Q&A with Dr. Persky

Q:  Sculptra Expert Encino, Los Angeles, Beverly Hills, Calabasas, Malibu..Is Sculptra a good option for me?

Actual RealSelf Patient Comment: Hello, I am a 26F. A couple of years ago I hit 210 pounds then dropped down to 160 pounds over the course of one summer (3 months- 50 pounds). This resulted in flat cheeks and hollowness under my eyes that have since not gone away. I understand that Sculptra helps with volume restoration. I love the idea that it is slow-acting and a more ‘organic’ approach to volume restoration compared to dermal fillers. Would this be a good option for someone like me? Thanks

Dr. Persky’s Reply: You are actually a perfect patient for Sculptra Aesthetic treatment. The most important aspect of your treatment is choosing your treating physician very carefully based on their skill, experience, anatomy knowledge, and most importantly their natural artistic vision. With patience over time in the hands of an expert Sculptra injector you should be able to achieve and maintain your facial re-volumization goals. Good luck and be well.

Q: Swelling of lower lids 6 moths after Botox – what is a good treatment option? (photo)

Actual RealSelf Patient Comment: Hello. I had Botox injected directly into my lower lids last July. I developed swelling of the lower lids. The doctor who peformed the procedure indicated it would go away when the Botox effects wore off but the problem has persisted for 6 months though my crows feet are visible again. Does anyone have any thoughts on whether this swelling can last this long and can anyone offer a good treatment/solution? Thank you!

Dr. Persky’s Reply: The effects of the Botox injections should have long worn off by now. I would recommend an in person evaluation by an expert injecting physician to determine your best course moving forward. Feel free to contact our office to schedule a complimentary consultation.

Q: Which procedure options would help address lower face volume loss and laxity issues? (photos)

Actual RealSelf Patient Comment: Looking for suggestions on how to treat lower face laxity and hollowness on right side of face. The same thing is happening on the left side but seems a few years behind. I started developing this issue in my early 30’s and just turned 40. I have had a few consults along the way, most doctors recommended fillers, which I am hesitant to start doing, laser, or RF. RF did not work for me. Looking for recommendations on best treatment and hoping to avoid spending a small fortune in the process

Dr. Persky’s Reply: You are an ideal candidate for properly placed Sculptra combined with skin and muscle tightening treatment Ultherapy. Volume loss and asymmetry can be corrected though as you mentioned, it is not inexpensive. Please feel free to contact our office for an in person or virtual consultation at which time we will give you a quote on the cost of the treatment.

Q: Developing these lines when I smile. What causes these lines? What can be done to make them go away? (photos)

Actual RealSelf Patient Comment: I started developing these lines when I smile. It makes me self conscious because they’re very dramatic. What can be done to make them go away? When I pull back on the skin while smiling they disappear.

Dr. Persky’s Reply: You are not alone, this is a common complaint. It occurs because of loss of volume, loss of elasticity of the skin, and facial movements. Loss of volume and elasticity can be addressed, we want to keep your facial movements. I would treat you with a combination of treatments for maximum results. I would use a foundation of Sculptra under muscle and over bone, combined with Profound RF (microneedle radiofrequency) with PRP (Platelet Rich Plasma). In addition you would likely benefit from additional filler at the angle of your jaw and along your jawline. If you are ready to undergo surgery, then a deep plane facelift should help as your problem disappears when you pull back your skin. Please feel free to call our office to schedule an in person or virtual consultation.

Q: Cheek implant vs filler? Is it possible to have filler that doesn’t move when animating the face?

Actual RealSelf Patient Comment: I had a product similar to bellafill about 15 years ago, and the volume is fine, but when I smile it looks very unnatural because the product was injected right under the skin. I’m in the process of having it removed, but want to have a replacement of volume that doesn’t move and look huge and unnatural when smiling. Is it possible to have filler in the cheeks that doesn’t move when animating the face, or will I need an implant?

Dr. Persky’s Reply: Your first step is to have the offending filler removed, which with Bellafill is difficult. There are fillers that are “expressive”, one of which is Restylane Defyne. The other technique to avoid filler moving unnaturally on expression to have the proper filler injected at the proper level (an example is having Sculptra or Voluma injected deep below muscle and over bone.). My best advice is that patients must choose their injecting physician very carefully in the first place.

Q: I lost 55lbs and my skin is sagging. What are my options?

Actual RealSelf Patient Comment: Hi I gained 68lbs after covid and was 215 from 153. I was also not working out taking vitamins and not taking care of my health. I always use to be at the gym, are healthy, and worked out prior. Now my face looks different and lower and saggy. I lost 55 but still want to lose 15. The. First photos are before covid, the third is being overweight and the last is current, please advise I am looking at fillers.

Dr. Persky’s Reply: Great work on losing the weight! Congratulations!!! Either face/neck lift surgery with fat transfer, or combination of fillers and lifting and tightening non-surgical devices is the best way to address your concerns and help you achieve and maintain your aesthetic goals. Very important to choose your treating physician carefully! Good luck and be well, stay healthy!!!

Q: What can I take to alleviate the pain during & after Botox injections for migraines?

Actual Real Self Patient Comment: I’ve suffered from chronic migraines for twenty years. In the past, I was treated with Botox injections to treat my migraines. It helped BUT I stopped due to the pain of the procedure. I must be usual… it is NOT a mild stinging pain. Those 30 plus injections HURT. Especially those administered to the scalp, neck, and shoulder. My doctor wants me to treat me again with Botox ( nothing else works). What can I do to alleviate the pain… ice is not as effective with 30 different site injections.

Dr. Persky’s Reply: You may find an office that uses inhalational nitrous oxide. Applying ice firmly in an area away from the injection a millisecond before the injection really helps.

Q: Best Physician Filler Injector..My cheek filler seems to have lumped up in one location, normal? (Photos)

Actual Real Self Patient Comment:
Will this spread out over the year?

Dr. Persky’s Reply: Not normal for filler to lump, too much was placed in the area. It will not spread over time, though it should come down some over time depending on the filler that was used, hopefully not a permanent filler. Non-permanent fillers can be dissolved. If you are bothered by the appearance then I would recommend having the filler dissolved. Would also recommend choosing an expert physician injector with artistic vision.

Q: Will smoking my vape affect getting lip flip Botox for a gummy smile, directly impact my results?

Actual Real Self Patient Comment: see above

Dr. Persky’s Reply: You may vape all you wish and your lip flip and control of your gummy smile will continue to not be affected. Just read an article stating that having the CV boosters is causing their botox to not last as long.

Q: Cheek ripples? Help! (Photo)

Actual RealSelf Patient Comment: How can I get rid of these ripples in my cheeks. They are getting worse! I do have dimples which I’ve always had. But now it ripples all the way to the top of my cheeks! How can I get rid of this? Filler? Face lift? Any advice please? (I’ve never had any filler in my face by the way so it’s not a complication of any of that!) help!

Dr. Persky’s Reply: You have a beautiful face. I would treat your concern with Restylane Contour filler. You may also benefit from the skin/muscle lifting device Ultherapy. Feel free to contact me with any further questions.

Q: Would Botox help fix asymmetry and texture in the cheek area? Should I consider surgery? (photos)

Actual RealSelf Patient Comment: Is it possible to amend the jaw asymmetry i have with Botox and fillers vs surgery (35 years old)? I prefer my left side with the green check but am open to surgery if it’s most effective and a better financial option (also interested in cheek implants for lifting the mid face). I notice my skin texture is just awful despite using retinol and a great skincare regimen for the past few years. I had Sofwave done in 2021 and Halo in 2020 but am alarmed by how blah I’m looking.

Dr. Persky’s Reply: Fillers are your best option. Feel free to call our office for a virtual or in person consultation.

Q: Best Deep Plane Facelift…Is it safe to have a deep plane facelift with an Acoustic Neuroma?

Actual RealSelf Patient Comment: I am exploring having a Deep Plane Face & Neck Lift & Upper Blepharoplasty. I was recently diagnosed with a very small acoustic neuroma. Is it even something that needs to be brought up or discussed

Dr. Persky’ Reply: Yes, it is safe to have deep plane facelift, neck lift, and blepharoplasty in patients with a small acoustic neuroma. You should include it in your medical history with your facial surgeon. William C. Harris, MD (Encino, CA) is my recommedation as an expert deep plane facelift, necklift, and blepharoplasty surgeon. As with any aesthetic procedure, make sure to choose your surgeon most carefully.

Q: 6 vials of hyaluronidase after vascular occlusion – will I ever look the same? (Photo)

Actual RealSelf Patient Comment: I had 6 vials of hyaluronidase when I had a vascular occlusion now my face feels strange and looks very different- will I ever look the same? Or am I permanently damaged from that much hyaluronidase??

Dr. Persky’s Reply: Sorry for your bad experience. The swelling from the hyaluronidase will come down and hopefully you will not have any permanent damage. Most likely the swelling that is in the photo will resolve within a day or two. Hope that you are better by now!

Q: Should I get Morpheus8 or Ultherapy first for jawline sagging, fine lines & acne scars? (Photo)

Actual Real Self Patient Comment: My concerns are sagging skin around the jaw line, fine lines in my forehead and crows feet, and a few acne scars/redness. I want to get both the Morpheus8 and Ultherapy done in the near future. Which procedure would you recommend I get done first?

Dr. Persky’s Reply: Your neck anatomy is best suited for liposuction which would be best to restore your jawline definition. If you are looking for non-surgical treatment, I believe that Profound RF or FaceTite would be your best choices, though FaceTite is a bit more invasive. Morpheus 8 will not do much for your neck and jawline. Multiple M8 treatments may help with fine lines. Ulthera is good for lifting the muscles and skin of the face and neck, though your neck will not respond well to just Ultherapy. Make sure to choose an expert physician in these procedures.

Q: Gonial area improvement during facelift?

Actual RealSelf Patient Comment: I am interested to know what technique is used to improve the gonial area during facelift. In other words how is posteriol mandibular area improved?

Dr. Persky’s Reply: The gonial area is the area at the posterior jawline, the angle of the jaw. During a facelift, the skin and muscular tissue is lifted and tightened around this area. We prefer the deep plane technique of facelifting. Should further augmentation of the gonial area be desired, then a mandibular angle implant may be placed. I personally recommend William Harris, MD (Encino, CA) for the deep plane facelift. Good luck and be well.

Q: HIFU (Ultherapy) for facelifting, could this affect the depth of my surgical face dimples?

Actual RealSelf Patient Comment: Does the HIFU affect the depth of my face dimples? btw it’s surgical dimples.

Dr. Persky’s Reply: HIFU (High Intensity Focused Ultrasound) or Ultherapy should not affect the depth of your surgical face dimples. Ultherapy is a very effective and safe non-invasive procedure that lifts the skin and muscles of the face and neck and décolleté.

Q: What exactly causes deepening of the mental crease? (photos)

Actual Real Self Patient Comment: I’ve had some major changes to my face over the past months after a facial injury. The main differences, even though hard to see in photos, is slight sagging. My face went from a top heavy oval shape to a more boxy oval. I have watched as the tissues have dropped. This seems to have caused more bottom heavy face, a deepening of the mental crease, lengthening of my philtrum. I was wondering of saging of the midface/lower cheeks can cause influences on the lips, philtrum, and mental crease?

Dr. Persky’s Comment: It appears that you may be losing some midface volume. I would treat you with a collagen stimulating filler, Sculptra, and perhaps use Ultherapy to lift the skin and muscles of your midface. Feel free to contact our office with any questions or to schedule an in person or virtual consultation. Good luck and be well.

Q: How many sessions for Sculptra does a 60 year old need and when should the so called “new Sculptra be mixed prior?

Actual RealSelf Patient Comment: Hello, I had my 1st session with Sculptra and I am very concerned because everything I have read states that Sculptra should be mixed 72 hours prior to injection. The Doctor mixed it right then and there! Will this effect the outcome? and should I seek someone else as this doctor has already used incorrect fillers which did not work at all for the problem areas I have and now she states I probably need Sculptra. I feel like I am being taken for?

Dr. Persky’s Reply: f mixed properly, it is now an accepted practice to mix Sculptra immediately prior to use. I personally still pre-mix our Sculptra for at least 72 hrs prior to use as it has been a very effective and predictable method for excellent results in my patients. The number of vials of Sculptra and number of treatment sessions vary depending on the individual patient response, in general we estimate that patients will take about 1 vial per decade of age over a 6 to 9 month period, in your case the estimate would be 6 vials of Sculptra.You should always take your time to carefully choose an expert injector physician, if you have lost faith in your current doctor, then you may choose to move on.

Q: Is Sculptra an option if you have a mild autoimmune disease?

Actual RealSelf Patient Comment: ‘d like to have 1-2 vials of Sculptra injected, but have a mild autoimmune disease (alopecia areata). It usually only causes 1 small coin-sized patch of hair loss when it flares up. I am otherwise healthy, but am concerned because Sculptra is contraindicated in patients with autoimmune disease. Is Sculptra contraindicated in ALL cases of autoimmune disease, or generally just the most severe? Would it likely cause disease flare-ups, or otherwise be harmful in my case?

Dr. Persky’s Reply: Sculptra may be used in patients with mild autoimmune disease, and has been used in many patients over the years. I would not use it in patients with severe disease, particularily those patients who get very ill with flare ups. Feel free to contact me with any further questions or concerns. It your case it would be safe to be treated, please make sure to discuss this with your expert injecting physician.

Q: Would cheek filler help target my full and round face? Already had buccal fat removal done. (photos)

Actual RealSelf Patient Comment: I’ve already had buccal fat removal, yet my face is full very round and full despite being on the low end of average weight. Especially the apples of my cheeks are very full and create very deep nasolabial folds when smiling. Would cheek filler help me or would it just make my face wider?

Dr. Persky’s Reply: Smiling is the best form of plastic surgery! In most of the photos you are smiling and look great. It would be best to evaluate your face in person. You may benefit from an energy device facial tightening procedure. Feel free to contact my office (818 501-3223) for an in person or virtual consultation. Keep smiling! Good luck and be well.

Q: Age 60, malar groove correction – most efficacious options little/no downtime? (Photo)

Actual RealSelf Patient Comment: Age 60 4mo. s/p upper and lower bleph with residual malar depressions refractory to morpheous 8 , tca peel, at home laser. Concerned about risks with HA fillers. What treatment options are most efficacious with little or no downtime?

Dr. Persky’s Reply: If you do not wish to have hyaluronic acid fillers I would treat you with Sculptra and Ultherapy to correct your malar grooves. Make sure to choose an expert injector for your treatment. Feel free to contact our office with any further questions or concerns. Good luck and be well.

Q: Indention and tip rotation -what would cause this? Is this poor healing? (photos)

Actual RealSelf Patient Comment: I had a rhinoplasty and Septoplasty in November of 2020, about a year ago I started noticed an Indention on the left top of my nose near the tip. I have also noticed the tip seems to rotate to the right now. What would cause this? Is this poor healing? Or the technique of the surgeon? I was told he would use a graft and it was harvested from cartridge taken from behind my own ear.

Dr. Persky’s Reply: The indentation is due to your surgery. I would recommend discussing your concerns with your rhinoplasty surgeon. Excessive tissue may have been excised, the graft may have moved or warped, or there may be scar tissue. If your nose appearance bothers you then a revision surgery is indicated. A temporary fix can be injection of fillers, though I would recommend considering consultation with a revision rhinoplasty specialist. Good luck and be well.

Q: Can closed rhinoplasty correct a bump on the nose (hit by vehicle as a child)? (Photos)

Actual Real Self Patient Comment: I was hit by a vehicle as a child and have suffered from facial asymmetry as I’ve gotten older. I notice one side of my nose has a bump and the other side is flat. I’m not sure if this is some type of scar tissue or cartilage issue. Can it be corrected with closed rhinoplasty if it isn’t scar tissue? I had septoplasty earlier this year for breathing issues but the bump has been here since college.

Dr. Persky’s Reply: Yes, a closed approach rhinoplasty can remove the traumatic bump on your nose. The most important aspect of your surgery will be choosing your expert rhinoplasty surgeon very carefully. I recommend William C Harris, MD, feel free to contact us for a virtual or in person consultation regarding your rhinoplasty questions and concerns. Good luck and be well.

Q: Age 22, what are these lines & excess skin on my jaw & how can I better them? (Photos)

Actual RealSelf Patient Comment:Hello I am 22 years old I have those lines and excess skin when I smile what are those please ? And how can I better the appareance , it really bothers me.

