Ask Dr. Garcia - The Archives

• 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 Resty