Question:

Just saw the question about Renuva, about which I myself have only recently heard. Is it better/more robust than a strong HA like Voluma? And what do you imagine the cost/syringe is likely to be?

Answer:

I cannot say anything about the pricing as all physicians will come up with what they want to charge after buying the product from the company. As to longevity of the product in comparison to HA fillers like Voluma, in particular, I beleive it will last as long and likely a little longer than Voluma

Question:

I havea noticeable contour deformity in my thigh from liposuction. Fat grafting hasn't worked; neither has RF tightening. What do you think of Renuva? How often does it need to be reinjected?

Answer:

How long it will correct the depression varies from patient to patient. The company's site suggests it can last 4- 6 months before repeat injections are required.

Question:

Thank you for your kind answer about the antibiotic resistant biofilm and the generous offer to see me if I can't find a local physician willing to order that peptide, which I fear I won't. What, if any, are the side effects of LL-37? I ask because what started me down this long road to HA filler and infection was an ill-advised massive dose of kenalog from a plastic surgeon to my cheek to address a small scar, which resulted in complete soft tissue destruction (a known side effect that was not revealed to me at the time). It left me with a uge red depression, right down to the cheekbone.  He attempted to correct the problem, foolishly, with Radiesse, which resulted in granulomas that had to be surgically removed. Then he tried fat, which took unevenly and temporarily. Then another plastic surgeon tried HA's, which resulted in the biofilm. My lid retreat from all this, so I've had to undergo multiple oculolplastic surgeries. All of this, from a singular iatrogenic injury, has cost me approximatley $100,000! 14 years later and I am still dealing with this. I want to avoid yet more unforeseen complications, obviously, from the LL-37, My face was never classically beautiful, but it was at least presentable. Now, for well over a decade, it's been a disfigured mess--and for absolutely no reason. As you can imagine, it's been incredibly difficult and depressing, made more so by the fact that I participated in my own disfigurement/I am to blame because I followed the advice of these (board certified) physicians.  I feel like I deserve the isolation and shame it's brought me for all these years. I wish there were something I could do to correct my appearance even after clearning the infection. Thank you for your help and information, Dr. Garcia.

Answer:

LL-37 Is an antimicrobial peptide which belongs to the cathelicidin family of AMPs(antimicrobial peptides). LL-37, like cathelicidins, is stored in neutrophil granules as inactive precursors and are released as mature peptides when neutrophils are stimulated. LL-37 is expressed in various cells and tissues such as circulating neutrophils and myeloid bone marrow cells, epithelial cells of the skin, and is also expressed in the gastrointestinal tract, as well as in the epididymis and lungs. Moreover, the production of LL-37 in macrophages is stimulated by vitamin D released by sunlight through the skin. LL-37 plays an important role in the first line of defense against infection and systemic invasion of pathogens at sites of inflammation and wound. It is cytotoxic to both bacterial and normal eukaryotic cells and is significantly resistant to proteolytic degradation in solution. LL-37 shows a broad spectrum of
antimicrobial activity against bacteria, enveloped viruses, and fungi. It has also demonstrated success in helping promote wound healing and it may play a negative role in atopic dermatitis and psoriasis.

It is very safe

Question:

Dear Dr. Garcia, I have had a biofilm in my L cheek for the past four years due to HA filler. Though it's been dissoved several times with hyaluronidaise and treated with multiple  oral courses of every possible class of antiobiotics, we haven't been able to kill it. It's like I have a swamp in my face.  Every few months, it flares up (for no apparent reason), with a cinically impressive result of eythematous, swollen, indurated tissue that is so agressive, my eye swells shut. When that happens, we try another round of anitobitics (typically, penicillins), which calms it down after 10 days; but inevitably, another eruption recurs. We are out ouf ideas about how to treat this. Do you have any suggestions? What about direct injections of antibiotics into the infected area? Thank you for any thoughts you can offfer.

Answer:

There is an injectable peptide that is called LL-37. I have used it for recalcitrant infections. It is given as a daily injection under the skin using an insulin needle. I usually hav emy patietns use it until the entire vial is finished, usually 3-4 weeks. It does not have to be injected directly into spot. Injecting nearby is enough. If you find a doctor in your area that uses peptides, they can order it for you, it will likely be more effective than the repeat antiobiotic you have been given. Otherwise I would have to see you in person to prescribe it for you, once received I could ship it to you

Question:

I am always extremely itchy for weeks after the injection of any hyaluronic acid products. It's not a frank allergic reaction; rather, it's just persistent pruritis. It usually calms down after about 6 weeks or so. What causes that?

