Dr. Garcia, I just looked at all the photos on your site and discovered that in addition to not having any examples of lip lifts, you don`t have many examples of other procedures as well -- and certainly none of your filler injections. MIght you be updating your site soon to include a greater variety of photos? I`m sure I`m not alone in wanting to see more of your always realistic examples of your fine work. Thanks so much!
sorry but I have no plans in the near future to expand the photo gallery of different procedures. Although some doctors do have many photos, in my over 26 years I have not found that to be something that I needed as results vary form patient to patient. JG 1.12.14
Thanks for your answer about the corner lip lift. I can`t find any examples of your own work in this area in your photo section. Would you kindly post some? Before I make my decision, I would like to see the real extent of the scars, which I know you would reveal -- unlike so many who play with lighting in their before and after shots! The identity of the patients need not be disclosed because it would only be their lips you would show. Thank you kindly for considering this request.
I do not have many photos on my website for many different reasons, some of it is because patients nowadays do not like their images on the web and some of my patients prefer to have their pictures only seen in the books we have in my office where the images cannot be copied or shared and I also think it can lead to inaccurate expectations.As you can see many other doctors feel differently and post many photos on their websites, but in over 26 years of doing this I have never followed that dictum. Additionally seeing one patient does not mean that a different person will have the same end result. All the results will vary from patient to patient. At times the scars can be imperceptible but the longer the lift, the more visible the scars can be.Also as the length of the scar is limited buy the distance form corner of the mouth to the nasolabial fold, not all patients can achieve the degree of lift that they desire. JG 1.12.14
When you have a temporal fascia graft taken, can it be taken anywhere from top of scalp or only in a certain area? I ask because I have a bald spot in band area on top of head so I was wondering if the bald spot could be cut out when taking a temporal fascia graft?
it has to come from the area over the temporal muscle, so it is the lower scalp lateral side of the forehead only. The location of the bald spot would make access to the fascial graft difficult I am afraid. JG 1.10.14
Thank you for that encouraging prognosis regarding my alopecia! I`m elated! That`s 1 full inch/month. I`ll be awaiting hair with even more enthusiasm than the spring grass after this bitterly cold winter in Baltimore -- as in so many other places! One additional question: Should the hair that fell out the earliest (in late August) be starting to grow back now, with the hair that fell out the latest (in early December) coming along at the end of the predicted regrowth, or will it all start to grow together at once? Bald (and Grateful!) in Baltimore
the first fall-outs should be the first to regrow, yes.Keep your spirits up, Spring brings new growth. JG 1.10.14
Hi, Dr. Garcia. Happy New Year! You were very kind to me last summer when I started experiencing global alopecia exactly 12 weeks following a facelift in early June. My hair finally stopped shedding in early December. I am wearing a wig -- which is hideous! -- and can`t wait for my hair to start growing back. I look like I`ve been through chemotherapy. I have just a few thin patches left and the rest of my scalp is completely bald. Just terrible. If it`s going to grow back, when should it start? And do you find that hair typically grows about .5 inch/month? Thank you ever so much for your encouraging word and your kindness. You have made a grim period in my life a bit more tolerable by giving me hope that this will get better. God bless you!
Should start in the next 2-3 months, and it does grow about 1mm per day, there are 25mm in an inch so you can calculate form there. Good protein intake will also help as hair is all protein.Keep me posted and I wish you the best. JG 1.9.14
This may seem like an odd question, but I`m going to ask it anyway. Now that the New Year has arrived, all the diet companies are pushing their advertisements constantly on television. Marie Osmond is hawking one of these companies, so I`ve seen her several times in the past week. We are the same age. She easily looks 30 years younger than I, and she looks terrific -- not at all surgical. Some of that, I know, is makeup and lighting, but she HAS to have had some work done. I wonder what you think she may have had done/is doing on a maintenance basis to look so good. I`d like to try whatever she`s doind! Her face is full but not filler-full in that peculiar way that people usually look after Sculptra or fat injections. I wish that people who have successfully undergone plastic surgery would tell us all 1) what they had done and 2) by whom! Thanks, Dr. Garcia. Good health and happiness to you and your family in 2014!
She has had a forehead lift in the past. If you search for photos of her form a few years ago you will see that. As to what else, well I cannot say 100% but I would imagine medical grade skin care, likely fillers of the face after her weight loss, and also possibly some other facial procures one can imagine since she had already conceded to them before. As to looking surgical, as long as the patient and the surgeon are willing to leave a natural look, they will look good. Having said that, after her apparent forehead lift a few years ago she did not look so natural for quite some time. The best to you for the New Year too. JG 1.4.14
Hello Dr.Garcia, well firstly Happy New Year to you and your family in your part of the world and may this year be a wonderful year for you all. I am considering having either some cool sculpting or relatively new one called Zerona to get rid of some serious love handles. I do not want to resort to surgery. In your opinion which one do you prefer and why? What sort of result would you expect and how many treatments do you need. Thanks in advance
I would skip the zerona and use coolsculpting. You can expect about a 20% loss with each session, it takes a couple of months to see the results. I wish you the best for the New Year. JG 1.4.14
I have fair skin. I stopped bathing out in the sun in summer when I was 15. Since then, I have not got much sun. Now, I am 40. I do not understand why I have this turkey neck texture in middle of my neck since I have avoided the sun. Unless this is damage from childhood that showed decades later? I know TV show host Barbara W sees dermatologist for cosmetic skin treatments. Although she is twice my age, her neck does not look like it has a turkey neck texture. She may be using a laser...I wonder which laser? Or what can I do to improve this neck texture that makes me look much older than I am?
sun exposure will speed it up but it will also happen, yet at a slower speed to to aging and genetics.Any exposure you had when you were younger will contribute to it, as well as other factors such as second hand smoke. BW has had at least two facelifts that I have heard of and who knows how many laser sessions and chemical peels over the years, along with a good make up artist.Lasers can be tricky on the neck as they cannot be used at too strong of a setting, but lasers are better for texture issues than surgery. Fillers will not help I am afraid. Might want to seek out a plastic surgeon or dermatologist in your area for an in person consultation to give you available options after seeing you. I wish you the best. JG 1.3.14
Hi, Dr. Garica. Happy Holidays! I know you`re a big proponent of supplements. What do you make of the three studies published last week in the Annals of Internal Medicine which claimed that they are worthless -- and, rarely, even harmful if taken is extreme doses? This latter claim seems to have been widely known and carefully observed by most of us who take them (e.g., vitamin A and their derivatives), etc. Thank you. Happy New Year!
well, if you read the article closely you will find that they are attempting to compare vitamins to medications which is never done by anyone reputable. I do not think they are the same, and I think treating with vitamins to very high doses can have negative side effects but much less frequency and of lesser severity compared to medications. I think vitamins are helpful in treating deficiencies and if used properly that can allow the body to protect itself. I think it is hype by the medical community to discredit others while protecting their turf. BTW, most medications do not get the prevention that they are expecting from the vitamins. They write for reasons, at times, beyond what is best and inflate or cite certain things that they claim the others purport with none of the evidence to prove it. I am still taking my vitamins and will continue to do so, and I bet you most of the docs that wrote the paper also take vitamins too! Best for the Holidays and a happy new year to you. JG 12.26.13
I have the herpes simplex virus and it has erupted with a vengeance around the corners of my mouth following facial implant surgery. I think that the fact that retractors were in there for a couple of hours, pulling on the tissue. I started taking Acyclovir (1 gram/day) immediately following the surgery, but it seems that I should have done so prior to the surgery because it has proven ineffective -- 7 days post-op despite daily dosing. Have you ever come across this phenomenon, Dr. Garcia? Anything you can suggest? How long do you think an outbreak like this will last? It`s incredibly painful, far more than the surgery. My cheeks are also burning and stinging. Thank you for your help.
Try changing to Valtrex pills but use Zovirax oitment too. JG 12.22.13
Dr. Garcia, what do you think of this line of bio-identical hormones? http://www.askdrhelen.com/ Thank you so much for your opinion.
they are not true hormone,s true hormones for replaceemnt need a prescription. Sorry. JG 12.4.13
Is there any neck cream that can firm the neck? I have the beginning of a turkey neck. Is surgery the only option for this problem? Thanks
sorry, no creams, just surgery I am afraid. JG 12.1.13
Is there any neck cream that can firm the neck? I have the beginning of a turkey neck. Is surgery the only option for this problem? Thanks
Surgery is all you can do, creams will not help I am afraid. JG 12.1.13
Hi Dr., in response to your answer on hair loss and progesterone, which do you recommend? As you can imagine, the best progesterone cream leads me to about 20 different companies trying to sell their product. I just want to pick one up from Whole Foods and start the process to see if it not only will alleviate the hair loss, but also the many other symptoms I can relate to. Your service is greatly appreciated!
Just make sure in the ingrefient list it is USP progesterone, if it does not have that do not buy it. Some companies claim their ingredients will convert into progesterone but they cannot. The brand does not matter as long as it has the USP progesterone. JG 11.30.13
Hi Dr., is there really an effective supplement to stop hair from falling out? I am 50, have always had a lot of hair, but recently noticed that after shampooing, or in the shower, more than usual, seems to be falling out. My hair dresser claims it is nothing to worry about as I still have quite a bit of hair. I worry that if this continues, I will be left with thin old lady hair. What to do??
In many women it is due to low progesterone, it happens with Menopause. Might want to have your progesterone level tested. If low you can take some USP progesterone sold at health food stores. It will be applied to your inner arm at night.JG 11.28.13
I have seen plenty of people helped by Botox for the 11 s, but I have a horizontal line between the eyes, kind of at the very top of the nose. The older I get, the more noticeable it becomes. It pulls down the eyes and makes me look mean (which I`m not!). Does Botox fix this as well? There are no other lines across the forehead, and really no wrinkles towards the lateral part of the brows (crows feet). I want to look a bit less mean and feel like I need to have a more relaxed eye area. Will I benefit from Botox, and is it something only few injectors are well trained in fixing?
If injected right beneath the wrinkle in order to weaken the Procerus muscle it will help but if the wrinkle has been there a long time you might also need a filler to fill the line in. Any Botox injector with experience should be able to do that for you. I wish you the best. JG 11.20.13
Which is better at clearing an emerging pimple (a cystic one) sodium sulfate or benzoyl peroxide?? Thank you for your time
I prefer t use benzoyl peroxide. JG 11.16.13
I am the one considering eye lash tint at my local day spa. What do you mean by coating the lashes vs actually dyeing the lashes? You had mentioned that one is safe but not the other. Thanks!
if the process they use is similar to scalp hair dying it can harm the hair and I would not suggest it. If they are tinting, or just coating the hair it is safe, but it will not last too long. JG 11.16.13
What is the best option to tighten the skin (without surgery and not much down time). I don`t have many wrinkles just am starting to see those pesky little marionette lines and some lines around the lips. I would like to know if there is truly an option that works, or should I just go the filler route?
I would suggest the filler route, there is no skin tightening without surgery or downtime that will give you what you are looking for, sorry. JG 11.15.13
I have had some mild hyperpigmentation/melasma covering most of my forehead and part of my cheeks for 2-3 years now. At this point, which is my best option: Obagi, chemical peels, laser, other, leave it alone? Honestly, if it is best left alone then I am ok w/ that answer as I certainly don`t want to make things worse. But if I can effectively treat it, I would like to. Thanks.
I think trying t lighten it is worth a try so you can use less make up. The most effective and fastest option is the laser, so I might suggest trying a small spot with the laser so you can see how you react. To lighten it will take a series of laser sessions and if you do not use sunblock, in time most of the color will come back. I wish you the best. JG 11.15.13
I am interested in having eye lash tint (dye) done at a salon. Is this safe?
if it is just a coating and not an actual dyeing of the hair, it should be safe. JG 11.15.13
What is the name for the little sill of skin at the base of each nostril, between the alar walls and the columella?
the nostril sill, you already knew it! JG 11.4.13
Hi, Dr. Garcia. I wrote to you last week after cryotherapy to several dozen AK`s on my hands and arms. Thanks so much for your answer. I`ve been keeping the lesions covered in Aquafor and, of course, covered in sunblock and clothing (which I do all the time anyway). The blisters have now ruptured, and they are now very angry-looking wounds. I`m concerned that these are going to leave really bad scars. Is that likely? Anything else I can do, in addition to what I`m already doing, to lessen that possibility? And if they do leave scars, what can be done to treat them down the road? Thank you so much for your help, Dr. Garcia.
It will look bad but they will heal, albeit slow,y, as in essence it was a `cold burn . Might want to switch to tea tree oil once the top layer of skin becomes intact or is created again. Alternatively you can use squalene oil, both great for burns, sold at health food stores. If there is residual redness, which is at most what would happen, a laser should settle that down. Hang in there for a bit longer. JG 11.3.13
What is your opinion of Chromogenex`s i-lipo?? Comparable with Zeltiqu? Better, the same, not as effective? Thanks as ever for your honest assessment of these technologies.
much less effective than Zeltique, I actually think it is more of waste of money than anything. JG 11.3.13
I know that Latisse, if inadvertently dropped into the eye itself, runs the risk of changing the color of the iris. I`ve used the product for 4 years and have been very happy with it, no problems at all. On Sunday night, a tiny bit fell into my right eye, and it`s been, expectedly, irritated and red ever since. I am using eye drops to calm it down, and I`m sure that will work. I`ve never had any difficulties with this product, but I`m writing to ask if you think that there is any possible long-term damage to my eye from this exposure. Thank you for your opinion, Dr. Garcia.
Besides the color change there is low chance of any visual problems unless it happens every night. JG 10.29.13
Hi there. I had cryotherapy to about 40 AK`s on my hands and arms last Friday. What a mess I am! I am covered with red and purple blisters. I didn`t really appreciate how terrible this looks while I was still at my dermatologist`s office and so, failed to ask him how long this will take to heal. What do you think? Thank you for your kindness, Dr. Garcia.
7-14 days I am afriad. JG 10.28.13
Thanks for that answer, Dr. Garcia. And if the broken capillaries could appear as soon as 2-3 weeks, when is the latest that they could appear if they were going to occur at all? I ask because I`d like to know when I might be out of that danger. You are truly wonderful to offer this help and support to so many strangers.
Should be safe after 6-8 weeks, wish you all the best and my pleasure to help. JG 10.19.13
PS I meant to tell you that I have become so desperate about my hair loss that I fell for the Hair Max Laser Comb. As far as I can tell, I paid a LOT of money for a comb that blinks a red light and offers a reassuring beep every few seconds, alerting the user to move the comb to a different part of the scalp. One has the feeling that one is doing something productive with this flashing, beeping gizmo, but alas, it seems like I have just thrown my money down the drain along with my remaining hair. Would you agree?
yup, you are right sorry. JG 10.16.13
Hi, Dr. Garcia. It`s the Bald-in-Baltimore lady again. you so kindly and compassionately responded to me when I developed an acute case of telogen effluvium exactly 12 weeks after minor surgery. Well, it`s been about two months since my hair started to fall out, and it`s now about 70% gone. The shedding has slowed down to about 100 hairs/day from a high of about 150-175/day, but it`s still coming out. In your experience, how much longer might this last? And does it usually grow back or does such aggressive hair loss mean that it will only come back thinner, if it returns at all? Thank you so much for your kindness. It`s really, really depressing at such a young age. You are an angel.
might expect another 4-8 weeks, hard to say really. But on average 100 hairs per day is what we all lose. In time it should grow back as long as the causative agent is gone, which in your case it is. Hang in there a bit longer. JG 10.16.13
would thermage help tighten the knees? It seems the skin is just a bit loose in that area. My weight is good, as I am a runner, but it just seems I have wrinkly knees. Thanks
In my humble opinion Thermage will not help anywhere on the body.Sorry. JG 10.15.13
Is there any way to lift the corners of the mouth with intra-oral incisions so that no scars are visible? My surgeon is familiar with Dr. Flowers` Valentine lip lift but he doesn`t like to do it because it leaves scars. I need my modiolus elevated a bit and the corners lifted -- Botox is of only limited value. Any suggestions for him? Thank you for any help you can offer us.
Sorry, nothing. Intraoral will work. JG 10.12.13
I`ve been having HA injected into my nl folds for about 12 years. In the past year, I`ve developed 16 small black dots on my L nl fold, which my dermatologist and I thought were vascular. He`s used every laser he owns, I think, trying to treat them and we`ve had no results. Could this be scar tissue from the repeated injections to that area? Have you ever seen this in your own practice? Any thoughts about how to treat this? Thank you, Dr. Garcia.
have not seen it before, if the lasers have not worked and they are visible about all that is left is to have him remove them with a miniature punch biopsy tool and stitch them close. Might be from the repeated needle punctures. JG 10.8.13
I have flat shiny spots on my arms. I think that these are actinic keratoses. Is that right? I`ve had IPL, YAG, Fraxel ReStore, liquid nitrogen, chemical peels, etc. Nothing seems to help. Any other suggestions? Thank you!
Might want to see a dermatologist to check for a fungus infection. JG 10.5.13
Dr.Garcia What do you think is the best treatment for cellulite? thank you
I am afraid I am not a believer in any of the methods presently in use. Endermologie is non-invasive but only helps for a few weeks. JG 10.5.13
I have three stubborn pigment marks on my lower legs that haven`t responded to anything my derm has tried -- NdYAG, VBeam, IPL, etc. Three weeks ago, he gave Fraxel ReStore a try, thinking it couldn`t hurt. Wrong! Those three spots are now surrounded by dark brown stains on my skin, making them look about 4x bigger than they were at the start. (I am very, very fair, by the way -- almost porcelain white -- so these marks are extremely visible.) I live in Georgia and it`s still very warm here, but I must now wear dark tights to cover these marks. Any ideas about how I can expedite the healing/lightening of these marks? Thank you, Dr. Garcia. What would we all do without you? Wish you made housecalls all over the US!! Hope you`re having a great fall and are in good health.
Spits in the legs are hard to get rid of. All I might suggest is a spot TCA peel avoiding the normal skin. I wish you the best. JG 9.28.13
What do you believe will help the most for acne scarring. Too young and broke for any kind of injectibles (since I know they are just temporary), but have enough $ for something like peels, or microderms. To add insult to injury, now there is lovely hyper pigmentation over the lip, and around the eyes...this happened almost instantly when I went on birth control pills. Needless to say, no longer a method of birth control for me. Any help you could give is so much appreciated. All very frustrating. I just want to have good skin.
Microdermabrasions, beta hydroxy acid peels and glycolic acid cleansers. Best of luck. JG 9.21.13
I know that injecting Botox into the eyelids themselves can result on edema, so I never allow my plastic surgeon to do that. Can the same thing happen when it`s injected into the DAO? I ask because I have that done every 3 months and it always works wonderfully to raise the corners of my mouth, but I had it done last week (by the same surgeon I always see) Andy lower face looks puffy now, like I gained 10 pounds or so. Have you seen this happen? Thank you for your help.
should not have edema after injecting the DAO, must be something else unless it was injected too laterally and affected other muscles unintentionally, but it would still not be edema, just weakens of the muscle allowing fat to fall. JG 9.19.13
Hi, Dr. Garcia. It`s the alopecia-post-surgery lady. I`ve been down this road twice before, so now on my third trip, I know that this is usually a time-limited event. I`m writing to you for a reminder of that and some encouragement! Sorry if that sounds pathetic and self-pitying. As I type this, my hair is actually leaping out of my scalp and dropping onto my keyboard; 10 hairs have fallen since I started typing this note. Whole patches of my scalp are now visible, and it`s just been 10 days since I started shedding. At this rate, I`ll be completely bald in another two weeks. It`s so upsetting and demoralizing at 36 years old. If I`m rememberig correctly, the shedding lasts 3-5 months. Is that correct? Ughhhhh. In your experience, does the shedding concatenate such that with each round of hair loss--this being my third--it comes back thinner and thinner each time? Thank you for any true words of encouragement you can offer me, Dr. Garcia.
It can continue for a growth cycle but no way to tell when in the hair cycle you were. I would start some Men`s strength Rogaine foam to slow it down and speed the growth. Try to shampoo less and use very mild shampoo. Hang in there and I am here for you. JG 9.12.13
What is the best way to get rid of a vessel under the eye? Laser, schlerotherapy?, etc? What has the least risks?
What do you think of SeroVital? And of HGH in general? Any way, other than SeroVital, to get a safe OTC version of HTC? Thank you.
Oral secretatogues for hgh are not very effective, sorry. Save your money. JG 8.31.13
Since peels don`t work, have you found anything that`s effective for tightening the skin on the arms and hands?
sorry, but I have not. JG 8.23.13
It doesn`t state it in the operating report, but a doctor said he banked a ball of leftover rib graft in my chest. I had an MRI of chest to see if it was there since I need rib graft for a nose surgery. The radiologist did not see any ball of cartilage around the chest incision area. Do you know if such cartilage can be detected in an MRI? Or is the banked ball of cartilage not there if it can`t be seen in an MRI?
If the whole piece of rib is not usrd is placed back in the same ribspace where it was harvested then it does not show up as well. JG 8.25.13
I`ve had three surgeries in my life -- two for medical reasons and one for cosmetic reasons, the last procedure was in early June. After the first two procedures at 3 months out, I suffered from pretty dramatic alopecia. One of my surgeons suggested it was a cortisol response due to the metabolic insult of the surgeries. (I wasn`t emotionally stressed by any them, by the way.) I`m now 10 weeks out from my most recent surgery and, to my horror, my hair is starting to fall out in clumps again. Can you explain this to me? Have you seen it in your own patients? It`s extremely distressing, as I`m a young woman. I don`t suppose that there`s anything I can do at this point to arrest the shedding, since its origin was in early June, but I`m open to suggestions. Thanks ever so much. Balding and Bummed.
Some patients do have that happen but the exact cause is not well understood. I might suggest using Rogaine as I have found that it does help in theae cases. JG 8.22.13
What do you think of supplements that claim to interfere with the metabolism of carbohydrates? For instance, GNC`s Carb Intercept http://www.gnc.com/product/index.jsp?productId=2134305 or the supplement Garcinia Cambogia? Thank you for your opinion, Dr. Garcia.
Save your money. JG 8.20.13
I know enough to buy generic OTC products like aspirin, since they contain the same active ingredients as brand names at half the price. That said, is the same true of probiotics? I have used Culturelle for the past year and have been amazed by the difference it has made in my health. It`s pretty costly, and I notice that CVS markets its own probiotic immediately beside it on the shelf at a much reduced price. Same thing? Thank you, Dr. Garcia.
Pretty similar, just check the culture numbers. JG 8.18.13
Thanks for your answer below. One additional question: why do you suppose the first surgeon severed the arcus marginalis? Isn`t it`s purpose to suspend the midface? What do you imagine he could possibly have intended in releasing it?
Hard to say, maybe he wanted to reposition the fat over the rim orr to gain access to the layer below the cheek oad in order to pull it up. JG 8.16.13
What do you think of EPrime?
Sorry not a fas, just a new twist on technology which is of questionable effectiveness. JG 8.14.13
If you have chin (bone) reduction surgery in near future after surgery to tighten saggy muscle under chin, will the chin reduction surgery cause the surgically tightened muscle to come untightened?
Yes, along with the neck skin. JG 8.10.13
Dr. Garcia, my irises seem to be fading as I age. I`m now 57 and have notice that all of my features are losing their sharpness -- some of which can be compensated for with make-up (like brows and lips), but some of which (like eye color) can`t be addressed. Am I imagining this loss of sharpness in eye color or is this something that actually happens with age? There`s probably nothing that can`t be done at this point, but for the sake of your younger readers, is there any preventive measures (beyond UV blocking sunglasses) you might recommend? Any vitamins or supplements that might help either ward this off or -- less likely, I assume -- reverse or halt the loss of pigment now that this process is well underway? Thanks, as ever, for your wisdom, expertise and help!
I have honestly never heard of that happening as part of the aging process, might want to speak with your eye specialist but sunlight can cause not only wrinkles but increased cataracts so good eye protection against the sun is always a good idea. I wish you the best. JG 8.8.13
To be more specific in last question, if it was stated that the patient was cycling before loss of consciousness.
hard to say without knowing more. JG 8.7.13
What does the medical term cycling mean that hospitals might use in relation to the heart or some function of the body? I can only find bike cycling or not the medical term on the internet. Thanks.
most systems in the body have repetitious rhythms that have a process peak and ebb, creating a cycle. For example, the heart beats in a cycle with some parts squeezing and then relaxing, our bowels propel food though it by pulsing peak sand valleys of muslcular contraction. JG 8.7.13
I have a sagging modiolus. My plastic surgeon is recommending a modiolus hitch in which he places a couple of sutures in it to suspend it to the tissue above. Stupidly, I failed to ask him when I saw him if this can be done with an intra-oral incision in his office. Is that possible? I don`t need (and certainly don`t want) a facelift in which the access to that area could be exposed through dissection from the ear to the mouth. Thank you.
It is possible but if there is any significant lift of the modiolus with a suture the skin over it will need to be redraped, so just putting a stitch and lifting it up higher alone will likely not work unless it is very subtle. JG 7.29.13
What is the typical number of units of Botox you use on each side of the depressor muscle under the corners of the mouth to raise it? I want to be able to anticipate the amount because my dermatologist charges/unit. Thank you.
well you dermatologist might charge that way but is is direct violation of the FDA labeling law as the bottle of Botox clearly states that the entire bottle is for single patient use, which means you cannot open a bottle and share it between patients, for fear of cross-contamination. In other words you need to pay for the whole bottle and what he is doing is wrong. It has been settled with a class action suit against the makers of Botox, you can look it up. I start with 5 unis of Botox into the DAO. JG 7.26.13
Is there any treatment for cellulite?
nothing that lasts very long. There is a new machine called Cellulaze which involves small incisions and appears to last a number of months but it does not always work. JG 7.24.13
Thanks for the answer about the DAO release. One follow-up: if it`s a simple surgery that provides a permanent correction, why do you prefer to inject Botox, which needs to be repeated every 3 months and which delivers sometimes variable results? What prevents you from opting for the relatively simple surgical solution? Thanks so much.
Thanks for the answer about the DAO release. One follow-up: if it`s a simple surgery that provides a permanent correction, why do you prefer to inject Botox, which needs to be repeated every 3 months and which delivers sometimes variable results? What prevents you from opting for the relatively simple surgical solution? Thanks so much.
just like Botox, the cutting of the muscle can be uneven and the Botox is easier to use to balance it out. Secondly the function of the DAO is to depress the corner of the mouth, so if you are having it done to correct the marionette line, that will be short lived as the main cause of the marionette line is not due to the DAO, but to the falling of the cheek skin. JG 7.23.13
Where are the incisions placed for a DAO release? Do you perform this yourself? What are the common risks and how often do they occur? My surgeon is recommending it, and I`m inclined to do it, but I`m obviously nervous about resecting muscles around my mouth. Once they`re cut, that`s it, and I don`t want to be left looking and sounding for the rest of my life like I`ve had a stroke! Thank you.
can be done fro inside the mouth, I do it very rarely as I prefer to inject it with Botox.It is a simple muscle to identify due to the direction of the fibers. It should not look like a stroke as its function is to pull down the corner of the mouth and that is what would be gone. JG 7.23.13
I have a cosmetic and medical question for you, Dr. Garcia. Last week, I developed a small cluster of tiny, painful water blisters on my chin and knee -- without any evidence of trauma, abrasion or sun exposre in either area. This happened to me a few years ago too -- on my knee and inner forearm. The skin ruptured in both areas then and took months to heal. Could this be a systemic infection or some other condition? It seems unlikely that it would happen twice -- and in three different parts of my body -- without any apparent cause. Thank you for your wise opinion.
the fact that it took that long to heal makes me think you should see a dermatologist. It might be something simple like a variant of herpes, but having the test the fluid or scrape the skin is best to aid the diagnosis. JG 7.23.13
I know you`re not a dietitian, but your knowledge of medicine and the role of diet in aging is invaluable. I wonder if you would kindly look at this list of foods that I eat (almost exclusively) and tell me what you would suggest I add or remove for optimal health and vitality as I age. I`m now 55. Thank you so much! Egg whites, wild line-caught salmon, edemame, almonds, walnuts, kale, spinach, onions, garlic, red and yellow peppers, broccoli, tomatoes, cucumber, blueberries, strawberries, grapefruit, a few stone fruits, olive oil, coconut oil, green tea and water.
Pretty close to my diet. I would not go too crazy with the edename, small daily doses are fine, fermented soy like Tofu is superior. Would add some natural anti-inflammatory spices too. Cinnamon, Tumeric, sage, rosemary, paprika, black pepper, oregano. I also try to stay as Gluten free as I can. Cheers. JG 7.18.13
I just had a consultation with my PS this morning about lifting the corners of my mouth. He uses Flowers` Valentine technique, making small percutaneous incisions at the corners of the mouth, and never uses intra-oral incisions due to the risk of nerve damage. Having said that, he told me he`s reluctant to do it on me, though I need it, because I have no peri-oral wrinkles in which to conceal the scars. I went online and saw Dr. Flowers` pre and post op photos but can`t see any scars at all. Is my surgeon overstating the visibility of these scars at the corners of the mouth? By the way, my surgeon is extremely meticulous with his sutures. He`s done many procedures on me and the scars are virtually invisible. Where do you place your incisions on your patients who need this procedure? And are the scars detectable? I can`t find examples of your work on your website. Thank you very, very much for your kind help and guidance, Dr. Garcia!
Likely Dr Flowers showed his best and your surgeon is preparing you for the worst,that is a reasonable thing to do. I place them in the corner of the mouth and they can extend all the way to the nasolabial fold in severe cases. I perform the corner of the mouth lift but not all patients wish their photos show online.All the best. JG 7.17.13
With skin tags on the neck, do you prefer to snip them, cauterize them or use liquid nitrogen?
Snip. JG 7.11.13
I have an odd question for you, Dr. Garcia. Can anesthesia alter one`s taste buds? If so, by what mechanism? My sister was a coffee addict prior to a bodylift two years ago. The day after her surgery, she discovered she couldn`t stand the taste of coffee (or even coffee-flavored products), and that has remained the same to this day. She`s not mourning the loss of her addiction (and we suspect she was spared the worst part of withdrawal because she was on narcotics post-op), but we`ve wondered over these past two years if this is a known phenomenon in surgery. Hope you`re having a good summer!
Anesthesia is highly unlikely the culprit, but at times, if surgery is performed inside the mouth or nose, nerves can be injured that affect taste. All the best. JG 7.11.13
How long will it be before Zeltiqu finishes developing handpieces that can be contoured to thighs and arms? It seems like there would be great financial incentive for them to fast-track that project.
The last I heard they have put those heads on the bench for now and are not working on getting them approved and are concentrating on growing the business they already have for the torso. Not sure why unless the heads were not proving to be as effective or something. JG 7.10.13
Which types of doctors (besides a hospital) can take a CSF fluid sample to check for meningitis? Is the injection placed in the back?
It does have to be done in the back and a family practice, internal medicine ir neurologist can do it. JG 7.7.13
What is your opinion about the Venus Freeze? I have read nothing but rave reviews on RealSelf, and other sites, but ultimately trust your opinion and expertise.
I would not spend my money on it.Sorry. JG 7.3.13
How long does the efficacy on RevitaLash last? Iâ€™ve had a tube for the last year and 3 months, and I even apply it to my lower lashes. It still seems to be working but I wasnâ€™t sure if I should get a new tube. Thanks for your time
Strength goes down but likely has some effectiveness for 5 years, maybe more. JG 6.30.13
Dr. Garcia, before I leap into the bullhorn lip lift, I`d like your opinion of this purse string suspension alternative developed by Dr. Eger Yuksel of Houston: http://www.cbsnews.com/video/watch/?id=1807171n Have you heard of this before? What do you think? His patient in the news video certainly looks fantastic. I imagine that the issue with this would be longevity, but if it descends with time, it seems that it could be easily redone without much risk. Would you agree? Thank you. Happy 4th of July! Hope it cools down in Las Vegas soon. Wow -- 119 yesterday?! Stay hydrated!
I think it is an option for a small percentage of people that need only an eversion and not a skin reduction; as to his claim that it lasts for years, I am very skeptical as the suture can tear through the tissue or it can break and then the suspension is lost. I understand the desire to avoid a scar but it will not be possible in all patients. JG 6.30.13
What is your opinion of weight loss supplements like Hydroxycut and Xenadrine?
the new formulations are not as effective as they used to be, but OK to take them for 2-4 week , but the pills alone will not make you lose weight, they assist in you losing weight by trying to give you energy that you are supposed to use to keep moving and active. In general, a proper diet and exercise program is what is needed, the pills alon e will not get you there. JG 6.28.13
Thanks so much for your answer about the lip lift. I feel better. Yes, he will close in 2 layers and is very careful about tension. He did a facelift for me years ago and the scars are invisible. How long does it take for a lip lift scar to become undetectable? Also, you never said what you think of this procedure in general. If well done, does it usually provide a subtle, distinctly youthful improvement that doesn`t leave one with a surgical look? I am anxious about surgery on the front of my face, especially near the mouth and nose because--like the eyes--they really define one`s identity and if done incorrectly, even by a few millimeters, can really look odd. Do you do this procedure often in your own practice and, if so, areyou and your patients usually happy with the results? Thank you very much for your valuable time and help.
It takes 4-6 weeks for the scar to begins to fade. I perform the procedure and the patients are very pleased. All the beat. JG 6.27.13
I hope you can help me to make a decision about a bullhorn lip lift. 1) In general, do you think this is an effective procedure and one that doesn`t make a person look done if undertaken conservatively? 2) My anatomy makes it a challenge. I have a tiny threshold of skin at the base of each nostril (running inferiorly between the alar walls), That would need to be destroyed to make the incision inside the nostrils, which my surgeon prefers to do in order to hide the scar as much as possible. Normally, that would be fine, but I happen to have retracted nostrils from an aggressive rhinoplasty years ago, which would only make both that scar AND my retracted nostrils that much more apparent. So, my surgeon is proposing keeping the incision just below the nose entirely. He would close with 6.0 suture to make the scar as fine as possible. Do you think that the scar would end up being terribly visible as a result of this technique? Thank you so very much for your help.
I think the position for the incision he is suggesting will be fine and the ultimate scar quality depends more on the tension created with the skin excision. In other words, if the appropriate amount of skin is removed and sutures placed in two layers and not one, the scar should heal well. I wish you the best. JG 6.27.13
I regards to question I previously posted below, can endoscopic instrument be used so the forehead skin would need to be pulled down to eyebrows? If hairline lowering is done where an incision is placed at top of hairline, can that same incision be used to file down a prominent bone over eyebrows? Since the forehead skin will only be removed at top of hairline or not pulled down, can the filing instrument still reach the eyebrow area?
possibly, but the skin would still be lifted to the same degree as if it were done open, and the visualization for symmetry would be more difficult. JG 6.25.13
Since I am skinny, there is not much fat available for undereye fat injections. However, there looks like there is a bulge at corners of armpits in front. Is that a muscle or extra fat sticking out?
more likely fat. JG 6.25.13
If a person already had a lot of ear graft removed for nose surgeries and does not want the ears to look more flat to the head, is there a procedure that can be done to pull out the ears a little more...kind of like a reverse otoplasty surgery? I was thinking maybe graft could be placed back in the ear, but I am not sure where one could get a graft besides the ear.
either a skin graft or a rotation flap, the flap would yield a better result, but this applies if it is a skin problem. If the appearance of the ear being more flattened due to the conchal bowl removal, it would need a cartilage graft to support the ear in a more prominent way. JG 6.25.13
If hairline lowering is done where an incision is placed at top of hairline, can that same incision be used to file down a prominent bone over eyebrows? Since the forehead skin will only be removed at top of hairline or not pulled down, can the filing instrument still reach the eyebrow area?
It would require the skin on the forehead down to the area you desire filed down to be lifted too. JG 6.25.13
I have a little raised blue vein going down vertically in one spot in tear tough area. It is a short vein, but it is raised like a pimple. Could injection there also result in blindness?
if enough fluid is injected under enough pressure, yes it could. JG 6.14.13
Why don`t you think it is a good idea to get blue or purple veins removed (either lasered or injected) in tear troughs? The are hard to cover with concealer makeup.
The laser will not work and the injections can result in blindness. JG 6.14.14
I have had those fat pockets beside my mouth all my life like the young woman who wrote to you earlier today. I`m 53 and have had both a SMAS lift and a subperiostal midface lift and got no change in that feature. It`s not buccal fat, which I wouldn`t remove anyway for fear of hollowing. But this particular problem has dogged and aged me prematurely my whole life. If you don`t recommend liposuction for that area, what CAN be done? I`m sorry to say that if my experience is typical, that young woman`s problem will only worsen with age. Thanks for any suggestions you can offer your loyal readers!
Ir is hard for me to say without seeing you in person but I am not sure attempting to reduce it with liposuction is a viable option. JG 6.12.13
I see that you advise against running and jogging -- or any high impact exercise -- to avoid jarring facial tissue. I find it hard to get my heart rate sufficiently raised for a good cardiovascular workout with low-impact aerobic activity. What kind of rigorous aerobic exercise do you recommend that won`t cause facial tissue to fall? Thank you.
what is called metabolic training, it can be done as short burst circuit training with body weight or more if needed. I personally use kettle bells for my metabolic training. It will burn as many calories as running, maintain your heart rate as long and burn fat for longer periods of time with no impact on the face. JG 6.10.13
You know that new procedure to kill sweat glands in armpit for people who over sweat? Will it also work for people who sweat, but not over sweat? During ovulation and periods, my armpits tend to sweat and smell more. I wonder if this procedure would eliminate that?
It would decrease the sweating. JG 6.9.13
What is the technical name for tiny surgical drains that drain directly into the dressing and not into a drainage tube and bulb?
Penrose drains. JG 6.8.13
Hello Dr.Garcia ! I posted awhile back about having a short scar arm lift and was left with lots of sagging skin. It has been 5 years since the surgery. I still want to go SLEEVELESS!!! In your opinion, would the the traditional arm lift leave horrible scar? I understand it would be inside the arm, from the elbow upward. Thanks as always kind Sir. Any additional advice you would like to pass on would be appreciated.
the arm tuck scars can be quite unsightly, enough to make some women not want to wear short sleeves. Having said that, at times they heal very well, I think it varies from person to person, depends on how much tension is placed on the wound closure,and other small issues. The scars are well hidden when arms are by your side, but can be easily seen in short sleeves when your arm is in other positions. It will be trade off. JG 6.4.13
Thanks for your answer about the vitamin supplements prior to and following surgery. How much vitamin C and vitamin B (12?? 6??) do you recommend/day? You say to double the daily dosage but you don`t say what that daily baseline dosage should be. Thanks for clarifying.
Vit C 750mg twice daily. B6 50mg twice daily, B12 500-1,000 twice daily. JG 6.2.13
What is your estimate of SeroVital`s capacity to enhance production of HGH? Also, do you have your patients ingest extra doses of Vitamin C prior to surgery? If so, how much and for how long? Thank you.
I am not a believer in SeriVital but I do suggest doubling Vit C and Vit B`s for one week befor and after surgery. JG 6.2 13
Having facelift on Tuesday and have RX for Keflex for 7 days, beginning on Tuesday. I want to optimize its effectiveness immediately prior to surgery. Should I take it in the hour before the procedure? Thank you.
Yes, an hour before is good. All the best. JG 5.30.13
I heard sculptra injections are semi permanent meaning one cannot remove them or wait for them to dissolve if not satisfied. Since they are semi permanent, I was wondering if they can cause skin to sag. I am not sure if sculptra is made up of plastic particles? If so, it is the plastic particles I wonder if they sag over time. Do you like to use sculptra?
It is made up of L-lactic acid which is what temporary sutures are made of. Granulomas can occur but are quite rare. In most cases if a granuloma forms it can be treated by injecting it with saline, in rare instances it might be cut out. Thr particles are not plastic though and normally it is all gone in 12-24 months. JG 5.29.13
If you were born with eyebrow higher than the other, can surgery correct it? Would that be considered a brow lift surgery?
depends on why it is uneven. It might be able to be fixed with a brow lift, but you need to be evaluated as to what the cause is before saying. JG 5.29.13
What is the best treatment to deminish wrinkles on fingers and hands?
I ma sorry but I do not have anything safe or effective. JG 5.29.13
I had IPL on Thursday night. It`s now Monday night, and I still have localized swelling -- round, raised bumps all over my face. It looks like I have acne, but the lesions are closed. Is this normal? Is this a histamine response? Will antihistamines help? Thank you.
Not commin but can happen with aggressive treatment. Suggest antihistamine and motrin. It will get better in a few days. JG 5.27.13
I am scheduled for a lip lift. My surgeon tells me that while it will decrease the distance between my lip and nose, it won`t roll up the vermillion border at all, so I won`t have a fuller upper lip. Can you explain how this is so? When I simulate the lift by placing two fingers under my nose and pull the skin up, the vermillion always rolls up too. Actually, I don`t want my upper lip to be too full, so I`m glad that my surgeon doesn`t think it will get bigger; I`m just worried this procedure will inevitably change the shape of my upper lip as well as its placement. Also, is it just skin that is removed in that procedure or is it skin and underlying tissue and muscle? Thank you!
the upper lip reduction only reduces vertical length, and for the vermillion to roll, it has to actually roll out and up, and not just up.The red lip will look larger as it will be lifted,less thin, but the actual vermillion roll or edge will just be higher. You still might need a filler just in the roll to give it that firm edge between red lip and skin. It is just skin that is removed, nothing more. I wish you the best. JG 5.24.13
With your own patients, how long does it typically take before results are seen from Zeltiqu? Thank you. Have a wonderful, restful holiday weekend, Dr. Garcia!
With your own patients, how long does it typically take before results are seen from Zeltiqu? Thank you. Have a wonderful, restful holiday weekend, Dr. Garcia!
final results will be 2 months or so, won`t see much for at least 2 weeks or a little more. Same to you for the holiday. God bless our troops!
What is your opinion of the city lip lip plumper?
never had a patient try it,but I think the claims made will not apply to all patients and it is hard to say how long the effects last, my guess is that it all goes away when you stop and it likely will come under scrutiny by the FDA because if it allows something to be absorbed through the skin it is then classified as a drug and not a cosmetic, so if you like it, buy it now before they take it off the market. JG 5.23.13
I have been using latisse on my lashes but it is so expensive. Do you think the generic careprost would work just as well?
it`s the same product. JG 5.20.13
You didn`t tell us what you think of carboxytherapy for stretch marks (and for cellulite). Worthwhile? Hype? The photos seem impressive. If you think this treatment is effective, how long do the results last? Thank you, Dr. Garcia.
I think it is a scam, I have seen severe infections, permanent scarring, I would never do it. JG 5.19.13
How long does it typically take for a pneumothorax to resolve on its own without any intervention?
It can take a couple if weeks but symptoms are usually better in a few days. JG 5.19.13
Sorry! I meant to type garcinia cambrogia.
I thought so.
What is your opinion of the supplement garcinia cambrogosia?
Lots of hype, little science. JG 5.19.13
Thanks for the suggestion about the Botox. I`ll try that. In your own practice, would 70 units (50+10+10) be unusual?
no, more common in men to need a larger dose, but in some women with lots of strong muscles it is also needed. JG 5.15.13
Thanks for answering my question about the laser for the eyebrow pigment. Might microdermabrasion work? And Retin A and hydroquinone? I`m a little nervous about the collateral hair loss from the laser, since I had the pigment added due to thinning brows in the first place. Thanks so very much for your incredibly generous help! You are truly kind
Sorry, neither one will work. JG 5.14.13
I had pigment added to my eyebrows in December. The technician did a good job but chose a very dark brown/light black that is way too dark for me. Would a laswer remove the pigment effectively without killing the surrounding eyebrow hairs? If so, which laser? Thank you.
I would use an Nd:YAG laser and the hair might fall out for a bit but it should come back. JG 5.14.13
Hello Dr. Garcia, I got botox in my forehead last Friday (one week ago) & my forehead feels almost heavy... & I feel like I`d like my eyebrows are just a tiny bit lower than they should be & I can`t move them, Which also makes my eyelids look like they have more skin! Does this make sense? Is there anything I can do about it? help :)
makes perfect sense, that is what happens when the injector does not tell you that using Botox on the mid forehead can lead to that because what they did was to weaken the muscles that lift the eyebrows, so now everything is falling because what used to maintain them in a higher position has been weakened on purpose to alleviate the wrinkles. All you can do is to let it wear off I am afraid, sorry. JG 5.10.13
I have a couple of large-ish pimples on my chin and cheek. The lesions are closed, not open. I am scheduled to have IPL tomorrow. Will that help them to heal/deflate? Thank you.
In many cases yws. JG 5.9.13
How long do results from submental lipectomy last? Also, does a submental lipectomy or neck lift have better results? Are they both done to fix the same problem?
that fat taken out is permanently gone, but the skin might sag in time due to aging. which operation you need depends on your age and the amount of fat and skin laxity that exists at the present time.The lipectomy just removes fat where the neck lift removes fat and excess skin both. JG 5.8.13
How does an open wound without stitches heal? I ask because my stitches busted open so I have circle wound at one end. It is hard to form a scab because it is gooey. What happens is a scab forms, then when it is ready to fall off it will still be gooey underneath instead of dry skin like most wounds heal. It seems like it is healing slowly in layers. Why didn`t it just heal after the fist scab fell off? Is this how an open wound is supposed to heal? It my take 2-3 months to heal since it keeps forming new scabs.
if you clean it with half strength peroxide and then apply neosporin it will heal by a process called contraction where once the base is clean the sides will pull together and close the gap. That is the way it has to heal, from the bottom up, got to hang in there. JG 5.6.13
I am a 50 year old white female, very fair. As I`ve aged, I`ve noticed that my legs and arms are looking mottled -- not so much vessels as just red/purple/blue-ish blotches. What causes this? Anything I can do to improve it? I use full spectrum sunblock every day and stay out of the sun, but didn`t as a child when we didn`t have sunblock. Is this from previous sun damage or from age? Thank you.
It is the skin thinning with age. Lasers such as a VBeam or an Nd: YAG can be used to lessen the visibility but not remove them. Not much else can be done. JG 5.5.13
Hello Dr. Garcia, I have horizontal wrinkles, pretty severe, right in the middle of my knees. It just looks awful. I`m not sure exactly how to explain... Saggy? wrinkly, extra skin kinda, just ugly. What is ANY idea you may have that could fix it or at least help??? I have asked this before (over a year ago now) but I was hoping something has changed as I absolutely would do ANYTHING to get rid of this!!!! Thank you!
I am sorry but I really do not have anything that will help that, lasers do not work and cutting skin out will leave scars that are worse than what you have at this point. JG 5.3.13
What is the difference between Thermage and Exilis? They both use radiofrequency. Is one more or less effective than the other? I see you`re not a fan of Exilis -- and, I suspect, of Thermage -- but of the two, is one more reliable than the other? Thank you.
I cannot endorse either one. Thermage was supposed to tighten skin and it created some fat loss an no appreciable skin tightening. Now we have Exilis which claims to reduce fat, tighten skin, etc. It is a matter if expectations, if you expect little you might be happy but in my opinion I think they are both a waste. JG 4.30.13
What is your opinion of the exilis treatments for fat removal, skin tightening or cellulite improvement? Thanks
Sorry, not a fan. JG 4.30.13
What is your opinion of the exilis treatments for fat removal, skin tightening or cellulite improvement? Thanks
Sorry but not a fan. JG 4.30.13
If the muscle directly above the eyebrow is removed, which is best place to make incision to remove it/ Would it be the upper eyelid crease? If one has a brow lift, can is easily be removed while doing a brow lift? I do not know where the incisions are made for a brow lift or I thought the incisions were endoscopic or too small to pull a muscle out.
that muscle extends up to the hairline in some people and in the majority it extends at least 3/4 of the way up, so it would be difficult to remove through an eyelid incision, and again you run the risk of the eyebrows dropping on a permanent basis.If you desire that to be done then it has to be done through an open forehead technique and not an endoscopic one. JG 4.24.12
Hello Dr, After Botox injections, how long should you wait before having IPL? Thank you
next day would be fine. JG 4.24.13
Oh, and I meant to ask about the OTC product Estroven too.
Might help with the hot flashes a bit, not much else. JG 4.21.13
What do you think of the OTC product Amberen? Any good at countering menopausal hormone-related changes to skin and weight in women?
Sorry, not a believer. JG 4.21.13
I have a superficial puncture wound on my cheek. I`m keeping it clean and using bacitracin. I`m wondering if mixing bacitracin with topical vitamin c powder (made by Biomedic) might expedite the healing.
Ii would advise against it, just stick with the Bacitracin. JG 4.20.13
Where are incisions placed for a neck lift?
Usually behind the ear, also in front of the ear and sometimes under the chin. JG 4.19.13
For a double chin due to aging (not from being overweight), is a jowl lift or chin lift done? Where are the incisions placed for a chin lift?
In most cases you might be able to get away with the neck lift alone but there will likely still need to be incisions in front of the ear as you would get form a cheek/jowl lift to avoid any pleating. JG 4.17.13
I had a lot of TCA peels on my neck every few months for a number of years to get rid of some hyperpigmentation. It seems like the texture my neck has aged fast. Can the inflammation from lots of TCA peels cause the skin to age? Is there anything I can to do t smooth the texture?
it is possible but it is also likely age, time and sun have been the culprit.I think Retin-A is about the only thing I would suggest, sorry. JG 4.15.13
I have a wound or scab on my neck. Each time I take a shower, the scab comes off. It might be due to the towel accidentally hitting it when I dry my hair. I have trying putting a Bandaid on it, but the scab comes off when I take it off. Is there any type of bandage which the scab will not come off with it?
you would need to use something with a stronger adhesive on it, you could try to buy some collodion and apply it around the edges to make it stick a bit more. JG 4.15.13
What do you think of sculptra injections?
love them for the right areas and for the right reasons. JG 4.15.13
The link below did not copy right. Here it is: http://www.peds.ufl.edu/peds2/research/debusk/pages/page4_02.html
I think the CO2 laser might help the Dennie`s Lines for a few months to maybe 18 months is about all and I would not suggest cutting them out for fear of developing an ectropion. JG 4.9.13
Hi Dr. G, Dennie`s lines are jus wrinkles under the eyes caused by allergies instead of aging. They look like indented creases like wrinkles. I have 2 lines close together in middle to edge under eye. Can you answer the question below now? http://www.google.com/search?q=dennie`s+lines&hl=en&tbm=isch&tbo=u&source=univ&sa=X&ei=rHRkUev2I4H3ygH12YGwBA&sqi=2&ved=0CD8QsAQ&biw=1024&bih=699
I think the CO2 laser might help the Dennie`s Lines for a few months to maybe 18 months is about all and I would not suggest cutting them out for fear of developing an ectropion. JG 4.9.13
Hi Dr. Garcia, I got botox done about 2 weeks ago. I now have ptosis of my left eyelid. I`ve done botox for a long time and I have never had this happen before. Is there anything that can be done about this, or do I just have to wait for the botox to wear off?
your doctor can prescribe some Iodopine eye drops for a couple of weeks and by then the issue should be much better, that effect will not last as long as the entire Botox will. JG 4.9.13
So I`ve started using estriol and progesterone creams. How many weeks should it take before I notice effects like improved skin tone, better stamina, etc? Thanks ever so much.
skin maybe 4-8 weeks, not sure about the stamina, they are not really for that, maybe less fatigue, if that is what you are implying, in about the same time frame. The lower the levels were when you started, the faster you will feel better. JG 4.8.13
How long do neck lifts last?
depends on age, but 7-12 years, assuming no large weight fluctuations. JG 4.6.13
I am still in my 30s, and I do not get much sun. I have crepe skin on my neck. It seems like I am too young for this. What is the cause, and how can I treat it? I have had a few 25% TCA peels on my neck over the years. Can TCA peels cause this?
cause if genetics, sun exposure, smoking, dehydration. I would suggest using sunblock and possibly using some Retin-A too. I do not think the TCA peels did any harm but they likely did not help either. JG 4.6.13
I had CO2 laser resurfacing a week ago just under my eyes. I have a rash or pimples all the way down my cheeks. Why is this?
plugged ores form the ointments and also from the skin`s overproduction of oil to assist in healing, it will get better in time. JG 4.5.13
I should have specified the particular symptoms that I`m trying to address (and, if improperly dosed, the potential side-effects that I`m concerned about developing/exacerbating) with the bio-identical hormones: fatigue, weight gain, poor skin texture and tone, facial hair growth, decreased muscle tone and bone density, loss of libido Thank you for your help, Dr. Garcia.
properly dosed, all of those can be improved, not made worse or left unchanged. The most difficult one to treat would be the facial hair, the bio-identicals will help it form progressing but not reverse what you already have but there are lasers for that. JG 4.3.13
How do YOU remove spider veins on legs?? Do you use the injections and if so how many treatments? Or do you use the lasers?? How many treatments with lasers??? Thank you for your time:-)
we used to inject them, repeat every 6 weeks or so until we could get as many of them to go away and we would tell the patients that they can return at anytime after 6 months or so. The number of injections varied from patient to patient, sometimes as many as 6 sessions. I never use lasers for leg veins. JG 4.3.13
Which lasers can remove blue veins showing at surface? Or can only injections get rid of blue veins? Are injections permanent.? I know someone who had injections on legs a year ago, but they are back. However, she had a couple surgeries during the past year which tournicots were placed around her ankles. Not sure if that affected the veins or made them grow back exactly where they were.