Dr. Persky’s Reply: It appears that you would benifit from a little more volume in your face. Depending on your in person examination I would likely treat you with either Sculptra or Restylane Defyne. Make sure to choose your injecting physician most carefully! Good luck and be well.

Q: Would a lower eyelid surgery be my only option to fix this problem from tear trough fillers? (Photo)

Actual RealSelf Patient Comment: I had Juvederm (I can’t remember the exact one, whichever one that can last up to 2 years) almost 3 years ago in my tear troughs by a doctor that was very pushy saying I needed it bc I look very tired, when he was inserting the needle in my right eye, he was a little shaky and pushed it too hard and it jabbed harder than it should have and he swore it would go away but it’s been years and hasn’t. No matter wearing makeup or not it’s visible, is my only choice going to end up being surgery??

Dr. Persky’s Reply: First you must find an expert physician injector with experience. Next, hyaluronidase should be used conservatively to dissolve the filler. I do not believe that you will need surgery. Good luck and be well

Q: Fillers or fat grafting after deep plane facelift?

Actual RealSelf Patient Comment: I had deep plane facelift 6months ago and noted my face started sagging soon after the procedure. My surgeon says I have ”lazy smas” and refuses to revise. I do not wish another invasive procedure either so was thinking about just fillers or fat grafting. The sagging is significant on mid face area and under the eyes. But my tissues are scarred and fibrotic after the procedure. Would the fat even stay in scarred tissue? Are fillers more risky in such tissue?

Dr. Persky’s Reply: I have treated many patients like yourself after their facelifts. The good news is that the fibrotic or scarred areas respond better to the treatment than “virgin” facial tissues. I would treat you with biostimulatory filler (Sculptra) combined with either Ulthera or Profound RF. I would not recommend fat transfer. Feel free to contact me for either a virtual or in person consultation. The most important aspect of your treatment is making sure that your choose your treating expert physician very carefully. Good luck and be well.

Q: Swollen jaw lymph nodes 7 months after fillers. What should I do?

Atctual RealSelf PatienComment: Hi, I got 2ml hylauranic filler in my jawline in February to help with my side profile. Had really bad swelling on right side but it went down after two weeks after expected. However, since getting the fillers, the right side of my face which I suspect has the most filler swells every month before my period. It’s very uncomfortable and at times a little painful. It feels like a 2-3 cm ball in my jaw and is movable. Usually goes away in 2 days. Is this normal? What should I do?

Dr. Persky’s Reply: The swelling that you are experiencing is not normal. You should revisit your injecting physician for evaluation, preferably when it is swollen. Good luck and be well.

Q: Does hyalase damage your natural lips permanently?

Actual RealSelf Patient Comment: Hi; Does hyalase damage / dissolve the natural lips permanently? Will my natural lip shape come back?

Dr. Persky’s Reply: Hyaluronidase breaks down hyaluronic acid fillers as well as natural hyaluronic acid. It is best to be conservative with it when it is used to treat excess lip filler. Normally, in conservative doses there is no problem and original lip shape returns. I recommend waiting a few months before possibly refilling the lips if need be. Most important, be sure to choose your injecting physician very carefully. Good luck and be well.

Q: How to get more definition of the face – fillers, fat removal, alternatives?

Actual RealSelf Patient Comment: I feel like I have a very flat face with no definition. I am considering getting chin filler if I am a candidate. As for my very weak jawline, I’m unsure what to do as I’m scared it will look nice from the side but wider from the front me I feel my face is already too wide. I want more of a heart shaped face. I especially dislike my jawline from the right profile. I would also like more definition for my cheeks. What would be the best treatment for this?

Dr. Persky’s Reply: Without photos or seeing you in person, it is difficult to say what would be best for you. The most important thing for you is to choose an expert in facial fillers and have a consultation. You may contact our office for either a virtual or inperson consult at which time your best treatment plan can be determined. Good luck and be well.

Q: Is it safe to have Sculptra & Kybella side-by-side for uneven skin contours during the same treatment session?

Actual RealSelf Patient Comment: I had botched Lipo on my butt and thighs in 2006 in Costa Rica and am finally spending the $ for revision after years of research. I am tired of being disfigured . I have 3 seasons 6 weeks apart planned for filling the indentations with sculptra and dissolving the bulges/ uneven protruding contours with kybella starting Tuesday. I just want to know if it’s safe to do both procedures in the same general areas -side by side -& if sculptra is safe for inner thighs

Dr. Persky’s Reply: Sculptra is very safe for the inner thighs. Unfortunately liposuction of the body can leave lumpy bumpy surface, though one looks better in clothes, not so without clothes on. Sculptra acts to biologically stimulate volume while Kybella destroys fat cells decreasing volume. I would treat you separately with Sculptra first to fill in the deficits and if needed use Kybella later to dissolve any stubborn fat. The problem with doing the treatments together is that Kybella causes a great deal of swelling which could affect the placement of Sculptra. Be patient and do things one at a time, avoid making your situation worse. Good luck and be well.

Q: Crooked & round tip – what would you recommend to fix my nose? (Photos)

Actual RealSelf Patient Comment: Hi! I’m bothered that my nose is crooked (tilts to one side) and the tip looks very round. I don’t like how the tip goes way further down than the sides of my nose. When I smile, it looks even droopier. I don’t mind my side profile too much but I do have a slight nasal hump and would also like the height reduced a tiny bit. I’m looking for subtle changes where I still look like myself but improved. What procedures would you recommend and could I obtain subtle results while fixing my concerns?

Dr. Persky’s Reply: It is good that you have specific features that bother you about your nose. These can be corrected with a rhinoplasty by an expert rhinoplasty surgeon. I recommend contacting my associate William Harris, MD, double board certified rhinoplasty surgeon to help you achieve your aesthetic and functional goals. Feel free to contact us for a virtual or in-person consultation. Good luck and be well.

Q: Single-nostril alarplasty for small asymmetry? (Photos)

Actual RealSelf Patient Comment: Over time I developed an asymmetry in my nostrils. One is slightly wider, more open and looks wider than the other side when I smile. How effective/risky is doing an alarplasty to fix such a small asymmetry? Could it make the asymmetry worse? What about improving the symmetry when smiling? One surgeon said it can be improved, one said not to bother, it could make it worse. I do have a deviated septum but I am not planning to get a septoplasty. It looks worse in photos than in real life.

Dr. Persky’s Reply: If it’s not broke, don’t fix it. Anytime that you have any surgery there is a possibility of making something worse. Your complaint is extremely mild in photos, and less so in real life. The only time to consider doing a correction would be if you were having septoplasty, then you might address it at the same time. It is not a “minor” procedure. Good luck and be well.

Q: Profound and CO2 at the same time?

Actual Real Self Patient Comment: Hi I would like to rejunevate my skin and get it tighter with younger looking texture. I have considered fractional co2 laser as well as profound. I have heard that they can be performed together. When this is the case, is the laser co2 used with the same intensity than it is when used alone ? (I’ve seen that laser co2 can be used with very different intensity and that some practicians even put their patients under general anesthesia to use it full force.) Thank you very much in advance!

Dr. Persky’s Reply: I have combined Profound RF treatment with fractionated CO2 laser (from light settings to pedal to the metal maximum settings) with safe and effective results under local anesthesia in the office. We make our patients very comfortable with a tablet of Xanax, and a weight appropriate dose of Demerol and antihistamine. I also usually add PRP and Sculptra injections at the same session to maximize patient results and satisfaction. This is combined treatment should only be performed by an expert experienced physician. This not, not a commodity whose result is the same by all practitioner’s. Choose your treating physician most carefully to ensure your safety! Good luck and be well.

Q: Is there any new intelligence on mitigating Sculptra disasters? (Photo)

Actual Real Self Patient Comment: 11 months ago I had one vial of Sculptra to temple jaw and cheeks. I developed malar mounds – not sure if its the collegen building in the wrong place or edema. I also have a pad on my brow bone I think the product migrated. I hate it. Is there new effort towards decreasing the build or get rid of it? There are so many people on these boards suffering from Sculptra. Really bad, like systemic. Have any of you successfully treated and solved a bad sculptra outcome?

Dr. Persky’s Reply: Sorry that are suffering from this adverse event after Sculptra injections. I have injected hundreds of Sculptra patients since 2009 without adverse events. I have treated complications from other clinics. Unfortunately malar edema is caused by blockage of lymphatics. When injected just over bone and below muscle (not through muscle) this should not occur. Treating malar edema is difficult. The best treatment that I have found is a combination of micro-needle radiofrequency (either Profound RF or Morpheus8) with fractionated CO2 laser (like Fraxel repair.) Ultherapy can also be used in combination with laser. It may take multiple treatment sessions but I have seen very nice improvement. Good luck and be well.

Q: Would Profound laser or Renuvion help grooves in neck after neck lift? (Photo)

Actual Real Self Patient Comment: Igot a lower facelift and necklift 7 months ago after being insecure about my turkey neck after a 60 lb weight loss. It was one of my biggest insecurities. Now I have this groove in the middle with hanging skin on the sides of it that looks awful. I hate to do surgery again, I saved and worked overtime for 6 months to pay for it.

Dr. Persky’s Reply: I do not use Renuvion, but I do not believe that Profound RF will correct your concerns. Speak with yuor facelfit surgeon and ask if they can do a “tuck-up” procedure under local anesthesia in the office to minimize costs. I hope that you are able to have your neck problem corrected. Good luck and be well.

Q: Is it okay to get Sculptra (my 2nd appt) before starting a chemo or Immunotherapy?

Actual Real Self Patient Comment: I was jut diagnosed with metastatic cancer and I was starting my Sculptra treatments. I had one done in June and my second is next week. I’m not sure what the treatment will be for me if any, but I already needed Sculptra and I know Chemo will age me even worse. Not to mention the extra reduction from CTs and PET scans. Any thoughts would be appreciated. Thank you.

Dr. Persky’s Reply: You are in my prayers for complete remission and cure of your cancer. My thoughts about getting Sculptra injections are that you should not have them until after your treatment because Sculptra stimulates your immune system and uses energy that may be better applied to beating the cancer. If you wish to look better during your chemo/immuno therapy, there are many other fillers (hyaluronic acid fillers) that can add volume without your body using precious energy. Good luck and be well!!!

Q: Is widening face & numbness in jaw/jowl area normal after Profound RF?

Actual Real Self Patient Comment: Hi, i had profound done almost three months ago and im noticing my face widening. It looks wider. I’m also still experiencing numbness feel along the jaw, jowl area. Is this normal?. I’m not liking the wide look. Looks very full. I thought i would get more of of the chiseled look.. im hoping someone can help. Will i have that look after six months?

Dr. Persky’s Reply: As skin tightens after Profound RF, the cheeks commonly are lifted and may appear to be fuller. If your provider injected a filler such as Sculptra simultaneously there can again be increased volume of the face. As the effects of Profound RF continue to improve over the next 6 months and Elastin is formed, your skin should tighten and your face should not appear to be widened. The numbness along your jaw should resolve (most patients are not numb after a few days to weeks) by 6 months after the treatment the latest. There is not anything to do at this point other than patience as your symptoms resolve over time. Good luck and be well.

Q: Advice on how to make complications from Profound RF microneedling better? (Photos)

Actual Real Self Patient Comment:I am stressed about the changes I see after this treatment. Especially my right cheek seems dimpled and is cracking down my cheek like it added 10 years rather than tightening. I am hoping for advice on how to help make it better. The Derm I saw sold the business and isn’t helpful.

Dr. Persky’s Reply: Sorry that you are having this adverse effect from your treatment. The answer to your question depends on what your skin looked like before the treatment, how long ago the treatment was done, what tips were used, how many insertions, and more. There are some ways to help depending on the answers to those questions. Feel free to contact me at your convenience. Good luck and be well

Q: Can I do Profound RF at 8 months post op facelift?

Actual RealSelf.com Patient Comment: I had a facelift with neck left 8 months ago and my neck is no where near as lift as I had hoped. Can I do Profound RF at 8 months post op and what would the cost be. I’m having. A hard time finding someone who does this procedure in Miami.

Dr. Persky’s Reply: Sorry to hear that your face results did not meet your expectations. You may have Profound Rf 8 months after facelift surgery. I would treat your face and neck with Profound RF and PRP, additionally I would inject your neck with hyperdilute Radiesse at the same time to stimulate collagen production in your neck. We’re not in Miami, but if you ever get out to Los Angeles, I will be happy to help you. Good luck and be well.

Q: Breathing issues and pain post a few injuries = what can I do? (Photo)

Actual Real Self Patient Comment: Hello, 23 year old female I have had a few injuries to my nose starting at age 8 which was the worst damage wise (motorbike straight to the face/nose head on) A few yeas ago i had a minor incident with impact to the nose and since then ive had worst problems breathing and pain. One dr told me it is allergies and the other nasal valve collapse as a result of trauma 3rd pic is me inhaling

Dr. Persky’s Reply: You should schedule a consultation with an ENT (if you do not wish to change the appearnce of your nose) or with a facial plastic surgeon if you wish to breath better as well as change the appearance of your nose. Feel free to contact us with any further concerns or questions. Choose your surgeon most carefully. Good luck and be well.

Q: What procedures do I need to help with chubby cheeks and my flat Asian face? (Photo)

Actual Real Self Patient Comment:What can be done about fullness in lower face/saggy cheeks? Esp on the right near the corner of my mouth, theres a bulge that looks really bad from the side. Also, what would help with a “flat” face? I’ve had filler to my cheeks, nose & chin. Im hesitant to get buccal fat removal bc I’ve read it can make your cheeks look hollow as you age. Do I need facial lipo, kybella, facelift, facial fat transfer? Or vline surgery to fix the largeness of my lower face? I’m 26, 5’ 3” & 118lbs. Thanks!

Dr. Persky’s Reply: First of all you have a beautiful face and great skin. I would treat you with botox in your masseter muscles to thin your jaw angle, narrow your lower face) and a strong lifting filler at your pre-jowl area(supporting your natural ligaments) area and same filler to your anterior chin (to project it forward.) I would avoid buccal fat removal, Kybella, lipo, fat transfer, and facelift. If after Botox and strategically placed filler as described above, you still wished more improvement then I would treat you with a skin tightening device such as Ultherapy or Profound RF. Make sure to choose your treating physician very carefully. Feel free to contact me with any further concerns or questions or to schedule a virtual or in-person consultation at your convenience. Good luck and be well.

Q: Do nostrils still shrink after closed rhinoplasty? (Photo)

Actual Real Self Patient Comment:Do nostrils still shrink after closed rhinoplasty? All the photos my surgeons showed were still on the operating table and everyones nostrils were super huge, prbably because of all the tools being inserted, but after how long will they shrink again? I want my nnstrills a lot shorter, mnot narower, shorter. I hav no idea what the end result is going to ne because my surgeon doesnt do 3d models to not make expectations that cant be met but now he doesnt know my wishes. Shall i just trust him?

Dr. Persky’s Reply: Nostrils generally remain the same size after closed rhinoplasty unless the surgeon has actively tried to change the shape, either larger with grafting or smaller with nostril alar rim reduction. It is very important that your rhinoplasty surgeon and you are on the same “wave length” regarding your aesthetic rhinoplasty goals. I recommend holding off on surgery until the patient feels comfortable with their surgeon and the plan to change their nose. Good luck and be well.

Q: Grid marks and no improvement after Morpheus8 procedure. What are my next steps? (Photo)

Actual Real Self Patient Comment: Hello! Still have horrible grid marks post Morpheus 8 procedure. Grid marks remain red with no improvement. No pain. Looking for some insight and next steps.

Dr. Persky’s Reply: Sorry that you are having this adverse event from Morpheus8. Hopefully by now (3 days later) things are improving. I would treat your inflammation with a steroid cream Closbesterol Propionate 0.05% applied to the area twice a day for 3 to 5 days. Hope that you are better! Good luck and be well.

Q: Is this lip filler migration? (Photos)

Actual RealSelf Patient Comment: I’ve been getting lip fillers since May 2021, we started with a half syringe of versa, then 6 months later we did a full syringe of versa and it was PERFECT, they looked so even and natural! Another 6 months later we did less than half of versa in my lips. This was 3 months ago. I’ve noticed my lips now look different then they did before but I can’t tell if this migration or not. My injector is extremely reputable and this hasn’t happened before

Dr. Persky’s Reply: Yes, you have some migration of filler from your red lip up into your white lip. See your injector for treatment to dissolve the misplaced filler. Good luck and be well.

