Question:

Dear Dr Garcia, you are so unbelievably kind and generous with your time to answer my questions with your knowledge. My question to you is, how much do silicone Malar implants erode the bone, does the longer you have them in, the worse it gets over the years. I need to replace mine as I have been unhappy with size etc. I don't have much Malar presence so my mid face is very flat, will removing them cause a lot of assymetry so could put fillers on top once removed  or would you recommend I replace them instead of fillers. I have been terribly unlucky with my implants with the first set being too big now to the second set now infected as a result of dermal filler causing a biofilm infection. In your vast experience what would you advise I do? Replace them when all healed or resort to fillers instead. How long after removing can one get fillers? I am very concerned and so appreciate your honesty. Thanking you and Kind regards 

Answer:

The silicone implants in the malar area will have a relatively small amount of bone erosion, not enough to make a visual difference. You can have fillers put in after they are removed but I would give it at least a week to let the swelling from the surgery go down. The fillers are nice but they wear off and in the long run will cost more than just changing the implants to a larger size. Let me know if you have any other questions

Question:

How do you feel about INFINI? 

Answer:

I think the results will be short-lived and not dramatic, in my honest opinion, so I would temper your expectations if you are going to proceed

Question:

Facial filler

Answer:

The filler does not accelerate the aging process or speed up the laxity of the skin unless the skin is overfilled and stretched beyond its prior state.

Question:

Saggy neck and jowls

Answer:

The results from either of your choices will be mild at best, especially in the jowl region.If you are willing to accept a small degree of improvement, then I would suggest the ThermiTight.

Question:

Procedures for fat in abdomen

Answer:

Whether skin will be loose after fat removal from the abominal area depends on a number of variables. The longer the fat has be there, the larger the amount of fat that is removed, the presence of stretch marks and the older the patietn is, the greater the chance of being left with loose skin.

Question:

Thermage tightenting procedure

Answer:

I have to say that I have never been impressed with the average patient's results with Thermage. Some do great and many others see little improvement. I am not a fan.

Question:

Vampire Facelit

Answer:

Merely injecting PRP alone under the skin will not do much. It has to be combined, in my opinion, with some type of injury first (thermal in laser or something like that), followed by the PRP (Platelet-Rich-Plasma), in addition to some type of stem cells or a filler, and then followed by another "injury" to the skin in order for the skin to send out signals to attract its own healing components. It will improve skin quality but it will not lift loose or saggy skin, if done with the things I mention.

Question:

  I asked you earlier today about fillers for the lower cheeks, kinda like in the middle of the upper teeth and lower teeth, just cheek area and where no bone is. I asked if Scluptra would be better or if a filler would work, and you said either would work, but Sculptra would take longer. My dr has always told me he couldn\'t just inject a filler in the middle of the cheek because he said it had to be where bone was underneath, and no way the filler would work there. I am confused now.

Answer:

I am afraid he is the one who is confused. No filler, including Sculptra, has to be injected on the bone for it to work. Nor is there any advantage, in experienced hands to inject it that deep.You may need to find another person to inject you

Question:

I have had tear trough fillers and some for the cheeks, but now it looks like there is a dent or sunken place like down where the back bottom teeth are on one side. Can filler be put there or would Sculptra have to be put there for collagen growth?

Answer:

you can use either an HA filler or Scultpra for that area. I have used both. Of course the Sculptra takes time and he HA filler is immediate but the HA filler will not last as long.

Question:

I got restylane lyft for my cheeks and not sure what the dr used for my tear trough and nasal labial folds on Oct 3. It looked really nice when I left the office, but now it appears to be leaving and he said it should last for a year or longer. The last time I got filler for my cheeks it was Voluma and I really liked it, but he said it was more expensive and said the Restylane was more reasonable and lasted about the same. Is this normal for it to already be leaving? Also, I use to get Sculptra and know it causes ur body to produce collagen, but he didn't really push it.. What do u think I should get for the cheek filler and tear trough to last, and what would cause what I did get not to last? Also how does the Sculptra know where to make the collagen form or grow, where does the collagen form on the face, does it have to be near or on the bone or what? Is there any filler that can be used to fill out the area under the cheek bones or does it have to be near bone or on bone? Another question I have is would the plastic surgeon tell you if you needed a facelift instead of the fillers?

Answer:

It should not be dissolving this fast. Your effect might have been from the swelling and as that went away, the improvement went away. Might want to go back to the injector and see what they have to say. I use Restylane for the tear trough and Sculptra for the cheeks myself. I find the Sculptra last 18 months and sometimes more while the Restylane lasts 8-12 month. The collagen from the Sculptra forms only in the area into which it was placed, it does not move around. It is injected into the soft tissue so the new collagen will form. I do not inject onto the bone myself. You should inject it into the exact area where the loss is, not onto the bone, that is a waste in my opinion. I always tell my patient what the best option is and then give them options if they do not choose what I might suggest.

Question:

Hi Dr. Garcia, I'm thrilled to still find this great resource available.  Haven't written with a question for a couple of years.
My question is this: I had fillers injected into the cheeks and find I'm left with permanent red dots from where many of the injections went in.   Is this normal?  I'd probably have to get laser to get rid of them I'd think.
Thanks for your great service.
 

Answer:

Unless there were small blood vessels that were injured during the injection, I ma not sure why that happened I do think a laser is a good option for it though

Question:

That is a problem only when overdone. Properly used fillers only bring you back to the place you were before. If you use fillers when it actually is surgery that you require, then an over use of fillers happens. Sculptra is the only filler that significantly grows collagen, the rest are just spacers. Proper filling should not lead to a botched scenario Up above is ur answer to a question I asked earlier about fillers stretching out the face. Why would the filler stretch out the skin if you needed surgery? Why would that cause an overfill? Looks like if you needed surgery to remove excess skin from the loss of collagen, it looks like the fillers would just fill the space as you speak of and plump it back up where it use to be filled with collagen and look youthful, not stretch out the skin. Now you have me worried that is perhaps what has happened to me. I have excess skin, but the fillers make my face look youthful again. Please explain a little bit more in detail please.

Answer:

some surgeons will use fillers to fill the face up in order to lift the skin and avoid surgery.The saggier the skin is , the more filler they put in but fillers do not replace surgery. The stretched out look is when the wrong choice of correction, in this case fillers, is chosen. There is a point where fillers are OK but there is also a time when fillers have to be overdone if one refuses or is unable to do surgery, but that gives you the overfilled look. The overfilled patient should have had surgery and not fillers but not all doctors can do surgery and if all you can do is fillers, then fillers is what you will get, instead of the proper choice, surgery

Question:

I was watching an episode of Botched on tv tonight, and there was a woman on there that had gotten fillers in her face and said it was a liquid facelift and said it looked really nice until the fillers started to leave, and now her face was all deflated looking and looked worse than it did before the fillers. The dr's took fat from her abdomen and harvested it and then injected it along with a facelift. I have had fillers injected in my face, but didn't know it would stretch the skin, just thought it replaced the collagen that was lost and made it more youthful looking. Is this the case with all fillers or just if the face is overfilled? Also if it is overfilled, how would I know it?

Answer:

That is a problem only when overdone. Properly used fillers only bring you back to the place you were before. If you use fillers when it actually is surgery that you require, then an over use of fillers happens. Sculptra is the only filler that significantly grows collagen, the rest are just spacers. Proper filling should not lead to a botched scenario

Question:

I would like to know which filler you use for the tear trough area and how long it usually lasts? Also can you put the filler next to the inner corner of the eye to make it fill out? It has been three weeks since I had tear trough filler and cheek filler and I still have a bruise under my left eye and it looks like it might be some sort of red looking vein that he hit and might not leave. Is this normal and will it leave? Also if you have ultherapy and have face fillers, will it hurt the fillers?

