Trust Your Face To A


Real Self FAQ

I’m in my late 40s and i’d like to get rhinoplasty to take care of the bump on my nose. it looks great from the front though, it’s thin and it has a good length. is it possible at this age to only remove the bump and to keep the rest of my nose?

Rhinoplasty is great for any age as long as the patient is medically healthy. Removing this bump will improve facial contour and direct more attention to your cheeks and eyes. When rhinoplasty is performed patients often looks younger and the often-used term “mature rhinoplasty” acknowledges this appearance change. In my practice, most women over 40 as very pleased with the results. It’s great that you are happy with the nose tip because most patients lack tip support, which weakens as they age. At your rhinoplasty consultation your doctor will test your tip support and if necessary he can utilize tip support techniques in surgery. It is very important to find a doctor with whom you feel comfortable.

I am 41 years old and 11 days ago i had my upper and lower eyelids done. i feel like i look plastic with the scarring that is still at the sides of my face and under my eyebrows. my eyelids aren’t opening all the way and they feel tight when i look up and the shape changes. also, one of my bottom lids seems to droop a little. i look like i am half asleep or have had too much to drink.

The issues you are experiencing will resolve with time. Incisions from eyelid surgery fade really well, but the redness may take longer to subside. Follow up with your surgeon to make sure the healing process looks normal. Also, ask when you can apply cover up to cover the incision lines so you can show off your rejuvenated eyes.

I had an upper eyelid blepharoplasty done 18 days ago. i have developed small ‘pimples’ on the inside of both my eyes and they have not gone away yet. the skin on top of my incision is thickening into a ridge and i have three small cysts. i don’t seem to be getting better and my incision condition keeps worsening as it heals. should i ask my doctor for steroid injections?

Definitely follow up with your surgeon to make sure your healing process is progressing well. The cysts you describe could be milia occurring along the incision, which is common. These pimple like cysts can be easily taken care of and they are nothing to worry about. The healing process may take longer than a year to finalize so keep going to follow ups! Good luck!

Can radiesse be injected in all of the areas of my cheeks, including the buccal area?

Radiesse is a great option for cheek augmentation, including the buccal area. Other filler options for you include Restylane, Juvederm, and Perlane. Sculptra or fat transfer should also be taken into consideration. I would advise that you select a board certified facial plastic surgeon experienced in all types of fillers so that you have many available options.

Can dermal fillers be added to other parts of the nose, like the columella and lateral sidewalls, to increase nasal volume?

Yes, dermal fillers are a great option to increase volume and alter the shape or appearance of the nose. Excellent filler options include Restylane, Juvederm, and Radiesse. These natural fillers can create volume on the nasal dorsum, tip, and sidewalls of the nose. They work best when used in small amounts by a skilled practitioner.

I’m almost 16 and i’m looking into getting laser hair removal on my bikini, arm and armpit areas. my parent’s heard from their friends that laser hair removal is not good for people under the age of 40, so they disagree with my decision. is this true? does this treatment come with any risks for a 15-year-old? thank you!

Laser hair removal is a great way to remove unwanted dark brown or black hairs on all skin types as long as the procedure is done under doctor supervision with the correct laser. Teenagers are perfect candidates for the procedure with parental consent as long as they stay out of the sun during treatment. However, it is very important to make sure that you are hormonally stable. Laser hair removal is greater than 90% effective, but it is less effective on patients with Polycystic Ovarian Syndrome. Before beginning laser treatments, female patients should get examined by a doctor to make sure their menses are regular and their hormones are stable. This way you can get the best treatment and be carefree.

I am 33 and two months ago i had a mandible silicone implant removed. i am now looking for a procedure (like a facelift) that will reattach my muscle to its original position. my doctor explained the procedure by saying: “if you need immediate correction, i suggest an intraoral approach to pull down the redundant skin onto the underlying muscle.” what are your thoughts on this?

I could better advise you with a little more information on where you find a deficit. However, once an implant is removed, the face may definitely appear older due to the lack of volume and the loss of muscle attachment. I would recommend you schedule a consultation with a facial plastic surgeon in your area.

