Question:

Fordyce spots and exfloliative chelitis on lips. I'd say my exfloative chelitis is mild (only rub off a little dead skin in the shower in the morning) but my fordyce spots are bad. They are small and in the skin (they don't stick out) but there is thousands of them and my lips look pretty ravaged. I'm a male and considering a paramedical tattoo but do not want to aggravate my exfloiative chelitis and have heard mixed results with some claiming success and others saying the ink does not take because it is being put into oil glands instead of skin. Thoughts?

 

Answer:

The ink may not last as long as it does on people trying to get a uniform color. I do not think it will worsen the Fordyce spots though.  I think you should expect some aggravation of the chelitis if you have it though. All other treatments out there can help in some patients, but not in all.

Question:

IPL safety

Answer:

Older skin is more fragile, especially in thin-skinned people as well as in thinner skin areas like around the eyes. The thicker the skin is, the more aggressive the setting on the IPL can be. The chin is thicker than the eyes and should take a fairly high setting, but as IPL is done as as series, I would suggest starting with relatively low settings and see how you respond. If things go well, you can always have a stronger session in the future.  

Question:

I am praying you can help me because I've been to several doctors and they don't seem to know what to do, I have had for a couple years now, this like rash that seems to go thru cycles and it's never like pimple stuff that comes out if I squeeze the spots, it's like gray and sometimes like a real blue color that comes out. I think I have a fungus called Malassezia, because this started after I had been on antibiotics, and if I put makeup on or moisturizer with oil suddenly it makes me itch and burn and gross stuff comes out. It's awful, it just keeps coming it never stops like a pimple. Also, I sprayed an antifungal spray on me and I had the worst rotten eggs smell coming from my skin. I also used a shampoo with a 1% Permethione Zinc and it was helping, but now it seems like it's not helping as much and I heard fungi can make something called a biofilm to fight back, which is what I am wondering if that happened. This is on my face, my neck, my armpits and I have noticed I have a weird smell even with deodorant on and right out of the shower. My skin has like gray patches too. Antibiotics make it way worse. What should I do???

Answer:

I think that in order to be able to see what can be done to make it get better, we need a couple of things. The area needs to be scraped for cell analysis as well as a small punch biopsy that can also be examined for a diagnosis. With those results we can better focus on treatment options.

Question:

Hi Dr. Garcia,

Does localized anesthesia (lidocaine), when injected into parts of the face, cause temporary swelling? Not huge amoung but enough to notice when looking up close? If so, how long should it subside?

Answer:

the time for it to resolve will depend on the volume injected as well as if epinephrine is used. Epinephrine slows the resorption, and the larger the volume injected, the longer it takes to go away.

Question:

I have been using this serum on my eyes during the day. Is there anything in it that would make my lashes grow? Niacinamide Vitamin B3 5% Serum With Matrixyl 3000, Argireline & Ferulic Acid. My lashes are growing? Yet I haven't used Revitalash in over two years?? If it's not this, than not sure what else it could be??? Thank You for your time and advice.

Answer:

the Niacinamide and the Matrixyl can improve the hydration but that is about all they can do for the lashes, so I am not sure they are having a large impact on your lashes growing

Question:
Answer:

It is our custom to see our patients at their one year anniversary to evaluate the surgery and see if anything needs to be done. Please call the office and make an appointment so that I can evaluate you and determine what you might benefit from.

Question:

Dear Doc. Garcia,

I’m a middle-aged woman who can do Standing Rows with a 50lbs. weight with one arm! I do weight training 2 to 3 times a week along with cardio. My problem is the lower arm flab! I was told this was genetic and the only solution was procedure. But which one! Where I live I can have Smartlipo, Lipoplasty, Venus Freeze,  CoolSculpting ??????Everyone I speak to says theirs is the ONE!  What would be good for genetic arm flab? Thank you for your time and advice, I appreciate it much

Answer:

It is hard to determine without seeing you but in general, I think taking a conservative approach is best because if you do something like liposuction, you can end up with loose skin. The scars from removing that skin can be quite unsightly. I think that CoolSculpting is a wise way to start, and I do not own a CoolSculpting machine. Best to luck and keep up the hard work

Question:

What is your estimate of SeroVital, an OTC product that claims to stimulate the pituitary gland to produce HGH?  As a postmenopausal woman struggling with weight, fatigue, and sleeplessness. I'd like to try HGH but I can't find any doctors who prescribe it. So I'm wondering if this might be the next best thing.

Answer:

I am afraid that the product you mention will not be very effective. Oral powders and pills have not been shown to be effective in causing the release of growth hormone. The only scientific studies where that was seen was with things that were given intravenously. As to boosting your own levels, things like lower carbohydrate intake, especially at night, makes the pituitary more likely to release growth hormone. Getting a good night sleep is also essential so you can get into stage 4 sleep. You can try liquid melatonin or chamomile to help you sleep. Exercise can also help HGH release. In post menopausal women, getting on a bioidentical hormone regimen does help get your body to release HGH. The symptoms you describe are very common in post-menopausal women and replacing their estrogen, their progesterone, as well as testosterone when the blood levels show deficiencies, can help immensely. I would try that before considering the use of injectable HGH. It can be prescribed if you take a growth hormone stimulation test and you are shown to be deficient, but without a stimulation test is should not be prescribed. HGH would not necessarily correct the weight gain, lack of good sleep or fatigue you have, even if you did take it.

Question:

Hi, Dr. Garcia. I thought I'd follow up on the hemosideran staining question I asked a few weeks ago. I decided that since I donate blood regularly anyway, I'd give that option a shot. Guess what? The next day, the staining had decreased by about 50%.I guess it really did dump some hemoglobin from my system. I'm going to try this again in 60 days when I am eligible to donate again to see if I can get even more improvement. I thought you'd like to know what happened because you always say you learn things by answering questions on this blog. Thanks for your support of all of us out here with crazy problems!

Answer:

Glad it got better. I cannot say how the hemosiderin that was in the skin got back into your blood stream to allow it to go away, but I am glad that it did!

Question:

I know that for a long time, you actively discouraged microneedling, saying that it simply scarred the skin and/or opened pathways to infection. I see from a recent answer that you posted re skin brightening treatments that you now promote it, particularly as a way to introduce growth factor products like PRP. What changed your mind? 

Answer:

Thank you for asking the question. The ONLY reason I am using microneedling now is because I am doing it in conjunction with either stromal vascular fraction additives (Adipose-derived-stem cells) or amniotic cell growth factors form a tissue bank ( in order to be certain there are adequate numbers of factors as well as viability of the cytokines and growth factors). It is still my opinion that microneedling alone will do very little to nothing. What it does do is provide an injury that helps attract the additives we administer to the patient and it is the additives that cause the change, not the microneedling alone. I do not think that microneedling with un-enhanced PRP will do much either as the number of growth factors and cytokines is very small.There are also numerous types of microneedling pens. The hand rollers are not very good for what I need. I use an electric pen that pierces the skin over 1,2000 per minute and I can alter the depth of the injury to what I need, to what depth I want the additives delivered. So my opinion has changed in a way, but not to what most other practitioners do. Hope that clarifies it

Question:

I have extensive hemosideran staining on my lower legs from a pulsed dye laser treatment for veins this past winter. They haven't faded much with time. What would you suggest at this point? Another pulsed dye treatment, but lighter? Something else? My dermatologist has recommended that I donate blood, since doing so would lower my hemoglobin level, thus perhaps diminishing the deposits in my skin. What do you think of this idea? Anything topical I could try? It's pretty depressing. I appreciate you and all you offer all of us who write to you.

Answer:

Pulsed dye laser are known to do that. I think a treatment with IPL might work but it is not a true laser, so its weaker. I think a treatment with a Q-switched Nd:YAG laser is  a better option. Donating blood will do absolutely nothing, not sure why your dermatologist would even think that. The hemosiderin staining comes from the blood that was in the blood vessel that was treated with the pulsed dye laser. After any treatments on blood vessels it can happen and you have to have no sun exposure at all until all bruising is gone, otherwise the staining gets worse and lasts longer. I wish you the best.

Question:

I have a hypertrophic surgical scar. (1 year old). I've had a kenalog injection which improved it about 10%. How many times can these injections be repeated without risking a hypotrophic scar? And how long should one wait between additional injections? Thank you.

Answer:

The issue with kenalog is the dose used and proper technique. I try to use a low concentration, 10mg/ml or less and inject every 6 weeks. Care must be taken to put the kenalog only into the scar and avoid the normal tissue.

Question:

I had CoolSculpting to my upper abdomen last Friday. I've had it many times before without incident, but this time, I have been left with an acute burning and stabbing pain in the treated area. I'm afraid that some nerves may have been damaged. I don't usually panic about pain, but this level of pain is intolerable, and I'm terrified that the treatment may have caused permanent damage. The pain isn't responding to NSAIDs. What do you think, Dr. Garcia? Thank you for your help. I'm feeling pretty desparate.

Answer:

in patients who have had CoolSculpting before and their layer of fat is thinner, the nerves can be affected by the cold. In all cases I have seen the pain passes and the nerves go back to normal. I have not seen one that is permanent. I think I would suggest putting some warm packs or a heating pad  to see if we can control it. As the NSAIDs, I might suggest 800mg of Motrin, so that is 4 of the OTC dose, a smaller dose may no be enough

Question:

Silly question, but I can't seem to get a straight answer from aestheticians, who obviously want to sell their product. Will eyelash extensions pull out the native lashes to which they are attached? I had them applied once but my own eyelashes, which are already quite sparse and thin, looked even thinner after the extensions came off. My aesthetician says it only seems that way because I forgot what they looked like originally in the intervening 2.5 weeks. Sorry for a non-medical question!

Answer:

If the eyelash extension does pull out the native eyelash along with the follicle bulb, the natural eyelash will be permanently gone. Does that happen all the time, no. Does it happen sometimes, yes. Hope that helps, I agree with your skepticism.

Question:

I know that Latisse can cause damage to the meibomian glands. Can Rapid Lash do the same? I'm trying not to aggravate my dry eye condition. Thank you.

Answer:

the reported issues with RapidLash, although rare, are very similar to those with Latisse I am afraid, at least from the published reports I have read

Question:

Does ThermiSmooth cause fat loss in the same way that Thermage, Pelleve, and Ulthera do? I'd like to try it on my face to build a little collagen and to tighten the skin slightly, but I won't do it if it will cause fat atrophy. Thank you.

Answer:

The heat required to damage the fat would be quite high and I have not seen it happen with ThermiSmooth as the probe is constantly moving and the patient has no anesthesia or sedation. The heat generated is done slowly and not immediately as it is in the other machines. In that way, if it is painful, they will let the operator know and the session is stopped before fat loss occurs.

Question:

Does ThermiSmooth cause subcutaneous fat loss the way that Thermage, Pelleve, and Ulthera do? I would like to try it to build a little collagen in my face and to tighten my skin a bit, but I obviously don't want to do that if it's going to cause fat atrophy.  Thank you.

Answer:

puposeful fat loss can be performed on a mild scale with ThermiTight, but it is usually avoided by maintaining the internal tempeature below a certain level. That is the advantage of ThermiSmooth as it has instananeous tempersature monitoroing so we can prevent fat loss. As to tightening the skin, that is where Thermi does really well as it can heat the tissue to create new collagen and shrink the collagen that already existed. The areas of the face that respond the best are the neck and lower face when it comes to ThermiTight

Question:

Does ThermiSmooth cause subcutaneous fat loss the way that Thermage, Pelleve, and Ulthera do? I would like to try it to build a little collagen in my face and to tighten my skin a bit, but I obviously don't want to do that if it's going to cause fat atrophy.  Thank you.