Answer:

I use Restylane and I find on average it lasts 8-12 months. I do place the filler near the inner part, but the techniques is very important there as the skin is quite thin and you do not need to place too much. Bruising in the inner eye part is very common and I might suggest some warm moist heat and some Arnica Montana, can be purchased at a health food store, to help it dissolve. The Arnica should be taken orally and also as a cream for fastest results. As to Ultherapy and fillers, that question has not been studied to any great extent but I believe it would likely speed to dissolving of the filler due to the amount of heat.

Question:

 I got restalyne lyft for the tear trough and it looked great, but today it looks as though it has already started to leave and is kinda sunken in and I need more. I have never had this happen, usually lasts a year or longer... Is this normal and if not, what would cause this and what kind of filler do I need?

Answer:

I do not think it is the filler causing the problem, it is more likely the techniques used. I would suggest going back to the injector and discussing it with them. In that area, a little shift in where it is placed can make a huge difference

Question:

I sent you some pics of my face after the fillers I got this past Saturday with the email you sent, but not sure if you received them because it said the email was invalid. 
Also where I received botox in the forehead to keep me from frowning and pulling my eyebrows down, it now is letting me pull the right one down but not the left one. It really looked good yesterday, eyebrows looked lifted and eyelids didn't feel saggy and looked more open, now today they look heavy and saggy again. I don't understand that. 

Answer:

I received the emails and have responded to your questions via your email

Question:

 I would like you to take a look at my face after me paying over two thousand for some filler to a very well know plastic surgeon team that is suppose to be the best at fillers and liquid facelifts. I am so not happy with the results and think I look worse now then when I went in. I think my nasal labial folds look worse and just hate it. Can you give me your email so I can send them to you to view so you can tell me what you think I need to correct it?

Answer:

Certainly, Before pictures would help too. The email is drgarcia@lvcosmeticsurgery.com. When you say the plastic surgery team, that implies it was not the plastic surgeon did the injections, correct? Also if you can tell me what filler was injected where, that would help too.

Question:

I got filler Saturday for my tear trough and cheeks and nasal labial folds. When I left the office it looked great, now it looks deflated and my nasal labial folds look worse, why??? And if you say it's because of water and it got absorbed by my body, why don't they just use the filler and overfill to make up for the loss of water they know you will have? So disappointing, especially after spending over two thousand dollars and traveling all that way.

Answer:

I do not think it has anything to do with water, more likely it has to do with the fact that the fillers were injected too deeply and the temporary effect from the needle causing some swelling or bruising that is not seen as a blue mark is diminished

Question:

 I got voluma injections last May and some restalyne for the nasal labial folds and was quite pleased with the end results. It has been a year and 5 months so I went today to get some tear trough filler and some fillers for the cheeks and some filler for the nasal labial folds. He said I didn't need any voluma because I still had high cheeks and had some of the voluma and said it would last for two years and wouldn't need any until next May. He used Restalyne lyft for the cheeks and tear trough area and a bit for the nasal labial folds... It looked good when I left the office, but now that I am home, it looks like my folds are worse than they were when I went in.... Why is this? Last time the filler lifted my cheeks and made them look better, he said that wouldn't help this time because he said in order to get that lift you had to put filler near the bone of the cheeks and said I didn't need any, so used some in the tear trough and lower down in my cheeks and a bit in the folds... Do you think it will get better  and if not, what can I have done to fix this?

Answer:

The difference is due to the placement of the filler in or around the nasolabial fold. If it is injected above the line, it makes the fold look worse as it accentuated the height difference. It will get better in time but as they used Restylane Lyft, that last about as long as Voluma, so it might take some time. The filler can always be dissolved with hyaluronidase, but it is an all or nothing injection, you cannot dissolve part of it, it will all go away

Question:

I have read where you can get a filler in the eyebrows for a lift for the eyelids and raise the eyebrow. What kind of fillers are used and where are they placed?

Answer:

I use Restylane and I place it into the brow and above, where depends on what the patient needs

Question:

My dermatologist suggested Voluma in my temples. Do you think it is a good product? Any special warnings? Because I have used Sculptra many times in my temples but have never gotten a good fill.

Answer:

It is my preferred option for the temples. I like to dilute it a little more than usual to allow a more broad dispersion and I place it between the skin and muscle.

Question:
Answer:

It can happen, just use some Chapstick and it should go away i a few days

Question:

I have some loose creepy skin on my upper arms and you had said before if it wasn't too bad that an incision could be made under the armpits. I can take the skin and pull up a little towards my armpit and it fixes the problem with the skin, not too much looseness, but bothers me. Would it be painful and could it be done under local not general anesthesia?

Answer:

I prefer to do the procedure under general anesthesia as there are many nerves in the area and obtaining good control of the bleeding done with a cautery unit can be uncomfortable, even under local anesthesia.

Question:

I keep getting these tiny red dots on my skin, and if I stick a pin in them, they bleed and bleed and they get bigger. I have them all over my body and keep getting more and more, what are they and what causes them? Also, what can I do to get rid of them?

Answer:

might want to see a dermatologist to make sure but the sound like cherry angiomas, some people get them for no reason, they are more frequent as we age, not dangerous thing though. The dermatologist might be able to laser them off for you.

Question:

yes they can, but in time they will all come back as the cause, which is broken valves that communicate the deep high pressure system to the low pressure skin system is broken and cannot be fixed.
 
The above is the answer you gave me when I asked if spider veins could be fixed on my legs and ankles.  What does it mean when you say the valves the communicate the deep high pressure system to the low pressure skin system is broken? Why did it break and is it dangerous? What caused this problem?

Answer:

The cause is unknown but long periods of standing will make it more common. It is not dangerous. It broke because the valve could no longer handle the high deep pressure and keep it from affecting the superficial system

Question:

I have all these broken spider veins appearing on my legs and around my ankles, can a dermatologist fix these?
Also, I have sagging skin under my chin and my neck has wrinkles, would a neck lift be painful?

Answer:

yes they can, but in time they will all come back as the cause, which is broken valves that communicate the deep high pressure system to the low pressure skin system is broken and cannot be fixed. As to a neck lift, they are not usually that uncomfortable at all, pain pills for a few days is all that is required in most cases.

Question:

 I am a 55 yr old woman, and I never knew getting old would hurt so much. Seems ever day there is something new on my body that wasn't there the day before. I have these spots, not sure if they are age spots or what, but I have them on my legs, arms, and then I have these bright red little dots or spots all over my body and new ones really do appear ever single day. I also have started noticing the veins in my legs, not really vericose, but spider veins and around my ankles, and also the skin kinda looks like elephants skin now, and I am freaking out with all these issues. Is there anything I can do to address these issues as I read of all the new skin tightening things that are available these days and I know there is laser for the skin imperfections, perhaps with a dermatologist, but I wonder if he could get all the spots at one time, or would he have to do them over several appts as there are so many all over? Please help!!!

Answer:

the spots can be treated all at one time but most of the will need a series of treatments to improve or reduce them. It cannot be done with complete removal in one sitting. A dermatologist is your best bet for that type of treatments.

Question:

What filler do you prefer for oral commissures (the lines that extend parallel to the lips on the sides of the mouth, which make the lip appear lengthened and turned downward)? Also do you think fillers are better than lip lifts for that problem? What clinical components in an aged lip would prompt you to recommend a lip lift to a patient rather than fillers?  Thank you.

Answer:

If they are superficial I use Restylane and if deeper I use Perlane. Fillers well not be able to correct all commisure problems and surgery is required in some patients, but there is the trade off of a permanent scar in the area that may require makeup to hide. There is also a limit of how much the lift will correct. The decision to do one over the other depends on the patients needs and desire, it has to be individualized for all patients.

Question:

I want to the least painful and yet longest lasting and method which does not cause scarring or negative side effects.  Thank you Dr. Garcia for all your valuable service to the public.  It is so much appreciated.