Answer:

I have to say that is quite rare, rare to the point that we do not test for allergic reactions prior to an HA injection. I would suggest taking an antihistamine starting the day before you receive another injection and continue for 5-7 days, and see if that can control the issue. It has been reported in the medical literature but the number of allergic reactions compared to the number of people injected is very small 

Question:

Dear Dr. Garcia, I hope you are keeping well. What are your thoughts on dermal grafting especially for nasolabial folds and to augment deficient/add volume etc to cheeks? Is it a good type of filler, reliable source, natural looking etc..? What are your thoughts on this for use in the face? Thanks

Answer:

Dermal grafts are pieces of skin where the superficial layer has been removed and what remains, the dermis, is then placed beneath the skin to lift or protect a depression from getting worse. Dermal grafts are at times placed under nasolabial fold or in cheeks but they are not permanent and the thickness of the dermis is usually not thick enough to make it a  worthwhile endeavor

Question:
Answer:

Yes, I perform non-surgical rhinoplasties in my office

Question:

Fillers 

Answer:

Bellafill should never be used in the lips for fear of developing granulomas that would need to be surgically cut out. I think if you are looking for a longer lasting filler for the lips you can try Restylane Lift, but it will last only a litttle bit longer than the others. I understand you may not like getting frequent injections, but long term fillers do not do well in the lips and I strongly advise you not to use them

Question:

9!years ago, I had fat grafting done to my face. It was way overdone, and I have been left with a weirdly puffy cheek on one side and 4 "islands " of fat on the other side. I know that deoxycholc acid is approved only for sibmental fat; but I also know it's being used off-label for such thins as gynocomastia. do you think it coul de successfully used on my face? By the way, I've never been overweight, but as I've aged, I've lost a fair amount of weight--probably 20 lbs or more-- and the facial fat has stayed! Thank you for your opinion, Dr. Garcia.

Answer:

the deoxycholic should work but you can also have damage to surounding nerves and could injure the nerves permanently. It is also unknown how much to inject or how many sessiosn would be required

Question:

Knot on the inside of my mough after facial injections.

Answer:

Whether it can be dissolved or needs to be cut out depends on what filler was used. If it was a hyaluronic acid filler, it can be dissolved easily. If it is a different filler, and one that should not be used in the lips, it will need to be surgically removed. Why it happens is either too much was injected in one area at the initial injection, or the action of the muscles caused the material to push together, something that can happen, although very rare.

Question:

Astrophic scars

Answer:

the scar has reached full healing capacity by 12 months. There may be things that can be done to make the appearance more similar to its prior state, such as CO2 lasers, fillers or surgery. I would suggest consulting with a plastic surgeon in person to determine what might be the best option for you.

Question:

Hi Dr. G,

I was wondering what your general opinion is on the safety of using silicon micro droplet for acne scars? Thank you and have a Happy New Year!

Answer:

I am not a fan of silicone microdroplet injections for depressed acne scars. It is nearly impossible to inject anything into scar tissue to allow it to stretch, including silicone. If there is undermining or release of the scar from the skin and then a filler such as silicone is placed into the gap to prevent the attachment from recurring is bound to fail as the filler utilized will migrate out of the desired area.Unfortunately that filler that has moved can cause lumps to form, especially with products like silicone.

Question:

Bruise from filler

Answer:

At this point firm massage and warm moist heat will help break up any blood that might have occurred from the needle stick. If the lump is just filler, the same applies.

Question:

Cheek filler with Voluma and tear trough filler.

Answer:

I do think that what you suspect happened and the prominence of the cheek now has made the trough look deeper. At this point you could do one of two things, more filler to the trough or dissolve the filler in the cheek. The dissolving though is an all or none phenomenon and you will lose all the filler in the area. Injecting more filler to the trough might make you look over filled. I think letting it all settles down for a few months and then re-evaluating where to put the filler is best.

Question:

Fat transfer verses dermal fillers and other treatments for volume loss.

Answer:

I personally do not believe fat injections to the face for volume loss are effective.The first problem is you have to use large needles or cannulas to place it compared to regular fillers so there is more and prolonged swelling and bruising, the survival of the fat is unpredictable, lumps are more common with fat injections and in most cases the fat does not survive as it fails to garner blood supply. 

Question:

Going blind from dermal fillers.