Answer:

I have not seen or read about un-lannedfat loss with ThermiTight. I will say that if one desires to mildly reduce fat, a higher probe temperature and internal temperature can be produced, but as Thermi is able to monitir tissue temperature instantaneoulsy, that can be avoided

Question:

I'd like to try ThermiSmooth on my face to build some collagen and to achieve some mild tightening, but I'm afraid of subcutaneous fat loss. I know that this is a problem with Thermage, Pelleve, and Ulthera. Is this also a problem with ThermiSmooth? Thank you for sharing your vast knowledge with us all.

Answer:

The heat required to damage the fat would be quite high and I have not seen it happen with ThermiSmooth as the probe is constantly moving and the patient has no anesthesia or sedation. The heat generated is done slowly and not immediately as it is in the other machines. In that way, if it is painful, they will let the operator know and the session is stopped before fat loss occurs.

Question:

I'd like to try ThermiSmooth on my face to build some collagen and to achieve some mild tightening, but I'm afraid of subcutaneous fat loss. I know that this is a problem with Thermage, Pelleve, and Ulthera. Is this also a problem with ThermiSmooth? Thank you for sharing your vast knowledge with us all.

Answer:

The heat required to damage the fat would be quite high and I have not seen it happen with ThermiSmooth as the probe is constantly moving and the patient has no anesthesia or sedation. The heat generated is done slowly and not immediately as it is in the other machines. In that way, if it is painful, they will let the operator know and the session is stopped before fat loss occurs.

Question:

What causes Brown Spots on my face?

Answer:
YOu need to sleep at least 8 hours a day to fix teh problem
Question:

Thanks for answering my question about chest striations. You mentioned that perfume should not be put on that skin, which I don’t do. But I’m curious as to why one should not. I do tend to put it on the back of my neck. Will that degrade the skin? (I use essential oils.) Thank you. I learn so much from reading your site!

Answer:

The alcohol in the perfume magnifies the bad effects of the sun and causes more damage than in no-alcohol area is the reason. Your essential oils are fine. Thank you for the kind words.

Question:

Hi, Dr. Garcia. You kindly advised me about supplements earlier this week. The only supplement on your list of suggestions that I wasn’t taking is MSM. I’ve found conflicting advice on the internet about the optimal dosage for joint health. What do you recommend? You also recommended zinc, 100% of the daily recommended dosage of which is already included in my multivitamin. Why do you think I should take more — and if so, how much more? Thanks so very much!

Answer:

I suggest starting at 500mg per day and I suggest increases by 500mg, to a max of 6,000, although that dose is rarely needed, always take it in divided doses too. I think that is plenty on the zinc.

Question:

My doctor is offering the HCG diet (for $2500!). The diet consists of a highly restricted caloric regimen of just 500 calories/day along with prescribed exercise, which in and of itself would necessarily result in weight loss. The claim is that the daily HCG injections prevent muscle loss and depress hunger throughout the 6 or 8 week course of “treatment.” Is that claim accurate? And if so, I assume that once one stops injecting oneself, one’s normal level of hunger returns and the weight will come back with increased caloric intake. I trust my doctor. She’s a good practitioner, but this seems like a starvation/crash diet with an expensive pseudo-medical scam to cover it up. Gosh, you’d think that you could SAVE money by eating so little, not go into debt. Anyway, if you think it’s a good and safe medical approach to weight loss, I might try it to lose the 15 pounds I gained after menopause and have been unable to lose for a decade no matter what I do. (1200-1400 calories of nutrient-dense food/day and at least an hour of cardio daily coupled with weights and resistance work.) Thank you for your opinion, Dr. Garcia. Happy New Year!

Answer:

That is the claim, but if you think about it, in women, they have the highest levels of normal hcg during pregnancy and I have never heard of a woman who is pregnant losing her appetite. I would do the diet and exercise and skip the hcg. As an aside, the physician cost of hcg is literally pennies per day, so the fee of $2,500 is a little outrageous

Question:

What do you think is the best treatment(s) for the vertical lines that develop on women’s chests with age? I assume that sun damage is part of the problem, but I’ve been careful my whole life about full protection. I’ve tried Total FX (didn’t do much except make me red for two months), and I use Retin-A and moisturizer as well as sunblock, of course. I’ve heard that diluted Sculptra can be helpful. What do you think? Have you used ThermiTight on that area before?  What about DermaPen/microneedling? I’m 56 and white.

Answer:

not a believer in the DermPen, I do think Sculptra would help some as well as ThermiTight, but it is a tough area. It comes from sun and sleeping on your side causing the skin to fold. Women also put their perfume in that area and that intensifies the sun’s effects, so put it on the back of your neck

Question:

I had cool sculpting to my lower right quadrant last week. Now for the past 3 days, I have had a constant, pronounced aching pain there, like a cramp from diarrhea, though I’ve had no intestinal symptoms. I have no fever, so I’m not suspicious of appendicitis, but I wonder if I should be. What do you think? I appreciate your opinion and time, Dr. Garcia.

Answer:

It is likely some muscle pain from the skin and fat being pulled up into the CoolSculpting head and causing almost like a pulled muscle. A heating pad and Motrin along with a little time should help you until it goes away in a little bit.

Question:

Hello dr Garcia, would Kybella be beneficial if you only have a small amount of fat & skin under the chin or is it meant more for people with more fat to get rid of?

Answer:

the less fat there is the better the cnadidate

Question:

How long after an Ultra Shape tx should one see results? And how necessary is that crazy strapping they put over the abdomen? It prevented the areas I really needed treated (upper abdomen -- just under the breasts -- and lower abdomen -- just above the mons pubis) from being treated. I tried to push that tissue down and up, respectively, into the exposed area for treatment, but it would have been far more effective without that crazy girdle thing. The nurses who did it were so into following their training protocol from the reps that they were afraid to take the girdle off and treat those areas. I'd had lipo on my abdomen years ago and don't need any more fat removed from the center. Anyway, I did one treatment and see no difference. How long does it take? And also, do you think I can talk them into treating the areas that need it? Thank you.

Answer:

the straps are needed to focus the ultrasound. The company is developing new attachments to treat smaller areas. The effects can take a few weeks to be seen as the fat cells that are destroyed take time to be absorbed. As to talking them into treating those areas, I cannot say what they will be willing to do. Might just be easier to get some small amount of liposuction to the areas that bother you.

Question:

I am forced to wear a wig due to hair loss following thyroid treatment. I’ll be in it for at least a year, probably more. I have a big head, so the wig is bending the tops of my ears forward. I’ve tried many wigs, and this happens with all of them. Am I in danger of permanently bending my ears? I’ve heard that it’s not possible to “train” cartilage to go in a desired direction by taping it, so I’m hoping that it’s not possible to “train” it to go in the wrong direction by pushing it forward. Am I right? Thank you.

Answer:

It will not permanently fold the ear down as it is pretty firm. You can try cutting  into the wig where it does that so that it does not feel uncomfortable though. Might be worth a try just for increase comfort.

Question:

I hope you and your family are enjoying a lovely holiday weekend, Dr. Garcia. I\'m writing because last year, I had 6 rounds of sclerotherapy to my legs and was left with terrible matting. It also didn\'t work all that well, which was really disappointing. (I had ultrasound studies, and they didn\'t reveal any deep venous disease, so I\'m not a candidate for EVLT, which I had hoped I might be.) Anyway, the vascular surgeon has tried Nd YAG treatments and V Beam, but they haven\'t worked. Do you think I should try more sclero on the matting itself?  Do you have any other suggestions?  Thanks for this great service you provide to all of us!

Answer:

To be honestly I am not sure that more sclerotherapy would help as it did not work before. You can try it though, maybe with a little stronger solution being injected to irritate the vein more. Usually we suggest the lasers but sounds like the two you have tried have not worked. If there is a pulsed dye laser in your area, that would be the next step. I wish you the best and thank you for the kind words

Question:

What is the "steroid pack" you're recommending for my sister's surgery? Don't steroids decrease bone density -- even one round of them? She has osteopenia and has to be careful with that. Thank you.

Answer:

It is a Medrol Pack, it has a decreasing does of a steroid that you take just for a few days. Steroid scan decrease bone density if used for a prolonged period of time, but not from short term use.

Question:

Thanks for your answer about my sister's hair loss. Her surgery was last January. Her surgeon agrees that it needs to be re-done and has offered to do it for free again in January. She'd love to try but is worried that since her hair fell out once, it will do so again.  Do you know if that is likely? Her surgeon had never heard of or seen hair loss following surgery, so we did our own research and learned that it's from a cortisol response from the metabolic stress of surgery. It happens to some people but not to others. What we can't discover from our research is whether or not it happens to some people all the time and to others none of the time, or if it's just random. She's considering doing the surgery anyway because she's already lost her hair anyway and is in a wig, but obviously, she'd like to avoid more hair loss if possible. If it is the case that once it happens, it's likely to happen again, are there any steps she -- or the surgeon or anesthesiologist -- can take to mitigate it? Thank you so much for your help. You are awesome!

Answer:

repeat hair loss is a possibility. I might suggest a steroid pack around the time of surgery to decrease her stress hormone, cortisol, release. It does not happen again 100% of the time, but there is a risk, yes. I wish her the best

Question:

I saw the question two days ago about telogen effluvium and I'm looking forward to learning your answer (did you miss that question because it hasn't been answered yet?) because my sister is going through the same thing following cosmetic surgery. The frustrating thing for her is that her facelift has made little to no difference in her appearance except for the fact that it's caused her to lose almost all of her hair and to give her highly visible scars. The upshot is that she looks absolutely terrible (and much older) from the hair loss, is disfigured by the scars, and is no better off from the facelift. She's an advertisement for why one should never even consider plastic surgery. It's really a shame because she saved money for many years for this surgery, which she really did need aesthetically, and had been looking forward to its results.

Answer:

I did answer the question, but in review, the hair falling out can go on for 3-6 months. There will be some hair follicles that will turn back on during that time. Not all the hair follicles will lie dormant until 6 months. Some will starting growing back sooner. The amount of hair that can be seen though is going to be quite fair. like baby hair, and it can take a few months in order for ti to provide coverage of the scalp. I am sorry to hear about your sisters situation. I wish her the best. I might suggest some Male strength Rogaine in the meantime

Question:

Any good? Any improvements or upgrades since it first came on the market? Worth the money? I'm thinking of using it on just one spot on my inner upper arms. I don't want to do liposuction there for fear of developing sagging, crepey skin. I'm relatively thin. Thank you.

Answer:

I think UltraShape is a very effective method for non-invasive localized fat removal. I do think it is worth the money. You will need to see if they have released the setting for arms though. Its initial release was for the abdomen alone.

Question:

I've been reading a lot about ThermiTight here and elsewhere. Can it be used on loose elbow skin, not the upper arms? I have tight and thin upper arms but my elbows look like an accordion. Is there enough tissue under the skin to make this a useful treatment? I tried ThermiSmooth -- the cutaneous version of this system -- but it did nothing. Thanks for your opinion.

Answer:

I think in areas of flexion that there can be some mild improvements, but the skin stretching over and over when bending the elbow will likely limit the results. Certainly safe to do if you want to try it, but it is not a common area compared to other areas of the extremities. I have never done the back of the elbow area before.

Question:

While you're discussing temperatures for the ThermiSmooth, what about ThermiTight? I had it done last winter, and the surgeon stopped at 44 C -- and as soon as he reached that temperature; that is,  he didn't linger there to keep the tissues at 44 C for more than 5 seconds. I have a friend who did ThermiTight with another surgeon, and he said that 48-50 C is the real clinical goal and that one must keep the tissue at that temperature for a while. I must say, my friend's results are far better than mine. What is your own temperature upper limit before you would worry about burns? Thank you.