Answer:

My preference is Perlane, it does not cause scarring and i swell tolerated. As to how long it lasts, it depends on the individual. The faster you are aging he faster the fillers dissolve.

Question:

I just moved to California from New York and last month, I got a  new plastic surgeon. I have been getting Radiesse to my temples for about 12 years now. He told me that "no plastic surgeon he knows and respects uses Radiesse anymore." He uses Voluma or Sculptra, which I've had to my cheeks and pre-auricular area in the past but only once to my temples but didn't like because not nearly enough was injected. So he used Sculptra and had to use far more of the product (3 vials) than I have required of Radiesse in the past.  Do you find that he is correct, that Radiesse is no longer being used by most plastic surgeons and dermatologists?

Answer:

I think doctors like to try new things but Radiesse is still a good product. I do not think it lived up to the promotional claims the company claimed and since 60-70% of the product is gone in 6-8 weeks as the carrier dissolves, some doctors have not been pleased with its results. Product slike Voluma and Sculpra also depend on the injector. I like them both for the temples,but Voluma is an immediate result. In my opinion, Voluma does not fill as large of an area as many doctors would like and it can get pricey.

Question:

 I got botox awhile back for the 11 lines and to keep me from frowning and pulling my eyebrows down and it would make my eyelids seem heavier. It also helped some with the lines in my forehead, but in order to get all the lines in my forehead gone, it would have given me droopy eyelids. The place the dr injected the botox for the 11 lines really did help, but you can still see a little indention. Can filler be injected there to fill these out and if so, what do you suggest to use?

Answer:

There are some patients that need both a neurotoxin and a filler once the lines start being seen at rest. Botox only helps the lines when animating

Question:

I have these veins on top of my feet which I just thought were normal veins because I am a thin person, but now I am wondering. Is there an e-mail where I can send you a pic so you can look at them and give me your thoughts on this?

Answer:

you can send them to drgarcia@lvcosmeticsurgery.com. I will be out until the 22nd though.

Question:

 I looked in the mirror this morning and seems my left earlobe was not hanging straight down, almost like it was pushed backwards maybe from sleeping on it. I noticed it looks so flabby and soft, not plumb and young looking anymore. Is there anything that could help that, maybe fillers without making them bigger of course?

Answer:

I have injected fillers into the lobes before, not sure why you had such a fast change though

Question:

Why are you ok with fat injections in the butt and you say they it won't move around much, but I have asked about it being used in the face as a filler, and you have said it isn't good for there. How is it when ur sitting on ur buttocks and it wont' move around much, and your face wouldn't be subjected to that, yet you have advised against it for the face?

Answer:

I did not say buttocks fat injections are OK, I do not perform them but I was giving the questioneer information so that they can make their own decision. I personally feel the results are quite variable from side to side as well as from patient to patient and I think they do not last as long as most patients think it does. I was only giving information on the procedure, not endorsing it.  I have never said I do fat injections to the face although many plastic surgeons do perform it there. The reason the fat does not move in the buttocks due to sitting is because you do not sit on the area where it is injected. You sit on the ischial tuberosity and there is no fat injected there. As to fat injections into the face, there is no pressure applied typically to the face that would move them. The cells tend to stay in the tract in which they were injected as they are too thick to migrate into tissue that does not have a tract opened. Patients can certainly have whatever procedure they want and they make their own decisions. I do not warn about facial fat injections as much compared to buttocks because as the fat volume injected into buttocks is much higher, the resorption rate and infection rte is higher. I do not think it lasts past 18 months in the face though in most cases, isolated cases, yes. If multiple sessions are done, it can place new fat over the old and maintain the shape but the volume will eventually be lost. My advice against them is merely because I think it costs a lot of money, has significant down time and does not last too long.

Question:

 I would like a firmer, rounder butt, and see and read where so many women are having butt injections. Looks like when you would sit on it, it would move it around and get all uneven. Does it work and if so how long does it last? Does it get out of shape and do you have to get it redone and how often if so?
 
 I have these tiny red dots on my body, and u have said they can be removed with laser. Do I need to see a plastic surgeon or dermatologist?

Answer:

Buttocks injections have to eb repeated about every 12-18 months but the fat injected does not move around much. As to the tiny dots, either the dermatologist or plastic surgeon can do them for you.

Question:

I would like to look in the mirror and not see all the creepy looking skin and dimpling, what is the best procedure to get rid of this and help tighten the skin? I am not an overweight person either.

Answer:

There are some new machines like CellFina that might help, but it is not permanent in its effects.

Question:

I am a thin woman, never have been very big, but always have had a stomach, or belly that sticks out. I could always hold it in when younger and it would look good, but if I would just relax and let it be normal, it stuck out like I was pregnant, which I have never been. As I have gotten older, I can’t hold it in where it looks as flat as it use to, and I don’t think exercise would help it because I know you can’t spot train, and I don’t need to lose any weight. I would like to know if cool sculpting or some other kind of procedure could get rid of the belly some and actually shrink the skin so the skin would be tighter?

Answer:

from what you are describing the fat that concerns you is intra-abdominal. Unfortunately, Cool Sculpting only works on subcutaneous fat and not on intra-abdominal fat, sorry. Surgery cannot remove intra-abdominal fat either but it can be used to bring the muscles together tighter.

Question:

I have crepey skin on my upper arms and I have read where an arm lift can be done with the incision under the arm if it is minimal, is this a painful operation and can it be helpful for the sagging of the skin? Also, what other options does one have for this issue of the skin on arms, stomach, legs?

Answer:

It is not a aprticularly painful operation, no. It can help the skin look better ,but it works only is a small percentage of people, those with minimal skin excess, and it needs to be mostly near the armpit. Besides excision of the skin, radiofrequency treatments such as ThermiTight do help, but they are not surgical results.

Question:

As to the leg vein, yes, you have an early stage varicosity. You can have it injected but it will return in time and it will also get larger and more visible in the future as the problem is broken valves deep inside that cannot be repaired.
That was ur reply I copied and pasted from a previous question I asked about my legs and wondering if I had some kind of vein thing going on on the inside, but couldn't see it on the outside. What causes what you describe as early stage varicosity and broken valves deep inside? Is it serious and does it mean I have blocked arteries in my legs or poor circulation?????

Answer:

It is not serious, can make your legs feel heavy if they get worse is about it. There are a number of vein clinics that can inject them for you. These are veins and not arteries so not to worry.

Question:

I have dimpled places on my thighs and buttocks, and I would like to know what the best procedure to get rid of it without leaving the skin sagging. I also have these red dot like things that keep coming up on my arms, legs, stomach, breasts, and I hate them. I have read they are cherry hemangiomas and also read where certain anti depressants can cause them, like celexa. What would be the best way to get them off? Another question I have is relating to veins in the legs. While I don't really have any visible ones on the outside of my legs, I can see a slight bulging every now and then underneath on one leg, but when I pull up on the skin, it goes away and when sitting you can't see it. Can you have vericose veins that are on the inside of the leg instead of the outside and if so, what can be done about them. Also can the veins on top of the hands be fixed not to look so big?

Answer:

The newest thing for the celulite is a technolgy called CellFina, might want to search in your area for someone that offers that. As to the cherry hemangiomas, having the hyfercated is the easiest and fastest. A dermatologist or plastic surgeon with a laser can do that for you. As to the leg vein, yes, you have an early stage varicosity. You can have it injected but it will return in time and it will also get larger and more visible in the future as the problem is broken valves deep inside that cannot be repaired. There is nothing safe or reliable for the veins on your hands, they are seen more as the fat is being lost from that area and the veins become more visible, I do not feel fat injections or filers work too well to hide them.

Question:

By precisely weakening the orbicularis, the frontalis wins the tug of war and the brow goes up. I copied and pasted this, it is where a dr posted about how to get a brow lift from botox. Could you please explain exactly what it means as to the location of the orbicularis is?

