Injectables:

What is the down time for Voluma?
Like most fillers, Voluma does not have any real downtime. However, with all injectable fillers, there can be mild to moderate swelling for up to 48 hours. In addition, there is always a chance of bruising with any filler, including Voluma. We generally recommend that patients undergo injections at least 1-2 weeks before a major event or party.

When does Botox start working?
Botox generally starts working in about 5 to 7 days, with most of it settled in at 10-14 days. Dysport generally starts working at about 3-5 days, with most of it settled in at 10-14 days. We generally recommend that patients give it 2 weeks before coming in for any “touch up” procedures, to allow for ample time for the Botox/Dysport to take effect.

What is the difference between Botox and Dysport?
Botox and Dysport are both neuromodulators which help relax muscle activity. They are two different brand names for Botulinum toxin type A. Some physicians prefer one over the other. While others prefer using Botox in one area and Dysport in another area. In our practice, we prefer using Dysport for the horizontal lines beside the eyes (commonly known as “crow’s feet”) due to its greater dispersion into the superficial muscles, creating a very natural look. We prefer to use Botox for the forehead and the area in between the brows, as it tends to be more precise, which is important when attempting to achieve defined eyebrows or a “Botox Brow Lift”.

What can I do about bruises post injection?
Bruises can happen with any injectable treatment. We always recommend to prepare ahead by discontinuing any medications or vitamins/supplements that contain blood thinners (aspirin and aspirin-containing products, NSAIDs, ibuprofen, fish oil, omega-3, vitamin E, etc). Also, taking Arnica few days before your appointment, in some cases, reduces the length of duration of bruising.

Is Radiesse a permanent dermal filler?

No, Radiesse is not a permanent dermal filler. It is a calcium based filler that will dissolve naturally between 9 to 12 months post injection.

Where can Radiesse be injected?
In addition to being used in various areas of the face, Radiesse is also FDA approved for injection in the hands, restoring a youthful appearance to thin and vein-ridden hands. As far as the face, some popular uses include injection for jawbone and cheek definition, as well as chin augmentation. Radiesse is also a popular injectable for the nasolabial folds and the marionette lines (lines from the mouth down to the chin). Areas where Radiesse should absolutely NOT be injected include, under the eyes and in the lips.

How many syringes of Voluma does one need?
The amount of syringes that a patient requires will be evaluated at the patient consultation. Depending on whether the patient has lost volume due to the aging process or weight loss, will play a role on how much Voluma the patient will need for volume restoration. If a patient already has sufficient volume in the cheeks, but he/she wants additional augmentation, then that will impact how much that patient will need. Finally, if a patient is hoping for a lifting effect rather than simply a filling effect, that will require a different amount of Voluma. Many criteria are considered such as patient’s age, amount of volume loss, patient expectations and patient goals (augmenting vs restoring).

What is the average amount of Restylane or Juvederm for lip plumping?
The average product used for lip plumping is 1 full syringe for upper and lower lips. However, if it’s the first time a patient is getting filler for the lips, patients often start at ½ syringe and gradually add more with subsequent sessions.

I did my lips with Juvederm three weeks ago and I my lips have gone down. Why?
Most dermal fillers “settle” completely at three weeks mark. Much of the fullness that one notices during the first few weeks is actually swelling and not the product itself. Most dermal fillers are now pre-mixed with lidocaine (a numbing agent) for maximum comfort. However, the addition of lidocaine causes slightly more swelling than the injected product alone. The vast majority of the swelling usually goes down within 48-72 hours. Two to three weeks after injection (when all the swelling has resolved) is a good time to decide if more product is needed.

I am experiencing more swelling with Restylane than I did with Juvederm in the past. Am I having an allergic reaction the Restylane?
The way Restylane is composed and cross-linked lends itself to more immediate swelling. So, it is not uncommon for a lot of patients to have a bit more immediate swelling with Restylane than with Juvederm. However, after the first 24-48 hours, the degree of swelling is similar for both products.

What dermal filler is best for marionette lines?
It is often a case of the doctor’s preference and the patient’s needs, but there are dermal fillers that are better suited for specific areas. For marionette lines, depending on the depth of the fold and thickness of the skin, good filler options include Juvederm, Restylane, Restylane LYFT and Radiesse. Juvederm and Restylane work well for mild nasolabial folds, while Restylane LYFT and Radiesse work well for moderate and severe folds.

I have heard of non-surgical rhinoplasty. What is it?
Non- surgical rhinoplasty consists of placing a dermal filler to smooth out imperfections on a nose. Typical indications include filling out a bump on the bridge of the nose or filling in a depression on the nose. While it may seem like a simple way to get a desired result without the need for surgery, this is a procedure that needs to be performed by an experienced surgeon and injector, as there can be serious complications, including skin loss.