Answer:

The ideal temperature for Thermi Tight varies depending on the region of the body and what one is trying to achieve. If nerve weakness to limit forehead wrinkling is desired it requires a very high temperature, destroying fat will also need a higher temperature. For skin on the face it can vary. I know of some surgeons that let it go to 50 for a bit but most will top it off at about 44. The length of time at the temperature does matter. I have found that taking it to a skin temp of 44, then moving to  a different area and returning to the previous area and raising it to 44 works quite well. The second, and at times third pass to 44 comes quicker every time. Also important to note is the difference between probe tip temperature and skin temperature. We do not like the skin temperature to go over 44, but we commonly use probe tip temps of 55-60. Ultimately it is time at temperature that matters.  Skin temp at 444 will make me move to a different area but I will return to that area again and bring the temp back up, aiming for a minute or two at 44 if I can .

Question:

Dear Dr. Garcia, I had ThermiTight to my upper arms last week. The surgeon who did it suctioned 10-12 cc's of fat from each arm because he said doing a little liposuction helps the RF to work better. My arms were already fairly thin, so I was worried about removing fat because I don't want loose, crepey skin. I know that it will take up to 6 months for the final (and, unfortunately, temporary) results to be evident, but I also understand that some improvement should be immediately visible after the procedure. That's what the literature says, and it stand to reason that even a little tightening should be apparent after so much heat has been applied to the tissue. Certainly, it shouldn't look worse, right? Well, I'm afraid my arms do indeed look worse, especially one arm. I now have "flapping" upper arms, which I didn't have before. I elected to do the procedure for prophylactic reasons.  What do you think happened?  Is it possible that this procedure did make my arms worse rather than better? I appreciate your perspective and opinion.

Answer:

Immediate results can be seen but are not the usual scenario, especially off the face on areas such as yours. That will take time, 2-4 weeks to begin to see things start to improve. I have not seen flapping of skin afterwards, more swelling than anything. I do not think the small volume of fat removed is enough to cause the increased looseness though as it is a very small amount. As to performing it for prophylactic reasons, I am not sure if that is worth doing and I have not done it for those indications. Best to wait until it is needed.  I think any worsening of the issue is unlikely and I think the worst case scenario is that once everything is healed, you would go back to the original appearance. I have never seen anyone go to a worse condition after the procedure, even with liposuction of small amounts as you described. I know it is tough, but hang in there, it will get better.

Question:

Dr. Garcia,  you have been immensely kind and helpful to me as I've coped with telogen effluvium following surgery. I am following your advice and using Rogaine as well as practicing patience and hope! I sincerely apologize for asking a third question on the same topic, but I've done a great deal of research and can't find the answer to this very specific question. You've assured me -- and I believe you, thank you!! -- that all the hair that is falling out is being replaced by new hair, but what I can't find out is this: When the old hair sheds, does that mean that the new hair beneath it has already come through the scalp (though I can't see it yet), pushing out the old hair, or does it mean that the new hair growing beneath the hair that is shedding is still under the scalp? If the latter, then how many weeks between the shedding of the old hair strand and the breaking-through-the-scalp of the new hair? From there, I can calculate the visible new hair growth at .5 inch/month, which would give me great encouragement. Thank you for putting up with me, Dr. Garcia. I'm trying to get as much information as I can not only to calm myself down but also to help my husband who, for the first time in all this trauma,  lost it today (in sympathy for me.) He burst into tears this morning when I took off my head scarf and cried even harder when he saw the sink full of what had remained of my hair! I'll try not to pester you again. We truly appreciate your kind and generous help. Thank you.

Answer:

God question. It is a misconception that when the hair falls out that there is a hair already growing that pushes it out. What actually happens is that the hair goes into a resting phase first. The follicle lies dormant for up to 3 months, but the hair can fall out at anytime during that 3 month period. If it falls out early in the period then there is a long time before you see a hair grow in the same place. If it falls out later, then the time is less. The difficulty is we cannot say when thee follicle went dormant.It is not a bother, ask away at anytime.

Question:

When will this injection to reduce neck fat be available? Sounds promising, and so simple. Do you believe the hype?

Answer:

We are hoping late summer or early fall of this year.

Question:

I have thickened, bumpy skin texture directly underneath my eye hollows. It kind of looks like seborrhea keratosis warty appearance, but it is skin or not a growth that is noticeable like seborrhea keratosis. One doctor told me it was enlarged pores with thickened skin. I don't see large pore holes. Is it enlarged pores? What is the bumpy texture? Or how can I treat or get rid of it?

Answer:

It is very difficult for me to say without seeing you. It can be pores and that with microdermabrasion and Retin-A can be reduced. It might be another problem though. I would suggest seeing a dermatologist to see what it is exactly before you go spending money on things that may not help.

Question:

I wrote to you a few weeks ago about chemical burns on my face. Unfortunately, I've been left with red scars in both place where I was burned. What do you suggest? My dermatologist, at whose office this happened at the hands of her aesthetician, is suggesting V-Beam, but isn't that only useful on vascular lesions? I'm not clear how this would help. What do you think? Is she just offering me a treatment to compensate for this injury, even though it won't help at all? If so, what else would you recommend? Thank you.

Answer:

The Vbeam and Nd:YAG lasers both work on the color red. They are both used to fade the red in a tattoo or in your case a recent burn. I do think it will help to fade the redness. I think you can proceed with it to shorten the recovery from the burn.

Question:

I bought one of those tanning sun lamps at a grocery store in the 1980s. It was only on the market for a short period of time, then it was banned due to health risks. I think I used it around 3 times. I don't know if it poses the same or more risks than tanning beds or why it was banned if tanning beds aren't banned. I thought I heard any sun damage you get will show 20 years later. Since it has been over 20 years, I am clear from getting skin cancer, etc, from use of this product. I looked like a lobster after using it, but then the red turned to tan.

Answer:

Well you can still get cancer on your skin as there has been others sources of sun since that time. I think if you only used it three times that it will have little effect on your skin cancer risk though.

Question:

What ingredient(s) can make a cream absorb better/deeper in your skin? 

Answer:

not many really that can enhance absorption, the size of the product that you want to absorb cannot be changed. Creams with petroleum will make it harder to absorb though

Question:

Dear Dr. Garcia, I see in a recent answer you offered that you have not found anything effective for hand veins. I thought you and your readers might like to know of a success story. Ten years ago,  I had the veins on the dorsum of both hands sclerosed in just one session by a vascular surgeon. They haven't returned yet, though I know they may. Perhaps others will have good luck too.

Answer:

Thank you for sharing your story. I am glad it worked for you. My fear in doing that is that it could diminish the outflow of blood from your hands and cause potentially permanent swelling.Similar to the lymphedema that can occur when lymph nodes are taken out of your armpit for cancer. I am glad your experience went well, but with the limited number of veins carrying blood away for your hands, I would be cautious with that approach.

Question:

Can you have sculpture injections in hollow eye area at same time you have that area co2 lasered? I'm not dsure if sculpture injections are injected from nasiolabila area instead of directly in hollow eye area?

Answer:

I would never inject Sculptra into the lower lid hollows, with or without a laser. The risk of granulomas is very high with that product used in that area.It is not recommended for use there by the company. Sculptra is intended for deep injections where there is tissue or fat loss. It is injected into the cheek area most commonly to lift the cheek skin.

Question:

 I have a nasolabial fold that is much deeper on one side. Although I tried fillers in this area, it still is prominent afterwards. I tried pulling my skin to ear to see if I needed facelift there, but it looks funny or rises up when I do that. How can I improve this? If you are going got stay filler, which filler is best and should be injected into nasolabial fold or cheek area>

Answer:

the looking funny can be due to the direction you pulled the skin. Properly pulled, a nasolabial fold can be decreased with a cheek or facelift and in some cases by using as filer such as Sculptra if there has been fat loss in the cheek region. The Sculptra is not injected into the fold, it is injected into the cheek though

Question:

What tool is used to shave down the chin to make contour symmetrical? Is a saw used?

Answer:

it can be done with a burr or a saggital saw, either one

Question:

For nose revision with rib graft surgery in females, what number rib is usually used? I am confused why some doctors make incision in breast fold while other doctors make in incision at another rib number? Is there a better rib number to make incision at? What is best rib number so an indentation in chest does not result?

Answer:

It is usually one of the ribs below the level of the breast bone where it is attached by cartilage and easily removed. Incision is typically underneath the breast in a female. There is not one rib that is better than another.

Question:

What are common antibiotics prescribed after nose surgery

Answer:

Usually it is Keflex or Augmentin.

Question:

Which filler is best for areas around chin? And how long does it usually last?

Answer:

I usually use Perlane or Restylane for that and it varies in terms of how long it lasts. It can be between 2-4 months in most cases.

Question:

If you have filler under eyes, will it evaporate if there is swelling from rhinoplasty?

Answer:

The areas are far enough away that the filler should remain in position and not be disturbed.

Question:

If you have filler around the chin pads on your chin and have chin contouring surgery, will the filler leak out if an incision is made at bottom of chin?

Answer:

no, the filler is held in the tissues and is not liquid enough for it to seep or leak out of the tissues.

Question:

Is cadaver osteochondral allograft the same as donor rib graft? Do both of these last or resorb?

Answer:

Yes, they are the same thing. They will scar in but the bone will not be alive as it was in the original body. It will last many many years but as it is not alive it can warp in some small percentage of cases over time. They do not resorb like fat though, there will be a strucuture of support for many many years.

Question:

ThermiSmooth -- the topical application of "ThermiThight", which is subcutaneous.  Worth it? Effective? My PS is pushing 4-5 treatments/area to build collagen and tighten the skin on knees and upper arms. Seems like it might be a waste of money. What are your thoughts? Thanks for your time!

Answer:

ThermiSmooth is topical and less effective than is the ThermiTight, which is where the needle or cannula is placed underneath the skin and greater temperatures are achieved for a more dramatic effect. I think for arms and knees I would do the ThermiTight as a single session and repeat after 6 months if needed. I do not think the ThermiSmooth will do much for knees are arms. It is more for the face than other areas when used topically. The ThermiSmooth is cheaper though and can be done by a nurse or other trained person where the ThermiTight is a bit more expensive and is done by the physician.

Question:

If you have a slightly double chin, how do you know it is due to saggy skin, loose muscle under chin, or weight gain (I recently gain 15 lbs). Are there any tests that can show which one is the cause? Could just 15 lbs give me a double chin?

Answer:

weight gain of that amount can certain change you appearance below the chin. If you did not have the double chin before the weight gain, it is more likely fat. Loose skin or loose muscle would have been seen at your prior weight.

Question:

I have a question about chin reduction surgery. First, is the chin part of the jaw? I have square edges on my chin that I would like shaved down. I am confused what the difference is between shaving the chin bone or burring the chin bone? Also, what do wedges removed mean? Wouldn't wedges be shaved down? 
And is the masseter muscle on the chin or just on the jaw? I don't know if the chin and jaw are the same thing. I heard that botox injections can shrink down the master muscle on the jaw to make it look less share shape, but can botox injections also make a square chin look more oval? Over time with continued botox injections, will this master muscle permanently shrink so no more botox injections required?
 

