Q. Can years of under eye Botox create Malar Mounds? (Photo)

RealSelf actual patient comment:

For the last two years I have been getting Botox under my eyes. I was starting to get deep creases under my eyes not cried feet. The last 2 times that I went for Botox it was with a new doctor. She injected 10 units and 6 of them were directly below my lower lid. I now how lower eye bags that are almost unbearable and they are worse in the am. I am only 29. Is this a result of Botox? Will it get better when the Botox wears off or is it permanent since I have been getting Botox for two years?


A. The relatively high dose of Botox for your lower eyelids is preventing your muscles from contracting and squeezing accumulated fluid from your malar area.  This should resolve when the Botox wears off, avoid injecting this area in the future and look to other ways to treat what bothers you.  Good luck and be well.

Q. I want to have my upper eyelids done and originally was going to go under anesthesia but now I don’t know?

RealSelf actual patient comment:

The 1st quote i was givin was including anesthesia but then they gave me a different price all together which added 1000 $. How “awake” are you under local only and which do most people do? I have extreme anxiety so i dont know if i could sit still during the procedure.

A. We perform upper eyelid Blepharoplasty under local anesthesia all of the time.  With proper pre-medication the surgery is very well tolerated.  We give Xanax 30 minutes before to help with anxiety and then give weight appropriate Demerol injection about 15 minutes prior to the surgery.  Most of our patients are in and out of sleep during the 1 hour procedure.  Love Austin! Good luck and be well.​

Q. Nose and neck nightmares! What procedures are available to correct these unflattering features? (Photo)

RealSelf actual patient comment:

As I age what used to be the “tip” of my nose is turning into the ” ball” of my nose. When I first noticed it I thought no biggie however the ball is GROWING! And my neck no doubt the formation of a turkey neck has began this is NOT something I am comfortable with! What procedures if any are available to correct these very unflattering facial features???

A. If those are your nightmares, I would like to see your sweet dreams!  The tip of your nose can be refined with a conservative rhinoplasty while there are a number of treatments both surgical and non-surgical that will address your neck concerns.  The most important aspect of your prospective treatment is to make sure that you choose your treating aesthetic physician/surgeon most carefully based on their skill, knowledge, experience, and natural artistic vision.  Boomer Sooner.  Good luck and be well.

Q. Could both Rhinoplasty and Septoplasty be done together? (Photo)

RealSelf actual patient comment:

When i consulted an ENT SURGEON, he suggested me to undergo septoplasty, to rectify the curve in my nose since birth. I asked him whether Rhinoplasty be done together, although i want to change my nose shape because it doesn’t suites me. He answered me with a no. Can it be done together?? Thank you

A. Unfortunately your ENT gave you bum advice.  Rhinoplasty and septoplasty are performed at the same time more often than not.  It sounds as if your particular ENT surgeon is not comfortable performing the aesthetic rhinoplasty portion of a septo-rhinoplasty.  Most ENT surgeons are very well trained in both septoplasty and rhinoplasty.  As long as you are going under anesthesia to correct your septum, you might as well consult with surgeons who are facile at doing both procedures at the same time.  Make sure to choose your nose surgeon most carefully.  Good luck and be well.


Q. The swelling is out of control after lip filler. Is this normal? (photo)

RealSelf actual patient comment:

I had lip injections yesterday, they were really painful after but not so much any more. The attached photos show before and after then what they look like now.

A. Sorry to hear about your adverse reaction to filler in your lip.  You must return to your injecting physician for evaluation.  Most likely you are one of the extremely rare patients who may be allergic to filler.  Make sure that you know what type of filler was injected.  You should inquire about a steroid shot and taking antihistamine for immediate relief.  In the future you should have a forearm skin test prior to any filler injections.  Good luck and be well.

Q. How often for maintenance Sculptra? Can’t go by looks since you see yourself everyday.

RealSelf actual patient comment:

I know a good rule of thumb is one vial per decade, but that’s at first? I’m 35 and although I noticed fine lines and signs of aging, I didn’t realize it was volume loss. During a botox visit, I was offered a free Sculptra treatment to be a demo. They said I was a perfect candidate as I had volume loss around cheeks, temple and jaws. After a total of three vials spaced out accordingly, I couldn’t be happier. It was a mini face lift! So if I want to maintain, how often should I get a vial?