Answer:

The orbicularis is the round muscle around the eye. Its upper part pulls the brow down, especially the lateral aspect. Weakening what depresses allows the frontalis to lift the lateral brow to a greater extent

Question:

 I read where people get botox for the outer part of their eyebrows to be raised a bit instead of a brow life and have good results, but for me, I don't need the outer part raised, I need the inner part raised. When I pull up to lift the outer brow, it looks evil, or not natural, I get more of a natural lift when I just lift the inner part to mid brow, but none of the outer part lifted. I read where it says that botox can be placed under the lateral part for a lift, where can it be placed to raise the inner to mid part of the eyebrow?

Answer:

The amount of lifting of the brow with Botox is quite variable. It will not get a significant rise in many people. The stronger the depressors muscles are, the lesser the lift. The medial lift needs injection to the inferior corregatorr and procerus muscle for it to rise.

Question:

 I got botox injected in my forehead two weeks ago and I told the dr I wanted not to be able to pull down on my eyebrows because it makes my eleven lines look worse and makes my eyelids feel heavy. She stuck me five times, one right in the middle between my eyes where the eleven lines are, and then once on the inner part of each eyebrow, and then one stick on the outer part of a wrinkle on my forehead. I can still raise my eyebrows and my forehead lines are still there, but it won't let me frown like it did before, but for some reason, my eyes look different, almost like I need the inner part lifted a bit. Where can I get injected with botox so it will give my inner eyebrows a lift, or is there a filler I can get put in the eyebrow or under them to lift them as I have read that in an article?

Answer:

where they injected it is where the lift would come from. They can try at little at the root of your nose to block the procerus muscle next time

Question:

I received Botox injections on this past Tuesday and I told the dr. I wanted a bit of a lift to the brow and didn't want to be able to frown and pull down the eyebrows. So far I can't pull down the eyebrow and make the 11 lines that were there before, but I can still elevated my eyebrows and the lines are still there in my forehead. I didn't want a droopy eyelid and I don't seem to have that, but seems my eyebrows or eyes look different, but I don't really like the look. Not quite sure why or what the problem is.I have more skin on my rt eyelid than I do on the left one. Do you think I could get more botox and have it injected to make me get more of a lift without the droopiness of the eyelid and I know u mentions lateral, but not sure exactly where that is on the eyebrow. I also wanted to ask after reading about an eyebrow lift done with the incisions made through the eyebrows and not the hairline. Are you familiar with this way for a brow lift? Also where I got filler last May for my face, it seems to already be leaving and I got Voluma and they said it lasted 2 to five years, but has only been one and seems I already need something more. I think I need the tear trough and is there a filler that can be used as I have read injected in or under the brow for a lift? I also wonder what is the best filler the give the nasal labial folds a lift being the dr said when the filler is used in the cheeks and upper face, it lifts up the face and takes care of the nasal labial folds? Also, would you recommend Sculptra or Voluma or both or neither for volume to the face and temple area?

Answer:

Injecting more Botox into the forehead will weaken that muscle, it will not allow the lift you desire and your face will look like it has no emotion.  As to the brow lift at the brow itself. Those scars can be seen and I would not recommend it. As to Voluma, the ad and package insert says it CAN last up to 2 years, not that it will. In my experience it is at least 50-75% gone in a year, sometimes less. The visual correction never lasts as long as the product does because the aging process continues. If you have deep nasolabial folds from the cheeks falling then a cheek filler is the way to go. If there is just loss of collagen in the fold, then I inject Perlane there. As to the temples, I usually use Sculptra there.

Question:

  I got botox this past Tuesday and wanted it to give me a bit of a lift to the eyebrows. It won't let me frown now, but still not lifting the eyebrows or eyelids as I would like. Where should the injections be put to get the best lift for the eyebrows and is there anything else that will give a brow a bit of a lift? Also I would like to know what kind of fillers is good to make the mouth look better when it is starting to turn downwards a bit? Plus, can you get lip injections that don't make ur lips look un-natural and without hurting?

Answer:

You need to have some Botox injected into the depressors of the lateral brow to lift the brow too. As to Fillers around the mouth I use Restylane or Perlane, depending on the depth of the wrinkles. As to having the lip injected I use a topical anesthetic or you can have a nerve block done so it does not hurt. The un-natural appearance is due to the injector, they must have an artistic eye to have it look good.

Question:

I had Sculptra injections to my lateral cheeks and temples yesterday -- 2 vials. Of course, swelling is expected with all the bacteriostatic water, but I've noticed today that the swelling has descended to my lower face. Is  this common? It looks pretty bad -- like I have mumps. Is this  the fluid descending? HOw long will it last? Will diuretics speed up its excretion? I appreciate your generous help. Hope spring is as beautiful in Las Vegas as it is in the upper midwest!

Answer:

The swelling migrating downward onto your cheeks happens in all cases, all normal, just not sure why they did not mention it to you. It will continue down and be absorbed usually in 2-4 days.Diuretics will not help as the fluid is not in the veins. Elevation and time is about all I can suggest at this point. All the best.

Question:

I got botox injections on Tuesday for my forehead wrinkles and the 11 lines between eyes. I have had botox many times in the past, but this time I went to someone I have never been to before. I have always gotten several sticks in my forehead, usually one right in the center of the top between my eyes where the 11 lines are and then one one each side of the inner eyebrow, then another one in the middle of my forehead where my lines are, then some out to the outer part of the wrinkles. This time I only got five sticks. One in the middle between the eyes and then one on each inner eyebrow and then one on each outer side of the first wrinkle in my forehead and that was only 5 sticks. It also didn't feel like it usually does when the needle goes in. So far I can't even tell I got the injection, so I was wondering if 5 sticks is normal for the injections? I paid 240.00

Answer:

The number of sticks required depend son the amount and location of the wrinkles. I will say that  the medicine does spread easily under the skin so it can still be effective. It depends also on what the injector was trying to achieve cosmetically. I cannot say if it would work for you without seeing how bad the wrinkles are and without knowing how many units were injected, I cannot say if it will work I am afraid. The cost varies from injector to injector and I have no way of knowing what they put in the shots, sorry.

Question:

  My neck sags and I would like to know if I have the necklift where they cut only under the chin and don't go behind the ears or around the ears, what kind of results will you have?

Answer:

In a small number of patients, those with mostly a very small amount of fat and minimal skin excess, the incision under the chin is the only one needed. Once there is a moderate amount of skin that sags, the other incisions are required to remove the loose skin and make it appear tighter.

Question:

I received 1 syringe of voluma to the bony area around the eyes (cheek/eye area). I am wondering if there is a "final result" time for this filler. It seems to look a bit obvious in that bony ridge area, and seems a bit hard to the touch. Dr advised not to touch, nor massage it at all. He did say some immediate swelling was normal. I like that it has made the cheek bones a bit more visible, but am afraid it does not look soft. Can you give your advise/opinion?

Answer:

What you got that day sis about the final, there is no growth phase. The hardness will get slightly better with time as the product dissolves. It is hard due to the amount injected in a small area, it does not always happen. Injecting in multiple levels will reduce that issue in the future

Question:

Having had very little improvement using botox to lift the lateral aspect of the brow, I went to a dermatologist who was highly recommended. His suggestion was to fill the temple area and that would give a slight lift to the slightly droopy corners of the eyes. My first thought was that I would look like Frankenstein. I don't see any indent at all between my bony part of the cheek and temple area, and wonder if this would look weird. Have you used this technique? What's your opinion?

Answer:

When the patient has lost fat in the temple region, it works quite well. It just has to be done carefully so as to not overfill it is all.

Question:

Are these essentially the same products?  If not, what's the difference? If so, do you prefer one over the other?

Answer:

very little difference, can be used interchangeably. No preference of one over the other at present

Question:

I had filler injected into my lips ten years ago, and would like to have some of it removed. Is that possible? I saw a video online of a doctor removing granulomas by piercing the lip and squeezing some of the filler out. Is that something that you could do, (providing your consultation confirmed that problem)? 