I’m asian and i have a slightly flat nose that needs a little lift. i’m researching rhinoplasty options and i’ve been looking into the pros and cons of using ear cartilage, rib, silicone, and gore-tex. my doctor suggested the use of ear cartilage to raise my nose tip and gore-tex for the bridge. based on your expertise, what do you suggest and advise?

For a subtle, effective, but natural change to your nose, injectable fillers like Restylane or Radiesse can give your nose a temporary lift or an implant can give you a permanent solution. Silicone dorsal implants are excellent and long-lasting, safe and effective, and I have been using them for many years. The key is to find a caring and experienced physician with whom you feel comfortable. Good luck!

I underwent rhinoplasty to slim down my already long and attractive nose. the result left me with a nose that is short, stubby, piggish, and bulbous. what happens in rhinoplasty to create a longer nose? my surgeon tells me i have no septum or cartilage left. does this matter?

Cartilage is the main component that determines the appearance of the nose tip. It is essential to find enough cartilage to reshape the nose. The cartilage is used to refine, elongate, and sculpt the nose. The septum provides nose tip support and is used to help create the desired look. Cartilage can be borrowed from a donor area if you have none left in your nose, like from your ear or rib. You should first discuss the results with the surgeon who performed the procedure. Then you can start the revision process or have a secondary consultation with another rhinoplasty surgeon.

I just turned 16 and i have a deviated septum, which makes my lips slightly asymmetrical. i also have large nostrils, a hump and wave, and a bulbous tip. i’d like to undergo rhinoplasty in vancouver in the coming months to correct the symmetry of my nose and help improve my self-confidence. is this a possibility for me or do i have to go in and see if i have finished growing? thanks!

It is not uncommon for sixteen year olds to undergo rhinoplasty. However, you do need parental consent to do so. Always make sure you find a board certified facial plastic surgeon that you and your parents are comfortable with.

I am having rhinoplasty done in a neighboring state. is it ok to stay in a hotel alone for a night after surgery? i’ll be picked up the next day and driven home.

It is better to have someone with you after surgery like a loved one. If you cannot find someone to stay with you, many medical offices provide nurse’s aids to stay overnight with you, including my own. While you are recovering it is nice to have a helping hand and a little pampering. It makes a nice difference. Good luck!

My cheeks and lower eye areas (mid-face) are sagging so i want a facelift but my neck is ok so i don’t need a neck lift. can i have a facelift without a neck lift?

If sagging cheeks and lower eyes are your only concerns they you have many great options. You can absolutely have a customized facelift by an experienced board certified facial plastic surgeon. You might also want to consider a mid-face lift or a cheek lift as options to target your cheek/ eye areas. Injectable fillers can also produce great results. You can get a dramatic cheek results from Juvederm, Radiesse or Sculptra. Restylane and Juvederm are good filler choices for your sagging or sunken lower eye area. You should find an experienced surgeon with whom you feel comfortable to discuss the many options available.

The corners of my eyes near my nose angle downwards and make me look asian, even though i have double eyelids. is there any way to change the corners of my eyes to a more level position without surgery? are there any other options?

It is not uncommon for many patients of varied ethnic backgrounds to have an “Asian” look to their eye medially (close to the nose). You should find a skilled facial plastic surgeon to perform an upper blepharoplasty so this area can be surgically altered to your liking. Good luck!

After spending years tanning without proper skin protection, i have age spots on my face, hands, and legs. how can i get rid of these age spots?

Age spots, or liver spots, result from prolonged and unprotected sun exposure. To treat these spots you can use an at-home skin lightening cream that contains hydroquinone and/or kojic acid. Chemical peels can also be used. The quickest and most intensive treatment method is with a laser, however you must be sure to complement the laser treatments with a powerful broad-spectrum sunscreen so the spots do not return.

How long does it take to recover from botox injections and what kind of limited activity can i expect?

One of the best things about Botox is that it is a “lunchtime” procedure. Right after being treated you can return to work. However, it is asked that you refrain from rubbing the injected area for the rest of that day and that you avoid taking NSAIDs to avoid bruising, like aspirin and similar blood-thinning medications (Advil, Motrin, or Alleve).

