for all the great advice. I had my second set of sculptra sessions almost 3 months ago in cheeks and temples. I had had quite a bit of volume increase. Do you think it is finished? Or am I looking at more to come? Also, is it permanent?

  Answer:  it wil increase up to 4-6 months after and it might last two years is about it. Glad all went well. JG 1.8.09

• My laso nabial folds were injected with Radiesse over two years ago. I was not pleased with the look of the filler as the injector was overly aggressive and placement was poor. I was told to not worry and that it would be gone in 8 mos. to 1 year. I didn`t like it but I waited patiently and now almost 28 months later I still have the same puffy/thick strips in the upper lip area and into the folds. It pushes my nasolabial folds to the side into an unnatural position and changes my smile. Is there anything that can be done to try to get rid me of these effects at this point or at least reduce them? Since it seems to be lasting so long is it possible that Artefille was injected instead of Radiesse?

  Answer:  sounds like something other than Radiesse was injected, I am afraid there is likely not much you can do to speed the dissolving of the material though. Might want to request your file form the docotr to see what is in there.JG 1.7.09

• What would happen if you had Aqumid injected on top of a previous Hyaluronic acid temp filler that hadn`t quite disspated, would it cause problems? Thanks for your time all the best for 2009

  Answer:  they should not interact. Best of luck. JG 1.7.09

• I`ve read about scar tissue from fillers that causes lumps? Does this always happen or is it rare? Is it the way the filler is injected? How is this treated? Is the person ever permanently left with unsightly lumps?

  Answer:  it is rare, not all lumps develop scar tissue, most are just little deposits of the filler that dissolve in time. It can be technique related at times. JG 1.7.09

• I had a consult for fillers. THe doctor suggested restalyne mixed with a little radiance for the tear trough and to lift the cheek area a little. Radiance for the nasal folds? THey massage the area and have never had a problem with clumping with massaging the area? Is the suggestion, in your opinion, the best solution for the tear trough? WHy or why not? Is this the best solution for the folds? Why or why not? What is the percentage of getting granulomas or lumps? Is it common or rare from Radiance, Juvederm or restalyne?

  Answer:  I use both fillers but I find the amount of cheek fill from the Radiesse not to be worth the cost. I think the difference between the two on nasolabial folds to be small. JG 1.7.09

• What is a granuloma and what causes it? Can it dissolve on its own or is it permanent? How do you get rid of it? Can you get a granuloma from restalyne?

  Answer:  a granuloma is scar tissue around some material. It usually will not dissolve on its own and at times needs to be cut out if it causes a problem. JG 1.7.09

• dear dr Garcia. what happens to my tissues if they use too much hialorunidase to dissolve juvederm bumps under my eye? what happens if hialorunidase is applied to tissues withuot juvederm? thank you

  Answer:  it does not affect the normal tissue to any appreciable extent. JG 1.6.09

• dear dr Garcia. how much hialorunidase and what concentration would you recommend to get rid of small (about 2 mm) juvederm bumps under eyes that were there almost 2 years.

  Answer:  those are things your doctor should know. JG 1.6.09

• Dear Dr. Garcia, Are you aware of any problem if expired artecoll or artefill is in injected when 5 to 6 months past the expiration? What is the stability of the product past the expiration and could injecting expired material of the nature be harmful? Thank you.

  Answer:  the only thing that could happen would be an infection which likely would be easy to treat with antibiotics. I think the product is stil stable though. JG 1.6.09

• dear dr Garcia. are there any dammages to tissues after using hialorunidase. i am talking about under eye area. thank you

  Answer:  none that I have heard of, read about or seen. JG 1.5.09

• what can i do to help remove a scar, i had tried the co2 laser, and i told you didnt do anything.. anything else that i can do laser wise or anything?

  Answer:  there is nothing that will completely and permanently eliminate a scar I am sorry to say. JG 1.4.09

• Hello Doctor and Happy New Year to you and your staff. One question: can a Sculptra test injection be done on one side of one hand to make sure that I will not have a reaction (ie: nodules, granulomas, inflammation) to the injectable?

  Answer:  having an injection in one area not create a granuloma does not mean you will not get a granuloma in a different area I am afraid, and Happy New Year to you as well. JG 1.4.09

• A girlfriend asked me if you were doing silicone injections for fillers and lips..I am a client of yours,(you have seen my face more often than the OB has ) and I was kinda dumbfounded. Is it legal to use silicone for those purposes and if so would you recommend its usage??

  Answer:  no, I am sorry but I would never do silicone injections, it is also illegal to perform them in Nevada. JG 1.4.09

• had CO2 laser one time for a small scar to my lower left cheek near jawline, it didnot help, it has been a month and redness and seems scar still there.. does it require another treatment? it is a minor minor scar.. will it ever go away with the treatments?

  Answer:  it will never remove the scar, it might flatten is is about all, not sure what they were trying to do, the redness will persist a variable amount of time dependent on how deep they performed the laser. JG 1.3.09

• Dear Dr. Garcia, Can a person opt for a filler such as Juvederm for the line between the eyebrow versus botox? Can they get the same effect? I am not a fan of botox, and would like that line filled. I have heard stories of people feeling ill, etc. Just wondering. Happy New to you. Thanks.

  Answer:  it can be done there, but a filler will not stop the area from moving, so it does differnt things, the filler helps the lines seen at rest only, not the ones when you animate yuor face. All the best. JG 1.2.09

• Hi just asked a question about my NL folds and I have one more. I began to notice them last year when I was 29 years old after going through a very stressful period in my life due to a traumatic event and I barely slept or ate for 2 months. Given my age and the situation, do you think my face began to droop causing these folds or was it the loss of fat? Thanks

  Answer:  more likley fat loss at your age. JG 1.2.09

• I developed pretty mild nasolabial folds last year when I was 29. I recently had them filled along with my upper cheek area. My upper cheeks definately look fuller but the NL lines look exactly the same. In the NL lines alone I had about .75% of 1 vial of restylane. I`m trying to figure out if her injection technique was incorrect or if I just need more product or a different product altogether. Will Perlane or Radiesse give me more volume than Restylane in this area? And for mild NL folds should they be injected deep or superficially? Thanks

  Answer:  might need more injected, superficially, and the other products will only last longer, not fill in better. JG 1.2.09

• What do you think about the research that shows that Botox traces can be found in the brain for 6 months after injection? I have been getting Botox for over 8 years now, and am a little concerned. I do experience some undiagnosed neuro. problems.

  Answer:  those reports as far as I know were done in cats and the Botox was injected into the area around their whiskers and cat whiskers send direct signals to the brain whereas the facial nerves in humans to not function that way, thye do not go retrograde, so I would say that it is not anything to worry about. JG 12.29.08

• I have had Juvederm Ultra injected three times over the past three years. The last injection, done two years ago, is still holding strong. Is this normal?

  Answer:  not normal at all, but I guess that is a good thing for you. JG 12.29.08

• Dr G- Just read about the person who has a old restylane lump...I do also...I showed it to a PS who said it could be a calcified lump from a bruise. Your thoughts please? Thanks

  Answer:  coud dbe, rare problem though, it is called a granuloma. Merry Christmas and Happy New Year. JG 12.27.08

• Hi Dr. Garcia-Just had Juvederm Ultra injected into nl fold and puppet lines. Got a few bad black and blue bruises...I know I do bruise easily though...I`m past the point of ice but wondering should I try some heat? Would that help dissolve the bruise? Many thanks!

  Answer:  heat should help, yes. Merry Christmas and Happy New Year. JG 12.27.08

• Dr. Garcia, a week and 1/2 ago, I had a fat transfer to my upper eye lids and under my eyes. There is now a hard, visible lump under my right eyebrow. Under my eyes it is still swollen and looks like shelves, but I can not feel any hard lumps. What can I do for the hard lump? When will the swelling / shelves go down under my eyes?

  Answer:  warm packs and massage at this point is what I would suggest. Hopefully it will all disolve and go away in time. Merry Christmas and Happy New Year. JG 12.27.08

• Dear Dr. Garcia, What filler do you believe works best to soften the jowls: perlane, restylane, juvederm or radiesse? Or, are they all equally good? Can the same filler be used for marionette lines? I heard that perlane and radiesse are thicker and injected deeper into the skin to smooth out the jowls; is this true? Thank you and Merry Christmas! Your generosity and help is a gift to us all year long!

  Answer:  I think Perlane if I am given those choices but it is the marionette line that is filled, not the jowl, jowls cannot be injected ss they get worse. Merry Christmas and Happy New Year. JG 12.27.08

• How much hyaluronidase would be needed to dissolve .6 mL of Juvederm? What should the cost be? Should I experience bruising, swelling, or any other complication if I have the enzyme injected to reduce the bags under my eyes created by a Nov. 8 injection of Juvederm?

  Answer:  there are accepted doses used per injection, there will likely be at least a little bruising and it can take more than once to get it to dissolve, it can be repeated 1-2 days after. JG 12.22.08

• u said it won`t be safe to try PCDC (phosphatidylcholine and deoxycholate) injections to dissolve the extra overfilled lumps that are bulging out under the eyes due to a past fat grafting gone wrong. pls let me know why u thinks it`s not safe? also, what abt phophatidylcholine alone? wud it wok and wud it be any safer? the lumps of fat seem to be enclosed (u can feel the capsules) and i already tried kenalog which did work for a month or so but after that the lumps always came back (probably showing that they r more fat than scar tissue) so i wud like to first try any other alternatives before getting them surgically removed.

  Answer:  well, the only place is was used legally was in Brazil and it was taken off the market there, it is still being used all over the world with little safety documentation, and is being used illegally in most cases. It is not approved by the FDA. I do not suggest you try either material to dissolve the fat. JG 12.20.08

• Hi Dr. Garcia, I had restylane injected into my nasolabial lines almost 2 years ago and the nurse practitioner that did it really botched it up. It was way overfilled on one side and much too superficially. It was a nightmare. The doctor promised it would get better with time. (But I did get my money back at least.) Well now 2 years later that one side still doesn`t look right. Two dermatologists have told me there is no way any restylane can still be there and seem puzzled. But my question is this: if the restylane is injected very superficially, is in possible that the body can`t absorb it? Or, if it was injected poorly, could what remains be a scar? I seem to be the only person in the world that`s had this problem. Any thoughts on this would be greatly appreciated. Thank you.

  Answer:  superficial injections will stil dissolve, maybe a little slower is all. The injections should also not cause any scarring either. JG 12.21.08

• Sorry about the Caps.....accidental...lol

  Answer:  no worries. JG 12.21.08

• If a BOTOX INJECTION IS PLACED IN THE LOWER PART OF THE CHIN WHERE THE PUPPET LINE ENDS DOWNWARD, WILL THIS NOT MAKE THE PUPPET LINE BULGIER LOOKING, LIKE HANGING DOWNWARD MORE, DUE TO NUMBNESS OF THAT MUSCLE ???? MY FRIEND HAD THE BOTOX INSTEAD OF RESTALYN AND IT SEEMED TO HAVE THE PUPPET BULGING LOOK WORSE? CAN YOU PLEASE EXPLAIN THIS TO ME. MUCHAS GRACIAS !

  Answer:  Botox is not a good idea for that area. JG 12.21.08

• if filler is place on the lines that are already bulging, sagging down...would the bulging not just look fatter , or would it be placed more to the inside of chin area?

  Answer:  it is placed on the derpessed area, not the bulging area. JG 12.21.08

• Dr....regarding the Puppet lines going from outter corner down,...where would the restalyn be placed since these lines are already buldging down

  Answer:  they are placed below the crease to attempt to plump it up. JG 12.21.08

• can PCDC (phosphatidylcholine and deoxycholate) injections be used to dissolve the extra fat overfill lumps under the eyes from a past fat grafting procedure gone bad? i want to avoid getting the extra fat and lumps surgically removed.

  Answer:  I do not think it would be safe to try that. JG 12.21.08

• Good Morning, I haver a Line Like Fold corners of mouth going doing (down to outter chin area) each side, like a Puppet....would you recommend Restalyn and Where would the filler be placed......Thank you

  Answer:  yes, Restylane is my choice there. JG 12.20.08

• I know you are not a big fan of fat transfer....just curious if you believe that MD technique has any impact on successful outcome (i.e. acceptable fat retention and natural appearance)?

  Answer:  to a small percentage, yes. JG 12.19.08

• Dr Garcia, my apologies to ask again about my big concern about a Dermalive granuloma in my eyelid socket just below my eyelash line. As I mentioned I have had two surgeries to remove the product however, the granuloma grows back. What are the risks of leaving the granuloma as it is ... i.e. could it cause blindness, can the product migrate into the blood system? I am very worried about it. Thank you

  Answer:  it will not migrate and will not casue blindess or any other problems except for the lump. Best of luck. JG 12.18.08

• Can restylane fine line be moved? I had some injected under my eyes 24 hours ago and some looked a little out of place so I pressed down on it with my finger pretty hard and kind of smeared it in the desired area, and to me it looks and feels as though it did the trick.

  Answer:  it will move it a small amount, but I think using Restylane Fine line there will not last long though. JG 12.16.08

• Second and last question, Doctor :). A friend of mine wanted some rather small and shallow acne scars filled in nose with some of the approved injectable fillers. The derm filled the scars in her cheeks but told her he could not do the same in the nose, because filling some of those scars could result in clogging a sebaceous pore - as if some scars were pores and that filling them would create problems. Do you agree or is it not true? (or did my friend understand things poorly?).

  Answer:  it is true. JG 12.16.08

• Hello Doctor, I thought I had posted my question but apparently my computer acted up. I would like to know what happens when salicylic acid in a concentration of, say, around 20% or less (but more than in over-the-counter salicylic based products for oily skin) is applied focally, to fight stubborn enlarged pores with blackheads and/or that, from what you said in previous posts (if I understood it right, if not, sorry) could remain enlarged because of having hardened sebum deep into the pore. If one applied (a higher than usual for other parts of the face) salicylic acid with a toothpick pressing the pore and only the pore, could that acid travel enough deep down to dissolve the hardened sebum and then could the pore become less large? Or is that hardened sebum too hard to remove by any means? Hugs and happy holidays :)I think a glycolic acid peel and then an immediate microdermabrasion migth help though.

  Answer:  the purpose of the acid is to remove the flimsy layer of skin at the surface to allow the oil to come out, it will not dissolve or dislodge any deeper material. JG 12.16.08

• Would I be able to share a vial of restylane with my husband at most places? Or is their policies against that?

  Answer:  that is a breach of the standard of care and should not be done. JG 12.16.08

• I have a small hollow in my upper cheek that I keep trying to fill in with restylane. Every time I fill it, it looks good for about a week while there`s swelling and then it pretty much looks the same after that. It can`t be that I`m burning the filler that fast because I can still feel it in other areas of my face like my NL folds. Should I try having the hollow injected more superficially?

  Answer:  I think that would be the logical next step, yes. JG 12.14.08

• Dear Dr Garcia I have an indentation in my right upper cheek which will not be filled--no matter what injections have been used, it still remains. I have been to three different dr`s and have been injected with restylane, juvederm and radiesse(the radiesse has been injected at least 4 separate times)The left cheek rounds out perfectly but the right side rounds out with the same indentation. Why does it not work on that small area? I have no scar there that may prohibit the filling. I guess at this point I just may as well give up unless you have a suggestion but it really bothers me especially when I use makeup. The indentation on my cheek always appears worse after an injection because the surronding area is plumped up. All three doctors have told me it was impossible not to be filled when injected but it simply hasn`t worked. Each also told me it was the fault of the injector but now I simply don`t know. I can`t keep this up as it is expensive and I am tired of the black and blue marks that take days to disappear. Is there anything I can do?

  Answer:  hard to say without seeing you in person, have you had surgery before on that cheek? JG 12.14.08

• hey dr garcia! what kind of material do you recommend for lip augmentation? i have seen some incredible before and after pix as well as horiffic ones. I dont like the results which make the lips lose its shape and has been filled in all the areas equally with make the upper lip look like one plump line going across and the bottom lip as one straight plump line. as supposed to the lil natural curves of the lips. (i hope that makes sense). but how can you avoid that done look.. if you see megan fox`s before pix and compare them to the most recent you can see the subtle yet plump natural look. thats exactly what i want. so plz offer your suggestions. thanks!

  Answer:  we use filers, mostly Restylane. Technique is very important to acheiving a good cosmetically pleasing result. They offer the greatest degree of control. JG 12.11.08

• ahhad onetreatment of co2 laser for marionette lines (primarily for the needle marks that i had sustained from doing a ton of juvederm injections.. it seems the need marks and marionette lines have disapeared, is this possible with only one treatment

  Answer:  I do not see how CO2 laser would help them, not really sure why they would have even suggested it, I honestly think it is a coincidence. JG 12.11.08

• What is the best filler for frown lines? Poeple are always asking me if I am mad but the ends of my lips just turn down. More as I get older.

  Answer:  we usually use Restylane for that area. JG 12.11.08

• In a previous question/answer, you thought it is probably best to wait until after a neck/lower face lift prior to getting a filler to the lower face if surgery is scheduled in the near future. However, will it affect the outcome of the procedure if done prior? I would like a little volumn now if possible. Thanks.

  Answer:  no, no negative effect if done before. JG 12.10.08

• How come I have not heard much about the HA filler Captique ? I have read it has less swelling and other adverse events than Juviderm, Restylane, etc.

  Answer:  no longer being sold. JG 12.10.08

• I had fat injected in my cheeks and lips a week ago , I HATE my lips they are very pouty , how can I kill the fat cells and get my lips back? Thank you

  Answer:  no need to kill the fat, it will likely all be gone in 6 weeks, just a little massage for now, not much else I think is safe to speed it up. JG 12.10.08

• Hello Doctor, I have had a Dermalive granuloma under my eye for many year, despite several operations to attempt to remove it. It is the size of a grain of rice and I have now learned to live with it. What is the worst case scenario that could happen if I just leave it alone and avoid further surgery to remove it? Also could 5FU be used in this area as the lump is positioned just a couple of centimetres below my lower eye lash line? Thankyou

  Answer:  it will likely stay that way with no further change. I think 5FU is worth a try but I am concerned that if they could not remove a lump that is felt, how can that doctor be able to stick a needle directly into it. I would leave it alone. JG 12.9.08

• I know it differs from person to person, and place that it`s injected, but on average, how long does restylane fine line last as it`s legal here in canada?

  Answer:  6-12 weeks in most cases, maybe a little more in areas with less motion, but around the vertical lip lines, that is about it. JG 12.8.08

• Hi Dr. Garcia- With the recent news of the Artefill developer going bankrupt, do you still offer the injections? Is the product still safe?

  Answer:  I think the product is no less safe than it was before, we still offer it until we run out of stock and I think the reason for them going bankrupt is likely the company had too small of a treatment option for their single product. JG 12.7.08

• Can you recommend a filler that can be used on the forehead between the brows? I have used Restylane there in the past (very painful). Can Juvaderm be used on the forehead? Thank you.

  Answer:  it can be used but it might hurt as much as the Restylane. JG 12.7.08

• Is it okay to have some type of filler (Juvaderm or Resylane) prior to a necklift (and partial lower face lift). I just want to make sure it will not affect the results of the lift, but need a little extra volumn. Also, is it okay to get a flu vacination prior to cosmetic surgery and/or receiving Botox/filler injections. Just wabt to be sure there is no interaction. Thanks in advance.

  Answer:  I think it is fine to do, but might be better to do it one month after is there is not much time between them. JG 12.7.08

• Co2 laser here again. the area is beet red, have been using ice with paper towel wrapped around it.. im just worried of infection.. i just keep cortisone on it and aquaphor the area is is about 1 inch ...

  Answer:  no on the cortisone, OK with the aquaphor and the redness is normal. Hang in there. JG 12.7.08

• hi co2 laser here again for small scar had done on tuesday still have extensive brown/red patch? should i be worried? thank you

  Answer:  no, might take a week or more to fall off, do not peel it off, let it fall off on its own. JG 12.5.08

• hello Doctor Garcia, With regard to fat transfer to the face, is it true that the fat cells injected can behave like the fat from the area in which they were taken? i.e if taken from the thigh and the patients puts on weight in this area, the fat cells taken from the thigh and injected into the face will also increase in the same way? Thank you

  Answer:  typically, if the fat cells survive, they will behave like the fat from where it was taken, correct. JG 12.5.08

• What is the best filler for under eye hollowness?

  Answer:  for the rim my preference is Restylane. JG 12.4.08

• dr. G thank you for answering my question about my facial fat transfer. questions...is there some kind of laser or ? therapy that can help with dissolving the fat that has been transfered into my face? what about having it removed? if the body is going to absorb the fat typically how long before before that happens? again appreciate your time. ED

  Answer:  I know of no reliable way to melt the fat I am afraid. I think most of what you have at this pint in time is swelling though. The body will absorb it and I think you wil be happy/depressed at how much dissolves in the first 6 weeks. All the best. JG 12.4.08

• Dr.G...Hi I had lipo to my hips and back three days ago. at the same time the dr. did a fat transfer to my checks and nose fold area. my face looks completley different, the corners of my mouth now goes downward. my shape of my face is different, my eyes, my mouth. i`m pretty disturbed at the results. even though it`s only been a few days. i can`t imagine it correcting itself. can a fat transfer be reversed? what are my options? i look like ms. piggy. please help! thank you!

  Answer:  not really able to be reversed but I think you will likely lose most if not all of the fat that was injected and return to your previous appearance. Hang in there. JG 12.4.08

• Hello. Great site for folks searching for honest comprehensive information! I am a 40yr old male. I have some depressed scars and uneven skin tone (white to red) on my cheeks. As you may know, in certain lighting, this can be flat out embarrassing. About 2 years ago I had some sculptra (1cc x2 tretments) and one fraxel treatment, from a fairly conservative (but good) plastic surgeon. I would have settled fo the slight swelling after treatment and called it a success. The actual results were so-so. Never seemed to be great or lasting. Recently, at a local dermatologist, I got a radiesse injection and, two weeks later, he followed followed with a partial, 1/3cc, restylane spot area treatment. At first this seemed like a good approach, but as the swelling disappeared, the product (restylane? radiesse?) appears to be shifting around and never looks even or consistently smooth. A bit lumpy looking. One of the depressed scars seems to have plumped-out around the edges, but remains depressed in the middle. Almost looks worse even though I know the product is in there. I am afraid to go back to the dermatologist. I am sure he`s knowlegable but maybe not experienced with fillers. My questions: 1) would continued massaging help the product adjust/smooth out - or should I wait until it desolves in several moths? 2) what would you recommend for me - testure/tone/depressions/general skin tightening? I am patient and I am willing to go through discomfort for decent results. I know it will never be perfect, but I would like to achieve more dramatic reults if possible. I believe an experienced motivated doctor is a must. Coincidently, I am in vegas regularly and look forward to scheduling a consult for a more involved opinion. Again, great site. Happy Holidays to you and your staff. AH. 12.3.08.

  Answer:  masssage might help smooth it out a bit faster, yes. It sounds like you have tried the minimalist things and now need to get aggressive, might suggest a moderate to deep regular non-fractionated CO2 laser, a few weeks of down time and a couple of months of pink skin for likely 3-7 years of improvement in most case. All the best and we would be happy to see you in consultation when you are in town. JG 12.4.08

• OK, so I just went to my PS office for a quarterly dose of botox. I read your posting about single use but my doctor says they pre draw botox in units of 10 from the vial, therefore eliminating cross contamination. Made sense to me! They also switched to doing these 2 days a week, so they can stack up patients so no risk of it going bad once its been mixed. Thoughts? I could not afford $1000- $1200 for a full vial.

  Answer:  still illegal, actaully it is worse becasue they admit what the proper way to use it is and they willfully attempt to circumvent the issue. Nice to know a doctor will justify breaking the rules for profit. JG 12.4.08

• ihad co2 laser yesterday, and only for one little scar have now a big brown patch.. i know it is normal, but it looks scary

  Answer:  it is normal but I will say that spot treatments like that yield small degrees of improvements that are disappointing as to get enough skin shrinkage to improve a scar a large area needs to be treated in the vast majority of cases. It might work if the scar was raised but then the surrounding area would not need to be treated, just the line. Best of luck. JG 12.3.08

• Hi doc I just had some hydraulise injected into some resty lumps he only put in a small amount how long before it will start to work and will it help with resty injected a couple of months ago near my eye to cheek area its causing a crease from my eye to my cheek. I s there anything I can do to spend it up massage more?

  Answer:  it will work if it is going to work in 1-2 days, many times it has to be injected more than once though. It will help with older injected hyaluronic acid products too. Nothing you can do to speed it up, sorry. JG 12.3.08

• Dr. Garcia, What would you recommend as a permanent filler/solution for fat loss in cheek? Thank you. Mac

  Answer:  there is nothing permanent I would suggest, I would suggest Sculptra and it might give you 2 years. JG 12.3.08

• Dear Dr. Garcia, I had restylane injections for the first time this morning. So far no side effects - how long after injections can side effects develop? I had just a couple of acne scars on my cheeks injected. Thanks for taking the time to respond.

  Answer:  they usually pop up in the first couple of weeks. JG 12.3.08

• Hello Dr, Which has the best chance of lasting longer, Restylane Sub Q or fat transfer? Thanks

  Answer:  Restylane. JG 12.3.08

• Dear Dr: I apologize for sounding demanding, by asking you if you understood how I was describing my nose. would you be willing to see me for a consult?. at least maybe I could be steered in the right direction...there must be something that could help..your time is appreciated.

  Answer:  I would be happy to see you, but I wil be honest, with what you have told me and the time and course of events and the highly unusual condition that has arisen, I am not sure I have much more to offer, but an in-persn consultation is certainly worthwhile if it will help you in any way. JG 12.3.08

• hello, I previously emailed re: radiesse injected along the bridge of my nose, with appearing redness, raised skin..would laser treatments help to eliminate the redness.and would putting some scar softening agents (like mederma) help to resolve and flatten the raised skin that appears to envelope my normal skin underneath. do you understand me when I say that the skin over my nose once injected with radiesse is smooth..it looks like a wax covering my normal pore texture when I look at my face in certain light, you can see the outline of where I was injected two years ago.

  Answer:  I understand and I do not have anthing to offer to help, sorry. JG 12.2.08

• Sorry, I meant to say that I live in Canada, and Restylane sub q is legal here. I know that Sculptra is best for the midface and not the NL folds or the upper cheeks, is Sub Q similar to Sculptra that it should only be used for mid facial fat loss and do you think there would be the same chance of lumps?

  Answer:  correct, it is meant for deeper injections similar to Sculptra but if injected into the malar area it will lift the nasolabial fold line. I think the chance for lumps is less with Restylane SubQ than with Sculptra, but it is low with Sculptra. JG 12.2.08

• What do you think of the new restylane sub q for the upper cheek hollow or the NL folds?

  Answer:  wish we had it here legally for that use. JG 12.2.08

• What do you think of the new restylane sub q for the upper cheek hollow or the NL folds?

  Answer:  wish I was able to use it in the US legally. JG 12.2.08

• Restylane only seems to last a week for me which is strange because I`m only 29. Do you think that since I am fast metabolizer of Hydraulic acid products, I will also likely be a fast metabolizer of fillers made of other substances like collagen (evolence) or Radiesse?

  Answer:  I have never heard of that if true Restylane was used and injected properly, if you were a fast metabolizer of hyaluroic acid you would metabolize your own too and would look older than your years. JG 12.2.08

• hi there, i just had botox to the forehead, for the 11`s and lines (horizontal) and botox to both eyes for crows feet at corners of eyes.. im having drooping now for both eyes.. its like my forehead has been lifted up, and my eyes appear to be closing since the procedure. the procedure was 2 weeks ago, and still have the ptosis both eyes. im filming a commercial on december 15th, and just want to be myself again.. will the ptosis disappear by then? im very worried, and anything i can do? i had seen my doc for a follow up today to question the ptosis bilaterally,a nd he really said that there was nothing that can be done.. he really appeared apathetic...and told me to stop worrying.. can you help??? thank you!! first botox experience here and i need my eyes to be open for my commercial... putting on eyeshadow and mascara is difficult..

  Answer:  it will likely get better but might not totally be gone, it is from the Botox and the locations injected. It can be predicted in some cases. Best of luck. JG 12.2.08

• Hello Dr: I`m the one with the radiesse on the nose bridge questioner...can the side effects to radiesse include formation of scar tissue underneath..this one plastic surgeon said it was scar tissue that had developed underneath the skin, not just residual filler matter as you opined..your clarification is appreciated..if I were to see you, would you be able to ascertain that distinction..the skin remains reddened and swells, and the texture is different over those portions of the nose where the radiesse was implanted.. my other question is, (independent of whether I have developed scar tissue underneath), would laser treatment over the area in an attempt to resolve the redness, aggravate the skin (and then develope further scar tissue..or whatever the thickened skin is underneath)

  Answer:  well, I guess in theory it could but I have never seen it happen nor read about it happening. It has not been reported in any medical literature. I am afraid that an in-person evaluation would yield little new information, sorry. Might suggest a 6 week course of Cipro to see if it is a low grade infection is about all I can think of. JG 12.2.08

• Hello Dr. when I previously told you that I had posted an email regarding radiesse injected along the bridge of my nose, it has been over two years ago that this was done..that gel carrier has no doubt dissolved a long time ago I am left with skin thickeining..I thought radiesse doesn`t cause scar tissue formation..anyway, now that you know how very long ago the injections were, any other advice for me?

  Answer:  sorry, I misunderstood, I thought it was two months and not two years, if in fact it has been two years then the gel is long gone. I have not seen true Radiesse last that long either though. Radiesse can cause granulomas but that causes lumps and not a general thickening of the skin. I do not think surgery will be easy in terms of removing any residual material though, tough problem, wish I had more to offer. Still do not think steroids will be a wise and effective option though. JG 12.1.08

• hello..I wrote you 10/3/08 regarding a horrid result of skin thickening/scar tissue where radiesse once was injected from the top of the bridge to the tip.the outline remains hard and red and the tip is still enlarged, with constant redness/inflammmation..you advised against any steroid treatments or tissue excision. Is there anything that can be done..one dr suggested laser tx over the reddened area..could that help in any way to hone down the tissue..my nose tends to swell naturally..do you think paying you a visit would be a good idea..it seems like every doctor (dermatologists, plastic surgeons) have a different suggestion..I don`t trust any of them and I am reticent to do anything..when I look in the mirror, however, I become extremely despondent, angry and want to take some action..the skin texture on my nose is smooth and raised,.it is shiny/translucent like and of a different texture then my normal skin, with no pores showing through the injected areas. Your feedback is greatly appreciated.

