Ask Dr. Garcia - The Archives

• You know the two larger veins that go down your neck- they usually buldge out more in old women. Mine show more because I do not have much fat on my neck. Do you think filler injections will help?

  Answer:  in that area, not really. JG 7.3.09

• Hi Dr. Garcia, 1)is there anything to help the hands-veins & loss of fat? 2)Does Retin A help? 3)What can be done to soften the knuckle creases which worsen as I age. I am 50 yrs old. Thank you !

  Answer:  Sculptra injections, or fat injections. JG 7.3.09

• I wrote the question about areola reconstruction. My problem is that tattoo did not take at all on sides of areola although it was tattooed like 5 times. One nurse suggested to tattoo the grafted skin before it is grafted so I do not have to worry sbout the tattoo not taking. My question is here will the tattoo on PRE-grafted skin still look the same color when it is grafted onto nipple? I have to remove the total nipple area since the sides are collapsed. I need nipple reconstrcution for nipple shape. So, do you think it would be better for me to have the tops of my nipples cut off and saved to graft onto nipples right after nipple reconstruction? Or do you think I would get better results if nipple reconstruction was done without adding the tops of my natural nipples? I just thought the skin texture of my natural nipples might look more natural, but I need to know if my natural nipple tops will lose their color (turn white) once grafted?

  Answer:  no, tattoed skin will not keep all of the color and will likely not have even color either. I personally would keep as much of your own tissue as possible and not remove any more tissue or skin. JG 7.2.09

• Regarding nipple reconstruction, the only savable part is the top side of my nipples. I have to have the sides or center reconstructed. I would like my reconstructed nipples ot look as natural as possible. I thought if the doctor cut off the tops of my nipples and then grafted them on top of the reconsturcted nipples, the top of nipples would look more natural. I am just worried about matching the color of the tattooed sides to the my natural top color. 1) If the tops of my nipples are grafted, will they still be the same color after they are grafted? If not, how much lighter will the color get? 2) Right now I have white grafted skin around the sides of my nipples that would not take tattoos. I am afraid the tattoo will not take again after the second skin graft. Is there a way to graft the skin so it will take a tattoo? Or is the only way a tattoo will stay is if you pre-tattoo theskin to be grafted before it is grafted? Again, will this tattooed skin lose some color after it is grafted? In other words, if I had the skin tattooed to match the current color of the tops of my nipped= would the tops of my nipples and the sides of my nippled match after the skin graft? 3) Is it possible to even graft the tops of my nipples onto a newly reconstructed nipple? Thanks.

  Answer:  grafts will never look as good as the natural areola that survived. The color may not match but that is one of the limitations of the procedure that cannot be surmounted. Graft reconstruction of the areola, like any skin graft, typically is not a completely uniform color, there wil be light and dark areas depending on how well the graft heals. The ability of grafted skin to accept tattoo pigment is variable and unpredictable but in most cases the color takes, tattooing the potential skin graft will not help in any way. I think you need to come to the understanding that your areolas and nipples will never look totally natural in shape or color, no matter what you do to reconstruct them, sorry. JG 7.2.09

• I am in my mid-thirties, skinny, and I have never been pregnant. I used to have a flat stomach in my twenties. I had liposuction for love handles in my late 20s. I notice that I do not have a flat stomach anymore. Is it because the fat from love handles now goes to my belly or is because your digestive system slows down as you age so your stomach gets bloated all the time?

  Answer:  it most likely is the accumulation of intra-abdominal fat from metabolism changes from aging. JG 7.1.09

• For areola reconstruction, do you think you get the best result with a skin gratf from groin area or just to have the area tattooed? If I just had the area tattooed (without plcing a skin graft there) my breast augmentation incision scare at breast crease line would move up more. They are already 1/2 inch above breast crease line. What if I had expanders placed near my breast implant incisions to stretch out the skin so it would be able to cover the areola area without moving up my breat implant scars??? Would I need ot be put asleep to place expanders at bottom of breasts? How long would I have to wear these expanders? See, my skin is very taut or doe snot stretch as it is so that is why I would need to stretch it with expanders. Or do you think a skin gratf from groin would give a better result? In your opinion, which method would show most natural looking results or areola?

  Answer:  I feel tattoo is best. I think the other questions you are asking are impossible to answer without seeing you in person and examining the tissues, sorry. JG 7.1.09

• I wrote the question about Mexico. I also want to AVavoid travler`s diarrhea. Should i avoid eating any food in Mexico- like avoid eating hotel food and restaurant food since the food is washed with water that might be contaminated. I heard Mexico water is contaminated. I do not know if they mean all of Mexico or just certain parts.

  Answer:  I think the quality of the food in Mexico and its water are much improved, I drink the water and eat the food whenever I go there, if you are concerned, just drink botteld water and cooked food should be safe. JG 6.30.09

• Do they sell tamiflu at any drugstore in mexico? Do you know the average price in US dollars for it in Mexico? I would prefer to get tamiflu here but my doctor`s receptionist said I need to make an appointment with the doctor, but I am leaving soon so I don`t have time for appointment. Thanks.

  Answer:  yes they do.I am unsure of the price though. JG 6.30.09

• If you will be traveling to Mexico, do you know if you can ask for Tamiflu drug before you travel (to have protection right away if you get symptoms)?

  Answer:  yes, or you can buy it there, I was just down there and they sell it OTC. JG 6.30.09

• Will you catch a superbug if you only take antibiotics for 4 days or is that onyl if you already have a bacteria infection?

  Answer:  catching the superbug is not from taking antibiotics, but the superbugs develop when people are given antibiotics for no reason and then it infects people down the road. JG 6.30.09

• If you have surgery, do you need to take antibiotics for 10 days for precautions against possible bacteria infection?

  Answer:  in most cases, just the day before and 2-3 days afterwards. JG 6.29.09

• Hi Dr, I bought a stack of vitamins (C,E,zinc, fish oils etc) to help me heal following a blepharoplasty but then I read somewhere that antibiotics can cancel out the benefits of vitamins so there is no point taking them whilst of a course of antibiotics? Is this right? Thank you

  Answer:  you should only be on antibiotics for 2-3 days, so just start them after. JG 6.29.09

• How long do you think it might be until Dysport will available in USA doctor`s offices- a couple months, a few motnhs,a year? Do yo think the price will be cheaper than botox to drive customers away from botox to new product?

  Answer:  we will be able to use Dysport in July. As to chepaer, that is up to the doctor and not the manufactuer. I will persoanlly stop using Botox in most cases. JG 6.29.09

• I have a very sensitive digestive system. I am afraid to take a trip to Mexico because of contaminated water. I do not know if the hotels have contaminated water (to cook food and serve beverages)or if I should all avoid hotel or restaurant food and only buy bottled water and beek jerky. I do not want to get diarhhea. Do you know if hotel water is also contaminated?

  Answer:  almost all the hotels have purified water sources now. JG 7.1.09

• I saw some pictures of breast reconstruction surgery where an areola was grafted. I saw a line of white scar tissue around the areola. I did not know that an areola graft caused white scar tissue around the areola. Do you think the white line was left because the areola area was not tattooed enough to cover all of the grafed skin? Or does a white line of scar tissue automatically form around the grafted skin? It looks like the person had a skin graft on areola area since there is white outline of scar around it.

  Answer:  there is always a white line as there is a scar and commonly scars can heal like a white line. When a graft is performed then that can leave the scar, if it is tatooed rather than grafted, then there is no white line. JG 6.28.09

• Do many plastic surgeons move the muscles closer together in the abdomen area after childbirth? I read about a woman who had that done. I never heard of it before.

  Answer:  it is called a repair of diastasis recti, usually done by plastic surgens while doing a tummuy tuck if needed, it is not something general surgeons or gynecologists typically do. JG 6.28.09

• I am very fair skinned with dark hair. I had electrolysis on my armpits. It permanently removed the half the hair. Then I I had laser hair removal to finish it up. The other hald of my hair eventually came back with laser hair removal. This was when hair removal was newer to the market and it just might not have been a quality machine. Whic machines work better- like I heard Sheer light does not work as well? I was wondering if it did not work for my armpits if it would not work for other areas of my body? Again, it just might have been a poorer quality laser machine.

  Answer:  an Alexandrite laser works the best I feel, it is made by many companies though, need to ask the spa what they have and use. JG 6.24.09

• If granulas develop from filler injections, how long do they take to appear and how long (or how many years) would it take them to appear? To know when you are safe of not getting them?

  Answer:  they take at least 6-8 weeks to start to form, in most cases longer. If there is no granuloma by one year, the chances are small that it will form. JG 6.23.09

• It might sound funny for me to say this, but I wish I was completely bald in a circular area near my bangs. Since I have some hair, I was told that that hair could fall out due to shock if I receive a hair transplant. That means the transplanted hair will look how my hair looks now (sparse) if the hair I have now permanently fall out due to shock. If I had no hair in that area, they would be able to completely fill in the area hair by hair, but right now the hairs I already have would prevent them from placing hairs in those occupied areas. Since a hair transplant is not possible, do you think the circular area with sparse hair could be surgically removed so it doe snot show? Do you think doctors could do that?

  Answer:  any hair loss from the not uncommon shock effect is short term and the hair grows back. I think cutting the circle is an option but will likely leave a long wide scar. JG 6.23.09

• Before there were laser to remove freckles, I had multiple 25% TCA chemical peels. I do not know how many layers of skin you need to peel off to get the effect of the laser. Maybe I did not get down to the last layer. I do not know. But freckles come back in those areas on their own (shoulders) although I stay out of sun. Is it more permanent with the laser? Also, I get seborrea keratosis in the areas I had the chemical peels. i do not know if the chemical peels cuase these growths since the chest area or shoulder area are common for SK.

  Answer:  the number of layers one needs to go depends on how deep the freckles are, the longer you have had them the harder they are to remove. In time they almost all come back. It is no more permanent with lasers. Lasers and peels can aggravate the SK`s. JG 6.23.09

• What is a photo facial? Is it the same as IPL or foto laser? Does it only work on darker freckles instead of lighter freckles? I also want to know if the same freckles that were removed will come back? I do not know if your body is programmed to make melanin in the same spot you had it removed. Let`s say you stayed out of the sun and wore sunblock= would the freckle eventually form in that same spot again?

  Answer:  it is the same thing as an IPL. It can lghten darker freckles but likely will not totally remove them. In time and with sun exposure, they will all, light and dark, come back. Even flourescent lights can make them come back. JG 6.23.09

• What do you think of eyelash transplants? I know hair from the scalp is usually transplanted to the eyelashes. On one eye, I have a little space of eyelashes missing in the center. It makes my eyelashes look parted in the center. Strangely on the other eye, I have a couple extra row of eyelashes in the center that I have to pluck out. I thought maybe those extra eyelashes that I do not need could be transplanted to the other eye instead of using hair from the back of my scalp? I know with hair transplants, little dot holes are punctured on your scalp. Is that how it works with eyelash transplants?

  Answer:  I think for cosmetic reasosn I would not recommend it, I would do it for patients after a burn or scar tissue. I am unsure whether they could remove the extra eyelash and include the hair bulb for it to work. JG 6.23.09

• Some people have said that if you have liposuction, the fat taken out will develop in another area of your body. I had liposuction 10 years ago, but I have not noticed fat in any new areas. Is that because I am thin so you only grow new fat in areas you never had it before if you gain weight?

  Answer:  if you gain weight after the liposuction, the excess calories will find somewhere new to go, if you maintain a healthy weight, that does not happen. JG 6.23.09

• If you had fat injections or some other filler in the undereye area for hollowness, will CO2 laser resurfacing in that area cause the fat injections or filler to dissolve? I read that some lasers (maybe it was IPL)dissolve fat in the face.

  Answer:  should have no effect unless it has radio frequency waves which true lasers do not. IPL should also be safe. JG 6.23.09

• Hi Dr. Garcia, I`m considering trying Botox for a brow lift and to treat crow`s feet. Can you tell me how many injections and units of Botox would normally be used for this procedure? Thanks!

  Answer:  when I perform that I typically use 70 units for that. JG 6.21.09

• Dr. Garcia, I just wanted to thank you for your time and patience. I refer to your site very frequently, and have posted numerous questions in the past. I`m not sure how I stumbled across your site a few years ago, but so glad that I did. Just knowing that you are here has eliminated many potential panic moments!!! I can`t imagine how busy you are with your practice, let alone answering all of our questions. I so appreciate what you do, and the enormous heart you obviously have. Thank you so much Dr. Garcia. Best wishes to you and yours :)

  Answer:  I wish you all th ebest and thank you for the kind words, sorry for the slowness in getting back as I was not available for a week. JG 6.21.09

• Good Evening Dr. Garcia, A couple years ago, my ENT prescribed elocon ointment to apply inside my nostrils when they swell and get irritated from blowing my nose all the time (allergies). I am out of the elocon ointment, but I do have a tube of Triamcinolone ointment (0.025%). Is it alright to apply that inside my nostrils? Thank you! :)

  Answer:  short term use is OK. JG 6.12.09

• I have a lopsided hip so one hip is higher than the other. Also, it looks like I have a curved in waistline on on side, but a straight waistline on the side. I was just wondering if there is a such a hip surgery to straighten the hip so it is not lopsided. If so, what is this surgery called and do you think it would be covered by insurance? AN MRi confirms I have a hip defect (if ionsurance needs verification).

  Answer:  it is most likely spinal surgery and I am not sure the risks would be worth it. I do not think insurance will cover it, sorry. JG 7.1.09

• What is risky about large amounts of a filler like like Artefil? Would the hand area be considered a large amount?

  Answer:  I think the risks of grnaulomas in the hand is high and I would not do it. JG 6.10.09

• Why would you not use Artefil on other areas of the body, such as the buttocks?

  Answer:  not approved for that, the amount needed to be injected would be very large, I think in general, buttocks enlargement with injections is not worthwhile with fat and with other fillers is risky.JG 6.10.09

• What do you think of PMMA fillers?

  Answer:  I used Artefil for nasolabial folds for a short period of time, but the company closed so I do not use it any longer, I would not use it anywhere else. JG 6.10.09

• Do PMMA fillers disappear from buttocks like fat fillers? Or does PMMA stay or buttocks maintain their volume?

  Answer:  usually the volume injected into the buttocks is large enought that it will not dissolve. JG 6.10.09

• I wrote the recent question about the breast scar moving up. The breast scar is about 1 1/2 inches long. I had a prior skin graft taken from my buttock which was at leasr 3 1/2 inches long. It seems that 1 1/2 iches is not long enough and 1/2 inch wide is not wide enough for skin graft over whole circular areola area? That means that the 1 1/2 inch scar would need to be cut larger to about 3 1/2 long? Although that would now be in the breast crease area, it seems like a larger scar like that would be noticeable. Would the scar need to be cut longer across for a skin graft meaning it would increase from 1 1/2 inches long to 3 1/2 inches long? Also, is the groin area better area to take skin graft from or is it equal to breast area skin? I thought the groin area might have more color to it.

  Answer:  the scar will need to reflect the size of the graft needed. The groin is not equal to any other skin, it is taken from that area as it is an easy site to hide a scar in. The color will nto match breast skin. JG 6.6.09

• After breast implants, let`s say a woman has a scar that is located 1/2 inch above the breast crease line. The woman needs to have areola reconstruction. The damaged areola area needs to be removed either by cutting it out and pulling up the skin underneath the areola to the nipple OR placing a skin graft onto the areola area. If the skin is pulled up to the nipple meaning a skin graft is not placed, would the breat implant scar (that is 1/2 inch from crease of breast) move up one inch (if the diamter of the areola removed is 1 inch all around)? In toher words, would the breast implant scar now be 1 1/2 inches above the breast crease line? I think that would look bad to have the scar closer to the middle of the breast instead of closer to the crease line. Maybe the scar will not move up, but I need to know? In this situation, do you think it would be better to remove the areola without doing a sking graft OR do a skin graft over the removed areola area?

  Answer:  yes, it would move up, but if you use the skin between the old crease scar and where the crease is now for the skin graft, you might be able to pull the scar that rose up onto the breast down and keep it in the crease. JG 6.6.09

• If laser hair removal is only temporary, then that probably means that laser hair treatments to shock hair into growing back is only tempoary??? Right now I am using the HairMax comb due to permanent hair breakage in bang area. It might be due to braiding my hair- not sure. I have been using the Hairmax comb for 2 months now to see if it works before I consider a hair transplant. I do not see any results yet, but it takes at least 2 months before it starts working I hear. Does it work at all? Also, is it more effective if you get laser treatment (to make hair grow back) professionally than if you use your own HairMax comb?

  Answer:  I think the results from the comb will be minimal to none and will not replace hair transplants, as your loss is likely due to the follicles being pulled out from the braids, the combs, if they work, will assist in hair follicles that have lost some of their blood supply. There are no lasers that reliably grow hair. JG 6.3.09

• Is micro hair grafting only grafting one hair at a time? There is this one place that gratfs one hair at a time near the hairline, but a few hair chunked together in the same graft for the rest of the hair. Is tat how micrografting is done= you only graft one hair at a time near the hairline, then graft in multiples for rest of hair? I thought it was supposed ot look more natural if you only graft one hair at a time everywhere. This place`s price is drastically lower (less than $1 per graft), but I don`t know if it`s because they are not as skilled. Do you think price makes a difference?

  Answer:  micrografting is 1-3 hairs, what they are describing is micrografts at the front where they are easily seen and then regular grafts further back where they are less easily seen. I do think price can make a diference, but in this economy, prices for many things have gone down, the usual low price is $4 though. JG 6.3.09

• How long does hair growth slow down for laser hair removal? Why do people get it down if the hair will gorw back. It is expensive procedure. I think most electrolysis people went out of business due to laser.

  Answer:  the length of time varies from person to person and area to area. As to why people still do it, because they do not research it enough to know the truth. Electrolysis works if the hair follicle is killed but that is not easily done and can hurt more than laser and is painstakingly slow to perform. JG 6.2.09

• Is electrolysis permanent? When you say laser hair removal is not permanent, do you mean 1/4 or 1/2 or all the hair eventually grows back? Thanks.

  Answer:  in most cases but not all. As to the laser, it means that the growth will slow down but none of the follicles are likely ever injured to the point that they will never work again. So thay all still grow, just slower. JG 6.2.09

• What do you think of the Light Sheer laser for laser hair removal? Which lasers are the best or fastest results?

  Answer:  no personal experience with it, but none are permanent, and work best on light skin with dark hair. JG 6.2.09

• i had a medium sided mento chin implant 12 days ago and the right side of my entire chin is numb but when i talk or open my mouth the bone hurts like the implant is pressing into my bone when i move my mouth... is that why my face is numb? also my smile looks like a withches chin now, will this get better? my chin looks longer and the skin at the very bottom looks puckered when i smile and my chin jets forward when i smile so its very flat now on my chin too. will tghe smiling problems get better? i did not think an implant would change my smile.

  Answer:  the face is numb from the pressure exerted on the nerve in order to position the implant, in the vast majority of cases that gets better but can take up to 6 weeks in some patietns. I think many of the issues you now have will get better over the next few weeks. JG 5.31.09

• I am a female lsoing my hair. Globs clog un the bathtub and vacuum cleaner. I do not have a receding hairline- my hair just sheds or falls out a lot. This has been happening for a long period of time. My life has always been stressful so I do not know if that is the cause. Or do I have too much DHT or would low progesterone cause this? What can I do to reduce the number of hairs falling out?

  Answer:  stress, low progesterone, skin fungal infections and low thyroid are common causes for female hair thinning. JG 5.31.09

• What are side effects of Latisse?

  Answer:  floaters that are visible, macular edema, changes in occular pressure like glaucoma and permanent discoloration of the iris. JG 5.31.09

• Is there a way to lower the hormone DHT?

  Answer:  propecia or make sure your progesterone level is normal in females. JG 5.28.09

• Do females who grow hair on their upper lip have a higher level of male hormone?

  Answer:  it is due to a male hormone called DHT, but women have it too just in lower amounts, it is growing due to a genetic predisposition, it can still grow when the levels are low if you are suceptible to having it grow. JG 5.28.09

• I`m 9 days post op butt implants augmentation. everythiing was going okay but now im getting very paranoid. Had my stitches removed 2 days ago and the doc said the wound is healing good and its almost dried up. Yesterday I felt feverish and checked my temp its normal, i checked every hour and my temp is normal 37 - 37.5c. I contacted my doctor and said he told me to take ciprobay 500 mg 2x for 5 days as a precaution, since i was on cefalexin for the first 7 days post op. I feel so feverish inside like im hot and warm but when I check using a thermometer( 3 different ones to be sure) its always normal, I even went to my work`s clinic and they said my temp is normal. I have runny nose so I was also thinking of a flu. what do you think? Should I suggest a stronger antibiotic to make sure theres no infection?

  Answer:  I do not think you have a bacterial infection that a different antibiotic will help with, most likely just normal feelings after the surgery, you have to give it time. JG 5.28.09

• also does fat transfer work for sunken cheeks?

  Answer:  into the subcutaneous area, yes, to some unpredictable degree, but not to the bucal fat pad. JG 5.27.09

• hey dr! i had asked u aques regarding the removal of buccal fat pads.. well is is possible to gain fat there (after removal of buccal) if u put on a little weight or is it a permanent thing? cuz i noticed that my cheeks do get a little fuller when i put on some weight?

  Answer:  no, once it is removed you cannot regain the fat there. You might have put on fat in an adjacent area but not in the buccal fat pad, so weight loss will make it go back down. JG 5.27.09

• Dear Dr. Garcia, I have been getting eyelash extensions. I find it very expensive to keep up. I am thinking of using one of the eyelash liquids. You mentioned you didn`t care for Latisse and preferrred Revitalash. May I aak why the preference? How are they different? Thanks.

  Answer:  I think the side effect profile from Latisse with the potential of affecting eye pressure and causing eye color change are high enough that I prefer Revitalash. JG 5.24.09

• right now i have pretty long lashes in good health but there not too thick so i wanted to try latisse. will latisse possibly mess up my own lashes. I dont want to ruin them as there a very nice lookin just want them thicker/darker?

  Answer:  sorry, I am not a fan of Latisse, we use RevitaLash. JG 5.23.09

• I wrote to you last year about a black eye I received from a tennis ball in August of 2008. The discoloration has disappeared but there is still some puffiness, that I assume is fluid, under the one eye. Is there anything I can do to get rid or it. And if not, is there still a chance it will disappear. It has been 9 months.

  Answer:  not sure why it would still be there to be honest. JG 5.23.09

• I wrote the question about not being sure where the groin area is. See, if the groin is the labia majora or area between the labia majora and thigh I need to get laser hair removal so I will not be growing coarse, balck hair on breast area. If the groin is the thigh area, then I will not need ot have laser hair removal before the skin graft.

  Answer:  well, if they take a full thickness skin graft, which is the usual method, there wil be some slow and mild hair growth no matter what you do before. JG 5.22.09

• Can laser hair removal be done on labia majora and around anus?

  Answer:  yes. JG 5.22.09

• I am not sure where exactly the groin area is when a skin graft is taken from the groin area for nipple/areola reconstruction. Is the groin the labia majora, the skin between the labia majora and thigh line, or the thigh line/crease?

  Answer:  it can be taken from either place. JG 5.22.09

• I just had butt implants done on Tuesday- three days ago. Is it normal to have the drainage tubes connectedinside the butt from the incision? The doctor took it out just today and it was painful, i didnt know it was that long till i felt him pullihng it out. I cant sit or lie down on my back as of yet. Is it bad to try sitting at it this early. With a rounded floater I think i can tolerate sitting down. What are the best tips to avoid infection.

  Answer:  I think it best not to sit for two weeks after buttocks implants. JG 5.22.09

• Hi Dr. Garcia: What is the best way to tighten the skin of the lower arms? Can they do surgery like they do on the upper arms, or is there any other way? Thanks in advance.

  Answer:  I am sorry but I do not think that is an are that is able to be treated effectively in terms of tightening. JG 5.22.09

• I had butt implants yesterday. Gosh the discomfort is over. Ive read the first 48 hrs is the worst. i cant lie down and sit down. I have two drainage pumps also. I just hope my 7 days vacation leave from work is okay..

  Answer:  we usualy had patients take two weeks off. JG 5.20.09

• Hi dr...its the chin implant girl again...I thought of a way to rephrase my question, so you can better know my real concern...I feel my cheeks are full, kinda on the bottom...i think my narrower pointy chin in the bottom helps to balance that out. Im nervous a chin implant will fill out the sides of my chin...making it look fuller and my face bottom heavy. Do you think thats a valid concern? The implant type looks like a U. ...sorry, just trying to decide if I should continue with the implant...thank you so so much. (hope i made sense, :) )

  Answer:  well, it might do that if an extra large implant is used. JG 5.17.09

• Thank you for commenting so quickly about the chin implant so fast. Yes, you are right, he is a very good dr. Thank you. I hate to be a pain, but does the oblique angle always fill out like that??? Im scared I wont like the way it makes a longer look in that view. Soryy to ask, I really appreciate your input.

  Answer:  no, that depends on your underlying bone and the size and shape of implant placed. Best of luck. JG 5.17.09

• hi Dr. Im scheduled to have a chin implant on Tuesday along with another surgery. Im really nervous about the chin implant as far at the nerve damage goes...should I be really concerned if hes a good dr? And im really nervous suddenly it will look bad..... I never really thought about it before but now when I look at before and after pics of chin implant patients, they look like they have really long face from the oblique angle....Would you agree with that??? Is that common? Cause I do like how in the oblique angle that my chin indents in, I just don`t wannna trade a profile thats ok for a oblique that Ill hate, ya know? Sorry, Just nervous!

  Answer:  the risks of that are quite small in experienced hands.Relax and trust in your surgeon. JG 5.17.09

• Do you think the Foto laser is effective for brown spots, scars or anything else?

  Answer:  brown and red spots, yes, all else, not too much. JG 5.16.09

• What is a good laser to use to: 1) remove redness from new scar 2) reduce uneven pigmentation from burn scars (white line scars mixed with brownish discoloration 3) light brown freckles 4) broken red blood vessels around nose nostrils 5) spider veins Please number 1-5 in your answer. Thanks.

  Answer:  for the redenss I use a YAG laser. Similar laser used for the hyperpigmentation of burns or freckles, for the broken blood vessels can use a YAG or an IPL or VBeam laser. I do not recommend any laser for leg veins. JG 5.16.09

• A doctor was supposed to fix two things on my nose. He worked on one the things, but he underworked on it meaning I need to have more surgery to correct it. He did not even fix the other problem I wanted fixed. It looks the same as before surgery so I asked him if he worked on it and he suspiciously said that he did not remember. Obviously, he did not work on it since it looks exactly the same- a lump on my nose was supposed to be removed or shaved down but it was not. He charges one fixed price for nose surgery whatever you have done. He said he did not think he was skilled enough to do another surgery. My question is if I could ask him for a refund since he did not do one of the things he was supposed to do and the other thing was not fixed because he did not do enough work on it to fix it? I do not know if I could get back the hospital fees as well as the surgeons fee? Or just the surgeons fee? So, is any kind of refund possible? I am disappointed I have to have surgery again and I paid all this money for nothing.

  Answer:  refund policy varies from doctor to doctor, no way for me to tell what they will do,you need to ask them, sorry. JG 5.15.09

• I`m scheduled to get my buttocks implants this coming Tuesday. I`m excited but of course I am scared of the recovery period, I might not be able to sit on my butt for a while. or even lie on it. how long does it take before i can do normal stuff like sitting and lying on my back

  Answer:  2 weeks or so. JG 5.15.09

• Is a fellow a doctor who is still in residency? If a fellow is working with a plastic surgeon, can the patient request the fellow not to be there for the surgery (if the surgery is private and the patient wants the least amount of people there)? How can the patient reqiest the fellow or anyone extra (students/interns) not to be there?

  Answer:  in some cases making that request is reasonable, but in some institutions like universities, it is a requirement for you to be able to access the supervising surgeon,only way to tell is to ask. All you have to do is say what your wishes are and then see what happens. JG 5.14.09

• Also, another place I just called uses the Palimar laser for broken capillaries or red cherries. I get so confused when they say you can buy a package for 5 or 10 treatments. Again, the original laser used on me zapped the red spot away in one treatment.

  Answer:  it does not always work in one session, you got lucky. JG 5.5.09

• I wrote the question about the cherries below. I called one place that uses a Sciton laser. Does that laser work for cherries?

  Answer:  may not work in one session. JG 5.5.09

• I know a candela laser was used on me awhile back for red cherries (round, broken up blood vessels on central part of my body). One zap and the red spot disappeared that same day. However, when I call places about laser treatment for red cherries, they say it will probably take 10-15 treatments to make it go away! I asked what place what laser they use and they said IPL. I don`t know how many places use the candela laser. My question is what lasers work for the red cherries in one treatment? Thanks.

  Answer:  the ability for it to work in one session is not for all patients and for all red spots, I have to say you likely got lucky to have it gone in one session. JG 5.5.09

• What is the best filler for under the eye area, to fill in hollow?

  Answer:  I use Restylane for the rim. JG 5.3.09

• I have a horizontal line when I smile below my nose. Kind of a u shape. Have you seen this before? What can be done? Thank You

  Answer:  yes, it is due to the muscles causing the skin to fold, not much I would suggest be done. JG 5.3.09

• is it safe to get butt implants if i had silicone oil injected on that area 6 years ago

  Answer:  I would say no. JG 4.30.09

• I wrote the question about the buttock implants shifting. If the implants are placed below the muscle, do they tend to shift? If so, does movement (like exercising) cause them to shift? Have many patients wanted the implants removed that were placed under the muscle?

  Answer:  less so when under the muscle but can still occur. Any motion of the muscle can cause them to shift more, yes. I have no data as to how many patients wanted the implant adjusted, sorry. JG 4.28.09

• Is it common for buttock implants placed higher up on buttocks to fall down to lower end of buttocks?

  Answer:  common, especially if placed below the skin on top of the muscle. JG 4.28.09

• Hi, Dr. Garcia, Some cosmetic surgeons offer Cosmedical skin care products in their offices. On a scale of 1 to 10, how would you rate Cosmetical compared to other lines, such as Skinceuticals? (I assume you would rate your own line at a 10, since you`re developing it and feel it`s the best.) Thanks!

  Answer:  it is likely a good skin care product that the doctor can place their name and label, saving themselves the time and knowledge in developing their own, will probably be similar to SkinCeuticals. JG 4.26.09

• HI DR G:: I have large veins on the backs of my hands. My hands look old. The have no fat. What do you think is the best treatment or combination of treatments?

  Answer:  could try Sculptra injections. JG 4.26.09

• I am interested in having the prominent muscle removed above my eyebrows to remove the bunps and not have to get botox anymore. However, I have a little bit of a hair loss at hairline so I am concerned I might lose more hair with the scar incision? Where is the incision placed- at hairline or further back? See, I have sparse hair in bang area so I am afraid the scar migth show since I can see my scalp in bang area.

  Answer:  it can be removed through an incision further back and since no skin is being removed there should not be any hairloss, it also can be removed through an incision on the upper eyelid. JG 4.24.09

• I wrote the question about the hairmax laser. Do you think it doe snot work at all for women with a slight receding hairline instead of balding men? The laser is supposed to make your stop falling out so it seems like your hair would become fuller? Have you heard that it did not work at all for people? I am just looking for a slight improvement as I only have a little hair loss at hairline.

  Answer:  I think the science behind it is pretty sketchy. JG 4.24.09

• Do you think Hairmax lasercomb really makes hair grow back? Do you think it is effective?

  Answer:  personally I have not been impressed with the results. JG 4.23.09

• Cana laser go into your eyes if you have your eyes closed tightly? What I mean is if your eyes can be damaged if you are not wearing protective eyewear, but you have your eyes closed during a laser procedure that requires eyewear?

  Answer:  I am sorry, but it depends on the laser, some could be safe that way, others might not. JG 4.23.09

• Can a minimal amount of botox be injected under the eye area for expression lines. If not, what can be done, I hate these lines?

  Answer:  all I suggest for that is either Retin-A or a light laser, I think the risks of something bad happening with Botox injections to the eyelid are too high to be contemplated. JG 4.23.09

• Hi Again, just one more question... if I do not want to wait (12-18 months) for the scar to look better using a topical solution, based on your experience have you used a laser to improve scars or have you be able to improve scars in your experience with plastic surgery? What do you recommend.Thanks again for your time.

  Answer:  the wound is healing and laser might help, but it also might iritate the skin and prolong the fading process. JG 4.22.09

• Hi, In Feb.09, I had a cancer tumor removed from my right thigh. My onc surgeon is not a plastic surgeon & left me with a 2.5 scar in my inner thigh. He closed the incision with surgeon glue, However, my scar is red/purple and uneven 1/4 line. Very ugly. What do you recommend to improve appearance? Based on your experience, can a topical solution improve a scar. I am using Mederma but see no results> Have you ever used Dermatix and does it work?? Other than a topical solution applied to the scar, what would you recommend (ie: laser (what time frame), surgery to improve scar (what time frame). Thanks for all your help.

  Answer:  all we use is Mederma or ScarGuard, but it will take 12-18 months to fade, have to give it time. JG 4.22.09

• THANKS SO MUCH FOR YOUR TIME.

  Answer:  you are most welcome. JG 4.21.09

• What Vitamin C product do you recommend for the face? I have just run out of SkinCeuticals liquid Vit C, but I think I would prefer a cream because the liquid is sort of awkward to use. Also, what cream do you think is best for a 68-year-old face that has few lines but sagging skin. Thank you. Lilacs

  Answer:  our eye booster cream has Vitamin C in a cream, on our shopping cart. As to the fine lines of the face in your case I might suggest our peptide cream. JG 4.21.09

• If a teenager has a labioplasty, will she need to have another one after she gives birth? I do not know if childbirth permanently stretches the tissue so it lengthens again.

  Answer:  there is no way to tell for sure if it will elongate again, some women, during pregnancy and childbirth do elongate their labia, but another common cause is wearing tight clothing in the groin region which pulls and tugs on the labia and elongates them. JG 4.21.09

• Since I have been receiving botox treatments, the texture of my forehead looks different. Although I do not have acne, my forehead has little bumps like I have acne. Well, it guess it is not really little bumps- just the texture has changed somehow. If it is related to botox, can you guess why botox may cause this?

  Answer:  do not think the Botox has had any causative effect on your forehead for that. JG 4.21.09

• What potential problems has the FDA banned the tanning pills for? Is there a safety issue?

  Answer:  there was a concern with potential skin cancers I believe, it has been awhile since most of the pills were taken off the market. JG 4.20.09

• I get all kinds of pricing for IPL treatments. Today, I called and was told quote: 4-6 spots $150. 7-15 spots $200.00 I was looking to do my back, shoulders and arms for the freckles and pigmentation. What would be the reasonable market rate for IPL`s just for per location rather than spots? I used to get my entire face done for $225 from a medspa that is too far for me to travel to now...thanks

  Answer:  Honestly, since it will take a series of treatments over the same spot to get it to fade and it is only temporary, I would save your money. JG 4.20.09

• In regarsds to my previous question: Taking into consideration the cost and end result, would you recommend VelaShape or endermologie for someone who is in fairly good shape with just a few trouble zones that I`d like to smooth out and if possible, slightly reduce in size? Thank you for your time! Answer: I think between those two I would suggest VelaSmooth. JG 4.18.09 **You would recommend VelaSmooth over VelaShape? Thanks! :)

  Answer:  VelaSahape might be slightly better. Sorry. JG 4.20.09

• Does the laser hair removal work on hairs that are a mix of black and blond? Well, if the hair looks black in bright light, but blond in dim light.

  Answer:  not on blonde hair, no matter what the light is. JG 4.20.09

• In the 80s, i know there were tanning pills that made your skin look orange. Since then have there been any improvements in tanning pills so that the color looks more natural? If so, what brand? Thanks.

  Answer:  their availability has been curtailed by the FDA due to potential problems. JG 4.20.09

• Taking into consideration the cost and end result, would you recommend VelaShape or endermologie for someone who is in fairly good shape with just a few trouble zones that I`d like to smooth out and if possible, slightly reduce in size? Thank you for your time!

  Answer:  I think between those two I would suggest VelaSmooth. JG 4.18.09

• I had hydrogel injections for the butt more than 5 years ago. Im planning to get butt implants.. Is it okay to get butt implants?

  Answer:  no studies have ever been done to determine the safety of that combination. Sorry. JG 4.18.09

• Hi Dr. Garcia, Thanks for your response regarding using Botox in the lower eyelid area. If this is not an option, are there any other options that work well for dynamic wrinkles in the area under the eyes such as fillers, etc. Thanks again for your advice.

  Answer:  I am sorry but besides creams or lasers to attempt to induce new collagen, there is not much at present. Fillers cannot be reliably used in that area for dynamic wrinkles as it will look lumpy when relaxed. JG 4.15.09

• Hi Dr. Garcia, I am 52 years old and have what I consider significant dynamic wrinkling under my eyes when I smile. I would like to smooth this area and already use Retin A for skin care. Would Botox injections work under the eye or are they just for crow`s feet around the eyes? If so, is there any particular technique for injecting under the eye versus crow`s feet ? Thanks so much for your advice!

  Answer:  Botox injections are used off-label for the outer corners of the eye region but injecting it to the lower eye muscle can in many cases cause the muscles to weaken to such an extent that the eyelid function can suffer and the lid not be held agianst the eyeball as it is supposed to be, I do not recommend Botox injections for the skin of the lower lids. JG 4.15.09

• I am writing again about the visible pleat I have on the left side of my face from a fallen midfacelift. Has the muscle detached from the bone, can this be easily repaired? Does skin need to be taken off, or will I have to go in and repair the midfacelift. There is no one in Tennessee who does midfacelifts like you. It makes so much more sense to go in on the side of the ear for this surgery. Is there anyway to fix this manually, cheek lift exercises etc? Thank you so much - nv

  Answer:  It likely will need more surgery and at least the skin relifted and possibly the tissues below the skin too, hard for me to say without seeing you in person. At times the pleat is due to agressive lifting of the tissues and no to little skin being removed and that can cause the skin to fold. That is one of the great deficiencies of an endoscopic procedure as it does not allow the skin to redrape well. I am sorry but no exercises will help. It cna likely be repaired with a traditional cheek lift. Best of luck. JG 4.13.09

• Hello, and thanks for considering my question. I realize this is off-label, but theoretically can retin-a be used to treat cellulite? I understand that the appearance of cellulite is due to poor skin in the area. Why do they not make a weaker version of retin-a which can be used over a larger percentage of the body? Areas that come that come to mind are feet, hands, elbows, and cellulite.

  Answer:  it can be used but it will not work I am afraid, it has been tried by many. JG 4.9.09

• Dear Dr. Garcia, I am a female who often wears my hair back in a headband. I always had some baby hairs that only gorw 1-2 inches at the front of one side of my forehead hairline. However, I think I might have lost some hair directly behind these baby hairs since it looks like a bald line. I always wear my hair pulled back and this was not there before. last week I had my hair colored at the salon- just a root touch up. It is the same dye I always used without any problems. I do not know if this may have anything to do with my hair loss. But then why is the hair loss just in one area= in back of those baby hairs? Another question I have is if testosterone hormone might be causing this? I think I am low in both estrogen and testosterone hormones so it might be even amount of those hormones- just a low amount. If I took estrogen pills, would my hair grow back? Is it safe to take estrogen pills or some sort of cream?

  Answer:  testosterone replacement can certainly cause things like this due to its conversion to DHT that affects hair loss. Estrogen will not make your hair grow back, but stoppig or decreasing the testosterone might help along with some Propecia. I feel estrogen creams are better than pills. JG 4.7.09

• Do some patient respond better than others to Botox? I have had Botox injections for crow`s feet 2 or 3 times over the last several years by a Board Certified Plastic Surgeon. In each instance, I was retreated approximately a week after the initial injections due to little improvement. I am now considering Botox to raise the corners of my mouth. If I had little success treating crow`s feet with Botox, should I expect the same results with the lips? Thanks for your time.

  Answer:  yes, stronger muscle needs more, so all patients respond differently. The Botox for the corner of the mouth is something I do not endorse. JG 4.6.09

• Do you recommend using Botox for lifting the corners of the mouth? Thank you.

  Answer:  no, I do not, sorry. JG 4.6.09

• I think you`ve siad there is nothign that can improve the lines on the neck. But what about the texture? Are there any laser treatments or creams that can improve the aging texture of the neck- at leas temporarily?

  Answer:  Retin-A and peptide creams can hep some, I think the improvements from lasers and chemical peels are short lived as they cannot be done too deeply. JG 4.5.09

• Hi Dr. Garcia, I`m interested in doing Velashape to smooth out cellulite and for some circumference reduction (nothing major). I saw your previous answers on VelaShape from the past 2 years (although nothing recent) and it seemed like you weren`t impressed...has it improved? The place I`m looking into says you do go for maintenance treatments once a month or so depending the individual`s condition. Also, can it be done on calves for size reduction? What`s your take on Botox injections to reduce calf size? Thank you for your time- it is truly appreciated. :)

  Answer:  has not improveed, still the same, works pretty well for small areas but needs to be continued. I am not sure it will reduce the calves much, and I think the amount of Botox needed to reduce the calf muscle would be huge. JG 4.5.09

• Thanks for your response. When you say cutting out the veins can cause chronic swelling ... does it go away with time? if is how long does it take? If the blood can`t get through those veins, wont it find another vein to travel through?

  Answer:  it might never go away. That vein is bigger for a reason, maybe because the surrounding ones could not handle the needed flow, so cutting it might not be able to allow the others there to compensate. JG 4.4.09

• Thanks Dr G. If a cream wont thicken the skin under my eyes enough to hide the blue veins, is there any treatment that would minimize them .... laser, injection, surgery?? Surely there is something I can do to improve under my eyes ... I hate the blue veins.

  Answer:  not much, there are attempts to cut the vein out but it is there for a reason and cutting it out might leave chronic swelling. JG 4.2.09

• DR G:: I have blue veins under my eyes. Do you think a laser treatment would thicken the skin so they are not so noticeable? If so what type of laser?

  Answer:  I doubt the skin there would thicken enough to hide the vein as the vein is likely in the skin itself. JG 4.1.09

• I do not know if you remove skin growths and send them to labs. I have had a couple of 1/4 inch round raised growths on my neck for the past 20 years. I have had MRI of brain and neck for other things and no cancer has shown up. Sometimes these growths itch after I apply retin-a on my neck making me think they are seborrhea keratosis so I spray ligquid nitrogen on them. But the freezing does not remove these growths like it does seborrhea keratosis. I do not know if I should these growth as the texture is regular skin texture and color, but it is raised liek a misquioto bite. Well, it is a little less noticeable than a mosquito bite, but it feels a little hard when I move my finger over it as though it was scar tissue. I have never had any surgery on my neck, though. Just wondering if you have any ideas what this might be- like common growths that may grow on the neck area. I have seen a dermatologist in the past who could not see it so he acted liek I was imagining things . Like I said it is my regular skin texture and color, except it is raised and feels hard like scar tissue. It is more prominent when I put things like retin-a on my neck.

  Answer:  hard to say, might suggest you have a dermatologist do a biopsy on them to see what is going on, it does not sound like cancer though, and cutting them out will leave a permanent scar. JG 4.1.09

• 1. Is the incision made in the same place as a facelift to remove the muscle above eyebrows which botox is used for. Will you lose hair where the incision is made? 2. I have 2 humps over each eyebrow caused by this muscle. I heard that the end of this muscle is trimmed for facelifts. However, is the whole musle ever removed?

  Answer:  no, typically it is made in the scalp. Hair should not be lost if the incisions are not closed under tension. Complete removal of the muscle is rarely done during a facelift, only during forehead lifts. JG 3.31.09

• What do you think of acell`s wound care sheets? Do you think they would be helpful after a dermabrasion for acne scars? The company said they could help regenerate the skin as long as the scar tissue is removed.

  Answer:  it might help, yes, not been stdied though. JG 3.31.09

• Hi Dr, garcia, I was wondering if isometric facial extercises would tighten under the chin in the neck area to get rid of the turkey neck such as sucking in the under chin neck area and holding it in tight makes it appear that i have a face lift ., such as holding in the tummy makes the tummy tighter., would this extercise work or help someone who has already had a face lift, thanks, your the best.

  Answer:  no, it actually might make it worse as muscle function causes wrinkles, that is why they use Botox, to relax the muscles. Facial muscle do not sag much, it is skin and the fat compartments on top of the muscles. JG 3.31.09

• Have you heard of MIMOSA TENUILORA oil from the MIMOSA TENUIFLORA TREE? If so what can you tell me about it? Thank you

  Answer:  no personal or patient experience with it, sorry. JG 3.31.09

• What can a woman do to improve a flat butt?

  Answer:  sqauts, at the gym. JG 3.30.09

• If you are skinny and have not fat to liposuction for buttock augmentation, can you use fat from right after you give birth to liposuction for buttock augmentation. Genrally, how long does this pregnancy fat remain after birth?

  Answer:  you can but if you were going to lose that fat with time, it will also melt from your buttocks, how long baby fat lasts on the mother is variable, no way to predict. JG 3.30.09

• Do hair grafts often grow in the wrong way? Or are people usually pleased with hair grafts?

  Answer:  rare nowadays to have them grow in the wrong direction. JG 3.30.09

• Should you wait until after you have a baby to have labioplasty? Does childbirth make the labia permanently longer?

  Answer:  yes, childbirth will potentially make it worse. JG 3.30.09

• Does at least 70% of liposuctioned fat transferred to buttock area stay permanent? I read after 3 months, you will lose as much fat as you are going to lose. Have you heard about success rates with fat injected into buttock area?

  Answer:  I think if you get 30% of it to last in that area I would be ecstatic, in most cases it is gone, albeit slowly, over two years. I think the success is erratic and unpredictable. JG 3.30.09

• Hi Dr. Garcia, My areolas are very large for my breast size, and I went to the dermatologist and was prescribed Tri-Luma cream. I was just wondering if you knew of any other ways of reducing the size or any advice. thank you so much,

  Answer:  TriLuma will never work, it will require surgery and that means permanent scars. JG 3.15.09

• Hi, I really appreciate this service you are providing. On to my question. I have a fairly uneven/askew chin, in that one side projects out quite a bit more than the other. Is it possible for a skilled surgeon to only burr back one `side` of the chin to achieve more even projection?