I have male pattern baldness and i am considering hair transplant surgery. if male pattern baldness is progressive, how would i be able to achieve a permanent full head of hair? it was recommended by my doctor that i get 4,000 grafts. i would be ok getting this done in one session, but i would rather not have to keep going back for surgery every few years. is this a permanent solution or am i just delaying the inevitable?

Since donor hairs are taken from the back of the head where these hairs are resistant or less affected by DHT (Dihydrotestotorone, a natural metabolite that causes hair loss) and then transferred to the affected areas, the completed procedure will be permanent.

I am 24 year old and i have dents in my cheeks. where did these come from and can they be removed without surgery?

Acne and chicken pox usually cause facial dents because they leave scars behind after the condition is gone. You have many options to eliminate these indentations. Facial filler injections of Juvederm, Restylane, Perlane, and Radiesse can be used to fill in the depressions. By utilizing a substance called hyaluronic acid they work as natural skin plumping agents. You can also use fat grafting where fat is taken from another part of your body and then transferred to fill in the dented areas. Fat grafting does require some minor surgery. Then there is another option called resurfacing where special dermabrasion equipment, chemicals, or lasers (the CO2 fractionated laser is thought to be best) work to smooth complexion.

My left eye is blind and excessively smaller than my right eye, which is functioning. i have no pupil in my left eye due to underdevelopment caused by a prenatal fall. is there anyway to adjust the size of my left eyeball or add a new one so they are equal?

It is possible for this to be achieved however the risks are far too great for a patient only seeking cosmetic changes. This would involve highly complex craniofacial surgery that could result in permanent blindness or even death. This type of procedure is only reserved for those with extreme facial deformities or other serious medical conditions because the risk of complication is so severe. However, there are other options to make the distance between your eyes more symmetrical. Please schedule a consultation with a board certified facial plastic surgeon to determine the best treatment option.

I am almost 16 and i’m interested in getting botox treatments. i have a wrinkle on each side of my mouth and a few on my forehead. they bother me because i know they are there, even though they are not that noticeable. are there any doctors near scottsdale, arizona who are willing to give botox injections to a 16 year old?

It is becoming a trend for younger and younger patients to request facial fillers like Botox, Restylane, etc. This may seems absurd but there is a method to this madness. If wrinkles are prevented before they start then it inhibits or prevents the forming of more serious wrinkles in the future. However, 16-year-olds are still too young to get Botox treatments. I would only recommend Botox for someone of such a young age if there were underlying conditions affecting the patient like blepharospasms (eye spasms) or excessive perspiration. As always with young patients, parental consent is needed to undergo such treatments.

I received laser hair removal and was left with ugly burns, is there any medication that can help they go away? i have seen several women with the same thing but they all have different colored skin, light medium and dark.

You should first revisit the physician who treated you. They can determine whether you are having a pigmentary reaction or if the laser burned you. Then you can obtain the required treatment for the burn or lightening cream for the pigmentary reaction, if necessary.

I am 38 and i have a genetic sag in my neck from my jaw. how can i fix this?

A facelift procedure can correct a sagging jawline surgically but because you are young, you may want to minimize the appearance of jowls with an injectable filler or laser. These injectable fillers can be injected in front or behind the sag to hide it. Adding volume to the cheek can also sometimes help the early appearance of droop.

Lasers can also be used for skin tightening. You should consult a respectable facial plastic surgeon to recommend an effective laser. The Fractional CO2 laser provides amazing degrees of skin tightening, but it also requires healing. The Cynosure Affirm is also a good option with fast recovery.

I have terrible migraines and so i am considering botox injections to relieve my pain. will insurance cover this procedure?

I have known several patients to have their insurance cover Botox injections because Botox is clinically proven to relieve and prevent migraines. My staff has also helped some patients successfully persuade their insurance company. Please contact your facial plastic surgeon and your insurance company for more information. Make sure to discuss a detailed history of your migraine work-up from your neurologist or primary doctor.

I had restylane injected under my eyes and it gave me bags that have not gone away. why haven’t they disappeared yet?