Answer:

Blindness as a result of fillers is extremely rare. In experienced hands is is even more rare, and it has been reported only from injection around the eye, the trough of the eye. An experienced injector knows the precautions to take so you should not be worried.

Question:

In a "part 2" of my question to filler to temple area. Is it ever best to fill the upper cheeks, and add minimal amount to marionette area? I just feel the filler to temple caused a very wide face w/ flat cheeks. Which was not something I ever noticed before. I'm trying to get rid of "sad mouth" issues, that was not really fixed by the filler at all.

Answer:

Fillers to the temple will never lift a marionette line. Fillers to the cheek can, in many cases, helps reduce the marionette line, but it will not go away entirely. A filler to the marionette line, if it is superficial, will work well. Filler to a marionette line that is deeper will make you look heavy as the amount of filler required to hide the skin that is falling works by lifting the normal skin to the level of the skin that has fallen, ergo, your mouth looks fuller and that can make you look heavier.

Question:

Dr. Garcia. About 7 months ago I wanted filler to be injected into marionette lines. Nurse injector insisted it was not best idea, and instead suggested filler to the very top of my cheekbones (near temples) and slightly inwards (but very little) near actual upper cheek area. All was well, for about 3/4 months. Now in pictures it seems like my face is just round with no projection in upper cheek area...causing my nose to appear bigger, and even my lips to appear smaller. I Do you believe this could be the cause, or do you think it's more the aging process? My face has never been round, in fact, it was more angular, which I was happy with. I hope this makes sense, and the final question is; do you think some conservatively applied cheek filler will put balance back and stop the flat, round look? It's making me crazy!

Answer:

I think it certainly can be due to the placement of the filler. Although fillers in the temples and cheeks are helpful, every patient is different and choosing how much to inject and where is crucial. If it is a hyaluronic acid filler, you can always have it dissolved and start all over again. I do think there are times when injecting the marionette lines is also not a good idea so, placing the fillers higher might have been a good idea, but where you fill is an important concern.

Question:

I got fillers in my face a little over a month ago and not happy with the results at all. Have an appt back to try and correct them and they are going to charge for the products but the dr said he wouldn't charge for his time.

Answer:

Every doctor is different. I see patients that have been injected by someone else and I charge them my cost of the product to dissolve it, and if they want me to do the filler later, I charge my regular price. I have only had 2 instances in 22 years of doing fillers where one of my patients did not like the filling and wanted it removed, which I did for free. They did have to pay for the repeat filler but I offered them a discount on that session. 

Question:

I have several syringes of voluma in my jaw right now and am not a happy with the look. It came out too large and asymmetrical. Would having it this amount dissolved pose any risks to the skin and how many sessions do you think it will take?

Answer:

It should not damage your skin if you were to dissolve it. Usually one or two sessions should suffice, with a period of a couple of days in-between.

Question:

I got voluma in my cheeks two weeks ago this past Friday and I'm still bruised and have lumps. I now have developed a sunken in spot or dented place on my face. I'm very unhappy and my cheeks look wide at the top and at the outer edge at the top of both cheeks it just looks big and makes my face look distorted. Looks like I need some volume in the lower part along the jaws or lower face to fill it out now. I hate it and he also injected restylane defyne in my tear trouhgs but it feels hard and has changed the way my eyes look. Looks like he didn't go up far enough under my eyes. He also gave me botox to stop the eleven lines and stop me from pulling down and said it would give me a lift but it lets me raise my eyebrows a little but the outer corners raise and the inner ones dont and I look werid, kinda like spock. What can I do and why has this happened?

Answer:

It sounds like what happened is that the filler was placed in small aliquots and as the swelling goes down, the area where it was injected appears higher than the area where it was not injected. You have two choices. First is to put fillers into the areas that are a little too flat to bring them up to the level of the other injections sites or second choice, to dissolve the filler using hyaluronidase. That would remove the filler anywhere it was injected, but it is an all or nothing response, you cannot just dissolve a portion of it. 

Question:

I got filler last Friday for my cheeks and the dr used voluma and for my tear trough he used restylane defyne. I have had the Voluma before and liked the results but this time it has made my cheeks look pointed out on the side like he went to far over and makes my face look weird. It's also really hard there and just doesn't feel right and also still really sore and bruised. The filler for my tear troughs has actually made my eyel look more hollow and looks like it's raised and the dip looks greater than before and I hate the results of both. He used some of the restylane for my nasal labial folds and marionett lines and they also look worse. It looks like I need more filler or volume in the lower part of my face because it's way wider at the top and slimmer and almost sunken in looking now at the bottom. He also gave me botox for my eleven lines and to keep me from frowning and pulling down my brow but it doesn't look like it has helped. He said it wouldn't make my eye look drooped because he only injected the muscles to keep me from pulling down but it still seems to make my inner brow look fallen. He said it would give me a lift but it hasn't. What can I do?