Answer:

The chin is part of the jaw bone, yes. As to shaving or burring the bone, it is the same thing, done the same way. When wedges are removed that is where the bones are cut with a reciprocating saw blade, a slice is removed, and then the bones are attached with plates and screws. The masseter is just on the back part of the jaw bone, not on the chin.The amount of muscle on the chin is small and Botox would not give a rounder appearance if used.With repeated injections the muscle does atrophy, but not on a permanent basis, the Botox would need to be continued indefinitely.

Question:

Can orange-like texture on chin be improved by cutting incision underneath chin and somehow smoothing out the chin muscle if the chin muscle is bunched up causing the orange-texture? Or what is cause of the orange texture?

Answer:

The orange texture is due to small amounts of fat being lost between the skin and the muscle. Some doctors use low dose Botox to help it temporarily but not permanent. Fillers can also be used but again, only short term relief. doing what you are suggesting will likely make the problem worse.

Question:

Hello Dr,
 
how soon after having fat transfer to the face is it ok to have a microcurrent facial?
 
Thanks

Answer:

I would wait 4-6 weeks to allow all of the swelling to go down.

Question:

Thank you! An incredibly helpful, constructive response. I really appreciate it!

Answer:

you are very welcome

Question:

Dear Dr. Garcia, I wrote to you a few weeks ago about subluxed joints (proximal interphalangeal) on my fifth fingers, bilaterally. I saw an orthopedic surgeon who specializes in hand surgery. After X-Rays and clinical exam, he has determined that the lateral tendons on both fingers have slipped out of place (likely from a lifetime at computers) and that they need to be surgically repaired, preferably sooner rather than later before the tendons completely rupture from the friction of being dislocated, at which point suturing them back in place would be extremely difficult. ("It would be like sewing together wet tissue paper if that happens," he told me.) I asked him about alternatives to surgery (he injected cortisone, but as he predicted, it did nothing to fix this mechanical problem), and he told me that he is conservative and doesn't recommend surgery unless it's absolutely necessary. I mentioned this to a friend of mine who is a general surgeon and he urged me to avoid hand surgery "at all costs" because "hand surgery almost never, ever works and usually makes things significantly worse." I admit that this has been my own opinion from my casual observation of friends, colleagues, and family members over the years who have had hand surgery. Though my own colloquial sample is small and definitely not scientifically significant or relevant, I can't recall knowing of a successful hand surgery, even at nationally renowned orthopedic hospitals, like the one where I am seeking my care. I believe that my own surgeon's diagnosis is correct, but I don't know if I should risk tendon ruptures (which he predicts will happen within 6-12 months) or risk the surgery. Both options might alter my life and significantly limit my ability. Right now, the problem is annoying and uncomfortable but not crippling or extremely painful, but if I do nothing, I am told I would be courting danger. In addition to needing my fingers for ordinary living -- like grip strength, typing, ADL's, etc. -- I'm a cyclist and an amateur musician and need all my fingers. I'm not usually afraid of medical interventions, but I'm reluctant to make this situation irreversibly worse. By the way I have a second opinion lined up, though I'm pretty sure I'm going to get the same diagnosis. Before proceeding, I'm collecting as much advice as possible. If you were in my situation, what would you do? Of course, as a surgeon, you need every one of your precious fingers! But as a surgeon, you also know far more than I about the potential risks of this admittedly minor procedure than I ever could. Sorry to sound like a chicken, but I don't want to do something I'll regret for the rest of my life.  Thank you for sharing your thoughts with me.

Answer:

The problem you have is relatively less problematic to fix compared to the hand disasters of others. It involves essentially creating a small slip over the tendon to not allow it to sublux. Taking a piece of the non-functional palmaris longus tendon can be done to create the slip. As there is no actual joint or bone work, which is where the major problems come from, it should do well.  As to the cortisone, never do it again, it helps the pain short term but actually allows destruction of the cartilage and soft tissues. I would suggest proceeding with the surgery in your case and with your work and passions.

Question:

I have small, flat, shiny spots on my arms. Are these actinic keratoses? I've had 5 Fraxel ReStore treatments (which apparently have been FDA approved for the treatment of these lesions, but that doesn't necessarily mean that it's an effective treatment) and several peels (VI Peel, 35% TCA, etc.). My skin is a more even tone as a result of all that, but I still have the lesions, though they are lighter than they were before all those interventions. Would spot treatment with another few rounds of the strong TCA peel help? Cryotherapy? (But wouldn't that leave a burn scar bigger and more noticeable than what we're trying to treat?) More Fraxel? Apparently, there are a couple of topical treatments that are quite harsh, which my dermatologist uses on faces from time to time but he has cautioned me that arms don't heal as robustly as faces, so he thinks it would be 1) painful and 2) more unsightly, at least for quite a while during the healing process, than what I currently have. What are your thoughts? I appreciate your help.

Answer:

I am not sure what the lesions are but the safest option would be to use the Fraxel ReStore rather than more chemical peels

Question:

What is the best treatment for hemosideran staining after sclerotherapy? Very pale white skin. Thank you!

Answer:

I would suggest a Q-switched Nd:YAG laser. It will likely require a series of sessions to lighten it though.

Question:

I forgot to tell you that the first surgeon also completely obliterated the center of my upper lip, making it wierdly flat. The surgeon who corrected his work even managed to give me a natural-looking dip in the center, which frankly was even better than what I was born with. She was amazing!

Answer:

Awesome!

Question:

Hi, Dr. Garcia. It's the infamous gullwing lip lift lady again. You've been so extremely patient, generous, and helpful that I thought you'd want to know how this turned out. As you may remember, I had this lip lift to try to correct some of the visual effects of the hemi-paralysis I had suffered during a small cheek lift years ago. Only one side of mouth moves when I speak. (I also can't move that cheek, and I've had to have multple procedures to protect my cornea, which has desiccated because the lower lid now sags due to the paralysis. It's been fun.) Anyway, after the  gullwing lip lift, I was left with a dark brown line about 1/4 inch above my whole lip, making me look like I had a mustache, and to make matters worse, the corners of my mouth became depressed, sunken, and measurably turned down as a result of the surgery. The corners looked puckered, like those dried apple granny dolls. Lovely. But perhaps the worst outcome was that the surgeon had lifted the animated side of my mouth more than the paralyzed side, emphasizing rather than minimizing the paralysis. I think he confused which side was paralzed, even  though I had double checked his surgical markings and made sure he knew which was the paralyzed side before he cut. (Let's just say, I've not been lucky with surgeons, though the two I've used are highly respected chiefs of their departments at major teaching hospitals.) Following the surgery, he kept telling me that this would all get better, to just give it time. After months of this, he finally agreed that the emphasized paralysis was not a matter of swelling but was a result of his lifting the wrong side, making the asymmetry worse, and that the scar was not going to fade on its own. But he said that there was nothing I could do to repair it now without making matters worse. So I decided that the best I could do was to try to fade the scar with the help of a dermatologist and just live with the now exaggerated paralysis. Maybe I could join a religious order and take a vow of silence, never speaking again, right? I went to a dermatologist at a teaching hospital near me. He owns every imaginable laser, and he tried everything and anything that he thought might help: Q-switched Yag, short-pulsed Yag, 1064, 1540, IPL, etc. etc. Nothing. No improvement at all. It looked like I would be left forever with a dark brown mustache over my permanently distorted mouth. It was like bright yellow police tape around a crime scene, calling attention to mess within! Finally, I screwed up my courage and went on a few more surgical consults -- this time, with less "famous" but also highly respected surgeons. Each of them was simply appalled by what they saw, and each of them told me that they could improve it. They told me that the incision itself looked widened but in fact that it was not -- that it was, for no apparent reason,  "paralleled" like two train tracks, almost as if the guy who did it made two separate incisions instead of one. No amount of laser treatment would ever fix it.  The scar needed to be completely excised and closed again. They also thought that the paralyzed side of my mouth could be significantly lifted.  I confess that I was, understandably, terrified, to try this again, but I finally decided to do it. The surgeon I chose did a magnificent job. It's like she was a magician. Honestly, Dr. Garcia, it's been just a few weeks, but you can't even see the incision, and you can barely tell that I'm paralyzed when I speak. My teeth even show on that side of my mouth, which they haven't in about 6 years. It's just incredible. I don't usually focus too much on my appearance, and I have been as dismayed by the imposed narcissism (and self-indulgent expense--$10,000!!!) of all this as I have been by the disfigurement, but this is so visible and so central that it's been impossible to hide or mask. It's been really quite traumatic, I'm ashamed to say. I know that countless people live with horrible, life-threatening, or disfiguring diseases, including innumerable children around the world, so I'm very impatient with myself for even a minute of self-pity. But now that this is fixed, I can see what a huge toll it has taken. It feels like I've been released from a little prison. Sorry for the very long story, but I thought you'd like to know about this, and I also thought you'd like to hear a story about how your profession which can, I'm sure, feel on some days pretty ordinary and repetitive (not to mention that it can feel like it's catering to the terminally self-involved) can also make a huge, huge difference in people's lives.  Thank you for listening to all of us with our woes and complaints and for giving us encouragement and advice. I hope that this story will also encourage you to tell your writers that sometimes a completely terrible and apparently hopeless mess can indeed be made much better. I feel very, very lucky. Thank you so much, Dr. Garcia.

Answer:

I am so glad you found someone near you that could help you out. I know form our chats that the has been a true ordeal but you are moving forward now. Keep that positive attitude you have now. I appreciate you sharing your story here. I am sure it will help many people, and for your bravery in sharing, I want to thank you. I wish you all the ebst.

Question:

I meant to ask you: Anything I myself can do to minimize the chance of a nasty scar forming, other than my standard full spectrum sunblock?

Answer:

if it is on the skin you can use Mederma or ScarGuard, but if it is on the red lip, that is not needed. Sunblock is always a good idea for the first 6 months and then when out in the sun

Question:

I slipped on the ice last week and split my lip. (It's been a long winter here in the midwest.)  I went to the local ER and they paged the plastic surgeon on call. She sutured the cut in several layers and closed it mostly along the pink edge of the lip (the vermillion?) in a straight line. The cut didn't reach to the cupid's bow. She said it should heal very well and that I shouldn't even be able to detect it in a few weeks. The sutures come out at 7 days, next Wednesday. It looks just terrible right now and I'm pretty freaked out. Does her optimism seem well placed to you, or is this standard ER discharge-talk to keep patients from needing sedation?! Ha! That is, in your experience, do scars like these usually heal very well? Not in my favor: I'm only in my 40's. If I were extremely old, I know that the scar would turn out to be mostly invisible. In my favor: I don't smoke, take good care of my skin, and am white so haven't formed keloid scars in the past. Thank you for your time.

Answer:

The lip can get quite swollen but it does heal extremely well. It will take a few weeks for the majority of the swelling to go down. Actually as long as there is no tissue missing, the younger you are the better then healing capabilities, so you should do just fine. Keep your appointment and I wish you the best.

Question:

Can eating foods rich in collagen create more collagen in your face? If so, would it affect the underye hollows or make the facial skin any tighter?

Answer:

I am afraid that dietary intake of collagen will not affect your skin. It will not make your skin any tighter. Sorry.

Question:

Last month, I noticed that the knuckles on both my fifth fingers had dropped, looking like classic boxer's fractures; but neither finger was broken. What could cause this? Might it signal some ominous systemic problem? Thanks.

Answer:

they joints ma have subluxed, that can happen without a fracture just due to laxity of the ligaments. Yo should see an orthopedist but I do not think it is a sign of anything worse if that is the only issue

Question:

Are there any creams or laser that can improve sagging skin (or muscle) under the chin?