  Answer:  well some lasers like a YAG will help with the redness but will not do anything to speed up the dissolving of the material. It will not help the swelling either. I am not sure I can offer anything besides just waiting it to get better on its own, most of the carrier gel should absorb in the next few weeks and hopefully that will help, I think trying to do too much will make it worse and make it last longer. Time will make it better, so patients is your best friend for now. JG 12.1.08

• Dr. Garcia! Whats the difference of Juvederm-REstylin-Radissene-Botox. What lasts the longest and what are the differences

  Answer:  Radiesse and Juvederm are fillers and Botox is a msucle weakening shot, the fillers work by filling in wrinkles and the Botox works by weakening the muscles that cause motion that cause wrinkles. Radiesse lasts longer than Juvederm and Botox is entirely different so there is no correlation. JG 12.1.08

• Hi: I recently went to my physician about removing a bump caused by evolence injection. I had it performed a year ago and the bump under my eye caused by the filler has not gone away. He told me I should leave it alone and it should disappear in about another year or so since it is a collagen like filler. I did not want to push the matter as for fear of a scar once it was removed or messed with. Do you believe that these bumps disappear in time? Should I possibly have you look at the bump for removal the next time I am in Vegas? Will it disappear if I leave it alone? It seems that fillers can be good and at the same time cause side effects that may be bothersome. Please advise on this matter. Thanks for your answers.

  Answer:  they should dissolve on their own, might be able to make a small nick and push it out in a small number of cases too. How involved removal is depends on how deeply it was injected, the deeper the injection, the more challenging it is to remove. Should also report it as an adverse event to the FDA. JG 12.1.08

• Dear Dr. Garcia: I had juvederm injected into my nasolabial folds and jowl lines on 11/12/08. I`ve had restylane in these areas before, but this time my plastic surgeon used juvederm. He also filled in a few divots from old scars in my chin. All seems to be going all right (finally) with healing/swelling/bruising except for one thing. I`ve had a painful area in my far right cheek next to my ear for several days now. Could this be related to the filler injection? A trigeminal nerve problem? Or salivary gland (e.g. parotid)? Other? Have you ever heard of anything like this as a filler injection side effect? Thanks so much, and I really do love your site. Regards, Julie

  Answer:  I have not heard of that occuring due to the filler, doubt they are related though. Might be something else. Best of luck and thanks for the kind words. JG 12.1.08

• Do you think some patients may be more prone to getting lumps from facial fillers or is it ALL due to substance used and the skill of the injector?

  Answer:  the patient`s efects on developing lumps is small, it is mostly due to the other issues you mention. JG 11.26.08

• I`ve been getting Restylane in the dividing area between my upper cheeks and lower eye bags and the results are incredible.. for a couple weeks and that`s it. It seems my body eats up filler very fast. Is this because I have a fast metabolism? What other fillers can I try in this area that will actually last? Radiesse? Perlane?

  Answer:  I think Perlane is an option but it might take more injected at a deepr level to stay longer. I would likely not use Radiesse in that area for fear of lumps. JG 11.26.08

• how do yu feel about radiesse at the oral commisures.. have you seen granulomas after injection.. im very happy with mine, but a doc told me a granuloma can develop , but when if it does?

  Answer:  I think it works pretty well, I have been fortunate and not had any of my patients get granulomas but they can happen. If it does it usually develops during the first few months. JG 11.25.08

• My doctor used juvaderm as a filler for lip augmentation. My lips are too big and he suggested to use a laser called yag laser which produces heat to disperse the product. I have also read about vitrase or Hyaluronidase. Does the Hyaluronidase get rid of the entire thing or can it b used to reduce the amount? What about the yag laser, have you ever heard of this? MY appt is tomorrow

  Answer:  the hyaluronidase is not specific and will dissolve what it comes in contact with, I do not think a YAG laser, or any other laser as far as that goes, will help dissolve it any faster than allowing it to dissolve on its own. JG 11.24.08

• Hello Doctor, What filler do you recommend for the malar region? Thanks

  Answer:  for the malar folds I use Restylane, for the malar fat I use Sculptra. JG 11.24.08

• Dear Dr. Garcia, what do you think is the best a longest lasting filler for the nasolabials? I have used juvederm and restylane, neither of which lasts very long. Perlane lasted a little longer. Can Sculptra be used in the nasolabials? I assume that the more the cheeks sag, the worse the nasolabials get? Thanks

  Answer:  the longest lasting filler for nasolabial folds is Artefil, but technique is important as long lasting can be both good and bad. I would not use Sculptra for folds, it is for tissue or fat loss over large areas. JG 11.22.08

• Hi Dr! I had Sculptra injected in the nasolablial folder over 5 years ago and developed small nodules which have not been such a problem. However, since I had a Thermage treatment last year, I have noticed these areas have become more puffy and now and again I have had cysts appearing. Could this be due to the collagen stimulation from Thermage? I also don`t understand why granulomas form if this is not a permanent product? Thank you

  Answer:  I am not sure why thatt occured, in most instances the Sculptra should have dissolved long ago, but if you had granulomas it might be the inflammation of the granulomas that caused it. JG 11.22.08

• Hi Dr...I am the one who went with my friend tuesday as she had radiesse in her nasolabial folds...now she has purple bruise around one corner of the lip and green bruise around her corner of the other lip including part of the cheek. I don`t understand what is the difference between the purple and green bruise. Also she had radiesse on tuesday, how long is she going to have the bruises? Also do bruises cause swelling? I ask all this because she is swollen but I don`t know if it is because of the bruise...we are just worried because she needs to be okay for 11/26...will she? thanks so much for your advice

  Answer:  the purple is a bruise that has not broken down as much as the green one, all normal from getting shots into that area. They might last 7-10 days in some people. Best of luck. JG 11.21.08

• Dr. G! How many suringes does it take to fillin those 2 nostrilefold lines fromthe nose to the mouth? Which filler do youfind the best?

  Answer:  in most cases one syringe of my preferred material, Restylane, is enough, in some small percentage it requires two if they are really deep. JG 11.21.08

• Hi Dr Garcia...my friend had radiesse on tuesday for nasolabial folds. I went with her to see if I wanted to do that too this week. Well, she was swelling a little bit...yesterday I saw her too and still some swelling. Well I wonder what her doctor did to her because it seems that the needle was placed in her cheek about one inch from the corner of her mouth(one inch apart from the corner horizontally)...but she didn`t have radiesse for the cheeks only for the folds...do doctors place the needle in the cheeks for the naso labial folds? or the doctor made a mistake? I want to know because I am considering doing this procedure and I don`t want any mistakes. THANK YOU SO MUCH

  Answer:  the needles are many times placed thorugh a hole far away from where the needle ends up depositing the material in order to avoid the material from coming out through the puncture hole, not unusual at all. JG 11.20.08

• Docter G, Iam 31. And fighting the adult oh my lord chin breakouts from HELL! I have very oily skin and well my spa at my PS office put me on OBAJI ACNE KIT...good stuff thus far. But heres my question. I am very lean and my skin is getting dry from it so i get these lines more deeper on the sides of my mouth and brows. I dont know if Restylin and BOTOX is what i want this early in my 30`s. Is there anything i can use to help with thise lines while fighting all my oily gross breakouts? Or should i just wait till my acne clears and use a wrinkle creame?

  Answer:  I think those two products are certainly reasonable to use at this point. Best of luck. JG 11.20.08

• where should botox be put to lift medial brow is this a place that can cause lid to droop how much do you use thanks

  Answer:  it needs to be injected at the root of the nose, and yes, it can cause a dropy eyelid if the Botox migrates over the muscles of the eyelid. JG 11.20.08

• i had 20 units of botocx 13 days ago to try to lift eyebrows and very little results. Can I have a touchup(more injected) at this time? How much would be safe in your opinion. I don`t want to end up with a droopy lid. thanks so much

  Answer:  yes, more can be injected at this time. The droopy lid is more of placement of the medication rather than dose, it also depends on where it was injected. JG 11.20.08

• I wanted to know if its effective to use restalyne or perlane on the outer corners of the mouth as I have lines there now too..Thanks so much, Love your site!

  Answer:  yes, it is effective there and thanks for the kind words too. JG 11.19.08

• Hi Dr. Garcia, I am about to get Restalyne to augment my upper lip and smooth out lines above it that I`m starting to see for the first time (i`m almost 44). I was wondering if I could also use Restalyne or Perlane for another issue thats a bit unusual: I have very noticeable depressions (I think concave is the word?) on the outsides of my eyes (as though I was a forcep baby and after they used them my face never went back) I know it sounds crazy but thats the best way to describe how it looks, its like my face is squished in just in those areas. I do not want facial implants unless I have no other choice, what is your suggestion as far as injectables or other non-invasive surgery options go for something like this? Thanks so much for your opinion!

  Answer:  I think Sculptra might be a better and longer lasting option for that area, all the best. JG 11.19.08

• I had restylane in the NL folds 2.5 weeks ago and I still have lingering bruising. I`m scheduled to have a touch up this Friday. Should I cancel the appointment and wait for the bruising to completely resolve before having any more touch ups?

  Answer:  it think it will be more accurate if the bruising and therfore the swelling is gone before placing any more. JG 11.19.08

• have a mild to moderate scar about 1 cm on face, tried mederma, kelocoat.. etc, can i do anything else at all diagnostically like laser to get rid of it, there is also small amount of pitting, little deeper than surface level.. thanks

  Answer:  could try a regional CO2 laser to tighten the skin and maybe remodel the surface to make it look a little less depressed. JG 11.18.08

• Dear Dr. Garcia, I am 56 years old and have some fat loss in my chin (a doctor told me that). I am afraid of using sculptra to fill it out as I`ve read mixed reviews about it. What I`d like to know is, does radiesse work in a similar way and can it be used as an alternative to sculptra? Thank you for answering my question and for providing such a valuable service!

  Answer:  I honestly have never heard of losing fat in the chin and although Radiesse could be used, it can potentially have the same problems as the Sculptra. JG 11.18.08

• For acne scars, do you recommend Restylane or Juvaderm? Thank you.

  Answer:  not a big difference between them. JG 11.17.08

• 25 units of botox in glabella to try to raise medial brow 3 days ago-no improvement-how long do you suggest to wait to try to touch up? How many units? Thanks

  Answer:  wait at least ten days and I usually use 30 units in that area.JG 11.17.08

• thank You for the e-mail.My question is I had the Lifestyle lift done 2 months ago with excellent result and healing but now my mouth and especially nasolabiel fold is deeper than before the lift with extra lines that were not there before. The extra fold presses against my nose cutting off air depending what side I sleep on creating stuffy nose and headache. Which fill would be good to correct this?

  Answer:  well for nasolabil folds I usually use Restylane or Perlane but I do not think that will help your breathing in any way. JG 11.15.08

• It has now been 2 weeks since getting my nl folds injected with Resty. The bruising in the area started off as blue/purple blood droplets trapped under the skin (that would momentarily dissapear if I pressed down on them) and they faded a bit after the first couple of days to a reddish slightly purple color, but since then they have pretty much stayed the same, not fading to the yellow color that bruises on me usually do. I am taking Arnica orally and applying the cream as well as lightly massaging the area, but the discoloration has not budged. Is it time for me to hit the panick button and go into a frenzy of gloom and despair?

  Answer:  no, just give it some more time, apply some warm packs and lets see what happens over the next couple of weeks, no need to panic yet. JG 11.15.08

• what are your`e thoughts on artefill ( pmma ) ? is this a long term filler ,?

  Answer:  reasonable to use in the nasolabial folds in experienced hands, would not use it in too many other areas though. JG 11.14.08

• How long will restylane last in the upper cheek/lower eye area?

  Answer:  it wil vary from patient to patient, I have seen it last as long as 10 months on the orbitla rim, but that does not mean it will last that long for everyone. JG 11.14.08

• That hollow spot right on the top of the upper cheek directly below the center of the eye bag which makes the eye bag appeat larger, is it safe to do sculptra there or is restylane a better option?

  Answer:  I prefer Restylane there. JG 11.14.08

• Hello< is it possble to have a PERMANENT yelid droop from botox? It happened to me over 6 months ago & I still have my lid somewhat drooping. better than what it was but not completely to what it was. If so what can be do done to fix this dilemna> its hard to read for a while it starts bothering me or night driving. Like i can actually feel the droop. Appreciate any help. Thank you

  Answer:  cannot see how it could be permanent as the motor end plates that are blocked by the Botox under normal circumstances are replaced by the body every few months. Should get better, but I think it might be a good idea to see an eye docotr to make sure it is not something else. JG 11.13.08

• dr. Garcia, Does sculptra injected in the naseofolds,cause puffiness for a few days ? I got injections of 1cc 2 days ago,and my face is swollen,as if i gained weight. is this normal? on top of that i had restalyn, so my face is a bit uneven and huge.. thank you!

  Answer:  it can, yes, but it is not indicated to be used for nasolabial folds, not sure why your doctor would suggest or do that. I suggest giving it all a little time. JG 11.13.08

• dr garcia, I had perlane injected in my lips from dr. seldon,and the next day, the puffiness went away,but i have 4 bubbles on the inside of my lip. Every morning when i wake up, i am swollen,but after a few hours, its as if i had not done a procedure. Is this normal,just as i am told? should i worry? I trust you but went to him, because of the price/ please help

  Answer:  not normall, but in his case, as he has been accused, but not convicted, of using fake materials, it might not be true Perlane you had injected, no way for me to know. You might have some small plugged glands in the lips as injected material should not change size throughout the day. All the best. JG 11.13.08

• I would like to know what areas to avoid having botox injections if I want to avoid a droopy lid or brow??

  Answer:  the droopy eyelid can come from the glabella injection migrating towards the eyelid and the eyebrows drooping can occur if the horizontal forehead wrinkles are weakened too much. JG 11.13.08

• Dr Garcia, Thank you for being so helpful to so many and your expertise is obvious. I wrote you a month ago with a worry about swelling from my second set of Sculptra injections. I wake up with a puffy swollen face every morning. It tends to get better during the day. This did not happen before the second set of injections. Do you think it is related?

  Answer:  well, after this amount of time and since it goes up and down, I do not think it is the Sculptra, if it were, it would not go up and down, might be something else, sinus infection or a small tooth abcess, wish I had more. JG 11.13.08

• Docter...whats the best filler for those 2 lines across the sides of your nose to your lips? How long do those last and how does it work? How much do you need to plump those up

  Answer:  I like Restylane and it typically last 2-4 months in most people. Usually it is one syringe that is needed in most cases. JG 11.11.08

• Dear Dr. Garcia, I had Sculptra injected approximately 1-1/2 to 2 years ago at 3 separate settings. I developed lumps in the some areas of the injection sites that are hard and round. They are most noticeable in the chin area and under one eye. They wouldn`t bother my that much but some of them are visible. Do you have any information on treating these lumps and do you know if they are scar tissue formation or the Sculptra itself? I would appreciate any information you could give me as they don`t seem to be resolving at all. Thank you.

  Answer:  after this amount of time I fear they will only be able to be removed but cutting them out. You have formed granulomas and they cannot be broken up too well. Sorry. JG 11.11.08

• A woman told me its actually good to get botox and facial fillers because it prolongs the need of a facelift when yourolder!! Is there truth tothat?

  Answer:  fillers and Botox can help somethings but it will not replace a facelift if needed. JG 11.10.08

• Dr. G...I went to a SPA where these plastic perfect ladies had PERFECT SKIN. It was a comsultation because my face is tired at drawn and i wanted to get rid of that darn line between the brows. Well the lady suggested BOTOX for $200 to fill that line. She immediatly got out the siringe and i told her to WAIT IT DONT know yet! She then says to get rid ofmy lines around my cheeks to actually put a filler in MY UPPER CHEEKS then to the lines!! Then another woman comes in and tells me that you dont need that you need (I have pimples on my chin..im 30 BTW) She said i needed this $400 skin care line and a makeover with these PRO MINERAL BIOTIC MINERALS that will make you look amazing and a lil lip injection. Im was in complete shock...I got home and immediatly waiting was a message on my phone and email of them wanting meto start the botox--skincare-facial!!! Is this ODD TO YOU? Do you think its best i go to my PS that did my BA for these facial fillers?

  Answer:  very odd, but during desperate times like this, I think some places get pretty pushy. I definitely would go to your previous plastic surgeon. JG 11.10.08

• About 8 months ago I had an IPL/RF spot treatment in my upper cheek area to remove a vein. It caused indentations and hollowing in the area. Last week I went to go get the area filled in with restylane, along with the other upper cheek on the other side to add more symmetry, and my nl folds as well. Everything looked great while it was swollen, but now that the swelling has gone down all areas on my face that were filled still look good and more full and I`m happy with them EXCEPT the upper cheek area that had been hollowed by the IPL/RF which now looks just as hollow, if not more so than it ever has. Why do you think the filler did not take as well in this area? Do you think restylane can damage areas of previous fat loss further damage? What should I do? Thanks

  Answer:  I would have to say that the amount to fill in the depression will be quite a bit, the area does not dissolve any faster in the depressed area. Restylane or other HA fillers has never been shown to cause more tissue loss. Also, care must be taken when filling in the depressed area to make sure that the edges are not injected as then the depressed area will be even more of a surface differential. JG 11.9.08

• can you recommend doctor for sculptra in the bayarea?

  Answer:  best thing is to get on the Scul0tra website and locate a docotr they have on their list. JG 11.9.08

• thanks for the quick response. So what do you think would be effective for fullness of the cheek area?

  Answer:  my choice is Sculptra. JG 11.9.08

• Hi Dr. Garcia, do you think evolence is a good filler compared to restylne and juvederm? Are there less side effects such as lumpiness in the skin? I would like to fill my cheek area with this filler. Thanks.

  Answer:  about as effective, maybe a little less pain upon injection. Risks are all the same though. I do not think using any of the hyaluronic acid fillers available at the present time in the US for loss of cheek fullness is a financially worthwhile choice due to price and length of time they last. JG 11.9.08

• i have had a punch biopsy on my breast and the scar is not healing evenly. It has been one week but the way it`s healing i can tell that i might end up with a dented scar on my chest. It is about 1/2 centimeter in size but the way is healing is that in addition to the line the corners look like puckmarks. i was thinking to show it to a plastic surgeon to see if i need to undergo scar revision surgery. Will I get rid of it by surgery or will it look worse or should i simply wait. in case i decide to wait would you think that lasertreatment could enhance its look

  Answer:  more surgery with a longer scar but one that is smooth and not depressed is what is likely to happen with an appropriate revision, best of luck. JG 11.8.08

• I still have inflamation in one cheek after sculpra. Do you think it makes sense to take a course of prednisone?

  Answer:  well it at times can persist for a week or more, I think Prednisone might help but might also decrease the effectivenss of the Sculptra filling. JG 11.8.08

• Dr Garcia Is sculptra FDA approved? I thought it wasn`t, but see that you use it at your office. Do you like the results? And, what are the side effects.

  Answer:  it is approved for use and we use it frequently in my office, in the proper patient it is a great option that can achieve resutls not acheivable with surgery. JG 11.9.08

• am 57 and had botox injected into crowsfeet, when can i expect to see the change. just want your opinion. thanks

  Answer:  maximum effect will be about 10 days or so. JG 11.9.08

• hi dr. i am a 58 year old female with marionette lines, but there are wrinkles that crisscross and don`t go away even when i pull the marionette line back, so i was wondering what procedure would make that disapear? some of the wrinkle are horizontal and vertical. thanks so much for this site. i hope you can help me. what about juvederm?

  Answer:  sounds like a laser is what you need to tighten the skin and reduce the wrinkles. Fillers like Juvederm will help but when there are many lines it can lead to a very full appearance due to the amount of filler needed to be injected. JG 11.9.08

• Dear Dr Garcia, hope you are well? My question is regarding cheeks. I currently use Teosyal for my cheeks but due to my fast metabolism I find they dont last very long, approx 3 months max, Radiesse only last a few months also. Should I consider getting Aquamid or even going under the knife and getting cheek implants. I am only 30, what would you advise me to do as I am after the fullness and definition for the cheek area but getting fillers done so often is a hassle and also costly! Thanking you in advance!

  Answer:  I am not a fan of Aquamid so it sounds like cheek implants are the next choice. Could try Sculptra injections but they are also temporary. JG 11.7.08

• Docter Garcia, When a spa offers botox or fillers at cheaper prices can that be a bad thing? Like their formula for that may be tainted or not as good as places that charge you an arm and a leg? Or is there no such thing. Botox and all are all pure forms as is no matter?

  Answer:  not always a negative, it is cheaper for them to do it as they do not have doctors injecting the materials. But it is not just the product, it is the skill of the injector that can make the bigger difference, or the appropriate choice of where to put it, some injectors do not understand that it is not the doing of the injection, but more importantly where not to put it that ends up with a happy patient. JG 11.7.08

• Can botox reduce or eliminate the static fine lines of a 29 year old in the crows feet area?

  Answer:  no.JG 11.7.08

• Can botox reduce or eliminate the static fine lines of a 29 year old in the crows feet area?

  Answer:  Botox does not help static lines. JG 11.7.08

• I have had some pesky bruising in my nl area that has not seemed to budge since I had my resty injected a week ago. Could pricking the area with a sterilized pin drain the bruises?

  Answer:  no, and it could make it worse.JG 11.7.08

• Hello: I posted a question regarding lumps caused by evolence filler around my eyes. You stated that they can be removed or possibly injected with saline to try and disperse the filler. If a doctor injected the area with a needle, would they have to squeeze the area to remove some of the filler? Would this cause black eyes or an infection to the area? Please let me know. I am seeing the MD next week who injected the filler. He wanted to put juvederm in the area to mask the area. Please give me your thought on this. I am afraid of more lumps in the area. Thank you.

  Answer:  no need to squeeze but it could cause a bruise and the risk of infection is very low. I would avoid more fillers until it al goes away first. JG 11.7.08

• Can sunless tanning creams stain bruises on the face?

  Answer:  only on a temporary basis, but they would be brown and not blue stains. JG 11.6.08

• I have a series of small purple, red bruises that appeared after a restylane injection in my nl folds, the bruises appeared in areas where I wasnt even injected! They have shown no signs of subsiding or changing color and it has been 6 days. How come after I had the injections, when I pressed down on the bruises with my finger, they would momentarily dissapear, but now when I press down on them, they remain the same?

  Answer:  not really sure why you would have them in areas that were not injected, I think it best to see your doctor in person to see what is going on. JG 11.6.08

• Dr. G! I am considering Botox for my lil lines between my brows. I have very sensitive skin tho and dont react well to certain things in my body so iam very sensitive. So I read this ona BOTOX WEBSITE: BOTOX® Cosmetic is approved for the temporary treatment of moderate to severe frown lines between the brows in people ages 18–65. Important Safety Information Serious heart problems and serious allergic reactions have been reported rarely. If you think you’re having an allergic reaction or other unusual symptoms, such as difficulty swallowing, speaking or breathing, call your doctor immediately. The most common side effects following injection include temporary eyelid droop and nausea. Localized pain, infection, inflammation, tenderness, swelling, redness, and/or bleeding/bruising may be associated with the injection. Patients with certain neuromuscular disorders such as ALS, myasthenia gravis, or Lambert-Eaton syndrome may be at increased risk of serious side effects. Is there a way to tell if iam prone to this

  Answer:  sorry, but no way to tell before hand. JG 11.5.08

• Hello I Appreciate your time and answers. Your site is valuable. I had a thought>has there been any problems medically that is with use of fillers like resty juve or radiesse? I have had all three & got to thinking if I continue will this cause harm to one`s body? Also in time if used every 6 months in same areas will/could the injections or fillers themselves cause either trauma or looser skin due to forcing plumpness? I hope you understood my concerns. Thank you so much for your generous time for all us out here in the beauty/perfection/anti-aging pressured world!

  Answer:  these products have been in use for many years in Europe with no reports of medical problems in the medical literature. I do not think the plumpness causes anything negative long term, no. All the best. JG 11.5.08

• I had thermage done on my knee area and am very disappointed with the result. I notice now that i have a discoloured indentation on the right side of my left knee! I had this done over a year ago. Is there anything i can do about the indent? Also what dermal fillers are most long lasting out of them all?

  Answer:  might need some fat injections or another filler to lift it up. I think Sculptra and Fat will be the best options in that area, best of luck. JG 11.4.08

• Hi Dr Garcia, I made the bad mistake of having Argiform injected in my lips over 8 years ago. Although I have not had any problems, I have read this may cause cancer. Is it better to remove it or is this just a small risk. I also read that removal can be done by puncture and manual pressure, is this the case 8 years on or would this require surgery? The product is incapsulated in my own body tissue and I can feel where it is. Thank you

  Answer:  I think it will be dificult to remove so one has to balance that out with the relatively small risk of the cancer developing. JG 11.3.08

• Wow my fillers that I got were swollen and bruised for a bit but now I can see they work wonders to enhance your countours. Why risk laser when you can have these kinds of results with fillers when they have less side effects (fillers are obviously not without side effects). Do they last longer in young people?

  Answer:  filles and lasers do not do the same thing, that is why they are both used. Fillers do last longer in younger people, yes. JG 11.2.08

• Dear Dr. Garcia, I wrote you an email too, but then I got my confirmation. After Alloderm has made its changes for one year +, is it still possible to remove? I am talking about a chunk of Alloderm placed on a nose and not Alloderm placed in the lips. Thanks.

  Answer:  after one year if it is still there it can still be removed. Best of luck. JG 11.1.08

• I just wrote you about the sculptra and made a mistake. I am only 16 days from the last set of sculptra, not two and 16days. Sorry

  Answer:  understood. JG 11.1.08

• Well, Dr. Garcia, I had sculptra in cheeks and temples eight months ago, and then again two weeks ago. The first time I noticed a little bit of difference but it was slow and gradual. This time, I am two 16 days out and notice a LOT. My face is filled in much more. Can that be possible? I thought it took time to work? I am worried that if it is so much now what will happen in a month or two. Thanks for listening

  Answer:  it is likley swelling and will go down, unless you had a very large amount injected, and even then, it would take weeks to months to grow. Give it some more time. JG 11.1.08

• why do some doctors say it`s better to let restylane dissolve on its own if you are unhappy with it? Are their risks of having it dissolved?

  Answer:  well, because injections to dissolve it can cause bruising and it is difficult to get the material in exactly the rigth spot, so it does not always work, it takes alot of experience,and massage and time usually work. JG 11.1.08

• Is it common to do n/l fillers during lower face/neck lift? my PS plans to do this for me. I take it the n/l folds are not improved at all with lower face lift, if fillers are planned to be used?

  Answer:  not usual, no. The nasolabial fold is improved after a facelift for a period of time but not permanently. Sounds like he is being not aggressive with the facelift. 11.1.08

• I had a restylane filler in my upper cheek earlier today, she basically injected in a horizontal line in the upper cheek area, and since the injection the area below it has the appearance of being depressed, like a large horizontal depressed area, what should I do? area under the horizontal she basically

  Answer:  just massage it and give it some time, that should get better. 11.1.08

• thank you/ I went to see a plastic surgeon asking what procedure I need for like my skin i see to sagg alittle / hollow around my eyes and line between nose and cornrer mout / line above my lips / he said a fat grafting to be best / I m leary about this / I never heard of this / I was wondering wont` juverderm/ Restyalne or injection would take care of this and if so which in your opinin iw best?

  Answer:  I think Restylane or Juviderm are more reliable than fat grafting. JG 10.31.08

• could filler affect blood pressure? Maybe to your face or brain since its a foreing object blocking underneath skin?

  Answer:  I have never heard of that occurring. JG 10.29.08

• Dear Dr Garcia, a couple of years ago I had 4ml of Bio Alcamid injected in each cheek, but since the results were bad (lack of symmetry) I had it taken out. Now I would like to try with some Sub Q as I`ve heard that it lasts longer than Restylane, but I am not sure whether this is possible. What would happen if a Restylane implant mixed with some Bio Alcamid residue? Apart from a couple of small lumps than I was told are scar tissue I can neither see nor feel the BA anymore but I guess there might be a very small amount of it still in place.

  Answer:  Restylane subQ is not able to be used legally in the US, so you would not be able to have it done here. There is likely no cross reactivity between the two products. The lumps you feel at present will likely remain though. JG 10.28.08

• Hi Dr. Garcia, i have been to two consultation with dermatologist regarding getting injections to make my face look fuller, i`m 43 and have no wrinkles just the lack of fullness two years ago i had restylane in the nasal folds and it`s still there. One of the doctors suggested radiesse and after 8 months that i go back and do the sculptra, the other doctors advised me to go see a plastic surgeon she said i would get better results with fat grafting but after reading several articles on how variable the fat injections are i`m confused. Can you shed some light on this? what would you recommend if i were your patient. Thank you.

  Answer:  I would do Sculptra and skip the Radiesse, if there is no fat to lift the surgery will not do much I am afraid. JG 10.28.08

• Hello Dr. Garcia, I had Restylane injected in my tear troughs last January and again just a little bit in my tear troughs and marionette lines... (9 months later) now, 3 weeks after the second time I got it, I have just developed quite noticable (to me anyway) lumps under both my eyes and one small one on one side of my mouth... have you ever heard of this? It didn`t happen until 3 weeks after the injection? If I rub it too much - seems to agrivate it then I put ice on it reduce inflamation... any ideas what this is or why??? it was two different people who did it?

  Answer:  it can happen, at times it cannot be seen right away due to swelling and once that goes down the lumps appear, also if it was injected into the muscle itself it can lump a couple of weeks after the injection due to the muscle pushing it together. Massage lightly should help, otherwise you can try dissolving it. JG 10.27.08

• will mri if goes over face do anything to prematurely dissolve filler?