Answer:

It sounds like the Voluma was placed with a large depot type injection laterally, into a small area, and that feels hard as it is localized rather than spread over a larger area. That can make it feel firm and also give the exaggerated fullness. That is an injection technique problem. As to the tear trough problem, that is also an issue with injecting the filler a little too low where it augments the bony part and leaves the area of fat loss under treated. As to the Botox, I think it might just be that you need a larger dose to get the effect you desire. I would suggest just letting the filler dissolve over time and then re-injecting again in the future. If you do not want to wait, then it can be dissolved wit hyaluronidase, but  that will dissolve all fo the filler, it cannot be just partially dissolved.

Question:

Not satisfied with botox and fillers

Answer:

The location of where the filler is placed and the amount injected seems to be the problem. That is usually due to the skill of the injector. You might need the filler to be totally dissolved with hyaluronidase and then start all over I am afraid. As to Botox not working, that can come from too much dilution of the Botox, or the sharing of bottles, which is illegal, and that leads to the Botox losing strength when it is not used right away.

Question:

Hello Dr Garcia! I had Juvederm in my nose about 8 months ago and it's been good all along and is still going strong. Unfortuanately today my nose tip became very painful (I had filler in there as well) and swollen on one side by my right nostril. There is no visible redness on the outside of my nose. This has never happened to me before. I'm not sure if it's related to filler?

Answer:

This far out I do not think it is related to the Juvederm, if some type of reaction or infection were to happen, it would have happened fairly close to the injection time. I would watch it and possibly put some warm moist soaks on it to see if it will soften with that.

Question:

Profound with fillers

Answer:

It has not been studied but my suggestion is to do the Profound session first and then a few days later do the fillers. My guess is Profound will likely decrease the filler to some degree due to the radio frequency heating.

Question:

Should dr use canuals for fillers?

Answer:

In my personal opinion, I think the advantages of canulas are overstated. You cannot just poke the canula through the skin so a needle does have to be used to open a hole for the canula. If a needle is used and the filler is injected as the needle is advanced the bleeding or bruising is minimal versus if it is injected upon withdrawal. Lastly the canula will not have the finesse of the needle and leave a less natural more tube like appearance. In order to get the contours needles can do you need to reposition the canula numerous times and you therefore need numerous holes that can cause bleeding to position the canula, so the advantage goes away.

Question:

Fat transfer and stem cell transfer verses fillers for the face.

Answer:

In my experience and from what I have observed, it is rare for it to last a long period of time. Many surgeons use methods to promote their practice to bring in new patients. Fat injections for volume loss are very unpredictable, if they were not then the regular off-the-shelf fillers would have fallen by the way side and they have not because they are predictable.  In most cases the fat is resorbed in a few months because the blood supply in insufficient to keep the fat alive, so it just dies and becomes oil and sits there while the body digests it. In some cases the fat does survive but more so on one side versus the other. I think the important words in their claim, and it is the same word the companies that make fillers use, is the words 'up to'. What they use that phrase for is to entice buyers. They are careful not to say it will last a certain amount of time because if it does not, they will be on the hook, but if they say up to, it is potential length of time, and no guarantee is made.

Question:

What do you think of Bellafill? Are the claims of lasting up to 5 years legitimate? In light of how faces age, I wonder if placing filler in 2016 will look right by 2020 -- since the rest of the face will have migrated with time.

Answer:

You have hit it right on the head. Yes, Bellafill can last up to 5 years and maybe more, but it does nothing to halt the aging process. With aging, tissue is lost and tissues shift and that is why no filler of any kind will 'last' forever. The product may last, but the cosmetic effect will not.

Question:
Answer:

I think Juvederm XC can be used as well as Restylane to correct the dent after the Voluma injection

Question:

How challenging is it to reverse Voluma and do I need to go to same injector?  I'm unhappy with results and unhappy with the MD who injected -- feel she was misleading in claiming Harvard board certified MD when the board certification was in pediatrics.  Caveat emptor. Would a new MD know where to inject the hyaluronidase?  Are there risks involved in using it I should be aware of?  Thanks Dr. G you are so gracious with your time.