Answer:

lots of company claim they do but nothing works for that as far as creams

Question:

I think I have prominent nasiolabial folds due to fat or muscle loss (aging in 40s) rather than from smiling. For some reason the side of my face that the nasiolabial folds are deeper looks like it has fuller cheek or the other side looks like I have flatter cheek. I would think the cheek that looked like it had less volume would have deeper folds. 
My question is what filler is best for nasiolabial folds. Do you like sculptra for this area? Is it best to inject directly into the folds or ignore this area to inject above in cheek ara to lift up the skin (if it somehow lifts the skin with more volume). Or I do not know if a mini facelift is better than fillers in the sense that the results will last longer. Bt, I am not sure what types of facelifts result in unnatural, plastic look.
Overall, my skin is in good condition without any wrinkles except I also have deep undereye hollows. And which filler is best for that? Are there any creams I can put in hollows that will plump it up or create more collagen there?

Answer:

for the under eyes I use Restylane. As to Sculptra, I do not use if for folds, I use it to replace lost fat in the face. If it is just a straight forward nasolabial fold I will use Restylane if it is superficial or Perlane if it is deeper. Whether you are a candidate for surgery is something that is best determined in person with a consultation. I do agree that usually the smaller cheek is the one with the deeper fold, not sure why that is not the case in your face though. Hope that answers some of your questions.

Question:

hello dr. Of all the things noticed in the aging process, I have now realized I am developing loose vertical skin in the neck area...ugghh. Ironically, the aging process has gone quite well for the rest of my face, which seems kind of odd. I really don't know what to do about this. At this point, surgery is not an option. Is there anything that fixes/disguises it? I'm not buying into the "strivectin neck cream" hoopla, as I am fairly certain no cream will really be effective.

Answer:

In some patients that are willing to accept a degree of improvement that is less than a surgical lift, we can  do something called ThermiTight. It is a radio-frequency machine that brings your skin up to a desired temperature using a small needle probe below the skin. The heat produced assists in building collagen and tightening the skin. The results come slowly over a few months as it depends on your body to create the new collagen. It is done under local anesthesia in the office, you are a little swollen for about 5-7 days but are back to normal activity after a couple of days. Might be an option for what bothers you

Question:
Answer:

there is nothing new, just the same direct excision and then possibly a CO2 laser.

Question:

Dear Dr. Garcia...I have been going to a dermatological nurse (MN, RNC, FNP, DNC) for 15 years.  She recently opened her own place under an MD, Medical Director, who refuses to prescribe pain meds for plasma or any resurfacing.  (She uses The Portrait by Rhytec.)  I freshen up with the Portrait every 4 years or so, so it was a shock when she told me her new protocol, which was to get my own pain meds, prescribed by my regular doctor or dentist.  She said to ask for 2 10 mg Valium and 2 Percoset.  Is this ethical, normal?  Is it unwise to see her anymore under these conditions?  Would regular general doctors or dentists see this as bad if I asked them for an RX?  I have gone to her for so long that I am really confused, but in my gut it doesn't feel right.  Any insight would help me greatly.  Thank you.

Answer:

Well as to ethical, hard to say, but I think it is improper to make you do that. It points to her supervisor not willing to do what he/she needs to do in order for the patient to have the procedure properly. A much as you like her I would suggest you tell here you are going somewhere else as you do not feel that is the standard of care and are concerned about the new oversight physician.

Question:

Since both these treatments use ultrasound, and since UltraShape destroys fat cells, wouldn't Ulthera also destroy much-cherished fat cells in the face? I've had Ulthera and didn't notice a reduction in fat, but I'm fearful of it. What's your advice? Thanks!

Answer:

Ulthera certainly can and does destroy fat as can be seen in some of their before and after photos. It is all dependent on how much energy is used and how long the probe is over a particular area though.

Question:

Good day, Dr. Garcia. Saw your recent posting about Ultra Shape. It's great that there are these new technologies out there! Wondering if you can compare for us Ultra Shape and Cool Sculpting. Which is more effective in your opinion? Which is more cost effective? And which is more flexible in terms of the areas that can be treated. We all appreciate you so much!

Answer:

in my opinion the UltraShape is more effective.I also think ti is likely more cost effective but the UltraShape can only be used on the abdomen, at least for now, so CoolSculpting wins there. Thank you for the kind words

Question:

Hi, Dr. Garcia. It's the gullwing lip lift lady again. Have you missed me? Gosh, sorry to be a pest, but I thought I'd check in with you. I'm 6 weeks post-op and the brown line above my lip is still very, very visible as is the incision scar itself along the vermillion border. I saw my surgeon last week and he said it looked "good" but that it would take a long, long, long time to heal fully. He had told me originally that it would be about 6-8 weeks of healing, so I am now fearing that 1) he revised his projection based on the poor outcome he saw last week, aiming to reduce my hope that it will look OK any time soon and so 2) over time, I will grow accustomed to this terrible outcome and give up hoping that it will EVER look OK. It's pretty alarming, as there is just no way to cover this. It's made even more noticeable by my facial paralysis, which this surgery was an attempt to mask, to some degree. By the way, I'm white (Type I skin), non-smoker, sun-avoider, sunblock-wearer. The whole thing is a disaster and of course, there's no going back. I'm very sorry to bother you again, but I wonder if you think that what I'm seeing now at 6 weeks is pretty much indicative of what it's going to look like going forward, of if you agree with my surgeon that it will take a "long, long, long time to look better."(Before the surgery, he had promised that the scar would fade to invisibility by 6-8 weeks.) I so greatly appreciate your advice and guidance, Dr. Garcia. You are extremely generous to all who write to you in circumstances like the one in which I  find myself.

Answer:

I think it will get better but it might take a while. In the meantime, and of course discuss these options with him, but maybe some Retin-A on the scar to help fade it or alternatively the use of an Nd:YAG laser done lightly just on the scar to fade the brown color. Those options might speed it up. Sorry this has been such an ordeal for you but hang in there, things will get better, just cannot say how long it will take.

Question:

What do you make of this ostensible conflict? Many anti-aging treatment modalities -- from simple chemical peels to laser resurfacing to various heat-delivery techniques to bio-stimulating "fillers" like Sculptra -- rely on inducing an inflammatory response. In the short-run, these have the effect of imparting, at least partially, the appearance of youth, but in the long-run, don't these just exacerbate and accelerate the aging process, which is--among other things--an expedited version of metabolic inflammation? I avail myself of these many technologies, but I find myself wondering if I'm digging an anatomical hole more quickly than I am filling it by doing so. Should we abandon all of this in favor of (what?) strategies that aggressively reduce inflammation, especially of all depths of the skin? And if so, what would those strategies (other than UV protection) be? Thank you for your learned opinions, Dr. Garcia, and for sharing them as generously as you do.

Answer:

intermittent inflammation is not a bad thing, it is the process the body goes through daily like fighting a cold or healing a scrape,chronic unrelenting inflammation is the bad one. Those modalities you cite only cause short term inflammation so I am not concerned about you speeding up any aging process. So keep doing those little things. Best for the New Year to you.

Question:

What do you think of this product, Dr. Garcia? Of course, it won't deliver miraculous results, but do you think it might be mildly effective on fine lines and age spots (and,  for the blue light, on acne)?  Also, an unrelated question: I had a facelift some years ago which did a nice job but it never picked up the collection of soft tissue accumulating on either side of my mouth, one side more than the other. It ages me oddly; the rest of my face looks young but these soft pouches on my lower face look like they belong to someone 25 years older than I -- like they weren't lifted with the rest of my face, which, of course, they weren't. One plastic surgeon says that nothing can be done to repair this. I think he just didn't want to operate on anyone who'd  had a previous facelift. Another plastic surgeon is recommending an endoscopic mid-face lift. The second opinion makes the most sense to me, but it seems like I'd need to have skin excised too (which an endoscopic lift wouldn't do), probably superior to the anterior portion of the ear, to get this problem taken care of, or else I'll be left with an excess soft tissue envelope over the lifted SMAS. What do you think? Thanks for your opinion. And a happy and healthy new year to you and your family!

Answer:

it might, and I repeat, might help decrease bacteria on the skin, but as to collagen and fine lines, nope, the only thing smoother will be your wallet.It i shard to advise relative to the pouches without seeing pictures, but a limited cheek lift with repositioning or removal of the fat pockets and a small skin excision is likely the best,. I agree that the endoscopic approach has the limitation of no skin removal that is required in most cases.Happy Holidays to you and yours and to a safe and properous New Year!

Question:

Dear Dr. Garcia, You have kindly answered two questions for me recently about corner lip lifts. Well, I had it done and was very surprised after the surgery to discover that the surgeon did a gullwing lift rather than the tiny corner lip lift we had discussed. I have a suture line all the way to the edges of the cupid's bow on either side of my lip. I am even more shocked because I had asked the surgeon to mark me and allow me to look at his marking in the mirror before he began. He obliged, and it was just two tiny marks at the corner of my mouth. Then he wiped those marking off and said he was making more precise pre-surgical markings. I should have insisted on looking again, so I guess it's my own fault, but I believed what I saw the first time. Anyway, the sutures came out yesterday. I know it is still healing but I can easily see that he rolled out the vermillion border at the sides of my mouth, giving me an exaggerated upper lip that is much wider at the sides than in the middle. It changes my face entirely.  It looks like someone who was drunk misapplied a permanent lip liner, going way outside the lip border on the lateral margins.  Is it possible to have someone else lift the cupid's bow? I never wanted any scars on my lip, especially not along the whole lip; but I think I may have to extend this scar to lift the middle of my lip now to try to restore some semblance of balance. I look like a clown right now. Making matters worse is the fact that I have paralysis of the buccal branch of the facial nerve on one side of my face. This surgery was supposed to make that less evident, but it has only made it much, much more apparent. This is all very discouraging. Here's another question for you: The surgeon told me afterward that the procedure would make my mouth appear wider and in fact, it does. I thought that the whole point of a lip lift was to shorten the lengthening of an aging upper lift. How is it that my upper lift now looks longer, not shorter, especially since he did indeed remove a fair amount of skin. The distance between my nasal base and upper lip also hasn't been shortened, which seems very mysterious to me. What do you think happened?  I'm sorry to take so much of your valuable time. You are very kind and compassionate. I hope you receive as much generosity in your life as you offer to others.

Answer:

Revision of the central part can always be done, yes, but give it a little time for the swelling to go down so correct measurements on how much to lift the center part can be done. That might take 6 weeks or more. In the method used  in your case it is wider as the lateral part of the excision that is pulling on the corner of the lip and the rolling out gives it a wide appearance, That is due to the amount of skin removed at that point. Usually it is a minimal excision at that part with a normal gull-wing procedure. Without a central excision the distance from nostril to lip will not be altered. Give it  a little time and you can always send me some pictures in 6 weeks or so and I might be able to tell you more once the swelling has gone down. Hang in there.

Question:

 

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Water, Cyclopentasiloxane, Glycerin, Phenyl Trimethicone, PEG-10 Dimethicone, Hexyl Laurate, Dipropylene Glycol, Dimethicone, Arbutin, Cyclohexasiloxane, Butylene Glycol Dicaprylate/Dicaprate, Magnesium Sulfate, Aluminum Hydroxide, Stearic Acid, Calcium Stearate, Disteardimonium Hectorite, Propylene Carbonate, Polysorbate 80, Propylene Glycol, Triethoxycaprylylsilane, Dimethicone/Vinyl Dimethicone Crosspolymer, Talc, Tocopheryl Acetate, Adenosine, Alcohol, Lecithin, rh-Oligopeptide-1, Glycine Soja (Soybean) Oil, PVP, Platinum Powder, Steareth-20, Chrysin, N-Hydroxysuccinimide, Palmitoyl Oligopeptide, Palmitoyl Tetrapeptide-7, Disodium EDTA, Phenoxyethanol, Methylparaben, Butylparaben, Propylparaben, Iron Oxides, Titanium Dioxide, Zinc Oxide.
 