Q: Restalyne Defyne injected in lips 9 months ago – has it migrated? Will it resolve on its own? (photos)

Actual RealSelf Patient Comment: I was last injected with Restalyne Defyne on 10/7/2021. I now have what looks like filler mitigation. I’ve attached photos. Is this in fact filler mitigation? If so, does this resolve on its own? Thank you so much

Dr. Persky’s Reply: Restylane Defyne is a filler of expression, it is excellent for the areas around the mouth because it spreads and integrates into the surrounding tissue. It is not a filler that I would reccommend in lips. Whether to dissolve it with hyaluronidase depends on how much it bothers you. I would consult with an expert injector if you choose to have it dissolved. Feel free to contact me for a virtual consult should you have further questions or concerns. Good luck and be well.

Q:Is it safe to do Fraxel laser at the same time as a brow and lip lift?

Actual Real Self Patient Comment: Is it possible to get fraxel laser done safely at the same time as a brow and lip lift? The laser wouldn’t be on my lip, more so on my cheeks and nose and forehead areas.

Dr. Persky’s Reply: Yes, you may have Fraxel laser at the same time that you have a brow and lip lift. You need not worry. Good luck and be well.

Q:What is wrong with my eyes? Are these little blobs actually the filler? (Photos)

Actual RealSelf Patient Comment: Could it have migrated this close to my eyes? Recently had Juvederm placed in my lips, nasolabial folds and under my eyes. I’m 48. First time ever getting filler and I’m really regretting it. I’m so distraught. Want to have it dissolved but have heard horror stories about HA. Plus it’s so close to my eyes. I would only consider seeing a doctor experienced with dissolving fillers around the eyes. Are there even doctors that inject anymore? Or do most have aestheticians? Any advice is appreciated.

Dr. Persky’s Reply: Sorry for your bad filler experience. I perform all injections in my patients, yes, there still are facial plastic surgeons who perform filler injections without relegating injection patients to non-MD injectors. In your case, it appears that your have been undertreated, I would recommend additional strategic filling by an expert injector to correct your concerns. I would personally use Sculptra with a bit of Restylane in your under eye hollows. Feel free to contact us for a FaceTime virtual consult to answer any further questions or concerns. Choose your injecting physician most carefully. Good luck and be well.

Q:Is fascia for rhinoplasty safe & more natural & what are the complications?

Actual RealSelf Patient Comment: Hi I am planning on getting a bulbous nose reduction with defatting. The doctor recommend me to put silicone since in korea, it is common to put silicone but I don’t want any implants since I want my nose to look natural. The doctor however said, my nose will look flat and not as good without silicone but instead, he recommend me to get human fascia if I dont want silicone. Or cow dermis. I am hesitant about the cow dermis but is human fascia for the nose safe? Can move around is it better than silicone and more natural? And what are the complication

Dr. Persky’s Reply: In the hands of a rhinoplasty expert surgeon, fascia is safe and effective. I would recommend your own fascia which is easily harvested from your temple during your rhinoplasty surgery. Choose your surgeon most carefully. Good luck and be well.

Q:Will loose skin after septorhinoplasty go away by the 12 month mark & how to reverse it? (Photos)

Actual RealSelf Patient Comment:I had septorhinoplasty 4 and a half months ago. After surgery, my skin became too loose, which makes my face look like it is drooping, adding at least 10 years to my face(I am 33). See the pictures. Will the issue go away by the 12 mo mark. Is there anything that can be done to reverse this effect(besides plastic surgery)? I have thick skin but I don’t see any improvement over time…the problem becomes worse. Thank you

Dr. Persky’s Reply: We begin to lose facial boney volume from age 25 on. It appears that you would benefit from a small amount of volume. I would treat you with one vial of strategically placed Sculptra which would take care of your concerns. Unfortunately, I do not believe that your hollows will improve over time without a bit of volume replacement. Be sure to have an expert physician take care of you. Feel free to contact me with any further questions. Good luck and be well.

Q: Should I wait between TCA Cross/Peel, Collagen Stimulator + Subcision & Fractional Erbium laser treatments? (Photo)

Actual RealSelf Patient Comment:1. Should I wait between these treatments? if yes for how long and what treatment(s) would come first? If no, what’d be the sequence within that 1 session ie. TCA Cross – collagen stimulator – subcision (if needed) – Erbium.Also, is it OK to poke frosted area of TCA Cross with needle & subcision? 2. Radiesse or Sculptra , scars located on the apple of the cheek to sidetemple? 3. Does collagen stimulator yield a better outcome combined with subcision (especially for my scars)?

Dr. Persky’s Reply: The only treatments listed that I would not perform at the same time are the TCA Peel and Laser. I would treat you with subcision, Sculptra injection, and erbium laser at the same treatment session. Make sure to choose an expert in these treatments. Good luck and be well.

Q:Jowl lift with Profound or other recommendations after double jaw surgery? (Photos)

Actual RealSelf Patient Comment: Hi, I had a double jaw surgery over a year ago with metal parts in 5 areas of my jaw. Since then, I’ve noticed sagging jowls. I had a consult with a surgeon who said a mini office surgical facelift is not recommended and also I didn’t need as much lift as required for surgery. He recommended morpheus or profound to tighten the area. I’m wondering if I can get either of those with my metal jaw hardware or if there are any other recommendations. I’m 33 yrs old. Thank you!

Dr. Persky’s Reply: Profound RF is a great choice to address your concerns, it is perfectly safe in the hands of an expert in the treatment. Please feel free to contact me with any further questions that you may have about correction of your sagging jowls with Profound RF. Good luck and be well.

Q: Which nose edit best suits my face? (Photo)

Actual RealSelf Patient Comment: the first collage is 2 before/un-edited photos) trying to narrow down what i will decide to show my surgeon once i find someone. i know some of them are very similar so i may be obsessing too much on small details, but i’d like to go in with an edit that’s as close as i can get to the result i want. overall i want: – natural and proportionate to my other features – straight with *maybe* a very slight curve – smaller overall, not too projected after – lifted tip

Dr. Persky’s Reply: It is great that you are detailed with your rhinoplasty goals. You certainly should share these with your rhinoplasty surgeon. I personally like the profile aesthetics of #3. Of course, the nose is 3 dimensional and all views must be considered as well as your anatomic structure. Choose your rhinoplasty surgeon most carefully. Good luck and be well.

Q:Would facial fat transfer benefit me? What exact procedures would you recommend for facial contouring? (Photo)

Actual Real Self Patient Comment: Hi everyone, I am 22 years old, female, and asian. I am considering a facial fat transfer to my midface/cheekbone area. I feel that my face has a lot of fat and a lack of definition between the lower face and cheekbones, including when I smile. I do not want to increase the width of my face, but increase projection because I notice in my side profile that my cheek extends past my eyes (which naturally protrude more out). Please help me figure out whether this procedure is right for me.

Dr. Persky’s Reply: I would not recommend facial fat transfer in your young face. There is too much risk of asymmetry and possible fat hypertrophy as you get older and gain weight. Instead I would treat you with strategically placed Sculptra which is much more predictable than fat. You may have botox injections into your masseter muscles to help narrow the lower third of your face. Choose your treating physician most carefully. Good luck and be well.

Q: How to fix sagging skin around eyes? (Photo)

Actual RealSelf Patient Comment:Are there any non surgical things that can be done to fix this sagging drooping skin around my eyes when I smile? I am 39, I use medical grade skin care and do regular face treatments including morpheus8, halo, chemical peels, etc. I typically do not do Botox around my eyes as I feel it deadens my expressions.

Dr. Persky’s Reply: I would recommend a fractionated CO2 laser around your eyes and expertly placed dysport. Make sure that your choose your treating physician most carefully based on their experience, skill, knowledge, training, and natural artistic vision. Good luck and be well.

Q: Are there any solutions to resolve the overall asymmetry of my face? (Photo)

Actual RealSelf Patient Comment: Hi, I feel like my face is quite crooked- the entire right side is lower than the left. The nose dips lower and my jaw on the right side is much fuller. Additionally, my chin points towards the left. I am considering a rhinoplasty but are there any solutions to resolve the overall asymmetry?

Dr. Persky’s Reply: You have a pretty face. I would use fillers to balance your face symmetrically. Sculptra mainly with some hyaluronic acid filler as needed. Most important is that you choose your treating physician very carefully, make sure to choose an expert! Good luck and be well.

Q: Combination of modalities to treat minor acne scars?

Actual RealSelf Patient Comment: Hi 64 male relatively good health no chronic conditions I’m interested in face procedures but non invasive ones Fraxel Repair FaceTite Ultherapy There is overlap and perhaps contraindications on combination therapy but I’d like to treat the sagging and some minor acne scars and age related areas on my face and neck. The only surgical procedure I am interested in is genioasty or mentsplasty but no implants strictly autograft or osteotomy. Thank you

Dr. Persky’s Reply: often treat patients with multiple non-surgical modalities at the same treatment session. Fraxel repair can be used in combination with Ultherapy as well as with Profound RF. I encourage my patients to also have structural support treatment with Sculptra at the same time. Combination therapy results in natural rejuvenated great outcomes. Please feel free to contact me for a virtual or in person consultation at your convenience. Make sure to choose your treating physician carefully. Good luck and be well.

Q: 33 years old – FaceTite ruined my face contours, how can I fix this? (Photos)

Actual RealSelf Patient Comment: Hello! I am a 33 year old female who got facetite at 30.5 The first year, it looked great. But I slowly realized that by melting the fat towards the back of my jawline and focusing on just the jawline, he created an awful ‘bubble’ effect in my cheek when I smile where the fat abruptly stops on my face. I wanted this treatment for lower facial fullness, not a sharper jawline. In a way, it had visually made my lower face fat look more prominent. I have a very low BMI, as An FYI.

Hello Meow,
Sorry to hear of your complication with Face-tite. I would treat you strategically with Sculptra to replace your lost volume. Fat transfer can be used, but I find that Sculptra is much more predictable, and is a long term answer to your concerns. Please feel free to contact my for a virtual or inperson consultation at your conveniece. Be well.

Michael Persky, MD
Encino, CA

Q: What available options are there to treat a vertical indentation on the front of one of my thighs after Profound RF?

Actual RealSelf Patient Comment: I developed a vertical, indentation on the front of the one thighs I had done. Are there any treatments or options available to help with this?

Dr. Persky’s Reply: Sorry to hear of your adverse event after Profound RF. I have not seen this in my patients, but would treat you with dilute Sculptra injections. Choose your treating physician carefully.
Good luck and be well.

Q: Malar edema 1 year post upper and lower blepharoplasty – Is there anything else I can do? (photos)

Actual RealSelf Patient Comment: I had a lower and upper blepharoplasty exactly one year ago. I had severe chemosis afterwards. which resolved within a few months, however I still have very noticeable malar edema. I have been checked out by an opthamologist and a cornea specialist and I do not have dry eye. I am currently having lymphatic drainage massage done which seems to be helping briefly but does not complete resolve the swelling, it just appears better for a few days afterwards. Is there anything else I can do?

Dr. Persky’s Reply: I have treated malar edema with a combination of Ultherapy and fractionated CO2. Profound RF may also help. Make sure to choose your treating physician most carefully. Good luck and be well
Michael Persky, MD

Q: Am I a good candidate for rhinoplasty? (Photos)

Actual RealSelf Patient Comment: Feel like m nose dominates my face especially when smiling. Can I correct crookedness, droopiness and de project while keeping a natural look suitable to my face ?

Dr. Persky’s Reply: Yes, a rhinoplasty will address your concerns. It should result in taking the focus of your face away from your nose and allow your eyes to be the initial focus. Be sure to choose an expert rhinoplasty surgeon. Good luck and be well.

Q: Lost ~145lbs. What would you do to make my facial profile look more harmonious? (Photo)

Actual RealSelf Patient Comment: 32f. I’ve never really liked my facial profile. Something just seems… off. I had weight loss surgery and have lost ~145lbs. As I look at these photos, I know my jawline is an aspect that throws things off. Would something like ultherapy/thermage/etc be helpful for my jawline? If you were given carte blanche, what would you do to make my profile look more harmonious?

Dr. Persky’s Reply: Congratulations on your weight loss. It has been said that at a certain point of every woman’s life she needs to choose between her face or her fanny. Fortunately today we have excellent treatments that allow a patient to lose weight and still maintain their facial volume. I would treat you with foundational Sculptra, a collagen bio-stimulatory filler, and Ultherapy at the same treatment session. Most importantly be sure to choose your treating physician very carefully. Good luck and be well!

Q: Can CoolSculpting reduce the appearance of horizontal stomach lines/creases? (photos)

Actual RealSelf Patient Comment: Hi, Can coolsculpting reduce the appearance of horizontal stomach lines/creases? If not, what procedure can?

Dr. Persky’s Reply: Coolsculpting reduces fat bulges and in doing so will decrease the “valley” that is causing your “horizontal abdominal creases. Coolsculpting and Emsculpt would be good choices to help you achieve your aesthetic goals. Good luck and be well.

Q: 21 years old, would CO2 laser be effective to treat enlarged pores and sun damage?

Actual RealSelf Patient Comment: I am a 21 year old male considering the CO2 laser treatment. I have genetically small pores but have enlarged them myself through squeezing and sun damage. Would this treatment be effective? And how long would the results last for? Thank you

Dr. Persky’s Reply: CO2 lasers can improve large pores and sun damage. Consult with an expert laser physician. The results can last for years (5-10) before you may desire to have additional treatment. Good luck and be well.

Q: Would a CO2 laser be suitable for someone who is 27? (Photos)

Actual RealSelf Patient Comment: General question here, would a co2 laser be okay for someone who is 27? Would it make me age faster lets say when im 45 due to the layers of skin being removed? I hate how my face is already starting to droop and lost volume. I want to do an aggresive laser to refresh my skin as well as tighten it. But, i dont want to make things worse when i am older!

Dr. Peresky’s Reply: If you are concerned about volume loss and sagging of facial skin, I would recommend treating you with collagen stimulating Sculptra injections. Make sure to choose an expert in Sculptra. CO2 lasering at your age would be helpful for early fine lines, scars, and discoloration. Enjoy your youth, nothing beats youth! Good luck and be well!

Q: How soon is it safe to get Botox after giving birth?

Actual RealSelf Patient Comment: I gave birth in February and am interested in getting botox. I am prone to various allergies and am wondering if it may be too soon to get botox in the event it could cause an allergy given the fluctuation of hormones postpartum. While I have never had an allergic reaction to botox, I did experience delayed reactions to hylauronic acid facial fillers on multiple occasions. Please let me know if this is an issue to consider with respect to the botox and how long I should wait for, if at all. Thx!

Dr. Persky’s Reply: Congratulations on your baby! It is safe to have Botox injections anytime after birth for the mother, the baby likely will not need any Botox for the next 25 to 30 years! There have not been any studies on the transmission of Botox through mother’s milk to infants. If you are breast feeding consult with your pediatrician. No worries regarding any increased risk of allergic reactions to Botox post partum. Good luck and be well!

Q: Would I be able to achieve a slimmer face shape with masseter Botox? (Photo)

Actual RealSelf Patient Comment: I hate how wide / rectangular my face is. Would this be improved if I stopped chewing gum? Would masseter Botox be able to resolve the issue? Or would I require a v jaw surgery?

Dr. Persky’s Reply: Yes, injecting Botox into the masseter muscles results in narrowing of the lower third of the face at the angle of the jawline. The treatment usually lasts for 3 to 5 months. It also helps relieve TMJ pain and teeth grinding. Stopping gum chewing will not likely help. Good luck and be well.

Q: Can AquaGold be used on the back of the hands?

Actual RealSelf Patient Comment: ‘d like my hands to be a bit younger looking. I’m not ready for a load of filler yet but I hoped it could be preventative and help the skin look youthful?

Dr. Persky’s Reply: Yes, Aquagold may be used on the back of the hand. Aquagold is a very nice skin boosting treatment that is quick, easy, safe, and effective, resulting in rejuvenated and hydrated skin. Good luck and be well.

Q: What are my options for fixing my lower eyelids? (Photo)

Actual RealSelf Patient Comment:I’d like to know the options for fixing my lower eyelids. I hate how much skin i have there and at 37, it’s become crepe like. I’d prefer noninvasive, but I’m wondering if a lower blepharoplasty is my only option.

Dr. Persky’s Reply: The best non-surgical treatment for the crepe skin under your eyes would be a fractionated CO2 laser treatment, I like to use Fraxel repair for this. Otherwise, the skin can be excised under local anesthesia, a skin pinch. You also appear to have thickened muscle under your lower lid. Make sure to choose your treating physician most carefully. Good luck and be well.