  Answer:  no, it will not. JG 10.27.08

• Hi Dr. Garcia AGAIN! O K I am seriuosly frustrated & at the point of what the heck? Ok so Keep in mind I am a very loyal client> so for a year now I have been working on fixing plumping (same injector) to dimples I loathe. She has one looking 80 % better but the other side continues to be a problem sometimes the indention gets larger from filling (juvi) SO anyways I stay with her bcuz 4 other injectors failed miserably> leaving me oh my gosh with clumps of product in all the wrong areas. Ok so what da heck is my point right? Dr G> Why is a dimple so freaken (so sorry) hard to fill? What do you do in this area? I mean do you ever have a problem? They are small oval like areas>DIMPLES They are right by the area by mouth that has all the connections that extends outward (hope that made sense)Like middle of lip level outward toward cheek area> so could it be location>I mean I would think filling right into the spots in beads would pop it out> that is her technique but it still isnt working>quite right arghhhhhh! what do you think suggest orrrr am I totally screwed for hope????? MUCHISMA GRACIAS!! ESTOY vuelta loca con esta situacion!!!!!!! por que piense que ceria facil y nadie puede ??hareglarlos??

  Answer:  if you mean a real dimple that one was born with,if you do not do a subcision and a filler, it will not work and it will also only last a few months to a year, no longer as the attachments from the deeper layers to the skin will reform. JG 10.26.08

• Hi Doctor, I had an intralesional steroid injected into a granuloma - how long does it usually take before this starts working... at the same time, when does the steroid stop dissolving the tissue? Thanks

  Answer:  migth take 4-6 weeks. Thesteroid effect shouldwear off in 2-6 months. JG 10.25.08

• I am looking into getting a very small amount of restylane or juvederm filler in 1 very small area on my face that has a very slight hollowing. Is there less of a chance of complications with a smaller ammount of filler being used? Also, since most of the vial would not be used can I come back and continue to use the same vial until it is finished?

  Answer:  I think the chances of something bad happening are small. The vial can be kept sterile and used at a later date. JG 10.25.08

• Has restylane fineline been approved in this country? What else is used for fine lines around the lips? thank you...

  Answer:  no, not yet, it likely will not as the demand is low for that type of product so I believe the company will not push it. You can use the new Elevess or Prevelle for that, both work well. JG 10.24.08

• What are the CONS of any facial fillers....any problems that can occur

  Answer:  lumps are the most commpn CONS, along with not correcting the problem adequately. JG 10.23.08

• Do facial fillers cause any blood or long term body face posioning down te road. Also a plastic surgeron, Dermatologist, Med SPA all do these procedures are ANY of these facilities better or not safe to go to? Anything I should ask or be aware of ...

  Answer:  I have never heard of a filler causing that. I think as to who does the filler, the questions to ask is how long have they done it for, how many patients have they treated are a good place to start. JG 10.23.08

• Thank you for your earlier recommendation! You recommended Sculptura for my area of concern in my glute...since I just had Radiesse injected in the area (1 week ago)...how long do I have to wait to do the Sculptura? Are they compatible? What are your feelings on Artefill in this area being as it is permanent? Are Artefill and radiesse compatible? Thank you again for all your sound advice!

  Answer:  I do not think there is any cross-ractivity so it likley OK to proceed, not sure how good Artefill would be in that area, it has not been studied. No known problems mixing Artefill with Radiesse that I have heard of. JG 10.23.08

• Iam 31 years old, What causes those deep lines down your face on the sides of your nose? Iam athletic and very lean and started getting those when i got really lean. My family says its cuz iam dehydrated and tooo lean and if i gained weight my face would fill back out...how do i know if its that or iam just old...

  Answer:  it is due to the muscles pulling on the tissues and also they advance and get deeper as the fat on the cheek is lost and then the skin is not as well supported and the skin folds and creates a deeper wrinkle. Gaining weight would help, if it goes to your cheeks. Dehydration, unless severe, will not cause that. JG 10.23.08

• Hi Doctor, Which is the best antibiotic for skin infections caused by a granuloma, Ciprobay or Augmentin? Thanks

  Answer:  both pretty good, not a large difference. JG 10.23.08

• I had NewFill (Sculptra) in my naso labial folds over 6 years ago.I have developed nodules which I can feel however do not seem visible. The problem is, in one area, every six months or so, a cyst forms to the size of a small grape as if the same area gets reinfected. I either treat it with antibitiocs and failing this, intralesional steroid. Why does this keep occurring and what is the correct treatment? Thanks

  Answer:  sounds like a granuloma and might need to be cut out to avoid its recurrence. JG 10.22.08

• im confused and scared now...what would happen if i keep using them. I didnt feel sick until juverderm. I think ill go back to restylne and see what happens. what is the bacteria though....

  Answer:  well, since I seriously doubt the fileer gave you the sinus issue, proabaly nothing bad would happen, but you seem emotionally convinced that the filler has caused your problems so for emotional reasons I do not think you should have them anymore. JG 10.22.08

• Whats the difference of Botox and facial fillers and do any of them cause wrinkles to get worse or dmage your skin in the end

  Answer:  Botox weakens the muscles so it indirectly helps wrinkle as they form from the function of the muscle whereas the filler just lift the wrinkle up, so they are different in how the help and can be used together in some cases. Neither causes your skin to worsen. JG 10.22.08

• hi doctor, i am using retina 0.05% its not giving any result. should i ask for a higher %? if so what% should i ask for???

  Answer:  yes, ask for 0.1%. JG 10.22.08

• Docter what do you recommend for a facial filler for that one little line across thy brows? Iam 30 so that one line bothers me it makes me look mean! Botox? Also is Botox better than Juviderm or that REstilyn? What are the differences

  Answer:  Botox is not a filler so although it might make a filler last longer, it will not fill it in, I usually use Restylane or the new Elevess. JG 10.21.08

• is it ok to have a MRI of brain and spine with facial filler in? I dont know if that would matter?

  Answer:  yes, safe to do so. JG 10.21.08

• Dr, Thank you for your earlier response concerning the metacril buttock injections! Do you have any other suggestions to correct indentation other than fat transfer, which I already tried, also, am very fit and do not have any more fat to graft...any other options or suggestions would be GREATLY appreciated! What you do is truly admirable...taking the time to answer other`s questions/concerns!

  Answer:  maybe Sculptra injections. JG 10.20.08

• hi dr. can you tell me the price of a syringe of artefill costs and what it is best used for. how a bout marionette lines? thankyou

  Answer:  it is used ony for deep injections so the marionette lines will be an option, as to the cost, you need to decide on the doctor first as the prices will vary. JG 10.21.08

• Hello, I am conidering Juviderm or restylane to add volume to my lower face. However, I am also interested in the new Fraxel Repair C02 for face and neck. Should I wait to have any injectable (filler or botox) until after laser resurfacing. If I have the filler and/or Botx prior, how will affect the filler? Also, if I opted for a mini face lift, would it be advisable to wait until after the procedure before having injectable? Thanks in advanc.

  Answer:  in general it is alwyas better to have the laser first and then the fillers. No one knows for sure if the laser will shorten the effect of the filler or Botox, so why take the chance. JG 10.20.08

• how come a filler cant affect your sinuses? Is it injected right where they are? Also could a filler or implants ever grow mold or cause a tumor?

  Answer:  well, although they are injected over the sinus, in between the filler and the sinus is fat, then muscle, and then bone, the sinus is below the bone, so the filler cannot get past all of that. I have never seen a filler cause a tumor or grow mold. JG 10.20.08

• Dr Garcia, I sent you a note last week after having scuptra in temples and cheeks. I have had sculptra before and did not have near the swelling. You suggested I be patient. I had the procedure on the 17th, and now it is the 20th and I am still slightly swollen and puffy. Is that possible? Could I still have water in my cheeks. I know it could ot be working yet, and I am concerned that I am still puffy. thanks for answering so many people`s questions

  Answer:  yes, it certainly is still possible, not unusual at all. JG 10.20.08

• Hi there! In March, I had a bad fall, which left me with a indentation in my glute (due to fat loss from trauma)...I had lipo on flanks and fat transfered solely into the indentation...4 months later, all fat has absorbed! I recently had Radiesse (3 syringes) injected into the depression...although much better, still not happy and this is not permanent..I am considering Metacril Injections...into that area and other buttock to make them even...would it be okay to inject Metacril after already injecting Radiesse? Thank you!

  Answer:  I would not suggest Metacril, it is not legal to use in the US, I have also read of numerous complications from it. JG 10.19.08

• Dr Garcia, I just had my second set of sculptra injections in the cheek area (eight months apart). My question is, can the sculptra be too much and change the way you look? Or does it contour to your natural bone structure? My doctor says it is subtle and slow to change so I may not notice that much. Do you find that to be the case?

  Answer:  well, I guess it could if too much is placed, it does not contour to the bone, it stays where the inject it. Dramatic results can be acheived but also subtle one, all depends on how much is injected. JG 10.19.08

• Hi Dr. Garcia! Yesterday I had Juvederm injected into my undereye hollows. I had virtually no bruising or swelling. However today there is a giant 1.5 inch protruding lump in the lower left section of my left eye - it looks like someone has stuck a oversized pale yellowish kidney bean under my skin. It is not at the curvature of the orbital bone, but halfway between the orbital bone and my eye. It is soft and palpable. I have the horrible feeling my doctor (who is supposed to be excellent in his field) really messed this up - it looks like he put a quarter of a syringe in the completely wrong place. Is there a way to remove the blob or something that can be injected to make it absorb faster? I look like a monster and my wedding is coming up in 3 months! Any information would be appreciated!

  Answer:  sounds more like a hematoma from a needle stick than the material injected, they can take time to develop where the material if incorrectly placed would show up right away, warm moist heat and massage will help it to absorb. If it liquifies it might be able to be expressed through a small needle hole buy the doctor. JG 10.18.08

• hi.doctor.i had these collagen fillers on my both cheecks to fill out my acne scars..i remember... he gave me about 7-9 shots on each cheek.. and he said..its going to last about a year.. but i ended up paying 4000dollars..yes 4000dollars. i know there are couple of permanent fillers such as sculptra,, or radisse.. i had thse temporary fillers.. are they these expensive??? i cant trust this doctor ..anymore....

  Answer:  well, firstly ance scars are very difficut to fill without subcision done immediately before and Sculptra and Radiesse are longer acting fillers but not permanent. As to trusting the docotr, it depends on what he said and promised you. JG 10.18.08

• What would you say the % chance of lumps are in the upper cheek with restylane if you have a good injector? What would you say the % chance of lumps are in the upper cheek with restylane fine line are if you have a good injector?

  Answer:  should be quite low if done at the proper depth, if you are talking about the rim of the eye socket, maybe 5-10% and they should disapate with massage. JG 10.18.08

• Dr. Garcia, I had sculptra yesterday in the temples and check area. I am pretty swollen today. Is that normal. Does the swelling indicate how I will look in a few months? If so it seems a bit much. It is not horrible and I had scuptra about 8months ago in the same areas? Just seems more swollen to me this time.

  Answer:  yes, all normal, might take a few more days for the swelling to go down, all depends on how much was injected. The swelling has no bearing in most cases on how it will look in a few months it wil never be as filled in as you are seeing now. Swelling can be different every time you get injected, just have to ride the wave. JG 10.17.08

• Hello Dr. Garcia, Do you do Radiesse injections into the jawline to contour the jowl area? I had 1 cc of Radiesse injected into my chin area by a PS in Los Angeles and think it would look a lot better if it extended out a bit into my jowl area. But I live in Las Vegas and would like to find someone out here who could inject me (driving to L.A. is a hassle, and holding ice on your face on the drive home is no fun either!). I have been to your office before and have seen Janee for other types of injections. Thank you!

  Answer:  well, they make the normal area larger so it matches the saggy jowl if it was done for a saggy jowl, in your case it sounds like the augmentation of the chin made the normal tissue look deficient so more Radiesse could be used, I would be happy to see you for that if you wish. JG 10.17.08.

• What is the ideal female lip shape, achieved thru fillers? Upper lip larger seems to be what is considered sexy, but this seems unnatural. What about length of lips? preference for one shorter than the other as far as a more youthful look? What fillers do you prefer in lips, with least amount of post injection soreness and swelling?

  Answer:  I am afraid there is no ideal shape for lips, that is a personal preferene. We usually use Restylane for the lips and there is some swelling for a couple of days, pain is minimal. JG 10.17.08

• Silly question but can fillers ever be injected in pesky butt dents? I had a butt lift recently and at first it looked great(April) smooth as can be, but it has since settled, tho better, my same 2 cellulite dimples are back. what type of filler would you use there? If any? I know it would take alot, but i would brobably only do it before summer, bikini season.

  Answer:  they can but it will not last long and therefor not a good option. There are no fillers that work well for cellulite I am afraid. JG 10.17.08

• DOES resty or juve help with permanent rebuilding of something in those areas of injections?? my lips are not going down to ther normal size after years 2 plus? im not so thrilled about that tho

  Answer:  there is nothing permanent with either to any clinical significance as the process the body has that dissolves its own hyaluronic acid will also affect the injected HA and nothing can stop that. I seriously doubt you had authentic legitmate Restylane or Juvederm if it is still in place this far out. JG 10.17.08

• DR Garcia what would you suggest for me?? I had 2 dimples filled with juve > Not only was I left with 2 beautiful brusies that just wont fade (1 month) to top that off they were not filled completely so I have 2 smaller versions of dimples with bruises> I know you cant do much for me in the filling dept from a website but what can I do for the discoloration??? Thank you

  Answer:  sunblock, bromelain and Arnica montana from the health food store, all the best. JG 10.17.08

• hi i am the one whos been feeling sick after juverderm. I just found out I am highly allergic to mold and ragweed, could this be y the juverderm is bothering me since they say dont use if u have severe allergies...? What filler would be best then restylyne?

  Answer:  I do not think it is the Juvederm, no. I do not think changing fillers will make a difference as I do not think the filler caused it. JG 10.16.08

• Dr. Garcia, what would be better option radiesse verses restylaen for chin enhamcement. Can you please describe a little bit of each,the differences. thanks much

  Answer:  I think fillers are in general not good options for chin enhancements, sorry. JG 10.15.08

• i have a small round scar on my face, and wondering what you think is the best remedy for it? thank you

  Answer:  hard for me to say, sometimes subcision and a fller and sometimes having it cut out. JG 10.15.08

• Hi, Dr. Garcia. When I had Juvederm injected into my nasal tip to repair a soft tissue deficit, it left me with the dreaded blue tint. Do you think I might be able to avoid that if I were to use Restalyne instead? (I am concerned that Radiesse would be too aggressive a product, since the hole, while very noticeable, is small and the skin over it is thin.) Any other suggestions? Thanks, as always, for your sound guidance and generous advice!

  Answer:  the blue tint is due to too superficial of an injection and can happen with any filler. I think to avoid it the filler needs to be a little deeper. Best of luck. JG 10.14.08

• hello is it true that getting juvederm all the time like ever 3 monthswill assi st in collagen production long term? thanks

  Answer:  the company would like to claim that but I have not seen anyone getting it done less and less over time. JG 10.14.08

• Hi Dr Garcia, I have made an appt to see a famous plastic surgeon in L.A next week for botox and fillers. It has been a least 1 year since I have had those treatments. My biggest concerns are my crow`s feet and some mild lines around my mouth. My concern is that when I have had botox around my eyes in the past, my smile lines look really weird when I smile. So, I don`t want to make that same mistake. Any suggestions for fillers in that are that you have been very happy with? Or, if this Dr. is so experienced, perhaps I will have a more successful outcome w/ the botox? I just want to look as natural as possible! Any advice is greatly appreciated. Thank you.

  Answer:  fillers for the crows feet are tricky because that skin is so thin that very thin fillers need to be used, and even then can still leave lumps, and the thin filler will not last too long. I think the only thing that would give you a less artificial appearance around the eyes would be less Botox and then the wrinkles would not be as much improved. JG 10.13.08

• Dr. Garcia, I had gortex cheek implants to correct severe facial assymetry, and a few years later had a fat graft by injection (30cc of my own fat) to further correct the side of my face where the cheek and zygomatic arch are naturally quite depressed. I was quite happy with the result, but the graft was six years ago, and over time I`ve had fat loss in the area in addition to the effcets of aging (I`m 35). I need another fat graft, but I`m wondering if there are other options that would save me from having to use my own fat. I do not want anything less permanent than the result I`d have from using my own fat. I also am quite opposed to using fat from a non-human animal (I`m a 20 year vegetarian/vegan). Is there any product out there that uses human cadaver fat or something like that? I thought I read something about it, but I may be mistaken. Any suggestions you can offer would be helpful. Thank you so much.

  Answer:  there si no cadaver fat that codu be used, at prestn there are no good alterantives simialr to fat, there is Scultpra but that will last maybe 1-2 years is all. JG 10.13.08

• Hi, I`m 46, very thin, and under so much stress this past year that I have aged about 10 years in appearance. As part of a major `over-haul`, I had a doctor recommend cheek injectables to improve the dark, hollow, wrinkled area beneath my eyes. Is that a viable option for my concerns, seems lasers & lotions don`t do much. THX, Dee

  Answer:  I think for what ails you the injectables are a good option, yes, hope all the stress goes away soon too. JG 10.13.08

• Dr. Garcia I have been considering restalane for the nasal labial folds but am concerned about the injections possibly leaving little holes behind. I had a blackhead in the middle of my chest that I used to squeeze and a cyst developed that I had removed. Finally the little hole was gone...........until I had an injection there to fill out a depression that had formed after the removal of the cyst. The small injection left a tiny hole behind that now gets filled up as a blackhead.....once again. Soooooo I am wondering if I could be prone to any small injections leaving holes behind. What do you think? I also have medium to large pores on my face. Thanking you in advance. G. P.S. What do you think about the Titan procedure for the face?

  Answer:  I have never seen the small needle holes from the filler injection cause that, I think in your case on the chest it got injected into a piece of skin and it is coming out through a previously existing small pore that was not seen before. JG 10.11.08

• Sorry forgot to ask in my last question about fillers, are lumps and other complications as problematic in the upper cheek hollow as common as they are right above in the tear throughs?

  Answer:  less in the cheeks because it is thicker skin and the lumps are covered by thicker tissue, can still get them but they are less visible and less palpable. JG 10.11.08

• looking to have my upper cheek hollows filled because they are making my eye bags appear larger than they are but I`m getting after reading all of these posts about people who either don`t like their results with fillers in the eye area (close to the upper cheek) or are getting permanent lumps that have to be surgically removed. Pretty scary stuff. Do you think something lighter like restylane fine line in the upper cheek area would have less chance of lumping and also not last as long so that I can see how it looks in that area on my face before commiting to a longer term filler? How long will it last there?

  Answer:  the Restylane fine line would be easier but lumps can still happen, also remember, people do not post on message boards when they have good results so you are getting a slanted view of the perentage of patients that have problems,it is much lowwer than one would think by reading the blogs. Best of luck. JG 10.11.08

• I have terribly deep tear trough indentations and need to do something about them cause they are all I see when I look in the mirror. There is no face cream or concealer that seems to help hide them Is there anything you know of that would help cosmetically? I do not want surgery and have been thinking about having a filler procedure done I live in Rhode Island and do not know of a good doctor in my area, I have read so many horror stories and I don`t want to just pick a name out of the phone book What do you suggest?

  Answer:  I think fillers are a good source, might want to look on the website for the filler you are interested in, they have lists of doctors there that perform the procedures. JG 10.10.08

• I have had restlayne and radiesse injections before. I had asked the plastic surgeon if he could inject any of the products, juviderm, radiesse etc into the chin area about an inch below my lips for wrinkles. I am 49 and loved the results I have had but would really like to get rid of those two wrinkles in my chin. He got busy and never answered me. Is it do-able or is that area too thin skinned to be injected?

  Answer:  I thnk there is a risk for bumps in that area. JG 10.10.08

• Hi Dr Garcia, I have been reading about Radiance/radiesse to plump out the cheek area. I have had a few bad experience with fillers particularly NewFill which caused granulomas so don`t want to make the same mistake again. What is your opinion of Radiesse as I heard it can last up to two years. Is it safe? Thanks

  Answer:  I do not think it is cost effective for cheek filling and I think Sculptra is better for that purpose. JG 10.9.08

• Hello again. I just wanted to let you know that I went to a plastic surgeon who specializes on the eye, and he very masterfully put Restylane above my eyelids - under the brow to plump up the area which makes the over-eye hollowing virtually disappear!!! I am so happy with the results :) I had started to see hollowing - more lid if you will in proportion to the fat pad under the brow - and it made my eyes look a bit skeletal. Now they look very youthful again. Still a bit curious as to why you don`t recommend this more to correct around-the-eye hollowness?

  Answer:  I am glad that you had a good result but I thnk that is likely not the general response most people would get.JG 10.8.08

• Thanks for your quick response. You mentioned you prefer Restlyn for the orbital area of the eye. I have had Juvederm (I think Ultra) without complications and it has lasted far longer the Restlyn. Should I be concerned about further use in that area? Why do you prefer Restlyn?

  Answer:  I like the feel when I inject Restylane and I do not like to use material intended to be injected into deeper structures like Juvederm Ultra or Ultra Plus since the area around the eye is quite thin. JG 10.8.08

• Dear Dr Garcia I am a 32year old, and have been having fillers in my cheeks and very happy with the results (Teosyal) and considering having fillers for the hollows under my eyes as I have dark circles due to having very thin, translucent skin, which seems to be getting more apparent the older I get. My main concern is after having read a lot of negative feedback with patients having had this for the under eye area, can you tell me is this procedure one with a good turnover of positive results? Or should I not risk it as I would hate to get lumps or bruising/staining under the eyes which does not always dissipate/heal? I have good skin, that heals well and doesn`t bruise too easily. Please could you kindly advise me? Thanking you in advance!

  Answer:  well it is a risky area to inject due to bruising and lumps, so having good success in other thicker areas does not mean you will not have problems around the eyes, it can improve things that cannot be improved in other ways, but there are risks. When using hyaluronic acids fillers there, the lumps should go away in time. Best of luck. JG 10.8.08

• Will Perlane last as long as Juvederm Ultra (or visa versa) when used in the nasial folds? How about the eye area for that hollow look? Thanks Again for your response

  Answer:  I feel they are about the same. I would not inject Perlane or Juvederm Ultra around the oribital bone below the eyes, just Restylane. JG 10.7.08

• what filler is the safest to fill in lines and not freeze ur face muscles

  Answer:  fillers never freeze muscles and I prefer Restylane. JG 10.7.08

• how long does Restylin, Juviderm, and Botox last before u get them redone?

  Answer:  it varies from patient to patient, the amount injected and also depends on the area injected, no way I can tell you that. JG 10.7.08

• Thank you Dr. Garcia - regarding my question yesterday about fat injection to treat the Kenalog-induced dimple, do you recommend this over a silicone injection? Are there any potential side effects for a fat injection vs silicone?

  Answer:  I would never never never recommend silicone injections except for a retinal detachment. In Nevada it is illegal and a felony to inject silicone for anything except a retinal detachment. The down side to the fat injections is that it might not survive and it would need to be done again. JG 10.7.08

• Docter, I know every one has a vary in price when it comes to facial fillers. Iam 31 years old and dont really have any wrinkles but THAT ONE LINE/CREASE that is inbetween my brows that bugs me. I was wondering how much would just that line run me in a round about price. Also, what filler is best for those..Botox--Juvederme, resylin? whats the difference of them all

  Answer:  would use Restylaen at a 0.4cc size, fee would be about $400 and Botox on top of that might help it last longer, that is an additional fee, need to buy the 50 unit bottle for that, fee for that is about $500. Botox weakens the muscle that causes the wrinkles but does not fill it in while the filler fills but does not weaken. JG 10.7.08

• Hi Dr., I am supposed to get the IPL every 5 weeks so how mong should I wait after the restylane to get another laser tx? Thanks

  Answer:  do the Restylane the next day and OK to proceed with the next IPL 5 weeks later. JG 10.7.08

• Hi Dr., I am supposed to get the IPL every 5 weeks so how mong should I wait after the restylane to get another laser tx? Thanks

  Answer:  you can do the Restylane the day after the IPL and by 5 weeks the effect should be much less. JG 10.7.08

• Hi Dr., I have been getting IPL for brown spots and mild acne scars. I will be getting some restylane and botox on Oct 9th and was wondering if the heat from the ipl ,I will be getitng on the 22nd, will casue any dmaage to the restylane or botox? Will the IPL cause the restylane to be dissolved? Thanks

  Answer:  I think it best to get the IPL first to avoid any potential interference, although chances are slim. JG 10.7.08

• can the granumola (if it is one) get bigger? or am I safe that it will not get bigger (after 5 weeks)

  Answer:  yes, granulomas, by their nature, can grow. JG 10.7.08

• Thank you so much for your services! I have a hard non movable lump on the top of the orbital bone after a radiesse injection after five weeks. Is it still to early to tell if it a granuloma? I am still hoping that it will resolve on it`s own, is there still a chance? Also, I lost 5 lbs (I was already too thin before the weight loss), but would this weight loss make the bump more noticeable?

  Answer:  well, it sounds like it will become one from what you are describing. There is still a chance it will dissolve in time though, give it another 3 weeks and see. Losing fat can at times make things seem more visible, yes. Best of luck. JG 10.7.08

• Hi Dr. Garcia, I am considering getting a fat injection to fill the Kenalog-induced dimple in my arm. How long does it take to recover from a fat injection? Are the results permanent or will I have to get fat injections periodically to keep the dimple filled?

  Answer:  the fat injections are quick healing, back to normal activity in a few days, it can require a touch p 3-6 months afterward to get it to be smooth. Once there, the results should be permanent. JG 10.7.08

• I am going to have Juvederm in my NL folds and lips on Monday. I need to get on a plane and be working on Tuesday. This is the first time in my lips but I have had Juvederm and have bruised and swelling. The swelling is manageable, so I have several questions: 1. there anything I can do to prevent the bruising in ADVANCE. 2. I have seen arnica and bromelain in your posts, but how soon do you start? 3. Is there anything else food or vitamin wise that should be avoided? If so, when? 4. Or anything that promotes quicker healing like increased Vit. C? This is a very helpful site and I thank you for answering these questions.

  Answer:  in advance avoid anything that thins the blood like aspirin or Motrin. As to arnica and bromelain, I start before if possible and continue after until the brusing is gone. I do not think anything else will make a big enough difference, except maybe pineapple. Best of luck, and do not forget the ice afterwards. JG 10.6.08

• DR. GARCIA, I ALSO RECENTLY RECEIVED A KENALOG INJECTION TO TREAT MY ALLERGIES AND NOW I HAVE A BIG DIMPLE ON MY ARM. IS THIS DIMPLE PERMANENT? IS SO, CAN A FAT INJECTION PERMANENTLY REVERSE THIS SIDE EFFECT? HOW LONG DOES IT TAKE TO RECOVER FROM A FAT INJECTION?

  Answer:  in most cases the dent fills in on its own, it can take up to 6 months, after that what you see will remain and need to be corrected. Fat injections are the most common rememdy, yes. JG 10.5.8

• Thank you so much for all of your great advice. I am thinking about having perlane injected into my lips as I would like something that lasts longer tha juvederm. Do you think its a big risk or just a small chance of lumps? and have you personally done Perlane in the lips and gotten a good result?

  Answer:  I think long term fillers, at present, are not good options for lips, I understand the desire but the negatives far and away outweigh the benefit of fewer injections. I would not even think about using Perlane in the lips and have no intention of doing so, it is not made for that. One should use a product in the way it is meant to be used. If you use wood during the construction of something when it should be paper, you will have problems, and they will likely last a lot longer than you are willing to deal with. JG 10.4.08

• What will happen if Perlane is injected into the lips? Do you still not recommend it in that area?

  Answer:  I feel it has a higehr chance of lumps as it is meant to be injected deeper into skin. JG 10.4.08

• Hi Dr. It seems to me that if i get resty or juvy in n/l folds, and possible corners of moths, that when i get a fac lift a 9 weeks later, that due to the pulling of skin, the resty line might show up outside of the injected place, or does the PS just srape it out if needed? He said he was going to do resty in my n/l folds during surgery. Should i just wait till then? I am sheduled for injections(botox and resty or Juvy) Oct 7th. I know I definately am due for botox, and that wont matter, i may be getting it to lift corners of mouth,(first time to try that) combined with resty. Should i just do botox and not resty? I am waiting to hear back from doc on this. I am also scheduled for the Profractional about 6 weeks after injections. If i do the resty/juvi, will it affect the laser resluuts? Thanks!

  Answer:  there is no scraping of filler done and if those fillers are injected correctly, what you are concerned should not happen because the filler is injected into the skin and when pulled taut it will smooth it out.I personally would never do Restylane for the folds at the same time as a facelift. The fillers will not affect the Fractional laser and I wish you the best. JG 10.4.08

• Dr Garcia I was wondering if it is possible to have a permanent bruise at filler injections site> I had to little dimples filled in and not only are they not filled in(out)still have grooves actually 1 groove is larger then before but NOW I also have bruises on both sides>(they have faded a little not completely tho) it has been 2 weeks? Also I am having vein therapy for spider veins on face do I need to stop taking St johns Worts? Can i safely add arnica w/o stopping St johns? oh About my dimples is it possible to have them filled in?? THANKS SO MUCH I really do appreciate the ability to depend on you & your expertise as well as your kindness

  Answer:  well if there was a bruise and the bruise got exposed to sun it can stain the skin and might need a YAG laser to fade the discoloration. I think th St John`s Wort and Arnica are OK to use too. As to the dimples being filled in, I cannot say without seeing you in person, sorry. JG 10.4.08

• A laser treatment left me with a very slight hollow on my upper left cheek... right in that spot below the eye bag that casts a shadow and makes my eyebag appear larger than it is. How safe is it to inject fillers in upper cheek hollow? Which filler would you suggest?