Answer:

Dissolving Voluma is pretty straight forward. I suggest seeing a board certified plastic surgeon or a dermatologist that does Voluma and they can dissolve it for you. There will likely be a small charge for it. You will just need to tell them the area on the face that was injected. There are no risks except for the loss of the money you spent on the Voluma. I would wait at least 2 weeks before having new filler placed properly. Best of luck and yes, Caveat Emptor! Another case of pure profit overwhelming  person's educational background

Question:

Dr. Garcia is it possible to have an adverse reaction to voluma a month after injection?  Face looks swollen and having facial pain and jaw pain.  Possibly bruxism but worried its related to volume because of the swelling in upper cheeks.

Answer:

I have not seen nor heard about such an occurrence in the medical literature. Usually if an adverse reaction is going to happen, it would happen in the first couple of days to a week. A month later is is unlikely due to the filler. Sorry I cannot say much as to what is the cause of your present problem

Question:
Answer:

If injected early on, by that I mean a few days after injection, saline injections will help by spreading the Radiesse out, but it does not truly dissolve it. At this point in your case the Radiesse has aggregated and the saline will likely not help disperse nor dissolve it I am afraid.

Question:

I am coming in next week for lip fillers and wanted to know which one you use and what are the side effects.  You also gave me a script for cold sores.  Should I take them one day before the procedure and 2 days after or 2 days before and one day after?  I have (stupidly) watched videos on you tube about lip injections and a few things stood out.  First of all, do you do a nerve block because it looks like it can be pretty painful.  Second, will the lips be lumpy for awhile until the filler settles?  I think you are a very caring doctor but this is my first cosmetic procedure and to say I am nervous is an understatement.

Answer:

We recommend using the medication to avoid the cold sores for 2 days before and after, yes. We use a topical anesthetic for the lips which is usually enough. We on rare occasions due nerve blocks if the topical anesthesia is not enough. As to lumps, we suggest the patient use a lip balm like Chap Stick on their lips 2-3 times per day for 2 days to smooth anything out and it helps with any swelling too, but lumps are not a common occurrence. We also give you cold packs to apply to the lips for post-injection comfort and to minimize any bruising. Make sure you have stopped all over the counter medications that can cause you to bleed more easily, things such as aspirin, Alleve, ibuprofen and Motrin. It is very common to be nervous, especially the first time. Looking forward to seeing you and please let me know if you have any other questions before you come in

Question:
Answer:

I am sorry but I do nto see the question you have about filers, please repost it and I wil answer it for you

Question:

if you have botox injected into your chin for orange texture problem, can you have a facial filler injected around chin in same area on same day or same time? Or does it require two separate trips to the doctor's office?

Answer:

Botox to the chin the same day. I suggest the filler first so that you can have the filler placed where it is needed and then follow with the Botox.

Question:

Hi Dr., I know from past answers that one of your favorite fillers in the cheek area is Sculptra. Is that because it seems to last longer? I've been doing some price checking and note that it seems a bit pricey. To give a nice noticeable but not too obvious lift in the cheek (bony) part area, how much of this filler would be necessary? I see that juvederm seems to be quite q bit less than Sculptra, and want to know if one syrginge of this would give any lift?

Answer:

The first thing is that Scultra can typically treat a larger area per vial than 1 cc of Juvederm can. Also, regular Juvederm will not last more than a couple of months when injected intho the cheeks where Sculptra can last 12-24 months. Juvederm Voluma can last UP TO 2 years but from my personal observation it is about 1 year until the visual effect is gone in most patients. Juvederm Voluma is also much more expensive than reguara Juvederm.Voluma does not create any new tissue where Sculptra does. That fact makes it so that keeping up with Sculptra will slow the aging process while Juvederm only hides it. I have found that if a patient uses Juverderm for 5 years and quits, they look older, but with Scultra and then quiting, since they did gorw new tissue, they seem to have held up better than the HA filler patient. In the long run I feel Sculptra is less coslty becasue of the new tissue growth. The thing with Sculptra is that it needs to grow over 4-6 months, so you lose out on the immdeiate gratification you get with Juvederm

Question:

I'm on celebrex for osteoarthritis. Is it okay to get filler and botox injections? Will I bruise more?

Answer:
Question:
Answer:

Happy Thanksgiving to you also, please post the question again as it appears it got truncated.

Question:
Answer:

Happy Thanksgiving to you also, please post the question again as it appears it got truncated.