Nothing is permanent in this case, the blue veins, if they are really small can be treated with either a YAG or a VBeam laser if on the face, but on the legs I suggest injections. I don`t think her surgeries had anything to do with the veins coming back. JG 4.3.13
Perusing your blog, I see you`re familiar with the new Thermigen product. Do you intend to purchase it yourself and offer it in your own practice? Asking because if you do intend to, I`d like to make an appointment and sign up!
At the present time I have no plans to purchase the technology until standardized settings are established by the company for different treatment areas. Until that time it would be a guessing game as to what settings would be required to get the desired result. If and when I do, it will be announced on the website though. JG 4.2.13
I just had CO2 laser resurfacing under eyes. I noticed the end of the tear duct was missed under one eye. The other eye area looks smooth while the missed area skin actually raises above the rest of the skin since the skin on both sides of it is smooth. Now, it looks worse than it did when I had crepe skin all the way on the tear duct because it stands out by itself just having raised crepe skin at the end of the tear duct. The problem is the plastic surgeon is located out of state. I am thinking about seeing a local dermatologist to us a fractional CO2 laser so I do not have to travel out of state again. Would the fractional CO2 laser set at the highest setting get the same results of a full CO2 laser? Or what would be a good setting on the fractional CO2 laser?
The fractional set at the highest density will be close to the CO2 and should be enough for eyelid skin. JG 4.2.13
Is there anything to make the neck look younger- crepe skin and horizontal lines?
Retin-A is about all I can recommend that is safe. JG 4.1.13
Thank you so much for your answer about HRT. Do you know of any colleagues in the Boston area whom you consider competent age management physicians?
You can find one on www.worldhealth.net. JG 3.30.13
I went through menopause early (at 41) and, although I take excellent care of my skin (sunblock all the time, Retin-A, etc.), including visits to my dermatologist and aesthetician every 12 weeks for peels, lasers and so on, my skin tone has necessarily declined due to the lack of estrogen. I`m now 54. I`ve done one full CO2 resurfacing, several fractional resurfacings and a facelift, but none of that restores the skin texture. I`ve been very reluctant to try HRT due to the cancer risks; but if I should be able to find a good endocrinologist who specializes in hormone replacement and aging, is it too late to expect any improvement? That is, has too much time passed to restore what I`ve lost? And can you suggest any colleagues in Boston or the New England area who specializes in this area? Thank you.
It will help some, you can always consider using estriol as the cream, of the three estrogens in the body, it is the weakest yet should still give you some benefit. I am afraid that estrogen is required for the best maintenance of the skin and having none cannot be overridden by lasers and peels. I do not think you need an endocrinologist though, just a dermatologist or an age management physician who can monitor your hormone levels. Best of luck. JG 3.30.13
I am not sure it is called forehead or skull reduction surgery to make the forehead size smaller. Since bone/skull is hard, how can it be pushed together if a piece of skull is removed? Or it is not like skin that can be removed and the edges pushed together with stitches. It seems like piece of skull would have to be removed all the way around the head to push the bone together? I am asking how can skull/bone be removed from forehead to make it smaller? Is the skull/bone removed right under the hairline? Let`s say a person wanted to make forehead abut 1 inch smaller right under hairline or removed 1 inch of bone under the forehead. Is this possible?
In a usual forehead reduction what is usually involved is something like a reverse forehead lift where the hairline is brought forward to reduce the visible size of the forehead skin. If what you are referring to is a prominence of the bones of the forehead, they can be burred or sanded down a small amount but anything more than that would require major cranial bone surgery that would likely not be attempted for cosmetic reasons, just for birth defects involving the skull bones. JG 3.30.13
How long does an eyebrow lift last? Also, how long does upper lid bleph last?
10 years or so on the eyebrow lift and a little less on the eyes. JG 3.29.13
Is laser hair remova with Alexandrite laser permanent by at least permanently getting rid of half the hair? If it is not permanent, do you mean all the hair eventually grows back months or years after you stop the laser treatments?
no laser hair removal is permanent.And yes, the hair will grow back, more slowly and possibly thinner, but it will grow back. JG 3.29.13
Well, the manufacture and sales forcer of Thermigen must be busy because I logged on tonight to ask you about this technology and see another person has just posted a question. MY surgeon just bought it too , and I`m scheduled to have him treat my face. Like everything else, this is being marketed as minimally invasive, with little to no downtime. We all know how that goes! What`s your take on this, Dr. Garcia? I`m having it done at 9 AM. Can I go to work at noon that day or should I prepare for the unadvertised but inevitable bruising, swelling, compression dressing, a week or more off from work etc. etc.? Thanks for your help. Happy Easter if you celebrate it!
if it is the external device, it is likely a minimal downtime thing, the internal is not , it will be at least a few days down. JG 3.29.13
Will CO2 laser resurfacing remove deeper wrinkles at inner corner of upper eyelids? Or can one get filler injections to smooth out the lines?
the effects of the laser will not last long as it cannot be done too aggressively there due to the skin being thin and fillers will likely not work very well and could leave lumps. JG 3.28.13
I have arched eyebrows. A doctor recommended an eyebrow lift since my eyebrows are close to my eyes. However, many people compliment me on my eyebrows. Would an eyebrow lift change the shape of my eyebrows making change from arched to more rounded?
the arch of the brow can be changed during a browlift, attempts can be made to leave it the same but since the muscles and tissues around the eyebrows are being manipulated, you might lose the effect you have at present and either look more flat or even more arched, depending on how tight things are pulled and in what direction. JG 3.28.13
Oh dear God, even our EYE tissue gets saggy?! Are you kidding? I`m rolling my ever-increasingly saggy eyes. We should all just quit this losing battle now, right? But I`m not ready to wave the white flag yet, so here`s a question for you: My PS is now offering Thermigen. Of course, the company is (off-label) marketing the internal probe for the neck and the body and the external probe for the face. The pitch is that the skin of the face is more delicate than the skin of the neck and body, which is why the minimally invasive procedure can only be used on the neck and the body. But isn`t the neck far more delicate (and slow to heal) than the face? Can the internal probe be used safely on the face? I ask because I want to tighten my facial skin a bit and the prospect of 5-6 expensive txs, spaced a month apart, seems wasteful to me if I can do it once or twice with the internal probe. Thank you!
I am quite familiar with the technology and it shows much promise, but the technology is still evolving so no one knows for sure what the best settings or how many sessions a person will need. I do agree that the face responds better and heals better than the neck. I think the internal probe is superior to the external probe. I wish you the best and keep fighting the fight. JG 3.28.13
Is it normal to see raised bumps here and there on side of scar revision stitches? I do not know why some tissue on side is flat and looks like normal skin, but other tissue on side is bumpy. It looks like a zigag of bumps along sides of stitches.
difficult for me to say what they are without seeing them, sorry. JG 3.26.13
Is it easy to see scar tissue outline after numbing injections, which makes the area swell? After a scar revision, there were a couple of bumps along the side of the stitches that looked hypopigmented and shiny or not like normal skin. It still looks that way 1 week later so I hope it is not old scar tissue that was not completely removed?
Usually the scar to be removed is delineated with an indelible marker to avoid that. I would give it a little time before making judgements about an incomplete excision. JG 3.26.13
Will labia majora reduction surgery sever the nerves so the area can no longer be sensitive and swell up when having sex? Is there a way to avoid cutting these nerves or vessels?
Those nerves are not at risk. JG 3.22.13
What is the muscle above the eyebrows called? If one has naturally arched eyebrows and has those muscles removed, will the arched eyebrows turn into straight eyebrows without an arch and will the eyebrows lower? If so, can botox injections underneath edge of of eyebrows raise the eyebrows to make them arch again?
the muscles between the eyebrows are called the corrugators and procerus, they pull the inner part of the eyebrow closer to scowl and also pull the inner eyebrow down towards the nose. They are frequently partially or completely cut. The muscle above the eyebrows is the frontalis and it only lifts the eyebrows. Years ago surgeons would partially cut into it to get the scarring to form and hope for the scar tissue to hold the forehead in a higher position, but it was unreliable. Cutting the procerus and corrugators will likely not affect the arching although in a small percentage of patients the brows will move slightly further apart, but cutting the frontalis likely would cause you to lose the arching. If the frontalis is cut there is nothing Botox could do to get it to arch again. JG 3.23.13
What do you think of LaVive? I`ve read that Dr. Frederic Brandt is getting great results. How long to the results last? Also, I had Restalyne injected into my marionette lines last week and today, the skin over that area peeled off in chunks almost as if I had had a chemical peel. This has happened to me before after an injection. What`s going on? Is this normal? Thank you for your time and help, Dr. Garcia. Have a great weekend!
Sorry, no experience with La Vie. As to the peeling off of the skin after a filler, if it is injected too superficially it can cause that to happen, it should not happen but if the needle gets to superficial with a product, it can occur.It is when it is placed in the area between the dermis and epidermis when it happens.JG 3.22.13
Is brow bone prominence the same thing as an oversized muscle above the brow? I am a female considering having this muscle removed whatever it is called.
No they are not the same, the muscle is easy to remove but the bone has to be burred done, big difference. JG 3.21.13
When does a newly revised scar start to stretch if it is going to stretch since located in high tension area? When do I need to be most careful in restricting movement so it does not stretch? Is it within first week of scar revision when it still has glued bandage on so it seems to be held in place or when the bandage comes off? What can I do to avoid a scar from stretching?
the first three months are the time period where the greatest degree of stretching occurs, especially the first 6 weeks. JG 3.20.13
I am trying to figure out why my face looks puffy in the cheek area. About 2-3 years ago, I had sculptra injections which faed long ago. I had it injected in my jowls and folds on side of nose. Does sculptra ever result in a permanent puffy face. I do not mean the benefits of sculptra since my face looked good after sculptra injections, but now it looks puffy like I have fluid build up in my face. It does not look good.
I have not seen it last that long, I think it must be due to something else. JG 3 19.13
Thank you for the answer about pigment that was added to my brows, making them too dark. You said that it might fade a bit in a year or two. In the meantime, might hydroquinone and Retin A help?
Retin-A maybe, hydroquinone no. JG 3.18.13
What are your thoughts on using fillers on Upper Lip Lines? What Filler would be the best to use? Can the fillers be used vertical on the lines? Thanks
My choice is Prevelle or Belotero.I use them for the vertical lip lines. JG 3.18.13
What is the best way to get rid of lines in the upper Lip? I have used Tretinoin cream for a year and no results. Thanks
I would suggest a CO2 laser. JG 3.18.13
Where is fat taken from on skinny people for undereye injections?
Inner kness, inner thighs, lower back. JG 3.16.13
Which lasers or other treatments can reduce horizontal lines across neck? I guess you call those neck lines. And how long do results last?
lasers are risky on he neck as that skin does not heal as well as the face, here are none I would recommend, sorry. JG 3.15.13
Is there anything to do about the hard balls where the PMMA collects into a smaller area causing unnatural bulges? For instance, is there any kind of injection which can help dissolve these balls without leaving an indentation in buttocks?
The only option is to cut them out and that can leave depressions where they were. There are no injections to dissolve PMMA. JG 3.15.13
How long do fat injections last in under eye hollows? Is it permanent? Also, if one is skinny and seems to have no fat can you still do the procedure? Or where do you take the fat from?
how long they last is variable and how well they work is variable, I for those reasons, I do not use fat injections around the eyes.I use Restylane for that area myself. JG 3.15.13
When you say PMMA can be permanent but the shape of the material may change with time, do you mean the shape of the butt may change with time as in the butt might go flat? Or one buttock might shrink smaller in size than the other one? How maybe years does it take for the shape of material to change. And will it always happen in time?
no, it will likely not go flat but rather you can develop had balls where the PMMA collects into a smaller area causing unnatural bulges.It will happen in time especially in buttocks due to the large amounts injected. JG 3.15.13
I had black permanent upper eyeliner makeup done 15 years ago. Unfortunately, the line was a little uneven. Although I have had about 100 TCA peels on the area, the tattoo is still there. It just looks like a charcoal color instead of a black color now. Since it is a lighter shade of black or more of a grayish black color, will a laser still pick it up? And can it be done near the eyelid? Do you think Black Magic IPL (home device) will work on it? Also, do you this device will get rid of red cherries or does it only target black color?
I do not think the home unit will work, but a laser will work much faster and effectively than the TCA peels. JG 3.14.13
I feel like a fool. I`m in my mid-50`s and have experienced, like many women my age, thinning of my eyebrows. I decided to have them filled in with hair-stroke pigment by a really experienced permanent make-up artist. Well, she did a great job, but they are way too dark and because of that darkness (not because of her technique, which indeed was hair-stroke, as can be seen up close), they look like those old ink tattoos -- not quite but almost like they were drawn on with a black sharpie. They were done two months ago and have faded to what they are going to look like. I know that, unlike ink, the pigment does fade over the course of years. I`m writing to ask how many years! And is there anything I can do to lighten this a little bit on my own? Honestly, I am so embarrassed that I did this. I suppose I deserve what I got for wanting to look better. Sigh.
Should fade some in 1-2 years but you can fade it sooner with a laser. JG 3.14.13
Hi, Dr. Garcia. I have a relatively superficial but visble acne scar on the bridge of my nose that I`ve had treated with fractional and fully ablative CO2 over the past four years. It`s gotten better, but it`s still visible. Might microdermabrasion help at this point to make it even more superficial? By the way, my surgeon also subcised it but to little effect because it wasn`t really tethered and because it`s pretty small. Thank you for your guidance. Hope you`re having a great day.
I think the lasers you have had would go deeper than a microdermabrasion, so better to get one of those than spend your money on something weaker. I wish you the best. JG 3.14.13
Will hollows in tear ducts fill n a little after full Co2 laser resurfacing under eyes? If so, how long will it last?
Sorry but no filling in the tear trough wuth CO2 laser. JG 3.11.13
I have a permanently inverted nipple that I`m considering having repaired. Will a cartilage graft compromise the sensory nerves?
The cartilage graft itself will not but the pocket that needs to be created might cut some nerves. JG 3.5.13
I have Lupus and have that characteristic butterfly rash. I`ve had dozens of VBeam treatments over the years, countless IPL sessions, etc. Nothing seems to help much. Is this particular deformity untreatable? Have you ever been able to help a patient with this problem? If so, what have you done? Of course, I use broad spectrum sunblock all the time. I also use SkinMedica`s products, including their Calmplex (which isn`t effective for reducing the redness in my own case, I`m afraid). Any other suggestions? Thank you, Dr. Garcia.
You have already tried everything I would suggest, sorry. I am at a loss for your issues. JG 3.2.13
Thanks for your thoughts about Thermigen. I know you haven`t used it and that it`s only been FDA approved for nerve ablation, but based on what you do know about it from your own research, do you think it could be of value to festoons? Mine aren`t so much saggy as puffy/swollen in appearance, and the texture of the skin over them is unlike the rest of my skin, which is in good shape. The skin over my festoons has enlarged pores and is loosing its elasticity. (Very pretty!) My PS thinks it Thermigen might help by tightening that skin, but I wonder if creating more collagen there might make them look puffier. Of course, no one -- including you, I know -- can answer that question with full confidence because there`s no research; but based on what you DO know, what do you think about giving this a try? (By the way, my surgeon is so far having great success with necks, backs of hands, knees, arms, and thighs.) Thank you so very much for your considered opinion!
I am not sure but from what I know I doubt it as it will not repair the defect causing the problem, making any improvement you might see short lived. JG 3.2.1
What do you think of Thermigen (subcutaneous radiofrequency)? My PS is offering it for skin tightening of neck, arms, thighs, knees, periorbital and perioral regions. Thank you.
It has been approved only for the temporary weakening of nerves of the forehead but doctors are using it on other areas. I have looked at the technology very closely, and I think it is a promising option. The issue for me at the present is that there are no set parameters for treatments on other parts of the body as he has told you, so it is sort of figure it out as you go. That can lead to disappointment if the settings are too low and a burn if too high. For those reasons I am waiting on it before I buy one. They also do not know how long the results will last, so something else to consider. I wish you the best. JG 3.1.13
I have limited $. I am considering either a Botox brow lift , knowing the results are quite mild, or fillers to the smile lines/marionette lines. Can`t have both. What would you suggest would give me the most less aged appearance?
I would go with the fillers. JG 2.8.13
I have limited $. I am considering either a Botox brow lift , knowing the results are quite mild, or fillers to the smile lines/marionette lines. Can`t have both. What would you suggest would give me the most less aged appearance?
I would go with the fillers. JG 2.8.13
Dr., what can really be accomplished by a so-called chemical brow lift ? I don`t have lines or furrowing between the brows, but have been noticing a lot of hooding around the eyes....kind of like a permanent squint . I can`t spend the $ for the surgical option, and I am curious if this would be worth the investment. Thank you.
You can get a mild lift if a chemodenervation agent like Dysport or Botox is used to weaken the depressor muscles in the glabella and crows feet area. Mild lift and you might get 3-6 months from it. JG 2.3.13
Two weeks ago, I had my usual Botox injections, which I`ve been doing for the past 12 years every three months. This time, my provider seems to have weakened the wrong muscle over my right eye, and now the lid has dropped, particularly in the corner. I suddenly have severe hooding that I never had before and look, literally, a decade older. Do I just need to wait three months for this to wear off, or can he try to oppose this weakened muscle with another injection of Botox, thus raising the lid a bit? I obviously don`t want to make this worse. Thanks for your suggestions, Dr. Garcia. Have a great week of helping people to look and feel their best! You are a gem!
If the hooding is out laterally you might try some Botox to weaken the depressor muscles in the crows feet area and allow it to lift but the effect will likely not be dramatic. If the hooding is medial, there is likely little that can be done but to wait. I wish you the best. JG 1.29.13
Hi there Dr. Garcia....Hope you are well as with your family. I would appreciate your professional opinion on scars I have on my face as to what would be the best way to remove or reduce the appearance of them. One scar is the size of a large brazil nut and the other the size of a pistacchio (sounds kind of nutty...but that`s what I think when I look at them). Both are slightly lumpy and are discolored slightly redish purple. It has been almost 6 months since the cysts were removed. I see my PC this Friday but would like to know what you would suggest. I would really like to stay away from fillers if at all possible and would like something more lasting. Thank you so much. I have relied on your oppions in the past and they have always been very helpful. God Bless you in all that you do Dr. Garcia, sincerely lorrilea
On the face, although I am not a big fan of fat injections, that can do well and might fit the bill and they should last a long time or be permanent. Otherwise I think I would let it heal for a year, all the while it will shrink and then cut them out to leave a better quality scar. I wish you the best and I appreciate the kinds words, thank you. JG 1.28.13
I have been considering a sliding genioplasty since my chin receded a little with aging. I always liked the overall shape of my face. I read that a sliding genioplasty can make your face or chin look longer. I do not want that. Instead, I want my chin to be projected outward instead of downward. I also do not wsnt my chin to look any bigger? Is a sliding genioplasty for me?
a chin implant or a sliding genioplasty is usually more of a forward push rather than downward. But there is no way you can push the bone out with either a sliding genioplasty or an implant without it being larger. If you do not like your appearance because the chin looks smaller than desired, then leaving it small will not correct the appearance. JG 1.17.13
Hi Dr. Garcia, My chin has an orange peel texture- almost looks like acne skin although it is not acne skin. Botox injections can really make the skin look totally smooth again?
the Botox will help if the appearance is due to excess muscle activity, but it is usually not the cause and will help but it will never be totally smooth if that is the cause. JG 1.17.13
Is there any way to remove blue veins that moved up to surface on buttocks? I am not referring to purple spider veins or varicose veins. The veins are flat blue veins. Can some type of laser remove them s they are not visible at the surface? Or could those spider vein injections (although not spider veins) work better?
The spider vein injections or a VBeam laser might work. JG 12.24.12
My daughter sustained a 5 cm facial lac in a car accident 10 days ago. Sutures were removed today and, of course, the incision line is red and raw in appearance. We want to minimize the scarring. Of course we`ll keep up sun-protection. My sister is a derm PA, and she came by tonight with a copper peptide tissue repair product called CU3 Complex. She thinks it may be of help. The plastics service didn`t recommend anything except sun protection. I`ve been an ER nurse for years, so as much as I love and respect my sister, I thought I should check with a plastics specialist before using this on her. Thank you, Dr. Garcia.
I like CU3, and sunblick too. I wish her the best.JG 12.18.12
Just wanted to weigh in on the Ulthera from a patient`s persepctive. I had this treatment done multiple times over the past two years and saw, maybe, a 5% improvement in skin laxity. I finally gave up and had a facelift, which turned out to be far less expensive, farless painful and vastly more effective than all that ultrasound. (I recovered in about 5 days and missed only 3 days of work.) I also went back to using fillers, moderately. I look immeasurably better. I think that once physicians purchsse that machine, they need to sell the treatment to patients to pay for it. In my own humble opinion, having undergone that treatment, I would suggest to your readers that they save their money and spend it on a facelift and fillers.
I truly appreciate you sharing for all to benefit. JG 12.18.12
I had a facial cyst removed 1 inch x 1 inch about 4 months ago. I now have a knotted lumpy scar that is purplish red. Do you have any suggestions for treatment options....will do anything to make it less noticeable. Thank you so much for time and professional advice. May God continue to Bless you in All things, lorrilea
Might suggest some 5FU injections to soften it and them maybe a Nd:YAG laser to fade the color once it is flatter. I wish you the best and thank you for the kind words. JG 12.8.12
My daughter recently received second degree burns to his hands and face in an accident. Her medical team tells us that the burns on her face will likely heal better and more quickly than the ones on her hands. Why is that so? And can you give us a rough ratio of the healing rate. For instance, is it 2:1 (as in if the hands take12 weeks to heal, the face will likely take 6 weeks, of if the hands tek 20 weeks to heal the face will take 10 weeks, etc.)? We`d just like to know what to expect and are trying to gather as much information as possible for her. She is very fair-skinned, which we understand is in her favor for the healing process. We deeply appreciate your expert opinion. You are obviously an uncommonly generous and kind person. Blessings upon you.
there are more hair follicles and sweat glands on the facial skin and that is where the new skin cells grow form. It will likely take 2-3 times as long to heal and fade on the hands compared to the face.Follow all of the instructions from the burn center, especially with moisturizing and compression gloves if required. I wish her the best. My you have a blessed Holiday Season and a Healthy New Year. JG 12.5.12
How many years does a chin lift last?
On average 5-7 years. JG 12.1.12
You know how more women tend to get facial filler injections instead of facelifts today? Do women also get facial fillers underneath chin for saggy skin underneath chin instead of a chin lift? Where is the scar for a chin lift? And do you think those noninvasive laser skin tightners are effective?
Fillers do not work fo the neck, non-invasives are no too effective and the scars will be under the chin and then around the ear. JG 12.1.12
I have banked rib in my chest from a revision rhinoplasty. Can a test like an ultrasound or MRI show where the banked rib is? It is a ball of rib cartilage.
Yes, either in should work. JG 11.30.12
I have consulted with a plastic surgeon who uses radiofrequency and needling (under local anesthesia) to tighten the skin on the backs of hands and on the neck. There`s a 5-7 day downtime due to swelling and erythema, which apparently looks pretty bad for the first 3 or 4 days. If necessary, he also does a fat transfer to the dorsum of the hands. What do you think? Effective? A waste of money? Thank you kindly for your valuable opinion and time, Dr. Garcia.
in my humble opinion, any improvement will not last and I would not suggest having it done, sorry. JG 11.29.12
I have skinny face and body or I do not have seem to have extra fat on my face. I am 40 years old. I notice in my facial profile that my chin looks saggy, but I do not have fat for there to be a double chin. Does liposuction correct the saggy chin look that looks similar to a double chin in profile although it is not a double chin? How is this corrected?
It will take a neck lift with skin removal to fix that, liposuction will not help and could create new problems. JG 11.29.12
Thank you for making the perspiration/odor problem clearer for me! That helps a lot. One more question: If the oils are in the hair follicles, then destroying those follicles (both through MiraDry--that`s one of their explicit claims) and/or laser hair removal should help significantly? Is that a logical conclusion? Sorry for multiple questions. I`ll stop now!
only if the oil glands are also damaged, and the degree of that is not as predictable as it is for the sweating. Although laser hair reduction does thin and lessen the hair, I cannot say it will totally eliminate the follicle enough to stop the odor. All the best. JG 11.28.12
Thank you very much for your answer about the MiraDry below. But would you kindly explain the mechanism behind the odor problem, which I still don`t understand. If I`m not perspiring, why do I still have odor? Isn`t odor the waste product of bacteria digesting the perspiration? Or is the apocrine glands that, independent of the perspiration, produce the odor? If the latter is the case, then I think I will try another session to see if I can destroy those glands entirely. Thanks again for all your help. You are so lovely, Dr. Garcia.
the odor is from the break down of skin oils by the bacteria in your hair follicles. Unless all of the oil is stopped, the odor will continue, not sure how likely that will be, if it were, the company would have gotten FDA clearance for that too. JG 11.28.12
I had my first MiraDry tx 9 months ago and have not had any sweating since, but because I still had an odor problem, I underwent a second tx last month. Would you please tell me if I`m understanding the odor problem correctly? If it`s the byproduct of bacterial digestion of the perspiration, then why would I continue to have an odor problem if I am no longer sweating? Also, if the radiofrequency kills the eccrine glands, wouldn`t it also kill the apocrine glands too? (And the apocrine glands are more responsible for odor than eccrine glands, right?) I ask because the second treatment seems to have helped the odor problem only slightly, and I was hoping for more improvement. The company suggests a protocol of 3 treatments, so perhaps I`ll need a third round; but I don`t want to waste my money if this only stops the sweating but not the odor. Thank you for your help and time.
The degree if damage to eccrine and apocrine varies, another session might help but no way to tell 100%. You will need to decide on your own whether an incremental deceease is wortth it. I wish you the best. JG 11.27.12
Thanks for your answer below about the hemosiderin stains. Would you please also tell me if they are likely to be permanent?And if not, how long will it take for them to go away? I think I`m at month 5 now. Thank you.
if left untreated that can be permanent in some cases, especially if they get exposed to the sun.If they were going to fade on their own you should see some fading by now. JG 11.13.12
Which is the more effective treatment for poikiloderma: 1) VBeam, 2) IPL 3) both of those, 4) something else? (Type I skin) Thanks so much!
VBeam. JG 11.7.12
What is involved in lifting the corners of the mouth? What is moved during that surgery and are the incisions on the face or inside the mouth? Is it expensive. I`m only 30 and don`t need a facelift, but my mouth is turned down and makes me look like I`m grimacing all the time. Thanks for your help.
am experienced user of Botox and fillers can likely help you weaken the depressor angulii oris and fill in any residual area 10 days later. JG 11.3.12
Prominent modiolus which makes me looks pudgy and old. Three possible txs: 1) Inactive the muscles with Botox (which I don`t want to do for fear of speech impediments and inability to animate perioral region naturally), 2) Cover the problem with Sculptra or an HA filler, which I don`t want to do because it will make my lower face heavy and masculine; 3) Surgery: I`ve already had a good facelift, but it didn`t touch the problem. Is there another surgery for this besides a facelift? Something that can be done intraorally? Is it safe? Side effects and risks? Do you perform this procedure yourself? If so, what is the average cost for it? No plastic surgeon I have consulted in my region does this specialized surgery. Thank you.
intra-oral removal of the fat pad of Bichat most likely will help. I do perform it, can`t imagine that there are no plastic surgeons that do it in your area, some oral surgeons perform it also. JG 11.3.12
I forgot to aks in my last question how one can thicken skin under the eyes?
Retin-A and lasers but the amount of thickening will likely at best slow the progression yet not reverrse anything you are already seeing. JG 11.2.12
I use retin-a. I thought retin-a was supposed to thicken the skin? But I guess not since I get those crow`s feet when I smile? I have been using retin-a that expired in April 2012. I figured it was still good for another year. Could crow`s feet be showing because the retin-a expired? I do not recall if I still got crow`s feet before the retin-a expired.
it will to a small degree but never enough to avoid the wrinkles of animation. I think even a new tube of the Retin-A would not alleviate those wrinkles that you speak of. JG 11.2.12
I am in my late 30s, but my skin looks like it is in 20s if I do not not smile. When I smile, i get deep crow`s feet under my eyes. What exactly causes this since wrinkles do not show unless I smile? Can CO2 laser resurfacing remove these crow`s feet that show when I smile? Do under fillers prevent wrinkles from showing since there is hollowness under eyes.
it is the thinning of your skin and upon animation, the skin folds and as you have lost some thickness and elasticity, the skin does not collapse the way it once did. CO2 laser is an option for that skin but as the skin there is quite there, the strength of the treatment cannot be very strong and the improvements will likely last a year or two at most. Fillers repair what is seen at rest, not what is seen upon animation. If you have a hollow where your eyelid meets the cheek, that can be improved, but not the hollowness above that line. I wish you the best. JG 11.2.12
I have a strange cosmetic question. I`m in my mid 50`s and have had an upper and lower bleph with nice results. Despite the lack of hooding and wrinkles, I`ve noticed that my eyes look significantly duller and softer in the last two years. They are like oddly aging marbles in my face. What are the physiological reasons for this? (I don`t have cataracts, by the way. Normal eye exams annually.) Do you have any recommendations for improving this -- beyond Visine?! Thanks very much!
Really do not know, suggest seeing an optometrist. JG 10.27.12
I was on prednisone last March for three weeks for adhesive capsulitis; I also received an injection to my shoulder in the same month. I had a terrible reaction to the meds but it resolved about two weeks after I was taken off them. In June, my hair started to fall out and it has continued to shed through now, late October. I have lost about 50% of my hair. The only thing I can think that caused this was the medication. The fact that my hair started to fall out about 12 weeks after that massive metabolic insult increases my suspicion that this is the cause. Is that a medically reasonable hypothesis? Have you heard of this happening before? Will my hair grow back or, because I`m now a 57 year old post menopausal woman, is it likely to stay this thin? It`s pretty alarming. I look so haggard and old. I`m discouraged. Thank you.
It is possible, it usally comes back once the body recuperates but it can take months, could try some Rogaine in the meantime. JG 10.23.12
Hi, Dr. Garcia. Almost 2 weeks now since my Juvederm injection and, despite your good advice to use antihistamines and ice, I`m still quite itchy. What do you think is going on? I`ve never been allergic to HA products before, but is it possible to develop an allergy after years of use? I have another question. My ps has 2 aestheticians in his office. One uses acetone prior to peels; the other uses 70% alcohol. Which do you prefer and why? Any difference in the quality of the subsequent peels? Thank you, as ever!
not sure, it is very rare to be allergic to the HA fillers, especially if you have done well before. Mitth want to see your doctor and they might want to give you a Medrol Pack to control it. As to the peel pre-treatment, they are pretty similar, patients seem to tolerate the alcohol better but I think the acetone does a better job of degreasing the skin which is the intent. The pre-treatment allows uniform depth of penetration,as skin oils will slow the penetration of the chemical. All the best. JG 10.20.12
Dr. Garcia , apart from HIV and Herpes , what are other sexually transmitted diseases that are recurring in nature ...meaning that they don`t have a cure or just goes on periods of remission until its symptoms emerges again ?
Other viruses like herpes zoster, HPV, and verrucus warts are the most common. JG 10.20.12
I went ahead and had my earlobes trimmed yesterday morning. One ear won`t stop bleeding. I have to change the dressing every 10-15 minutes and need to wear a towel around my neck to catch the excess blood. Holding gentle pressure on the wound isn`t stopping the flow. Time for more sutures?
ice first, avoid aspirin and Motrin. If not better by tomorrow, might need more stitches. JG 10.16.12
I used the Tria laser removal home device. Hair that disappeared grew back 5 months later. Why did it disappear than reappear? The hair in this area usually grows back within 1-2 weeks.
It killed the hair deeply but the root survived and it took time to grow back. JG 10.15.12
Why don`t you recommend fat injections (mixed with stem cells) under the eye?
firstly because the claim they are mixed with stem cells, unless you are doing as part of a study or done with specialized machines that take a few hours to isolate and then reintroduce the stem cells,is a false statement and they can also leave lumps that are difficult to remove and the fat injected is not as smooth as off the shelf fillers. JG 10.15.12
I`m another Boston area reader of your blog. The aesthetician looking for a Q-Switched YAG should definitely check out Skin Care Physicians of Chestnut Hill (www.skincarephysicians.net). They are a major clinical and research center, and the physicians there specialize in laser treatment. I`ve been a patient there off and on for the past 15 years and have found them to be extraordinarily competent.
many thanks for the help! JG 10.13.12
Good evening, Dr. Garcia. I just checked this blog and saw the question from the person in the Boston area about a Q-switched YAG. I hope it`s not inappropriate to do so, but I live in the Boston area and would like to recommend highly my own fabulous dermatologist Richard Eisen, who has this laser--as well as many others. Your inquirer can read about him and his practice at http://www.southshoreskincenter.com/.
no problem at all, I appreciate you sharing the info. JG 10.10.12
Why do earlobes thin and lengthen with age? Have you ever trimmed earlobes in your practice? I`m considering having this done. Thank you.
Usually just skin stretching, but in women with earrings, they make them stretch much more. They can be trimmed, usually heal quite well. JG 10.6.12
Hello, Dr. Garcia. I am taking diphenhydramine to redress itchiness following a laser procedure. I know it`s a soporific, but can it also make people anxious and jittery? I feel so strange: at once sleepy and restless, like I can hardly keep my eyes open and like I`m racing, wanting to crawl out of my skin. Also, I just read the question today from the person wondering about local anesthesia for a facelift. I`ve had two facelifts -- one under general and the other with local. I far preferred the local. It wasn`t at all painful, though I did once have to ask for more lidocaine in one area about 3 hours into the surgery, and I was able to watch in an overhead mirror and sit up from time to time so we could see how it looked. I was able provide feedback to the surgeon throughout the procedure. The result the second time around was much better than the first because we could collaborate on the extent and vectors of the lift
it normally makes people sleepy, but a small percentage of patients have the effect you are describing. JG 10.3.12
Hi, Dr. Garcia. It`s the vampire lady. Thank you so much for taking the time to answer my questions about pigment yesterday! Very helpful. Does the damage that appears in UV photos inevitably rise to the top of the skin, becoming visible? That is, if it`s visible in a UV photo, will it eventually -- within a year or more (how long on average?)-- be visible to the eye? I really appreciate all your help. You are amazingly generous. Good health to you and your family!
no, it can lie `dormant` and never be seen as it might rise so slowly that your exfoliation will remove the little part of the whole thing that surfaces. It is dark because it is likely thick or deep on the photos, but it never all comes to the surface at once. Thank you for the kind wishes. JG 10.2.12
is this working now?
I`m considering permanent makeup for my lips. I still have very good pigment in my lips at the age of 55, but one distinct corner of my bottom lip has lost color. It looks like a square white spot. A few questions: 1) Can i have just that corner tattooed, not the whole lower lip, or will that create its own problem of a line of demarcation? 2) I assume that permanent makeup is not, in fact, permanent. How long does this last in your experience? 3) One doctor told me that while she would have her eyebrows done, she herself would never haver her lips done for fear of a viral infection. What do you make of that? Thank you for your help.
yes, just the area that is white can be treated alone. The pigment will typically need a touch up in 3-5 years or so. I think viral infections can be avoided during the healing period by using Zovirax or other antiviral medications until healed. It is not a permanent risk. I wish you the best. JG 9.30.12
Sorry, The wound is open and has been drainig, sometimes clear and sometimes a little puss. It`s about the size of a dime. Thank you
You need to see a doctor to best advise you before trying to heal it yourself. JG 9.27.12
Is there an excellent wound healing cream you would reccomend? I see MANY for Diabetic Ulcers, but don`t know which might be best. Thank you for your insight!
depends on the type of wound, if it is open, sutured closed, most times just a topical antibiotic like Neosporin until it is healed and then after that we use Mederma or ScarGuard to fade the scar. JG 9.27.12
When you wrote removing skin would help to position eyebrow up after a brow muscle removal, which skin were you referring to? Did you mean they would make an incision on the skin above the eyebrow so there would be a scar or possible hair loss on eyebrow?
during a regular forehead lift, if the muscle is removed, then the skin can be redraped so as to lift the eyebrows into a higher position if needed. If the muscle between the eyes in the glabella is removed through the eyelid incision, then there can be no upward lifting as there is no way to move and reposition the skin. JG 9.23.12
Dr. Garcia, have you read any literature on Cutera`s Trusculpt (radiofrequency fat reduction)? If so, what do you think?
too early for me to say, but I find it funny that companies in one breath will say radio-frequency is safe and does not cause damage, and then low and behold, there is a new machine using radio-frequency being used for fat loss. JG 9.21.12
Hi Doctor, What is your opinion of the efficiency of oral sheep placenta supplements in terms of anti ageing/skin etc? Here is a link to the one I have been considering www.placentaproducts.com/order.htm Thank you
Soory, but save your money. JG 9.9.12
Dr. Garcia. Hello. Have you ever heard of lipodissolve . you inject it into a fat pad (under the eye) and it dissolves the fat pad. I read about it but no doctors seem to know about it.
I have, it is extremely unreliable, there are no legal FDA approved medications in the US that are approved for such a use. I do not recommend it. In Brazil, where the procedure was originally described and published, they took the medication off the market due to safety reasons.JG 9.8.12
How many units of Botox do you typically use for the glabella and the entire forehead to achieve optimal/relative immobility?
100 units. JG 9.8.12
Hi, Dr. Garcia. It`s me, the leopard-spotted lady again. I wrote to you eight weeks ago after having had Q-switched YAG for brown spots on my arms, hands and legs and found myself COVERED in dark black and red/purple marks. Honestly, I looked like a leopard. Well, they have faded a bit, but 8 weeks into this and they are still there! I`ve had to wear tights and long sleeves all summer (and it`s been really, really hot where I live). Just terrible! Is this just a tincture of time thing or is there an intervention I should seek at this point? I`ve been using hydroquinone and Retin A, which I plan to continue. Sigh. Pretty discouraged. Thank you for being an incredibly generous and unusually learned resource for so many people.
I think doing anything else on the areas where you had the treatment would likely delay the resolution, so best to do what you are doing and fight the temptation to intervene with stronger things. Hang in there. JG 9.7.12
There is a product out Amino-Fill 33. It claims to turn off the collagen blockers, thereby turning up collagen production! Here`s the list of ingredients: WATER/EAU GLYCERIN ETHYLHEXYL ISONONANOATE OCTYLDODECANOL DIMETHICONE BUTYLENE GLYCOL POLYMETHYL METHACRYLATE TRISILOXANE HYDROXYETHYL ACRYLATE/SODIUM ACRYLOYLDIMETHYL TAURATE COPOLYMER ISOHEXADECANE ACETYL TYROSINAMIDE DIMETHICONOL PEG-100 STEARATE LAURETH-4 POLYSORBATE 60 POLYSORBATE 20 ASCORBIC ACID BHT SODIUM HYDROXIDE DISODIUM EDTA RETINOL PHENOXYETHANOL METHYLPARABEN, Anything in here that can do that??? Thank you for your time
I do no think it will do what it claims. JG 9.2.12
I want to give MiraDry a try. I have a relative who did two treatments last year and has had no more problems with her hyperhidrosis. Wanted to check with you about fat loss from the radiofrequency used in the device. I don`t want to end up with armpits that are at last dry but look like I`m 92 years old. Thank you.
the risks should be small. Best of luck. JG 8.27.12
If Vaser Shape destroys unwanted fat on the body through the use of ultrasound energy, then it would seem to me that Ulthera, that is marketed as tightening skin and underlying tissue on the face through ultrasound energy, would also destroy fat cells. I would like to tighten my facial skin but obviously don`t want to lose any facial fat. How does Ulthera`s delivery of ultrasound energy prevent facial fat loss? Thank you.
It can also destroy fat, just more unpredictable. JG 8.26.12
Hi Dr., what do you recommend for what I assume to be age-related thinning and loss of eyelashes. I`m concerned because I have blue eyes and hear that Latisse changes the eye color. Does this always happen, and what else would you suggest?
I used to use a product called Revitalash but Allergan, the company that makes Latisse field a lawsuit against Revitalash alledging certain improprieties, so until the lawsuit is finalized, I am not selling anything in the office. I understand the concern about the eye color change, it does not always happen, the chances are greater if the product gets into the eye and does not stay on the lash, but if it occurs, it is permanent. I guess all I can say is to wait a while until the lawsuit is concluded. JG 8.25.12
Hi, Dr. Garcia. I just wanted to thank you for your help with my chemical burn. I followed your instructions and sure enough, my skin peeled off. I`m still splotched and have some bright red spots, but I`m not in pain any more. THANK YOU! Also, an unrelated question: my cousin had liposuction on her upper back 3 months ago and now is going crazy with itching in the treated area. What`s up with that? Anything she can do to help it? Have a great weekend, Dr. Garcia.
the itching can be form small nerves that wee irritated at the time of surgery. It is not a permanent thing and using OTC antihistamines will help it.Glad the peel is getting better. I wish you the best. JG 8.24.12
Is it possible to remove a non barbed threadlift suture that was inserted in the cheek through the temple/hair region, if the knot can`t be found. My surgeon removed the other 3 but said it was to dangerous (risk of nerve damage,digging around blind) to remove the fourth because the knot couldnt be felt.
`t can be removed by cutting the knot but then the suture needs to be pulled out from the old needle hole where exited on the cheek. You cannot pull it out from the temple unless the barbs never attached to the tissues.No more dangerous than putting in tbe barbed suture in the first time. JG 8.21.12
I wrote to you yesterday about a chemical burn on my face. Thank you so much for your quick reply! I`m following your advice and hoping it will get better. I`m also trying squalene oil. But a new development emerged today that I wanted to ask you about. The skin that was burned (and very swollen) now looks like crumpled tissue paper. It looks like it might peel off in sheets in the next several days. Meanwhile, the skin beneath it is a bright, angry red. Does this sound like the normal course of things for a chemical burn? Thank you.
yes, that is normal, it will heal just like a deeper chemical peel. The skin superficially will dry and flake off, then heal like a bad sunburn. Hang in tbere. JG 8.21.12
What do you think of the diet aid lLipozene?
Save your money. JG 8.19.12
I just checked your archives for folliculitis and found a recent series of questions and answers. There must be an epidemic of this affliction! My sister-in-law had electrolysis 3 weeks ago and developed a bad case of folliculitis within a week of that treatment. It`s really quite disfiguring and she says it`s very uncomfortable. She hoped it would go away on its own but it just got worse, so she finally saw a dermatologist on Monday of this week. He put her on Minocycline and Mupirocin. It`s now Friday and she hasn`t seen much change at all, just a tiny improvement. How long do these medications take to work before they show signs of effectiveness? Are there other prescriptions typically given for this condition she could ask for if these don`t work? Thank you.
the problem can take time, a week or two, at times more to get back to normal. It varies from person to person due to their skin and the energy used with the electrolysis needle. It essentially a miniature burn in the deeper levels of the skin, where the hair follicle resides. I think what she is doing is about it, we do not want to cause any more irritation than already exists, it is frustrating, but will get better in time. I wish her the best. JG 8.17.12
Hi Dr, I am considering two procedures and not sure yet if I will do them at the same time. Can you please tell me the recovery time before I go back to work after having breast implants (under the muscle) and also liposuction for excess fat on the knees. I am a flight attendant so obviously there is a lot of lifting in my job. Thank you
I think your recovery with both done at the same time will be the same as the breast provedure alone. All the best. JG 8.12.11
Hi Dr., is there any reason why you are not a fan of Latisse? I have noticed my eyelashes just aren`t what they used to be...much thinner and seems like less lashes. I guess this is just another age-related issue, but what is the best product? I`ve heard these medications can change the eye color too.
the potential eye color change and the chamges in eye pressure since the medicine was originally for glaucoma. JG 8.8.12
Hi, Dr. Garcia. My dermatologist told me of a recent study indicating that zinc picolinate, if taken several days prior to a Botox injection, can extend the effectiveness of the toxin by 30-40%. This sounds too good to be true. Do you know of this study, and what is your assessment of it? Thank you! Have a great week.
it was the use of zinc and phytase in patients being treated with Botox, but most for blepharospasms. I think if the patient is deficient in zinc, it might help, but I think the difference in cosmetic patients would be almost not perceptible, especially in view that few people are deficient in zinc. Little harm in trying it though. JG 8.6.12
The incision around belly button was made a year ago.
`fillers like fat will make the area puffy, but in a percentage of cases can smooth out the pleats. JG 8.4.12
I have bought waterproof, purple skin markers (medical) online. But when I wipe them with alcohol or lots of water, it dissolves. The ones doctors use seem to last so it does not dissolve when patient is prepped for surgery with alcohol or iodine wipe. What brand name skin marker do you use or can you recommend one that will last? Oh, it is for scar revision. When area is injected with numbing shot it swells and hard to make out all of scar tissue. Thank you.
`the scar area does not puff up as much as normal skin, so no problem there. As to the markers, most use a Sahrpie as they do not rub off. JG 8.4.12
Thank you for the answer about Hydroxycut. Can you recommend any other supplements -- natural or synthetic -- that might be effective as appetite suppressants?
they are all more hype than anything, all of the ones that were effective have been mandated by the FDA to cease sales or take out the ingredients that were helpful. JG 7.30.12
What do you think of Hydroxycut as an appetite suppressant? Any other products you like for appetite control? And what is your estimate of the Cerave line of moisturizers and sunblocks? Thank you!
save your money on the Hydroxycut and I have no personal or patient experience with Cerave line of products, sorry. JG 7.29.12
Thanks for your answer about fat graft to the arms, but the typos in your reply made it hard for me to understand. Do you mean that if the fat survives, the arms would 1) look tighter and 2) lose definition and 3) look smoother? Wouldn`t they gain definition is they looked tighter and smoother? Thank you! Sorry for two questions
sorry about the typos. The arms will look smoother, losing any definition, but the skin will be draped tighter with less loose skin as the arm will be slightly larger or thicker for lack of a better word. The fat makes seeing the muscle definition harder, but will fill in the empty skin envelope more.JG 7.24.12
I know liposuction to the upper arms is commonly done but what about fat transfer to redress the deflated, flabby upper arm phenomenon?
It will likely have to be done at least twice and it is unpredictable as to how much will survive, and if it works, your skin might be tighter, but the arm will likely lack definition and look smoother. JG 7.24.12
Good evening, Dr. Garcia. Here`s a shout from your Amen Corner. I was just reading some of the questions here and am sooooo grateful for your clear and honest answers. Readers, listen to this man! Years ago, a dermatologist injected Radiesse under my eyes, which left me with granulomas under my eyes. All the attempts at repair developed into a cascade of disfiguring disasters. Never allow anyone to put any long lasting fillers (Radiesse, Artefill or Sculptra -- which isn`t really a filler but should never be placed under eyes or in lips) under your eyes. 100K and 7 (yes, 7!) surgeries later, and I was left with facial nerve damage and huge scars around my eyes. In a related (fortunately, temporary) misstep, the surgeon who finally put me back together--sort of--attempted Botox to my chin (just 5 units) to see if it would even out the asymmetry of my face caused by the nerve damage I sustained in an initial surgical attempt at repair. BIG mistake. My speech impediment from the nerve damage was exacerbated by about 50% for the next three months. I would never let anyone put Botox anywhere near my mouth again. Thank you, Dr. Garcia, for all you do for all of us! You are an angel. Again, readers, listen to this man!
You are so kind, I greatly appreciate it. JG 7.23.12
Dr. Garcia, how does your cell matrix cream mimic retin a results if it doesn`t exfoliate like retin a? What is argiriline and what does it accomplish? Just wondering before I purchase one more product. Thank you.
it helps replenish the cell membranes so they maintain their appearance. Argireline also may help stabilize cell membranes.I do not believe the claims that it weakens muscle action though. JG 7.23.12
Hi, Dr. Garcia, I have really crepey, loose skin (looks like an extremely aged person) on the INSIDE of my arms wher my elbow bends, and also on my inner upper arms. I have weighed the same since high school (107 lbs) and I work out and never sun. Any surgeries, laser treatments or creams that would work. Collagen treatments or pills? I don`t care about cost as long as it really works! I am not even fifty yet! I am so desperate, so thanks so much. B
nothing topical and no lasers or peels will help. About the only thing is to have the skin cut out and it will leave a visible scar from your armpit down to your elbow I am afraid. JG 7.22.12
Hi Dr. Garcia and happy summer! Thanks to menopause my face is now absolutely covered in fine hair. Ugh. Lasers won`t work since it is blond so what would you recommend? Electrolysis? An epilator? It is too much to get waxed and I am very self conscious about it.
Elecrolysis, prescription Vaniqa and getting started on natural progesterone cream. All the best. JG 7.15.12
What do you think of the Derma Wand?? Or the Stem Cell Facelift ?? Thank you
I think they are both loots of hype, especially the Stem Cell facelifts, the number of stem cells in it are minimal, they are just selling the buzz word. Save your money. JG 7.15.12
One may take Alli to reduce the absorption of fat. Are there any products that one may take to reduce the absorption of carbohydrates? I`m on a high protein, low carbohydrate diet to rebuild muscle, and I`d like to be able to reduce the absorption of the few carbs that are in my diet. (I know I need some -- in vegetables, for instance, but I`d like to lower my intake. I eat no processed carbohydrates at all.) Thank you.