Thank You for your time!

Answer:

there is no White Gold in it, it is a cream meant to fade brown spots and make your complexion lighter, popular in Asia.

Question:

Do you like this procedure? Do you do it often? My surgeon is recommending it and says it usually heals quite nicely, since the suture line is on the vermillion border and becomes almost invisible. He is planning to remove less than a centimeter of tissue superior to the vermillion border on either side of my upper lip. Thank you for your opinion.

Answer:

well the incision is on the vermillion border for part of it but there is also an incision that goes from the corner of the mouth out to the nasolabial fold, and that one is a little more visible. I do agree though that it heals pretty well. If there is no incision going towards the nasolabial fold I think the degree of lift is minimal.

Question:

I see that you've answered several questions on ThermiTight. All your information accords with what my own surgeon has told me -- that most of the full results will be evident at 4 or 5 months, peaking at 6 months and then slowly deteriorating. I am 2 months post-procedure. I've experienced very, very minimal improvement (as my photos confirm). In light of your timeline, it seems like what I'm seeing is about 50% of the results at this point, right? And I know it varies from person to person but about how long can the results be expected to last before deteriorating noticeably? Thank you for your time, Dr. Garcia.

Answer:

I think 50% is pretty accurate but it is likely less as it takes about 4 weeks for the collagen to be laid down and and then it has to organize, what I mean by that is that for the first 4-6 weeks the skin tightening effect is mild and gets better form then out. That initial tightening is just from the collagen that was already present shrinking some due to the heating, but the new collagen takes time to form and improve.

Question:

9 weeks ago I wore compression stockings on a long flight -- 6 hours. When I took them off, I had dark red marks encircling my legs, around my knees where the elastic was. I'm not overweight, so it can't be that they were digging into fat; and my legs didn't swell at all during the flight. Those marks are still there all these weeks later. 10 days ago, my dermatologist tried IPL and V-Beam to get rid of them, but to no effect. Any thoughts on what happened and what might help? Thanks for your insights. You are quite a person to answer all these ridiculous questions that come flying at you through cyberspace!

Answer:

I am at a loss to explain why they are still there. I would have thought that if there were a dermatitis reaction from the rubber that it should have improved by now. I will say that it is uncommon for a single laser session to remove spots in general so maybe a few more sessions a few weeks apart might do the trick but stick with the VBeam here on out, the IPL is likely not strong enough for what has occurred. There is always a little leg swelling that most of the time goes unnoticed during flights due to the difference in cabin pressure but I do not think that is what has caused the problem. Wish I had more to offer.

Question:

Thanks so much for your answer about the biotin! I realized that my note contained a typo. I'm taking 5,000 mcg, not 5,000 mg! Still, it looks like I'm overdosing and that it won't do me very much good. I appreciate your help.

Answer:

yes back it down to 50mcg a day

Question:

Thanks so much for your answer about the biotin! I realized that my note contained a typo. I'm taking 5,000 mcg, not 5,000 mg! Still, it looks like I'm overdosing and that it won't do me very much good. I appreciate your help.

Answer:

best of luck

Question:

Hi, Dr. Garcia. I asked this question earlier, but you didn't answer it, so you probably missed it. Here it is again: I've been taking 5,000 mg of biotin daily for my hair and nails. Is that the dosage you recommend? Is there any advantage or disadvantage to taking more? Thank you.
 

Answer:

Sorry, I thought I had answered it, must have gotten lost in the ethers. The biotin will only help hair if you are deficient in it, which is possible. It is generally well tolerated but the usual recommended dose for deficiency treatment is only 30-100mcg daily, so you are taking a large dose.If you did not have a biotin deficiency to begin with, it likely will not do much good I am afraid.

Question:

I've been taking 5,000 mg of biotin daily to improve my hair and nails for some time. I think that's the recommended daily dosage. Yes? No? Any advantages or disadvantages to taking more? If there are advantages, what is the maximum daily dosage you recommend? Thank you.

Answer:

unless you have a biotin deficiency the effects might not be very dramatic, but I think that is a huge dose for you to take, although it is pretty safe in general.

Question:

Hi, Dr. Garcia. I had ThermiTight 2 months ago and haven't notice any difference at all yet. I know it takes some time to work and that the results can continue for 6-12 months (in rare cases, 12 months); but shouldn't something be visible yet in terms of improvement? What is the earliest that improvements can begin to be visible? Thank so much.

Answer:

most of what you will see is there at 4-6 months, the speed of the improvements depends to a great degree on what energy was able to be accomplished and the time at that temperature. By now you should see at least a mild degree of improvement. I would suggest seeing your doctor and having some 'after' pictures taken to compare the appearance in a more visual way.

Question:

 
 

Answer:

depending on what is causing the problem, it might be something that can be safely removed, yes. I would need to see you in person to decide what might be a good option

Question:

 
 

Answer:

I would need to see what is causing it but I am sure we can help you take care of the problem. just hard to say what might be needed until I see you. Please call the office and they will arrange a consultation for you

Question:

Hi, Dr. Garcia. I had ThermiTight to my arms two weeks ago. One of the incision sites isn't healing well -- white and black granulation and widening of the wound edges. (I'm a nurse and am familiar with wound healing phases.) I was on Duricef for four days post-op. The surgeon isn't worried and advised warm soaks, which didn't do anything. A dermatologist friend wasn't as unimpressed as the surgeon by this development and applied silver nitrate, which seemed to help a bit, and he put me a course of Keflex. It seems to be getting a bit better but it's still not looking great for such a tiny incision. Any additional advice? Thank you.

Answer:

I might suggest a little half strength hydrogen peroxide twice daily to get any superficial non-viable tissue off, then apply bacitracin or triple antibiotic. I would allow the wound to heal by secondary intent and then if needed, it can always be revised at a later date. Without cellulitis I am not sure there is any advantage to adding the oral antibiotic. Hang in there, it will get better, but never as fast as we want.

Question:

Do you happen to know the target temperature to which MiraDry heats the subdermis? I know that the handpiece keeps the epidermis and dermis safely cool, but I am curious about the degree of heat needed to damage the appocrine and eccrine glands. Thank you.

Answer:

I am sorry but the company does not release that information.

Question:

Despite never having been a smoker, I find that I am getting those pesky little vertical lip lines. Not deep, but just noticeable enough to drive me crazy. What do you recommend as the best treatment? I have heard of something called "restalyne lipp". What is this, and why is it different than regular restalyne? Anything else that would help, that maybe doesn't use filler...I'm a little afraid of that weird puffy upper lip area, that I've seen on some women. Kind of looks a little ape-like, to me.
 
 

Answer:

I think Restylane, or Belotero are good filler options, otherwise a series of ThermiSmooth sessions. The more aggressive would be a CO2 laser resurfacing to create more collagen and shrink the skin.

Question:

Despite never having been a smoker, I find that I am getting those pesky little vertical lip lines. Not deep, but just noticeable enough to drive me crazy. What do you recommend as the best treatment? I have heard of something called "restalyne lipp". What is this, and why is it different than regular restalyne? Anything else that would help, that maybe doesn't use filler...I'm a little afraid of that weird puffy upper lip area, that I've seen on some women. Kind of looks a little ape-like, to me.
 
 

Answer:

If it is the vertical lines that need filling with the new Restylane, it does not have to be injected into the lip so the trout pout can be avoided. As to other non-filler options, you could have a light laser or you could have a procedure called ThermiSmooth where targeted-temperature radio-frequency heating is employed to create new collagen and minimize the fine lines. It is done in a series of 6 sessions a couple of weeks apart. Hope that helps

Question:

Can ThermiTight be used multiple times to achieve cumulative improvement or are the results after one treatment about as much improvement as one can expect?

Answer:

ThermiTight can be repeated for additional tightening, I suggest waiting about 4-6 months in-between toe evaluate the progress though.

Question:

Which do you recommend: MiraDry (microwave) or ThermiTight (RF) for hyperhydrosis?  MiraDry claims permanent results - -that sweat glands can't regenerate; but ThermiTight makes less promising claims -- that there will be an initial reduction in sweating followed by a return of the phenomenon, but at a lesser degree than it had previously existed.  What's the science behind this? How can the glands, injured by any kind of heat, ever function again? And which of these two technologies do you think is most promising? Thank you!

Answer:

Between those two I would suggest the MiraDry. ThermiTight does not have it tested for as long so I would wait on them for this indication.The issue is they cannot tell what percentage of the cells were injured versus killed, and that is why there is a chance of the sweating coming back. If they are only injured they go int a state of shock and can heal themselves as long as the injury is not too bad. If it is a bad injury they die and never produce sweat again.

Question:

I had a small face and neck lift several months ago in which only the very top of the platysma muscle (submental) was sutured and suspended. It didn't really do all that much for my neck, so I went to a few other plastic surgeons. No one really likes to do full neck lifts any more, it seems; all of them are pushing less invasive procedures like various RF procedures and ultrasound (ulthera), etc., though I think at this point, I need a full corset platysmaplasty. Anyway, I settled on one surgeon who did ThermiTight on my neck. What I hadn't fully understood is that he needed to undermine the tissues on my neck that the previous surgeon had suspended. As he was doing it and this was becoming evident to me, he insisted that separating those tissues and introducing the RF energy would only tighten, not loosen, the previous surgeon's work; but that makes no sense to me. If you rip out a seam you've sewn into fabric and don't sew it again, even if you shrink the fabric a little bit, it won't hold together as well as it did before. Did he essentially un-do the previous surgeon's work? I fear he may have, as I now have once again the bulges under my jaw that the previous surgeon repaired. The current surgeon is giving me the standard line about 6 months of collagen remodeling, etc., and telling me that it will be like the facelift I had only better; but it seems to me that, at best, in 6 months, I'll just be back to where I was before the facelift, since he ripped apart the suspension that the first surgeon accomplished. I wish I had never done this. Furthermore, it seems that I just threw away all the money I spent on the facelift AND paid someone else even more money to undo it. I'm as heartbroken as I am wallet broken. What do you think? Why don't surgeons do full neck lifts anymore? It's ridiculous, all this "less invasive" nonsense that doesn't really accomplish much of anything at all. I know it's less risky, but if it's unproductive, or, as in my case, potentially counterproductive, it needs to stop. Is this being discussed in your professional societies? Someone has GOT to start telling truth about all this. Less invasive is not necessarily better; in fact, it's just disappointing and a huge waste of  patients' hard-earned money and time. Thank you for your time and insight. 

Answer:

I do not think he undid the suturing into the platysma that had been done previously while doing the ThermiTight. I will say that the skin was separated from the muscles and that needs to be done to tighten the skin. The effects of the ThermiTight do take 6 months to get the final effect. Less invasive is exactly that, less invasive, but that also means less effective. ThermiTight is not surgery, both in the good and in the bad. It will never achieve the effect you can with a neck lift, but it is a lesser procedure. As to why surgeons do not do neck lifts anymore, I cannot say as I routinely do them to this day. There are some patients that do not need a full neck lift and in those cases I offer the ThermiTight, but they compliment each other, they are not equal. You were nto happy with ethe facelift but I do nto think the ThermiTight will do anything negative. It might not make a huge diffirence and it does not tighten msucles, but the skin will get better to some degree.