  Answer:  yes, in some cases that is possible and is less risky than orthognathic surgery. All the best. JG 3.14.09

• Hi DR G::: I had Labia surgery 3 weeks ago. I`m a little worried ... its so bumpy and uneven on the edge were the stitches were. It looks so unnatural. Is it normal at this stage to look deformed?

  Answer:  all normal, and all will get better, that area gets swollen for a long time and contributes to that temporary appearance, give it some time and it will get better. JG 3.11.09

• When you say friction makes it get darker, is it permanent color change? Does friction somehow damage the skin causing a color change? Just wondering if the area can turn lighter again if friction is reduced?

  Answer:  yes, it is essentially permanent. The friction essentially causes a burn which alters the skin and the skin tries to protect itself and hyperpigments. If it is treated and lightened, it comes back to the dark color shortly thereafter and it is difficult to treat and lighten it in either regard. JG 3.10.09

• As a woman get solder, does her labia lose shape? Not due to childbirth, maybe gravity or something? Does it tend to pull apart if it used to be in tact or tighter together? Would you say it loses elasticity? Also, does it get a darker color as a woman gets older?

  Answer:  all tissue lose shape as we get older and in areas of friction, the tissue can be pulled without noticing and that can accelarate the loosining of the tissues. Friction also makes it get darker. JG 3.10.09

• Hi doctor, Some time ago you suggested I treat a small, brownish v mark on my leg, the result of ironing while sitting on my bed! I have several questions...Is there a specific type of yag laser that can be used for this, could it clear my skin permanently, would it come back if I expose my skin to the sun (it is really not realistic to think I will never let my legs see the sun)

  Answer:  ND: Q-switched laser but if you expose it to sun it will come back. JG 3.8.09

• Dr. Garcia: What is your opinion on Lipodisolve? Seven months ago I got a tummy tuck and breast lift/reduction. Needless to say it didn`t go as one would have hoped. I now have what my dr. refers to as a shelf right below my belly button. I have had so much cutting on my body that I really don`t want that. So he is thinking lipodisolve. What do you think?

  Answer:  I personally think it is a large scale experiment being perpetrated on patients in the US with little standardization and little information telling them that even after over thirty years of it being inflicted on patients in Europe, there is a dirth of medical evidence of its effective, but hope and the desire to avoid surgery spring eternal. I would not do it. JG 3.5.09

• Can the hyperpigmentation caused by the diode laser be permanent? Do fair skinned or dark skinned people tend to experience the hyperpigmentation? Is there a low or high percent chance of hyperpigmentation happening? Also, when you say the hair removal is not permanent. It will be at least finer or you will have at least 50 percent that is permanently gone?

  Answer:  in rare cases, any hyperpigmentation from any cause can be permanent. The darker your skin is to start with the greater the risk. The risks in general are low in fair skinned people. JG 3.5.09

• Hi Dr. Garcia, I had a sliding genioplasty in dec 2006. Afterwards I have had numbness on the left lower lip and chin which I am sure is permanent nerve damage. The Dr. did an exploratory in April 2008 and said nerve narrower on that side, but intact. Even worse than the numbness is a digging type sensation I feel on the left. The bone is higher on that side since original surgery. The only relief I get is to put a piece of tissue paper between my lower lip and gum area or over my lower teeth in that area. Is it possible to reverse the surgery and for a Dr. to move the bone back so that it is closer to the original position to see if that helps the digging sensation? I can feel the ridge of bone inside my mouth and it just seems like he moved the bone up too high on the left and too far forward. I just want it back like it was originally hoping it will feel normal. Whenever I talk or eat I get a burning or stinging type discomfort. Thanks so much.

  Answer:  That is possible and the small ridge can also be burred down to alleviate some of the problem, but it likey will ntot help the numbness I am afraid. All the best. JG 3.5.09

• What do you think of the diode laser for hair removal? Is it better or worse than other lasers?

  Answer:  I think the Alexandrite laser is the best for hair removal. JG 3.4.09

• youde have to use latisse forever then, otherwise youd waste money using on for a few months if the result will go away? whats the best then to just help thicken, srenthen, and possibly grow longer.

  Answer:  correct, you lose the effects when you stop. All products out there are the same in that regard, as to what we use, we sell RevitaLash. JG 3.1.09

• right now I have pretty long lashes, but there not so thick, could you some more. if i use latisse would I ruin my own that are there now? Also what hapens when u stop using it?

  Answer:  not sure Latisse will do much to thicken them and any positive effects will be reversed if you stop using it. JG 2.28.09

• Thank you for answering the question about the scar in the scrotum region. Would you be able to provide an in office consultation for this sort of problem? i realize it seems like a simple issue. But if sometihing can possibly be done i think its worth having it looked at. Thank You.

  Answer:  I can certainly see you in consultation if you desire. JG 2.28.09

• Hi Dr Garcia, I have had 3 left breast capulectomys/silicone/unders. Went for consult yesterday and PS recommending putting silicone(300cc) over the muscle/ making pocket bigger and putting steroids inside lumen of implant to help prevent cc. What do you think?? I am desperate for any advice you could give me. PS: When my original implants were put in I had developed a staph and pseudomonis infection which required taking out implant for 6 months and being on vanco Iv for 6 weeks at home. Sincerely, Bobbie

  Answer:  to be honest you have at least a 50% chance of getting a capsule again, even if it is changed into a new positon. Putting steroids into the lumen will not help with capsular contracture, that was tried in the 80`s and found to not help. Wish I had better news for you. JG 2.27.09

• Dr Garcia: Is a dime size scar on the scrotum treatable? If so what type of treatment or surgical procedure would help scars in the genitle area? Thank You.

  Answer:  About the only thing that could be done is to cut it out and suture it closed, but I am not sure if it would be worth it, there is likely no other treatment that will yield a substantial benefit. JG 2.26.09

• which would u recommed i spend money on li lash or latisse?

  Answer:  I prefer RevitaLash. JG 2.26.09

• sorry i meant billion dollar brow, to regrow brow?

  Answer:  don`t see anything in the ingredients that will do much. JG 2.26.09

• i know u dont believe in it but can anything bad happen if i use castor oil on brows, like pooisining myself?

  Answer:  no poisoning effect. JG 2.26.09

• what do u think of brow diamond?

  Answer:  sorry but not familiar with it. JG 2.26.09

• Hi Dr. Garcia. What are the options to tighten loose crepey skin under eyes? And which is your preferred option? Thanks.

  Answer:  usually I use a light CO2 laser for that. Best of luck. JG 2.25.09

• i read alot about castor oil for eyelashes...what do u think? if nothing what is something people can use who cant afford latisse to help thicken them

  Answer:  I do not think it will work, think about it, if it did, then why would anyone buy the expensive products for sale now when they could buy Castor Oil. JG 2.24.09

• Hello Dr. Garcia I`ve recently bought the product Lilash and have read many reviews on it..Good and Bad. Is this product safe to use? Also I read something saying that your body can build up a tolerance to the drug in the product and your eyelashes can consequently fall out. Is this true? I am not sure if I should use this product.

  Answer:  I cannot say if it works and as to tolerance, it can happen,but in general, tolerance to medications is rare. JG 2.24.09

• Hello, a few years ago, I had an IPL treatment using Levulan on my chest to treat redness (which treatment burned terribly although the woman said it wasn`t going to.) Months later, I noticed my skin, in the middle and slightly above my breasts, had become crapey and if i fold my arms, that area of skin is severely wrinkled. It could be a coincidence that my skin just aged but I was reading that perhaps this condition was caused by the IPL/Levulan treatment as it may have burned off fat cells in the area? I am wondering what you think as my current Dr says a series of IPL sessions will reduce the wrinkles as it will cause my body to produce more collegen. Dare I get more treatments? Do you have any other suggestions? Thanks so much!

  Answer:  I do not think it is due to fat loss, but something else. I will also say that I am not sure what they were thinking about though as the Levulan in conjunction with the IPL takes the effectiveness for the red out of the picture and can actually make it worse. I think series of IPLs will do little as the degree of collagen production from the IPL on the face is minimal and it is much less on the chest. I would skip the IPL on the chest unless you are trying to help the brown spots. Best of luck. JG 2.20.09

• I asked the other day about an arm tuck. Where would the icisions/scars be and how long are they in length? Thanks

  Answer:  they extend from your armpit down towards your elbow on the inner part of the arm, the length will depend entirely on how much skin is removed. JG 2.20.09

• Dsear Dr. Garcia, Do you have any satellite offices that you work out of or do you strictly work out of Las Vegas? I thought I heard that you come to Arizona or did??

  Answer:  no, just here in Las Vegas at the present time. I was thinking about a satellite office but have not done so, sorry. JG 2.19.09

• Hello Dr., I wrote to you a while ago about like my face seeming saggy and I think its my midface..i don`t have very deep nasal folds but I have gotten jevederm in nasal folds and it just makes my face appear too full...but my problem is the skin below my eyes makes an arc down...and if i pull up on my face by the sides of my ears i have a more flat and desired look...im only 28 though and i feel this makes me look older and angry sort of...its getting worse in the past couple years too...would a midface look be an option i will be 29 in june and Ive lose 50 pounds in the past so I think these could have to do with the problem but even looking at pictures as a child ive always had this look...any advice you can give is appreciated as I don`t even want to take pictures and Im depressed to look so old and be so young . Thanks Dr.

  Answer:  a flat cheek ages a person so I seriously doubt a midfacelift will help as there is likely not enough tissue to lift that will make a substantial difference. Migth want to consider filler like Sculptra to refill the area and give it more shape as you issue is from the fat loss of the cheeks and not descent of the tissues. JG 2.19.09

• Thank you so much for answering me, Dr. Garcia. Maybe that´s why my nose tip did not swellow. Should I force my smile, streching it to make it go back to normal sooner or should I just wait? Is there a chance of my smile never be the same?

  Answer:  no need for anything special to be done, things will heal and stetch in time and I think your smile will come back to normal in the not too distant future. Best of luck. JG 2.19.09

• I live in South America. On Jan 13th I had a facelift, otoplasty, rhinoplasty (+ septoplasty, turbinetomy, sinusitis and a piece of bone taken from my nose. One incision was intraoral, for allowing the depressor muscle to be released. I like my new nose a lot, but my smile is still very odd. It makes me feel very unconfortble. I wonder wow long it will take to be normal again. For me, normal smile would be my exact old smile. The numbness in the middle of my upper lip is still there. The doctor told me to wait 6 months. He´s very experienced and trustfull. What is the advantage(s) of this intraoral incision compared with the traditional ones?

  Answer:  it can take 6-8 weeks for the muscles to reattach so they can start to work more normally, the adavantage to the incision intraorally is that the muscle is right there, so less swelling. Best of luck. JG 2.18.09

• lately i have been notcing my eyelashes falling out more than usual. what would cause that? i have no disesase or anything. i have been on prozac for like 7 mths, would that cause it. what can i do to help it, im afraid they will fall out ttally...

  Answer:  not sure, sometiems low thyroid can cause it too. JG 2.18.09

• What is a limited incision arm tuck?

  Answer:  a procedure valid for a very small number of people who have very limited excess skin of the upper arm only. JG 2.18.09

• whats ur take on latisse? u recommed it? is there side effects that are really bad like loss of vision....

  Answer:  I prefer Revitalash. I have not read about any vision loss with it. JG 2.16.09

• Dr Garcia I`ve had fat transfer to the eye area and I`ve swelling in the left eye and each side of the nose is now white in colur, no make is covering this. Can I expect this and swelling to subside. Procedure was carried out 9 weeks ago. Regards

  Answer:  whatever is going to get better should be gone 3-6 months after the procedure. JG 2.14.09

• Why is Latisse not supposed to be used on lower lashes? If lumigan is approved for actually in the eye, and has the same active ingredient, then whats the problem? Wouldnt something that goes IN the eye, get to the lower rim? Ihave Latisse, and do use it on lowers occasionally, no problem, but whats the reason they say not to?

  Answer:  that decision was made by the company and the FDA, I cannot comment on it, but although it has active ingredients similar to other eye medications, I think it is determined by the amount. It also might not have been able to show as much of an increase of its effect on the lower eyelashes and therefore did not get approved for that. JG 2.12.09

• I`ve read that it is good to load up on vitamin K before surgery. What good does it make. I bought some menadione 10mg earlier. I`m planning to get cheek implants 3 weeks from now. I`m a heavy bruiser, my bruises when i had my lower bleph lasted so long and was so black and even my sclera got blood shots. so im looking for a med/vitamin that will make me bruise less on my upcoming cheek augmentation. I`m planning to take sinecch on my operation and right after. what can you recommend. I just want a more rapid healing after cheek implants. Thanks again from the Philippines! Cheers

  Answer:  it is rarely of any beneift unless you have a Vitmain K deficiency, which is very rare, you can also have overload from Vitamin K, so I would personally not do that. Might suggest bromolain, arnica Montana, and papaya and pineapple juice. JG 2.11.09

• Dr. G., I have no question, but wanted to thank you for taking the time to be an unbiased and very helpful source of information to many who are not even your patients. You`re a helpful guy, Pamela

  Answer:  thank you for the kind words and I am glad I can be of assistance, you all teach me mre than you will ever know. Best with all. JG 2.11.09

• Dr. When using filler such as Restalaye or Radiesse does it wrinkle the skin around it that is not filled--like the perpendicular line between eyebrows. It can`t weigh that much right? Also, does it dig the nasio-labial folds or any wrinkles deeper/wider should you stop using fillers? Thanks, I appreciate your knowledgeable and kindly help, Pamela

  Answer:  it should not have that effect, no. It also does not make the folds or wrinkles any deeper.JG 2.10.09

• Hi Dr, I`ve noticed in movies when they have close-ups of actors the whites of their eyes are always really white with virtually no veins. Are they just blessed with good genetics or do you know if there is some sort of cosmetic procedure or product they are using to achieve this?

  Answer:  very temporary effect from Visine. JG 2.6.09

• I have a very odd problem. I am too skinny and have very boney shoulders. I don`t have an eating disorder, in fact I eat like crazy, and just have very fast metabolism. I have tried working out my shoulders but that doesn`t work. Is there any procedure that can round them out?

  Answer:  sorry, but none that I know of. JG 2.2.09

• Why might retin-a cause growths on your body? I use it on my hands and notice raised sun damage type of growths from using it. I stay out of the sun and they appear when I use retin-a. I thought retin-a was supposed to make skin younger, not age it with growths?

  Answer:  not cancerous ones and rarely if at all, but it can irritate the skin and cause some normal skin lesions to get larger. JG 2.2.09

• Have you heard of the Galvanic Spa system? Its an ionically charged hand peice combined with a gel to smooth out and tighten skin on face and body? Its for home use but has been used in spas for years. Whats your opinion?

  Answer:  not sure you will get much from the device. JG 2.2.09

• Greetings, Dr. Garcia, I am writing to problem-solve about scar revision. In 2004, I underwent a Mohs on the infratip of my nose for a basal cell CA (I am up to 11 now, elsewhere on my body and face, and I am only 52 so I am not likely done with this - all have healed well and inconspicuously except for the nasal infratip). Following the Mohs I shortly thereafter underwent a skin graft taken from behind my ear. I am a ruddy-complected Caucasian woman and the skin graft from behind my ear was not a great color match (far whiter than the rest of my nose), plus the graft did not take all that well (had some pincushioning) so it is raised and the edges have not blended in with the surrounding skin. I think of it as my nasal elbow patch but I`d sure love to know what I can do so that I can continue to improve on it towards inconspicuousness so as not to have to think of it at all! What has been done since is that in 2004-2005 I underwent a series of steroid injections, then IPL then VBeam with only slight improvement. I have to wear concealer makeup to try to even out the color but even that works only so-so. The real issue is the contour. I think it would bother me less if it were flatter and if the edges feathered in better so that it did not look so blunt. This past summer when I was off work healing from a back surgery I went to the local dermatologist laser expert who tried VBeam one more time and that helped with the depigmentation some (it looks a bit less hypopigmented, interestingly, because I thought VBeam was best for evening out redness). I asked about microdermabrasion because in my mind it looks like if this graft could somehow be sanded down it might confer the effect I am hoping for - but I could be misinformed about the benefits of microdermabrasion. On a problem-solving bulletin board website, my primary dermatologist posted photos of my nose asking for suggestions and one was for some filler to be instilled at the edges to try to level the raised edges with the surrounding skin but I am a bit dubious about it. I also consulted with a second local plastic surgeon in 2005 whose career has been built on nasal reconstruction and he was frank with me and agreed that the result from the original plastic surgeon was non-ideal and that he`d have to start all over again but first recommended laser treatments - and so here I am. 1) Do you allow posters to send pictures by email? 2) Based on what I have described here, can you say anything about non-surgical treatments that might be of benefit (or might not be - is microdermabrasion or even ordinary dermabrasion an option)? 3) Because I am cropping up basal cells rather regularly (guess ruddiness did not protect against too much sun exposure as a child), I am a bit concerned about having to undergo any further skin grafts for fear THEY could develop basal cell carcinoma and then the wheel of fortune revolves anew. I guess I don`t want to make anything worse but still, at 52, would like to know what kind of chance I may still have at trying for a better degree of inconspicuousness. 4) Do you, as a cosmetic surgeon, have a preferred way of identifying which surgeons (in addition to yourself!) are considered to be top doctors for success with specific cosmetic or scar revision problems? I am afraid a blind Google search may indeed be just that, and further direction would be appreciated. I have no way of really knowing or discovering whose reputation is well-regarded. It`s ironic because the original basal cell on the infratip of my nose was far smaller than the skin graft that replaced it. Hindsight is 20-20 and I do wonder whether had I just had it excised and sutured without Mohs or without a skin graft whether the outcome would have been as unfavorable - I raise this because I don`t know whether scar revision surgery could make sense (as opposed to a fresh skin graft or no surgery at all). I appreciate any answers you may have for me. Thank you for being so responsive.

  Answer:  I think repigmentation with a microdermabrasion or VBeam is likely not effective. I think excising the skin graft could be done, but then we would have the same problem. The reconstructive options there are not very good and very complex I am sorry to say. It might be something that not much can be done for. As to pictures to me, please feel free to send them directly to me at drgarcia@lvcosmeticsurgery.com. I will give you some further recommendations after I see the pictures too. I think these types of issues are most commonly treated in Universities I must say. I think as to future skin graft, taking it from a non-sun exposed area is best, but that leads to greater differences in skin color I am afraid. JG 2.2.09

• Is liposuction commonly done for chubby cheeks? Is the instrument inserted inside the mouth or directly on the cheek? What is average cost for this procedure?

  Answer:  no, not common, and not very effective most of the time. JG 2.2.09

• Dear Dr. Garcia, we have a plastic surgeon in my city who positively asserts that his fat grafting is permanent, and he`s even ewritten a book about fat grafting. However, I`ve had fat grafting twice from well respected plastic surgeons - the first lasted 3 months, and the second lasted a year. Is it possible for the grafting to be permanent? If so, why does it last such a little time from other doctors?

  Answer:  in some cases it can, it is unreliable and unpredictable too though, but in most cases, even by the same surgeon, results can vary. If he is so confident, which I think is false bravado, ask him if he will refund your money if all of the fat does not survive and see how confident he is then. JG 2.1.09

• Dear Dr. Garcia Are you familiar with Latisse by Allergan? Supposedly it has just been approved by the FDA for use on eyelashes and it can only be purchased through a physician. Since it is very expensive 125.00 for one month supply, I want to know your opinion before I try it.I have been using Revitalash and it works for length but I am more interested in achieving thicker eyelashes. This new stuff promises that. As always, thank you for all you do. I very much appreciate you sharing what you know in an honest way.

  Answer:  well, it is the old Jan Marini product that she got in trouble for using an Allergan product without their OK. I think it is good, do not think it is any better than ReviatLash and you need to make sure the doctor has a pharmacy dispensing license to distribute or else he is selling it illegally. JG 2.1.09

• I wrote the question about taking estraidol during puberty. So, a female who was genetically depositioned to have broad shoulders would not have broad shoulders if she took estraidol during puberty? Or her shoulders would be less broad than they would be if she didn`t take estradiol? Also, her breasts will be a little a larger (1 cup, 2 cup sizes?) if she took estradiol during puberty? Also, if the female`s adult height is 5`9 , what do you think it would have been (estimation)if she took estradiol during puberty? And the less broad shoulders, shorter height & slightly larger breasts woud remain permanent after she stopped taking hormone when she stopped growing (at age 21)? I know it is too late now, but I am curious.

  Answer:  no, if they are genetically prone to broad shoulders, they will stil be broad if she took estradiol, she might just not be as tall if she took hormones during puberty. The breasts might be large as breast tissue is sensitive to hormones but agian, if she had high hormone levels but a genetic predisposition to have small breasts, they will stay small. Some women with small breast get large in later years but that is not an increae in breast tissue, it is an increase in fat, making the breast a larger shape, and that size would be lost with weight loss. Similarly, some women than have high sensitivity to estradiol can develop large breasts even with low estradiol levels. It is not just the blod level of the hormone, the receptor sensitivity is more in control. As to how much shoter she would have been, that depends on when during puberty the estradiol is given, the earlier in puberty it is given the shorter, if given late in puberty, the effect will not ba as great. Once puberty is done, bones will not change, smaller or shorter. JG 1.31.09

• i suffer from chronic neuropathic pain in the eye,i go to a pain clinic.so far anticonvulsants an steriods have been tried,but with no effect.my doctor is now thinking of performing a nerve blocker.do you think this could work and what would the side effects be?.when the pain is at its worse the eye appears small an begins to close.

  Answer:  might work, should not make it worse, certainly worth a try. JG 1.31.09

• The lower end of my buttock feels stumbly (like shaven hairs are growing back in)but I don`t shave there. I have little blond hairs there, which makes my skin rough to touch. Just wondering if laser hair removal will work? Don`t they now have lasers which can also treat blond hairs?

  Answer:  if the hair is dark it migth help. I think the claims of it working on light hair are overhyped. JG 1.31.09

• Do you know if taking estradiol during puberty will permanently affect a female`s bone structure, breast development or fat deposition? Well, if it was taken until she stopped growing at age 21. Then if she stopped taking it, would her breasts get small, her bones enlarge and her curvy fat lost? I am in my mid thirties, but blood tests show my estradiol is only 41 pg/ml. I have broad shoulders, no hips and small breasts. Is it all related to my estradiol hormone level? If I took estrogen now, would my shoulders become less broad, my hips more broad, and my breasts larger? Again, if I would have taken this hormone durig puberty- would have I ended up with nonbroad shoulders, larger hips and breasts? By the way, my testosterone level is 29.

  Answer:  it can affect the bones by getting them to stop growing sooner and can affect the breast by making them large, but it is not consistent in its effects as it depends on the patient`s heriditary predispositons and if it were to affect it, it would most likely affect it during puberty only. I do not think it would affect the fat deposition. After she stopped, she might gian fat, hard to say, and the breast might shrink a small amount but again, not predictable. Estradiol is important but it also depends on the receptors to the hormoenes in your tissues and that cannot be manipulated. Taking the hormone now will likely not change bone structure, or breast size, its effects on fat now would be difficult to decide. JG 1.31.09

• I have heard that you can get an eyebrow lift from botox. I am interested in knowing if this is true and if it can be done to kind of raise the outer portion of the eyes.

  Answer:  it will only raise the outer portion, it can be done only if the crows feet area is injected and not the lateral forehead and the amount of elevation is hard to predict. JG 1.27.09

• HI DR, I AM SENDING MY QUESTIN TO THIS CATEGORY B/C BREAST AUG IS NOT WORKING RIGHT. I WAS WONDERING...SINCE I AM SEEKING 2 OR 3 OPINIONS BESIDES MY DOCTOR´S IN MY FORMER LOCATION, CAN I SEND YOU A PICTURE OF MYSELF SO YOU CAN GET TO SEE THE BUBBLE ON MY LEFT FOLD I HAVE BEEN TALKING TO YOU ABOUT AND GIVE ME YOUR INPUT AS TO WHAT WOULD BE A GOOD COURSE OF ACTION? FOUR HEADS THINK BETTER THAN ONE!

  Answer:  sure, send it to drgarcia@lvcosmeticsurgery.com

• Good Evening Dr. Garcia. I had a very tiny amount of fat removed from my abdomen (next to my belly button) 4 days ago for a fat transfer (into a dent in my nose). My abdomen is swollen and bruised, as I expected, but now the lymph nodes on the right side of my groin are swollen and very tender. Is this something to worry about? Thank you!

  Answer:  noting to worry about, all normal and will get better in time. JG 1.24.09

• In your opinion what is the best solution other than cosmetc prcedures for smoothing the texture of one`s face and pore`s and as a anti aging product all rolled into one if possible?

  Answer:  Retin-A. JG 1.24.09

• Hi Dr, I consulted a PS years ago about a dimple in the middle of my cheek which I have had all my life. As I age, it seems to get more noticeable when I smile. I have tried fillers but they don`t seem to work. At the time he said it was caused by the muscle and suggested an incision into the muscle which I didn`t want to do. Now I think its the only solution. Is this a straight forward procedure and are there any risks? Thanks

  Answer:  well, I think the problem is that most likely the attachment of the skin to the underlying muscle, will, with time, reform and you will be back to the previous state I am afraid. JG 1.23.09

• I am scheduled to have a BI-Lateral Mastectomy. I would like to get reconstruction surgery. Do you specialize in that as well as all your other specialties.

  Answer:  I do many breast reconstructions but at present only accept patients on HPN insurance for that issue. JG 1.23.09

• Hi Dr. Garcia! Here is a question you may not get very often ... Is there a way to keep your vocal chords / voice youthful? I feel like my voice is getting a bit gruff and I`m only 40, not 80. I do not smoke or drink. Is there anything that can help? Thanks!

  Answer:  I think the best thing is to not strain them so they do not get nodules, besides that, not much you can do I am afraid. JG 1.22.09

• Hello DR G: Can you inject fat between the skin and a vein so the vein does not stick out so much.

  Answer:  sorry, but no. JG 1.22.09

• Hi DR G::: I have a largest blue vein that runs across my temple and under my eye. It also sticks out. What can be done to get rid of this? what`s the best way?

  Answer:  I am sorry but it might not be able to be treated for fear of chronic swelling. JG 1.21.09

• Hi Doc, I was wondering if there is any further developments concerning hair cloning or transplants? Also, do you currently or are you planning on offering these procedures? Thank you

  Answer:  sorry, but nothing new to report on that front. I am still, at present, not offering the procedures again, sorry. JG 1.20.09

• Do you need a medical background to be certified for botox or derma filler injections? I know some states require you to work under a doctors license. How do you go about breaking into this field?

  Answer:  yes, you do need a medical training background and supervision, although there are many places out there that break the law every day. JG 1.20.09

• Hi Dr. Garcia! I`m 43 and in the past year I just started noticing a line/piece of skin beginning to do the old droop under the neck. I`ve heard of botox for the neck, but I have to tell you, I wonder if it is just loose skin rather than a loose muscle. Is there a way to check? AND are there any neck exercises that you would recommend? I don`t feel ready for any botox OR surgery. Thank you!

  Answer:  well, a surgeon could tell you if it is skin or muscle but Botox will not help either one I am afraid. I think neck exercise if anything will make it worse I must say. Might just have to wait for things to get worse and then do the surgery. JG 1.19.09

• I am in my mid-thirties. The oast week I thought aging accelerated fo rme because it was been hard for me to walk around (achy). I think I have shingles. I had chicken pox as a child. I had a bad headache the past few days which I thought I might be poisoned by fumes somewhere in my house. One day I felt feverish. have had bad cramps (and it is not period time). One thigh is painfulw hen I sit on like there is a big bruise, but there is no bruise. Then last night I noticed 4 hard, raised, painful bumps (filled with fluid)in a row across my back (waistline area). If this is shingles, do you think I will get more bumps or that is as many as I will get? I do not have insurance so I do not plan to go to doctor to get prescription for anti-virus meds. Just wondering if I will get more bumps (which meds can prevent)? Also, is something wrong with my health to be getting shingles at a younger age when most people get it over 50?

  Answer:  it could, might suggest seeing your internist and maybe getting started on some Zovirax. JG 1.18.09

• Doctor, I got a cystic pimple on my chin two days ago. I put a warm compress on it and then 2.5% Benzoyl peroxide, morning and night. 2% salicylic acid in makeup during the day. Tonight I noticed it was oozing a clear but yellow fluid? What is that and what should I do about it? Thanx

  Answer:  it is the serum of the cyst coming out that is fine, no problem with that happening, just let it dry out now. JG 1.18.09

• I have been using TriLuma cream for acne scaring on my face a few times a week for approx. 1 month. I plan to get pregnant in the near future. How long do you recommend I wait (after stopping use of the medicine) before I can safely conceive?

  Answer:  I think 3-4 weeks should be OK. JG 1.16.09

• If you are a teenager, when do your breasts usually stop gorwing. I had my period at ag 12.

  Answer:  about age 21.JG 1.15.09

• Was wondering what you would suggest to someone who has uneven brest? what options would this person have to fix the problem?

  Answer:  best option would be breast implants of different sizes. JG 1.14.09

• Is it common for women to get restylane of some injection at their lower neck/upper chest junction to fill cover the neck vein/atery or whatever sticks out there if you have less fat to cover it up.

  Answer:  I have never seen that done actually. I would think it would take a large amount to do that. JG 1.12.09

• I notice that seborrheic keratosis erupts on my chest if I use retin-a there. I have a history of sborrheic keratosis in that area. Does retin-a cause eruptions of these growths. I heard that the gorwths can be caused by dry skin so I do not know if it due to the drying effects of retin-a.

  Answer:  it can aggravate the skin and cause certain growths, yes. JG 1.12.09

• Is it possible some buccal fat maybe broke off when the surgeon was pulling it out...because my right lower cheek is slightly bigger...and my face was symmetrical before the surgery

  Answer:  could be swelling or that only the upper part of the fat was removed and there is still some fat there that might need to be removed to get symmetry. JG 1.11.09

• I had buccal fat removal and now the right side is a little larger...do you think lipodissolve could fix this?

  Answer:  I do nto think it will work. Likely need more surgery. JG 1.11.09

• Dear Dr. Garcia, Thanks for all of your advice on various topics as I wade through the aging process kicking and screaming all the way!!! I have a question about vitamins and herbs. I went to a fitness eminar at a local hospital this week given by a nutrionist (touting her own vitamins), A lot of what she said made sense and I will follow some of her advice and others do a trial and error method. She did say not to go to Costco for vitamins and minerals and if they are not from a health food store and expensive it is just giving you expensive urine. Do you believe this? She also said Omega =3 fatty oils needs to say that on the label(mercury free) and not to buy fish oil. Is this your opinion? I am going to see you in April when I am in LV for a consult on some facial surgery for the summer. Can I pick your brain as well on supplements? Do I need to tell your ladies that to allow more time...I think I have a lot of questions on what your suggestions are for anti aging and also use of HGH (do I need some tests done in advance for you to know what I need? Is this two consults in one? I don;t mind paying extra for your time but since I do not live in LV I need to make the most of it. As always thanks for your time ...Bless you.

  Answer:  well, I think that is likely inaccurate. I think Costco would have too much to lose if they did not have vitmains that had what they claimed to have. Also, the sale of vitamins is likley to make sure you have fresher vitamins. There is a website called Consumer Labs that reviews vitamins for their ingredients if you are interested. I like to take DHA and EPA oils instead of the fish oils as they are more concentrrated. I do agree on avoiding the mercury too. Feel free to send my any supplement questions to drgarcia@lvcosmeticsurgery. com and I can answer those via email to make it time efficient. I now have an associate that is doing the anti-aging consults, well trained and he can see you the same day for that too. You can set that up so your blood tests are done before you come in so there will be much more information to review. Their number is 702 838-1994, they are in my smae office, his name is Dr Pierce and his website is my old anti-aging one at agelessforever.com See you soon. JG 1.10.09

• One time a few days after ovulation, my breasts doubled in size like I had breast enlargement surgery. It was not the typical half size breast increase with your period or ovulation. My breasts were huge. I know it had to do with the possibility of pregnancy. My breasts only stayed large for a few days or week, then I had my period. However, I was wondering if breasts double in size when the sperm joins the egg OR when the egg actually implants into the uterus? Was I pregnant, but had a miscarriage? Or does breast size always increase when the sperm fertilizes the egg, but does not yet implant?

  Answer:  usually you need the fertilized egg to implant into the uterus and form a placenta for a large increase in the hormones enough to show what occured in your case. JG 1.10.09

• I had buccal fat removal..and i notice that the lower right side is a little bigger..is there any way a doctor can look and see if theres some more fat..like with an x-ray or something?

  Answer:  there are no tests that will show it well, a MRI scan might, but hard to say. JG 1.9.09

• DR. GARCIA: I HAVE PIERCED EARS AND FROM WEARING HOOP EARINGS, I MY EARLOBE IS TORN. WHAT IS THE COST, CAN IT BE FIXED . THANK YOU SO MUCH

  Answer:  I am sorry but I do not offer that service in my office due to our schedule. JG 1.8.09

• Hi Dr Garcia, I had a granuloma from a polyacrylamide product removed from my lower eyelid. Is it possible to have an MRI scan or ultrasound to see if any remnants of the product are still there? I want to make sure everything has gone so that I can fill the hollow areas with a temporary product .... Thank you

  Answer:  in most cases the granuloma will not show up too well as it is similar to the surrounding tissues but it can be done if desired. Small amounts of the material may still be scattered over the area and may not be able to be seen but they might congeal into another mass with time and motion of the muscle. Best of luck.JG 1.8.09

• I do not know if this shoe shop was just trying to make a sale or if it is true. See, the heel on my right shoe tends to erode at the spot where I rest my right heel by gas pedal in car. I thought the erosion of the heel was due to that so I thought of wearing slippers while driving. However, this shoe shop said the erosion onheel is due to pressure n that spot due to my high arches on feet. If that is so, how come I don`t have erosion on both heels? Just wondering if it is my arched feet or gas pedal causing the erosion.

  Answer:  high arches are never even from side to side, I think it can be the high archs, the resting of the foot on the gas pedal, and also how you walk, whether the foot is supinated or pronated or straight, if it is supinated, then the heel wears out on the outer part more and pronated wears the inner part of the heel out. A podiatrist or foot specialist can tell you that but not much to do besides replacing the heels. JG 1.8.09

• Just during menstrual time, I get armpit BO. I mean it is there without any exertion to cause it. What is the name of the hormone which increases to cause this BO?

  Answer:  it is due to the lower progesterone content and therefore reflexive higher DHT that can allow the bacteria in your sweat glands to increase, not much you can do except using deodorants. JG 1.8.09

• Is someone has oral herpes on their chin, is it only tansmitted through contact with chin area or would the virus also be in saliva (if it is only on chin)?

  Answer:  only on the chin. JG 1.7.09

• Dr. Garcia: I have consulted with you on two occasions throughout the past several years and am now ready for my procedures. My question is: can I have all the procedures done at one time (breast lift, upper and lower eyes, and lipo on my stomach and lower back)?

  Answer:  yes, that can all be done at the same time as long as you have no underlying medical problems. See you soon. JG 1.5.09

• How many IU of vitamin D is safe to take on a daily basis? is 1000 IU safe?

  Answer:  usually a safe dose, yes. JG 1.5.09

• Does prgenancy permanently change your butt (make it drop)or breasts (make them sag or decrease in size after birth)? Let`s say if you don`t breastfeed.

  Answer:  the weight gain can cause such changes. JG 1.4.09

• What do you think of the results of cosmetic toe (shortening, narrowing or hammer toe correction) surgery?

  Answer:  I would not recommend it. JG 1.4.09

• Does retin-a help with lines on neck? I thought restylane would work to fill in lines on neck if it can fill in wrinkles on face?

  Answer:  to a mild degree, yes. The lines there, if injected, will commonly leave lumps. JG 1.4.09

• Will botox help to decrease lines in neck?

  Answer:  no, because they are static lines, not dynamic lines. JG 1.2.09

• Hi Dr. Garcia, I`m considering using Botox Cosmetic for crows` feet but I also have some lines under my eyes when I smile. I have previously been treated with Portrait Plasma under my eyes with some smoothing of the lines but they are still evident. Is Botox the best solution or would fillers be a better choice? Thanks in advance for your time. Happy New Year!

  Answer:  I would never use Botox for the lower lids lines for fear of ectropion and corneal exposure along with allowing the fat pockets to puff more. Best of luck. JG 1.2.09

• When I take a shower and scratch/srub my neck/chest area with my fingernail, something slothes off. I do not know if it is dead skin cells or moisturizer. I don`t use mositurizer that much, but I don`t know if moisturizer remains on the skin as residue? No other part of does this except my face or dry feet. Actually, I exfoliate dead skin cells from my face on a daily basis. What is coming off my neck/chest? I know that dead skin cells take longer to flake off in aging skin. Does this only happen on my face, neck, chest (and feet) because those areas age more than rest of body? Will I experience this on the rest of my body as I get old? Does it help/renew your skin to scrap off old skin (if that is what is in) in shower?

  Answer:  could be moisturizer, dead skin cells or just skin oils. Everyone is different as to how much it happens. No need to do anything special for it though. JG 1.2.09

• What do you think of the new product out for cleasing skin called Clarsonic for older skin?

  Answer:  I see no great advantage but it is very popular. JG 1.2.09

• Do you think restalyne injections (or some other filler)on the cheek area work better as just as well as cheek implants? I had small cheek implants removed because I could see the outline of the cheek implant instead of it blending into my skin.

  Answer:  no, I think if needed, the cheek implants offer the best long term result. The cheek implants should be placed below the muscle so I am not sure why you could see them in your case. JG 1.2.09

• Does restylane help lines in the neck? How long does restaylane last? Is there a certain motion which causes lines in neck- moving neck up or down or from left to right?

  Answer:  no, it does not work well there. It is the flexion of the neck up and down, like nodding yes. JG 1.2.09

• What are lines on the neck caused by- more by moving your nexk than age? I started to get deep lines on my neck early on so I am not sure it is due to age? It does not seem like I move my neck around too much- maybe my neck jerks in my sleep- I don`t know. What can I do about these deep lines? I notice that no everyone has them. They aren`t wrinkles/sags- just lines.

  Answer:  they are caused by both things, the neck skin thinning with age, and motion. There is not much that will help those lines, chemical peels do not help and surgery just pulls them higher, neck skin cannot safely be lasered or resurfaced without risk of scarring. JG 1.2.09

• Four years after facial cosmetic surgery, I still have a dark scar 1/2 high and 2 long on my right jaw, in front of the ear. The scar has flattened and the skin is relatively thin. Recent fat transfer has filled out the scar where it was a little dimpled and indented, but the only solution suggested has been micropigmentation...unfortunately, I have a very light/fair complexion, and I have no reason to expect that cosmetic tattoos can camoflauge a dark purple-brown scar - I am now thinking my only options are to live with it or get a dark design tattooed on my face to cover the scar. Are there any other options? I was told that laser would just burn the scar and turn it darker or redder...no additional surgery is being considered, and I am prone to keloid formation, which is noticeable in front of my right ear, where several rounds of surgery have not helped that, either.

  Answer:  I think pigmentation will likley not work, about all I can suggest is to eventually have the scar cut out, but you need loose skin to perform it successfully with low rsk, that might take a temporary disfigurement with a tissue expander to produce more skin so the scar can be revised with less tnesion. All the best. JG 1.2.09

• Dear Dr. Garcia No question today.:) Just want to wish you a safe, happy and healthy New Years and may you be blessed in 2009. Thank you for all you do..very much appreciated.

  Answer:  thank you kindly and may the New Year bring good cheer and prosperity to you. JG 12.31.08

• Hello again, I continue to retain water. Is there anything I can do? Are there any surgeries or anything?

  Answer:  just time, no surgery, sorry. JG 12.29.08

• HAPPY HOLIDAYS! Thank you for answering our questions even during this time of year! My problem is this, I now have like this extra skin in my underarm area and I want to get rid of it. Is the only thing surgery? It is only under one arm. This happened after having babies. Please help!

  Answer:  I am afraid that surgery is the only reliable way to do it, the other methods out there are not predictable. Sorry. JG 12.29.08

• Hello Doc. Is there anything to these detoxifying pills, liquids or teas? One web sight said we should detox our bodies once a year. Is there such a thing as a detoxing diet? Thank you

  Answer:  not much, a liquid diet is the best if you desire, and take your vitamins when on it to keep nutrition up. JG 12.29.08

• I am in my late 30s. I notice that teh area on side of mouth (smile lines location) is sagging a little. Do you think a jowl lift or resylane will work better?

  Answer:  at your age, Restylane. JG 12.29.08

• What reason do you think a tattoo without a sking graft would look better than a labia graft for areola reconstruction? I thought maybe labia tissue might make the areola look more natural?

  Answer:  because since it is a graft, it will loose some of its pliablility and color and will be more stiff, and wil also have thinner skin in that area. JG 12.29.08

• For areolar reconstruction, do you think the best results are achieved through labia graft, regualr skin graft, or tattoo without a graft?

  Answer:  tattoo and no graft. Merry Christmas and Happy New Year. JG 12.27.08

• I heard that the company that makes botox may have a competitor soon, which will lower the price. Do you know when the other company will start selling botox?

  Answer:  there are two companies but they are still months away, and I am not sure Botox prices will drop either. Merry Christmas and Happy New Year. JG 12.27.08

• How long does sculptra last in the hands? Also, does some build over time or become permanent?

  Answer:  might need a touch up at one year. It is not permanent in any way. Merry Christmas and Happy New Year. JG 12.27.08

• What is the general age range which women start to lose fat from their hands as they age? Is it fat loss which makes veins buldge out more? Does Juvaderm work just as well as Sculptra. How long do these treatments last and what is hte average price or number of units (cc) needed? Also, do women get injections in their fingers or just their palms?

  Answer:  it is the fat loss that makes the veins seem more prominent and it happens usually in their mid 30`s. I think Sculptra works better than Juvederm because it typically lasts longer. The injections are done only to the back of the hands and usually I use two vials of Sculptra so the total cost is about $2000. Merry Christmas and Happy New Year. JG 12.27.08

• People have had surgery to shorten their fingers in the case of macrodactyly, which a phalangectomy was done. But is it possible to have each of the finger digits shortened int he case of arachnodactyly? Would a hand surgeon or plastic surgeon perform the procedure?

  Answer:  I would not recommned that, but it would need to be a hand surgeon. Merry Christmas and Happy New Year. JG 12.27.08

• I have so many cosmetic problems. I was just wondering if the average woman has many cosmetic problems? Or I should ask if beautiful woman have many cosmetic problems?

  Answer:  trust me, I have patients that are famous celebrities and without make up they look pretty similar to the average woman. JG 12.20.08

• Do you know if those blue ray lights for acne also work for pores or blackheads? I do not know if acne bacteria is the same bacteria in pores or blackheads?

  Answer:  they do not work for pores and the pores might harbor the bacteria, yes. JG 12.20.08

• Lately, I have seen on the news that some moisturizers may contain estrogen. However, it is not listed in the ingredients. How can we find out which moisturizers have estrogen in them?

  Answer:  look frr things like estradiol,estriol or estrone. I wil say I say those repsorts and the medical experts really were very confused about what they were talking about, misquoting things and claiming some things like pregnenolone were estrogens which it is not. In fact these are natural substances that women and men make in their bodies and the amounts absorbed into the body are small, I think the risks have been exagerated and unfounded. JG 12.20.08

• Is there a difference between the pulsed dye laser and the Excimer laser (Utrac Utra & Xtrac Velocity)?

  Answer:  not sure what you are trying the have the laser do. JG 12.16.08

• A few years ago, this cosmetic place told me that some patients no longer have to get botox shots after awhile since the effect will stay. Was this place not telling the truth? If the muscle does gain its full strength back, about how long does it take when one does not receive botox shots anymore?

  Answer:  they were not telling you the truth. The longest I have seen the effects of the Botox last was one year, in most patients its back in 3-6 months. JG 12.16.08

• Do you know what kind of doctor would be best for herniated disc back problems which are interrupting electrical signals to brain? Would it be a chiropractor?

  Answer:  neurosurgeon. JG 12.16.08

• Thank you so much for your fast reply. I decided to start taking Accutane but is there anything I can do to avoid hair loss durin taking this medcin and how can I minimalize other side effects? Is it true that L-carnitine can help?

  Answer:  there is really not much you can do to mitigate the side effects I am afraid, that is part of the medicine. I do not think L-Carnitine will help against the Accutane. Sorry. JG 12.16.08

• Is it safe to take hormones like estrogen or use a cream to make you more feminine?

  Answer:  they will likely not increase your degree of feminization to any great extent. JG 12.15.08

• Do you think that progesterone cream can help woman with acne who have low estrogen level????

  Answer:  it can help the acne but it will help because it will compete with the 5-alpha reductase that makes DHT form testosterone, it has nothing to do with the estrogen. JG 12.15.08

• Dr Garcia, I`m 26 and have acne on my face, chest, and back. My dermatologiest wants to put me on low dose course of Accutane (10mg/day). Do you think that it may help? Can I take spironolactone (100 mg/day) with Accutane together, as spiro works perfect on my hair? How to prevent hair loss during taking Accutane? And the last question is there any product I could put on my spots to avoid scars?

  Answer:  they can be taken together and I think starting on a low dose of the Accutane sounds reasonable too. I do not have any product that will prevent scars though. JG 12.15.08

• Do you know anything about lasers used to treat psoriasis? The lasers that zap blood vessels are used for psoriasis treatment because the blood vessels somehow cause skin cells to grow too fast. I don`t recall if the excimer laser was listed as one of the lasers uses. The average treatment is every 3-4 weeks for 6 months. Then after 6 months, is the psoriasis in that area gone for good or do you have to have laser treatment again in a year or so? The area is on my lips.