There are claims about some herbs doing it but little medical science to back it up, so in shott, none that I beieve work. JG 7.10.12
I read about Lipodissolve. Can this be injected in fat pads under the eye to disolve the fat??
Any LipoDissolve used in the US is not approved by the FDA, and the original place where it was used, Brazil, it was stopped and taken off the market due to complications, so I would seriously consider not doing it. JG 7.7.12
Would CO2 laser resurfacing get rid or orang peel or pitted texture on skin? Why does the skin look this way? I mean if it is caused by the chin muscle, how come there aren`t wrinkles on chin instead of pits?
I think the laser will have minimal effect on the orange peel skin as it is there on animation and not much in the relaxed position. The skin looks that way form the flexion of the mentalis muscle in an area where subcutaneous fat has been lost and the flexing of the muscle more easily seen. The pits form the muscle are not lines due to the direction of the muscle activity. JG 7.7.12
Is it possible to remove the mentalis muscle from chin that causes the dimpling? If so, what could it be replaced with? Would a chin implant be sufficient?
it is not a good idea to remove the mentalis muscle as you will lose function of the lower lip, the chin implant will not change the appearance of the orange peel skin. JG 7.7.12
I don`t know why, but my chin looks like it has receded. I also notice orange peel texture skin on my chin, which makes it look a little deformed when I pucker my lips. I was thinking of a chin implant. My questions is if a chin implant would cover this orange peel texture? Or might I not feel the need for a chin implant if I have botox injected in chin? It is hard to tell if the orange peel texture could be making my chin look receded.
the implant will make the chin bone larger but will not change the orange peel skin. That is there from loss of sucutaneous fat and the activity of the mentalis muscle when it flexes.Low dose Botox can help the appearance but can also therefor affect the ability and function of the lower lip, so puckering could be affected too. The chin might appear smaller from loss of both subcutaneous fat and loss of bone. JG 7.7.12
Happy 4th of July Dr. Garcia. I hope you get a long weekend off with your family. I have a general medical question for you. I try not to take any OTC products for pain, especially acetaminophen due to the potential for liver damage. Neither do I like to take ibuprofen if I can avoid it, particularly since it often requires multiple dosages to relieve pain. Is naproxen relatively safer than either of these options, since it`s slower acting and doesn`t require more than one dosing? (I know that both ibuprofen and naproxen are anticoagulants and so are contraindicated before or after surgery.) Thank you for your help.
ultimately, the naproxen method of action will yield the same negative effects as ibuprofen I am afraid. Safe for 4-6 week period and then you need to come off, long term use with any NSAID will have side effects.Happy Fourth of July! JG 7.3.12
Regarding my question below about stem cells, do you mean the technology is not available in the USA right now. However, it might be available in other countries right now to do this?
no, it is worldwide, there are no stem cells that can be used to avoid scarring on people. They are doing surgery on a fetus with promising results but not on humans after birth yet. JG 7.2.12
Hello again., can you suggest a less expensive alternative to the Obagi skin care line? My daughter was told by a MedSpa that it will help with hyper pigmentation of the cheeks, large pores, dull skin, and acne. I did see some before and after pictures which seem impressive. It seems a bit pricey, but I would gladly help her with the cost, if you feel it would have impressive results. If not, what would a less expensive option be?
You can spend less just by getting a prescription of Retin-A and hydroquinone from your doctor, that is the effective part of the program. JG 7.1.12
I had brachioplasty about six weeks ago and am having persistent swelling in one of my arms from elbow to wrist--this morning even my fingers were swollen. I use pillows to elevate my arms while sitting and sleeping--also am wearing compression garment by Design Veronique that covers arms to the wrist. The other arm just has a little swelling at the elbow. My scars look fantastic, but I am depressed about the swelling. What else can I do to support healing? Do you have any idea of how long this will take to resolve? I am in contact with my Plastic Surgeon so he is aware and has recommended elevation and compression. Thank you!
Hard to say how long it will take, but you need to continue wearing the garment as much as possible. It is not common for some of the lymphatics to be scarred down during the surgery and it can take time for them to re-adapt and be able to handle the increased fluid load.I agree with the elevation too. I wish you the best. JG 7.1.12
I have had a correction to a inverted nipple recently and I feel like it is protruding out more than I would like. The doctor told me they will die down and shrink a little bit. I was wondering if this is true and usually how long it will take? I got them done in march and had to go back recently to have my Dr look at it because it was settling outwards instead of forward. He just injected some stuff to help correct the direction of healing but told me I may need to come back and get injected again next year. Can I ask him to correct it since its unevenly done.. The inner side of my nipple is visible out more by a couple millimeters than my outer side which is making my nipple look like its pointed outward. What should I do?
it is true and it can take a few months for the selling to go down. I would not consider anything more surgically for another 3 months. You may need another injection to let the tissues soften up. Best of luck. JG 6.30/12
Would a labia majora (not labia minora) reduction cut nerves or affect blood supply to area and prevent swelling/orgasm?
there should not be any nerves cut, but if too much of it is removed near the clitoris, then the clitoris will be constantly exposed and in the long term that can cause loss of sensation. JG 6.29.12
Dr., what is your best suggestion for acne scarring? Strangely, seems to have become more pronounced lately, although the acne cleared up years ago due to accutane. Not fair skinned at all, more olive, but I am not a sun-worshipper, and with hyper pigmentation in my face even less so. I would like to smooth the face, and get rid of this awful scarring. I am 24 and feel like by the time I`m 30 I`ll just be a mess of scarring and dark spots.
the best thing is a CO2 laser, but in olive skin it can be risky for developing areas of hyperpigmentation or loss of pigmentation. You are seeing it now as the skin is starting to loosen with age so the skin is not as taut. When skin is tight, the acne scars are seen less.I do not think chemical peels will help. Anything you do with the laser will be a short term improvement though. Sorry. JG 6.29.12
Have you ever done surgery to remove saggy skin on elbow? It is strange how I only have saggy skin on one elbow. Do you recommend using a laser to tighten the skin or cutting the saggy skin. Where is the incision placed- is it noticeable? What is price for one elbow?
no I have not, the scars would be long and quite visible. Laser works well on the face but not in other locations. JG 6.28.12
How long do fat injections last in the face? Also, how long do fat injections last in the butt and breasts?
some say for ever, but in many cases it is about 1-2 years, the greater the amount grafted in one setting, the less time it survives. The length of survival in the buttocks and breast are being followed at present but in many patients it is all gone within 2 years. JG 6.28.12
My daughter is 23, with some very marked acne scars from her teenage years. The skin seems very lax and soft. She continues to have breakouts occasionally and I wonder when this vicious cycle will end. What would you recommend to do? To top it off, her bc pills have given her dark spots. All in all, she seems to be having one problem after the next. It worries me, because I wonder if the laxity will continue and she will not age well...already having slight n/l folds. Please tell us what she should do. Nothing over the counter seems to work.
might wan to try some OTC progesterone USP cream sold at the health food store and have her use it the days she is taking her BCP and stop it the days she takes the blanks. Otherwise, the more sever option would be to go to a dermatologist to start her on Accutane. She also needs to use sunblock to slow the progression of her dark spots from the bcp`s. The dermatologist can also likely give her things for the dark spots too. I wish her the best. JG 6.27.12
Hi DR. G, I am seeking your advise on acne scar correction. In the past I have undergone Fraxel, Obagi and most recently had a deep full face dermabrasion (1.5 yrs ago). I did see about 40% improvement from the dermabrasion but still have several boxcar type scars. My scars do soften when the skin is pulled and are mostly on the non boney area of my cheeks. What do you feel is the best approach to acne scar correction. Any suggestions are greatly appreciated. Thanks
I would suggest a fully ablative CO2 laser resurfacing. All the beat. JG 6.26.12
Hi Dr., I have noticed that my eye lashes are not what they used to be. It seems that with age, they have lost some length and to top it off....I used a very sticky eyelash curler and it seems I ripped a small area out. Is there anything that will regrow lashes.
if the follicle has been pulled out, no. But if it is just a thinning out, then products such as Revitalash or prescription Latisse might help you. JG 6.25.12
I was trying on shorts and noticed some horizontal sections of blanching on the back of my thighs, but it is permanent. I wonder if this is cellulite. Can cellulite look blanched or lighter than rest of your skin? It is like striped that run all the way across the back of my thigh.
I do not think it can be caused by cellulite, if you were in a tanning bed, it might be from the skin folding when lying on your back and using the tanning bed though. JG 6.14.12
Well, you could surely anticipate these questions after this week`s news cycles! What do you make of the study that now warns of the carcinogenic risks from particulates of spray tans (especially when absorbed incidentally by mucosa and/or accidently inhaled)? And now, vitamin D and calcium supplements are being discredited as ineffective and potentially just nothing more than expensive causes of kidney stones? Even more interesting is the growing debate around the ineffectiveness of statins (including red yeast rice) -- as well as their potential to increase insulin resistance, induce muscle injury and impair cognition. Thanks for your considered.
I think a person should always protect their mouth and nose when using a spray tan, as I do with any aerosol, and then use a self tanner cream for the face.Having said that, I think although there might be risks, the degree of risk is hard to determine and we don`t know how much exposure will ultimately cause a problem. It is still likely better and safer than a tanning bed.One cam likely say the same thing for hair spray. As to the Vit D and Calcium, I am still taking mine.I find the studies unconvincing and as most studies, when you read the entire article rather than depend on the abstract, the evidence against I feel is pretty weak, and certainly seems to push the use of prescription drugs, which have their own problems. As to statins or red rice yeast, I would not take them, but I also think they have the order wrong. The early signs of metabolic syndrome is a high cholesterol, and then the person goes on medications. If one can treat the metabolic syndrome/ insulin resistance, then the body`s own attempt to boost more hormone production by making more cholesterol, as it is the back bone for the hormones, goes away. It is not the statins that cause the insulin resistance, it is the insulin resistance that already exists that causes the need for the statins due to the insulin resistance promotion of higher cholesterol. JG 6.13.12
If I had the muscle above the brow removed, would I look like one of those people who had too much botox since they can`t make any facial expression? Also, would botox remove horizontal wrinkles on my forehead after I had borw muscle removed? My main problem is the oversized muscle, but I still have some horizontal wrinkles.
if the glabella muscle is removed, you might have that look. I you then have Botox injected for the horizontal lines, the eyebrows might fall lower as the muscle you just injected is what keeps them in their position, and working unopposed laterally, will pull the outer part of the eye brow down. JG 6.11.12
I don`t want botox for my forehead wrinkles. I want botox to make the muscle right above my brow smaller because it sticks out a lot. But botox does not make it look any smaller. That is why I want it removed. Can just the center of the brow muscle be removed to make the muscle appear smaller so I will still be able to make facial expressions? Or would the brow muscle still stick out ? The brow muscle sticks out the same in the center and at ends. I read somewhere that some doctors just remove the center of the brow muscle, but wrinkles will still show on forehead if the doctor does not get all of the center of the muscle.
Yes, the glabella muscles alone can be removed, but the brows will move slightly laterally and you will not be able to scowl or look angry on a permanent basis. It would not stick out any longer as the bulk of the muscle will be removed. It would leave the horizontal wrinkles in place though. JG 6.10.12
If you have an arch on your eyebrow, will that arch go down if you have your brow muscle removed? And will you be able to make facial expressions (surprise, anger) after a brow muscle is removed?
if the muscle is removed, you will no be able to raise it again, you can use Botox for a shorter term result to see if you rare willing to live with it. JG 6.10.12
In general, do you think it`s wise to take a low dose aspiring daily if one doesn`t have any clotting or digestive disorders? Do you yourself take one? If so, why? If not, why not?
I take a daily baby aspirin, studies have shown benefits of heart protection and even earlier fiagnosis of colon cancer. JG 6.10.12
Thanks! Where exactly is the incision placed in upper lid lid lift, and how big is the incision?
Same as the inner half of an eyelid surgery, in the crease of the eye, well concealed. JG 6.9.12
Hi Dr. Garcia! Would you believe it possible to use 475 units of botox total for both feet for sweaty feet.
that seems like a very high dose, not sure if injected properly that it would take that much. If injected too deeply, it does not work. It has to be injected into the skin and not deeply. JG 6.9.12
I`ve been reading this website for a while and have found that you endorse supplements. I started taking many about 6 months ago and feel better. But i have a question about how long it takes for most of them to be absorbed. Often within a couple of hours of taking fish oil, I excrete an oily stool. That seems too fast for for a complete digestive process, which I understand takes at least 8 hours, but I`m assuming that it`s the fish oil. Is that possible? And if it is the fish oil, am I not getting the benefit of it if it`s passing through me so quickly? Another digestive question: Occasionally, the mixture of supplements will upset my stomach and within a couple of hours, I will vomit and see the remains of capsule casings. When this happens, have I lost the benefit of the supplements I have taken if they`ve only been in my stomach for two hours or have I absorbed most of it by then? Thank you for taking the time to answer and for providing this terrific, educational site.
oil based supplements at times can be absorbed faster, but it usually takes 8-24 hours for the supplements to get to the colon, so more likely, it was the fish oil taking before that last time. In large doses, like when taking mineral oil for constipation, it can go faster due to the large volume of oil taken. You can test it by stopping them for a few days and then restarting them and see when the stool gets oily again. I will also say that some less expensive brands of fish oils have coverings that do not dissolve as well, so its best to take supplements form large well known companies. Try taking the fish oils with food too. If you vomit the pills up, you likely have lost at least 50% of the product. You might want to search for another brand of oil, and maybe keep them refridgerated, along with buying them from a place that sells a lot of them so the supplements are fresh and not spoiled, the spoiled oil can have more nausea effects. Although the research is still coming out, the Krill oil seems to be as effective as the fish oil, it is a smaller and easier to tolerate capsule. MegaRed is a good brand. I wish you the best. JG 6.8.12
I have rosacea and stay out of the sun as if I were a vampire. I completely over myself in sunblock multiple times every day. I am so pale --except for the redness on my face -- that I actually look ill, especially in the summer when wearing ighter clothing. I am considering trying a botanical spray tan at a local medispa, which will last no more than 10 days. Before I do that, would you please tell me if that might aggravate the rosacea? Thank you, Dr. Garcia, and good night.
I do not think it will affect the Rosacea. Best of luck. JG 6.7.12
Hi Dr. If a surgeon is a D.O., board certified in plastic and facial surgery how does that differ from an M.D., with the same cosmetic surgery credentials?
a DO who is certified in plastic and facial surgery usually is a person who has gone through an ear, nose and throat residency where some plastic surgery is done, but it is mostly ear, nose and throat, such as tonsils and cancer. A plastic surgeon is someone who has completed typically 5 years of general surgery and then an additional two years of plastic surgery alone. There are currently only 4 training programs for DO`s in plastic surgery whereas there are about 90-100 in traditional medicine. Cosmetic surgery is part of plastic surgery, but not all plastic surgery is cosmetic, as it also involves reconstruction, maxillo-facial surgery, birth defects, burns, and many more things. JG 6.5.12
Thank you for your answer about supplements. What else do you take and why? I can`t be alone in wanting to learn how you stay so healthy and young!
Oh boy, I take NAC, Acetyl L carnitine, Niacinamide, Magnesium, Vitamin D, a broad multi, extra Vit B6, B12 and folate, GABA, melatonin and Chia seeds. JG 6.5.12
What are your thoughts on the real value of supplements? My pcp is against them because she says we just end up excreting them and absorbing very little, but I keep taking them anyway (omega 3; red yeast rice with co-Q10; multi; vitamins B, C, and E; biotin; calcium and vitamin D). Thank you.
I take what you are taking and lots more. I guess he believes them same for the prescription medication you take, that the pass through and are not absorbed. JG 6.5.12
Hi, Dr. Garcia. I was in a bad car accident 2.5 years ago and was confined to bed for about six months. I lost 20 pounds in the process -- from 109 to 89 -- and I think much of it was muscle. I looked and fetl terrible. At 5`6 , 89 pounds was very scary. Fortunately, I have recovered and have about 80% of my mobility back. Since regaining mobility about 18 months ago, I have also put the weight back on, plus 5 or 6 additional pounds. I`m up to 116. The problem is, I now look and feel fat, something that was never true before the accident. I do some light weight training, resistance work and brisk walking (can`t do anything aggressive anymore, sadly) and eat a high-protein, low carbohydrate diet. I`m guessing that what I lost in muscle mass came back as fat. Also, of course, I have aged along the way. I`m now 47 and post-menopausal. What is your estimate of what`s going on here? Do you have any thoughts about how I might regain the muscle mass--is that even possible? I have no idea--and lose the fat? Thank you so much for any help you can offer me!
well, I think the diet you are on is a great start, also looking into a physician that does bio-identical hormone replacement might be a good second thing to see if anything can be replaced to get you back to a better quality of life and make the sacrifices you are making worth it. I will say that you likely lost mostly muscle and as your resistance training is limited, that most of the weight gain has been fat. Trying to increase the resistance training as tolerated is the next step in order to maintain and increase some muscle mass.Use more free weights, nothing super heavy and try to avoid the machines if possible. Shorter intense work outs are going to eb better than long workouts too. Also you need to continue the cardiovascular training, biking or swimming might be less damaging to your system. Reversing the catabolic scenario you were in takes time. Over-training and stress make it hard to overcome, so don`t forget stress reduction too, like Tai Chi or Prana Yoga, I wish you the best. JG 6.4.12
Is the diet aid Sensa any good? Is it based on junk science? If it`s effective, is it due to the placebo effect? At the very least, are its ingredients safe? Here`s the list: http://ichoosebeauty.com/sensa-ingredients.php Thank you, Dr. Garcia.
placebo effect I am afraid. If it worked, Oprah and Rosie O`Donnell would be skinny. JG 5.31.12
Which fillers do you recommend for hollowness under eyes?
my preference is Restylane. JG 5.28.12
Is it possible for one`s lips to stick out more as one ages? My upper and bottom lip seems to stick out more. Maybe that is causing my chin to appear smaller? Is there surgery to bring down a lip that is sticking out like duck lips? Is this procedure called a lower lip lift?
it might happen depending on bone loss or denture/tooth projection. Cannot see your chin losing that much bone to recede enough to make the lips look larger. It might also be some loosening of the muscles of the lower lip that can be improved with surgery. Most likely that is the cause and the possible correction. JG 5.28.12
I do not have hair on my labia minora, but I have thick hair on my labia majora. Do you mean the labia majora has hair on the outside, but not on the inside?
I think you are mistaken, you have hair on the mons pubic skin that meets the labia majora. JG 5.27.12
Where is skin removed from labia majora for a skin graft to place on areola area? Wouldn`t it make the areola area hairy if the labia majora is hairy? For someone who has an enlarged labia majora, could the skin graft be removed from the top of labia majora like it is for the labia majora reduction procedure or could the skin be used from a labia majora reduction procedure?
no, labia does not have hair, it is inside of that, they are fleshy and crinkled. The piece of skin removed for a labia reduction is the skin that would be used for the areolar reconstruction. JG 5.27.12
Dr. What is the best way to get a nice dewy /airbrushed complexion at a MedSpa? I am not looking to get rid of wrinkles or anything drastic, but my facial skin lacks luster and has many small areas of hyperpigmentation. I would love a more even complexion with some glow .
IPL or microdermabrasion. JG 5.26.12
What do you think of using labia minora for areola reconstruction?
Majora yes, not minora. JG 5.26.12
Which procedures can an aestetician perform in your office. Are they allowed to use laser and / or ultrasound? I see they now have high tech procedures like plasma and ultrasound for the face and I would like to be able to perform these and am wondering what training I would need besides aesthetician training. Thanks for whatever information you have,
You can use ultrasound, but not any true lasers, you would need to be a medical assistant ir a nurse. JG 5.26.12
Hello Dr. Garcia, I was reading your posts about 5-FU, I was wondering if you know of any doctors in Utah that use 5FU to dissolve scars?
I am sorry but I do not, you would need to call around and ask, more likely to find a dermatologist than a plastic surgeon for it. Best of luck. JG 5.22.12
hey dr garcia! i had asked a ques about prevelle in bottom lip and it being a little hard and palpable.. this is my first time getting fillers and its been about 5 days.. am i feeling the filler material? was it injected too close to the surface/superficially? i mean it looks fine but its hard when i push down on my bottom lip i want that to be soft and natural..what can be done?
sounds like it, Prevelle is usually very soft and it is quite thin material. I think the best is to let it dissolve away and start over, maybe with a different injector as it is technique dependent. JG 5.20.12
hey dr garcia! just had prevelle injected in my bottom lip earlier today. the pout part middle of bottom lips feel hard to touch dos this resolve with time? if so, how long? will my bf be able to feel it while kissing or is that something i dont have to worry about after letting it heal a while?
yes, it will soften up, ice for the first 24 hours and then you can apply a little moist heat, and massage with Chapstix.I doubt your bf will feel it, and kissing will not hurt it either. JG 5.17.12
Is there anything to these herbs that will HELP my acne skin?? Emblica officinalis Rubia cordifolia Acacia catechu Berberis aristata Thank You for your time!
nothing that has been shown to work in scientific articles. JG 5.16.12
I got hydrogel (hialucorp 3000) injections in the buttocks but it seems that my body rejected it or I`m allergic to it. Red lump flare ups are occurring. Medrol makes it go away but just for 2 weeks n I have to take it again. Now I`m seeking removal or dissolve method n replace with fat. What do u recommend and through what dr? I`m a Florida local
you will need to call around and see what plastic surgeon is willing to take your case on as I do not have anyone that I know that would be willing to accept you after going elsewhere for your surgery. I will say that it will not be easy to remove the material, if it is true hyaluronic acid, then injections of hyaluronidase should help. JG 5.14.12
For a little heavy of an uppereyelid, what is the best eyedrops to open the eye when it feels closed due to stress or tiredness?
I would not suggest any prescription medication be used for that problem. I think it best to see a plastic surgeon or eye surgeon to evaluate you to see what would be needed. JG 5.14.12
Re the bone spurs in the toes, I meant to tell you that I am female -- and you would be AMAZED to discover how hard it is to find non-orthopedic looking closed toe shoes for all seasons. This affects how I can dress in the summer because I usually need to wear knee-high stockings with closed-toe shoes so that I don`t get blisters (and knee-highs so I don`t faint from the heat of wearing full stockings); but then that means I have to wear ankle-length skirts and dresses so I don`t look Iike I`ve just escaped from a nursing home with knee-highs and a knee-length skirt. This little toe problem of mine has turned me into a frumpy sister-wife when that is absolutely not what I am! I`m explaining this because I suspect that these kinds of cosmetic problems don`t cascade so easily into sartorial nightmares for men as they do for women! LOL
Men can sometimes be just as vain. JG 5.13.12
Hello Dr. I had lipo on my inner thighs 3 days ago and had the fat transferred to my butt. However I now have a deformed looking butt where the fat was placed. Is this going to go down by itself? Is this normal? Thanks!
All normal, it will be swollen on your buttock for a while, but in time, it will flatten out. A little massage should help. JG 5.9.12
My 14 year old daughter has a problem with upper lip hair. We have been bleasching, but now that is not enough. I am afraid electrolysis would be to slow and painful for her--I do it and don`t think she would go through with it. What do you think about laser hair removal for the upper lip. Is there a danger of scarring or discoloration? She had medium brown hair and fair to somewhat medium skin color.
pretty safe, especially in fair skinned and dark haired people.You will need to let the hair get dark again for it to work well. Best of luck. JG 5.3.12
I tried Zeltiq last year and want to give it another go. I do think it reduced a very small portion of my lovehandles, but not as much as I`d like. Here`s my question: All the literature I`ve read on this technology claims that it takes about 3 weeks to see any results and then it takes about another 2 months for the full results to be seen. But the results I had at 3 weeks out were all that I saw -- that is, I didn`t see any further loss of fat after those initial 3 weeks (no weight changes, by the way). Is this typical -- that whatever you`ve lost by 3 weeks is about all you`re going to get from this? Or does the physiology of this kind of fat reduction require that it will take longer than 3 weeks, indeed up to 90 days? Thank you.
the love handles in some patients do not respond as well as the stomach because the skin has to be pulled into the machine to freeze the fat. Love handles at times have very tough skin and it can be difficult to suck the skin into the head adequately to get a good result. The final result comes after 2-3 months, but that relates more to the skin and not the fat, most of the fat that will go away is usually after 6 weeks. JG 4.29.12
Hello Dr., last year I had Botox injected for the first time. At 48, I feel that I have minimal wrinkles and pretty good skin, but notice the brows could use a lift. I took the plunge and the $500 cost, and noticed nothing more than some very noticeable eye bags underneath both eyes. I was less than thrilled with the results. Because I can`t afford the cost of a surgical lift, I am tempted to go get it done again, with a different dr. Is there anything I can make sure he does or maybe does not do to avoid the swollen under eye look? I know it was the Botox because it eventually wore off and my lower eyes returned to normal. Any suggestions?
I think injecting the glabella and then just the upper crows feet in will yield the greatest lift without wasting any of the dose of Botox. JG 4.28.12
I had Zeltiq to my abdomen 2 weeks ago and my skin is now covered in tiny, flat red dots (not itchy). I lost count after 150. What happened? Is this common? Thank you!
It is from the cold and in time they will go away. JG 4.26.12
My thighs are loose skin due to aging what can I do to tighten it up
Surgical thigh lift is the only thing. JG 4.26.12
I had a CO2 resurfacing 8 weeks ago. 1 week in, my ps injected a highly diluted solution of kenalog into a large pimple that had developed on my chin. Now I have a deep depression there. He was very surprised to see it because it was an unusually low dose. Will this fill in on its own? He thinks he may need to do some subcision on it ... and then fill it in with filler (which, of course, will need to be repeated). I want to avoid another incredibly expensive, permanent pothole in my face! Thank you for your time, Dr. Garcia.
Post analog depressions can fill in on their own, but it can take 6 months or so. I would not jump to anything for now. Just give it time. If you do need the subcision and filler, it will likely be a smaller problem or you may not need it at all. All the best. JG 4.25.12
Thank you so much for the quick answer regarding Otoplasty. Before the mini-lift my ears did not stick out like this. I actually feel like I look like Spock from Star Treck. Why would they now stick out? He is denying this can happen. I will of course use a new Doctor in the Boston area. Can you recommend a good doctor for Otoplasty and tell me the approximate cost?
if the incision behind the ear cut the muscle that pulls the ear back, it can happen. Otoplasty fees vary from surgeon to surgeon and whether they can do it under local or general anesthesia. I am not aware of any specialists for otoplasty in Boston, might seek out someone that does pediatric plastic surgery as the commonly do it, or a plastic surgeon who did ear,nose and throat before plastic surgery. I wish you the best. JG 4.24.12
Hello Dr. Garcia, I had a mini-lift in February supposedly to fix my turkey neck. My PS also shortened my platysma muscle through an incision under my chin. He didn`t tighten the skin and I look worse than I did before. How can this be fixed? Also, my ears now stick out and my ear lobe is attached on one side of my face and not the other. Can I have otoplasty surgery and have my ear lobe repaired? I would like to have the otoplasty surgery soon. Thank you.
well, you will need more surgery, it will involve lifting the skin of the neck and removing any excess. When this is done the earlobes can be revised as there will likely need to be incisions both in front and behind the ear. The otoplasty can be done at the same time as the neck surgery if desired, or alone. If the earlobe issue is due to the mini-lift, revising cannot be done until there is enough skin to allow the lobe to attached in a better position. JG 4.24.12
Should you wait to have a jowl lift until after you have surgery to shave down your chin? Will the skin become saggy if your chin is narrowed after a jowl lift?
Bone work should always be done first. JG 4.24.12
hello, 40 here, and it seems i have a hyperactive upper eye lid... i did have botox to the outer parts of the eyes about 2 weeks ago. it seems that for my upper left eyelid, when i put on eyemakeup it quivers and there has become a crease that has formed to the middle of the upper eye lid, due to the hyperativity. i had a surgeon see it and he went so far as to tell me i could use an endoscopic brow lift. I have been understress lately and taking valerian root to calm mynerves. im wondering if this is related to the botox.... to the eyes. im thinking also warm compresses to the eyes would relax them as the left upper lid seems like it quivers when i close it. thank you.
more likely related to the stress, doubt it is the Botox as it can be used for things like that. Holding a very mild pressure on the area for a few seconds can help break the spasm.. Might continue until the stress evens out. All the best. JG 4.23.12
Is there a differance between taking 100mg of CoQ-10 and taking 100mg of Ubiquinol? Aren`t they the same thing?? Thank You
essentially yes, best taken with fats or with a little coconut oil or peanut butter to enhance absorption. JG 4.23.12
Hello dr garcia It`s been a while since my last contact with you Hope you are doing well and the family as well Here is my question: what do you recommend for hair loss i tried everything from hair vitamins to topical lotion nothing seems to work I am menopausal I went to see my dr who recommend me to see a dermatologist In the meantime what vitamins would you recommend me to take thank you !
For vitamins, would suggest Biotin and increase your protein intake, can also you some OTC progesterone use cream, apply your inner arm. All the best and thank you for the kind words. JG 4.22.12
Hi Dr. Garcia. I had fat transfer to under eye area by well known dr. in CT, about 4 years ago. Recently the fat has become puffier, more noticeable than before. It`s not even or symmetrical, so in the wrong lighting my face looks oddly lumpy. I would like to have this corrected. Is there anyway to either remove or reposition the fat? Thanks for your help.
The safest option would be small cannula liposuction to remove it, it cannot be repositioning. All the best. JG 4.21.12
What are the normal estrogen levels for a healthy 30 year old female!! Thanks much
depends on the day of the menstrual cycle and which of the three estrogens you are referring to, or a total for the estrogens. JG 4.20.12
YOu`ve had just a few before and after photos (and the same ones) on your website for a long time. Do you plan to update and expand them soon? It would be lovely, for instance, to see your own photos of your Sculptra work, rather than Sanofi Aventis`s commercial ones, as well as to see some more examples of your surgical work. It would help us to envision some of what you suggest and describe so well in this blog! Thank you for everything, Dr. Garcia.
I will try to get some new photos on the website, soon, especially Sculptra. It is my fault, I have the pictures but I do not bother patients to ask them for their permission to be on the internet. Some patients let me show pictures in the office but not on the internet. But I will do it. JG 4.17.12
Dr. Garcia, Thanks for your quick response. How you find the time to address us all:) In regards to the over the counter progesterone is there any harm in taking it at all? Can it create any problems? Same question with the iron (liver damage?) If I take the 325mg dosage a day, can I continue until I cease having periods? I currently take a multi-vitamin that contains iron and I take 2,500 of Biotin. Do you ever recommend birth control pills like Yaz? Thanks again!
at the dose in the OTC cream, the worst that can happen is you might get sleepy if you use the whole tube. I think that dose of iron is fine as long as you are having the flow. I do not think any birth control pills will help with the hair loss, and some make it worse. All the best. JG 4.16.12
OK, inquiring minds want to know! WHEN do you find the time to exercise? You seem always to be working, Dr. Garcia! Do you post your replies to this blog from a smartphone while running? Do you do laps around the OR while the anesthesiologist is putting your patients under?! Not only do we want to know how you fit exercise into your incredibly full days, but we all also want to know what you do for exercise. It`s so essential for health and well-being, and we know you practice what you preach. Let us in on your secrets.
I work out in the early AM Monday, Wednesday, Friday and Saturday, then I get an evening workout twice per week. Its a system like cross fit, just with more variety, and at night I do aerobic training, like pulling sleds, battling ropes, tire flipping. It keeps me sane and that`s when I think about things. Without it, I am a mess! I am on the blog in between patients during the day though, when I am waiting for the next surgery to start or the patient to be ready in an exam room. I also have a very understanding wife who works out we me three times a week! JG 4.16.12
Hi Dr. Garcia, I am having hair thinning in the front of my hairline where my hair is really receding. I noticed this a few years ago and I`m 42 years old. I previously had bloodwork done and my progesterone was 0.3, and my ferritin was 33. Otherwise results normal. My doctor seemed to think that these 2 levels were normal as well. If I am premenopausal, how do you combat the hair loss/thinning? How long till your hormones level off. I don`t want to just lose more hair and time. Could I be low on estrogen? Do you suggest any non-estrogenic herbs like Macafem? Or a progesteron supplement? I just don`t want to take anything harmful. I had placed myself on iron supplements due to what I read was a low iron score but then was concerned to take it for long term. Thanks so much.
the hormones can take 5-7 years to level off. As to progesterone levels, I will say that a single blood test when dealing with hormones that change from morning to night and day to day, can be not as accurate as we want. Estrogen typically does not affect hair loss, it is more of a skin effect.I think trying some progesterone USP cream sold over the counter is a good place to start. The dose to start is on the tube, it is sold as a cream in most good health food stores. Along with that I would take biotin and increase your protein intake as hair is protein. I think as long as you are having a menstrual flow, taking iron is fine. I would usually stop them once you stop having a menstrual flow. Start with that and lets see how it goes. You could also use Rogaine too, it is also OTC. JG 4.16.12
I had Zeltiq to my abdomen 3 weeks ago and have been really, really puffy ever since. Is this just swelling? If so, should it have lasted this long? I actually feel fatter than before.
that can happen with some patients, just give it time, the inflammation form the fat cells being damaged will get better in time. JG 4.15.12
If a doctor takes photos of you before a procedure, can he send your photos to places (medical organizations or other doctors) without your knowledge to show the damage you have from a certain procedure? I do not want this doctor distributing my photos.
the doctor needs to obtain written consent before they do that, so you are safe. JG 4.14.12
For what areas do you tend to prefer Perlane to Restylane? For what areas do you tend to prefer Restylane to Perlan?
it is not based on area, but where the filler is needed, the more superficial the depth is required, then Restylane is what I prefer. If it is needed deeper, then I use Perlane. JG 4.14.12
Hello Dr. Garcia, I have horizontal wrinkles, pretty severe, right in the middle of my knees. It just looks awful. I`m not sure exactly how to explain... Saggy? wrinkly, just ugly. What is ANY idea you may have that could fix it or at least help??? I have asked this before but I was hoping something has changed as I absolutely would do anything to get rid of this!!!! Thank you!
I am sorry but I have no good solution for that area, injectables will not last and surgery will leave bad scars. Sorry. JG 4.13.12
Thank you so much, Dr. Garcia. Your answer about the MiraDry clarifies things immensely for me! Just one more question: What are the other tissues besides the sweat glands at that depth that you fear might be damaged or destroyed by the microwave energy and what would the consequences of that tissue damage be? A grateful heart for you.....
there are the precursors of skin cells, nerves, hair follicles and oil glands.The precursors for the skin cells and oil glands are needed to keep good skin integrity and appearance. It is the attempt to mitigate those problems that leads me to believe that the effects on the sweat glands will not be perfect, since they hopefully are trying to not damage the pother areas. The technology cannot be specific to one type of cell and not others, that is not how that technology works. JG 4.13.12
I searched your site for MiraDry and read your recent responses to a few questions. You express skepticism about its long-term efficacy. Can you tell us why? The oompany claims that apocrine and eccrine glands can`t regenerate once they have been damaged, so I`m not clear on why the hyperhidrosis would return. If the damaged glands don`t regenerate, then do NEW ones grow to replace them after the treatment? Also, an unrelated question: I had a lower pinch bleph 5 weeks ago. How long do those scars (lateral to the eyes) tend to stay red? Thank you for this wonderful site, Dr. Garcia. You help us all greatly!
my concern is the effectiveness of killing sweat glands and not injuring other tissues in the same depth level. I feel the destruction cannot be targeted at only sweat glands and nothing else. That being the case, I think that reduction of some degree of sweating is possible, but not sure for how long or to what degree on the average person will it be reduced. Sweat glands cannot regrow, so once dead, they are dead, but the same applies for all other tissues at that depth.I am skeptical, and if the provider of the procedure is a dyed in the wool believer, then they should not balk at offering treatments ad infinitum as if it is effective, they should not have to offer any sessions free of charge. As to the bleph scars, I think they will look much better in a coupe more weeks, that skin is thin and looks red for a bit after surgery.Hope that all help and thank you for the kind words. JG 4.12.12
I`ve had a flat dermatofibroma on my shin for 15 years. It`s dark brown in color. (I`m white and extremely fair, so it`s quite visible.) Since it`s larger under the skin than on top of it, my dermatologist doesn`t want to excise it, since the visible scar will be larger than the visible fibroma. Are there any lasers you can suggest to lighten it? Nd Yag? Medlite? Could I have it treated like a tattoo removal? Thank you so much.
The Medlite Nd:YAG should help with a series of treatments. Best of luck. JG 4.11.12
Hi, I had an excision of a mole on my upper lip. The plastic surgeon put in dissolvable subcutenous sutures as well as four visible sutures. I had the visible sutures taken outt after three days as five days fell on a holiday. I was told not to open my mouth too wide as it would pop open . Last night I was flossing very carefully and afterwards, I noticed that the excision line has gone a pinky/bloody colour and looked as though the middle subcutenous suture had broken as the middle looks like it has come apart. I started to panic a little because I thought I heard a popping sound, but it sounded like the sound floss makes so I`m not sure. So, my question is, has a subcutenous suture broken and if so, what will the plastic surgeon do to fix it? Thanks
At this point, short of opening the incision again and placing new sutures, the use of steri strips or Dermabond is what I would suggest. JG 4.9.12
Hi, I had Botox in my frown lines about 3 weeks ago. My eyes balls feel odd on both sides inside corners, when I need to look at something close they feel like if my eyes are really straining hard. Also my forehead feels very tense...but no frown lines... Is this normal?
It can be, should get better I`m another week or so. JG 4.6.12
I had artecoll injected in an acne scar about 10 years ago. It has formed a granuloma which is a concern. Can a granuloma be removed without scarring. Can it be addressed from inside of the mouth. What are the risks involved. if it is excised how big is the scar.
well, it needs to be cut out and any cutting will result in some scar tissue, although likely less than the granuloma. It cannot be excised from the inside as more structures would be damaged compared to going through the skin. The scar would be the length of the granuloma. All the best. JG 4.3.12
Hello, again. I STILL can`t get over your generosity of time & knowledge to the lay public. Thank you! My question is about a new treatment: Reaction. It`s purported to significantly reduce cellulite w/6 sessions. How does this compare to VelaShape?
Very similar, and than you for the kind words. JG 4.1.12
Will an OTC diuretic speed along my loss of excess fluid following the Medrol pack? Thank you for your incredible generosity, Dr. Garcia. You allay many concerns and give excellent advice!
OK to use, but it will get better on its own. JG 3.31.12
I am taking a medication that I have determined has caused malar bags. They are pockets of fluid on my cheeks. I cannot stop taking this medication. My question is, if i have the bags cut out, will the fluid stop collecting there?
It should stop their collection if indeed it is a festoon. JG 3.31.12
I was prescribed a Medrol pack following rhinoplasty. Just finishing and notice that I feel incredibly doughy ! I`m usually extremely thin and fit. I know prednisone causes weight gain but can such a short course of it do this? Thanks.
Just short term fluid retention, will go away in a few days. JG 3.30.12
One last question about the MiraDry. Would you please clarify why you wouldn`t personally have it done and won`t offer it in your office? Is it because of the potential collateral tissue damage -- e.g., fat loss -- or because of some other reason? I`m just trying to make an informed decision! Sorry to pester you with so many questions. Thanks again, so very much, Dr. Garcia.
potential collateral issues, cost of the technology and treatment, question of it s permanence and there are lower risk issues that need to be repeated but are quite effective. JG 3.29.12
Thank you for the answer about MiraDry. Do you mean that the microwave heat won`t cause fat loss?
They claim that their machine is focused enough to avoid things like that. I persomally would not have it done nor will be offering it in my office though. JG 3.29.12
I see some questions here about MiraDry. Since the sweat glands are in the fat beneath the dermis, does thermolysis include that tissue as well as the glands? Trying to avoid that old lady crepey under arm thing but really tired of the hyperhydrosis. Thanks, Dr. Garcia!
Damage to cause crepey skin should not happen. JG 3.28.11
Good evening, Dr. Garcia. Zeltiq promises about a 20-25% reduction in fat with each tx. In the clinical literature --and, more importantly, in your own clinical experience (because we all trust that more!)--is that promise turning out to be truly cumulative? That is, if one has an area treated twice, is there genuinely about a 40-50% reduction? And if treated three times, about a 60-75% reduction? Thank you, as always, for your honesty!
well, its not one plus one equals two. If you lost 25% the first time and then 25% the second time, the second time removes about 25% of the remaining 75%, so the second session is about 19% of the first amount and 25 plus 19, and 44 is less than 50.That revised loss continues to accumulate so three sessions will not lead to 75% loss of the original fat in my opinion. Hope that explains it without adding confusion. JG 3.27.12
Dr. Garcia....hopefully you remember me...former patient and you did my GF`s breasts several years ago. www.totalhealth4life.net (Rico) My question is I`m thinking of doing hgh as part of my protocol for adrenal fatigue/exhaustion. I was going to start anyway as I`m 57.There are a lot of brands out there.......Norditropin, Omnitrope, Genotropin, Saizen and Tev-Tropin, Serostim, Humatropin, etc. Which ones do you recommend/have experience with and how much, ballpark would the monthly cost be? Rico Connor
great to hear from you. I like the website too! I have experience with all of them and I think the Omnitrope is good, as effective as the others and usually the least expensive. The price will vary from pharmacy to pharmacy though, so I can`t say what the monthly price will be. Possibly around $500-700 depending on the dose used. Make sure you get your levels tested before you start too. I wish you the best. JG 3.26.12
I have a bump scar on the top of my lip. Can a laser permanently make the bump flat? I tried a cortisone injection before, but it did not work or was temporary.
the laser might help, but it might also come back due to the healing of the laser. JG 3.19.12
I`m doing a series of Smooth Shape treatments. The technician says 8 treatments are needed to obtain optimal results then just 1 treatment/month to maintain those results. Does this sound right to you, corresponding with your experience, Dr. Garcia? Once the optimal results are achieved, does it really take only one treatment/month to maintain them or is that part of the sales pitch? (It sounds a bit too good to be true, which always makes me suspicious.) Is it more like 2-3 treatments/month to maintain the results, meaning almost a weekly commitment of time and money? Thanks ever so much for always giving us the whole and real story, Dr. Garcia. You are a Godsend!
That is about right, the worse the problem is to start with the more sessions it will take to get to the maintenance phase.The frequency of the maintenance program will vary, but most people do it every 4-6 weeks. I wish you the best.JG 3.15.12
Hi Dr., this may be a stupid question, but....as a cosmetic surgeon and someone who constantly evaluates the face, what would you say is the one thing that gives one an aging appearance ? Is it wrinkles, skin tone, droopy eyes, marionette lines, the neck? I would love to know!
loss of facial fat as that causes sagging of the skin, and loss of the youthful contours. JG 3.15.2
Hi Dr., this may be a stupid question, but....as a cosmetic surgeon and someone who constantly evaluates the face, what would you say is the one thing that gives one an aging appearance ? Is it wrinkles, skin tone, droopy eyes, marionette lines, the neck? I would love to know!
Facial fat loss causing sagging skin and loss of a youthful shape. JG 3.14.12
Thank you for your reply to my sister`s question about Alli the other day. You kindly listed the possible side effects from doubling the dosage from one to two pills but you didn`t answer her question: One pill reduces fat absorption by about 25%. Will two pill reduce fat absorption by about 50%? Thank you for your help, Dr. Garcia. Hope you`re having a great weekend!
It will not work that way, she will absorb less but it might not be double. JG 3.10.12
Hi Dr. Garcia, I would love your input on the y lift.I saw the Dr.Oz show and was impressed by Dr.Tykell.I was also considering sculptra but hate that 3 injections are needed.Also, I fear a big fat puffy face.thank you so much for your time.Sincerely, S.Mccrrssin
here is the long of it. There are a few different types of fillers that are legal in the US, Sculptra, hyaluronic acid fillers and microgranules, such as Radiesse or Artefill. All offer some good and some bad. The hyaluronic acid fillers will last a relatively short time as they are broken down but the body as part of the normal aging process. Sculptra works by creating new tissue, but it takes 4-6 months. It will last longer though, at times 1 1/2-3 years. Radiesse is micro calcium pearls for lack of a better word, and they are suspended in a sugar base, but the sugar base dissolve in 6 weeks and you are left with about 25% of the volume injected and is typically gone in less than a year. Artefill is touted as a longer filler, as it is more difficult to break down, and there comes the bad, if you get lumps, they also will last for a long time. I do not watch the Dr Oz show, nor do I know Dr Tykell. Having said that, Dr Oz likes to show new stuff,as that is what TV is about, but I cannot vouch for many of those techniques shown in terms of long term safety or efficacy. I cannot say what Dr Tykell injects, but how long it will last is dependent on the material injected and not the technique. There is nothing special about the Y injection shape, plastic surgeons and dermatologists have injected in that direction and shape for years, it is more of a marketing term to make it sound new and improved I am afraid. Hope that helps. JG 3.5.12
Thanks for the answer about MiraDry below. You say that it helps but isn`t permanent. Do you mean that any improvement achieved will eventually be completely undone by time -- that the sweat and odor glands will regenerate after they`ve been damaged by the microwave energy?(Is that even possible?) Or do you mean that the microwaves will damage the glands only up to a certain point and that they will always remain partially active? The way you answer will determine whether or not I try this. If it`s the former -- that is, if it`s truly a temporary solution -- then I might as well use Botox, which is also temporary and incredibly expensive but at least it works. If it`s the latter -- that is, that the improvement might be minimal but at least is permanent -- then I think I`ll give it a go. Thanks so very much! Sorry to ask for the clarification.
well, in their studies, 30 days after the second treatment the patients were measured at a reduction of 56% of the sweating, they have no data past that point to show long term effectiveness, so one cannot say what will happen. If your doctor is so convinced it is permanent, ask him if he will perform Botox for you afterwards at only his cost for the medication if the MiraDry fails, and see what he says. JG 3.4.12
Hi, Dr. Garcia. My dermatologist is now offering MiraDry. His practice was one of the device`s clinical trial sites. The protocol is three treatments, spaced at four weeks each. I`m interested in trying it, but it`s expensive. Before I part with my cash, I wonder if you`ve read the literature on this and if you think it`s effective; that is, over three treatments, are the sweat AND odor glands really likely to be rendered nonfunctional? Or am I likely only to see a minor, if measurable, improvement? Thank you, as ever, for your time and expertise. You are amazing.
it appears to help, but I cannot say that it will be permanent.All the best. JG 3.4.12G
During general anesthesia, is it like having an EKG when your heart is monitored or are heart problems detected?
an EKG should be used when using sedation or general anesthesia as in those cases the patients cannot tell you if they are having a heart problem. JG 2.28.12
If one has laser hair removal, what are the best lasers for that? Is the gentle YAG one of the better lasers for hair removal?
I feel an Alexandrite laser is very good, the YAG is good, but not as good as the Alexandrite, in my opinion. JG 2.21.12
Will a jowl lift get messed up if one has surgery to shave down chin a few months later? I do not know if the jowl lift will be lost when moving shaving down chin/jaw area? Also, can a jowl lift and shaving down chin be done on same day. If the surgeries on done on different dates, is it better to have the jowl lift or chin shaving surgery first? I know the jowl lift can be done in office with numbing shots, but I do not know if chin shaving can be done in office, too?
surgery on the chin might cause some swelling in the surrounding areas but should not affect the outcome of the previous procedure. I think a surgical lifting of the jowl and the chin surgery could be done at the same setting, yes. If done separately, it really will not matter much which one goes first. It would be hard to shave the chin bone down under local anesthesia. JG 2.16.12
Thanking you in advance for your tireless efforts towards educating the lay public on cosmetic procedures. I`m a 54 yrs female & really would like an upper lip lift. I`ve view various before/after pics & have been very impressed. Before I go thru w/the surgery, is there any procedure (lasers, etc.) that would give me some shortening effect temporarily done in office?
I am afraid there are no non-surgical options that will do much to improve that area. Thank you for the kind words and I wish you the best. JG 2.10.12
Hello Dr. Garcia: I had posted a question about the Propecia side effects a couple of days ago and was wondering if you know about how long it take for Propecia (Finasteride) to be out of the system after suspending use? Thank you very much.
The libido issues might take a month or two. JG 2.9.12
Hello Doctor: I was wondering if you have had any experience with any of your patients taking Propecia for hair loss? I have been taking the medication for about 6 years now and have very recently (last 2 weeks) been experiencing a loss of libido. I understand that this is a potential side effect of the drug; however, it seems very odd to me that it would just now occur after so long on the drug. Would you recommend coming off of the medication or would you suspect that there is another cause for the issue? Thank you for any help that you can provide.
Yes, coming off is a good idea. The longer you are on it the greater the decrease in DHT. That affects your hair loss and your libido. Your libido will return to normal as the Propecia wears off. All the best. JG 2.6.12
I saw my plastic surgeon last week about a scar revision on my back. He told me that I have stretch marks around the scar, and that this will make revision difficult because it means the skin is thin. Can`t he just excise the stretch marks? I`m confused by this. Thank you.
the stretch marks mean the skin has lost its elasticity and the scar will likely stretch out with time. The only way the stretch marks can be cut out is if they are in the loose skin that was meant to be cut out anyway. JG 2.6.12
Hi Dr. Garcia, I`ve recently been considering hair-transplant surgery to help correct some thinning hair. I`ve done some preliminary research and have read some favorable reviews about Bosley. I was curious if you have heard much about Bosley? Also, is there any site or other resource that you would recommend for continuing my research? Thank you very much.
I think they are a large company with well trained practitioners and a good track record. MHR was the other large company but they have joined together and are now both all in one. JG 2.6.12
I often see light chemical peels recommended in a series. Is there any benefit (pigment, pores, skin texture) to continuing to have a monthly light chemical peel indefinitely? Is all that peeling eventually harmful to the skin?
Continuous skin peeling can over irritate the skin and cause blemishes or abnormal skin growths, it should not be done unless needed. JG 2.4.11
I see that you recently answered a question about cortisone on your website. I know it`s not a plastic surgery matter, but I too have a simple question about cortisone. I had my first injection of it last week to my knee for arthritis. The doctor told me it would take 48-72 hours to kick in. I`m at day 7 now, and I do notice about a 10% improvement in the pain. My question: is the full anti-inflammatory effect experienced at that first 72 hour point, decreasing thereafter (that is, is the amount of pain reduction I currently feel as good as it will get), or will the anti-inflammatory effect increase with time (that is, can I reasonably hope for further reduction in pain the weeks ahead)? Also, when cortisone wears off (at about 3-4 months?), do its benefits drop off gradually or precipitously? Many thanks for your time and expertise. God bless you.
well, it depend son what type of cortisone shot was given, some are longer lasting than others. Whatever effect it will have will reach a maximum, which you already have, and then from then on will continue to help for the time relative to the type of cortisone, and then wear off. In your case what you have is the best you can expect and will go down from there. Cortisone can help, but it will not help in all cases. The decrease is gradual and not precipitous. I wish you the best. JG 2.3.12
I know you`re not a cardiologist, but I wonder if you can offer a general medical opinion about a simple cardiac question. I have mild hypertension that has been successfully controlled with HCTZ for some years. Last year, I developed an orthopedic injurgy that has caused me to use NSAIDS (naproxen- Aleve, only in the recommended dosages). Predictably,as a result, I develped systems of mild heart failure which prompted me to stop the NSAIDS. Since doing that, I seem to have had some symptom relief from the CHF. What I can`t seem to get a clear answer about from my cardiologist is if the damage done to my heart by the NSAIDS is permanent or if it is generally reversable once the NSAIDs have been discontinued.Thanks very much for venturing a bit out of your field, Dr. Garcia, to proffer an opinion.