Q: What are my options in getting a sharp well defined jaw line? (Photos)

Actual Real Self Patient Comment: Please have a look at my photos provided and let me know what are my options in getting a sharp well defined jaw line ? My surgeon said there isn’t much fat underneath that skin so he did not do liposuction , instead he did some thermal skin treatment and I am wearing a neck garnet now . Is there a better choice to achieve my goal ( non invasive or invasive ) ? Thank you

Dr. Persky’s Reply: From your photos it appears that liposuction of your neck is the ticket. You may also benefit from Sculptra injections along your jawline. Good luck and be well.

Q: What’s the difference between Profound RF and other micro-needling RF treatments?

Actual RealSelf Patient Comment: why is the profound so much more expensive than something like Morpheus or Secret? what is the difference? are the results better? Less pain? I went for a consultation and the doctor recommended this and I was seriously considering this procedure but am concerned about the high cost in light of the low rating on real self (only 62%) vs secret which is much less expensive and has higher satisfaction. Thank you for any and all insights/advice!

Dr. Persky’s Reply: Profound RF is a device that can give excellent rejuvenation results on the face and neck. It is performed by a physician, takes more time than Morpheus or Secret, and is a “one time treatment” whereas the others involve multiple treatments. I usually sedate my Profound RF patients so that they are very comfortable and do not feel the treatment (they also receive nerve blocks and local anesthesia.) To maximize our patients results and satisfaction, I combine the treatment with Sculptra, PRP, and light laser skin resurfacing all at the same time and with the same recovery period of 5 to 7 days. I would recommend that you do your homework and make sure that you choose your treating physician most carefully. Good luck and be well.

Q: Will Profound RF dissolve fat cells in addition to tightening skin?

Actual RealSelf Patient Comment: 1 year old male I had chin lipo a year and a half ago. I still feel that I have a thin layer of fat remaining (in addition to some thicker skin) underneath my chin. Does profound rf also destroy fat cells to better contour the neck, or is it solely used for skin tightening?

Dr. Persky’s Reply: Great question. Profound RF has two different sets of needles, one for tightening the skin at 1-2 mm deep which stimulates elastin formation tightening and lifting the skin, the other for melting unwanted fat at 6 mm deep. This deep set of needles is used to destroy fat cells in the neck to give an improved contour. Please feel free to contact me any further questions. Good luck and be well.

Q: Hard lumps and painful swelling after receiving temple filler over a year ago, is surgery the only option to remove them?

Actual RealSelf Patient Comment: I had temple filler over a year ago- it’s something I’ve had before and had no problems! For the last 6-7 months I have had continued swelling in both temples which is persistent- I get maybe a week without swelling then it flares up again! It’s incredibly painful & I’m also unable to open my mouth properly when the swelling is particularly bad! I have very hard lumps on one temple but not the other! I’ve had hylase twice which hasn’t had any effect! Is the only option surgery to remove?

Dr. Persky’s Reply: It sounds like you have a biofilm which responds to Biaxin 500 mg twice a day, but patients must take it for 6 straight weeks, if it does not completely disappear, then another 6 week course is given. Discuss this with your treating physician. We sometimes use hyaluronidase as well to help dissolve the product that the biofilm is attracted to. Good luck and be well.

Q: Had Sculptra 10 years ago, lumps underneath my cheekbone. How can I break them up?

Actual RealSelf Patient Comment: Had sculptra 10 years ago. Amazing stuff then after that was only filled with hyaluronic acid. Couldn’t understand why it never lasted. Fast forward to now my doctor recommended I have sculptra for sunken cheeks as the product had changed and no problems with the new solution. I now know that must be the lumps underneath my cheekbone. Never knew what they were. How can I break them up?

Dr. Persky’s Reply: Sculptra treatments have improved at great deal over the years. I have been treating patients since 2009 without any adverse events. I have dissolved Sculptra “nodules” in patients from other injectors. A combination of saline, 5FU, and Kenalog injected directly into the “lumps” is performed every 3 weeks until they are no longer present. You should have an expert in Sculptra perform this for you. Good luck and be well, down under!

Q: Which is better: filler or Sculptra in the temple?

Actual RealSelf Patient Comment: I have been researching both, but I am wondering which is the smartest treatment to fill the temples in in 2022? Thank you.

Dr. Persky’s Reply: I prefer using Sculptra in the temples of my patients as I find that the results are long lasting and the treatments are extremely safe. The filling is uniform and natural. There are many other fillers that can be used in the temple for immediate results, but for long term results I prefer Sculptra. Please feel free to contact me with any questions. Good luck and be well.

Q:Is Sculptra the best way to get rid of cellulite?

Dr. Persky’s Reply: There are many “treatments” for cellulite which usually means that there is not a great treatment for it. Sculptra is good to use as a filler of the indentations of cellulite. We have had nice results with our patients. Good luck and be well.

Q: 67 years old- Cheek crepiness & wrinkles, what can I do to improve this area? (Photos)

Actual RealSelf Patient Comment: 67 years of age & had a full face & neck lift with fat grafting to temples and cheeks & lower blepharoplasty. When I have a full smile or laugh I now have lines & crepiness on upper checks. The surgery was 5 months ago. What can I do to improve this area? I have more lines now after the surgery.

Dr. Persky’s Reply: I would treat you with Botox around your crow’s feet, and then a week or so later treat your peri-orbital area (around your eyes) with a Fraxel repair laser (fractionated CO2 laser). Radiofrequency micro-needling with PRP may also be helpful. Feel free to contact me with any further questions.

Q: I’m 26 with lower eyelid wrinkles – which procedures can I do to look younger? (photos)

Actual RealSelf Patient Comment:
I have wrinkles on my lower eyelid, and a skin which isnt exactly tight.

Dr. Persky’s Reply: I would say that “Nothing beats being young!” You are beautiful as you are. If you must do anything you may do a little bit of Botox at the corners of your eyes. For the skin under your eyes, a light laser treatment. Good luck and be well.

Q: Medi-Inject..Best treatment for fine lines/damaged skin in someone with atopic dermatitis? (photos)

Actual RealSelf Patient Comment: I am 27, with atopic dermatitis that is mostly under control right now. The skin on my forehead seems really thin and deflated. Possible sun damage? I’ve added niacinamide, vitamin C, sunscreen, and peptides to my skincare routine, but am not seeing results so far. What are the best next steps to treat this texture issue? Introducing a retinoid? Microneedling? Some sort of laser? Injectables? Are any of those even safe for atopic dermatitis? I also have deep lines from making worried faces.

Dr. Persky’s Reply: I love treating my patients with a “skin booster” treatment using a automated injection system, Medi-Inject. With Medi-Inject technology I am able to inject about 10 ml of a cocktail into the skin of the face in a precise dose and placement level. We use a mixture of PRP (platelet rich plasma), hyaluronic acid filler, Vitamin C, Botox, and skin lightener. The micro-needles are adjustable as is the micro-volume injected uniformly. There is minimal downtime of 1-2 days, and the results are seen very soon after treatment. Feel free to contact me with any questions. Good luck and be well.

Q: Is there a procedure that can improve my upper eyelid hollowing? (Photo)

Actual RealSelf Patient Comment: Is there a procedure that can improve my upper eyelid hollowing?

Dr.Persky’s Reply: Injection of filler under the brow can correct the area that is bothering you. This is advanced injection technique so choose your injecting physician most carefully. Good luck and be well.

Q: 25 years old- How do I fix dent on my forehead? (Photos)

Actual RealSelf Patient Comment:
Hi I’m 25 Years old and I have what I call a dent head, it’s like a divit that’s insot very prominent when I am looking straight at myself but when I lay down or from the side I can see it on my forhead, I want to know how to fix it

Dr. Persky’s Reply: I would try Botox injections in your prominent glabellar muscles (just above your brows.). Injecting filler in the forehead can lead to severe complications such as blindness and tissue loss in the hands of expert physician injectors. It is just not worth the risk in my opinion. Good luck and be well.

Q: Where would dermal fillers best enhance my face? Considering under eyes, nasolabial, cheek, and chin (Photo)

Actual RealSelf Patient Comment: I have had good experiences with cosmetic procedures in the past (a rhinoplasty and dysport injections) and I’m now looking into dermal fillers. I feel like my face looks a bit flat, especially in photos, which is why I’m considering cheek and chin, although my undereye bags are intense for my age and I don’t like the prominence of my laugh lines. Realistically I can’t do everything due to cost but what would be best prioritized?

Dr. Persky’s Reply: After in person evaluation of your facial structure and volume, I would likely recommend a foundational treatment with Sculptra, 2 vials at a 6cc concentration. This would replace lost volume in your face in a natural manner. It would address your chin, cheeks, jawline, undereyes, give your skin the “Sculptra Glow”, and even help with your cheek acne scars. Please feel free to contact me with any questions or to schedule a consultation at your convenience.

Q: Profound vs facetite – which one would be best for my goal to get the most bang out of one session? (photos)

Actual RealSelf Patient Comment: I have skin laxity in the lower half of my face and neck. I am not willing to go under general anesthesia right now, so am weighing the best non-surgical options. Facetite is highly reviewed but mentions fat dissolving, as I am quite thin, I worry losing any fat would actually age me. Profound seems like another strong option. There are SO many rf treatments out there – which one would be best for my goal to get the most bang out of one session?

Dr. Persky’s Reply: Both Profound RF and Facetite are excellent rejuvenation treatments. I agree with you that Facetite does dissolve fat. Facetite is also more invasive and has a much higher incidence of adverse events (un-evenness and scarring.) My preferred treatment for you would be a combination done at one treatment session. The treatment is performed in our office. In your case, I would treat your chin muscles with 8 units of Botox to smooth and project your chin. Patients are given 1 mg of Xanax upon arrival. Their face is washed and topical numbing cream is applied. A tube of blood is drawn, centrifuged, and the yellow plasma rich in platelets is set aside (PRP). Ten minutes prior to the beginning of treatment patients are given a weight appropriate does of Demerol and anti=-histamine, awake but drowsy and very comfortable. In thin patients I begin with local anesthetic nerve block injections followed by a facial foundation building deep treatment of Sculptra. The neck skin is too thin for Sculptra so I inject hyperdilute Radiesse throughout the neck to stimulate collagen production. This is followed by Profound RF from the forehead hairline down to the clavicles (entire face and neck.) At the end of the Profound RF treatment, since our patient is already numbed from forehead to clavicle, I then use a light to heavy laser treatment (depending on the patient’s desired result, a Fraxel CO2 repair or Fraxel Dual, for additional skin tightening and brown spot removal.) The recovery period is 5 to 7 days. This has been a fantastic rejuvenating treatment. Feel free to contact me with any further questions. Good luck and be well. Aloha!!!

Q:Sculptra for the face – will it slow the progress of my cheek wrinkles?

Actual RealSelf Patient Comment: I had CO2 laser surgery which worked well on one side of my face but not the other. I want to try Sculptra to even this problem out. My surgeon says it won’t give me the results I’m looking for, and is suggesting a mini facelift which I cannot afford. Will Sculptra slow down the progression of my cheek wrinkles even if it does not dramatically improve the wrinkles on that side of my face? Will injecting platelet rich fibrin with Sculptra be useful? I’m a65- year- old woman. Thank you.

Dr. Persky’s Reply: An experienced injector of Sculptra should be able to help you. Some injectors have combined Sculptra injections with PRP which may be a very good idea in your case. Not only does Sculptra injection result in improved volume, but it also improves the quality of the skin, experienced Sculptra injectors call “Sculptra Glow.” Another treatment that may be very helpful for your condition is automated computer controlled precise injection with Medi’Inject. We are able to control the precise amount injected to the hundredth of a milliliter, as well as controlling the depth of the injection with adjustable micro needles (from 0.25 to 2 mm deep.) Medi-Inject is a terrific skin-boosting treatment using PRP, hyaluronic acid filler, vitamin C, skin lighteners, and botox in a 10 cc syringe “cocktail.” Make sure to choose your treating physician very carefully. Good luck and be well.

Q:Can you tell me please how Lanluma V differs from Sculptra?

Actual RealSelf Patient Comment: Hi, Many clinics here are offering this but I am wary as it is new. Thank you.

Dr. Persky’s Reply: Lanluma V is Poly L-Lactic Acid (PLLA), as is Sculptra. Sculptra is the original product and has the longest track record of safety and efficiency. Lanluma V comes in vials of 210 mg and 360 mg, diluted in 15cc and 40 cc of saline respectively. Sculptra comes in 367.5 mg vials and is diluted in 6 to 20cc of saline depending on the area treated. Lanluma V is available outside of the USA. I personally have used Sculptra with excellent results without adverse reactions since 2009. Make sure to choose your injecting physician most carefully based on their skill, experience, and natural artistic vision. Good luck and be well.

Q:Lanluma V overfill – can anything be done to prevent the further production of collagen?

Actual RealSelf Patient Comment: At 63 I had 1.5 vials of lanluma 4 months ago and loved it. I had another 1.5 vials two days ago and am definitely over-filled. My lovely shaped face is round, chubby and I have chipmunk cheeks. I know this will be the end result as the swelling accurately showed the end result last time. I am so depressed I can’t face a future with my face like this. Is there anything that can be done to prevent the further production of collagen? Steroids? I can’t live like this. Please help.

Dr. Persky’s Answer: Please speak with you injector regarding your swelling. It is possible that during the injection process a deep blood vessel was punctured which could result in excess swelling during the first few days. Steroid injections may decrease inflammatory response, but I would not recommend unless your injector believes it best. Good luck and be well.

Q: Had bad filler done under my eyes, dissolved for 7 times and filler didn’t go away, what can I do? (photos)

Actual RealSelf Patient Comment: I’ve had versa under my right eyes by unprofessional injectors on my tear trough, I don’t have eye bags before, but after her bad work I have eye bags right now. After 7 times treatment of dissolve filler, some of the filler gone, but rest of it still lasting under my eyes. I feel like the Hylenex she injected to me was too light, it didn’t work for me. But she refused to dissolve for me and yelled me at the phone told me not to come back and she won’t injecting to me. What I can do right now?

Dr. Persky’s Reply: Sorry to hear about your terrible experience with your injector. I would recommend that you consult with other experienced physician injectors to determine your best treatment plan. Good luck and be well.

Q: Can filler or PRP help fill fat atrophy from steroid injection?

Actual RealSelf Patient Comment: I had a pain management doctor inject me above my eyebrows with steroids. I thought he was doing a normal lidocaine injection as that is what all other doctors have done. i would never have had steroid injected in my face as i know it causes atrophy. i had a head ache/ surgery done where they were able to replace some fat when they cut around the muscle when they did the nerve entrapment. Unfortunately, i still have atrophy on above above my eyebrows. can filler or prp help this?

Dr. Persky’s Reply: Yes, I would use Sculptra in this area. The forehead is an area where only expert injectors should treat as there can be significant adverse events related to injection in this area. Call our office for an in person or virtual consultation. Good luck and be well.

Q: Best treatment for under eye inner lines? (photos)

Actual RealSelf Patient Comment:
I have dealt with lines under my eyes specially the inner part of my eye the line is very visible is their a possible way to get rid of them by fillers or any other treatment?

Dr. Persky’s Reply: Fractionated CO2 laser (Fraxel repair) is the best treatment for these lines that are troubling you. I would combine your laser treatment with simultaneous platelet rich plasma topically and injected under the skin. Choose your treating physician carefully. Feel free to contact our office for an in person or virtual consultation. Good luck and be well.

Q: Young Female, Heavy Upper Eyelids…Am I a candidate for upper eyelid surgery? (photos)

Actual RealSelf Patient Comment: I think they hang, one side more than the other. I’m 35, but they’ve been hanging for a long time.

Dr. Persky’s Reply: Yes, a skin only upper eyelid blepharoplasty will correct what is bothering you. I perform this surgery in our office under local anesthesia, it takes less than an hour to look better for the rest of your life. Good luck and be well.

Q: Very rough texture on cheeks after Morpheus8 need advice! (Photos)

Actual RealSelf Patient Comment: Hi everyone I had one Morpheus8 session in November full face and neck and after I developed a rough texture on my cheeks. Idk if u can tell from the pic but there are areas that are raised and now some indented. It was set on 2mm but there was a terrible burning smell of skin in the room which the practitioner said was normal. It was also incredibly painful esp on my cheeks. It did give me some tightening but not much. What can I do to make the texture better again? Help!