  Answer:  sorry, but I have never used lasers for psoriasis. JG 12.15.08

• I do not know what the muscle is called inbetween the eyes which makes a furrow. I have been getting botox shots in that area for 4 years. I usually get botox shots every 4-5 months. It has been 4 months and that area hardly furrows. Does that mean the furrow is permanently gone now meaning the muscle will not work in that area from now on?

  Answer:  no, but the muscle has likely gotten weaker from the Botox, it will eventually come back to function though.JG 12.15.08

• How does one see when having upper lower bleph and lower face lift and rhino? I wera contacts/glasses and PS says no contacts for 2 weeks, glasses ok while splint on but i will hve stitches behind ears from lower face lift. I assume the ear pieces wont touch? He says after splint comes off, glasses cant rest on nose. WTH? are there little things to rig up where glasses stay off nose? If i cant see to watch TV while recovering i will go nuts!

  Answer:  might need to tape the glasses up to your forehead with tape. JG 12.15.08

• Do you believe that arnica montana truely helps reduce bruising when taken regularly weeks before surgery and couple-3 weeks after? my PS actually has it in his list of instrucions. I have always taken it pre and post surgery and rarely bruise, so i dont know what it would be without, and dont intend to find out bu not taking it. And how about the topical? i have never had much luck with that, hv only used if i have a bruise from bumping myself

  Answer:  I have been using it for 15 years and I believe in it, yes. I use both oral and topical. JG 12.13.08

• Hi and thanks Dr. Garcia-I had juvederm ultra, one vial to one (side) n/l fold and cheek. Three days later (today) you can see bumps and there is palpable, wormy, lump. Did I do something to cause this? (drinking from straw, bottle, etc.) Will it subside? Your thoughts, please. AND THANK YOU!

  Answer:  it is technique related,nothing you did, suggest warm packs and massage to smooth it out. Might take a few days to a week or more though. JG 12.11.08

• Have you ever heard of anyone having restylane injections (or some other injection) to make their hip curvier? Is there an injection which builds up meaning some remains permanent? I have indentations on my hips which could use filling with fat, but I am too skinny to transfer fat from another part of my body- even if I did, I am not sure that fat would last permamently.

  Answer:  I have not heard of Restylane being used due to its short survival, maybe Sculptra is another option. JG 12.5.08

• Buttock implants are popular in Brazil. Women in Brazil are known for their attractive figures, many of which have buttock implants. Do you think buttock implants look unflattering? Do they look unrealistic- being too toned? It sounds like such a great idea to me since I can`t wear pants since they`re too baggy on me, but I recall you stating you don`t think buttock implants look natural.

  Answer:  whether an implant of the buttocks looks unflattering is a matter of personal taste. I find that in many cases, but not all, they can look fake though. JG 12.4.08

• Before buttock implants were well known, buttock implants used to be custom made by doctors (meaning they did not have pre-made ones like pre-made breast implants in different sizes). Well, hip implants are not well known. Hence, I was wondering if docotrs can custom make them liek they used to custom make buttock implants? I am interesting a small implant. What kind of material do you think it would be made of?

  Answer:  I think it would be difficult if not impossible to fashion something, have it stay and look natural. JG 12.4.08

• Hello Dr. Garcia, I have some very small pitting along the sides of my nose that are the results of multiple laser and hyfrecator treatments to eradicate telangiectasia. I have had two Fraxel treatments over the past twelkve months that were to no avail. Fillers have not done a thing. I had a subsicion treament, too, but it did not help. I have been on a regimen of cooper peptides and emu oil, as well as, the use, albeit very lightly, of a microdermabrasion cloth. About five years ago, I had a dermbrasion procedure that did not do too much. Micro dermabrasion has absolutley effect, as the pitting is too deep. I am at my wits end. Any advice? Thank you. Brett

  Answer:  CO2 laser will be the best option. JG 12.3.08

• Suggestions for the neo nasal labia wrinkles? What I am looking for is purely cosmetic quick fixes. Just a product I can use each day that will help fill them in some. Thank you

  Answer:  sorry but nothng topical will help, it will likely need injections to fill in, my choice is Restylane. JG 12.2.08

• I have been thinking about having a labiaplasty since I have extra tissue. The pro of removing that tissue is that it can be used for areolar skin graft. Just like some plastic surgeons do nose surgeries and some do not- some do labiaplasties and some do not. I think a plastic surgeon should be trained in the procedure or be already doing that procedure before it is attempted on a patient? See, I thought maybe I could have the labiaplasty and areolar skin graft performed at the same time. However, the labiaplasty doctor does not specilaize in breast reconstruction, and vice versa. I know that breast reconstruction doctors can remove tissue from the labia for a skin graft, but they are not experienced in a doing a full labiaplasty. It seems like that is a delicate surgery or you should not cut in the wrong place. So, I do not know what to do about this surgery. Should I have a skin graft taken from the labia for areolar reconstruction one day, then schedule a labiaplasty with the labiaplasty doc on a different day? Is the labia cut in the same place for skin grafts as a labiaplasty?

  Answer:  the labiaplasty is different than a regular skin graft donor site so it might be necessary to perform it in two stages in your case. Sorry. JG 12.1.08

• Are tanning booths equally as harmful to the skin as the sun?

  Answer:  sorry, but yes. JG 11.26.08

• I read recently that women should wear a bra all the time - even to bed! I`m fairly large breasted (38D), and the bigger they are, the harder they fall, LOL. But for a LONG time I had a dark line under my breasts from bras (guess it was digging in?) so I wonder what might happen if I start wearing a bra ALL THE TIME. Conversely, I would like to do what I can to keep my girls in the upright position :). Thanks.

  Answer:  I think bras are fine but they will not stop the descent of the breast tisuse, no matter how long you wear them for. I am afraid them falling is part of nature. JG 11.25.08

• Hi, doctor. In March I made the mistake of ironing in bed and burned the front of my leg. I took good care of the bruise with topical antibiotic for about two months. It became barely noticeable. However, during summer I spent a lot of time in the sun and now I have a brownish v (exactly the shape of the iron!!!) on my leg!!! Is there a treatment that can get rid of this hiper-picmentation?

  Answer:  might try some prescription hydroquinone, always use sunblock or try a YAG laser. JG 11.25.08

• what form of arnica(oral) do you recommend? My PS wants me to take it a week before surgery. I ordered the SinEcch, which is in capsule form, and only 12 pills, to be taken couple days before and week or so after. I was going to go ahead and take the pellets the week before and then the SinEcch. Your thoughts? It really does work for bruising. I only have experience with the pellets tho.

  Answer:  we use oral sublingual pellets and also topical gel. I think taking the pellets and the SinEcch as you describe is fine too. I personally think the pellets work better. All the best. JG 11.24.08

• Is it more effective to shave off a small raised scar than to have it cut out? In other words, will the scar tissue raise again where it was shaved off?

  Answer:  shaving it flat is a bad idea. JG 11.23.08

• If you have a raised scar on your lip (sticking out like a pimple), do you think shaving it off would be more effective than cutting it out?

  Answer:  cutting it out will be much better. JG 11.24.08

• dr. Garcia, I have learned a lot about so many topics on your website. Thank you for being so generous with your time and knowledge for free. Have you ever considered writing a book?Seriously, I know skin care products and laser info change somewhat but it could be a reference for so many. Then you can be on Oprah along with Dr. OZ..he could be the Dr of Health and you could be the Dr of Beauty. Something for you to consider I hope. Thanks for all you do, Happy Thanksgiving. Christine

  Answer:  Well, I might just do that, Happy Thanksgiving to you too! JG 11.22.08

• Dr Garcia, Do you have any idea what a fabulous person you are to provide such a service? And i am sure you are an skilled surgeon, obvious with your great knowlege and advice. Plus, your arent bad on the eyes, either. Question, i think i read awhike back that you just got married or engaged recently. Is this the first time? If so, how on EARTH could a catch such as yourself stay single for so long??? I hope you dont think that is too personal a question but i have know and had work done by, alot of PSs, and none of them are as compassionate,caring or knowelegable as you. Wish we had more Doctors out there who truely care, and i am sure i speak for everyone who reads your advice and comes here for answers. You are a true gem.

  Answer:  well, firstly thank you for the kind words and the making me blush from your comments. I did get married this past June for the first time. I guess I am like red wine, I had to wait to mature a bit first. I am glad I have been able to provide insight for these posters her, I must say that it helps to keep me on my toes and I learn something everyday from the questions asked. Thanks again and I wish you the best. JG 11.22.08

• Thanks for answering my question regarding botox jaw reduction. I had one round to jaw and I don`t like the result. Please tell me if you think my jaw will return to the way it looked before, or if some of this is permanent. Thank you.

  Answer:  in time the muscle all comes back to the way it was, the effect is not permanent. JG 11.19.08

• I had buccal fat removal..and now i notice my face is asymmetrical..what can i do?

  Answer:  hard for me to say without seeing you, it might be able to be improved with either fat injections to fill one side out or try to remove more fat from the larger side. It might also have unmasked some previously hidden bone asymmetries too. JG 11.18.08

• I`ve read here you don`t do Botox jaw reduction. Is this due to uneven or unpredictable results? I had it and think it`s made my neck more slack as well as some jowling. Just wondering what you think of this procedure.

  Answer:  I think the reliability is not good enough for me to use it for that purpose. JG 11.18.08

• Hi Dr. I am very depressed/ frustrated..i am only 28..but have had a huge change in the way I look...My mid face is falling and giving my cheeks and whole face such a different appearance. my lower face is bigger (fuller) And less defined..i hate to even look in the mirror lately..when I pull up on my midface and suck in my cheeks it seems like I look more like myself just a year ago. Have you ever heard of aging so young? I was always a runner(not good), lost about 50 lbs. about 8 years ago and kept about 35 lbs off and I think I have bad bone structure. Do you think a midface lift would help? I know I am young but its hard to look so different (bad) with so many years ahead. Im sorry to bother you but i really need your advice.

  Answer:  at your age a midfacelift might not be the solution as it sounds more like you have lost the fat which supports your cheeks and therefore the skin, maybe a filler like Sculptra and cutting back on the running which accelerates aging is in order. JG 11.17.08

• Hi-had eyes,brow,and midfacelift approx 18 mos ago. Left side from eye down face there is a noticable line, loose skin there. When I smile there is a dent between my cheek pad and midface area. If sutures broke that pulled my cheeks up, can facial exercises restore this? I went to my ps and he said only a facelift will fix it. I don`t want to use a filler because I am very allergic to things. Any suggestions? thanks so much, nv

  Answer:  facial exercises will not restore it and could actually speed the fall. I guess you are finding out about some of the limitations of a midfacelift, and I do agree a regular facelift might be needed. I am not sure fillers would help either, sorry. JG 11.16.08

• dear Doc. Would it be better to use Retin-A or a new product containing Durian on my skin. I have a reddish hugh to my skin and a few small veins, also many wrinkles. Thank you

  Answer:  not sure what effects if any the Durian will have, but the Retin-A will do nothing for the reddish hue, in fact it might make it worse and increase the small veins. JG 11.12.08

• Have you heard of the ELOS hair removal technology? They claim it works on light hair, including red (mine). Appreciate any feedback, thank you

  Answer:  seriously doubt its effectiveness. JG 11.10.08

• Dr. Garcia, With all of your knowledge and expertise, do you do any work on children? In the area of reconstructive surgery , wound or trama maybe outside your normal practice? As a consultant if nothing else? Thanks for taking the time to read this and answer.

  Answer:  I do reconstructive surgery for children, yes, I presently accept patients on HPN insurance in Las Vegas. JG 11.9.08

• Hi Dr Garcia, About 7 months ago i had a laproscopy and the resulting scars have healed very darkly and raised. Is there a product you recommend for this? I am pregnant also. Thanks in advance.

  Answer:  Mederma or ScarGuard is where I would start, both are OTC. JG 11.9.08

• Dr. Garcia, Is there a good skin tightening treatment for larger areas of the body as in abdomen, thighs etc. I am not a fan of thermage, but thought maybe some of the lasers available could give some improvement.

  Answer:  nothing safe and effective that I have seen, sorry. JG 11.6.08

• Dear Dr. Garcia, I am contemplating a tummy tuck, yet i am concerned about finding a good plastic surgeon for the procedure. I live in Florida,otherwise i would definitely book a consult with you. What credentials should i seek in a doctor to perform this procedure? Do you know if the methods used for tummy tuck surgeries vary much between doctors that do them, or is there usually only one method used for this? I have also heard of endoscope tummy tucks? Do you know much about this particular method?

  Answer:  look for a board certified plastic surgeon, ask the state medical society for his history of any complaints, ask to see what hospital he has priveleges to work at, ask to speak to some of his previous tummy tuck patients are good places to start. There are small variations but they are not great. Endoscopic tummy tucks are for people with loose muscles and no loose skin. Best of luck. JG 11.5.08

• Dr. Garcia, I have deep indentations on the upper thigh area in the front of my legs. It has been there for a long time, ever since i can remember. My mother told me it is scar tissue from injections i had as a baby when i was hospitalised for quite a time. I can`t remember now why i had to have so many injections, and my mother has died, so i can`t ask her anymore, but i remember she said i had pyloric stenosis, and also diptheria. I would like to know if there might be anything non-surgically i could get done to make my legs look more normal in their appearance. Thanks for any advice you could give.

  Answer:  might benefit from fat injections into the depressions. JG 11.5.08

• Is it possible to enhance the shape of the buttocks with a dermal filler, and if possible what filler would be used for this? I am wondering about the buttock area at the base of the buttock. And if not any dermal filler, would a laser treatment help, and what type of laser to enhance the shape? Thankyou.

  Answer:  very difficult and very expensive if it were. No lasers there either. JG 11.5.08

• Thankyou very much Dr. Garcia for answering the questions i have posted. You are very helpful and very much appreciated for your knowledge. The adhesions i was referring to was an old scar from a laparotomy that was done years ago, and on my last check up with the gynaecologist, i happened to mention how i often get pain in that area, worried i might have something with the ovary on that side, but he mentioned more than likely it was adhesions, so i am not sure. He did a fairly thorough check and palpated around my lower abdominal area, so i guess he would know what to look for. Once again thanks for your very good advice.

  Answer:  adhesions cannot be felt from the outside, they cannot be seen on a CAT scan or ultrasound either, they are made as a presumptive diagnosis or upon seeing them in surgery, in most cases nothing bad comes from them and since gynecologists deal with that all the time, I am sure they felt confident that is was just that. JG 11.5.08

• Dr. Garcia, Could you please tell me what adhesions are, and do they cause a lot of pain, and if so what is treatment for this? Thankyou.

  Answer:  well if you are talking about adhesions in the abdominal cavity, they are where the bowels have become attached to one another from an inflammatory process or surgery and can on rare occasions cause intestinal blockage. JG 11.5.08

• Could you please give your opinion on O.T.C. progesterone cream? I use one called Pro-Gest currently. I was getting perscription bio-identical hormones, in cream form, but found i was getting some dizziness while on it, so i changed back to the other product. I am potmenopausal for a few years now, and have some of the usual issues associated with that, and want to protect heart and bone density.

  Answer:  good product, but because it is OTC it is pretty weak, so if you are defiecient in progesterone, it might requie quite abit to be applied. JG 11.5.08

• Dr. Garcia: Two questions: First, my PS led me to believe that Alloderm lip implants would be permanent, vs injections. I read from your website that they only last 1-3 years. Is that true? Second, it`s been about 60 days since the implants were placed. They are very small implants, but my ability to open my mouth wide - has been greatly reduced (some people wouldn`t mind this). Do you know why this is, and if it will subside? Thanks for your response.

  Answer:  well, Alloderm is not permanent, not sure why they claimed that, especially in the lips. I think there is still some muscle inflammation from the surgery and as you stretch the opening of your mouth will return to the previous state with time. Best of luck. JG 11.5.08

• I have been diagnosed with an enlarged thyroid gland (goiter),Left side of my neck, a few years back. My doc. at the time told me it was nothing to worry about, and that there was no specific treatment i needed for this. Just to get an ultrasound done on it every 2 years, because they can turn cancerous. I have researched the subject a bit, and from what i have read i can get treatment to get it back to normal. Armor Thyroid is supposed to be a good natural medication for this problem, i was told. I just feel that if my thyroid gland was okay, i wouldn`t have one that was enlarged, that it would be normal size? Just my view. I also get a lot of heart palpitations that i have been told could be because of the enlarged thyroid?

  Answer:  medication might help, hard to say without blood tests, but if your palpitations are due to the thyroid, it is too high and the medication will not help. JG 11.4.08

• Does everyone experience hair loss from anesthesia?

  Answer:  no, only a small percentage. JG 11.3.08

• Just wondering why a labia graft can`t be used for the nipples? I am not sure what the difference is between grafting it on the areolar area or the nipples.

  Answer:  the nipple is the protuberant piece and the areola is the round skin around it, the labia will not hold the shape and projection of a nipple. JG 11.2.08

• I just have a couple more questions about reconstructing nipple with labia skin graft. 1) I read elsewhere that the a graft with labia skin might make the nipple less projected than other grafted skin? Why would this be? 2) Would it be possible to have a plastic surgeon (who specializes in labia surgery) visit the doctor`s office I am having nipple reconstrcution at? I thought maybe there would be less complications if a doctor experienced in performing labia surgery or knew where or not to cut came in to remove the labia tissue, then left for the breast reconstructive surgeon to do labia graft to nipple. Would most doctors be willing to visit another doctor`s office?

  Answer:  the labia is used just for the areola so I do not see how it would affect the nipple itself. All plastic surgeons are experienced in skin grafting and labial skin grafts are no different than any other full thickness skin grafts. It is unheard of to have what you are looking for to happen. JG 11.1.08

• If labia tissue is grafted to nipple/areola area and it loses color, does grafted labia tissue have the same difficulty of taking tattoos as no-labia skin grafted from other area?

  Answer:  yes, same difficulty. JG 11.1.08

• I have not heard about women using labia to graft in nipple reconstruction. I only seem to hear about tattoing. Is labia tissue used much? Is there a way I can learn more about the outcome of patients who had it done? Again, I only hear about tattoing. Why don`t more women use labia skin so they don`t have to worry about tattoing?

  Answer:  the labia tissue, I shoudl explain, is more correctly used to reconsruct the areola, not the nipple itself. It is used as a pigemented skin graft. The color wil be darker but at times not all of the color stays and it gets lighter, it also involves surgery and some women try to avoid more surgery. 11.1.08

• There was a movie made a long time ago- I think it was titled Why Me?- about a woman who got into a car accident and lost her face. Her plastic surgeon used tissue from her labia to rebuild her lips (maintain the pink color on lips). Can the labia tissue be used to trnasplant onto the nipple area to maintain nipple color in reconstruction? Well, I know it can be transplanted but are the results any good? If not, can skin be grafted from inside the mouth liek the sides of the cheek (I do not want to actualyl make my lips smaller by removing tissue from my lips). I am thinking the inside tissue of your mouth would be dry (like any other skin on your body)if it wasn`t for saliva.

  Answer:  yes, it can to a great degree, the movie starred Armand Asante as the surgeon and I believe he ended up marrying her, if it is the one I am thinking about, it was a true story. The inner lining of the mouth cannot be used as that is wet mucosa and would dry and not heal well as you said. JG 10.31.08

• Please refer to my question about inverted nipples below. The surgery I had scarred me and it was not succesful in giving definition to nipples. It looks worse so my only option to have my nipples surgically removed. They do not look like nipples anyway. The orginal nipple skin remains only on the top of my nipples. It is just the sides around the nipple which had a skin graft (when the inverted nipple was pulled out more). Here`s what I want to do. 1) Have my nipples removed, but save the original top part of nipple to transplant later that same surgery time. 2) Have my nipples reconstructed with skin graft or however nipples are reconstructed 3) After the nipples are reconstructed with skin graft, add the saved original nipple tissue to add only to the top of the reconstrcuted nipple while a skin graft will be placed around the sides of the nipple (I do not have any unscarred tissue left to add to the sides of nipple so I have to use skin graft instead). My question is can the top sliver of removed nipple be used to add onto reconstrcuted nipple that same day? Also, if the tattoo did not take the first time around the sides of the skin grafted nipple, is it possible it might take this time?

  Answer:  it is difficult for me to say whether all of these things could be done without seeing you, the nipples and some skin could be transplanted to another part of your body and then moved back in time but the retention of the grafts is not always good. As to why the tattoo color did nto take, that is not uncommon as grafted skin has dense scar tissue and that can make it hard for the color to hold fast. Can the top part of the areola be used to reconstruct things, yes, in some cases, but I cannot tell that without an examination I am afraid. I wish you the best. JG 10.31.08

• I had inverted nipples. A doctor placed a skin graft around my nipples after they were pulled out more. However, the skin graft around the nipples will not tattoo. The pinks of my nipples still remain on the top of my nipples, but they have white colored sides. The nipples are still not well defined or do not have much shape to them so I am planning on having them removed and reconstructed. I would like to save the top part of my nipples so the texture/color at top of nipple will look like nipple tissue. What I mean is I would like the doctor to cut off the tops of my nipples and save them to tranplant onto the top of newly constructed nipples. Is that possible? Also, since the first skin graft around the sides of teh nipple did not tattoo, I am worried this skin graft will not tattoo (to match the top color of the nipple). Is it possible for the tattoo to take the seond time? Or if it didn`t work the first time, is it just my skin that scars? Does everyone`s tarnsplanted skin scar? Could i get lucky the second time with the tattoo taking? Has that happened before?

  Answer:  I am sorry but I am having a hard time imagining what you are describing and I do not want to suggest or not suggest something incorrectly, I would need to see you in person to help you out, sorry. JG 10.31.08

• Let`s say your areola was so scarred that you needed to have it removed and place a skin graft over it. Instead of plcaing a skin graft over it, could the tope layer be cut off and your regualr skin on breast (nonareola skin) be pulled over the areola over? Can the skin on breast stretch over the areola area if you do not have saggy skin? Also, what are benefits to having a skin graft instead of tattooing on regular skin? I do have a mound of areolar tissue already there if the purpsoe is just to make a mound. I just wonder if the top part of my scarred areola could be removed leaving the mound?

  Answer:  if the area is small and the surrounding skin is loose enough, it is possible, if it is too tight, then the incision will widen with time and reveal a spread out scar. There are no real benefits to the skin graft, it is used when there is not enough normal surrounding skin to correct the problem. The top part could be removed, but how to close it would need an inperson consultaton to determine if there is enough skin to close it. Also, if the loss is at the top part of the areola, trying to close it with surrounding skin wil pull the nipple itself into a higher position, something to consider. JG 10.31.08

• i cant find my question about vitamins(gingo Biloba and Vitamedica). I posted it under Nutrition but see that is not listed in Explore Archives .

  Answer:  it was answered under the Agless Forever site. JG 10.30.08

• Hi Doc if you have laser hair removal is it permanent or does hair grow back? Thanks

  Answer:  it grows back in time, although sometimes it is less dense. JG 10.28.08

• Hello DR. Garcia, I would like to know what over the counter skin wash you recommend / i have been using obagi and it is teriffic but I can`t keep buying it because of the price and everything is to darn expensive. I have med to lge. pores and skin can be oily but with the obagi system I have it under control but I have only used the facial wash for a long time and still the cleanser has done he job but as i said It is getting to expensive and i wondered what over the counter wash you might recommend for me also I am 57 trs. old with pretty good skin maybe I can rotate the obagi with a over the counter and I want have to buy obagi so often what do you suggest? thanx

  Answer:  you can try Neutragena or Cetaphil. Best of luck. JG 10.27.08

• Hi Doctor, Do dents/fat loss caused by intralesional steroids get better with time or is the only solution fillers?

  Answer:  they can improve for up to 6 months after the injection, by then what you see will need to get filled in by injections usually. JG 10.27.08

• DOCTEUR GARCIA MERCI BEAUCOUP POUR LES BONNES, SINCERES ET RAPIDES REPONSES QUE NOUS RECEVONS DE VOUS. VOUS ETES UN ANGE DE DOCTEUR ET SURTOUT VOUS POSSEDEZ UNE GRANDE PATIENCE,SANS OUBLIER DE RECONNAITRE QUE VOUS POSSEDEZ AUSSI UNE GRANDE INTELLIGENCE. ENCORE UNE FOIS, JE VOUS SOUHAITE BEAUCOUP DE BONHEUR POUR VOUS ET VOTRE FAMILLE, ET SURTOUT LA CONTINUATION D`UNE BONNE SANTE. BONNE SEMAINE ET A BIENTOT ! MARIE-CLAIRE LE 26 OCTOBRE 2008

  Answer:  merci` beaucoup!

• Greetings, Dr. Garcia, a followup question (last posted on 10/19/08 in the Miscellaneous category). I am watching the progress (or not!) of scar healing from excisions of two separate basal cell cancers on my forehead. The lower incision (from the endophytic basal cell) remains much more erythematous (thus obvious) than the upper incision in a natural crease. It also remains more tender, with more of a pulling sensation, though it is definitely not infected. I just think that it is probably slower in healing because the incision could not have followed any pre-existing skin crease since there was none there, above my eyebrow. You had mentioned massage for the pucker (thanks!) but had also mentioned Mederma or ScarGuard. I`ve tried doing some research into each of these products and am uncertain whether one is better than the other for erythema in a somewhat ruddy-complected Caucasian. Can you say a word about the difference between these products and what they each do best? Appreciate it. P.S. I am wearing some concealer during the day on the healing sites to make me feel better.

  Answer:  the is no great difference between thos two for redness, the redness is more of a matter if time. What they do is ot help flatten the scar out to some degree. JG 10.24.08

• Hi Doc, Just ordered your undereye dark circle cream, can`t wait to receive it! What procedure if any, do you recommend for loose skin on the neck other than surgery? Thanks a bunch. JR

  Answer:  sorry, not much I can recommend for loose neck skin except surgery. JG 10.21.08

• Hi Dr Garcia. I live in Australia and I`ve seen a cellulite and tightening treatment called Regen. It is a TriPolar device. Do you know anything about this treatment and if it could work?

  Answer:  I have no personal experience with the technology so I cannot really say. JG 10.20.08

• Greetings Dr. Garcia, and thanks for being willing to answer questions. Mine is: what are the best earliest things I can do to minimize or improve the appearance of a 3-week old scar above my eyebrow as the result of an incision to excise an endophytic basal cell CA? The scar slants medially to mimic how the skin creases when I frown (it is not true vertical and not at all horizontal) and the incision cleft is still surrounded by some erythema. There is a bit of pucker there (not totally flat, yet anyway - I hope!). I have another scar higher above it, horizontally in a natural forehead crease incised at the same time for a second, exophytic basal cell that is presently healing flatter without the pucker (though is also a bit erythematous). Would it help to gently massage the lower scar at this time? Or wear a compression bandage (at night, say, as I would rather not sport it in public all day long)? If so, what type? Is laser appropriate at this time for fresh scar? I am a fair-skinned Caucasian woman, age 52, youthful appearance, weight proportionate to height, on the ruddy side. The incisions were made on September 25 (3 weeks ago) and the sutures were removed on September 29. I am aware that I will likely end up with a permanent scar whose appearance I would love to minimize (the upper scar is going to be trivial, eventually, due to falling into a natural skin crease but the lower scar may be more prominent). So since it is early in the healing process, your input about what are the best management strategies towards achieving the most seamless, least noticeable possible outcome would be very appreciated. I do not form keloids, but in an eventual separate submission I would ask about a skin graft to the infratip of my nose following a Mohs (again for basal cell) that had some pincushioning on healing. Thanks!

  Answer:  I think using sunscreen and also something like Mederma or ScarGuard will help. The cleft will get better as the surrounding skin goes down. Massage and time will also help the puckering get better over the next couple of months. I do not think the compression dressing will do much at this time though. I think lasers are overused for recent scars and the evidence for it helping is scarce. The pincushion effect from a skin gfraft is more common as the depth of the scar is different and is made worse but the need for a skin graft. JG 10.19.08

• Testing... (first time here and checking how posting works; no response required to this post!)

  Answer:  all went through. JG 10.19.08

• Hi Dr Garcia. I have a Lazy Boy recliner in my bedroom that has been a life saver for after body PS surgery recoveries. I intend to sleep there after my upcoming lower f/l, rhino, u/l bleph. How long is good for staying reasonably upright for sleeping after such surgery?

  Answer:  if you can do it for the first 2-5 days that would be great. JG 10.19.08

• i had breast reconstuction and then got into an accident. i was told to remove my silicone implants for at least 3 months. my question is when i am ready to put back my implants, do we need to create a new pocket or is the existing pocket still there, because i might be going to a new doctor. how long does it take for the pocket to heal on its own? my second question is, i had a problem a clear fluid hematoma/seroma in the past, will it develope again even if i let my breast heal for 3 months without the implants? galactorrhea? had it... can i have implants put back in? thank u so much for your time.

  Answer:  the existing pocket has at least partially closed off, so the replacement surgery will not be so quick, but likely easier than the first time. The pocket starts to close off the day the implant is removed. The chances for seroma are higher if you had the problem before, yes. Likley not as high for the galactorrhea due to the pocket being formed though. I cannot say 100% without seeing you in person but in most cases the implants can be replaced. JG 10.18.08

• I am confused as to what my PS told me about having to widen my nose a bit after shaving off bump(no breaking). He said he will use my own cartilige. My tip is also going to be raised/refined. I assume this cartlige he used to widen my nose(now it is really narrow from the front, which i like) will come from the tip? At 2 weeks post op, with such a smallish procedure, will the swelling be better? It is one of those things i am hoping will go unnoticed, by all but family. Also, are upper lower bleph stitches removed after 1 week, along with nose dressing? I am also getting lower face lift. What kind of bandage will i have for that, which is removed next day? will there also be a drain for that?Will it come out next day? i am getting neck lift too, with a little lipo thru chin incision. Will i have to wear chin strap?

  Answer:  swelling will be less if no bones are broken but there will still be a good amount of swelling at two weeks. I think there might be some family members that will notice the change. Should be no bandages after the sutures come out on any of the other areas. As to the drain, some doctors use them and some do not, no way for me to tell. Same for the chin strap. JG 10.17.08

• Hi Dr. Garcia, I will be having a breast reduction in 7 weeks. I smoke marijuana about 2 times a week. Will this have an effect on my healing process or my surgery? If so, how long before surgery should I quit? Thank you.

  Answer:  it will potentially slow the healing, like regular smoking would. Ideally one should quit one month before and after. JG 10.16.08

• Hi Dr Garcia. I want to pursue my questions yesterday about hair removal. If electrolysis can leave small bumps in the moustache area, then would laser be better there? What would be the average length of time that laser hair removal would last in that area and in the armpit area? If it varies from person to person, could you please just give a really large estimate? Thank you very much.

  Answer:  well, the laser will likely not leave bumps but it is also not as effective as electrolysis. The time period in which hair reduction lasts in the arm pit area varies, after a series of treatments it might be 6-12 months,no way to tell, the faster it grew previously the faster it will come back. JG 10.15.08

• I have seen pictures of breast reconstruction. It seems like everyone else`s nippled tattooed. Is this right or just not discussed? What can be done to make the skin graft scar less? I was told by one doctor the graft must have been too thick. So does that mean using a thinner layer of skin for the skin graft will cause less scar tisue?

  Answer:  I am sure they do not show the pictures of the ones that did not take the pigment, and there is not much that can be done to reduce the scarring from the skin graft I am afraid. Actually the thinner the graft is the greater the scar tissue that is formed. JG 10.13.08

• Do you know why a tattoo might not take with graft for nipple reconstruction? Was the graft cut too thick? How can I prevent this from happening for the next surgery? I never heard of other women having this problem with tattoos.

  Answer:  well becasue it is mostly scar tissue and not normal skin so it will no hold the pigment as well. Tattoos placed over scars anywhere on the body do not color as well as in normal skin, and a skin graft has more scarring than a regular linear scar that might be attemtpted to be hidden with a tattoo. JG 10.13.08

• What do you think of Artefill for laugh lines and marionette lines? I don`t want temporary stuff--to expensive for to little time.

  Answer:  it is a good option but long term means long term for both good and potentially for bad too. JG 10.13.08

• I had skin grafted from my buttock crease to reconstruct nipples. I had the area tattooed multiple times, but the tatto won`t take. Is the buttock area a common area to use as a graft? Why won`t the grafted skin tattoo? I heard that if you do a skin graft from the groin area, then you might not need a tattoo since it tends to brown when grafted? I don`t know what area to get a skin gratf from because I am afraid the tattoo won`t take. I have a noticebale scar on buttocks. Will I have a noticebale scar in groin area or does that area heal well?

  Answer:  it is not uncommon to take it there but it does not influence the degree of holding of the pigment, that can happen no matter where the skin graft was taken from. Most skin lightens when used as a skin graft so the groin skin will not end up as dark as it used to be. There will be a scar no matter where the full thicknes skin graft is taken from. JG 10.13.08

• Are nipples tattooed on the same day they`re reconstructed?

  Answer:  they can be, but it depends on the way the nipple was reconstructed. JG 10.13.08

• Is the same insurance cpt code used for scar tissue removal? Are there different codes for scar tissue removal or is it just one code?

  Answer:  there is no CPT code for scar tissue removal unless it is a breast surgery, then there is one and only one. JG 10.13.08

• what is the best way short of a face lift to help marionete lines--what fillers would be the best for pretty deep lines?

  Answer:  Artefill or Restylane is what we use. JG 10.13.08

• Hi Dr Garcia. What is the best treatment for ingrown armpit hairs? I`ve read that laser is good for that, but i`d like your opinion on that please. Also, could you comment on whether or not electrolysis is permanent, and whether there is any risk at all to having electrolysis in the moustache area please?

  Answer:  electrolysis is the longest duration hair reduction, as to ingrown hairs, either electrolysis or lasers have been used with fair results. Moustache area electrolyisis has been known to leave small little bumps in some people. JG 10.13.08

• Dr Garcia...I`m going to call my ps to ask him what his protocol is for botox, as far as doing it safely. What exactly should I ask? thanks

  Answer:  just ask him if he uses only one bottle per patient and ask that you want to see them mix the bottle after opening the box and you want to see them pour out any remainder in front of you. Essentially, ask him to follow the label on the box which is single patient use. JG 10.9.08

• Dear Dr. Garcia, I e-mailed you about the Quicklift I had on 9/15/08 and the hematoma I developed. Thank you for your response. I have another question. I also had eyelid surgery (lower) and I have a small pimple like place that appeared in the outer corner of the incision line about 10 days after my surgery. My doctor said it would go away but is hasn`t. I also have one of those small hard white bumps underneath my eye about 1/4 in below my lower lashes that was not there before the surgery (the kind that you get around your eyes right underneath the skin) I can`t think what they`re called. I also have a question about emu oil. Is it true that it will help dimish brusing? Or if you add it to you shampoo or say a facial cream it will help the product to absorb? I read that if you add it to Arnica cream (that I`m using for the brusing (hematoma) that the Arnica will work better. Are any of these things true? What do you recommend for hair loss? I know these are alot of questions. Oh, one more. Have you ever heard of using a tens unit on a hematoma? You advised me to use warm moist heat and light massage which I`ve been doing. I`m also taking the arnica and bromelain you recommended and using the arnia cream on the hematoma and the brusing under my eyes. Hope you can answer all these.

  Answer:  I think the small white lumps might get better with some warm packs, otherwise they can be unroofed with a small needle by your surgeon, not a big problem. I have had many people use Emu oil for a moisturizer but have never seen nor heard that it helps resolve bruising. I think the addition to a product to aid its absorption is likely not possible as it will not bind to most products that could do that. For hair loss I suggest ScalpMed or Propecia. Best of luck and hope things keep getting better. JG 10.8.08

• After I put on foundation, my face looks shiny (or oily) in my t-zone (middle forehead, bridge of nose and chin. What can I do to make it look less shiny/oily. Although I use those oil blot tissues- it still looks shiny/oily. I wear powder as well.

  Answer:  can try using a little Retin-A under the makeup to try to dry it up some. JG 10.6.08

• If you are having surgery on you body, not your face, then why do they tell you to waer no makeup? Like why does it matter if you have eyebrow pencil on your eyebrows?

  Answer:  they tell you that so while the anesthesia doctor is taking care of things around your face that the materials do not get into your eyes, many times they tape yoru eyes closed or put protective googles over the eyes. JG 10.6.08

• Would you please tell me what this means with regard to a brachioplasty? The incision is at the junction of the nedial and posterior aspects of the arm. Does this mean the mid center of the back of the arm or more toward the side of the arm; i.e., where the side of the arm meets the back of the arm?

  Answer:  should be in the midcenter. JG 10.6.08

• Someone I know had a fatty tumor removed from her leg just below the knee. After surgery, her thigh above the knee looked like it could have a fatty tumor since it stuck out more than the other thigh. She though it might be another fatty tumor because it hurts. However, the doctor said he also performed liposuction in knee area to help contour the leg after taking out tissue. How long is it supposed to hurt after liposuction is done in knee area?

  Answer:  it can hurt for a week or more in some cases. JG 10.6.08

• Say you have a double line under one of your buttocks. Or a double crease. Could that double line disappear if liposuction was done between the lines?

  Answer:  liposuction would make it worse. JG 10.6.08

• WHat is your opinion about peels like tca for helping skin probs like scars redness & brown spots> I know most people opt for lasers but arent peels good for skin integrity?

  Answer:  good for brown will make the red ones worse or leave them the same , not anything for the scars. Peels are no better than lasers. JG 10.4.08

• If you have a flat, tight belly where can tissue be taken to reconstruct nipples?

  Answer:  groin or buttock. JG 10.3.08

• I`m going on a cruise and know I will get my period during that week, which will really put a damper on my vacation. Is there a medication or anything I can take to delay it by a few days to a week? There isn`t a lot of time; I`m leaving on October 11th and my period is due that week. What, if anything, can I do to delay my period, in the next week?

  Answer:  I think you need to speak with your gynecologist about that, birth control pills are the most common option but not sure it would work in time. JG 10.3.08

• Dear Dr. Garcia, I had a Quicklift on 9/15/08 and developed a hematoma of the left side of my face. My doctor has been having me come in almost daily to have it aspirated. Today he drew less than 1/2 a cc and told me I could wait until Monday to come back. My problem is the scar tissue. It is quite a large area and very bumpy looking. My question is, is there anyway to help rid myself of this scar tissue more quickly than just waiting around for it to go away? I read on your website that massage helps but is it too soon for me to begin massaging it? I would hate for it to start bleeding again. Are there any vitamins/herbs I can take or creams I can use? I have been out of work for 3 weeks and have to return next week. I also had my lower lids done and a rhino tip. I still have bruises under my eyes that cannot be covered with makeup. Do you have any suggestions for fading? When I asked my doctor he just says it will take time. I would sincerely appreciate any help you can give me. Sincerely, Becky White

  Answer:  I doubt it is scar tissue at this point,it is too soon for scar tissue, that takes 6 weeks or more, it is most likely small localized areas of fluid or selling that occur after heamomas, we typcially use a series of ultrasound massages twice per week to help healing and I think it would be helpful in your case too. I would also suggest Arnica Montana tablets and bromelain, along with warm packs and light massage. OK to do them now. I guess you are finding out what most people find out about the QuickLift and that is the only thing quick is how fast the money goes out of the pocket and the time spent in visits after they have your money. Theses things happen and having good support from your surgeon is key, for now hang in there and give it time. All the best. JG 10.2.08

• I asked about my falling lashes. Thank you for your quick response. I`ve heard that people using revitalash lost lashes instead of gaining them. But i`ve had great rseults with Jan Marini. My only concern is if my product has expired and therefore is causing lashes to fall out. Unlikely, but possible. Correct?

  Answer:  very unlikely. JG 10.1.08

• I have really lush lashes and I keep them that way by never using mascara and I use Jan Marini`s eyelash intervention. I`ve been using mine for over a year now. I just noticed today that my left set of lashes seems unusually sparse and a few were on face, fallen off. I am really worried; why is this happening? could the jan marini eyelash intervention have expired or are my lashes just regenerating and will fill in on their own? maybe I can`t see the small ones but I am really worried....any thoughts?

  Answer:  hard to tell, lashes do fall out intermittently. I have not heard of that product causing the lashes to fall out faster though. JG 10.1.08

• In regards to the question I posted yesterday about the subcutaneous fat atrophy from a kenalog injection. How long does it generally take for this to stabilize? It is still getting bigger and the injection was given in the beginning of May `08. It started as a small dimple, but is now a cresent shape and approx. 5-6 cm. Also, with fat injections, where does the fat come from? Myself, a donor or an animal? Thanks

  Answer:  in general about 3-6 months, after which, what you see is what you will have. It depends greatly on the dose though, the larger the dose the longer the atrophy will go on for. Usually the fat is taken from abdomen, buttocks or love handles, it must be your own fat though. JG 10.1.08

• Dear Dr. Garcia, Thank you for your past kindness in answering my various questions. You have been so helpful. If you please, I would like to ask you a question about botox. I have received it 2 times over the past year to relax those 11 lines between the brows and have been very happy with the results. I know there can be side effects and am wondering if certain symptoms I am having are related to past botox treatments. My first treatment was back in January. 4 months later I developed fibromyalgia, which has been lasting now for 6 months so far. My first time with fibro was in 2003 and that lasted for 1 year--at that time I had no botox treatments. I had heard that after 3-4 months when the botox degrades, that your liver cleans in from the body. Can the botox moving through one`s body at that time cause a flare-up of horrible muscle and joint pain which is what defines my fibromyalgia? Thank you for your time and all your help.

  Answer:  I have never seen nor heard of Botox causing fibromyalgia, all the best. JG 9.30.08

• I have a fatty subcutaneous atrophy from a kenalog shot received for allergies. It seems to be getting larger and is a bit sore. How can this be corrected?

  Answer:  once it stablizes having fat injections is the most common method of correction. JG 9.30.08

• I had surgery 6 to 7 days ago on my face to reconstruct my cheek bone and around my eye. The surgeon went through my mouth and now i have stitches. I`m a smoker. I started smoking 5 days after surgery can cigarettes affect the stiches or cause any pain, or other problems?

  Answer:  smoking will slow the healing and you should stop if at all possible. JG 9.27.08

• 8 weeks after breast reduction, I am a smoker, poor healing at incision/anchor scar under the nipple. Silver nitrate was used, created a huge black scab. Also have a small, oozing hole under the nipple. The scab is wet, not crusty, and every time I get out of the shower, more and more of the scab comes. The skin underneath is red, sore, and VERY tender! I like to go topless at home, hoping to dry out the skin, but what to do at work? Can I use a bandage, like Adaptic, when I have to put clothes on? Do you recommend a wet bandage, just until the new skin heals a bit? Thank you.

  Answer:  I think Neosporin and Adaptic bandage at work are the way to go. Best of luck. JG 9.27.08

• i have a puffy vein that does not show up all the time, but i notice it in a certain lighting. its close to the bridge of my nose. do you know what that is, and if so, what can be done to make it disappear. thanks for your site.

  Answer:  they are difficult to remove, might have to be cut and stitched closed by a surgeon. JG 9.28.08

• Concerning your answer to my question about HCG weight loss programs: I have always appreciated your honesty. Thanks so much. You have saved me from wasting time, effort, and money. Thanks again for what you do.

  Answer:  my pleasure. JG 9.27.08

• Hi Dr Garcia, I had a thermage treatment done a few months back and have since noticed in the past 2 months an almond shaped indent in my lower eyelid. I think this can only be from the treatment and fear this is fat loss. I believe it can be helped with fillers but is there any chance that fat can regenerate or is this a permanent damage? Thanks

  Answer:  after 6 montsh whatever was going to come back will have come back.

• Please tell me what this means with regard to brachioplasty. Where is the incision when it is placed at the junction of the medial and posterior aspects of the upper arm? Would this incision be visible from the rear? Is this the same as and incision on the postermedial aspect of the arm?

  Answer:  if you draw a line from your armpit down on the inside part of your arm that would lie against your chest wall if you are where in the relaxed position, palm to the side of your thigh. It should not be visible from the rear. JG 9.25.08

• Hello Dr Garcia, What is your opinion of HCG weight loss programs?

  Answer:  does not work, is illegal to use that in many states for that purpose, actually in the PDR in the package inset it specifically says it is not aproveed for that and does not work. Programs that use it combine it with diet and exercise and that is likely the part that works. JG 9.24.08

• Thanks for your quick response to my question about my bruised eye. I tried to find some info on Yag laser. It seems there are quite a few different types. Can you offer me any help in finding someone in the Denver area or what I need to know or ask to make sure I am getting the right treatment. My eye is just slightly darker. Will is go away if I do nothing or could it be permanent? Do you THINK that insurance would cover treatment since it is a result of an injury? Thanks again

  Answer:  I would try dermatologists as they are the more likely ones to have on. Look for a Q-swiched Nd:YAG. I do not think insurance will cover it though as a bruise results in no medical limitation. Best of luck. JG 9.24.08

• I wrote about a month ago regarding a black eye (complimentary of a tennis ball). I still have some discoloration. You mentioned that it could take up to a month to go away. I am beginning to be concerned that it will not disappear. Can I do anything and is it possible that it is permanent?

  Answer:  could try a YAG laser to speed it up some, JG 9.24.08

• Dear Dr. Garcia, Thank you so much for all the salient information you provide.What do you think of the One Stitch Lift for an older person? I know that it is done in L.A but also at Harvard and the Cleveland Clinics.I don`t know anyone who has had it. I am obsessive about protecting my skin but I read in National Geographic that Titanium Dioxide may cause cancer when used as a sun screen ingredient. Also, how long does the effect of Radiesse lasts. I had a brief arthritic reaction after being injected (swollen fingers, redness) but I`ve developed a constant flushing of my cheeks , I am not sure if it was caused by the Radiesse but I was tested for some other possibilities and my tests were all negative.