Although hypertension is more common with nsaids, the heart faure can be evaluated by getting an echocardiogram to check wall motiom and ejection fraction, should be reversible if it was short time of use. JG 1.31.12
Hello Dr. Garcia I have been up and down las vegas to look for a surgeon. It is for my daughter ruby hernandez, she was born with a hemangioma on her left cheeck and it is the size of a half dollar. I have gone to 2 plastic surgeons this year and none of them can do anything since it is to big for them, and also they say that there are too many veins around the hemangioma for them not to damage her facial nerves. I am covered by hpn hmo and I just want a sertified surgeon to take care of my daughter so she doesn`t have to be the child who gets thrown on the side because of what she has since she was born. So my question is... Can you treat her and take out her hermangioma or will it be difficult for you to do so?
I cannot say what I might be able to do without seeing here. I might suggest you see a dermatologist to see if they can shrink it with a laser such as a diode or VBeam in order to make the eventual cutting smaller. If the local plastic surgeons and dermatologists cannot or will not treat your child then it is within your rights as an HPN patient to get a referral out of the system, like to UCLA for example, to get the laser. When I was the plastic surgeon for HPN, that is how it worked I wish you both the best JG 1.31.12
Hi Dr. Garcia, I`m 54 years old and need a neck lift. Can you please explain where the incisions are for a neck lift and healing time? Thank you!
healing time before you are out in public is about 10 days. The scars will be both in front and in back of the ear, and maybe a small one under the chin, the length of the scars around the ear depend on how much skin needs to be removed, the greater skin excess, the longer the scars will be. Best of luck. JG 1.27.12
I`ve read on this website of many people who have fat atrophy after steroid injections. I had to have cortisone injected directly into my shoulder capsule this week (under fluoroscopy, so we could confirm that it was placed in the capsule only). Because of that, am I protected from the possibility of tissue atrophy around the capsule? If not and I end up with a deformity, is the tissue likely to regenerate with time? Thank you. Enjoy your weekend!
the chances of steroid atrophy in your case is almost none as long as it is in the capsule only. Best of luck. JG 1.27.12
Hi dr...thank you for so graciously answering our questions here. I would like to come in and have you tell me what I should do as far as injectibles, no surgery....yet! my budget is quite tight so I am looking for that one thing that would make me look a little less than my 48 years! What do you charge for consultations or what does your nurse charge and can it be applied to the injection coat?
consultations are $50, it can be applied to surgery costs if performed within 6 months, but not towards injectable costs, sorry. Looking forward to meeting you in person.JG 1.25.12
Silly question, but here goes....as a PS and one who sees things as aesthetically pleasing, have you ever encountered a person who looks years younger and pleasing to the eye without having had anything done? I say this because I see so many women out there who don`t necessarily look younger, just injected/done and wonder what the actual secret may be to looking a few years younger without having that look . Have you any ideas...is it genetics, lifestyle, etc?
well between good genetics, taking care of one self and not overdoing things cosmetic surgery wise, those are the keys. More is not necessarily better, especially when it comes to surgery and fillers.The least amount possible is the wisest choice. JG 1.25.12
Which is better for acne prone skin? Hydroquinone gel or cream? And what concentration do you recommend? Thank You for your time!
gel would be better in your case and I suggest at least 4%. JG 1.20.12
I had an Ulthera treatment on Monday and now my lower face looks like it`s be extremely overfilled with filler. I look like a chipmunk or like I have the mumps -- no exaggeration! It`s terrible. . Is it possible that the treatment created that much collagen in such a short time or is this swelling? The plastic surgeon`s office where I had the treatment done said they`ve never had anyone develop noticeable swelling from Ulthera, so I`m getting scared that I just had a robust response to this and will be stuck with this! Ice and head elevation aren`t helping. Thank you for any advice you can offer me, Dr. Garcia.
you do not have collagen creation, you have swelling, that is all at this point in time, the collagen takes weeks to form. It will go down over the next few days. JG 1.19.12
I see a lot of people are asking you about removing fat from their upper arms. Is it possible to do a transfer TO the upper arms? I`m 55 and have hollowness and skin folds near my armpits. When I push the skin together and simulate the addition of fat, it drastically improves. Have you ever heard of fat being added successfully to the arms? Thank you for your help.
fat injections can be done to that area, but count on at least two sessions with about 6 months apart. JG 1.19.12
My dermatologist is now offering MiraDry for the elimination of sweat glands in the axilla. What are your thoughts? Does this really work? And what do you think of Pelleve for periorbital skin texture improvement? Thank you, Dr. Garcia!
I have not seen any patients treated with it, if the heat does work to kill the sweat glands, then its great, I am just unclear on how effective one session will be in doing that. As to the Pelleve, I am not a believer. All the best. JG 1.19.12
When you want to narrow the width of the chin, would the bone be sawed on each side? If so, how would you hold the cut chin bone in place? And if you wanted to add a little more projection in center, would you use a part of bone you cut from narrowing chin or a chin implant?
It can be cut down or burred down, like a sander. There is no need to hold the chin in place as it is still connected to the rest of the jaw bone. I personally would use a small chin implant on the tip rather than the cut bone. Best of luck. JG 1.17.12
If the sides of chin is indented in due to loss of collagen or fat, would ultherapy or sculptra be better? Don`t both treatment build collagen? My jowls are also a little saggy due to collagen loss. I guess I want to know if you would need sculptra if you had ultherapy? Or would you still need both procedures?
if it is loss of collagen, the Sculptra would be better. The Sculptra builds new collagen whereas the Ulthera more shrinks the collagen present. Some people benefit from both therapies, all depends on what is going on individually. JG 1.17.12
I have heard about eyebrow lifts resulting in bald spots on eyebrows, hairline, or hair on side of head? Is this true? Would I be likely to permanently lose hair where hole was made in head to endoscopic eye lift? Also, is the just the outer edge of eyebrow usually lifted up in eyebrow lift?
that can occur when excessive tension is placed on the wound upon closure, it can happen under those circumstances under any technique. The outer part of the eyebrow is usually lifted during a brow lift, yes. JG 1.17.12
Hi Dr, I have been having botox around the eye area for almost 9 years. I have been to many doctors but no matter what technique or dosage I am given, it doesnt seem to last more than two and a half months. My forehead lasts about 4 months. This time I went to a doctor and explained my problem. He believes this is due to the fact that I have an expressive face and probably using the muscles more which is causing the botox to wear off quickly or I may be coming immune. What are your views on this doctor? I also wonder if it is OK to keep repeating botox after 2 months as it has completely worn off after this time. Thank you
I have never seen a true case of immunity although it is possible in theory. As to the function of the muscle, yes, in areas of high activity the wrinkles can come back sooner. It is for that reason that Botox has not been FDA approved for the crows feet area, it is used legally off-label, but the differences were not dramatic enough to warrant the FDA approval. You are likely destined to need frequent injections, although you could also try using a higher does than previously and that might help prolong it some. JG 1.15.12
Hi, Dr. Garcia. I`ve posted before about a white/yellowish pigment tattoo I had placed on an ear scar. I`ve had 3 laser treatments to get it off and it doesn`t yet appear to be breaking up. An aesthetician told me that because it`s clay pigment and not ink, it is likely to fade entirely on its own anyway within two years of being placed. Is that true? Thank you for your help.
I have not heard that they use clay, as to removing it with a laser, since the laser needs a color target, and there is no laser for white and light yellow, that is likely why it is not working well. Using a dermabrasion or a CO2 laser might remove the skin surface allowing the pigment to come out, but that can lead to worse scarring. I think its best to leave it alone and let it fade away with time. Sorry. JG 1.9.12
Hi Dr. Garcia, I posted last week about hair loss and you said I might try an OTC Progesterone cream USP. Can you recommend a particular brand that might be beneficial? Thank you!
All otc progesterone creams are generic, no difference. JG 1.7.12
I saw the questions below about Cool Sculpting for the arms. While the hand piece to fit the arms isn`t available yet, I was able to use the existing small hand piece on my arms for two treatments (with some acrobatics on my part and great ingenuity on the part of the technician) and have been thrilled with the results. I followed that up with Ulthera to tighten the skin. Those combined treatment modalities cost more than liposuction, but I thought it was safer for a middle-aged woman, since I didn`t want to be left with sagging skin after liposuction, which would be worse that too much tissue in the upper arms. I hope that my experience helps your other readers.
Yhank you for sharing your experience, but in all honesty, if you had conservative liposuction done, you likely would have had the same or better result. The loose skin aftet liposuction is due to the amount of fat removed. When one compares apples to apples, in terms of percent of fat removed, I think lipo would have done as well or better. Maybe a bit more down time but likely less cost. Thanks again for sharing, it is always good to hear people`s rxperiences. JG 1.5.12
You have kindly answered a few cosmetic questions for me in the past, Dr. Garcia. I wonder if you would be willing to answer a general medical question. I am using the OTC transdermal analgesic Salonpas for relief from adhesive capsulitis. I am also taking Aleve. Salonpas contains the NSAID methyl salycilate. Are there any dangers of liver toxicity with this? If so, might it be mitigated by the fact that the delivery is transdermal rather than oral? Might the use of this patch also potentiate the possibility of liver toxicity when used in combination with Aleve? Thank you for your time and expertise.
Ingestion of topical products containing salicylates, such as Ben-Gay, salicylic acid (keratolytic), and oil of wintergreen or methyl salicylate, can cause severe salicylate toxicity. One teaspoon of 98% methyl salicylate contains 7000 mg of salicylate, the equivalent of nearly 90 baby aspirins and more than 4 times the potentially toxic dose for a child who weighs 10 kg.A comprehensive review of the existing medical literature on methyl salicylate poisoning has determined that it is a relatively common source of pediatric exposures. In younger children, most of these exposures are accidental. Intentional ingestions are much more common in adolescents.A 16% morbidity rate and a 1% mortality rate are associated with patients presenting with an acute salicylate overdose. The incidence of morbidity and mortality for a patient with chronic intoxication is 30% and 25%, respectively. Hepatitis can occur in children ingesting doses at or above 30.9 mg/dL. Reye syndrome is another form of pediatric salicylate-induced hepatic disease. It is characterized by nausea, vomiting, hypoglycemia, elevated levels of liver enzymes and ammonia, fatty infiltration of the liver, increased intracranial pressure, and coma. The effects on children come sooner than in adults though. I think to use it occasionally is OK, but I would not suggest long term use, especially while also taking Aleve.All the best. JG 1.5.12
Saludos Dr. Garcia, practique artes marciales y ya tengo varios a@os con deformidad en ambas orejas las que comunmente las llaman orejas de coliflor, podria informarme el costo aproximado de una intervencion quirurgica para las mismas ? gracias.
seria aproximadamente $5,225, todo incluso. JG 1.3.12
Happy New Year, Dr. Garcia! Would you please give us all your opinion of the supplement 5 Hour Energy? Here are the ingredients: http://www.5hourenergy.com/ingredients.asp Is this safe? Hype? This looks to me similar to what one could obtain from a good B-complex. Thank you for sharing your expertise with us all. A healthy--and energetic!--new year to you and your family.
I think it is safe, some people might feel their heart race a bit or feel warm, but nothing dangerous, as long as you don`t take too much. It is like a weak form of Red Bull or Rock Star, not much more than b vitamins and a cup of coffee. Al the best for the New year. JG 1.1.12
i had flat but visible temporal/periorbital veins. A bay area board certified plastic surgeon made this situatuin infinitely worse by tying iff the veins at the hair line. Now I have bulging periorbital veins along with worsening temporal hollowing that only Steve`s to accentuate the problem. Would your temporal implants modify this poor outcome. I`ll send photos upon request. Thank-you.
The implant will help the hollowing but not the veins, sorry. JG 12.31.11
i had flat but visible temporal/periorbital veins. A bay area board certified plastic surgeon made this situatuin infinitely worse by tying iff the veins at the hair line. Now I have bulging periorbital veins along with worsening temporal hollowing that only Steve`s to accentuate the problem. Would your temporal implants modify this poor outcome. I`ll send photos upon request. Thank-you.
The implant will help the hollowing bit not the vein, sorry. JG 12.31.11
Hi Dr. Garcia, I need to decide whether to have fat removed from my jowls by sono bello which uses a laser to remove fat or by the new EndyMed pro 3 deep radio frequency device. Sono Bellow would make three small incisions under my skin, one directly below my chin and the other two on underside of my ears. Theyll remove the fat that way. This would be done by a plastic surgeon. The EndyMed Pro 3 Deep would be performed by a derm. I cannot afford to do both, only one. Which do you think would help me the most. I have mild to moderate jowls that drag my face down. thank you jc
Between those 2, go with the sono bello. JG 12.29.11
Hi Dr. Garcia, I`m 54 year old and experiencing noticeable hair thinning. I had a hysterectomy at age 40 and have taken Menest 0.625mg. daily since that time. I was wondering if progesterone cream USP might help? Also, wondering if you have ever heard of good results with a supplement called Viviscal? Thanks for your response and Happy New Year!
I habe no experience with the Vivisval, but you likely need some progesterone, OK to start with the OTC USP, but could also get blood tests to monitor them, should shoot for a level normally found mid cycle. All the best and Happy New Year. JG 12.29.11
Let`s say you had a rib graft for nose revision surgery and the doctor banked some rib cartilage in chest in case you needed another revision. How is removing banked rib different from removing rib for the first time? Will general anesthesia still be required to remove banked rib? I feel a hard a ball of something over a hollow area. I am thinking that is where rib cartilage was removed and bank rib added. I am not sure why the doctor did not lace banked rib behind my ear since he would still need to cut my chest open again? Is it possible for the doctor to recut the incision on my chest to remove the rib and then place it behind surgery for revision surgery in the near future? I was stressed over having my breasts exposed the first time during surgery. If possible, I would rather have the doctor remove the banked rib from behind my ear. I can wear a bra in office procedure vs. surgery center.
I am not sure why banked rib was placed, very unusual. I think you will need general anesthesia though. JG 12.26.11
Hi, I am dealing with overfilling from silicone in my lips and cheeks. I`ve had kenalog injections and they have been successful in reducing the size, but after time more scar tissue always forms. Would 5fu mixed with kenalog help in reducing the collagen and prevent it from coming back? Do you have a recommendation for a doctor in Southern California? I would be willing to drive up to Vegas to have it done by you, but your receptionist said you can`t take patients that aren`t former clients. I`ve been struggling with this since I was 20, and I`m now 26. This has been a heart breaking mistake.
I am sorry but any ef fect you are getting from Kenalog or 5FU are likely from effects on your normal tissue as those medications will have no effect on silicone. Eventually if they form lumps it might be able to be cut out, but there is really nothing I can suggest for you at present. Sorry. JG 12.17.11
I`ve had facial swelling since after getting the second set of kenalog injections (Sept., then Oct.) The injections were of at least 40mg each session (under trapezius, top of shoulder, base of neck, skull). The area above the right upper lip has darkened (the skin, not the hair)...there is slight puckering of the lip, too. On the left side, there`s more puckering of the lip, but much less darkening of the skin. Will this fade?!?! The right side was once totally black after botox injections, but that faded very quickly. Thanks!
I am sorry but I have never heard of a reaction like what you are describing form a Kenalog shot in those areas. JG 12.15.11
Thank you, Dr. Garcia, for your comforting and informative reply about the hematoma in my butt. I`m so grateful to you for answering my (and others`) questions when we`re struggling. One final question for you about all this: The hematoma liquified at day 9 post-op, which, of course, caused the blood to leak out. My surgeon expressed it manually on Saturday, and I have been doing the same morning and evening as instructed, but the wound is still oozing a great deal of blood. It doesn`t look like old blood from the hematoma but fresh, frank blood; it`s bright red and not clotted, unlike the kind we were able to get out on Saturday at my surgeon`s office(dark red, clotted and sticky). At this point, I`m thoroughly soaking an ABD pad every 1-2 hours. Does this sound right to you? What could be causing this extra bleeding and what can be done about it? I`m not seeing my surgeon again for two more weeks. If thislevel of bleeding keeps up, would you recommend that I call him by the end of the week, or is this to be expected from a wound this size? Thank you again, Dr. Garcia. I apologize for bothering you twice with this matter. I wish you and your family a blessed and healthy holiday season and new year.
Bright red blood is new blood, maybe a small blood vessel has popped. You should see the surgeon soon, they can likely cauterize it for you. Best of luck. JG 12.12.11
Hi, Dr. Garcia. I wrote last week about bleeding from the incision of a scar revision on my butt 7 days after the procedure. I did see my surgeon and we both agreed that it was likely leftover blood in the tissue from the procedure leaking through. But yesterday and today, it has started to gush, causing me to need to change the dressing every 10-15 minutes. It has also become excruciatingly painful -- like a burning hot poker is stuck into the incision. I passed out from the pain this afternoon. There is no pus in the blood and I have no fever, but the blood smells distinctly sweet and acrid, like rotting flesh. Do you think it`s infected? I called my surgeon and he is very kindly seeing me on Saturday. In the meantime, any suggestions to stop the bleeding and to handle the pain? Acetaminophen isn`t helping at all. (By the way, I`m taking no anticoagulants of any kind.) Thank you for your help!
Applying pressure somehow could help, maybe getting you int a compression garment might help, you might have been placed in one after your original surgery. Sorry to hear about the issues, hopefully that old blood will absorb soon and stop draining. All the best. JG 12.9.11
Had a scar on my butt revised last Monday, closed in 3 layers. It kept bleeding that day, so the surgeon kept me in his office and ended up opening it after a few hours to see if he could cauterize any bleeders. He did find an artery that he had nicked, so he cauterized it and closed again. It`s Sunday morning and it`s starting to bleed again. What`s going on? II`m not taking any anti-coagulants, by the way.) Do you think he`ll have to revise it for a third time? I really hope not.
might be just bleeding from the scar tissue not being able to collapse on the bleeding vessels, I think you should see the surgeon this week and I cannot predict whether you will need another revision. All the best. JG 12.4.11
Had a scar on my butt revised last Monday, closed in 3 layers. It kept bleeding that day, so the surgeon kept me in his office and ended up opening it after a few hours to see if he could cauterize any bleeders. He did find an artery that he had nicked, so he cauterized it and closed again. It`s Sunday morning and it`s starting to bleed again. What`s going on? II`m not taking any anti-coagulants, by the way.) Do you think he`ll have to revise it for a third time? I really hope not.
bleeding is more common when operating on old scars as the tissues do not collapse well around the blood vessels. I think seeing your surgeon again is a good idea, but no way to predict whether another revision will be needed. All the best. JG 12.4.11
Dr. Garcia, not a question this time (just catching up with your pearls of wisdom) I thought I would also take this opportunity to wish you and your family a wonderful Christmas and a safe and prosperous New Year. God Bless and cheers.
Thank you very much, my family and I appreciate it. JG 12.4.11
Good evening, Dr. Garcia. One year post-op from a butt lift and the scar is absolutely terrible -- wide, red and railroad tracked. It`s also too high. My surgeon doesn`t want to lower it because it will require him to dissect the skin off my mid-back, but can the scar at least be excised and made thinner, if not lowered? Of course back scars are never the best, but this is truly terrible. He`s a great surgeon; I just got unlucky. He told me the scar would take its final form at one year, but now that we`re at that one-year mark, he`s telling me it will take another two or three years. Is this accurate? I fear he just doesn`t want to revise it. Should I find another surgeon? Thank you for your advice.
there has to be some laxity or looseness of the surrounding skin in order to revise the scar and make it thinner, so either the back skin needs to be lifted or the buttocks undermined again and lift up further. If you have concerns, seeking a second opinion might be a good idea. It might be something that cannot be revised at the present time and you will need to wait until there is enough loose skin to make it worthwhile to attempt a revision. JG 11.4.11
The place where I feel hard rib is on my chest directly below breast. I am not sure if you thought I meant I felt hard rib on my nose?
Sorry, that is what I thought, that would not shify but the edge may need to be burred down smoother JG 12.1.11
I think swelling went down so I am just noticing it now. In regards to my question below, is it normal for the rib tip to wobble or move back and forth when you press it? Why does it wobble? When you mentioned the rib graft shifting, did you mean the rib moved out of place where it was cut?
it is not uncommon, although it is usually held in place with sutures, they will not hold it rigid.As to shifting, if the pocket where the rib graft was placed was bigger than the rib graft itself, it can sometimes shift as the surrounding tissues do not grow into the graft in order to immobilize it. JG 12.1.11
I had a rib graft for nose revision surgery. An inch above the incision line, is something that wobbles and feels hard. It is about a half inch wide. It feels too hard like bone to be scar tissue and it is above the scar or not on the scar. I am concerned that either a rib was cut and is ticking out or too much cartilage was removed from my rib so there is no padding over my rib- and that is why I feel a pointy end. Do you know if the ribs have points at top- something like a knuckle on a finger? Do you know if the rib is cut through to get to the cartilage?
the rib can have a tip that feels like that, it can be from the rib graft shifting or from the swelling going down and now the tip is more visible and palpable. I think you should see the surgeon to make sure that a revision is not in order. Typically the rib graft is just the bone, and minimal to no cartilage. All the best. JG 12.1.11
I had Perlane injected in the tip of my nose do to the fact it is lopsided & boxytip. In 3 1/2 weeks my body seemed to metabolize it & I need to go back for more a month later. Is this normal or is my body missing something & trying to get it from this Perlane? Should I take a supplement to prevent this or does this normally happen after only a month of being injected?
should last longer than that, might have been injected too deeply.There are no supplements will slow the absorption of a filler. JG 11.18.11
Hi Dr. Garcia! I`m a bit flustered. I`ve had the sixth round of 5-fu injections in attempt to dissolve dense internal scar tissue about the size of a small tootsie roll following gynecomastia surgery a few years back. Having been on an aggressive administration being every two weeks, it seems that the lump hasn`t responded as much as I had hoped. It seems like the mass had initially responded somewhat and now it`s about 75% of the original size but very firm and dense. It`s this highly concentrated, hard nub of tissue that seems to be more resistant to 5-fu treatment. It`s as if subsequent injections are working very slowly or not at all following the third treatment when the lump had become noticeably hard but constricted. Still lump is tender from the 5-fu. I know my surgeon takes great care to inject into the lump because he squeezes around it so that it sits tight against the skin before jabbing. Having much experience in this area, what is your take? Do you have any recommendations or suggestions? Many, many thanks!
Assuming the injections are done properly, you might want to mix the 5FU with kenalog to soften the scar tissue and make the intralesional injection easier and more effective. Also the injection should be done while withdrawing the needle so.as to leave the 5FU in the tract rather than allow it to go outside of the scar tissue. JG 11.14.11
The only time I used to get BO underarms was during my period or if I overexerted myself. Or I only had to wear deodorant during that time. I am in my late thirties now with fibroids in uterus. Since then, I have BO underarms all the time. I had a blood test and my hormones are normal. Just wondering what hormone I might have too much of or too little of to cause this BO. The BO is the same as it was when I had my period, but it is like that all the time now. as women get older, do they usually get more BO?
The BO is related to the hormone DHT and to bacteria in the oil and sweat glands. It is safer to control the bacteria than manipulate the hormones, but you can try some topical progesterone cream from the health food store. JG 11.13.11
How many milligrams of Red Yeast Rice with CoQ10 does one need to take for it to be clinically effective in lowering LDL? My capsules come in 600 mg doses. Do I need to take one, two or more/day? And if I need to take more than one, is it best to separate them into morning and evening doses? Thank you so much for your time and kindness, Dr. Garcia! Hope you`re having a great weekend
That will vary from patient to patient, it will need to be a trial and error issues. Start with one and then get your blood test done after 6 weeks, then increase as needed. JG 11.13.11
Hi Dr Garcia, I had my corner of mouth lift done, my mouth look like I was frowning all the time. It looks like the plastic surgeon removed some skin from the corners of my mouth downward a little bit, Does this work? I cant tell because I am swollen still and I have white tape strips over the stitches. The strips are pretty gross looking yellowish and curling up. My question does this procedure work? Can I remove those strips it been 5 days?
The swelling will mask the degree of improvement for a while, I would leave the strips on until you see your surgeon. JG 11.12.11
Thanks for answering my question below, but you didn`t tell me if the whole ear scar can be revised once the lobule is pulled forward and up onto the cheek. Can it be set back to its original position, or would a revision only advance it farther onto my cheek? Thank you!
likely not as it will be pulled further out of position, it would take a long time for the skin to relax enough to do it safely. JG 11.12.11
The aesthetician in my plastic surgeon`s office tattooed a small red facelift scar of on my lobule with the lightest pigment available, but now it just looks like a red scar with crusty make-up on it. My dermatologist tried to get it off with an NdYAG, but it didn`t do much of anything. Can I ask my plastic surgeon to dig the pigment out? It`s just a few milimeters deep. He`s tried to revise this scar before, by the way, and he ended up advancing my ear forward, so he can`t revise the whole thing again. (Once that has happened, the ear can`t be put back in it`s original position because too much skin was removed, right? If I`m wrong, maybe i should ask him to try to revise the whole scar again?) Thank you for your help, Dr. Garcia.
well, he might be able to dig it out but it might leave a thicker scar. JG 11.12.11
I`ve gained a little weight, which has gone to my hips and thighs -- of course! -- and it`s incredibly itchy. Why would it be itchy? This has happened to me before. Thank you.
Rapid weight gain can create micro tears in the skin, and that can itch short term. It will go away though. JG 11.11.11
Dr. Garcia, thank you so much for your prompt response. I have another question regarding radiesse injected along the nasal labial lines. It seems as my doctor injected it low for the cheek and high for the fold. It`s making my face very full around the bottom 2/3`s. That along with the flat lip makes me look off . I`m going to get juvaderm to build the cupid bow and philrum column but I don`t know if I should get more radiesse higher on the cheek bone. Thank you for taking your time to answer all these questions. sincerely, jc
I think the amount of Radiesse you would need to lift the cheek enough would be quite a bit. Not sure it would be worth it. JG 11.6.11
Hi Dr. Garcia, I had some botox to relax lip lines and radiesse for nasal labial folds. I had asked my dr for juvaderm instead of the radiesse but he said the radiesse would last longer. Now I have a very flat upper lip and there`s no definition between my cheeks and my mouth. What can I do to fix this? Can I use juvaderm by another Dr. build the philrum column and add a little bit of juvaderm to the cupid bow? Thank you in advance.
well, you will need to let the Botox wear off, nothing is going to speed that up I am afraid. That is why Botox is not approved for use around the lips. I think fillers to plump the lip might help some, but it will not look as natural as your own philtrum. Best of luck. JG 11.6.11
Hi Dr. Garcia, I am scheduled to have an revision endoscopic brow lift on one eye and corner of mouth lift. I had a face lift and brow lift 2 1/2 years ago. My question is, should I expect the same amount of swelling from the brow lift? is there something I should be asking my surgeon before the surgery? Mouth lift...........swelling too? Thanks for your advise.
about the same, might take a little longer for the swelling to resolve due to the scar tissue form the first surgery. If the corner of the mouth is just done with incisions near the nasolabial fold, it should not be bad in terms of swelling. If the facelift incisions are used for the corner of the mouth lifting, then the same thing will apply as it does to the brow lift. Best of luck. JG 11.3.11
Hello Dr. Garcia. Is it normal for internal scar tissue mass to feel sore during 5-fu treatment? I received a shot about 10 days ago and if I apply any pressure to the lump it feels a bit tender / sore. Thanks.
yes, it is normal, just the body dealing with the injection and the scar tissue, it will be less and less with future treatments. JG 11.2.11
I had a CBC on Thursday and then got a phone message from my doctor`s office that they need to do it again. In the meantime, they instructed me not to drink orange juice or to eat bananas. What did they see in the results that is causing them to give me those instructions? Thank you.
not aware it would affect your CBC, but could affect your electrolyte SMAC 6 or 12. JG 10.30.11
Supplements are back in the news due to some recently released studies indicating that they not only may not be useful but may also be actively harmful. What is your take on this, Dr. Garcia? Personally, I take a multivitamin, calcium and D supplements, B12, omega 3 oil and red yeast rice with Co-Q 10. I`m not particularly worried that I`m endangering myself, but I`m wondering now if I`m really benefitting from any of this. Thank you, as ever, for all your wise guidance.
well, as always, one side is trying to disprove the other side.Let me start by saying that there are many medications that are marketed or used to try to prevent disease and they do not all work and many have serious side effects. Secondly, it is an unfair comparison to equate a mediation with a nutritional supplement. Usually these comparative studies are done with single vitamin,and in many cases, not even the actual vitamins nutritionists recommend. Too much of any one thing will upset the balance in your body and potentially cause problems, therefore vitamins are not like medications, you need to take a balanced array, not just a single one. Also in the recent release about vitamin E, they only used a single type of the vitamin and left the others out, that created a man made imbalance that could explain the problem with the data interpretation. Vitamin E comes in many different components, it is not just one thing, so you need to take all of them, not just a part of them. I can tell you that I take a whole lot more than you do, and will continue to do so. All the best. JG 10.28.11
Hi, Dr. Garcia. Last week, I had micropigment placed along a red scar (3 years old) on my ear that hasn`t responded to lasers. The technician`s work is remarkable; I`ve seen many of her clients. Unfortunately, it looks like I`ve made a bad situation worse. I`m really, really white, so she used the lightest pigment she could, but in my skin, it looks yellow -- and crusty, like bad make-up. Now, the scar is still visible and it`s covered in yellow, chalk-like striations which make-up can`t cover. How do I get this stuff out of my skin so I can go back to the terrible scar that I can (sort of) cover with make-up? Thank you for your help!
can try a YAG laser to remove the new pigment, but as it is light, it might be difficult to make it look better. JG 10.27.11
Hi Dr. Garcia. I messed up the 5-fu doses in my previous response. It`s should read 50mg/ml and whether 100mg/ml would be more effective. Thanks.
no need to use anything stronger, I also dilute mine with lidocaine before injecting, so that drops the concentration too. JG 10.26.11
Hi Dr. Garcia. Just a few more questions regarding the strength of 5-fu for internal scar tissue reduction. My doctor uses 500mg/ml strength. Is that what you normally use? I notice that there`s a 1000mg/ml strength as well. Would that give a faster response or would it be overboard? Thanks again!
Going stronger is not better. Your doctor should know the proper dose that is used in the medical literature. JG 10.26.11
Hello there. Is the response time for 5fu similar to kenalog for treatment of internal scar tissue or does it take longer? Thanks again!
the response varies form one person to another, the newer the scar the faster it responds, but I prefer the 5FU as it does not cause normal tissue loss in the surrounding area. JG 10.24.11
hello dr. garcia, I have horizontal wrinkles on my knees that I hate... they`re pretty thick & noticable and right in the middle. Do you know of any way to get rid of these? Thank you!
I am sorry but I do not have anything that is reliable that works for that area. JG 10.20.11
Hello Dr. Garcia I am so happy you have a site like this. Thank you. I had Dermalive injected in my lips 4 years ago and recently had restylen injected in the same place. I have a granuloma that has formed on the ridge of my lip. It has remained consistently the same size now for 9 months, I have had 6 steroid injections and had some of it cut out. Is there any way this will go away on its own? Is there anything you can recommend? My plastic surgeon the one who did the injections wants to go in and attempt to cut more of it out. Im nervous and upset that it may get worse and Ill have to live with it for the rest of my life, please help. Thanks you
I am sorry to say that it will not go away on its own, granulomas can at times be helped with the steroid injection, but it will likely need more surgery to cut it out. JG 10.17.11
Hi Dr, I have avoided wearing short skirts for as long as I remember as, although my legs are in fairly good shepe in the upper leg, I have very chubby knees which kind of looks odd compared to the rest of my legs. What would be the best procedure to remove this, surgery or maybe Accent for the body? Thank you.
It depends where the fat is and how much, a small amount of fat can be removed with liposuction to make it look better. I am not a fan of the Accent though. JG 10.14.11
Dr. Garcia, Ive finally decided to do a brow lift and under eye lift. My doctor gave me the option of light sedation or anesthesia. The former I would be sedated but awake. I`ve never done this before but I`d save $1500 on anesthesia. Do you have any thoughts on this? Not the money factor (per se) but the pros and cons and the differences between the two options? Since it is a 3 hour procedure, I can only wonder how I`m going to lay there awake for 3 hours. Thank you!
I prefer general anesthesia as laying on your back and not moving for 3 hours can be tough, sedation or no. JG 10.6.11
Dr. Garcia I can`t find an earlier post about DHEA. I just had some blood tests which said that mine is elevated but my testosterone was normal. I am female 62 yrs young. What would an elevated DHEA level do to me or what symptoms show up now or later. Thanks as always.
Nothing bad, DHEA is a precursor for stress and sex hormones so you likely are well balanced. JG 10.3.11
Hi Dr. Garcia, Nearly 9 weeks ago I had an inner thigh lift and buttocks lift. This was done because I had lipo dissolve several years ago that destroyed the banana under my buttocks and skin with poor elasticity due to fluctuating weight during adolesence. I am pleased with the results except I am noticing one buttocks hangs an inch lower than the other. The incision is smaller and stops about 4 inches closer to the groin than the other. As a result, my cheeks look uneven and the droopier side has a few rolls . It is very noticeable in pants. I want to discuss it with my doctor and consider a redo in that area. Could the appearance possibly change in months to come? Is there a reason why one incision goes close to the outer thigh and the other stops underneath? If I believe it is poor work and not poor healing how can I approach a redo? Thank you in advance for your feedback.
I do not think what you are describing will likely get better and a revision is likely. I think waiting a few months to let it all soften up is best though. As to why that happens, it can be because the sutures placed into the deep tissue did not hold, or your skin is of poorer quality on that side and does not hold up as well. I think most surgeons want their patients to be happy and an open discussion about what you feel is the ebst. JG 10.3.11
Hi Dr. is there any truth to the notion that using heavy moisturizers in the lower eye lid causes puffy bags under the eyes? I read this somewhere and just recently bought some very oily skin cream and it seems my eye bags have gotten worse. My husband, on the other hand, simply washes his face (no moisturizer, no nothing) and has zero puffiness under his eyes. Is he just lucky (we are both in late 40`s) , or should I stay away from heavy creams/oils under the eyes?
The cream will not cause or aggravate the lower lid bags, its just part of the aging process and that is highly dependent in genetics. JG 10.1.11
Hi Dr. Garcia. I`m in my 40`s and have been thinking of starting on progesterone cream. My partner and I are considering trying to have a baby (difficult though it may be at my age) and I am wondering what this means in terms of taking progesterone. For how long would I want to stop taking it before conceiving? What are the dangers? Thank you for your advice.
High progesterone levels can keep you from ovulating,but once pregnant, your placenta will make lots of it so you need to discuss all of that with your obstetrician first. JG 9.28.11
It might be easier to send you a private message since you have an email address. But what if a busy doctor has no email address or does not take calls from patients. What if a patient wants to make complaint about staff to doctor, but patient does not want to go back to doctor`s office for appointment, which would be only way for patient to privately talk to doctor. If the patient mails a letter, the staff will open it. Do you think the staff would open a telegram? Or how can I get a message to doctor without the staff reading it?
maybe call after hours and have the answering service put you through to the doctro directly. JG 9.28.11
When I log onto www.Luments.com, I get this message This domain has recently been listed in the marketplace at domainnamesales.com.
Sorry, it is www.lumenis.com JG 9.26.11
How much down time is there with a 12.5% TCA Peel? I already peel for 4 to 5 days with one application of .1% retin-a a week!Thank You for your time.
might take 2-4 days also for the 12.5% TCA peel. JG 9.26.11
Just one other question about Ulthera: It seems you don`t think it`s particularly effective, but do you think it`s possibly harmful? Thank you.
I think it is likely effective, but for a short time, and it hurts, is relatively expensive , I don`t think it will harm you though, if done properly. JG 9.22.11
I did Ulthera last night and was warned that the heat could dissolve the HA I have in my face. Today my face looks weirdly swollen and distinctly lumpy. Is it possible that the HA dissolved into little pools, causing the lumps, or are the lumps more likely just residual, temporary sweIling from the heat? I`m hoping it`s the latter but would like to know if it`s the former and if I`ve inadvertently gotten myself into a permanent mess! I kinow you`ve not been too impressed with this technology in its start-up phase. Now that it`s been around for a few months, have you formed more opinions about it? Any new reports about it at the professional meetings you attend? Thanks so much, as ever! By the way, for any of your readers thinking of having this procedure done, my advice is to take acetamenophine in advance. It can be quite uncomfortable at points.
There are no studies showing the effects of Ulthera on fillers, what you are seeing though are very well recognized side effects of the Ulthera, and they get better with time. JG 9.22.11
Will having a doctor burn off seborrheic keratosis get rid of it? Or does it need to be cut out?
it will remove it but it can grow back, in general they are not worth cutting out as you will likely get more with time. JG 9.21.11
Thanks so much for suggesting I see a neurologist to assess my shoulder and arm pain. Just curious: what is typically done to treat nerve entrapment? Will this likely require surgery? I just want to be mentally prepared for whatever a neurologist may suggest. Thanks again. You`re awesome, Dr. Garcia!
All depends, might need some injections, might need surgery on a herniated disc, hard to say.the injections are tried first. Best of luck. JG 9.18.11
Sorry to ask you a non-plastic surgery medical question, but you kindly answer such queries from time to time, I see. I have had persistent, increasing and now debilitating pain in my L trapezius and rhomboid muscles over the past eight months and can no longer dress myself without assistance, carry anything in my left hand, etc. My primary care physician thinks it`s just strained and will heal on its own. I tried physical therapy for 4 months, but it didn`t improve the situation at all. In fact, it got worse. Since it`s become so disruptive and all-consuming (the pain even wakes me up whenever I move in my sleep), I`m ready for some kind of significant intervention. Will a cortisone injection just masque the pain temporarily? What are the real risks of such a course of treatment? I assume that tissue atrophy is right at the top of the risk list. HOw often do those need to be repeated in most cases? Is that something my pcp could do, or do I need to see a specialist? Is it something my plastic surgeon could for me? I`m scheduled to see him again before I see my primary care person, and if he can do it for me, that might get me out of my agony sooner.) Any other, safter suggestion? By the way, I can`t locate the cause/origin the pain. I`m athletic and had been lifting light weights, rowing, biking and running for years, but I don`t recall a specific incident that brought this about I just noticed it one day last February, and it has grown progressively worse ever since. Of course, all my athletic pursuits are largely on hold since the advent of this pain. Now all I can handle are very gentle, slow walks, so my fitness has deteriorated markedly, another distressing consequence of this development. Thank you very much for any suggestions you can offer me, Dr. Garcia. I greatly appreciate your help.
I think an evaluation by a neurologist to evaluate the source of the nerve compression is best, most likely a pinched lower cervical or thoracic nerve root, and would not use a cortisone shot until an accurate diagnosis is made. Best of luck. JG 9.18.11
Is someone immunocompromised if they have anemia?
it will have a negative impact on healing. JG 9.14.11
Hi, Dr. Garcia. Wondering if you`d be willing to tell us all what you regularly do for your own lovely face -- daily and occasionally? And how about your wife (whom we don`t see, of course)? I have learned a lot from asking my docs what they do and use and what they encourage their family members to use and do -- in addition to the requisite sunblock every day!. Of course, everyone`s facial anatomy, skin, age and needs are different, but I`ve found that this question is a great way to get to the musts ! Thank you for all you do, Dr. Garcia!
I use a facial cleanser twice daily, I use my cell matrix cream at night, I have Botox or Dysport injections done about once per year, and that is it. My wife does the same, but she also uses a Clairsonic power scrubber at night to help remove all the make up, but I don`t need that. Nothing fancy, keep it simple, most times people over do it with the products. All the best. JG 9.14.11
Dr. Garcia, I`ve had juvederm injected in my cheeks, temple area and under eyes within the last two months. I`m considering having dermabrasion done on my face as well. Is it ok to have this procedure done while having filler in my face or do I need to wait a certain amount of time?
OK to proceed anytime. JG 9.10.11
Thank you for the answer below about the butt lift scar. Yes, the tracking is from the internal sutures. Anything that can be done about that? Laser? Or is this a matter of persisting tension that no amount of laser treatment can fade? Thank you so much for your help!
Laser can help redness buy not for pale spots. JG 9.1.11
This is more of cosmetic issue than cosmetic surgery issue. I got an oozing and itchy sore under my mouth after a guy kissed me. It definitely looked like a herpes sore. When I did not go away after a month, I got a prescription for herpes cream. The herpes cream worked so I thought I had herpes. This happened 5 years ago. Recently, I ha a herpes 1 & 2 blood test, which was negative herpes. Do you know if you can get a herpes outbreak without coming down with herpes? I thought herpes was a life long condition.
The blood tests are not always accurate as when you do not have an active infection, the blood titers are low and might not show positive. It so might have been some other cause long ago, like a fungus, that was going to heal on its own, with or without the herpes cream. JG 9.1.11
One year post op butt lift, and the scar is still red, though flat. One side also has bright red railroad track marks (which extend about 1.5-2 inches on each side of the scar!), though no external sutures were used. That side is also 4 inches higher than the other side. It obviously needs to be revised as well as lowered. My surgeon says that it isn`t possible to repair it. Is that really true? I cannot wear any pants, since it always pops out if I bend over and my shirt comes untucked. I`ve been living in dresses for the past 11.5 months. I`m so discouraged. I paid an immense amount of money for this long-awaited improvement, and it left me seriously disfigured and apparently with no option for repair. Thank you very much for any advice you can offer, Dr. Garcia.
The tracks might be from the stitches used below the skin, as to revising and repositioning the scars, that cannot be done until there is enough loose skin to cut the scars out and shift their position and close the incision with low tension. All the best. JG 8.31.11
Is it normal to have anemia after any surgery done internally in your abdomen area?
depending on the type of surgery and what was encountered, it can be normal, yes. JG 8.26.11
You have been very kind in answering some of my plastic surgery questions in the past. I`m hoping you can help my family with a more general medical question. My niece was recently diagnosed with an eating disorder and is now receiving good psychiatric care on an out patient basis. Her preferred method of purging has been laxatives, a very dangerous choice for electrolyte imbalance, cardiac implications, etc. Of course, this is a disorder that doesn`t yield to rational argumentation, but my sister and her husband are wondering if appealing to her common sense might support her therapy in this regard: isn`t it true that laxatives will only temporarily dehydrate a person and not prevent the absorption of nutrients, since they only affect the large intestine from which waste is expelled, not the small intestine where food is absorbed? This disease is not about rationale choices, we know, but this particular method of purging not only seems highly dangerous but also uniquely ineffective. Thank you very much for any help you can offer us in this stressful time for our family.
That is a valid approach and explanation and worthy of being tried. JG 8.21.11
I have severe anemia after rib graft for nose surgery. I had a blood test earlier in month I had surgery, but I did not have anemia then. Is it possible to have internal bleeding from rib graft? I am trying to figure out if I could be bleeding from my rib.
possible, but your body should be able to replace the blood after 3-4 weeks, might need a little iron supplementation too. JG 8.21.11
What do you think of nitric oxide supplements marketed by GNC? The claim is that taking them 30 minutes prior to a workout will increase the amount of nitric oxide metabolized by muscle, thus increasing muscle duration and, presumably, increasing muscle mass. Hoax? Dangerous? Worht it? Thanks!
Little science to prove the claims, some claim they get a better pump but the degree of pump does not mean greater muscle growth. jG 7.26.11
My aesthetician is really pushing ultrasound facial combined with sessions of microderm. She says both would have a great result in plumping the skin. I say, I`d rather have chemical peel and microdermabrasion. What is your expert opinion. Cost is same for either combination. If chemical peel, what strength...I am blond blue eyed but not fair skin (Cuban descent). Thx.
Maybe 15-20% TCA peel after the microderm. JG 7.26.11
Hi Dr G. When i have my mouth closed without making a smile i notice the bottom corners of my mouth pull down. I`ve noticed this on alot of elderly people. I am only 52. What is this and how can I correct it?
If you send me some pictures to email@example.com I migjth be able to give you some optons. jG 7.23.11
I`ve been reading your replies to the person who wants a small amount of perioral fat removed. I have the same problem, though I am older than she (52). Looking at her photo, it seems that my problem looks more like a classic descending modiolus than hers, accompanied by a very small accumulation of fat. My own ps refuses to remove that fat for fear of nerve injury. How common is that complication? I am also reluctant to do it because I don`t want perioral hollowing; I`ve already got submalar hollowing which I need to correct with Sculptra. I`ve had a facelift already, so my surgeon doesn`t think it can be corrected through another face lift; that is, I don`t have jowls along my jawlin that can be lifted, but I do have mouth jowls. Picture a mild version of Arlen Specter. but on a woman. Very pretty! My four questions for you are: 1) Is it possible to remove only SOME of that fat rather than all of it to avoid the hollowing -- and/or is it possible to slide the fat upward rather than remove it entirely? I think the dilemma is not unlike the classic lower bleph issue: you can remove the fat, but then you may end up with a hollowing that looks even worse, and I obviously want to avoid that at all costs. 2) Might it be necessary (and even possible) to lift the modiolus a little through the same intraoral incision you would use to remove a tiny amount of that fat? I ask because I agree with my surgeon that another classic facelift--which addresses the jaw-- won`t do a thing, but that small area does indeed appear to need to be actually lifted as well as very, very slightly reduced. If we just take out the fat, then I`ll be left with sagging, empty perioral skin, which seems, on the whole, to be worse than what I currently have. 3) How significant is the risk of nerve damage in a surgery like this, since that area is so close to the buccal branch of the facial nerve? How often have you performed this particular procedure yourself and how often has nerve damage resulted in your your own patients? 4) Do you accept out-of-town patients for this procedure and if so, what is the approximate fee? I assume that this is a relatively brief office procedure that would require only a one-two day stay in Las Vegas. Is that correct? Thank you very, very much for your time and assistance, Dr. Garcia. God bless you.
it sounds like in your case accessing the fat through the previous facelift incision and not removing the fat but suspending it in the submalar area is a better choice, the chance of nerve injury then is very small, the incision in the lip would not allow proper suspension of the fat which it sounds is needed in your case. Likely not something that you can have done in the office as a small procedure though. if fat is removed, the amount can be decreased to avoid any hollowing. Best of luck. JG 7.21.11
Thanks for the answer to my previous question as I am still in recovery from my surgey I asked the question wrong. My question is what can I put on the stitches in front of my ear so when healing it will minimize the scare. Thanks again
you should not apply anything to the incision until the sutures have been taken out. JG 7.15.11
I had a middle fossa craniotomy to repair semicircular canal dehiscence in the right ear I have a two inch scar, one inch is in front of the ear. Yes I also said wtf is that. Question is what can I put on the scar in front of my ear to minimize the scarring? thanks
you can try ScarGuard or Mederma, hope the surgery went well. JG 7.15.11
Hi Dr.Garcia - Back again....I had a short scar are lift with liposuction about 3 years ago. I am / was slender then and the end result was terrible. I think he should have left the fat in my arms.The original problem was excess skin due to a little weight loss and age. What can be done now? I still cannot go sleeveless
tough problem, maybe some fat injections to try to smooth things out is about all I can suggest, survival of the fat injections is unpredictable though. All the best. JG 7.13.11
What is fascia?
fascia is the thin silvery layer that totally surrounds muscle fibers. JG 7.6.11
Dr. Garcia: Is it possible to remove the big blue bulging veins in one`s hands? If so, what is the rehabilitative time? Thank you. 07/03/2011
no safe way to remove them, some doctors use fillers to hide the, but it does not work well, they are more visible as the tissue over and around them disappears with age. JG 7.4.11
If a patient seems nervous before surgery, do they have to have valium or some relaxer in IV? I mean is it required? I do not know if nervousness makes your heart eat faster or if that can interfere with twilight sedation. But relaxers make my heart race faster for some reason.
yes, it is very commonly done. JG 7.3.11
What do you think about the effectiveness of stem cell therapy for facelifts? Does stem cell therapy work effectively for treatment of arthritis?
At present it is just a marketing scam trying to capitalize on the stem cell buzzword. I have not read about legitimate studies proving stem cells help with arthritis. There might be potential years down the road.JG 6.28.11
Let`s say you were doing a nose revision on a patient and twilight sedation and facility fees were $3k. Would those fees be any less if only local shots were used instead of twilight sedation? If so, about how much less?
that varies from one surgicenter to another, so I cannot say, sorry. JG 6.24.11
How many years do you keep patient records?
varies from state to state, but average is five years from the last visit, except for pediatric patients, they need to be kept until they are 18 years of age. JG 6.23.11
For a surgery procedure, which costs less= IV sedation with twilight or... only local shots to numb area?
only local shots. JG 6.23.11
It`s the progesterone lady. So I bought the cream and have been using it for six days. Is it too soon to start noticing a change, or would any changes I am noticing just be like a placebo effect at this early stage? My hair seems to be falling out less. Maybe just a coincidence? Oh, and will the progesterone also help with other menopausal niceties -- like skin tone and texture? Anything else that might improve? Thanks so much, Dr. Garcia.
the lower your levels are, the faster you feel better, so it cna be real and not a placebo. The skin issues are mostly controlled by estrogen so progesterone has no direct effect, but a balance between the estrogen and progesterone must be maintained, so some patients with estrogen dominance from low progesterone, will in some cases, see skin improvements. Progesterone will also help sleep patterns, help build bone too. best of luck
I had lipsuction a nother of years ago and am not happy with the lumpy ineven appearance of my stomach and the uneveness of my waist. What do you recommend to correct this?
Hard to say without seeing you in person, might be more liposuction to smooth it, or a tummy tuck. JG 6.7.11
Lines in the upper Lip. What is the best filler to use? Upper Lip area under nose is dry,looks flaky, slightly white, have tried scrubs, eucerin crm, zinc oxide, nothing works. What do you recommend to use for this? Thanks
Prevelle or regular Juvederm. They will not last long due to frequent muscle action. Could try squalene oil for the dry skin. JG 6.5.11
So excited to see the information posted here recently about progesterone cream! I just ordered it, hoping for some improvement with my post-menopausal thinning hair. Can I also hope that the progesterone might help with my thinning eyebrows? I don`t have a thyroid problem, by the way. The eyebrow thinning was just one more delightful gift of the Menopause Fairy.
The hair loss of the eyebrows is due to age and not DHT , so progesterone will not help. You can use Revitalize for that, it is used for eyelashes. JG 6.5.11
For twilight sedation, does it make a difference if the IV is inserted into the hand or the arm? When you take ear cartilage for nose graft, do you turn patient on side to remove ear cartilage or does patient stay lying flat on back?