Answer:

That is possible in a small number of patients, the more common process required is an incision and having the granulomas cut out. All depends on what was injected. I would be happy to see you for a consultation and see what we can do for you

Question:

I was reading where Marie Osmond had the Syneron eTwo laser procedure performed on her face and where it is good for tightening the skin and making it produce collagen. Do you think this procedure is a good one to have done?

Answer:

In my opinion it is useful for superficial fine lines but I would not except any significant tightening of the skin. I have not taken care of Marie Osmond but it would appear that she has likely had more than just the Syneron laser as a method.

Question:

 Dear Dr Garcia, I'm 67 years old and have lost a lot of plasticity in my skin, especially on my face. The last time I had filler in my cheek area, (Juvederm Plus done by an excellent injector) the filler disappeared within two weeks.  I tried again and the same thing happened. I'm wondering if this is   the laxity in my face which doesn't allow the filler to stay. I cannot t have a face lift because of health issues. Im petite and not overweight. Is there any filler that IS NOT scuptra as Im afraid of lumps (even with twice daily massage) ? Thank you again Dr. Garcia. Blessings to you and your family in the New Year!      

Answer:

The only thing I can think of as to why the filler is only lasting a couple of weeks is that the amount of filler required may be so large now that it is no longer a viable option. I am not sure what health issues you have but maybe considering a deep CO2 laser resurfacing might be an option to tighten some of the skin for you. Sculptra, when properly injected has a very low chance of lumps but it is still a filler and the amount you may need may still be large and not viable.I wish you the best.

Question:

I use a bipap machine with nasal pillows every night. The pillows lean on the skin just under my nose. How will it affect the filler I'm planning to have injected? How long would I need to not sleep with the mask? Thank you!

Answer:

Placing pressure on the area with the filler will make it dissolve faster no matter when it is applied, so if the mask falls on the area you are getting filled you might want to rethink the expense. Stopping the bipap for a few days and then restarting it will still affect the filler

Question:

I was reading to find what fillers for the face would be better for volume and it pulled up Sculptra which I have had in the past, and Voluma, which I have also had, and then it said autofat grafting was the best and also permanent. I know I have read where u say fat fillers isn't permanent and can be absorbed back into the body and also moves around. Is this something different, and do u think it is the best filler for volume in the face?

Answer:

autologous fat grafting, if it survives, will last years, but the aging process will eventually win out and it can then sag. The problem with fat grafting is the inability to predict how much of it will last. I personally use Sculptra and Voluma as I find fat grafting unpredictable where one side will do better than the other, the healing time is longer than the other fillers and usually requires repeat sessions as the fat that does not survive dies and is absorbed.

Question:

I think I'm done with "tear trough" filler. I once had a great result from a great dr., but he was so very expensive that it was not something I could keep up with. It was something so small, but seemed to balance my face perfectly. I've been to two other injectors, they used the same product, same amount, but the result was not the same. It doesn't seem to be as seamless and especially in pictures I notice it may have been either too superficial, or injected too low. I'm considering just having filler to the upper/outer cheek area (not the pillowy/apple cheek look, though). Does this do anything to help with slight eyebags, and some slight smile lines?

Answer:

helps the slight bags but not the fine lines I am afraid.

Question:

Your blog is incredibly helpful. Thanks so much!

Answer:

I cannot say 100% as it has not been tested but I would guess that it would make the fillers dissolve sooner due to the inflammation that is what will stimulate the skin to achieve the purported effects.

Question:

Hi Dr., I've been to 2 different "injectors" in the past. I guess I don't understand why their opinions differ so much. I hope your answer helps me decide. I have very limited funds to use to do just one thing. In my opinion, what looks the most aging on me (besides the fact that I know I need a blepharoplasty) is the nasolabial crease, and slight marrionette lines. I feel both things combined give me a sad/bitchy look, and actually (my own observation) makes my nose look bigger. First injector will not fill marrionette or smile lines (says it creates an unnatural look), and says the best look is to fill the cheeks which will in turn pull up the rest of the of the lower face (my lines are slight, not deep folds). Of course, one syringe each cheek...syringe $450 x 2.  The other injector says sure, fill in the smile lines and marrionette lines....one syringe should do the trick...$500 one radiesse syringe. I want to do what looks best, not exactly what is the cheapest alternative. What should I do?

Answer:

well, not to be difficult, it depends on what the patient has. If the folds are minimal, then filling the fold and marionette line is reasonable. If there is a significant loss of fullness in the cheek and that is causing the skin to fall and create the folds, then a cheek filler is better. Without seeing pictures it is difficult or seeing you in person. Having said that the cheek filling will likely lift the nasolabial fold  but not so much on the marionette line. Wish I could tell you more.

Question:

Have you noticed an improvement in skin texture following Sculptra and/or fat injections? There's some discussion of that, but I'm not sure if it's hype or science. Thank you. Hope you had a lovely Thanksgiving with your family.

Answer:

I think it is mild at best, there are lots of claims but little science to back it up. Thanks for the wishes and the same to you and yours.

Question:

Hello, I have tried fillers in nasal folds, and so far best results with Radiesse, now that my nasal folds look better,(and perhaps more noticable due to about 20 lbs. Weight loss) I have deep lines when I smile, it looks like parentheses but on the sides of my mouth, lower than the nasal folds. Im 34 and I feel it is making me look old. Do you think Radiesse will help this rippling when I smile?? It's not there when I'm not smiling,  so I wonder if this can be difficult to correct?  

Answer:

all fillers help when the face is not flexed, by that I mean that fillers only help lines seen at rest. If you inject the lines you see when you smile or animate your face, as soon as you relax the filler will look lumpy. What you are seeing is likely not helpful with fillers into thee skin. Possibly something like Sculptra to refill the loss volume in your cheeks from the weight loss might help though

Question:

.( Fat is also a temporary filler for the hands and face for the same reason, although if injected into the muscles of the face some of it can last a longer time period).   This is what you replied back with to a question I asked about fat being injected from your own body and you said it would last longer if injected into the muscle. I have never heard of it being injected into the muscle. Where are you speaking of when you say the muscle? Are you speaking of the face, and if so, how much longer and would it be painful? Also what areas of the face if that is what ur talking about when you say muscle?

Answer:

I am  speaking of the muscles in the face, they only way the fat survives as a filler is if new blood vessels grow into the fat to make it live, if no blood vessels grow into it dies and turns into rancid oil that  will slowly be absorbed by your body. Fat injections to the face can typically leave patients swollen for 4- 6 weeks in most cases. It needs to be done under local anesthesia with sedation for it to be tolerable, if done properly. The muscles of the face would be the cheek muscles, the muscles of the  lips and at times the muscles of the temple region. Fat injected merely underneath the skin works as a filler only for a short time as it turns to oil in a few days, then is absorbed by the body in time.

Question:

I read where you can get butt injections of your own fat and it will last forever, then I read where if you get fat injections in your face that it will be absorbed and wont't last as long as other fillers and will travel to other places. I would like to know how this can be. Looks like of all places to travel other places, or get squished flat it would be the butt. I would like to know if you get these butt injections of your own fat if it does last or doesn't? Do you have to go back and get more over time, and if so, why does it state that is last forever and also if that is so,then why wouldn't that be a better filler for the face and hands?

Answer:

I believe the same fat injection loss happens in the buttocks as well. Many or most of the fat cells injected die and leave their oil behind and that can take time to have the body absorb but I think the number of patients where fat injections give them a long lasting effect are very low. Fat is also a temporary filler for the hands and face for the same reason, although if injected into the muscles of the face some of it can last a longer time period.

Question:
Answer:

I will speak to my webmaster about the color, sorry.As to the Venus Freeze, I have not seen it be as effective as CoolSculpting, the original freezer of fat, but Venus Freeze claims to do areas that CoolSculpting does not. Certainly worth a try but I would expect mild improvements at best.