What is the longest lasting dermal filler?
The longevity of a product depends on the amount of product injected and the location of injection. For example, filler placed in the cheek (an area of little movement) is going to last longer than the same product injected around the mouth (area of significant movement). One syringe of any product is not going to last as long as having 2 or more syringes of the same product. A recent study looking at Voluma revealed that in patients receiving multiple syringes of Voluma with a touch up a few months later, resulted in patients not requiring additional filler for up to 2 years. Sculptra, which is not really a true filler, but rather a collagen stimulator, has been reported to last up to 2 years, as well.

Should I massage the areas where I was treated with dermal fillers?
Some areas like the lips can benefit from light massage (after 1 week from injection) but most areas are better left alone. Massaging a filler can often move the product in areas it was not meant to be.

How many treatments are recommended for Kybella?
The average patient will require 2-4 sessions treated with multiple vials per session. At the time of the consultation, the expected amount of vials should be discussed and anticipated while keeping in mind that it can only be an estimate, since each individual will respond differently to any product.

How long does Sculptra last?
Sculptra is injected into areas where fat is noticeably lost. It causes stimulation of collagen and neocollagenesis (new growth of collagen), improving appearance of folds and hollow areas. For most patients, the effects of treatment can last up to two years.

 

Cosmetic Devices:

How many treatments are typically recommended for Fraxel Dual (hyperpigmentation)?
Fraxel Dual delivers great results if done in a series of 3 treatments along with a strict skin care regimen.

Is Coolsculpting permanent?
While results vary greatly with this treatment, CoolSculpting’s unique technology uses controlled cooling to freeze and eliminate unwanted fat cells without surgery. Assuming the patient maintains a healthy lifestyle and does not gain additional weight, the results are very long-lasting since the fat cells have been eliminated. It does not prevent anyone from gaining weight.

Is there any downtime with CoolSculpting?
There really is no associated downtime. Patients can return to work immediately after the treatment. There may be some occasional bruising, usually in patients who have tendency to bruise easily.

What is the most effective laser to treat a scar?
The most effective laser is Fraxel Restore, ideally the scar should be treated as early as possible in its healing process for optimum results.

What is the best topical product to heal a scar?
The product that our office recommends for optimize wound healing is BIOCORNEUM. It is the 1st and only topical silicone scar treatment with SPF incorporated.

How many treatments are required for Venus Freeze and Venus Legacy?
We recommend a series of 8 weekly treatment for best results, along with a firming lotion and a healthy lifestyle. Once the series is completed, a quarterly maintenance is strongly suggested for upkeep.

What is the PRO Lift™?
It is a combination of microneedling and the use of the patient’s own growth factors and platelet rich plasma (PRP) from their own harvested blood to achieve improvement in the appearance of fine lines, reduction in appearance of pore size and improved appearance of overall skin quality. The whole procedure allows for collagen stimulation and collagen production at the skin level.

 

Surgical procedures:

How do I decide between a mini facelift and a regular facelift?
While only a surgeon should be the guide in making this decision, it is important to understand the difference between them. Simply put, a mini lift does not surgically involve the central neck area and the incisions do not go above the ears on each side.

What is the definition of downtime?
We consider real downtime when a patient is incapacitated in some ways. If a patient is unable to drive for more than 48 hours, cannot have a regular routine, is home bound, exercise is not allowed for more than 72 hours and if there are body movement restrictions.

What is the downtime for a neck lift?
Downtime for neck lift is 7 days for most patients.

Are facial surgeries very painful to recover from?
Most facial surgeries are surprisingly not. While there is some discomfort the first couple days most patient take acetaminophen after that stage. Otoplasty (ear pinning) and brow lift would be considered more uncomfortable but if the patient follows post care instructions, the recovery should be rather smooth.

What is the difference between in-office and out-patient surgery?
The difference between those two terms is whether general/twilight anesthesia is involved or not. In-office surgeries involve a combination of local anesthetic via injection and oral medication to provide patient with complete local numbness, psychological comfort and analgesics. Out-patient procedures are done in an operating room along with an anesthesiologist putting the patient fully under anesthesia.

Why are there some surgeries that can be done in-office and others only in operating rooms?
Any surgeries that are lengthy or potentially risky should be done in an operating room. Also, any surgeries involving bones should be done in an OR as well since bones cannot be anesthetized. It is, more importantly, at the doctor’s knowledge and preference to make such call. Not all patients are created equal therefore calling for different needs.

What can I do or take for a fast recovery after surgery?
We ask our patient to be very diligent in following our post-care instructions. We give our patient an exhaustive list of over the counter and prescription medicine to discontinue 14 days prior to surgery (all blood thinning medication) and to start a regimen of arnica and vitamin C.

What can I do to upkeep with my surgical results?
The best way to protect patient’s investment can be easily done. Using SPF every single day is essential. In addition, a good skin care regimen and quarterly treatment to enhance your results is a sure way to continue enjoying long-lasting results. Cosmetic devices like Fraxel lasers, Ultherapy and Venus Freeze are examples of what can be used.