Either place is OK for the IV,as to the ear cartilage, patient can lay on their back and just turn their head. JG 6.4.11
My doc has me on somatropin growth hormone replacement therapy. I am concerned about the fact that my body will stop producing it if I get it artificially. Is there any way to take it to slow this process down? Right now I`m taking 2iu five times a week.
as long as you get your blood levels checked, the dose at which you suppress your own production is easy to figure out. I am assuming you were already low, so a low dose should not inhibit your own production, that happens when larger doses are given and then the negative feedback loop kicks in. Having said that, the replacement or supplementation doses in women needs to be higher than in men, in most cases males need only 1 unit 7 days a week, women, 1.5 is the more usual dose. I see no need to take weekends off, it makes no physiologic sense as long as you are not suppressing your own, and even if you were, your own production would not kick in within 48 hours. JG 6.3.11
I saw the exchange about the bullhorn lip lift below. Wondering if you prefer an incision in the vermillion so that the red scar is just a part of the lip. Would that be more or less visible in the end than a bullhorn lift? When a scar in the vermillion matures, would it be white rather than red, like other scars? If so, I assume that it would be *more* visible, not less visible, than a white scar under the nose. Thanks. Have a great weekend!
incisions in the vermillion tend to flatten the roll out and I do not use them. The vermillion scar will be paler and once flattened, it will need frequent fillers to regain and maintain the normal plump roll. All the best. JG 6.3.11
Dr. Garcia, I read through your archives about fillers. Thanks to you I know most of the names and what they may be able to do. I want my nasalabial folds done and I have never had any fillers. You recommend Juvederm, Radiesse but said Aretefill may last a bit longer. If it lasts longer, why would this not be the filler of choice? Do I ask for a particular filler or does the doctor/nurse decide? I have limited funds right now and want to get the most bang for the buck by being knowledgeable and informed thanks to you. I don`t want a trial and error method to see what may work if I don;t have to. I am afraid to have it done, it not working and I have to try something else. Thanks for all you do by being truthful and honest.
well, it cannot be injected as superficial, and it takes greater injector skill since it lasts so long. Maybe try one of the HA fillers, and if you like the result and want something that lasts longer, then try the Artefill in experienced hands. They will all work, but they will last varying amounts of time. I do use Artefill but the HA injects easier, and on the rare occurance of a lump, it is more easily treated. Best of luck. JG 6.3.11
Thank you, Dr. Garcia, for your answers yesterday to my three questions. Two follow-up questions for clarification: 1) About how long does it take for the scar from a bullhorn lip lift to heal so that it`s not visible? I can`t take much time off from work and don`t want this procedure to be apparent anyone when I return. 2) Where are the incisions placed for temporal implants? Behind the hairline or in front of it? And about how long are those incisions? Thank you again for this incredible service you so generously supply. I recently made a small donation to a local pediatric medical mission to Ecuador for cleft palate repairs, and I did it in your honor to offer a little bit of the kind of help you offer every day to strangers.
it will look pretty good in 4-6 weeks. It will be red before that but able to be hidden with make up well after 10 days or so.The upper lip will be swollen for a few weeks though, not something that will look totally normal very quickly. The temporal implants are placed through incisions in hair bearing scalp.Similar to a forehead lift incision. Incisions are maybe 4-6 cms. All the best. JG 6.2.11
Thank you for acknowledging and answering my query about my tvt op, yes i thought so too, its sort of obvious really, Thank you once again
My pleasure. JG 6.1.11
Welcome back, Dr. Garcia. Hope you had a great time away! 3 questions for you: 1) Do you find that the scar from a bullhorn lip lift is mostly invisible? How long does it typically take to heal? (Type 1 skin) 2) I`ve had two facelifts in the past and don`t need another, but have really annoying perioral collections of fat that look like mouth jowls. (Not the buccal fat, which is higher.) I`ve researched this and found that some plastic surgeons recommend microliposuction for this problem. What do you think? Will it make the problem better or worse? I`ve reached the point that putting fillers around it only makes my lower face look bigger, which is not the goal. 3) I have congenitally hollow temples, which only worsen with age. I`ve used fat and later Sculptra augmented by Radiesse, but we can`t seem to get enough product in there to fix the problem. What do you think of temple implants? What would be better: Alloderm rolls or Medpor sheeting? Or something else? Would implant surgery in that area be a big procedure? Thanks so very much for your time and help, as always. A beautiful summer to you!
great time at the plastic surgery meeting in California, lots of great information. I think the scar from the bullhorn lip lift is a thin scar, if someone looks closely they can see it but for the vast majority of the time, it is imperceptible. As to your perioral fat collections, that can still be the buccal fat pad as the tissues below the skin stretch and will allow the buccal fat pad to be seen there, think Arlen Spector, the Pennsylvania ex-Senator. The fat pad is higher in youth, but drops with age. Microliposuction might work but better to just cut it out through an intra oral incision. I have done tempel implants, both Alloderm and silicone, that I carved myself and they both work well, the silicone obviously lasts much longer. All the best and thank you for the kind words. JG 6.11.11
Hi Dr. Garcia, i need to ask you something thats bothering me after a checkup with a gynachologist who did a procedure on me mid April. I had a TVT operation to fix a prolapsed bladder which was succesful, but i also had a cystocele that i wanted tucked away. After My first consultation, the Dr. said that it would also be pulled up(cyctocele) along with the bladder and not to worry, it wasnt however and i went back after a week very distressed that it was still there and even more pronounced and asked him why he didnt fix this also during my surgery, he told me that it was a separate operation and i was to go back to him in about four months and have a separate op. I dont believe this and theres nothing i can do about it only follow his advice and go back but i would rather go to a separate Dr. because i think he is just trying to profit from my insurance and im just angry that he isnt adhering to any ethics code, i live in Ireland by the way and this is a top gynachologist in my area, i dont think that my muscles are strong enough even with pelvic floor exercises to tighten the cystocele after having 2 children so i have to go through anestetic and time off work and pain again in August, so my question to you is, could he have performed the tvt and cytocele tightening in the same operation, thank you in advance for any light that you can shed on my query
I think both procedures could have been performed at the same time, sorry to hear about your issues, and I wish you the best. JG 6.11.11
To follow up on the cellulite vs. Loose skin issue, guess it sounds more like cellulite since there are definitively no folds, but now my curiosity is peaked....why would pulling the skin taut diminish the appearance of the dimpling?....and, can building enough muscle underneath have the same effect? is there anything out there that fixes it?
because it puts tension on the skin, but cutting skin out will not mimic that effect. There is no amount of muscle that will correct it, not diet. Things like endermologie will help, but only as long as you are doing the strong massage and suction. JG 5.23.11
Hi, Dr. Garcia. I see that you are not recommending Ulthera because you`re not convinced the results are more than short-term. You also think it`s too costly. How much does a full face treatment typically cost? I`m assuming that in addition to the machine itself, a chief cost driver of the cost is the disposable transducers. My sister is considering having it done, but wants to know what she can likely expect to pay before she bothers making consult appointments. Seems to be the newest hot procedure in our region of the country. (I assume you were at last week`s AAASP meeting. Any impressive data on this device discussed there? And any other new developments discussed there about which you are optimistic -- e.g., the arrival of Restalyne SubQ in the States any time soon?) Thanks for all you do!
I have heard fees at about $5-6,000 for a face, not including the neck. Also, I think the pain issue is something to be dealt with as if it is too much for the patient to endure, they turn the energy down so then the results are decreased. I think the issue also of potential fat loss of the face needs to be observed.I think new things are always attractive, especially when it involves no cutting, but although I think Ulthera is likely better than the predecessors, I am not sure about it at present. Nothing earth shattering form the presentation, at least if you look objectively and listen carefully.As to the Restylane SubQ in the US, I have grown very pessimistic I am afraid. JG 5.16.11
How many days does one need to wait before they can apply makeup to undereye area after full CO2 laser resurfacing? Can any plastic surgeon perform CO2 laser resurfacing even if they rent the machine or do not use it as much?
depends on how deep the laser went, but it might be 1-2 weeks. I think if the surgeon rents the machine,it is still safe to have them do it. JG 5.14.11
Hi Dr Garcia, I have just heard about Zeltiq. Is it an effective treatment for fat in the tummy after a C-section? I have had 2 c-sections and can`t lose my tummy. Thanks
I have not seen any actually patients that have had the procedure. Sorry. JG 5.6.11
Dr. Garcia, you have kindly answered several of my cosmetic quesions in recent years. I wonder if you would be willing to clarify a general endocronology question I have and about which I have received conflicting guidance. I developed Type 2 diabetes after menopause, which was discovered when I exhibited symptoms of peripheral neuropathy. My endocronologist says that the neve damage is reversable with tx of the diabetes (much like vision impairment), but my pcp tells me that once the nerve damage is done, there is nothing that can reverse it. Which is accurate in your view and experience? Thank you for taking the time to consider a matter outside of your speciality.
if the neuropathy is recent, months to a year or a little more, it might be reversible to a degree, but once it has been there long enough that the covering of the nerve is damaged, it will not come back, So the sooner the diabetes is controlled, the better the chances. I wish you the best. JG 4.29.11
Sorry to ask one more question today. What exactly do you think the harm might be from the EPrime? My friend who underwent the procedure would like to know. Thank you, Dr. Garcia!
Scarring of the dermis, loss of pigmentation, and having it done and getting nothing long term from it. The heat is higher than you need for collagen shrinkage and stimulation. JG 4.23.11
Hi, Dr. Garcia. Your answer to my questions below didn`t come through. What are your estimates, respectively, of the No No, Ulthera and EPrime? Thanks so much!
please see prior answer, sorry I did not get to it earlier but I was answering others from my smartphone and yours was more involved.All the best and a Happy Easter to you too. JG 4.23.11
How many units of Botox are typically required to address axillary hyperhydrosis per side? Thank you!
50 units per side. JG 4.23.11
Hi, Dr. Garcia. I`m wondering about your estimate of a few new devices on the market: 1) the at-home thermal hair-reduction device marketed as the No No. Surely, its not as effective as laser hair reduction, but do you think it could work well enough to be worth the investment? 2) the two new technologies alleged to offer modest skin tightening -- the ultrasound system marketed as Ulthera and the radio-frequency system marketed as E-Prime (by Candela). A friend of mine recently underwent E-Prime and, good heavens, it had BETTER work after all the downtime and pain she endured. Two weeks of horrific bruising and swelling, as much from the tumescent anesthesia as from the device itself. Honestly, she was so swollen, she couldn`t even speak clearly for a week. (The handpiece for the E-Prime has 10 32-gauge 1.5 inch needles on it that are inserted into the skin at a 20 degree angle and heated to 70 C, repeated about 150 times all over the face! That`s 1500 burning hot needles, at 165 F, inserted into the dermis! Unbelievable! The things we do to look better! We`re all crazy. I think a facelift would have been easier and less painful, but she didn`t want any scars and simply wanted some skin tightening.) Thanks, as ever, for your honest opinion and guidance. If you celebrate Easter, I hope it is a joyful day for you. Thank you for all you do to make small resurrections possible for people who suffer with genuine deformities. Yours is a merciful profession.
I think the at home hair removal is not worth it, best to have it professionally done and potentially avoid any negative effects from the home device. As to Ulthera, the jury is still out in my opinion and I would not use it yet, I have never seen a picture of a result past 3 months, so I cannot endorse it, although there are doctors out there claiming two years of improvement even though they have no patients out that far after the treatment. I find that curious as the data submitted to the FDA was only for 90 days. As to the E-Prime, I think even less of that and feel it is likely more potentially harmful than the Ulthera. All the best. JG 4.23.11
I read on one of your posts that a person was taking 10,000 iu of Vitimin A (retinyl palmitate)and it effectivly cleared their acne! Would`nt Beta Carotine do the same? Without the risks of toxisity?? Thank You and Happy Easter!
As only about 10-15% of oral intake get s to the skin, high dose vitamin A or beta are not something I would recommend. JG 4.23.11
Hello Dr. Garcia: Just posted a question about the perm make up. Sorry for the typos using a tiny keyboard. I wanted to be a little more clear. I had a spot lasered with a tatoo removal laser not sure which one, but two spots turned blacked, then I had to have that dug out and it was pretty scarred under there or I guess the ink was solid. Anway, will any laser get rid of the lipliner, or is there something else you can do? I did try the IPL it faded it a little. It is now light purplish or even blackish purple. I have to get rid of it, it is above the lipline. Thank you.
Scraping it out was the worst thing you could do, that will create more scar tissue than a laser or IPL, just continue with the laser, it will be the best. JG 4.23.11
Hi Dr. Garcia, I have permanentmake up lip liner and I had a spot test it turned black. I am not sure the ink had ir9on in it. How can I remove it. It is faded to a light purple after using IPL and salt removal. The line is above my naturl lipline. What can been done? Do you have experience with this type of problem. Thanks!!!! Cher
That is normal and the best thing is to keep up with the lasers, it will be the most effective way to remove the dark spot, the doctor should have warned you as it is very common . JG 4.23.11
Dr. Garcia, I am planning our family holiday next January/February and I would like to make an appointment with you regarding Bio Hrt. Do you still specialise in this area or should I make an appointment with your colleague Dr. Pierce. Cheers
Dr Pierce now does the day to day consultations, I am a consultant to the clinic and to clinics internationally at the present time. Hope to see you early next year. JG 4.18.11
Dr. Garcia, I am planning our family holiday next January/February and I would like to make an appointment with you regarding Bio Hrt. Do you still specialise in this area or should I make an appointment with your colleague Dr. Pierce. Cheers
Dr Pierce has taken over the day to day treatments, I am a consultant and do consulting for clinics internationally now. All the best and hoep we see you early next year. JG 4.18.11
I have 2 questions. First-what can I use to diminish the lines I have above my upper lip-similiar to those that a smoker gets. Second-I got a lip wax a week ago and my the same area is sore and irritated. I have stopped using my Retin A so it won`t get more irritated. It just doesn`t seem to be getting any better and it also exagerates those lip lines I mentioned. What can I use to help with the irritation. Thanks so much.
for the upper lip lines, you can do fillers like Prevelle, you can also do lasers like a CO2 laser.In general you should stop the Retin-A for 2-3 days before and after a waxing to avoid skin burning and irritation. The skin dryness caused by the Retin-A will make the wrinkles worse in appearance, I suggest using some copper peptide creams to help the skin heal. Best of luck. JG 4.18.11
What treatment or cream would you recommend for deep wrinkles UNDER the eyes? Thank You Much
Retin-A or a light CO2 laser. JG 4.7.11
hello how important is it to be drinking orange juice (vitamin c) to keep tightening the skin/collagen/elasticity? how much should i drink a day to prevent over all looseness of skin? i do use obagi vitamin c 20 percent serum as well
easier to take Vitmain C pills, and Vitamin C deficiency is rare, so you do not need large amounts. Drinking orange juice will not prevent the skin from sagging. JG 4.5.11
Good morning, Dr. Garcia. It`s the butt lift lady again, 3 months post-op. I have 3 questions for you. 1) I saw my surgeon this week and he claims that the distinctive red rail-road tracking along my scar is just the internal sutures that have yet to dissolve. Does this sound right to you? 2) He also says he`ll need to revise the scar at one year because it`s far too high, particularly on one side, an assessment with which I agree. But I can`t figure out how that particular scar can LOWERED because there`s no extra skin above the incision, just below it -- seems like a revision could only make the scar higher. Does this sound plausible to you? 3) Do you have an experience with or opinions about the Image Skin Care line of products. I have a friend who is extremely impressed with their The Max serum, and I`m trying to decide if it`s worth the investment. Thank you, as ever, Dr. Garcia. You are amazingly generous to all of us. May you have a restful and peaceful weekend.
Usually sutures below the skin do not show on top of the skin, if they are red, it is a sign of irritation of some sort. As to revising the scar to place it into a better location, there will need to be some loose skin for it to succeed as merely suturing the scar to a lower point will not likely keep it there. I have no patient experience with the Image Skin care line, sorry. I wish you the best, and thank you for the kind words. JG 4.1.11
Dr. Garcia, seeking your opinion (if familiar with) procedure termed the Sciton treatment described as a minimally invasive neck left - small slit made under chin, laser inserted to melt fat and tighten skin. Thank you! Brenda
might get a small amount of fat removal at best, but will not tighten loose skin. JG 3.23.11
Just a note to the person with the saggy elbow skin. I had the same problem and had a small fat graft to my elbows about 10 years ago, and it pretty much solved the problem .My sister did it with Sculptra 2 years ago and also had great success. (I`m 60 and she`s 55.) Everyone`s anatomy and skin tone are different, of course, but it might be worth trying. Thank you for the wonderful service you provide to so many people, Dr. Garcia.
thanks for the personal story. JG 3.23.11
I have a question about saggy elbow skin. Although I had this area filled in with fillers, it is still saggy. It was suggested that I get the saggy skin surgically removed. Is this something plastic surgeons often do? My arm scars the worst. Does it scar any less in elbow area? Would the scar be noticeable? Would the scar appear in a horizontal or vertical direction? Do you think this surgery would be effective?
I think the scars in that area are quite unsightly and I do not perform skin excision there for that reason. JG 3.21.11
Hi Dr. Garcia, I just posted a question, but did no mention my question was in regards to the permanent makeup turning black with the laser. And how long will have to walk around with black on my lip. Please explain the process before I decide to go and do it. What do you charge per session?
As the laser works it will fade to a lighter color but in the meantime you will need to cover it up.We charge $100 for 15, should be more than enough time. JG 3.15.11
Hi Dr. Garcia! Thanks for the info on the laser, no, I was told if it turned black I would have to have it cut out. So if it turns black, then how long for the next treatment and does it get lighter pretty quickly or a long time. Can you explain the treatments? Thanks!!!
You will not need to cut it to, the laser will fade it well, it gets black because the ink oxidizes, all expected.you can have the treatments as normally scheduled.JG 3.15.11
Hi Dr. Garcia, I have a question about permanent makeup. A doctor tried a laser on my lipliner and it turned black almost immediately. I have some very light purple left on my top lip above the lip line. I am sure that will turn black too. Are there any lasers that won`t turn it black or can that be removed without cutting it out. I tried the removal process and a small raised scar on the one side of my lip. How do you suggest that can be removed or flattened out? Thanks.
actually, no, there are not, that is expected and you should have been warned, but in time with more sessions the laser will eliminate the color. The raised scar might benefit from a kenalog or 5FU injection. All the best. JG 3.14.11
Hi Dr. Garcia, an aesthetic question to do with the eyes, do you know if using topical steroids on the face near the eyes (on the skin just above the cheek bone) can cause the steroids to be absorbed by the eyeball and damage them (ie cause prominent red veins). Can anything can be done cosmetically for eyes that always have a lot of prominent red veins on the white part? thank you
the cream should not affect the eyeball itself. I am afraid there is nothing long lasting that can be done for the veins, just Visine type drops, short term. JG 3.12.11
Just read the posting below from the person whose oral competence has been compromised from botox. Have you ever heard of this happening when botox is injected into the platysma? I ask because I believe that muscle is innervated by the facial nerve too. Might weakening that muscle also affect speech?
not a loss of oral competence but difficulty swallowing and more looseness of the bands, absolutely. JG 2.20.11
Hi, Dr. Garcia. For years, I`ve been receiving 2 units of botox in my chin and it has smoothed everything out very subtly. Two weeks ago, my doctor misread her records and injected me with 4 units instead of 2; that is, she put two units in each side rather than one in each side. You can guess the results! When I speak, I sound like I`ve had a stroke. I feel like a fool. I should have checked my chart myself. I didn`t realize what she`d done until after she had injected me. Anyway, I know that this is temporary and will correct itself in time, but I`d like your estimate of just how long -- 12 weeks or so before I even begin to see any improvement or perhaps sooner? (4 units isn`t a great deal, I know, so should I be optimistic about this situation getting better sooner rather than later?) In the meantime, I might join a monastery and take a vow of silence! Thank you, as ever, Dr. Garcia, for your kindness and help.
it should get better in 3-6 weeks, hang in there, and it is not up to you to check your chart for the proper dose, it is up to the doctor. One more thing about Botox. It has come out that the education that injectors were given since the beginning of Botox release was incorrect. The bottle is to be used for a single patient. That means that a bottle should not be shared between multiple patients. The company that makes Botox has known about this but has never issued an alert to doctors or patients. The risk is that of the bottle becoming contaminated and passing a communicable disease like HIV or hepatitis from one patient to another. There are no known reports of disease transmission in the use of Botox, but it has not been looked at yet in order to determine that issue. For that reason I strongly urge you to demand that a new bottle be used when you are treated and then observe the injector destroy the remainder of the bottle. If that is not done I urge you to contact the local board of health for the violation. Ask to look at the box it comes in and you will see the single patient, single use wording. JG 2.20.11
What does it mean if a Dr. has a sanction on his record? Would it be wise not to have work done by him? Thank you in advance.
depends on what the sanction was given to the doctor for, hard for me to say without that information. Sorry. JG 2.17.11
Dr...in the world of plastic surgery I notice that there are people who don`t necessarily look younger , but rather different yet they resemble others walking around with that same look. Do you think it is just nearly impossible to really make someone look youthful, or is it the hand of the surgeon?...is it possible that a little filler may actually create that look vs surgery, albeit temporary?....thanks so much for answering my complicated question.
I think it is mostly in the hands of the surgeon, sometimes, if one does not individualize the surgery to each patient, then many of the patients done by one surgeon can start looking the same. There are many cases where a filler is actually better and more youth providing than a surgical intervention. Its not a cookie cutter thing, it needs to be individualized for each and every patient. JG 2.17.11
Hi, Dr. Garcia. It`s the butt lift lady again -- 8 weeks post op. My scar has widened considerably, despite the fact that I`ve been extremely careful and have only done short walks and absolutely no lifting. I saw my surgeon this week and he agrees that it`s extremely wide, but he claims that the scar is in its most intense phase of contraction at 8-10 weeks post-op, which is what makes it appear wide, and that it will settle down and thin out in time. I understand that scar tissue evolves over time and that I`m far from the end result, but I don`t understand how contracture would make it look wider rather than narrower; indeed, isn`t contracture just that -- contraction? Also, it seems to me that once a scar widens, it can`t get thinner, simply as a basic matter of physics. I`m writing to ask if you think my surgeon`s explanation is sound or if you believe he`s (understandably) trying to offer me some consolation and false hope for what looks to be a bad result. Thank you so much for your opinion and time. I value both greatly. A good weekend to you, Dr. Garcia!
I think the color will likely fade, making it less visible, but I do not think the width of the scar will get any thinner I am afraid. Hang in there and give it some time. It might need to be revised later, once all the healing is done. All the best. JG 2.12.11
Wondering about the long term results of a thigh lift, addressing the fronts and sides, just skin? I have a friend who had it done during a tt revision and she said it didn`t last very long. She went back for a redo consult and the ps said only way to make it last is toattach the thigh muscle to the pelvic muscle. Can you explain that more? I know my butt lift didn`t stay tight for mud longer than a year so it makes sense that without doing anything to muscles,gravity gradually wins out.
well the inner thigh skin can be attached with sutures to the pubic bones, not the pelvic muscles, but due to the degree of motion in the groin where the sutures are placed, the sutures will eventually break, the skin will slowly sag and the scar that is originally well hidden in the crease of the groin, can become visible in underwear. In general, if the patient has generalized skin laxity, when you tighten things up, the genetic limitations of the skin come into play, having said that, patients who have loose skin after large weight loss have poor quality skin and things don`t hold up as well as other patients. The gastric bypass patients tend to have the poorest skin quality, both short and long term. Yes, gravity wins. JG 2.9.11
In previous leg lift question meant to say I WORK out regularly
got it. JG 2.9.11
Hello. I have had a FTT few years ago, healed well, scar low and faded. I am 51 yes old. Was wondering if lifting the skin on the fronts of thighs could be done using existing TT scar or would the incisions be somewhere else? Recovery time? Drains? I also had a butt lift few months after ftt, with very easy recovery since no muscle work was done. Scar also healed well, thin and white, very low going to a v into top of butt crack. I out regularly but am not liking the sagging of fronts of thighs.
The incisions are normally done much lower on the torso, healing time and recovery is about the same, maybe a little more. Yes to the drains. Best of luck. JG 2.9.11
If you have a bald patch of hair (due to injury) near your hairline, do you think any plastic surgeon who does facelifts can cut the bald patch and pull down the hairline? The bald patch is only about 1/4 inch is diameter. Just wondering if any surgeon can do it or if they need to specialize in hair transplants or hairline lowering surgery.
I think cutting and pulling is not always an option, easier and better to have hair transplants placed into the area. JG 2.4.11
Just want to say thank you for the help you`ve been to me over the years! I really appreciate it! :)
my pleasure, glad I could help. JG 2.3.11
Hi, Waiting for the PS in the Essex/Passaic County Area from the person who said he/she knew of one!!! Please tell me who it is. Did she tell you Dr. Garcia???
she has not posted yet, sorry. JG 2.3.11
Thank you so much for the answer about the vegetables below. What`s the problem with consuming the charred surface? What are the ill health effects?
there are anecdotal reports that the charred parts have possible carcinogens in them, it is a larger problem in charred meats due to the fat content, but it is best to wipe the char off and then eat them. JG 2.2.11
Hi, Dr. Garcia. Sorry to bother you with a non-surgical question, but you are so knowledgeable that I am sure you can answer this question. Several years ago, my sister lost 150 pounds and has worked hard to keep herself healthy ever since. She eats a plant-based diet and has discovered that she absolutely loves the flavor of oven-roasted vegetables (roasted with a tiny amount of olive oil) -- cauliflower, onions, parsnips, broccoli, kale, celery, etc. Since the process of roasting dehydrates the vegetables and condenses the sugar in them, they taste especially sweet. We are wondering if the process of roasting changes the chemical compounds of the vegetables, making them more caloric than eating them raw or steamed. Of course, we know that adding a teaspoon of olive oil to a tray of vegetables adds fat and calories to them, but they taste so remarkably good that we can`t believe that they are actually healthy to consume. I apologize for our ignorance about such a basic question of chemistry and nutrition. Thank you for your help.
no negatives, just try to limit the eating of the charred surface is all, and coggrats to her on the weight loss. JG 2.2.11
The other day I noticed that the singer, Jennifer Lopez, looks quite stunning. She used to not look so good, if you take a look at some pictures from years back. In your professional opinion, is she the result of some very good and discreet cosmetic surgery, or is most of her look from fillers and botox? Specifically, I am referring to the area of the eye/cheekbones.
most likely non-surgical things along with a healthy lifestyle. JG 2.1.11
What is wire subscicon for release of deep depressions and how does it work? From what I read it pulls the subcutaneous tissue together from underneath in an area surrounding a depression? Is this wrong
there is a shar edged wire that is placed underneath the skin and then pulled to release the skin form the underlying tissues, like a garrote wire. I t can never bring tissues together as all it does is cut. All it does is release the tissues and then leave a space between them. JG 1.29.11
hello 39 yrs old no contacts no glasses, noticing heavy eyelids (upper) even now with prominent crease no photophobia, no spots in vision, sometimes blurred vision but i worry about the upper eyelid levator muscle i even woke up yesterday with right eye completely closed did use eyedrops which helped some im trying to avoid this deep upper eyelid crease, and wondering if yu think heat to the eyes warm compresses while laying down will make the levator less excitable. this upper eye muscle seems to be not relaxed and could even be jumping around in my sleep. anything else i can do i use obagi and retin a and on no other meds. i sleep wellbut the heavy feeling to upper lids occurs from nightime till the am. i m thinking i should see an optometrist too. i even use an eye mask at night to relax the eyes even more, any suggestions would help.. thankyou
I do not think the warm compresses will do much. If the eyelid was stuck down due to dried tears, that is normal and the eyedrops at night and in the morning will help. If it is an issue where the eyelids look different in the sense that the eyelid looks lower than it used to, I suggest seeing an eye specialist for an exam to make sure your levator muscle is working and intact. Not much else you can do on your own.I wish you the best. JG 1.25.11
Hi, Dr. Garcia. It`s the butt lift lady again. I`m 5 weeks post-op today and continuing to heal pretty well. Thanks again so much for your encouragement to do this. It was a big deal and a big recovery, and your words have helped a lot, particularly when I spent 2 weeks immobile with an infection in one of the incisions! I`m writing to ask how long the swelling in the lower back usually persists after this surgery. I am still quite swollen and it doesn`t seem to show any signs of resolving. Is this common? How long does it typically go on? (My surgeon told me he did 3 layers of closure and the surgery lasted 7 hours, if that tells you anything significant.) Also, while the scar is fairly thin, there is one 6 inch length of it where it looks like railroad tracks. Is that because it`s widening? Will this likely be permanent? And is it an early sign that the rest of scar will eventually look like that too? I`ve been extremely careful and not done anything to further traumatize the area. (Couldn`t have even if I wanted to! This whole thing has completely laid me low.) Thank you again for everything, Dr. Garcia!
that swelling should show some visual improvement over the first 6 weeks and then continue from then on. Being in bed and immobile makes it happen slowly. Sorry to hear about the wound infection, but it is not uncommon I am afraid. The wider scar is likely due to swelling. As to scars and their final width, usually all scars will look pretty good for the first 4-6 weeks and as time goes own and greater motion and activity occurs, the scars can spread, so too soon to tell. I cannot predict at this point whether that wide scar now will stay that way, if it is wide due to swelling, it should improve with time. Because one site is wide does not mean all of the scar will follow suit. Hang in there and I wish you the best. JG 1.25.11
sorry, the question is: how many 60ml bottles of minoxidil I must use AT LEAST to see results ? Thank you
should see something after the first on. JG 1.22.11
sorry Doctor, i meant i had perioral laser not periorbital and wondering why on this 9th day after the laser to the mouth and nasolabial folds only i have upper eyelid crease that is prominent and deep crease, could inflammation from the PERIORAL laser cause this upper eyelid deep crease?
see the answer just posted. JG 1.15.11
i meant i had perioral laser only nor periorbital typo
thank you Doctor about the prominent upper eyelid crease which yu speculated may be due to the laser swelling ..can yu explain to me the physiology of why yu feel inflammation can begin at the eyelids (upper) from a laser treatment from erbium which was deep and ablative to perioral area, why is it that inflammation would accumulate to this upper eyelid crease when i only had laser to the perioral area only? thankyou!!!!!!!!!!
it is essentially a burn to the skin, all of the skin of the face will absorb some of the swelling but in very think skin, like the eyelids, it can be much more visible and prominently seen. Try keeping your head elevated during sleep, that will help it go down. JG 1.15.11
i recently just noticed prominent upper eyelid crease it is a normal crease but it seems to look pronouunced and alittle heavy i did have a laser erbium treatment to only the periorbital area, and i noticed possibly due to the inflammation to the periorbital area it made my upper eyelids more pronounced (as far as the deep crease) ive never had this prior to the laser. im now day 9 of the laser will this crease go away? as ive said it is the normal upper eye crease that we all have but it is more deep than before and pronounced. do yu think botox to the eyebrow area willhelp lift this crease? anything i can do? thank you
most likely still residual swelling form the laser and that should all go away on its own over the next few weeks. I would hold off on using Botox until the swelling goes down and everything can be properly evaluated. JG 1.15.11
I crushed my thumb in an industrial accident at work.There is a lump of scar tissue in the middle of my thumb`s finger pad.I also had the nerve reattached.I am under going PT for range of motion and scar management.My question is this:Do you think a scar revision to remove some scar tissue would be beneficial after a year or so.The scar is quite bulky,it protrudes outwards too much interfering with grasping objects.
possibly, but you should wait at least one year to see if it flattens out on its own to avoid further surgery. JG 1.15.11
My upper lip has lengthened considerably in the past year so I`m considering a lip lift. In your experience, does that scar (beneath the nostrils or is it INSIDE the nostrils??) heal well? I`d hate to do this and be left with a highly a visible scar in a place that`s impossible to conceal. (I have Type I skin -- very, very fair and thin skin). Thank you, Dr. Garcia.
it is where the nostril skin goes form horizontal to vertical, so right where the inside meets the outside. It is usually an imperceptible scar in nearly all patients. That area usually heals quite well. Best of luck. JG 1.4.11
I`ve been using a sauna at my gym and amazingly my skin has not broken out, but is soft. Are sauna`s good, bad or neutral for your skin? Thank You
they can dehydrate the skin at times. JG 12.28.10
Hi, Dr. Garcia. Just a quick note to thank you for all your advice and encouragement prior to my recent butt lift. You gave me the courage to do it. I made it....but it wasn`t easy! Oh my goodness, what a journey! 5 hours of surgery, 2 days in the hospital, and, honestly, a LOT of pain and nausea. But I`ve finally turned a corner and now feel more discomfort than pain. My surgeon ended up doing a small wedge excision of skin at the gluteal crease in addition to the lift itself and the fat grafting. So far, it seems to have been the best decision since it preserved the crease while eliminating the sag, but I know it`s still very early. Time will tell. Anyway, my new butt and I thank you again very much for all your help! May the angels of Christmas bless you with the kindness and generosity you consistently offer others. A healthy and peaceful new year to you and your family.
thank you for the kind words and wishes, glad I could help in some way and I wish yo the best of luck for your surgical outcome and also for the New Year. JG 12.27.10
My sister is talking about doing a chemical peel with a Glycolic Acid 35% or a Salicylic Acid 20%. Which would you recommend. Or would using just .1% retin-A be better? Thank you for your time.
the glycolic and salicylic acid at hose strengths are pretty similar, they can be used in conjunction with the Retin-A . JG 12.21.10
Hi there, Dr. Garcia. It`s the Butt Lift Lady again, one day pre-op, with one final question for you. My surgeon tells me he places dozens and dozens of sutures subcutaneously to achieve the lift, of course, but he also says he uses dissolvable subcutaneous sutures on the incision itself. I was surprised by this; I thought I`d have a long line of sutures he would need to remove two weeks post-op. Does his plan sound right to you? Do you think it will hold, especially in light of the degree of tension on this particular incision? I`m confident that he`s a competent surgeon, of course, but before this thing is irreversible, I thought I should ask for your opinion Thanks for sharing your knowledge. Honestly, how else would we all know if we were being sold a thingymabob when what we really needed is a thingymajig? Wish me luck tomorrow. (At least it will be nice to get this over with and not feel like I`m being followed all the time -- by my own rear end!) Merry Christmas, Dr. Garcia! Thank you for everything.
I use the same type of sutures below the skin so they do not have to be removed, sutures there can leave railroad marks and we try to avoid skin sutures for that reason. The deep sutures are what holds, and they should do that. Best of luck and Merry Christmas! JG 12.12.10
Thank you so much for the time you have taken to educate us on single-use Botox. Since you have raised this issue, I have noticed that my doctor, Howard Lang, MD in Irvine, uses a sealed vial of Botox on me (I checked)- the bottle has not been used previously. He uses 30 units for between my brows and outer eye corners.
so what does he do with the rest of the bottle? JG 12.16.10
Well, it`s official, my butt has fallen and it can`t get up. Yet another gift of the Menopause Fairy. It`s a sad and sorry situation back there. I`ve had three consultations with three different surgeons and they all say the same thing: to achieve any real improvement, they`d have to 1) perform the standard lift below the waist, 2) transfer some fat to add volume to my flat pancake, and 3) perform a conservative wedge excision of skin at the inferior gluteal crease. Let me just say now, OUCH! After a few years of considering this, I have finally booked this unbelievably barbaric procedure for next week and have arranged to take several weeks off from work. I plan to return from the hospital strapped to the front grill of a car as if I were an unfortunate deer caught in a hunt and will then spend untold hours on my stomach on the couch. Happy Holidays! My questions for you are these: 1) Is this just about THE most hideous recovery process one can expect in any form of plastic surgery? That is, is this going to be really, really bad? I suspect you`re going to say yes. 2) I am concerned about the wedge excision due to the inevitable tension on the incision. Even if I spend four weeks floating on my stomach on the couch, I will eventually have to sit down again. I fear that the scars may widen and will become unmanageable. I should say that all of the surgeons I consulted agreed that this will be the most necessary part of the surgery due to the excess skin at the bottom of my ancient rear, though they don`t like to do it for exactly the reason I state. They all agreed that I needed this surgery. The last surgeon I saw even said I have one of the most challenging bums I`ve ever seen in 30 years of practice. (Good God! The sad truth is, I`m sure he`s right.) Have you ever done a wedge excision as part of a butt lift? If so, is it always a disaster? I fear you`re going to say yes. 3) I am utterly mortified by the fact that an entire OR staff will be hovering over my old butt for four hours. I know that this is what you folks do for a living and that it`s no big deal to you, but I feel like I should give these poor people combat pay or something. Any ideas about what would be an appropriate gift I can offer these brave staff people beyond their salary for the morning? So, I know you`re a man of science, but I`m seeking all the help I can get here: Please pray for me! (Better yet, pray for my poor surgeon!) Thanks for your honest ass-essment of this situation, Dr. Garcia...and for sharing your experience. I`ll let you know how it goes.
I think it is a challenge because of the required limited motion after the surgery but is not that painful. I will say that the scars are not hairline incisions no matter what is done as every time you sit or walk the motion will stretch and widen the scars. I have not seen the need for a wedge excision on the crease, unless it is a small one medially towards your anus where there at times can be a small little bump that cannot be adequately lifted with the buttock lift due to the direction of pull of the lift. If the excision in along the crease that can flatten the projection of the buttock which is what you are trying to improve. I understand the apprehension but the operation will likely give you a good improved appearance but the scars will need to be covered in bathing suits. All the best and thanks for entertaining me with your story! JG 12.12.10
I am fait skinned with dark purple circles under my eyes. Do you know of a good undereye concealer? My problem is I have to wear it thick or I can`t let it smear so the purple will show.
I am afraid it is a matter of trial and error, not one single one is best for all patients. JG 12.8.10
Hi DR G: Does retin-a thin the skin? And is there a certain filler that should be used on scars? thanks :)
no one filler is better for scars than another and as to the Retin-A and skin, it thins the epidermis and thickens the dermis, both good things. JG 12.7.10
What is your price for CO2 laser resurfacing on eyelids and undereyes? Is it cheaper if you just have it undereyes?
same price for all of that and it is about $3000, as it is done under general anesthesia. JG 12.7.10
Hi Doc What do you think of Pixelï¿½laser by Alma laser? Does it stimulates collagen regeneration? And have you heard of MATRIX RF - Sublative Rejuvenation? does that work? thanks for your time.
not a fan, minimal collagen generation. I think the Matrix is even less effective, if that is possible. Lots of hype and little to no results.JG 12.6.10
Say one women used retin-a on her face for 10 years, then she stopped using it. And another woman never used retin-a during those 10 years. I realize the effects of retin-a go away when you stop using it. Just wondering if the woman who used it for 10 years would have more youthful skin although the effects wear off when you stop using it?
younger to have used it and stopped, there will be less cumulative damage, she will always be ahead of the game if she used it. JG 12.6.10
Sorry one more question... what is a good treatment for helping skin elasticity on the neck?
Retin-A is about all. JG 12.5.10
Thanks Doc. What is the risks of using lasers, like a CO2 laser, for the neck?
developing a burn scar which is permanent. JG 12.5.10
Last night I was squeezing a pimple and I used alot of alcohol pads to swab it and squeezed it for a very long time along and consitantly wiping the skin with alcohol. Well although I guess I shouldnt have picked at it for so long now the pimple is the least of my worries. My skin area about 2 x 2 wide is all swollen and red. I woke up this morning, its all red patched some tiny rough bump on skin, it burns and hurts even without touching the skin. When water touches it it burns like crazy. It never happen to me before that I have this large patch of face on the side of my face. Could it be a chemical burn from the alcohol and squeezing combination. I do not know what to put on it. Please help me relief my worries and pain. Any advice is greatly appreciated. Last night I used neosporin cream. I often over squeeze pimples but this has never happen to me before. What to put on it, what to do? Thank You.
just use the Neosporin and stop squeezing the pimples,it will all be OK in a few days. JG 12.5.10
Hi Doc....one more question. Is there a laser or treatment that helps to increase collagen and elasticity...rejuvenates the face and neck, etc? thanks for your time.
all lasers, like a CO2 laser, will do that but they are risky for the neck. JG 12.5.10
Thanks Doc Re BeautyTek. Is there any non-surgical treatment you think works well for a face lift and increase collagen? thanks again
sorry, but no, not that will simulate a facelift type result. They use that term to basically fool people for marketing reasons. JG 12.2.10
Hi Doc. Can you tell me...what do you think of BeautyTek for lifting and increasing collagen etc? Is it a good non-surgical treatment? thanks.
I have tried and and stopped due to no results. JG 12.1.10
Iknow the amounts of ingrediants aren`t given, but which product would you use on over 40 skin? 1) Aqua/Water, Bifida Ferment Lysate, Glycerin, Alcohol Denat., Dimenthicone, Hydroxyethylpiperazine Ethane Sulfonic Acid, Peg-20 Methyl Glucose Sesquisterate, Sodium Hyaluronate, Salicyloyl Phytosphingosine, Palmitoyl Oligopeptide, Palmitoyl Tetrapeptide-7, Adenosine, Ammonium. Polyacryldimethyltauramide, Disodium Edta, Caprylyl Glycol, Citric Acid, Xanthan Gum, N-Hydroxysuccinimide, Chrysin, Octyldodecanol, Sodium Benzoate, Phenoxyethanol, Limonene, and Parfum. OR 2)AQUA / WATER / EAU BIFIDA FERMENT LYSATE GLYCERIN ALCOHOL DENAT. DIMETHICONE HYDROXYETHYLPIPERAZINE ETHANE SULFONIC ACID SODIUM HYALURONATE PHENOXYETHANOL PEG-20 METHYL GLUCOSE SESQUISTEARATE PEG-60 HYDROGENATED CASTOR OIL SALICYLOYL PHYTOSPHINGOSINE AMMONIUM POLYACRYLDIMETHYLTAURAMIDE / AMMONIUM POLYACRYLOYLDIMETHYL TAURATE LIMONENE XANTHAN GUM CAPRYLYL GLYCOL DISODIUM EDTA OCTYLDODECANOL CITRIC ACID CITRONELLOL PARFUM / FRAGRANCE Thank you for your time!
I honestly see little difference between those two, they do not give the concentration of each ingredient, as you say, but it is policy that the concentrations get lower as you go down the list. JG 11.29.10
Hi Dr, Hope you had a great weekend! Just wondering what you thought of the new platelet skin rejuventation procedure called PRP using ones own blood reinjected back into the skin? Thank you
I had a great holiday, thanks. As to the PRP injection when nothing else is done for the face, I feel it is a waste of time and lots of hype, it helps things heal after an injury but without an injury, it will not do anything. I use at at the time I do a facelift though as it helps the healing process for the patient. All the best. JG 11.29.10
What is a ballpark figure for having a neck lift. I have had a face lift but the neck has never been satisfactory. Thanx
about $6500, all inclusive. JG 11.28.10
Hi Doc, I was wondering what benefits both IPL and Retin A offer for correcting PIH from recent breakouts as well as over all skin texture? How would you compare the two treatments? Thank you very much.
I think the Retin-A will do more with less risk. JG 11.18.10
What is your position on Zeltiq and Ultherapy, both of which are FDA approved; you can find it on their website.
although they are approved by the FDA, we will not be offering the technologies as I feel they are unreliable in the degree of benefit and they are quite expensive for an unknown amount of time of improvement, that does not mean you should not do it, but caveat emptor. If you read on the FDA website the degree of improvement that the technologies offered in their trials, you can decide whether you want to spend that much money for what they say will happen.JG 11.15.10
Hi Dr...what is your opinion about the Titan Laser? What is the best (non surgical)option to restore that dewy/glow to the face? It seems the botox/dysport thing just made me look weird...I wanted it to lift the ends of the brows, but it has not done that (5 days into it). I think at this point I will just be concerned with the actual look of the facial skin.
I am not a believer in the Titan being as effective as they claim, I think for a nice glow to the skin, it can be accomplished with light YAG lasers, or chemical peels and microdermabrasion and IPL sessions. I think anything non-surgical besides Dysport will not work very effectivley in lifting the brows past a few weeks of swelling. The weird appearance after injection of Dysport or Botox is not the medicine injected, it is the artistic skill and knowledge of the injector. Best of luck. JG 11.15.10
Hello Dr. Garcia: I suffered a fall to my face 4 weeks ago and my dermatologist put in 15 stitches which were removed after 10 days. It has been a month since my fall; is it too late to have hyperbaric oxygen to aid healing? When is it too late for hyperbaric oxygen treatments? Thank you in advance for your response.
I think the best time for the HBO is right away, I think the improvement right now would not be worth it, sorry. JG 11.10.10
Hi DOC. I have a small scar near the corner of my eye. It is a small line with two small bumps. When I push the bumps they sort of disappear for a little while and then pop back out. Is there any way I can get rid of these bumps. thanks so much for your time and advice.
they can likely be cut out, I think lasering them or burning them off can be tried but they might very well come back if that is how they are treated. JG 11.9.10
Dr. Garcia Regarding Bio Hrt, My Doctor insists that Bi Est hormone replacement is made up of 80% estriol and 20% estradiol. However from your archives you suggest that Bi est is made uo of 80% estriol and 20% estrone. From experience I would rather take your advice than my own Doctor`s. I am also aware that your information is predominately a guide only and I need to check with my own Doctor. (I absolutely respect that) However, your advice through this forum, is in my opinion the best in the world, so could you be so kind to `double check` your advice regarding what is in Bi Est. Thank you
let me clarify, Bi-Est is 80:20, Estriol and Estradiol. Estriol is very weak and Estradiol is the strongest of the three human estrogens. I see no reason to give Estriol as it is so weak and the body can convert Estradiol into it. I avoid giving Estrone. When I give a female estrogen, I give pure Estradiol only. Sorry for any confusion. JG 11.9.10
Dr. Garcia, Aesthetically, speaking and being an expert in the aging process...what is it (in your opinion) that gives a person an aging appearance...is it the eyes, the neck, the skin? Since I can`t afford to have it all taken care of at once, where should I begin to get an effective more youthful result?
well, if your issues are the eyes, neck and skin, I would look at the eyes first, then skin and neck last. But what needs to be done on what area varies from perosn to person. No way to really tell without you identifying on yourself what bothers you the most. JG 11.7.10
Why is Radiesse better than Restylane for nose?
lasts longer as you need it for lost cartilage whcich will never regrow. JG 11.4.10
Is it better to use sculptra, restylane, or radiesse on chin/jaw area to fill in hollowness? How about the nose to fill in missing cartilage?
Sculptra for the jawline and Radiesse for the nose in your case. JG 11.4.10
Is the plant Dianella Ensifolia just as good (if not better) then 4% hydroquine? Thank You
I cannot say becasue there is no standardized concentration of the Dianella, it might be as effective or too weak, or too irritating. JG 10.31.10
Hello Dr. Garcia: I understand botox can be used to alleviate tinnitus - ringing in the ears. Who should I see for this solution - an ENT or a dermatologist?
I have not read about it being used for that, sorry. I think if anyone is going to do it, it would be an ENT.JG 10.31.10
I`ve spent two years addressing leg veins with schlerotherapy followed by YAG treatments for clean up of surface vessels. I had very good results. Then in August, the vascular surgeon who was doing all this suggested that we could get rid of the small remaining vessels with the new Vein Wave, which seemed to me to be little more than an invasive form of cautery. What a mistake! My legs are now an unsightly mess, looking worse than when we began two years ago. They are red and inflamed; 9 weeks post treatment, and I am sporting new, red veins that look like very, very bad scratches. The surgeon tells me that the Vein Wave merely made visible on the surface what was lurking just below the epidermis so now it can be treated...with the YAG again, I am assuming. This whole escapade has been very expensive. What would you suggest I do? I had hoped that this would be the final step in this long series of treatments and that I would probably need occasional YAG or schelerotherapy in the future to maintain the results, but now I`m back to where I started, or worse. Thanks for any guidance you can give me.
well, I think you need to find a new doctor and then get the problem fixed once again, sorry. JG 10.26.10
Is a total hysterectomy more painful than a tummy tuck? Ty :)
yes. JG 10.26.10
Hi Dr. Garcia: How soon after a tetanus booster shot can I resume my botox treatment? I have the area between the brows done and outside corners of both eyes.
whenever you wish. JG 10.24.10
like to know more about ulthera treatment and cost thank you
Sorry, we do not offer the treatment in our office. JG 10.20.10
Dr. Garcia, You have performed a facelift on me and I have had several fillers done. There is a plastic surgeon in town that injects fat into the top of the hands to correct the thin skin and help the veins look less noticeable. I was wondering if you perform this procedure as I would not want to have any procedures done by anyone else. Thanks much, Kay
I appreciate it Kay, I have tried fat injections on the top of the hands and to be honest, I am not impressed by the reliablity of the fat as a filler or how long it lasted. Once the swelling was gone, it all seemed to disappear in a few weeks. I have tried other fillers, and have not been happy with the off the shelf materials either. I feel it is because the skin is very thin and the fillers do not last. Also, if you get lumps, tehy can take along time to go away and can be visible. At present I do not have anything that I feel is predictable in its results. Sorry. JG 10.19.10
I had breast implants 15 years ago to a size C cup. My breasts seem smaller now. Do you lose fat tissue on breasts as you age? I am 40 now. My breasts are not saggy. Just wondering if saline leaks over time so you need to get them replaced? Also, I am 5`9 and skinny. Do you think a C cup is too small since I am tall? However, I am model skinny.
yes, normal breast tissue does get smaller with age in most women. Saline implants leaking is an all or nothing phenomenom, so if it leaks it all leaks,not just a little bit. If they are not broken or causing a problem there is no need for replacement. JG 10.18.10
Hi Dr. Garcia! I`m 23 years old, physically thin and fit. I have chipmunk cheeks, and jowels that give me a very masculine look. The female jowels run in the family on my mothers side and get worse with age, and the chubby face is from my father`s side. (Lucky me! I inherited both!) Neither my mother or father`s face has changed with age so I have no doubt that`s it`s definitely not just baby fat I`ll lose later in life. I am very unhappy with my masculine shaped face but am unsure of options to fix this...is liposelection or buccal fat removal good choices? Any suggestions/comments...Thanks!
I think I would start with the buccal fat pad removal, that should take care of a good amount of the fullness and the jowl. Liposelection, which is just an amateur attempt to make it sound like a special liposuction, will likely not help your jowls at this age as the fat is most likely below the muscle, where the liposuction cannot get to. Best of luck. JG 10.14.10
Is it possible for a plastic surgeon to remove the titanium pins from long bones, which were installed to correct broken bones, rather than an orthopaedic doctor? (the breaks are healed) This way the scar can be corrected at the time of the surgery. Orthopaedic surgeons tell you that they are not plastic surgeons and make hideous long scars with no regard to cosmetic appearance or improvement.
I think, due to the small risk of breaking the bone while removing the screws and plates and also the screws breaking themselves, it would be difficult for the plastic surgen to agree to that, but you can certainly request he be there at the same time for closure of the wound. Having said that, there is a low likelihood that the insurance company would pay for the plastic surgeon to be there and it will probably fall on you to pay for it out of pocket.All the best. JG 10.4.10
Hello Dr. Garcia: I have a few age spots that are too light for the Versapulse laser to eradicate. It was very successful and my skin color after the scabs flaked off was the same as surrounding skin. If I have a treatment with liquid nitrogen, will skin color be stripped from those areas? Will the resulting skin color be lightened or will it match surrounding skin color?