A. Great to hear that you are happy with your Sculptra treatment.  It is thought that once a patient reaches “full correction” after their injections they may benefit from “maintenance” treatment about 2 to 4 years later.  We are all unique so it is best to return to your physician for re-evaluation whenever you notice that you may be looking a little tired or that dreaded five letter word, saggy.  Good luck and be well.

Q. Will a closed rhinoplasty accomplish my desired effect? (photo)

RealSelf actual patient comment:

The hump needs to be shaved a bit. I don’t want a curve. The overprotection of my tip is the biggest issue I have and I’m afraid of the tip appearing more bulbous and projected by bringing in the bridge. Can the desired effect be accomplished with subtle alterations made via a closed rhinoplasty?

A. Yes, a properly performed closed rhinoplasty procedure can accomplish your nasal aesthetic goals.  The closed approach rhinoplasty is becoming somewhat of a lost art as the last generation of rhinoplasty surgeons have learning rhinoplasty from their professors under the “open” or “external” approach.  The closed approach avoids any external incisions or scars, but is much more difficult to teach or observe the intricacies, thus most teaching centers use the open approach.  Subtle results can be achieved without leaving you with an obvious “done-look” nose.  Go Bears!  Good luck and be well.


Q. I have a dip at the tip of my nose and would like it gone. Was wondering about approx. cost, time to heal, bandage time? (Photo)

RealSelf actual patient comment:


A. The tip of your nose can​ be shaped to your liking with a properly performed rhinoplasty.  The cost of the surgery varies depending on the surgeon. Costs will include the surgeon fees, operating room and anesthesiologist fees ranging anywhere from $7 to $25K.     It is and will be your nose for the rest of your life, so as they say about sushi, going for the cheapest is not always best. The most important aspect of your rhinoplasty is making sure that you choose your surgeon based on their skill, experience, knowledge, and natural artistic vision.  The time line for healing is about 5 days until the tape and splint are removed, one week for walking around the block or out and about, one week for work, 3 weeks for aerobic exercise, and 6 months before diving head first into the water.  Good luck and be well.

Q. I want a smaller, youthful, more feminine nose not an upturned pig nose – could I get closed surgery?

RealSelf actual patient comment:

I also don’t want the standard nose that is often given to everyone. Not too sure about a chin implant, was suggested to me, I may consider it if I am 100% satisfied with my nose. below are my pictures, & a nose style I like. I am also worried about my nostrils being uneven. Will they show up more asymmetrical if I remove the tip and the hump? I am willing to travel a bit to find the right doctor, but I am terrified my appearance will cause me to not look like “me”.

A. The most important aspect of your​ prospective rhinoplasty is making sure that you choose your surgeon most carefully.  You can achieve a smaller, youthful feminine nose with a “closed” approach rhinoplasty, all incisions are inside of your nose without any external incisions or scars.  The closed approach has become somewhat of a lost art as a generation of rhinoplasty surgeons have been trained with the “open” approach as it is much easier to see the anatomy and techniques in a teaching environment.  Your nostrils should have a symmetric result and should not be affected by hump removal and tip refinement.  A “pig” nose should not even be a consideration in a properly performed rhinoplasty on your nose.  I agree that a conservative chin implant will improve the proportions of your nose and other facial features.  Choose your rhinoplasty surgeon carefully based on their experience, skill, knowledge, and most importantly their natural artistic vision.  Good luck and be well.

Q. Will half a syringe of Voluma make a difference in the cheeks?

RealSelf actual patient comment:

“Hello, I purchased 2 syringes of voluma, but my doctor ended up only using 1.5 of it. I now have half a syringe left and I don’t want it to go to waste I know voluma is most commonly used for the cheeks…I have good cheeks but a bit of a lift and/or some more volume/definition would probably be nice since I am quite thin. Can half a syringe actually make a noticeable difference? Also, what does brushing/swelling look like this little amount injected? I always bruise with injections by this DR”

A. Voluma is a great filler when used by expert injecting physicians.  A small amount can make a big difference.  I can always find room for a bit more to make a face look more beautiful in a natural manner.  Though patients may bruise with any injection, it is certainly not normal that you should always bruise when injected.  The most important aspect of any aesthetic treatment is that you choose your injecting physician most carefully based on their skill, experience,knowledge, and natural artistic vision.  Good luck and be well.