  Answer:  I think Titanium oxide will cause much fewer problems than other sunblocks, as to the One Stitch Lift, if it sounds too good to be true, it usually is. As to Radiesse, I have seen it last varying amounts of time, but most patients do not get that long out of it. I have not heard of that complication from Radiesse. Best of luck. JG 9.22.08

• Doctor, Do you use Botox to treat facial pain? Yours in Christ, John

  Answer:  I am sorry but in my practice we do not, we only use it for cosmetic reasons. JG 9.22.08

• hi dr. garcia, what are the complications that might occur from going in the sun without sunblock whilst using retin-a? are you just more prone to sun damage or is the actual amount of damage caused intensified? Thank you!

  Answer:  easier sun burn and the development of hyperpigmentation. JG 9.20.08

• 8 weeks after surgery, breast reduction, smoker(sorry), have a small hole under nipple, hole is leaking fluid, what is this fluid, how long will it continue to leak, no smell to fluid, color is milkish white, could it be an infected stitch? Cover with dressing or no?

  Answer:  it can be a seroma which is essentially swelling fluid from the surgery, or liquified fat which has dissolved and is slowly being absorbed or coming out of the incision. I would let it drain. JG 9.20.08

• Do you think haloxyl works for undereye circles?

  Answer:  reports are about 60% of people respond. JG 9.20.08

• I had breast reduction surgery 7 weeks ago. I am having some problems with healing, mostly due to smoking. What is your idea of using pure, ntural honey to heal the wound? I have read alot about this treatment on the Net, and it seems to be an old remedy that works. But I am afraid to try it.

  Answer:  well, the problem is that the honey you buy might not be sterile so I cannot recommend it. The honey helps in wounds with infections though, not wounds that are slow healing due to poor blood flow like in smoking patients. JG 9.18.08

• Have a horrible C-section, hysterectomy scar that has keloided to the point where it is causing internal pain and is huge on the outside. Would ultrasound treatments be an option to this issue since scar revision may only work for a time before it comes back? thanks jacquie galvin

  Answer:  I am afraid ultrasound will not do much, could consider some kenalog or 5FU injections though. JG 9.18.08

• Dear Dr Garcia, Before I ask my question I just want to thank you for such an informative and helpful website. My question relates again to Thermage. I had 3 sessions spaced out over several months over the past year but using the lower frequencies which did not hurt. Since reading about this, the term microwaving your face has stuck in my mind and really freaked me out as I never thought of it in this way before. Although I don`t see any damage, is there any long term damage beneath the skin itself, as well as fat loss and in my case would I have seen signs of fat loss by now (I had my last session 7 months ago). Thank you

  Answer:  no long term damage that has been reported, if you have no negative effects at this point I would not worry. JG 9.18.08

• COMMENTS ON ARDELL LASH ACCELARATOR SERUM? WHERE CAN YOU BUY...? WALMART?

  Answer:  sorry, I do not have that information for you. JG 9.16.08

• I do not know what the cartlidge inbetween the nostrils is called? I had cartlidge from my ear added to the tip of my nose (the surgeon said my tip was shortened so he lengthened it). He shaved off the cartlidge inbetween my nose, which I liked. I want to have cartlidge added back inbetween the nose. The bottom tip of my nose is hard (scar tissue) and bulbous. I wanted the bottom tip of mose sculpted a little so it isn`t as bulbous and perhaps that tissue sculpted out could be added inbetween my nostrils? Is it possible ot reshape hard, scar tissue? Also, can a procedure like this be done with local?

  Answer:  it might be possible, will likely need some cartilage added but I seriously doubt it could be done under local. JG 9.14.08

• I wrote about this question awhile back regarding the man who lost his nose due to frostbite. His plastic surgeon grew a new nose on his forehead to transfer to his nose area. Is this considered cloning? If so, was it done in a clinical trial study rather than a regular surgery? I was wondering if you wanted to have some areola tissue regrown to cover up scarred areola tissue. If the areola tissue was grown on your body instead of in a lab, would it be considered cloning? To me, gorwing a another nose or extra areola tissue is the same kind of thing? What about burn victims who need to grow new skin= is that considered cloning? I guess my question is it possible in any way to grow more areola tissue from my own areola tissue to cover scarred area? Thanks.

  Answer:  no, that is not cloning, it is a skin flap that is transfered to the nose in two stages, the skin is reshaped into the nose but it is not grown on the nose. There is no cloning at present for what your concerns are, sorry. JG 9/14.08

• I am 53 year old female. How do i get rid of crepey sking on thighs and legs? Is there anything I can do?

  Answer:  I am sorry but I do not have any solutions for you. JG 9/14.08

• Dr Garcia, you have stated that thermage does not work.Why are so many saying that it does. I spoke with a person who said that they have improved on the technique,what do you think of that.They also show very convincing before and after photos.......if this is risky then what would tighten african american skin. Thank You for your advice.

  Answer:  Well, the claims they are making are the same ones they made when it was first released, if it was so good then, why then did they improve it. As to showing some pictures of good results, I think they cherry pick the pictures and the average patient will not get that degree of improvement. I do not think there are ablative options for darker skin individuals that are safe and the technology for heat based skin tightening is not effective at present. If you are so convinced it should work, I suggest you try it but when you are disappointed, remember what I said here. JG 9/14.08

• Is there any evidence that using retinoids can reduce scarring following surgery? I had neck surgery, not plastic surgery and am trying to find a way to minimize the scars on the front and back of my neck.

  Answer:  no evidence they will make it worse and no evidence it helps either. JG 9.11.08

• I would like to know how long should I be on metformin for pcos? I`ve been taking it for a month, and the nausea is intolerable, but it has started my ovulation cycle.

  Answer:  might need to decrease the dose, your physician can do that for you, it will never cure the PCOS though so many patients need to take it long term. JG 9.10.08

• do you remove the excess skin under the chin and what is the called

  Answer:  yes, it is usually called a neck lift. JG 9.8.08

• Hi Dr. Garcia, I recently had a surgery scheduled with a doctor that was frequently mentioned on the online message forums regarding plastic surgery. I became alarmed when I noticed anything slightly negative about the doctor was quickly attacked and discredited. In speaking with the doctor, I uncovered that his staff frequents the sites, I presume as a marketing strategy. My question is, is there a standard thought to Plastic Surgery ethics, and where is the line drawn with this type of behavior? Thank you. David

  Answer:  well, the blogs and message baords are really up for grabs, we as physicians, at least those that follow the general rule of ethics, are very limited in what we can say due tp potential disclosure of confidential information. That has become one of the biggest hurdles in that if a disgruntled patient says something on the web, the doctrr usually cannot say much without breaching patient confidentiality. There are occasions where the patient has other issues that contributed to the less than optimal outcome and the surgeon cannot disclose them. As to having staff members lurking and saying things, I would not allow my staff to do it but it does happen and there is nothing that can be done to stop it I am afraid, they are just as free to post as the patients that are unhappy are free to post. JG 9.8.08

• Dr. Garcia - I have heard of a lip procedure where they go inside your mouth and make the top lip show more? Is there a formal name for this surgery? What do you think of this approach to lip augmentation? Thanks.

  Answer:  there are many names for it, I will say that it can have some sensation loss with it and if done, the normally wet lip inside of the mouth is rotated outward and that can make for some constant scabbing and cracking of the lip as the mucosa will no longer be wet. I do not perform the procedure for those reasons. JG 9.5.08

• hi Doctor, ihad a cortisone injection intramuscular to the buttock for moderate/mild psoriasis which is on elbows, hands, and knees.. the dermatologist put the most in she could.for one treatment. this was last monday.. as of yesterday, my face has been the size of a balloon, and stomach only slightly bloated.. i know steroid (kenalog) in this large ammount has to go somewhere, and just wondering if my assumption is correct.. that it bloated my face.. do you think this is possible and how long will it take to go away, i m using advil to help out..thanks

  Answer:  I guess it could be that if all other causes have ben ruled out, it will get better as the dose injected becomes less and less, no way t tell how long though, might be a couple of days to weeks. Best of luck. JG 9.3.08

• hi,dr.Garcia,you answered my question about the scar earlier,you said that a scar can not be removed,can any doctor remove it or thats in general,because i see all these pictures online that show before and after and it looks like the scar is completely removed after the surgery,i just really want to get read of it and i just cant accsept the ideea that its impossible...

  Answer:  the scar can be surgically cut out and in many instances be made to look much better or be able to be hidden but there will always be a scar, hopefully a better one, but still a scar. JG 9.2.08

• hi,i have a burn scar(8-12 inches) on my right shoulder since i was 6 years old,now i am 24 and i am really selfconcious about it,is plastic surgery an option to get it removed? thank you!

  Answer:  hard to say without seeing you but I will say that any options will need to be staged, likely with a tissue expander so while doing that part it will look weird and the scar can be reduced but never removed totally. JG 8.31.08

• Hi Dr. Garcia, I had genioplasty surgery and then exploratory surgery to check the nerve due to numbness and burning of the lower lip. I also kept feeling like there was not enough room in my mouth. There is a build up of scar tissue on the left side that rubs against the inside of my lower lip. The Dr. sent me to a PT to do stretching exercises and maninpulation and massaging to break up the scar tissue. It does not seem to be helping. Is there any other way to get rid of the build up of scar tissue? Thanks for any help.

  Answer:  might need some kenalog injections or 5FU injections to soften the scar tissue. Best of luck. JG 8.29.08

• What do you think about the FDA approved device NuFace that firms your face using microcurrent technology? I am a skeptic and my friend says the FDA approved it so it works. Are you familiar with this?

  Answer:  the FDA says it is safe, not necessarilly effective nor to what degree effective, I would not waste your money on it. JG 8.27.08

• Hi Dr. Garcia, I`ve been reading a lot about cortisone shots and fat atrophy and how tissues recover from this. My shot was about 7 weeks ago, I have a small pea-sized indent that seems to have stopped denting further and some hypopigmentation. My questions are: how long might it take until the tissues start to regenerate, enough for me to visually see happening? how about the hypopigmented spot, is this from tissue damage that will fade over time as it heals? Thanks for your time and for this extensive archive of questions!!

  Answer:  it can take up to 6 months to get maximum filling in and about the same for the pigment changes. All the best.JG 8.25.08

• Is there some type of shoulder reduction surgery for males who undergo gender reassignment surgery?

  Answer:  none that I am aware of,sorry. JG 8.25.08

• If you have the prominent muscle removed above your eyebrows so you no longer need botox treatments, isn`t it like having facelift surgery? In other words, is the same incision made at the forehead hairline? I wear my hair back instead having bangs cover my forehead. Will there be a noticeable hairline scraline? Do some peopel lose hair at the forehead where the incision is made?

  Answer:  well, that is part of a forehead lift but not part of a facelift. The incision can be made behind the hairline to hide it in some cases. There is the potential for hair loss no matter where the incision is made. JG 8.25.08

• Hi Dr.Garcia I am a 20 year old female who is contemplating surgery for my jawline. I feel like my jawline is a bit too big for my face and would like to change the size and shape of it. I use to have an overbite but now after braces everything is fixed but just hate my jawline shape. I dont know what surgical procedures to possible consider but any advice would definetly help.

  Answer:  hard to say without seeing you, the jawbone can, in some cases, be reduced but cutting it down or burring it down, I would suggest seeing a plastic surgeon that does orthognathic surgery for that issue. JG 8.23.08

• Does health insurance generally cover scar revision or the removal of scar tissue?

  Answer:  unless it is causing a limitation of function, it does not. JG 8.22.08

• Hi Dr...I had posted the other day about going to a consult with a dr advertised that he could do facial(pal) lipo..well I went to my consult and he said that he could do the lipo along the jawline and above to the lower cheeks (about 2 inches along the bottom of my face going over to my mouth sides if I want)..the incision would be behind the earlobe so he promised no scars and he said the chances of it being lumpy were almost impossible (he said he does 300 lipos a year and has maybe ever had 3 people look a bit lumpy)...does this all sound right? Would you agree with this type of surgery? He said it would give me back the look of more defined lower face cause I feel my face is starting to droop but I am too young for a facelift (28). I just thought Id ask you before I booked a surgery! I also asked him if it would cause more drooping cause of loss of fat and support but he said no. just wondering if you agree Thanks dr!

  Answer:  well, there is going to be a scar, it will just be hidden behind the ear, as to the smooth results, it all depends on how much is taken out, the greater the amount removed the greater the chance for an uneven surface. I agree you are too young for a facelift but I cannot say how well that skin will shrink and as I have said before, it wil likely make you age sooner as time goes. I seriosuly doubt he does 300 facial liposuctions per year, maybe all liposuction taken together. Ask him what he does if it is not smooth and what he does if the skin does not shrink and see what he says.So I agree a little and disagree some too. JG 8.20.08

• hi again... i was wondering about the serum you said is whats coming out, its been 5 months now and the problem is still there. is it ever going to stop. it keeps closing then reopening, ive tried antibiotics many times. is it a contiuous cycle that will never stop because the tissue around it is damaged and weak, or is it a problem concerning the inside tissue ? please help

  Answer:  I think if it is still happening at 5 months you likely need a re-oepration to find out what is happening and drain the material out. JG 8.19.08

• Hello Dr. Garcia: I had a kenalog injection for a facial scar 5 weeks ago, overall worked well, flattened the tissue. I have a small depression and reddish/dark spot. Saw my PS today, he feels that the color will fade as it continues to heal and said the slight dip should fill in as new tissues regenerate. And that I probably won`t need a filler since it isn`t a deep indent. Just wanted to get your take on the situation and see if you agree. Thank you!!

  Answer:  I agree as long as you do not get more injections. JG 8.18.08

• i recently had breast reconstruction on my left breast. After 1 month after surgery, i noticed a yellow-clear fluid coming out of a little hole on the incision site. i had the fluid tested and there is no infection. what is this and when will the incision finally close, the incision is on the areola. what should i do...please help!!!

  Answer:  it is called serum and is the breakdown products of blood that was in the wound The incision will close once the pressure from the fluid slows, I think antibiotics are a good idea along with seeing your surgeon so they can stay on top of it. JG 8.18.08

• hi dr...i just posted about the facial lipo...thank you for your honest answer...do you think that happens...dents in the face??? ohh...and which situations do you deem it necessary or beneficial to do that procedure (facial lipo under the cheekbone)....in a really chubby face?? Thank you for your help!

  Answer:  dents do happen, more often with liposuction of the face as it is so thin and visible and the amount of fat is not large. I will say that in some cases, even with that being done, faces will still look chubby due to enlarged pockets of fat insdie of the muscles, some of this can be removed, the fat pads of Bichat, but not all. JG 8.15.08

• Hello Dr I hope you are well! I was just wondering...i have a consult next week for a dr...he said they do facial lipo under the cheekbone...is that safe and effective?? are there any negative side effects to that?? Like facial drooping?? Does this give good results? I don`t think you do this procedure...am I right? thank you :)

  Answer:  in experienced hands it is safe, yes. The negative side is visible or palpable undulations in the skin and premature aging due to loss of support of the skin. I very rarely find it necessary to perform it. JG 8.15.08

• HI DR GARCIA. I SEARCHED YOUR WEBSITE IN HOPES OF FINDING BEFORE/AFTER PHOTOS OF PATIENTS YOU HAVE USED 5FU ON. I HAVE OVER FAT GRAFTED FACE AND EYES AND DOCTORS WANT TO INJECT KENALOG.....BUT THE DIVOTS SCARE ME. I WAS WONDERING IF YOU HAVE HAD ANY EXPERIENCE/SUCCESS WITH 5FU IN ADDRESSING MY SPECIFIC PROBLEM. I AM LOCATED ON THE EAST COAST, BUT I COULD SEND YOU A PHOTO IF THAT WILL HELP YOU DETERMINE WHAT IF ANYTHING WILL HELP.

  Answer:  I typically use 5FU for that to avoid the depressions, I do not have photos to show you though and it is very difficult to show them in photos due to the two dimensions in photos. 5FU injections are done as a long series two weeks apart so if you would prefer that, I think it best to find a plastic surgeon or dermatologist close to you for the treatments, all the best. JG 8.15.08

• Hi Dr. Is it true that if you have a puncture hole wound or any kind of cut, they said not to eat or drink anything that is dark in color or your scar will be darken as it heal?

  Answer:  never heard of that one. JG 8.14.08

• I am not sure it would be herpes. I have had pimples before which squeeze out clear fluid until I can get out the bacteria trapped inside. Perhaps there is bacteria stuck in some area like those other pimples I had (it`s just that I can seem to get it to expel)?

  Answer:  go see your doctor. JG 8.14.08

• Is there some type of lab test that can be performed to see what type of fluid is coming out my pimple or whatever it is? I need to know what it is in order to heal it. I do know when my stitches were in, there was no fluid filled pimple. It formed after the stitches were taken out.

  Answer:  your doctor can send it for analysis at the lab. JG 8.13.08

• Say the clear fluid in pimple like thing on revised scar on cheek is a herpes virus, would it never heal? This has never healed so far. If it is caused by a herpes virus what can be applied to make it go away? Is there a chance it might be the small stitch lef inside that is causing the clear fluid? It doesn`t ooze like i know herpes sores do. It looks like a regular pimple, but clear fluid comes out instead of bacteria when I squeeze it.

  Answer:  no, it will heal once the herpes is controlled. You need to see your doctor, this is not something that can be diagnosed via cyberspace. JG 8.13.08

• Hi Dr. I was wondering if tanning your legs cover some of the flaws on calves such as indents or uneven fat injection of the calves?

  Answer:  it might to a lsight degree but not in all cases. JG 8.13.08

• In regars to question below about clear fluid. That is where I had scar revision. Surgery causes a herpes outbreak? I thought maybe it would be a cyst if not a pimple. I never have any other clear fluid pimple like things except where I had the scar revision. I don`t know if I can say it`s infected from a stitch underneath if it is not yellow or green colored?

  Answer:  herpes can occur in an incision, might be some serum too, impossible to say without seeing it in person. I think you need to see the doctor who did the surgery for an evaluation. JG 8.13.08

• What`s the difference between a pimple with clear filled fluid than a pimple with yellow or green pus on your face? Is the one with clear filled fluid even a pimple? Is it called something else?

  Answer:  the clear fluid can be a herpes outbreak. JG 8.13.08

• I had a small scar revised on the side of my nose. I kept getting a constant pimple there so I had it cut out again thinking maybe I had a stitch in there. Well, when the black stitch was taken out this time there was a tiny piece that fell back under my skin. it was too tiny to grasp with a tweezer. Now, I`m having a liquid filled pimple again. Is this due to the stitch? Is a black stitch dissolvable? Will a cortisone shot cure the problem?

  Answer:  cortisone will not help, the stitich will not dissolve and you might have to wait until it gets closer to the surface and then have it removed. JG 8.13.08

• Dr Garcia, I was wondering if you believe that (although its an extreme measure) tissue expansion could be an option for extensive acne scarring of the temples?. I was thinking that if a person is willing to trade surgical scars for bad acne scarring as well as the time that the expansion bag is in your skin. That tissue expansion could be a good option for completely eradicating acne scars.

  Answer:  well, it will allow a greater amount of skin to be removed, but the skin that remains will still have acne scars that while the skin is taut will look better, but as the skin loosens, the acne scars in the skin that remained will reappear, I personally do not think the trade off would be worth it. JG 8.13.08

• Dr. Garcia I would like to enhance the the appearance and volume of my butt. Can Artefill be used to achieve this?

  Answer:  I think the price would be prohibitive to use Artefil there.JG 8.11.08

• Hello. I think I may have PCOS. I have irregular periods, brown spots on my skin, mood swings, fatigue, food cravings, weight gain centrally around my abdomnal region, low sex drive, and infertility. I have not been diagnosed by a physician yet. My gynecologist doesn`t seem to listen to me. I`m 36 years old. Who do I see to help me? Another gyno, or do I have to see a pricey fertility specialist? Also, I`ve seen herbal systems online, do they work?

  Answer:  see a different gynecologist, I think you need prescriptions not herbs. JG 8.11.08

• Hi Dr garcia, It`s miss PCOS again. Would the Atkins diet be effective for weight loss w/ PCOS? Also, if I do Atkins, is there any benefit to the metformin? Sorry for the multiple Q`s, and I appreciate any knowledge you can give me.

  Answer:  I think the Atkins should work well and I think the Metformin can still help, yes. JG 8.10.08

• Hi Dr Garcia, I am 33 yrs old and recently diagnosed w/ PCOS. I need to loose 23 pounds and have started Metformin to increase insulin resistance and hopefully augment my weightloss efforts. I am considering Yaz OCP as well for hormone regulation. Could Yaz possibly augment my weight loss as well? Thanks!!

  Answer:  I do not think Yaz will do much in helping you lose the weight, sorry. JG 8.10.08

• Love your web, thanks so much. Does the new Jan Marini eyelash work as good as the old? What is the cost of you doing the Rhytec Portrait.If I have to stay in LV. how long, cost? Could you, give me a Dr. in Phoenix area. Thanks

  Answer:  according to the people I know that have used it, it does not work as well as the other that had the pharmaceutical product. As to the Rhytec, the downtime depends on what is done, light or deep, fees are about $4500 and I am not aware of who in Phoenix is doing the Rhytec, sorry. JG 8.9.08

• Hello Doctor Garcia: Can a kenalog injection (performed to soften scar tissue) cause a bump at the injection site? And if so, can it flatten and fade over time? I have some redness which I know can occur, but the area looks a bit bumpy and irritated, almost like there is a pimple there, but I can tell that there is not one. It seemed too coincidental to me that this developed a week after the injection.Thank you for this fantastic forum! TC in NY

  Answer:  the bump would only be due to swelling and should be gone in a few hours, no longer, I have not seen a bump form long term after a kenalog injection. In very rare cases there can be a small infection that can happen from any injection, might want to go back ad see who injected you to make sure all is OK, all the best. JG 8.8.08

• Dear Dr Garcia. I had scar revision with Monocryl subcutaneous sutures 6 weeks ago. Would you recommend massage at this point or wait longer? I am worried about causing the scar to widen but also the possibility of scar tissue binding it down. How long should I keep taping with Micropore tape? Cheers

  Answer:  I think massage is fine at this time, as to the Micropore tape, I also feel you can stop that now. JG 8.8.08

• hello dr :) i hope you are well. I just read in a magazine that a newer procedure is called the cool touch laser and that you can do that to the sides of the mouth and soften the fat...put a small puncture by the sides of the mouth and massage out the extra fat and it will also tighten the skin. I am 28 and have good skin..but its just kinds chubby on the sides of my face by my mouth and im scared to do buccle fat removal...what do you think about this???

  Answer:  sorry but not true, not effective. JG 8.7.08

• Is it okay to use Rogaine to the bangs area while you`re pregnant?

  Answer:  I would wait. JG 8.7.08

• Hi Dr. Garcia: I had a kenalog injection 3 weeks ago, facial scar on side of chin. Overall helped to flatten out some bumps, but I`ve noticed one spot that seems to be a bit reddened with a slight indent. Can injections cause redness like this? Will it fade over time, and will the indent fill in over time? Thank you!

  Answer:  yes, it can cause both the redness and the indentation, in most cases it is temporary but can take a few months to self-correct itself. After 6 months if the dent has not filled in it might need something done.The blood vessels can be treated with a laser or an IPL machine. Best of luck. JG 8.7.08

• :( I don`t want to look like Betty Boop ! I have some restylane left at your office. Not sure if it is enough for another aplication. Would love to get it done again. Have a great day now!!! You should live around the corner!Y gracias!!

  Answer:  call the ladies and they can tell you how much is left, see you soon. JG 8.4.08

• I got restylane applied by you. It looked awesome ...but it lasted no more than a month or two.. :( that`s why Im trying to see what will work better. Thank you!! By the way..im Gabby from O.C.

  Answer:  longer lasting is not always better as long lasting good can also be long lasting bad, especially in thin areas like lips, there it is not a 6 month time frame, usually shorter due to the motion and blood flow being high. JG 8.4.08

• Oh.. and what do you think of UltraSoft Implants for lips? Thanks again!!

  Answer:  tey look great as long as you do not move your lips and then you look like Betty Boop, I will not use them. JG 8.4.08

• Hi!! is fat injections on the lips better than dermal fillers, such as restilene? Will fat last longer? Thanks!

  Answer:  I personally do not do fat injections into the lips as therw is a lack of finesse and the longevity is quite variable. I do use Restylane frequently there though. JG 8.4.08

• Hi Doctor. What is your opinion on mesotherapy? Does it actually get rid of fat and cellulite on the body or is this just a lot of hype? I`ve been reading a lot about it and it`s quite expensive and don`t want to invest money on a procedure that doesn`t deliver.

  Answer:  I do not believe mesothrapy works. The results are unreliable at best. I would save your money. JG 8.3.08

• Have you heard of Mona Vie, and is it a product you would recommend? I’ve been told most Doctors would love their patients to take this? Thank you for your time

  Answer:  very little to no scientific published research on it, in general the products like that which are sold through multi-level marketing firms are overpriced. I do not recommend any MLM products over normally purchased products to my patients. I am not sure where they got the information that most doctors would love their patients to take it though, sounds like a publicity or marketing firm statement. JG 8.2.08

• Do you know if time if birth is when a baby`s head appears or when the whole body appears?

  Answer:  I believe it is the whole body. JG 8.2.08

• Does the type of upper lip lift that you perform lift the corners of the upper lip and mouth or is the lift primarily in the center of the upper lip. Also, do you perform lower lip procedures that tighten the muscle for a drooping lower lip? Many thanks.

  Answer:  the degree of corner of the mouth lip lift depends on the procedure chosen and to some extent the width of the nose base and at times the distance between the corner of the mouth and the nasolabial fold. I do not perform lower lip tightening procedures, sorry. JG 8.1.08

• I asked the question below about the nose tip revision. My nose tip was pointed, and I had surgery to make it curve in a little. Six months after the surgery, it is still pointed in the profile. Does this mean the surgeon did not curve my tip in or will it stay pointed if that`s how it is after 6 months?

  Answer:  hard to say without seeing you but it likely will not get any less pointy with time. JG 7.31.08

• Dr. Garcia, I am 35yo male and don`t have sharp jaw line anymore and the skin below the chin seems to hang a little, it doesn`t stick to the muscle. I don`t think the platisma muscle itself is sagging, nor I have fat there. I am looking for a treatment to make the skin snap back on the muscle as in my younger years. Would Refirme help with that? I don`t have jowls or anything like that, just the skin seems not to stick to the muscle below and I was thinking, shrinking the skin will make it stick to the muscle better.

  Answer:  I do not think any non-invasive laser type treatments will reliably fix the lax skin on your neck, sorry. JG 7.31.08

• I`d like a one off Botox treatment for my wedding day for crows feet, frown & forehead lines. I don`t want to be expressionless. Can you please advise how long before the wedding I should have this done and what I should be asking for and is there any risk of droopy eyes etc? Also do you have an opinion on Skin Doctors Cosmeceuticals Instant Facelift? Thanks so much

  Answer:  I suggest getting it done 2-4 weeks before the wedding as it might take 10 days for it to work and that way you have time for a touch up, sorry but I have no experience with the Instant facelift product, all the best. JG 7.30.08

• Is IPL a waste of money? Are there any lasers that aren` waste of money?

  Answer:  IPL works well for controlling Rosacea, for brown and red spots. For wrinkles the CO2 regular laser (not fractional)and the Rhytec Portrait are good, the Rhytec is less effective. There are many lasers that work well, but many are marketed aggressively and show little effect for most people, especially the ones marketed for tightening skin. JG 7.30.08

• Even in the summer time, I try to stay out of the sun. Do you know of any side effects this might cause (if a person stays inside most of the time or works a long hour day which they don`t have any time to get outside)?

  Answer:  loss of Vitamin D. JG 7.29.08

• I asked a question about cloning. I know there has been hands on lab research for cloning fat for breast mounds in the USA. That is why I got the impression that it is alright to regrow tissue. I know the government doesn`t fund stem cell research, but I think labs can do research if it`s privately funded. So, is tissue cloning legal for research experiments only?

  Answer:  correct, only for reasearch, and to the best of my knowledge it is not being done on humans in any fashion. JG 7.29.08

• Have you heard of the Acne Free In 3 Days, 100% Natural ? www.acnefreein3days.com It involves doing an enema each day of the 3 day process! Does this all natural detox approach work? Thank you

  Answer:  I am afraid that it will not do what it promises. JG 7.28.08

• Do you think the problem with buttock implants looking unnatural could be solved with cloned fat mounds for the buttocks?

  Answer:  I do not think so. JG 7.28.08

• Is it legal to clone body tissue in some countries? Do you which ones?

  Answer:  no, it is not legal. JG 7.28.08

• You get a lot of questions which must take up a lot of space. How long do you store questions in your archives?

  Answer:  the page that loads is thinned out but the archives store the question indefinitely. JG 7.28.08

• Is it legal in USA to clone body tissue for cosmetic surgery (whether it be breast fat mounds, etc)?

  Answer:  sorry, but no, it is not. JG 7.28.08

• Do you think eyelash transplants work? I have too many eyelashes growing on certain parts so I have to tease them. I was thinking of transplanting those unwanted eyelashes to the area eyelashes are missing. The center of my eyelashes has missing eyelashes. It is more noticebale since it`s right in the center. There issomethign called a scarless FUE technique (well, that`s for hair transplant). Do you think this proedure will work? Will the transplanted eyelashes grow in kinky or in the wrong direction?

  Answer:  yes but they are challenging to do. They usually grow in the correct direction if done by an experienced surgeon. JG 7.28.08

• What exactly do these Ingredients do? : Calcium Carbonate, Titanium Dioxide, Zinc Oxide. The claim being made is: For excessive, stubborn blackheads, this oil absorbent powder will help to unclog congested pores. Absorbs excess oils to prevent blackheads and promotes a healthier complexion.True? Thank you for your time.

  Answer:  not sure it will work. JG 7.28.08

• Is is safe to dye your hair if fertilization has happened, but conception has not happened (in regards to preganancy)? In other words, do you need to avoid hair dye when fertilization or conception happends?

  Answer:  should be safe but hair dyes have neve been tested for safety. JG 7.27.08

• Why is it some plastic surgeons say that radiesse/sculptra fillers and fat injections will become permanent if you have a few injections over time? Then other plastic surgeons say it will not become permanent? Why is there a difference in opinion?

  Answer:  wishful thinking in order for them to convince someone of somethig in order to get them to have to procedure done.If I were permanent, on the fat injection part, all of the other on the shelf fillers would not exist and if the off the shelf fillers were nearly permanent the amount sold would decrease not increase. JG 7.27.08

• Which will last longer= fat or other injections in undereye hollowness?

  Answer:  I think fillers such as Restylane will last as long with less downtime, neither is permanent. JG 7.24.08

• Thank you for your response on weather or not to consider a skin graft. Would the procedure you are talking about go through a plastic surgeon or dermetologist? I am waiting on a referral from my Dr. so I may be seeing you soon if it goes through a plastic surgeon. Thank you so much and if I am a good candidate for this procedure that would be great, I just want the pain to go away and I want to feel like a normal woman again! Thanks again!! :o)

  Answer:  in most cases if it is going to be cut out it is done by a plastic surgeon while the dermaologist would do the injections of kenalog. JG 7.24.08

• Do fat grafts for undereye hollowness tend to become permanent since they are harder to dissolve?

  Answer:  if they form scar tissue they can be removed with surgery, but in most cases it just dissolves over a few months. JG 7.23.08

• Do most pregnant women get stretch marks? Also, do most pregnant women have permanent abdomen fat after they have baby (which you can only ge rid of by lipsuction)?

  Answer:  most get at least some, it varies though, but if you grow quickly they have a greater tendency to occur. Having a baby does not mean you accumulate fat inside of the abdomen, a healthy pregnancy only needs about 25 pound weight gain so if you keep to that there should not be much extra fat anywhere. Liposuction can only remove fat from below the skin, nothing below the muscles, so whether fat can be removed with liposuction depends entirely on where it is located. JG 7.23.08

• How often do you have to do revisional surgery for your patients? How do you handle the situation when your patients are COMPLETELY unhappy with their results? Have you ever had a patient that, even after revisional surgery, was dissatisfied?

  Answer:  I think revison rates of about 5% are the national norm, if it is something that I feel did not heal well there are times when I will do the revision at no charge, there are times when I feel all healed well but the patient wants something more and in those cases I might waive the surgical fee and only charge the operating room costs and the anesthesia costs. If the patient has aged or had expections that were not reasonable, then I would charge the patient again, all depends, no set answer. I have had patients that after one or two surgeries look tremendously better, to the point that their friends think they look great and they are still not happy. Happiness is inside of the head and what we do as plastic surgeons is psychiatry with a scalpel, some pateints, no matter how they look will not be happy, and some patients no matter what physical deformity they have are ecstatic. If one does sugery to make some one happy, there is no guarantee of the happy end result. JG 7.23.08

• I have a keloid scar that i`ve had for over 10 years on my chest. I had comsetic surgery to have it removed and it came back bigger. I have since talked to a friend and she told me to check into a skin graft, can you please tell me what your opinion on that is? I don`t want to do injections because they hurt to bad I just want this scar removed for painful and self esteem purposes. The size is approximately 3.5 inches. You response is appreciated. :o)

  Answer:  I think that would be a mistake, it might lead to yet a larger keloid on the chest and a keloid at the site where the graft was taken from, could consider re-excision of the scar followed by XRay therapy. JG 7.23.08

• Hi dr...i have a question about facial fat loss...it the skin always loose or saggy when weight is lost?? How come some people it doesn`t look saggy?? Especially celebrities. Does it help if one is younger?...oh and mainly...does everyone lose weight in the same spots on the face...like the midface...or does it vary from person to person?? just wondering..thank you!

  Answer:  it varies from patient to patient as the degree of fat loss is different and also the skin quality as well as the underlying bone structure. Good bone structure means better support and good skin quality means better tightening. Also where you lose it varies between people, they do not all lose it in the same area. JG 7.22.08

• Thank you for answering my question about fine lines undereyes. Please advertise on your site, when the cream for dark circles is available, I will be one of the first to purchase it!!! thanx again

  Answer:  will do, we are very close after over two years of testing. JG 7.21.08

• Which fillers are best to fill in hollow area under eyes? Alsom which fillers last the longest?

  Answer:  the only fillers I would suggest would be for the orbital rim and not the hollows of the lower lids above the rims and for that I use Restylane JG 7.20.08

• Dr Garcia, I have lines coming down from the corners of my bottom lip giving a puppet look, what options are there for me? (from the least invasive on-I am 58) Also, are there new ways of doing a facelift where you won`t have the scar in front of your ears?

  Answer:  fillers such as Radiesse or Restylane, followed by a cheeklift and then a facelift. Scars in front of the ears are need, usually, especially if there is loose skin, if not then you will have a pleat of skin in front of the ear when you pull the tissues up. JG 7.20.08

• Don`t know if you could help me butI had a lip lift also known as upper and lower lip advancement 2 years ago. To be more specific on what I had>>>>> A lip lift is performed to shorten the long lip of aging, allowing the upper teeth to show slightly when the lips are slightly parted. It turns up the upper lip creating a fuller appearance. A wavy ellipse of skin under the nose-lip junction is removed (average 5-7 mm). It involves an incision along the border of the upper lip. Once the incision is made the doctor removes a tiny strip of skin where the upper and lower lip meets. The lip is then pulled taut and stitched into it`s new position. It`s kinda like a face lift where the lip is pulled up. I have small incisional scars around the mouth. The final white scars are difficult to see. (I had the bottom lip done as well.) I have NO implants, injectables or fillers. MY PROBLEM IS that my scars on my lips feel very hard, tight, firm and obviously very uncomfortable for me. I also have nerve (painful) sensations....(burning/tingling sensations and sensitive to hot and cold temperatures.) My lips obviously move a lot which constantly pulls on the scar and is very uncomfortable which acts as a constant irritant to the scars, causing them to remain irritated, inflamed, etc....It is also annoying because I constantly feel the scar tightness when I talk. Do you know of any solutions that I can do with the scars as in make my lips SOFT, SMOOTH, and to get rid of the sensitivity?? (I have tried all sorts of massaging scar creams (Mederma, Preferon, Scar Zone, etc...) to massage the scar but they do not help.) I have suffered 2 years from this and don`t know what to do. (I have never been able to enjoy my full lips because of this.) My doctor who did this job is not a very good one...that is obviously why I am getting info elsewhere. Any advice would be greatly appreciated!! Thank You.

  Answer:  I think you will likely need some injections to attempt to soften the scar tissue, I use either 5FU injections or kenalog for that, sorry to hear about the troubles, best of luck too. JG 7.19.08

• Sorry for all these questions, but I am very curious. How did you learn of FOLDING OF TISSUE ABOVE THE CHIN PADS MUSCLES? Is it taught to plastic surgeons or have you seen any patients with this problem? I`m just curiosu if others have it in order for the condition to be known about.

  Answer:  it comes from the knowledge of anatomy, from operating in that area and undestanding how the tissues interact in a dynamic fashion, nothing special to plastic surgery, anyone with knowledge of the anatomoy and appropriate analysis should be able to figure it out. I see that in a number of patients, is more common as one ages but can be seen in younger individuals too and is more common in people with smaller chins. JG 7.18.08

• Is FOLDING OF TISSUE ABOVE THE CHIN PADS MUSCLES inherited? Does it run in the family?

  Answer:  yes, in the sense that the amount of tissue below the skin and above the muscle is genetic, as is the degree of motion and size of the muscle too. JG 7.17.08

• Hi Dr!! I have written before about a rev. abd. scar that needs to be raised up to be within the breast crease area better. In addition, he will be doing a R breast capsulotomy (grade 2 contracture) and he also needs to recreate the L breast crease which has been lost due to the pulling and pressure created by the rev. abd. He feels confident that he can do this all in one procedure. I am nervous because my two breasts look considerably different (picture the L one soft and natural looking, but loss of the natural crease under it and the R breast looking `tight` and round). I don`t even know how he is going to measure `where` to raise the rev. abd. crease to when the 2 breasts aren`t even the same right now. Should we consider doing the R breast release first, see how the breast forms and then go back in and raise up the rev. scar? He doesn`t feel this is necessary. ALso, he told me last time that he feels `confident` in the way he is going to approach the rev. abd. revision. He explained by using a series of 5 vertical permanent sutures applied under the skin and attached to the layers of tissue underneath (these will be placed lower than the scar in order to reduce the tension on the scar.) I have done research and other Dr.`s have attached the tissues and scar to the 5th rib/intercostal area underneath? My Dr. does not want to do this. In your opinion, could you give me some intelligent, critical questions that I should ask him during my pre-op visit to make sure that all bases are covered? One more thing: would it benefit me to lose possibly 5-10 pounds so that when he revises this, he has more skin to work with and little pressure on the scar afterwards? I am having a terribly hard time finding resources on specialists in this area of plastic surgery. Any websites where I might be able to find `the best ones` in this area of ps?

  Answer:  well, it might be best to do the surgeries split up because the abdominal scar will want to pull down and you want to limtit the downward pull on the side where you are recreating the fold. JG 7.17.08

• I am curious if there is a surgery to unfold the tissue above the the chin pad muscles?

  Answer:  nope, just Botox to help for a while, not permanent. JG 7.17.08

• How is FOLDING OF TISSUE ABOVE THE CHIN PADS MUSCLES caused?

  Answer:  the muscles contract below the skin and cause it to fold, just like around the corners of your eyes. JG 7.17.08

• Hello Doctor Garcia, do you feel that kenalog injections are generally effective in softening and flattening lumpy scar tissue? How long after the injection until results might be visible? I have read that this process takes some time until the crystals dissolve. Thank you!

  Answer:  it does help, but it typically is a series of injections done every 4-6 weeks, no way to tell how many it will take but there should be a change seen to some degree after the second or third injection if it is going to work, depending on the dose used. JG 7.17.08

• Just wanted to know if FOLDING OF TISSUE ABOVE THE CHIN PADS MUSCLES was common?

  Answer:  no, not really. JG 7.17.08

• REGARDING THE FOLDING OF TISSUE ABOVE THE CHIN PADS MUSCLES, CAN IT BE IMPROVED? WILL LASER RESURFACING IMPROVE IT? DOES EVERYONE GET THIS, AND HOW IS IT CAUSED? THANKS.

  Answer:  could try low dose Botox but it can affect the muscle to the extent that the lip gets weak if too much is injected. Laser will not help a dynamic line. JG 7.16.08

• What can you do for cellulite? How long does treatment last?

  Answer:  VelaSmooth, need 6-12 treatments and then a monthly maintenance, nothing permanent. Sorry. JG 7.16.08

• THIS IS NOT NOTICEABLE UNLESS I SMILE BIG WITH MY MOUTH CLOSED AND MY LIPS PRESSED IN MY MOUTH. THE WHOLE CENTER OF MY CHIN LOOKS LIKE MAJOR SCAR TISSUE (WHEN I HAVE NO SCARRING THERE). WHAT COULD THIS BE? DOES THE CHIN AREA TEND TO LOSE COLLAGEN MORE THAN OTHER OTHER AREAS OF THE FACE? WOULD SOME TYPE OF FILLER IMPROVE IT IF IT IS DUE TO LACK OF COLLAGEN?

  Answer:  it is folding of the tissue above the chin pad muscles is all. A filler there will not work as it is a dynamic fold and fillers are best used for static lines, otherwise it will look like a lump when relaxed. JG 7.16.08

• Hello Dr. Garcia, I had a kenalog injection today at both ends of a facial scar (the scar is 1 year old, surgeon is trying to flatten the lumps at the ends). It is a bit swollen and feels firm to the touch. Is this the actual kenalog that I feel? How long until it settled down and puffiness goes away? I`m trying to get rid of the lumps and I feel like I temporarily have more of them!! Thanks for your time today.

  Answer:  it is just the swelling from the kenalog being injected, that will all go away in a day or two. JG 7.15.08

• I HAVE A 2.5 INCH CIRCULAR INDENTATION ONE OF MY BUTTOCKS. I THOUGHT OF HAVING FAT TRANSPLANTED THERE. I HAVE NO EXTRA BODY FAT SO I THOUGHT MAYBE I COULD TRY IT AFTER I`M PREGNANT. OR I DON`T KNOW OF IS HOULD USE SCULPTRA? WHICH ONE WILL LAST LONGER? WILL MY OWN BODY FAT EVENTUALLY STAY IF I HAVE IT INJECTED MORE THAN ONCE?

  Answer:  Sculpta would be OK to try, and do not let them give you any more kenalog injections with an improper needle in the future. JG 7.15.08

• What do you think of the LD20K (diode) hair emoval laser? Does it work? If not, why?

  Answer:  I have not seen any patients that have used it but I think the Alexandrite laser is better for hair removal, none work great though. JG 7.14.08

• I have a couple of slightly raised moles that I want removed from my abdominal area. Would lasers make a significant difference? Would freezing or burning the mole off leave a scar? I would appreciate your reply.

  Answer:  freezing, burining or lasers all might leave a scar there as the abdomen does not heal as well as the face. JG 7.14.08

• have you seen bruises that are permanantly dark is there a treatment? thanks

  Answer:  the blood can on occasion stain the skin and if it is due to that, YAG laser can help in some people. JG 7.13.08

• Dear Doc. Is there ANYTHING I can do, take, or use to reduce the swollenness and redness if a cystic pimple while it SLOWLY heals! At least if the swollenness and redness where reduced I could cover it with makeup. Thank you for your time.

  Answer:  warm packs, massage and oral anibiotics. JG 7.13.08

• hello Dr. Garcia I am an African-American male with some significant back of the head fat. From a side profile you can see that it hangs over like a lip. The funny thing about this is that I`m what you would call athletic. For years i tried dieting, exercising, and even the extreme bandaging to see if some compression might redistribute the fat cells but that came with no avail. Recently I have search online for a solution to this problem and even was recommended to use a rolling pin which I`m not gonna dare try. My question to you is there any procedure that reduces these head jelly rolls without an appearance of radical scarring.

  Answer:  I am afraid that it is not much fat but more skin and muscle, it is a genetic issue, the only solution is to have it cut out and that leaves a permanet scar I am afraid. JG 7.13.08

• Hi Dr. G- I had kenalog injections for swollen bag over each portion of my upper cheekbone. First, I would like to know what causes fluid to coolect in these areas, as I have had this even as a kid. The injection worked on both sides and I was very happy with the results. However, on ones side the swelling came back. My doctor said she only use a tiny bit to see if I would respond to that, and if it didn`t work she would inject it again. Now she says the kenalog didn`t work for me and she will not inject the one side where the swelling returned. I am very sad about that because the other side look great and has stayed that way! What would her reasoning be to not give the other side a tiny re-injection since the swelling returned there? SHould I go to another doctor to get a tiny injection or should I leave it alone???? Thank you in advance fo ranswering my questions.

  Answer:  the fluid collects there because there is a watershed area where the muscles of the areas do not completely abutt to on another causing a small seperation that allows the fluid to accumulate there. The injections I am afraid are not permanent. I do not think kenalog injections ar a good long term option due to potential tissue loss. JG 7.13.08

• I had rhinoplasty done 5 months ago. Actually, it was just the tip of my nose worked on. It doesn`t look much different than before I had surgery. The point of surgery was to make more of an indented curve at tip of nose since it was more straight or not curved. Could it still be swollen? Again, I don`t notice a difference in my nose since the surgery.

  Answer:  the tip of the nose, even after a smaller operation can take up to one year to show the final result due to the swelling only getting better when you are lying down, while standing the swelling cannot improve much. JG 7.11.08

• Does you labia stretch bigger after you give birth? I was considering labiaplasty surgery. I have never been pregnant and don`t know if childbirth stretches it permanently. I just don`t want to have the surgey, then have the tissue stretch so it would be like I never had the surgery.

  Answer:  they can stretch with the pregnancy, but not always. JG 7.11.08

• Can scalpmed be taken even if your hair doesn`t fall out, but you want to go from a shaved head to longer hair?

  Answer:  yes, it can. JG 7.11.08

• Hello Dr. Garcia. I`m 38 and have very severe darkness around my eye not just circles. The area is black. Concealer can`t even over it. The darkness is around the entire eye not just underneath. My lids are dark as well. But it`s the underpart that is most noticeable and is spreading and darkening as I get older. I am desperate. I just got divorced and meeting people with this glaring problem is erroding my self-esteem. Is there any hope? I`ve tried every over the counter product on the market. I`ve also tried tazaorac. The doctors I have seen tried Fraxel and prescribed Elidel. This has not worked. Another reconmmended fat injections. Have you ever seen anyone with this condition? I have not seen anyone with darkness as pronounced as mine.