I think liquid nitorgen is much too unpredictable and could lead to permanent pigment loss, I also think the VersaPulse can be turned down in energy and make it able to be used for lighter spots. JG 10.1.10
Sorry for typo, what is in Biest!
gotcha. JG 9.28.10
Dr. Garcia, I would just like to clarify with you what is in Bieast, thank you
if you mean BiEst, it is estradiol and estrone. JG 9.28.10
Hi Dr. follow Q about Triamcinolone acetonide S/Es: G-Yag (Candela)? Not contraindicated since I`m on my Accutane Tx? thank you so much Dr ... You`re really a great help to me ... I`m so depressed of what happened ...
hang in there, there are options. JG 9.24.10
I saw a tv show which fillers were recommended for people in their 50s. I do not know if being skinny or having less fat on your face has anythign to do with it, but I am only in my late 30s and a doctor recommended fillers for my face. My face does look gaunt. Am I aging before my time since i am not in my 50s, yet?
the visual effects of aging start in the 30`s and in some cases, if the patient desires to maintain a very youthful look, fillers can be used to decrease even the slightest change, all depends on what you are looking for. JG 9.24.10
Hi Dr. This is a follow-up Q regarding Triamcinolone acetonide injection ... So, I have to wait for 6 months then I can have some fillers injected to it? What filler you would recommend? (areas with atrophy are? jawlines, back and li`l on my chest) ... I have noticed that it becomes shallow ... hope it will get better... you think it will go back to it`s normal look? just the way like it was before? another thing dr. ... The atrophied areas on my jawline appears to have hypopigmentation ... then on the other parts like my chest and back ... at the center of the dents ... there`s a red spot/dot ... which maybe the portal of entry of the needle during the injection... I believe, no Tx for hypopigmentation ... thank you so much for the help... hope to hear from you soon...
I would suggest using Restylane to make sure it looks good, then one can proceed with a different, longer term filler such as Radiesse or Artefill. In many cases it all fills in with time, but slowly. Not much except sun exposure will help the loss of pigmentation though. If the red spot persists a YAG laser might help fade that. Best of luck. JG 9.23.10
i fell face down on a tile floor on may 9, 2010 and fractured my nose I have had ct scans and seen by an ENT 2 times, who advised me the other day for a follow up visit that i had broken the capillaries around my eyes and i will have black eyes forever and use makeup. TRUE. i am depressed over this.
well, they might persist for a long time and capillaries are impossible to repair, but lasers, like a YAG laser, might help fade them a good amount. JG 9.20.10
I was injected with Triamcinolone Acetonide for my acne for almost 3 months already ... and I noticed that I have dents on the injection sites (atrophy) ... and it`s not nice to see them ... what are the other options I can do to resurface the area treated? I really feel bad about it... I can`t do laser resurfacing like Fractional CO2 lasers and the like coz I`m on my Roaccutane Tx... please let me know what are the possible options... hope to hear from you soon...
what has occurred is below the skin and surface lasers will not help, the atrophy might get better over a 6 month period, after that you might consider fillers for the depressed areas. Best of luck. JG 9.17.10
I had botox injected on my forehead about a week ago at a plastic surgeon’s office. Today, my dermatologist injected cortizone into an acne cyst on my forehead, in the same general area I had the botox injected. Can a cortizone injection reduce the effectiveness of botox?
should have no effect. JG 9.15.10
Hi Dr. Garcia, My second question is whether Silikon 1000 can be used safely to fill in the hollow parts under one`s eyelids? Thank you, Bill
I would never use Silikon 100, which is liquid silicone, to correct it, actually in the state of Nevada where I practice, it is illegal to use it for that purpose. If you develop a problem from the injection it can be potentially impossible to fix or remove the silicone. JG 9.14.10
Hi Dr. Garcia, I have two questions: 1) can applying mometasone steroid cream to one`s nose to get rid of an unsightly pimple cause the nasal skin to lighten? I applied a dab of this cream, and the tip of my nose is noticeably lighter. Is this permanent, and can anything restore the original color?
it can cause some short term lightening, yes. It is usually temporary and with time and sun exposure, the color should return. JG 9.14.10
I never noticed cellulite on my bittocks until after I had liposuction. That is where the canula or whatever you call it was used on my buttocks. Is it possible the liposuction thinned out my skin. It is just starnge I have it where I had liposuction. I had liposuction in my late 20s. I noticed cellulite sometime after that. But never had it before the procedure. Also, what is best treatment for cellulite. Are there any supplements that help with it?
in some cases removing fat will make the ksin looser and allow the cellulite to be seen more readily, but the liposuction did not do something to the skin to cause the cellulite to form. No supplements that will help, as to what works, VelaSmooth and endermologie work, but only as long as you are having treatments, once you stop it comes back. JG 8.26.10
Hi Dr. Garcia, About five weeks ago I had botox injections between my eyebrows. It has been about a year since my last injection. I`ve had botox many times with great results that last at least 5 to 7 months. This time, I noticed that it wasn`t very effective within two weeks of having it done. I still had movement, when in the past, it would not have happened. I went back to the doctor who injected me and he said that he couldn`t inject anymore because it would cause my brows to droop (to inject too close to the brow). He charges less than most doctors in my area for botox and now I am wondering if he used a watered-down mixture. I don`t think I am immune to botox because I don`t have it done that often. What do you think could be the cause of this and what can I do in the future to make sure the doctor is using a fresh batch? I have had this successfully done before, I feel like I was ripped off. Thanks! Anne C.
sounds like he watered it down and is sharing vials between patients which is not legal to do. Each patient is supposed to have their own bottle and any left over discarded. JG 8.26.10
Our school is interested in any information you may provide regarding Tattoo Removal.
we use a Q-swithced Nd:YAG laser for treatments to remove tattoos. The easiest color to remove is dark blue or black. Colors such as green and yellow can take longer to remove as those colors exist in the skin normally and we are attempting to remove the ink and leave the skin unaffected. Each session causes some percentage of the ink fragments to be broken up and digested by the body`s defense mechanisms. The greater the amount of ink in place, the more sessions it will take to remove the tattoo. There is no way to predict how many sessions it will take to remove it. The tattoo is also a great sunblock, so the area that has been exposed to the sun with the tattoo has not had sun hit that skin. Upon lightening of the tattoo, the skin below might be a little more pale and need months of sun exposure to regain an equal amount of sun exposure. After each session there is some temporary scabbing and we suggest applying ice and Aloe Vera. The sessiosn are done every 4-6 weeks, allowing the skin to heal and the ink to fade some before the next treatment. We charge by time, in increments of 15 minutes. It takes much loger to remove a tattoo to place one and it hurts much like getting it placed each time you have a treatment, although as the amount of ink diminishes, the pain also decreases. Some colors, like reds, can become darker purple during the process and appear darker until the ink has been removed. Hope that helps. JG 8.25.10
well i dont take any medication besides this gel, but do you really think the pigment will come back and how can i speed up the process
no way to tell if it will come back, but it should, and besides what I have already suggested to you with the sun exposure, there is not much else you can do but wait. Sorry. JG 8.24.10
it says to use it everyday on the bottle itself, but before you said even if i used it everyday i can`t get hypopigmentation from 3% salycilic acid gel...
it must have interacted with something else. It normally shoudl not cause that unless there was some other contributing factor in your case. JG 8.24.10
it actually looks like the darker areas are just darker than the rest of the skin, im really more concerned as to why I have the lighter spot from the use of salyciclic acid 3% gel. Can the gel actually lighten the skin that much to create a hypopigmented spot if you use the gel everyday or everyother day.
you have it because you overused it and burned your skin. It comes from misuse or unsurpervised used. There is no clinical reason to use that gel everyday, not sure who told you to use it that way. JG 8.24.10
The hyperpigmented areas are right next to the lighter spot , do you think the hyperpigmented skin has something to do with the skin adjacent to it being lighter? can I use a mild steroid, I`m currently using desonide on the hyperpigmented areas. Can that help remove the hyperpigmentation? will the hyerpigmentation go away on its own in time if I just use sunblock or do I have to use hydroquinone?
steroids will not help, and the area that appears darker might look darker just in reference ot the ligther spot. No way to tell if the darker spots will go away on their own.JG 8.24.10
Hi, I was told to massage my chin area because of an ArteFill lump. I wasted a whole month massaging -- morning and night -- an hour each, folled by icing. Since then, I have noticed that this area looks discolored -- like gray a little. Because of massaging and icing, could I have thinned the area out? I was wondering if the color will eventually even out and maybe thicken a little. Is there anything I can do? Is there a particular laser that might help? Thanks.
nothing you have done could have caused any thining, do not blame yourself for that. The color should get better in time, yes, on its own. Laser will not help, sorry. JG 8.19.10
Dr. Garcia, I`m the guy with the light/hypopigmented spot on my cheek from repeated use of a 3% salycilic acid gel for my seborhheic dermatitis on my face. I went out in the sun today for about 40 minutes and I did not see any change in color in that spot. Is there any way to speed up the repigmentation, do I have to stay long enough in the sun for it to sunburn? I really hope this is not a permanent thing. Are you sure that if I use 3% salycilic acid gel everyday it can`t possibly cause hypopigmentation?
you are nto going to see a color change in one day, that will take days of exposure, along with time. JG 8.19.10
I`m just freaking out because I`m scared the light spot is permanent. I reado online that repeated use of salycilic acid topicals can cause permanent hypopigmentation. is this true??
I have never heard of it happening without the patient sustaining a frank burn and blistering. JG 8.17.10
is there anything I can use to spead up the color coming back? I am now using desonide, which is a mild steroid in the area. There was a stretch last week where I used the salycilic acid gel twice a day for 4-5 days straight because the seborrheic dermatitis flared up bad on my face, but when I put it on my face I spread is around the cheeks so some of the salyciclic acid gel gets on normal skin areas and that lighter area was a normal skin area. Is this hypopigmented spot a normal side effect of this 3% salycilic acid gel? what can be done to speed up the repigmentation, I just dont want to make anything worse. Thank you in advance
the steroid will slow it down, you can just get some sun exposure to help it come back. The loss of pigment is not common though. JG 8.17.10
Dr. garcia, I use a 3% salycilic acid lotion (dermarest) for my sebborheic dermatitis on my face and I usually use it every other day. I notice now a lighter hypopigmented spot on my cheek where I usually use the lotion. Its been there for 3 days now. Is this permanent? will the pigmentation return. I have since stopped using the lotion.
seriously doubt it is permanent with that regimen.In time the color should come back. JG 8.17.10
Would a plastic surgeon be able to tell me if I had this curtis laxa or whatever you called it about having loose skin?
well, the complete diagnosis would need a skin biopsy. JG 8.11.10
You said you thought it might be cutis latix or something like that with the loose skin. Nobody else in my family has that. I use to tan in the tanning bed alot. Would that have caused this. You surgery is the only thing that would help. Is it a painful surgery. And is there lots of scarring and where would the scars be for the stomach and legs?
tanning woudl nto have affected it to any large degree, that affects more small wrinkles. The surgery most likely is large, whether on the tummy and even more so on the thighs I am afraid. There will be scars, yes, permanently. JG 8.11.10
I have a question regarding the loose skin on my stomach. I am a thin person and always have been. I am 5ft 6 and weigh 120lbs. The skin on my stomach looks like that of someone that use to be fat and lost a lot of weight and left extra skin or loose skin. What would cause this and is there anything that I can do the get rid of it or improve it. I don`t think all the exercises in the world would help?Legs are the same way. When I shake them, it looks like a tidel wave. And I have skinny legs but with a lot of flab or loose skin. Please help!
exercise will not help, sorry. As to the cause, hard to say, but there are genetic reasons that can cause premature lossening of skin, it is called cutis laxa. The fact that your legs are the same leads me to think that is is a geentic thing. Unfortunately the only thing that will help is surgery and if it is cutis laxa, the skin will stretch again in time and it will have to be redone in a few years. Best of luck. JG 8.11.10
Hi Dr. Garcia: Is there any therapy out there that disguises or lessens cellulite? My stomach looks quite bad. Lost, gained, and lost weight again.
VelaSmooth or Endermologie help, but only as long as you have treatments done intermittently, sorry. JG 8.4.10
Is coconut oil more like an omega-3 or an omega-6 oil? Thank you
well, maybe more like Omega 3, but not in scientific truth as Omega 3 and 6 are unsaturated fats and coconut oil is a saturated fat, but it is a healthy saturated fat as it is a medium chain fat. JG 8.2.10
Hi Dr. Garcia, I had a lot of scar tissue that was preventing the doctor from removing the fat. I recently had three 5fu`s and now I am hoping that the fat can be easily removed. Has 5fu helped you remove fat more easily?
I have never had to use 5FU for that, not sure further microlipo will help. JG 7.29.10
Hi Dr. Garcia, How many 5fu`s do you think is sufficient before a microlipo? I have had two microlipos and the doctor couldn`t get out any fat out of my chin. Since then I have had three 5fu`s and I feel my chin is a lot softer. Do you think that I am ready for another microlipo?
why would you do something again if it has not worked twice before? JG 7.29.10
I have fat cheeks and have seen the proccedure for buccal fat pad removal. I constantly bite into my cheeks and it has become quite painful and a nusance for me when eating. Do you do the proceedure and if so can the removal of the fat pad bemesured. I do not want the hollowed out cheek look. I think emaciated faces look older so I just want enough cheek fat removed so that I don`t bite into my cheeks when eating..actually I do it even when I am not eating and it is painful! LOL! also I would have to save up for this proceedure so approxcimately how much would this cost and if so..I have health insurance and since it is really a medical problem and not a cosmetic one would this possibly be covered under my health plan? Also a s
I do perform the procedure if I examine the patient and find an adequate amount of fat in the pocket to make a visual difference, typically the amount of fat is relatively small, about 3cc per side. If one has a very round face I do not think you will look emaciated afterwards, but the difference might not be as dramatic as you are hoping for. The procedure is not covered under health insurance and the fee is about $4000. JG 7.28.10
Hello Dr. Garcie: What do think about Botox injections into the masseter muscle - do you think it could reduce jowling? Thank you for all you do.
will do nothing for jowling, might actually make it worse as the muscle mass of the masseter will be less and therefore support the jowl skin less. JG 7.22.10
I know this may sound like a strange question, but as your time as a plastic surgeon do you notice that better looking people age slower? My sister was a fashion model in her teens and early 20`s with good bone structure and tight features. She doesn;t take care of herself at all and smoked and stayed in the sun and now at 31 she may not stop traffic anymore and have everyones eyes on her like she used to, but she is still very attractive and people usually guess her age at 22! I have never been that attractive and don`t have the same bone structure but unlike her I take good care of myself yet people usually guess my age at 29... and I`m only 28. I notice this with a lot of people who are exceptionally good looking when they are younger what are your thoughts?
well, although you may not see many differences between your bone structure and hers, as you are related, most people perceive beauty by way of facial proportions, and those are controlled by boney structure and fat distribution. It is true that attractive people age better or at least look better as they age, and it is mostly becaue of better tissue support and bone structure. The subtle differences between your bone structure and hers is likely the cause I am afraid. JG 7.22.10
I was not lookign to grow collagen. I was looking to grow cartilage to place inside nose for tissue graft. I have read about people who lost their nose or ears (maybe from frostbite) and a plastic surgeon grew a new nose or ear on their arm or forehead to transfer to face area. So, you are saying a nose or ear can`t be grown on another part of your body? I just want to use the tissue from it for a graft inside my nose.
I am afraid your information is incorrect, there is no way to grow a new nose or ear, there are experiments going on trying to use experimental materials in a mold to try to do that in animals. I am saying that they cannto grow cartilage somewhere else on your body in order to use it as a graft in your nose, correct. JG 7.19.20
I don`t understand what you mean about not being able to grow new collagen if you grow nose or ear cartilage behind your ear for nose rhinoplasty. Do you mean that patients who grew a new nose or ear were missing collagen in the new new nose or ear? Did the new nose or ear die because it lacked collagen? Is cartilage made of collagen?
cartilage is made partly of collagen but you cannto grow new collagen like the way you describe, sorry. There are no newly grown ears or noses on humans. JG 7.19.10
Is there anything that can be done to improve the skin of the neck. Not for sagginess, but for the crepe paper texture. Would a fractional laser help?
lasers such as that or chemical peels will give you maybe a few months at best, no much else though out there as it is the quality of the skin that has deteriorated and the treatments on the neck cannot be done as strongly as on the face to get improvements. JG 7.19.10
I wrote the recent question about growing nose or ear cartilage behind ear to use for nose graft. Why won`t that work?
because you will not be able to grow new collagen as you have been led to believe.JG 7.18.10
For nose revision surgery, I do not have anymore cartilage left in nose or ear for grafting. I do not want a graft taken from my rib. So, I was wondering if a nose or ear (which would be best source of graft= a nose or ear) could be grown behind my ear to use that for a graft. I say that because some people have grown noses or ears on other parts of their body to transfer for reconstruction surgery. Maybe I could just grow the cartilage or not the full shape of ear or nose behind my ear? Where can I find a doctor who would know how to do this? Are cells taken from your nose or ear= how is is grown?
sorry, that will not work. JG 7.17.10
OOPS--one more question--what is the other lip procedure you do around the cupids bow? And--do you know any PS in the Washington, DC area that still does PORTRAIT? Thanks. B
with the bullhorn lift there is nothing that needs to be done to the cupids bow, but a suture can be placed to cause some rounding and lift at the same time, when you are doing the vermillion roll lift, there is not much that can be done for the cupids bow in my opinion. I am not aware of who is doing the Portrait in the Washington DC area, sorry. JG 7.14.10
Hi, Dr. G--Does a bullhorn lip lift or vemillion lip advancement give the best results? Why would you recommend one over the other? Would you do a corner mouth lift with either procedure? Thanks. B
I would do a bullhorn lift over the vermillion lift, I feel the scar is easier to hide and the vermillion lift can leave the vermillion roll flat and unnatural in appearance many times, if needed, a corner of the mouth lift can be done at the same time as either one. JG 7.14.10
Hello Dr, I know in the past you havent been a fan on the Silhouette/thread lifts. Do you think that results from them are now better that they have improved them slightly. I also wondered if a Silhouette lift reversible if the outcome is not as expected? Thank you
to be honset, they have not convinced me yet, if it was so good before, why did they have to improve it, even slightly. As to reversing it, all that you need done is to have the sutures cut, but they usually break on their own with time and muscle action of the face. JG 7.14.10
Hello, I have a general medical question that I hope you will not mind answering for me. I was stung by a bee and had a reaction. The doc prescribed 60mg prednison x 5 days. Is this safe? I thought the dose had to be tapered? Thank you for your help!
it is short enough of a time period that there is no need to wean off. Best of luck. JG 7.13.10
Follow-up regarding subcision: should a filler be used at the same time as subcision or later?
same time. JG 7.10.10
Will subcision help treat a wrinkle that cannot be lifted with a filler alone?
possibly, but I woudl suggest placing a filler in the area subcised to slow the possibility/eventuality of the tissue re-adhering.JG 7.9.10
JUst wondering if the red light in lasers for hair growth is the same kind of red light in lasers for skin improvement?
What do you think about red light emitting LED light for home use. Will you get any results on skin like you do with red light lasers?
I do not think the home units will give you much. JG 7.8.10
Dr. Garcia; I know you are not a believer of Lipo Ex (RF)which claims to use radio frequency to melt fat. However, I would like to know if RF treatments are relatively safe. Thank you.
as for skin tightening, no, I do not find them effective and potentially can lose fat on the face on an irregualr basis. As to using it for melting fat, I think it is highly unpredictable and would not recommend it be used. JG 7.5.10
Hi, Dr. G--I heard about a lip lift that is done by taking a thread through the nose and no cutting. What are your feelings on this type of lip lift? Thanks.
it can cause some bunching of the skin as there is no skin removed and once the suture breaks, and it will, then all goes back to where it was. Best of luck. JG 7.1.10
I have ad about 15 tca 25& peels on area with hyperpigmentation, but it is still there. Before the first peel, the hyperpigmentation was light or not dark, but there is large area of hyperpigmentation so it stands out. After all these peels, the hyperpigmention doe snot look any lighter or les noticeable. How many layers of skin do I need to peel off before I see results? Would the laser work better?
you either need to go to a stronger TCA, 35% or higher or to a YAG laser. JG 6.29.10
I have a question about lasers for brown spots or hyperpigmentation. If put skin bleach on your skin, your spots will come back as soon as you stop using the bleach. Is that how it is with lasers? Or do the spots only come back if you are out in sun, etc? I mean do the spots come back right away if you stop laser treatmen? Or is it possible to go a couple years without any apots after you stop using the laser? I was wondering if lasers just made the spots lighter or if they got rid of them (even if temporarily)?
they will not come back immediately unless you go out in the sun without protection, no matter what treatment you have used. Lasers do help, but there is no way to guarantee the laser will entirely remove the spot. JG 6.29.10
Hi, Dr. Garcia--I don`t show my upper teeth when my mouth is open, but at rest. My PS suggested a bullhorn lip lift. A) will it change the width of my nostrils-I hope not as I have a very nice nose, B) is it necessary to do a corner mouth lift as well, and C) will it actually give my upper lip more volume by showing more lip or is it only lifted but just as thin? Thanks so much--you offer such a great service withthis column. B
it wil not change nostril size,it will usually need top be done to the corners so that they do not droop and the lip volume will not be larger, although more red lip will be seen. JG 6.27.10
I do not know if you would know the answer to this. I do not know if it is related to the hypothalmus or pituitary gland, but what blood tests show how your body is regulating your body temperature (especially in relation to ovaries). Like if your body temperature gets overheated or underheated at times.
TSH, reverse T3, free T3 and free T4. JG 6.27.10
Is there anything I can do to make my skin stretch (tug skin with tape, etc.) where I have a scar so I do not have to add tissue expander?
sorry, but no. JG 6.22.10
Is it possible for a revision rhinoplasty patient to obtain clone their nose cartilage for a nose graft? If so, how can one arrange to have this done?
there is no cloning available for huamn tissue at the present time. JG 6.21.10
Say you had a skin growth frozen with liquid nitrogen adn it forms a blister. If you pop open the blister right then, does it not bleed because the blood vessels freeze?
correct. JG 6.8.10
Just curious why skin does not bleed if it is a deeper wound?
in cases of a burn and only in a burn, the deeper the injury the less it bleeds as the burn has clotted off the blood vessels. JG 6.8.10
I accidentally burned myself again with a clothes iron. I think my hands are becoming more clumsy so I drop things or bump them into things more often. I burned two knuckles on two different fingers. The burn was white, but the skin came off on one of my fingers while my shoe hit it when I was putting on my shoes. The wound did not bleed, but the skin turned white and came off where it was burned. My question is if a wound that bleeds is depper than a wound that does not bleed? I hope these burns do not scar. My other question is if there could be something wrong with me. I can`t even draw a straight line. I had MRI of brain, but nothing came up. When I was at the store today. I dropped a greeting card that I was looking at. Then I dropped some papers I was bringing back to my car.
if it bleeds it is less deep, if it does not bleed it is a deeper burn. The deeper it is, the greater the chance for a scar I am afraid. I think seeing a neurologist is a good idea, many nerve issues are not seen on an MRI of the brain, I wish you the best. JG 6.7.10
If you have liposuction for saddlebages, can mistakes happen where you lose fat or get indentations on buttocks?
it can if the cannula is used in that area, also as the skin shrinks, it might sag causing some deformities, the older one is and the larger the amount of fat removed the greater the risk of it occuring. JG 6.4.10
Why should Sculptra not be used around the lips? Can it be used on smile lines?
it is meant for deeper injections for fat loss, if injected around circular muscles like the mouth, it can cause lumps, you can use it for nasolabial fold lines but it depends on what is causing them, not always a good idea. JG 6.4.10
What do you think of labiaplasty surgery?
reasonable thing as long as the expectations are reasonable. JG 6.4.10
Is Sculptra used on the lips? I do not want to make my lips fuller. I just want to add a little collagen on lips to make them softer or less dry since collagen holds moisture in the lips.
it should not be used on the lips or around the lips. JG 6.4.10
When I got Dydport the very first time - the results were amazing. The 2nd time I got it the results were good but not amazing. I get it a 3rd time and the results were not very good. I had to go back and get more injections. Am I building up a tolerance ---should I try Botox---is the anesthecian injecting it incorrectly? Which is better Botox or Dysport?
more likely it is the injector or how the mixed and stored the Dysport, tolerance has been discussed but not seen in clinical practice, especially after three injections. I prefer Dysport. JG 6.3.10
Why are osmotic tissue expanders unreliable? They seem so convenient since you do not need to refill them every week like with other expanders.
they leak and they might fill up faster then the skin can tolerate too. JG 6.2.10
Would you use Sculptra for undereye wrinkles or hollows? Why or why not?
nope, not meant to be injected into thin skin and you could get lumps. JG 6.2.10
I wrote the question about tisue expander below. How many ml (volume) do you think the expander would need? Also what do you think about osmotic tissue expander (ones you do not need to have filled)?
would not use an osmotic tiseue expander, too unreliable and I think you would need at least 200cc if not more. JG 6.2.10
What size and shape of a tissue expander would you recommend for a scar 1 inch wide and wither 1 or 1.5 inches in length? Also, does a tube end (like a plug on a raft) stick out of your skin? And how long would you need to wear a tissue expander for this size of scar?
rectangular or crescent shaped. The injection port is underneath the skin and usually is connected to the expander with tubing. The expander will likely need to be in place at least three months if not longer, all depends on how fast you can stretch the skin and then you need to let it sit for a month or two, removing it too soon leads to the ksin shrinking back and losing the effect of the expander. JG 6.2.10
What do you think about impalnting tissue expander for scar revision? I mean if the skin is veyr tight and you want to make less tension with not so tight skin. Will making a pocket for the tissue expander make the scar bumpy? Or will that pocket area be removed when the scar is revised?
placing the expander should not make the scar bumpy, but it is a significant deformity with the expander while it is in place. I think if the scar bothers you and the skin is tight, there is likely no other option though. Typically the pocket or capsule is not removed when the expander is removed in order to not damage the blood supply to the skin. Best of luck. JG 6.2.10
Hello Dr.Garcia, I want to have juviderm injected into my cheeks. I anticipate bad bruising for a week or more. Also maybe lumps to some degree. I want to know how realistic my thinking is on this. I read your columns for guidance and you have saved me alot of money over the years. Thanks, Sue
I think in most cases the bruising is gone in a few days, ice will help. I think if injected deeper, the bumps should be minimal to none. All the best and thanks for the kind words. JG 6.2.10
You wrote that people have been disappoited with laser hair removal. But is that just on certain parts of the body like the face or other areas affected by hormones. In other words, do other parts of body have more success than the face? Is the YAG the best hair removal laser?
I feel Alexandrite is best for hair reduction and in general, in areas where the hair grows the slowest is where you will have tee best results. JG 6.2.10
Dr. Garcia, Do you think a woman that is post menopausal can benefit from hormone treatment as far as the look of her skin overall is concerned? I have been told by the doctor that this can help? Would just like your opinion thankyou.
yes, I do. I have seen it work in many of my patients, especially the ones that use bio-identical hormone replacement. JG 6.1.10
Dr. Garcia, Thankyou firstly for your help with so many of these questions to help make better decisions regarding these procedures. I would like your opinion on a thigh lift. I am 57 yrs. of age with pretty good skin tone, but after lipo on the inner thigh area, i am disappointed with how that looks! There must have been a misunderstanding, because the Dr. was only supposed to laser the area and not take out any fat, but some fat was removed. Now i am considering a thigh lift, and that would be to improve the look of the leg area from the knee up to the thigh. What kind of scars are associated with this type of surgery, Thankyou for your reply.
well, that is one of the areas on the body with the least acceptable scars I am afraid, the act of sitting and walking places tension on those scars and they are usually not hairline scars, are wider and will many times migrate down below the inguinal crease where they are made to the upper part of the thigh making wearing revealing underwear or bathing suits difficult. I suggest you ask the doctor to see some examples of scars before you undertake the surgery and trade one thing you do not like for a new one you don`t like. All the best. JG 6.1.10
I wrote about tissue expander- the smallest size I guess is the half orange size. I want a scar revision. Would it cost more for scar revision if you had tissue expander implanted or would it cost the same price whether or not you had tissue expander. If it will cost more, about how much more for the smallest size expander?
the tissue expander surgery option would cost more as there would be two surgeries and the cost of the expander too. There is no cost difference on the expander size, they are all the same price. JG 5.26.10
I have silicone inplants under the mucsl. tisiue 21 years ago that I would like removed,Im a cancer pt.last chemo 7-2-09. Right lung removed 4-23-10. Need to know the down time off of work & ball park figure of cost.
insurance should cover that for you, I am pretty sure that after that amount of time they are ruptured, you would be on light duty, no lifting more than 20 pounds for two weeks and full activity in 4-6 weeks. If you do not desire to go through your insurance carrier I would be happy to see you in consultation to give you the fee, hard for me to say without seeing you and determining what time would be involved. JG 5.25.10
Why do people`s foreheads tend to shine if theny have botex?
actually should be the opposite as there should be less oil, maybe the fewer wrinkles reflect the light more, not sure why you see that. JG 5.25.10
I wrote question about tissue expander to revise a scar where there is tight skin. The scars are located on my arm and on my shoulder. If a half orange sized expander was placed in these areas, would it make my skin look older since it muight look saggy? Again, the width of the scar is only 1/4- 1/2 inch. And how many weeks or months would the expander need to be left in?
should not make the skin saggy. Expander would be in place 3-6 months. JG 5.23.10
Is catarizing the skin (heating up blood to form scab) better than using Dermabond glue so a wound will not scar as much?
no, that can cause more scrring as it can decrease the blood flow. JG 5.21.10
Hi have you heard of innoxa eye drops french blue?? Are they safe? Are they like visine because my eye doc told me long term visine will mae your eyes redder??
any eye drop can cause that problem, especially when the drops are wearing off. JG 5.21.10
Is Scupltra good for neck lines?
nope. JG 5.21.10
Have you heard of stitches irritating skin and busting open forming open scab due to too much tension in skin. Like if the skin area was really tight, but scar tissue was removed to make a scar smaller. Do you think placing a tiny tissue skin expander underneath scar would prevent the tension problem and help scar heal normally after next scar revision? Can you get tisue expanders so small for a 1 inch x 1/2 inch scar? Or what else can be done?
it could be an option but the tissue expander would need to be there for a few months to stretch the skin out adequately. The tissue expanders made will be larger than that I am afraid, about half of an orange size. JG 5.21.10
Have you ever used Botox in the neck area to diminish vertical lines?
no, because it does not work well. JG 5.20.10
what is the best eyelash growth product??
we sell Revitalash. JG 5.20.10
I am in my mid-30s. For the past years, I have accidentally burned my hands with curling iron, clothes iron, oven pans. In my 20s, these burns would always heal without a scar. But now I get a white scar everytime. WHY IS THAT? I just burned my hand again. There is white mark where I burned it with some peely skin. Is there anything I can put on it to prevent it from scarring? Also, how many days should I apply it? Thanks.
it can be due to deeper burns or you are burning tissues that have been burned before and not do not have the same healing capacity. Once burnt I would suggest at least neosporin or Silvadene, but the latter is a prescription. Apply it until healed.JG 5.18.10
Dr. Garcia, I usually have 32 units of botox for crows feet, 16 each side which tends to last 6 weeks or so. My Doctor changed to Dysport 32 units but still charged the same amount of 32 units of botox. I mentioned to him that I thought you had to use a least 2.5 times amount of Dysport compared to 1 unit of botox to get the same effect and as Dysport is cheaper the price works out relatively the same. His response was that although he only used 32 units of Dysport he used less saline so the product in the syringe was more concentrated. Is that correct? Incidently the results are still minimal. Thank you
personally I prefer Dysport when proper dose is used, the amount of saline is important as to the volume the doctor needs to injected, but the dose is the overriding important thing. Not sure why you are getting such a short time of response from either one too, I see 3 to 6 months from those injections, but I inject 20 units of Botox and 60 units of Dysport to each crows feet area. One last thing, the bottles of Botox and Dysport are not supposed to be shared between patients, it is a single patient use vial, splitting bottles between patients is illegal and can cause cross contamination with things like hepatitis, so make sure that you buy the whole bottle and they are not sharing. Best of luck. JG 5.15.10
Dr., What would be better for dry, middle aged skin. Olive oil or cocoanut oil? Thank You
olive. JG 5.9.10
I know you dont recommend eyelash extensions, but what is the best out there??
can`t really say. JG 5.9.10
I have an autoimmune disorder which my body attacks my collagen. I was wondering if collagen injections are just as good as laser procedure to put collagen back in your lips. Or what procedures(s) are best for that?
I think with your underlying diagnosis, nothing will work well I am afraid. JG 5.7.10
Good Day, In your opinion how well does Retin A work of treating moderate acne, milk wrinkling and overall skin texture? Are there any other alternatives that you would recommend over Retin A to better address these issues? Thanks.
it works well, for the money, since a generic is available, I think it is very good for the combination of issues you mention. JG 5.6.10
Hi Doc. I recently read an article pertaining to hair cloning restoration and was wondering if this is something you had any experience or information about? Do you see this replacing the contemporary transplant procedure? Thank you very much.
it is years away from being done commercially.Eventually it will likely replace the techniques presently used, but not for a long time. JG 5.6.10
is there a plae on the site that lists the ingredients in your products?? interested in lip plumper and the sunblock thanks
the sunblock is titanium dioxide, zinc oxide sunblock, Elefac I-205, tocopherol, tocopheryl acetate, pycnogenol, Vitamin C, beta-carotene, selenium and micronized iron oxide in a moisturizer and the lip plumper is a proprietary compund so I cannot disclose the ingredients, sorry. JG 5.6.10
I used a liquid nitrogen wart spray on someone with lots of seborrhea keratosis on back (like 100 of those growths). I just dabbed a q-tip applicator a couple times on the back. However, after 6 weeks the growths did not peel off. There are red dots all over her back now like she has a disease and these growths will not scrap off. In other words, the liquid nitrogen did not get rid of them. Although small in size, I guess they were too thick. What can she put on her back or do to make the redness go away. Please do not say a cortisone cream because she will not use any steriods.
can try squalene oil,tea tree oil,emu oil, ScarGuard or Mederma. As to the SK`s, might want to see a dermatologist and have then burnt off with a hyfercator.
I was born with a hip defect. It is lopsided so my waist is indented on one side, but straight on the other side. I do not like to wear tight fitting clothes for that reason. I know that people have hip replacement surgery. But do you know if a lopsided hip or whatever it is can be fixed? Is is something doctors can do?
It is seen on the hip but is more likely a problem with curvature of the spine, that would be a major issue and it might be able to be improved but likely not totally straightened, it would include permanent rods up and down your spine, that is done by orthopedic surgeons. JG 5.5.10
Hi Dr. Garcia! I had a BA performed by you in 06 that I am very happy with. I am thinking about coming back to see you for a possible rhinoplasty and some scar revisions from surgeries. So, I was wondering how much the consultation fee is? Thanks for your time and I look forward to seeing you again!
for prior existing patients there is no consultation fee, looking forward to seeing you whenever convenient. JG 5.5.10
Dr. Garcia, Do you perform fat grafting for Brazilian buttlifts? I am very intrested in this procedure. Thanks
sorry, but I do not. JG 5.4.10
How long do collagen injections last? Is a collagen injection the same things as collagen fibroblast injection (I was unsure by your last answer).
there is no such thing as collagen fibroblast injections and the collagen injections last a couple of months, much less than hyaluronic acid fillers. JG 4.24.10
When I talk you can only see my lower teeth. I notice that when I push my nose upwards slightly with my finger that my upper lip raises and I can see my teeth when I talk and I can smile more easily. What are my options to raise my upper lip a few millimeters and get this effect?
an upper lip reduction can be performed removing a small strip of skin right at the base of the nose to elevate the skin and therefore the lip up. JG 4.22.10
I have always been skinny. I used to have a very flat tummy, but since my thirties it has looked bloated like I am pregnant. It goes down when I wake up in the morning, but there is still a little bump instead of it being completely flat like it used to be. However, it seems to get flat again a few days after ovulation. I do not know why that happens. I would think I had belly fat if my swollen tummy did not go away in the morning. But it does go down somewhat. And I would think the little remaining bump was fat if my tummy did not go flat after ovulation, but it does. I have stress all the time, and I know that cortisol makes more fat deposit in tummy area. I am just wondering why I have this tummy. Again, I am skinny. So, is it common for skinny women in their thirties to get this?
well, it appears it is swelling as fat does not change from AM to PM. Likely related to the menstrual cycles. JG 4.18.10
Thanks for your prompt reply, re malar bags. I just contacted one of the top surgeons in Toronto and he said Sorry, but no. I`ve made peace with idea of scars, I just can`t find anyone to actually do it. I am willing to go stateside, just don`t know how to locate someone reputable and capable, yet on various sites there are pics of folk who apparently had it done and with minimal looking scars. Do you perform the procedure and would you be able to determine upon consultation just how extensive and noticeable the scars may be? Regards P.
Try Brooke Seckel MD in Boston. Julio Garcia MD 4.19.10
Hi: I`ve read thru the archives regarding malar bags and it appears that direct excision is the only option. How does one find a surgeon with expertise in this highly problematic area? I can`t find anyone in so far in my area who will touch this!!!!!! Also, you indicated that the post op recovery takes about a week, however In surfing the web I read that recovery is prolonged. Lastly I ran across a Nevada cosmetic surgeon touting a new procedure with an acculift (?) laser that has allegedly shown promising results on malar bags. Have you heard of this and if so, your thoughts please.
I know of no surgeon that bills themselves as an expert in this area, it is not difficult to perform though, it is just the resultant scars has to be acceptable to the patient. The sutures are out in one week and the swelling is decreased and you are able to go in public after one week but the final results take months. As to the acculift, save your money. JG 4.17.10
I have some lines of hyperpigmentation due to burn scars. If TCA peels remove the hyperpigmentation, will it come back over time. I know the sun can cause hyperpigmentation, but would the hyperpigmantation reappear in the exact same spot? Again, can the hyperpigmenation reappear if you stay out of sun or use sunblock?
yes, in time it will come back, the skin cells have memory. Although sunblock and avoiding sun are absolutely needed, in time, there will be some light damage and it will come back, sorry. JG 4.16.10
I think I may have a bacteria infection underneath skin where dissolvable stiches are. It is painful, and it looks like the scar might have yellow tint to it underneath. What developed is red inflammation all around the scar. And the red area hurts like it is inflamed. Does you skin hurt when you have a bacteria infection underneath? Do the stitches need to be removed?
it can, yes. Treatment with antibiotics is the first step. JG 4.16.10
In your opinion as a plastic surgeon, is bioidentical hormone replacement therapy generally safe and effective for post-menopausal women? In addition to seeking a general improvement in my level of energy, arresting the erosion of bone density, and improving my overall well-being, I suspect HRT may be the only way to improve my skin`s increasingly crepey texture. (I`ve done everything else available --Retin A and Botox for a decade, CO2 resurfacing, a facelift/necklift/browlift/midface lift, regular IPLs, occasional fractionated resurfacings, peptide cream, vitamin C serum constant moisturizer and full spectrum sunblock, of course. This past year, I`ve been using Sculptra (with some improvement of the skin`s texture but not much) and before that, hyaluronic acid fillers. I also take flaxseed oil, fish oil, multivitamins, DMAE, alpha lipoic acid, calcium and vitamin D supplements. I`m a non-smoker, a vegetarian, a cyclist and weightlifter. I`m only 48 years old but have been postmenopausal for 10 years. Despite all that I`m doing, I look 10-15 years older than my chronological age. At this rate, I`ll look 90 by the time I`m 55. I have extremely fair English skin and blue eyes. Thanks for sharing your thoughts on this complex topic, Dr. Garcia.
I think it is safer than the others out there. It is definitely effective for symptomatic relief. I would change the flax oil to straight Omega 3s to eliminate the pro-inflammatory Omega 6 in flax. All the best. JG 4.15.10
What is best way to keep scar on arm from stretching? Will an arm sling work?
in the short term, it will work, but since you cannot stay in the sling forever, eventually when you get out of the sling and the skin starts to move, it can widen at that time. There is nothing you can do to prevent it from stretching if it is in a place where there is skin tension, sorry. JG 4.14.10
For a scar revision, do you know why the skin underneath might sting or burn for months?
can be small nerves caught in the scar tissue. JG 4.14.10
What do you think of Ethicon dissolvable stitches? I am not sure if I spelled it right.
I use the Vicryl Plus Sutures by Ethibond. JG 4.7.10
Let`s say you have peach fuzz hair on your cheeks that sticks out instead of down. Would using Vaniqa on that area help the hairs to condition or grow down liek they are supposed to instead of stickign straight out?
Vaniqa. JG 4.7.10
Why don`t you like Monocryl or Dexon dissolvable stitches? Do they tend to cause infection? Everytime I get a scar revised byt this doctor, the area forms a scab bigger than the scar line so the scar quickly widens. And the revised scar will stil hurt with unhealed oozing scab 2 months later. Could this be an allergy?
I think Dexon causes more infections than Vicryl does and I feel the Monocryl is stiff and tends to poke through the skin edges and gets exposed. Scar revisions seem like they would be easy but actually they are difficult as they need to have larger and larger pieces of skin removed and unless one can diminish the tension on the wound when closing, the scabs form from the pressure and then they break open from lack of adequate tension release. It might be allergy, it might be infection and it also could be that there is not enough of a release of the tension to get the wound to heal without complications, sorry. JG 4.5.10
How long does it take for dissolvable stitches to dissolve? There a raised bump where stitches are tied under skin. I can`t pull out the clear stich string hanging out since the other end is somewhere under my skin. Do you think regular stitches or dissolvable stitches work best for scar revision?
depends on the kind used, it can take 6 weeks to 6 months, there are a number of different kinds. JG 4.5.10
I am using Rogaine 5% foam once daily with good results. However, I have read derm dr reports of premature facial aging d/t minoxidil prohibiting collagen synthesis. Have you seen this in women using minoxidil? Also, does scalpmed come in a foam concentration? Thank you for your time and opinion
I have not seen nor read of those reports about minoxidil myself. I am no longer affiliated with ScalpMed but I do not believe they have a foam application. Best of luck. JG 4.2.10
I recently had botox injected into my chin muscle as the muscle was starting to become a bit overactive. I have always had a very, very subtle chin cleft but since I have had the botox this is a lot more noticeable (lucky because I like it). Would this be because the botox flattens the muscle out so that the indentation in the bone is more noticeable? Thank you
hard to say what that occured, might not be reproducable in the future too, sorry. JG 3.31.10
How many weeks into pregnancy does fat usually start to appear (more in buttocks, etc.) when you are pregnant?
it varies, not set time. JG 3.28.10
is it okay to have lots of lidacane (pain) shots for surgical procedure while you are pregnant?
there are limits to how much can be injected, in most cases it is less than 50 cc of the lidocaine. JG 3.28.10
Hi,is Rogaine likely not working for me forever if already 6 months of trying without any results or I need to wait longer ?
if you see nothing by 6 months, it will not work, sorry. JG 3.28.10
Hello Dr. Garcia. Is 5fu effective topically in reducing slightly raised thin scars on skin? What about scar needling in conjunction with topical 5fu in order to puncture and slightly penetrate the scar? Let me know what you think. Thanks!
not sure how well it would absorb topically. I always inject it deeply into the scar for it to work. JG 3.16.10
Hi there, This question may seem irrelevant to your surgical procrdures but I just need some advice. A friend of mine has a non displaced fractured fibular that is taking several months to heal. As a result of anabolic steriod use, he has low levels of natural testosterone. Could this be why his fractured fibular is taking such a long time to heal? Many thanks
could be, might need some Calcium, Magnesium and Phosporus along with correction of his testosterone too. JG 3.25.10
I have a question about skin glue to use for stitches like dermbond. It says not to use on moist areas like lips. There is someone who wants to use some type of glue on lips to keep lip skin from flipping up due to a lip condition of lips constantly peeling in big sections. Also, this person wants to waterproof the lips to keep saliva off lips. However, moisturizer makes this person`s lips worse- like white new skin forming or mushy. Although it is not psoriasis, the skin cells grow too fast so the lip skin peel off. Can you think of any product that can hold the lip skin down while protecting it from water or saliva?
sorry but I do not. JG 3.22.10
I know you shouldn`t use retin-a while pregnant. But would it be ok to have a 25% tca peel under eyes (for wrinkles)two different times while pregnant?
no one has ever looked at the safety, should be OK, but no one really knows for sure. I would wait as skin treatments can already cause hyperpigmentation and during pregnancy the risk can go up. JG 3.22.10
Hi again -thanks for answering all these questions. May I ask why your prefer Dysport over Botox?
my personal experience is that it lasts longer and starts working faster. JG 3.15.10
The doctor did inject steriod in scar on arm (that had keloid). I wrote recent question about big indentation (like I had tissue removed for cancer- it looks deformed like that). What can I do to fix it?
I would wait at least 6 months after the injection and then consider either fat injections to the depressed area or cutting out the entire area, although the latter will have a high chance of a bigger scar. JG 3.15.10
I had a 1 to 1.5 inches scar revised on my arm near joint several times due to keloid forming. It`s been a few months since my last revision, but my skin looks indented where the scar is around it. It looks like an indented hole 1 inch in diameter. I am really scared. Can scar revision create a big indentation? I though you were just removing the scar, not tissue around the scar! I have never saw this before after healing. What do you think it is, and what can I do to make it look normal or unindented?
unusual unless they have injected steroids into it, if that has been done, the skin can get thinned after a series of injections. JG 3.14.10
Hi there: I am 61 and have been plagued with huge malar bags since childhood. Must be hereditary. I am at the point where I have had it with them and with people telling me I look tired. It is affecting my mental health. What do you think of direct excision. I have very few wrinkles, just a few dynamic ones around the eyes, so the skin is smooth and would not hide a huge scar. I would be fine with a fine line if indeed that would be the outcome. thanks p.
direct excison is the best option if you are willing to live with the small scars. JG 3.9.10
How long do you think skin colored tattoos last to cover up hypopigmented scars?
a couple of years maybe. The color match is never good though. JG 3.1.10
Will the silicone sheets for scars only work on new scars? Or does it also work on old scars? How old can a scar be for it to work?
does not work much on older oens, it helps get them flatter and less red,but they have to have a little pressure applied over them. Usually anything over 6 months and it does not do much. JG 3.1.10
In your experience, which is more effective, ScarGuard or Mederma ? Thanks!
I prefer ScarGuard. JG 2.28.10
Is this a perscription that u recommend in an answer you gave?? Can you prescribe it on phone?What are the side effects and how long typically to work please?? I usually use a combination of Retin-A 0.1% mixed in an equal amount of 4% hydroquinone so they are reduced by half of the concentration, effectivley then 0.05% and 2%.It can reduce skin sun damage in the surrounding areas so I like to have it applied over larger areas. JG 1.8.10
I would need to see you in person first, sorry. JG 2.28.10
Thank you for your site. You are an amazing person for doing this, you have relieved so much of my anxiety and fear. You can`t imagine how much it means to go on your site with anxiety at two in the morning and know that my anxiety will be relieved with an answer the next day! :) As someone once said wisely, Information is power
glad I can help. JG 2.28.10
What is your opinion of Zeltiq? A colleague of mine, a fine dermatologist I respect greatly -- someone who is as skeptical as I am of most new developments that seem too good to be true -- has been impressed by the clinical results he`s achieving. Worth trying, in your opinion?
all are cetainly free to try it, especially in offices where no real permanent fat removal is performed via liposuction, but I would not perform it on my patients. Ask him this question, if it so wonderful and effective, why has the FDA not approved its use? On the marketing material given to doctors to evaluate the machine, it says, in bold letters, not FDA approved. JG 2.27.10
Hello Dr. Could you please give me your valuable opinion/advise, as always: 1) Which home LED device do/will/can you recommend? 2) Are you familiar with the Sciton Laser for treating varicose veins, or which one do you recommend? 3) Is there a difference between Latisse and Lumigan? I can only get Lumigan Thank you very much
I recommend no LED system, I think the laser for varicose veins has to be an endo laser, inside of the vein, for it to work, there are a couple of companies that make it. I think Lumigan is fine. All the best. JG 2.25.10
Hello Dr. Garcia and thank you for taking time out of your day to answer our questions. My question is: can I use Revitalash during the day and Latisse at night? Currently I use Lastisse and it is for night-time use only. Can I use Revitalash for day? Will using it conflict with Latisse?
should not be a conflict that I am aware of. Best of luck. JG 2.24.10
I have been very ill for the past two months, and as a result, have been losing weight (about 12 pounds). I am trying to gain, but am concerned about the excess loose skin in my arms. I am 60 so had that problem anyway to a certain extent. If I can somehow gain the weight back, will my arms return to what they were before? Also, will weights help? I could probably do a little now but not much.I have been told to drink the protein shakes as I cannot seem to get enough calories in during the day with the nausea.
it is impossible to direct weight gain to a certain body part, I doubt the arms will go back to the way they were. Weights build muscle but do not tigthen skin. Protein shakes are certainly a good idea. JG 2.22.10
So this C8 peptide supposedly works like the Argireline? Isn’t that Argireline’s premise? Numbs nerves? Thank You for your time. I think I’ll just buy your cream!
that is the implication, they are careful what they actually say so that they do not get sued or fined, but they give you the buzz words and then allow you to make an assumption that it works like a drug. All the best. JG 2.20.10
What is this new C8 peptide? Is it better then Matrixyl? I know you don`t care for the Argireline. Is this peptide C8 in you cream? Thanks for your time
C8 peptide is a proprietary compound owned by Kinease and it is not in my cream. It claims, or implies, that it works on the SNAP receptors to reduce wrinkles by decreasing nerve function, one is led to believe it woudl therefore function as Botox or Dysport does, but that is a fine line as making a claim that it affects nerves in the skin is potetnially an FDA violation as anything that would affect the neves is no longer a cosmetic, it is a drug and would require a presription. They are using the words cleverly to lead the consumer to believe it is the same, but it is likely not truly accurate. I have not had any patients use the cream so I have no comments on it. JG 2.20.10
To elaborate on the question about the olive complexion, with the heavy piercing. They are not holes. They are track marks from bones (traditional tribal wear) She is excited that there may be a solution.
well, the track marks can be cut out but there will be a scar, without seeing them, it is hard to say whether the scar will be better than what is there now. JG 2.19.10
I have read that olive complections can not have reconstructive surgery. My good friend`s mother pierced her eybrow multiple times when she was an infant and there is much scarring from heavy jewelry above and below her eyebrow. Should she even consider a consultation?
although thicker scarring can happen in darker skinned individuals, it is not a 100% that it will happen, so it might turn out fine if she has the holes closed. JG 2.18.10
If a patient travels by plane to have you perform work on them (let`s say a facelift and/or CO2), how long must they convalesce in Las Vegas before going home?
usually we have them here for 10-14 days after that, especiallly because of the laser to make sure ther is no problem with the skin healing. JG 2.18.10
Hello Dr. Garcia, Do you do calf implants and if so what kind of recovery time is there on average for someone who works out 3-5 x`s per wk. Squats,lunges, pilates and yoga are my workouts of choice. Thanks so much!