Q. Am I a good candidate for Rhinoplasty?

RealSelf actual patient comment:

“I know I’ll ultimately need an in person evaluation, but can my nose be fixed with rhinoplasty? It’s very downward facing and long and my gap between nose/lip is large (I don’t want to lengthen the nose more though as is already quite long) also, I have a small bump and possibly overall narrowing of bridge for my face? Should I keep it as is or can I gain some overall aesthetic improvement? Thank you!!”

A. Your areas of concern about your nose can be addressed with rhinoplasty.  I would advise a subtle, very conservative rhinoplasty plan in your case.  Your small bump can be taken down and your tip can be refined.  The lines from your brows to the tip of your nose can be smoothed.  It is essential that your choose your rhinoplasty surgeon most carefully based on their skill, experience, knowledge, and most importantly their natural artistic vision. Good luck and be well!

Q. Would Alar base reduction be enough?

RealSelf actual patient comment:

“Or would I benefit more from doing some work on nose bridge as well? What can you tell by just this one picture”

A. Based on your photo, alar base reduction only on your nose would alter the natural proportions of your nose, causing your nose to be an unwanted attention getter.  A great nose does not draw attention, rather it gets out of the way of other facial features, particularly your eyes (which should be the central focus of your face.)  Consult with rhinoplasty experts to address your nasal aesthetic concerns.  Be sure to choose your rhinoplasty surgeon most carefully.  Good luck and be well.

Q. What kind of rhinoplasty would be the best option for me?

RealSelf actual patient comment:

“I’m 20 years old considering a rhinoplasty i feel like the tip of my nose keeps getting bigger every year and also I’m wondering if i have a deviated septum, I would like to know what kind of rhinoplasty would be the best for me and the pricing in my area. it’s the thing that makes me the most insecure should i do it now or just wait and do it all at the same time with FFS. i posted a picture of my nose and the desire nose i would want, are those results achievable ?thank you.?”

A. You have a nice nose and realistic aesthetic goals.  I love operating on noses like yours using a closed approach (no external incisions or stitches).  I would “sand down” your bump and refine your tip cartilages.  No packing is used.  Noses such as yours respond very well to subtle rhinoplasty where “less is more.”  You should still look like yourself, just your nose will not be stealing attention away from your eyes and other facial features.  Make sure to choose your rhinoplasty surgeon most carefully based on their skill, experience, knowledge, and their natural artistic vision.

Q. Would Sculptra be the appropriate filler to treat my nasolabial folds? Which areas would you inject?

RealSelf actual patient comment:

“I am a 37 years old male with pronounced nasolobial folds. I always had a bit of nasolobial folds and to be honest never liked them, but they just start to look really pronounced and the line is getting more vertical which really creates a very tired look. Please let me know your professional opinion about the best treatment. I am also adding some photos to give you a clearer view of the issue. Thanks in advance for your help”

A. Yes, Sculptra would be an excellent treatment to treat the volume loss in your face that has resulted in prominent nasolabial folds.  Make sure to choose your treating physician most carefully based on their experience, skill, knowledge and natural artistic vision.

Q. What is the best treatment for nasolabial folds?

RealSelf actual patient comment:

“I am a young patient 24 and I was wondering what is the longest lasting and best treatment for my nasolabial folds, around the mouth area, corners of my mouth , cheeks? I have read good reviews about sculptra but not sure if that is going to be the best alternative for me. Thanks”

A. Nothing beats being 23 years old for nasolabial folds.  Unfortunately from age 25 on we all begin the process of losing volume (bone, fat, and muscle) from our face.  When there is volume loss from the maxilla (cheeks), the soft tissue above the nasolabial folds loses its scaffolding support and begins to head south.  The best treatment to correct nasolabial folds is actually to avoid treating the fold itself (which is the result of volume loss in the cheek) and to instead treat the cause of the fold using either Voluma or Sculptra to replace (not augment) the lost cheek volume in a natural way.  So many patients are concerned and share that they do not wish to look unnatural or have “bigger cheeks”.  I do not make your cheeks bigger, rather just restore them to their previous more youthful volume.  Make sure to choose your treating aesthetic physician most carefully.


Q. How much is the average lines of Ultherapy for face and neck, or the most frequent/common number of lines used?

RealSelf actual patient comment:

“I know individual treatment may vary. But I would like to know as doctors that perform ultherapy what the most common number of lines you use is.”

