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

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• I often see light chemical peels recommended in a series. Is there any benefit (pigment, pores, skin texture) to continuing to have a monthly light chemical peel indefinitely? Is all that peeling eventually harmful to the skin?

  Answer:  Continuous skin peeling can over irritate the skin and cause blemishes or abnormal skin growths, it should not be done unless needed. JG 2.4.11

• I see that you recently answered a question about cortisone on your website. I know it`s not a plastic surgery matter, but I too have a simple question about cortisone. I had my first injection of it last week to my knee for arthritis. The doctor told me it would take 48-72 hours to kick in. I`m at day 7 now, and I do notice about a 10% improvement in the pain. My question: is the full anti-inflammatory effect experienced at that first 72 hour point, decreasing thereafter (that is, is the amount of pain reduction I currently feel as good as it will get), or will the anti-inflammatory effect increase with time (that is, can I reasonably hope for further reduction in pain the weeks ahead)? Also, when cortisone wears off (at about 3-4 months?), do its benefits drop off gradually or precipitously? Many thanks for your time and expertise. God bless you.

  Answer:  well, it depend son what type of cortisone shot was given, some are longer lasting than others. Whatever effect it will have will reach a maximum, which you already have, and then from then on will continue to help for the time relative to the type of cortisone, and then wear off. In your case what you have is the best you can expect and will go down from there. Cortisone can help, but it will not help in all cases. The decrease is gradual and not precipitous. I wish you the best. JG 2.3.12

• I know you`re not a cardiologist, but I wonder if you can offer a general medical opinion about a simple cardiac question. I have mild hypertension that has been successfully controlled with HCTZ for some years. Last year, I developed an orthopedic injurgy that has caused me to use NSAIDS (naproxen- Aleve, only in the recommended dosages). Predictably,as a result, I develped systems of mild heart failure which prompted me to stop the NSAIDS. Since doing that, I seem to have had some symptom relief from the CHF. What I can`t seem to get a clear answer about from my cardiologist is if the damage done to my heart by the NSAIDS is permanent or if it is generally reversable once the NSAIDs have been discontinued.Thanks very much for venturing a bit out of your field, Dr. Garcia, to proffer an opinion.

  Answer:  Although hypertension is more common with nsaids, the heart faure can be evaluated by getting an echocardiogram to check wall motiom and ejection fraction, should be reversible if it was short time of use. JG 1.31.12

• Hello Dr. Garcia I have been up and down las vegas to look for a surgeon. It is for my daughter ruby hernandez, she was born with a hemangioma on her left cheeck and it is the size of a half dollar. I have gone to 2 plastic surgeons this year and none of them can do anything since it is to big for them, and also they say that there are too many veins around the hemangioma for them not to damage her facial nerves. I am covered by hpn hmo and I just want a sertified surgeon to take care of my daughter so she doesn`t have to be the child who gets thrown on the side because of what she has since she was born. So my question is... Can you treat her and take out her hermangioma or will it be difficult for you to do so?

  Answer:  I cannot say what I might be able to do without seeing here. I might suggest you see a dermatologist to see if they can shrink it with a laser such as a diode or VBeam in order to make the eventual cutting smaller. If the local plastic surgeons and dermatologists cannot or will not treat your child then it is within your rights as an HPN patient to get a referral out of the system, like to UCLA for example, to get the laser. When I was the plastic surgeon for HPN, that is how it worked I wish you both the best JG 1.31.12

• Hi Dr. Garcia, I`m 54 years old and need a neck lift. Can you please explain where the incisions are for a neck lift and healing time? Thank you!

  Answer:  healing time before you are out in public is about 10 days. The scars will be both in front and in back of the ear, and maybe a small one under the chin, the length of the scars around the ear depend on how much skin needs to be removed, the greater skin excess, the longer the scars will be. Best of luck. JG 1.27.12

• I`ve read on this website of many people who have fat atrophy after steroid injections. I had to have cortisone injected directly into my shoulder capsule this week (under fluoroscopy, so we could confirm that it was placed in the capsule only). Because of that, am I protected from the possibility of tissue atrophy around the capsule? If not and I end up with a deformity, is the tissue likely to regenerate with time? Thank you. Enjoy your weekend!

