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

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

  Answer:  no worries. JG 12.21.08

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

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

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

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

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

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

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

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

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

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

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

  Answer:  to a small percentage, yes. JG 12.19.08

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

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

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

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

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

  Answer:  it is true. JG 12.16.08

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

  Answer:  no longer being sold. JG 12.10.08

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

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

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

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

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

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

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

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

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

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

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

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