It is very common to inject Restylane under the eyes (tear troughs) to improve hollow grooves. This is a special technique that requires precision and experience. The bags you are describing could just be swelling from the injections, but if it persists you may want to have some of the Restylane removed. Restylane can be dissolved with a tiny injection of hlyaluronidase easily and simply. Please see the physician who injected you for an evaluation so he or she can help you.

I have really bad dark circles under my eyes. is there any was to lessen them? my dark circles make me look much older than i am.

Dark circles can be caused by hollowness under the eyes that produce a shadow. This area, called a tear trough, can be corrected with an injectable filler, like Restylane, implemented by an experienced injector. Puffy fat pockets in the lower lid also cause under eye circles. Lower lid surgery (blepharoplasty) can remedy this cause.

A patient may also have hyperpigmentation of the actual skin under the eye causing it to appear darker. A prescription lightening agent can improve this hyperpigmentation. Another cause of dark under eye circles is thin, translucent skin that shows the blood vessels beneath. There are not many remedies for translucent skin, but hopefully I helped with my other suggestions!

What are some advantages and disadvantages associated with a facelift?

Facelifts are a great option for patients with significant jowls and neck issues. To improve the skin and restore facial volume, lasers and fillers are also great alternatives. To improve the jawline and reduce excess neck skin, facelifts give noticeably natural-looking results. There are very few alternatives to a facelift to dramatically correct loose neck skin and muscle. However, the disadvantages to a facelift should be carefully considered.

The facelift is a surgical procedure that requires incisions and recovery. Facial plastic surgeons are well trained to deliver the best possible results. Always review the before and after pictures of your surgeons work. Speak with other patients who have had facelifts. It is extremely important to make sure you are completely comfortable with the surgeon who will be performing your facelift.

I have genetic hollowness under my eyes that i am thinking of using dermal fillers to correct. how long do fillers last? how much filler should be injected and how should the procedure be done? are there any symptoms or risks post-injection that i should look out for? what questions should i ask my surgeon before the procedure? is there any other information i should know?

Injectable fillers are a good, safe option to fill under eye hollowness and Restylane is the safest choice, which lasts about 6 months. Many surgeons advise against the use of long-term fillers under the eye because the area is so delicate. You will be administered a topical anesthetic before the procedure, which is usually done in office. Then, depending on your needs and your doctor’s assessment, a small amount of filler will be used. Post injection symptoms include bruising or swelling that may take a few days to subside.

You should consider taking arnica to help with the bruising and avoiding NSAIDS (like Advil), aspirin, or any other blood thinning medications. Ask how frequently your surgeon performs this procedure because the delicate under eye area requires gentleness and experience. If the Restylane is placed too superficially, it can sometimes give off a bluish hue from under the skin. Ask for the Restylane to be placed deeply to decrease the likelihood of this occurring. Restylane can also be dissolved quickly if you are unhappy with the filler.

I am terrified of developing polly beak deformity because i have thick skin. it also concerns my surgeon. he explained that he has had some cases of polly beak earlier in his career and that since he has been suggesting tapping for eight to 12 hours a night for at least a month after the operation. are the odds that i might develop one high? when would it have appeared and what measures, if any, could i take to avoid this? what can be done if this happens?

It is very important that you choose a great rhinoplasty surgeon who understands your skin type, concerns, and who will take the necessary steps required to prevent polly beak. These steps include providing good tip support, removing the proper amount of cartilage, and close monitoring on post-op swelling. Even with these precautions, thick skin can be a challenge. If you suspect that you are developing a polly beak deformity, make sure you see your surgeon. Occasionally, there are injections that can be used to help the swelling.

Is it possible to have a neck lift and muscle tightening without making an under the chin incision?

Aggressive neck improvement generally requires the need to tend to excess laxity of skin and the platysma muscle, a very thin muscle that runs along the chin and jawline to the collarbone. With an under the chin incision, the middle portion of the platysma can be sutured together to tighten the central neck. Because the platysma does run almost to the ears, the surgeon can elevate the muscle by pulling the platysma laterally to suture it to a higher position, giving a tighter appearance. A combination of different approaches or one approach might work best for you depending on your physical exam and desired results.

