Question:
Answer:

Usually, recommend ScarGuard or Mederma for the scars. I like my patients to wait for 2-3 days after the stitches have been removed. I like the topical cream to be applied for at least 3 months and of course, use sunblock instead of sunscreen if you will be out in the sun

Question:

What is your opinion of Silhouette Instalift? Is it an improvement in technique and materials over the old thread lifts of 20+ years ago, which infamously failed, often unilateraly, leaving faces half "lifted" and half "descended" and/or the sutures for which often extruded through the cutaneous tissues? I know that this latest iteration of this old technique is not a substitute for a surgical facelift and that it will last, at most, only 2 years if it is successful; but I am intrigued by it because I had a facelift about 10 years ago and need just a little mid-face lifting (skin is beginning to gather up on either side of my mouth), but I don't want new pre- and post-auaricular incisions. The last time, they healed very poorly and were highly visible. After a year of trying to hide them wigs and makeup, which didn't work well, I was able to find another surgeon who corrected them. That experience was traumatic and inconvenient enough to make me shy away  from further surgery. So, what do you think? Does this latest version have the same problems as its predecessors, or is it an improvement over its ancestors? I assume it can done multiple times after it necessarily fails with time. Is that correct? Is it something you yourself would consider offering? Thank you for your opinion and advice.

Answer:

It might,and I repeat, might last longer then the Thread Lifts of the past, but not by much. The same issues of sutures breaking still exists I am afraid

Question:
Answer:

our fee for that is $750 per ear for a reduction and not a repair

Question:

Thank you for the answer to the question. What can/should be done if the healing around the scars isn't "going right"? What could be "going wrong" in this scenario? I don't think it's vascular because the scars don't blanche when I press them -- so a V-Beam treatment is unlikely to help. Sorry to be persistent and to ask more questions!

Answer:

I might be able to give you more information if I could see what it looks like. Please feel free to send me a picture or two to drgarcia@lvcosmeticsurgery.com and I might be better able to point you in the right direction.

Question:

You mentioned low level ND Yag and IPL for facial matting, but another thought occured to me, I had needlepoint electrocauterization/or thermcoagulation years back for a spider vein, and its the only vascular treatment I ever that was successful. Lasers have always reacted with matting on me and not helped the problem. Maybe it's just my skin type.

I realize that needlepoint coagulation has limitations to only the visible blood vessels, but is there a higher rate of effectiveness/lower rate of matting in this modality for visible thread veins as I suspect? Maybe that can be an option for me to clear some of this up.

Thank you for all your insight on this good doctor. 

 

 

Answer:

I do think that isolated small veins do respond very well  to electrocoagulation. That is what I use the vast majority of the time. As to using it for the matting, it may not be the best. The reason is the matting occurs because of the effect the laser by its spot size. The laser energy is therefore more dispersed and attacks the entire skin and not just the small blood vessels. So if you try electrocoagulation you may be burning the red skin with less chance of improving the redness while still having the chance of causing a burn. I would not use that technology at this point on you but it is a better option for you in the future.

Question:

Hey Dr G, what do you think of Radiesse or Silikon 1000 to fill in these grooves that appeared in my nose after a botched Rhinoplasty? I reallly dont want cartilage grafts because they'll make my nose fat.

Here is a pic

https://postimg.org/image/xvfyh19dd//

 

Answer:

Between those tow I would only choose Radiesse. Silikon is just silicone and in many states is banned from use due to potential long term complications. I might suggest using a shorter acting filler like Restylane or Juvederm so you know how much you will need to use to fill in the defect and then proceed with a longer term filler such as Radiesse. I think permanent fillers, such as Silikon, can cause permanent problems and I avoid using them, Even if I wanted to, I cannot use it legally in Nevada.

Question:
Answer:

I believe you were likely referring to neck lifts. I do perform neck lifts in many patients. What I would suggest to a patient varies from patient to patient but it is a popular choice for many

Question:
Answer:

Micropen alone will likely not be very effective in correcting wrinkles. It may allow the absorption of certain products and can cause an inflammation of the skin that can then be used to attract other injectable like cytokines that may help, but micropen alone is not going to make much of a difference

Question:

Any new hope regarding malar bags caused by fluid, or is surgery still the only reliable option?

Answer:

Although many have tried a variety of different things such as heating the deeper tissues, microneedle liposuction and laser, the only thing that I have found reliable and that works long term is surgery. Sorry.

Question:

9 days out from neck lipo/platysma tightening, i'm not noticing the regular lumps and bumps people talk about... but the platysma muscle itself is a slighty firm bulge.... I know it's the muscle bc i can flex it. Moreso on one side of it than the other. it's not really visible but iI can feel it when I touch it.
What do you think this could be?

