Ask Dr. Garcia - The Archives

• 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 poin