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.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

  Answer:  not a big difference between them. JG 11.17.08

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

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

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

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

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

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

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

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