I can’t seem to find a facial plastic surgeon specializing in african american rhinoplasty. i have been told to look at before and after pictures to see their aesthetic eye in real patient results, but the patients are almost always caucasian. how can i find a surgeon who can perform a great rhinoplasty on an ethnic nose? do you know of any surgeons who specialize in this area?

You need to have a quality consultation with a board certified facial plastic surgeon with many examples of their work. It may also help to ask to speak with past patients who have undergone the same procedure. I would recommend Monte Harris M.D., from the Washington D.C. area and Dr. Jeffrey Epstein from the Miami area.

I am 18 and considering rhinoplasty. i’m wondering, how does the surgeon know what nose shape will look most natural and fit my face? does the surgeon take into consideration face shape or follow a mathematical rule like length-times-width?

To find the perfect fit of the perfect nose when performing a rhinoplasty, it takes experience and lots of artistic skill as a facial plastic surgeon. However, some rules do apply like the “rules of beauty” and guidelines based on aesthetic principle. There are average angles and measurements that exist which create guidelines on how the nose appears on the face. This knowledge of natural measurements along with artistry, skill, and experience offer the best results. Computer imaging can illustrate these principles to you when you discuss this with your surgeon in the consultation.

Is radiesse an effective filler for under eye wrinkles and does it cause tissue scarring?

Radiesse is not the best filler choice for under eye wrinkles, but it is a great filler for facial volume loss, cheeks, and nasolabial folds. Basically, it works well below the orbital rim (the bottom rim of the eye socket). A better choice for under eye wrinkles is laser resurfacing or a chemical peel. Consult with a local, qualified, board certified physician to see which option is best for you.

I am a 20-year-old with a bmi of 18 and i am worried that i have sunken cheeks. why does my face appear sunken, what causes this, and how do i get rid of it?

It is common for athletic, slender patients to notice a thinning of the face, which might make them appear older. Facial fillers can help to soften the appearance and return the youthful look. In the U.S. and Europe, Sculptra is a great option for returning facial fullness. Results of Sculptra are similar to that of a fat transfer to the face. However, Sculptra does require an advanced injection technique so it is important to find a skilled and experienced physician.

I have a noticeable nasal hump that i don’t like and want removed. i’m 20 years old and i don’t want a sloping nose, but i’d like to have the hump reduced. i would like my nose to look natural and to match the other features on my face. how difficult would this surgery be? will my nose be broken? will the healing time be faster and will i have less bruising because i only want the hump removed?

The point that you make about not wanting a sloping nose is important and it is one you must discuss with your surgeon. Also check out your surgeon’s before and after photos and make sure the noses are unique and fitting to each person. The surgeon you choose should be able to tailor your results and give you a natural looking nose that is not “sloping.”

I have a small chin implant that is too sharp because only the bottom of my jaw extends out. i would like a more full look of a larger jaw by plumping up the area between my jowl and chin. i saw a plastic surgeon that recommended aquamid but it is non-fda approved. what should i use for this? i am afraid to use aquamid.

Restylane and Juvederm are great options to fill the area above the chin implant. They are completely natural hyaluronic acid fillers that dissolve in six months. Also, both can be dissolved immediately with another injection in case the results are less than ideal. This way you can see if you like the result before committing to a permanent filler, like Radiesse.

The skin in the center of my neck looks saggy and so i was wondering if peels or laser resurfacing would help. i don’t think it is sagging enough for a major procedure. i’m lucky to not have wrinkles and i haven’t had a procedure yet, except for peels.

Neck skin is thinner and finer than facial skin and so with lasers and peels it requires a more gentle touch. Excessive skin should be removed surgically, but lasers can improve mild laxity and wrinkles.

Laser resurfacing with a fractional CO2 laser would give you the most effective tightening of the skin under your neck. An experienced physician knows how to carefully adjust the settings to treat your neck. The neck requires a longer recovery period than a face would with the same treatment. Superficial chemical peels are safe, but would not give you the results you are looking for.