I do not perform them for cosmetic reasons due to the high rate of problems related to them like extrusion, hardening and nerve damage. Sorry. JG 2.18.10
What works better- a jowl lift or fat injections/restlyne around mouth?
a jowl lift. JG 2.17.10
I had scar revision on my navel. I left the tape the doctor applied for 1 week. I am not sure if the doctor applied skin glue or alcohol before she applied tape. When I took the tape off 1 wwk later, there was a circle of green soggy stuff instead of a thin, incision scab. I was afraid I had theat flesh eating bacteria. It took about 3 eeks to heal since it kept oozing something green. Why did this happen? I ddi not touch the area to get gersm on it since it had tape on it all week. So, why did it get infected? Can skin glue cause an infection?
it can happen as part of normal helaing and at times from the skin getting wet below the tapes, it is not unsual for that to occur and once the drainage starts it is wise to keep antibiotics on it and keep a bandaid on it and change it at least daily. An infection can occur any time the skin is cut, that is a risk of any surgery, no matter how small. JG 2.17.10
If your skin freckles, do you think it freckles less than when you were a kid? Does your skin build up a little more protection from sun over time or does it stay the same as when you were a kid?
no, no added protection due to age. JG 2.17.10
I had a mid face lift performed 3 months ago. I still have residual swelling under my eyes which is very slowly dissipating. I was wanting to have an IPL treatment done now and was wanting to know if it was ok to have the IPL done now or wait a few more months. My last IPL last summer made my eyes swell a little and I am just concerned about that happening again and didn`t want to damage anything from the mid face lift procedure. Thanks
yes, it is OK to proceed with the IPL at this point. The swelling from the IPL might happen again and add to the swelling you already have though. JG 2.12.10
Hi Dr. Garcia, My chin has drooped and I m wondering if their is any procedure that can reduce the drooped skin on the chin. I somehow think I`ve heard of a procedure that invloves only the chin.
it can be a neck lift in many cases. JG 2.11.10
Hi::::Sorry I can`t find my question I posted. I was wondering if you knew about removing veins from under the eyes. I had them diathermied. I have small lumps and was wondering what to do to help them go away. I am 2 weeks post op. What do you think causes the lumps? Can I do anything to help these go away.
the lumps might be a blood clot or scar tissue, in most caes, with time, they go away on their own. JG 2.11.10
Is juvederm preferred over resty for undereye? why do docs shy away from under the eye..i`m assuming it`s takes more expertise and the results are not as predictable.
I always use Restylane.It is a more difficult area to get a good correction but in experienced hands it does well. JG 2.10.10
Hi again Dr. Garcia, I asked previously bout the leg scars..but can you please advise me of what to do for my double chin...it makes me look older than my 40year old age...Thak you
without seeing you in person it is difficult, it might be straight liposuction and it also might need a neck lift with skin removal in larger cases. JG 2.8.10
Hello Dr, With regard to radio frequency and fat loss... is it mainly from unipolar/monopolar (i.e accent, thermage etc) where the fat loss usually occurs? I am considering Refirme which I understand is Bipolar and does not go as deep to affect the fat pad? Thanks
well, I have heard of it happening from both, at the begining only unipolar was out there and the reports started for fat loss, the bipolar people then promoted theirs as much safer, but as time went on, there have been reports of fat loss with those also I am afraid. I think for the degree of tightening you see, I cannot recommend either one. JG 2.5.10
Hi there. Im sorry I keep coming on with these questions but again your the only online doc I trust and value your answers. /theses are the last questions I will ask you about this I promise. Because of tazorac and 3 doctors telling me the worst I chose the worst and want to know how long after an abortion can I can pregnant again to carry to full term? Also is being of tazorac for 2 weeks long enogh or do I need longer? Thanks again and Im sorry if Im not suppose to ask these on here. Thanks
thank you for expressing your confidence. I would wait at least three months after, that should be enough. All the best. JG 2.4.10
Hello Dr...i hope all is well with you...i have a question but I feel mean for asking it but I was just wondering your opinion but maybe it is a dumb question...the dr i would like to perform my surgey is a very good dr but I fould out he is sort of older...in his 70s....do you think that is something to be concerned about...I dont mean it disrespectfully at all, i just wonder if that should be a concern at all??? im sorry if question seemed rude at all. Thank you.
I think there are a number of very good older surgeons that do a great job, plastic surgery is more like playing the piano than lifting heavy, so as long as he is in good helath, I think it is fine to proceed. All the best.JG 1.30.10
Dr. Garcia, about 1.5 years ago I had rhytec portrait done around my eye area. The results were pretty good, but I`d like to have a second treatment done. THe doc who performed the procedure used a stronger setting, but I`d like to see you about having another round done. First I`d like to know if the fact that I already had the procedure done once would pose any issues. I`ve also read that thermage in combo with portrait produces good results, you seem to not be a fan of thermage, not sure why. Just not effective?
no problems with repeating the procedure after time has passed. I am not a fan of Thermage, I had a machine and had to contend with so may dissatisfied patients and my disappointment with what it did not do that I sold it. JG 1.26.10
Dr. Garcia, I was wondering if you have done any botox for migraines and/or what the results were?
I have, and although it requires different injections for all the trigger points, in most patients, once you figure out where the triggers are, it works quite well. JG 1.16.10
I just started Sprinolactone (25 mg) and am still breaking out and have a decreased sex drive. Do these taper off once the body gets used to the med?
not always, I think it is an ineffective remedy for acne and has more side efects than antibiotics and Retin-A. JG 1.16.10
Hello Dr Garcia, I have been doing some research on procedures to make the eyes appear more slanted. I am a little confused on the information I have been reading. I was told that canthoplexy surgery is an option but judging from all the before and after pics, I do not think this is what I am searching for. Is there an actual procedure to change the shape of the eyes and make them more slanted or asian like ? Or can this be achieved through other non-invasive methods, i.e. fat transfer or injectable fillers? Thank you so much for looking into this for me!
the slant comes from the position of the outer canthus being higher than the medial canthius, so I am afraid there is nothing non-invasive that will accomplish that, it will require surgery and in almost all cases, a canthoplasty.Sorry. JG 1.16.10
Hello Dr. Garcia: Do you have any procedures that help with cellulite of the stomach or thigh areas? I have used creams that do not help with long term. I do exercise three times a week on an eliptical and try and watch what I eat, but not perfectly. I am 46 y/o, my weight is WNL for height.
I am sorry but any of the remedies pronoted are very short lived at best, things like VelaSmooth or endermologie. Cellulite is not dependent on fat though, best of luck. JG 1.12.10
Hi, I am early 30`s, considerably healthy.. I would like to have a tummy tuck, lipo in my arms, love handles, mid section of my stomach. Breast lift with augmentation.. I`m a 34b I want a full B. What do you think about all this? and I want in through the Areola. Can I have this done all at once? How much will this all cost? I am very eager to get it all done! Thanks in advance
yes, it can be all done at the same, time, you will need help at home for a few days and you will be down for about two weeks afterwards. I think you need to decide on your surgeon to get a fee quote as it varies from surgeon to surgeon quite a bit. JG 1.10.10
Hi Dr. Garcia, I got a brochure in the mail about a product called Omnilux new-U. It`s a handheld light device, supposed to help eliminate crow`s feet. This is from the brochure: Omnilux new-U is a handheld, Light Emitting Diode (LED) device for the treatment of the effects of aging; in particular, periorbital wrinkles – crows feet. Its patented technology bathes the skin in red and near infrared light. A study has also demonstrated improvements in skin tone and clarity. What do you think? Worth the $300.00, or snake oil? And bless you for telling all of us the truth about these matters-who else will?
snake do do, save your duckets. Wish it did though, I would buy one! JG 1.9.10
Hi Dr. Garcia. I`m the one who posted earlier about the purse string lips after fillers. You said that the wrinkles may need more fillers...but are these wrinkles? They are not lines carved into my skin...but rather the prominence of the muscles over the top lip...like when you pucker up for a kiss. Only those lines are starting to show when I`m not puckering :( Still fillers? Thanks
when you purse your lips, the skin folds and that is due to thining of the skin and loss of elastic fibers, repetitive pursing will make the wrinkles stay present even at rest. As one ages and the fat below the skin thins out, they are more easily seen. Yes, still fillers I am afraid. JG 1.7.10
If I stay in hotel room all day watching television, do I need to apply sunblock ?
if there are flourescent lights, yes. JG 1.2.10
I have noticed that my 16 yr old daughter has some noticeable veins on the back of her kneee. She is not overweight and quite fit with medium to olive skin. They are not spider veins but quite noticeable blue veins. Is this normal for someone of this age and is there a cosmetic treatment to make these less noticeable. Thank you so much for any advice.
it can be normal, some people have veins that are more easily seen in areas of thin skin like the back of the kness, not much that can be done for them though. JG 1.2.10
I often sleep on my stomach with my head turned sideways on my pillow. Sometimes when I suddenly move my body sideways like my head, my heart feels tightened or squeezed (gets a little pain). I was just wondering if this normal. Like maybe an organ pressed on it so that is why I got the squeezed feel?
normal, nothing to worry about. JG 12.28.09
If you get latisse in your eye, will it make just one area of your eye turn brown or the whole eye turn brown?
usually the whole thing. JG 12.28.09
There is one spot near the edge of inside of nostril that I always get a filled blackhead or pore. I squeeze the bacteria out, then it comes back the next day or so. Why do I have this constant filled blackhead or pore? I do not have any others in nostril area except for this one. Is there a way to make it go away? What is cause of it, and why do I only have one?
no way to tell what is causing it, it can happen, might need to be cut out to avoid it coming back. JG 12.28.09
Let me rephrase that last question about the shifting botox...it definitely did shift from the ski goggles as the inner corner of my upper lids are heavy and sagging into the corners of my eyes on either side of the bridge of my nose. So the real question is...how long is this likely to last?
I do not think it is due to the Botox in your case so I cannot say, if it were from the Botox it will last a few months, until the Botox starts to wear off. JG 12.28.09
Hi Dr. Garcia. Is it possible for botox in the forehead to be affected by wearing a ski mask for prolonged periods? Can the pressure cause the botox to shift? Assume the injections were over a month ago. Thanks.
after four hours it will not shift. JG 12.28.09
Dr. Garcia, No question tonight. I just wanted to thank you for sharing your valuable time and knowledge over the years. You have been so kind and generous to many and I wanted you to know how much you are appreciated.I have learned so much from this site and have shared a lot of what I have learned here with many others.It is so confusing out there and you have been a godsend to help wade through it all. May you and yours have a very Merry Christmas and a prosperous 2010 to you as well. CHEERS! Christine M (AZ)
I thank you for the kind words and hope all the best for the New Year to you and yours. JG 12.28.09
I did not have a beard when I used 2% Rogaine, but I did have blond vellus facial hair what is called peach fuzz. Unwanted facial hair is listed as side effect of rogaine so I just hope ALL of it goes away. I know the face area is not a good area to do laser hair removal since I heard the light can stimulate dormant hairs to grow (which remain forever).
stop the Rogaine and see what happens over the next couple of months. Merry Christmas and a Prosperous New Year. JG 12.22.09
Hi Thank you very much for your reply. I have another question regarding a very crepe lower neck. What would you recommend? Thank you very much again
tough area to improve, I normally use Retin-A and in some cases, for a relatively short term improvement will do a TCA peel. Merry Christmas and a Prosperous New Year. JG 12.22.09
In regards to my question below about rogaine causing a beard (I am a female), I found this information a guy wrote about using rogaine to make his beard thicker: A hair follicle has times that it is dormant and it has times that it grows. Some genetically remain dormant indefinitely. When Rogaine is used what happens is that a stimulated follicle will produce hair. What this means is that cessation of the use of Rogaine will NOT cause the hair to fall out . Facial Hair pretty much keeps growing once it is stimulated. Most of the men who tried this that I knew a few years ago never did lose anything that they gained even after they ceased using the product for this purpose. Dr. Garcia, is that true? I am so scared. I do not want this beard.
I think it is not likely in females, unless you already had facial hair to begin with. JG 12.21.0
Hi Doctor, I recently posted a question about the scars that I have on my face for 10 yrs., and you recommended that I have them cut out and closed below the skin, for little scarring. I was wondering what type of surgery I would ask about or look into, for this procedure.
it is called a surgical excision scar revision. Merry Christmas, Happy Channukah and a Propserous New Year. JG 12.21.09
I had kenalog injected into a hypertrophic facial scar 4 weeks ago. How long does it typically take to see the maximum effect of each injection? 1 week? 4 weeks? 6 months? I ask because my plastic surgeon thinks we`ll need to do a few of these injections to get my scar to flatten, but she wasn`t specific about the timing. I`ve seen a tiny bit of improvement; should I expect more improvement, or is this about it for now? Also, I read in another of your posts about coritcosteroids that while they may flatten scars in the short term, over time, the tissue mostly fills back in. Is that always the case? Thanks so much for your help, Dr. Garcia. You`re a gem!
6-8 weeks is about the average. It is common for it to take more than one shot though. I usually repeat them after 6 weeks. As to filling in, that relates to normal surrounding tissue fillig in and not the keloid scar. All the best and thanks for the kind words. Merry Christmas, Happy Channukah and a Prosperous New Year. JG 12.19.09
Hi, Dr. Are there any laser or light that can do blonde hair removal? Does IPL work better for blondes? thank you
none to my knowledge. IPL works best on dark hair in light skinned people. Merry Christmas, Happy Channukah and Happy New Year. JG 12.17.09
Hi Doctor, If in theory i had one eye that protruded further out than the other, could someone fix it for me? What surgery is involved? Would they put one further back in or could they bring the other one out? Many Thanks
depends on the cause but in many cases it can be improved, although total symmetry is difficult. It is one of help the one that protrudes more in most cases. JG 12.12.09
Hello Dr. Garcia What do you think of the NannoLight for Skin Rejuvenation on the face and neck ? Thank you
do not see how it would really work, JG 12.12.09
Hi Doctor, What is difference between sunblock and sunscreen? Which are the best ingredients for the face? Thank you for your great advise.
we use titanium dioxide and sunscreen lets a little sun in while the block totally blocks. We like Total Block by Fallene. JG 12.12.09
Hi Doctor, I`ve noticed small cracks in the corners on each side of my mouth. I also have an indented line 1/4 from a steroid injection for a previous pimple as well. What would be the best treatment for them. Thank you.
some type of filler, like Restylane would be my first suggestion. JG 12.10.09
Hi Doctor, What do you think of collegen induction therapy: ie, micro needling for fine lines. Do you think it improves collagen to any degree, even if to a small degree. Is there any science behind it? Thank you for your great service.
I am not a believer, I think it is more likley going to create scar tissue than new normal collagen. I have never seen any evidence in any medial journal to its documentable effectiveness, sorry. JG 12.10.09
hello dr. garcia, i was wondering isn`t there at least some benefit to strengthing jowl muscles using microcurrent or some other form of strengthing those muscles as opposed to just letting them droop???
I personally do not feel it is worth it because the skin is not loose due to muscle weakness, it is from excess skin and loss of facial fat, not loss of muscle mass. JG 12.10.09
What will help burn scars on arms?
possibly kenalog injections and maybe a YAG laser to settle the redness down is about all. JG 12.8.09
The first few months, retin-a made me undereye area red and peely. After months of using it, my undereye area no longer gets irritated and peely, which makes me look more normal. Is it still working?
yes, still working, your skin gets used it it and stops peeling though. JG 12.7.09
Since using Rogaine for Women, I have been growing dark facial hair. Do you think I would still grow facial hair if I switched to Latisse?
no way to know for sure, none has been reported. JG 12.7.09
Hello dr. Garica, I was wondering if microcurrent and galvanic treatments to tighten skin do not work... what would you recommend to tighten/lift the skin?
I would not suggest it, no. JG 12.4.09
How come your lip color fades or it is not the same bright color when you were a child?
the aging effects and sun damage. JG 12.2.09
How come when you get sometimes get a chemical peel for hyperpigmentation, the brown spots get wrose or you get more?
anything that removes the top layers of skin, wether chemical or laser has that potential, especially if not treated with hydroquinone and sunblock before and after. JG 12.2.09
What are physcians doign to stop the 5% cosmetic tax? Cosmetic procedures/surgeries are so expensive compared to alcohol or cigarettes. Patients can barely afford the procedures without the tax.
our natioanl societies along with the manufacturers of the materials we use are lobbying congress in Washington, this idea was tried in New Jersey a few years ago and the state, rather than making money lost over $3 for every $1 they collected in the tax and the law was overturned. I strongly suggest that if you are opposed to the tax that you contact your state Senator and Congressmen/women and tell them to vote no on the issue.JG 12.1.09
Hi Doc, I was curious if there were any new innovations on the horizon for hair restoration? If not, how effective are transplants and what down-time can be expected from the procedure? Thank you.
nothing new in the pipeline for release just yet, sorry. Hair tranplants are effective and downtime is about 10-14 days. JG 12.1.09
Is sculptra, restayline, or juvederma best for the face? What is best for the hands? Also, do people get it done on top of feet to cover up veins- what is best on feet?
for losss of fat I think Sculptra is a good option and it has been used in the hands as an off-label use. JG 12.1.09
I am using Rogaine for Women on a small area of my hair. I read that you should not use it if you get pregnant since its effects are not known. Do you think I could try Latisse instead of Rogaine for the 9 months I am pregnant?
neither one. 11.30.09
If someone has a longer back or waist, does that mean they have more discs on their spine? Or what is it that makes their back or wasit longer? I assume it is a longer spinal cord so would that involve more discs?
no, it is just the vertebrae are longer or taller. 11.30.09
Is the CO2 fractional laser good for uneven texture (scars here and there) skin? Which laser or treatment is good for smoothing out texture with scarring?
I prefer a totally ablative CO2 laser. JG 11.29.09
I have pale white skin and freckles. Does skin bleach oly target melanin (freckles) or does it also make pale white skin paler? In other words, can I apply skin apply over the whole area where I have both white skin and brown skin (freckles) or am I supposed to patch apply it only on brown spots? What is best skin bleach and strength to use? How long does it take to see results, and is it safe for long-term use? I am confused if skin bleach permanently bleaches the freckle or if the freckle will come back if you do not apply the skin bleach every day for the rest of your life?
although your skin is pale, it still has active melanin, so if you apply bleaching creams, it will lighten that skin also, unless you had vitiligo or were albino. Might be easier to use a YAG laser on the individual spots to avoid the pale skin. Prescription 4% hydroquinone is a good place to start. You can stop applying it once faded, but the spots will eventually come back, there is nothing permanent. JG 11.29.09
I am a female with some hair loss at my forehead. I have been using 2 percent Rogaine for Women for the past 2 months. I do not know if some drips down to my sideburns and cheek, but the peach fuzz hair inthat area is darker. Before I did not think I could use laser hair removal for my facial peach fuzz because it was mostly blond, but now it looks like a light black color. I do not know what I can do about this darker facial hair caused by Rogaine (should I wax it)? It does go away in about 3 months if you stop taking Rogaine?
you can wax it off and it should fall out when the Rogaine is stopped. JG 11.28.09
Hi Dr. Garcia, I had enquired about what to do regarding deep frown lines and you replied for me to look into filers and Dysport. When you say fillers do you mean something like a fat injection into the area? Also, is there a procedure where you could make an incision between the eyebrows at the and snip the muscles? I think I saw a something like that on line or television. Thank you.
as to the filler I would use Restylane over fat as fat is meant for deeper filling, not for wrinkles really. There are operations where the muscles of the glabella can be cut and that will help the dynamic wrinkles but not the wrinkles seen at rest. It can also leave your eyebrows a little wider apart in some cases. Best of luck. JG 11.25.09
Just wanted to wish you and your family a Happy Thanksgiving. Thank you for all you do here for us :)
thank you and the same to you and yours. JG 11.25.09
Hi Dr Garcia - thank you for your generosity of spirit. Your thoughtful answers to these thousands of questions we ask are so helpful. I know this must take up a lot of time (I certainly spend a fair amount of time here reading the archives) You are very kind.
thank you for the words of encouragement, all the questions posted here teach me mcuh more than I am afraid I teach you all, and please accept my best wished for a Happy Thanksgiving. JG 11.25.09
Dr. Garcia, I have accessed your site on and off for quite some time now and although I don`t visit as much as I use to, I still enjoy your `pearls of wisdom` I don`t think your answers are generic at all and I must say some of my friends including myself have benefited from your professional advice (and all for free!) God bless
thanks for the kind words and your visits, and I wish you a Happy Thanksgiving. JG 11.25.09
Hi Dr. Garcia, Can you comment on situation? Patient had a genioplasty and numbness and pain following procedure on right side. Bone on right was misaligned and up higher than left post op. Dr. kept saying wait for feeling to return. After consult and MRI showed nerve had been compressed due to surgery but been too long to help. Dr. doing surgery willing to give partial refund for original surgery, but wants patient to sign form saying releases him of all liability and is no admission or wrong doing and can`t discuss form with anyone. Is this normal procedure for Dr. to do this or just trying to avoid law suit? If you were patient, would you sign form since surgery carries that risk? Thanks for any help you can be.
well, it is not uncommon for a surgeon to try to mitigate the potential risk of the medical malpractice issue. Nerve injury during a genioplasty is a known risk and having it happen is not de facto malpractice. Most likely that risk was enumerated in your consents signed before the surgery. Although getting some of the money back seems like a good idea, I am not sure what can be done to correct the nerve problem though. Might be improved if the bones are realigned and the compression is relieved, but in many cases, if too much time has transpired, the chances of the nerve regaining function are not great. Signing the release prevents you from filing suit agianst him though, so if it is your decision to pursue a malpractice claim against him, then you should not sign the waiver. I cannot predict how easy or difficult it would be to file the suit and win though, as it is a known risk of the operation, sorry. JG 11.24.09
Is the rind of fruit that is called Zest good for you? Or just a flavoring? Thank You!
rich in Vitamin C. JG 11.17.09
What do you think works better for brown hyperpigmentation on body and why- TCA peel or fractional CO2? Or is anything better?
TCA peel, because it treats the entire surface with no skip spots. JG 11.8.09
They advertise accent xl laser is good for shrinking fat and getting rid of cellulite. Do they really work or is that all just hype?
No, I am not a believer.JG 11.8.09
If a woman stops using rogaine. will some of her own hair fall out with the rogaine grown hair? Why do some people say your hair gets yucky when you stop using rogaine? Does yucky just mean it goes back to the way it was before rogaine or that it gets worse?
stopping Rogaine will not affect the natural course of your own hair, if it was falling out before it will continue to do so. As to yucky, I am not sure exactly what they are talking about, I have never heard that said. JG 11.5.09
Is female hair loss due to stress permanent? Let`s say one moves to a less stressful environment.
in the vast majority of cases it is not, if the stress goes away, then the hair should come back.I will say that that since hair grows slowly and can go into dormant stages even without the stress, it can take time to return. JG 11.5.09
Hello ~ I live in Ft. Worth Tx and am looking to have some work on my face. I am 55 and have facial sagging, fine lines, and discoloration. I have thin fragile skin, and Fitzpatrick type 11. I am overwhelmed with all the choices of procedures and doctor’s opinions. Whom do you know of in the area, and what will give me the safest results. All I have done so far is injections and am ready to try the next step.
I might suggest seeing Jay Burns MD or Rod Rohrich MD, both in Dallas. Best of luck. JG 11.5.09
What are your thoughts about Juvederm ultra plus? Does it really last 6 months?
in certain parts of the face, possibly, but not in all. JG 11.3.09
During the week menustration, my stomach looks flat in the morning. The rest of the weeks my stomach is not flat in the morning. Why is this?
fluid retention and swelling are the cause and are all normal. JG 11.2.09
What is the difference between a thigh lift and a buttocks lift made via an incision in the inferior gluteal crease? They seem to be the same procedure, yes? I believe you do not advocate either, but the 3 surgeons I have consulted do not recommend a lower body lift for me, as I have only a small but highly noticeable amount of skin laxity in the upper thigh and lower buttocks. They all feel this situation couldn`t be significantly improved with a traditional lower body lift. All are recommmending an auto-augmentation in which the excess tissue is used to enhance the flattened buttocks, perhaps with the addition of tiny implants. (I am 5`6 , 100 pounds, 48 years old, athletically fit.) Thank you for your opinion.
well they are different in that a buttock cannot be lifted higher when you place an incision in the buttocks crease, excess skin can be removed but that will nto lift anything. A thihh lift is usually a medial thigh lift where sagging tissues are removed in a crease of the groin and in most cases also a vertical incision down the medial thigh. Autoaugmentation is the maintaining of your own tissues and folding them over to create more prominence, it does not involve implants, otherwise it is not auto-. JG 10.28.09
Hi there Doctor .......I`ve been having a problem with hair loss for a few months now. I`ve now lost more than half of my hair. We`ve just completed a kitchen reno and there was an extreme amount of stress there but it`s now done (and turned out lovely I might add) and now the stress is over.......is this what could be the cause of the hair loss and if so......will it come back...or am I doomed. I`m now trying not to stress over this but it`s pretty difficult because every time I wash my hair it just comes out by the hand full. And I keep finding it on my clothes and my husband has to check my clothes carefully before I cook....or it would be in everything. What can I do. Please help!
stress can do it along with some other dermatology issues, might want to see a dermatologist in person to see if there is another cause so they can determine how best to treat you. JG 10.26.09
HI DR G Can yu tell me, how long until the scars from a mini thigh lift flatten and stop being red. Also at the end of the cut on the inner thigh there is a large lump... is this normal. I am 2 and half months post op. thanks
well, they might be better after a couple of months but can take a year or longer to get as light as they will get, a YAG lase can help fade the redness, performed every 4 to 6 weeks. The lump is due to the tissue underneath puckering in an attempt by the surgeon to keep the incision as short as possible and will flatten out in time with massage helping. Best of luck. JG 10.24.09
Hi Dr. Garcia, I don`t know whether you can comment on this or not. I had a genioplasty in Dec 2006. If I have permanent discomfort and numbness do I have any basis for a law suit. It was mentioned as a rare complication, but the Dr. said he had never had any patients of his have this problem prior to me. Thanks for any help you can be.
it is a known risk, I think proving medical malpractice would be difficult. Sorry. JG 10.23.09
What do you think of dermasonic treatmens? Do you think they work?
not much better than regular old microdermabrasions do. JG 10.21.09
Hi Dr. Garcia, Like most people these days, I guess, I don`t have a fortune to fix my face so I`m hoping you can help me choose among the seemingly endless options. I`m 51, with pretty good skin for my age, some discoloration, few wrinkles, but mild sagging on my jawline and my neck. I don`t want to mess around with something that won`t make much difference in the long run. Thanks.
start with some Retin-A and hydroquinone, as things progress, then a facelift, mini or regular will likely be a good investment as at your age, it can give you about 7-10 years or so. JG 10.12.09
I always seem to have dark cicles under my eyes?? What can be don to improve that?? Creams, injections o fillers, or surgery? What are my options?
impossible to tell witout seeing you in person, for some patients, the options you suggest do work, but not for all, find a doctor that can see you in person and see what would be best. JG 10.10.09
I know you are not a fan of Thermage. Is there a differenc between Thermage and Skintyte and would I see ANY result in the neck area with Skintyte? I have mild sagging.
I would skip them both. JG 10.5.09
hi doctor, i dont know if this question is appropriate in your site, i just want to know if soy milk is beneficial for both men and women after age 40?
in small doses it is good. JG 9.29.09
I am having a Abdominal Myomectomy, Which is the best staple or stitches that would leave a less noticeable scar? What product would be best used on the scar to help heal faster and be less noticeable? thank you
I suggest PDS sutures intradermal, and after the incision is healed then start ScarGuard or Mederma, best of luck. JG 9.25.09
I had great, full eyebrows in the past. I am not sure if that changed when one makeup artist said Ew, don`t you tweeze your eyebrows or trim them? Then she tweezed my eyebrows so they were a thin line. I do not know if it is due to aging or due to her plucking out my eyebrows, but my eyebrows look so much thinner in pictures now. They looked so nice in past photos. She told me to trim my eyebrows so I do trim them just at the edges near nose since they grow longer there. Is it the trimming that might be makingmy eyebrows look thinner? Again, it just near the edge of one side of eyebrows. Or is that she plucked my eyebrows out so not as many grew back? Or is it due to aging- I am in my mid-thirties. Also, what do you think about eyebrow transplants using the hair on head?
trimming should not affect their growth but plucking them can reduce hair growth. JG 9.21.09
Have many females been disappointed with hair transplants to hairline area? Are they happy or do they wish they never had it done? Why is it that hair does not take on all patients- or what causes hair not to take?
I am not aware of them being disappointed but if they need hair transplants there and the cause of the hairloss is not corrected, they will need more in time, just like a male would. The graft not taking depends on the condition of the skin where it is implanted and the handling and care of the graft when harvested. JG 9.17.09
It`s me with the 400 TOTAL estrogen levels. I`m 47 year old female. No medical problems, no medications. I don`t think I have any symptoms, just some insomnia. Thank you
might be due to lower progesterone levels rather than anything to do with your estrogens I think. JG 9.16.09
Hi Dr Garcia. I am 5`2 147 lbs, desperate to loose at least 17 of them. I did Jenny Craig faithfully (apprx 1350 kcal/day) for 5 weeks, never cheating once and gained .2 pounds. I did Atkins to the letter of the book for 6 weeks and lost a grand total of .3 pounds. My thyroid labs came back normal. Are there any other lab tests that could give me some insight into what is going on? Anything else I should try? Hopefully you can shed some light on the situation. I appreciate any suggestions you may have.
really not much more I can suggest if all is normal, might consider looking at a diabetes profile though just to rule all out. JG 9.15.09
Dr.Garcia, I have been searching on your sister site (Ageless Forever) and I cannot locate the archives section. Is is still around? Thanks
that site is now run by my associate Dr John Pierce and there is no direct link from my website, you need to go to www.agelessforever.net. JG 9.15.09
THANKS FOR YOU ADVISE!
you are very welcome. JG 9.9.09
HI DR G::: I had a mini thigh lift four weeks ago. When can I start using the scar gel sheets? And how often? thanks for your time.
OK to use now if you desire, use them as much as you can. JG 9.8.09
Hi again. I posted a question about a black eye I got over a year ago and I don`t recall what you said might work. Sorry and here goes again. As I mentioned it has been a year since I got a black eye and I am left with a slight puffiness in the lower area of my eye socket. Sort of like a slight bagginess. I think you said there is somethink that might make it better. I would definitely not cosider any type of surgery for fear that both eyes would not look the same and it really is not bad enough for surgery. I just don`t like the appearance. Is there anything that might work and do you know of anyone in the Denver area who can help? Thanks
hard to say without seeing you in person, might want to go see Dr Stacy Folk, she is a friend of mine and can likely help, please say hello to her for me and best of luck. JG 9.6.09
Hi Dr!, I read everywhere how ageing alcohol can be on the skin but yet I hear that the antiooxidants in red wine are good for the skin.... What is the reason alcohol is so damaging (sugar, the dehydrating factor?), because I will find it very difficult to give up on my daily 2/3 glasses of red wine, and are spirits more damaging than wine? .... Many thanks !
just take grape juice or take the red wine capsules if you are concerned about it, but 2 glasses of wine per day is likely not going to have too negative of an effect. JG 9.2.09
My sister is 8 years younger then me, yet she looks older. the only difference I can find is that she took Accutane for 6 months about 15 years ago. Is it possible that that is the culprit?? Thank you
well, maybe, there might be other issues like sun exposure, smoking or being around smoke and a high glycemic diet along with jogging/running too. JG 8.26.09
Hi Dr. Garcia, I wanted to ask you about the Revital lash I believe it is called, does it work? I also was wondering about the Latiese, but my eyes are green and a warning says it could make them darker? What one will work w/out any side effects? Hope you are doing great and loving your new doggie. Christine
We sell RevitLash in our office and I feel it does work, we do not sell Latisse because of the side effects. Thanks for the good wishes and the new rescue dog of our family is doing AWESONE! JG 8.24.09
If having Epstein-Barr Virus in your blood was making you feel tired, will you start to feel less tired if the titers are lower in recent blood test?
that is correct. JG 8.17.09
Over the years, I had about 5 different Epstein-Barr Virus blood tests. All of them showed that I had the virus in the past. However, the blood test I took this week showed that I never had it. Did they make a mistake at the lab? Or over time, do antibodies against a virus disappear from your body? My cholesterol blood test was also lower than what it usually is.
the titers might have dropped low enough that they are no longer seen in your blood. I do not think it was a lab error though. JG 8.16.09
I saw an after photo of a patient who had an arm lift. I thought an incision was just placed on the side of the upper arm, but I also saw an incision going across the back of her arm right at the elbow. Is an incision for an arm lift usually made at the elbow or did this patient also have saggy skin removed from her elbow- if that is a procedure commonly done?
the length of the incision is all determined by how much extra skin there is, the more skin that has to be removed the longer the incision wil be. It is done, but many people opt against it due to the visible scars. JG 8.16.09
Hi DR G:::;;; Can you tell me, how long does the fat last when you have a fat transfer? does it last forever?
with the present technology you keep less than 50% and whatever is there at 6 months will likley last a long time, that is for the face. for the rest of the body it is likely less survival. JG 8.16.09
HI DR G::; I had thigh lipo six months ago and I had a dent in one area of my thigh and a bulge in the upper inner thigh. The PS said he could fix it but i would also need a thigh lift. I did the thigh lift last week and I can still see the same dent, the bulge looks smaller but there is uneven places. Do you think it will even out? I can see how the dent that was there fill in with time? I don`t want to have another revision, is there a filler I can use?
well, usually at this point there is swelling and the dent should look better, I think as the swelling goes down you will likely not see any difference in the dent, it might need some fat injections to lift it up. JG 8.15.09
I have no nose or ear cartilage left for nose revision surgery. I do not want to use rib. Someone told me their doctor grafted nose cartilage from a cadaver. How come none of the doctors I saw mentioned this option instead of using my rib? If a request a doctor to use a cadaver, could he? It seems like he could specify one with lots of nose cartilage.
I am not sure why they did not mention it, it is commonly done, the cost of the graft is about $600 though. They cannot request a certainn type though, the cartilage that comes from the rib is much stuffer than nose cartilage. JG 8.9.09
If another country can grow nose cartilage with stem cells, can the new nose cartilage be transported from that country to a USA doctor to be used for revision rhinoplasty? Or can the USA doctor travel to that country to do the surgery (not that the doctor would take the trip, but just wondering in case it is not possible to ship new tissue to USA).
no, it is illegal, and the doctor cannot do surgery unless he has a license in that other counry. JG 8.8.09
If someone with genital herpes dips a q-tip in peroxide to apply to herpes, can another person who dips a q-tip into perixoide bttle to apply to their skin get herpes?
I cannot say 100% that it will kill the herpes virus. JG 8.1.09
What do you think of dermaroller procedure? Does it work?
save your money. JG 8.1.09
HI DR G:::: Can you please please tell me, what is the best preparation for a thigh lift? Is there anything I should ask the PS about. What about after surgery, what is the best post op care in your experience?? thanks so much. Please anything you think is important, please let me know.
the post op care is pretty standard, there really is nothing special to do after the surgery compared to other surgery, just follow your doctor`s advice, best of luck. JG 7.31.09
How long should a person use the micropore tape on an incision after surgery. For example, tummy tuck incision. Will using it longer help the scar even more and how long should it be used? Thanks in advance.
we do not use it as I have never found that it made any difference. JG 7.28.09
This is an embarassing question, but I have a few dark brown discolored areas in the vagina.....kind of like large freckles. The doctor said they were nothing to worry about medically; cosmetically, however, it still bothers me. I was wondering....would it be safe to use IPL in this area to try and remove the spots? I had IPL for some post-inflammatory hyperpigmentatoin from a few acne spots on my back and it worked very well. If this is an option, what kind of dr. would I go to to try this? Thanks so much!
yes, OK to try and should work pretty well. JG 7.27.09
Hi, if i stop using latisse will my eyelashes be like they were. I had long eyelashes, but pretty thin. dont really notice much diff after using latisse for 1 1/2 mths. It wouldnt have damaged them of changed them right??
yes, they just go back to the way they were. The damage, if it occurs, is to the eye and not the lashes. JG 7.27.09
What do you think of Hydrolyz for undereye dark circles? If it is effective, is there any substitute for it that is cheaper?
I think the product we sell is better and stronger, I think the claims for Hydrolyze are a bit exagerated and the pictures have different lighting. JG 7.25.09
I heard that breast impants last only 10 years? Is this true? I did not think they needed to be replaced unless they got hard or leaked. But do they wear away after so many years and start to leak? I had mine for 15 years so far.
that is not true, the replacement additional warrranty that can be purchased lasts for ten years and the incidence of rupture is about 1% per year, so after 10 years, each implant has a 10% chance of leaking. I feel if it is not broken, leave it alone. JG 7.20.09
Hello Dr. Garcia, 1.I had 3 deep irregular ice pick scars that have recently connected together to form one irregular jagged C shaped scar right underneath my cheekbone. If I fly out to Las Vegas for a vacation will you excise my scar?! 2.What causes excisions to fail? 3.Is retin-a the only treatment for enlarged pores? 4.Will an ablative co2 laser worsen enlarged pores or fix them? 5.Do you think that skin needling and dermarollers work for acne scars and large pores? 6.In the hands of a skilled doctor is it safe to say that an ablative co2 laser procedure will not result in the worsening of scars, additional scars and other side effects? Sorry about all the questions and thanks a million doctor.
I would prefer to see at least pictures first before making the decision to come out here, curved large scars on the cheek when revised can leave chronic swelling that might not make it a good idea. Excisions fail if the skin is too tight to give a low tension closer, IPL can also be used for the pores, an ablative CO2 laser will not help and can worsen pores in some people if performed deeply, I do not think needling or dermarollers are any better than Retin-A, and I do feel that an experienced surgeon makes a difference. You can send the photos to firstname.lastname@example.org All the best. JG 7.20.09
What do you think of surgeons who charge 4x the standard price of a procedure because they say they are well known?
well, I think it is common, but they feel they are better and surgery is not like buying a burger at McDonald`s, who performs it does make a difference. JG 7.20.09
In my question below, there is a typo. It should read I decided NOT to take the antibiotics when I received them on my follow-up visit.
I think that is OK. JG 7.19.09
There was a mishap with my antibiotic prescription for fat buttock injections. I paid for an office worker to pick up my prescription in the pharmacy at the building since it would be closed after my procedure. This was a place located out of the country. She forgot to pick it up so it was not available after my procedure. Hence, I had to wait a couple days for my follow-up appointment to get it. I would have taken it if I received it the day of surgery, but I decided to take it since I seemed okay. I was experiencing extreme fatigue for about a week so I decided to take the 5 day course of 500mg antibiotics. The first night my hair sweated, then I felt a little more energetic by Day 2 of taking the antibiotics. I am just worried about a superbug if I did have a bacteria infection. Is 5 day treatment with antibiotics enough? Also, if I contracted HIV or hepatitis, would the symptoms of fatigue come on so soon? They use new needles for each patient (and I see them throw the used needles in garbage) so I do not think I could have contracted HIV or hepatitis?
the symptoms do not sound like an infection or hepatitis or HIV, it is normal after surgery. JG 7.19.09
I had fat buttock injections. I did not take any antibiotics and I have been feeling energyless. Is tiredness a symptom of a bacteria infection? Are bacteria infections common in buttock injectations?
it can be but it also comes with redness, increased swelling and pain, I think you need to see your surgeon to make sure all is OK. Infections ar ento common, no. JG 7.18.09
Hi Dr.Garcia. In your opinion which of the eyelash stimulators work the best? I heard that Latisse can be irritating to the eyes, and I have very sensitive eyes. I am interested in the Lilash? Is that a good one, or what would be best. Thanks in advance.
we use RevitaLash. JG 7.10.09
I heard that if botox is injected in underarm for armpit sweating that you start to sweat in other places. Is this true- if so where do some people start sweating? Also, how many botox injections do you do in underarm?
no, it does not cause you to sweat in other areas, you might just notice it more if the arm pits are more dry. There are about 12 small needle pricks for each armpit. JG 7.7.09
I am 35 years old. My knees do not look different than they have in the past. However, my elbows have about 1 to 1 1/2 inches of loose skin. My skin is taut everywhere else on my body since I am skinny. I can actually stretch the elbow skin out 1 to 1 1/2 inches and feel nothing but skin (no fat,bone). It feels like bone was just eaten away since there is no structure right at my elbow joint. Why are just my elbows affected? Is this normal= does the skin usually get extra extra loose like bone is missing when you reach your thirties? How come my elbows but not my knees are affected? Since I am skinny, my back has always been bony (so I do not know if I lost any bone on my back or not). Is there any disease that can cause this in elbow area? Again, is this something most people in their 30s start to experience? What is it about the elbows?
skin gets loose at different speeds on the body. It is not abnormal. JG 7.7.09
Hi Dr. Garcia; Can you tell me if there is a surgery that can increase a person`s shoulder width, for example with an implant to give the look of wider shoulders without shoulder pads? Funny question, but thought I`d give it a try. Thanks in advance.
sorry, but there is nothing. Happy Independence Day. JG 7.4.09
You know the two larger veins that go down your neck- they usually buldge out more in old women. Mine show more because I do not have much fat on my neck. Do you think filler injections will help?
in that area, not really. JG 7.3.09
Hi Dr. Garcia, 1)is there anything to help the hands-veins & loss of fat? 2)Does Retin A help? 3)What can be done to soften the knuckle creases which worsen as I age. I am 50 yrs old. Thank you !
Sculptra injections, or fat injections. JG 7.3.09
I wrote the question about areola reconstruction. My problem is that tattoo did not take at all on sides of areola although it was tattooed like 5 times. One nurse suggested to tattoo the grafted skin before it is grafted so I do not have to worry sbout the tattoo not taking. My question is here will the tattoo on PRE-grafted skin still look the same color when it is grafted onto nipple? I have to remove the total nipple area since the sides are collapsed. I need nipple reconstrcution for nipple shape. So, do you think it would be better for me to have the tops of my nipples cut off and saved to graft onto nipples right after nipple reconstruction? Or do you think I would get better results if nipple reconstruction was done without adding the tops of my natural nipples? I just thought the skin texture of my natural nipples might look more natural, but I need to know if my natural nipple tops will lose their color (turn white) once grafted?
no, tattoed skin will not keep all of the color and will likely not have even color either. I personally would keep as much of your own tissue as possible and not remove any more tissue or skin. JG 7.2.09
Regarding nipple reconstruction, the only savable part is the top side of my nipples. I have to have the sides or center reconstructed. I would like my reconstructed nipples ot look as natural as possible. I thought if the doctor cut off the tops of my nipples and then grafted them on top of the reconsturcted nipples, the top of nipples would look more natural. I am just worried about matching the color of the tattooed sides to the my natural top color. 1) If the tops of my nipples are grafted, will they still be the same color after they are grafted? If not, how much lighter will the color get? 2) Right now I have white grafted skin around the sides of my nipples that would not take tattoos. I am afraid the tattoo will not take again after the second skin graft. Is there a way to graft the skin so it will take a tattoo? Or is the only way a tattoo will stay is if you pre-tattoo theskin to be grafted before it is grafted? Again, will this tattooed skin lose some color after it is grafted? In other words, if I had the skin tattooed to match the current color of the tops of my nipped= would the tops of my nipples and the sides of my nippled match after the skin graft? 3) Is it possible to even graft the tops of my nipples onto a newly reconstructed nipple? Thanks.
grafts will never look as good as the natural areola that survived. The color may not match but that is one of the limitations of the procedure that cannot be surmounted. Graft reconstruction of the areola, like any skin graft, typically is not a completely uniform color, there wil be light and dark areas depending on how well the graft heals. The ability of grafted skin to accept tattoo pigment is variable and unpredictable but in most cases the color takes, tattooing the potential skin graft will not help in any way. I think you need to come to the understanding that your areolas and nipples will never look totally natural in shape or color, no matter what you do to reconstruct them, sorry. JG 7.2.09
I am in my mid-thirties, skinny, and I have never been pregnant. I used to have a flat stomach in my twenties. I had liposuction for love handles in my late 20s. I notice that I do not have a flat stomach anymore. Is it because the fat from love handles now goes to my belly or is because your digestive system slows down as you age so your stomach gets bloated all the time?
it most likely is the accumulation of intra-abdominal fat from metabolism changes from aging. JG 7.1.09
For areola reconstruction, do you think you get the best result with a skin gratf from groin area or just to have the area tattooed? If I just had the area tattooed (without plcing a skin graft there) my breast augmentation incision scare at breast crease line would move up more. They are already 1/2 inch above breast crease line. What if I had expanders placed near my breast implant incisions to stretch out the skin so it would be able to cover the areola area without moving up my breat implant scars??? Would I need ot be put asleep to place expanders at bottom of breasts? How long would I have to wear these expanders? See, my skin is very taut or doe snot stretch as it is so that is why I would need to stretch it with expanders. Or do you think a skin gratf from groin would give a better result? In your opinion, which method would show most natural looking results or areola?
I feel tattoo is best. I think the other questions you are asking are impossible to answer without seeing you in person and examining the tissues, sorry. JG 7.1.09
I wrote the question about Mexico. I also want to AVavoid travler`s diarrhea. Should i avoid eating any food in Mexico- like avoid eating hotel food and restaurant food since the food is washed with water that might be contaminated. I heard Mexico water is contaminated. I do not know if they mean all of Mexico or just certain parts.
I think the quality of the food in Mexico and its water are much improved, I drink the water and eat the food whenever I go there, if you are concerned, just drink botteld water and cooked food should be safe. JG 6.30.09
If you will be traveling to Mexico, do you know if you can ask for Tamiflu drug before you travel (to have protection right away if you get symptoms)?
yes, or you can buy it there, I was just down there and they sell it OTC. JG 6.30.09
Will you catch a superbug if you only take antibiotics for 4 days or is that onyl if you already have a bacteria infection?
catching the superbug is not from taking antibiotics, but the superbugs develop when people are given antibiotics for no reason and then it infects people down the road. JG 6.30.09
If you have surgery, do you need to take antibiotics for 10 days for precautions against possible bacteria infection?
in most cases, just the day before and 2-3 days afterwards. JG 6.29.09
Hi Dr, I bought a stack of vitamins (C,E,zinc, fish oils etc) to help me heal following a blepharoplasty but then I read somewhere that antibiotics can cancel out the benefits of vitamins so there is no point taking them whilst of a course of antibiotics? Is this right? Thank you
you should only be on antibiotics for 2-3 days, so just start them after. JG 6.29.09
How long do you think it might be until Dysport will available in USA doctor`s offices- a couple months, a few motnhs,a year? Do yo think the price will be cheaper than botox to drive customers away from botox to new product?
we will be able to use Dysport in July. As to chepaer, that is up to the doctor and not the manufactuer. I will persoanlly stop using Botox in most cases. JG 6.29.09
I have a very sensitive digestive system. I am afraid to take a trip to Mexico because of contaminated water. I do not know if the hotels have contaminated water (to cook food and serve beverages)or if I should all avoid hotel or restaurant food and only buy bottled water and beek jerky. I do not want to get diarhhea. Do you know if hotel water is also contaminated?
almost all the hotels have purified water sources now. JG 7.1.09
I saw some pictures of breast reconstruction surgery where an areola was grafted. I saw a line of white scar tissue around the areola. I did not know that an areola graft caused white scar tissue around the areola. Do you think the white line was left because the areola area was not tattooed enough to cover all of the grafed skin? Or does a white line of scar tissue automatically form around the grafted skin? It looks like the person had a skin graft on areola area since there is white outline of scar around it.
there is always a white line as there is a scar and commonly scars can heal like a white line. When a graft is performed then that can leave the scar, if it is tatooed rather than grafted, then there is no white line. JG 6.28.09
I am very fair skinned with dark hair. I had electrolysis on my armpits. It permanently removed the half the hair. Then I I had laser hair removal to finish it up. The other hald of my hair eventually came back with laser hair removal. This was when hair removal was newer to the market and it just might not have been a quality machine. Whic machines work better- like I heard Sheer light does not work as well? I was wondering if it did not work for my armpits if it would not work for other areas of my body? Again, it just might have been a poorer quality laser machine.
an Alexandrite laser works the best I feel, it is made by many companies though, need to ask the spa what they have and use. JG 6.24.09
If granulas develop from filler injections, how long do they take to appear and how long (or how many years) would it take them to appear? To know when you are safe of not getting them?
they take at least 6-8 weeks to start to form, in most cases longer. If there is no granuloma by one year, the chances are small that it will form. JG 6.23.09
It might sound funny for me to say this, but I wish I was completely bald in a circular area near my bangs. Since I have some hair, I was told that that hair could fall out due to shock if I receive a hair transplant. That means the transplanted hair will look how my hair looks now (sparse) if the hair I have now permanently fall out due to shock. If I had no hair in that area, they would be able to completely fill in the area hair by hair, but right now the hairs I already have would prevent them from placing hairs in those occupied areas. Since a hair transplant is not possible, do you think the circular area with sparse hair could be surgically removed so it doe snot show? Do you think doctors could do that?
any hair loss from the not uncommon shock effect is short term and the hair grows back. I think cutting the circle is an option but will likely leave a long wide scar. JG 6.23.09
What is a photo facial? Is it the same as IPL or foto laser? Does it only work on darker freckles instead of lighter freckles? I also want to know if the same freckles that were removed will come back? I do not know if your body is programmed to make melanin in the same spot you had it removed. Let`s say you stayed out of the sun and wore sunblock= would the freckle eventually form in that same spot again?
it is the same thing as an IPL. It can lghten darker freckles but likely will not totally remove them. In time and with sun exposure, they will all, light and dark, come back. Even flourescent lights can make them come back. JG 6.23.09
What do you think of eyelash transplants? I know hair from the scalp is usually transplanted to the eyelashes. On one eye, I have a little space of eyelashes missing in the center. It makes my eyelashes look parted in the center. Strangely on the other eye, I have a couple extra row of eyelashes in the center that I have to pluck out. I thought maybe those extra eyelashes that I do not need could be transplanted to the other eye instead of using hair from the back of my scalp? I know with hair transplants, little dot holes are punctured on your scalp. Is that how it works with eyelash transplants?
I think for cosmetic reasosn I would not recommend it, I would do it for patients after a burn or scar tissue. I am unsure whether they could remove the extra eyelash and include the hair bulb for it to work. JG 6.23.09
Some people have said that if you have liposuction, the fat taken out will develop in another area of your body. I had liposuction 10 years ago, but I have not noticed fat in any new areas. Is that because I am thin so you only grow new fat in areas you never had it before if you gain weight?
if you gain weight after the liposuction, the excess calories will find somewhere new to go, if you maintain a healthy weight, that does not happen. JG 6.23.09
If you had fat injections or some other filler in the undereye area for hollowness, will CO2 laser resurfacing in that area cause the fat injections or filler to dissolve? I read that some lasers (maybe it was IPL)dissolve fat in the face.
should have no effect unless it has radio frequency waves which true lasers do not. IPL should also be safe. JG 6.23.09
Hi Dr. Garcia, I`m considering trying Botox for a brow lift and to treat crow`s feet. Can you tell me how many injections and units of Botox would normally be used for this procedure? Thanks!
when I perform that I typically use 70 units for that. JG 6.21.09
Dr. Garcia, I just wanted to thank you for your time and patience. I refer to your site very frequently, and have posted numerous questions in the past. I`m not sure how I stumbled across your site a few years ago, but so glad that I did. Just knowing that you are here has eliminated many potential panic moments!!! I can`t imagine how busy you are with your practice, let alone answering all of our questions. I so appreciate what you do, and the enormous heart you obviously have. Thank you so much Dr. Garcia. Best wishes to you and yours :)
I wish you all th ebest and thank you for the kind words, sorry for the slowness in getting back as I was not available for a week. JG 6.21.09
Good Evening Dr. Garcia, A couple years ago, my ENT prescribed elocon ointment to apply inside my nostrils when they swell and get irritated from blowing my nose all the time (allergies). I am out of the elocon ointment, but I do have a tube of Triamcinolone ointment (0.025%). Is it alright to apply that inside my nostrils? Thank you! :)
short term use is OK. JG 6.12.09
I have a lopsided hip so one hip is higher than the other. Also, it looks like I have a curved in waistline on on side, but a straight waistline on the side. I was just wondering if there is a such a hip surgery to straighten the hip so it is not lopsided. If so, what is this surgery called and do you think it would be covered by insurance? AN MRi confirms I have a hip defect (if ionsurance needs verification).
it is most likely spinal surgery and I am not sure the risks would be worth it. I do not think insurance will cover it, sorry. JG 7.1.09
What is risky about large amounts of a filler like like Artefil? Would the hand area be considered a large amount?