  Answer:  it is a gentic issue with the skin, seen more in certain ethinic groups, lasers might help a very small amount and might be worth it if you are so concerned, I do not think topica creams will do much, wish I had more to offer. JG 7.11.08

• 10 years ago I stopped waxing and using hair cream removers on my cheeks for fuzzy peach hair. Ever since instead of the hairs growing in flat or laying flat across my cheek, they stick up straight! Tey`re blond hair so I don`t know if a laser can get rid of them. What made them grow in sticking out and is there anyway I can get them back to the way they used to gorw in (laying flat on my cheeks)? I suppose in certain light different sections of the hair can have a little black color to them so I don`t know if a laser can help or if that would be considered pigmented hair. The color looks mostly blond like peach hair color. I would say the length is about 1/4 inch.

  Answer:  if they are blonde the lasers will not work too well I am afraid. They are more of a baby hair type called villus hairs, pretty typical after years of treating them the way you did, not much to do except, pluck, wax or electrolysis. JG 7.10.08

• I had a small scar revised on my cheek. It`s been 6 months now. However, it is still red probably because I keep getting a pimple (bump) there. Will I always get a pimple there week after week? What is causing a continual pimple (which bacteria is squeezed out)? Do I need to have it revised again to prevent constant pimple?

  Answer:  the pimple might be due to one of the stitiches that was there,once that gets under control the redness should fade with time. If oral antibiotics do not take care of the recurrent pimple, a small excision and repat closure might be needed, yes. JG 7.10.08

• I have always been skinny, bu tit looks like I do have some cellulite on sides of buttocks. I have eating lots of fatty, junk foods. Just wondering if this bad fat from junk food causes cellulite?

  Answer:  no, food does not affect cellulite, it is a genetic thing where there are short attachements of the skin to deeper tissues, skinny and heavier people can both have them. 7.10.08

• Dear Doctor, I take 6423mg of fish oil a day. My friend says that is too much. Right now I have an acne cyst and was thinking of taking more for the swelling! What do you say? Thank you much

  Answer:  some people require more than others, I see nothing wrong with the amount your are taking, but I do not think it will do much for the acne cyst by taking more than you already are. JG 7.9.08

• Would you say those department store undereye circle brightners/lightners are a waste of money?

  Answer:  yes I would. JG 7.9.08

• Dr. Garcia, I completed a 12 treatment session of microcurrent facials in November, and have since noticed that one side of my mouth droops (no chance of Bell`s Palsy). Can this be a side effect of these facials and is there a chance that my face will return to equal balance, and how long a time period will be necessary? Thank you very much.

  Answer:  I do not see how that can be due to the microcurrent therapy. Not sure what the cause is though. JG 7.8.08

• what happens when you get the stiches out of the stomach out from a hernia operation 7 days later and puse start coming out of one of the holes alot of puse yellow stuff gushing out!! am very concern it was on my belly button where i got operated my belly button was out and the doctor put it back in what does that mean the puse part?

  Answer:  sounds like you might have an infection, I urge you to see the surgeon as soon as possible. JG 7.7.08

• Starting at what age do you usally do a jowl lift (not sure if I spekked it right). Is it jaw lift instead? It is to the lift the skin near the sides of the mouth which is starting to droop. I think the mini face lift lifts the whole cheek area which is not drooping. Just the skin at the smiles lines area is drooping.

  Answer:  there is no set age, that all varies from patient to patient. If it is just the jowls in some patients that can be corrected with a cheeklift alone without the neck part. JG 7.7.08

• Hello again Dr Garcia, Thank you so much for your response to my query re:IPL for red veins and accidental hair removal dated 7.4.08. Apologies for asking again, but I did not make it clear that I meant the hair line to the brow/border around my face, not my eyebrow hair. Does this make any difference? Thank you again for your kind response.

  Answer:  no difference, it will still grow back in time, but faster than the eyebrw hair. That is easily avoidable though in the future. JG 7.7.08

• Would it be okay to use retin-a under your eyes while pregnant? If not, why?

  Answer:  the safety of Retin-A has never been studied on pregnant women so I would nt recommend it. JG 7.7.08

• Have you heard anything about cosmetic toe surgery? Are most patients satisified or do they suffer from loss of feeling in toes?

  Answer:  I have heard of some podiatrists doing that but I cannot tell you what the chances of loss of sensation would be. It is not something I perform. JG 7.7.08

• Is it common to have the eyelid lasered (for creases)along with the undereye area? Do many people have their eyelids lasered?

  Answer:  it is common and I think a large number of patients with taht concern do get it lasered. JG 7.7.08

• Can you have local (instead of being put under)for laser resurfacing under the eyes?

  Answer:  in some patients that are tolerent, yes. JG 7.7.08

• Hello Dr. G, This question is in response to your answer reqarding my question on the new Fraxel Repair Co2 Laser Tx. I also was inquiring about the need for Botox after this procedure and your response was most likely. Then you talked about how Botox is supposed to be administered as a single use bottle even though in comes in 100 units vial. It is not to be used on multiple patients, correct? What if they clean the bottle each time with aseptic technique and always use a clean needle? Also why does the maker of Botox distribute it in such a large volume when most people do not use that much? Why not produce smaller bottles? What about just saving the 100 unit bottle for one patient and use it only on that patient? Again, thank you for your input on this matter. I am scared because I only use small amounts of Botox with each visit and my PS office have never mention this issue ever. I am now going to inquire what their policy is on this matter. Best Regards, LL

  Answer:  even if they do that, there is a potential and in either regard, it is still in direct violation of the labeling the company and the FDA`s approved. I do not suggest that practice be carried out. The company has recently produced a smaller 50 unit vial, although they had the OK to do so back in 2002. That is better but it is still 2 1/2 times the only approved usage dose. The problem with saving the bottle for the same patient is that the Botox becomes inactive after a certian amount of time after it is mixed. Best of luck. JG 7.7.08

• If someone had cheek implants removed because they looked unatural (you could see the outline), would there be some scar residue left behind (from creating pockets in cheeks)which might give the appearance of a small cheek implant?

  Answer:  a very small amount I feel. JG 7.6.08

• I want to have my undereye chikcen texture skin lasered. However, I do not want to stop using retin-a in order to show a doctor what my undereye chicken texture looks like. The retin-a improved the texture so it doesn`t look as bad as it does without retin-a. Can a doctor laser the area if they don`t ntoice the chicken texture skin since you`re usuign retin-a? Also, can the laser go all the way up to underneath your lower lid? And do patients find it is easy to cover up the underye redness with a makeup concealer? I know it is harder to cover up the redness if your while face is lasered.

  Answer:  yes, it can still be lasered without stopping the Retin-A. I usually laser all the way to the eyelashes. The make up to cover it will be able to do it after about three weeks if done deeply. JG 7.6

• Does the c02 laser get rid of the chicken texture in undereye area? I realize the skin of lasered area will go back to way it was in 2-5 years, but does having the chicken texture lasered minimize the chciken texture any? What I mean is will there be less chicken texture in 2-5 years (after laser results wear off) than you have now (before it was lasered)?

  Answer:  it does help but it is not permanent. If you do not have the laser done, the degree of chicken texture will be worse than if it was lasered. The lasered skin will always be better than if never done. JG 7.5.08

• Hello Dr. Garcia - I had my first of a planned course of IPL treatments carried out two weeks ago to improve red veins and background redness in the centre of my face. However, by accident the dermatologist also appears to have caught some of the hair o the border of my brow area which was singed and almost the entire area of hair has now fallen out. He assures me that this will recover in time as the IPL frequency used for hair removal is different to that used for skin improvement. Could you please provide you opinion. Thank you.

  Answer:  yes, I agree with him, but the hair there grows slowly so be patient. JG 7.4.08

• My husband has a birthmark on his rt. leg behind the knee. I would like to know is there a birthmark removal available? If surgery/ skin grafting is available,do you do the procedure? What type of a procedure is it called?

  Answer:  I think it can be lightened with a YAG laser but it might not totally go away and surgery will leave a potentially bad scar in that area. JG 7.2.08

• is sculptra safe or can it be used in temple area to fill up area same question for inner corner of eyes (more near inner corner of top lid) in not what would you use?I dont have any wrinkles but it appears eye area has kind of sunkin appearance I hate whats happening and there is sort of small fat pocket on left upper lid what caused that and what could be done I can tell a brow lift would not change this appearance thanks

  Answer:  it is commonly used for the temple area. As to the inner upper eye, I am not sure I would use it there. Filling in the lost fat of the eyelid is a much harder thing to fix I am afraid. JG 7.1.08

• To get the effects with retina-a for chicken texture skin on underye circles, will co2 laser get less, the same or better results? If so, how many laser zaps does the underye area need and how long will the effetcts last? I know of someone who had their whole face co2 laser resurfaced except the doctor avoided the undereye area which seemed like it needed it the most. Why would the doctor avoid this area? Is the co2 laser the best laser to use for undereye area?

  Answer:  I feel more of a result than Retin-A, but with down time and risks. The effect duration depends on the age of the patient, might be 2-5 years in most cases. I am unsure why that doctor you mentioned would have avoided the eye region, it can be done at a lower setting if one is concerned. JG 7.1.08

• What can you use in addition to retin-a for undereye wrinkles? Is there an eyecream cream you think is good for underye area? My priblem is when I use retin-a or other eye products it leaves a residue so when I apply makeup it looks cakey. Most times I have to wipe off any eye cream I put on for that reason.

  Answer:  I think DMAE creams are good and our peptide cream or our eye booster cream are also good. JG 7.1.08

• I had a small skin growth removed form my nose. I had another skin growth removed before without problems. However, this time it left a small line indentation which kept scabbing. One doctor said it wasn`t stitched correctly or the stitches came undone (that`s what caused it) and he wanted to use a puncher. However, other doctors thought a puncher would make the scar worse and thought the indentation line was too small to improve. Again, this area kept scabbing so it was always unhealed or always looked liek a blemish on my nose. Finally, I found a doctor willing to restitch it, but it was hard work convincing the doctor who said it likely wouldn`t improve it. The restitching was done, and it got rid of the indentation line (which looked like an oversized pore shaped in line shape instead of round shape). My question is why did all these doctors say it couldn`t be done when it could? Don`t they know that if something wasn`t stitched up correctly, it can be improved once it`s sttiched correctly?

  Answer:  they likely said it could not be done because in many cases the revision is attempted and leaves the scar looking the same, I think you got lucky. JG 6.30.08

• If you always had a skinny face, will it look skinnier when you get older? Would it be best to get restalyne injections in your face or something else to make you look healthier/younger?

  Answer:  yes, it will. I think Sculptra would be a better choice rather than Restylane injections for that. JG 6.30.08

• Do eyebrows thin as you get older? If so, what causes them to thin?

  Answer:  all body and facial hair thins with age, it is just the follicles burning out from getting older. JG 6.30.08

• I just looked at your resume,,,very impressive........this is a wonderful site......i know everyone that writes in is very appreciative that after hours you are willing to answer questions........i hope this will continue

  Answer:  thank you for the kind words, no reason to think it will stop, I am still here. JG 6.29.08

• Dear Dr Garcia. Which would you say is better to use on a scar excision after the stitches come out: Taping with Micropore or New Skin Liquid Bandage? New Skin requires acetone to remove it - is that bad for a healing scar? Thanx

  Answer:  both about the same, the acetone will not hurt the healing though once the skin is closed. JG 6.29.08

• I`m wondering if there is any other filler similar to sculptra? My problem is a real thin face (fat loss...sides of my face are gaunt/depressed...the area beside my nasabold (sp) folds) Is sculptra my only option for volume, fuller rounder face? Another Q. I had a breast life with new implants and the Dr. was to put it under my muscle, but after surgery I was told by his nurse that I had too much scar tissue and when I wanted to ask her more q`s she said it was too technical and to discuss it with the dr. When I did ask him he told me that I was too skinny and that I could never have breast implants under the muscle. (but that`s what they do for skinny people) I`ve had numerous surgeries prior for scar tissue with my implants, could that in anyway prevent me from having implants placed under the muscle? Is there any way sort of medical device scanning machine or something to see what`s going on under my implants or breast muscle to see if it really isn`t possible? Because I want to pursue having implants under my muscle with another surgeon and don`t want to run into any unexpected disapointments. are there any reasons why one couldn`t have implants under the muscle? I feel that I can`t really get a straight answer from my surgeon. How disapointing.

  Answer:  there is no other filler out there like Sculptra, sorry. The implant might not have fit below the muscle is another possibility, sorry to hear that he is not too helpful. JG 6.28.08

• will you consider relocating to Florida????

  Answer:  that is very kind of you to wish that for me, but I have family here and it is hard to leave them. JG 6.27.08

• Dear Dr Garcia. When does a revised scar get maximum strength? Also, will using a liquid bandage after the sutures help reduce tension? I am looking at New Skin` containing Hydroxyquninoline` or Dematrix. Are they ok?

  Answer:  one year. Those products are OK to use. JG 6.27.08

• Hello Dr. Could you please let me know the best method getting rid of deep lines around my mouth? I am interested in a long term result. Also, my mouth started to droop Thank you

  Answer:  Restylane, Juvederm, or Artefil. JG 6.24.08

• Dr. Garcia, Thank you, in advance. My plastic surgeon is recommending for the wrinkles under my eyes, actually just above my cheek area, to use botox. Nine months ago I had Thermage treatment and these wrinkles now appear when I smile. The doctor said that they are dynamic in nature and botox will eliminate them hopefully as I continue to heal from the Thermage treatment. What is your opinion?

  Answer:  I woudl NEVER do Botox there for fear of weakening the muscle that closes your eyelid and risking scleral show and drying of the cornea. JG 6.24.08

• Dr. Garcia thanks for your answer to my question about the ribbon technique for removing the wrinkles on my neck. You said it could be done by cervicoplasty by redraping the skin on my neck. So where would the skin be draped and where would the incision be?

  Answer:  the length and placement varies depending on how much skin needs to be removed, but typically the incisions are both in front and behind the ear for a variable distance. JG 6.23.08

• Hi again Dr. I just wanted to say first that I really appreciate you explaining my question to me, I wrote earlier about removing malar fat pads or possibly cheek implants. I have to thank you though, cause the PS I saw charged me 125 for a consult and didn`t even spend 5 minutes with me, so I really mean it when I say thanks for what you do for us here. My final question would be,...I understand now why it would be bad to remove malar fat pads, but if I put in a small cheek implant (in chubby cheeks) would it make them more sculped looking?? or would it make them look fatter??? I guess I really want the apples like janet jackson look and not such a chubby looking face. Is that what an implant would achieve? Thanks dr!

  Answer:  I think the implants would make you look even rounder. There are cases where the buccal fat pads can be removed, they are in the lower cheek, below the SMAS layer and that can cause a little hollowing of the area below the malar fad pad and can give an illusion of a more scultped face, less risky than removing the fat of the malar region, can cause some early aging, but not to the degree that the others could. Thinner faces, no matter how they got thin all age faster than chubby faces. Best of luck. JG 6.11.08

• Hello Dr. If I just wanted to make my cheeks not so chubby looking and have apples in my cheeks more prominent....could I have small cheek implants put in and have some of the fatty tissue removed on top of the implants somehow??? My goal would be to trade a fatty looking cheek for a sculpted cheek, mostly I mean in the malar fat pad area. That is the area that really bugs me, just above the nasal fold. What if I just had the malar fat pad removed?? ( I have good apples under the fat in my cheeks). Will the skin sag if I have just malar fat pads removed. Thanks for explaining this, I saw a PS and he didn`t really recommend that but I was trying to reserach on my own. Thanks!

  Answer:  I do not see how removing fat and placing an implant in the same area will make it look any better and I think removing fat in the subcutaneous part of the cheek is fraught with the chances of surface irregularities, so I do not recommend that. Removing the malar fat pad is also something I would not do. I think if you had that done the skin would sag and there could be nerve and muscle damage along with the surface issues I mentioned. JG 6.11.08

• Hey Dr. I hope you are well. I was just wondering...how do you feel about cosmetic tatooing??? I am thinking of doing it to the border of my lips, in a nuetral color. Do you feel tatooing is safe or risky at all? If I don`t end up liking it down the road, couldn`t I just go over it with a skin color??? Does it scar at all?? Also, I use fillers, that would probably make it kinda risky huh?

  Answer:  in experienced hands it is a good option, but needs to be touched up every few years to maintain the color. The scarring should be minimal to none. The fillers should not affect it, best of luck. JG 6.9.08

• Hello Dr Garcia, I was just wondering if you have an opinion on Velashape treatment for skin smoothing of cellulite(thighs) or circumferential reduction (abdomen). Thanks, K

  Answer:  for cellulite, good but temporary, not much for circumferential reduction of the abdomen. JG 6.4.08

• Would it be possible for the dr`s to use the same bottle of botox for multiple patients if they also change the syringe? Also do you know if all dr`s in all states were notified of the change-not to share the bottle? - Thank you.

  Answer:  the potetnial for contamination is still there and it is in direct violation of what the company that makes the product has put on their label and box. I know that all of the docotrs in Nevada and New York were told about single versus multi use vials. I have personally informed the two large national plastic surgery societies too. I cannot say about the others states as I am waiting for a communication from the board of health on that. But even in Nevada, where doctors have been told, they continue to break the rules for profit`s sake. JG 6.3.08

• Hi Dr Garcia - Regarding the Botox injections and one bottle for several patients. I am scheduled to be the first patient for the day and this is my first botox appt. Do you think I should call ahead and ask them to wait till i get there so i can see them open the bottle? I know the rest of patients will be using the same bottle since I am only getting my Glabella done. I feel dumb asking them. Other then this , in your opinion is Botox safe?

  Answer:  I think they should mix it in fornt of you to make sure it was not used the day before on other patients. I strongly urge you to also ask them to destroy the bottle or pour the remainder out in front of you to avoid the patients after you receiving it. I think in general, when propperly administered, as per the box and label for single patient use, it is safe. JG 6.3.08

• Hi Dr.garcia, I would like to remove a couple of moles on my face and was wondering which laser, if any would be suitable for this and if it completly can eliminate the mole or if I will have to worry in the future if it could ever metastisize?

  Answer:  well, lasers can flatten them, for that a CO2 laser is good, or the color can be reduced, a YAG laser is good for that, but they will never be removed with lasers. If they are cancerous they should be cut out and not lasered. If you are not sure if it is something bad a biopsy should be done. Non-cancerous moles do not metastasize.JG 6.3.08

• testing...

  Answer:  working.

• Do you think Thermage works well for skin thightening or is there another source that will yield better results? Thanks.

  Answer:  I think the only thing Thermage does is to make money for the company that sells it, it does not do much else that is reliable or reproducable. As to skin tightening, on the face, Rhytec or CO2 laser are much better. JG 6.2.08

• Hey Dr. thank you for answering my question earlier, I was the one who asked about injecting the perlane into the upper cheeks to give more cheekbone look and wondering if I shoud do it.....I`m sorry to ask, I just don`t want to spend the money on the perlane if it seems like a bad idea, its expensive. Do you think its a good idea to try that, to balance out the fuller lower face???? What if I just flat out asked if I could have a lower face lift or something??? Would a PS do it at my age if I could prove that my lower face is sagging from what it looked like a few years ago in pictures??? Thanks so much!!!

  Answer:  I think it would take a lot of Perlane to fill in your cheek, might end up costing quite a bit. As to them being willing to do the surgery, it is hard for me to say. JG 6.2.08

• Hi Dr. I am confused what I should do. I am seeing a very good PS who was helping me, I feel my face is getting a droopy look to it and I`m only 27, and I have somewhat chubby cheeks. It seems my face has thinned out since getting older, but I feel like I have more fullness now by the sides of my mouth. Well, the PS suggested that I could have buccle removal, but he questioned if it would really do much. He said first (since its permanant) that he wanted to inject perlane and give me enhanced cheekbones (to give the effect of how the buccle fat removal would look). Is that a good option??? I`m nervous to do the perlane and make my face FULLER as I feel its full already. Isn`t there any way to get rid of the fat right beside my mouth??? when I press on the skin inside my mouth and out with my fingers I can feel fat moving around sort of. That is really the spot I hate, can he just remove that instead??? What is that spot called???Thanks for the advice, I would just ask him but its sooo hard to get an apt. with him.

  Answer:  hard to say without seeing you but at your age I would avoid removing anything if I could JG 6.2.08

• how do u pronounce the word buccal ..like buckle..or like byoo kel Thanks, i have a presentation and i cant get it right..

  Answer:  boo cull or buckle, either way. JG 6.1.08

• Dear Doc., My skin has been extremely dry this past week so I was my face then put Proactive on, let that sit for 10 min. Then I put extra virgin olive oil on and let that sit for 10 mins. Shower, just rinsing off the extra olive oil. My question, is the proactive underneath still on my face or dose it come off with the extra olive oil? Thank you

  Answer:  showering after you applied the Proactive will wash the Proactive effects off. JG 6.1.08

• Hi Dr. Garcia, I had written to you before after having a genioplasty in Dec. 06 using the bone. I have had numbness in the lower lip and chin on the left side since. I had an exploratory surgery a few months ago and the Dr. said the mental nerve was narrower on the left side. He said maybe it was genetic, but I pointed out to him I had no numbness till the first surgery so it made no sense to say it was genetic and that would be a reason for the numbness. Can you think of anything that could have caused the nerve on that side to become narrower? If other nerves could have been damaged in the original surgery, what nerves would they be? Thanks for any help.

  Answer:  a partial cut of the nerve would have over time allowed it to heal in a smaller or thinner diameter. That is more likely the cause. JG 6.1.08

• Just wondering if you might know if a colonscopy or virtual colonscopy (swallowing camera pill) can show if you have parasites?

  Answer:  no, it cannot. JG 5.31.08

• Hi Dr Garcia - I have a botox appt scheduled for next Tues. My first one. I know they must use the same bottle because they told me they need to get atleast 4 patients to keep that botox day . And it can only be done at certain times since the bottle can only be open for 4 hours. I just read your info on using the same bottle and now i am concerned. Can the Dr change the Larger needle for each patient as well as the smaller needle so there is no double dipping?

  Answer:  even changing the needles if the same syringe is used on one patient can be a problem, what they are doing is not correct and I STRONGLY adivse you not let them do it that way. I know that is the way we were taught by the company years ago, but now that the information has come to light, I think it would not be appropriate to continue to do it that way. JG 5.30.08

• Why is it you need to keep using eyelash conditioner to make eyelashes grow where they don`t grow? If eyelashes come back/grow back, why don`t they just stay or why do you need ot keep using the product? thanks

  Answer:  some of the eyelash grow aids help thicken the lashes while applied, also, eyelashs are like hair elsewhere, they grow normaly, so in cases where they were not growing and the product helps them grow, it will need the product after they have started to grow for it to continue. JG 5.30.08

• Hi Dr. Garcia. About 4 weeks ago I had a Kenalog injection in the tip of my nose and at the bridge. When I look in the mirror now I can see a faint black and blue mark directly under the skin at the bridge of my nose, as well as a white area. I know that Kenalog sometimes does this, but is this a permanent side effect? Thank you, Dr.

  Answer:  it is too early to tell, most likely if it was just one shot it should all get better in time. JG 5.29.08

• where do all the hormone questions get posted? I asked something about HGH, dont know where it went Thanks

  Answer:  they stay on the Ageless Forever site. This message board is for plastic surgery questions.JG 5.29.08

• Dear Dr. I was wondering if there have been any new advancements in hair restoration? Ive read some articles regarding Cloning; anything going on there/ Thanks alot

  Answer:  cloning is not available yet, sorry. JG 5.29.08

• Hi Doc. Whats your opinion of IPL for enlarged pores? How effective is the procedure? thanks

  Answer:  pretty good, but very temporary.JG 5.29.08

• what is a patients rights as far as surgery? is the surgeon supposed to verbally inform the patient of all the risks, healing time etc..If i feel i was given poor care and certain problems weren`t addressed right away (blood clot wasnt drained until 12th day post op b/c he said he was stuck at hospital)and i feel this affected the outcome of the m/f surgery (left side is lower than right, nose and smile is crooked and cant purse lips evenly) Dr said it was not nerve damage..and something about muscles healing..I really hope this will go away..Im starting to think he punctured something when he went through the mouth that may have also made things uneven (maybe the juviderm or really a nerve?) I would like to know my rights just in case I do have a problem in the future..I have been very patient with him but feel that he is lying about a lot, as he keeps changing his answers everytime i see him.. I just really lost trust for him and he is very very busy .too busy to communicate with me or answer my questions or concerns via email or even a phone call back.. Like i said i have spent a lot of money on this and am extremely unhappy..He said he would do a free revision and I have to wait for 9 months, but thats not the point..I am really suffering now and hiding my face in hats, etc..I could have had a baby in 9 months..I cant go back to work, suffering mentally, financially, and in my marraige..could barely get out of bed or leave the house, had to cancel trips and events with no refund because he said i would be fine in 4 weeks.. The brows, m/f or lower eyelids didnt come out right at all..He said I wouldnt have lower eyelid retraction and i sure do..I dont know what to do here..I know certain things are hard to prove..I did have my husband as a witness on some pre-consults..He also admitted that he didnt have time to give me a pre-op appointment and i feel like if i had one , some of these mistakes would be avoided..like him deciding to pull of the lateral ends of the brows to avoid having lower eylid lift when i told him i would want one or a skin excision afterward ..so i asked him not to overcorrect.. I want to know if it is worth it to get a lawyer and what the chances of me getting compensated for this somehow are? Im going to check my chart as well b/c i dont believe I signed or read any risks, like blood clots or nerve damage for the endo m/f.. What is your professional opinion? Im not going to rush into anything yet, but i would like to know just in case THANK YOU:(

  Answer:  it is customary to mention and discuss the most common issues that migth arise, but it is not possibel to discuss all the potential complications. Post operative hematomas can cause pressure on muscles and nerves that can cause what you are describing though. In most cases it does get better with time. I certainly understand your frustrations and doctors do get busy but there should be time to speak with you and examine what is going on. It is hard for me to say whether it is worth getting an attorney at this point though. I think you need to ask for a copy of your records and go over the consents and see what they have to say. Best of luck. JG 5.29.08

• Hello, I would like to know if you have any experience or opinion on the use of the S-GAP flap for buttock augmentation? Do you know of any resources that I can use to see the efficacy, fail rate ect. for this procedure? All I can find is liturature pertaining to it`s use in breast reconstruction.

  Answer:  I have never heard of it being used for buttock augmentation, sorry. If anything it will make the buttocks smaller as it takes the upper part of the buttock off as the flap. JG 5.28.08

• If a woman has scar tissue on nipple,a nd the surgeon said she would not be able to breast feed, can the milk go away (without being released through duct holes due to scar tissue over that area)on its on. Does it somehow get evaporated or must it pass through milk duct holes?

  Answer:  the body will eventually absorb the milk back. JG 5.28.08

• Does skin bleaching cream work on undereye circles?

  Answer:  sorry, but no, it does not. JG 5.27.08

• Do you know if Kelo-cote topical gel for scars works (to flatten or get rid of red)? And how about Curad scar therapy (sticky pad you put on scar)?

  Answer:  small to mild improvement for the redness. JG 5.26.08

• When I get botox done, I only get 20 units. Did you say the samllest single use bottle was 100 units? I am only charged for 20 units instead of 100 units so does mean they are reusing the bottle? I know for restlyne injections, they said you have to buy a bottle which can be used up to 2 years.

  Answer:  it sure sounds like they are re-using the bottle of Botox. If they are charging you only for 20 units, they are either throwing the rest away and losing more money than they are making, or they are using the Botox on another patient. The Botox is single use, single patient, the filler can be stored, but makes sure they inject you with your syringe and not someone else, otherwise it is the same problem. JG 5.23.08

• It has been 3 months since I had a small scar revision on my cheek. I feel a little bump, but don`t know if that is a pimple or hard scar tissue. What is best thing to do to smooth it out if it is scar tissue (injection,silicone sheet, etc)?

  Answer:  injections will likely work better than anything topical on that, needs to be done by a doctor though. JG 5.23.08

• Dr Garcia....someone on a forum I frequent said yu state on your site that there has been a problem withthe way botox may have been administered and the issue of AIDS was raised. do we need to be concerned? thx

  Answer:  well, there have been no reports related to transmission of a communicable disease with using Botox the way the company taught doctors when it was released, but no one has looked at it I am afraid. The company has actually been aware since about 2002 that their single patient use vial was being used for multiple patients in direct violation of their labeling that had been approved by the FDA but they did nothing to correct the practice by telling the doctors that what had been taught by the company was incorrect and should be changed. Doctors are taught sterile technique in terms of how to mix and use medications out of a multi dose vial in their training. Botox comes in what appears to be a multi use vial, but it is labeled single patient single use. This came to physicians` attention after an outbreak of contamination of multi use vials by a small group of physicians in Las Vegas using anesthesia drugs and also a few reports of it in NYC. So although we are taught proper technique, there can be breachs in the standard. Actually, in New York State, in order to avoid this issue arising again, there are legislative attmepts to try to ban multi use vials in that state. I think in order to be safe, from now on, the vials should be for single use only. I think not following that dictum now that the scenario has been raised and physicians notified would be irresponsible. For that reason I suggest that you ask to see the new vial in the unopened box so you can read the label for yourself, have it mixed in your presence, and that the remainder of the vial be destoyed in your presence if you do not use the entire vial. I think the appropriate thing to do if you do not see that done is to report the occurance to the local board of health and/or the FDA. In Nevada, if that occurs, the doctor can lose his business license at minimum. Sorry to alarm people, I think that since there are no reports of any problems, we are likely safe, but we need to be careful from now on. JG 5.22.08

• What is a hard tract from belly button to breast?

  Answer:  a ridge of firm tissue. JG 5.23.08

• Does some of radiesse filler injections remain permanent? Not all of it, but just a little of it so if you keep getting injections eventually you will not any more injections?

  Answer:  it usually will totally dissolve in time. More injections typically are needed. JG 5.22.08

• 45 yrs old male skin graph foot on the right foot pinky was removed to cover the hole 2006 i recovered,now 2yrs later its back i put zeroform on it help a little but around the holec its soft like its not going to cover up. what should be done please help me.

  Answer:  if there is still a hole there, there is likely a bone infection that does not allow it to heal. You need to see a orthopedic surgeon for an evaluation. JG 5.22.08

• Does any of the fat from fat injections remain? Is it ever possible for some it to be permanent?

  Answer:  most of the time it all fades away. JG 5.22.08

• For breast augmentation surgery done through belly button, do some patients have problems with noticebale scar or stretched scar around the belly button?

  Answer:  no, but it can leave a hard tract from the belly button to the breast. JG 5.22.08

• How is the fat injection procedure done (with fat taken from one area of your body and injected in another area)? Do you need local? Is it a syrige type device to get fat out?

  Answer:  it is apirated with a syringe, cleaned and then injected into the new area. Can be done under local for smaller areas. JG 5.22.08

• Do you inject fat into labia vulva area when doing labia surgery. Or if you do not do this type surgery, do other doctors?

  Answer:  not as a routine, very few women need that and not much of it will survive long term. JG 5.22.08

• When I had lipsuction I thought it was only for saddlebags on hips. However, the doctor also liposuctioned the bottom edge of my buttocks. Before the surgery, the bottom end looked more like an upsidedown heart shape . After the surgery, the bottom end looked like the the number 8 sideways. The sloping down of my buttocks filled in pants better. Now there is bagginess in pants at bottom ends of buttocks. Do most surgeons shape the buttocks in perfect circle shape or let the buttocks slope a little? I feel my buttocks look more like a guys. Aren`t aguy`s buttocks supposed to be circular than oval shaped?

  Answer:  buttock shape is a matter of preference, in your case what appears to have happened was an over aggressive removal of fat from the buttock crease which has changed the shape, fat injections can be done there to try to fill it back in, JG 5.22.08

• Hi, I am 27 yrs old now. When I was 12, a dog jumped on a glass door that I was trying to open and the door smacked my forehead, I immediately had a bump on my forehead. I was so embarrassed I just ran home -I didn`t ice it or anything. The bump never went away and it is still on my forehead, it feels like bone, immovable. It bothers me when I see it in pictures and am self-conscious about it. Is there anyway to remove it?? Thanks for your time! K

  Answer:  could try making an incision over the lump and cutting it out, if it is bone, it will need to be burred down though. JG 5.22.08

• Can restalyne injections in cheek be substituted for cheek implants? I had the smallest size cheek implants removed becuase I could see the outline of them. I don`t know if it wa sbecause it was above instead of under a muscle? So, I was wondering if inhections could look more natural to give you fuller cheeks?

  Answer:  I do not think that is a practical long term option as the injections of Restylane will not last long. I think injecting Sculptra for that would be a much better choice. JG 5.22.08

• there are so many makeups out there making big claimes. Is there one that REALLY does reduce the appearance of fine lines and help you look younger? Thank you Dr.

  Answer:  anything over the counter that is contained in make up will not have any considerable improvement in skin texture or quality because the amount of active ingredients that can be added to make up is not enough to see a clinical difference. JG 5.21.08

• Hi Dr. G. I was wondering what options are available for me. When I smile, it looks like I have deep lines by the sides of my mouth and nasal folds. When I don`t smile they are not there. I`m late 20`s. I already use filler for nasal folds. Its by the sides of my mouth that bother me, really though. I feel it makes me look old when I smile, I have chubby cheeks and it looks like they are droopy. Just a few years ago, this didn`t seem to be a problem. If I pull up on my cheeks, it looks like it used to a few years ago. I know I am way too young for a face lift, but pulling up on my cheeks seems to make me look like myself again. Is it possible that some people just droop ealier than other and might need something like that sooner??? (I have always been a runner, maybe thats why, too) Any advice you can give would be helpful, my wedding is next summer and don`t want to look so OLD already in my pictures!! :-( Thanks Dr.

  Answer:  well, I will say that running causes premature tearing of the collagen of the body due to the impact when one steps forward so the facial skin will drop sooner than normal. I think filling with Sculptra right under the skin might give the skin a little more firmness and not fill the cheek in too much and might help the issue. JG 5.21.08

• Hi Doc!!! what is the name of the product that makes eyelashes grow? I saw long time ago posted here but cannot remember. Thank you for your time!!

  Answer:  they have all been taken off the market as they were putting a product in the solution without the OK from the manufacturer. JG 5.20.08

• How is the best way to obtain a few other opinions from PS`s? I am scheduled for another procedure in August (rev. abd scar redo/redefine breast crease etc.) and I feel pretty good about the plan for surgery. I do think that it wouldn`t be a bad idea to get a few other opinions on my situation. Are other PS`s open to this? Do I bring my medical/surgery records? I don`t want to cause any trouble, and I still respect and like my current PS. I just feel that I need to put my body first and make sure that there are not any other opinions out there. What do I say when I schedule an appt. with another PS? How much information do I give them on the phone and then in person when I meet with them? I don`t want them to think I am a psycho-crazy patient, just someone who is exploring all the options and making an intelligent and well though out decision.

  Answer:  in many cases they are willing to see you, yes. I think the more information you bring with you the better opinion they will be able to give you. I do not think it will cause trouble though. I would suggest you tell the new office you are seeking a second opinion up front too. JG 5.20.08

• For hupopigmentation, do many women get their skin airbrushed. I have some hypopigmentation marks on my chest. I was thinking of getting just my chest airbrushed (to do tan my skin, but to match my skin)to cover the hypopigmentation so I can wear more v neck tops in summer. Do you know how long airbrushing last on skin, and is it different for makeup airbrush than tan airbrushing?

  Answer:  the airbrush tan will last 2-4 days in most cases. JG 5.20.08

• You wrote that not all women can have the same size implant since it depends on how much breat tissue they have, rib size, etc. Does that mean if one woman has less breast tissue than other woman and they both want a size C implant, then then woman with less breat tissue will have smaller circle C size? But then would it be considered a size C if it was a smaller circle shape? Or would it be more triangular shaped?

  Answer:  no, it will not be a smaller size C, it is that she might not be able to be a C cup at all. Triangular shaped breast should not occur. JG 5.20.08

• My problem with padded undies is that it adds a little more volume to where I have a little volume so that makes the flat area above look even flatter. See, I have a longer waist so I need buttock volume to go a little higher so it does not look like I have long back. I thought maybe I could make my own padded undies except sewn in the foam at upper part of buttock instead of lower part of buttocks. Do you think that would look right or that is where I need the volume to be added so my butt does not look so flat? Can a buttock lift raise the butt muscle into the upper part of buttocks?

  Answer:  I am not sure the foam will help and if there is no sagging fat I think the buttock lift will not help, sorry. JG 5.18.08

• How is a buttock lift perfromed (butt muscle moved up)? How long does a buttock last? At what age does a women`s buttock muslce drop (and does it happened ot everyone)?

  Answer:  the incision is at the waist but the muscle is not moved, it is just the excess skin is removed and the fat is repositioned. The age of dropping is variable and there is no set time. JG 5.18.08

• I have always been skinny (genetic I suppose). I was wondering if breast implants and buttock implants would make me look fatter? Or at least maybe people would stop commenting how skinny I am. I already have breast implants. I asked for a size C since I did not want them to look artifical on me or strain my back. They turned out to be small C or I wear a C cup bra. I still look small chested with size C implants, though (maybe because they could not put in bigger circumference implants with 34 inches chest size which results in smaller circle shapes). I am 5`8 and weigh 120-125 (it goes up and down between 120 & 125). Today I heard someone say I looked like a pole. I could understand them saying that when I was flat chested, but I got a little something now with implants. Do you think a size D (would you recommend small, medium or large D) would make me look fatter/better? Or even bigger than a sizeD? Also, a buttock implant to match my breast area and to help me look fatter as well?

  Answer:  I do not think you will look fatter, in some cases it will just look obvious that you have had implants is all. JG 5.18.08

• A MRI shows a defect in one of my hips. One of my hips is lower the other. What it looks like on one side is a bump where my hip is. The other side does not have this bump- it is lower and the hip bone does not curve out like it does on other side. Can and do plastic surgeons fix hip defects? Is this a surgery women have had? Does it involve putting in an artificial hip bone (if so, what material?) or raising the hip bone to match the other side?

  Answer:  plastic surgery will not help that problem, sorry. JG 5.18.08

• How young can women start to lose breast tissue? Do many women get bigger implants as they age due to this?

  Answer:  it is genetically controlled, in some it can start in their 20`s. Some women do change implants out for larger sizes becasue of that, yes. JG 5.17.08

• If an MRI of spine is done, do yoour breast implants show up in images (as foreign material)?

  Answer:  yes, they do. JG 5.17.08

• Hello Dr. Garcia, I have dynamic wrinkles that run down the top outside of my cheeks on a 45 degree angle... So its kinda like crowsfeet but worse? What can be done about these? Thank you!

  Answer:  CO2 laser or Rhytec Portrait resurfacing. JG 5.15.08

• Instead of getting another breast implant surgery if you wanted your cup size to be a half or 1 size bigger, could you take hormones for a temporary time to increase your breast size. Would the results be permanent or would you have to take hormones for rest of life to keep it half-1 size bigger?

  Answer:  no, you cannot get that in that fashion. JG 5.15.08

• Do you know of any injections or procedures to make fat cells in an area increase in size?

  Answer:  sorry, but no. JG 5.15.08

• I read answer below that if lentigo spots are treated by lasers, they will likely come back in time. Do you mean in different areas of your body or the same exact spot where it was? Let`s say someone had a lentigo on thei rshoulder which they always kept covered/protected from the sun, are yopu saying in time it would come back on its own? What if you had it chemically peeled off or freezed off= would it come back in time as well?

  Answer:  the same exact spots. As to it coming back even when wearing clothes, you need to know that clothing is not a total sunblock, it is about SPF 10-15, sunlight still gets through, there are a few newer companies that make clothes that are totally sunblock like but they are clearly marketed and labelled that way. It will come back no matter what you do to remove them, cream, lasers, or chemicla peels. JG 5.15.08

• Do transgenders who take female hormones develop hips? Could a born female take female hormones as adult to make hips grow bigger? Can you take hormones temporarily for hips to grow bigger permanently?

  Answer:  to some extent yes but not as dramatic as if they were born a female as the fat cells need to develop during puberty for them to grow later. Hormones in a womna will not necessarilly lead to bigger hips, there are gentic controls over it. JG 5.14.08

• As far as vitamin D pill safety, I forgot the pills come in IU. So how many IU is 10 mcg?

  Answer:  400i.u. JG 5.14.08

• Is it safe to take daily vitamin D supplements? Is so, there a mg amount you should stay under? Thanks.

  Answer:  OK to take about 10mcg per day. JG 5.14.08

• An answer states that MRI can show leaking breast implant. I have saline, not silicone. However, I thought if your implant leaked it would deflate within a week? My implants seem smaller and I don`t know if it is due to tissue loss over leaking (I am only in my 30s). I had an MRI of spine= would leakign show up if the spine was the focus of MRI?

  Answer:  in cases of saline it can take a little longer than a week in cases where the hole is very small. Usually by one month if there is a saline leak it will be flat, and it will feel different, like it is folding beneath the tissues of your chest. The MRI would not show the implant to any great degree. JG 5.14.08

• If you had breast implants but they look more triangular shaped than circle shaped, is there a tye of implant you can get to make them look more round?

  Answer:  it depends on what type of implant you had placed that gave you that appearance. JG 5.14.08

• If you wanted a little ear cartlidge added between the nostril holes below the tip (the cartlidge which separates the nostrils), could it be done with local injections instead of sedation since it is small area which the nose tip does not need to be cut into? Would the price of a small procedure like this be much less than regular nose surgery?

  Answer:  it might be able to but injecting local anesthesia into that area can hurt quite a bit. The price will depend on the surgeon performing it, quite awide range I am afraid. JG 5.14.08

• Do you think patients would be more satisfied with botox or having the muscle above the brow removed (if the muscle sticks out above eyebrows)? Is botox needed (for forehead wrinkles) if the muscle is removed?

  Answer:  I think removing the muscle is more effective and when done the patient usually will not need Botox any longer. JG 5.14.08

• I am skinny and have no hips. Is this common among females who are skinny? I am afraid to wear tight fitting clothes because people will see that I have no hips (or might think I am a guy). Guys seem to look at me when I wear tight fitting clothes and I don`t know if they are thinking I look nice or like a man.

  Answer:  yes, quite common. I am not sure what the men are thinking when they look at you though. JG 5.14.08

• Dr. Garcia: I don`t know if this is the proper forum to address this question, but I know you`re a cosmetic surgeon. A few years ago, I sustained a fall on the sidewalk and tried to buffer it by extending my arm outward (big mistake, I know :) My wrist was sore for about four or five days, and I didn`t bother to have it x-rayed. My question is: if the bone did break, would it have healed/set on its own eventually? There wasn`t any excruciating pain; just soreness that went away in a few days, and I had flexibility in my wrist as well. If I were to have it x-rayed today, could a doctor tell if it was broken and never healed properly? Would they break it and re-set the bone in this case? Thank you for your assistance.

  Answer:  it can heal on its own and if indeed there was a fracture long ago it usually can be seen on X-Rays now. If it did not heal properly then it could be rebroken and reset if needed. JG 5.14.08

• I have puffy areas at the corners of my mouth. Is there anything that can be done to reduce that?

  Answer:  without seeing you in person to determine what is the cause I cannot say. JG 5.13.08

• Do most women need a tummy tuck after having a baby? Is it common to have your belly look flat the way it was before you had a baby? Or will there always be saggy skin or fat reminaing well after you recover from having a baby?

  Answer:  it is not uncommon but it all depends on how big they get with the pregnanacy. Anything over 25 lbs and the risks of looseness goes up. JG 5.12.08

• CAN YOU HAVE LASER HAIR REMOVAL WHILE YOU ARE PREGNANT? dO MOST PREGNANT WOMEN DEVELOP HAIRLINE ON ABDOMEN WHEN THEY BECOME PREGANANT?

  Answer:  I would suggest you wait until after the baby. JG 5.10.08

• I thought fat was hard to get rid of or you had to exercise to burn it off. Then why does fat taken from you own body transferred somewhere else eventually dissolve on its own?

  Answer:  because it never survives, or very littel survives to begin with. JG 5.12.08

• I think I read somewhere that fat injections (taken from your own body) into your face last about 3 years. So does that mean if you had fat injected from your own body into buttock area (as substitute for buttock implants) that it would only last 3 years?

  Answer:  It likey will last less than three years in the buttocks. JG 5.12.08

• Hi Dr. Garcia. I was wondering what your thoughts on micro fat grafting to the buttocks is and if you perform that particular operation. Thanks so much.

  Answer:  I do not perform it and I think buttocks augmentation with fat injections is quite variable, unpredictable and might last two years. JG 5.11.08

• Do you know where fat often goes on pregnant women who had liposuction on saddlebags on hip area? Will the fat go around the ex-saddlebag area and look lumpy? Will the fat not be distributed evenly?

  Answer:  could go to the upper back or arms. The fat may and may not be distributed evenly, no way to tell, it varies from patient to patient. JG 5.11.08

• Do many women get injections in their hands? Whatt is best= restalyne or radiesse or something else?

  Answer:  I like Sculptra for the hands. JG 5.11.08

• Dear Dr. Garcia, I took your advice for a few brown spots on my face and have been using Retina A .05% and Obagi Blender. It worked great but I only used it for a few short months as I saw a vast improvement. The spots faded but the skin never peeled or sloughed off. Now I notice the spots are gone but the skin there feels crusty and rough. Do I need to continue the treatment until the skin peels? The rest of my face is smooth, just the treated spots are rough. Thank you in advance for your mothering when we need it. You are awesime!!Happy Mothers Day and have a great weekend.