Question:

Hi Dr., I had restalyne injected to the orbital rim, and botox to attempt stop the squinty look. I've had both procedures done before, and looked great. This time, I look like I got in the box ring with Mr. may weather. There was bleeding at the injection site (which has never happened). I take no medications, except my chiropractor recommended 4 tablets a day of magnesium. I guess most people aren't aware that magnesium  (good for many things) is surprisingly also a blood thinner. I'm a bit horrified as I look in the mirror...my eyes are puffy, bruised. I don't know what to take, or if I should put ice on it, or leave it alone. Also, this has created puffy swelling in the orbital rim, and it literally looks like I have no cheekbone at all under the eyes. I suppose due to the swelling. Do you have any suggestions for me? I can't blame the injector. She's done excellent work before. She, in fact, saved the vial of the restalyne that was left, and told me she had to stop because of the bleeding. For those who take magnesium daily, beware.

Answer:

I would suggest switching to warm moist heat to the area, light massage and also oral as well as topical arnica montana.In time it will get better This can happen even if it never happened before as there are many small blood vessels in that area that are below the skin and cannot be seen in order to avoid them, As an aside, the company does not approve of the saving of the remaining Restylane for later use for fear of infection. Likely a low risk but still frowned upon.Hang in there, it will get better.

Question:

in mt case i am treating a relatively small area of fatloss so it would not make sense to use an entire vial at a time... but sculptra is likely the best option for my issue otherwise.

Answer:

It cannot be stored after it is used so you might want to consider either Juvederm Voluma or Radiesse as other options.

Question:

My lower face is sagging due to lose of volume. Doctor recommends Sculptra, but I'm a little nervous. Seventeen years ago I had a C-section and the ob-gyn said my scar developed keloids and I should be aware of that for any cosmetic procedures. Is this a concern with Sculptra? Would another filler be a better choice?

Answer:

that has always been a precaution but most likely what you have on the C-Section is a hypertrophic scar and not a keloid. Keloid scars are scars that grow beyond the limits of the cut where hypertrophic scars just are thick scars. You are likely fine to do the Sculptra, otherwise you can use Juvederm Voluma as it is a hyaluronic acid filler and is not affected by the scarring tendencies.

Question:

Can filling the mid-cheek extending out to hairline, help raise the down turns of the mouth...even slightly? My friend said she has done this in the past, and noticed it helped. 

Answer:

It would take quite a bit of filler to do that but it might give you a slight lift, yes.

Question:

What are your thoughts about voulm for the chin as opposed to supposed the gold standard (in this area) radiesse? I don't really want to use a filler that cannot be dissolved or has potential for lumps. Thanks 

Answer:

Supposed is right. I think Voluma is a good choice for chin injections.

Question:

If saline is injected to get rid of excess sculptra, will the area where it is injected swell for days just like it swelled from sculptra injections? Or will your face look normal like you had no procedure done? How long does it usually take for the saline injections to get rid of excess sculptra?

Answer:

saline will not dissolve the Sculptra. At best it will spread it out over a larger area but after a few days that will not work, would have to be done in the fist coupe of days. Some doctors inject saline into a granuloma to try to break it up but that is not what is happening in your case.

Question:

I just noticed this, but I can only tell when I look in 2-way mirror cabinet in bathroom looking at my face upsidedown. The more swollen looking side where I sculptra injected in undereye hollows looks like hollows are filled in, but the other side I still see sunken hollows. It has been 3 and half weeks since the injections. Will the hollows fill in more where it is sunken?  am afraid of the area filling in more on the other side where it already looks a little swollen. I think it is the cheek end that is a little more filled in than it should be. The other cheek end is more flat or normal looking. I do not know what to do since one hollow looks filled in while the other hollow still looks hollow. I am too afraid to have sculptra injected in the side that still has the hollow. Can the other side still be swollen after three and half weeks. This was the side which major swelling did not subside until 6 days after injections whereas it was 3 days for the other side.
The doctor said I would probably need to have touch up in hollows under eyes in 4-6 weeks. Why did he say this? Did he know that he injected it unevenly if he injected it unevenly?
 

Answer:

It takes 5 months for the Sculptra to grow so I would wait. I am unsure why he would say to do a touch up at 4-6 weeks if it takes 4 months to grow. I also do not recommend Sculptra to be used for under eye hollows, so I might suggest going to see another injector in the future. It is not approved for use in that area.

Question:

It has been 3 and half weeks since I had sculptra injections in under eye hollows. One side of face took twice as long for the major swelling to go down than the other side. My other side has a more flat appearance now, but the side with extended swelling still looks a little puffy. Could this mean a granuloma might be forming where it still looks slightly swollen? If so, will saline injections next week prevent it from forming? Should I get saline injections on that side of the face?

Answer:

A granuloma will usually take 6 weeks or more to form so I think it is likely just persistent swelling. I would not do anything for now, just give it time. The saline would just add to the swelling at the present time.

Question:

I would like to know which butt lift you think is the best? Also if the one is done with cutting at the waist to lift, doesn't that leave a big scar?

Answer:

the scars can be wide and unsightly yes. It is something that is done more frequently for people that have had weight-loss surgery and have lost large amounts of weight.It is uncomfortable to have done, yes. I am sorry but I do not have the breakdowns between buttocks lifts and Brazilian butt lifts as the national statistics are not broken down into those particular categories.

Question:

I would like to know if a butt lift and a brazilian butt lift are the same? When doing a brazillian butt lift, why does the fat transfer not disappear after time like it does if used in the face? I know you have said you don't recommend the fat injections for volume in the face because it can move other places and doesn't work as well as other things, yet when I read about a butt lift, they use fat transfered from the hips, thighs, and other areas. I also would like to know if it is painful and I have read where you can't sit on the buttocks normally for about two to three weeks because it won't take shape right. Is all this true?

Answer:

A butt lift is a surgical procedure that lifts the buttocks by cutting skin out at the waist. A Brazilian Butt lift is just fat injections to increase buttock size. The fat actually does disappear in the buttocks, it can take 6-24 months. The reason some of the visual improvement remains is that as the fat cells die they leave oil behind that can take a long time to be absorbed by the body. It is not that painful to have a Brazilian butt lift but you need to not lie on your back for a couple of weeks. Sitting is OK as you are actually sitting on your pelvic bones.

Question:

Hi Dr, I know years ago you didn't suggest permanent fillers like Artefill for injections, as they can leave permanent problems. What about Radiesse? I have read it can leave a rash like scar behind. Do you like Radiesse for nasal folds, and do you think it will last a year or so?  Thank you. 

Answer:

I have not seen Radiesse leave rash like marks but it will not last any longer than the other hyaluronic acid fillers. No filler in the nasolabial fold area will last more than 4-6 months as it does not stop the cause of the fold which is the cheek skin falling downward, so the filler can last longer but the effect will not.

Question:

I got Voluma back on May the 17th for my cheeks and they said it would last about two years. It looks like it has already gone back to the way it was. Why didn't it last longer? Also, I think I need some filler for the tear trough area, which one last the longest and is the best? I also would like for my brow to have some lift and got a bit from botox back in May, but I now read where there is a procedure called thermiraise and I would like to know if it would elevate the eyebrow any like the botox, and is it painful?

Answer:

As to the Voluma, it might be injection technique or that they did not use enough. As to the filler in the tear trough, I use Restylane and see 8-12 months on my patients. The ThermiRase will have the same effect as the Botox injections between your eyebrows, lasts about 18-24 months but is a bit uncomfortable to have it done.

Question:

How much Restylane is usually needed for a non surgical nose job? Thanks.

Answer:

it all depends on how much needs to be done, usually one half cc but sometimes it can be a bit more.

Question:

Dr. Garcia,
I have had Sculptra injections many times in my temples and just does not seem to "fill them up." What is the next best alternative in your opinion?