I think the risks of grnaulomas in the hand is high and I would not do it. JG 6.10.09
Why would you not use Artefil on other areas of the body, such as the buttocks?
not approved for that, the amount needed to be injected would be very large, I think in general, buttocks enlargement with injections is not worthwhile with fat and with other fillers is risky.JG 6.10.09
What do you think of PMMA fillers?
I used Artefil for nasolabial folds for a short period of time, but the company closed so I do not use it any longer, I would not use it anywhere else. JG 6.10.09
I wrote the recent question about the breast scar moving up. The breast scar is about 1 1/2 inches long. I had a prior skin graft taken from my buttock which was at leasr 3 1/2 inches long. It seems that 1 1/2 iches is not long enough and 1/2 inch wide is not wide enough for skin graft over whole circular areola area? That means that the 1 1/2 inch scar would need to be cut larger to about 3 1/2 long? Although that would now be in the breast crease area, it seems like a larger scar like that would be noticeable. Would the scar need to be cut longer across for a skin graft meaning it would increase from 1 1/2 inches long to 3 1/2 inches long? Also, is the groin area better area to take skin graft from or is it equal to breast area skin? I thought the groin area might have more color to it.
the scar will need to reflect the size of the graft needed. The groin is not equal to any other skin, it is taken from that area as it is an easy site to hide a scar in. The color will nto match breast skin. JG 6.6.09
If laser hair removal is only temporary, then that probably means that laser hair treatments to shock hair into growing back is only tempoary??? Right now I am using the HairMax comb due to permanent hair breakage in bang area. It might be due to braiding my hair- not sure. I have been using the Hairmax comb for 2 months now to see if it works before I consider a hair transplant. I do not see any results yet, but it takes at least 2 months before it starts working I hear. Does it work at all? Also, is it more effective if you get laser treatment (to make hair grow back) professionally than if you use your own HairMax comb?
I think the results from the comb will be minimal to none and will not replace hair transplants, as your loss is likely due to the follicles being pulled out from the braids, the combs, if they work, will assist in hair follicles that have lost some of their blood supply. There are no lasers that reliably grow hair. JG 6.3.09
Is micro hair grafting only grafting one hair at a time? There is this one place that gratfs one hair at a time near the hairline, but a few hair chunked together in the same graft for the rest of the hair. Is tat how micrografting is done= you only graft one hair at a time near the hairline, then graft in multiples for rest of hair? I thought it was supposed ot look more natural if you only graft one hair at a time everywhere. This place`s price is drastically lower (less than $1 per graft), but I don`t know if it`s because they are not as skilled. Do you think price makes a difference?
micrografting is 1-3 hairs, what they are describing is micrografts at the front where they are easily seen and then regular grafts further back where they are less easily seen. I do think price can make a diference, but in this economy, prices for many things have gone down, the usual low price is $4 though. JG 6.3.09
How long does hair growth slow down for laser hair removal? Why do people get it down if the hair will gorw back. It is expensive procedure. I think most electrolysis people went out of business due to laser.
the length of time varies from person to person and area to area. As to why people still do it, because they do not research it enough to know the truth. Electrolysis works if the hair follicle is killed but that is not easily done and can hurt more than laser and is painstakingly slow to perform. JG 6.2.09
Is electrolysis permanent? When you say laser hair removal is not permanent, do you mean 1/4 or 1/2 or all the hair eventually grows back? Thanks.
in most cases but not all. As to the laser, it means that the growth will slow down but none of the follicles are likely ever injured to the point that they will never work again. So thay all still grow, just slower. JG 6.2.09
What do you think of the Light Sheer laser for laser hair removal? Which lasers are the best or fastest results?
no personal experience with it, but none are permanent, and work best on light skin with dark hair. JG 6.2.09
i had a medium sided mento chin implant 12 days ago and the right side of my entire chin is numb but when i talk or open my mouth the bone hurts like the implant is pressing into my bone when i move my mouth... is that why my face is numb? also my smile looks like a withches chin now, will this get better? my chin looks longer and the skin at the very bottom looks puckered when i smile and my chin jets forward when i smile so its very flat now on my chin too. will tghe smiling problems get better? i did not think an implant would change my smile.
the face is numb from the pressure exerted on the nerve in order to position the implant, in the vast majority of cases that gets better but can take up to 6 weeks in some patietns. I think many of the issues you now have will get better over the next few weeks. JG 5.31.09
I am a female lsoing my hair. Globs clog un the bathtub and vacuum cleaner. I do not have a receding hairline- my hair just sheds or falls out a lot. This has been happening for a long period of time. My life has always been stressful so I do not know if that is the cause. Or do I have too much DHT or would low progesterone cause this? What can I do to reduce the number of hairs falling out?
stress, low progesterone, skin fungal infections and low thyroid are common causes for female hair thinning. JG 5.31.09
What are side effects of Latisse?
floaters that are visible, macular edema, changes in occular pressure like glaucoma and permanent discoloration of the iris. JG 5.31.09
Is there a way to lower the hormone DHT?
propecia or make sure your progesterone level is normal in females. JG 5.28.09
I`m 9 days post op butt implants augmentation. everythiing was going okay but now im getting very paranoid. Had my stitches removed 2 days ago and the doc said the wound is healing good and its almost dried up. Yesterday I felt feverish and checked my temp its normal, i checked every hour and my temp is normal 37 - 37.5c. I contacted my doctor and said he told me to take ciprobay 500 mg 2x for 5 days as a precaution, since i was on cefalexin for the first 7 days post op. I feel so feverish inside like im hot and warm but when I check using a thermometer( 3 different ones to be sure) its always normal, I even went to my work`s clinic and they said my temp is normal. I have runny nose so I was also thinking of a flu. what do you think? Should I suggest a stronger antibiotic to make sure theres no infection?
I do not think you have a bacterial infection that a different antibiotic will help with, most likely just normal feelings after the surgery, you have to give it time. JG 5.28.09
hey dr! i had asked u aques regarding the removal of buccal fat pads.. well is is possible to gain fat there (after removal of buccal) if u put on a little weight or is it a permanent thing? cuz i noticed that my cheeks do get a little fuller when i put on some weight?
no, once it is removed you cannot regain the fat there. You might have put on fat in an adjacent area but not in the buccal fat pad, so weight loss will make it go back down. JG 5.27.09
right now i have pretty long lashes in good health but there not too thick so i wanted to try latisse. will latisse possibly mess up my own lashes. I dont want to ruin them as there a very nice lookin just want them thicker/darker?
sorry, I am not a fan of Latisse, we use RevitaLash. JG 5.23.09
I wrote to you last year about a black eye I received from a tennis ball in August of 2008. The discoloration has disappeared but there is still some puffiness, that I assume is fluid, under the one eye. Is there anything I can do to get rid or it. And if not, is there still a chance it will disappear. It has been 9 months.
not sure why it would still be there to be honest. JG 5.23.09
I wrote the question about not being sure where the groin area is. See, if the groin is the labia majora or area between the labia majora and thigh I need to get laser hair removal so I will not be growing coarse, balck hair on breast area. If the groin is the thigh area, then I will not need ot have laser hair removal before the skin graft.
well, if they take a full thickness skin graft, which is the usual method, there wil be some slow and mild hair growth no matter what you do before. JG 5.22.09
I am not sure where exactly the groin area is when a skin graft is taken from the groin area for nipple/areola reconstruction. Is the groin the labia majora, the skin between the labia majora and thigh line, or the thigh line/crease?
it can be taken from either place. JG 5.22.09
I just had butt implants done on Tuesday- three days ago. Is it normal to have the drainage tubes connectedinside the butt from the incision? The doctor took it out just today and it was painful, i didnt know it was that long till i felt him pullihng it out. I cant sit or lie down on my back as of yet. Is it bad to try sitting at it this early. With a rounded floater I think i can tolerate sitting down. What are the best tips to avoid infection.
I think it best not to sit for two weeks after buttocks implants. JG 5.22.09
Hi Dr. Garcia: What is the best way to tighten the skin of the lower arms? Can they do surgery like they do on the upper arms, or is there any other way? Thanks in advance.
I am sorry but I do not think that is an are that is able to be treated effectively in terms of tightening. JG 5.22.09
I had butt implants yesterday. Gosh the discomfort is over. Ive read the first 48 hrs is the worst. i cant lie down and sit down. I have two drainage pumps also. I just hope my 7 days vacation leave from work is okay..
we usualy had patients take two weeks off. JG 5.20.09
Hi dr...its the chin implant girl again...I thought of a way to rephrase my question, so you can better know my real concern...I feel my cheeks are full, kinda on the bottom...i think my narrower pointy chin in the bottom helps to balance that out. Im nervous a chin implant will fill out the sides of my chin...making it look fuller and my face bottom heavy. Do you think thats a valid concern? The implant type looks like a U. ...sorry, just trying to decide if I should continue with the implant...thank you so so much. (hope i made sense, :) )
well, it might do that if an extra large implant is used. JG 5.17.09
Thank you for commenting so quickly about the chin implant so fast. Yes, you are right, he is a very good dr. Thank you. I hate to be a pain, but does the oblique angle always fill out like that??? Im scared I wont like the way it makes a longer look in that view. Soryy to ask, I really appreciate your input.
no, that depends on your underlying bone and the size and shape of implant placed. Best of luck. JG 5.17.09
hi Dr. Im scheduled to have a chin implant on Tuesday along with another surgery. Im really nervous about the chin implant as far at the nerve damage goes...should I be really concerned if hes a good dr? And im really nervous suddenly it will look bad..... I never really thought about it before but now when I look at before and after pics of chin implant patients, they look like they have really long face from the oblique angle....Would you agree with that??? Is that common? Cause I do like how in the oblique angle that my chin indents in, I just don`t wannna trade a profile thats ok for a oblique that Ill hate, ya know? Sorry, Just nervous!
the risks of that are quite small in experienced hands.Relax and trust in your surgeon. JG 5.17.09
What is a good laser to use to: 1) remove redness from new scar 2) reduce uneven pigmentation from burn scars (white line scars mixed with brownish discoloration 3) light brown freckles 4) broken red blood vessels around nose nostrils 5) spider veins Please number 1-5 in your answer. Thanks.
for the redenss I use a YAG laser. Similar laser used for the hyperpigmentation of burns or freckles, for the broken blood vessels can use a YAG or an IPL or VBeam laser. I do not recommend any laser for leg veins. JG 5.16.09
I`m scheduled to get my buttocks implants this coming Tuesday. I`m excited but of course I am scared of the recovery period, I might not be able to sit on my butt for a while. or even lie on it. how long does it take before i can do normal stuff like sitting and lying on my back
2 weeks or so. JG 5.15.09
Is a fellow a doctor who is still in residency? If a fellow is working with a plastic surgeon, can the patient request the fellow not to be there for the surgery (if the surgery is private and the patient wants the least amount of people there)? How can the patient reqiest the fellow or anyone extra (students/interns) not to be there?
in some cases making that request is reasonable, but in some institutions like universities, it is a requirement for you to be able to access the supervising surgeon,only way to tell is to ask. All you have to do is say what your wishes are and then see what happens. JG 5.14.09
I wrote the question about the cherries below. I called one place that uses a Sciton laser. Does that laser work for cherries?
may not work in one session. JG 5.5.09
I know a candela laser was used on me awhile back for red cherries (round, broken up blood vessels on central part of my body). One zap and the red spot disappeared that same day. However, when I call places about laser treatment for red cherries, they say it will probably take 10-15 treatments to make it go away! I asked what place what laser they use and they said IPL. I don`t know how many places use the candela laser. My question is what lasers work for the red cherries in one treatment? Thanks.
the ability for it to work in one session is not for all patients and for all red spots, I have to say you likely got lucky to have it gone in one session. JG 5.5.09
What is the best filler for under the eye area, to fill in hollow?
I use Restylane for the rim. JG 5.3.09
I have a horizontal line when I smile below my nose. Kind of a u shape. Have you seen this before? What can be done? Thank You
yes, it is due to the muscles causing the skin to fold, not much I would suggest be done. JG 5.3.09
is it safe to get butt implants if i had silicone oil injected on that area 6 years ago
I would say no. JG 4.30.09
I wrote the question about the buttock implants shifting. If the implants are placed below the muscle, do they tend to shift? If so, does movement (like exercising) cause them to shift? Have many patients wanted the implants removed that were placed under the muscle?
less so when under the muscle but can still occur. Any motion of the muscle can cause them to shift more, yes. I have no data as to how many patients wanted the implant adjusted, sorry. JG 4.28.09
Is it common for buttock implants placed higher up on buttocks to fall down to lower end of buttocks?
common, especially if placed below the skin on top of the muscle. JG 4.28.09
Hi, Dr. Garcia, Some cosmetic surgeons offer Cosmedical skin care products in their offices. On a scale of 1 to 10, how would you rate Cosmetical compared to other lines, such as Skinceuticals? (I assume you would rate your own line at a 10, since you`re developing it and feel it`s the best.) Thanks!
it is likely a good skin care product that the doctor can place their name and label, saving themselves the time and knowledge in developing their own, will probably be similar to SkinCeuticals. JG 4.26.09
HI DR G:: I have large veins on the backs of my hands. My hands look old. The have no fat. What do you think is the best treatment or combination of treatments?
could try Sculptra injections. JG 4.26.09
I am interested in having the prominent muscle removed above my eyebrows to remove the bunps and not have to get botox anymore. However, I have a little bit of a hair loss at hairline so I am concerned I might lose more hair with the scar incision? Where is the incision placed- at hairline or further back? See, I have sparse hair in bang area so I am afraid the scar migth show since I can see my scalp in bang area.
it can be removed through an incision further back and since no skin is being removed there should not be any hairloss, it also can be removed through an incision on the upper eyelid. JG 4.24.09
I wrote the question about the hairmax laser. Do you think it doe snot work at all for women with a slight receding hairline instead of balding men? The laser is supposed to make your stop falling out so it seems like your hair would become fuller? Have you heard that it did not work at all for people? I am just looking for a slight improvement as I only have a little hair loss at hairline.
I think the science behind it is pretty sketchy. JG 4.24.09
Hi Again, just one more question... if I do not want to wait (12-18 months) for the scar to look better using a topical solution, based on your experience have you used a laser to improve scars or have you be able to improve scars in your experience with plastic surgery? What do you recommend.Thanks again for your time.
the wound is healing and laser might help, but it also might iritate the skin and prolong the fading process. JG 4.22.09
Hi, In Feb.09, I had a cancer tumor removed from my right thigh. My onc surgeon is not a plastic surgeon & left me with a 2.5 scar in my inner thigh. He closed the incision with surgeon glue, However, my scar is red/purple and uneven 1/4 line. Very ugly. What do you recommend to improve appearance? Based on your experience, can a topical solution improve a scar. I am using Mederma but see no results> Have you ever used Dermatix and does it work?? Other than a topical solution applied to the scar, what would you recommend (ie: laser (what time frame), surgery to improve scar (what time frame). Thanks for all your help.
all we use is Mederma or ScarGuard, but it will take 12-18 months to fade, have to give it time. JG 4.22.09
THANKS SO MUCH FOR YOUR TIME.
you are most welcome. JG 4.21.09
What Vitamin C product do you recommend for the face? I have just run out of SkinCeuticals liquid Vit C, but I think I would prefer a cream because the liquid is sort of awkward to use. Also, what cream do you think is best for a 68-year-old face that has few lines but sagging skin. Thank you. Lilacs
our eye booster cream has Vitamin C in a cream, on our shopping cart. As to the fine lines of the face in your case I might suggest our peptide cream. JG 4.21.09
If a teenager has a labioplasty, will she need to have another one after she gives birth? I do not know if childbirth permanently stretches the tissue so it lengthens again.
there is no way to tell for sure if it will elongate again, some women, during pregnancy and childbirth do elongate their labia, but another common cause is wearing tight clothing in the groin region which pulls and tugs on the labia and elongates them. JG 4.21.09
Since I have been receiving botox treatments, the texture of my forehead looks different. Although I do not have acne, my forehead has little bumps like I have acne. Well, it guess it is not really little bumps- just the texture has changed somehow. If it is related to botox, can you guess why botox may cause this?
do not think the Botox has had any causative effect on your forehead for that. JG 4.21.09
What potential problems has the FDA banned the tanning pills for? Is there a safety issue?
there was a concern with potential skin cancers I believe, it has been awhile since most of the pills were taken off the market. JG 4.20.09
I get all kinds of pricing for IPL treatments. Today, I called and was told quote: 4-6 spots $150. 7-15 spots $200.00 I was looking to do my back, shoulders and arms for the freckles and pigmentation. What would be the reasonable market rate for IPL`s just for per location rather than spots? I used to get my entire face done for $225 from a medspa that is too far for me to travel to now...thanks
Honestly, since it will take a series of treatments over the same spot to get it to fade and it is only temporary, I would save your money. JG 4.20.09
In regarsds to my previous question: Taking into consideration the cost and end result, would you recommend VelaShape or endermologie for someone who is in fairly good shape with just a few trouble zones that I`d like to smooth out and if possible, slightly reduce in size? Thank you for your time! Answer: I think between those two I would suggest VelaSmooth. JG 4.18.09 **You would recommend VelaSmooth over VelaShape? Thanks! :)
VelaSahape might be slightly better. Sorry. JG 4.20.09
In the 80s, i know there were tanning pills that made your skin look orange. Since then have there been any improvements in tanning pills so that the color looks more natural? If so, what brand? Thanks.
their availability has been curtailed by the FDA due to potential problems. JG 4.20.09
Taking into consideration the cost and end result, would you recommend VelaShape or endermologie for someone who is in fairly good shape with just a few trouble zones that I`d like to smooth out and if possible, slightly reduce in size? Thank you for your time!
I think between those two I would suggest VelaSmooth. JG 4.18.09
I had hydrogel injections for the butt more than 5 years ago. Im planning to get butt implants.. Is it okay to get butt implants?
no studies have ever been done to determine the safety of that combination. Sorry. JG 4.18.09
Hi Dr. Garcia, Thanks for your response regarding using Botox in the lower eyelid area. If this is not an option, are there any other options that work well for dynamic wrinkles in the area under the eyes such as fillers, etc. Thanks again for your advice.
I am sorry but besides creams or lasers to attempt to induce new collagen, there is not much at present. Fillers cannot be reliably used in that area for dynamic wrinkles as it will look lumpy when relaxed. JG 4.15.09
Hi Dr. Garcia, I am 52 years old and have what I consider significant dynamic wrinkling under my eyes when I smile. I would like to smooth this area and already use Retin A for skin care. Would Botox injections work under the eye or are they just for crow`s feet around the eyes? If so, is there any particular technique for injecting under the eye versus crow`s feet ? Thanks so much for your advice!
Botox injections are used off-label for the outer corners of the eye region but injecting it to the lower eye muscle can in many cases cause the muscles to weaken to such an extent that the eyelid function can suffer and the lid not be held agianst the eyeball as it is supposed to be, I do not recommend Botox injections for the skin of the lower lids. JG 4.15.09
I am writing again about the visible pleat I have on the left side of my face from a fallen midfacelift. Has the muscle detached from the bone, can this be easily repaired? Does skin need to be taken off, or will I have to go in and repair the midfacelift. There is no one in Tennessee who does midfacelifts like you. It makes so much more sense to go in on the side of the ear for this surgery. Is there anyway to fix this manually, cheek lift exercises etc? Thank you so much - nv
It likely will need more surgery and at least the skin relifted and possibly the tissues below the skin too, hard for me to say without seeing you in person. At times the pleat is due to agressive lifting of the tissues and no to little skin being removed and that can cause the skin to fold. That is one of the great deficiencies of an endoscopic procedure as it does not allow the skin to redrape well. I am sorry but no exercises will help. It cna likely be repaired with a traditional cheek lift. Best of luck. JG 4.13.09
Hello, and thanks for considering my question. I realize this is off-label, but theoretically can retin-a be used to treat cellulite? I understand that the appearance of cellulite is due to poor skin in the area. Why do they not make a weaker version of retin-a which can be used over a larger percentage of the body? Areas that come that come to mind are feet, hands, elbows, and cellulite.
it can be used but it will not work I am afraid, it has been tried by many. JG 4.9.09
I think you`ve siad there is nothign that can improve the lines on the neck. But what about the texture? Are there any laser treatments or creams that can improve the aging texture of the neck- at leas temporarily?
Retin-A and peptide creams can hep some, I think the improvements from lasers and chemical peels are short lived as they cannot be done too deeply. JG 4.5.09
Hi Dr. Garcia, I`m interested in doing Velashape to smooth out cellulite and for some circumference reduction (nothing major). I saw your previous answers on VelaShape from the past 2 years (although nothing recent) and it seemed like you weren`t impressed...has it improved? The place I`m looking into says you do go for maintenance treatments once a month or so depending the individual`s condition. Also, can it be done on calves for size reduction? What`s your take on Botox injections to reduce calf size? Thank you for your time- it is truly appreciated. :)
has not improveed, still the same, works pretty well for small areas but needs to be continued. I am not sure it will reduce the calves much, and I think the amount of Botox needed to reduce the calf muscle would be huge. JG 4.5.09
Thanks for your response. When you say cutting out the veins can cause chronic swelling ... does it go away with time? if is how long does it take? If the blood can`t get through those veins, wont it find another vein to travel through?
it might never go away. That vein is bigger for a reason, maybe because the surrounding ones could not handle the needed flow, so cutting it might not be able to allow the others there to compensate. JG 4.4.09
Thanks Dr G. If a cream wont thicken the skin under my eyes enough to hide the blue veins, is there any treatment that would minimize them .... laser, injection, surgery?? Surely there is something I can do to improve under my eyes ... I hate the blue veins.
not much, there are attempts to cut the vein out but it is there for a reason and cutting it out might leave chronic swelling. JG 4.2.09
I do not know if you remove skin growths and send them to labs. I have had a couple of 1/4 inch round raised growths on my neck for the past 20 years. I have had MRI of brain and neck for other things and no cancer has shown up. Sometimes these growths itch after I apply retin-a on my neck making me think they are seborrhea keratosis so I spray ligquid nitrogen on them. But the freezing does not remove these growths like it does seborrhea keratosis. I do not know if I should these growth as the texture is regular skin texture and color, but it is raised liek a misquioto bite. Well, it is a little less noticeable than a mosquito bite, but it feels a little hard when I move my finger over it as though it was scar tissue. I have never had any surgery on my neck, though. Just wondering if you have any ideas what this might be- like common growths that may grow on the neck area. I have seen a dermatologist in the past who could not see it so he acted liek I was imagining things . Like I said it is my regular skin texture and color, except it is raised and feels hard like scar tissue. It is more prominent when I put things like retin-a on my neck.
hard to say, might suggest you have a dermatologist do a biopsy on them to see what is going on, it does not sound like cancer though, and cutting them out will leave a permanent scar. JG 4.1.09
What do you think of acell`s wound care sheets? Do you think they would be helpful after a dermabrasion for acne scars? The company said they could help regenerate the skin as long as the scar tissue is removed.
it might help, yes, not been stdied though. JG 3.31.09
Hi Dr, garcia, I was wondering if isometric facial extercises would tighten under the chin in the neck area to get rid of the turkey neck such as sucking in the under chin neck area and holding it in tight makes it appear that i have a face lift ., such as holding in the tummy makes the tummy tighter., would this extercise work or help someone who has already had a face lift, thanks, your the best.
no, it actually might make it worse as muscle function causes wrinkles, that is why they use Botox, to relax the muscles. Facial muscle do not sag much, it is skin and the fat compartments on top of the muscles. JG 3.31.09
Have you heard of MIMOSA TENUILORA oil from the MIMOSA TENUIFLORA TREE? If so what can you tell me about it? Thank you
no personal or patient experience with it, sorry. JG 3.31.09
What can a woman do to improve a flat butt?
sqauts, at the gym. JG 3.30.09
If you are skinny and have not fat to liposuction for buttock augmentation, can you use fat from right after you give birth to liposuction for buttock augmentation. Genrally, how long does this pregnancy fat remain after birth?
you can but if you were going to lose that fat with time, it will also melt from your buttocks, how long baby fat lasts on the mother is variable, no way to predict. JG 3.30.09
Should you wait until after you have a baby to have labioplasty? Does childbirth make the labia permanently longer?
yes, childbirth will potentially make it worse. JG 3.30.09
Hi Dr. Garcia, My areolas are very large for my breast size, and I went to the dermatologist and was prescribed Tri-Luma cream. I was just wondering if you knew of any other ways of reducing the size or any advice. thank you so much,
TriLuma will never work, it will require surgery and that means permanent scars. JG 3.15.09
Hi, I really appreciate this service you are providing. On to my question. I have a fairly uneven/askew chin, in that one side projects out quite a bit more than the other. Is it possible for a skilled surgeon to only burr back one `side` of the chin to achieve more even projection?
yes, in some cases that is possible and is less risky than orthognathic surgery. All the best. JG 3.14.09
Hi DR G::: I had Labia surgery 3 weeks ago. I`m a little worried ... its so bumpy and uneven on the edge were the stitches were. It looks so unnatural. Is it normal at this stage to look deformed?
all normal, and all will get better, that area gets swollen for a long time and contributes to that temporary appearance, give it some time and it will get better. JG 3.11.09
When you say friction makes it get darker, is it permanent color change? Does friction somehow damage the skin causing a color change? Just wondering if the area can turn lighter again if friction is reduced?
yes, it is essentially permanent. The friction essentially causes a burn which alters the skin and the skin tries to protect itself and hyperpigments. If it is treated and lightened, it comes back to the dark color shortly thereafter and it is difficult to treat and lighten it in either regard. JG 3.10.09
Hi doctor, Some time ago you suggested I treat a small, brownish v mark on my leg, the result of ironing while sitting on my bed! I have several questions...Is there a specific type of yag laser that can be used for this, could it clear my skin permanently, would it come back if I expose my skin to the sun (it is really not realistic to think I will never let my legs see the sun)
ND: Q-switched laser but if you expose it to sun it will come back. JG 3.8.09
Dr. Garcia: What is your opinion on Lipodisolve? Seven months ago I got a tummy tuck and breast lift/reduction. Needless to say it didn`t go as one would have hoped. I now have what my dr. refers to as a shelf right below my belly button. I have had so much cutting on my body that I really don`t want that. So he is thinking lipodisolve. What do you think?
I personally think it is a large scale experiment being perpetrated on patients in the US with little standardization and little information telling them that even after over thirty years of it being inflicted on patients in Europe, there is a dirth of medical evidence of its effective, but hope and the desire to avoid surgery spring eternal. I would not do it. JG 3.5.09
Hi Dr. Garcia, I had a sliding genioplasty in dec 2006. Afterwards I have had numbness on the left lower lip and chin which I am sure is permanent nerve damage. The Dr. did an exploratory in April 2008 and said nerve narrower on that side, but intact. Even worse than the numbness is a digging type sensation I feel on the left. The bone is higher on that side since original surgery. The only relief I get is to put a piece of tissue paper between my lower lip and gum area or over my lower teeth in that area. Is it possible to reverse the surgery and for a Dr. to move the bone back so that it is closer to the original position to see if that helps the digging sensation? I can feel the ridge of bone inside my mouth and it just seems like he moved the bone up too high on the left and too far forward. I just want it back like it was originally hoping it will feel normal. Whenever I talk or eat I get a burning or stinging type discomfort. Thanks so much.
That is possible and the small ridge can also be burred down to alleviate some of the problem, but it likey will ntot help the numbness I am afraid. All the best. JG 3.5.09
What do you think of the diode laser for hair removal? Is it better or worse than other lasers?
I think the Alexandrite laser is the best for hair removal. JG 3.4.09
youde have to use latisse forever then, otherwise youd waste money using on for a few months if the result will go away? whats the best then to just help thicken, srenthen, and possibly grow longer.
correct, you lose the effects when you stop. All products out there are the same in that regard, as to what we use, we sell RevitaLash. JG 3.1.09
right now I have pretty long lashes, but there not so thick, could you some more. if i use latisse would I ruin my own that are there now? Also what hapens when u stop using it?
not sure Latisse will do much to thicken them and any positive effects will be reversed if you stop using it. JG 2.28.09
Thank you for answering the question about the scar in the scrotum region. Would you be able to provide an in office consultation for this sort of problem? i realize it seems like a simple issue. But if sometihing can possibly be done i think its worth having it looked at. Thank You.
I can certainly see you in consultation if you desire. JG 2.28.09
Hi Dr Garcia, I have had 3 left breast capulectomys/silicone/unders. Went for consult yesterday and PS recommending putting silicone(300cc) over the muscle/ making pocket bigger and putting steroids inside lumen of implant to help prevent cc. What do you think?? I am desperate for any advice you could give me. PS: When my original implants were put in I had developed a staph and pseudomonis infection which required taking out implant for 6 months and being on vanco Iv for 6 weeks at home. Sincerely, Bobbie
to be honest you have at least a 50% chance of getting a capsule again, even if it is changed into a new positon. Putting steroids into the lumen will not help with capsular contracture, that was tried in the 80`s and found to not help. Wish I had better news for you. JG 2.27.09
which would u recommed i spend money on li lash or latisse?
I prefer RevitaLash. JG 2.26.09
sorry i meant billion dollar brow, to regrow brow?
don`t see anything in the ingredients that will do much. JG 2.26.09
i know u dont believe in it but can anything bad happen if i use castor oil on brows, like pooisining myself?
no poisoning effect. JG 2.26.09
what do u think of brow diamond?
sorry but not familiar with it. JG 2.26.09
Hi Dr. Garcia. What are the options to tighten loose crepey skin under eyes? And which is your preferred option? Thanks.
usually I use a light CO2 laser for that. Best of luck. JG 2.25.09
i read alot about castor oil for eyelashes...what do u think? if nothing what is something people can use who cant afford latisse to help thicken them
I do not think it will work, think about it, if it did, then why would anyone buy the expensive products for sale now when they could buy Castor Oil. JG 2.24.09
Hello Dr. Garcia I`ve recently bought the product Lilash and have read many reviews on it..Good and Bad. Is this product safe to use? Also I read something saying that your body can build up a tolerance to the drug in the product and your eyelashes can consequently fall out. Is this true? I am not sure if I should use this product.
I cannot say if it works and as to tolerance, it can happen,but in general, tolerance to medications is rare. JG 2.24.09
Hello, a few years ago, I had an IPL treatment using Levulan on my chest to treat redness (which treatment burned terribly although the woman said it wasn`t going to.) Months later, I noticed my skin, in the middle and slightly above my breasts, had become crapey and if i fold my arms, that area of skin is severely wrinkled. It could be a coincidence that my skin just aged but I was reading that perhaps this condition was caused by the IPL/Levulan treatment as it may have burned off fat cells in the area? I am wondering what you think as my current Dr says a series of IPL sessions will reduce the wrinkles as it will cause my body to produce more collegen. Dare I get more treatments? Do you have any other suggestions? Thanks so much!
I do not think it is due to fat loss, but something else. I will also say that I am not sure what they were thinking about though as the Levulan in conjunction with the IPL takes the effectiveness for the red out of the picture and can actually make it worse. I think series of IPLs will do little as the degree of collagen production from the IPL on the face is minimal and it is much less on the chest. I would skip the IPL on the chest unless you are trying to help the brown spots. Best of luck. JG 2.20.09
I asked the other day about an arm tuck. Where would the icisions/scars be and how long are they in length? Thanks
they extend from your armpit down towards your elbow on the inner part of the arm, the length will depend entirely on how much skin is removed. JG 2.20.09
Dsear Dr. Garcia, Do you have any satellite offices that you work out of or do you strictly work out of Las Vegas? I thought I heard that you come to Arizona or did??
no, just here in Las Vegas at the present time. I was thinking about a satellite office but have not done so, sorry. JG 2.19.09
Hello Dr., I wrote to you a while ago about like my face seeming saggy and I think its my midface..i don`t have very deep nasal folds but I have gotten jevederm in nasal folds and it just makes my face appear too full...but my problem is the skin below my eyes makes an arc down...and if i pull up on my face by the sides of my ears i have a more flat and desired look...im only 28 though and i feel this makes me look older and angry sort of...its getting worse in the past couple years too...would a midface look be an option i will be 29 in june and Ive lose 50 pounds in the past so I think these could have to do with the problem but even looking at pictures as a child ive always had this look...any advice you can give is appreciated as I don`t even want to take pictures and Im depressed to look so old and be so young . Thanks Dr.
a flat cheek ages a person so I seriously doubt a midfacelift will help as there is likely not enough tissue to lift that will make a substantial difference. Migth want to consider filler like Sculptra to refill the area and give it more shape as you issue is from the fat loss of the cheeks and not descent of the tissues. JG 2.19.09
Thank you so much for answering me, Dr. Garcia. Maybe that´s why my nose tip did not swellow. Should I force my smile, streching it to make it go back to normal sooner or should I just wait? Is there a chance of my smile never be the same?
no need for anything special to be done, things will heal and stetch in time and I think your smile will come back to normal in the not too distant future. Best of luck. JG 2.19.09
I live in South America. On Jan 13th I had a facelift, otoplasty, rhinoplasty (+ septoplasty, turbinetomy, sinusitis and a piece of bone taken from my nose. One incision was intraoral, for allowing the depressor muscle to be released. I like my new nose a lot, but my smile is still very odd. It makes me feel very unconfortble. I wonder wow long it will take to be normal again. For me, normal smile would be my exact old smile. The numbness in the middle of my upper lip is still there. The doctor told me to wait 6 months. HeÂ´s very experienced and trustfull. What is the advantage(s) of this intraoral incision compared with the traditional ones?
it can take 6-8 weeks for the muscles to reattach so they can start to work more normally, the adavantage to the incision intraorally is that the muscle is right there, so less swelling. Best of luck. JG 2.18.09
lately i have been notcing my eyelashes falling out more than usual. what would cause that? i have no disesase or anything. i have been on prozac for like 7 mths, would that cause it. what can i do to help it, im afraid they will fall out ttally...
not sure, sometiems low thyroid can cause it too. JG 2.18.09
What is a limited incision arm tuck?
a procedure valid for a very small number of people who have very limited excess skin of the upper arm only. JG 2.18.09
whats ur take on latisse? u recommed it? is there side effects that are really bad like loss of vision....
I prefer Revitalash. I have not read about any vision loss with it. JG 2.16.09
Why is Latisse not supposed to be used on lower lashes? If lumigan is approved for actually in the eye, and has the same active ingredient, then whats the problem? Wouldnt something that goes IN the eye, get to the lower rim? Ihave Latisse, and do use it on lowers occasionally, no problem, but whats the reason they say not to?
that decision was made by the company and the FDA, I cannot comment on it, but although it has active ingredients similar to other eye medications, I think it is determined by the amount. It also might not have been able to show as much of an increase of its effect on the lower eyelashes and therefore did not get approved for that. JG 2.12.09
I`ve read that it is good to load up on vitamin K before surgery. What good does it make. I bought some menadione 10mg earlier. I`m planning to get cheek implants 3 weeks from now. I`m a heavy bruiser, my bruises when i had my lower bleph lasted so long and was so black and even my sclera got blood shots. so im looking for a med/vitamin that will make me bruise less on my upcoming cheek augmentation. I`m planning to take sinecch on my operation and right after. what can you recommend. I just want a more rapid healing after cheek implants. Thanks again from the Philippines! Cheers
it is rarely of any beneift unless you have a Vitmain K deficiency, which is very rare, you can also have overload from Vitamin K, so I would personally not do that. Might suggest bromolain, arnica Montana, and papaya and pineapple juice. JG 2.11.09
Dr. G., I have no question, but wanted to thank you for taking the time to be an unbiased and very helpful source of information to many who are not even your patients. You`re a helpful guy, Pamela
thank you for the kind words and I am glad I can be of assistance, you all teach me mre than you will ever know. Best with all. JG 2.11.09
Dr. When using filler such as Restalaye or Radiesse does it wrinkle the skin around it that is not filled--like the perpendicular line between eyebrows. It can`t weigh that much right? Also, does it dig the nasio-labial folds or any wrinkles deeper/wider should you stop using fillers? Thanks, I appreciate your knowledgeable and kindly help, Pamela
it should not have that effect, no. It also does not make the folds or wrinkles any deeper.JG 2.10.09
Hi Dr, I`ve noticed in movies when they have close-ups of actors the whites of their eyes are always really white with virtually no veins. Are they just blessed with good genetics or do you know if there is some sort of cosmetic procedure or product they are using to achieve this?
very temporary effect from Visine. JG 2.6.09
I have a very odd problem. I am too skinny and have very boney shoulders. I don`t have an eating disorder, in fact I eat like crazy, and just have very fast metabolism. I have tried working out my shoulders but that doesn`t work. Is there any procedure that can round them out?
sorry, but none that I know of. JG 2.2.09
Why might retin-a cause growths on your body? I use it on my hands and notice raised sun damage type of growths from using it. I stay out of the sun and they appear when I use retin-a. I thought retin-a was supposed to make skin younger, not age it with growths?
not cancerous ones and rarely if at all, but it can irritate the skin and cause some normal skin lesions to get larger. JG 2.2.09
Have you heard of the Galvanic Spa system? Its an ionically charged hand peice combined with a gel to smooth out and tighten skin on face and body? Its for home use but has been used in spas for years. Whats your opinion?
not sure you will get much from the device. JG 2.2.09
Greetings, Dr. Garcia, I am writing to problem-solve about scar revision. In 2004, I underwent a Mohs on the infratip of my nose for a basal cell CA (I am up to 11 now, elsewhere on my body and face, and I am only 52 so I am not likely done with this - all have healed well and inconspicuously except for the nasal infratip). Following the Mohs I shortly thereafter underwent a skin graft taken from behind my ear. I am a ruddy-complected Caucasian woman and the skin graft from behind my ear was not a great color match (far whiter than the rest of my nose), plus the graft did not take all that well (had some pincushioning) so it is raised and the edges have not blended in with the surrounding skin. I think of it as my nasal elbow patch but I`d sure love to know what I can do so that I can continue to improve on it towards inconspicuousness so as not to have to think of it at all! What has been done since is that in 2004-2005 I underwent a series of steroid injections, then IPL then VBeam with only slight improvement. I have to wear concealer makeup to try to even out the color but even that works only so-so. The real issue is the contour. I think it would bother me less if it were flatter and if the edges feathered in better so that it did not look so blunt. This past summer when I was off work healing from a back surgery I went to the local dermatologist laser expert who tried VBeam one more time and that helped with the depigmentation some (it looks a bit less hypopigmented, interestingly, because I thought VBeam was best for evening out redness). I asked about microdermabrasion because in my mind it looks like if this graft could somehow be sanded down it might confer the effect I am hoping for - but I could be misinformed about the benefits of microdermabrasion. On a problem-solving bulletin board website, my primary dermatologist posted photos of my nose asking for suggestions and one was for some filler to be instilled at the edges to try to level the raised edges with the surrounding skin but I am a bit dubious about it. I also consulted with a second local plastic surgeon in 2005 whose career has been built on nasal reconstruction and he was frank with me and agreed that the result from the original plastic surgeon was non-ideal and that he`d have to start all over again but first recommended laser treatments - and so here I am. 1) Do you allow posters to send pictures by email? 2) Based on what I have described here, can you say anything about non-surgical treatments that might be of benefit (or might not be - is microdermabrasion or even ordinary dermabrasion an option)? 3) Because I am cropping up basal cells rather regularly (guess ruddiness did not protect against too much sun exposure as a child), I am a bit concerned about having to undergo any further skin grafts for fear THEY could develop basal cell carcinoma and then the wheel of fortune revolves anew. I guess I don`t want to make anything worse but still, at 52, would like to know what kind of chance I may still have at trying for a better degree of inconspicuousness. 4) Do you, as a cosmetic surgeon, have a preferred way of identifying which surgeons (in addition to yourself!) are considered to be top doctors for success with specific cosmetic or scar revision problems? I am afraid a blind Google search may indeed be just that, and further direction would be appreciated. I have no way of really knowing or discovering whose reputation is well-regarded. It`s ironic because the original basal cell on the infratip of my nose was far smaller than the skin graft that replaced it. Hindsight is 20-20 and I do wonder whether had I just had it excised and sutured without Mohs or without a skin graft whether the outcome would have been as unfavorable - I raise this because I don`t know whether scar revision surgery could make sense (as opposed to a fresh skin graft or no surgery at all). I appreciate any answers you may have for me. Thank you for being so responsive.
I think repigmentation with a microdermabrasion or VBeam is likely not effective. I think excising the skin graft could be done, but then we would have the same problem. The reconstructive options there are not very good and very complex I am sorry to say. It might be something that not much can be done for. As to pictures to me, please feel free to send them directly to me at email@example.com. I will give you some further recommendations after I see the pictures too. I think these types of issues are most commonly treated in Universities I must say. I think as to future skin graft, taking it from a non-sun exposed area is best, but that leads to greater differences in skin color I am afraid. JG 2.2.09
Is liposuction commonly done for chubby cheeks? Is the instrument inserted inside the mouth or directly on the cheek? What is average cost for this procedure?
no, not common, and not very effective most of the time. JG 2.2.09
I wrote the question about taking estraidol during puberty. So, a female who was genetically depositioned to have broad shoulders would not have broad shoulders if she took estraidol during puberty? Or her shoulders would be less broad than they would be if she didn`t take estradiol? Also, her breasts will be a little a larger (1 cup, 2 cup sizes?) if she took estradiol during puberty? Also, if the female`s adult height is 5`9 , what do you think it would have been (estimation)if she took estradiol during puberty? And the less broad shoulders, shorter height & slightly larger breasts woud remain permanent after she stopped taking hormone when she stopped growing (at age 21)? I know it is too late now, but I am curious.
no, if they are genetically prone to broad shoulders, they will stil be broad if she took estradiol, she might just not be as tall if she took hormones during puberty. The breasts might be large as breast tissue is sensitive to hormones but agian, if she had high hormone levels but a genetic predisposition to have small breasts, they will stay small. Some women with small breast get large in later years but that is not an increae in breast tissue, it is an increase in fat, making the breast a larger shape, and that size would be lost with weight loss. Similarly, some women than have high sensitivity to estradiol can develop large breasts even with low estradiol levels. It is not just the blod level of the hormone, the receptor sensitivity is more in control. As to how much shoter she would have been, that depends on when during puberty the estradiol is given, the earlier in puberty it is given the shorter, if given late in puberty, the effect will not ba as great. Once puberty is done, bones will not change, smaller or shorter. JG 1.31.09
i suffer from chronic neuropathic pain in the eye,i go to a pain clinic.so far anticonvulsants an steriods have been tried,but with no effect.my doctor is now thinking of performing a nerve blocker.do you think this could work and what would the side effects be?.when the pain is at its worse the eye appears small an begins to close.
might work, should not make it worse, certainly worth a try. JG 1.31.09
The lower end of my buttock feels stumbly (like shaven hairs are growing back in)but I don`t shave there. I have little blond hairs there, which makes my skin rough to touch. Just wondering if laser hair removal will work? Don`t they now have lasers which can also treat blond hairs?
if the hair is dark it migth help. I think the claims of it working on light hair are overhyped. JG 1.31.09
I have heard that you can get an eyebrow lift from botox. I am interested in knowing if this is true and if it can be done to kind of raise the outer portion of the eyes.
it will only raise the outer portion, it can be done only if the crows feet area is injected and not the lateral forehead and the amount of elevation is hard to predict. JG 1.27.09
HI DR, I AM SENDING MY QUESTIN TO THIS CATEGORY B/C BREAST AUG IS NOT WORKING RIGHT. I WAS WONDERING...SINCE I AM SEEKING 2 OR 3 OPINIONS BESIDES MY DOCTOR´S IN MY FORMER LOCATION, CAN I SEND YOU A PICTURE OF MYSELF SO YOU CAN GET TO SEE THE BUBBLE ON MY LEFT FOLD I HAVE BEEN TALKING TO YOU ABOUT AND GIVE ME YOUR INPUT AS TO WHAT WOULD BE A GOOD COURSE OF ACTION? FOUR HEADS THINK BETTER THAN ONE!
sure, send it to firstname.lastname@example.org
Good Evening Dr. Garcia. I had a very tiny amount of fat removed from my abdomen (next to my belly button) 4 days ago for a fat transfer (into a dent in my nose). My abdomen is swollen and bruised, as I expected, but now the lymph nodes on the right side of my groin are swollen and very tender. Is this something to worry about? Thank you!
noting to worry about, all normal and will get better in time. JG 1.24.09
In your opinion what is the best solution other than cosmetc prcedures for smoothing the texture of one`s face and pore`s and as a anti aging product all rolled into one if possible?
Retin-A. JG 1.24.09
Hi Dr, I consulted a PS years ago about a dimple in the middle of my cheek which I have had all my life. As I age, it seems to get more noticeable when I smile. I have tried fillers but they don`t seem to work. At the time he said it was caused by the muscle and suggested an incision into the muscle which I didn`t want to do. Now I think its the only solution. Is this a straight forward procedure and are there any risks? Thanks
well, I think the problem is that most likely the attachment of the skin to the underlying muscle, will, with time, reform and you will be back to the previous state I am afraid. JG 1.23.09
I am scheduled to have a BI-Lateral Mastectomy. I would like to get reconstruction surgery. Do you specialize in that as well as all your other specialties.
I do many breast reconstructions but at present only accept patients on HPN insurance for that issue. JG 1.23.09
Hi Dr. Garcia! Here is a question you may not get very often ... Is there a way to keep your vocal chords / voice youthful? I feel like my voice is getting a bit gruff and I`m only 40, not 80. I do not smoke or drink. Is there anything that can help? Thanks!
I think the best thing is to not strain them so they do not get nodules, besides that, not much you can do I am afraid. JG 1.22.09
Hello DR G: Can you inject fat between the skin and a vein so the vein does not stick out so much.
sorry, but no. JG 1.22.09
Hi DR G::: I have a largest blue vein that runs across my temple and under my eye. It also sticks out. What can be done to get rid of this? what`s the best way?
I am sorry but it might not be able to be treated for fear of chronic swelling. JG 1.21.09
Hi Doc, I was wondering if there is any further developments concerning hair cloning or transplants? Also, do you currently or are you planning on offering these procedures? Thank you
sorry, but nothing new to report on that front. I am still, at present, not offering the procedures again, sorry. JG 1.20.09
Hi Dr. Garcia! I`m 43 and in the past year I just started noticing a line/piece of skin beginning to do the old droop under the neck. I`ve heard of botox for the neck, but I have to tell you, I wonder if it is just loose skin rather than a loose muscle. Is there a way to check? AND are there any neck exercises that you would recommend? I don`t feel ready for any botox OR surgery. Thank you!
well, a surgeon could tell you if it is skin or muscle but Botox will not help either one I am afraid. I think neck exercise if anything will make it worse I must say. Might just have to wait for things to get worse and then do the surgery. JG 1.19.09
I am in my mid-thirties. The oast week I thought aging accelerated fo rme because it was been hard for me to walk around (achy). I think I have shingles. I had chicken pox as a child. I had a bad headache the past few days which I thought I might be poisoned by fumes somewhere in my house. One day I felt feverish. have had bad cramps (and it is not period time). One thigh is painfulw hen I sit on like there is a big bruise, but there is no bruise. Then last night I noticed 4 hard, raised, painful bumps (filled with fluid)in a row across my back (waistline area). If this is shingles, do you think I will get more bumps or that is as many as I will get? I do not have insurance so I do not plan to go to doctor to get prescription for anti-virus meds. Just wondering if I will get more bumps (which meds can prevent)? Also, is something wrong with my health to be getting shingles at a younger age when most people get it over 50?
it could, might suggest seeing your internist and maybe getting started on some Zovirax. JG 1.18.09
I have been using TriLuma cream for acne scaring on my face a few times a week for approx. 1 month. I plan to get pregnant in the near future. How long do you recommend I wait (after stopping use of the medicine) before I can safely conceive?
I think 3-4 weeks should be OK. JG 1.16.09
If you are a teenager, when do your breasts usually stop gorwing. I had my period at ag 12.
about age 21.JG 1.15.09
Was wondering what you would suggest to someone who has uneven brest? what options would this person have to fix the problem?
best option would be breast implants of different sizes. JG 1.14.09
Is it common for women to get restylane of some injection at their lower neck/upper chest junction to fill cover the neck vein/atery or whatever sticks out there if you have less fat to cover it up.
I have never seen that done actually. I would think it would take a large amount to do that. JG 1.12.09
I notice that seborrheic keratosis erupts on my chest if I use retin-a there. I have a history of sborrheic keratosis in that area. Does retin-a cause eruptions of these growths. I heard that the gorwths can be caused by dry skin so I do not know if it due to the drying effects of retin-a.
it can aggravate the skin and cause certain growths, yes. JG 1.12.09
Is it possible some buccal fat maybe broke off when the surgeon was pulling it out...because my right lower cheek is slightly bigger...and my face was symmetrical before the surgery
could be swelling or that only the upper part of the fat was removed and there is still some fat there that might need to be removed to get symmetry. JG 1.11.09
I had buccal fat removal and now the right side is a little larger...do you think lipodissolve could fix this?
I do nto think it will work. Likely need more surgery. JG 1.11.09
One time a few days after ovulation, my breasts doubled in size like I had breast enlargement surgery. It was not the typical half size breast increase with your period or ovulation. My breasts were huge. I know it had to do with the possibility of pregnancy. My breasts only stayed large for a few days or week, then I had my period. However, I was wondering if breasts double in size when the sperm joins the egg OR when the egg actually implants into the uterus? Was I pregnant, but had a miscarriage? Or does breast size always increase when the sperm fertilizes the egg, but does not yet implant?
usually you need the fertilized egg to implant into the uterus and form a placenta for a large increase in the hormones enough to show what occured in your case. JG 1.10.09
I had buccal fat removal..and i notice that the lower right side is a little bigger..is there any way a doctor can look and see if theres some more fat..like with an x-ray or something?
there are no tests that will show it well, a MRI scan might, but hard to say. JG 1.9.09
DR. GARCIA: I HAVE PIERCED EARS AND FROM WEARING HOOP EARINGS, I MY EARLOBE IS TORN. WHAT IS THE COST, CAN IT BE FIXED . THANK YOU SO MUCH
I am sorry but I do not offer that service in my office due to our schedule. JG 1.8.09
Hi Dr Garcia, I had a granuloma from a polyacrylamide product removed from my lower eyelid. Is it possible to have an MRI scan or ultrasound to see if any remnants of the product are still there? I want to make sure everything has gone so that I can fill the hollow areas with a temporary product .... Thank you
in most cases the granuloma will not show up too well as it is similar to the surrounding tissues but it can be done if desired. Small amounts of the material may still be scattered over the area and may not be able to be seen but they might congeal into another mass with time and motion of the muscle. Best of luck.JG 1.8.09