  Answer:  I think using the Retin-A alone should help with that, just be sure to avoid sun exposure. Thanks for the kind wishes too. JG 5.11.08

• Hello Dr. Garcia, My husband bought me a Beautiful Image Facial Sculpting machine for Mothers Day... It says it is consistently shown that Microcurrent causes the following: *500% increase in ATP (Adenosine Triphosphate, the chemical fuel of energy), *35% increase in blood circulation, *40% increase in Gluconeogenesis (production of new glucose), *45% increase in the number of elastin fibers in the dermis, *50% increase in the length of the elastin fibers, *10% increase in collagen thickness in the connective tissue, *35% increase in the number of blood vessels, *28% increase lymphatic drainage I was wondering what your thoughts are on this machine???... It was a very thoughtful gift (as he knows I`m ALWAYS concerned about aging) LOL Thanks so much! All of these combinations are key factors in the effectiveness of Microcurrent Facial Sculpting

  Answer:  I am sorry but it is a waste of money. JG 5.11.08

• Does high cholesterol cause cellulite? Or is how fat one is?

  Answer:  cholesterol does not influence cellulite and even skinny people can get it, its a skin problem, not a fat problem. JG 5.11.08

• If a woman had liposuction, the she gets pregnant will new fat cells grow where she had liposuction? If not, will new fat cells grow in wrong areas since they are unable to grow in waist, hip or thigh areas?

  Answer:  far gain in any area once liposuction is performed, it will accumulate in other areas. Once the fat cells are removed, the only thing that can happen is that the ones that remain will grow, but new ones will not form. JG 5.11.08

• suicide hotline? is there anywhere else she can go to get it fixed to solve her problems? SHe is telling me it can`t be fixed//Her doctor made her face worse than it was before the surgery and she is only 30 years old, was suffering from some severe hormonal issue

  Answer:  I am sorry but this is not the correct forum for this question. JG 5.10.08

• Is Rhytec safe on dark skinned people? I know lazers are not safe for dark skin.

  Answer:  it can be used at the lower settings yes. JG 5.10.08

• I thought people gained fat when they got older instead of lose fat?

  Answer:  it is not distributed evenly over the body. JG 5.8.08

• Is there a hip implant surgery? Or do some women have wider buttock implants to increase their hip size?

  Answer:  there are no hip implants. Sorry. JG 5.9.08

• I had ear surgery which some stitches here and there are still inside my skin on the back of my ear. I feel a little bump where the stitch is. It has been there for years. I thought these were dissolvable stitches but maybe not. Would dissolvable stitches remain inside your skin? I know they are stiches because one bump was sore and itchy so I went to doctor thinking it was some kind of growth when he removed it and found out it was a stitch left inside my skin.

  Answer:  in most cases, the stitches placed to pin ears back are permanent sutures, but if they have been there for years, they can be cut out now with little bad effect as the scar tissue that has formed should keep everyting in position. JG 5.9.08

• Do most women lose breast tissue as they age or just some women? Do most women also lose buttock tissue as they age?

  Answer:  almost all do. They also lose buttock mass, but some of that is muscle with some fat. JG 5.9.08

• i really need to know where to go for help is someone is contemplating suicide post-surgery (facelift)

  Answer:  call a suicide hotline immediately. JG 5.8.08

• My daughter hit her cheek very hard from a fall. After the bruising and swelling has gone down, she is left with a dark line(about 1 to 1.5 inches long), something hard on the tissue and it is causing a dent or ridge in her face when she smiles. Is this something that is permanent needing some type of plastice surgery? (she is 3 and her pediatrician said that it is boold that for the most part clotted and turned hard???)

  Answer:  warm packs and massage for the first year and then re-evaluate it, might benefit from something being done to lift the depresson. JG 5.10.08

• I heard of some women having 2 implants in one breast. Like a smaller implant on bottom of breast to make the breast sag more. Do you ever insert more than one breast implant? Or I guess my question is can a owmen bring a picture of a model from a magazine and say I would like my breasts to be shaped like hers? Is that possible?

  Answer:  Stacking implants is something that should not be done. It is nearly impossible to match your breast to someone elses, model or not, due to underlying anatomical differences. JG 5.8.08

• Does bleachign cream permanently get rid of brown spots? What I mean is do you have to apply the bleach daily or you will see brown spots come back? This is if you stay out of sun. I do not know if somethign in the bleach dissolves the brown pigment or if it is just temporary?

  Answer:  no, with time and sun exposure they will come back. Once they are gone or reduced you stop the cream and do not use it again until they come back. JG 5.8.08

• Can a women have breast implants when they are older? If not, why?

  Answer:  as long as they are in good health, they can have it done. JG 5.8.08

• At what ages do women tned to start losing breast tissue? And how much (i.e 1 cup size, etc) and about the same on on both breasts?

  Answer:  they start losing it at varying ages, there is no set date or time. The amount, speed, and balance are individually determined, in some cases you can lose almost all of the breast tissue. JG 5.8.08

• Any opinion on the Baby Quasar? thanks

  Answer:  skip it. JG 5.10.08

• Good day Dr. Garcia I was wondering what I could have done to fill out the area between the bottom of my nose and the top of my lips. I have very fair skin and I don`t have much fat on my face so the two veins, one on each side of that area of my face stands is standing out quite a bit. Now that I`m getting older and there is even less fat in that area, I am beginning to show signs of vertical lines which I would like taken care of. I would like to have something done that is permanent but I don`t know where to begin investigation different products. Thank you for your time

  Answer:  I would strongly suggest you avoid any permanent products, you can consider a combination of Sculptra for the deeper part and Restylane for the more superficial ones, but they will last only months. JG 5.7.08

• Dear DR.Garcia. I hope you are doing wel. I previously asked questions about good over the counter stuff to buy to help in the aging provess. I really appreciated your answers and went to GNC to purchase the items (some I had already been using). I did get overwhelmed when I noticed the different dosages. I guess I never looked and just bought the products before by grabbing it off the shelf (uh oh). The sales person was no help so I am wondering does it matter your age or weight? How do I know what dosage for a healthy 58 yrs old female for Vitamin C B E Coq10 Calcium with Vit D Fish Oil? Should I take Vitamin D seperately? I asked my PCP and she said middle of the road dosage!!!! GOD bless you for all of your help. Your site is much appreciated.

  Answer:  they can all be taken together, CoQ is 100mg or more in gel caps, the fish oils are at least 1000mg per day. The B and C I suggest twice the RDA. The E about 400iu daily. I need all the blessings I can get, thanks. JG 5.7.08

• Dear Dr. Garcia Thank you for always answering my questions honestly and promptly. I value your opinions. My question is this. Most plastic surgeons provide many services, treatments and surgeries but do have an area of expertise. What is yours? Face, breasts, eyes?? What do you like doing the best? I need some help in several areas and am just wondering? Thanks in advance for your honesty.

  Answer:  over 50% of my practice is facial cosmetic surgery so that would be where most of my experience is. JG 5.7.08

• If I move my face a lot, the botox will wear off faster?

  Answer:  to a degree, yes. JG 5.6.08

• Dear Dr. Garcia, I am a 40 year old male caucasian with fair skin, brown hair brown eyes. I have a depressed saucer type of scar on my right cheek. I have had this since I was about 15 and was caused from either acne or a cyst. It is approx. 5mm wide and 10mm high. There is also a hard lump on one side of the depressed area. The scar goes away when I smile. The scar seems to be getting more noticable as I age. Do you recommend excision or subcision/filler? With excision, approx. how big would new scar be and what prevents there still being a depression in the area? What is the best filler if I choose that procedure? Is there anywhere to view before/after pics of each? Thanks for your time.

  Answer:  I think subcision and fillers should be first, the length of the scar if cut out would be 50% longer than the diameter of it now.Results will vary from patient to patient I am afraid so pictures do not always show a good representation JG 5.6.08

• Hi Dr Garcia, I am in my first month after my botox injections, from now the effects will gradually wear off?

  Answer:  yes, that is correct. JG 5.6.08

• Dr Garcia, can botox do permanent damage?

  Answer:  I have not seen that nor read bout it occuring. JG 5.6.08

• I am guessing part of my eyelash have not grown back sue to chemical burn damage. I had a tca peel down on eyelids and when the skin shed, a chunk of eyelashes came out when shedded skin. If eyelashes do not grow back due chemical burn, will eyelash conditioners make it grow back or is the damage permanent? The eyelashes have been missing a few years now. What is best thing to do for it?

  Answer:  the conditioner can help in some peopel, it is rarely permanent loss though. In your case since so much time has transpired it might be permanent though. JG 5.6.08

• If a patient does not have any complications from buttock implants the first year, do you think it is most likely they will not have any complications (since it seems like the majority of complications occur right after surgery= implants moving out of place, wound opening, etc).

  Answer:  they can stil happen, although the chances do decrease. JG 5.6.08

• You mentioned that breast implants could appear smaller a few years later due to loss of breast tissue. How is the breat tissue lost? Do surgeons remove breast tissue when they insert breast implants? Or do you mean weight loss which I have not lost any weight.

  Answer:  aging is the cause of the lost breast tissue, even with no weight loss. JG 5.6.08

• Dear Dr Garcia. What subcutaneous sutures are best for oily skin, beard area? My PS mentioned Vicryl but I read it causes inflammation? Another Dr said he uses Moncryl. What do you recommend? Thanks

  Answer:  I honestly do not think there will be much difference as long as it is not braided. JG 5.5.08

• Do breast implant drop or move position after a few years? The first few years my implants seemed bigger, but now they appear smaller in clothes.

  Answer:  if they are large and in thin skiined people with little supoort, they can drop with time. They migth appear smaller from loss of your own breast tissue. JG 5.4.08

• I read a question about eyelash conditioners that were taken off th emarket. Why were they taken off the market? Is it because they don`t work?

  Answer:  it was taken off the market because the companies used products owned by other companies without their approval, it did work though. JG 5.4.08

• For faded permanent black makeup on eyelid, how many laser hits does it take to remove? Also, can a toothpick or something be held against the eyelash so it will not burn the eyelashes? This is not for my whole eyelid, just a small area which teh technician`s hand jerked slightly above my eyelash line.

  Answer:  the eyelashes can be protected with a wet tongue blade but it is difficult to predict how many treatments it will take. JG 5.4.08

• hi Doc,what is your take on facial fat grafting,my skin is in pretty good condition I`ve realized what is aging my face most is a hollowness happening around eyes,cheeks.What else could help this problem?I have never had lipo and have (sorry to say nice amount of abd fat to donate lol).do you do this procedure?what is ball park cost?thanks

  Answer:  I prefer Sculptra for that problem, I feel fat injections lead t lots of swelling and unpredictable results. JG 5.4.08

• Hello Dr. Garcia- I was wondering if the SCALP MED, actually will work on a guy like me that is totally bald? Heriditary baldness. Losing hair really affects me still at 44 yrs. of age.

  Answer:  it is intended for hormonal hair loss so it should work in your case. JG 5.4.08

• Dear Dr. Garcia, I am a 57 year old woman who lives here in Vegas, I have had many procedures over the years to keep up and am very happy with myself however, I REALLY want dimples..I have wanted them since I was a teenager..My problem is the closest doc who does the procedure is Dr Samuel Lam in Tx.. I am asking you if you will do this for me, I am not a perfectionist nor do I expect miracles..but I know you are the best doc here in Vegas and I REALLY need those dimples to give my face a cuter look:) Can you help me? Sincerely, Susie Bowie Henderson, NV

  Answer:  I am sorry but I cannot do it for you, I do not think the results are reliable enough to attempt it. JG 4.29.08

• Can steroid injections to treat acne cysts also cause steroid acne if overdone?

  Answer:  yes, it can. JG 4.29.08

• Dear Dr. Garcia, You kindly --- and it turns out correctly (even though my own PS differed) --- responded to my panicky inquiries nearly a year ago after I had face/neck lift and revision rhino and genioplasty. Many of the problems have been or will be corrected or resolved (year-long nightmare!), but one remains that I`m trying to figure out how to address. The PS removed an old style chin implant, put in a new one. As I feared and you said was possible, it turned out to have been inserted over rather than under tissue on one side. PS refused to remove it until several months later. Two bad results: first, on the side where the implant was inserted over tissue, there is now a depression (think about if you made a thumbprint right at the jawbone about an inch out from the right corner of the chin). I think that either the surgeon was overzealous in removing the old implant (which was silicone gel) and took out some tissue, and/or the tissue atrophied from the badly inserted new implant. Its improved with time but remains weird looking. On the other side, where the under-chin incision was reopened to remove the new implant, the scar tissue stuck to the bone, pulling in the previously smooth new lifted line along the jaw on that side. After eight months of Mederma and massage, it too has loosened and improved, but there is still a little pooch in the tissue above where that scar is pulling in. My PS poo-pooed both of these and is now no longer practicing. Any ideas? I don`t want to make another screwy choice. Eternally grateful for your calm advise. Have referred folks to you and will continue to do so.

  Answer:  might want to consider a little filler injection with undermining or releasing the tissue first, that would be the least invasive. Hope that helps and I appreciate the referrals. JG 4.28.08

• Can any plastic surgeon regrow a nose on a patient`s forehead (like the one patient whose nose was lost to frostbite)? What is the speciality called for a plastic surgeon who does things like this?

  Answer:  they are all trained to do it but not many continue to do it after they finsih training, look for a unversity based reconstuctive surgeon. JG 4.27.08

• What do you think of an eyelash or eyebrow transplant from the hair from your scalp?

  Answer:  it can work, not many surgeons do it though. JG 4.27.08

• I heard awhile ago that this one celebrity had part of her rib removed to decrease her waist size. Is such a surgery possible?

  Answer:  possible but not very effective. JG 4.27.08

• Hello - I am scheduled for a minimal invasive arm lift on 5/22/08. When I asked the p.s. via email how many times he has done the surgery, he wrote back 15. During the consultation he said 12. Thats a small red flag...can he not count or not remember or did someone else answer the email ?? The next red flag..2 patients got bacterial infections, 1 patient (a nurse) the sutures came apart, 1 patient did not think it tight enough. The one patient that he thought I could acheive the same results as has moved and he did not have the before and after photos. In fact I did not see any photos. I may already be financially bound at this point. I am 52 years old and 5`9 tall and 130 pounds. My highest weight was only 15 pounds heavier. My arms are a mess and I do not wear short sleeves let alone sleeveless shirts. I am afraid that when the excess skin is pulled up to the armpit and sutured that the circumference skin will have obvious `pulled` signs. He explained that in also doing liposuction it can enable him to get more loose skin this way. Do you have experience in this procedure and what is your opinion? I really would love to wear short sleeves and so far he is the only surgeon I have found in the area that does this procedure. Thank you so very much.

  Answer:  not sure what the difference in numbers mean, in small number that is likely more important of an issue than when quoting large numbers since when small the numbers can be more easily remembered. You are never financially bound, they might keep some money for the blood work but they cannto legally keep your money if you cancel the procedure. I cannto say without examining you but the limited incision arm tuck is a good option is a very small number of patients. JG 4.27.08

• Hi Dr Garcia, you said that in areas where there is a lot of motion botox wears off sooner...that area would be crows feet?

  Answer:  yes, especially if you squint a lot. JG 4.27.08

• Can you tell me common complications patients had with buttock implants. I do not want big implants so any complications with smaller implants?

  Answer:  infections, the incisions splitting open, the implant coming out through the incision, the implant beceming dislodged and moving to an area that is not normal, pressure on the nerves of the leg casuing pain or loss of muscle funtion. They can all happen no matter the size of the implant. JG 4.27.08

• Do most people who have restylane lip injections get their lips tattooed (the part which they get injected)?

  Answer:  never heard of them doing that too. JG 4.27.08

• Hi Doc....what`s the best OTC eye cream/serum? thanks

  Answer:  I feel for the money the eye booster cream we sell on my shopping cart is the best. JG 4.26.08

• Thank you,Dr. Garcia I have been going about this all in the wrong direction. The reason why I initially did the Artechol was because the nature of my work has me in the Middle East for extended periods of time. I found that the heat and years of smoking (no long doing that) made my lips thin, dry and old looking. I hoped that I could rejuvenate what the elements and smoking took away. Could you plse suggest something that would just freshen up this area of my face? thank you

  Answer:  I think that although it will not last as long that Restylane wil yield a more natural result with less problems. Best of luck. JG 4.26.08

• That is wonderful, so if slight vertical lines are beginning to show above my lip, only seen when the light hits me in such a way, will this be taken care of by having the lip lift? I think that is what I`m seeing more then the slight lump that was left after I had the Artechol. I`ve been blessed with mother nature being kind to me and unfortunately I let vanity take over and now I would just like to have my upper lip area corrected and then just let nature take it`s course from here on out. Thank you Dr Garcia

  Answer:  not really, the lip lift is intended to raise the small volume of the lip up or to reduce the stretched skin between the base of the nose and the vermillion border, ti is not really for wrinkle reduction or lip enlargement. JG 4.25.08

• Thank you for answering so quickly Dr Garcia, that is absolutely wonderful. Could you please tell me what the recovery time is for the Bull Horn lip lift? Thank you

  Answer:  your lips are pretty swollen for about 7-10 days but after that you look pretty good, scars are a little pink for 4-6 weeks, easy to hide with make up though. JG 4.25.08

• Hello Dr. Garcia I have spoken to you in the past about different fillers for the lips and area. Artechol was what I initially tried, had lump problems, thought I could fix it by having another filler done which was less evasive and well now that the Restylane has disolved, I`m back to really feeling insecure about my lips, more so now because when natural or artifical light shines on me, the lumps or imperfections are very noticable. So I read a bit on your bull horn proccedure and thought that maybe this is what I should have had done right at the beginning. I am going to Dubai for an estended period of time and I was hoping that you might have a name of someone that I might see about having this done, IF it is what I should be having done at all. If not then I guess we will be talking more in the future about when and what I should have done by you and your staff. Thank you so much

  Answer:  I am not familiar with anyone is Dubai I am afraid, but best of luck and hopefully the lumps will get less over time. The bullhorn lift will not take the lumps away though. JG 4.25.08

• For prominent muscle above eyebrow (which stikcs out on a flat forehead), do you think it would look better to surgically remove the muscle or botox. I think with botox the muscle will still show but just not move.

  Answer:  in time with the Botox injections the muscle should shrink some due to atrophy, otherwise it could be surgically removed. JG 4.25.08

• Will restylane or radiesse (spelling?) injections fill in a flat forehead? Would implants work for a flat forehead or would they look too artifical (show outline of implant on forehead)?

  Answer:  I do not think the injectable fillers will be cost effective nor long lasting enough. Implants could be custom made I guess and as long as they are under the muscle should look OK. JG 4.25.08

• do you think endermologie is better than velasmooth i understand it is only temporary but want to know which is better for that temporary look on legs or are both a waste?? thanks

  Answer:  I think Velasmooth is better. JG 4.25.08

• Dr Garcia, tip (about half distance of nail) of left thumb was cut off in a childhood accident. Now age 37, would like to know if possible to reconstruct thumb so the nail looks natural, instead of the claw appearance it has now. Thank you for your time and assistance.

  Answer:  not much that can be done I am afraid, they might be able to trim it so it does not claw as much though. JG 4.25.08

• Dear Dr Garcia, I am 27 years old and the doctor put me injections in my frown lines, crows feet and forehead, he used 85 U in total ...I don´t like the results, it changed my facial expression completely...my questions are: When do you start to get rid at least a little bit of the effects? is it progressive since the injections? or is only after the 3 or 6 months that you start to note an improvement? with that dossage, in how many months do you think the botox will wear off? the location of the injections influences in the duration of the effect?...I mean, in some places it will go faster than in others? thanks a lot Dr Garcia! and sorry for my english...

  Answer:  nothing you can do to make it wear off faster, should be gone in 3-4 months, in areas where there is alot of motion it wears off sooner. JG 4.23.08

• Hello doc thanks for all your help ,doc wanted to know at what age must a baby stop bottle feeding and start on the cup feeding? i hear its not good to bottle feed after 1 yr old? it can cause ear infections,poor growth,poor sleep patterns and even tooth decay in babies and children? thanks alot for all the help again

  Answer:  that is not a plastic surgery question, sorry. JG 4.23.08

• Dr. Please tell me what I can take for bruising? I bruise very quickly and it takes very long to fade I ALWAYS bruise when I have Botox under my eyes. I am thinking of having a mini face-lift/neck-lift but just the thought of bruising and the period it stays `blue` makes me shiver. Please help me. Thank you very much

  Answer:  Arnica Montana, topically and orally, bromelain also will help. JG 4.24.08

• Dr. Garcia, what is the most effective, yet least invasive solution to fix some mild/but noticeable acne scarring (mainly the cheek area) and also without going the accutane route (been there) what would your recommendation be for re-ocurring acne (not too bad just a few clusters here and there)?

  Answer:  I think a deep Rhytec Portrait laser would do it. As to avoiding further breakouts, I think oral antibiotics or Retin-A topically are the best. JG 4.23.08

• In regards to my question below about buttock implants. I just saw a video of a newscast about a patient who had too large of buttock implant size put in so she in unable to bend over. I do not know if the implants were put over or under the muscle, but they looked like a water balloon hanging down. In other words, they looked saggy and droopy. I do not know if more implants tend to look firm or droopy? The droopy look scared me.

  Answer:  that is a matter of size more than anything. JG 4.23.08

• Is there some kind of hip implant surgery or something to enhance the hips?

  Answer:  nope, sorry. JG 4.23.08

• I am seriously considering buttock implants. Have you heard patients complain about the results of their buttock implants? Or were the complaints written in article? I do not ever hear about patient`s experience in the long run.

  Answer:  I have heard of many short and long term problems with implants in the buttocks, I no longer do them due to the complaints faced from other surgeons. JG 4.23.08

• What is best injection for hard lump (scar tissue) on lip?

  Answer:  I feel 5FU is the best. JG 4.23.08

• A plastic surgeon who specializes in buttock implants said the most life changing surgery was buttock implants. Do you think patients can ever get good results (look better than before) with this surgery?

  Answer:  occasionally, yes, the majority of the time, no, and I would expect him to say that if he specializes in it, if he specialized in facelifts he would say that facelifts are life changing events. JG 4.23.08

• helo doc is it normal to have dry skin on the breast as was checking and came across a tiny one then i peeled it off its not cancer it was like dry skin how you have then kind of peel it pls help thanks alot asap

  Answer:  I think you need to see your gynecologist. JG 4.21.08

• helo doc thanks alot for the response back and also wanted to ask you okay i havelike a tiny small moving ball like feeling above my elbows can it be a cyst or what you can feel it like how you can feel cyst or lump on breast pls help thanks alot asap

  Answer:  I think you need to see your primary care doctor. JG 4.21.08

• `Dr. Garcia, I posted a question last night that I don`t see - perhaps it did not go through. I am wondering if there is anything that can be done to counteract dark skin around the eyes. I don`t have dark circles beneath my eyes, but the skin from the inner corner of each eye to the bridge my nose is noticeably darker. I notice some people have this, and in my case it is so pronounced that someone commented on it once in a negative way. I was just wondering if there was anything I could do other than cover it with makeup.`

  Answer:  sometimes fillers can help but they are temporary. JG 4.20.08

• Are you familiar with a new method to lip the upper lift performed by a PS in Texas. It is called a lip suspension & there is no outside scarring? Apparently he`s the only one who performs this innovative lip lift, so I`m considering making the trip.

  Answer:  well, when there are operations that a surgeon claims he is the only one who knows and can do it, I become very suspicious, I would wait it out and see. JG 4.20.08

• Hi Dr. Garcia, On 9/24/2007, I had a colon resection due to a long and eventful history of diverticulitis, that stopped responding to traditional treatment. 4.5 months later I was operated on for an incisional ventricle hernia, repaired with sutures. I`m again experiencing the same kind of pain in the same area, and have an appt with my surgeon for 4/15/2008. After doing internet research, I discovered that the rate for these hernias to reoccur when sutured is 55%. I have no earthly idea why my surgeon didn`t know this, or why he opted for suture repair. I`m scared to death to have yet another surgery again, and wanted to know what would be the best way to repair this new occurance, and does it absolutley have to be repaired? Any input that you can provide me with is greatly appreciated. I`m afraid that I`ve lost confidence in my surgeon.

  Answer:  if the hernia is not at risk of becoming incarcerated or trapped to cause a blockage, it can be left alone. JG 4.20.08

• helo doc wanted to ask you a question regarding nipples of the breast well is it normal to sometimes have pain when you press the nipples my periods are due on 2nd or 3rd amy pls help me as i am very concerned there is no discharge or redness anything like that its normal its just when i press both of them pls help asap thanks doc

  Answer:  yes. it can be normal. JG 4.20.08

• I understand there was some recent news about botox causing brain damage. Do we need to be concerned? I`ve been doing it for 7 yrs. Would you give it to a loved one? thanks Doc

  Answer:  it was reported to occur in cats when injected into their whiskers that have connection with the brain, it cat anatomy is quite differnt from humans and has never been reported in the 20 years of it being used. JG 4.20.08

• In your opinion what is the best peptide serum I can purchase? Thank you for your time

  Answer:  the one on our shopping cart. JG 4.19.08

• Who would be better to perform umbilicoplasty where problem is caused by a small hernia- a general surgeon or plastic surgeon?

  Answer:  might need the general surgeon to fix the hernia and the plastic surgeon for the umbilicoplasty. JG 4.19.08

• Dr. Garcia, Whst is you opimiom about the new GFX procedure? It is being touted as a great alternative to Botox. I understand botox is about $1,500 per year and GFX is about $2,200 for 18 months. Less down time and cost about the ssame all in all. I just saw it on our local news since a local ps is using it. I value your honest opinion and am grateful that you are willing to share your knowledge and expertise in this forum. Many thanks as always.

  Answer:  a little early to tell, I think I would wait a bit more to see how well it works. JG 4.19.08

• helo doc i can feel like a very small movable cyst above my elbow it moves when i feel can it be a cyst or what pls help you can feel it very surperficial thanks asap

  Answer:  needs to go to an appropriate website for your problem, that is not a plastic surgery issue. JG 4.18.08

• Hello Dr. I was wondering. I grabbed a brochure at a PS office that told about facial sculpting. It said that one could do cheek implants, but it also said if you felt your face was too full you could sculpt it using the same incisions that you would use to put cheek or chin implants in, but it didn`t really specify what would be done. What is it they would do?? Some type of facial liposuction?? I am just curious as I feel my face is too full and am interestd. Thanks so much!

  Answer:  they take fat out with a scalpel, of the cheek, to make it look more slender, it can prematurely age you though. JG 4.18.08

• Hi Dr. Garcia. About a year ago I had a flat red, pimple-like blotch right above my nostril, and had a plastic surgeon use a laser to try and remove it. The laser was to no avail, as I still have the red blotch. A few days ago, I noticed that I have a second blotch in the same area. Are there any alternatives to the laser that would remove or substantially reduce the appearance of these unsightly marks? I tried using salicyclic acid, but it didn`t help. Thank you, Dr.

  Answer:  the acid will make it worse, and in my experience, the lasers work but almost never after just one treatment, it takes a seris of them I am afraid. JG 4.17.08

• what does chirally correct mean in terms of product? thanks

  Answer:  esentially, molecules can be oriented in a right or left orientation and some work better than others. JG 4.17.08

• If a woman is skinny or her skin is not stretchy (from gaining and losig weight), can you put a size D implant in? I had a small C implant put in, and it was very painful. What I mean is it felt like a tight rope was tied around my chest (due to my skin stretching). It doesn`t seem like my skin was capable of stretchign anymore, but was it? Well, if I had a size D implant put in now I suppose it would not be as painful because my skin was already stretched and only needed to stretch 1 cup for D cup.

  Answer:  I think the pain might be worse if you go larger. JG 4.16.08

• helo doc what can cause burning on the lips will it stop itself as it just started today thanks again asap

  Answer:  hard for me to tell, sorry. JG 4.16.08

• helo doc wanted to know can you get cancer when using anti-persoirant deodrants as read an article about that thanks again

  Answer:  I think the risk has been discussed in the media but the science does not seem to prove it out. JG 4.16.08

• I read the answer for a question about Retin-A. You replied to apply Retin-A for 9 months, then stop for 3 months. I have alwasy used it year round. Won`t your skin bounce back to way it was if you don`t use if for 3 months? Should I be taking a 3 month break?

  Answer:  it will likely not go all the way back to the way it was originaly, but part way, yes. I think everyone should take a three month break once per year. I just like patients to stop during the summer months as the Retin-A sensitizes you to the sun and it is hard to avoid sun exposure then. JG 4.15.08

• I am the one who asked about my daughter`s sebaceous cyst excision. Thanks for your prompt response doctor !.. My only concern was about how much the scar fades over the period of time with use of mederma / vit E oil?..How much time will it take to resemble like surrounding skin? Thanks once again..

  Answer:  it will always be visible, no matter what you do. JG 4.15.08

• Hello Dr ..I am so happy to find this informative site. My daughter is 14 months old & she has got a 7-8mm epidermal cyst on her right cheek since 3 mths..She had dry skin in that area before..Now paediatric plastic surgeon has adviced excision.. My question is how do they excise it..I mean total excision or minimal incision technique?..I am really worried about scar bcoz it will be visible on cheek..How big will be the scar & considering her age 14 mths, will it be less & less visible once she grows...Is there anything I can do after the surgery for getting a less visible scar?..Can laser resurfacing be doe in younger kids? Thanks again & hope 2 hear from you soon...

  Answer:  it is done through a small incision and the entire wall of bag of the cyst should be removed. The scar will be visible as she grows though, it will grow as she grows. Laser will not remove the scar, only decrease the redness at times, otherwise using ceams like ScarGuard or Mederma do help, along with sunblock. JG 4.15.08

• Everything on my body is petite except for my shoulders. I have broad shoulders which do not go with the rest of my body. I know there is shoulder replacement surgery for those who injured their shoulders. Do you know if shoulder replacement surgery can make your shoulder blade size smaller. Just 1 or 1.5 inches shorter on each shoulder blade would make such a difference. I have a hard time with tops fitting me.

  Answer:  sorry, but there is nothing that will do what you are searching for. JG 4.15.08

• Do you know if people have cosmetics surgery now through labs which can grow new skin cells (for scarred or damaged skin)? Or maybe for women with had to have one breat removed= to grow new aerolae tissue on reconstructed breast from aerolae cells taken from other breast? Do you know of any labs which migth do this- I don`t know it a person would go to lab or a cosmetic surgeon?

  Answer:  that technology is still years away. JG 4.15.08

• helo doc i cant explain and also you cant say until i saw you in person its like its not folding or anything it feels like pimple when you touch like how you have around the nipples its small its not cancer is it asi dont get to see my doc soon enough thanks and he examined me 3-4 dys back so he cld havenoticed anything unusual isnt it its just my anxiety may be thanks again doc asap pls

  Answer:  you need to see your doctor in person, I cannot help you on this forum. JG 4.15.08

• Thanks for the answer about liposuctioned areas being unsuitable donor sites for facial fat grafting. Is the inner thigh a suitable donor site for male facial fat grafting - reason being that is an area I have not had liposuctioned and I seem to have some fat there. Am I right in assuming that in general, you aren`t a big fan of fat grafting?

  Answer:  if you can get some fat, it can be injected but survival of that fat is not great. JG 4.15.08

• I am a 37 year old male interested in facial fat grafting. However, I have had (a few years ago) a liposuction in my trunk. Although there were no incisons into my buttocks, the surgeon did slightly liposuction into the buttocks are through the trunk incisons. My question is: Does this mean that it will be difficult to get donor fat for facial fat grafting, as it is my understanding that a liposuctioned area is unsuitable for obtaining donor fat?

  Answer:  that is correct, yes. JG 4.15.08

• helo doc thanks so much for the quick responses to the questions ipost okay i wanted to know dont know if its a strecth mark i have on the breast well there is no lump or anything like that its like a small speck if i press its like skin folding and it looks like same colour of skin and you can feel on top like when press its smooth but its like fold so its nothing to worry about breast do have stretch marks as well thanks alot i am very anxious about my health so keep checking thanks doc asap

  Answer:  need to see a doctor in person I am afraid. JG 4.15.08

• Hi Doc---do you ever review pictures via email? Also, I am scheduled for multiple revisions in the fall (rev. abd scar revision/recreate L breast crease? and R breast capsulotomy). You mentioned to me that these could all be done in one procedure (my ps said the same thing). Considering the fact that I`ve had 5 procedures in the last 18 months (4 being redos) I`m nervous. What do you suggest? My ps is highly competent, very sweet man. However, Sometimes I feel that he treats the `revisions` very lightly and offers them without hesitiation. I am so nervous about further complications. I want to stress to him that I need to make sure that these future revisions give us a great chance of success--can`t guess or hope anymore---too emotionally draining. Do we do these revisions over 2-3 surgeries to ensure more success? I`ve had too much trouble with the rev. abd scar pulling down on a freshly revised breast, only to see the crease pulled flat---very scary.How do I communicate that I need him to take this step by step with very careful consideration to finally resolve these problems? I don`t want to insult him or come across emotionally unstable. 2nd opinion?

  Answer:  you can send me photos to drgarcia@lvcosmeticsurgery.com. I think for your doctor, you need to tell him all of yoru concerns so he is aware and he can then deal with them and discuss them with you beforehand. It is very difficult for me to predict the degree of success of the procedures though. I would suggest you write it all down so you do not forget anthing and ask him to print your pictures so you can both sit down and see what the issues are too. Best of luck. JG 4.15.08

• helo doc thanks alot i can use vaseline cream for the rash or not also wanted to know if you dont have children doesit mean you willhave breast or uterus cancer ahead or its not ovious thanks doc

  Answer:  you can try the vaseline and it should not cause any cancer. JG 4.14.08

• helo doc i know its embarassing asking this question but wanted to know can it be a rash i started having this feeling in the mid section of the butt areas where the tail bone is below the mid region that joins the butt its like burning when i touch can i apply polyposrin cream or cream that was given for constipation problem when feel ithcy pls help thanks alot its not any infection is it its kind of pink like skin colour thanks alot asap doc thanks

  Answer:  it can happen, use the diaper rash ointments sold OTC. JG 4.14.08

• I am long waisted and have a flat behind. Because I have a flat behind, my back looks even longer. A curve in my buttocks would make my shape more in porportion. I have tried all the different padded undies, which all look unnatural. The best one I coudl find was silicone padded undies since the humps blend in better instead of firmly sticking out. Myabe the buttock shape of undies was meant for a different body so it doesn`t look right on me- I don`t know. It is embarrasing wearing padded undies= I don`t want anyone to accidentally touch me or bump into me. Also, I will not wear the silicone undies when I goto the airport or other places with metal/security detectors. My question is if I have buttock implants will my butocks look as bad as the unnatural padded undies I have tried on? My buttock do not even look flattering with padded undies because the buttock curves are off. I don`t know if the curves will be just right for my body type with buttock implants. That`s what I`m asking= althought the padded undies do not look right, will buttock implants if the doctor uses the right size and shape? Would you say padded undies do not look right on most people because it needs to be a custom fit?

  Answer:  they should nto be as bad as what you describe, but they have other risks, such as infection or malposition. I have never thought padded undies looked good on anybody. JG 4.13.08

• Dr. Garcia, I am interested in having a buttocks lifting procedure done, the kind that involves a deepithelialized dermal flap connected to the fascia of the skin and muscle in order to correct butt ptosis. First, is it true that you must remain the same weight you are when having the surgery performed? In other words, if I gain or lose weight will this adversely affect my lift? Also, are you familiar with the dermal flap procedure? If so, do you have an opinion on it?

  Answer:  weight fluctuations will affect the size as the dermis is quite thin and what is giving the buttock change in size is the fat below it. I think it wil help in some people, but not all people have enough of it to make a large size change. JG 4.13.08

• Hi. I am hoping that you can help me. 5 years ago I made a very stupid decision. I was at my salon and a woman was there from South America who was injecting bee pollen and vitamins into lips. She was there for months. It was not a one time deal. So, they told me that it would last for 3 months. I needed a pick me up - it was February and cold in the Northeast. It has been 5 years. My lips are completely distorted. It is quite horrible. I just want my old lips back. I went to a plastic surgeon and he told me that the only thing he could do is add more to fill them out. That is the LAST thing that I want. I look ridiculous! Is there anything that can be injected to melt away whatever was put in my lips? I feel quite stupid and all I want is my smile back. Thank you for your time.

  Answer:  well, I seriously doubt if you still look distorted that it was vitamins and bee pollen, she likely injected you with silicone or wax and unless there are lumps that can be individualy cut out, I am afraid there is not much that can be done. JG 4.13.08

• Thank you so much for your reply on the labiaplasty. Needless to say, I`ve been really worried about this! Your service on your site goes well above and beyond the call of duty . Many thanks!

  Answer:  hang in there, it will get better, thanks for visiting. JG 4.13.08

• Hi Dr. Garcia, I had labiaplasty surgery 10 weeks ago. I am pleased with the appearance. I did not have any complications at the time of surgery. But, about 4 weeks after surgery I had hypersensitivity. Now, at 10 weeks I have some loss of sensation. It is taking longer to acheive orgasm and the feeling is not as strong. Do you think this could be permanent?

  Answer:  I doubt it is permanent as in a typicla labiaplasty the area around the clitoris should not be injured, it might just be due to swelling in the area, which can happen and is normal, and should get better in time. JG 4.13.08

• What is DMAE cream? Does it irritate the skin or make the skin peel? Do you need a prescription for it or is it only available at a pharmacy? What is a good strength to use if it lists the strength on package.

  Answer:  it is a cream with DMAE in it to attempt to control the issues that arise with aging. In some people the skin can become irritated by it, yes. It is OTC, no prescription needed. I think 4% at least is needed. JG 4.10.08

• Does hair not ever grow back as long as you continue to apply Vaniqa cream? Are there any side effects/dangers to using Vaniqa cream on a daily basis over long time? Do you know if this cream is covered by insurance- probably not since it is a brand name?

  Answer:  it can grow back, yes The side effect profile is minimal as I understnad. I do not think it is covered by any insurance companies because it is for cosmetic use. JG 4.10.08

• helo doc i have anxiety so i always think there is something wrong with me eg when i examine my breasts under the breasts where yu can feel the ribs and if checking with your fingers pressing you can feel nodes both the sides are the same and when feel on outside there is no lumps or bumps where yu can feel the ribs and the below breast tissues is it normal as i kept feeling both the breats now have pain around the areas bse was seeing if there was no lumps or anything unusual pls help thanks alot and also the underarms was clear so was it the bones and glands i was feeling thanks alot pls help i am very worried there is nothing wrong with me is it thanks again

  Answer:  I think you need to see your promary care physican if you are that worried. There is nothing I can do for you. JG 4.10.08

• helo doc wanted to ask you a question regards benign cysts/tumors of the breast does it mean if you get it more then once and report is negative you can get cancer later on , and do thigh muscles tend to have strecth marks its like white lines is it normal and for the breast you dont have to worry unless you see a lump if you feel and its all normal then its fine right does breast have nodes too thanks alot pls answer for me asap as am anxious thanks again

  Answer:  it does not mean you will get cancer in the future. Thigh skin can have stretch marks too. As to the breast, a mammogram is more important than self breast exams. JG 4.10.08

• In your opinion do facial exercisers using low voltage electricity have any benefit? I have seen them advertised at medical spas and on the internet.

  Answer:  no, I do not. If anythig they might cause new wrinkles or worsen ones you already have. JG 4.9.08

• to clean my face i use cetaphyl and baking soda. is it ok to do it everyday? i love how it makes my skin look and how it preps my skin for actives. thanks

  Answer:  should be OK to do, yes. JG 4.8.08

• The skin on my face looks nice. However, the skin on my neck is starting to look older than my facial skin. I am not talkign about age spots, but the texture is looking chicken skin like. What can I do for my neck? What are best nonsurgery (creams, topical medications, etc) and best surgery treatments (laser)?

  Answer:  the only laser on the neck I would suggest is a light Rhytec Portrait, as to topicals I think Retin-A or DMAE ceams are a start. The neck cannot be treated as aggressively as the face so the results are not as dramatic. JG 4.8.08

• Hey Doc, Since you are opposed to thermage, what do you recommend to tighten the neck area? Much appreciated

  Answer:  I am afraid it is surgery. It is not that I am opposed to Thermage, people are free to do it, but I just feel it is not worth the money. JG 4.8.08

• What is the best filler for underye hollowness (where dark circles ar elocated). Would it be Restylne or Radiasence or something else? Are patients generally happy with undereye filler results or do many get a lumpy appearance?

  Answer:  I use Restylane or Juvederm there, but not Radiesse. Most patients are happy. JG 4.8.08

• helo doc i am anxious wanted to know does breast have fatty tissues like tiny lipomas and nodes as well as was examining my breasts and felt very tiny at the begining and also under the nipples areas on the sides like small nodes same on both sides i dont have lumps or anything like that and skin is normal as for lumps you can feel this was pressing so cld feel is it normal its not cancer or anything bad thanks alot doc

  Answer:  need to see your gynecologist. JG 4.8.08

• How long do injections to flatten rasie scars last? If it flattens the scar, is the injection uspposed to last forever or do you need repeat injections over time?

  Answer:  once flat it should stay that way in most cases. JG 4.8.08

• What is exactly the lip vermilion border. Is it where the skin colored skin meets the lip colored (rose color) skin? I know the skin above lip is called upper lip, but it is not the lip. So, I`ll call it the skin where men grow mustaches. Is it the border where the mustache skin meets the lip? or is it the border of the dry and wet part of lip?

  Answer:  that is correct, the slightly raised border. It is the border where the skin that grows hair meets the red lip that is stil on the dry side. JG 4.8.08

• helo doc wanted to know if its harmful to stop taking diazephame anxiety meds when i see my doc on frid as this was given to me by another doc as am also taking effexor the doc gave me for 2 weeks and effexor am on it when i take in the evening i feel better then morning i start feeling scared and worried so will the doc give me effexor to take in the morning and stop the diazepham (valium) pls help as dont want to get worse thanks alot how long does it take for effexor to work i am on the 5th week 75mg thanks alot doc pls help doc are they many out there who have this kind of issue

  Answer:  this is not an appropriate message board for your question. Sorry. JG 4.7.08

• good day dr. garcia. so glad you have this site. this might sound like a strange question, but has anybody ever told you that their face looks less wrinkly since they dont tan anymore. i am 57, and i have quit tanning 2 years ago, and my face seems smoohter. can this happen? thanks

  Answer:  yes, your body will be less dehydrated and less damaged because your skin wants to try to remove the damage if you are young enough, keep it up. JG 4.7.08

• what are the problems as you see them w/livefill? thanks Doc

  Answer:  dissolving of the fat, developing oil cysts, developing lumps are the most common, along with the fat not surviving. JG 4.7.08

• helo doc i was just wondering is it normal to have different colour of skin on the abdominal areas and hands as i am brown colour hands are lighter then inside areas of the body its kind of browm patches where skin folds kind like yellow brown not the yellow but like brown when look in mirror it looks same pls help thanks alot or is it just the skin colour not liver disease as my eyes are normal thanks alot

  Answer:  it is not uncommon for different parts of the body to have different skin tone, due to location and sun exposure and type of skin too. It is not due to liver disease. JG 4.7.08

• What do you think of the Nefertiti Lift which uses Botox or the cheek sling for the mid face region? AB

  Answer:  lots of hype for little improvement. JG 4.6.08

• hello doc well thanks for all your help and again sorry for any inconviniences , i know the forum is not for breast feeding issues,its regarding the question i had posted about the pumping ,well i will speak to the lactation nurse to get some help,thanks anyway and hope you will help me in other issues if anything comes up have a nice weekend and evening ,thanks again !!

  Answer:  best of luck. JG 4.5.08

• Will Mederma / scar guard / silicone sheet help a red depressed scar where the skin is thinned, or does it only work on raised inflamed red scars?

  Answer:  it is more for raised scars. JG 4.3.08

• Hey doc, I just posted about the juvederm lumpyness and swelling by the side of my mouth. You just said to wait 2 weeks (thanks for your response by the way ;-) But do you think waiting the 2 weeks would cause stretching of the skin at all?? Just wondering, I`m nervous about that. Thanks, happy spring to you, too.

  Answer:  no, I do not think there will be any appreciable stetching if the skin that will affect anything long term. All the best. JG 4.3.08

• Hi Dr. Garcia, I just had my 2nd microdermabrasion done yesterday..it was one week after the first one, and I`m looking to due a total of 6, each spaced one week apart, then followed by one microdermabrasion per month for maintenance. My question is, unless it`s my imagination, this morning it appears as though I have lost some facial volume in my midface/cheek area on one side. Have you ever heard of this?? I am now not sure if I should continue with the microdermabrasions..what is your advice? Thank you so much for your time.

  Answer:  just swelling, it will not last I am afraid. That is from the frequent microdermabrasions. JG 4.3.08

• helo doc wanted to know what is fat deposit can you feel then around your abdominal areas its superficial like small balls is it harmful its not cancer is it or is it blood vessels or muscle tissues pls help its the area below your chest and mid abdomen pls help doc thanks alot , doc is it possible to still have anxiety attacks after starting effexor, am on the 4th week taking 75mg i take in the evening then dont have the panic attacks and fear then morning it comes back so shld my dose be increased or what pls help thanks alot as i know its not your area but am very anxious its not cancer is it

  Answer:  could be small lipomas, no way to tell 100% without a biopsy. JG 4.2.08

• Do you know why your some areas of eyebrows grow kinky as you get older? You stick out so you have to pluck them. What makes them get kinky, and is there anything you can do to keep them from sticking out?

  Answer:  all controlled by genetics. JG 4.2.08

• Hello doctor, Great site here! I was wondering, for facial contouring, if I didn`t like the shape of my face and wanted to change it, what are my options. I guess its the lower 3rd of my face I don`t like, I wish it had more contouring. I like my jawline and chin, but from the front wish my cheeks stood out more, but am afraid of cheek implants beucase when I smile my cheeks get really big already. What is your opinion?