  Answer:  the chances of steroid atrophy in your case is almost none as long as it is in the capsule only. Best of luck. JG 1.27.12

• Hi dr...thank you for so graciously answering our questions here. I would like to come in and have you tell me what I should do as far as injectibles, no surgery....yet! my budget is quite tight so I am looking for that one thing that would make me look a little less than my 48 years! What do you charge for consultations or what does your nurse charge and can it be applied to the injection coat?

  Answer:  consultations are $50, it can be applied to surgery costs if performed within 6 months, but not towards injectable costs, sorry. Looking forward to meeting you in person.JG 1.25.12

• Silly question, but here goes....as a PS and one who sees things as aesthetically pleasing, have you ever encountered a person who looks years younger and pleasing to the eye without having had anything done? I say this because I see so many women out there who don`t necessarily look younger, just injected/done and wonder what the actual secret may be to looking a few years younger without having that look . Have you any ideas...is it genetics, lifestyle, etc?

  Answer:  well between good genetics, taking care of one self and not overdoing things cosmetic surgery wise, those are the keys. More is not necessarily better, especially when it comes to surgery and fillers.The least amount possible is the wisest choice. JG 1.25.12

• Which is better for acne prone skin? Hydroquinone gel or cream? And what concentration do you recommend? Thank You for your time!

  Answer:  gel would be better in your case and I suggest at least 4%. JG 1.20.12

• I had an Ulthera treatment on Monday and now my lower face looks like it`s be extremely overfilled with filler. I look like a chipmunk or like I have the mumps -- no exaggeration! It`s terrible. . Is it possible that the treatment created that much collagen in such a short time or is this swelling? The plastic surgeon`s office where I had the treatment done said they`ve never had anyone develop noticeable swelling from Ulthera, so I`m getting scared that I just had a robust response to this and will be stuck with this! Ice and head elevation aren`t helping. Thank you for any advice you can offer me, Dr. Garcia.

  Answer:  you do not have collagen creation, you have swelling, that is all at this point in time, the collagen takes weeks to form. It will go down over the next few days. JG 1.19.12

• I see a lot of people are asking you about removing fat from their upper arms. Is it possible to do a transfer TO the upper arms? I`m 55 and have hollowness and skin folds near my armpits. When I push the skin together and simulate the addition of fat, it drastically improves. Have you ever heard of fat being added successfully to the arms? Thank you for your help.

  Answer:  fat injections can be done to that area, but count on at least two sessions with about 6 months apart. JG 1.19.12

• My dermatologist is now offering MiraDry for the elimination of sweat glands in the axilla. What are your thoughts? Does this really work? And what do you think of Pelleve for periorbital skin texture improvement? Thank you, Dr. Garcia!

  Answer:  I have not seen any patients treated with it, if the heat does work to kill the sweat glands, then its great, I am just unclear on how effective one session will be in doing that. As to the Pelleve, I am not a believer. All the best. JG 1.19.12

• Do chin implants look bad as women age with saggy chin/jowl? Do many people choose to remove a chin implant as they get older?

  Answer:  The chin implant will not have any bad effects and it can stay in. JG 1.18.12

• When you want to narrow the width of the chin, would the bone be sawed on each side? If so, how would you hold the cut chin bone in place? And if you wanted to add a little more projection in center, would you use a part of bone you cut from narrowing chin or a chin implant?

  Answer:  It can be cut down or burred down, like a sander. There is no need to hold the chin in place as it is still connected to the rest of the jaw bone. I personally would use a small chin implant on the tip rather than the cut bone. Best of luck. JG 1.17.12

• If the sides of chin is indented in due to loss of collagen or fat, would ultherapy or sculptra be better? Don`t both treatment build collagen? My jowls are also a little saggy due to collagen loss. I guess I want to know if you would need sculptra if you had ultherapy? Or would you still need both procedures?