Question:

Hi Dr...well, the turkey neck seems to have happened literally overnight. The rest of my face seems to be doing rather well as far as the aging process. I notice that when I pull my cheeks ever so slightly (just a tiny bit), amazingly the slight marrionette lines, beginning of jowls, and beginning of turkey neck disappears! Can a nice heavy filler like Juverderm XC, plumping up the cheeks lift the other sagging (slight) parts? I'm only 53, have been told I have "pretty" skin (not necessarily "good" skin), and have really no wrinkles. I think I would wait a few years as money, and time are a huge concern, before embarking on a surgical option. What will help. Do you agree with my filler observation?

Answer:

Hard to say without seeing you. In some case a a filler can correct some of what you see, but people will eventually get to a point where fillers will only make them look fat rather that younger. Most people loose fat in their cheeks and I like filling that area up with Sculptra to have a small skin lift, and it also lasts 18-24 months.

Question:

HI Doctor
 
I had fat transfer to the cheek and under eye area 5 months ago.  Whilst I am happy with the result, on one eye I have what looks like scar tissue from where the cannula may have entered and it looks like a scar of about an inch long. It isn't very lumpy but it some light it is very noticeable.  I don't want to have fillers to camouflage it so was wondering if IPL would help to get rid of it?
 
 
Thanks 

Answer:

Hard for me to say without seeing what is going on but in general an IPL will not do much for scar tissue I am afraid. Sorry.

Question:
Answer:

properly injected in looser skin probably yes. Hard to use in thick skin and areas where the scars is hard though.

Question:
Answer:

If the droop is due to loose skin the filler can be used to hide it but it will not lift it. If it is due to the pulling down of the corner of the mouth then a small amount of Botox can weaken the muscles that is pulling it down.

Question:

I had Juvederm Ultra injected into my lips two years ago and it's still fully there, nothing has dissolved. I had had it done years ago and it resorbed, mostly but not entirely by 8 months; but this latest round hasn't budged, and it's been at least 30 months. Is this common? Could the scar tissue from the injections be coupling with the filler to keep it in place? I have heard that more than one layer of hyaluronic acid can lay down a permanent base, reducing the need to have it repeated; but this seems more of a sales tactic than a clinical reality.   I know I could have it dissolved, but I don't want to do that, since it has become something of my "look" at this point. Just trying to figure out if I will be lucky enough not to have to spend that money again!

Answer:

I will be honest with you, I have never seen nor read about true Juvederm Ultra lasting that long,anywhere on the face, and especially in the lips. I have also never seen any evidence that the hyaluronic acid lays down a permanent base as the body breaks down hyaluronic acid, no matter the source, as part of th  aging process. I might venture to say that something else was injected. As to how long it will last, hard to say at this point as everything seems unusual.Wish you all the best.

Question:

If one had Sculptra injected into their chin for fat loss, is it possible to get permanent granulomas or lumpy tissue in your chin? If so, is there a way to dissolve it?

Answer:

That is not a common location to inject Sculptra, into the chin pad itself, although it can be used at the jawline. With the muscle function in that area, even with good technique, granulomas can form. If they do, they can be attempted to be broken up by injecting them with saline but if that does not work the only way to be rid of them is to cut them out. Granulomas, once formed, usually do not just dissolve away the way Sculptra would normally.

Question:

What is this version of Restylane used for? My aunt, who lives in Europe, swears by it since her dermatologist introduced her to it a while ago. It's not a filler, is it? She says it makes her skin glow, but that sounds like a topical product, not an injectable, to me.

Answer:

It is a filler injected in minute amounts directly under the skin, They claim it can make your skin look "refreshed". I have no direct experience with the product nor have I seen the FDA information they would have had to provide before authorized sale in the US to tell you if I think it would help. They refer to it as a skin booster, but it is unclear what that really means

Question:

Dr. Garcia,
 
Thank you for answering my question regarding fat loss/Scultra/and Perlane so quickly.  May I ask what generally causes sudden facial fat loss.  It's only on one side of my face.

Answer:

Short of trauma there is nothing that causes it to be lost fast, but the side you sleep on, the side with the most sun damage and the side with the smaller bones typically lose first.

Question:

Hello Dr. Garcia,
I slowly developed a dent in my cheek within 6 weeks of having Sculptra injections. Could the Sculptra be the cause? If so, will the dent eventually disappear? Also, until it disappears, can Perlane be used to fill it in?
Thank you for your time.