  Answer:  migth want to consider Sculptra injections as they can be injected in different locations to acheive certain appearances. JG 4.2.08

• what is Livefill and do you offer it? thanks

  Answer:  do not offer it, do not believe it. JG 4.1.08

• Hi Dr. Garcia...I receive a kenalog shot in my hip during allergy season for allergy symptoms. The kenalog has been a lifesaver for me. My question is...what are the risks,if any, of having a retouch botox to my forehead performed on the same day. The reason I am asking is because both doctors having practices in proximity of each other and I drive an hour to reach them and it would be convenient to schedule on the same day..Thanks...

  Answer:  no reason why not to do it. Go ahead. JG 4.1.08

• what is the best treatment for wrinkles and creepiness on the neck? are non-evasive laser treatments a good option or something else?

  Answer:  not much is really effective except surgery I am afraid. JG 3.31.08

• Hi Dr. I was the on who is having aging skin problems at 27 and I conslulted with a PS who suggested fractional laser for me. Do you think this is a good option for firming and fine lines and skin texture? That is what id like to fix a lot. Also, he said it would boost and make new collagen. Is that true??? I`m not making an appointment until I hear from you :-)

  Answer:  I think the improvements are very mild at best. It does in theory boost new collagen production, the thing is whether or not that amount of collagee will make a difference visually.JG 3.31.08

• Hi! I am a 29 y\o woman and I have been losing my hair for 3 years now. Have been to several different doctors who have told me I have alopecia areata due to stress(I disagree). Would Scalpmed work for me? or do you know of anything that will help me? I want to feel pretty again! Thanks

  Answer:  we have had it be helpful in some cases but not all, worth a try I think. JG 3.31.08

• Hello Doc,thanks for all the help well i had send you the question regards to when hair falls out due to delivery ? is it normal and will it make me bold my doc has said i use centrum vitamins and it will be okay, so is it the hormone levels now going back to normal and is it normal to have hair fall out after delivery after some months,is it serious or it will get back to normal ,how long will it take ,thanks alot again

  Answer:  it is from the progesterone iand it gets better once the hormones get into better balance with time. JG 3.30.08

• I had an accident on a snowmobile Jan. 12, 2008 and bruised my face. My eye is still puffy and dark underneath. How long will the puffiness and discoloration last? It is now March 28, 2008. It has been 3 months and 16 days. Thank you for responding. Connie Harper

  Answer:  in severe cases I have seen it take 6 months. JG 3.28.08

• Have you heard of ThermaClear?(http://www.thermaclear.com/shop1/TAMDOAGMZ/about.cfm) If so what is your opinion? Thank you

  Answer:  do not think it will do much over traditional methods. JG 3.28.08

• Hello Dr. Garcia, My son is 13 years old and has always had large ears that totally stick straight out. Is there some way to correct this for him as now he is getting older and it bothers him. How much would something like this cost and how long would the recovery be? Thank you!

  Answer:  it is called nan otoplasty, downtime is about 7-10 days and the fees around the country go for about $4600, all inclusive. JG 3.28.08

• For a nose surgery I had the doctor said he was giving me local sedation. However, I woke up during surgery and felt tube down my throat, and it hurt down my throat days after surgery from the tube. It felt like I had local instead of general because I was able to get up right away after surgery. Do you know why a tube was placed down my throat if I did not have general? I had a respiratory virus 3 weeks earlier so I do not know if I maybe I sounded liek I had breathing problems/ Would they put tube down throat if you sounded like you had some mucus in your lungs? I read the question below about tube down throat.

  Answer:  they might have started with it under local anesthesia with sedation and they might have given you too much medication and you lost control of your airway and that is why they put in the tube down your throat, hard to say without looking at the record. JG 3.27.08

• Hi Dr. Garcia, I have a cosmetic problem rooted in a medical problem. I am not sure where to seek help next. Despite following a 1200 kcal/day diet with 45 minute intense cardio sessions 5 mornings a week, I have gained 11 lbs of blubber over the past 2 months alone. In fact, my petite little 5`0 frame has gained 30 lbs over the past year. I have seen two physicians. One laughed at me, and the other ran a CBC, TSH, T4, free T4, lipid panel, and LFT which all came back normal. Other than a highly irregular menstral cycle, I have always been healthy and I take no medications. I presently feel fine other than some mild fatigue. I have no family hx of obesity. I refuse to give up. Where do I go from here? What kind of a doctor can help me? I sincerely appreciate any direction you can give me. Thanks for your time, I sincerely appreciate it.

  Answer:  tough call, irregular periods could be a sign of mild poly cystic ovary disease which has hormone imbalances that can lead to weight gain from too much testosterone and nt enough estrogen, maybe see your gynecologist to see about that. Best of luck. JG 3.27.08

• Can one use Retin-A cream 0.025% in undereye area forever. Or must they increase it to the next higher strength? I htink .1% is the highest dose so you can`t keep going higher and higher. I was just wondering if people were usually able to remain at 0.025% forever?

  Answer:  no need to increase it if it is doing well. JG 3.27.08

• Would you say scars on lip heal well or not so well? i had a small raised scar lump removed from lip. However, instead of the incision lookign like a cleancut thin line, it was circle scab. The circular scab worried me because I was expecting a thin line scab instead. Right after teh scab healed, teh scar was flat or unnoticeable. Then a month later, it becamse raised and i as big as the orginal scar. I don`t know if it is just how the scar was revised (due to the circular scab the same size as original scar worried me) or if the lip area tends to scar more? Have you ever removed any scar tissue from lips or managed to make a flat, thin line scar instead of raised, circular scar?

  Answer:  on the red lip they heal will, on the vermillion, it varies. Might need another revision. JG 3.26.08

• You wrote before that you think buttock implants look unnatural. Do you mean they feel unnatural or look like hard rocks? Did you ever see someone who had silicone gel buttock implants from Mexico or Brazil? If so, did those feel`look natural? Also, do buttock implants genrally last a lifetime ordo they need to be replaced every 10 years or so (the same question goes for breast implants).

  Answer:  both actually, at least with the ones available in the US at present. The buttocks implants can last years if they are solid but if they are gel they can leak. JG 3.26.08

• helo doc i wanted to know if you have infalmmed ribs it can cause pains in upper chest areas and left side where the heart is and sides back pains its not the liver nor kidney right i had a urine test bse had trace of protein not high so my doc did not give meds is it normal and how long before it gets normal , pls help and also if have spasms can it cause pains as also feel like contractions on left side

  Answer:  yes it can and no way to tell how long it will last. JG 3.26.08

• Hi dr. Its me again,the 27 year old with the drooping face. I had my injecort tell me that I should inject juviderm to make my cheekbones and malar fat pad area to make them look fuller at the top and she said that would pull the skin to look tighter in the malar fat pad area, (where I feel its dropping, too)but I am scared I will look like Pricilla Presley (face full of filler looking). Do you think that could help? Or would I more likely get a full face look if she injects that much?

  Answer:  well, I think it will likely take a large amount of filler to lift skin, and I think it would take a real lot to look as fuls as PP. JG 3.26.08

• Hi Dr. I have been so concerned with becuase I feel my skin has premature aging. I just consulted with a PS who wouldn`t do lasers she said a TCA 30% chemical peel. But I really feel that my skin is sort of dropping, like, my cheeks are fallling. The problem is...I`m only 27!!! I think I`m too young for a mid face lift, but when I pull my face up it looks like how I looked just a year ago or less. I`m not sure whats happening, but I`m so upset these past few months. It is giving my a chimp sort of look (as I have chubby cheeks) Would buccle fat removal maybe offset this look? (I used to have such nice apples of my cheeks showing and I have good cheekbones, but I feel they are hiding now, as my face is drooping) What would you recommend for someone who is young like me experincing this? I`m so depressed.

  Answer:  buccal fat removal can actually make you look even more gaunt and I would not suggest that. I really cannot begin to advise you on what to do without seeing you in person to see exactly what has happened, sorry. JG 3.26.08

• Hi Dr. Garcia. I have symptoms of PCO: acne and falling hair. My dermatolgist prescribed me Accutane but I`m worring that this drug will have negative effect on my hair. Is it a good idea to take accutane if I am sensitive to DHT (all my hormons are ok). And the next question: can I take accutane with natural DHT blokers like zinc, saw palmetto and linen oil?

  Answer:  I think it is fine to take and you can take it with the natural DHT blockers. JG 3.26.08

• Hi Doc...I asked yu a few months ago about a minimal skinlift to the innerthigh and you said it was very doable. Since it is skin only are the results for something like that very short lived? thanks

  Answer:  well, it depends on weight fluctuations and motion, it is not that it will not last, it is more of the scars migrating to a more visible location and the scars speading out wider. JG 3.25.08

• Just wanted to wish you and your family a happy holiday weekend. Thanks again for all you do.

  Answer:  that is very kind of you, many thanks and best wishes to you and yours also. JG 3.23.08

• Hi Dr. Garcia, Is it standard practice for a surgeon`s insurance company to have them ask the patient to sign a form prior to revision surgery stating that they agree never to sue the Dr. for any possible complications from the surgery such as permanent numbness? Thanks

  Answer:  an insurance company does not have that authority, that is coming from the surgeon himself. JG 3.21.08

• Hi Dr. Garcia, Thank you for all the information you have given me during past questions. I wrote about having discomfort and numbness on one side of my lower lip and below following genioplasty surgery. When I put a piece of thin tissue between my lower lip and teeth/gum area, it makes it feel much more comfortable and increases the sensation some. There is still some numbness. Do you know why this would make things better? Would there be anything to do surgically to create more space between the gum/teeth and lower lip? Thanks for any help.

  Answer:  hard to asy why, it might be able to be achieved by placing a material called Alloderm underneath the mucosa to achieve that effect. JG 3.21.08

• You answered my question earlier about botox used for the neck. What do you recommend for the area of the neck just under the chin. It`s just beginning to loosen up a little and wanted to take care of it now.

  Answer:  might need a neck lift procedure to fix that. JG 3.20.08

• I have seen botox used in the neck with impressive results. Is it used for the neck area just below the chin? And I love your website. Very informative.

  Answer:  I personally do not use it there, I feel the number of patients that have flexing platysma bands causing visible neck folds at rest to be quite rare. Thanks for visiting. JG 3.19.08

• Hi Dr. I recieved botox to my lateral brow (just the outside edge above my eyebrows) last Wed. (one week ago) After 2 or 3 days it looked really good, I could tell a difference, my brows seemed lifted, I liked it a lot, but the last couple days it seems that I`m losing the brow lift effect :-( Could it be because I told her to be very conservative??? (I was nervous, it was my first time) She didn`t put very much she said. Should I have her do more??? I really liked the way it looked at first. Thanks so much!

  Answer:  I do not think the lift you got was from the Botox, it would likely not work that fast nor wear off that soon, the lift might have been from the swelling from the fluid injected, you likely need much more injected I think. JG 3.19.08

• Dr. Garcia, What is your view of the combination of Matrix IR (wrinkle reduction), ReFirme (tightening) and Skin Rejuvenation with elos (pigment)in a series of 5 treatments, with each treatment a combination of all three?

  Answer:  waste of money. JG 3.19.08

• Hi Dr Garcia, I have been using Carac cream over my face for the last 2.5 weeks. my skin has areas of brown patchy pigmentation -they were initially red but turned darker with ongoing use of the cream. Could this be post inflam. hyperpigmentation and from your experience does it resolve on its own. is it common with the Carac cream. i am due to see my dermatologist later in the week. thanks in advance!

  Answer:  it is post inflammatory hyperpigmentation and you might need some hydroquinone to keep it from getting worse, it should go away on its own if you stop the Carac. JG 3.18.08

• Hello dr. Can you tell me if you think that botox is good to tighten the jowls that are beginning to sag. I have noticed recently that I have looser skin in this area especially when i bend forward. I have become self conscious about it. I am 36.

  Answer:  I do not think Botox wil fix jowls, no. JG 3.10.08

• Do you offer a payment plan or finance a procedure?

  Answer:  we offer financing through different companies, you can actually call the office and get the names of the company and apply for the amount before even coming in to see what you can get approved for. JG 3.4.08

• Dr Garcia, I have somthing under my arm pit called excise or excess breast tissue. I would lkie them removed. since 2005 I have lost 67 pounds so it look like loose skin but very unattractive. How much for a procedure like this?

  Answer:  hard to say without seeing you and telling how much time would be involved, but if both sides are invovled a guess would be about $4500-$8550, depending on if there is loose skin too. JG 3.4.08

• belo doc i am curious and worried wanted to know if this is due to anxiety as my blood sugar is normal at times fell thirst not that i am so thirsty but the craving for water as i went thro the internet and read it as being one of the symptoms of general anxiety disorder doc i also want to concieve so will the baby be effected in any ways pls help thanks alot

  Answer:  excessive thirst can be anxiety or diabetes, you should see your doctor to make sure all is OK. JG 3.4.08

• Hi Dr. Garcia, I had written before asking possible cause and treatment for numbness and discomfort in my lower lip and jaw following a genioplasty over a year ago. You said small nerves may have been cut and neurontin may help. When I look up you can see the bone is higher on the right which is where most of the numbness and discomfort is. Do you think it is possible the bone that is higher up could be putting any pressure on a nerve and cause these symptoms? Could scar tissue be causing any pressure on the nerve? Also my teeth are misaligned on the bottom and when I talk for any length it feels like the teeth rub on my lower lip and below. The Dr. wants to do exploratory surgery, but I don`t want to make things worse. Is it possible he moved the bone too far forward? If so is there a way to move it back some? Thanks for any help you can be.

  Answer:  It could, but shifting it now might not reverse the nerve damage that might already exist. I think revision can be done and might be worth considering in your case, all the best. JG 3.3.08

• hello doc thanks for your help i wanted to know if it was normal for a 3 month baby to have baby eczema? and does it go away in time or it comes back again? and does it happen when baby is growing up or it tends to go away ?? is it serious condition and how can i help my baby??thanks again

  Answer:  see his pediatrician please. JG 3.3.08

• helo doc pls help me here i wanted to know are these symptoms of allergies as i started having coughing , want to clear the throat sneezing , ithchy eyes, burning nose , burning throat fever and chills or is also cold or flu combines i am taking lozenges for the throat, claritin for allergy and tylenol for fever is not anxiety attacks is it pls help thanks alot have a nice day

  Answer:  possibly. JG 3.4.08

• Is it true that dermotologists have lasers that give a controlled pulse of heat to neutralize the bacteria of a zit? Does this work on cystic zits, before they emerge? Thank you

  Answer:  they might own one and if they do it might help decrease the bacteria. JG 3.1.08

• Hello Dr. - I am only 40, but I have thin-skinned and fair-skinned hands (veins have always shown), plus I do a lot of work with my hands in my daily job, and I have not been very careful about sun on them in the summer. This past year I have noticed that my hand skin is crinkly, and looks like chicken skin, and I have bracelet wrinkles around my wrists. I have tried AHA creams, etc. and they don`t help. What procedure can be done to help my plucked chicken skin ?

  Answer:  maybe Retin-A, maybe a light laser or chemical peel, maybe soem filler injections. JG 2.28.08

• Dr. Garcia,I know you normally don`t make recomendations for surgeons, but I have a quick question. Have you heard of Dr. Michelle Copeland of NYC??? Thanks.

  Answer:  well, to be honest, I have never heard of her so I cannot say much. JG 2.28.08

• Dear Dr Garcia. You said recovery of atrophy from cortisone depends on the amount of cortisone and depth of injection. Is a deep injection more likely to recover than a shallow injection or vice versa? Is fat atrophy more likelt to recover than dermal atrophy? Is there anything to speed the recovery? Thanks

  Answer:  the deeper the injection the lesser the skin changes are and potentially the greater amount of the cortisone got into the muscle where atrophy will be minimal to none. Deep atrophy is easier to recover from, yes. Nothing will speed the recovery though. JG 2.27.08

• Dear Dr Garcia. Is atrophy from cortisone usually accompanied by a persistent red / brown mark? Also, in cases of atrophy from cortisone injection, what percentage recover over say 6 months?

  Answer:  if the atrophy is supeficial, it can be, yes. As to percentage of recovery, it is impossible to tell because it depends on the amount of cortisone used and the depth injected. JG 2.27.08

• If a single cortisone shot reaches normal skin, is it likely to cause atrophy?

  Answer:  it can, yes. JG 2.26.08

• Can a hematoma be filled with clear fluid, not blood? I think i have localised swelling that is not blue/dark but does not move with gravity.

  Answer:  once it liquifies it can look clear when aspirated, yes. JG 2.25.08

• Dear Dr Garcia. What is the best way to reduce a mild hematoma/swelling?

  Answer:  alternate warm and cold packs, light massage, and Arnica Montana from the health food store, along with bromelain. JG 2.25.08

• Hello. I just read that you do not recommend massage after cortisone injection to scar. I was told by my doctor to massage. What are the potential problems with this? Thank you

  Answer:  well, it is being injected into a scar typically to soften the scar, and on the chance that the kenalog went out of the scar, then massaging it will push it into the normal tissues we are trying to avoid atrophy in. If the material was injected into the scar and only the scar, you cannot massage it out of the scar. JG 2.25.08

• Hey Doc. I have a quick question. I was reading here that someone had brows thick and droopy and sore after having Botox injected in their forehead, they were trying to have the brow lift effect. I have an appt. coming up for this same thing and I`m nervous, its the first time. Does that mean that the injector should not poke anywhere in the forehead area at all? I know that there should be poking/injecting by the crowsfeet area. Is that all? I really don`t want to have a droopy brow area. Thanks Dr!

  Answer:  correct, just crows feet and glabella. JG 2.25.08

• Hi Doc: I was curious to know how well you felt IPL worked for enlarged pores, and what type of improvement can be expected. Thank you

  Answer:  the heat generated can help remove some of the superficial oil that can at times clog the pores thereby allowing them to close. JG 2.26.08

• helo doc i am sorry but its in regards to the queston i emailed earlier can it be bse of penedal nerve irritation i feel like numbenss and pain around perenium areas at the edge of vaginal opening and the sides of vagina then makes my thighs and butt area and legs also numb pain and burning it will settle itself right pls help thanks alot

  Answer:  you need to ask your gynecologist as I have said. I will also say, I have told you numerous times before about your questions here and told you they are no appropriate for this message board. In the future, the questions will be deleted and not answered, sorry. JG 2.25.08

• helo doc i know its not your area of questions but if you can help me i dont know if i must have pulled a muscle or nerve around the groin areas where the joint is below as i feel numb and pain around the tighs ,buttock , leg, feet and genital areas around the outside of the vagina what can i do for that and it wont hinder if want to concieve will it thanks alot pls answer for me asap as i am concerned

  Answer:  sorry, can`t help you there. JG 2.25.08

• Dear Dr Garcia. Is there a syringe that a can be set to deliver precise small doses `mechanically`, or are they purely manual, relying on the operator? If one exists, what is the syringe called, and are they common? Ta

  Answer:  there are mechanical devices but the amounts injected are much larger than the amounts used for cosmetic purposes in most applications. JG 2.24.08

• Dear Dr Garcia. In your experience does Mederma help smooth the topography of all scars or just reduce redness and flatten raised scars? Will it smooth pitted scars? Thanks

  Answer:  I do not think it helps pitted scars but does flatten them some and does help the redness too. JG 2.24.08

• Dear Dr Garcia. My dentist told me I have many scars inside my mouth on the upper left side (I guess from biting and ulcers etc). From in front I believe this side is visibly prouder and asymmetrical to the other side, just above and beside my naso-labial fold. The tissue feels thicker and slightly firmer too. Have you seen something similar to this? Any suggestions as to what could improve it? Ta.

  Answer:  I have seen people that having biting issues inside their mouths but I do not see how the amount of scar tissue formed would cause the asymmetry, more likey is the muscle action of the cheeks causing early descent of the tissues. JG 2.24.08

• Dear Dr Garcia. How long after cortisone injection would you expect to feel scar tissue softening? Is massage beneficial? Thanks

  Answer:  massage does not help much nor do I recommend it, as to softening, after the first one there is at times very small softening, it usually takes a series of injections. JG 2.24.08

• Hi Dr G. Are glucosteroid (Celestone) injections known to cause depression / anxiety / mood swings? Also, can steroids affect general skin appearance / color etc for a few days (eg pale and drawn)?

  Answer:  if enough is injected, it can happen, yes. I think after a few days and only one injection there should not be any skin changes though. JG 2.24.08

• Thank you for your help. It`s not so simple I guess because the other part of the steroid is important too..... Wikipedia says: Betamethasone (Celestone) -Glucocorticoid potency: 25-30 Hours of action: 36-54 Triamcinolone (Kenalog)- Glucocorticoid potency: 5 Hours of action: 12-36. Anyhow, thanks for your time. Interesting stuff.

  Answer:  again, none of that is applicable for scar injections. JG 2.22.08

• Dear Dr Garcia. I came across the following info on steroids types (at http://heelspurs.com/bbs/bbt.cgi?n=185112): PHOSPHATES: short acting, clear liquids, purely anti-inflammatory actions. ACETATES: intermediate acting, cloudy suspensions but not as dense as acetonides, mixed anti-inflammatory and and atrophing actions. ACETONIDES: long acting, mild to minimal anti-inflammatory action, strong atrophy of scar tissue and other tissues. Since Celestone is an equal mixture of phosphate and acetate this would suggest it is short-medium acting and has less atrophying effect than Kenalog, which is an acetonide. Is that correct?

  Answer:  I have seen as many fat atrophy cases from Celestone as from Kenalog, might sound right in the abstract but not relavent in real life, those half lives are when measured after use in the normal indications, not when injected into scars or fat. JG 2.22.08

• Dear Dr Garcia - Sorry to keep pressing the point but the reason I am asking is because my doctor has been using Celestone on my scar, not Kenalog. I want to know if this is a not the best option because Celestong is more likely to cause ATROPHY (or other problems) than Kenalog, or just because it is less EFFECTIVE than Kenalog on scar tissue. Thanks

  Answer:  for potentially both reasons. JG 2.22.08

• Hi Dr Garcia. Is Celestone Chronodose a LONG or MEDIUM acting steroid? Is Kenalog long or medium acting? Do you know which acts longer? I have read differing accounts for both.... Ta

  Answer:  they are used for slightly different things, the Celstone is used for intramuscular injections, and is not a good option for scars if that is what you are wondering about, the length of dosing interval is not based upon scar injections. JG 2.22.08

• Dear Dr G. Why do you say you would not use Celestone for scar tissue - does it not act long enough to cause scar tissue to atrophy? Thanks

  Answer:  it has not been studied for its effects on scars. JG 2.22.08

• 20yrs ago I had a 260cc HP Dow Corning prosthesis placed on the right breast side. (I am 35yrs. old currently) The right breast never developed which left an empty pocket. (Birth defect..Poland Syndrome). The last three months I have been experiencing pains around the nipple and far right side of the breast. My doctor has scheduled me for my baseline. My main question is after 20yrs, could my implant rupture or could scare tissue have built up after all these years.

  Answer:  it can and I think an MRI will give you a much more accurate picture than a mammogram in terms of rupture. JG 2.22.08

• Dear Dr Garcia. Does cortisone flatten on scar tissue and normal tissue equally, or more effect on scar tissue? Is Celestone a slightly milder cortisone than Kenalog 10? Thank you

  Answer:  it can affect both, the normal tissue is affected sooner and I would not suggest using Celestone for this. JG 2.22.08

• Dear Dr Garcia. In 2002 I had a ingrown hair cyst on my cheek excised. The PS said there was a `hole underneath` and he used `fat flaps` to build up the contour. However over the next year the scar became red and sunken again. I had Scupltra filler which wore of last year. Several lumps / ridges remained outside the margin of the scar which are not directly visible but form creases when I smile. I guess these are either scar tissue from the fat flap or nodules from the Sculptra? Over the last few weeks my surgeon has been injecting these with tiny quantities of Kenalog. This has shrunk and flattened them well but (after 2 weeks) the general cheek is currently a bit flatter and slightly asymmetrical. When I smile it puffs back out and stays that way but with time flattens again. Do you think it should fill out again? Over what time? Do you often use fat flaps for excisions or prefer another method? Thank you kindly

  Answer:  it might fill in again with time, otherwise more fillers, I am afraid. It is not uncommon to rotate healthy tissue below a scar to avoid a depression, yes. JG 2.22.08

• I am very curious about your take on soy and breast cancer. Apparently it mimicks estrogen (too much estrogen cans cause breast cancer (no?) Its not a medical question I`m just trying to figure out if I should give up my soy milk? Also in hopes you will be able to answer my questions if I do stop soy should my own level of estrogen go back to being MY normal> I guess what I am asking if you find soy to not be such a great thing> after 10 years of eating and drinking it will I be at a higher risk for future? Thank you very much. DO you have limits on questions? I may have over exceeded mine quota:) :(

  Answer:  welll, firstly, I doubt that taking soy has dropped your blood estrogen levels. Secondly, soy is good only in small quantities and due to marketing, most Americans that believe in soy over do it, it needs to be fermented soy, like Miso, and you only need about 4-5 small cubes per day, the amount you see floating in Miso soup. As to soy milk, it is a waste if you are trying to get the health benefits of soy. I do not think you have altered your risk, good or bad, of anything by taking it though. JG 2.22.08

• What in the world is Pro-Sirtuin TX complex? And what should it do? Thanks

  Answer:  it is actually a crowbar, used to pry your hard-earned money out of your wallet. JG 2.21.08

• these are the ingredients to a serum that`s $50. Do you think it`s worth it? thanks for your time: WATER/EAU PENTAERYTHRITYL TETRAETHYLHEXANOATE GLYCERIN BUTYLENE GLYCOL SD ALCOHOL 40-B DIPROPYLENE GLYCOL POLYMETHYL METHACRYLATE ISODODECANE CYCLOPENTASILOXANE HYDROXYETHYL ACRYLATE/SODIUM ACRYLOYLDIMETHYL TAURATE COPOLYMER PHYTOL THIODIPROPIONIC ACID ALUMINUM STARCH OCTENYLSUCCINATE ECLIPTA PROSTRATA EXTRACT HUMULUS JAPONICUS FLOWER/LEAF/STEM EXTRACT PALMITOYL TETRAPEPTIDE-10 HEPTAPEPTIDE-6 PALMITOYL LYSYL AMINOVALEROYL LYSINE GLYCINE SOJA (SOYBEAN) SEED EXTRACT DAUCUS CAROTA SATIVA (CARROT) ROOT EXTRACT SQUALANE PEG-60 HYDROGENATED CASTOR OIL CAPRYLIC/CAPRIC TRIGLYCERIDE HYDROGENATED POLYISOBUTENE HYDROGENATED POLYDECENE BEHENYL ALCOHOL STEARYL ALCOHOL GLYCERYL STEARATE LAURETH-8 DIMETHICONE/VINYL DIMETHICONE CROSSPOLYMER SODIUM ACRYLATE/SODIUM ACRYLOYLDIMETHYL TAURATE OPOLYMER ACRYLATES/C10-30 ALKYL ACRYLATE CROSSPOLYMER CARBOMER SODIUM HYDROXIDE POLYSORBATE 60 POLYSORBATE 20 PHENOXYETHANOL METHYLPARABEN DISODIUM EDTA PARFUM/FRAGRANCE MICA TITANIUM DIOXIDE

  Answer:  seems a little pricey to me, tough to say 100% as they do not list the amounts but I see nothing there that should warrant $50. JG 2.21.08

• Hi Dr Garcia - I wrote today re my 7 year old with a scar on cheek caused by her sister scratching her. Can I just clarify - when you say there is not much that can be done do you mean not ever or just not until she is older ? I wasnt really envisaging treating her whilst a child anyway. Also what type of laser treatment is used and is it effective on indented scars ? What about the use of collagen to plump scar when she is older ? Thanks

  Answer:  a YAG laser might fade the redness some but the surface will requie something like a Rhytec Portrait or a CO2 laser, once she is a little older. I think plumping with collagen is possible but tricky to do and leave it flat instead of a bump. JG 2.21.08

• I have a small scar that was sutured in May 07, a few spitting sutures but no other problems. Incision looks good but area is still a bit bunched and lumpy looking, although looks perfect when skin is pulled flat. Do you think this will still smooth out and flatten down? What causes this appearance? Thank you Doctor Garcia!

  Answer:  I think it likely will continue to improve with time, it might take up to one year, hang in there for a bit. JG 2.21.08

• Dear Dr Garcia, My 7 year old has a couple of scars on her cheeks from when her little sister (then one year) grabbed her face a little roughly and her nails caught the skin with their edge. She was three at the time and the scars are still there one an inch long and horozontal, noticeable and raggy and indented. It is pinkish especially when she is warm. It is such a shame as she has beautiful porcelain skin otherwise with a lovely face. Mainly i worry about her resenting her sister when she is older. Is there anything that can be done for indented scars and when is best to do it if so ? many thanks

  Answer:  I am afriad there is likely not much that can be done and I think treating her with lasers will be a small improvement and will scare her at this age, might want to wait until she is older. JG 2.21.08

• helo doc wanted to know if you have esophagus spasms is it life threatning you can lead a normal life with that is it and can take prevacid and tums when needed pls anyu suggestions is it something common thanks alot

  Answer:  you need to speak to a gastroenterologist, this is a plastic surgery site. JG 2.20.08

• Dr. Garcia, When you say let a scab fall off on its own, do you mean fall off when it is dry??? because mines fall off during shower, maybe the water made it soft and it came off before it is ready, that is why my scars keep scabbing probably. Thank You.

  Answer:  correct. Try too keep it covered in shower if you can then. JG 2.20.08

• Dr. Garcia, do small dog ears typically flatten over time? If they do, how does that happpen...do they shrink? I have a half inch facial incision with a small dog ear at the end. My surgeon said we wouldn`t touch it until the 1 year mark if we even need to at all. I`m at 8 months now, looks sort of like a large pimple, but skin colored of course not red. Just wondering how likely this is to resolve in time. Thank you very much for your time!

  Answer:  in many cases, yes. They shrink by the tissues and skin actually contracting or shrinking on their own. I like to wait one year also. JG 2.20.08

• I have just come home from having Botox injected by my surgeon (have been to him for many years). This time, while injecting, somehow, some Botox squirted into my eye and into the corner of my mouth as I was talking to him. He said it squirted through a pore . Regardless of how it happened, should I be worried that it may affect my eye, vision, or make me sick, etc. from getting a bit in my mouth? I am concerned. Thanks for any info you may have on this.

  Answer:  unlikley due to the small amount and it being broken down in the saliva, you should be OK. JG 2.20.08

• helo doc i wanted to know if this is todo with the clomid i started taking on my cycle well outside at the sides of the vagina feel ithchy and uncomfortable and burning at times or is it due to harmonal changes my periods it to come on 2md march or earlier as it was late this time and did ovulation test and was negative so whats the reason thanks alot pls help

  Answer:  sorry, not an appropriate question for a plastic surgery forum. JG 2.20.08

• Hi Dr. G. I consulted with a PS to minimize my tip and thin the bridge and a small amount. Very mimimal change as I don`t want to make my nose too thin for my face (I have wider face) I also don`t want to change my profile. The PS agreed with all these things during my 1st consult a month ago. I just went back to go over pics he took and he didn`t even remember me. Last time he told me I need my tip refined a bit, this time he said, No he wouldn`t touch the tip. . The main thing I don`t like IS the tip, which I thought he understood. What do you think of this? Do you ever not remember a patient??? And tell them a completely different plan for their surgery? After just a few weeks? I`m concerned because now he wants to do something completely different. Also, I asked him questions (about the thickness of my skin) and such and he got annoyed and said to stop researching because I will just confuse myself! But I think this Dr. is Very skilled, so I`m confused what I should do? I just wonder if you think this is normal for a PS to forget like that. Thanks, you are so highly regarded, thats why I ask.

  Answer:  I usually remember my pateints bt even if he did, if he now does not want to fix what you are interested in you will need to go somewhere else. Skilled doctors can stil be pompous, patients asking questions is of the highest importance to me when consulting with my patients, sounds like he does not like to be questioned, so I think going elsewhere is the way to go. JG 2.20.08

• Diaper rash cream that contains zinc oxide and petroleum helps with redness, I was wondering if that would also help redness on skin during the scar healing process?

  Answer:  not if the skin is intact but the zinc oxide is a good sunblock. JG 2.20.08

• My cheek scrape scab 2 times and both times came off in shower, however I see that the area is dry again, and starting to appear scab like but thinner skin, and when left dry the skin shrinks up, looks like it is going to rescab again, it has been 3 weeks since first injured, it is on the cheek and the area tends to have more motion. The second time it scab and fell off I notice it was less red, what should I do or use on it. Leave it dry so the skin comes off later, or use some kind of cream? Thank you.

  Answer:  apply some moisturizer to it if the skin is intact and avoid sun exposure, if another scab forms let it fall off on its own. JG 2.20.08

• What can help with redness on the skin?

  Answer:  it depends on the cause but IPL and YAG or VBeam lasers help. JG 2.20.08

• Dear Dr G. What would happen if IPL is done to a recent red wound? Thanks

  Answer:  if the skin over the wound is intact it might blister it but it also might help fade the redness. JG 2.20.08

• Dear Dr Garcia. I had some Kenalog shots to Sculptra lumps a week ago. Can I do a mild 6% salicylic peel? Thanx

  Answer:  sure. JG 2.20.08

• Dear Dr Garcia. Is massage a good / bad idea after cortisone injection? Will it reduce the risk of local atrophy and even up the flattening effect or have an undesirable effect? Thanks

  Answer:  I do not think it will matter much as it should be injected into the muscle if being done for an allergic reason and that is likely too deep for massage to make a dfference. JG 2.20.08

• Dear Dr Garcia. What causes the brown colour that comes after a cortisone shot? Is there any way to speed its disappearance? Thanks

  Answer:  it is from th eblood leaked by the shot, hydroquinone and YAG lasers will improve it. JG 2.20.08

• I read online that using aloe on wounds delay healing, is that true? And another said it promotes healing. Which is true?

  Answer:  I have not seen it delay healing, in superficial wounds I think it helps. JG 2.19.08

• When there is a cut and some part of the skin flips up is it better to keep that skin intact or to pull it off, will that skin that flip off eventually come off anyways, or does it stick back together?

  Answer:  best to let it stay on as a better cover. It will act like a natural bandaid. JG 2.19.08

• Hi Dr. Garcia, I have a scar on my cheek which is shiny pink and center looks a bit wrinkled and also producing more oil than my regular skin. Does the wrinkle go away? and why is it producing more oil? Thank You.

  Answer:  it should as time goes on and the oil is just its normal healing process. JG 2.19.08

• helo doc pls help me out here well i started having kind of burning sensation in my tongue at the tips and sides is this bad i have appmnt with dentist on thrd its nothing serious is it i am concerned pls answer asap and when it will stop thanks alot

  Answer:  doubt it is anything serious but I cannot offer any insight as to the cause. JG 2.19.08

• If a scraped wound got stung by alcohol, would that be considerd a burn wound?, and do those take longer to heal?

  Answer:  no, not a burn and should not affect the healing much if it was only one time. JG 2.19.08

• Hi, Do you perform sclerotherapy? If so, does it help with reticular veins in back of calves? Thank You

  Answer:  sorry, but we no longer do it. JG 2.19.08

• Is mederma to be used starting when the scabs come off? And is there anything that can help with the redness from the scar when the blood vessels are repairing themselves? Thank You Dr. Garcia.

  Answer:  do not apply it to the scar until the scab has come entirely off. The Mederma should hep the redness, along with sunblock and possibly an IPL or YAG laser for the red blood vessels. JG 2.19.08

• Hello Doc thanks alot for all your help in answering my questions ,i wanted to know if at all all i have it muscular or something else? i tend to get body pains and aches when am sleeping and have to get up feel it then in the course of the day its okay only at times? can it be muscular i have lower back,legs,hands etc can it be due to holidng the baby and not resting alot, and also is it normal to still have water retnsion in my body its almost 3 months now? when will it go down its still mild swelling in my feet and ankles or can it be due to standing and sitting lots with baby?? it tends to go down when rest at night then agian during the day it flares up? can i soak my feet in cold water? and take pain meds for my pains ,thanks agian have a nice week ahead

  Answer:  impossible for me to tell by this method, sorry. JG 2.18.08

• Does keeping a red/pink scar moist all the time help the skin heal faster so that the redness goes away faster?

  Answer:  once the top layer of skin has formed the moisture will not make a difference. JG 2.18.08

• Hello Dr. Could you please tell me what you think of Coffee Bean Extract or Coffee Bean Berry ? What is it and how does it work? Thank you once again for your help

  Answer:  research on its effectiveness for skin is very limited, I would wait on using it. JG 2.18.08

• Hi Dr Garcia,I`ve heard about the Gold Thread Lift and would like to know if it would work on me.I`m 46,chinese female with sagging cheeks and fine wrinkles around the eyes.Thanks,stephanie

  Answer:  I cannot endorse it, sorry. JG 2.18.08

• Dear Dr. Garcia, I am sorry, I forgot to sign my e-mail I wrote you (regarding my problems with my surgeon following a facelift and lipo of my abdomen). I also wanted to add that she told me that she operated on a famous celebrity, of whom I won`t name here, but isn`t that trespass of patient-doctor confidentiality? Also, I know I told you that she offered me a discount if I paid her in cash, but I am not sure if I told you when I gave her the money she did not give me any discount . Thank you for reading my letter, and I look forward to your response. Sincerely, Susan

  Answer:  well, if the celebrity signed a disclosure to use their name, it is OK, if they did not, it is actually a federal violation. As to paying cash and getting a discount, at best it is illegal. One cannot offer a discount for cash versus the use of a credit card, that is illegal, I will also say that some doctors like to receive cash because they then do not declare it on their taxes, also illegal. Sounds like you might want to go somewhere else in the future. Also, no need to sign the question, the only place the registration was needed was in order to place the question, it is a deterrant to all the spam postings we were getting months ago, this is all anonymous, except for me. All the best. JG 2.17.08

• Hello Dr. Garcia, thank you kindly for your time today. I`m a 35 yr. old female, 8 months ago had a surgical scar repair (jawline). Incision is pretty good but bumpy/slightly elevated near the ends. Surgeon says that there is sometimes excess tissue at the ends which usually flatten down in time. My questions: Do you think things will continue to settle/flatten over the next few months? Do you agree that the ends can take longer to blend in? Is kenalog an option to help correct this if needed? Thanks again!

  Answer:  it can take up to one year, yes. I do not think kenalog is a good option as it is likely a small pleat of skin and the kenalog will affect the tissues below the skin and not the skin itself. Give it time and if not gone in one year, a small excision and sututes will do the job.JG 2.17.08

• I`m scheduled to get botox for brow lift benefits. Its my first time. Supposed to be in the lateral brow and glabella, they said. Will this limit me raising my brow or limit my expressions? I am very expressive with my face, but I have no forehead wrinkles,(thats not why I`m getting botox). My concern is that I won`t look normal if I can`t express myself by raising my eyebrows. Thank you Dr.

  Answer:  It will decrease your ability to scowl but it should not affect your ability to lift the brows. I will say that there can at times be wrinkles on the forehead after what you are planning on doing as the forehead muscles will be unopposed and be contracting all the time, small but at times visible wrinkles, especially in the lateral brow. Best of luck. JG 2.16.08

• Dear Dr Garcia. My face is slightly asymmetrical just above me naso-labial folds where one side is puffier / fuller than the other. Is it feasible to reduce the raised area with cortisone / 5FU injection?

  Answer:  if it is normal tissue and a genetic difference that one has, as we almost all have, I do not think those injections will help, if it is due to surgery and scar tissue it should help. JG 2.15.08

• Dear Dr Garcia. Do you ever use cortisone / 5FU injections to flatten / soften raised edges to a scar? Thanx

  Answer:  frequently. JG 2.15.08

• The last time you had said that when a scab comes off it doesnt scab again. However I have a really red spot where I am still using neosporin like you told me to and it is starting to dry and shrink together a bit, is this normal, and is it a good thing, and will this layer growing help make it heal again? Thank You.

  Answer:  the shrinking is normal and part of the healing process. If you pulled the scab off too early, then a new scab will form, but if it fell off on its own, then it usually means the skin was healed enough below it. JG 2.14.08

• Dear Dr Garcia. Before excising a scar that is already filled with Juvederm, would it be a good idea to dissolve the Juvederm with hyaluronidase? Otherwise, how can you see the margins of the scar to excise? Thanks

  Answer:  makes no difference I feel. The margins are easy to see. JG 2.14.08

• There is this Dr. Blaine`s Complete Scar Care Treatment, say FDA approved and will flatten and fade any scar. There is a silicone gel pad, and a solution which contains, 50% vitamin E, 50% silicone liquid gel. Does silicone flatten scars if used regularly?

  Answer:  I am unsure what part of the product is FDA approved because they usually do not approve OTC products. As to improvement, it will likely give some improvement but the degree of improvement cannot be predicted nor guaranteed. JG 2.13.08

• Is shark liver oil good for scar, or is it just a moisturizer? Thank you

  Answer:  I feel that it is good, yes. JG 2.12.08

• Dr. Garcia, you said that hydrocortisone is bad for red healing scars, but scarguard contains hydrocortisone, how long after the wound heal is best to use it, and is using neosporin for too long not good because it is antibiotic? Thank You

  Answer:  I suggest waiting at least 2 weeks if not more, the amount of cortisone in the ScarGurad is minimal and will likely not affect it as much as a prescription steroid cream would as that would be significantly stronger. Once the sutures are out I feel there is no need to use neopsporin. JG 2.12.08

• i just wanted to comment on something that i read. a 30 yr old with a round face wanting to possibly have some fat removed from cheeks. first, round faces are great for hairstyles and wearing hats. i have always had a skinny face and have always been limited by it in those ways. now, in addition to the aesthetic issues, you might find when you get closer to 50 that that fat starts going away naturally. if you have lipo on it now you might regret it later since the disappearing facial fat is also accompanied by an aged look. i`m 50 and always had a skinny face, no visible cheek bones really at all. so now, in addition to the fashion issues (hairstyles ...), i am finding that my face just looks older as it gets skinnier. my skin sags maybe more than yours will. just some thoughts for you, but i`m not an expert. nancy

  Answer:  I agree that removing fat in some faces can make one look older, I have mentioned that in many previoos posts, but in my expericnee in people with chubby cheeks, that does not dissolve with age and just drops downward. JG 2.13.08

• Dr G: Is the impaired wound healing caused by cortisone simply a delay in normal healing or does it cause permanent defect, such as atrophy? Ta

  Answer:  could do both short and long term damage. JG 2.13.08

• Will using topical hydrocortisone help remove redness from freshly healed wounds, and will that actually be bad because it can thin the skin, so will that make the skin heal slower? Thank You.

  Answer:  no, actually it might keep it red longer,and will likey slow the healing too. JG 2.12.08

• helo doc i wld really appreciate if you cld answer for me this question okay i dont know what is causing this to happen upper epigastric areas its like when you are breathing then you have to take a deep breath again while breathing you feel like you are short of breath why is it happening if you have anxiety attacks can it be spasms in epigastric areas is it possible its nothing to do with my liver is it also when you press on it you feel like throwing up is it bse of acidity and gas travelling bse i also burp and have lazy bowels i am very concerned pls help had gall bladder surgery recently thanks alot doc pls asap

  Answer:  sorry, this in not the corect forum for that topic. JG 2.12.08

• Hi dr. You answered earlier that I could benefit from the removal of bichat fat pad (buccle fat pad). But it seems like (from the before and after pics I saw) that that make the apples of the cheeks more prominent, by hollowing out underneath the apples of the cheeks. I basically want to reduce the size (width) of the apples when I smile, would that still be bichat/buccle fat pad removal? Thanks for explaining.

  Answer:  you are correct, the fat pad is below the actual cheek and if your face is wide over the cheek only then your only option might be to try liposuction there but I am not sure how effective it will be without examining you. There actually might be nothing you ca do. JG 2.12.08

• hello. I was just wondering if facial liposuction would help me in my case, do you think. Basically, my face is a bit round and it seems like my cheek bones are hidden unless I smile. But the problem is, when I do smile, my cheeks seem so wide right next to the nose, they shoot outward, making my face look wide in the center, then skinny at the chin and jaw. But I`ve only noticed this problem since I`ve gotten older (near 30) and lost weight since I was in High school. Do you think the cheekbones are too big, or possibly just fatty cheeks and need facial sculpting. I would really like your advice, Thanks Dr!

  Answer:  could be fat, could beneift from some small liposuction or removal of the fat pad of Bichat. JG 2.12.08

• dr. garcia, i am a very petite person with heavy calves and ankles, fat actually. i was check out thouroughly for vien insufficency and have none at all, just fat legs and ankles. what, if anything can be done. i am 54 years old, in decent shape and have always wanted to be able to wear skirts and shorts. there are little pouches of movable round fat in the front of my ankles (lipoma maybe?). help and thank you, lynne

  Answer:  could have liposuction there, swelling lasts a long time but it does help quite a bit. JG 2.12.08

• I had a inner thigh lift and ond my stitches are removed my left side looks good but my right side looks like i might need to have stitches replaced. a little opened. I still have a little fluid coming out of this side and still had swelling. thank you

  Answer:  I think the sutures should not be placed until the drainage stops and in most cases small openings like that will close without sutures once the drainage does stop. Closing the incision when it is draining can at times lead to an infection or abcess, I think it best to take a wait and see attitude for now. JG 2.12.08

• One more question, you would not just try to fill the creases on each side of the mouth? I would be afraid if the hyloranaise might dissolve in some unnatural fashion,e.g., be lumpy. Or is that not an issue?

  Answer:  personally I would not, it sounds from your description that it was injected not in the fold but around it and to corect that with the filler stil being in there will be difficult and will likely make you look quite full. JG 2.11.08

• One more question, you would not just try to fill the creases on each side of the mouth? I would be afraid if the hyloranaise might dissolve in some unnatural fashion,e.g., be lumpy. Or is that not an issue?