Dr. Persky’s Reply: Sorry to hear of your adverse event. Depending on what your skin looks like on actual physicial exam, I would likely treat you with a non-ablative fractionated laser (Fraxel restore) along with an automated skin boosting treatment (Medi-Inject) which would include PRP, hyaluronic acid, vitamin C, and low dose botox. Good luck and be well.

Q:Is it safe to have Profound RF after having Aquamid filler in 2007?

Actual RealSelf Patient Comment: Can I have profound RF if I have had Aquamid filler in 2007. The areas treated with aquamed was nasal labial folds a small scar near my corner of my mouth ( that I think I can see the filler maybe not sure ) and between my eyebrows. I only had two syringes of the filler to treat all areas. The reason I say I don’t know if it’s the filler that I can see that was placed where the scar was; is because the doctor before using the filler tried to release the scar by cutting underneath the scar.

Dr. Persky’s Reply: Yes, it is safe to have Profound RF to rejuvenate your face and neck after you have had Aquamid filler previously. Aquamid has been associated with a much higher rate of infection than other injectable fillers. Your treating physician can treat your face and neck without going into the limited places where you have Aquamid. Good luck and be well.

Q: Botox for masseter and temporalis muscle asymmetry?

Actual RealSelf Patient Comment: Hello! Im 19 years old and plan to get some procedures to fix my facial asymmetry. (one side is simply wider than the other). I already hat botox for masseter muscle on one side which was a great succes. (10 months ago and muscle is still way smaller than before) So i plan to get Botox into my masseter on one side to fix this. Its more in the posterior masseter muscle. Is this possible? Thanks!

Dr. Persky’s Reply: Yes, Botox is a great treatment for masseter muscle asymmetry as well as a great treatment for patients suffering from TMJ Syndrome pain. I love to use Sculptra injections to correct asymmetric faces as it is a very natural and long lasting treatment. Always choose your treating physician carefully. Be well.

Q:Why is asthma a contraindication to Emsculpt?

Actual RealSelf Patient Comment: I want to get emsculpt but every site I read asthma is a contraindication. I don’t understand why.

Dr. Persky’s Reply: Asthma is not a contraindication to have EMSCULPT treatments. A patient is ineligible for EMSCULPT treatment if the following conditions are present: cardiac pacemakers, implanted defibrillators. implanted neurostimulators, electronic implants, pulmonary insufficiency, metal implants, drug pumps, application in either the head or heart area, malignant tumor, injured or otherwise impaired muscles, fever, or pregnancy. It is also recommended that patients have a BMI lower than 35. Good luck and be well.

Q:Want to diminish dimples and creases on butt after weight loss – will 24 syringes of Sculptra make a dent in my dents? (photos)

Actual RealSelf Patient Comment: I am scheduled to get 12 syringes in each buttock cheek this coming Tuesday. My main goal is to diminish the dimples and creases after recent, modest weight loss. I do not want a tiktok butt. Will 24 syringes make a dent in my dents?

Dr. Persky’s Reply: Sorry that I just got around to answering this question a few weeks after you were scheduled to have 12 vials of Scuptra in your bum. I hope that you conveyed your wish to avoid TikTok butt as 12 vials in each side is quite a bit of Sculptra. To diminish dimples and creases after recent weight loss2 to 4 vials per side should be able to do the trick. 24 vials is more than enough to “make a dent in your dents.” Good luck and be well.

Q: Is it important for doctors to mix Sculptra two days before treatment to prevent lumps?

Actual RealSelf Patient Comment: I’ve read that it’s important to mix sculptra at least two days before treatment to prevent lumps. I’ve also learned some ‘world renowned’ docs who don’t mix early. I’ve heard it needs to be kept warm. What’s the truth here on mixing sculptra and preventing lumps? Also, how would one mix sculptra with prp? Thanks for taking the time to review and respond.

Dr.Persky’s Response: For many years it was recommended that Sculptra be mixed a few days before use. Recent studies and research have shown that mixing Sculptra immediately before injection is also safe and in the studies did not prove to have increased complications including lumps and nodules. I personally have been using Sculptra since 2009. I prefer to mix it a few days and let it “marinate” before using. We have not have any problems with lumps, bumps, or nodules using this technique. PRP can be added to the syringe when injecting Sculptra. As with any aesthetic procedure, be sure to choose your treating physician most carefully! Good luck and be well.

Q: Why does the collagen formation from Sculptra last less than collagen formation from lasers or subcision for acne scars?

Actual RealSelf Patient Comment: I was wondering why does the collagen formation from Sculptra lasts less than the collagen your skin makes through lasers or subcision?

Dr. Persky’s Reply: Sculptra is an excellent injectable collagen stimulating filling. I have used it since 2009 on hundreds of patients with excellent results. It is extremely safe and effective when used properly by skilled physicians. I am not aware of any studies or research that have proven that the collagen stimulated by Sculptra lasts any differently than that formed by lasers or subcision for acne. Good luck and be well.

Q: How big in inches (diameter) is the treatment area on the applicator for abs?

Actual RealSelf Patient Comment: I understand the Emsculpt applicator paddle is meant to be positioned with the center over the belly button. I was wondering how large in inches of diameter is the effective treatment “circle” area of one Emsculpt paddle applicator for the abdominal region?

Dr. Persky’s Reply: The Emsculpt paddle is about one foot in diameter. The electro-magnetic pulses are low frequency and stimulate the nerves to the abdominal muscles so that 100% of the abdominal muscles contract. The area of effect goes beyond just the size of the paddle. Good luck and be well.

Q: Emsella and Emsculpt in Patients with Titanium Screws (or Other Metallic Implants)

Actual RealSelf Patient Comment: I am interested in getting emsella done but I have titanium screws in my jaw is it still ok to do the procedure even with my screws? What are the possible side effects/interference that can happen with emsella and titanium screws?

Dr. Persky’s Response: In your case, because your titanium screws are so far away from where Emsella is emitting it’s electro-magnetic energy, you are completely safe to have the treatment. In general, as long as any metallic implant is at least 7 cm (a little less than 3 inches) away from the seat (or the paddles in the case of Emsculpt), then it is completely safe. Patients with metal implants that are too close to the emission of the energy can have excessive heating of the implant. Good luck and be well.

Q: Durability of Profound RF vs facelift?

Actual RealSelf Patient Comment: In terms of longevity and durability of the results, does profound have the same as a facelift? Or does it just provide a temporary fix where as a facelift is more permanent? I know both of them do not stop aging.

Dr. Persky’s Reply: When my family goes on vacation in Mexico, our saying is, “Another day, another guac & chips on the beach!” In terms of the longevity of Profound RF vs. Facellift, both procedures will leave the patient looking better for the rest of life compared to how they would look had they not had the procedure. My experience is that both hold upo well for 7 to 10 years depending on the patient as everyone is different. Profound RF is the best treatment non-surgical treatment in selected patients who do wish to undergo surgery. The results of facelifting will give a tighter result along the jawline and neck. If only the treatments stopped aging, you are correct, they do not. Good luck and be well.

Q: Which area has less blood vessels and is less likely to lead to some of the bad complications of fillers (e.g. blocking blood vessel, etc.) – filler in face or sculptra filler for hip dips?

Dr. Persky’s Reply: Fortunately the face has lots of blood vessels which helps it heal well. It is very important to choose your injecting physician most carefully to avoid complications with filler injections. The Hips have a lower risk of injection into a blood vessel, once again as long as your injecting physician is properly trained in anatomy and Sculptra techniques. Your injecting physician must know facial anatomy as well as the danger zones to avoid. The central portions of the face are the most dangerous to inject, though experts can inject this area safely. Sculptra is the most forgiving injectable filler in terms of vascular complications because it is injected as a fluid, not a gel. Good luck and be well.

Q: Is it possible to reverse forehead wrinkle at 28? (Photos)

Actual RealSelf Patient Comment: Hello, I’ve started to notice a wrinkle on my forehead while I rest my face. It’s has a noticeable crease. I’m 28 years old. Is it possible to reverse the wrinkle?

Dr. Persky’s Reply: Yes, a little bit of Botox properly placed will take care of your forehead line. Choose your treating physician carefully. Good luck and be well.

Q: Asymmetrical smile – Botox, surgery, or orthodontics? (Photo)

Actual RealSelf Patient Comment: The right (picture left) corner of my mouth pulls very far when I talk or smile and it creates a weird overly exposed mouth corner. What are my options for fixing this? Botox? Orthodontic work? A gummy smile surgery only on that one spot?

Dr. Persky’s Reply: I would treat you with a little Botox to even your smile. Feel free to contact me with any further questions or concerns. Happy Independence Day Weekend! Good luck and be well.

Q: Can I have Emsella after a hysterectomy and vaginal repair?

Actual RealSelf Patient Comment: Can you have Emsella after a hysterectomy and vaginal repair to help strengthen pelvic floor and prevent prolapse reoccurring?

Dr. Persky Reply: I hope that you have healed well from your surgery. As long as you do not have any metal implants or metal staples in the area you may have Emsella to strengthen your pelvic floor muscles. It is a good idea to check with your gynecologic surgeon before your Emsella treatment for added assurance. Good luck and be well.

Q: Can I treat my nasolabial fold shadow with fillers or a plasma pen? (Photo)

Actual Real Self Patient Comment: Hi I am 26 years old and I don’t actually have the fold it seems like I can’t feel it but recently I have noticed the lines it’s more of a shadow and it’s pretty dark sometimes I feel like it makes me look sick or like a smoker I don’t know if I need fillers or may be a plasma pen or what can help lighten these lines I want to protect my youth as long as possible. Sometimes it’s not so dark sometimes it’s very dark and I really don’t like it I’ve had a light shadow probably since early 20s

Dr. Persky’s Reply: I would avoid using an aggressive treatment such as plasma pen for your naso- labial groove. Instead I would treat you with 1 syringe of Voluma in your cheeks above the fold which will correct your concerns. It is essential that you choose your expert injecting physician very carefully. Good luck and be well.

Q: What is this line? How can I get rid of it? (Photo)

Actual RealSelf Patient Comment: I’m a mom of 2 young kids. I noticed back in 2018 right after having my second child this deep darker line in my right eye. Sometimes it is puffy too but if I massage it the puffiness goes away. I have tried ice, massages, creams … I am developing a huge complex about it and I am not even sure what is it 🙁 any help appreciated.

Dr. Persky’s Reply: Have you ever had any filler under your eyes? It is difficult answering your question without examining you. Please feel free to contact me for either a virtual or in person consult. Good luck with those two kiddos!

Q: Cheek volume loss at 23 years old? (Photos)

Actual RealSelf Patient Comment: Hello, I am only 23 but I seem to have some significant volume loss in my cheeks. My nasolabial folds have been prominent since I was a teenager, but are worse now. My cheeks have a saggy, jowly appearance. Underneath my cheekbone my cheeks have a hollow, and this hollow becomes very obvious whenever I open my mouth, giving me a gaunt appearance. Do you think these issues are from volume loss? Would fat grafting be a good option? Or filler? Would filling the cheek hollows be a good idea? Thanks.

Dr.Persky’s Reply: I would treat you with a small amount of Sculptra, a bio-stimulatory volumizer. Sculptra is more predictable than fat. Fat transfer in young patients is not prudent. The other filler that you may consider is RHA-3. The most important aspect of your treatment is making sure to choose your injecting physician very carefully. Feel free to contact me with any other questions or concerns, or to schedule a virtual or in-person consult. Good luck and be well.

Q: Tear trough or cheek filler?

Actual RealSelf Patient Comment: I’m trying to decide what to do first. Are there more risks or chance of error involved with either one?

Dr. Persky’s Reply: I recommend treating your cheeks first as this also helps with your tear trough. After treating your cheeks, you may not need treatment of your tear troughs. Tear trough injections are more likely to result in bruising and have greater risk of complications. Most importantly, choose your injecting physician very carefully. Good luck and be well.

Q: Help for nasolabial folds and jowls (Photo)

Actual RealSelf Patient Comment: I’ve tried ulthera (when I was 23, probably helped the most), radiesse in my nasolabial fold (only into part closest to nostril not in the whole fold), kybella in buccal fat/jowl area, jaw filler, filler in nasolabial fold (whole fold, did not like so dissolved), RF micro needle lifting, botox in masseter (I clench in my sleep made face large) and I believe that’s all. I just turned 25, used to bed tan religiously every day for 6 years.

Dr. Persky’s Reply: I would recommend that you stop your daily tanning bed treatments both for the damage it is doing to your skin as well as the increased risk of skin cancer. At age 25, you have done quite a bit to your face. At this point I would treat you with foundational Sculptra and possibly Ulthera over the next few years. Choose your treating physician most carefully. Good luck and be well.

Q: Is it safe to do Ultherapy if I have a family history of melanoma?

Actual RealSelf Patient Comment: Is it safe to do ultherapy or LED red light therapy or even a chemical peel to my face if i have a history of a primary member who died of melanoma ? would the heat or the burn of any of these treatments lead to melanoma ?

Dr. Persky’s Reply: Ultherapy is a great lifting and tightening treatment. A family history of melanoma is not a contra-indication for ultherapy. Choose your treating physician carefully. Good luck and be well.

Q: Fillers for hollow temples at 19 and would there be any real change? (Photo)

Actual RealSelf Patient Comment: Hi, I’m only 19 and have hollow temples. I was wondering if it’s too early to get fillers and if there would even be a real change with the fillers? I included a photo as well. Thank you in advance.

Dr. Persky’s Reply:I would recommend treating your temples with a series of Sculptra injections. This will give you a long lasting natural correction. Choose your injecting physician most carefully. Good luck and be well.

Q: I am middle eastern and my skin is olive colour. Is hyperpigmentation a side effect of Profound treatment?

Actual RealSelf Patient Comment: I am interested in a Profound treatment to tighten my face and neck but the nurse told me that I may end up with hyperpigmentation due to my skin tone. I am middle eastern and my skin is olive colour I was excited to have the treatment done but now I feel it’s risky to do it Please advice if hyperpigmentation is a side effect of Profound treatment

Dr. Persky’s Reply: Good news! Profound Rf is color-blind, there is not a contra-indication treating skin of color. I have treated many patients with dark skin types without any hyperpigmentation. Choose your treating physician most carefully. Good luck and be well.

Q: How do I manage these deep creases on the side of my face when I smile? (Photo)

Actual RealSelf Patient Comment:

See attached picture. This has only started happening as I’ve aged, so I assume it has to do with collagen production but is there anyway to address it?

Dr. Persky’s Reply: Don’t smile, just kidding. I would add some volume to your face, likely with Sculptra, and use a non-invasive device to tighten your skin. Feel free to contact our office to schedule your consult/treatment, we look forward to meeting with you and helping you achieve and maintain your facial aesthetic goals for many years to come. Good luck and be well.

Q: Is there something less aggressive to improve my slightly hooded eyes?

Actual RealSelf Patient Comment:

I’m 36 and a lot of people in my family eventually end up needing blepharoplasty later in life. My right eye is a lot more hooded than my left but I feel like eyelid surgery could be a bit too much at my age. Is there anything else I could try like thread lifts or Botox that would improve this? I feel like I look really tired or aged unless I’m wearing a lot of eye makeup.

Dr. Persky’s Reply: Yes, I would treat you with Botox to pharmacologically lift your blows. You may also benefit from a small amount of filler. Please feel free to contact our office to schedule you complimentary virtual or in person consultation as well as your treatment. I look forward to the privilege of helping you achieve and maintain your facial aesthetic goals for many years to come. Good luck and be well.

Q: Lip filler migrated and not dissolving after 6 years. Would hyaluronidase be effective to dissolve this? (Photo)

Actual RealSelf Patient Comment:
I had filler in 2015. 3/4 of a syringe, top lip only, focused on the ‘flipping’ upper lip out to make mouth look wider. Product migrated down into the bottom part of my upper lip. Dr Gavin Chan has done MRIs to show how long fillers actually survive in the body, and that it is much longer than anyone assumes. He indicates that hyaluronaise may still be effective to dissolve this. I am concerned about possible negative outcomes. If it hasn’t dissolved by now, does that mean it never will?

Dr. Persky’s Reply:
It is unusual for hyaluronic acid fillers to last 6 years, yet possible. It would be helpful if you got your medical records from the clinic you were injected in 2015 to confirm what filler was placed in your lip. I would treat you with hyaluronidase in an attempt to dissolve the filler. There should be not be a negative outcome if performed properly. Please feel free to contact our office. Good luck and be well.