  Answer:  in experienced hands it works well.I usually use Restylane. JG 10.4.08

• dear Doc. what kind of surgery would i require to remove juvederm bump under my eye that you just suggested? any chances that it would still dissolve without intervention? it is very superficial, whitish, it can not be felt palpating. the other side lump looks even worse, even when it is not swollen. what can i do? thank you

  Answer:  it would take an incision over the bump and then stitches resulting in scars. JG 10.3.08

• dear dr Garcia. i am the victim of juvederm under my eyes injected and dissolved a couple of times. each time the results were worse. it has been a year since the last intervention. i am left with a asymetrical bags, on one side there is a lump, that sometimes swells. the other side a small bumb, very superficial, that creates that fold in my cheek that old ladys have. i am very afraid of hialorunidase, because it looks like it is dammaging my tissues. i can not do anything for another month because i am pregnant, but i have to do something as soon as i have my baby. any sugestions? thank you.

  Answer:  hard to say wothout seeing you in person but it might require surgery to remove the bump that is there all the time and if the swelling comes and goes there is not much we can do for that, sorry. JG 10.3.08

• Two years ago I has radiesse injected into the bridge of my nose..what remains in the area of injection is an outline of the stuff, the injection sites on both sides of the top of my nose remain hard, and the same outline continues down to the tip and sides of my nose..when my nose swells, the ridges become prominent..the skin texture is shiny and red, compared to the rest of my face..I also notice areas where the skin appears to be peeling...I keep waiting for the stuff to go away..it feels like there is fluid under the skin as it feels puffy and lumpy in areas..does this sound like there has been collagen formation where the radiesse once was..is there any treatment..one dr I saw thought it may be scar tissue formation..the area is dynamic in terms of the swelling..when I perspire, my nose returns to normal and the hardness and largeness are gone..otherwise, my nose is usually swollen..there is like a half dome, semi circle texture thickening above my eyes at the top of my bridge which is where the radiesse was injected.. Is what I`ve described something that would require surgical intervention, or is there some steroid to take to dissolve this scaffolded tissue

  Answer:  more scar tissue than collagen. No real safe treatment I fear. Surgery could prove difficult to remve it and the steroid injections might create new problems. JG 10.3.08

• Hi Dr Garcia, I had fat transfer to my cheeks last month. I loved the result until the swelling went away. I feel that I have not had enough fat injected. Is it OK to get Restylane Sub q to top it up so soon after my op?

  Answer:  Yes, it is OK to use the Restylane SubQ. JG 10.2.08

• I got juvaderm for my nasal labial fold line and they were pretty bad last Sept. After the injections I kept noticing a purple look underneath the skin where the line was and thought it was a bruise, but it is over a year and it is still there. I can still feel the juvaderm. What could be causing it? And doesnt juvaderm absorb or disappear by now? Also where he went up high around the nose area I can see where he stopped off and it looks very noticeable and kind of lumpy. Is that normal? What can be done about it and is there a better filler than juvaderm?

  Answer:  it is from too superficial of an injection, causing the light to reflect off of the filler, it is called a Tyndall Effect. Can be injected with hyaluroidase to dissolve it. Lumpiness is not normal and will also improve with the hyaluronidase. Massage might help some to, all the best. JG 10.2.08

• Hello Dr Garcia, I am planning to have a TCA peel under the eye but have had a granuloma from a permanent filler in that area for many years which I have had to accept and live with. Would the peel aggravate the granuloma and make it bigger? Thanks

  Answer:  should have no effect on the granuloma. JG 10.1.08

• Doc,I have not been happy with Restylane for my thin lips. I would like to know what you think of alloderm and autologous fat injections. My friend had allodrem with restylane and she has a much more natural&long lasting results.

  Answer:  I think Alloderm might last a year and is more of a sausage shaped augmentation, no real shape, I do not feel fat injections to the lips work well, are not reliable, and typically do not last longer than other off the shelf fillers. JG 9.30.08

• How can granulomas be removed from the eye area caused by the radiesse?

  Answer:  cutting them out. JG 9.30.08

• Radiesse again, Is there any chance the hard one could be some of the gel? Also, do I need to fear more lumps and bumps...or do you think I am safe and the worst is over. Sorry to bug you, I have just been an absolute wreck over this. I still can`t believe this happened! Oh and I get this weird feeling every now and in and around the areas where the radiesse is...I keep imagining that can only mean that it is GROWING! is it?

  Answer:  it could, yes. I think the lumps that were going to form will form in the first 4-6 weeks usually. The granulomas shouls not cause any significant pain though. JG 9.30.08

• I asked you a few questions last week regarding a radiesse injection that I had. I have two lumps one hard and not movable on the bone under my eye, and another softer one that is movable in the middle of my eye just above the bone. Does the harder one sound like it might have turned into a granumola? and what could the soft one be. If it is a granumola, will it go away on its own? It will be four weeks tomorrow since I had this done. I fear looking in the mirror each morning in fear that another bump or lump will have formed. Do you think the worst is over or do I still have to fear this? Due to all of this stress, I have lost 8lbs, can that also make the lumps and bumps appear more prominent.

  Answer:  yes, it might have turned into a granuloma but it is still too early to know for sure. The soft one could be a clump of the carrier gel that has not dissolved or an area of the calcium that has not hardened into a granuloma. Granulomas do not commonly go away on their own and where yours are, they will likely be visible for a long time even if they did. The carrier gel takes 6-8 weeks to dissolve so hold on for now, could ask the injector to try to squeeze some of it out through a small needle hole over the lump too. JG 9.30.08

• Hi; I had evolence injected under my eyes 10 months ago to lessen the look of darkness and hollowness. Two bumps were immediately under my right eye after the procedure due to more injection of filler on the right than on the left. My doctor from Canada told me that it may take 1-2 years for the bumps to go away. Will they disappear all the way? Is there anything I can do to speed up the process of not seeing the two bumps? Can anything be injected to make these bumps disappear? Can they last longer than two years? Please advise. Thanks.

  Answer:  well, in most cases if they appeared right away they could have been removed through a small needle hole, as long as they do not turn into granuloms, they will dissolve in time, injecting them with saline to disperse the material is done at times to speed it up. JG 9.30.08

• my thinking is either with my allergies or sinuses juverderm just didnt work well for me...i really dont know. is a shame cause i liked it the best of all fillers.

  Answer:  I have never seen nor read in the medical literature of it causing allergies or sinus problems. JG 9.27.08

• Hello Dr Garcia after reading your q&a you seem like a wonderful Dr of good character,therefore I am asking for your advice regarding Dr S OURIAN. I am so angry with myself for trusting his sales pitch after a consultation regarding Sculptra for my sunk in cheek area, he sold me on Radiesse and his 35 year Guarantt package. After visiting DrJon Pearlman someone I trust he confirmed their was not enogh fat to transfer and fillers are not his speciality. Since my career is in representing beauty manufactures my looks are very important and I madea impulsive decision to let Dr frankenstein inject me. The radiesse took wonderful in January I felt so confident and my friends were thrilled but, after 5 weeks the volume began disappearing the Dr re-injected me in MAY and sometning went terribly wrong. By that evening i notice my cheeks were brown appearance resembled Jessner Peel. When I went to see him less then 48 hours later he asked me If I had laser done? Hello After 5 weeks he continued to ignore his responsibility in burning my face and gave me 8% Hydoquione which I did not apply as it was summer. I called Radiesse and spoke to Becky Cron who said yes that can happen if you hit the blood vessel. I asked for my money back $6,000 and the Dr acused me of visitng another DR the day after I saw him and receiving inadequate care and then shaking him down. After researching him I found out to late he is not Board certified or a dermatologist and Radieese list him still a Plastic Surgeon Do you have any advice other on the best way to keep this awful man from continuing to cause unnecessary damage? I have the paperwork to file a complaint with the AMA. Thank You in advance for any direction you can share with me. Best Jennifer Prizant

  Answer:  well I think filing a complaint with the local county medical society and the state medical board are other options you can explore. I would also ask the Radiesse people to modify their listing of physicians to reflect accurate material. That would be the most effective way to get him to be looked at carefully. I am sorry to hear about the issues and best of luck. JG 9.27.08

• Hi Dr. Garcia! What a generous guy you are, answering all these questions--I`ve learned so much reading your posts. I was wondering if anything can be done by injector or patient to minimize the chance of a filler migrating? I`m getting Juvederm for the first time for my nasiolabial folds with a very good injector. I`ve had Zyplast and usually it was great, but there were a couple of times that it migrated upwards, which actually made the NL fold look worse than before in contrast. If I remember right, injecting along the lower edge of the NL fold seemed to make for a better result... do you agree? Do you find some patients are more likely to have migration than others? Sorry for so many questions, I just like to go into things with a lot of information for the best chance of a good result. Thanks again. :)

  Answer:  well the best thing to do is to ice afterwards so the tissue become a little firm and do not allow migration, but migration should be almost unheard of in the vast majority of cases. I think what you describe is more of a case of improper location than migration, the materials do not readily move too far, not like liquid injections such as Botox. Best of luck. JG 9.26.08

• radiesse question again.forgot to ask you...could I be aggravating it and increasing the puffiness from touching it? would ice help at all. I can`t stop crying

  Answer:  I do not think you are aggravating it and you can alternate the ice and warm. JG 9.24.08

• Dr. Garcia, It is the Radiesse questioner again! I am driving myself crazy with this, I can`t stop looking in the mirror and crying after I have done it. But it seems I have another nodule...this one seems to be movable as the other one is not...but they are both hard. The doctor said he did not inject in the area where I have the second nodule. I think he did though. I have been applying hot compresses and massaging. Do you have any other suggestions. I am so distraught right now...I would fly there to have you help me. I am so afraid I am going to be lumpy and bumpy for the rest of my life. OH MY GOSH, What have I done.

  Answer:  could have the doctor make a small nick with a needle and see if they can squeeze any material out, I do not suggest you try it on your own though. JG 9.24.08

• Dear Doctor Garcia. Will be in next week for sculptra. Had it done about a about a year or 2 ago I know it comes in 2 syringes. Would it be possible to inject both syringes the same day instead of having to come back. Has it been done that way? I`ll be out of state around the holidays, so it would be easier not to have to travel back. Thanks, E H.

  Answer:  yes, that is possible. JG 9.24.08

• I was just wondering if I made a big mistake by lying down prior to 4 hours after having botox injections forehead plus I have been at the pc for a long time (LOOKING DOWN) > I was called by a friend and told me IT WAS A BAD thing I did. I may have poor and troubling results WHY??? I only lied down for 15 minutes. Thank you Dr. Garcia!

  Answer:  if you did not lie face down you are likely OK. The problem with lying face down is the presure on the area of injection pushing the Botox to where it does not belong. working on a computer should not have any negative effect. One more thing about Botox. It has come out that the education that injectors were given since the beginning of Botox release was incorrect. The bottle is to be used for a single patient. That means that a bottle should not be shared between multiple patients. The company that makes Botox has known about this but has never issued an alert to doctors or patients. The risk is that of the bottle becoming contaminated and passing a communicable disease like HIV or hepatitis from one patient to another. There are no known reports of disease transmission in the use of Botox, but it has not been looked at yet in order to determine that issue. For that reason I strongly urge you to demand that a new bottle be used when you are treated and then observe the injector destroy the remainder of the bottle. If that is not done I urge you to contact the local board of health for the violation. Ask to look at the box it comes in and you will see the single patient, single use wording. JG 9.24.08

• Dr. Garcia, Will the radiesse continue to grow and if so for how many more weeks it has been three weeks, and it seems like it keeps growing. One more question...will my skin go back to its original place once the radiesse is gone...or will it sag more. Thank you for your patience!!!

  Answer:  hard to say if it will grow any more, it might to a small degree. The skin should not sag once it s all gone. Best of luck. JG 9.23.08

• Hi, Dr. Garcia. I wrote you a short while ago asking whether or not having dental work done a few weeks after having Restylane injections would have any impact on the injections. I had Resty injected along my jawline (jawbone) twelve days ago to correct an uneven jawline, and the injections have made my jawline look great! Yesterday I had my dental work done and the dentist had to take an impression of my lower teeth -- he was pressing really hard on my jawbone for about three minutes and I was really panicking, fearful that he`d disturb the Resty. Anyway, my jawbone still looks the way it did before he pressed on it, so I am hugely relieved (you had told me I had no worries about him disturbing the Resty so obviously you were right!) My question is, even though my jawline looks the same, could all that pressure yesterday make the Resty start breaking up faster? From what I`ve read, once the Restylane has been there for three or four days, which it as, all the pressure in the world won`t affect anything. (I hope I`m right?!) Thanks again for your wonderful website, Dr. Garcia!

  Answer:  it should not affect it, no, but if you get swollen from the dental work it might make the jaw look different until the swelling goes down. You are correct about the 3-4 days and it not moving any more. Glad all went well. JG 9.23.08

• THANK YOU SO MUCH FOR YOUR RESPONSE!!!! regarding the hard bump and wormy thingies under my left eye. I feel a little better (THANK YOU)...was actually thinking about seeing a therapist, thats how upset I have been over this. One more question though, since it is three weeks out would massaging or hot compresses help any?

  Answer:  yes, to both. JG 9.23.08

• Three weeks since my injection of radiesse. I went to the appointment with the understanding that restylane or juvederm would be injected to help with the hollowness in the tear trough area. I now have this hard bump on the top of my left cheek bone...and other areas under the left eye seem wormy looking. Everyone tells me that they can`t see it, but I think they are just being gracious. I am not getting any suggestions from the surgeon as to what to do. What can I do for this hard bump? and the wormy things Will it ever go away? I can`t stop focusing on this and it is all I can think about...please give me some suggestions. Will it ever go away.

  Answer:  well I suggest you wait about 6-8 weeks after the injection because the carrier gel will dissolve and maybe it will get better, in time the other component will also most likely dissolve too, but I am unable to say what time frame though. Best of luck. JG 9.23.08

• Hello, Dr. Garcia-- I have mostly rolling scars left from Acne. I`ve hadFraxel in the past and had developed brown spots from it (even though I am a light-skinned person). The doctor I consulted is hesitant to use another laser on me because of the FRAXEL results. He suggested Subcission with Filler (Radiesse). What is the chance and percentage of improvement on rolling scars using Subcission? Is it worth the cost? Can Fillers be used without Subcission? Is there something better for Rolling Scars?

  Answer:  I think you might get 12 months from the subcision and filler, I think fillers for acne scars without subcision are prone to get lumps. normally I woudl suggest a laser resurfacing with diligent sunblock and bleaching agents before and after. JG 9.22.08

• Hi Dr. Garcia! What would happen if Sculptra was mixed only an hour before injection? Would it cause more bumps, inflammation etc? Would it create more volume?

  Answer:  maybe more lumps, and it would clog the needle easier too. It will never create more volume, it is not dependent on that, that is dependent on the amount injected and the patient`s response to the filler. JG 9.21.08

• Can Restalyn be used for the under eye area?

  Answer:  for the rim of the eye, not the eyelid though. JG 9.20.08

• Hi again, Dr. Garcia. I recently wrote you with some questions about Restylane (whether or not I have to worry about dental work disturbing it, etc.). Two months ago, I had some Restylane injected near the lower corner of one eye to fill out a hollow (along with having it injected in other areas). The Restylane improved the hollow tremendously, but for some reason, this particular area developed a nasty bruise and swelling. Eventually the swelling and bruising did seem to dissipate. However, in some lights, the bruise is still somewhat visible -- it seems to have travelled downwards onto the cheek area, further down than where the Restylane was injected. It sort of looks like an age spot, about the size of a dime -- but quite visible in really bright light. My surgeon has given me Neostrata to apply to the area (the cream used to lighten skin and reduce age spots). He says that eventually the cream -- used once or twice a day -- will lighten the area caused by the bruise. Have you ever heard of a bruise from Restylane lasting this long -- or, worse, forever? Do you think the Neostrata will indeed clear up the discoloration? Many thanks, Dr. Garcia, for your advice and for your wonderful website!

  Answer:  it is no longer a bruise but it is skin stained from the blood that was on the bruise, I would prefer Retin-A mixed with 4% hydroquinone or a YAG laser to fade it, best of luck. Thank you for the kind words too. JG 9.19.08

• Hi Dr Garcia, I had Dermalive injected into my lower eyelids and lips almost 7 years ago. I ended up with terrible hard lumps which I then had to get removed surgically. I recently had a Thermage session on my face and since then a couple of the original lumps have started to react and swell up again like an allergic reaction as if maybe some of the product is still there. The lumps are not unsightly but I don`t want to have to repeat the surgery. Is there anything else I can do and could this be a temporary allergic reaction? Thanks

  Answer:  I seriously doubt it is an allergic reaction, the heat generated might have caused new scar tissue to form as the Thermage is meant to stimulate collagen, no other real options I am afraid, might just wait it out though and see what happens. JG 9.18.08

• Thanks for the wonderful question (JG 9.16.08) below on the friend who has many different procedures scheduled quite close together. Very complete answer (you are a genius, thanks!) only one little question. When speaking of TCA Cross done on her on some spots (close in days to the microdermabrasion / fillers procedures) you said I feel the TCA cross will disappoint . By that, you mean when done a couple of days before a microdermabrasion, specifically, or in general terms, that it is not a procedure whichs effects are likely to be visible either way (with or without other procedures going on). Sorry I still asked that. Hugs a ton.

  Answer:  no, I think in general it does not work well, it does help some mild recently formed spots but it is mild and can cause hyperpigmentation, something you do not want. JG 9.18.08

• Hello, I had juvi injected today it was a slight mistake (misplaced)trying to inject a dimple> I was also bruised right in the dimple groove so of course It looks worse than when I went in> however she injected hyalrondaise> it almost instantly dissolved product. I still feel lumps She said I am feeling mostly the bruise>(not product) can a bruise clump up in the inside? Oh and the dimple looks even more prominent and indented on top of purple> I guess I am scared> I made a mistake today> in your experience what do you see happening in the next few days Whether it be positive or negative please tell me IS there anything i can do? DO you know why it looks more indented? THANK YOU A WHOLE BUNCH

  Answer:  I would give it some time and then re-evaluate it in 6-8 weeks. I suggest some warm packs and massage to help the bruising resolve. JG 9.16.08

• Hello dear Doctor! I know that you here can only give opinions and guess from what you are told, that you can not actually give advice ... so I am only looking for your opinion from afar . I have my friend who more or less is having or will have some procedures I am interested in myself. The thing is, she is leaving soon (important commitments) and ironically the two good derms in her office too (congresses and the like). So they have tried to find a way to give her all or most treatments possible in two sessions, not on the same day (one with each doc, as each is more specialized in some procedures than the other) but with only two days apart. Unfortunately my friend has not been smart enough or lucky enough to talk to them at once. So she will have all the following... and I wonder how safe or compatible having all those procedures at once or so close are. a) On Monday a bit of Artefill for off-label use for the tip of the nose and the bridge of the nose (upper part only, above the bridge) and cheek augmentation (after an accident) -two off label uses of Artefill... and a few MAYBE (not sure) pitted scars treated with TCA Cross. On Wednesday evening (2 days and a half later) the other doc was planning Restylane in areas where Artefill is not approved or considered suitable (small lines in the glabella, corners top of the nose -but she will have had artefill there two days ago!, just this should be less deep than artefill, of course), a couple of glabella lines and small superficial wrinkles around her mouth. But the doc was also thinking of putting Restylane on some scars where fillers could work and to finish it all with a microdermabrasion (micro, not dermabrasion, yet, I know she goes a bit deeper than non professionals who do microdermabrasion - to the point of creating sometimes a scratch so to speak)-. if she does microdermabrasion over an area where the filler/s artefill and/or resty were injected (the first two days ago, the latter in the same day) should my friend be ok? I want her to be safe and not do anything crazy. And also want to know how that wors out because some of the procedures are of my own interest for some near future. Artefill and Restylane are compatible, you said, but so close apart in days? So, to sum up, ok a) resty on some scars in areas where where deeper there was Artefill a couple of days ago; b) microdermabrasion afterward (last procedure or last day), in areas where there might be some of both fillers?; and c) micro over maybe bits of area where a few pitted scars had TCA Cross two days ago?Again, I know you can only give your insight from someone who is not watchign the patient nor talking to the docs, but I want to have an idea to in turn tell my friend if she should worry more or less about these consecutive treatments. Hugssss

  Answer:  OK on the Artefill, I feel the TCA cross will disappoint. I think the second filler will be OK to use a few days later in experienced hands. I would not do the micordermabrasion in order to avoid any potential injury to the skin after the recent filler at the same session. Best of luck. JG 9.16.08

• would a filler cause any kind of blood circulation problem that could cause dizziness

  Answer:  not that I am aware of. JG 9.16.08

• Can Radiesse dermal filler be used in the glabellar area as well as the forhead and below the eyebrow? or are there only certain areas it can be used.

  Answer:  It might be OK to inject in the glabella and forehead but I think under the eyebrow might be tough to get a reliable result. JG 9.16.08

• can i use restylne with allergies.

  Answer:  we have done it on many patients with allergies and not had a problem. JG 9.15.08

• Hi Doctor :) Can Restylane and, in general, fillers, be used in an area that was injected priorly with Artefill? Not the same day, of course. But after a few days, can it? Because there are areas for which Artefill is approved and for others not, and there are some areas where the Restylane might intersect areas where there are maybe some particles of the Artefill (as in areas slightly overlapping ... say nasolabial folds with Artefill and close to there areas filled with Restylane). Hugs!

  Answer:  yes, it can. JG 9.15.08

• whta do they mean when they say dont use juverderm in pateints with severe allergies. I have like evry allegy known to man. Also they say dont use in patient with allergy to posotive gram b baceteria...?

  Answer:  they are precautionary measure to limit potential issues. If you have allergies that severe I suggest you not use it. JG 9.15.08

• Hi dr garcia i posted a question regarding puffy cheek a few questions down and you advised it may be exhuberent scar tissue formation that makes the cheek look puffy if this is the case what can be done to make the puffiness go away?

  Answer:  kenalog or 5FU injections possibly. JG 9.15.08

• so in general i may just have a bad body response to juv and should prob;y go back to retsylne?

  Answer:  I think if you have had no reaction to Restylane you will likely not have a bad reaction to Juvederm either. If allergic reactiosn were common then the FDA would ask for testing prior to use, and it does not. JG 9.15.08

• WHEN THEY SAY JUVERDERM IS NOT FOR PEOLPLE WITH SEVERE ALLERGIES, WHO DOES THAT INCLUDE? ALSO COULD JUVERDERM BE DYHYRATING ME OR MY SINUSUS AND THATS WHY I DONT FEEL WELL AFTER IT. DOES RESLTLYNE RETAIN LESS WATER THE JUV?

  Answer:  I do not think Juvederm will affect your sinus issues or dry your skin and allergies are always a small risk with any filler. Restylane and Juvederm do not contain water, but once injected, the Restylane absorbs more fluid to fill itself up more, that will not affect your skin or sinuses though. JG 9.15.08

• Hi dr Garcia i had some radiesse injected a few years ago to hide a scar on my right cheek bone. Unfortunately this just caused a lump which looked quite apparent. About 10 months ago the dr cut out the existing scar about 2cm in length and 2-3mm in width and he scraped out the lump and stitched it back up. I have had a puffy cheek ever since and it seems like the muscle on my right cheek lookes swollen and raised compared to normal it looks like it could be swelling in the cheek muscles and its been 10 months please can you tell what this could be and if it is swelling how long it will take to clear so my cheek looks flat like it used to, also is there anyway of helping the cheek to not look puffy as in can you drain out the excess swelling fluid thanks.

  Answer:  it would be unusual for it to be swelling this far out, more likley exhuberent scar tissue formation I think. No way to drain the fluid out I am afraid, I really do not know what I can advise without seeing you in person, sorry. JG 9.14.08

• Thanks so much for answering my questions on Restylane, Dr. Garcia. I was so pleased at how quickly you responded, especially on a Sunday! I am very relieved to know that the dentist`s hands against my face can`t affect the fillers. Would you be good enough to answer a few more Restylane questions? Can it be injected in small dispersed amounts in the area directly below the bottom of the cheekbone (area of the side of the face that is between the jawbone and the lower part of the cheekbone that sometimes looks sunken with age or if your cheekbone sticks out a little too much) to give the face a smoother and fuller look when viewed from an oblique angle? I`ve heard Sculptra works well there, but I simply can`t afford Sculptra. Also, my plastic surgeon tells me to massage the cheeks every day with my face cream and apply gentle pressure, or, if I see anything that looks a little lumpy, to apply firm pressure and massage. He likens the Restylane to ``silly putty`` and says it can be manipulated to get a smooth effect. I`m worried about overdoing the massaging or that I might be simply massaging swelling and making it worse. What are your thoughts on this? Lastly, just out of curiousity, what is the longest time you`ve ever seen Restylane stay put when used for filling hollows/creases (not just for filling little wrinkles)? Many thanks again for your kind help, Dr. Garcia!

  Answer:  it can be injected into that area of the cheek, yes. As to the massage, after the first few days, 2-5. It will not flatten out any more, the flattening effect is not long lasting. The longest I have seen it last is 10-12 months in that area. All the best. JG 9.14.08

• Hi, Dr. Garcia. I have three questions regarding Restylane. I had some Resty injected in my cheeks to fill in a few folds in the cheeks when I smile. I also had some injected in the outer corners under my eyes (good result) as well as along the jawline to correct an uneven jawline (also good result). I only had this done on Thursday, but today (Sunday) I am still not happy with the way my cheeks look. Could they still be swollen (even though I can`t see bruising?) One cheek looks fuller than the other (in fact, that cheekbone was always higher than the other one, but now the Resty seems to draw attention to that). I am wondering if the doc put a little too much in my cheeks and if some of it could be dissolved with that ``counterpart substance`` you have referred to here on your board. If it can be dissolved, will that substance ``migrate`` all OVER my face and dissolve the good injections near my eyes and on my jaw -- or does it only dissolve in the area you inject? Second question: Restylane`s website says it only lasts six months; however, my doc says that he`s seen it last for a year to a year and a half. I`m worried that my cheeks might stay this way forever, as about six years ago I had some Resty injected into a tiny wrinkle, which has never come back. I want my injections near my eyes and on my jaw to last as long as possible (this stuff is so expensive!) but I`m just not happy with my cheeks because they look assymetical. Last question: I am having some extensive dental work done soon -- can the nice new improved jawline be ``dislodged`` by the dentist poking and prodding around my teeth and inadvertently pressing his hands against my face? Thank you SO much for your time and for your wonderful website, Doctor Garcia!

  Answer:  yes, swelling can be there for up tp one week in some cases. I would wait some more time before deciding to dissolve it. The hyaluronidase does not move all over, it stays where you inject it. As to how long it lasts, the greater the motion and the deepr they inject it the less time it lasts, there is no way to predict, all patients are different. Dental work will not affect the filler, no need to worry there. JG 9.14.08

• hi, i had juvederm two months ago in my cheeks and was wondering if its safe to use the baby quasar or one of the at home LED devices. also, is it safe to do any LED treatments if you have fillers? i don`t want to do anything to shorten the life of the juvederm! additionally, are there things to avoid in order to preserve juvederm? thank you!

  Answer:  I think it is likely safe yes. I do not think LED treatments do much so I doubt it will affect the filler. Once injected it is really up to your aging process as to how fast the Juvederm will dissolve. JG 9.13.08

• I have a lump on my upper lip about 1/4 round from juvederm. It`s very noticable. Massaging it hasn`t improved it at all and it`s been over a week now. Basically the rest of my upper lip isn`t very smooth. Will a very small amount(drop size) of hyaluronidase remove that one lump and the rest of my upper lip job? Will I be unbalanced requiring more juvederm? I plan to see you since my injector lady doesn`t even know about hyaluronidase. Also how much would this cost to just have the lump removed only. Thank you sir

  Answer:  it could, or a small puncture wound and then pressing it out could work also. The visit for dissolving is $50 for the consult and then $75 for the injection but you need to book ahead as we order the hyaluronidase as needed, we do not use it enough to keep it in stock. If it needs more it can be redone but if it dissolves too much then you need more filler. It is not an exact science. JG 9.9.08

• what d u think of castor oil for eyelashes?

  Answer:  see no reason to use it. JG 9.9.08

• do u have a home remedy (ie vaseline) for for healthier eyelashes? I dont like mascara because I have very long ones and want to keep them that way? also can you see that maybe restlne could be a bit safer than juverderm?

  Answer:  sorr, but I do not have one. I do not think there is a difference in safety between Restylane or Juvederm though. JG 9.8.08

• Dr. Garcia--I am learning so much--thank-you I had Juvederm Ultra Plus and am not happy with the change in my face. You suggested massaging might work in a previuos email--should I see a doctor about the techniqe? How long does this filler last in the cheek area. Thanks Again--

  Answer:  no need to see the doctor, just little circles over and over on the area is all that is needed. I think in the cheeks it will likely not last to long, warm packs might help too, all the best. JG 9.7.08

• I have a question about Juvederm. I had it in marrionett lines and smile lines six months ago and it has lasted longer on one side then the other, thus giving me an uneven mouth. One side of my mouth is pulled up and the other down and I look weird. Is this fixable?

  Answer:  might need to get the side that has absorbed a filler up. JG 9.5.08

• Hello, Doctor! Can a person have IPL treatment in an area that had Artefill injected?

  Answer:  yes, OK to do. JG 9.5.08

• I`ve heard that botox may be used to turn up the tip of the nose. Then I learned that some doctors use a filler right at the columella-labial angle to turn it up. What do you think of these procedures?