  Answer:  well, I only usgges taht becasue you ahve tried at least once to correct the fill and it has not worked. JG 2.11.08

• Dr. Garcia, I had a problem with Juvederm/Restaylne that I am not sure is an injector problem or a product one. I have gone to this injector twice before with a good results. This time she used Juvederm around my mouth lines (to chin) and the corners of my mouth. The result was perhaps overfilled and created bigger creases on each side of my mouth. I have been back twice to correct and each time it looks ok when I leave, but quite swollen. when it goes down, it looks exactly the same with the creases at each side of my mouth still there. These are not my normal wrinkles. These were created by the product. She agreed it needed to be fixed, but doesn`t seem to know how to do it. She didn`t charge me for the second fix ...but honestly it didn`t fix anything. I would appreciate your thoughts on what might be causing this and if I should go back to this same doctor. She seems very nice and wanting to make me happy. Thank you for your time.

  Answer:  I might suggest either letting it dissolve and starting over, or dissolving it with hyaluronidase and then starting over. Best of luck. JG 2.11.08

• Dear Dr. Garcia-I have had two rounds of Botox. I love the results, but have two questions. First, where does Botox go ? (Isn`t this harmful to the liver?!) Second, headaches. I seem to be one of the few who suffer headaches (almost daily) post-Botox. Call me crazy, but I suspect it`s from the body wanting to make the expressions and not being able to-the conflict there at the synapse level. I am someone who was getting lots of wrinkles precisely where I`m constantly making expressions, like raising one eyebrow, etcetera. Again, I love the results but wonder if I`m killing my liver and then the headaches...Thank you for your valuable time!

  Answer:  it is metabolized and removed but it is not harmful to the liver. The headaches are usually due to the injection itself and not to the chemical, might be something else if they persist past a few days. JG 2.11.08

• Dr. Garcia, If a scab comes off a wound and the area is still red, does it scab over again, until it is not as red? Thank You.

  Answer:  if the wound is still not healed it will scab agian, if the epidermis or superficial layer of skin has formed a new scab will not form again. JG 2.10.08

• hello doc ,thanks alot for the answer so roughly how long will it take for my feet ankles to get back to normal,will it take more then 8 weeks(swelling of feet and ankles after delivery),at times at night when sleep and on wake up i tend to get some pains all over my legs and then in the course of the day its okay so can it be muscular due to standing and sitting with baby, so its nothing serious and 8 weeks is normal ,so do i give myself another 3 to 4 weeks and see how it goes , ways to make the water get less?? thanks once again

  Answer:  no way to tell. I think you need to see your obstetrician. JG 2.9.08

• Dear Dr. Garcia, I am very serious about having upper/lower eyelid surgery in the fall. I would like to have some permanent eyeliner put on this summer. Am I wasting my time to do this before the surgery? WIll the area be cut anyway and the tatooed area disappear? If I should wait until after the eyelid surgery, how long should I wait to safely have this done? My priority is to have safe procedures but not waste money unnecessarily. As always,thank you for sharing your expertise, knowledge and experience.

  Answer:  I think you might lose some of the color on the lower lid if the lower lid surgery involves an outer incision, the upper should not be afected. I think waiting 6 weeks at least after the surgery is a good idea. Best of luck. JG 2.9.08

• hello doc thanks again for all your help,doc wanted to know if its normal to still have swelling on feet and ankles after pregnancy its been 8 weeks now? what must i do? my pressure is normal, and also wanted to know is it normal for 2 months old baby to start teething? will the teeth fall out and new set comes in?? at 6 months old,thanks again !! have a nice weekends

  Answer:  yes.JG 2.8.08

• Hi Dr. Garcia, 2 weeks ago I fell down a flight of stairs which was carpeted, and suffered from really bad carpet burns on my knees. i have been putting neosporin on the wounds, but they don`t seem to be healing quickly, do you think the wounds will heal by 2/23/08, I have a special event to attend and my knees look horrible.

  Answer:  hard to say without seeing them, I think they likely will be healed but still quite red or pink by then. JG 2.7.08

• Hi Dr. Garcia, After having a tummy tuck in 1/07 and a mini tuck in 11/07, I have noticed that my upper abdomen is still large i think it`s from swelling, how can i stop this. is it possible that I need lipo in the upper abdomen? I do think it`s swelling though. After my 1st tummy tuck I was still experiencing swelling in both upper and lower abdomen in 11/07 when i did the mini tuck. Will my stomach ever be normal again? I continue to wear my girdly garments at home, but when i am at work or away from home i dont wear them so thats when the swelling begins and then i look horrible. i know i am not fully healed yet but after 6 - 12 months i should be normal right? Also I am doing exercising including abdomen workouts.

  Answer:  well, if it is swelling that should be reduced or totally gone by now, if it is because the muscles in the upper abdominal region are not tightened enough, it will require more surgery. JG 2.7.08

• Hi Dr. Garcia, After having gastric bypass 3 years ago, I recently had a thigh lift, breast lift tummy tuck and lipo in 11/07. For some reason I am experiencing a lot of swelling in my right hip, as well as fluid build up along my incision on the right side above my hip. This has been happening since 12/07 and has not stopped yet. The swelling in my right hip is very noticeable as well as the hump on my side from the fluid build up. Every couple of weeks I have the fluid drained, but it comes right back and the swelling never seems to go away in my right hip. Are these symptoms normal? If so how long should I experience these symptoms? Also I am completely numb on the right hip and when i touch it, it almost looks like a water ballon because it`s so swollen and jiggly. Should I be worried about all of the symptoms I am experiencing.

  Answer:  not normal and if it comes back that fast as you describe it might benefit from a drain being placed to seal that off. Best of luck. JG 2.7.08

• I have had a inner thigh lift and the stitches and tubes are removed. i was wondering that my thighs fell like that have pressure and possible fluid inside and was wondering how i can remove the tighness. thank you

  Answer:  mild compresssion, massage and keeping your legs elevated should help that. JG 2.7.08

• There is this product called,Bio-Oil Scar Treatment, contains many oil, is that nay good for scars?

  Answer:  have not seen anyone that has used it to tell, sorry. JG 2.7.08

• My wound is very itchy, I use neosporin but it is still itchy and the itch doesnt stop, the scab came off but I can tell the very center of the wound is thin and needs to scab over because I can see the tiny blood vessels. I had used a jojoba bead scrub thinking it would help remove left over dry skin in the surrounding, but some of the jojoba beads got stuck in the pores of the wound and I had to pick them out. I am kind of afraid maybe some beads got stuck in the pores and closed up so that is causing the itch, prior to that it never itched. There is no oozing or puss. Will that effect the wound healing? Can I use hydrocortisone on a wound that hasnt fully grown back the skin. Thank You.

  Answer:  do not use the beads until the wound is totally healed, go back to the neosporin and you can use OTC antihistamines for the itching. JG 2.7.08

• Hi Dr. Garcia. I am recently a patient of yours, and have a breast reconstruction surgery scheduled soon. I was on your website and was reviewing all of your questions that people had asked, and noticed one that had mentioned reconstruction of the breast and your answer to the question was that you no longer do this type of surgery . I have also noticed you do not have any info regarding reconstruction. This concerns me because I really have been through a lot with my breast cancer, and want the best results possible. Please explain why there is not any mention of this on your website. I would also like to know the cost of a tummy tuck as well. I know I have jumped from one question to the next, but I just want to get my point across. Can the tummy tuck be done at the same time as the reconstruction? Thanks for you time. I also wanted to comment on your office, and your staff. Perfect!!! What a great staff, and your office was amazing. I have been in the medical field for 15 years and have never seen a office so well put together....Love you website also.

  Answer:  it is difficult to do the tummy tuck and the breast reconstrction at the sae time as the place where the reconstruction is alloed to be done does not accomodate us for cosmetic cases and the billing would be higher than I ca get eleswhere. As to the lack of reconstruction information on the website, it is just since December 2007 that I resumed doing breast recosntructions and only for one particular insurance carrier in Nevada, so the website has not been updated to reflect that, but it is that insurance and only that carrier that I provide those services for, so it is a limited number of people that I can provide those services for. Thank you for the kind words and I will see you soon. JG 2.7.08

• Dr. Garcia,I have used mederma but it left my skin red and itchy, is it normal?, I am using mederma for kids, is that a less strong dose,and will it work just as good?

  Answer:  that can happen at the begining, if it continues switch to ScarGuard, another good product for scars. I think the kid`s formula is OK to try. JG 2.6.08

• Hi Dr. First, I just wanted to say, thank you SO much for the good advice, becuase I`m the one who needs maxilla reduced instead of bullhorn lift. I had a consult with the oral surgeon yesterday and he said I definately wouldn`t be a good candidate for the bullhorn becuase I`m young and have a good amount of tooth show and I would have too much if I did it. (Thats why I`m thanking u for referring me to an oral surgeon becuase just a PS might have just done the procedure anyway). But I do have a question, he said that what he would do would be to move the upper jawbone up. Does that sound right? Would that change anything else besides the area between the nose and mouth? The Dr. said it would only change that area,but I wanted to get your opinion, too beucase your opinion is so highly regarded!

  Answer:  that is correct, the right thing. That should be the only change really. Best of luck and glad you found someone that can help you. JG 2.6.08

• When a wound is almost all healed and it itches, is that ok, or is it infections?, what to use on it? Thank You Dr. Garcia.

  Answer:  nope, that is part of the normal healing process, it all goes away in time. JG 2.6.08

• Hi Dr. Garcia, Can the hydrogel injections affect your menstral cycle? Also what type of complications are linked to hydrogel injections? Also I had a tummy tuck, thigh lift & beltectomy & a breast lift in 11/07, how long should I experience swelling from the tummy tuck?

  Answer:  usually the problems are lumps and infections, I have not heard of it affecting menstrual cycles. With that much surgery you could be swollen for 6-12 months. JG 2.6.08

• This product Scarguard, does it really flatten raised?

  Answer:  it helps fade the redness is what it is best for, I think the raised aspect improvement is slight at best. JG 2.5.08

• How long after the stitches are removed from a inner thigh lift does it take for the puckering from the stitches to relax. and also when can i go to a indoor tanning and put vitamin e oil on. thank you karyn

  Answer:  it can take a month or more in some cases. I would wait on the tanning for a couple of months and Vitamin E is Ok after 2-3 weeks. JG 2.5.08

• helo doc i will apprecaite if you can answer for me these questions okay if you have the HSG done does it also show you the ovaries and how they are so if you have cysts it can show and if yu have spastic colon or ibs can yu have left lower quadrant pains as the ovaries are on the sides this above so is it the ibs as am going to start clomid tonight so wanted toknow if it was okay pls and thanks

  Answer:  you need to see your gynecologist.JG 2.5.08

• tummy tuck - the loose skin is all the way across - side to side not just at dog ears.

  Answer:  might not be able to be done under local anesthesia alone. JG 2.5.08

• Tummy tuck for husband in March 07. Dr. tightened muscle and removed loose skin from substantial weight loss. Husband is still concerned about slightly loose skin and dog ears leftover. He is going for a followup soon. Is it reasonable to ask the doctor if he can tighten the skin a little more and remove the dog ears? Husband doesn`t want to go through being put to sleep, etc.... again - can a request such as this be done in office or would he have to go under again.

  Answer:  might need a touch up, very common in massive weight loss patients, but I am not sure it can be done under local though, all depedns on how extensive it needs to be. JG 2.5.08

• DR. GARCIA, I NEED YOUR HELP. I HAVE BEEN WITH MY PRIMARY CARE DOCTOR FOR MANY YEARS.BUT NOW THE TIME HAS COME FOR ME TO CHANGE MY DOCTOR. WE NO LONGER HAVE A GOOD PATIENT-RELATIONSHIP.HE REALLY MESSED ME UP WITH MY HEALTH.AND HE DAMN KNOWS IT AND HE IS TRYING TO AVOID ME AT ALL COST- AND BEFORE I TAKE A LEGAL ACTION AGAINST HIM , I WOULD LIKE TO FIND FIRST ANOTHER DOCTOR - WHERE TO LOOK, AND HOW TO GO ABOUT IT? THANKS ANONYMOUS 2-5-08

  Answer:  well, one way is to get a list from your insurnace company as to who is on the list and then cal the medical board to see if any of them have any listed problems, then ask yoru fiends as to whom they are happy with is a good option, best of luck. JG 2.5.08

• Hi Dr Garcia could you please tell me how long does dermalive stay in the lip after one lot of jections. Also how long does aquamid stay in the lip after one procedure. I have some research and would like some information thankyou.

  Answer:  I am sorry but I strongly advise against using either one of those products, especially in the lips. JG 2.4.08

• hi dr garcia i was just wondering if your facilities had saline injections if so i would like to know how much and what the procedure is for this. thank you

  Answer:  if you mean for the dissolving of Sculptra, I think it best to have the original injector do it. JG 2.4.08

• what can be done for lynphatic drainage under the eye? I don`t want surgery for the little pouches it makes but, I hate tose liitle pouches.... it makes you look like a freak, help if you can. Yhank you

  Answer:  the puuches are usually fat and lymphatic massage will not help, sorry. Likely will need surgery. JG 2.4.08

• I have acne, and three weeks ago I had surgery. While in the hospital (one night) they gave me 4 shots of a non-inflammation drug. They didn’t want me to swell and bust stitches. My face stayed clear for about a week ½ then began to break out again. Could that med have been responsible or was it coincidence? Thank you

  Answer:  it will certainly slow down the inflammation that can aggravate the acne, but it cannot be used long term for that. JG 2.3.08

• I don`t exactly have the most poreless skin on my face. When I do my spray on tan, should I avoid my face? thx

  Answer:  it might be a good idea. JG 2.7.08

• how long does the stitches remain in after a inner thigh lift. thank you karyn

  Answer:  7-10 days usually. JG 1.31.08

• Dr. Garcia,your responses are very well appreciated. Thanks. I`m having a hard time finding a plastic surgeon in NYC. They all seem good and dandy but I just don`t know. Do you have any suggestions of one or how I can make sure I`m choosing the right one. I`m planing on having a rhinoplasty. (Is it better to find a surgeon that specializes in face surgery, or does that overall really matter?)

  Answer:  I think it best and some even specialize in Rhinoplasties. Due to potential legal issues, and some doctors wanting to know why I referred a patient to someone else and not them, I think you are best to go to this website and look for a plastic surgeon in the area you desire. I wish you all the best. JG 1.31.08 http://www.surgery.org/public/findasurgeon.php.

• Dr. Garcia, I was wondering how the post-op stuff works following a rhinoplasty. 1.Surgery, 2. two day`s later removal of cast 3.seven days after the surgery visit??? Am I right, or is there more?

  Answer:  usually seen the next day to make sure all is OK, cast is usually on for seven days, any sutures removed at that time, then next follow up is at one month. Then again at 3 months and then 12 months. JG 1.31.08

• good morning doctor....the sclera, white part of my eyes are becoming more discolorated, in very good health with no redness problems or dry eye problems, but I hate the way they look, why do you think and is there anything I can rinse my eyes with to make the sclera whitter?

  Answer:  not much you can do in terms of drops, should see your doctor to have them check for early signs of liver disease though. JG 1.31.08

• Dr. Garcia, thank you for your time and for this superb forum. (I apologize if this post shows up twice, I was having some troubles posting.) I have read a lot about suture rejection, I have had 3 of mine spit . The surgeon had to go in to get them out since they were somewhat intertwined in the tissues). My questions: Is the spitting primarily due to patient tolerance, or more so due to the surgeon`s technique? Does the tissue take a while to settle down like with the initial wound, or is it more of a speedy process once the suture is out? Thank you!

  Answer:  well it really does not depend on surgeon technique exactly, it depends on the bulk of the suture material, the material it is made up of, the patient`s immune response, and the brand, there are sutures that tend to cause more problems, they are braided so they have a higher chance of becoming contaminated with bacteria, get infected and then spit, to remedy that one company soaks their sutures in antibiotics to reduce the problem. Also if large sutures are used near the surface they tend to poke through more easily too. It can take a few weeks for the skin to settle down after a suture spits as it needs to heal and also fight off the slight infection. Warm packs will help to speed it along, best of luck. JG 1.31.08

• Dr.Garcia, Do you recommend rubbing off the old scab which is thick so a newer thinner scab can form to reduce scar?

  Answer:  no, that will make it worse. JG 1.31.08

• Is it possible to get raised scars from scrapes? And if there are some areas where the scab grows thicker does that promote raise scar or does all that fall off?

  Answer:  absolutely possible, actually the chances are high due to the way the skin heals, by contraction. The thickness of the scab can potentially point to a thicker scar, yes. JG 1.30.08

• On a skinless wound on the face I notice after a shower there are little tiny white bumps that shows only when skin is still wet. Are those fat cells, it comes out from the pores, or is that clog pore, or oil glands? and is that normal. Thank Dr. Garcia.

  Answer:  most likely pores as the fat is yellow. JG 1.30.08

• Dr. Garica, I was wondering what`s included in the price of the surgery?? Consultation? Post-op care??

  Answer:  not the consultation, although that fee is applied towards the surgery, it otherwise includes everything except the medications after the surgery. JG 1.30.08

• Hi Dr. If I wanted to make my bone strutcture more square, instead of an oval face, like make is shorter instead of longer is that something that is possible, like with an oral surgeon? Thanks for your advice

  Answer:  it might be, they would need to see you and take some XRays to tell. JG 1.30.08

• Hi Dr. I was the one who posted last week about shotening the distance between nose and upperlip. Since I`m younger, you recommended shortening the maxilla, so I wouldn`t have an altered upper lip. I was just wondering, if the maxilla bone is shortened, where does the extra skin go that is there now? Or does it just somehow all go together and look good. Thanks Dr. I tried to research this procedure myself, but there really isn`t a lot of info about it online.

  Answer:  at your age it should srink in most cases. Best of luck. JG 1.30.08

• Dr.Garcia,Have you heard of side effects from long term hair dyes, since it is chemicals and it is aplied on the head, will it effect brain cells or cause cancer?ThankYou.

  Answer:  I do not think it will affect brain cells and there are lots of reports out there from both sides of the debate so I do not think there is a universal consensus on the issue. JG 1.30.08

• For Arnica what is a more concentrate the 30X or the 30C and is the higher the number means more concentrated or more diluted? Any known side effects? Thank You Dr. Garcia.

  Answer:  Homeopathic remedies are diluted (potentized) and manufactured under very strict and specific guidelines. Potentization consists of precise dilutions and hand succession (vigorous shaking and sudden impact). The most common dilution (potentization) factors are decimal (X) and centesimal (C). This means that for each stage of potency, a remedy has been diluted by either a 1:10 or a 1:100 measurement of the crude substance or previous potency to dilutent (usually an ethanol/water mixture). A belladonna remedy at a 6X potency has been diluted 1:10 six times. This results in the final product possessing one part of the original substance in one million parts of finished potentized product. 1x to 5x or `c` are not so frequently used, but when they are they`re given 3 or 4 times a day, often for several weeks or months. 6c potency is usually given 3 or 4 times a day, often for several weeks or months.the 7c and 9c are prescribed similarly. According to the French method the 4c stimulates, the 7c regulates and the 9c subdues.12x or c potency is given twice a day as are the 18 and 24 potency 30c potency is given once a day or once a week or just once, depending on the patients requirements 200c is given as a SINGLE dose or occasionally as a single collective dose, (eg night-morning -night) 1M and 10M [and the higher potencies] are only given as a single dose Some people will respond as strongly to a single dose of 6c as another will to a single dose of 10M, and some people are so sensitive they can only take the LM potency. The higher the potency, the greater response it will elicit from the system and so the greater the chance of an aggravation but also the greater chance there will be of a complete cure, because a higher potency generates a deeper and longer lasting response from less doses. A high potency is not given to someone with bits missing or replaced {ex surgery} or with compromised organs or deep pathology or who is already on other medications; as the strong response to a high potency will cause them discomfort, i.e. an aggravation, or worse still not improve them at all, or even make them worse. Where patients are on medications already or if for other reasons it is necessary to repeat the remedy more often, then it is given in low potency.Infirm and aged patients will not be able to tolerate aggravations and so when in doubt go low. If someone needs a high potency due to the intensity of their symptoms but a high chance of aggravation is predicted, there are techniques that can be used to overcome this problem. No reported significant side efects. JG 1.29.08

• Hi Dr Garcia, Can Retin A be used around the orbital bone under the eye (not on the actual eye area). I am 32 but have quite thin skin there. Also, does Retin A help thicken the skin? Thanks, Laura

  Answer:  yes, it can. Retin-A helps to thicken the dermis and thin the epidermis, both good things. JG 1.29.08

• Hello,Dr.Garcia,When you recommend neosporin, which do you prefer the cream or ointment as the ingredient is a little different?Thank You,

  Answer:  I prefer the ointment myself. JG 1.29.08

• What do you recommned for water burns? thank you

  Answer:  Neosporin for OTC or Silvadene if you can get the prescription. JG 1.29.08

• Dr. Garcia, is it better to have thick or thin skin? I`ve heard many conflicting things.

  Answer:  it depends on what you are interested or worried about. JG 1.28.08

• Hello Dr. Garcia, I have written before about my spitting sutures (apparantly me and these pds sutures do not get along well). I had one removed today by my surgeon...he made a small cut and went into the deep tissues to remove the whole thing, knot and all. I didn`t notice until returning home how swollen the area is...which I assume is pretty normal but I wanted to see what you thought. Also I failed to ask how long until the area sort of settles down again. One step forward, two steps back it seems! Thank you, Dr.

  Answer:  all normal, should look lots better in 24-48 hours. JG 1.28.08

• Dr.Garcia,My cheek area(almost 1 inch long)the redness extends wider, where some skin were scraped when extraction from blackhead only and not pimples, I had used alcohol on it with Bismuth Formic Iodide powder(it says it helps dry the area to form a scab. Now that area has a yellow on the skin, is it burned by the alcohol and Bismuth Formic Iodide powder? It is not thick or pus when I keep it dry it doesnt ooze but the top layer doesnt completly dry either, but is it normal for it to be yellow, or is it infected? I did try to scrub it off but it doesnt seem like a scab just the meat of the skin is yellow and feels hard and rough, I can still see the pores are pink. When water touches that area it swells up and gets red more. Also it still feels hard like a lump underneath the wound. It has been 3 days.I am really conserned about the yellow meat, last night I took advil and used neosporin with a bandage over it, when I took the bandage off I can see some light yellow on the bandage where the wound is. When dry it is a hard crust glossy but not wet, maybe forming a scab? or was it because of what I used on it? Is this a normal sign of healing or an infection? Thank You so much.

  Answer:  I really think you need to see a dermatologist or a plastic surgeon to see what is going on. JG 1.28.08

• Does Advil help with swelling? Thank You.

  Answer:  yes, it does. JG 1.27.08

• Hello,Dr.Garcia, on a skinless wound, when alcohol is applied, does it actually burn the skin and make it worst, leaving a white rough hard skin even when wet(not scab)? That is what I have now,Because I am not sure if it is an infection, if it is an infection the wound area stays wet and if it is not infected it would dry completly? Thank You.

  Answer:  the wound will make or develop a fluid, a transudate, which is trying to help the wound heal, alcohol on skin that has had the top layers taken off is not a good idea. JG 1.27.08

• Now that silicone breast implants are allowed to all women in the USA, are silicone gel buttock implants allowed or are USA surgeons using them?

  Answer:  there have been solid silicone implants available in the US but not the soft ones like the breast implants and I am not sure that any company is trying to get them through the approval process here. JG 1.27.08

• Hello Doctor Garcia, a few days ago I noticed a small red spot which turned into a bump on my incision line. The skin broke, nothing really came out. Healed over, then flared up again.I don`t know if it will resolve on its own. Does this sound like a spitting suture? Or a suture granuloma? I`m not really sure if the two are different, I just have a feeling it involves a suture in some way. THX!!

  Answer:  yes, sonds like a suture trying to dissolve or get out. The granuloma is a hard lump like a scar. JG 1.27.08

• Hi Dr.Garcia,Due to the intensive squeezing of the skin from extraction, my center cheek has a large hard swollen lump, is there anything I can put on it to help it heal faster or is waiting the only thing, it also hurts a little when touched and stings when water touches it.Thank You,

  Answer:  warm moist heat and light massage. The discomfort is normal from the trauma. JG 1.27.08

• hi doc ,i have a question of concern, well i have some pains on my feet and front of my legs can it be due to walking lots ,and also have some fluids still in my feet and legs? is it normal if feet dont have rest and do walks alot ,so can i use tyelnol and brufen ,ice packs to help me ,thanks alot and its not anything serious, or of a worry ? do i need to get my urine and blood tests done to make sure my kidneys ,cardio vascular system are okay and its not DVT? thanks agian

  Answer:  I think you need to see your primary care doctor to determine the causes. JG 1.27.08

• hi doc ,wanted to know if baby develops a mild cold when he is 7 weeks old ,what can we give him to make him feel better for his cough? he nromally coughs in the evenings and night time? and it drains him a lot?? i had gone to emergency and the doc said not to give any meds only if baby has fever or cough gets worse and mucous is yelow or green in colour? so far he is okay and his temperature is normal. any thing i can do to make him feel better in the evenings and nights, i am rubbing some vicks vapour rub on his chest and back,what else can i do,also i give him water to drink inbetwween his feeds? thanks alot may be you can help me in this matter ,thanks again

  Answer:  you need to speak with your pediatrician, this is a plastic surgery site. JG 1.27.08

• hello doc,thanks once again,well i have a question regards to the feet? i have been having some pains on and off on my legs and feet can it be becuase i am carrying baby and walking and at times have to stand as well, there is mild swelling on my ankles and feet? can it be inflammation and can i use ice packs,tyelnol and brufen and see if it helps me or is it DVT and have to get it checked out? i dont have any shortness of breath?? so is it short term and it will go away on its own? thanks alot have a nice weekends

  Answer:  seeing your gynecologist is the best thing. JG 1.26.08

• Hi Dr.Garcia,Will taking arnica orally before and after procedures help reduce brusing and skin heal faster,and applying arnica on the skin will also help bruises heal faster?? Is this what arnica is for? Thank You,

  Answer:  yes, it will, in my personal experience in using it for over 14 years. JG 1.26.08

• Hello,Dr.Garcia, I have taken prednisone 10mg on and off for abotu 2 years for skin allergy also kenalog injections on and off for 2 years as well. I now notice when I squeeze a pimple even with less pressure the skin would still rub off, and healing time is slower than normal. I am a 28 y/o female very light asian skin. This thinngin of the skin might be due to the oral and injected steroid. If I completly stop taking those will my skin turn normal again and heal fast and dont scrape of easily? Thank You.

  Answer:  you are young enough that if you stop the steroids your skin might get back to normal but there is no guarantee I am afraid. JG 1.26.08

• Dr. Garcia, there is this product called Zim`s Wound Care, Advanced Collagen Gel,just contains hydrolzed collagen 50% and purified water 50%. It say,Collagen Helps:Reduce Pain, Reduce Bleeding, Protect Wounds, Reduce Scarring. its forms a layer over the skin which dry like an invisable bandage. They say it can be used on large wounds, but it doesnt contain antibiotic. Have you heard of this and would you recommend this? Thank You.

  Answer:  I do not believe the claims they are making but it is likely an OK product to use to cover a scar to protect it against the elements. JG 1.26.08

• Thank You Dr. Garcia for answering my question so fast, I am the face picker, so just to make sure, should I use neosporin or something to disinfect the area, and keep it moist like in lotions?Thanks again.

  Answer:  leave it dry. JG 1.26.08

• HI DR.Garcia,Last night I did a bad thing to my skin.The area which I had kenalog injected,and am waiting for the skin to heal.I saw a bump like blemish around that area.I put a needle those for extractions in it and try to extract what I though might be a hard pus, but it bleed a lot, I mean dripping blood for a whole hour, that would not stop.Maybe it was because of the kenalog injection?But it was only that spot.Ok but this morning is fine,I didnt pick it.However, I have swollen skin and some area the skin are kind of scrapped off from squeezing.Also since it is on the cheek there are many pore, I guess the pore got infected all around because there was a speck of pus coming out from it.Then I try to take out the pus,which is a bad move.So now I made matters worst than before.I know I should have no picked it last night,and this morning I should have not picked it either.Now I do not know what to do,Im afraid using neosporin might clog pores and make it pus more.SHould I just use the neosporin and if the pores do clog they will eventually come out more which is better than me trying to poke a needle in it to extract it.Or should I leave it dry and use nothing on it?I made it worst myself,so I would like your advice, since now it is more of a wound like healing.It is on the center cheek,many pores have whiteish puss on the surface and some redness with swelling,and some skin scraped off. :( How long do you think it might take to heal? Should I not touch or pick it at all now? I pick it thinking it helps but I make it worst each time, please help me,Thank you!

  Answer:  warm moist heat and leave it alone, do not pick or needle it anymore. JG 1.26.08

• hello doc thanks for all your help again, well doc i have a concern, its regards to some swelling on sides of feet? when press hard it forms dimples? i had gone to see the walk in clinic doc and he told me it was not to bad and to wait and see if the swelling goes down in few days or else go back to the family doc and get blood work and urine tests done? so what do they look for,and if have protien in urine does it mean its diabetes? or kidneys not functioning well? please help me , i just delivered 1 month ago ?? can it be water retension yet or can it be lots of salt in diet or sugar?? thanks again have a nice weekends !!

  Answer:  the protein in your urine can mean either diabetes or kidney problems but diabetes does nto make your feet swell. It can be something as simple as poor veins in your legs not helping the fluid get out too.In your case it is likely the veins are overwhelmed from the baby recently and all in time should get better with nothing being done. JG 1.26.08

• hello Dr. Garcia. i have some pigment spots and i was wondering about a retinol product or the hydroquine or the combination of both. if the spots go away will they come back after i stop using the cream?

  Answer:  combination would be faster and more efective, if you do not avoid sun and do not use sunblock after they are gone they wil eventually return, yes. JG 1.26.08

• Dear Dr. Garcia, I was assaulted over a year ago, my face beaten severely yet I did not seek medical treatment. There is now a permanent scar on left (most prominent part) of cheekbone, I would describe as rolling-indented scar. I am considering a process called subcission. Do you recommend it? If not, what? thank you tish

  Answer:  I think it is a good option but I feel subcision with a filler at the sae time is better as it helps to avoid having the skin reattach to the underlying tissues. JG 1.25.08

• Dr. Garcia: I had a scar revised in July 07, to this day I can still feel the healing ridge as my surgeon called it. Feels like some firm knots in the deep tissues right under the incision. I had 3 sutures spit, no other complications. Is this scar tissue? Will it soften and flatten more? Can there still be swelling since the sutures used were slow dissolving ones? Thanks Dr!

  Answer:  yes, scar tissue that can take a year or more to flatten and soften. Likley no more swelling though. JG 1.24.08

• helo doc i know its not your area of questions but i started having this feeling since yesterday evening around the pubic areas okay you feel like your muscles are vibrating dont know how to explain so is it harmful and when will it stop i am very worried pls help will it be a problem when want to concieve thanks alot have a nice day

  Answer:  no idea what is going on. JG 1.24.08

• helo doc garica i know its not your area of questions but i wanted to know how long does it take for costochrondirits to heal weeks months as i am concerned and also if you have ibs and acid reflux is it safe to concieve the baby wont have effect as my G.I said i cld take prevacid when needed and also to take tylenol for the ribs the gyno nurse said so so pls get back to me asap have a nice day .

  Answer:  it can be months, at times up to a year or more depending on the patient. JG 1.23.08

• Dr. Garcia: Are spitting sutures still possible 7 months post-op? I think that I just had one come thru a jawline incision, almost looked like a pimple but it was directly on the incision line so I thought suture. I still have some bumps and swelling over the whole area, which says to me that sutures are still trying to dissolve and maybe that means still possible for spitting sutures to happen. Thank you for your help while I wait (impatiently) for my Drs. appt. on Monday.

  Answer:  it is still possible, yes. The lumps could still be deeper sutures, yes. Hang in there. JG 1.23.08

• Hi Doc. I just consulted w/ a very experienced, yet arrogant dr. for a rhinoplasty. I look at his work and feel it is very good, but I was very, very troubled by his approach at asking if I was gonna do the surgery. He asked, when would you want the surgery and how soon . Then he wanted to know which day of the week Id want to do it on. Then he told me that I have 3 weeks to decide if I want the surgery (he said that shoud be long enough to decide if I`m serious about it) and I have to put 1200 down by 3 weeks to book my appt. I think its wierd for a dr to go over that, isn`t that what the office staff does?? And I felt rushed, and he didn`t really look or comment on the pictures of myself I brought that showed what I dislike about my nose. In your professional opinion, shoud the surgeon act this way, I mean about the prices and appt booking? Thanks for your opinion.

  Answer:  well as to putting a deposit down, that is done by some surgeons, as to the amount, that varies. I do not think putting time limits on decision making processes is reasonable. If you feel at all pressured you should not follow through there and go somewhere else. JG 1.23.08

• Hi doctor: I had a inner thigh lift and was wondering the tubes to release the fluid (how long will that last and what color should the ligquid be after 5 days. thank you

  Answer:  it is likley still pink to red and it might be a week or two before they can come out in many cases. JG 1.22.08

• Hi Doctor I know this isn`t a strictly plastic surgery question but it is an aesthetic one, Are the sclera(whites) of peoples eyes supposed to be totally white or is it normal to have some small red veins running through the area. I wouldn`t say my eyes look bloodshot but there are some veins that are permanently there in the same place and shape all the time regardless of the amount of sleep I get. Is this normal? Thank you!

  Answer:  it is quite normal to have veins running through them, they are very rarely all white unless they have been altered by eye drops. JG 1.22.08

• helo doc i am very worried and concerned okay i alrady had my gall bladder surgery in nov 13th 2007 i was recovering fine then use to have pains where the small and big intestines are so doc told me it was ibs so to continue with fibre and lots of fluids okay i have plane sickness so on sat was back from toronto and took gravol while on plane so was feeling nausea and acidity so took prevacid when went home so the feeling that i have when had gallstones its like that mid epigastric dont know if its acidity bse also feel burning at times and also feel like muscle contractions as my doc said was bse of ibs so shld i continue taking the prevacid and gravol when needed and also want to concieve so its safe bse the nurse told me i cld take tyelnol as i also have the inflammed ribs pls help as will not be going to the doc for a while thanks alot for your help have a nice day

  Answer:  I think you need to speak to your gastorenterologist, this is a palstic surgery site. JG 1.21.08

• Hello Dr. Garcia......Could you please tell me what causes a person to have swollen eyelids most of the time. They are more swollen when I wake in the morning and go down gradually during the day but never really disappears. Is this an symtom of an underlying problem and will I always have this. It started about 12 years ago and I`m now 57 yrs. I`ve had an upper bleph because of very heavy hooding about 2 months ago with the hopes that this problem would correct itself but of course the problem is worse.....I`m sure do to the surgery.....do you think the heavy hooding for so many years could have caused this swelling because my eyes would always water. I`m trying to come up with my own answers as you can tell but I need the advice of an expert. Thanks so much!

  Answer:  most common causes are allergies, after that it is low thyroid disease. Best of luck. JG 1.21.08

• hello doc, thanks again for all the help,well i wanted to know is it normal for babies to have some small dots spots on their face,body ? after they are born? is it the oil glands? and also what cream is best for diaper rash? i use vaseline and cream that contains zinc oxide ? any good ones?? thanks alot again

  Answer:  yes, normal plugged oil glands. I think you need to ask your pediatrician about the diaper rash. Best of luck. JG 1.21.08

• Hello doc how are you,thanks alot for all the past help you have given me in answering my questions,i wanted to know is it true coffee is not good for health? it causes the bones in the body to break down, in the sense it eats the bones that causes osteoporosis? and some say its good to have its good antidioxitant? so how much coffee is good and bad or must one just avoid it?? thanks alot again have a nice week !!

  Answer:  the reports about coffee are about evenly split about their risks and benefits. When research is so far over the board, I think generalizations cannot be made. I think anything in exceess is harmful though. I think keeping it to 2 cups per day should keep you in the safe zone, all the best. JG 1.21.08

• Dr.Garcia, my dr. injected 50% anesthesia with 50% kenalog-40, the solutions seems to sit under the skin for a good 3-4 days before the skin absorbes this(leaving a lump with liquid under the skin), usually with another dr. the solution usually sinks in the skin the same day, and no bump of liquid is under the skin. Is it the anesthesia that is thick or is it the kenalog that makes it thick and not easy to be absorbed by the skin? Do you know about how long after this dose of kenalog-40 & anesthesia will wear off and is safe for me to use fillers to the dent?Thank You.

  Answer:  it is the kenalog that makes it thick but also that happens when it is injected too superficially. Fillers are OK if there is a dent and if there is going to be tissue loss you will likely see that after a few weeks. JG 1.20.08

• what is your opinion on the velasmooth or velashape

  Answer:  I like VealSmooth but not VelaShape. JG 1.20.08

• what is your opinion on the velasmooth or velashape I am interested in having it done? 16 treatments 1600.00 or 4 treatments 2000.00

  Answer:  I think VelaSmooth works but not the other. JG 1.20.08

• Hi Dr.Garcia, I just found out my dr. used 50% kenalog-40 and 50% anistisia for my cheek injection. (Does that seem like a heavy dose?,You said kenalog-10 wears off in 4-6 weeks so will kenalog-40 take longer than that to go away?)I already accepted the fact that my cheek is indented,so I am now looking forward for my skin tissue to regenerate.Thank You so much again.

  Answer:  it is a little heavy, yes. It might take longer to wear off due to the dose, yes. Just have to wait and see I think. JG 1.20.08

• Thanks for your time, Dr. Garcia: I`m a 35 yr old female, had a scar repair in July 07 on side of chin. Trying to understand what I am seeing at this stage and if it is on track (next post-op visit isn`t until the 1 yr. point): some bumpiness to the incision, mainly where the cut marks end, feels slightly firm in the deep layers. If I pull the skin really flat it looks nice and tight, but in a relaxed state it looks a bit bunched . Do you feel this will flatten and smooth out over time? Can there still be swelling from long-holding stitches? Thank you for your guidance. --TCI

  Answer:  the bumps and firmness are due to the sutures used below the skin to keep the tension on the closure low so the scar will have less tendency to spread, all normal stuff. In time it should all get better. Sutures dissolve by the body breaking them down with inflamamtion so they do actually cause some swelling when dissolving. JG 1.19.08

• Hello,Dr.Garcia,I wanted to know since kenalog makes skin heal slower, does that apply to only the injected area or everywhere ingeneral?, and if I was to do extraction for blackhead or pimple on or around the injected area should I wait 4 weeks before doing any extracting on the face?Thank You.

  Answer:  well, the only way it would affect things far away is if you had large doses for long periods of time.JG 1.19.08

• Thank you for the explanation, I just asked about the lip lift. I am young, almost 30. That information is good to know, becuase it sounds like I would need to have the maxilla bones shortened then. (Because I don`t to give my upper lip a lifted up look, main reason) What sort of downtime or complications would be involved with reducing maxilla bones? (I`m sorry to ask) I have never heard of this type of procedure before. Thanks much!

  Answer:  well, the swelling will be evident for a couple of weeks, all incisions done on the inside of the mouth, bones are held in place with titanium plates, numbness for a couple of weeks, but overall a good surgery with small complications in experienced hands. JG 1.19.08

• If one was gonna get a liplift (probably bullhorn from researching this site)can I just narrow the length between nostrils and upperlip? I like my lips just how they are, any change to lips would prevent me from wanting this procedure. Also, any downsides to this surgery that you can think of?? Also, Great site for researching procedures, thanks from many!

  Answer:  that might be possible in older people where the long lip is due to stretching of the skin, but in younger folks where it is a genetic long distance and the skin is still its normal strength, the liplift will pull the lip up as that is more mobile than the nasal sill. The only negative issue is the lifting of the lip, besides the tiny scar. If you are yong and the apperacne is that way because the bones of the maxilla are too long, the only better way to fix it is to have the maxilla shortened through oral surgery. Best of luck. Thanks for visiting. JG 1.19.08

• Dr. Garcia,I am very light skin, and I had kenalog inject 3 weeks ago, lead to a dent because injected into the wrong area. Now that dented area and injected area,has a bruise like dark hue,shaped in a C shape, which looks very weird in the center of my cheek. You had said it was probably injected in the wrong layer or with a short needle, or because of the thinning of the skin which reveals the blood vessles. I wanted to know will the discoloration heal by itself or will it stay that color forever? Is there anything I can do that may help with the healing? Like massage or warm compress, or some kind of cream? Or will it all heal in time on its own, and will it completly go away, and how many months will that take. Thank You so much, I am so happy I found this site.

  Answer:  As the tissues regenerate and the fat returns, then the reflection of light through the skin improves and most if not all of the shadowing goes away. If the fat does not rebuild, then when it is filled in it does improve, but not as much as if our own body did it. I am afraid there is really not much to speed the process since the problem is quite deep. Whatever you have at six months is likey what you will have and then can proced with correction. I have has seen people do short term fillers while waiting for the fat to return to minimize the depression. Those temporary injections do not cause the fat not to return. Best of luck and glad you found the site too. JG 1.19.08

• Hi Dr. Garcia, I just notice that the area where I had Kenalog injected does not have any oil coming out on the surface while everywhere else on my face has oil, which is normal. Is this because the kenalog dry the skin or because the fat tissue shrunk? Thank You.

  Answer:  I have actually never seen that occur, I am unsure what is going on in your case. JG 1.18.08

• helo doc i wanted to know if this is normal okay i have been carrying my baby nephew so since then have pains in the arms and hands and also the fingers i dont know if my structure is like that at end of fingers i feel pains when press and there is no swelling bse when press doesnt dent inwards feel pains when press on palms and fingers pls help or will it go away on its own thanks alot

  Answer:  sounds like muscle or nerve strain from the lifting, just got to give that arm a break. JG 1.18.08

• Dr. Garcia, what do you know about paris butt lifts and would you recommend them? Also, can you give a brief explanation on what liposuctioning in the derriere region would entail? Someone told me that it would tighten the muscle under the skin and that it`s preferred over a butt lift that would leave a scar....I am guessing the scar never goes away even with reconstructive surgery, right? Sorry for all the questions...

  Answer:  minimal lift is acheived with the PAris Lift. Liposution of the buttocks is no difference to it being done anywhere else, just need to be careful not to remove too much or the skin and buttocks will droop and it will absolutely not tighten the muscles. The scars from the buttock lift are permanent, yes. JG 1.18.08

• Hi Dr.! You are a life & money saver. Thank you! 2 Questions: 1, I`ve just had Titan (twice), and really like the results. But I`m wondering if some of this positive result may be due to swelling (which, for me, has a youthful effect)... (last treatment was only one week ago). How long before swelling subsides due to Titan, or how long before I can see the TRUE results? Question 2, I understand that Alluma may not bring great results, but.. Is Alluma safe? Thank you once again. I am truly grateful that you are here for all of us!

  Answer:  I think alot of what you have is from swelling,improvements, if there are going to be any, should be seen in one month, but you need to wait 6 months to tell if it really did anything. I think the Alluma done in experienced hands is safe, yes. JG 1.18.08

• Dr.Garcia,You had said that if kenolog caused a dent(dent is not too deep)in a raised scar, the skin will not come back up. My Dr. told me that the dent will come back some. So I am confused, Will nto come back up at all or does it still come back up a little bit? Thank You,.

  Answer:  I am sorry if i was unclear, I think the degree of the tissue coming back is unpredictable but in general, the deeper it is, the less likely it will fill in, so if it is superficial, you have a better chance of it correcting on its own. JG 1.17.08

• Dr. Garcia: I have been massaging a scar (face) per my surgeon`s advice, I am 7 months post-op. I did it longer than usual last night with more pressure and today it almost feels slightly sore. Most of my scar tissue is in the deep layers, not really problematic on the surface. Is it possible to damage the tissues this far out after surgery, or is a degree of pressure generally okay? Thank you!

  Answer:  difficult to hurt anything. JG 1.17.08

• Hi, How much time would you recommend waiting before starting Accutane FOLLOWING a surgical procedure, specifically breast augmentation revision?

  Answer:  I think 6 weeks is adequate. JG 1.17.08

• Hi Dr.Garcia,The kenalog injection gave me a C shaped dent, and it also has a dark shade,you said before it might be visable blood vessels, if I do fill in the dent with fillers will the area still have a dark shade?

  Answer:  that should improve to some degree, yes. JG 1.17.08

• Dr. Garcia: thank you for this forum. Can you briefly tell me about scar maturation and what sort of visible improvements can be seen as a scar matures. My surgeon told me it will be a year until my incision is mature. Right now I have some pinkness, bumpiness and surface irregularities. Just wondering what this will ideally look like after one year. Thank you.

  Answer:  as time goes on the scar matures by creating more normal collagen structure, that translates into a flatter and smoother scar which is less red. I think what you are seeing and feeling is all within normal expectations during the healing process. JG 1.16.08

• Im considering labiaplasty but want to know first if the labia stretch out after childbirth? IS it better to wait until after I have kids?

  Answer:  they can be stretched with childbirth but not always. JG 1.16.08

• can botox be used to reduce the trapezius muscles? will it affect how the shoulder moves?

  Answer:  I do not think it will make much difference. JG 1.16.08

• is there a surgery that exists to remove muscle? or reduce the width of a female`s upper body (back and shoulders)??Thanks so much

  Answer:  nothing safe, sorry. JG 1.15.08

• Dr. Garcia, I am so grateful for your opinions. Thank you! My doctor has suggested Alluma (radio frequency energy) to replace Titan (which I found too painful.. I wrote to you earlier). From my reading, it seems as if radio frequency can cause fat loss. Is this the case also with Alluma? Or is Allumina too gentle to cause harm? Is Alluma safe? Thanks again.

  Answer:  well, to be honest I think you will likely be disppointed with the degree fo improvement from either one. It might hurt less, but it also might not help much. JG 1.15.08

• dear dr., I am currently using 1% retin-a. I would like to use the proactive products. I see that step 2 has glycolic acid. Should I just use step 3 (repair lotion)? Thanks

  Answer:  if you are using the Retin-A already you can skip the glycolic step, yes. JG 1.15.08

• Do you think Glucosamine Chondroitin & MSM have any effect on skin tissue or bone health as they say it does on vitamin labels, or is it a waste of money? Thank You<