  Answer:  if it is loss of collagen, the Sculptra would be better. The Sculptra builds new collagen whereas the Ulthera more shrinks the collagen present. Some people benefit from both therapies, all depends on what is going on individually. JG 1.17.12

• I have heard about eyebrow lifts resulting in bald spots on eyebrows, hairline, or hair on side of head? Is this true? Would I be likely to permanently lose hair where hole was made in head to endoscopic eye lift? Also, is the just the outer edge of eyebrow usually lifted up in eyebrow lift?

  Answer:  that can occur when excessive tension is placed on the wound upon closure, it can happen under those circumstances under any technique. The outer part of the eyebrow is usually lifted during a brow lift, yes. JG 1.17.12

• Hi Dr, I have been having botox around the eye area for almost 9 years. I have been to many doctors but no matter what technique or dosage I am given, it doesnt seem to last more than two and a half months. My forehead lasts about 4 months. This time I went to a doctor and explained my problem. He believes this is due to the fact that I have an expressive face and probably using the muscles more which is causing the botox to wear off quickly or I may be coming immune. What are your views on this doctor? I also wonder if it is OK to keep repeating botox after 2 months as it has completely worn off after this time. Thank you

  Answer:  I have never seen a true case of immunity although it is possible in theory. As to the function of the muscle, yes, in areas of high activity the wrinkles can come back sooner. It is for that reason that Botox has not been FDA approved for the crows feet area, it is used legally off-label, but the differences were not dramatic enough to warrant the FDA approval. You are likely destined to need frequent injections, although you could also try using a higher does than previously and that might help prolong it some. JG 1.15.12

• Hi, Dr. Garcia. I`ve posted before about a white/yellowish pigment tattoo I had placed on an ear scar. I`ve had 3 laser treatments to get it off and it doesn`t yet appear to be breaking up. An aesthetician told me that because it`s clay pigment and not ink, it is likely to fade entirely on its own anyway within two years of being placed. Is that true? Thank you for your help.

  Answer:  I have not heard that they use clay, as to removing it with a laser, since the laser needs a color target, and there is no laser for white and light yellow, that is likely why it is not working well. Using a dermabrasion or a CO2 laser might remove the skin surface allowing the pigment to come out, but that can lead to worse scarring. I think its best to leave it alone and let it fade away with time. Sorry. JG 1.9.12

• Hi Dr. Garcia, I posted last week about hair loss and you said I might try an OTC Progesterone cream USP. Can you recommend a particular brand that might be beneficial? Thank you!

  Answer:  All otc progesterone creams are generic, no difference. JG 1.7.12

• I saw the questions below about Cool Sculpting for the arms. While the hand piece to fit the arms isn`t available yet, I was able to use the existing small hand piece on my arms for two treatments (with some acrobatics on my part and great ingenuity on the part of the technician) and have been thrilled with the results. I followed that up with Ulthera to tighten the skin. Those combined treatment modalities cost more than liposuction, but I thought it was safer for a middle-aged woman, since I didn`t want to be left with sagging skin after liposuction, which would be worse that too much tissue in the upper arms. I hope that my experience helps your other readers.

  Answer:  Yhank you for sharing your experience, but in all honesty, if you had conservative liposuction done, you likely would have had the same or better result. The loose skin aftet liposuction is due to the amount of fat removed. When one compares apples to apples, in terms of percent of fat removed, I think lipo would have done as well or better. Maybe a bit more down time but likely less cost. Thanks again for sharing, it is always good to hear people`s rxperiences. JG 1.5.12

• You have kindly answered a few cosmetic questions for me in the past, Dr. Garcia. I wonder if you would be willing to answer a general medical question. I am using the OTC transdermal analgesic Salonpas for relief from adhesive capsulitis. I am also taking Aleve. Salonpas contains the NSAID methyl salycilate. Are there any dangers of liver toxicity with this? If so, might it be mitigated by the fact that the delivery is transdermal rather than oral? Might the use of this patch also potentiate the possibility of liver toxicity when used in combination with Aleve? Thank you for your time and expertise.

