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.

• Thank you for the answer about the MedPor implants. But you didn`t say if you concur with my surgeon that replacing it is dangerous. He keeps talking about nerve damage, but if he routinely replaces other surgeons` implants, why should replacing his own be any more dangerous than others?

  Answer:  I do not think it is dangerous per se, but it will be difficult to remove and in that process tissues and nerves can be damaged if one is not experienced in dealing with MedPor implants. Silicone implants are much easier and therefore safer to remove as they are flexible and do not adhere to the tissue the way that MedPor implants do as they are rigid and allow the tissue to grow into the implant. JG 5.13.13

• Hi, Dr. Garcia. I had medpor cheek implants placed four years ago and loved them. Foolishly, I let the PS who placed them talk me into letting him trim the lateral edge of the R implant because he thought it was too projected. Unfortunately, it left that side of my face distinctly flat, so I`ve spent more than $10,000 on fillers trying to correct it, but it never gets it right. I`ve used a dermatologist for this rather than my surgeon because I fear, perhaps irrationally, that he did it deliberately to create a revenue stream. Anyway, he won`t replace it because he says it`s too risky. Is that right? I`ve gone to other surgeons who all agree that it should be replaced but they don`t use medpor and they don`t replace cheek implants. They all send me back to the guy who did it because he`s renowned for his ability to revise other surgeons` cheek implants. But he won`t revise his own. What should I do? Thanks,

  Answer:  Highly unusual that the original surgeon will not revise his own work, all I can suggest is to contact MedPor and ask them for a list of surgeons that use their cheek implants. Wish I had more. JG 5.12.13

• What do you think of the soft temporal shell implant designed by Barry Eppley and marketed by Implantech? Sculptra needs to be repeated too often as I age and I`m looking for a more permanent solution. I am concerned about visible margins, but it`s made of soft pliable (and trim-able) silicone. Where would the incisions be placed for this implant? Thank you for your opinion.

  Answer:  when placed at the correct depth the edges will likely not be visible. The incisions are placed in the hair-bearing scalp, so they would not be seen. It is an option if you are willing to have surgery. JG 2.11.13

• I had Medpor malar implants placed 4 years ago. I like them but they don`t project laterally enough for me. Removing them is very difficult, as you know. Would you think it a safer option to have tiny, individually carved additions placed along the lateral cheekbones rather than to try to remove them and replace them entirely with larger ones? (Alternatively, could small silastic implants be hand-carved and placed along the lateral cheek bones?) My surgeon is reluctant to try either adding tiny new implants or removing them entirely and starting over. What do you think? A complicating factor: my surgeon transected the right buccal branch of my facial nerve when he implanted the first round. I have only about 20% of motion on the right side of my face now. Thank you.

  Answer:  I think it might be better to use longer term fillers to achieve the effect you desire rather than having more surgery as you already have had some issues and more surgery would be more difficult than the first. I wish you the best. JG 2.10.13

• Sounds good, but would it be a problem to use bone matrix substitute, or other custom made materials on the jaw and side areas, if i already have a chin implant of silicone? I hope i don´t have to remove the chin-implant? And is the bone matrix substitute, or other custom made implants of porous material?

  Answer:  Not a problem and they are rigid and in some cases are porous, it depends on what the surgeon orders. JG 12.20.12

• Dear Doctor. Is it called oral-maxillo facial surgery if a plastic surgeon cooperates with a dentist, when it comes to using implants for the jaw-chin area? And the surgeon said they used custom-made implants. He said the implants are of some specific material, not necessary silicone. Do you know what they usually use? Thank you for you`re answer on advance.

  Answer:  That is correct and the implant might be made of a bone matrix substitute. JG 12.18.12

• Well then, do you think that fastening silicone implants with screws increases the chances for infection? (for all bacterias) Thank you on advance.

  Answer:  I do not think that would affect infection rate. JG 12.2.12

• Dear Doctor. I have just removed a medpor implant because of an infection. The bacteries were in side of the medpor implant since the implant was of porous material. The bacteries were white staphylococcus. My surgeoun told me that since the implant was porous material, the white staphylococcus has developed over time inside the implant. This is why i am only considering silicone implants from now on. He also told me that yellow staphylococcus is a immidiate scar-infection, while white staphylococcus developes over time. And since the implant was porous the chances for white staphylococcus is larger in medpor implants. Would you agree?? Because i thought the infection-rate was 50/50, both in silicone and medpor? What do you think? Silicone or medpor, what is the better option?