Answer:

It most likely is the induration from the sutures being placed into the muscle as well as the muscle irritation form any fat removal. Those issues can take 4-6 weeks to get better. Heating pad and massage as well as stretching usually help quite a bit. It is not a sign that anything is wrong.

Question:

Last, last question on this subject. I know I have gone well over my limit and appreciate your council. I was wondering if in my case a submental lipectomy could be carried out by cutting out my deep subplatysmal fat, and tightening the muscle position without liposuctioning the superficial fat to ensure a smooth result? Thank you so much.

Answer:

no need to apologize. I think if you are concerned about the smooth result that what you are suggesting is certainly a good choice. If you want more in the future, in terms of the above the platysma fat removal, then Kybella is still an option. Best of luck.
 

Question:

Hello Dr. Garcia... I am the one who is scheduled to have the submental lipectomy. A couple Plastic surgeons told me that a chin implant with lipo would be the way to go, but my current PS believes that I will get the most natural result from a submental lipectomy due to my anatomy. He also thinks a chin implant would look silly as it would exaggerate the crease under my chin.
I agree with him in a sense because I don't really want to change my bone structure or look, I just want to address the area under my chin (the tissue that give me a double chin appearance is directly below my chin... my jawline is otherwise fine). On the other hand, I don't want to go through a grueling, lumpy healing process that I have read others take months to resolve and I watched a submental lipectomy on Youtube and it seems a little heavy handed... God forbid I be left with any permanent irregularities and trade my slight double chin in for bumpy old looking skin as I am still relatively young (36), male and tall. I have enclosed a pic... what are your thoughts? I have read about Kybella... it sounds great but I don't want to be forking a lot of cash over for a minimal result. Or lipo alone? I am thin and in relatively good shape, but I am genetically predisposed to carrying around fat under my chin, love handles ect.
Thank you. Here is the pic. Please advise.
http://i60.tinypic.com/2gse9u1.jpg

Answer:

In experienced hands the chances of the lumps is  low. I thin if you are good with your jawline and chin, leave them be. The submental lipectomy, if it is to remove the fat underneath the muscle, should do well for you. The fat can also be removed from above the muscle if that is the only thing or in combination with the fat removal from below the muscle. In evaluating someone for Kybella, we need to know if the fat is above or below the muscle because the Kybella is meant only for fat above the muscle. I use it and find it to be a great option and the fat loss will be permanent. If you only have fat above the muscle, the Kybella may be the way to go. Less risk of lumps, which is already low, and no scars. Your surgeon can tell you if the fa is above or below the muscle. If it is all above the muscle, I would offer you Kybella before surgery.

Question:

I had Medpor cheek implants placed in 2011. I've thought that they look good in mirrors (any lighting, any time of day), but lately I've seen some photos of myself and am thoroughly shocked to see how extraordinarily odd I look. My face looks "blocky," stiff, and almost doll-like. After I had the surgery, I asked several plastic surgeons at the hospital where I work about cheek implants, and all of them said that they only place them if the patient has had extensive facial trauma/fractures or if the patient has a congenital malar defect because cheek implants always look fake, changing the planes of the face in such a way as to make the person look fundamentally odd, particularly at a gestalt level. They were polite enough not to tell me that I looked like that, but from the photos, it's clear that I do. Two questions for you: Do you agree with their opinion -- that is, that you never place malar implants simply for aesthetic reasons?  And now, what can I do? The bone has grown into the Medpor material, so the implants can't be removed -- or if they are, I will be even more deformed by the extensive dissection require to get them out and by the likely nerve injury I will incur. I appreciate your opinion and your time.

Answer:

Cheek implants do change the way someone looks as it changes the bony contours which is how we recognize each other. If a person does not like their facial structure, then cheek implants are great, but they should not be used for correction of the aging process as they replace bone and not the tissue that dissolve with aging. It might look more blocky now because of the aging effects of the last few years, loss of facial fat, and then allowing the underlying structure to appear more squared off. If you had been born with facial features like that and had not had implants the appearance would change in the same way. Medpor implants are certainly more challenging to remove, but they can be. Nerve injury can occurs, but when removed  by someone with Medpor implant experience, it should be a very small risk. You may want to consider some filler to replace the lost subcutaneous fat and return you to the appearance you had back in 2011 if you prefer not to mess with the implants.

Question:

Hey, Dr. Garcia! Hope you had a good summer! I had a facelift last year and now my lateral cheeks are distinctly flat. Imagine a reversed C -- from the top of my ear, circling out to my cheekbones, and dropping down to my earlobe -- all flat. it almost looks like you can see the outline of the surgery. It's especially noticeable when I smile. Is this an expected outcome of a facelift? I wish I had known this would happen. I've had several vials of Sculptra injected, but it hasn't really corrected the defect. Anything else I should try? Thanks so much.