  Answer:  Ingestion of topical products containing salicylates, such as Ben-Gay, salicylic acid (keratolytic), and oil of wintergreen or methyl salicylate, can cause severe salicylate toxicity. One teaspoon of 98% methyl salicylate contains 7000 mg of salicylate, the equivalent of nearly 90 baby aspirins and more than 4 times the potentially toxic dose for a child who weighs 10 kg.A comprehensive review of the existing medical literature on methyl salicylate poisoning has determined that it is a relatively common source of pediatric exposures. In younger children, most of these exposures are accidental. Intentional ingestions are much more common in adolescents.A 16% morbidity rate and a 1% mortality rate are associated with patients presenting with an acute salicylate overdose. The incidence of morbidity and mortality for a patient with chronic intoxication is 30% and 25%, respectively. Hepatitis can occur in children ingesting doses at or above 30.9 mg/dL. Reye syndrome is another form of pediatric salicylate-induced hepatic disease. It is characterized by nausea, vomiting, hypoglycemia, elevated levels of liver enzymes and ammonia, fatty infiltration of the liver, increased intracranial pressure, and coma. The effects on children come sooner than in adults though. I think to use it occasionally is OK, but I would not suggest long term use, especially while also taking Aleve.All the best. JG 1.5.12

• Saludos Dr. Garcia, practique artes marciales y ya tengo varios a@os con deformidad en ambas orejas las que comunmente las llaman orejas de coliflor, podria informarme el costo aproximado de una intervencion quirurgica para las mismas ? gracias.

  Answer:  seria aproximadamente $5,225, todo incluso. JG 1.3.12

• Happy New Year, Dr. Garcia! Would you please give us all your opinion of the supplement 5 Hour Energy? Here are the ingredients: http://www.5hourenergy.com/ingredients.asp Is this safe? Hype? This looks to me similar to what one could obtain from a good B-complex. Thank you for sharing your expertise with us all. A healthy--and energetic!--new year to you and your family.

  Answer:  I think it is safe, some people might feel their heart race a bit or feel warm, but nothing dangerous, as long as you don`t take too much. It is like a weak form of Red Bull or Rock Star, not much more than b vitamins and a cup of coffee. Al the best for the New year. JG 1.1.12

• i had flat but visible temporal/periorbital veins. A bay area board certified plastic surgeon made this situatuin infinitely worse by tying iff the veins at the hair line. Now I have bulging periorbital veins along with worsening temporal hollowing that only Steve`s to accentuate the problem. Would your temporal implants modify this poor outcome. I`ll send photos upon request. Thank-you.

  Answer:  The implant will help the hollowing but not the veins, sorry. JG 12.31.11

• i had flat but visible temporal/periorbital veins. A bay area board certified plastic surgeon made this situatuin infinitely worse by tying iff the veins at the hair line. Now I have bulging periorbital veins along with worsening temporal hollowing that only Steve`s to accentuate the problem. Would your temporal implants modify this poor outcome. I`ll send photos upon request. Thank-you.

  Answer:  The implant will help the hollowing bit not the vein, sorry. JG 12.31.11

• Hi Dr. Garcia, I need to decide whether to have fat removed from my jowls by sono bello which uses a laser to remove fat or by the new EndyMed pro 3 deep radio frequency device. Sono Bellow would make three small incisions under my skin, one directly below my chin and the other two on underside of my ears. Theyll remove the fat that way. This would be done by a plastic surgeon. The EndyMed Pro 3 Deep would be performed by a derm. I cannot afford to do both, only one. Which do you think would help me the most. I have mild to moderate jowls that drag my face down. thank you jc

  Answer:  Between those 2, go with the sono bello. JG 12.29.11

• Hi Dr. Garcia, I`m 54 year old and experiencing noticeable hair thinning. I had a hysterectomy at age 40 and have taken Menest 0.625mg. daily since that time. I was wondering if progesterone cream USP might help? Also, wondering if you have ever heard of good results with a supplement called Viviscal? Thanks for your response and Happy New Year!