Answer:

My next choice would be either Juvederm Ultra Plus or Juvederm Voluma. The Voluma one will likely last longer than the Ultra Plus

Question:

I have some wrinkling on the sides of my hips and legs and some dents on my buttocks. When I lift up on the skin, u can't see them. What would be a procedure that would help the skin to be tighter and work?

Answer:

I think ThermiTight is a reasonable option as there is not much else that can be done for the loose skin there short of major surgery. As to the cellulite, there are a number of lasers out there that claim good results , such as CelluLaze, might see improvements for about a year or so.

Question:

Hi, Dr. Garcia. I had Restalyne placed in my tear troughs this afternoon. The right side has a distinct lump, not just swelling from the injection site. Is it true that if I massage this in the first 24 hours after injection, I can flatten it? It looks pretty bad. Thank you.

Answer:

mild firm pressure while pushing ti more downward than anything should help.

Question:

I have read good things about the thermirase and how it can replace botox. I know botox can leave you with drooping eyelids, and wondered if the same can happen from the thermirase procedure? Also I would like to know if one would still need botox with this, and if yes, why?

Answer:

The nerves that are treated with the ThermiRase procedure do not cause the droop as the nerve ablation is very precise and there is no spreading out of the effect as there is with a liquid such as what we have in injecting Botox. It is effective for the glabella, so if you are using Botox off label in other areas, you will still need tit there. The results of ThermiRase can last up to 2 years but it is not 2 years for all, it varies.

Question:

I keep reading about Ultherapy being so good for the face, neck, and chest area for wrinkles, and lifting. They say it is the greatest thing. What do you think about it? Does the results last very long?

Answer:

I think it hurts to have it done, it will cause unwanted fat loss in some patients and I think the length of time the results last is variable,6-12 months in most, some will get a little more.

Question:

I have some wrinkles on my arms, neck, chest, legs, and buttocks, I would like to know which one would be better, thermagen or thermitight , or another procedure for this? I also have some lines beside my inner arms beside my armpits or outer breasts and would like to know if these procedures would help tighten or help the lines or wrinkles?

Answer:

I think ThermiTight would be better in my opinion and can be used in the areas that interest you.

Question:

I am so disgusted. I paid 3,900.00 on May 17the for Voluma in the cheeks, juvaderm or restalyne in the nasal labial folds and botox for forehead wrinkles. The botox is already wearing off and I hate the way Voluma has made my face look wide. It makes my eyes look hollow now, and sunken in. Now I need tear trough fillers. When I lean forward, I can see the skin under my eyes crepey looking and kinda loose. What can I do for my face that will tighten up the skin? Getting old sucks.....

Answer:

well for loose skin, if it is mild, a laser might be able to create enough collagen to tighten the skin. Fillers only tighten the skin in the sense that they replace lost volume that has occurred in the process of facial aging.In other words the replace or recreate shape more than anything else. Otherwise it is surgery I am afraid. Crepey loose skin will not respond to fillers on the eyelids, that is a laser or surgery I am afraid. As to getting old, yes, you are right but the alternative is much worse!

Question:

I would like to know if this is a new site or if I stumbled upon the wrong one. I liked the one that was yellow and black and was really easy to understand and view the questions you just asked. I can't see the question I asked earlier today, and don't know how to tell when it is answered. Can you please tell me how to tell when my question gets answered? Do you send an email to me, and if not, where do I go to view the answer?

Answer:

actually I misspoke, as you have to enter your email to ask the question you will receive an email confirmation when the question is answered. I have also spoken to me web peopel and they are going to make the text darker to make it easier to read

Question:

I would like to know if this is a new site or if I stumbled upon the wrong one. I liked the one that was yellow and black and was really easy to understand and view the questions you just asked. I can't see the question I asked earlier today, and don't know how to tell when it is answered. Can you please tell me how to tell when my question gets answered? Do you send an email to me, and if not, where do I go to view the answer?

Answer:

This our new site and I apologize for the difficulty in reading the questions. I will see what I can do to improve it. To follow your posted question you just click on the follow button.

Question:
Answer:

It can be used on the cheeks, yes, depending on how severe the jowls are.It will give a nice improvement, but it will never be equal to a surgical lift result, just to be clear.

Question:
Answer:

It can be used on the cheeks, yes, depending on how severe the jowls are.It will give a nice improvement, but it will never be equal to a surgical lift result, just to be clear.

Question:
Answer:

It can be used on the cheeks, yes, depending on how severe the jowls are.It will give a nice improvement, but it will never be equal to a surgical lift result, just to be clear.

Question:
Answer:

It can be used on the cheeks, yes, depending on how severe the jowls are.It will give a nice improvement, but it will never be equal to a surgical lift result, just to be clear.

Question:

Dear Dr. Garcia, I had juvederm plus (2 vials) but my face looks over filled. I'm wondering if I massage the area, it will help it to go down. I know about hylaurondaise but just wondering if massage (same day I had it) could help?

Answer:

massage, if done close to the time of injection may be able to flatten it out to a small degree, but the gel, in general, is not mobile and massage will not truly accelerate the dissolving of the material. Unfortunately it might take the hyaluronidase and that will likely dissolve essentially all of what you had placed and you will need to start over again. Sorry.

Question:

I know you recommend arnica cream for post-injection bruising. How many times/day is an optimal number for application? We all appreciate you, Dr. Garcia! You`re amazing!

Answer:

Three tmea per day for 3-5 days. Best of luck.

Question:

Is there anything (fillers or Botox) that can be used to make the corners of the mouth be more neutral, less of a frown? I don`t think I have really the downturns of marionette lines,but when not actively smiling I look like I want to punch someone. I don`t! It seems that my resting face is a bitchy face. How can this be fixed without surgery?

Answer:

Well placed Botox can help I believe soften the look.

Question:

I had belatero injected for fine diagonal lines below the corners of my mouth. Didn`t really do any thing. Would you use something else for that area? Definitely sun damage related. I`m 58, the rest of my face looks good but not around mouth. Also some mild acne scarring. Thank you

Answer:

It is more relative to the injector and not the material. Might want to try a different injector.

Question:

Dr. G., Every PS I have talked to thinks the Threadlift (Lifestyle Lift, and a host of other names) is a waste of time and money. I am wondering why doctors who have really nice offices who offer anti-aging improvement procedures on a full-time basis (ie, they don`t do something else and provide these services part-time) would offer and promote these Thread Lifts. Do they really believe these procedures are a legitimate alternative? I would be really curious to know your professional take on this. Thank you.

Answer:

It is their attempt to increase income by taking a four course but as they are not trained to understand why it fails and alao does not give natural appearance, they cannot tell if it is worth doing. Its about the money.

Question:

Hi Dr. G., What do you think of the Tria (FDA approved laser gadget for home use)? Thank you!

Answer:

Not a believer.

Question:

Hi Dr., is it okay to fill only the lateral and bony cheek area (under eye) without filling the fleshy part of the cheek? The practitioner I saw said she would also fill the area (the apple) of the cheek to make the face more balanced. I am skeptical because I have never had those fleshy/apple cheeks and am afraid it would make me look weird, and not myself. Would you agree with the injector I this case?

Answer:

I think the goal is to return you to the way yo looked, unless you disliked your appearance even then. If the apple of your cheek was never a concern, then do not fill it as you will look different. Just tell the injector not there. They are there to advise but as it is a cosmetic procedure, ultimately it is you who controls the where.

Question:

Dr. Garcia, for filling the mid-face, mainly lateral cheeks; marrionette lines, what is the longest lasting, effective filler? I`ve been to 2 different consults. One says Radiesse (except near the tear trough), and the other prefers Restalyne. Everything I read tells me Radiesse can promote stimulation of collagen, and that it lasts longer. What is your preference, and why?