  Answer:  I think that both ideas are flawed and will not work in the vast majority of patients. One more thing about Botox. It has come out that the education that injectors were given since the beginning of Botox release was incorrect. The bottle is to be used for a single patient. That means that a bottle should not be shared between multiple patients. The company that makes Botox has known about this but has never issued an alert to doctors or patients. The risk is that of the bottle becoming contaminated and passing a communicable disease like HIV or hepatitis from one patient to another. There are no known reports of disease transmission in the use of Botox, but it has not been looked at yet in order to determine that issue. For that reason I strongly urge you to demand that a new bottle be used when you are treated and then observe the injector destroy the remainder of the bottle. If that is not done I urge you to contact the local board of health for the violation. Ask to look at the box it comes in and you will see the single patient, single use wording. JG 9.5.08

• Hello Doctor! I have noticed that Artefill has been approved by the FDA. Does it mean PMMA particles used for filling are safe? I am specifically asking for its use in the nose and for the malar area. a) Regarding both (nose and cheek areas), have you ever seen granulomas or nodules develop from it? b) Since it is a permanent filler, what happens as years go by with the Artefill injected in the cheeks? I mean, our cheeks change over time, by ageing. Does having that filler there eventually cause an odd look to the cheeks? c) Have you any idea why other fillers based on PMMA alone (no collagen vehicle) and used in Europe and Latin America have not been approved by the FDA? Thanks in advance for your time!

  Answer:  it would be an off-label use, so legal, but it has not been looked at for long term safety nor effectiveness in those areas. There are reports of granulomas with most fillers, and the longer lastng the product is the greater the risk for that. As to what happens to it, long term it will sag along with the other tissues that are falling due to the aging process. There are no other PMMA injectables that I am aware of slated for US release. As to looking funny long term, it will never stave off the need for a surgical lift over time. JG 9.4.08

• Hi Dr. Garcia. I hope your summer is going well. I wondered if besides botox, you can use Restylane or one of the fillers to fill in the grooves of the forehead? Genetically some people naturally create fairly deep grooves that even when motionless show as a deep wrinkle. Is this doable or is the are to superficial for this to work?

  Answer:  yes, they can be used but it is an area that can show bumps, I suggest using thinner fillers there but they will not last as long as Restylane does. JG 9.4.08

• what do u think of tanda proffessional skin system for collogen and younger skin they claim? also how would it affect filler?

  Answer:  unimpressed by the claims, little to no science to speak of behind it. I do not think it will stimulate much more collagen than over the counter products and the effect on the fillers is unknown and untested. JG 9.4.08

• dr. what can you tell me about teyosal 27 for the lips? is it as good as restalyn lipp and is the consistance the same..it seems less expensive 2 syringes for 299 in canada..whats the price out in vegas and have you used it on your patients?

  Answer:  It is illegal to use in the US, I have not used it personaly, from my communciations with doctors that have, it is essentially the same as Restylane or Juvederm, not any significant difference. JG 9.3.08

• does prozac, klonopin, or a centrum vitamin speed up dissoliving of fillers?

  Answer:  I do not think so. JG 9.2.08

• Hi Dr. Garcia: Is there any type of filler one can use to alleviate the hollowness around the eye? Thank you.

  Answer:  none that are reliable and reproducable for the eyelids. JG 9.2.08

• Do you recommend fillers along the jawline to fill in the space to make jowls less noticeable. Thank you

  Answer:  they cna be used but will make the area around the mouth look bigger, so there is a trade off. JG 9.2.08

• Hi, Dr Garcia: What is best filler for vertical lines above nose between eyebrows? How long does it last?

  Answer:  I like Restyalne there and it should last 2-6 months, depending on the degree of motion. JG 8.31.08

• could the juverderm possibly b leading to dehydration, and thats y i feel so sick? my potassium was low all the sudden too.

  Answer:  go see your doctor. JG 8.30.08

• if it is the juverderm making me sick is there anything I can do? I am very dizzy with shakiy vision all the time?

  Answer:  I do not think it is the Juvederm, you need to see a doctor and see what else is going on. JG 8.30.08

• Do you in your office inject Silikon 1000 in micro droplets in Naso Labial lines, between the brows, and in verical lines above and below the lip and other vertical lines on the face and in laugh lines on the side of the eyes? What is the cost of Botox....I usually require at least 35 units in my forehead area.. Thank you Judy Fullerton

  Answer:  not, we do not, it is illegal in Nevada and in many other states to use that product off-label for cosmetic reasons. The price for the Botox is either for an entire small or large bottle, bottles of Botox cannot be shared abnd the prices vary depending on whether I or my nurse inject it, the ladies in the office can give you those fees if you call. One more thing about Botox. It has come out that the education that injectors were given since the beginning of Botox release was incorrect. The bottle is to be used for a single patient. That means that a bottle should not be shared between multiple patients. The company that makes Botox has known about this but has never issued an alert to doctors or patients. The risk is that of the bottle becoming contaminated and passing a communicable disease like HIV or hepatitis from one patient to another. There are no known reports of disease transmission in the use of Botox, but it has not been looked at yet in order to determine that issue. For that reason I strongly urge you to demand that a new bottle be used when you are treated and then observe the injector destroy the remainder of the bottle. If that is not done I urge you to contact the local board of health for the violation. Ask to look at the box it comes in and you will see the single patient, single use wording. JG 8.29.08

• is it possible to have a bad reaction or auto immune reposne to juverderm? Could it affect sinuses and vsion? ever sinec I had it ive had dizziness, pulsing vision, light headness, overall dont feel well. I read some people can get sick or have bad reaction? Also something about gram b bacteria?

  Answer:  I have not heard of it happening but I guess it could be possible. I have never seen it affect sinuses or vision and cannot see how that would occur. If the material was contaminated it might, should ask your doctor to report it to the company so they can see if other people treated out of the same lot number have been similarly affected. JG 8.29.08

• Do fillers interfere with the connectivity of skin tissue. I have had Radiesse placed in my laugh lines a year ago and it appears to me that the lines are worse and the skin more loose than they were prior to the procedure.

  Answer:  no, but the filler blunts or improves the appearance and one gets used to the bter appearance and then when it fades, the change is more drastic than in the normal aging process, it does not accelerate aging though. JG 8.29.08

• Do you think it is ok to have botox and filler on one day and then the next day have ipl? Thank you.

  Answer:  I would reverse the order and do the IPL first on the slight chance it might speed the resolution of the filler and Botox.One more thing about Botox. It has come out that the education that injectors were given since the beginning of Botox release was incorrect. The bottle is to be used for a single patient. That means that a bottle should not be shared between multiple patients. The company that makes Botox has known about this but has never issued an alert to doctors or patients. The risk is that of the bottle becoming contaminated and passing a communicable disease like HIV or hepatitis from one patient to another. There are no known reports of disease transmission in the use of Botox, but it has not been looked at yet in order to determine that issue. For that reason I strongly urge you to demand that a new bottle be used when you are treated and then observe the injector destroy the remainder of the bottle. If that is not done I urge you to contact the local board of health for the violation. Ask to look at the box it comes in and you will see the single patient, single use wording. JG 8.27.08

• Thank you for the quick answer. Can you please explain WHY exactly it is difficult to correct over-eye hollowness? Are there a lot of nerves there? There is a video on youtube that shows restylane (or radiesse?) injections done over the eye. They seem to stick the needle all over the place in that area. Also, since there is not much movement in that area, should I expect the filler to last longer than a couple of months? Have you ever filled up this area yourself, or is it a relatively rare complaint? Thanks again. I am recommending this page to everyone I know :)

  Answer:  because of how long the filler lasts and because the fillers are being injected not exactly where the fat was removed. Fat injections will not survive and the fillers need more superficial injection levels than the level of the fat that was removed. If injected over the lateral brow on the bone it migth last a long time but what I believe you are describing is the eyelid and that cannot be injected as much and has almost constant motion from blinking. I have filled it in over the lateral aspect only due to aging changes. All the best. JG 8.27.08

• I was wondering what filler you would recommend for filling the area OVER the eyes (under the brow). My eyes are getting hollow (opposite to many people`s problem with eyes). My doctor injected some Restylane - it was her first time in that area. It looks better that it was, but I am wondering if you have any specific recommendations for this area. I can`t find much info on over-eye hallowness. Thank you :)

  Answer:  that is what I would use but it is difficult to correct that area. JG 8.27.08

• i had bruising which turned yellow i know that is normal if i went in the sun with makeup for one hour(not staring at the sun just sitting outside) but not sunscreen do you think it will stay yellow?? thanks

  Answer:  the yellow will not stay but you might develop brown spots down the road with prolonged exposure to the sun, so best to avoid it until all of the yellow is gone. JG 8.26.08

• an juverdem injections cause sinus infection?I have no history of allergies and sinus problems Now I have been diagnosed with a very series case and now i am scheduked for surgery this wek and pernament hearing loss and no tase or smell . Can you give me some advice

  Answer:  I have never heard of those injections causing sinus infections. JG 8.25.08

• would juverderm or any other filler cause a brain tunor, or a neurological problem? I had it done and know i always have headaches, dizziness, and numbness in hands with muscle spams in hands?

  Answer:  I have never heard of that happening. JG 8.25.08

• WOULD ANY MEDICATION (EX. PROZAC) INTERACT WITH JUVERDERM OR BREAST IMPLANTS?

  Answer:  not that I am aware of. JG 8.25.08

• Hi Dr. Garcia--I had 67 units of botox--I feel like it was far too much for my face and it was twice what I normally have had in the past. My right side brow is lower, it is difficult for both eyes to close, occasional slight blurred vision, and I notice the the filler is uneven. The botox was also injected under my eyes which I now know from you is a very problematic injection site. Is there anything I can do to help process the botox and filler faster--maybe massage or facial exercises? ANY suggestion is appreciated. Thank-you

  Answer:  massage will help the fillers but only time will help the Botox, in some cases the saggy eyelid can be helped with eyelid drops your doctor should know about. JG 8.25.08

• Hi Dr. Garcia. I had restalyne injected in my smile lines and juvederm in my lips about 2 months ago. Will massaging these areas daily help to dissolve the product quicker? I feel that the left side of my smile line shows more than the right..and i do not want to inject more product since i do not want to keep up the results. Will the massage help?

  Answer:  yes, I feel massage does help it dissolve faster. JG 8.25.08

• hi Dr. Garcia, how safe is Hydrolgel injections for the butt. it seems this is the craze for many young girls and i have friends who are inquiring to get this procedure done.

  Answer:  I personally feel it is not safe at all. JG 8.22.08

• I had restylane injections in my naso labial folds in the beginning of June. The bruising was quite bad but did fade after about 1 week. However recently I have noticed that bruises are reappearing, experiencing small spots of bruising along the fold after exercise or physical exertion where my face gets red. I also feel a tingly sensation at times. Is this normal and why are the bruises reappearing after so many months? I am concerned as it seems everytime exercise hard a little bruise appears on my face!!

  Answer:  very unusual, I have never seen nor heard of that happening before, sorry. JG 8.21.08

• Dr. Garcia: had a kenalog shot 5wks ago (scar area), it flattened and indented a little, indents seems to have stopped.Surgeon says that underlying tissues should intervene and help it fill in over time. Any guidance as to how long this can take to fill in? I have slight discoloration also (darker), will this fade also? Thank you kindly.

  Answer:  the discoloration will usually go away in time and the depression can take up to 6 months in severe cases. Best of luck. JG 8.21.08

• dr.garcia,does a (kenalog injection of 5FU) completley make a scar tissue or granomula disapear?or does it have to be cut out eventualy?

  Answer:  it usually will soften it so that it flattens and gets softer, it is never totaly removed and if it can be reduced in size then the removal can be easier. JG 8.20.08

• hi dr.when cutting out an already existing scar tissue,how can you avoid possibly creating another scar tissue after the procedure?thank you

  Answer:  you cannot, new scar tssue will form, that is why an evaluation of whether it is beneficial or not needs t be made by an experienced surgeon. JG 8.20.08

• hi dr.how much chance is there that there will be distortion after the surgical removal of large lumps in lips, caused by newfill?thank you

  Answer:  in experienced hands it should be small. JG 8.20.08

• hi dr. when cutting out granuloma or scar tissue from the cheeks is there any side effects that could happen to the size or shape of the cheek after the procedure?thank you

  Answer:  there is a chance that there will be a depression there due to normal tissue being injured or removed. JG 8.20.08

• I recently had therma frax, botox and filler. Everything is fantastic except that I am experiencing some problems closing my eyes as well as a small swelling under one eye. This is 10 days post procedure. My Dr. said to wait but I am wondering if there is anything I can do to facilitate the eye closing problems. It is very diificult in the sun and quite uncomfortable. It appears to be too much botox under the eye but I am not sure. Thanks so much--wish I had seen your site previuosly.

  Answer:  well, if it is due to too much Botox under the eye it might take 3 months, I do not recommend it be injected there for that very reason. JG 8.19.08

• I was planning to get a touch up injection in the orbital area for hollowness in my eye are. I just got a really good shiner from a tennis ball. How long should I wait to get the injection? On a funny note: I haven`t been able to play for about 5 months due to a back injury. My husband wants to send pics to his friends letting them know that I am back to playing and that my timing is a little off. I hope this gives you a good laugh.

  Answer:  I think until the swelling is gone, might be 2-4 weeks. Better wear goggles next time! JG 8.19.08

• Is swelling common after having tear trough filler? I am afraid my eyes will look puffy, like I`ve been crying and they won`t look smooth and refreshed. How much product is normal for each eye? Thank you.

  Answer:  yes, very common, actually I would be surprised if you did not get it. As to what is needed for each eye, it varies from person to person, no set amount is normal. JG 8.19.08

• Dr.Garcia, Is it appropriate to inject restylane in the lower (malar) tear trough area? I`ve heard that this area is full of blood vessels and it needs to be treated with a deeper dermal filler such as perlane. However, I trust my doc and assume that since he`s using resty in this area he`s injecting in the mid-dermis. Have you experienced any issues with moderately superficial injections in this area? Thanks very much for being a resource : ) Dee

  Answer:  I have used both there, I prefer Restylane as it is less thick, but both can be used. I feel the results there in experienced hands are well worth it. JG 8.19.08

• Dr.Garcia, Have you ever heard of vaporizing a silicone granuloma with the CO2 laser? A skin incision is made where the lump is then the laser is used to vaporise the silicone droplets. The area I am concerned with is in my cheek.

  Answer:  well, the thing is it can vaporize normal stuff too, and it might just heat up and melt rather than vaporize, not a reliable method I feel. JG 8.18.08

• How is a liquid facelift performed....injection all over the face? THanks.

  Answer:  no, mostly over the cheeks and at times the temples. JG 8.16.08

• I`m seeing some info about using one`s own fat for n/l folds..what are your feelings about it? Thanks!

  Answer:  I do not feel it lasts any longer than off the shelf fillers. JG 8.16.08

• Are bumps in the tear tough area common after using Restylane?

  Answer:  it can happen, but not common, at least not past 10 days. JG 8.16.08

• Five days ago I had juvederm injections in the under eye area. One eye is ok. The other eye was swollen immediately after the injection and has bruised badly. The real concern, however, is that I feel increasing pressure in the eye area, as if fluids have accumulated and have no escape. It is like having a bad sinus headache, with pain spreading out to the ear and gums. The clinic I attended will not open again until Tuesday-but I plan to request hyalronidase injections to remove the filler-and hopefully decrease the pressure and pain. Have you experienced anything similar with your patients? Can I safely conclude that I got unlucky, and that my injector is capable of handling the repair of the problem or should I be looking elsewhere for a solution? Will I need to inject both eyes-or just the problem eye? Thank you for your help! Cynthia

  Answer:  might be due to bleeding too, suggest warm packs and massage and see what happens by Tuesday. JG 8.18.08

• What filler would you suggest for the lines that are beginning to develope above my upper lip?

  Answer:  Restylane. JG 8.17.08

• Hello, In the past three months I have had restylane sub-q in the mid face area and perlane in the cheekbone area. I am now considering some filler in the tear trough area. The Dr. has recommended Teosyl(sp?) for this. Do you see any problems with mixing these fillers? Thanks very much.

  Answer:  I think they are OK to use. JG 8.17.08

• I am 43 and recently got Juvederm injections in the Marionette lines and nasoblastial folds. The person injected too much, and now I have two saggy bulges where too much product is. Can I have her inject hyalaronidase into the sections of too much? I don`t even care if ALL of it goes away. I really didn`t need it--was just trying to prevent lines since I read restyline actually promotes your own collagen production. What are the side effects of using hyalaronidase? I am afraid I am a slow absorber since I had some in my lip last November and it is just now starting to wane. Please help. You seem very reasonable and not prone to hype.

  Answer:  I believe you can, yes. The amount of collagen production that fillers produce, if any, is minimal and in most cases not clinically significant. There are very few downsides to the hyaluronidase so it might be a good option in your case. Best of luck. JG 8.15.08

• dr.garcia,is kenalog injections painful?

  Answer:  typically yes. JG 8.15.08

• hi dr.garcia.what is triamcinolone injections,does it dissolve scar tissues and granuloma like kenalog?is 3 mg/mL of kenalog injected alone safe?can an atopsey show if a certain lump is scar tissues or a granuloma?which is easier to dissolve granuloma or scar tissues?thank you

  Answer:  essentially it is like Kenalog. As to the amount being safe, there are too many variabels to say, like how much and over what size area it is injected, and how often. The biopsy of the lump will show little difference in most cases between scar and a granuloma. JG 8.15.08

• Hi DR G...just had regular ol` Juvederm into my lips,yop and bottom. Used a whole syring. Very dissapointed with the results...after 4 days, no noticible change..NONE!I cant tell, co workers cant and my before and afters show no real change. What gives? Can my body of absorbed it already...ALSO..who patrols the botox issue? It seems very few places here in LV are using the single use rule according to many co-workers.

  Answer:  hard to asy what could have happened, the most common thing would be you needed much more for yoru anatomy, then it that it was injected too deeply, the third sis that it was not real Juvederm. As to policing the botox issue, it should be under the county board of health, the FDA and then the state pharmacy board. All woudld be appropriate places to file a complaint. I would say that the vast majority of the injectors in Las Vegas are breaking the rules, all for profit with little concern for the law and patient safety, makes you wonder where else they are cutting corners. If you know they are doing that, the best issue is to tell the county board of health and they can move on it. JG 8.15.08

• Hello again. What do you recommend for the lines I am beginning to notice right above my lip? I was told that a small amount of botox would work. What do you think about Artefill, what is it used for, and what is the approximate cost? Thank you.

  Answer:  I totally disagree, lines at rest are not improved by paralyzing muscles, they need lasers or fillers. If it did work it could lead to you drooling or being unable to say certain words. Artefil is for nasolabial folds and should not be used for lip lines due to high chance of lumps. One more thing about Botox. It has come out that the education that injectors were given since the beginning of Botox release was incorrect. The bottle is to be used for a single patient. That means that a bottle should not be shared between multiple patients. The company that makes Botox has known about this but has never issued an alert to doctors or patients. The risk is that of the bottle becoming contaminated and passing a communicable disease like HIV or hepatitis from one patient to another. There are no known reports of disease transmission in the use of Botox, but it has not bee looked at yet in order to determine that issue. For that reason I strongly urge you to demand that a new bottle be used when you are treated and then observe the injector destroy the remainder of the bottle. If that is not done I urge you to contact the local board of health for the violation. Ask to look at the box it comes in and you will see the single patient, single use wording. JG 8.14.08

• Hello Dr Garcia Hope you are keeping well. I am 50 yrs old and I am enquiring about vertical lines around the lips that are starting to show. I am unsure about fillers as realise once I start I will have to keep having it done. I have not got many and I am wondering if they can just be treated individually with a laser? eg. zapped away? of if they can be filled in permanently individually and if so what would be used? Thank you so much for your time. LJ

  Answer:  the laser typically needs to be done in a larger fashion to get the surrounding skin to pull on the depressed wrinkle, lasers do not work like fillers in the sense of an individual wrinkle or fold, therefore you would need the entire lip area treated and the results as to longevity of the correction will depend greatly on the depth that the laser goes to, it will likely last longer than a filler if done deeply, but not more than a few years at most as the aging process is not halted. JG 8.14.08

• I recently had sculptra injected in my face and at the time of my session I had two cysts. the next day I woke up with 3 near one of the injection sites and as the days past I started getting more and more along with small pimples. I never breakout like this (if anything it`s the occasional pimple or cyst...keywork ocassional and only one or two) Could this be from my tx? a reaction to the sculptra or the fact that I had a small breakout prior to my appointment? I am far too embarresed to call the dr. or go back. What do you think? I read that some fillers can cause acneform papules. I am not even sure what papules are. Thanks

  Answer:  hard to say, might be a nodule at the injection needle pierce site, I think you need to see your injector to see what is going on. You might need antibiotics and your doctor would need to prescribe them for you. JG 8.13.08

• HELLO DR. GARCIA I WAS WONDERING IF I COULD GET THE MUSCLE CUT BETWEEN EYEBROWS FOR WRINKLE THERE AND NOT HAVE A FORHEAD LIFT , DO YOU DO THAT KIND OF SURGERY? JUST TO CUT THAT MUSCLE? THANK YOU VERY MUCH!

  Answer:  it can be done, yes, through an eyelid incision and we do perform it for certain people. I would need to see you to give you a quote though. JG 8.13.08

• hi dr.i want to come to your office and have lumps on my lips cut out(which were caused by newfill),how many hours will it take and will i feel pain while your removing the lumps?can you also give me approximate cost?`they are 3 small lumps`.thank you

  Answer:  we need to see you in consultation first and the procedure might take 30-60 minutes, all depends on what we need to do. You are likely looking at about $1500. It is done under local anesthesia and you should be pretty comfortable having it done. JG 8.13.08

• hi dr. is it true that scars on the face heal faster than anywhere else on the body?thank you

  Answer:  in general, yes. JG 8.13.08

• Are there any side effects to having hyaluronidase or a similar product injected to get rid of Juvederm (e.g., does it damage the skin or leave marks, ridges...)? I have read that some doctors won`t use it because it can create new problems. Thank you Dr. Garcia.

  Answer:  I have never seen any problems from the use of hyaluronidase alone. JG 8.12.08

• How often does an individual need to do any facia, fillers? Like what is the upkeep on them? How much does one spen yearly on that if its 2 or 3 lines?

  Answer:  no way to tell as it is different frm person to person due to genetic and environmental factors. JG 8.12.08

• Dr. Garcia, can you get Artefill done while u are still on Accutane?

  Answer:  yes, it is OK to do. JG 8.11.08

• Dr. Garcia! I saw you on TV for some Hair info merical! I was like HEY ITS THE DOCTER i always ask questions too..AWESOME!! ANyways. I have noooo NO, I mean no knowlege on botocx or facial fillers. I was wondering what the best filler is for that ONE LIVE between your brows and the two side nostrile fold lines. How often and howmuch would it codst for those 3 lines?

  Answer:  typicaly we use Restylane and the price varies on the amount needed, it migth be one or two syringes, the fees per syringe is $535 for my nurse to inject and $635 for me to inject. JG 8.11.08

• I have granuloma occurring in my lips from silicone injections a few years ago. I have tried everything to lesson the appearance and I realize removal is the only way. Who would be the top 3 Doctors in the US you would suggest I call for consultation regarding this very delicate and difficult proceedure? (Difficult in the sense that it will be very hard to get my lips even.) I am in Central Florida, but will travel anywhere if can be confident I`m with the best Doctor for this type of proceedure.

  Answer:  I know of no surgeon who is is an authority in the removal of granulomas, sorry. JG 8.10.08

• When using Botox to treat the glabellar lines, do you use the same or less units if the patient only has a single glabellar line and not two ? Thanks

  Answer:  same amount. JG 8.10.08

• Hi. Dr Garcia...I was just wondering if I need to wait for the filler in my nasolabial folds to completely dissolve before getting more filler or could I get some added(touch up) before it is completely dissolved?...Thanks ..

  Answer:  no, it can be added before it totally wears off. JG 8.10.08

• I recently had silicon injections into my top and bottom lip. I am very unhappy with the outcome. My top lip projects too far, and the bottom lip is asymmetrical. I know that this procedure is permanent. Is there a surgical procedure that I can have to remove the implant? Will I still look normal after it is complete?

  Answer:  if the silcone forms clumps then they clumps might be able to be cut out. If the amount of normal tissue removed is large there can be distortion after the surgical removal. JG 8.10.08

• does body heat/sweating speed up the dissolving of fillers?

  Answer:  no, it does not. JG 8.8.08

• Dear Dr Garcia Is it possible to lift the tails of the eyebrow slightly with botox?

  Answer:  with an experienced injector, yes.JG 8.6.08

• hi dr.garcia,how much do you cost (approximatley) for injecting a mix of 5fu & kenalog?and how much is the price range for cutting out a small newfill lump in lips?thank you

  Answer:  would need to see you in person to determine costs for surgical excision and the injections are $50 per visit and it is never effective after only one,it requires a series and they are typically repeated every two weeks. JG 8.6.08

• Hello dr garcia. Are u familiar with surgilips? Its a crosslinked HLA filler. I injected 2 syringes into my patient`s labia majora for labia augmentation. 3 days later certain areas became lumpy. I massaged them and it disappeared almost immediately. My question is, do u think the lumps are early granulomatous reaction and would they come back. How often should i ask her to massage the area? Thanks.

  Answer:  granuloma would likely take 4-6 weeks to form as the scar tissue will take time to encapsulate the area. I cannot comment on Surgilips as it is not used in the US and I do nto have the information on the type of cross-linking it has. I think your massage suggestions should be similar to the instructions you use when injecting other hyaluronic acid fillers elsewhere. JG 8.6.08

• Dear Doctor, can a gummy smile be corrected by the use of fillers in the area under the nose? Is that possible without injecting the filler in the lips? I have naturally rather large lips, it would not look nice to have fuller lips. Can the filler injected under the nose weigh down the lips so as to not show so much of a gummy smile when smiling?

  Answer:  I do not think fillers will correct what bothers you. JG 8.5.08

• Dear Dr. Garcia I wrote to you sometime ago about juvederm injections and my eyes are still quite swollen and the doctor tells me that after 4 months he thinks my lymphtic nodes are plugged what can I do about that?The juverderm was injected around my eyes.

  Answer:  boy, I am curious where he came up with htat one, I think that is impossible for it to occur. Sounds more like improper injection technique. Might need to get it dissolved. JG 8.5.08

• granuloma or scar tissue, what is the solution?and how effective is it?

  Answer:  your question is too vague and general to offer a suggestion, I think you need to see a doctor in person JG 8.5.08

• hi dr. garcia, if its a granuloma or a scar tissue, is it possible to cut out?

  Answer:  they can be cut out but all wounds heal with scar tissue so care must be taken to get it to heal properly to minimize the scar tissue. JG 8.5.08

• Hi Dr. Garcia, I wonder if there is an opposite of ptosis of the eyelid after a botox brow and frown correction. What I mean is is it possible one eye is open quite a lot and the other normal or even a bit droopy? thanks a lot for your time.

  Answer:  it can happen if one side got more elevation from the forehead muscles. JG 8.5.08

• Hi Dr.Pierce. Would fillers turn the corners of mouth up.

  Answer:  no, it would only fill in the crease to make it look flatter. JG 8.4.08

• HI Dr. Pierce, I am 43 and my mouth corners are turning downward. People think I am mad all the time. Would fillers fix this problem?

  Answer:  it would certainly help, yes. JG 8.4.08

• hi dr. what would you do at you office to a patient to find out wether a certain lump is a granuloma or just a scar tissue?

  Answer:  there is essentially little to no difference, there are no tests that can be run unless it is cut out and even under the microscope they look similar. JG 8.3.08

• hi dr. what would you use for scar tissue caused by restalyne?and how will it work?does the hard lump totally disapear or just gets soft? thank you

  Answer:  to be honest I have never seen it happen, but I usually use injections of 5FU for scar tissue. JG 8.3.08

• Hello Dr.~ What do you think of the filler Sculptra? I use Restylane now from my Dermatologist but do not like the way my upper lip curls at the border in an unnatural way looks fake and not soft. I am in my fiftys and have thin lips to begin with but now the are flat and lined.I would like to try something different.

  Answer:  I use Sculptra quite a bit but it is not interchangeable with fillers such as Restylane, the Sculptra is meant for deeper injections. What you are describing is not due to the filler used, it is a technique issue I am afraid. JG 8.2.08

• do you put fillers like restalyn or juviderm in cheek area to give fuller cheeks. I dont want it to look lumpy. I have seen too many results from sculptra where it looked bad and wondering if this is an option?? Thanks

  Answer:  I do not as they are too short acting to get a worthwhile effect. I prefer to use Sculptra myself for the cheek filling. It is a matter of technique too. JG 8.1.08

• do you see any way that juviderm to fill wrinkle under eye could have blocked a tear duct? ihave dry eye in the one eye where it was injected thanks

  Answer:  almost impossible for that to occur, and blocking the tear duct would not stop tearing and cause a dry eye, it would cause the tears to overflow, if the tears have diminished it would be from a tear gland injury and that would not happen with a filler. JG 8.1.08

• HI I WAS JUST WONDERING IS IT POSSIBLE TO FILL ANNOYING AS HECK (SORRY) STUBBORN DIMPLE LIKE SCARS ON THE RIGHT AND LEFT SIDES OF MY MOUTH.THEY FALL BELOW WHERE LAUGH LINES MIGHT BE. THATS THE GENERAL AREA. I HAVE BEEN AT THIS FOR 2 YEARS AND NO ONE CAN FILL THEM? DO YOU HAVE ANY IDEAS WHY????????? I AM ALWAYS LEFT THE THESE DARN INDENTS. PLEASE IS THERE A SPECIFIC TECHNIQUE I CAN PASS ONTO MY INJECTOR. I AM TOTALLY LOSING HOPE

  Answer:  I really think it best to find an injector that knows what they are doing, me telling you what to tell the injector means the injector does not know what to do and would not be appropriate. That having been said, I think they can likey be improved with the proper technique, although not filled in perfectly. JG 8.1.08

• Hi Dr. Garcia, About one year ago I had restylane injected in my jawline. and chin. My doctor filled up my jawline and chin so that it looked huge and overfiled. For the last year he has been slowly taking it down with hylauronadaise. Now it is all gone but I see a lot laxicity under my jaw (under the chin). Could the restylane that was in that area for a year, have stretched my skin? Does retyalne stretch the area if it has been overfilled?

  Answer:  it would have taken a very large amount of Restylane to cause enough swelling to allow the ksin to become lax, and one year is not typically a long enough time period for that to occur without resolving on its own. JG 7.31.08

• thank you for your quick response. since the restalyne cannot be squeezed out thru a pore can the hyalaurinase be used to lessen the puffiness but not totally dissolve. is it difficult to get the correct amount to do a small reduction? thanks again!!!