  Answer:  I habe no experience with the Vivisval, but you likely need some progesterone, OK to start with the OTC USP, but could also get blood tests to monitor them, should shoot for a level normally found mid cycle. All the best and Happy New Year. JG 12.29.11

• Let`s say you had a rib graft for nose revision surgery and the doctor banked some rib cartilage in chest in case you needed another revision. How is removing banked rib different from removing rib for the first time? Will general anesthesia still be required to remove banked rib? I feel a hard a ball of something over a hollow area. I am thinking that is where rib cartilage was removed and bank rib added. I am not sure why the doctor did not lace banked rib behind my ear since he would still need to cut my chest open again? Is it possible for the doctor to recut the incision on my chest to remove the rib and then place it behind surgery for revision surgery in the near future? I was stressed over having my breasts exposed the first time during surgery. If possible, I would rather have the doctor remove the banked rib from behind my ear. I can wear a bra in office procedure vs. surgery center.

  Answer:  I am not sure why banked rib was placed, very unusual. I think you will need general anesthesia though. JG 12.26.11

• Hi, I am dealing with overfilling from silicone in my lips and cheeks. I`ve had kenalog injections and they have been successful in reducing the size, but after time more scar tissue always forms. Would 5fu mixed with kenalog help in reducing the collagen and prevent it from coming back? Do you have a recommendation for a doctor in Southern California? I would be willing to drive up to Vegas to have it done by you, but your receptionist said you can`t take patients that aren`t former clients. I`ve been struggling with this since I was 20, and I`m now 26. This has been a heart breaking mistake.

  Answer:  I am sorry but any ef fect you are getting from Kenalog or 5FU are likely from effects on your normal tissue as those medications will have no effect on silicone. Eventually if they form lumps it might be able to be cut out, but there is really nothing I can suggest for you at present. Sorry. JG 12.17.11

• I`ve had facial swelling since after getting the second set of kenalog injections (Sept., then Oct.) The injections were of at least 40mg each session (under trapezius, top of shoulder, base of neck, skull). The area above the right upper lip has darkened (the skin, not the hair)...there is slight puckering of the lip, too. On the left side, there`s more puckering of the lip, but much less darkening of the skin. Will this fade?!?! The right side was once totally black after botox injections, but that faded very quickly. Thanks!

  Answer:  I am sorry but I have never heard of a reaction like what you are describing form a Kenalog shot in those areas. JG 12.15.11

• Thank you, Dr. Garcia, for your comforting and informative reply about the hematoma in my butt. I`m so grateful to you for answering my (and others`) questions when we`re struggling. One final question for you about all this: The hematoma liquified at day 9 post-op, which, of course, caused the blood to leak out. My surgeon expressed it manually on Saturday, and I have been doing the same morning and evening as instructed, but the wound is still oozing a great deal of blood. It doesn`t look like old blood from the hematoma but fresh, frank blood; it`s bright red and not clotted, unlike the kind we were able to get out on Saturday at my surgeon`s office(dark red, clotted and sticky). At this point, I`m thoroughly soaking an ABD pad every 1-2 hours. Does this sound right to you? What could be causing this extra bleeding and what can be done about it? I`m not seeing my surgeon again for two more weeks. If thislevel of bleeding keeps up, would you recommend that I call him by the end of the week, or is this to be expected from a wound this size? Thank you again, Dr. Garcia. I apologize for bothering you twice with this matter. I wish you and your family a blessed and healthy holiday season and new year.

  Answer:  Bright red blood is new blood, maybe a small blood vessel has popped. You should see the surgeon soon, they can likely cauterize it for you. Best of luck. JG 12.12.11

• Dear Dr. Garcia, You have been extremely kind in offering me advice as I heal from a scar revision on my butt that has been bleeding now for 12 days (from an opening in the incision line). I saw my surgeon today and he confirmed I`d had a hematoma. He expressed the blood manually and put me on silver sulphate and Keflex. He told me that allowing the wound to heal from the inside out, keeping the hole in the incision line open, will help reduce the chances of infection. It`s still actively bleeding, but I felt better that he had the chance to examine it. So I came home tonight and used the sterile swab to insert the silver sulphate into the wound and along the incision line, as instructed, while changing the dressing, and I was horrified to discover that the hole in my butt (under the incision, which I accessed through the hole in the incision) is AT LEAST 6 inches deep by 8 inches wide! Here are my questions for you: 1) Was that hole created by the hematoma? 2) Does that seem like an unusually large wound to you? It takes up almost half of that butt cheek. 3) Do you think the course of action my surgeon is taking is a wise one? If you were he, would you open and reclose the wound? 4) If we allow the wound to heal from the inside out as he is recommending, how long do you think this will take, in light of the size of the hole? Sorry to ask so many questions, but I`m a little freaked out (and a bit grossed out) by this development. You are an angel. Thank you, thank you for being there for us all!