Q:I’m 35 years old and hate these nasolabial folds. Not interested in filler, other opinions? (photos)

Actual RealSelf Patient Comment:

Im not interested in filler to treat them, any other guidance? One surgeon gave me a quote of $101,000 for his *signature facelift* (feels a bit extra) so I would like insight on what other surgeons might suggest before a few consultations I have coming up.

Dr. Persly’s Reply:
I have found that Profound RF is very effective at treating the area you are concerned with. Please feel free to contact our office to schedule your virtual or in person consultation at your convenience. We look forward to meeting with you and helping you achieve and maintain your facial aesthetic goals. Good luck and be well.

Q: Best Botox Practice…How many millimeters does Botox need to be injected in these areas?

Actual RealSelf Patient Comment:

I want to learn more about Botox before I go ahead and receive it, as I hear some conflicting information but I’m wondering how many millimeters deep does Botox get injected into the DOA muscles and the Orbicularis around the eye?

Dr. P’s Reply:
Your most important consideration in having Botox treatment is making sure to choose your treating physician most carefully and trust and have “faith” that they know the proper “millimeter depth” to inject Botox. Botox injections require knowledge of anatomy that varies from patient to patient. The injection must be placed into the DAO muscle, the depth in mm’s varies. For Crow’s Feet injections at the orbicularis muscle, Botox is placed just above the muscle which is very superficial. Feel free to contact me with any other questions or concerns, or call to schedule your consultation/treatment. Good luck and be well.

Q: What is this area of the cheek called, and what filler can be used to fill this hollow space? (photos)

Actual RealSelf Patient Comment:

I’ve been trying to figure out what this area of the face is called. I thought it was submalar, but it seems to be a little bit below that area based off of what google images says the submalar region is & right above my jaw. Also, what filler can be used to fill this area

Dr. Persky’s Reply: The area that you are asking about is the lower pre-auricular area. It is often overlooked by filler injectors. I love to treat this area as it lifts jawline and rejuvenates the face in a subtle natural manner. I use Voluma, RHA-4, and/or Sculptra. Make sure to choose your injecting physician carefully for best results. Good luck and be well.

Q: Will my skin sag overtime after getting fillers and will I need more and more filler year after year?

Actual RealSelf Patient Comment:

It is a common misperception that facial fillers stretch the skin and accelerate aging. The opposite is true. You not only benefit immediately from facial filler injections by increased facial volume, but in addition most injectable fillers stimulate some natural collagen production so that even when the filler has been reabsorbed by the body, there is still more residual volume that before. I treat many patients in their early 40’s with filler. We love to use Sculptra initially as it is a bio-stimulating filler that gives naturally beautiful results, building the patient’s own collagen. With Sculptra, once your volume is replenished, patients may not require maintenance for 2 to 6 years. As with any facial aesthetic procedure, it is most important that you choose your expert injecting physician most carefully based on their skill, experience, knowledge, care, and natural artistic vision. Feel free to contact my office to schedule your complimentary consultation. We look forward to meeting with you and helping you achieve and maintain your facial aesthetic goals for years to come.
Good luck and be well.

Q: Will I get more long-term benefit out of a series of Fraxel or Morpheus8 treatments? (Photo)

Actual RealSelf Patient Comment:

I am 35 Caucasian with fair skin. I had a 3D skin analysis and it shows I have less wrinkles than 90% of people my age but that I have %90 more sun damage below the surface. I have a few freckles. No broken capillaries. No brown sunspots on the surface. I always wear sunscreen and use glycolic to tone. I would like to treat my skin to support the collagen, tighten facial contours, reduce fine lines and especially reduce the deeper sun damage. I was recommended to get both. which one is better?

Dr. Persky’s Reply: Both treatments Morpheus8 and Fraxel Dual will benefit you. If I were to choose one to treat you I would use Fraxel Dual as is will help with both your early sun damage as well as with fine lines and rhytids. Choose your treating physician most carefully. Good luck and be well.

Q: Best Millennial Facial Aesthetic Treatment…I have severe nasolabial folds at 27, any suggestions? (Photos)

Actual RealSelf Patient Comment:
I’m 27F. Skin history: acne scars from skin picking/acne, use tret on and off since 18, have micro needled twice. TCA  CROSS done once. I use lots of sunscreen bc I’m so pale. Is this is premature for my age? Is Ulthera an option? or would filler be more appropriate? Also, wondering if this issue looks like bone structure or if there could be a connective tissue issue? evidence attached. Any thoughts are appreciated!! Thanks in advance!!

Dr. Persky’s Reply: You have a very sweet smile, which is always the best form of plastic surgery! Just by turning the corners of your mouth upward changes the entire dynamic and appearance of your face. I would treat you with a combination of Sculptra injections and Ulthera which can both be performed at the same treatment session. I would also inject a small amount of Juvederm in the corners of your mouth to change “the sad to glad.” Make sure to choose your treating physician most carefully as results of the treatment will certainly vary depending on who is treating you. Good luck and be well, smile!

Q: Is 19 too young for Botox for non-comestic reasons?

Actual RealSelf Patient Comment: I suffer from TMJ. I get headaches, tinnitus, my jaw pops every time I open my mouth etc, but is manageable. I was looking at possibly getting Botox as a last- resort option, but I am worried I might be too young to start it. One side is bigger than the other because of TMJ, and I know Botox can atrophy these muscles so my jawline can be more symmetrical, another benefit I was also looking at. Primarily though, I am looking for some relief from my TMJ. Is 19 too young to get Masseter botox?

Dr. Persky’s Reply: Botox injected into the masseter muscles for TMJ is very effective for all ages, so no, you are not too young to have Botox treatment to relieve your TMJ Syndrome problems. Make sure to choose your injecting physician most carefully as Botox injection in the TMJ is an advanced technique to get right. Good luck and be well.

Q: When the nose bone is shaved down during rhinoplasty, how do you get out the shavings?

Dr. Persky’s reply: Large pieces of bone and cartilage are removed with forceps, smaller shavings are suctioned and sometimes rinsed out. Do not try this at home! Choose your rhinoplasty surgeon carefully and leave the rest to your surgeon. Good luck and be well.

Q: Can you put fillers in the area above marionette lines? (Photos)

Actual RealSelf Patient Comment:
I have a weirdly shaped upper mouth. Is it possible to put filler in the area beside my philtrum to even it out more? I want to make the area more smooth. Could it also be possible to do some tiny liposuction to my philtrum to even it out more that way? If neither of these is possible, what should I do about this issue if anything?

Dr. Persky’s reply: I would inject hyaluronic acid filler in your area of concern under your nose and around your philtrum. I would advise you to not mess around with any micro-lipo suction in the philtrum area as that may lead to difficult to correct problems in the future. Choose your injecting physician most carefully. Good luck and be well.

Q: Do fillers damage or dissolve facial bone?

Actual RealSelf Patient Comment:

Do chin fillers dissolve bone or damage it? Also, is there fat in the chin where filler can be injected and where is that fat because Botox needles hit the muscle and those needles are very small.

Dr. Persky’s reply: Fillers do not damage or dissolve facial bone. Facial bone begins to lose volume naturally from age 25 on. Chin implants have been known to cause the bone of the chin to reabsorb, we see this occasionally when chin implants are removed. There is fat under the skin in the chin. Filler in the chin area is injected under the muscle over the bone, or in the subcutaneous tissue. Good luck and be well.

Q: What facial procedures (preferably permanent) would help my seemingly saggy/droopy face? (Photos)

Actual RealSelf Patient Comment:
I have an asymmetrical face. I am 25 years old. I have come to realize over years of reflection that my biggest insecurity comes from very droopy/sagging cheeks and eyelids. It seems to be more extreme on my left side of my face. My cheeks are very thin cheeks and often get very cold when the weather drops. I am thinking that maybe a fat transplant to my cheeks or some sort of tightening from the inside of my mouth could help improve the appearance. I am very open to suggestions. Thank you.

Dr. Persky answer: Hi Josh, I would treat you with Sculptra which naturally builds your own collagen and is long lasting once you achieve correction. I am not a fan of either facial implants or fat in young patients.
Good luck and be well.

Q: I was wondering if achieving a nose like this would be possible? (photos)

Actual RealSelf Patient Comment:
I’m not expecting to receive the exact same results, but would like to achieve something similar. pictures of my nose are shown.

Dr. Persky’s Answer: I recommend that you reach out to Ari Hyman, MD, an expert rhinoplasty surgeon who is extremely well trained, experienced, skilled, knowledgeable, and an artist. I have personally seen many of his patients and their results are amazing and naturally beautiful. Please contact Dr. Hyman to schedule your virtual or in-person consultation at which time he will share what he can do to help you achieve your rhinoplasty goals. Good luck and be well.

Q: Advice for minimal scarring alarplasty/alar/nostril reduction on thick scar prone ethnic/African American skin? (photos)

Actual RealSelf Patient Comment:
1. Where would you make the incision to achieve the results for minimal scarring? 2. I’m looking for a nostril reduction that will fit between the corner of my eyes is that possible? 3. Have you done it on AA patients or Asian patients, do you have front facing and side view photos with no photo shop to show your minimal scarring results for this procedure? Thank you.

Dr P’s Answer: I recommend that you check out the webpage of Dr. Ari Hyman. Dr. Hyman is an expert rhinoplasty surgeon, experienced, well trained, skilled, knowledgeable, and is an artist. I have personally seen his natural beautiful work. He has performed alar reduction and rhinoplasty on many AA and Asian patients with minimal scarring, go to his website or follow on Instagram. Good luck and be well.

Q: Skin Boosting with Medi-Inject and Exosomes…What procedure would be best for tightening the area under my eyes? (Photos)

Actual RealSelf Patient Comment:
I had a fractional laser tx about 4 months ago, including filler under my eyes. I am regularly treated with botox. As someone who is pretty fair I still have a significant amount of redness and continue to treat it with Alastin Skin Nectar. While there has been some improvements to the crepiness, there is still quite a bit of feathering/vertical wrinkling in the under eye area which I assume is due to volume loss. Should I continue to be patient or there other procedures I might consider?

Dr. Persky’s Answer: Since you have already had fractional laser treatment 4 months ago and the results continue to improve for 6 to 9 months I would not recommend further lasering at this time. If you did not have fractionated CO2 lasering then that is an option. At this point I would treat you with a skin boosting treatment where a mix of filler, PRP(plasma rich platelets), neuromodulator, and vitamin C are precisely injected into your skin at micro doses and very superficially with an automated hand-help injection device, Medi-Inject. At the conclusion of the treatment I would apply exosomes topically. Please feel free to contact me with any further questions, concerns, or to schedule your complimentary consultation. I look forward to meeting with you and the privilege of helping you achieve your facial aesthetic goals for many years to come. Good luck and be well.

Q: Non-Surgical Facial Shaping and Rejuvenation…What can I do about my droopy/lumpy lower face? (Photos)

Actual RealSelf Patient Comment: I’m 30 y.o., but have had fatty perioral mounds/a droopy mouth area since I was a teenager. I’m thin, so losing weight won’t fix it – it’s something I’ve inherited from my mother. (I also know that it will get worse with age.) I’m open to liposuction, but am afraid of losing my general face shape. I like my round face, and don’t want to look too thin or gaunt (esp. because I have big cheeks). I just want to get rid of the lumpiness – e.g., when I smile and the fattiness gets pulled taut.

Dr. Persky’s Answer: Hi Mowski,
I would recommend a combination treatment of tightening your skin non-surgically as well as strategically adding volume to your facial foundation. I have successfully treated many patients with this approach resulting in beautifully natural outcomes that are long lasting. The treatment with multi-modalities (Sculptra, Profound RF, PRP (platelet rich plasma), laser, and exosomes) is performed at one sitting. Please feel free to contact me with any further questions, concerns, and/or to schedule your personal complimentary consultation. I look forward to meeting with you and the privilege of helping you achieve and maintain your facial aesthetic goals for many years to come. Good luck and be well.

Q: How can I improve my face and/or make it more symmetrical? (photo)

Actual RealSelf Patient Comment:
Hello! I am looking to improve the symmetry of my face as well as make some improvements overall. I am likely going to get a forehead reduction with a brow lift, which should help the most. I have already had ptosis surgery since this photo was taken and that corresponding brow has lowered properly due to it. However, I feel my face also has little fat on it and no forward growth of the mid face and brow area/forehead. I feel I look too young for my age. Any suggestions are welcome! Thanks 🙂

Dr. P Answer: Hi T,
First things first, you look great! “Looking too young for my age” is something that we do not hear often in our office! Everyone’s face is a little asymmetric, the two halves of the face are not “identical twins” rather they are “siblings.” I would use a combination of Sculptra and perhaps other non-surgical modalities to correct your facial asymmetry. I would not advise surgical forehead reductionb and brow lifting at this time as I feel that you risk ruining your “natural beauty” and becoming “plastically unnatural.” Don’t ruin a good thing! Please feel free to contact my office with any further questions, concerns, or to schedule your complimentary consultation. Good luck and be well.

Q: Best Rhinoplasty in Los Angeles..Can you reduce the width of a nose with a closed rhinoplasty?

Actual RealSelf Patient Comment: Best Rhinoplasty in Los Angeles..Can you reduce the width of a nose with a closed rhinoplasty?

Dr. P Answer: I would recommend consulting with Ari Hyman, MD regarding your rhinoplasty wishes. I have been extremely impressed with Dr. Hyman’s rhinoplasty results as well as his patients happiness with their natural results. Dr. Hyman is extremely well trained, experienced, skilled, knowledgable, and has natural artistic vision. Call our office to schedule your consultation either in person or virtually with Dr. H. Good luck and be well.

Q: Best Natural Facial Rejuvenation for Early Signs of Aging in Mid-40’s..What to do about my face? (Photo)

Actual RealSelf Patient Comment:
Hello I am in my mid 40’s and I do a great job taking care of my skin with products and have not gotten any injections. However this year my face is looking bumpy around my mouth and a lot of sagging. I think if I hit fillers it would make it worse. (But I don’t know much about that) I am ready to do something about it and wonder what can be done, I am looking for long term solutions. I truly appreciate any suggestions Thank you!

Answer: You are not alone, many of our patients share your concerns about early aging which results from loss of facial volume from bone and fat as well as loss of skin elasticity. I would recommend a combination treatment with a skin tightening device and the use of Sculptra which is a biological natural volume stimulator. The treatment can be performed in one sitting and it will correct your concerns. It is a long lasting solution. Please feel free to contact me with any further questions or concerns or to schedule an in-person or virtual consultation. Stay well.
Michael Persky, MD

Q: What’s up with my face, I feel like it’s heavy and very tired, any suggestions? (Photos)

Actual RealSelf Patient Comment: Hi, 28(f). I came across the posts from verified doctors here and wanted to ask for expert opinions. My face looks very tired and heavy. Is it about my jaw shape or smile lines or recessed chin…? I always look, how to say, too mature with a wise man face compared to my peers. Could you please help me identify my major problem areas? I don’t know what kind of doctor I should see. V-line, bullhorn or v-y lip lift, rhino.. they all just confuse me. Thank you in advance.

Answer: You are lovely as you are. I believe that a combination treatment of foundational Sculptra treatment combined with proper Ultherapy would give you a “lift” and rested appearance. Feel free to contact our office with any further questions or concerns. Happy and healthy New Year. Good luck and be well.

Q: How do I lift corners of my eyes and my hooded eyelids? (photos)

Actual RealSelf Patient Comment:
I have inherited downturned hooded eyes and I’m becoming more and more insecure about it. My hood crease goes past the corner of my eye, so I can’t even apply the eyeliner the way I want it. There are two things I would like to address: droopy eyelids and downturned appearance of my eyes. Do I need a blepharoplasty or some sort of a brow lift for droopy eyelids? Is lateral canthoplasty what I need for the corners of my eyes? Thanks in advance!

Dr. P Answer: Your complaint and concerns are quite common. A simple upper blepharoplasty will correct your hooding, droopy upper eyelids, and the downturned appearance . This can be done under local anesthesia in our office with minimal downtime. Please feel free to contact our office with any further questions, concerns, and to schedule your consultation and treatment. Merry Christmas and Happy, Healthy New Year to you and your family.

Q: Best ‘Biostimulator’ or ‘Skinbooster’ How do I choose Sunekos,Ellanse, Profhilo, Redensity1, Volite, or Skinboosters?