My oculoplastic surgeon gave me restylane injections two weeks ago to correct the hollowness under my eyes. now, after the swelling has gone down, i am noticing dark circles under my eyes and more prominent lines from my cheeks to the corner of my eyes. it is darkest at my inner eye and it spreads to the inner corner of my upper eyelid, changing color depending on the light. is this evidence of the tyndall effect considering the hallows of my eyes are not over corrected? is vitrase an effective option if the area is not overfilled?

Restylane is a great filler for the tear trough (under eye) area. However, if it is placed too close to the surface of the skin it can give off a bluish hue, which may be the cause of your dark circles. This occurs frequently because the skin is so thin. Vitrase will dissolve the Restylane and the blue tint but it will also remove the facial volume from the Restylane as well.

You should revisit your oculoplastic surgeon and together you can find the best solution to this problem. If you had taken aspirin or NSAIDs (Alleve, Motrin, etc.) there is a greater possibility of developing bruising after Restylane injections.

I’m interested in having an alar base reduction this fall, but i have an ethnic nose with thick, oily nasal skin. i am using differin for acne but i was wondering if the use of accutane could thin out my skin before surgery for the best results. would it be more beneficial to start using accutane before i get a rhinoplasty or should i wait till after?

Accutane is a very powerful medication and it can slow the healing process. Many surgeons advise waiting for at least six months, sometimes even a year after going off of Accutane to undergo elective surgery. If you want an alar base reduction this fall, I would recommend waiting until after your rhinoplasty to begin Accutane.

Is an alar base reduction a more difficult procedure than a tip plasty? i have heard that it is a risky procedure that needs to be done very precisely to ensure the two nostrils are even.

Rhinoplasty in general requires an aesthetic eye, steady hands, and lots of experience. Surgery of the nasal tip is one of the most challenging aspects of rhinoplasty but surgery of the nostrils also requires a lot of care. There are a few different ways to narrow the alar base.

Your plastic surgeon should be able to show you the different locations for the incisions and tell you how the narrowed alar base will affect your appearance (it can make the tip more prominent, etc.). Measurement is extremely important when trying to make the nostrils even. However, remember that complete perfection is not possible, but your surgeon should be able to make them as symmetrical as possible.

I have huge puckers of skin along the incision lines by my ears. how long will they last?

Please see your surgeon for a follow up exam and then you can ask whether massage or silicone scar products can help you.

Would a chin augmentation using radiesse or restylane be less effective or less natural looking than a surgical implant?

For a temporary chin augmentation Radiesse and Restylane are great options. Many patients are pleased with the results from them. You may also want to consider Sculptra, which can give you a semi-permanent customized augmentation that can last up to two years. You will need to choose a physician experience with Sculptra however, because it is a very advanced injection technique.

I am 52 and i have really thin skin. the areas around my temples have lost fat and are really sinking in. i would like my temple area to regain its fullness but i don’t want it to be lumpy. someone recommended radiesse as a good option. do you know if radiesse or any other filler is good for injecting around the temples area?

For injecting the temple area I would recommend the use of Sculptra. It is an excellent filler option for the temple area and one I use frequently on my patients. It is also used for patients with temporal wasting from HIV lipostrophy. Since Sculptra uses a more advanced injection technique I recommend you choose a physician who is skilled and experienced with injecting the temporal area. Patients are pleased with the results from Sculptra. Best of luck!

What are the options for tightening jowls and skin laxity in the face in general?

It is important to evaluate three key components of aging with every patient:

  1. Skin
  2. Gravitational changes
  3. Volume loss

Skin resurfacing with a laser or chemical peel is best considered for sun-spotted, wrinkled skin with mild laxity. Surgery is the best option for gravitational issues to restore the skin and underlying structures to their previous position. Your expectations and physical characteristics will determine whether a mini or traditional facelift is needed. Loose jowls and sagging cheeks can often be corrected with volume replacements, or injectable fillers. It is essential that you first have a consultation with an experienced, honest, and versatile facial plastic surgeon that can discuss these options with you and answer any questions you may have. As always, it is important to be open and honest with your facial plastic surgeon.