Answer:

Thank you for the good wishes. What you are describing should not happen. It might be form the tension applied in closing the skin, loss of subcutaneous fat, or the pulling of the underlying tissues in a less than desirable direction. Hard  to say what I might suggest without at least seeing some pictures. You could contemplate some small amount of fat injections, but I am not sure why the Sculptra has not worked. It must be injected into a thin layer in a cross-hatched fashion for it to work well. Feel free to send me some photos of the problem to me at drgarcia@lvcosmeticsurgery.com and I will take a look at them and get back to you.

Question:
Answer:

I do perform them, the entire cost except for you medications around the time of surgery is $7,1000. All monies have to be paid at the pre-operative visit which is about 10-14 days before the surgery.

Question:

How well do the ears heal for nasal composite grafts? I have mild but very noticeable alar retraction from over-resection of the tip cartilage in a rhinoplasty. I'm considering repair with composite grafts, but I'm worried that the ear will be noticeable.  Will they need to take skin and cartilage from both ears or just one? And how noticeable will the grafts be? Will there be a "seam" and a difference in color along the alar rim themselves once the grafts are placed? Finally -- you will probably think this ridiculous-- might it be possible for me to stretch the alar walls down by pulling on them daily, for long periods of time? I know that skin can be stretched, so I am foolishly hoping that I might be able to repair this defect myself? Thank you kindly for so generously answering my questions, and those of others. God bless you.

Answer:

There will some slight difference in the ear, the greater the piece removed the more visible it will be. The color latch is usually pretty good in time, but not right away. That skin will not stretch enough by pulling on it until something is put into place to keep it from shrinking back down I am afraid.

Question:

The corners of my mouth have turned down (mildly but noticeably) with age. I've consulted with several surgeons across the country (thanks, Skype!). All but one have suggested an anguloplasty that would leave scars on my face. I flew to Boston last year to consult with Michael Yarmechuk, who recommended a midface lift, which would leave only tiny scars in my crow's feet. What do you think of this approach? Do you think it will be effective in lifting the corners of the mouth? Of the options available, I'm leaning in this direction. Do you know Dr. Yaremchuk? I know you probably can't comment on a colleague's work on a public forum like this, but in general, do you think he's a good surgeon?

Answer:

I think a mid-facelift is a good option for you. He is an excellent surgeon and avoiding he scars at the corner of your mouth is a good idea unless there are no other options, which there are at this point. Best of luck.

Question:

Even though it is low in both, Which has the higher chance of leaving bumps and iregularities... platysmalasty or neck lipo alone?

Answer:

lipo by a very small amount

Question:

After having a chin reduction surgery, can one eat as usual Or does one need to be on a liquid diet?If so, for how long?

Answer:

usually a soft diet for a few days is a good idea

Question:

After having a chin reduction surgery, can one eat as usual Or does one need to be on a liquid diet?If so, for how long?

Answer:

Usually it takes a few days for the muscles to re-attach so being on a soft diet will be required for 3-7 days.

Question:

Hi Dr Garcia! Quick question! Is it safe to have a fat graft to the face if you've had cheek implants?Mine are a comb of goretex and silicone (I believe) I ask as I once had an infection in my previous goretex medpor ones  so don't want to go through all that again with removal and re-insertion etc! Also how long is recovery and to see results? Would it be safe for me to have this procedure as I would hate another infection!!  Thank you so much!  

Answer:

The fat grafts are placed either into or above the muscle so it should be OK to have it done with cheek implants in place below the muscle. Infections with fat grafts can happen but are rare. Recovery will vary depending on how much fat is injected but look at 3-6 weeks before all looks pretty normal. I wish you the best.

Question:

Hi, Dr. Garcia. You were extremely kind to answer some questions for me about a lip lift a few weeks ago. As you predicted, it's looking much better with time. THANK YOU for reassuring me in the midst of my panic! The scar from the incision along the vermillion border is almost invisible now. What IS visible now is a brown line just above my lip, which I initially thought was the edge of the vermillion that the surgeon had rolled out too aggressively (which he had not). He is assuring me that this faint brown line, which looks like the budding mustache of a newly pubescent boy, is simply inflammation from the surgery and that it will fade to invisibility in a few weeks. Does that sound right to you, or do you think that this might be a permanent feature of my face now? Thank you so very much for your frankness and for your incredible generosity in answering questions like these from patients who are not even in your care. What an incredible human being you are!

Answer:

yes, I agree that will also get better in time. Thank you for the kind words and Happy New Year to you.