Actual RealSelf Patient Comment: 30/F – I DO NOT WANT SCULPTRA OR BELLAFIL Noticed my forehead has lost volume and firmness, it’s thinner and less elastic. Alot of these ‘Biostimulators’ cannot be injected into the forehead (something to do with the blood in the forehead?) What is the best one for this area (I’ve read redensity1 possibly?) I also want the product that will stimulate collagen production the most for rest of my face. Sunekos, Ellanse & Redensity 1 are so new it’s hard to know what is better than the other.

A: Using an automated injection system (Medi-Inject), your skin can be “boosted” with micro injections at precise depth. Our patients love the treatment. I use Platelet Rich Plasma (PRP) mixed with hyaluronic acid filler, botox, and vitamin C. Feel free to contact our office with any further questions. Merry Christmas and Happy New Year.

Q: Seeking input on treatment for sunspots on the face, any suggestions? (Photos)

Actual RealSelf Patient Comment:
From years in the sun, i now have sunspots on my face. Visits to dermatologists resulted in a variety of treatments (triluma + a mild peel, just triluma, other 4% hydroquninone creams, tretinoin cream (.05%). none did anything. no lasers yet. i’ve been told there r risks b/c of my skin tone. but maybe not? “Lasers” is a very broad topic, with multiple options. & there’s also microneedling. & the ZO products. & etc…b4 i make yet another appt, i’d appreciate some expert input.

A: Hi KLW,
You are a great candidate for Fraxel Dual laser treatments, likely a series of 2 to 3 over the course of 6 to 12 months. It should clean up the brown spots as well as helping with fine lines and wrinkles. Good luck and be well.

Q: Non-surgical face skin tightening, would you suggest Morphous8 or Ultherapy? (Photos)

Actual RealSelf Patient Comment:
For a start I would like to get Morphous8 for lower face skin tightening. After that would you recommend another Morphous8 treatment or Ultherapy? (Please see attached photos) Thank you

A: HI Caleee,
I would recommend Ultherapy of your lower face after your first Morphous treatment. Profound RF with PRP and a light fractionated CO2 laser is a more aggressive treatment that lifts and tigthens more. Whatever you choose, may sure to choose your treating physician most carefully as these treatment modalities are just tools to be used by experienced physicians for the best results. Good luck, be well, happy and healthy holidays!

Q: Will facial fat transfer cause looser skin long term?

Actual RealSelf Patient Comment: I am in my early 30s but have a significant amount of volume loss around my eyes. I am considering a fat transfer to the area, but will the fat shift as I age? Especially under the brow? Does the fat put increased weight on the skin?

A: Hi That One Girl,
Fat would not be my choice for facial volume in a young patient. Fat transfer is unpredictable, either over or under done. If you should gain weight, fat can increase abnormally disproportionately in the face. I prefer to use Sculptra, Voluma, and Restylane to replace volume around the eyes. Please feel free to contact our office to shedule your consultation/treatment. Good luck and be well.
Michael Persky, MD

Q: What to do about drooping eyes? (photos)

Actual RealSelf Patient Comment: My eyes appear sad and slightly drooped. What would open up my eye area more and/or provide a slightly upward slant (for a more alert, refreshed look)

A: Hi Lil’ Flapper,
A great non-surgical, non-invasive solution to your concerns would be either botox, Ultherapy of your forehead/eyebrows, or best option of all, a combination of both. Please feel free to contact our office to schedule your consultation/treatment. We look forward to meeting with you and the privilege of helping you achieve and maintain your facial aesthetics.

Q: Asymmetrical eyes. Can I do anything about it? (Photo)

Actual RealSelf Patient Comment:
Hello, I was wondering if anything could be done to achieve more balance and align my eyes, as they are quite asymmetrical. I understand that whilst some degree of asymmetry is normal, I would like to see if I could do anything about it. Thank you!

A: Hi Fabulous in Beverly Hills,
Yes there is something that you can do about it! The asymmetry of your eyes goes along with the asymmetry of the two sides of your face. You have a longer, narrower left side while your right side is fuller and rounder which gives the impression that the left side of your face is smaller, set back and higher. I would recommend non-surgical facial filler injections to restore your facial symmetry. I would likely begin with a treatment session of Sculptra which allows full facial correction. The treatment would initially be directed at adding a little structural volume to the left side of your face, bringing the two halves of your pretty face into balance. Once your facial asymmetry is corrected, it will likely be at least 4 to 5 years before you may need a minor maintenance treatment. This is an advanced treatment and you should make sure that you choose your treating physician most carefully based on their skill, knowledge, expertise, experience, and most importantly their natural artistic vision. Please feel free to contact our office to schedule a consultation at your convenience. I look forward to the privilege of helping you achieve and maintain your facial aesthetics for many years to come. Stay well.
Michael Persky, MD
Encino, CA

Q: What can be done for my nose? (photos)

Actual RealSelf Patient Comment:
Hi – I have always really disliked my nose from a side angle and at the age of 30 I am finally in a position to fix it. Straight on it is fine albeit a little off centre. My issue is the size of my nostrils, they are long and thin and I have a deviated septum. I also don’t like how projected my nose is and feel that it is out of proportion with the rest of my comparatively small face and features. I was wondering if closed or open rhinoplasty would be best for me?

A: Great rhinoplasty can be performed either open or closed. In your case, due to your concerns about your nostrils, I would recommend an open rhinoplasty. More importantly is who you choose to have your rhinoplasty performed by. I highly recommend that you consult with Ari Hyman, MD who is a very talented expert rhinoplasty surgeon as well as an artist. Dr. Hyman is extremely well trained, experienced, skilled, knowledgeable. and possesses natural artistic vision. His incisions heal beautifully and his results are naturally beautiful. Please contact our office at your convenience to schedule your septo-rhinoplasty consultation at your convenience. We look forward to meeting with you and the privilege of helping you achieve and maintain your facial aesthetic aesthetic goals for years to come.

Q: Should I get a nose job for a smaller nose? (Photos)

Actual RealSelf Patient Comment:
I feel like my nose is wide and flat, especially when I smile, I’d really like to know if it’s too ugly to be left as is, please let me know what I should do to fix it and any other parts of my face that are off. Thank you.

A: You are beautiful. If your nose bothers you, I would recommend consultation with Ari Hyman, MD. Dr. Hyman is a rhinoplasty expert, extremely well trained, experienced, knowledgeable, and is an artist. At your consultation you can share your concerns, photos will be taken, and accurate computer imaging will be performed to give you a realistic idea of what your nose will look like after surgery. Please feel free to contact our office to schedule your consultation at your convenience. Good luck and be well.

Q: Am I good candidate for Sculptra or should I just get fillers? (Photo)

Actual RealSelf Patient Comment:
Hello! I’m very self conscious about how hallow my face looks. I just turned 30, I don’t smoke, drink or do drugs and I want a more full face and i’m debating if Sculptra is right for me or fillers is best? What are the complications from Sculptra and how common are the risks?

A:You are an excellent patient for Sculptra treatment by an expert injector. I believe that I can help you achieve your facial aesthetic goals with one or two sessions of Sculptra injections spaced over a 2 to 3 month period. I have been treating hundreds of patients like you with Sculptra over the past ten years without complications or problems. The most common adverse event, though I find it quite rare in my patients, may be a small bruise that resolves within a few days. Sculptra injections on the face require advanced injection techniques, the rate of complications is related to the injector, not the product. It is very. important that you choose your Sculptra injecting physician very carefully based on their experience with the product, their skill, knowledge, and most importantly their natural artistic vision. Please call my office at your convenience to schedule your consultation and appointment for your Sculptra treatment. I look forward to meeting with you and helping you achieve and maintain your aesthetic goals for many years to come. Happy and healthy Thanksgiving.
Michael A. Persky, MD

Q: Would alarplasty and ear cartilage reshaping the nasal tip help to narrow my nose? Approx cost in CA?

Actual Real Self Patient Comment:
I really dislike how my nose look and I’m looking forward to get the procedures done. Thank you very much for taking your time and read my post. Your answer is really appreciated 🙂

A: Yes, alarplasty (rhinoplasty) would help you achieve your nasal aesthetic goals. The most important aspect of any aesthetic procedure is making sure that you choose your treating surgeon very carefully. I highly recommend Ari Hyman, MD who is an expert rhinoplasty surgeon with great skill and experience in treating Asian noses. Please feel free to call our office to schedule your virtual or in person consultation with Dr. Hyman, he is a great rhinoplasty surgeon as well as a true artist, with meticulous attention to detail. At the time of your consultation, our office medical director will give you a quote for the cost of your rhinoplasty. We look forward to meeting with you. Good luck, be well, and see you soon!

Q: The skin next to my nose is sunken in and so it seems like my mouth protrudes. What can I do? (Photos)

Actual Real Self Patient Comment:
I have had these strange lines that almost look like a mustache, that I hate and feel make me look haggard, since I was really young.

A: I would treat you with Sculptra to fill the area and naturally smooth the “hills and valleys” that are causing the shadows which make you look haggard and you hate. The treatment is quick, easy, safe, and effective when performed by an expert. It is very important that you choose your treating physician most carefully to achieve your goals and the best possible results. Please feel free to contact my office to schedule your consultation/treatment appointment. Good luck, be well, and hope to see you soon.

Q: I always look so tired because of my under eye bags, what can I do to get rid of them? (Photo)

Actual Real Self Patient Comment:
Hello, I have really bad under eye bags and was interested in getting under eye fillers. I was wondering if this is a procedure that would work for me. I am 43 years old. I hate the fact of always looking so tired. Also, is there and approx. of how many cc’s go into each eye? Sorry so many questions. Thanks in advance.

AHi 4xmom,
With 4 children it is no wonder that you eyes look a little tired. There are surgical and non-surgical procedures to correct your concerns. The surgical treatments included blepharoplasty and fat transfer/re-positioning. Non-surgically I would treat you with Voluma and Restylane to fill the “valley” hollows under your eyes to hide the fat pads. I would estimate 1 to 2 syringes of Voluma and 1 to 2 syringes of Restylane to correct your hollowness. The results should last you about 18 to 24 months, and even if you let it go without further maintenance, the fillers do stimulate some of your own collagen production so that you should have less hollowing. This area is extremely delicate, challenging to treat, and unforgiving, therefore make sure that you choose your treating injecting physician most carefully. Feel free to contact me with any further questions, concerns, and to schedule your consultation/appointment. Good luck and be well.

Q: What are my options after trying to dissolve under eye fillers 3 times?

Actual RealSelf patient Comment: Hi, I had my under eye fillers (hyaluronic acid) almost three years ago. I have been trying to dissolve it with another great doctor but it’s barely working it’s my third time and scheduling for fourth time and the filler is still there. Is that something typical? What are my options? Thank you.

A: Sorry to hear about your trouble with under eye filler dissolution. I have successfully treated patients with your complaint with Ultherapy under and around the eyes. Make sure to choose your treating physician carefully. Good luck and be well.

Q: Best Rhinoplasty…Would rhinoplasty fix my profile/hump? (Photos)

Actual RealSelf Patient Comment: Hi, I am 32F, I have never been unhappy with my nose, but I saw some pictures recently that made me feel it’s getting bigger with a bigger hump. I also never liked my side profile. Would rhinoplasty fix my profile?

A: Yes, rhinoplasty would fix your profile and hump. I would recommend a rhinoplasty consultation with Ari Hyman, MD. Dr. Hyman is an expert rhinoplasty surgeon who is experienced, extremely well trained, skilled, knowledgable, and most importantly is an artist with natural artistic vision. The most important aspect of any aesthetic procedure or treatment is making sure that you choose your treating physician very carefully. Check out Dr. Hyman’s results on his Facebook and Instagram posts. Good luck and be well.

Q:What is the best method to eliminate fine lines and a scar on my forehead? (photo)

Actual RealSelf Patient Comment: Hi. I have always struggled with rough textured skin, with BIG pores and blackheads. But reaching 30 years of age, I started noticing fine lines on my forehead, which is my biggest concern now. I always thought I had time to achieve a smooth forehead, untill I saw the fine lines appearing. What is the best method to eliminate them? Blue peel? Tca peel? Or is laser better? I also have a scar so I am prepared to do both. Thank you. I have added a photo of only my forehead.

A: I would initially treat you with micro-Botox followed by a Fraxel restore laser treatment. I would follow that with a Brazilian Skin Boost treatment with the precision automated injection system Medi-Inject. I would mix a customized injection cocktail after examining your skin consisting of hyaluronic acid, platelet rich plasma, vitamins, and neuromodulator to be injected precisely in minuscule amounts just under your skin. We would also add a complimentary treatment with LED Celluma. You should also be on a great skin care regimen including lifelong Retin-A. Please feel free to contact my office to schedule your consultation, I look forward to meeting with you and the privilege of helping you achieve and maintain your facial aesthetic goals for many years to come.

Q: Best Injectable Filler in Los Angeles..Can filler even actually help my face at this point? (Photo)

Actual RealSelf Patient Comment:
Will filler even help fix my sagging face? Will I even see a difference? If so, would I need a lot? Very depressed about how badly my face has aged, no one in my age group looks like this.

A: I am sorry to hear that you are depressed about your aging face. I can help you as I have helped thousands of our patients over the years. “Filler” itself will not help your sagging face, but an expert facial aesthetic physician using rejuvenation tools including filler will help you. In other words, “filler” is not a commodity, rather it is a tool when used in expert hands that will help you restore your appearance. You are a great candidate for facial rejuvenation. I would treat you with Sculptra Aesthetic. You would likely have 2 to 3 treatment sessions over a 6 to 12 month period. Once your facial volume is restored you would likely require a maintenance treatment about 2 to 4 years later. The most important aspect of your successful treatment is making sure that you choose your injecting physician very carefully based upon their skill, experience, knowledge, and natural artistic vision (da Vinci, not Picasso!). Please feel free to contact my office to schedule a consultation at your convenience. I look forward to the privilege of helping you achieve and maintain your facial aesthetic goals and psychological wellness for many years to come. Stay well.

Q:Best Rhinoplasty…Can I get rhinoplasty if I have a lot of acne scars? (Photos)

Actual RealSelf Patient Comment:
Hi! I’ve been wanting to get rhinoplasty for many years to fix my nose’s dorsal hump as well as slim down a bulbous tip. My issue is that I have chronically broken out in my nose and it’s done some severe acne scarring damage on my nose over the years. Would I still be a candidate for this surgery?

A:Yes you may undergo a rhinoplasty with acne history. If your acne is active then your surgeon should prescribe antibiotics orally and topically before and after your surgery. You may also see a dermatologist to help you. The most important aspect of any aesthetic treatment, particularly rhinoplasty is making sure that you choose the best rhinoplasty surgeon. I highly recommend Ari Hyman, MD as he is both an artist as well as an expert in rhinoplasty. Dr. Hyman is skilled, experienced, knowledgable, and possesses natural artistic vision, his results are amazing. Call my office for a virtual or in person consultation at your convenience. Good luck and be well.

Q: Best Treatment for Pores and Fine Lines…What would you suggest for pores and fine lines over 30? (photo)

Actual RealSelf Patient Comment:
Hi! I was planning on aging gracefully until this picture lol. What would you suggest for the lines and pores? I have done Forma skin tightening which I didn’t think did anything and PRP injections which I think maybe sort of helped. Filler wears off right away on me and laser did not benefit me in any way. I also would like to avoid botox. Thanks!

A:You have a very common complaint that I frequently successfully treat in my patients. Pores are a difficult problem to solve, in fact prior to a recent treatment added to my practice I would tell patients “the only improvement for your pores will be in your next life.” Fortunately today we have a safe and effective treatment for pores. I would recommend my “Brazilian Skin Boost” treatment with an automated injection system call Medi-Inject. Medi-Inject allows me to inject minuscule consistent amounts of an individually formulated solution into your skin at the same level immediately below your skin and pores. In your case I would likely mix PRP, 30 units of Botox, 1 cc syringe of hyaluronic filler, and Vitamin C. The mixture is placed in a syringe and it is precisely injected with the Medi-Inject system through a tip that has 9 adjustable tiny needles that inject while the skin is pulled into them. The entire face and neck can be treated in a short period of time. The treatment involves a day or two of redness and the results are visible within a few days. Once you are treated I would place you on a regimen of Retinol. Oxygen infusion facials are also helpful. Fraxel restore laser is also excellent for fine lines and pores. Please feel free to call my office to schedule your consultation. I look forward to meeting with you. Stay well.
Michael Persky, MD
Encino, CA

Q: Best Rhinoplasty Los Angeles…Is my skin too thin for a rhinoplasty to treat my flared nostrils?