A. The average number of Ultherapy lines for the cheeks is 240 lines deep, 190 lines superficial;  for the eye and forehead area, usually about 70 deep, 100 superficial;  for the neck 110 deep and 120 superficial.  If an extended neck is included (down to the clavicles) then an additional 150 deep and 150 superficial lines are used. Make sure to choose your Ultherapy physician most carefully.


Q. Could my nose use surgery? Is the bump bad/ugly?

RealSelf actual patient comment:

“I’ve always been self conscious about my nose. I have a dorsal bump, and I hate it very much. My parents say I’m overreacting, and that it’s nothing, but I would like a professional answer as to if it would look better with surgery, and if my nose currently has bad form. Am I overreacting? Or is it truly ugly?”

A. You have a very nice nose with a small bump on the profile.  If it bothers you a lot then it is worth investigating rhinoplasty.  I love operating on noses like yours as it is possible with just a few small internal incisions (closed approach rhinoplasty) to take down the bump with minimal other changes to the nose resulting in a beautifully natural nose.  In your case it is most important to choose a rhinoplasty surgeon who will listen and understand what your aesthetic goals are, and who will honor your request without drastically changing your nose with an “obviously done” appearing rhinoplasty.

Q. Should I be more direct to the doctor when being treated with Botox?

RealSelf actual patient comment:

“I am 59. I’ve had Dysport and Botox and experienced the droop. I believe only the central glabella area should be treated not above my eyebrows. Last time I asked the doc not to do above my brows but she went ahead and did a couple injections just above the tail of my stronger side, hence droop. To get positive results, should I suggest she only do the glabella and possibly under (rather than over) the tail of my eyebrow to get a slight lift? Thank you for any help you can offer.”

A. Yes, you should definitely discuss what works and what doesn’t work for you with Botox.  Everyone’s anatomy is unique, every injecting physician should assess the patient’s anatomy prior to treatment.  If you are dissatisfied with your injector, make sure to choose your next doctor most carefully.


Q. Have you ever seen swelling this bad 8 days post-op?

RealSelf actual patient comment:

“I had septorhinoplasty (closed) with work done to my tip. I’ve never seen a photo like this…. all of the cast removal day photos of noses look so nice and mine just looks completely deformed. I had surgery exactly one week ago. I am so depressed.”

A. Sorry to hear about your post-rhinoplasty swelling.  You should have your rhinoplasty surgeon examine your nose to make sure that all of the “packing” has been removed and that you do not have an early infection.  I personally have not seen your amount of swelling one week post rhinoplasty.

Q. I had 1 cc of Juvederm injected into my lips yesterday and absolutely hate how they look….

RealSelf actual patient comment:

“Where should I ask for the dissolver to be placed so that I can have a more natural shape but still keep filler in my lips? Can I just partially dissolve it? How long should I wait? I’m very upset because I had put the money aside for it and cannot afford to pay for another syringe at the moment. Would wydase etc dissolve everything? I still want the filler but a more natural look! It also caused weird lines around my mouth.”

A. Sorry to hear about your lip injection dissatisfaction.  It appears that your lips were large and pretty to begin with, and then on top of that too much Juvederm was injected.  At this point it is best to wait a few days and then consult with someone whose artistic vision can be trusted.  Most likely you will have some of the recent filler dissolved with hyaluronidase.  I would begin with your upper lip because the natural ratio of beautiful lips is the lower lip being about 1.6 times larger than the upper.  As with all aesthetic treatments, the most important aspect of your treatment is making sure that you choose your physician most carefully based on their skill, experience, knowledge, and natural artistic vision.

Q. I had Ulthera on my neck November 2016…

RealSelf actual patient comment:

“5 months later I look just awful, what should I do to fix it?”

Ulthera Patient

A. The excess skin on you neck can be reduced by either surgery or minimally invasive non-surgical procedure called Profound. Profound uses radio frequency energy emitted through micro-needles below the skin to tighten lax skin of the neck, jowls, cheeks and forehead. As always, be sure to choose your treating physician most carefully.

Q. Bulbous nose reshaping – can it be done without redoing whole nose?

RealSelf actual patient comment:

“Can it be done without redoing whole nose? Not looking to have full reshape, but just the tip.”