Question:

I'm scheduled for ThermiTight for my upper arms, which have a mild amount of laxity. I'm female, 56, white, non-smoker, almost no sun damage, 5'5' 115 pounds. I know it's hard to say precisely, but in your experience, about how much improvement in terms of tightening should I expect? 5%? 20%? 50%? More?  I suspect my own doctor believes in the wise principle of "under-promise so that any delivery will be a bonus." All he'll say is, "We have no way to tell if this will actually help at all." Of course, when pressed about why, then, he offers the service, he says that RF heat will contract tissue. What is your experience with this, Dr. Garcia? Thank you.

Answer:

I usually tell patients about 30-50% but I used to think that the tightening was done after about 6 months and now I have seen things get better for up to one year in some patients. If you have stretchmarks on the skin it will be less of an effect

Question:

So in your opinion thermage is not worth the money? I don't want to spend $3500 ( for face and eyes) if it not going to be worth it. Would Titan or ultherapy be a better way to go? Thanks :)

Answer:

I am sorry but in my opinion, I can not recommend any of those modalities, sorry.

Question:

What is your opinion about thermage? Is it something you do often. Was recommended to me to as a nonsurgical way help with under eye creases and things that aren't responding the best to fillers. I am a marathon runner and am wondering if that is causing me to break down fillers quickly under eye creases t

Answer:

the running has not been studies to see if it impacts the speed of the aging process but it does create a lot of free radicals that can contribute to aging, so that is a question that will be answered over time by investigators. As to Thermage, I have not seen it be worth it in general or the eyelid skin especially as it is very thin skin and the energy level tolerated is lower.

Question:

Which is more clinically effective in your opinion? And which is more cost-effective?

Answer:

I think the Ultrashape is more cost effective but it can only be used on the abdomen at the present time, from what I understand

Question:

What do you think of garcinia cambogia supplements as an aid to metabolizing carbohydrates efficiently?

Answer:

I am sorry but it is just lots of hype. Save your money.

Question:

Thanks for the answer about pain following CoolSculpting. I can understand that more skin will be pulled into the handpiece when there is less fat beneath it; but does CoolSculpting technically "thin" the skin in any way other than removing some of the subcutaneous fat? That is, does it actually damage and thin the dermis and epidermis, or does it only destroy some of the subcutaneous layer of fat, making the skin looser? Obviously, I don't want to make my aging skin any thinner than it already is. Thanks for clarifying this detail for me.

Answer:

The actual skin is not thinned, just the layer of fat below it. It does not damage the epidermis or dermis as the blood low is very robust and can tolerate the cooling without any negative effects.If enough fat is reduced there can be some loose skin in some individuals as it does not tighten any skin.

Question:

Hi, Dr. Garcia. I've had a few rounds of Coosculpting without any pain at all. My last session was one week ago today. This morning I awoke with pronounced sharp pain at both treatment sites. It feels as if I had a steel rod placed under my skin. Is this normal? Why am I feeling pain now if I haven't before? Thank you.

Answer:

when you have sessions done again on the same area, since the skin is now thinner than before, a greater amount of skin is pulled into the head, allowing the freezing to affect it more as there is less fat to absorb the cold, and that can make it hurt more as the skin gets thinner.

Question:

I was watching a new  tv show called Botched, and they were mentioning a full body lift. I wanted to know if you did a lot of these and if there were a lot of people that had this done when they had never been overweight and lost weight? I think I have sagging skin all over my body, buy I only weigh 125, and have never been big in my life. I don't know if this is what I need, and it sounds like a very serious surgery, with lots of scars involved. I also read where it usually costs about six to ten thousand. I thought that was what just a facelift alone costs. Why wouldn't a total body lift cost more? And, wouldn't there be a LOT of scars on ones body?

Answer:

I personally do not do many of them but my associate does do them. They are long surgeries and the fess will vary from surgeon to surgeon. The costs depend greatly on the time it takes to perform for each individual patient as the cost of the hours in the operating room come into play. Typically a body lift really relates to a lower body lift only where what is lifted is the buttocks and outer thighs while doing a tummy tuck at the same sitting. It is unusual for someone that has not lost large amounts of weight to have this type of surgery done as the scars are very long and are not typically hairline scars. In the massive weight loss patients with large skin excess the scars can be worth it but less so in people with mostly poor skin quality and mild laxity. The scars for the lower body lift are circumferential around your lower torso, so quite long.

Question:

I am scheduled to have ThermiTight to my lower face and to my neck. How great is the risk of damage to the facial nerve? I am especially concerned about damage to the buccal and mental branches, as the procedure will be largely peri-oral and submental. Thank you for your help. (By the way, from a reader's perspective, the recent change to this page is far from optimal. It's almost impossible to read and to navigate. Might you be willing to convert it back?)

Answer:

I have already alerted the webmaster to change the text color, I apologize for that. As to the nerve injury risk of the buccal and mental branches, from the user stats available from the company it is about 0.5% in the area. The small number of issues have been all resolved in 2-6 weeks when they did occur, there are no reports of any permanent loss. It is the same risk as if liposuction of the same area is done or a facelift. The nerve can be bruised but not cut, therefore allowing it to heal.

Question:

I see that you recommend plant sterols and stanols over red yeast rice to reduce serum cholesterol. What brand(s) do you recommend and in what dosage? Thank you.

Answer:

Nature Made Cholest Off.

Question:

Have you ever seen a clinically impressive improvement in the appearance of your patients who have switched to a Mediterranean diet from the standard American pro-inflammatory diet? Obviously, that change augurs well for overall improvement in a person`s health, but have you also seen such changes reverse the appearance of aging? If so, what specifically have you noted? Thank you, Dr. Garcia.

Answer:

it is hard to say but in general all you can see is a slowing down of the visible aging, that is quite hard to discern as one never knows the speed of the process, yet it is something that people may comment on in the future when they say that the patient appears to look as good or better than they did a few years before. Advanced glycation endproducts are the cause of the visible signs of aging and a Mediterranean diet does decrease their production so it is an intuitive assumption.I think claiming a reversal is hard to prove, typically what is seen is in dehydrated and sun damaged skin looks better with better hydration and avoidance of sun exposure, but once formed, the AGE`s do not break down just with the diet. Sorry to disappoint Dr Perricone.

Question:

Have you ever seen a clinically impressive improvement in the appearance of your patients who have switched to a Mediterranean diet from the standard American pro-inflammatory diet? Obviously, that change augurs well for overall improvement in a person`s health, but have you also seen such changes reverse the appearance of aging? If so, what specifically have you noted? Thank you, Dr. Garcia.

Answer:

it is hard to say but in general all you can see is a slowing down of the visible aging, that is quite hard to discern as one never knows the speed of the process, yet it is something that people may comment on in the future when they say that the patient appears to look as good or better than they did a few years before. Advanced glycation endproducts are the cause of the visible signs of aging and a Mediterranean diet does decrease their production so it is an intuitive assumption.I think claiming a reversal is hard to prove, typically what is seen is in dehydrated and sun damaged skin looks better with better hydration and avoidance of sun exposure, but once formed, the AGE`s do not break down just with the diet. Sorry to disappoint Dr Perricone.

Question:

Hi, Dr. Garcia. I just had RF treatment of telangiactasia on my face (Pelleve) Stupidly, I failed to ask if this is like other treatment modalities for that problem -- that it makes the vessels darker at first and then they resorb OR if what-you-see-is-what-you-get at the end of the treatment. The technician said that the vessels were blanching, but some of them look worse to me now. Thank you for your help and sorry to bother you with such a minor question I should have remembered to ask at my own doctor`s office! Happy April!

Answer:

They can look worse for a bit, especially the larger ones, but it gets better. Hang in there. 

Question:

Would Saw Palmetto help lower the male hormones and thereby reduce acne breakouts?? Thank you for your time!

Answer:

Have never seen it be effective for that, sorry.

Question:

How many units of vitamin E and vitamin C do you take, and recommend others take, daily? Thank you.

Answer:

E is 400 and C is 1,000.

Question:

I want to ask you if there is any known remedy for the redness caused by Retin A...my face does not match my upper chest and looks odd without makeup...and boy do I hate foundation. Is there any remedy to make this red face disappear? Maybe a better option than retin a?

Answer:

You can stop it, or decrease the dise and frequency of applucation. Usually in 6-8 weeks it gets better but if you are past that I would decrease the dose. Moisturizer 15 minutes might help a bit after its application. But if it is really bad you should stop it. Not everyone can use it. There is a similar product called Renova that be better tolerated. Best of luck.

Question:

I cannot use Latisse cause my opthomologist said my green eyes could change color. Do you have any thoughts on Rapidlash or Neulash in terms of whether they work and potential side effects. Thank you!

Answer:

I have not had any patients use those two products so I cannot say how effective they are.

Question:

I wonder if you have developed any tricks over the years to keep warm compresses actually warm. I`m finding I need to spend the whole day in the bathrooom running a washcloth under warm water and then getting about a minute of use out of it before I have to do it again (post bleph). Of course, heating pads are absolutely out of the question as are those microwavable soft packs which can get too hot and burn the skin. Are there any good products on the market for this or is there some secret that you know about that I can deploy? Thank you for your help and experience!

Answer:

Short of the heating pads, as they now have timers, I have nothing new. Sorry.

Question:

If you had to use your expert eye to guess what procedures Putin has had done between these two pics taken 11 years appart (in the link below) where he actually looks better now.. what would you say he`s had done? http://www.telegraph.co.uk/news/picturegalleries/worldnews/8958602/Botox...

Answer:

obviously it is a guess as I have not seen him in person and he is not my patient but if I was to play the guessing game I would venture a light skin resurfacing with something like a Fraxel laser, and upper lid blepharoplasty, a lower lid blepharoplasty with fat transposition or grafting and  a filler, either fat, Voluma or Sculptra to his malar cheek areas. 

Question:

Dr. Garcia, I have recently read some beneficial information regarding Garcinia Cambogia for aiding in reducing weight. I am a 51 year old menopausal woman and definitely finding it harder to lose that middle aged spread. It is worth the expense? and would you recommend it? How much would you need to take to be beneficial? and finally which is best, the extract supplements or the fresh vegetable? I value your honest professional opinion and still appreciate the time and effort you give us all in answering all our concerns . Thanks in advance

Answer:

it is not worth the price in my humble opinion. You would be better off just eating raw vegetables for the fiber content. If it worked then there would not be those heavy Hollywood celebrities!

Question:

What are the issues with statins and red yeast rice that you seek to avoid by taking plant sterols?

Answer:

Headache Difficulty sleeping Flushing of the skin  Muscle aches, tenderness, or weakness (myalgia)     Drowsiness     Dizziness     Nausea and/or vomiting     Abdominal cramping and/or pain     Bloating and/or gas     Diarrhea     Constipation     Rash  Statins also carry warnings that memory loss, mental confusion, high blood sugar. It`s important to remember that statins may also interact with other medications you take. 

Question:

I saw your recent advice to a writer about red yeast rice. I had understood that two years ago, the FDA ordered the removal of monacolin from all OTC red yeast rice, thus rendering it clinically ineffective. Is that not true? Do you still recommend its use to lower cholesterol? Thank you. You seem to know so much about so many things. We`re very grateful to you for sharing your vast knowledge.

Answer:

I actually prefer to use plant sterols and stanols to lower cholesterol, but many physicians still do. I think red rice yeast has many of the issues that the statins do so I have not used them in a number of years them. Thank you for the kind comments.

Question:

I have a divot under my eye where too much fat was removed years ago. I`ve been having it filled hyaluronic acid for years and am about to have a tiny fat graft. Can the HA be dissolved while the fat is harvested and before it is placed? My surgeon doesn`t have another opening in his schedule to inject the hyaluronidase any other time before the graft is placed. He says the HA (about .4 cc) should be gone by the time he`s done harvesting the fat. Do you agree or do I need it to be dissolved by someone else sooner than the day of the procedure so that he can accurately see the defect he`s trying to correct? Thank you.