  Answer:  yes, that is an option. Most likely all of the recently injected Restylane will dissolve and you will have to start all over again. JG 7.30.08

• can restalyn be massaged to lessen the puffiness a tad 3 wks post injection? can it be squeezed out by opening a pore?? thanks

  Answer:  at three weeks iI do not think it is still swelling and it cannot be squeezed out through a pore, sorry. JG 7.30.08

• i understand that restalyne is hydrophilic. Does that mean that it will get fuller in the injected area as water is pulled inor do i have that concept wrong. Please explain. Thanks

  Answer:  that is correct, there will be about 30% increase over a few hours. JG 7.29.08

• Hello, dear Dr :). I was the one who asked (and thanks for answering so soon) about is this composition of a filler similar to Restylane or to Perlane? Hyaluronic acid sodium salt 25 mg + Cross linked hyaluronic acid sodium salt 25 mg + Hypromellose 12,25 mg? Sounds safe? to which you responded Answer: likely safe. JG 7.26.08 . I just realized I missed copying the whole formula. The ingredients are those named plus a couple more... still sounds likely safe?? Are any of these products one people can be allergic to? Hugs again! :):) Hyaluronic acid sodium salt:25 mg;Cross-linked hyaluronic acid sodium salt:25 mg ;Hypromellose:12.25 mg;L+ lactic acid:3,3 mg,Sodium chlorid:6,9 mg,Sodium hydrogen hosphate - dihydrat:0,60 mg.;Water for the injection, ad1 ml. All the ingredients of the preparation are not of animal origin.

  Answer:  likely yes, but I cannot speak to how long it will last though as the cross-linking and how well it is cross-linked controls the longevity of the product. JG 7.29.08

• So you think injection technique may make rest or juvi last longer?? I ask bcuz my dilemna with the juvi going thru me like water is from a different person than the resty injector. The resty was long lasting but the injector never got it right. Then I was told it could be that resty is too thick for me. So wiht the new person we have been using juvi the past year or so. Any ideas please why I could be needing so much juvi?? Could it be possible to dissolve that quickly with position technique or is it soley me?? I am trying to trouble shoot so I can go at least 4-6 months w/o injections. Thank you again

  Answer:  it think technique has a lot to do with it yes. I have never heard of Restylane being too thick for a patient, unless it was injected somewhere where it was not supposed to be injected, like fine vertical lip lines. I would seek out another injector. JG 7.29.08

• Hello Dr Garcia, Thanks for being such a great help to us all! My question is. I had sculptra injected in the corners of my mouth. Is it possible to shift the sculptra through massage. I ask this because It looks a bit to heavily injected and makes my mouth corners look a bit to heavy. I had it injected about 2 hours ago. Thanks so much!

  Answer:  no, sorry but it is not possible. There is lots of swelling at this point and in time you will lose about 60% of what you see so give it some time, massage will help the swelling go down though. JG 7.29.08

• Hello Dr. Garcia, i had artefill done 3 months ago on some acne scars, but mainly had one big indented scar that bothered me the most. the doctor missed the are on my cheek and now the filler is above the indent. he marked my face up with a pen first, then numbed me up with injection which totally swole my face up. i am wondering if my face being huge from the numbing injections helped cause him to miss the area he was suppose to inject. i now have a lump above the indent which makes it all look worse. i am suppose to go back to him next week and may get another one, is it necessary to use that numbing injections? thank you for any info you could tell me about what may have went wrong and what maybe i should do. thanks again

  Answer:  I never use the local anesthetic when injecting scars for that very reason, best of luck. JG 7.29.08

• Hello DR Garcia I was wondering in the past year I have had juviderm injected in many areas mainly nasial lines But my concern is I have had to get it done like every month. Im not kidding> in the same areas over and over again. 1)is it possible that I am metabolizing it monthly??? (Resytlane lasted a year on me> But it was to thick to many mistakes with is). 2)Arent they the same thing?? Anyways or could it be the product Like old orrrr ??? MY LAST QUESTION is.... 3)is it possible I have all this product still in my face somewhere but spread out> Cuz Im scared it will like make my face super saggy after it all wears out one day. IS that a strange possibility. What would you suggest for me. I could have had a mini lifty with all the money I have spent on fillers. If this helps you assess my situation I have the Same problem with Botox> I am getting touch-ups every 2-3 months. THANKS A BILLION!

  Answer:  they are very similar but there are diferences, injecting monthly seems excessive. One has to assume that if the Restylane lasted a long time that the technique is not the problem, but I am not sure why you would be dissolving it so fast. The product does not spread out though, it stays where you inject it. As ot the Botox, it might just be too low a dose. JG 7.28.08

• what happend if you have juvaderm on your face but they put to much on you, how can they solve the problem

  Answer:  they can use hyaluronidase. JG 7.28.08

• can i have a glass of wine with dinner 7 hrs after restalyne thanks

  Answer:  yes, cheers. JG 7.28.08

• when one ices after juviderm---how long and how much does it prevent bruising and swelling thanks

  Answer:  5 minutes every 4-6 hours for the first couple of days is all. JG 7.28.08

• is there a value yo bromelain in your opinion thanks

  Answer:  yes, I do. JG 7.28.08

• is there a value yo bromelain in your opinion thanks

  Answer:  yes, I do. JG 7.28.08

• restalyne under eyes --how many hours after injection can i take a brisk walk- i have no bruising can i do yoga tomorrow thanks

  Answer:  just a few hours later is OK. JG 7.28.08

• can a filler be put in a wrinkle under eye where thes skin actually folds over onto itself as opposed to a deep groove??? thank you

  Answer:  very difficult to do and get a smooth result. JG 7.27.08

• hello dr garcia i had juvederm injected into my cheeks. I just decided to get a cheeks lift. Will this effect the procedure in anyway? Im worried because if I get a lift with fillers in it might look good and later when the fillers disolve it might look different and or bad. will it effect it any way?? problem is that i just got juvederm 1.5 months ago so its still in the cheeks. thanks

  Answer:  no problems with it. JG 7.27.08

• juviderm injection in tear troughs 17 days ago two small areas not adjacen are too puffy can the hyalaurinase be injected into these 2 small areas without impacting the rest? How deep and how much? I may have a different doc do the correction. Is there as much bruising as one gets from the juviderm when this is typically done? Thanks a ton!!!!

  Answer:  it can but it might seep into the surrounding areas as the hyaluronidase spreads easily. The doctor will know how much and the strength, or at least they should. Minimal bruising usually. Best of luck. JG 7.26.08

• Dear Doc, what is a malar bag or malar festoon? I can`t find any pic to understand it :).

  Answer:  it is an area of swelling that occurs in the area where the lower eyelid muslces end and the cheek muscles begin, usually curved in shape, lies below the rim of the eye socket over what should be the highest point of your cheek as you look at in profile. JG 7.26.08

• Doctor, is this composition of a filler similar to Restylane or to Perlane? Hyaluronic acid sodium salt 25 mg + Cross linked hyaluronic acid sodium salt 25 mg + Hypromellose 12,25 mg? Sounds safe? Hugs

  Answer:  likely safe. JG 7.26.08

• juvederm ultra plus today only tiny amount to one marionette line.the area is now slightly raised more than it should be and slightly hard causing also a distorted effect.. isnt it better to push in on the area with fingers rather than massage in circle to avoid friction abrasions? would that be good to do here? thank yu

  Answer:  as long as you use a cream with the massage it should not happen you should not be massaging that hard to cause an abrasion though, just lightly. JG 7.26.08

• I actually had minimal depletion on the nasolabial lines. They used initial Juvederm to fill in under corners of mouth and a little lip augmentation. However, not a big difference, I later noticed in naso lines, so they went over it with radiesse. Now a few weeks later, still not a big difference in naso lines, am scheduled for a `touch up` in two weeks for minimal work. Even so, could this create `putty face` ? ;(( Does this still not sound right? Wished I lived in LV, then you could do this right the first time!!

  Answer:  since it is in a few different areas the Putty Face is not a risk, all the best and thanks for the kind words too. JG 7.25.08

• Dr. Garcia, my doc used Juvederm first then later added Radiesse over it because it was not at the desired fullness. In fact, I am scheduled for a touch up in a week (recieved Radiesse about 3 weeks ago) Yikes!! Is this ok?

  Answer:  OK, yes, unusual though, you must have very deep folds to need that much. JG 7.25.08

• Hi Dr. Garcia. Will you please tell me which one you prefer for nasolabial lines and why? Radiesse or Juverderm? thx, x

  Answer:  Restylane. Between the two you mention I would use the hyaluronic acid filler Juviderm over the minimally longer acting calcium based product in Radiesse. JG 7.25.08

• I have been posting over the past several days regarding Restylane injections in my forehead (both vertically & horizontally). I have been trying to massage the lumps throughout my forehead (although it is difficult with pain shooting into the top of the right side of my head). So far, I`m not having much luck getting my forehead to smooth out. It is still uneven (peaks & vallys). The injections were done on Monday afternoon. When I message, the lumping is hard; it really does not feel maleable at all. I would think the gel would be easier to manipulate. Do you think I should allow more time and continue to try and massage the lumps or should I seek out hyaluronidase injections..am I being impatient? If I pursue the hyaluronidase avenue how long will it take to get the situation resolved? Is this something that can be corrected fairly quickly or am I stuck with a lumpy forehead until the filler wears off? Also, typically how long does Restylane last? I appreciate any insight you can offer. Thanks again.

  Answer:  I would give it at least 10 days before contemplating the hyaluronidase injections. The injections should have a very quick onset of effect, it is done conservatively so it might need to be repeated in a few days but there should be visible improvements in a few hours in most cases. Restylane can vary as to how long it lasts depending on the degree of motion in the area and how deeply it was injected. JG 7.24.08

• sorry i did not complete last question i can push down on a raised area and it flattens out briefly does this mean it is swelling or can one flatten juviderm and have it pop back out?? thanks sw

  Answer:  if it is Juviderm it cannot flatten and pop back, might be a cyst of some kind. JG 7.24.08

• how long do juviderm injections in tear troughs usually cause swelling or too variable to comment?? thanks

  Answer:  wide range, I have seen 2 days to 3 weeks. JG 7.24.08

• i appreciate your answering my question just now re bump from juviderm under eye. If I elect to inject the wydase to this very small area is there an amount that you would suggest. I want to be very conservative and not dissove areas where i am satisfied. Also how likely is a bruise from the injection. Is it a fairly superficial ijection?? Thanks SO much!

  Answer:  I do not think you need to inject more than 1/3 cc if it is that small. Bruises from injections do occur, so ice before and a small needle are good idea. It needs to be injected into the lump. JG 7.24.08

• joey line out is a product that really does seem to temporarily fill in wrinkles.I think it`s like a glue. ADo you see any problem using this in terms of harm to skin?? thanks

  Answer:  could have allergic issues and could plug pores and it could crack and flake when you move the face. JG 7.24.08

• i had juviderm for under eye hollows and there is one small area that looks too puffy to me. My dr says he didn`t inject there which i am not so sure about. He says it can`t travel. QUESTION ONE--Is this true? Also says it could be swelling or orbital fat. I am sure it is not orbital fat unless it popped up over night. I find that hard to believe. QUESTION TWO -Do you agree that this would be impossible? Also he said it could be swelling. It`s 2 weeks post filler.QUESTION THREE- How long do you think I should give it before he injects spot with wydase. I want to be sure it isn`t swelling even thought I think it isn`t. LAST QUESTION-- is there a way to confirm whether it in fact IS swelling?? thanks and sorry for so many concerns

  Answer:  it is very difficult for it to travel, that is correct. What the lump could be without having seen the injections done is difficlt. I do not think orbital fat can travel like that either. I think swelling can persist but it would likely not look like a bump but be more diffuse. I think injecting the hyaluronidase now is certainly low risk. JG 7.24.08

• Hope you are well Dr. G- Can you tell me if it`s safe to use ThermaClear (http://www.thermaclear.com/) a device that uses a high heat pulse to kill pimple-causing bacteria, on areas which have been injected with hyaluronic acid? Could it burn or melt the filler? Thanks!

  Answer:  might help, likley not as fast as they claim, unknown what effect it will have on the filler though. JG 7.24.08

• Hi Dr. Garcia, to help correct under-eye hollowness I`ve had restylane injected. The problem is it caused a couple of bumps that looked like the area was irritated or inflamed - lumpy - and that never went away even after multiple follow ups including use of hyaluronidase to try to even it out. Anyway I`ve read about EVOLENCE which according to a doctor who used it for under-eye hollowness it doesn`t swell up like hyaluronic acid Here`s the link: http://www.miinews.com/pdf/eabg_colbar_oct07.pdf I`m writing to ask if you`ve used EVOLENCE for under eye hollowness and if you`ve seen better results than other fillers? I`d like to avoid fat graft surgery if possible so appreciate your feedback on evolence and any other options. I look forward to your comments/advice! Thanks!!

  Answer:  Evolence is not released for use in the US yet and any filler can leave lumps in that area, the advantage to hyaluronic acid fillers is that they can be dissolved where collagen or fat injections are more difficult to dissolve if lumps occur. JG 7.23.08

• I posted earlier in the day regarding Restylane injections in my forehead. Upon messaging gently (or even washing my forehead), I notice when touching the right side of my forehead, I feel a pulling sensation on the top of right side of my head (far from the injection sites). Almost like my hair is being pulled, although, it is not. It is a very strange sensation. Could this be due to swelling or perhaps an inflammed nerve? Have you ever heard of this and is it something to be concerned about? Thank you.

  Answer:  more likley the inflammed nerve source as it courses from the edge of the eye socket bone and runs upward through the foreehad, not heard of it happening but I have no other explanation. I do not think it will last long nor be anything dangerous. JG 7.22.08

• are fillers safe to do while breast feeding? which ones if any?

  Answer:  they have not been tested on pregnant patients so I think you should wait. JG 7.22.08

• I had one syringe (1mL) of Restylane injected between my brows vertically and also injected in the horizontal lines accross my forehead. This was done yesterday afternoon. This morning my forehead continues to be extremely red, swollen, inflamed, painful and lumpy. It was not what I was expecting. Is this a normal response and is there anything topically that can help with the swelling, redness and pain? Also, can makeup be applied in an attempt to cover some of the redness? It looks bad enough that I cannot go out in public without makeup. Thank you.

  Answer:  can be normal, ice and massage lightly 3-4 times per day. You can apply makeup today, yes. JG 7.22.08

• Hi Doc, What in your opinion, is the best way to rid fine lines, and dark circles under the eyes? I am petrified to have fillers there, too many horror stories.. I also live in Ca., and don`t know of anyone I can rely on. We did live in Vegas, but I didn`t need any work then.... Thanx for you help!!

  Answer:  for the fine lines maybe a Rhytec Portrait Plasma done deeply. For the dark circles, that can be tough, not much to offer for that yet. I am working on a cream but it is not ready yet. JG 7.21.08

• is there any way that juviderm injection in tear trough could have gotten in my eye? i have had dry eye in the past as i have some lower lid retaaction but i have had off and on dry eye at night since injection? Could it get in one`s eye--seems impossible but never know! thanks

  Answer:  I do not see how that could have happened. JG 7.20.08

• I have like a little pocket under each eye, kinda like a little volume loss (not as tight). I am 26 and my surgeon recommned botox. What do you think. I saw u mentioned a bliking problem below. He said some peolppe put filler there but a lot dont like the results. Any suugests like maybe a good eye cream to tightented it?

  Answer:  I do not think a cream will help, and I do not think the Botox will do anything that will help. I personally use fillers there and with experience, it yields good results. JG 7.20.08

• Do you think Fraxel (deep) would help to dissipate Restylane or Cosmoplast? (I`m aware of Vitrase/hyaluronidaise for Restylane, but I`m still curious re: Fraxel`s effects, if any. Was told on a consult today it might work - very skeptical, however.) Thanks!

  Answer:  seriously doubt it would do anything beneficial. JG 7.20.08

• Hello Dr. Garcia, I`m curious about several things: (1) how common is it to lose hair around the sides of the face/head after a face lift? (Haven`t had a FL, but might sometime in the next 5 yrs and I`m a bit concerned with already thinned hair from wearing individual hair extensions for 19 months.) (2) Is there anything available to dissolve Cosmoplast? (It`s around the eyes and has persisted since Dec. 07; albeit, somewhat diminished.) (3) Will blue/red marks near the eyes eventually recede when Restylane dissolves? (Not sure if it`s the Tyndall effect or some sort of general irritation because of the redness too. Maybe both effects? The Restylane has been near my eyes for over a year now. It seems to take a very long time to dissolve in that area.) Thanks much!

  Answer:  it happens on occasion if the tissues are pulled too tight or blood vessels are injured but it is not a routine thing to expect. As to the Cosmoplast, there is nothing I would suggest for dissolving besides just giving it some time. Blue marks after a Restylane injections will fade if it is a Tyndall effect but there should not be any red spots, not quite sure why you have those I am afraid. All the best. JG 7.19.08

• Is there anything in the diet one can eat,or maybe drinking more water to help restylane last longer? Thanks for your response.

  Answer:  sorry but no. JG 7.17.08

• how can you tell if discoloration from juviderm is bruising or tyndall effect--13 days later still bruised and just not sure also can bruises really be removed and after how much time if so?? thanks

  Answer:  bruising turns to yellow green after that time where the Tyndall effect is like a grey blue shadow that does not change in color with time. The bruising, in some people around the eyes, I have seen take 3-6 weeks to get better. JG 7.17.08

• I still have black bruising under eye from juviderm done 10 days ago. Is it worth it to keeep taking arnica and/or bromelain? The swelling seems to have gone---can i do yoga or should I wait? Is it true that the jusviderm can discolor the skin blue?? thanks

  Answer:  I would wait on the yoga but continue the arnica and bromelain. If the Juviderm is injected too superfically it can cause a Tyndalll effect, yes, but it goes away with time. JG 7.17.08

• Hello dear Doctor, hope you are doing great, as you deserve. Today I suggested a friend to not go ahead with seeing a doc because, from reading your posts, I thought the treatment my friend was suggested was probably not useful or not safe. This friend was suggested to have mesotherapy in the undereye area, to treat the wrinkling, bags, etc. Isn`t having many little injections, even if superficial, in that area, potentially dangerous for the eyes/sight (and wouldn`t that create many bruises?). Also, this doc says the mesotherapy is done with Restylane... but isn`t hyaluronic acid injected intradermally something that, if it worked, would only work temporarily filling the area? something maybe a good cream with DMAE or sodium hyaluronate would do, anyway?? Did I give good advice to my friend? Is meso there risky or useless? Or was I unfair with that doctor?

  Answer:  well, it greatly depends on what is injected into that area. The injection of mesotherapy products, whcih is not FDA approved, was first published in the Brazilian medical literature as showing reportedly a mild improvement but subsequently, the Brazilian government outlawed its use. For that reason, and the fact that it is not FDA approved, I think doing it could be dangerous because if the injected material causes an infection or inflammation, it could potentially cause problems with the eye itself. The injection of a filler like Restylane is not mesothrapy though and is temporary. I think you did the right thing, good for you! JG 7.17.08

• i had juviderm injected under eyes not only is it greenish yellow in the part that looks good(contour) but the bruise in the ridge of the eye where it meets the cheek is still bruised after 2 weeks, I can live with the greenish discoloration but do you think the bruise will last forever?? thanks

  Answer:  the bruise will go away in time, but since that area has thin skin, it can take a while for it to do that. JG 7.17.08

• Are there any new fillers you have heard about comming in the near future that are as safe as restylane and will last longer?

  Answer:  sorry, but none. JG 7.17.08

• I had Radiesse injected into my left cheek 6 months ago and it now has dissolved and has been for at least 2 months. Everything I`ve read says that this filler lasts longer than the others. Is that true? What filler do you recommend for symmetry of the cheeks (the right is more prominent than the left)? Also, my PS said allergy testing had to be done with the other fillers, that is one of the reasons he used Radiesse on me. What is your opinion??

  Answer:  the filler can last up to one year but in most cases that is the exception to the rule, it varies greatly from one patient to another and also depends on where it is injected, the deeper it is injected the faster it dissapates. I personally use Sculptra for filling of the cheeks. JG 7.16.08

• Dear Dr Garcia - I had teosyl deep injected for some loss of cheek volume - for 3 weeks after I had a large haematoma below the left eye. When this resolved I was left with a small ridge infraorbitally. It is 8 months since the injection and the situation has not improved - the doctor has suggested hyaluronidase but I was worried about overcorrection and being left with a hollow. Could you please advise me if the hyaluronidase is the best option, plus do you know how long the teosyl lasts? Thanks so much

  Answer:  I think at this time that the Teosyl is not causing the problem and it is more likey due to scar tissue formation from the hematoma. I think injecting hyaluronidase will do little to improve things so I do not think it is worth trying it. I think by this time most if not all of the Teosyl has likely dissolved. JG 7.16.08

• I was wondering how long one much wait to kiss after a restylane treatment plumping up lips?

  Answer:  2-3 days is OK. JG 7.16.08

• i have a lot of under eye bruising from restalyne. i was in the sun (not sunbathing or looking directly) for about 45 min with sunglasses and cover up but no sunscreen. could this amount of time cause permanent bruising?? thanks

  Answer:  no, it should not cause permanent bruising but it can cause some freckles or brown spots to appear, if they have not shown up in a few days you are likely OK for now and just need to avoid the sun or use total sunblock until the bruising is gone. JG 7.16.08

• i had juviderm under my eyes 2 weeks ago and i am still bruised in the ridge between eye and cheekbone, the blood just seems to stick there. Do you think this will ever go away. Also i have a lot of greenish tint where product was put. Should i have it removed. it looks nice except for the color. thanks

  Answer:  that should get better, maybe I could suggest taking some arnica ontana and bromelain from the health food store to assist in getting it to resolve. I would use the make up and not dissolve it as it looks good and the color should get better in time. Not uncommon with either Juviderm or Restylane. JG 7.16.08

• I had restaylane injected 5 days ago and my ps put some in a small area in my upper cheak near where the eye rim mets the cheak I think he went up to far because i have a lump under my eye its very noticable. I have tried ice and massage but it seems to only make it worse. Should I try moist heat or do I need some haudraylise or should I give it another week. Thank you , you are truley a saint to answer so many questions

  Answer:  warm and massage is what I would suggest for the first 7-10 days as in most cases that will fix it, try to avoid the hyalronidase if you can as then you will have to start all over again. All the best. JG 7.15.08

• Hi Doctor, My dr. in Ca. wants to inject botox under my eyes for fine lines. I have heard of fillers being injected there, but not botox. I would appreciate your opinion on this. Does this seem O.K? Thank You

  Answer:  I think the chances of it helping are very small anmd there are risks of it weakening the musscle so your eye would not blink properly. One more thing about Botox. It has come out that the education that injectors were given since the beginning of Botox release was incorrect. The bottle is to be used for a single patient. That means that a bottle should not be shared between multiple patients. The company that makes Botox has known about this but has never issued an alert to doctors or patients. The risk is that of the bottle becoming contaminated and passing a communicable disease like HIV or hepatitis from one patient to another. There are no known reports of disease transmission in the use of Botox, but it has not been looked at yet in order to determine that issue. For that reason I strongly urge you to demand that a new bottle be used when you are treated and then observe the injector destroy the remainder of the bottle. If that is not done I urge you to contact the local board of health for the violation. Ask to look at the box it comes in and you will see the single patient, single use wording. JG 7.15.08

• Dr. Garcia also one more question. I have restylane injected into my tear troughs. It`s been about a yr. The one side was also worse then the other but, today I woke up and noticed a huge hollow ditch under the one eye. It looks horrible! Is this where the filler dissipated? I didn`t expect it to happen like this. I thought they would fade not wake up one day looking worse.Do you know how long it will stay like this? Also, should I get somthing to make it all go away? Thanks!

  Answer:  I do not think the filler would disappear to such an extent overnight, so there might be something else going on. Might want to go back to the doctor and see what they think after seeing you in person. JG 7.15.08

• Hi Dr. Garcia! I agree with the 28 yr old. I am 27 and I didn`t lose any major weight yet, look like I need a face lift. I didn`t think it was possible but it is true. I have major aging goign on. I tried fat injections and it made me worse now I have tear troughs. Is there anything I can use to help look younger that wont age me more?

  Answer:  impossible for me to say what if anything without seeing you, I suggest you see a plastic surgoen in person. JG 7.15.08

• is sculptra used for nasal folds? how long it last if so?

  Answer:  no, it is used to fill in areas of fat loss, like the cheeks. JG 7.15.08

• hello, I`m the 28 year old who wanted a facelift and you said no. You scared me now... I work out everyday so I have my cheeks down and all. I really feel better when I pull my whole face up though with my hands. I hate the folds from my nose to mouth. you said sculptra will be good for cheeks but wouldnt a lift be better for the nsaal folds? I just want to achieve what I want. Coz i already used juvederm for nasal folds and it didnt work. I already used juvederm for my cheeks and it just made my face look big. Then will a cheek lift be ok for a 28 year old? or other choices???

  Answer:  I do not think at age 28 that a facelift is needed or required. Nor would a cheek lift. JG 7.15.08

• i had restalyne under eyes 8 days ago and still so bruised. Is this normal or do you think I am black forever. It is an accumulation of blood in the divots that are left. Any thing to do? Massage? Continue arnica???

  Answer:  not nusual, it should go away in time but it might take a few weeks. I think warm packs and massage will help and you need to stay out of the sun so it does not stain your skin. JG 7.15.08

• hello i had recieved your answer on botox,t hankyou, howsoon after a botox treatment to the forehead can you get more? the doc did a small tiny amount, and dont see a change as of 7 days ago, thank yu

  Answer:  it can be repaeted in 10 days if you need more, we wait ten days to make sure it will not kick in as some people need more time for it to work. One more thing about Botox. It has come out that the education that injectors were given since the beginning of Botox release was incorrect. The bottle is to be used for a single patient. That means that a bottle should not be shared between multiple patients. The company that makes Botox has known about this but has never issued an alert to doctors or patients. The risk is that of the bottle becoming contaminated and passing a communicable disease like HIV or hepatitis from one patient to another. There are no known reports of disease transmission in the use of Botox, but it has not been looked at yet in order to determine that issue. For that reason I strongly urge you to demand that a new bottle be used when you are treated and then observe the injector destroy the remainder of the bottle. If that is not done I urge you to contact the local board of health for the violation. Ask to look at the box it comes in and you will see the single patient, single use wording. JG 7.14.08

• hello, will it be safe to get fillers done in the cheeks or temples after a midface lift if needed? will it damage anything?

  Answer:  should be safe, should not damage anything. JG 7.14.08

• hello Dr. Garcia. i had diamond wire around mouth area and 3 weeks later i have what feels like a lump under skin in that area what could that be and will it go away? thank you so much!!

  Answer:  most likely either a small hematoma that needs to resolve or some scar tissue building up, I suggest seeing your doctor to see what it is so they can determine what is best to do for it. JG 7.14.08

• Dr, GArcia, I had botox in my forhead and it is completely frozen. I just wish it would disolve! Will it get less frozen within a few months? I dont know how much was put in but I cant move my forehead at all. What is the longest you`ve ever seen it last and what is the shortest? (I mean for a forehead that I described?) I just dont understand why a doctor would do that.

  Answer:  you will likey start to get some motion in a couple of months if not sooner, but it might take a while longer for it all to stop working, all depends on the amount injected. I have seen as little as two months nad as long as 6 in some cases. One more thing about Botox. It has come out that the education that injectors were given since the beginning of Botox release was incorrect. The bottle is to be used for a single patient. That means that a bottle should not be shared between multiple patients. The company that makes Botox has known about this but has never issued an alert to doctors or patients. The risk is that of the bottle becoming contaminated and passing a communicable disease like HIV or hepatitis from one patient to another. There are no known reports of disease transmission in the use of Botox, but it has not been looked at yet in order to determine that issue. For that reason I strongly urge you to demand that a new bottle be used when you are treated and then observe the injector destroy the remainder of the bottle. If that is not done I urge you to contact the local board of health for the violation. Ask to look at the box it comes in and you will see the single patient, single use wording. JG 7.14.08

• Hi Dr Garcia - I have been reading about silicone oil injections to the lip line to fluff the lips or fill naso-labial folds, for a much longer period of time than resty or juvy can last - do you know anything about this, and if there is a down side to this solution? Thank you so much for your time!

  Answer:  yes, it is illegal in many states, never been approved by the FDA, if anything they have warned against its use and can have serious long term complications, I strongly advise against it, it is difficult if not impossible to remove if there are problems. JG 7.13.08

• juviderm under eye-my eyes are teary only at night ever heard of this-had it 3 days ago and started on day 2 considering removing the product thanks

  Answer:  I have not seen that happen and I do not think it is related unless it was injected into the tear duct, which is nearly impossible to do. JG 7.13.08

• i am planning to inject the hyalaurinase to dissolve restalyn. can you get just one small spot or does it spread and tend to dissolve more than that exact spot. Does it work right away and have you seen any bad side effects?? thanks

  Answer:  a small drop can be used, yes. It should work right away, yes. I personally have not seen any bad effects. JG 7.13.08

• regarding the botox issue, i know of a clinic that does use each bottle of juvederm,restylane,etc among patients.. so shoud the rule with botox about multiple patients using it that you mentioned below apply to restylane and juvedrm too? should those also be brand new bottles,brand new boxes

  Answer:  absolutely, without a doubt. Fillers are not be be used to treat multiple patients from one syringe, the syringe of the filler is not uncommonly saved for the patient if not completely used as its potency does not change like Botox which loses its effectiveness after awhile once reconstituted.That should be reported to the local Board of Health and the State Medical Board. JG 7.12.08

• bluish color from restalyne will it go away if i put in the hyalaurinase?? thanks sw

  Answer:  it should, yes. JG 7.12.08

• what do you think of botox at the chin area for marionette lines? many docs wont do it as they say the result is inable to use straws, puckering, etc what are your thoughts

  Answer:  not very effective, more negative side effects than any good effects I am afraid. One more thing about Botox. It has come out that the education that injectors were given since the beginning of Botox release was incorrect. The bottle is to be used for a single patient. That means that a bottle should not be shared between multiple patients. The company that makes Botox has known about this but has never issued an alert to doctors or patients. The risk is that of the bottle becoming contaminated and passing a communicable disease like HIV or hepatitis from one patient to another. There are no known reports of disease transmission in the use of Botox, but it has not bee looked at yet in order to determine that issue. For that reason I strongly urge you to demand that a new bottle be used when you are treated and then observe the injector destroy the remainder of the bottle. If that is not done I urge you to contact the local board of health for the violation. Ask to look at the box it comes in and you will see the single patient, single use wording. JG 7.12.08

• how lon g does botox take tto work at the glabella forehead area?