A. Your question is a common one and is best answered in person after examination and evaluation by an expert rhinoplasty surgeon. ​Shaping a nose is like sculpting, once one part is changed it is essential to be sure that the rest of the nose is in harmony. Rhinoplasty has evolved over the years to where the surgery is more conservative, we consciously attempt to preserve more of your underlying bone, cartilage, and soft tissue. When I consult with a patient with your goals, we share a computer image of before and after, and then decide on the plan. Sometimes thinning and refining the tip is all that is needed, in other cases, small refinements of the rest of the nose is required for the best aesthetic outcome. The most important aspect of your rhinoplasty is making sure that you choose your rhinoplasty surgeon very carefully based on their experience, skill, knowledge, and natural artistic vision.

Q. If I decide on a tip rhinoplasty and then want a full rhinoplasty, is that bad?

RealSelf actual patient comment:

“What is your advice? I’m just a little too worried about actually having them hammer and break the nasal bone. I’m also terrified about anesthesia going wrong and being awake during.”

A. Rhinoplasty is an artistic procedure. Everyone’s nose is different. Some noses may lend themselves to just having the tip refined, and the majority of noses benefit from having the entire nose shaped to create nice harmony that does not attract attention to aspects that may be out of proportion. Fortunately, anesthesia today is much improved over years past. When my patient is undergoing anesthesia prior to rhinoplasty, I tell them just before the IV medication that lets them “go to sleep” to think of their favorite people, places, things to do (i.e. paddle boarding in Hawaii, etc.). Our patients experience what seems like a one minute dream and the next thing that they know is they are in the recovery room comfortably awake from the 2 to 3 hour rhinoplasty. There is no need to worry about “waking up” during the rhinoplasty surgery. You should not be aware that the nasal bones are being cut (“hammer and breaking”). I would not limit your rhinoplasty because of this fear, whether to address your nasal bones or not should be based on the goals of the surgery, your anatomy, and your shared artistic vision with your rhinoplasty surgeon. Choose your rhinoplasty surgeon based on their experience, skill, knowledge, and most importantly, their natural artistic vision.

Q. Skin Tightening? Any doctors have experience with “Profound RF” treatment?

RealSelf actual patient comment:

“The Profound procedure looks very promising. Is any doctor doing it? What can one expect as far as down time? What is the typical pricing?”

A. Profound uses paired micro-needles that emit radio frequency energy in a precise temperature controlled manner that maximizes the production of new elastin, collagen, and hyaluronic acid in the treated skin. I have used Profound on the face and neck (including the forehead to lift tired brows) resulting in impressive lifting, tightening, and natural rejuvenation. We have also treated cellulite of the thighs with Profound. Patients are quite swollen after the treatment, usually lasting 5 to 7 days. Bruising varies and also resolves within 5 to 7 days. Our pricing varies depending on the areas treated, anywhere from $4,500 to $8,000. I personally perform all Profound treatments on my patients. Make sure to choose your treating aesthetic physician most carefully based on their experience, skill, knowledge, and natural artistic vision.

Q. “Injectable laser” for tightening? Profound? Has anyone used it on legs yet?

RealSelf actual patient comment:

“I recently read about a new laser that is supposed to be “injectable” for tightening?? I think that it is called Profound? I think they have been using it on the face but going to be getting a new way to use it on the legs for loose skin? Has anyone heard of this and what kind of results it is having? I’m curious about it. I would love to have tighter skin on my legs.”

A. Yes, we have used Profound on the thighs to treat cellulite with nice results and no downtime. There are certain areas on the legs where if the skin is thick enough Profound can tighten loose skin. It does work very well on the face and neck to tighten and lift, rejuvenating the face in a natural rested fashion.

Q. Can you suddenly develop an allergy to Juvederm? What are the chances that the same thing will happen again?

RealSelf actual patient comment:

“I had a horrific and traumatizing experience with Juvederm Summer 2015, which has lead me to fear any type of lip fillers or fillers in general. I got a hematoma, which lead to an infection, which lead to a huge bump on my lip, which had to be drained at the ER. Before this happened, I had no problems with Juvederm, and had it done regularly over the Aquamid which I’ve had in my lips for over 8 years. I want to do Juvederm again, but I’m so afraid that the same thing will happen again!?”