Answer:

I use either Sculptra or Voluma for that, and as to the claim that Restylane induces collagen growth, it is something that might happen under the microscope but it is not clinically or visibly seen.

Question:

Just saw the question about Voluma. What is it that makes this version of Juvederm longer lasting ? Is the HA cross-linked differently? Is it simply thicker material? Is it that it is typically placed more deeply than Juvederm Ultra or Ultra Plus? Most HA`s last only about 5-6 months for me, so I`m trying to decide if this is worth the investment. Thank you.

Answer:

It is a little of both. If injected outside the body it holds its shape whereas other Juvederm would slowly flatten out. It is certainly placed more deeply then the other Juvederms. In the clinical trials it has lasted up to 2 years, but the degree of cosmetic correction will vary. Not all participants in the trials had it last 2 years It cannot be used interchangeably with the other Juvederms but it will last much longer. The degree of correction after initial filling will decrease with time so one cannot expect the same degree of correction after 2 years, it will be less by then. Hope that helps.

Question:

Now that Voluma has finally been approved, what do you think? Better than Sculptra? Obviously, they are different products and have different modes of action, but I wonder which of the two you prefer and why. Thanks so much for your opinion.

Answer:

Cost wise over two years the Sculptra is cheaper but there is no immediate fill, so that is the trade off.

Question:

Well, my friend took the filler plunge and got Radiesse on her upper cheeks. The fleshy part, I guess. I feel bad because she looks inflated . Her eyes seem smaller for some reason, too. I am mortified at the results. I was going to consider doing the same, but now I am scared. I only want to enhance a little and extend to the lateral cheeks, not the fleshy part. I`m not going to go to the same injector, but what should I request, or not request to an injector so that I don`t end up with this surreal look. Is less more, in this case, or is it all in the placement and product?

Answer:

Placement and amount injected are the most important. Just ask them to inject in small amounts and ask to see your face in a mirror inbetween shots to see if you want more. I wish you the best.

Question:

I have been pretty satisfied with various fillers (sculptra, juvederm) over the years to fill out my cheekbones. This is a more attractive aesthetic than my natural narrow face. I am having some lipo in the OR and my doc has suggested fat transfer to my face in place of injections. I am concerned as it seems no way of knowing how much fat will take and what if it takes unevenly. Do you think I would be better off sticking with fillers or should I try the fat?

Answer:

I would stick with the off the shelf fillers.

Question:

Hi Dr., I guess I have an angry resting face . I think it has more to do with the mouth, than the eyes. I never furrow my brows, in fact, I don`t even know how to! I have never been a natural smiler , but going on 50 years, the look seems to be angry. I notice when I lift the skin next to the corners of my mouth ever so slightly, the miserable look just becomes a neutral look. Can I benefit from fillers, for this, and if so, where should they be injected? I don`t want an upturned look because I would not look like myself. Thanks again, again, and again!

Answer:

whether fillers will be enough will depend on how empty your cheeks have gotten with age. If they are still pretty full, fillers will not help in lifting them. If you are empty then filling the malar/ cheek area is where the benefit would come. I wish you the best.

Question:

So, in response to the question of tear trough filling/ vs cheek filler, I have to ask...what exactly is the purpose of using filler in the upper/outer cheeks. I understand as we age, the face becomes more pyramid shape and less inverted triangle . I look at people like Kim Kardashian and am skeptical that this is really a nice look. To me, she has an alien look (too much inverted triangle, I guess). I just want a bit more balance so as to detract from the nasolabial lines/marrionette lines,but nurse says neither are severe enough to inject, and it would just make me look puffy. I know tear trough filling is truly an art, so I would only go back to The original dr for that. Can you help me sort this all out?

Answer:

The amount of filling in the cheeks it to re-establish what was lost from the aging process or weight loss. In Hollywood, it is common to see almost everything overdone and certainly fillers in the malar area can be overdone to the point of making one look worse, but properly done with the correct amounts leaves one looking better.If you have not lost any fat in the malar area and are just trying to lessen the nasolabial fold, then any filler there will make you look different and I would not suggest it. Hope that helps.

Question:

Hi Dr., will filling the lateral cheeks, and a bit in the apple area give a more balanced look to the jowls/bottom half of the face? I initially asked for some filler along the marrionette (very slight), but was told that a more aesthetically pleasing result would come from cheek filler. Would you agree?

Answer:

In general I do agree with that opinion regarding filler to the marionette line and I think filling the apple, so to speak, can help balance the appearance of the more boxy lower face that we see when the cheeks deflate.

Question:

If I have hyaluronidase injected into what is a hematoma and not the voluma is it dangerous? Not really sure which this is Thank you

Answer:

no danger, no negative side effect/

Question:

What do you think of dr putting filler along jawline Thank you

Answer:

in some cases it is a great idea, I do it sometimes.

Question:

Had voluma almost 2 weeks ago. Two questions 1. Can a lump be removed with hyaluronidase and do you think it would spread to areas beyond lump? 2. Still green from bruise. Do you think permanent and if so can laser remove green? What type of laser is used? Many thanks!!

Answer:

it will dissole more than the lump, yes. The green is just the bruise amd will go away in time. Warm moist heat will help that.

Question:

hello, had juvederm to right nasolabial fold and a little to left (right was neeed more than the left) and when I smile it is a bit crooked... please inform.. is there anything I can do? thank you

Answer:

initially it can be form the swelling which gets better in about 7-10. if it lasts longer it is due to the filler and that will last a while as the side that got more filler will be slightly stiffer than the better side and that is somewhat of the tradeoff with a filler for that problem. The fillers are made to correct the lines at rest but they are stiffer than normal skin and therein lies the trade off.

Question:

I had filler (HA) injected on Monday and am scheduled for Pelleve on Friday. Will the Pelleve negatively impact the filler? Thank you.

Answer:

No one knows for sure, but likely no effect.

Question:

Hi Dr. Since you don`t believe in Ultherapy, what else is out there for skin tightening, other than surgery? Thank you.

Answer:

Nothing reproducible or consistent at the present time in my opinion.Sorry. 

Question:

Hi Dr. G., I was told that Artefill lasts for years so had injections done last June 2013(cost: over $12,000) but it doesn`t look to last very long. Also, the injections on the forehead seems to make that area kind of wavy, despite 2 additional injections since last June, ie not smooth as in other areas. What can be done to make my forehead smooth like it used to be (even if it was more hollow). Thank you!

Answer:

The only way the Artefill can be removed is to have it cut out. I am afraid some of the waves are due to the material congealing together and in some cases, especially where the muscles are more circular in function, it can form visible and palpable lumps. The claim that Artefill will last for years is technically true, but since it does nothing to the process that created the need for it in the first place, the improvement does not last.Sorry.

Question:

I had Restalyne injected into my oral commissures today (2 vials total). It looks great but the entire area beside my mouth on both sides is bright red. Is this what is meant by temporary redness at the injection site ? If so, wow! I look like I have a really bad rash. How long does it last? Is there anything I can or should do to make it better? If it`s not normal, what could it be? My doctor left town this afternoon for the week. I imagine that he has someone to cover for him while he`s away, but I don`t want to make an appointment with a stranger if this is an expected and passing thing. I`m a little concerned because I have this done many times and have had a little redness but nothing so pronounced as this. I greatly appreciate your time and assistance, Dr. Garcia.

Answer:

with that amount of filler I am not surprised, but all normal. Ice and a few days should aee a big improvement. Hang in therw.

Question:

Hi Dr., for a while now, I`ve noticed that in pictures when I am not actively smiling, I look angry. I`ve dissected this, and it seems that with age (51) what was once a serious, but sultry look has become a downright disgusted look...oh, that aging fairy has so many gifts! I would not say I have marrionette lines (yet), but it`s more of a frown. What can be done, short of surgery?are there fillers and what should I avoid (if fillers are the answer)?

Answer:

hard to say without at least seeing pictures but likely a combo of fillers amd a neurotoxin.