  Answer:  2-10 days. One more thing about Botox. It has come out that the education that injectors were given since the beginning of Botox release was incorrect. The bottle is to be used for a single patient. That means that a bottle should not be shared between multiple patients. The company that makes Botox has known about this but has never issued an alert to doctors or patients. The risk is that of the bottle becoming contaminated and passing a communicable disease like HIV or hepatitis from one patient to another. There are no known reports of disease transmission in the use of Botox, but it has not bee looked at yet in order to determine that issue. For that reason I strongly urge you to demand that a new bottle be used when you are treated and then observe the injector destroy the remainder of the bottle. If that is not done I urge you to contact the local board of health for the violation. Ask to look at the box it comes in and you will see the single patient, single use wording. JG 7.12.08

• is it a danger to inject hyalarinase after restalyn that it would dissolve something else besides the filler and make it look too sunken thanks

  Answer:  the amount of normally existing hyaluronic acid dissolved with hyaluronidase injections after the attempt to dissove Restylane or Juviderm is usually imperceptible. JG 7.12.08

• dear dr Garcia. i am the one with juvederm injected and dissolved under my eyes a couple of times. the end result is tragic. i have bumps under one eye, and big triangle bag under the other one - i think there is juvederm left there too but deeper, so it gives impression of this bag going deep into my cheek. unless hialorunidase did it. last intervention was done a year ago on one side, and about 10 months the other. whot would you advise i should do? thank you.

  Answer:  I doubt after that period of time you have any Juvederm left in there, might be some scar tissue or something else. I am afraid that without seeing you it is difficult to determine what should or could be done, but I am afraid it might require more filler, as scary as that sounds. JG 7.12.08

• What, if any, affects would Botox have on marionette lines? I have tried fillers and look like a monkey. Any other suggestions would be welcome.

  Answer:  Botox will not help there, so it migth be time for surgery. JG 7.12.08

• how long after you injct restalyne can u use hyalaurinase to dissolve?? Thanks

  Answer:  no time limit as long as it is still there. JG 7.11.08

• how long after you injct restalyne can u use hyalaurinase to dissolve?? Thanks

  Answer:  immediatell if desired, or can wait as long as you want. JG 7.11.08

• Hi Dr Garcia, I asked you if there was an operation to remove excess skin from my elbows but you said it would leave a bad scar. Is it possible to improvre the saggy skin slightly by injecting some sort of filler maybe just to plump out the surrounding skin slightly i know it will not be a big difference but if this is possible what filler do you think would be the best for this area?

  Answer:  I have not heard of any filler yielding a good result in that area, sorry. JG 7.11.08

• is it true that juviderm can migrate from the site on a plane?? i feel like it may have done that Can the hyalorinase to dissolf=ve it just be used in one area and how long would you wait to inject thanks

  Answer:  I cannot see how it would do that to be honest. The hyaluronidase will dissolve any Juviderm or Restylane it touches so it might dissolve more that you want if it is a small area only. JG 7.11.08

• I had Juviderm injected into the undereye and cheek regions of my face to fill some very disfiguring scarring that occurred as a direct result of an acid peel gone awry some 15 years ago. The procedure literally ate away portions of my skin. Have you ever heard of a case where these fillers did not work? Does that indicate the severity of damage to the innermost structures? The idea was that if the Juviderm worked, we could go to a permanent filler. It made no impact, and actually made it slightly worse. Have you heard of fillers not working. I am an African-American female.

  Answer:  if the filler is injected too deeply, it will not fill the area in, that holds for any filler like Restylane or Juviderm, race does not make any difference here. JG 7.11.08

• Is there a way to tell whether puffiness after injection of juviderm under eyes is swelling or the product? it feels smooth but very puffy when can massage be started is massage for swelling or to spread the product or both? thanks

  Answer:  well, after about 7 days the swelling should be alot better. We start massage the day of the injection of Juvederm or Restylane actually. It is to do both, correct. JG 7.11.08

• have you seen allergic reactions to wydase. would you recommend a skin test first?? thanks

  Answer:  I have never seen nor heard of there being an allergic reaction with wydase. JG 7.11.08

• I had juviderm under eyes. is it normal to have a lot of swelling?? I just had a small amount injected and it doesn`t look lumpy but like a big puff. Should i massage on day 2? thanks s

  Answer:  it is very normal to have swelling there, more so there than in other more common areas of injection of Juviderm like the nasolabial fold. Massage and a little ice will help, it can take 5 days and at times more to go down. Restylane would do the same as the Juviderm, even fat injections would do it. JG 7.11.08

• I know you mentioned that there is a product to dissolve juviderm. Does it work immediately upon injection? What is it? thanks

  Answer:  pretty much immediately, yes. It is called hyaluronidase, that is the generic. JG 7.11.08

• I have had restalyne a couple of times for marionette. Good result for only about 4 months. Would you recommend radiesse or sculptra for a longer result? Does it have to be injected deeper and what are the sides affects vs. restalyne? thanks

  Answer:  I think you migth get an adidtional 50% or so, not much more with the Radiesse and I would not use Sculptra for that. Radiesse does need to be injected deeper, yes. JG 7.9.08

• Hi! I recently had fat grafting done to an indented portion of my lower abdominal region. This occurred as a result of a previous tummy tuck years ago. The fat injected was my own from some left over fat on my stomach area. The area now looks full and a little overfilled and my doctor told me he had done that in order to try to get the depressed area even with the rest of my lower abdominal region. It has been about seven days now and I have been told to wear a compression garment over the area which i have been but the filled area is very hard. It feels like a big, hard lump under the skin while the untreated areas surrounding feel natural and smooth. Is this normal after fat grafting or should I be worried? If it is abnormal, Is there any way it can be corrected in order to obtain a natural, smooth feel? Im going back to my doctor next week for a follow up appointment but I would appreciate any feedback you can give me until then. Thank You very much!

  Answer:  all normal, nothing to worry about, and in time it will shrink quite a bit and get softer.JG 7.9.08

• Dr, Garcia, I had Botox injected for my forehead and I look completely frozen. Ive heard it lasts 4 to 6 months. I m hoping it doesnt last longer. Have you ever heard of it lasting more than 6 months. Also does it depend how much was injected in terms of how long it lasts? I`m so freaked out. i have no facial expression.

  Answer:  I have never seen it last longer, especially in cases like yours where it is totally frozen. The length of time does depend to a certain degree on how much was injected, yes. One more thing about Botox. It has come out that the education that injectors were given since the beginning of Botox release was incorrect. The bottle is to be used for a single patient. That means that a bottle should not be shared between multiple patients. The company that makes Botox has known about this but has never issued an alert to doctors or patients. The risk is that of the bottle becoming contaminated and passing a communicable disease like HIV or hepatitis from one patient to another. There are no known reports of disease transmission in the use of Botox, but it has not been looked at yet in order to determine that issue. For that reason I strongly urge you to demand that a new bottle be used when you are treated and then observe the injector destroy the remainder of the bottle. If that is not done I urge you to contact the local board of health for the violation. Ask to look at the box it comes in and you will see the single patient, single use wording. JG 7.8.08

• Dr. Garcia, Thanks for your time and effort in answering all of these questions. Is it okay to have botox in the forehead and between the brows a week or two before an upper eye and mini face lift or is it better to wait until after? How long after the mini facelift and upper eyelid procedures do you usually look too bad to appear in public? Thanks so much.

  Answer:  I thin it is safe to do so, yes. I find that in about 10-12 days you are out in public with my patients. One more thing about Botox. It has come out that the education that injectors were given since the beginning of Botox release was incorrect. The bottle is to be used for a single patient. That means that a bottle should not be shared between multiple patients. The company that makes Botox has known about this but has never issued an alert to doctors or patients. The risk is that of the bottle becoming contaminated and passing a communicable disease like HIV or hepatitis from one patient to another. There are no known reports of disease transmission in the use of Botox, but it has not been looked at yet in order to determine that issue. For that reason I strongly urge you to demand that a new bottle be used when you are treated and then observe the injector destroy the remainder of the bottle. If that is not done I urge you to contact the local board of health for the violation. Ask to look at the box it comes in and you will see the single patient, single use wording. JG 7.7.08

• Hi DR Garcia. Am planning to make an appointment for cheek filling. in Sept. . Has the Restylane Sub Q been approved in U.S.? You did my last Sculptra about a year or 2 ago and would like to try the Restylane Sub Q. Which do you think would be the most effective? Thanks, E.H. Las Vegas

  Answer:  no word on the Restylane SubQ yet, all we have is Sculptra for now. JG 7.4.08

• Hi DR Garcia. Am planning to make an appointment for cheek filling. in Sept. . Has the Restylane Sub Q been approved in U.S.? You did my last Sculptra about a year or 2 ago and would like to try the Restylane Sub Q. Which do you think would be the most effective? Thanks, E.H. Las Vegas

  Answer:  no yet I am afraid. I think for now all I can suggest is the Sculptrra. JG 7.4.08

• Dear Dr. Garcia, I was told that after one vial of sculptra I need to wait another month for another vial. Do you ever inject 2 vials in the same places at the same time?

  Answer:  I commonly will inject more than one vial in patients that I know will need more, and then bring them back in 4-6 weeks for a little more if needed. There is nothing restrictive to the one vial. JG 7.3.08

• Hi Dr. Garcia, I have an appt. to see you in September for Sculptra! Yippee!! ;) One more quick question, what is your filler of choise for the nasolabia lines? I had Juvederm about 3 weeks ago and see very little improvement. thx

  Answer:  I use Restylane or Juvederm for the nasolabial folds most often, and occasionally Radiesse. I think they work well, but not for all patients, see you soon! JG 7.3.08

• Hello dr...I am sorry to ask, but I had juvederm put in yesterday...and of course...I have the ducky look. The problem is...I already have it put in my lips a few months ago and I just wanted it in the outer quadrants...cuz it already looked very full in the center...well the Dr said it was uneven in the center and that he really wanted to fix it ...that it really bugged him..so i agreed to let him fix it even though I thought it was a bad idea...now the center of my lips are so ducky..but he said he only put .2 in ..hardly any product and that it should not look ducky....it still feels swollen and it is bruised in that spot in the center...do you think this will get better since my lips feel hot still and are bruised??? Im panicked I`m gonna be a duck! oh yeah...i hope you have a very nice holiday, too!

  Answer:  I would wait about a week or so and see what happens, if it is still too big then you can have it dissolved. Best to you too on the holiday! JG 7.3.08

• Thank you for the information regarding Sculptra. Do you offer a 1 vial treatment if requested?

  Answer:  yes we do but you need to understand that the degree of filling will be less. JG 7.3.08

• i was thinking of having sculptra injections but reading so much information about the bumps i am concerned..and the newness of the product..how is restylane since i have peri-oral dermatitis and this would be injected in the area from the nose to the mouth on each side those lines? also how do you feel about sculptra....it seems like a lot of people are getting those bumps

  Answer:  well, it has been around for a number of years, the lump risk is minimized with small aliquots per injection and injecting deeply. I do not use Sculptra for nasolabial folds, and I prefer Restylane or Radiesse for that. I think when you read on the internet you only hear about the problems and not the good outcomes. In generla in experienced hands it does quite well. JG 7.2.08y

• Dr. Garcia, Which is most effective with Sculptra; one injection with a `fanning` technique or multiple injections? What is the cause of bumps? thank you

  Answer:  the bumps come from too much product in one spot, I use multiple punctures at multiple levels. JG 7.2.08

• Also, are there specific questions I should ask the Dr? For instance,`How far in advance do you mix sculptra before using`? Thank You! ;)

  Answer:  I mix it at least 24 hours before, it needs to rehydrate slowly. JG 7.2.08

• Hello Dr. Garcia, I have an appointment this week for Sculptra. The Dr. I will be seeing will be using 1 vial ($1,100) for a first treatment. I only have minimal sagging of the cheek. Does this sound right to you? Thank you ;)

  Answer:  sometimes I use more than that for the first one. JG 7.2.08

• Hello Dr. Garcia, I have an appointment this week for Sculptra. The Dr. I will be seeing will be using 1 vial ($1,100) for a first treatment. I only have minimal sagging of the cheek. Does this sound right to you? Thank you ;)

  Answer:  I would use at least that much, all depends on how much fat you have lost. JG 7.2.08

• Dr Garcia, I am considering filler for the tiny lines around my lips. Do you have an opinion as to which filler is best for this....and how long does it usually last? Thank you so much

  Answer:  will likley last about 2-4 months and I suggest Restylane Fine line or Juvederm, or Prevelle. JG 7.1.08

• hello dr. garcia, how long does restylane last in lips? I had 1 syringe put in a week ago & I love it!

  Answer:  2-4 months in most people. JG 6.30.08

• What do you charge per session (or vial) with Sculptra? thx.

  Answer:  $1000/vial, two vial minimum, total. JG 6.30.08

• Is there any drug interactions that should be avoided with Botox use (ie. muscle relaxants, etc.)?

  Answer:  none that I have heard of. JG 6.30.08

• Which filler is superior for forehead wrinkles (between the brows and vertical forehead line) - Restylane or Cosmoderm. I am taking a break from Botox for awhile and looking for a good alternative.

  Answer:  Between those two I feel Restylane is superior. JG 6.30.08

• DEAR DR. GARCIA, IPosted a question but I can;t seem to find it. In general, what is your opinion of all of the medi-spas that are popping up? I know they are usually supervised by medical personnel, but you have also said that it is the skill of the injector not necessari;y what filler is injected. In checking further, there does not seem to be any financial savings as it costs about the same as going to a ps or derm`s office and seeing a nurse. Can you give me some insight to all of the hype? For skin care or a n occasional facial I don;t see the harm but for botox or fillers I feel wary and jaded? I value your opinion as it is always honest and trustworthy. Thanks in advance for being there.

  Answer:  I have to agree wth you, I think it is best to get injections in a doctor`s clinic, and by that I mean a plastic surgeon or dermatologist. I think that is where you are going to get the best service, not only for a qualified injector but also for the best care on the vey rare occasion that something would go wrong. People think that MediSpas are like McDonald`s,same thing everywhere you go, but injections are not hamburgers. JG 6.29.08

• I can`t seem to find the question I just posted so forgive me for posting it again. I appreciated you answer to my previous post. I just want to make sure we a talking about the same procedure. Following is what I found on the internet and what I was told by my doctor. According to it I would be a good candidate. Please let me know what you think: The use of Botox® Cosmetic to lift the neck is off-label and has some risk. In general, cosmetic use in the neck has been reserved for people with little fat under the chin and mildly hanging skin and muscle bands. By relaxing the muscle band, the skin appears to droop less. If a botulinum, like Botox®, is injected too deeply, the ability to swallow or move the head normally may be affected.

  Answer:  I do not recommend the use of Botox on the neck, it is meant for dynamic wrinkles and it never tightens loose skin. If ever it would help, it would only help when you clench your teeth, otherwise there would be not noticeable difference. JG 6.29.08

• On both sides of my face in the naso-labial fold area I get red lines where the wrinkle is. I don`t really have much of a crease. When I make my face taught it is elevated. This redness usally appears after I have been smiling for a while or squinting you can really see it when I am outside,it is very pronouced. Can this be from using retin-A cream? Does a filler help if the wrinkle isn`t that deep? Which is your favorite in that area? Thank you!

  Answer:  it is likley beacause the Retin-A is tending to accumulate into the crease and casues a higher degree of irritation than in the other areas. JG 6.29.08

• Hey Dr. ...In 5/08 I had Juvederm Ultra plus injected in my nasalabial folds..my Dermatologist told me it would last around a year..in reading your responses to others I see that you said it wouldn`t...even Allergan`s pamphlet says it will...what`s the real story as I respect your opinion...also is it possible to get new wrinkles above where the filler was injected?..I swear there are new lines forming above the site...Thanks for your response in advance!

  Answer:  it depends on how deep it was injected and the degree of motion you have in that area. It might in a small percentage of patients last up to one year, but in most patients you can estimate 2-4 months. I think new wrinkles can always form as one ages and it is at times more visible when one area isinjected as those wrinkles are better and the new ones are therefore more easily seen. JG 6.29.08

• sculptra is a filler for older people that have a loss of fat in their face.......5 years ago i had peri-oral dermatitis...it was cured with antibiotics and has never returned....my plastic surgeon feels it won`t be a concern to have this filler....it last 2 years...i can not find any info. on people that have sensitive skin and have had this peri condition and if there are concerns when getting sculptra ( i am 58 have beautiful skin i have adult acne so i use benzoyl peroxide/ retin-a with no adverse side affects from these products and no blemishes when being consistent) have not found any research on people that have had peri-oral and sculptra put into their face......what`s your say on this

  Answer:  since it is injected deeply, below the skin, it should be OK to use it in your case. JG 6.28.08

• Is sculptra a real effective product? What`s the average price for a tx.? Thanks, R

  Answer:  it is effective but the price depends on how much is used, it is not cheap but it is effective and can last 1-2 years at times. JG 6.28.08

• hello what do you think of circular massage with the fingers at the platysma to help with marionette lines? to help relax the muscle to prevent more lines from forming? and where should i massage? thank yu

  Answer:  will not help. JG 6.28.08

• hi there, i had restylane for my tear trough on the 10th of june, when i look in the mirror, i still see a curvileineiar line where the nasojugular groove is which still bothers me, is it possible to still be able to push the restylane fro m inferior to superior to help smooth out the line at this stage post 2 weeks..? thank yu

  Answer:  could just need a little more is all. JG 6.28.08

• HELLO DR. GARCIA I WAS WONDERING HOW LONG FACE WILL BE SWELLED UP AFTER A DIAMOND WIRE DONE BETWEEN EYES FOR WRINKLE?

  Answer:  5-10 days.JG 6.28.08

• Dr. Garcia, My cosmetic dermatologist filled my jaw with restylane. It was very overfilled and I was unhappy with the way it looked. He is taking it down with hylauronadaise injections, but it is taking a very long time to get back to normal. I do see improvement little by little. My doctor said he has to use the hylauronadaise in small amounts little by little. That is was very important to do it this way, rather than all at once. I`m wondering why it must be done slowly. I think the most he has ever used per visit is one and a half syringes. Can you guess as to why he wants to go slowly in taking out the restylane? syringes.

  Answer:  well, it can be done faster but slowly is the more common way. JG 6.28.08

• Dear Dr. Garcia, My derm put restylane in the border of my upper lip. My lip felt very tight like I couldnt smile at all, and I went back to her and asked her to take it out with hylauronadaise as I knew I had been overfilled. Now my upper lip became very small, it is almost non exsistent. I believe the lip collapsed from being stretched out. My smile was originally very prominant and and now it is so small. and my teeth even look different. The collapsed lip presses against them. I had a small amount restylane added (in the bulk)hoping for even slight improvement but the restylane last only for one week. (its true) I dont know what to do. Is there anything surgical I can do? and my lip

  Answer:  hard to say without seeing you in person, the surgery for the lips will not do exactly what a filler would do though. JG 6.28.08

• What do you know about the use of Botox to achieve a lift to the lower face and neck?

  Answer:  will not work. One more thing about Botox. It has come out that the education that injectors were given since the beginning of Botox release was incorrect. The bottle is to be used for a single patient. That means that a bottle should not be shared between multiple patients. The company that makes Botox has known about this but has never issued an alert to doctors or patients. The risk is that of the bottle becoming contaminated and passing a communicable disease like HIV or hepatitis from one patient to another. There are no known reports of disease transmission in the use of Botox, but it has not been looked at yet in order to determine that issue. For that reason I strongly urge you to demand that a new bottle be used when you are treated and then observe the injector destroy the remainder of the bottle. If that is not done I urge you to contact the local board of health for the violation. Ask to look at the box it comes in and you will see the single patient, single use wording. JG 6.28.08

• hi dr garcia. My problem is that my cheek fats are gone and the skin sags. I can see bone on sides of my cheeks without fat and the high ceeks are gone too. However everytime i get juvederm injected to the fat area it looks like i need a cheek lift. ps says i need more fat in my cheeks so he injects it close to my nasal fold to have a fuller cheeks. but it doesnt look so uplifting it just looks like they are sagging. i never had it injected in the high cheek bone area. Is that the problem? am i suppose to get the filler in the upper cheek area like on the bone? or are there any other options? will sculptra fix the problem?? im really confused how all this works.. im 28.smoker)

  Answer:  I think Sculptra would be my next choice to fill it in and give better contour where the fat has dissolved. JG 6.27.08

• can you tell me if botox is safe if you take prozac, xanax, and naproxim sodium?

  Answer:  yes. JG 6.27.08

• How long after a botox inj before all of the symptoms will go away? Today is the third day i still feel extremely tired and now am having stomach pains and stomach problems. Im afraid it will get worse and i will have more severe symptoms. Are there any bacteria medications or antiobiotics that can help?

  Answer:  the Botox wears off over a few months, the time depends on the patient and the amount injected. I have never seen it cause the symptoms you are having though. One more thing about Botox. It has come out that the education that injectors were given since the beginning of Botox release was incorrect. The bottle is to be used for a single patient. That means that a bottle should not be shared between multiple patients. The company that makes Botox has known about this but has never issued an alert to doctors or patients. The risk is that of the bottle becoming contaminated and passing a communicable disease like HIV or hepatitis from one patient to another. There are no known reports of disease transmission in the use of Botox, but it has not been looked at yet in order to determine that issue. For that reason I strongly urge you to demand that a new bottle be used when you are treated and then observe the injector destroy the remainder of the bottle. If that is not done I urge you to contact the local board of health for the violation. Ask to look at the box it comes in and you will see the single patient, single use wording. JG 6.27.08

• Hi Dr Garcia The Botox injection that i had was in my Glabella. I had 17 or 18 units injected. About 7 or 8 pokes - part of them were above the brow area- they said that is part of the glabella muscle. Does that sound right? Its only been 2 days - the skin on my top lids seem alittle losse.

  Answer:  yes, that sounds right,the skin can at times feel like that for a short period of time, I usually do my glabella with just three punctures. JG 6.26.08

• Hi Dr Garcia, I had a botox injection two days ago. I have a headache and feel extremely tired. Is this uncommon? If this is not uncommon do you know how long these symptoms will last? I just read on one of the sites about botox that side effects can last for months. The dr i went to said most patients do not experience side effects.

  Answer:  headaches are not uncommon and usually go away in a few days. One more thing about Botox. It has come out that the education that injectors were given since the beginning of Botox release was incorrect. The bottle is to be used for a single patient. That means that a bottle should not be shared between multiple patients. The company that makes Botox has known about this but has never issued an alert to doctors or patients. The risk is that of the bottle becoming contaminated and passing a communicable disease like HIV or hepatitis from one patient to another. There are no known reports of disease transmission in the use of Botox, but it has not been looked at yet in order to determine that issue. For that reason I strongly urge you to demand that a new bottle be used when you are treated and then observe the injector destroy the remainder of the bottle. If that is not done I urge you to contact the local board of health for the violation. Ask to look at the box it comes in and you will see the single patient, single use wording. JG 6.26.08

• how about just massaging would that help, thanks

  Answer:  the more time that has elapsed since the event the less effective it is, but it won`t hurt. JG 6.24.08

• hi so after a year if the swelling hasnt gone down what can be done to make the cheeks seem not as puffed out?

  Answer:  the incision might need to be opened and the tissue below imbricated to flatten them out some, done with stitches that are underenath the skin. JG 6.24.08

• Hi dr Garcia i had a radiesse lump removed from my right cheek bone. This made the right cheek muscle seem more puffed out and fatter its been 7 months since i had the radiesse lump surgically removed and the cheek still looks puffy and fat and surrounding muscles look raised and fat you advised that it was swelling and will take some time to go in your medical expertise can you give me a rough idea of how long it can take for the swelling to go as its been 7 months already?

  Answer:  after one year it might require something to be done to achieve more symmetry. JG 6.24.08

• hi dr garcia if you have juvederm injected can i still get sculptra done even when the other filler is still in my face? or do i have to wait for juvederm to fully leave before i get sculptra?

  Answer:  yes, that is possible since they are usually injected at different levels. JG 6.24.08

• Hi dr Garcia i posted yesterday regarding having a radiesse lump removed from my right cheek bone. This made the right cheek muscle seem more puffed out and fatter its been 7 months since i had the radiesse lump surgically removed and the cheek still looks puffy and fat and surrounding muscles look raised and fat you advised that it was swelling and will take some time to go in your medical expertise can you give me a rough idea of how long it can take for the swelling to go as its been 7 months already? thanks for your kind advice

  Answer:  if still there at one year it might need a revision after the Radiesse removal. JG 6.24.08

• ARE YOU SURE??? COZ I DONT WANT FILLERS TO GOOO ----->>>>dr, i have juverderm in my cheeks just about 2 weeks ago. I am planning on losing weight for a special day , say about 5 or 8 kilos.. will this effect the filler? will it all be gone? or will the filler still be in the same spot and last the normal way? coz i work out everyday too for about one hour. Answer: weightt loss will not affect the filer but the fat in your face will decrease so the filling you got from the Juvederm will not look as full. JG 6.26.08 THANKS)))))

  Answer:  weight loss does not affect the fillers, but it will affect everything else there. JG 6.24.08

• does drinking green tea and rosehip tea help the skin (face) to look good?

  Answer:  not to any great effect. JG 6.26.08

• dr, i have juverderm in my cheeks just about 2 weeks ago. I am planning on losing weight for a special day , say about 5 or 8 kilos.. will this effect the filler? will it all be gone? or will the filler still be in the same spot and last the normal way? coz i work out everyday too for about one hour.

  Answer:  weightt loss will not affect the filer but the fat in your face will decrease so the filling you got from the Juvederm will not look as full. JG 6.26.08

• Hi dr Garcia i posted about a year ago where i had radiesse injected near my right cheek bone to hide a scar unfortunately it just caused a significant bump. About 7 months ago i had the initial scar that was on my right cheek bone (2mm in width and about 2cm in length) cut out so the dr could get access to the filler he managed to cut some of the filler/collagen out and then he stitched the scar back. After this treatment i noticed that my right cheek muscle has become more plump and it looks fatter than before it looks like the cheek muscle has become enlarged and puffed out. I was wondering is this swelling that still trapped in between the muscle or anything else?

  Answer:  just swelling, it will all go down in time, but it will take a bit of time. JG 6.25.08

• Hi Doc, A couple wks. ago I had my marionette lines filled with restylane which was great. I now have some darkness around the area of my jawline, is this normal? I don`t know what to do. Would a peel help? I am italian so I have olive complexion. Would appreciate your help!! Thank You

  Answer:  coudl be a little deep bruising that has migrated downward, most likely will fade soon if it is that. JG 6.24.08

• I`m thinking of geting fillers injected in the nasolabial area. I wonder if yo have an opinion regarding which filler type: Restylane, Collagen, Hyaluronic Acid?

  Answer:  Restylane is hyaluronic acid and that will last longer than collagen. JG 6.25.08

• heyy, would juvederm and resty subq feel the same in cheeks?

  Answer:  I think the SubQ will likely feel a little firmer, more like the normal tissue. JG 6.24.08

• dr garcia my friend had juvederm put into her undereyes and one of her eye is good but the other one is all puffy still. It looks really bad. Its been ten days now. Should she worry or will it calm down a little later?

  Answer:  I would give it a little more time and have her massage it and ice it for now. JG 6.24.08

• Hi Dr. Garcia, I had juverderm put in in my eye troughs about 4/5 mths ago. The results were a bit lumpy and I looked like a football player ( with puffy bags under my eyes) up until recently.I loved the fact that it seemed to subdue the darkness under my eyes but did not like the lumps/puffyness that showed up.Ah-especially in florescent lighting!! Is there a way that you could use filler in the eye trough without this happening? Can you recommend someone in Orange County California? If you cant I will have to see you next time I am in Vegas for business. Thanks for always being here to answer questions.

  Answer:  well, the lumpiness can be avoided with smaller amounts for each needle poke. Due to potential legal issues, and some doctors wanting to know why I referred a patient to someone else and not them, I think you are best to go to this website and look for a plastic surgeon in the area you desire. I wish you all the best. JG 6.24.08 http://www.surgery.org/public/findasurgeon.php.

• hello, i had restlane for the oral commisures last wednesday. It appears as though the vertical line i once had is filled in, but it also has creeped down about a quarter of an inch more than it was..in a way i thought it was a long needle mark.. but i dont know what to think.. im thinking that restylane made the line longer (the marionette line) than it was originally ..ive been massaging it, and no change.. this may all be a shadow..what are your thoughts?

  Answer:  I think it is likely just swelling and should get better in time. JG 6.24.08

• hi dr, how long does restylane sub q last? does it last longer then juvederm? is it used the same way?

  Answer:  it might last 1-2 years, varies from patient to patient. It lasts much longer than Juvederm. JG 6.24.08

• hello dr garcia... ok, is subq the one for filling the cheeks???? will it give a good result? and if i have juvederm done can i put subq ontop?? coz i have juvederm in my cheeks and i want to put subq ... coz subq sounds better from what i read... thanks

  Answer:  SubQ is for the cheeks, correct. As to the effect, it depends on the injector, but it should be better. The two can be mixed but as the Juvederm dissolves you might need more SubQ. JG 6.24.08

• hello dr garcia... i am interested in cheek fillers... i was wondering if radiesse is the same as sculpture and if not how is it different? is radiesse the same as juvederm?? and how long does it last? and how do you use sculpture? for e.g. say i have 2cc of juvederm in my cheeks will i then need 2cc of sculpture in cheeks? thankyou.. yasemin

  Answer:  I think you get a more immediate effect but the cost is likely higher and will likely not last as long either with Radiesse. Maybe up to one year for the Radiesse and 2 or more for Sculptra. There is no equation that converts one to another as they behave differently. JG 6.24.08

• I have used Juviderm and Botox, Botox for forhead and the corners of my eyes and juviderm for my mouth lines. I was wondering for areas to the left and right of my chin in thoses void areas what can be used to fill those and any void areas on your cheeks and sides of your face.