  Answer:  The size of the hole was made by the surgical procedure where the tissues were undermined, and then the hematoma kept them apart . It sounds big, but in that area, it is not unusual. It will heal but it will take weeks. Using a girdle of some sory will get the spave to collapse and close faster. It sounds bad in your eyes but as long as the tissues are clean, it will close. Hang in there. jG 12.11.12

• Dear Dr. Garcia- thank you for providing such a great informational resource. I have two/three things going on that I would like to ask you about. I have necklace bands or deep, horizontal lines across my neck. They are so severe that it looks like someone tried to strangle me. Do you have any treatment ideas? My PS is baffled. The other thing that concerns me are the dark circles around my eyes, I have had that my entire life - all arou d my eye- not just under. Is this common? Would your product help me? Under what circumstances is your product most successful - and is it safe to use all around the eye? Finally recently I have noticed little white bumps underneath my eyes. Is there anything I can do to treat th bumps? I am 35 and have never had this problem before. Thank you for the advice!

  Answer:  for the horizontal wrinkles, I might suggest some Sculptra, diluted a little more than normal and injected directly under the wrinkle, those wrinkles are very very difficult to improve though. As to dark circles, I think my product will help some, but might not totally remove them, if they have been there your whole life, there is likely staining of the skin from the blood vessels and that is much harder to totally eliminate. My cream is safe to use all around the eye, yes. As to the white bumps, a dermatologist or plastic surgeon should be able to hyfercate them. All the best. JG 12.9.11

• Hi, Dr. Garcia. I wrote last week about bleeding from the incision of a scar revision on my butt 7 days after the procedure. I did see my surgeon and we both agreed that it was likely leftover blood in the tissue from the procedure leaking through. But yesterday and today, it has started to gush, causing me to need to change the dressing every 10-15 minutes. It has also become excruciatingly painful -- like a burning hot poker is stuck into the incision. I passed out from the pain this afternoon. There is no pus in the blood and I have no fever, but the blood smells distinctly sweet and acrid, like rotting flesh. Do you think it`s infected? I called my surgeon and he is very kindly seeing me on Saturday. In the meantime, any suggestions to stop the bleeding and to handle the pain? Acetaminophen isn`t helping at all. (By the way, I`m taking no anticoagulants of any kind.) Thank you for your help!

  Answer:  Applying pressure somehow could help, maybe getting you int a compression garment might help, you might have been placed in one after your original surgery. Sorry to hear about the issues, hopefully that old blood will absorb soon and stop draining. All the best. JG 12.9.11

• Had a scar on my butt revised last Monday, closed in 3 layers. It kept bleeding that day, so the surgeon kept me in his office and ended up opening it after a few hours to see if he could cauterize any bleeders. He did find an artery that he had nicked, so he cauterized it and closed again. It`s Sunday morning and it`s starting to bleed again. What`s going on? II`m not taking any anti-coagulants, by the way.) Do you think he`ll have to revise it for a third time? I really hope not.

  Answer:  might be just bleeding from the scar tissue not being able to collapse on the bleeding vessels, I think you should see the surgeon this week and I cannot predict whether you will need another revision. All the best. JG 12.4.11

• Had a scar on my butt revised last Monday, closed in 3 layers. It kept bleeding that day, so the surgeon kept me in his office and ended up opening it after a few hours to see if he could cauterize any bleeders. He did find an artery that he had nicked, so he cauterized it and closed again. It`s Sunday morning and it`s starting to bleed again. What`s going on? II`m not taking any anti-coagulants, by the way.) Do you think he`ll have to revise it for a third time? I really hope not.