Answer:

I do not see how something that will build tissue cause a dent or depression. It might be something else, but it is fine to use a filler such as Perlane for it until whatever caused it is corrected.

Question:

can you use fillers for the rest of your life to camouflage a small cartilage bump on nose bridge? I had 2 surgeries and it still isn't right so I don't wanna have any more surgery but I do want to fix it. Are there long term side effects to fillers? ty.

Answer:

not a problem with using fillers on that. I will say that since that area does not 'age' like other parts of the face, using long term fillers is safe once you know the amount needed and location where it is to be placed.

Question:

Hello Dr. Garcia,
Do you have any opinion/experience with PRP injections (Plasma Rich Protein), or the "vampire" face lift? Thank you so much!

Answer:

I have used PRP during facelifts to help speed the healing but there is no scientific evidence that injecting PRP will rejuvenate skin by that alone.

Question:

Hello Dr. Garcia,
Do you have any opinion/experience with PRP injections (Plasma Rich Protein), or the "vampire" face lift? Thank you so much!

Answer:

Yes, although I have used PRP as as spray at the time of a facelift when the wounds are still open to shorten recovery time, merely injecting it under the skin in the hopes that anything positive will happen is an absolute waste of time and money. There is absolutely no science behind it.

Question:
Answer:

The fine lines are much more difficult to treat as too deep of an injection will not correct it and too superficial will leave lumps. It is technique dependent but not all fine lines are correctable with fillers I am afraid.

Question:

What filler do you recommend for treating jowls and the chin area?

Answer:

my preference there is Perlane or Juvederm Ultra Plus.

Question:

My mother is 71 just had volumina to the infraorbital ridgeand tear ducts to fillin bags.  The outcome is stellar, but bumpiness presents itself and we are past the acute stage regarding cryotherapy.   At this point , which is 3 days now should she use moist plus light friction to the area .  follow up is in two weeks  A plastic surgeon performe d the procedure, who is astute at injectables... just concerned about the bumpiness only with her side profile. thank you.

Answer:

I think moist and light massage is what is indicated. I must say that the tear trough area is quite thin and superficial and I am surprised that Voluma was used there as it is intended for much deeper injection. I think they bumps should get better with the massage but it will likely take longer to resolve as the Voluma is thicker than the more commonly used HA products there

Question:
Answer:

massage and warm packs is about all you can do at this point. Hang in there, 60% of whatever filler is there will be gone in 6 weeks

Question:
Answer:

full growth takes 4-6 months. As to how many sessions are needed, that depends on how many vials are used per session but more importantly it depends on how much volume loss the patient has. The more the loss is, the more vials would be needed. The vials can be done in a single sitting or spread out over time.

Question:

So I had my injectable rhinoplasty yesterday and to my surprise he wanted to 2 syringes of juverderm ultra plus filler. My doctor is highly respected and has been doing this for years. Even touted as one of the pioneers... so I took his advice against better judgement.
My nose looks ridiculous today... a little bit better from the profile but the tip is bulbous and the bridge is massive. Some of it is likely residual swelling but I'm strongly feeling too much filler was put in.
I'm thinking it's highly likely that I'm going to have it dissolved. I hate to feel like I'm out $1000 for nothing. Does it dissolve immediately so that the injector can sort of eyeball how to take some of the bulk of the filler out without taking all of it so it can be scultped to not take all of it out? Or does it dissolve in a less precise way where it's better to remove it all at once? Thanks.
 
 

Answer:

the dissolving effects is seen in just a few hours and totally done dissolving in about 12-24 hours. The hyaluronidase diffuses quite easily so it is hard to dissolve only part of it, anything close by will likely dissolve too.

Question:
Answer:

My preference is Restylane for the vermillion border and Juvederm for the actual lip.  The Restylane is a tiny bit firmer and the vermillion border is normally more firm that the actual lip. Juvederm is slightly less firm and the lip is less firm than the vermillion border. In general I like to replace what ever I am targeting with some filler that is closest to the area in question.

Question:

If you recently had sculptra injected in eye hollows and found out some people are allergic to it and develop large nodules as inflammation process, what can you do now to cut down on inflammation if you might be allergic to it? Also, does the new or more diluted formula decrease the chance of nodules? And, does injecting it deeper instead of at surface also decrease the chance of nodules? I wonder if these photos of nodules growing out of control under eyes is a result of the old formula as well as it being injected at surface instead of deeper down? And, does skill of the injector make a difference? I just read all these horror stories, but I don't see it in my doctor's sculptra after photos. The same patients have been coming back for over 10 years for sculptra under eyes. Additionally, when do nodules start to form and stop forming? I don't know if you know this, but what percentage of patients develop nodules= is it a small or large percentage. Not all patients form nodules, right?
 