  Answer:  I think both can get an infection, but once the infection starts, the Medpor makes it more difficult to treat with antibiotics alone and usually means that the Medpor implant will need to be removed. JG 11.30.12

• Dear Dr Garcia. I had Sculptra injected in my temples, two vials 8 months ago, with very little improvement, so have decided to go back for some more. My question is that in the same week I am scheduled to have botox 3 zones, including lateral periorbital. Would it be safe to have both procedure so close to each other? Thank you Paco

  Answer:  do the Botox first and then wait at least one day for the Sculptra. JG 11.12.12

• Medpor cheek implants 3.5 yrs old. They look terrible. They`ve hardened my face and given me a strangely masculine rather than more feminine look, which was the original intent. I look like one of those plastic surgery disasters that the media ridicule. Honestly, as bad as Michael Jackson, minus the pigment changes. The surgeon who placed them says if they`re removed, my midface will comopletely collapse and I`ll be left with dents on my cheeks in the exact shape of implants. That would be far worse than what I have now. Do you agree with him? Wouldn`t the scar tissue hold up my midface and also fill in the dents? I feel as stupid as I as I look. I guess I deserve this fate for choosing to put them in in the first place. Do you have any suggestions at all? I`m sorry to take up your valuable time with my selfishness.

  Answer:  I do not think you would be left with dents as long as they reattach the tissue back down to the bone, but you will look like you did before, maybe some looser skin. You could consider some Sculptra to the lower face, below the implants on the cheek to give you a rounder look and take the overly sculpted appearance and soften it, that might work and would avoid the surgery to remove them. I wish you the best. JG 10.26.12

• I mean: What made bacteria suddenly develop there then? If the implant itself is not the issue.

  Answer:  It ocurred during the implant insertion. JG 10.9.12

• Alright, but what makes all bacteria suddenly develop in that area? Is the implant itself is not the issue?

  Answer:  Usually the contamination occurs during the placement of the implant and grows slowly. JG 10.9.12

• But would not a new medpor implant give me another infection again? Why do you think anyone/I - /reacts/reacted to it in that particular area in the first place? Is medporimplants better than siliconeimplants? Which have less infection rate worldwide?

  Answer:  It is not the implant, it is the bacteria in the area whwre the implant is placed that causes the infection. Infection rates between Medpor and silicone are similar. JG 10.9.12

• Sorry to ask again Doctor. But i will have it removed in approximately 2 weeks. I should have treated the infection immediatly 4 months ago, but it was hard to understand that it was an infection when it occured. You said the faster i remove it the faster i can do something to achieve the look i want. But since i suddenly had a small reaction to the medpor implant. Will it be a problem having medpor jaw-chin implants in the future(in 1-2 years)? I have a chin implant which i didnt react to at all. Thank you very much for you time and patience.

  Answer:  implants in the nose are at high risk for infections, the other areas are much less, so you can likely use the MedPor implants there. Best of luck. JG 10.8.12

• Alright. But, how long can i wait maximum time before i remove the implant? Can i remove it in January 2013 for instance? Or should i remove the implant as soon as possible?

  Answer:  the sooner you remove it, the sooner it will heal and then the sooner you can have something else done to achieve the appearance you desire. JG 10.8.12

• Ps. The liquid is also more clear-looking. The amount the liquid is decreased, but it still leeks out.

  Answer:  I think it will not heal as long as the implant is in there. JG 10.7.12

• Hello again Dr.Garcia. The bacteria results of the white-like liquid just arrived, but they showed no sign of bacteria! Have you any idea of what they can be? The doctor would not give me any more antibiotics, and told me to wait and see. He had no idea of what it could be. The red scar-lump is lighter now, but some liquid is still come out. But the liquid contains blood and is now much more yellow looking.