  Answer:  bleeding is more common when operating on old scars as the tissues do not collapse well around the blood vessels. I think seeing your surgeon again is a good idea, but no way to predict whether another revision will be needed. All the best. JG 12.4.11

• Dr. Garcia, not a question this time (just catching up with your pearls of wisdom) I thought I would also take this opportunity to wish you and your family a wonderful Christmas and a safe and prosperous New Year. God Bless and cheers.

  Answer:  Thank you very much, my family and I appreciate it. JG 12.4.11

• Good evening, Dr. Garcia. One year post-op from a butt lift and the scar is absolutely terrible -- wide, red and railroad tracked. It`s also too high. My surgeon doesn`t want to lower it because it will require him to dissect the skin off my mid-back, but can the scar at least be excised and made thinner, if not lowered? Of course back scars are never the best, but this is truly terrible. He`s a great surgeon; I just got unlucky. He told me the scar would take its final form at one year, but now that we`re at that one-year mark, he`s telling me it will take another two or three years. Is this accurate? I fear he just doesn`t want to revise it. Should I find another surgeon? Thank you for your advice.

  Answer:  there has to be some laxity or looseness of the surrounding skin in order to revise the scar and make it thinner, so either the back skin needs to be lifted or the buttocks undermined again and lift up further. If you have concerns, seeking a second opinion might be a good idea. It might be something that cannot be revised at the present time and you will need to wait until there is enough loose skin to make it worthwhile to attempt a revision. JG 11.4.11

• The place where I feel hard rib is on my chest directly below breast. I am not sure if you thought I meant I felt hard rib on my nose?

  Answer:  Sorry, that is what I thought, that would not shify but the edge may need to be burred down smoother JG 12.1.11

• I think swelling went down so I am just noticing it now. In regards to my question below, is it normal for the rib tip to wobble or move back and forth when you press it? Why does it wobble? When you mentioned the rib graft shifting, did you mean the rib moved out of place where it was cut?

  Answer:  it is not uncommon, although it is usually held in place with sutures, they will not hold it rigid.As to shifting, if the pocket where the rib graft was placed was bigger than the rib graft itself, it can sometimes shift as the surrounding tissues do not grow into the graft in order to immobilize it. JG 12.1.11

• I had a rib graft for nose revision surgery. An inch above the incision line, is something that wobbles and feels hard. It is about a half inch wide. It feels too hard like bone to be scar tissue and it is above the scar or not on the scar. I am concerned that either a rib was cut and is ticking out or too much cartilage was removed from my rib so there is no padding over my rib- and that is why I feel a pointy end. Do you know if the ribs have points at top- something like a knuckle on a finger? Do you know if the rib is cut through to get to the cartilage?

  Answer:  the rib can have a tip that feels like that, it can be from the rib graft shifting or from the swelling going down and now the tip is more visible and palpable. I think you should see the surgeon to make sure that a revision is not in order. Typically the rib graft is just the bone, and minimal to no cartilage. All the best. JG 12.1.11

• I had Perlane injected in the tip of my nose do to the fact it is lopsided & boxytip. In 3 1/2 weeks my body seemed to metabolize it & I need to go back for more a month later. Is this normal or is my body missing something & trying to get it from this Perlane? Should I take a supplement to prevent this or does this normally happen after only a month of being injected?

  Answer:  should last longer than that, might have been injected too deeply.There are no supplements will slow the absorption of a filler. JG 11.18.11

• Hi Dr. Garcia! I`m a bit flustered. I`ve had the sixth round of 5-fu injections in attempt to dissolve dense internal scar tissue about the size of a small tootsie roll following gynecomastia surgery a few years back. Having been on an aggressive administration being every two weeks, it seems that the lump hasn`t responded as much as I had hoped. It seems like the mass had initially responded somewhat and now it`s about 75% of the original size but very firm and dense. It`s this highly concentrated, hard nub of tissue that seems to be more resistant to 5-fu treatment. It`s as if subsequent injections are working very slowly or not at all following the third treatment when the lump had become noticeably hard but constricted. Still lump is tender from the 5-fu. I know my surgeon takes great care to inject into the lump because he squeezes around it so that it sits tight against the skin before jabbing. Having much experience in this area, what is your take? Do you have any recommendations or suggestions? Many, many thanks!