A. Sorry to hear about your bad experience with lip filler injection. What you experienced was not an allergy to the Juvederm injected into your lips, rather you had a vascular (blood vessel) event, either there was too much bleeding from a deep needle puncture, or you may even have had filler injected into a blood vessel which can cause overlying skin to break down. Aquamid has been known to have severe delayed response infections and that may have played a role in your complication. It is most important for you to consult with and be treated by only an experienced, skilled, and knowledgeable physician injector in the future. I believe that you may be able to have lip injections again, but only with precautions taken.

Q. How do I choose my rhinoplasty surgeon?

A. The absolute most important aspect of your rhinoplasty is your choice of rhinoplasty surgeon. Rhinoplasty is considered the most difficult of all facial plastic surgeries combining art and science. You should consult with at least 3 or more rhinoplasty surgeons prior to making your decision. Your decision should be based on the surgeon’s experience, skill, knowledge, and most importantly their natural artistic vision. Make sure that your rhinoplasty surgeon listens to your concerns about what bothers you about your nose as well as appreciating your aesthetic rhinoplasty goals. It is important to be on the same wavelength prior to surgery so that you are not left to be surprised by unwanted results. Look at before and after photos, ask to meet or speak with the surgeons rhinoplasty patients, ask if anyone in the office has been operated on by the surgeon. Computer imaging is helpful to communicate your goals for rhinoplasty, make sure that the imaging is realistic and not just a nice photo-shopping job. Should you have any further questions about selecting your rhinoplasty surgeon, feel free to contact me. Good luck and be well. ~Dr. P

Q. Can Sculptra Be Injected Into the Lips?

A. Sculptra is an excellent facial volumizer. It works by stimulating your body to make new natural collagen where it has been injected. There are areas where Sculptra should never be injected and the lips are one of those areas. Sculptra is injected deep to muscle and over bone in most facial areas. When injected in areas without underlying bone, Sculptra is injected beneath the skin. Sculptra is not injected in the lips or superficially around the eyes because unwanted lumps and bumps can form. We prefer to inject lips with Juvederm, Restylane, and Restylane Silk, all of which in our hands results in natural beautiful lips. Always make sure to choose your injecting physician most carefully to ensure safe, effective, and long lasting results. Good luck and be well. ~Dr. P

Q. Is Ultherapy permanent?

A. Patients often ask, “How long does Ultherapy last?”  The best answer is that when performed properly, a patient who has received Ultherapy will look better than they would have for the rest of their life had they not had the treatment.   I have personally performed Ultherapy for the past 6 years, and can only answer this question from my personal perspective.    The treatment is the best non-surgical lifting and tightening procedure available and is thought to be a onetime treatment.  I have seen many patients five years after their Ultherapy still looking better than they did before their treatment.  Other patients return after one year and are very happy with their results and wish to have more with another treatment.  Unfortunately the aging process continues with time, fortunately we have wonderful safe and effective treatments to help you keep looking your best.  Good luck and be well.

Q. Why does Ultherapy cost vary so much?

A. Ultherapy costs vary depending on the area(s) treated as well as on who is performing the treatment. In my practice, I perform all Ultherapy treatments because as a facial plastic surgeon I believe that my knowledge of anatomy and my ability to keep my patients as comfortable as possible leads to the best possible results safely while minimizing any adverse reactions or complications. My charges are slightly higher than the charges in a practice where the treatment is delegated to an assistant with little or no knowledge of vital facial structures and anatomy, and minimal experience in the treatment. The three main areas of Ultherapy treatment are the face, neck, and brows. The cost of the treatment varies depending on whether all three areas, or one or two areas are treated. Good luck and be well. ~Dr. P

Q. What constitutes of a thorough facial analysis?

A. Patients come to my practice not for a syringe of filler or a certain number of units of Botox. My patients benefit from my technique of full facial analysis using natural artistic vision to create the best naturally beautiful version of themselves. Over years of experience as a facial plastic surgeon treating thousands of patients, teaching others how to perform treatments, and staying up to date on the latest safe and effective facial rejuvenation treatments, I have developed the ability to thoroughly analysis your face and recommend the best individual plan to keep you looking your best. Leonardo da Vinci, hundreds of years ago described the “devine” or golden ratio that is found in nature as well as in beautiful faces. I use those natural ratios to create beauty on your face after careful analysis. At your consult, we will discuss the analysis of your face and give you a beauty plan for years to come. Good luck and be well. ~Dr. P

