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

• 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