  Answer:  Assuming the injections are done properly, you might want to mix the 5FU with kenalog to soften the scar tissue and make the intralesional injection easier and more effective. Also the injection should be done while withdrawing the needle so.as to leave the 5FU in the tract rather than allow it to go outside of the scar tissue. JG 11.14.11

• The only time I used to get BO underarms was during my period or if I overexerted myself. Or I only had to wear deodorant during that time. I am in my late thirties now with fibroids in uterus. Since then, I have BO underarms all the time. I had a blood test and my hormones are normal. Just wondering what hormone I might have too much of or too little of to cause this BO. The BO is the same as it was when I had my period, but it is like that all the time now. as women get older, do they usually get more BO?

  Answer:  The BO is related to the hormone DHT and to bacteria in the oil and sweat glands. It is safer to control the bacteria than manipulate the hormones, but you can try some topical progesterone cream from the health food store. JG 11.13.11

• How many milligrams of Red Yeast Rice with CoQ10 does one need to take for it to be clinically effective in lowering LDL? My capsules come in 600 mg doses. Do I need to take one, two or more/day? And if I need to take more than one, is it best to separate them into morning and evening doses? Thank you so much for your time and kindness, Dr. Garcia! Hope you`re having a great weekend

  Answer:  That will vary from patient to patient, it will need to be a trial and error issues. Start with one and then get your blood test done after 6 weeks, then increase as needed. JG 11.13.11

• Hi Dr Garcia, I had my corner of mouth lift done, my mouth look like I was frowning all the time. It looks like the plastic surgeon removed some skin from the corners of my mouth downward a little bit, Does this work? I cant tell because I am swollen still and I have white tape strips over the stitches. The strips are pretty gross looking yellowish and curling up. My question does this procedure work? Can I remove those strips it been 5 days?

  Answer:  The swelling will mask the degree of improvement for a while, I would leave the strips on until you see your surgeon. JG 11.12.11

• Thanks for answering my question below, but you didn`t tell me if the whole ear scar can be revised once the lobule is pulled forward and up onto the cheek. Can it be set back to its original position, or would a revision only advance it farther onto my cheek? Thank you!

  Answer:  likely not as it will be pulled further out of position, it would take a long time for the skin to relax enough to do it safely. JG 11.12.11

• The aesthetician in my plastic surgeon`s office tattooed a small red facelift scar of on my lobule with the lightest pigment available, but now it just looks like a red scar with crusty make-up on it. My dermatologist tried to get it off with an NdYAG, but it didn`t do much of anything. Can I ask my plastic surgeon to dig the pigment out? It`s just a few milimeters deep. He`s tried to revise this scar before, by the way, and he ended up advancing my ear forward, so he can`t revise the whole thing again. (Once that has happened, the ear can`t be put back in it`s original position because too much skin was removed, right? If I`m wrong, maybe i should ask him to try to revise the whole scar again?) Thank you for your help, Dr. Garcia.

  Answer:  well, he might be able to dig it out but it might leave a thicker scar. JG 11.12.11

• I`ve gained a little weight, which has gone to my hips and thighs -- of course! -- and it`s incredibly itchy. Why would it be itchy? This has happened to me before. Thank you.

  Answer:  Rapid weight gain can create micro tears in the skin, and that can itch short term. It will go away though. JG 11.11.11

• Dr. Garcia, thank you so much for your prompt response. I have another question regarding radiesse injected along the nasal labial lines. It seems as my doctor injected it low for the cheek and high for the fold. It`s making my face very full around the bottom 2/3`s. That along with the flat lip makes me look off . I`m going to get juvaderm to build the cupid bow and philrum column but I don`t know if I should get more radiesse higher on the cheek bone. Thank you for taking your time to answer all these questions. sincerely, jc

  Answer:  I think the amount of Radiesse you would need to lift the cheek enough would be quite a bit. Not sure it would be worth it. JG 11.6.11

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