Answer:

I do not think the hyaluronidase will work that fast, it is usually a few hours. You will need to have it dissolved before that I am afraid.

Question:

Dr. Garcia, I had Belotero in my lips yesterday. I have had a lump on the inside/bottom of top lip, towards the middle. But, not quite the middle, so my lips looks lopsided. Is there a chance this could still go down? I iced it the first day. Any other suggestions? How long should I wait before I contact my doctor for any fixes? Thank You.

Answer:

For niw massage and ice and if not better in 5-7 days I suggest seeing the injector to either put more in to smooth it out or it can be dissolved away. Best of luck.

Question:

Hi, Dr. Garica. It`s the twitching eyelid lady again. Unbelievably, I now have 25 units of Botox in the obicularis muscle, and it`s still twitching! Any other thoughts about what I should try? Should I ask my dermatologist to try injecting farther away from the eye, near the stylomastoid foramen where the nerve arises to see if it can be controlled from there? I don`t use caffeine and am not unusually stressed, so I can`t figure this out. Meanwhile, it`s like having an unrelenting case of hiccoughs. Incredibly annoying. I really appreciate your kind help.

Answer:

I would actually see an opthamologist, eye specialist for these injections as they are not typically done the same as they are for cosmetic reasons. Can also try injecting a local anesthetic like bupivicaine but it is short acting. Wish I had something else to offer.

Question:

OK to take red yeast rice before surgery?

Answer:

Yes it is OK.

Question:

I know enough to avoid all anticoagulants prior to injections or surgery, but what about eating oily fish like salmon? Thank you.

Answer:

Eating the fish is OK but stop any fish oil supplements. 

Question:

I`ve been impressed by the research on the GI biome in the past decade or so and started taking probiotics about 5 years ago. I`ve been taking Culturelle and am wondering if you think that that pharmacy brand equivalents (like CVS`s brand) is just as effective. It`s about a third less expensive than Culturelle, so I`d like to save the money if it`s essentially the same product. Thank you for your opinion.

Answer:

For probiotics I would stay with the name brand.

Question:

I recently moved and changed dermatologists. I`ve been getting Botox to the crows` feet for a number of years. My previous doctor used only 8-10 units/side, and I had to have it done every 3 months. My new doctor uses 18-20 units/side. Two questions: 1) Does this sound right to you? 2) Should it last longer with this higher dosage, or does it wear off at 3 months no matter how much toxin is injected? Thanks, Dr. Garcia. Have a great weekend!

Answer:

Every patient is different, the larger the dose in my experience, the longer it lasts. The bottle cannot be shared between patients so he may be using more so he does not throw it away.

Question:

Thank you for the information about the red yeast rice. I`ve been taking 2400mg daily, but you seem to suggest 1200 mg taken at 2x/day, dosed apart (e.g., morning and evening), would be better. Is that right?

Answer:

it is the total dose that is important but if you have no stomach upset with 2,400 at the same time it is OK to take it that way.

Question:

Good morning, Dr. Garcia. I`m having an upper bleph in a few weeks. How much bromelain should I take in advance and for how long? And how long do you usually have your own patients stay on it post-op? Also, I take red yeast rice with Co-Q10 to reduce my serum cholesterol. On average, how much do you think is usually necessary to achieve a significent clinical result? Thank you for your time and expertise. God bless you.

Answer:

Start the Bromelain 3 days before and continue for 7-10 days after, 150mg three times daily. On the Red Rice yeast I start at 1,200mg daily and increase up to twice daily depending on cholesterol panel results.Best of luck with everything. 

Question:

Hi, Dr. Garcia. It`s the person with the twitching eyelid again. It`s been 7 days now since the Botox injection (10 units) and it`s only about 20% better. The lid is still twitching with the same degree of regularity, but just not as forcefully. How many more units do you think I might need? Thank you for your help and advice.

Answer:

I would likely use another 10-15 units. 

Question:

What do you think about Thermi-RF? I am 63 yr old women with some jowels & a little loose skin under shin. I am a thin so I do not have a heavy neck and my jaw line is defined except where I have some jowls. I have some nasal labia folds/mild marionette lines. My skin tone is overall very good. I am thinking about having ThermiRF for tightening sides of my face & jawline & upper neck. Thanks for your opinion.

Answer:

I think it works better in patients with fuller faces. If you have a thin face it might not the best option for you.

Question:

I wrote to you last week about a twitching eyelid and you suggested that Botox would help. I found a dermatologist and this morning he injected 10 units to the crow`s feet area on the left side of my eye to see if that would calm it down. It`s been about five hours and hasn`t worked yet. He says it takes a day or two to kick in. Is that right? It`s driving me crazy. Thanks so much for your advice, Dr. Garcia.

Answer:

No, it can take 7-10 days to kick in. Got give it some more time is all, You might need a bit more if it is not totally gone in another 2-3 weeks.

Question:

Hi Dr Garcia, Do you have any experience with E Matrix and do you think it is effective for eye rejuvenation. Also, have you heard of patients getting stys after E Matrix treatment?

Answer:

have not heard of getting styes, but I think in general, the results are mild and do not last very long. Sorry.

Question:

I`ve developed a persistent, pronounced twitching left upper eyelid for the past 2 weeks. I don`t use caffeine and am not particularly stressed. Might botox help? It`s so annoying. Any thoughts on the cause?

Answer:

most of the time is is stress related,or it can at times be from pressure on a nerve and yes, Botox can help. I wish you the best. 

Question:

Is there any cream to lighten I Under eye darkness? I am weary of Injections that close to the eye and I don`t know howling how long they will last.

Answer:

all the creams will have a mild effect and will not work in older patients where the problem is truly due to fat loss, creams will never help that. Sorry.

Question:

Last year I sent you a question about treating a pimple I had in my peritoneum. You suggested tea tree oil and it worked. Thank you! Since then, I have used it to clean myself after using the bathroom, and I have been pleased with its antimicrobial properties. Are there any side effects to long-term, chronic use of which I should be aware? Thanks for our advice.

Answer:

No, long term use is certainly fine. 

Question:

How long does it take to undo collagen/elastin effects to improve aging/droopy upper eyelids if you stop using retin-a and other creams for this problem?

Answer:

a guess is about 4-8 weeks.

Question:

Thank you so much for the reply about the shingles, Dr. Garcia. Is there anything I should be doing in addition to the anti-virals? Rest? Analgesics? Just wait it out?

Answer:

not much, stress can trigger them but once you get them it is just a matter of time, sorry.

Question:

Dr. Garcia, you have been so helpful to me with some cosmetic questions over that past few years, and I have been most grateful. I`m writing now to seek your more generalized medical opinion. I have shingles. Joy! I caught it early at the first sign of the rash and was put on valacyclovir (3 gms/day for 7 days); but t I haven`t been given any other instructions other beyond what I can look up myself. Is there anything else you would recommend I do? Will one course of antivirals be sufficient? Do I need any other medication? (Fortunately, there`s no ophthalmic involvement, since it`s on my trunk.) Miserable little affliction, this! I appreciate that this is not the kind of question you typically answer. I appreciate your kindness ever so much! May you never get this yourself.

Answer:

The course of antivirals will speed the recovery from this bout but nothing will prevent another round of it coming in the future. It is a virus that cannot be killed, just controlled. Sorry, hope they are infrequent.

Question:

Would forehead lowering surgery make hair along my hairline temporarily (or permanently) fall out from incision stress?

Answer:

not if properly performed and closure done with minimal tension.

Question:

I have read that ultherapy causes unwanted facial fat loss. What else can I do for rejuvenating neck and face without major surgery? Why don`t u do Portrait anymore? R there any similar facial fat loss results from it? TY ever so much. Trying to make sense of all that is out there in terms of skin rejuvenation and skin tightening which is noninvasive.

Answer:

I am afraid I have not much besides surgery options for the aging neck, sorry. I have stopped doing Portrait as it was taken off the market for a while when the company filed for bankruptcy. It has since returned but as it really only treats fine lines and does not tighten skin to the level that the patient that seeks me out desires,Ii saw no need to reintroduce it into the practice. I never saw fat loss with the technology though. I think non-invasive or minimally invasive techniques for fine line reduction can be achieved on a short term basis but I think the claims of skin tightening with those machines when the actual problem is excess skin are not valid.The term skin rejuvenation is quite cloudy and non-specific, meaning different things to different people, and it can encompass almost anything relative to the skin. Somewhat the same although less with the term skin tightening.

Question:

Hi, Dr. Garcia. I posted a question yesterday that you may not have seen and didn`t answer in the constant stream of questions we send you! (How do you keep up with it all?!) Just wondering if Zeltiq might work in the axilla and lateral breast tissue instead of liposuction. Thanks so much for your time and help! God bless you.

Answer:

If the head can get a good suction, it should work. It will likely take a number of sessions to get it done though. It might be more efficient, faster and more definitive to have the liposuction if you are willing. If the CoolSculpting does not give you as much of a change as desired, you can always have liposuction after it. I do not think there would be any difference between the liposuction and the CoolSculpting in terms of the effects on the actual breast tissue in tat area, so either one would not cause that to happen. Thanks for posting again, I had answered it but likely got lost in the metadata the NSA is collecting! Just kidding.

Question:

I just went to the Revitalash website and they are not marketing Revitalash again. Here`s what they`re selling: Nouriche® by Athena Cosmetics for $130. Is this the name of re-released product that you are now selling at your office?

Answer:

no, it just got re-released and they likely have not updated their website yet.

Question:

Hello Dr. Garcia, been using LATISSE to make my lashes grow and it does a great job, is there something you recommend that does the same thing but less expensive? Thanks,

Answer:

We use the re-released RevitaLash.

Question:

Hi, Dr. Garcia. I`m trying to decipher what you meant in your reply to the person who just asked you about Revitalash. It appears that you think the new formulation won`t affect her/his eye color but it`s not clear if you think the new formulation will be as effective as it previously was before its active ingredient was removed. I`d like to buy it if it`s going to work but obviously don`t want to waste money if it`s still ineffective, unlike its original formulation.

Answer:

They had a formual after Allergan made them take an ingredient out which I used and found it to be very effective and that us what they have re-released so it should work well.

Question:

How would I email a picture and what type of response can u give from a picture? Thank you.

Answer:

send it to drgarcia@lvcosmeticsurgery.com and include as much information about it and your concerns as you can.

Question:

What is the new revitalash and when will you have it. My opthamalogist does not want me to use latisse cause I have green eyes. Would this be safe? Thanks so much

Answer:

The re-release of Revitalash does not contain the medication that can change color, it is the same formula they had after they took that out and replaced it with a proprietary formula. I think it would be safe and I was happy with the results before it was temporarily taken off the marke..

Question:

Hey, great news about the Revitalash! When your order arrives, would you please post what you discover about its effectiveness here to your blog? Thanks very much.

Answer:

Certainly.

Question:

Dr. Garcia, I cannot remember what the status of Revitalash currently is. I recall that a while ago, they were forced to remove the active ingredient in their formula, rendering it pretty much useless. Has that ingredient been reintroduced? Is it now once again an effective product? Thank you for your generous help to all of us, You are the best! Really.

Answer:

I heard today that the original formulas has beem released. I have ordered some and will know in a couple of days if that is true.

Question:

Thank you kindly for the answer about the hyaluronidase. Would warm compresses be helpful in aiding it to do its work -- or a waste of time?

Answer:

will not help, sorry.