Q. When can a patient shoot a gun after otoplasty and rhinoplasty?

A. It is always best to consult with your surgeon when you have questions after surgery. We ask our patients to avoid strenuous activities for about 3 weeks after rhinoplasty at which time they may resume all physical activity other than boxing and diving head first into swimming pools, lakes, or the ocean. After otoplasty it is important to not traumatize the ears again for about 3 weeks. Good luck and be well. ~Dr. P

Q. Can all dermal fillers be dissolved?

A. Not all facial fillers can be dissolved. We prefer to use fillers in the face that can be dissolved, especially in areas of the face where there are significant blood vessels. Permanent fillers such as Bellafil and Silicone cannot be dissolved at all. Radiesse, though not a permanent filler, cannot be dissolved. The fillers that are made up of hyaluronic acid (Restylane, Juvederm, Voluma, Belotero) can be dissolved with an injection of hyaluronidase, an enzyme that rapidly breaks down the filler. The advantages of fillers that can be dissolved are that any lumps, bumps, or filling that is not good can be quickly corrected, and in the rare case of filler being injected into a blood vessel with vascular compromise, impending vascular necrosis can be avoided. Sculptra is a biological collagen stimulating filler that cannot be dissolved, yet is very safe as the fine Sculptra particles are dissolved in water and local anesthetic solution. My philosophy is to avoid the use of permanent fillers in the face because if there is a problem it can be very difficult to take care of….”Permanent filler, permanent problems.” Good luck and be well. ~Dr. P

Q. How long do dermal fillers last?

A. There are long lasting dermal fillers, short lasting dermal fillers, and those in between. The longest lasting dermal fillers are permanent fillers that include Bellafill, Silicone, and the patient’s own fat. The advantage of these fillers is that they last forever, the disadvantage is that they last forever and are very difficult to remove. The next longest lasting dermal filler is Voluma which is said to last up to 2 years. Sculptra is a bio-stimulating product that stimulates natural collagen production. Once patients have reached their “full correction” point with Sculptra, the results last for 2 to 4 years before additional treatment. Radiesse, Juvederm, Restylane may last from 9 to 12 months. Belotero is the shortest lasting dermal filler, lasting about 3 to 4 months. Make sure to choose your injecting physician most carefully to ensure that your treatment is safe and effective. Good luck and be well. ~Dr. P

Q. What is the difference between Fraxel restore and dual?

A. Fraxel restore laser was the first laser to use “fractionated” technology. Fractionated lasers treat a percentage or fraction of the skin surface area which is different from how older lasers treated the entire skin surface. The advantage of fractionated lasers is that normal skin aids in a more rapid and natural healing without the lines of treatment demarcation between treated and untreated areas. Fraxel restore laser is considered a non-ablative laser which means that it leaves the surface of the skin intact without removing any skin. Restore sends columns of heat through the skin which stimulates new collagen production and improves brown spot pigmentation. Restore treatment involves a 20 minute treatment, usually repeated 2 to 4 times every two to three weeks. Restore results in improvement of fine lines and wrinkles, better skin tone, texture, and color. The treated area is red and slightly swollen for 1-2 days, followed by a bronzing appearance that leads to a powdery flaking on days 3-5. By one week the skin looks beautiful.

A second type of laser was added to the Fraxel restore platform, this second laser is Thulium laser which specifically targets brown spots. The combination of the two laser systems is called Fraxel Dual. The Thulium laser is the best treatment for brown spots. The two lasers may be combined at the same treatment session to give patients a true “dual” treatment that results in beautiful skin. Good luck and be well. ~Dr. P

Q. What is the typical recovery after fillers?

A. Fortunately most of my patients are able to return to their normal activities immediately after their injectable filler treatment. In rare cases, there can be a small bruise which I minimize by using special advanced injection techniques. In the event of a small bruise, our patients are given arnica gel skin patches which have been proven to minimize bruises within 24 hours. We ask our patients to discontinue any medications that thin their blood for one week prior to treatment, and they can be resumed the day after treatment. We have found that not working out strenuously for one day after injections helps to decrease any late bruising or swelling. We like to see our patients back for follow up examination 10-14 days after their initial treatment to make sure that they have an excellent naturally beautiful result. As with any aesthetic procedure, be sure to choose your injecting physician very carefully based on their experience, care, knowledge, skill, and most importantly their natural artistic vision. Good luck and be well. ~Dr. P