  Answer:  Juvederm can be used there. JG 6.24.08

• hello , from rubbing restylane with my fingers at the marionette line i have caused a crater like patch..like a little of the skin is missing due to friction im using arnica and cortisone creme.. will this go away and how long do you think

  Answer:  I would not use either and just let it heal on its own, those products will not help what you have at present. JG 6.24.08

• I read on the Restylane website that the product may be used to decrease both the horizontal line across the forehead and vertical lines between eyebrows. I need to take a break from Botox for awhile and I am thinking about trying this approach. Can it be done successfully? Thank you in advance.

  Answer:  yes, it can. JG 6.24.08

• Hi Dr. Garcia. I wrote to you sometime ago about several small bumps (look like pimples) that began to form around a hyaluronic acid injection. You said that you thought it might be granuloma. The bumps have not gone away. What is the proper treatment for such a granuloma? Might it go away on its own if I don`t treat it? I recently had a mid-face fat grafting (FAMI) procedure so I need to wait for a few months before treating. But I`m trying to plan ahead. Thanks for any advice you can offer.

  Answer:  if they are very superficial the doctrr might be able to open them with a small needle and push the material out. It still might go away though, on its own. JG 6.23.08

• how much juvederrm do you normallly inject in the cheeks??? 1mll????2mmmll??3mll??6mll?

  Answer:  I usually do not use Juvederm to enlarge deflated cheeks as it does not last long, it is meant for nasolabial fold or creases or the lines around the mouth. For regaining the size of the cheeks I use Sculptra. JG 6.11.08

• Hi Dr.Garcia I know you don`t think fat grafts to the orbital rims are a great procedure but if one has them done is it safe to resume a sport like scuba diving four months after, or could the pressure of the mask and water destroy the fat? thank you

  Answer:  whatever will survve will likely not be affected by the pressure of submersion of a few atmospheres or the pressure from the mask, OK to proceed. JG 6.11.08

• is Fraxel Co2 good for skin firmnesss? i asked for co2 and p s suggested Fraxel Co2 . he said is better than co2. Is this true? i want to get rid of lines and sagging skin to make my skin more uplifting.

  Answer:  I am not a fan of any of the Fraxel technologies, sorry. I think it will heal faster and reduce some of the risks, but in terms of improvements, there is no comparison, Fraxel will not even come close because the whole surface of the skin is not treated. I think the CO2 laser would be superior than using a Fraxel CO2 which is not going to give you as much. JG 6.11.08

• hi, I had juvederm under my eyes. Now i have it moving to he corner of my cheeks. is this normal? and why did this happen?

  Answer:  I have not seen that happen, the Juvederm can be massaged to flatten it out if it has a lump but it normally cannot migrate distances. It might just be swelling though, I suggest seeing your injector for an evaluation. JG 6.11.08

• I am scheduled to have Artefill injected for some medium depth acne scars. What is your opinion on it for this particular use? And what would happen if I developed lumps down the road? What would my options be? What is the likelihood of that in your opinion? Thanks~

  Answer:  I think it can be challening to get them to fill in without doing a subcision first and then using the filler. If the subcision is not done it can lead to lumps. If you develop lumps the Artefil would need to be cut out. JG 6.10.08

• Hi Doctor. Thanks for your quick reply. The Radiesse was for nasolabial fold lines. I had very deep fold lines, but yet I don`t have a wrinkle to the rest of my face and I`m going to be 50 yrs. old. Also, is it common for having had 2 treatments of Radiesse within 3 months and for it to start to fade? Thanks again Doctor for your reply.

  Answer:  well, in some people the filler needs to be repeated more often than in others, it also is, you need to understand, a compromise, any filler is. The action of a filler in the fold is to actually lift the normal skin to the higher level of the skin which has sagged to make the appearance or depth of the fold look less deep. The true correction would be that of lifting the skin that has sagged, rather than using a filler. Filler are temporizers. JG 6.10.08

• Hi, Doctor, I`m the same woman that asked about the Artefill. You said that it is approved for deep injections only. What does that mean? Isn`t Radiesse also a deep injection. Thanks again.

  Answer:  yes, but since you did not mention where the Radiesse had been injected, and since some doctors inject Radiesse more superficially than they should, I wanted to make sure you knew it about the Artefil. JG 6.10.08

• Hi Doctor. I`ve had radiesse injections done twice since March and I love the results. The only problem is that it`s already starting to dissolve. I can`t afford to keep doing this every 4 months or so. I`ve heard a lot about Artefill injections and that they last for at leat 5 years. Would you recommend that instead of the Radiesse. Thanks.

  Answer:  it is an option, it is much longer lasting than Radiesse, but is approved for deep inejctions only, like nasolabial fold lines. JG 6.10.08

• Hello Dr. Garcia, I am getting collagen injections to fill in some acne scars followed by IPL to help with the redness. Do I need to wait for a certain amount of time to get the IPL after getting collagen injected? Will the IPL affect the collagen in any way? Thank you

  Answer:  I would do the IPL first as it might to a small degree affect the filler. JG 6.10.08

• my doctor injected a little botox twice in my liplines 2 wks ago , plus juvederm and my lips look very natural and i am really pleased. will the result last a little longer with the botox in the liplines? thanks

  Answer:  It might. One more thing about Botox. It has come out that the education that injectors were given since the beginning of Botox release was incorrect. The bottle is to be used for a single patient. That means that a bottle should not be shared between multiple patients. The company that makes Botox has known about this but has never issued an alert to doctors or patients. The risk is that of the bottle becoming contaminated and passing a communicable disease like HIV or hepatitis from one patient to another. There are no known reports of disease transmission in the use of Botox, but it has not bee looked at yet in order to determine that issue. For that reason I strongly urge you to demand that a new bottle be used when you are treated and then observe the injector destroy the remainder of the bottle. If that is not done I urge you to contact the local board of health for the violation. Ask to look at the box it comes in and you will see the single patient, single use wording. JG 6.9.08

• can mesotherapy (phosphatidylcoline) dissolve the fat under the eye area (which was result of excessive fat injection) and is still bulging out 5 year post-op.

  Answer:  I have not found it be be reliable, nor legal, in the US. JG 6.5.08

• Hello Dr. Garcia, I had restylane injected under my eyes for hollowed eyes at the beginning of January. How long do you think it should last and when should I get it done again?

  Answer:  it might last 8-12 months in some people. JG 6.5.08

• Hello again, also how do you feel about scultra? Do you and the majority of people like the results, don`t see any results, or unpredictable???? I`m considering it and any comments would be appreciated! Thank you!

  Answer:  I like it and in properly chosen patients who understand what it can and cannot do, they are generally happy. JG 6.5.08

• MY PS has recommended restalyne injections for under eye area (for hollowness) and upper eyelid area (for slight droopiness). Have read so many accounts from people dissatisfied with results, does this procedure generally look good after sufficient heal time? Why so much talk about having to use the hydraulanaise to dissove. Is need to dissolve that prevalent or are those just the ones you read about? I suppose people happy with result aren`t the ones on line. Please comment. Are risks worth benefit here?

  Answer:  for most it yields a good result, I think patients that are happy just do not get on the internet to talk about it as much as those that are unhappy. I feel the benefits for most patients are worth it. JG 6.5.08

• regarding my question below (regarding overfilling of tear trough) which resulted in excess fat and scar tissue bulging out, the filler was FAT. And its been now 5 years since the procedure but hasnt gone down one bit since then. kenalog has only worked to temporarily atrophy the area, but the fat and scar tissue just regenerate and bounce right back after getting time to heal and fill themselves in. so i dont want to keep getting kenalog all my life, and was wondering if there was any more permanent solution short of surgery. This is why i am interested in collagenase and wanted to know if this has the same problem of the fat and scar tissue coming back, or when it dissolves the fat n scar tissue, is the result more permanent?

  Answer:  I am afriad short of surgery, there is nothing that I can suggest. I do not think collagenase will ultimately work if injected though as the problem is more than likely due to the fat and not actual collagen. Collagenase will not dissove the fat. JG 6.5.08

• Even after getting Kenalog injected so many times to dissolve the bulging scar tissue that resulted from excessive overfilling of my tear trough area (under both my eyes), it worked but the result was always only temporary. It only lasted about a month and a half, but then after that, the bulging scar tissue came right back, just as it was before. So now i believe that, rather than dissolving the scar tissue permanently, the kenalog is just giving me a temporary atrophy effect (which is welcome in my case). Is there any way to make it permanent? Second question is, when will the collagenase injections be available, and will they be more permanent in dissolving the extra scar tissue/fat under my eye area? Or will the scar tissue come right back after a few months or so and the treatment will need to be repeated lifelong?

  Answer:  I am not sure what I can advise you without knowing what filler or procedure you had to correct the tear trough, most injections there dissolve with time and do not cause any significant scarring issue.I am not aware of any company marketing collagenase as an injection. JG 6.5.08

• Do you think patients would be more satisfied with botox or having the muscle above the brow removed (if the muscle sticks out above eyebrows)? Is botox needed (for forehead wrinkles) if the muscle is removed? Answer: I think removing the muscle is more effective and when done the patient usually will not need Botox any longer. JG 5.14.08-------------> what is this procedure called? and are the results good? can young patients get this procedure done too?

  Answer:  the procedure is part of a forehead lift but the amount of forehead lifted can be lessened if not needed. If no lifting is done it can still be done on young patients. JG 6.5.08

• Hi Dr. Garcia. I`d like to ask a question about my eyelid. I had botox over my eyebrows for the 2nd time after 3 months. I`ve noticed about a week later my left eyelid is drooping a bit. Will this resolve? Thanks very much for your help.

  Answer:  it wil resolve in a few weeks, it is due to the Botox spreading into the muscles that lift yoru lid and creating ptosis of the lid, it will usually wear off sooner than the rest of the Botox as the dose there is smaller. One more thing about Botox. It has come out that the education that injectors were given since the beginning of Botox release was incorrect. The bottle is to be used for a single patient. That means that a bottle should not be shared between multiple patients. The company that makes Botox has known about this but has never issued an alert to doctors or patients. The risk is that of the bottle becoming contaminated and passing a communicable disease like HIV or hepatitis from one patient to another. There are no known reports of disease transmission in the use of Botox, but it has not been looked at yet in order to determine that issue. For that reason I strongly urge you to demand that a new bottle be used when you are treated and then observe the injector destroy the remainder of the bottle. If that is not done I urge you to contact the local board of health for the violation. Ask to look at the box it comes in and you will see the single patient, single use wording. JG 6.5.08

• heyy doc, you know anything about macrolane? thick filler for breast area thats supposed to be safer than implants??? they are temp.... what do you think about them??

  Answer:  not available here in the US, I do not think it will last long as it is hyaluronic acid filler, but it is injectable so shape is easier to control, I think it will be pricey. JG 6.4.08

• Hello, my hair is not growing for almost 3 years now! it normally grows very slow but it just doesnt grow anymore. Im trying to drink alot of water and so on for it to grow...is there anything you can suggest for my my hair to grow? maybe vitamins? diet hints? workout? pills? i am using anthogenal, i dont know if its working though coz its still not growing...help

  Answer:  it all depends on why your hair stopped growing. I think it best to see a dermatologist to find out what happened to make it stop gorwing and then possibly a remedy can be used. JG 6.4.08

• Dr. Garcia, Thank you so much for your response regarding the eye trough bruising from Restylane. If the problem is that the restylane was injected too superficially do you think I would need Vitrase injected to dissolve it? Would that work?

  Answer:  it would work, yes. JG 6.4.08

• heyy doc, I have the sensitive skin problem.. you said I should use squalene oil... can i use it all over my face? under my eyes too??? and how do i use it? will i apply it onto my face in the mornings or nightS?? is the oil good for little wrinkles and pigmentation?? how does it work??? please explain to me abit ?? plsssss))

  Answer:  yes, all over, use it just like a liquid moisturizer. Use it twice daily before make up and after washing your face. It will not do anything for wrinkles or spots. It is essentially a moisturizer, similar t the oils in your skin in the cell membranes. JG 6.4.08

• Thank you for answering my question regarding Botox and single usage vials. I must assume that Allergan is turning a blind eye to what I would guess is 100% abuse of the single dose vial recommendation. A quick call around today to the doctors and plastic surgeons in my area suggests that not one of them are complying with this recommendation. One doctor said that there are many drugs in use today that have multi-dose usage, like Lidocaine. That there is only a risk if a doctor was to use the samem needle for more than one patient. Am I correct in understanding we run a similar risk from contracting HIV or Hep C with cross-contamination each time we visit a dentist? I seek your opinion so that I can make a considered judgement based on what you have said about Botox risks. Thank you for your valuable time.

  Answer:  Allergan has known about this since about 2002 and has not alerted doctors as they would receive negative press, especially now since their competition is coming out in about 12-18 months and they do not want to come under Wall Street scrutiny. If the dentist is using single use vials for multiple patients, the risks are the same. In fact, here in Nevada, most multi-use vials are being used for a single patient and then discarded. There are legislative attempts here in Nevada and also in New York state to outlaw multi-use vials for that reason, one was sponsored by Senator Hilary Clinton in fact. To be honest I am not surprised that the doctors in your community are stil breaking the rules, that is the way they were taught, and once they are alerted, many will not change for fear of losing the business and the money. I think once the issue is brought to their attention, and all they have to do is read the labelling, it is irresponsible to continue to use it the old way and the only one it cnn hurt is the patient. JG 6.4.08

• hello doctor, you said for sensitive skin you can use squalene oil. Can a normal olive oil be used on face? will it help the skin or make it worse?

  Answer:  I would use the squalene over the olive oil if at all possible. JG 6.3.08

• Dear Dr. Garcia, Does Vitrase disolve Perlane?

  Answer:  yes.JG 6.3.08

• Dr. Garcia, I had Restylane injected into my tear troughs 5 weeks ago and I still have deep bruises underneath my eyes. What is the longest you`ve ever seen this take to go away. Has the darkening underneath eyes from Restylane ever been permanent. Is there anything that I can do?

  Answer:  in some cases 3 months, if you have had it injected too superficially, it might be what is called a Tyndall effect where the small particles are dispersing light in the filler causing it to appear that way, in those cases it will not get better until the filler dissolves. I have never seen it be permanent if it was not there to begin with. JG 6.3.08

• thank you!

  Answer:  you are most welcome. JG 6.3.08

• Re. badly swollen face after massage: thanks, that makes sense! If it was a hematoma, then I would have been better to use warmth than cold/ice the next morning? Also now assuming I`ve loosened the hematoma, can I follow up with gentle massage and warmth, carefully, do you think, or is it better to leave it alone? You have greatly set my mind at rest, thank you!!

  Answer:  I think that enough time has not passed that warm would be better, yes. I think you can proceed with mild massage and warm too. JG 6.3.08

• hello Dr Garcia, I have really sensitive skin. Everytime i use a face cream my face starts to make pimples and leaves scars and usually after any sport my skin becomes red. I was using retin-a years before and my skin was really nice. I started to use it again but my doctor told me to stop using it becuase my whole face became sooo dry for several months and really red/itchy. He told me to stop using anything... but when I dont use anything my skin becomes dry and not smooth... im 27 years old. what do you suggest for my skin? laser? or any creams? or can i not use anything? im really confused.

  Answer:  maybe some squalene oil for the moisturizing effect is about all to start. JG 6.3.08

• hello dr, will drinking plenty of water and being active during the day make lines on the face less? and tighten the skin?..thaksssss

  Answer:  no to both, sorry. JG 6.3.08

• dr I had juvederm under my eyes about almost a month ago and the area still looks bruised. I have to keep putting make-up on. It didnt really make the under eyes look nicer though. What do you think is wrong?

  Answer:  might have been injected a little too close to the surface and has left a little bluish tinge, that should go away in time though with nothing being done. JG 6.3.08

• Hello Dr. Garcia. Thank you sincerely for your unbelievable generosity; this site is providing a tremendous service. I`m a 49 year old female troubled by very deep vertical forehead frown lines since my late 20`s, previously untreated. Twelve days ago I had Radiesse injected between my eyebrows. Also Radiesse was injected in my nasolabial folds and Restylane in my upper lip at the same time. Results in all locations were beautiful. All swelling/bruising was gone by 5 days -- EXCEPT for one side of the frown lines. A firm raised area on one side of the 11 area in the forehead remained swollen and and ultimately became a more visible bump as rest of the brow swelling went down. It is the full height of the brow crease and about a centimeter width; it just looks exactly like I walked into the corner of a door or something that left me with a vertical swelling on my forehead. I suspect overfilling in that crease maybe? It is firmish but squishy and can be moved around under the skin to some degree. I have continued massaging it multiple times a day with Arnica cream but improvement is only ever temporary, in fact it has seemed to be getting bigger. As we approached the 2 week mark I was becoming concerned it was settling in to being permanent which would be a problem since it`s quite visible in profile. So last night I got more aggressive in the massaging, applying quite a bit more pressure, and I was able to really completely smooth the area and spread it out across my brow. I continued to work it for about 10 minutes until finally completely smooth. Afterwards my entire forehead skin was red from rubbing, but I went to bed. When I woke up this morning, my forehead, nose bridge and upper cheeks were swollen like a balloon. My forehead was painful to touch, and both my eyes were swollen almost shut. I had to call in sick to work. It has taken an entire day of nonstop anti-inflammatory triage -- icepacks, cold compresses, teabags on the eyes, high dose ibuprofen, chilled eye gell -- 16 hours later I am about half-way normal again. The hard lump that presumably provoked this is still there, but, is now smaller -- so I did make some inroads last night!! Two questions: (1)-What the heck happened?? (2)-What to do now about the remaining still bothersome portion of the bump [I am scared to massage again]... Can I do anything more to minimize final contours at this stage? Will ingrowing collagen cause further noticable thickening in coming months? THANKS for reading...

  Answer:  it might be overfilling, or a deeper layer hematoma because the Radiesse is injected deeper and that can slow or minimize the appearance of the bruise. I do think the massage last night though did a good amount to getting you over the issue. I think you had a small hematoma that the massage started to break down and the swelling and maybe some small amount of new bleeding has migrated due to gravity and will all go away in time. The Radiesse has the long term particles floated in an absorbable gel that takes about 6-8 weeks to go away, so just waiting should show some significant improvement over time with nothing further being done. I think some collagen will form but not enough to distort anything. Hang in there and best of luck. JG 6.3.08

• You mentioned that a new bottle of Botox should be used for each patient to avoid transmission of diseases. How many units are there in a bottle? For example, I am wanting only a small amount of Botox done (for the dao muscle around the mouth) which I`m told is about 6-8 units in total. That is going to be prohibitively expensive if I had to pay for a whole bottle. Can you think of a way to keep people safe who only want small amounts of botox done at a time?

  Answer:  there are 100 units in each large vial and 50 units in the smaller recently released vial. There is no safe way except to by the bottle, a permanent infection with hepatitis or HIV is nt worth trying to save money when doing Botox injections. JG 6.3.08

• is there a cream or something in the stores that will fade black and blue marks faster after injections?

  Answer:  Arnica Montana and Bromelain from the health food store help. JG 6.2.08

• i had juvederm injected in marionette lines by the doc i always go to and am satisfied, however this time there is dark brusing on each side about the size of a tiny button. how long before that goes away? makeup covers it to some extent, but still shows. thanks

  Answer:  could be 10-12 days, sounds like a small hematoma. JG 6.2.08

• Hi DR Garcia, I wanted to know if using the hyularondaise is very bad for the skin (tissues) Does it (could it) cause damage (if down numerous times) to the inside of areas that it was injected? I had a consult with a Dr today who said he would prefer to wait until my product was gone as opposed to dissolving it. He said it is NOT good to do that. Thank you for you expert opinions!

  Answer:  I think since it is injected only in small amounts and not all the time the effects are minimal. I think if the lumps bother you it is worth dissolving them. JG 6.2.08

• I had ArteFill injected into the tear trough area about 6 weeks ago and initially it looked much better but, now it is getting very dark in that area. Is this common and can anything be done to help with this? Thanks.

  Answer:  might just be some bruising, avoid sun and give it some time. 6.2.08

• Four years ago,I received a Sculptra treatment to my face. However, the cosmetologist put it along my jaw line by mistake causing an effect of thickened chin and jowls immediately after treatment. It has not improved which at the time I was told it would eventually disappear after 2 years. Will the Sculptra effect ever dissappear or has my jawline now always going to look like this? I used to have a nicely defined jawline. Is there anything I can do?

  Answer:  I have to be honest, I have never heard of real Sculptra lasting that long and I also have never heard of a cosmetologist using Sculptra legally. I would start to wonder whether it was true Sculptra. I am not sure what could be done after this much time. Sorry. JG 6.1.08

• I emailed approximately three months ago regarding botox injected into neck bands that caused problems swallowing and throat spasms. I will never have botox injections again anywhere close to my neck/throat; however, I have had injections in my forehead for the past four years with good results. It is time for my forehead injections and want to have it done, however, I am still experiencing throat spasms and swallowing difficulties from the neck band injections three months ago. My questions are: 1) if I have the injections to my forehead, is there anyway this could cause an increase in the problems I am still having with my throat (I understand it is being injected in an entirely different area, but I really don`t know if Botox can have systematic effects also) and 2) is there an alternative such as laser or some type of filler that would work on the forehead area? There`s got to be something besides botox. Thank you.

  Answer:  forehead injections wlil not casue any problems in the throat. The only other option for the forehead is surgery to cut the muscles. One more thing about Botox. It has come out that the education that injectors were given since the beginning of Botox release was incorrect. The bottle is to be used for a single patient. That means that a bottle should not be shared between multiple patients. The company that makes Botox has known about this but has never issued an alert to doctors or patients. The risk is that of the bottle becoming contaminated and passing a communicable disease like HIV or hepatitis from one patient to another. There are no known reports of disease transmission in the use of Botox, but it has not bee looked at yet in order to determine that issue. For that reason I strongly urge you to demand that a new bottle be used when you are treated and then observe the injector destroy the remainder of the bottle. If that is not done I urge you to contact the local board of health for the violation. Ask to look at the box it comes in and you will see the single patient, single use wording. JG 6.1.08

• will excercising help tighten my skin (e.g cheeks etc)and help to firm up? or will it make it worse? I work out normally run and light weights (im a female) i started to have red sensitive skin. I shower each time after a work out so it should be ok. However i read somewhere that excercising can make skin sag... i dont really understand this though... isnt excercising good for you? thankyou

  Answer:  no, it will not do that. Running actually causes premature sagging of the skin. If your skin is sensitive you need to avoid sun and topical irritants like glycolic acid products and avoid hot showers too. Exercise is good for the muscles but does nothing for the skin, the reason runners` skin sags faster is due to the impact when your foot hits the ground and the skin bounces and tears. JG 6.1.08

• hiii, im interested in co2 laser. if something goes wrong e.g scarring or pigmentation change how can it be treated? will it ever heal well if anything goes wrong after the treatment? Im a little worried. Also with rhytec laser will it give a lifting effect on young skin ?

  Answer:  if the scarring is mild, in most cases it improves wth time, if the scarring is deeper it can be permanent and in some cases nothing can be done. I think the lifting from a Rhytec will be very small. JG 6.1.08

• hello. My question is if it seems to me that i need little bit of cheeks (with fillers) and lift, will laser resurfasing be a good idea to get the effect?

  Answer:  no, for that you need fillers injected. JG 6.1.08

• what can you do to minimise pores ?

  Answer:  Retin-A and microdermabrasion, short term, nothing long term. JG 6.1.08

• Hello Dr. I had botox in my eyebow and forehead areas 4 mths ago and it has worn off but is it possible that I have permanent side effects. My upper eyelid skin is alot more fleshy,hooded and dropped since the injections.I thought the droopiness would disappear after time but it didnt. I am 35 and I did not have this pre-injections.

  Answer:  the effects migth still persist eventhough there is some return of the wrinkling, it migth take longer for al of that to return to normal. JG 6.1.08

• I just had botox injected into my forehead and pelane into the nasolabial folds. When they injected the pelane into the nasolabial folds, one of my eyes started to water immediately, as if they hit a certain nerve. It`s now been 2 days and that eye is contiuing to water. Is this normal? Should it stop soon?

  Answer:  not normal and not likely due to he Perlane, I suggest you go to see the doctor. JG 6.1.08

• can you tell me the latest research on cosmoplast or news that youve heard about it possibly building a matrix when you get it done frequently? i seem to get it done every month to the marionettes, and it seems to last longer and longer as i keep building upon it.. could ffrequent cosmoplast injections be actually building a collagen layer? thanks

  Answer:  Cosmolplast is being removed from the market due to poor sales. Frequent injections do not create new collagen with that product, sorry. JG 6.1.08

• can radiesse lift eyelid if some is injected at temple?

  Answer:  a minimal amount, and only laterally. JG 5.31.08

• hello dr. i was wondering if radiesse injected in cheeks will lift them slightly. can it also help with the crowsfeet that are on the cheeks when animated. what would be the average cost to have it done this way. thank you very much for your insight.

  Answer:  it will but it would take quite a bit of Radiesse to accomplish that lift. I do not think it is a good idea to use that for crows feet though. Fillers in crows feet wrinkles, especially those seen only upon animation, do not do well as the skin is thin and the chances of lumps are high. JG 5.31.08

• Dear Dr.Garcia i just had juvederm injected under both my eyes 15 days ago and I still have some bluish tone coming through my lower lids maybe because the skin is very thin but also have some bags more so in the morning will all that go away with time ?they still are very puffy is this normal how much longer ,by massaging it will it help to disolve some more or will it just add wrinkles.Very concern what do i do?

  Answer:  the swelling/bags normally go away, as to the bluish tinge, in most cases it gets better, but if the material was injected too superficially, it can last a long time, massaging should help, yes. JG 5.31.08

• What is the best filler for the Lips that last the longest?

  Answer:  Restylane. JG 5.31.08

• I tried Juvaderm ultra for the first time (I have used restylane previously)My Dr. used a less than 1/2 cc on either dide of cupids bow to add a little bit of fullness and now I am completely swollen. It never happened with restylane.She was not in today but the nre assured me that the duck lip is just swelling? It was not as swollen yesterday after the injection, should I get it removed or wait it out ..I could not go out today as I look strange. I was also told NOT to take any NSAIDS or anything that is a diueretic...if I use those drugs will it go away faster? Thanks for any advice

  Answer:  In my experience the Juvederm causes less swelling than Restylane. I think waiting it out is best, I would not jump to dissolving it just yet. I do not think NSAIDs or diuretics will make the product dissolve any faster but the NSAIDs taken before the injections can cause more bleeding though. JG 5.30.08

• Hi Doctor. What laser machines would you recommend to tighten the skin? I know that some cause loss of facial fat. Thanks.

  Answer:  I only recommend CO2 lasers or Rhytec Portrait Plasma treatments for that. JG 5.30.08

• Thanks for the response. I am already scheduled for Juvederm on June 4, then 10 days later I have scheduled YAG laser. Is that enough time or should I skip a month? thx!!

  Answer:  that is enough time. JG 5.30.08

• Hi Doctor, I had radiesse injections in my marionette lines back in March. I had to go back and get injected again 6 weeks later because there wasn`t much difference with the first procedure which now looks much better. I was reading that sometimes the difference is subtle with these injections because the doctor injects the skin too deeply. So when I need to have it redone, do I just tell the doctor not to inject the radiesse to deeply into my skin or is this something they should already know. I don`t want to insult him either because I really like him as a doctor. You being a doctor yourself, how should I approach this to him. Thanks. Also, what is the difference between Artefill and Radiesse?

  Answer:  they should already know that. I would remind them though that last time you needed a touch up so they will remember. The Artefil and Radiesse are similar but Artefil lasts much longer. JG 5.30.08

• Hi Dr. Garcia. I have done 3 YAG treatments for tightening and I plan on having a 4th done this month. I am also planning on having Juverderm injected into smile lines. My question is; Is it safe to do both treatments, could it affect the facial filler? thx

  Answer:  best to inject the filler after the YAG. JG 5.30.08

• I have written to you a couple times about Sculptra and appreciate your answers. I am obviously very unhappy with the product - it was placed in the wrong place, I was given too much etc... It`s been about 10 months since and was wondering if there is any way of removing the tissue build up it has caused? If surgery is an option, will a Surgeon be able to differentiate between my natural tissue (fat) and the Sculptra build up? Or will I be left in a position that when the Sculptra build up goes away I will have holes in my face? Will a Surgeon need to pull up my skin ala a face lift to take it out? Thanks in advance for your help -

  Answer:  I do not think surgery or any injections will work for diffuse Sculptra filling, sorry. I do not think the skin will need to be tightened but I think it best to let it dissolve on its own. JG 5.30.08

• I am having liposmart,Dr, recommended using the fat at that time for the lips. I have used Restylane, Juvederm in the lips but only last at very short time. I am told that because I have low body fat it does not last. My questions are---Am I wasting my money with fat injections to the lips? How long does the fat remain ? Will it last longer that the restylane and juvederm?

  Answer:  I think it is a waste of time to use fat for lip injections and if you mean SmartLipo, the fat cells are supposedly destroyed by the laser so it will never work. JG 5.30.08

• I have a nickel sized indention >very slight (not very deep)> but if you squeeze my cheeks skin together it forms a crease I can see it at profile and of course when I smile it grooves.IT really bugs me! I do have juve looks much better however still there> If we keep filling I may look chubby?? The other issue is a small dimple like area that follows down to my smile lines. It is always indented> like a deep pitted scar. She has filled (juve) the area around it but