  Answer:  it could be a sterile abcess, but it also could be somehting they did not look for, something like an anaerobic infection, and they should also have looked for an acid-fast bacterium and that can take up to one month to grow in culture. I am afraid you will need to have the implant removed for the problem to stop and the area to heal on its own. Sorry. JG 10.7.12

• Sorry to ask again Dr. But i am still waiting for the bacteria test results. I am on antibiotics for 12 more days. But the red lump is actually a small pit where the white-like liquid comes out. My surgeon had no idea why there was a pit in the skin, but is it because the infection is serious there? The small pit sort of syncopates the skin and makes it red. Out of it comes white liquid. Is it a good sign if the liquid bisects?

  Answer:  there is a pit because the pressure from the infected material thinned the skin out some and likely you also lost a little bit of the tissue beneath the skin, that usually fixes itself in time.It is good if the liquid comes out, yes, but that will not make it certain that the implant will not still need to be removed for the infection to totally clear. JG 9.23.12

• Well i have just started a long-time well known antibiotic-cure.Is the chances good on becoming well by the cure? Because it did not seem to my that my surgeon had seen this type of small infection before. He was also really surprised of the infection evolving over a long period of time, and that it was not painful for me at all.

  Answer:  It is possible, yes, but when there is a foreign material in place, like an implant, the success rate is less compared to when there is no foreign body in place. Infections around implants are commonly seen to grow very slowly and many times they are not painful as the skin can stretch. JG 9.20.12

• Dear dr. Garcia. I have just been to my plastic surgeoun for the red lump. He said that it could be an infection. When we pressed it white liquid came out. He was surprised because it was almost 4 months ago this occurred. He took a bacteria test of the white-blood liquid coming out, and gave me antibiotics. Do you have any idea of what it could be? The bacteria test will come in 1-2 weeks. I hope its not an infection by the implant. Because i do not want it removed. Can it be an infection of something else??

  Answer:  well, it likely is an infection, just not a bad one, all you can do is wait and see how it goes, not much that can speed it up. Sorry. JG 9.20.12

• dear Dr. Garcia. Hope you can tell me what is happening now. It is about the sore lump on my jaw. The lump on my bruised jawline is now a soft and very red lump. It gets smaller in time. But what can it be? Is is blood vessels? Because its frighteningly red.Or keloids? Or scar tissue. Its a soft round very red lump.My face is becoming normal again after the hit, but its just red on the lump. Help. What can it be? The red lump has also contain small white lumps that look like small zits.

  Answer:  it is old blood that has liquified, and your body is trying to absorb it. Your surgeon might be able to aspirate it now that it is more liquified. All the best. JG 9.11.12

• Dear Doctor Garcia. I would like a fuller looking face. Im planning to get fat-transplants in my face (cheeks and eye-area). Im also planning to define the jawline with medpor implants (very little). There are to different surgeons i have chosen for the two different procedures. Which of the procedures would you suggest is better to perform first? The fat-transplants or the jawline definition implants? Thank you.

  Answer:  I suggest the implants first so they can see the framing better. JG 8.19.12

• Thank you very much for a quick answer Doctor. But how long should i wait and how long does it take for the body to break the blood down and absorb it? Thank you again on advance.

  Answer:  No way to tell, buy the blood should be gone in a couple of weeks or so. All depends on the amount of blood. JG 7.26.12

• Dear Dr. Garcia. I had a medpor jaw implant a few years ago. Almost 2 months ago i got a punch in the face next to the implant. The next morning i had a very swollen up face in the implant area. After a few weeks the swollen area got soft and flat. So i started to massage the swollen area a few days ago. But the swelling suddenly came back and it is worse today. I have a huge hard and sore lump on the jaw implant area. Could the swollen area be keloids or scar tissue?? What should i do? What can it be?? Can internal scar tissue be surgically removed? How long should i wait before having a new chin implant surgery?

  Answer:  not a keloid but maybe scar tissue, more likely is some bleeding around the implant and it will take time for the body to break it down and absorb it. Internal scar can be removed but new scar can form. I would wait for all of this new stuff to get better before deciding on a new chin implant. JG 7.25.12

• How long after implantation does it take for tissue ingrowth to be completed with ePTFE implants? After that time, is the risk of extrusion significantly diminished?

  Answer:  6-12 months, and yes. JG 7.24.12