How long does restylane for under the eye treatments last and how many times is the procedure need to be done?

I perform Restylane under the eyelids on a daily basis and I sincerely recommend you only find a very experienced physician, who you trust, to perform this procedure. This area requires a less amount of Restylane compared to other areas of the face, which makes the procedure great and cost-effective. You will love the results once you correct the tired, sagging look under your eyes.

I want to correct my nose, which droops when i smile. my doctor does not want to cut my depressor septi, he wants to attach cartilage or something else to the septum. my sister had the muscle cut eight years ago and she had good results. which way do you believe is better?

I would suggest you try a small Botox injection into the muscle before surgery, which can give you the “fix” you are looking for. For a more permanent alternative I would recommend rhinoplasty, because muscles just heal if you cut them. The results of a cartilage graft really depend on your individual nasal tip. Skin type, shape of your nasal cartilages, and septal deviation factors can all play a role. I would advise to try Botox first and to schedule a consultation with an expert.

Surgery scares me so i’d rather fill in my tear trough depressions and lessen my bags with a facial filler. will restylane help me with these problems?

Restylane is an excellent option that will last for six months in this area and it is reversible so you can “try it out” first. Even though Restylane can be dissolved if you are not happy with the results, you should still choose an experienced physician because this is a delicate area.

What is the best laser to use on light brown skin for laser hair removal? which is better ipl or cynosure?

Laser is more effective than IPL for permanent hair reduction. The Cynosure Elite laser has both Alexandrite and NdYag wavelengths. It is the most effective because these wavelengths are precisely for melanin in dark hair follicles. There will also be less of a chance that there is an effect on the surrounding skin. I would say that the NdYag laser is the best choice for your light brown skin. Always go to an experienced physician because a lot of laser centers do not have a physician overseeing the treatments, especially here in NY. There is more of a chance that dark skin can get burnt or darken from absorbing the laser or IPL energy. The treatments are painless and effective and you want to be treated by a caring physician. Physician offices also offer comparable prices to those advertised with laser hair centers so try not to be lured by price. Make safety your first priority and choose your physician wisely. Laser hair removal works really well and with the right machine and physician the results can be great.

I have trouble breathing because of a deviated septum i am looking to get fixed in the near future. would this be considered a cosmetic procedure even though it is for medical reasons?

Correcting a deviated septum is always a medical, not a cosmetic, procedure. When there is nasal obstruction that cannot be corrected with medical therapy, like nasal steroid sprays, a surgical approach is needed to straighten the septum and improve nasal airways. Changing the septum generally does not change the appearance of the nose. Please contact a board-certified otolaryngologist (ENT) surgeon for a consultation. If you are interested in having rhinoplasty surgery at the same time as a septoplasty, consider visiting a double board-certified ENT and facial plastic surgeon.

I’m interested in a permanent wrinkle treatment for the vertical lines around my mouth that has few side effects because i have sensitive, fair skin. what would you recommend?

You have many options to choose from to improve the wrinkles of your upper lip. Botox can help relax the muscle responsible for pursing your lips, though you may notice that you are not able to move the same way when drinking from a straw or trying to whistle. You can also try filling in the lip lines with a hyaluronic acid like Restylane or Juvederm. Thicker fillers are not an appropriate option in the lip area or for superficial lines. A third option would be skin resurfacing with several lasers that offer improvement with little or no downtime. The fractional CO2, erbium, or the Affirm by Cynosure work well and because you are fair skinned you make a great candidate for laser procedures. As always, wear sunscreen and avoid drinking from straws to keep from making those lines worse.

I have developed an immunity or a strong resistance to botox a. what are my other options for crow’s feet? i don’t think botox b is an option in my area.

I have occasionally come across a patient who has developed a Botox “resistance” however, the patient usually responds if it is properly dosed. Beyond Botox, a fine injectable filler, like collagen or hyaluronic acid, works well also. You could also be a candidate for upper eyelid blepharoplasty because the excess upper eyelid skin can make crow’s feet worse. This heavy excess skin can be removed with a blepharoplasty to improve your appearance. You have many options to choose from.

Written by Dr. Halaas

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