Q. What is the best way to get rid of this “tired, saggy” look on my face?

A. Many of our 35 to 50 year old patients complain of looking tired and noticing that their face is sagging for the first time in their life. Fortunately there are some great choices of treatments that address the problem quickly, safely, and effectively. I particularly love to immediately correct “tiredness” with strategically placed injection of Voluma using The Master Injector Technique. With a 10 minute comfortable treatment, properly placed Voluma helps to rejuvenate the under eye area, the cheeks, the nasolabial folds, the corners of the mouth, and even the jawline. Ultherapy is the best lifting, tightening non-surgical treatment for the face, neck, and brows. Depending on the patient, Botox and/or Sculptra are used to complete their natural beauty rejuvenation. As with any aesthetic procedure, be sure to choose your treating board certified cosmetic physician very carefully based on their experience, care, knowledge, skill, and most importantly their natural artistic vision. Good luck and be well. ~Dr. P

Q. What makes Voluma different from other facial volume fillers?

A. Voluma has been a God send in my ability to rejuvenate patient’s face within 10 to 20 minutes. A small amount of Voluma is able to lift the face unlike any other facial filler. It is also the longest lasting non-permanent facial filler, lasting for up to two years. Voluma injection experts such as Dr. Persky are able to inject the product strategically to maximize the lifting effect while using the minimum amount of product to give you your best naturally beautiful results at the most economical cost…the biggest bang for your buck! More than any other aesthetic treatment that we perform, when patients are handed a mirror after their Voluma treatment, they respond with a spontaneous, “Wow!” As with any aesthetic procedure, be sure to choose your treating board certified cosmetic physician very carefully based on their experience, care, knowledge, skill, and most importantly their natural artistic vision. Good luck and be well. ~Dr. P

Q. How Often Do I Need to Repeat My Voluma Treatment?

A. The nice thing about Voluma treatment is that the effects are additive and cumulative. The first time that I treat a patient I like to remain conservative, usually using only 1 or 2 cc syringe(s) for a naturally beautiful result. I re-evaluate our Voluma patients about 10 to 14 days after their treatment to make sure that their results are maximized. Though Voluma lasts for a long time (when Voluma is injected properly, the results are very natural and long lasting, up to 2 years), I can usually find somewhere to place another little bit of Voluma to make you look even better. I recommend that patients consider a little more Voluma whenever they wish to look better, refreshed, rested, and beautiful. That can coincide with holidays, special occaisions, birthdays, etc. It is best to have your treatment 10 to 14 days before your special occasion. As with any aesthetic procedure, be sure to choose your treating board certified cosmetic physician very carefully based on their experience, care, knowledge, skill, and most importantly their natural artistic vision. Good luck and be well. ~Dr. P

Q. Why Do Many Voluma Patients Say That It Helps Them to “Go From Hottie to Oh My Goddie!”?

A. Recently while speaking to a new patient I asked whether she had ever had Voluma injected. She responded that she loves Voluma more than any of the other facial fillers that she has experienced and added, “In 5 minutes Voluma made me go from Hottie to Oh My Goddie!” Voluma results are immediate and long lasting. The injections are less uncomfortable than Botox injections according to our patients experience. As with any aesthetic procedure, be sure to choose your treating board certified cosmetic physician very carefully based on their experience, care, knowledge, skill, and most importantly their natural artistic vision. Good luck and be well. ~Dr. P

Q. What is The Dr. Persky Facial Beauty Plan?

A. Dr. Persky believes that each of his patients deserve an individualized beauty plan, not just for their immediate treatment but for the long term over many years. At your initial consultation with Dr. Persky, he will discuss what your goals and motivations are for your aesthetic needs. Next, Dr. Persky will perform a complete facial analysis discussing your unique rejuvenation. There will be recommendations made for immediate treatment, treatments for maintenance, and then long term treatment plans. Dr. Persky is conservative and usually proceeds with moderate improvement at a time. Included will be a discussion and recommendation of the best skin care products that will compliment and maximize your rejuvenation. As with any aesthetic procedure, be sure to choose your treating board certified cosmetic physician very carefully based on their experience, care, knowledge, skill, and most importantly their natural artistic vision. Good luck and be well. ~Dr. P