Question:

Happy New Year, Dr. Garcia! A few weeks ago, I wrote to ask about a scar on my vermillion border. My surgeon had suggested that we next try dermabrasion, but you recommended a different laser treatment than the one  I had already undergone (2 fractional CO2 procedures and multiple IPL and Genesis treatments). The problem is that one side of the lip was raised higher than the other in a lip lift surgery. The surgeon thinks the lopsided appearance is due mostly to the scar on one side, but the scar mearly exaggerates the frank assymetry he created. To be fair, it's just a few millimeters, but on the lips, as you know, millimeters are miles. To make matters worse, I had a buccal branch injury to that side of my face 10 years ago in a botched implant surgery; in fact, it was that injury that inspired the idea of a lip lift, since my lips are naturally thin. It was suggested to me that a lip lift could help with the appearance I was left with following the paralysis. Alas, rather than relieve that situation, the lip lift only emphasized the paralysis of the upper liip and draws even more attention tomy subsequent speech impediment! And now, of course, to make matters worse, that side of my mouth is oddly warped by the lift even in stasis. So...I haven't done the dermabrasion or yet sought out the laser treatment you reommended, since, even if it worked to improve the appearance of the scar,  it would still leave me with the underlying assymetry. Sorry for the long story, but I wanted to give you some background. You had mentioned that dermabrasion presents significant risks, but you didn't say what they were. Can you tell me? Also, what do you think of micro-pigmentation? If a medical tattoo artist could truly match my skin tone, that would seem to potentially take care of the problem by covering that tiny portion of the vermillion. But...if the color and/or placement of the pigment were "off" in even the smallest of ways, it could easily make my problem significantly (and permanently) worse! Do you know of any medical tattoo artists who could handle something this tiny and this visible? Again, my apologies for this long tale of woe! I wish you and your family a healthy 2019 -- and as much peace as we can find and create in these tense, worrisome times.

Answer:

The dermabrasion risks of the vermillion are that there can be scarring as well as loss or darkening of the normal pigment in the area. I do not think dermabrasion is going to do much good in any case. I do think the tattoo is the least problematic. The entire vermillion would need to be colored but the one area would need a little more width. The colors fade over time and need to be reinforced. I think you should seek out a permanent makeup person, they are the most schooled on lips coloring and see their pictures to get a level of confidence. Hope the info helps.

Question:

Hello dr garcia.. have sent you an email regarding my procedure. I have read that live grafts like fascia are more dfficult to modify/remove as they fully integrate with your own tissues. What is the timefeame of this happening?

Answer:

the facial graft is not alive, it never develops any blood supply so all it does is allow collagen, and in essence scar tissue, to form. The sooner one wants to have it removed the easier it is because there is less car tissue formed and the graft is softer.

Question:

Wow this recovery has been brutal lol I have a huge hard lump on my head after the fascia graft last week. Is this normal? How long will it last or is it permanent? I like to keep my hair short and it is now puffing out bc of this flinstones lump.

Answer:

It is most likely some old blood. Hot packs and massage will help it go down, it will take a week or more but nothing permanent

Question:

The reason Im asking is because post op im going to be covered in a non removable tape for a week before my follow up so I will not be able to see signs develop if it occurs 

Answer:

the sooner the better. Once it is soft and has started to dissolve, it is a good idea to aspirate it. Whatever can be removed is done and as it softens some more, at times more can be aspirated. Usually for the first week or so the blood is firmly coagulated and hard to aspirate.

Question:

Even though my PS agrees that I have a recessive chin, he said I should not get a chin implant bc it will not look good due to the crease above my chin. Is there any other options for someone who has this crease

Answer:

well, that is a cosmetic decision. Hard for me to say without seeing you. Yes, putting a chin implant can cause the crease to look deeper, but that depends on the size of the chin implant in terms of its vertical height. If it is a short vertical height it will accentuate it more, if it is taller, it will do it less so,

Question:

Which has more potential for contour irregularities? Cutting the fat out in an open procedure, or suctioning it out with traditional lipo?

Answer:

In my opinion a direct excision has a higher chance of contour irregularities.

Question:

How can you tell the difference between standard, healing process, lumps and bumps after a submental lipectomy vs. an actual hematoma that needs to ve drained?

Answer:

the normal bumps are small, not bruised looking and are firm, the hematoma is usually visibly bruised and softens over a few days

Question:
Answer:

usually we remove the keloids surgically and then apply pressure clips if needed.I would be happy to see you in person and let you know what your options are.

Question:
Answer:

la nariz completa es $7,250, la punta nada mas es $4,775, asi que depende de lo que quieres cambiar.

Question:

At what point should I start thinking about cosmetic surgery, since you say it isn’t for everyone?

Answer:

once you start seeing changes that seem to bother you, then seeking out a consultation is OK to do.