 
 
 

Answer:

The only thing I might suggest for the allergic reaction would be to treat it with anti-histamines or steroids if severe. The greater the dilution, the lesser the chance of the nodules as long as it is not injected in a bolus or large quantity in a small spot. I do think skill makes a difference as placing it in the correct place and level is important, as well as knowing where not to inject it. If a nodule is going to form it can start 6 weeks after the injection and if nothing has happened in 3-6 months, it is likely OK. The percentage of nodules now with the new injection techniques is very low newer injection techniques is very very low.

Question:

What is the average price of Restylane and Juvederm?

Answer:

It depends on the size syringe you are using as they come in two sizes. Also Juverderm has three types, Juvederm, Juvederm Ultra and Juvederm Voluma. Restylane is roughly $600 for the large syringe and about $400 for the half syringe.

Question:

Do fat injections lighten dark circles circles under the eyes?

Answer:

I personally do not recommend fat injections into that area as the survival is unpredictable and lumps can for due to the needed use of larger cannulas to place the fat

Question:

Do Sculptra nodules evaporate over time or are they permanent? If they evaporate, how long does it usually take for it dissolve?

Answer:

It depends on how large the nodule is, if they are small they usually dissolve in time on their own. They can be treated by injecting saline into the lump to break it into smaller pieces. Large ones at times require surgery to remove them

Question:

How long do Sculptra injections last? How long do Restylane injections last? Which one has better or longer results? Also, do they cost around the same price?

Answer:

Sculptra can last 1-2 years, Restylane's length of effect varies depending on what area is injected. The two products are not interchangeable, by that I mean they are not meant to be used for similar problems. They are supposed to be injected into totally different levels. The cost is a bit more for the Sculptra but Restylane is sold by the syringe where Sculptra is sold by the vial, so there is no real ability to equate them, especially as they are not used interchangeably, or at least should not be used that way.

Question:

As I approached 40, the hollows under my eyes extended to outer eye. Before, my hollows or undereye circles only ran the length of inner eye to middle of eye. 
I was considering Sculptra, but I'm afraid of developing nodules since my skin is very thin there. My skin is not as thin in the outer part under my eyes. Is this outer area just a prone to nodules? I was thinking of only getting it injected there. It would still leave my with hollow, undereye circles but it wouldn't extend as far out. It would like my undereye circles when I was younger.
The doctor's office doesn't use other fillers under eyes like restylane because there have been too many lumpy results. I think they only use sculptra and voluma, but I read reviews which voluma made undereye circles permanently darker. 
So, can I expect not to develop nodules if I only have Sculptra injected in outer part under eyes?
 

Answer:

I would not use Sculptra to correct lower eye hollows. It is not intended for use in that area, it is meant for much deeper level of injection than what is needed in the lower eye hollows. Voluma, when injected deeply, as it is intended to be injected, should not have that problem. If the injector uses Voluma in too superficial of a plane, then there can be a bluish discoloration, yes. I always use Restylane for the tear trough and orbital rim, It does take an experienced user and the lumps should be rare, depending on the technique used. I might suggest you get another opinion by another injector in your area.

Question:

Dos one need 3 platelet rich plasma injection in hollows under eyes? After 3 injections, is the result permanent or will one require ongoing injections just like fillers every year?

Answer:

I think PRP injections are a waste of time and money for the hollows underneath your eyes, so doing it three times is three times as worthless.

Question:

Dos one need 3 platelet rich plasma injection in hollows under eyes? After 3 injections, is the result permanent or will one require ongoing injections just like fillers every year?

Answer:

I do not think PRP injections for the hollows are worth spending any money on

Question:

Oh mercy, I feel like I've really messed upi this time. Yesterday I had 2 units of Restylane injected in my lip,around my nose and corners of my mouth. I am bruised beyond beleif and have serious trout pout going on. Please tell me some of this is still swelling and should go down by tomorrow. What a sickening feeling, my husband doesnt even want to look at me me . He even called me a 'sucker' (haha) guess I deserve it

Answer:

I would ice it three times per day for 3-5 minutes each time and give it some time, some of that is certainly swelling, especially in the lips, and should go down to some extent. Might take a few days for all of the swelling to go down and after 5-7 days you will see what will remain.