Actual RealSelf Patient Comment: Couple of years ago I went for a rhinoplasty consultation but the surgeon told me that my skin is too thin and he would not be able to do my rhinoplasty due to my thin skin. My main concern is my flared large nostrils. I left very sad knowing that my nose has no hope and I’m stuck with this nose for the rest of my days. 🙁 Is this true? Would other surgeons be able to do it? TIA

A: A skilled rhinoplasty surgeon can help you achieve your rhinoplasty goals. Thin skin is not a reason to not perform rhinoplasty. There are advanced surgical techniques that will allow you to get the nose of your dreams as long as you choose your rhinoplasty surgeon carefully. I highly recommend my colleague Ari Hyman, MD who is both an expert rhinoplasty surgeon as well as a true artist. Dr. Hyman is trained in advanced rhinoplasty techniques, experienced, skilled, knowledgable, and possesses natural artistic vision. Feel free to call our office to schedule your consultation with Dr. Hyman, we look forward to meeting with you. Stay well.

Q: Would I be a good candidate for rhinoplasty? How would fixing the bump effect the nose overall? (Photo)

Actual RealSelf Patient Comment: I do snore quite a bit. How would rhinoplasty help that if at all? I believe this bump is a result of a broken nose that was not properly attended to after being hit in the face with a softball roughly 30 yrs ago.

A: You are a very good candidate for rhinoplasty. If your snoring is caused by nasal breathing problems, a septoplasty to improve your breathing can be performed at the same time as your rhinoplasty. The most essential aspect of any rhinoplasty is making sure that you choose your expert rhinoplasty surgeon very carefully. I highly recommend Dr. Ari Hyman as he is a top rhinoplasty surgeon as well as a true artist. Please feel free to call our office to schedule your consultation at your convenience. We look forward to meeting with you and the privilege of helping you achieve your rhinoplasty and nasal breathing goals for life. Good luck and be well.

Q:I’m 29, and I have deep creases that have developed under my eyes. What is the best treatment for this? Is it fixable? (Photo)

Actual RealSelf Patient Comment: I’m considering Blepharoplasty, fillers, or even as much as a mid-face lift, but I don’t know enough to know if there is a good solution. In the last year I have also developed nasolabial fold lines that stay without smiling and a vertical frown lines on my forehead. It seems to have suddenly happened all in a year. What can I do??? Please help!

A: You definitely do not need to undergo surgical blepharoplasty at this point in time. I would treat you with a little bit of filler which will correct both under your eyes as well as your nasolabial folds. I would not recommend mid-face surgery or the use laser at this time either. Treating this delicate and unforgiving area is not a “commodity”, it is most important that you choose your treating physician very carefully based on their skill, experience, knowledge, and natural artistic vision. Please feel free to contact our office to schedule your complimentary consultation at your convenience. We look forward to the privilege of helping you achieve and maintain your aesthetic goals for many years to come.
Good luck and be well.

Q: What procedures can treat my uneven face muscles in addition to normal loss of elasticity? (photo)

Actual RealSelf Patient Comment:
The muscles on the right side of my face are much stronger than my left. My smile is uneven and the wrinkles on the right side of my face are much more prominent. Dysport has worked well for the last several years but I’d like to think about other options. I’m 32 and starting to see additional signs of aging as well. What procedures can treat my uneven muscles in addition to normal loss of elasticity? Can I use Dysport / Botox in addition to these procedures?

A: Best to have an in person consultation. Neuro-modulators like Botox and Dysport are great to even out asymmetric faces due to muscles. I would evaluate you and then give you my plan to help you achieve your aesthetic goals. That may include the use of Sculptra, other fillers, and rejuvenation devices such as Ultherapy and/or Profound RF. Profound RF is the only treatment proven to create Elastin, helping with your elasticity. Please give us a call to schedule your consultation at your convenience. The most important aspect of your treatment is choosing your treating physician carefully. Good luck and be well.

Q: Is there any way I can reduce the size of my nose and if so how? (Photo)

Actual RealSelf Patient Comment:
I’m very insecure about it and I don’t know what I should do

A: You look like you have a nice nose, sorry to hear that you feel insecure about it. Rhinoplasty can change the appearance of your nose. Great rhinoplasty is an art and exact science. I recommend that you consult with a rhinoplasty expert to discuss your goals. I highly recommend Ari Hyman, MD as he is extremely well trained, experience, skilled, knowledgable, and has natural artistic vision, he is an artist. At your consultation, you will share your vision and Dr. Hyman will computer image your nose to give you a realistic appearance of what you can expect. Please feel free to contact our office to schedule your consultation, we look forward to meeting with you and helping you achieve your rhinoplasty goals. Good luck and be well.

Q: Fat transfer vs injectable for lower face?

Actual RealSelf Patient Comment: I am 62, and getting ready to do a lower facelift. One of the surgeons I consulted with recommended doing fat transfer at the same time, the other recommended doing fillers at a later date. I could definitely use something to fill in lost volume in my cheeks and under eye hollows. Which is the better option? Is fat as predictable as fillers would be? Other than the permanence, do they both yield similar results? Thank you!

A: As long as you are undergoing surgery, you might as well have fat used to restore volume. As with anything aesthetic, it is imperative that your surgeon is an expert as fat or fillers for that matter are not standard “commodities”, rather the results are extremely dependent on your physician. Fat is not as reliable as fillers as the amount that takes and remains permanent varies from 40 to 60%. The fat that does survive past the first 6 months will be permanent. Again, the most important aspect of your lower facelift will be choosing your surgeon most carefully. I strongly recommend Ari Hyman, MD for a natural beautiful result. Good luck and be well.

Q: Nose tip options? (Photo)

Actual RealSelf Patient Comment:
Hi! So I am overall pretty satisfied with my nose but I was thinking of altering the tip a little so it is more streamline. What surgical options do I have? What is recommended? Also what would be the cost of a nose tip operation? Thank you!!

A: Great rhinoplasty is an art and exact science. I recommend that you consult with a rhinoplasty expert to discuss your goals. I highly recommend Ari Hyman, MD as he is extremely well trained, experience, skilled, knowledgable, and has natural artistic vision, he is an artist. At your consultation, you will share your vision and Dr. Hyman will computer image your nose to give you a realistic appearance of what you can expect. Please feel free to contact our office to schedule your consultation, we look forward to meeting with you and helping you achieve your rhinoplasty goals. Good luck and be well.

Q: Can you tell me if this level of aging is normal for a 24 years old or do you think I am aging too fast? (Photo)

Actual RealSelf Patient Comment: I smoked quite a lot for several years and I gave up on smoking about a year ago, however, I feel like my skin looks worse than before. What do you think is the main cause? Can you recommend any ways besides fillers to drastically reverse the signs of aging? Aren’t fillers going to make my skin worse in the long run?

A: I would treat you with micro-focused ultrasound treatment, Ultherapy. I would combine it with a vial of Sculptra on each side of your face. Sculptra is a bio-stimulatory filler, it will not make your skin worse in the long run, in fact it not only rejuvenates your face with natural volume, but also gives your face a very nice “Sculptra Glow” where the quality of your skin improves (tone, texture, and color.). It is essential that you choose your treating physician most carefully based on their skill, experience, knowledge, and natural artistic vision. Good luck and be well.

Q: Is a result like the morph achievable or realistic for nose in profile? (Photo)

A: Yes, you have realistic expectations for your rhinoplasty result. The most important aspect of achieving your rhinoplasty aesthetic results is taking your time to choose your expert rhinoplasty surgeon carefully. I highly recommend consulting with Air Hyman ,MD. Dr. Hyman is skilled ,well trained, experienced, knowledgeable, and has natural artistic vision. Good luck and be well.

Q: How long to wait in between surgeries to be safe?

Actual RealSelf Patient Comment: Hi I am interested in doing a rhinoplasty procedure and a breast augmentation as well. I do not want these done by the same surgeon as I only want to find someone who focuses on solely rhinoplasties & then another dr who focuses on breasts. So in other words doing these the same time is not an option for me. How long should I wait in between the procedures to go under general anesthesia to be safe? I heard it is not healthy to do this back to back? Thank you so much for any feedback

A: If you have y our breasts operated on first, then you may have your nose done a week or two later. If you have your nose done first then you should wait 2-3 months before your breast surgery because anesthesiologists use masks on your nose. The most important aspect of either surgery is making sure that you choose your operating surgeons most carefully. I highly recommend consulting with Ari Hyman, MD (Encino, CA) for your nose. Michael Schwartz, MD in Westlake, CA for your breasts. Good luck and be well.

Q: Can hyaluronic acid be injected intramuscularly to increase the size of a muscle?

Actual RealSelf Patient Comment: If it were to be injected in the subcutaneous layer I imagine it would blur out the striations in your physique when below 10% body fat or getting ready to step on stage around 4-6%. From what I understand people are using Bellafill to achieve this, but it sounds like that isn’t put into the muscle either. Anyhow, just curious if hyaluronic acid can be used intramuscularly without causing major health issues.

A: Intra-muscular injections can lead to terrible complications, especially with a filler that cannot be dissolved (Bellafill.). I would recommend that you have Emsculpt to build your muscle bulk and decrease your fat to achieve your goals. Please feel free to contact my staff to schedule your consultation either in person or virtually at your convenience. Good luck and be well.

Q: Should it stay or should it go….Should I dissolve my botched jawline filler or wait it out? (Photo)

Actual RealSelf Patient Comment:
I got Juvederm Voluma 2 weeks ago in one particular area in my jawline to “smooth” It out and it left my face looking lumpy and saggy. Do I leave it alone to dissolve or do I get injections to dissolve? Is it possible she damaged my facial tissue and I’ll look like this forever?

A: Your injector has masculined your jawline. I would recommend an in person evaluation to determine your best course. It may involve dissolving some of the filler, or we may decide to give it a little more time to settle. Please feel free to call our office to schedule a consultation either in person or virtually at your convenience. Good luck and be well.

Q:Would chin and lip filler help my lower face? (Photo)

Actual RealSelf Patient Comment:
I’ve put together photos of stronger lower faces compared to my own. Would chin and lip filler help my lower face not look as weak? I feel like something is off about my Lower face. Not sure if I’m into the idea of a chin implant, though someone suggested that to me before

A: Hi J,
Properly placed facial fillers will help you achieve your goals. It appears that you can have filler in your chin area, at the angle of your jaw posteriorly, and a bit in your upper face to lift your jawline. As with any aesthetic procedure it is essential that you choose your treating physician most carefully based on their skill, knowledge, experience, and natural artistic vision. Feel free to contact my office to schedule your consultation either in person or virtually. I look forward to the privilege of helping you achieve and maintain your facial aesthetic goals for many years to come.

Q: What are the best non surgical options to tighten the abdomen area?

RealSelf Actual Patient Comment: hello–I don’t have loose or hanging skin, but it is not smooth, and the texture has lost its integrity around the belly button area–the kind of thing where when I pull it up only slightly it looks good, but left alone, it looks slack and wrinkly/cellulite like. I saw a doctor who said she had only a 30% success rate with RT laser and fraxel…she had no other options…does anyone have something for me…or are my bikini days a thing of the past 🙁 thanks

A: You are not alone, many of our patients have a similar complaint. Depending on what your abdomen looks like, I would treat you with a combination of treatments. We begin with hyperdilute Radiesse biostimulating filler injection, followed by Ultherapy or Profound RF. Having a series of Emsculpt which is radio magnetic energy used to build muscle and shape the body. Please give my office a call to schedule your consultation either virtually or in person. Good luck and be well.

Q: What is the alternative for under-eye wrinkles if I can’t inject under the eye?

RealSelf Actual Patient Comment:

I have under eye wrinkles and theurse said you can’t inject under the eye. I’m 26 and I love doing my makeup but recently I’ve stopped doing it. The third picture with the powder on my face specifically. I have this cluster of under eye wrinkles when I smirk, smile or scrunch up my face and some when my face is settled. Botox can’t be injected under here, so what are the solutions to prevent them getting worse and also to erase them?

A: I treat under eye wrinkles such as yours with either fractionated carbon dioxide laser or with an in office under local anesthesia skin pinch minor surgery. In either case, make sure to choose your treating physician most carefully in this very delicate and unforgiving area. Good luck and be well.

Q: Best Injectable Fillers…Marionette lines. What are my options when fillers don’t work?

RealSelf Actual Patient Comment:

Besides a facelift….or Dao botox. What are my options? I have like 3-4 ( I can’t remember ) syringes in my Marionette lines and they are just not budging and now the area feels kind of heavy… are there any other options out there that I’m missing? I absolutely hate them… thanks

A: I would treat you with Profound RF to tighten and lift the area. 3 to 4 syringes of filler in the marionette area is a bit excessive and makes the lower third of your face heavy. I would be happy to discuss your situation in a virtual or in person consultation at your convenience. As with any aesthetic procedure it is important to choose your treating physician most carefully based on their skill, experience, knowledge, and natural artistic vision. Good luck and be well.

Q: How long after I receive septoplasty can I proceed with a Rhinoplasty surgery?

RealSelf Actual Patient Comment:

What is the healing times in between septoplasty (I have a deviated septum) and Rhinoplasty surgeries? Insurance will only cover this surgery using a referral of my ENT surgeon, therefore I plan to carefully chose a Rhinoplasty surgeon after I have healed from the 1st surgery septoplasty (correction of my deviated septum). I obviously would like my rhinoplasty done as soon as possible, however I also want to take in consideration scar tissue healing for optimal results for my 2nd surgery.

A: Your best course would be to have both surgeries at the same time. Many ENT surgeons are excellent rhinoplasty surgeons as well. You can have the septoplasty portion of your surgery covered by insurance and pay a separate fee for the cosmetic rhinoplasty portion of your surgery. I highly recommend Ari Hyman, MD, both an excellent ENT and Facial Plastic Surgery trained rhinoplasty expert. The most important aspect of rhinoplasty is making sure that you choose your expert rhinoplasty surgeon most carefully. Dr. Hyman is both an artist and an expert in rhinoplasty. He is meticulous and his rhinoplasty results are beautiful and natural. Call the web reference below to schedule a virtual or in person consultation. Good luck and be well.

Q: What is the chance that a rhinoplasty using rib cartilage grafts will calcify long term?

RealSelf Actual Patient Comment:

I’ve been reading many articles about rib cartilage harvesting technique and many mention avoiding the use of calcified cartilage. Does this mean that a viable cartilage from the ribs might calcify over time once it’s placed in the nose? Are there any long term studies about this risk?

A: When needed, rib cartilage grafts are an excellent grafting material in the nose. Rib cartilage is used only when a patient has no remaining nasal septal cartilage or if a major reconstruction of the nose is necessary. As long as it is properly placed, it should not cause a problem if it calcifies. The most important aspect of rhinoplasty is making sure that you choose your expert rhinoplasty surgeon most carefully. I highly recommend Ari Hyman, MD. Dr. Hyman is both an artist and an expert in rhinoplasty. He is meticulous and his rhinoplasty results are beautiful and natural. Call the web reference below to schedule a virtual or in person consultation. Good luck and be well.

Q: Would getting rhinoplasty done while being a bit overweight be a bad idea?

RealSelf Actual Patient Comment:

I want to get my nose done but my face has gained some weight, I’m worried that if I get one now and lose the weight later that my new nose wouldn’t match my face. Is this a valid concern or am I just over thinking it?

A: You should consult with a few rhinoplasty experts. Generally weight gain or loss does not affect rhinoplasty, or the nose matching the face. You can have your rhinoplasty when you decide you are ready. The essential aspect of rhinoplasty is making sure that you choose your surgeon most carefully.I highly recommend Ari Hyman, MD. Dr. Hyman is both an artist and an expert in rhinoplasty. He is meticulous and his rhinoplasty results are beautiful and natural. Call the web reference below to schedule a virtual or in person consultation. Good luck and be well.

Q: Best Rhinoplasty..Will I be able to achieve something like this with rhinoplasty?

RealSelf Actual Patient Comment:

I’m 24 yrs old & I never been happy with the way my nose looks, especially my side profile. I’m ok with the front of my nose because my bridge is pretty slim as well as my tip ? But I just hate the bump on the side of my nose, I added some wish pictures, wanted to know if that would be realistic, all in all I would be happy with just a straighter bridge w/out the hump. Thank you !

A: Yes, you can achieve your rhinoplasty goals by choosing an expert rhinoplasty surgeon. I highly recommend Ari Hyman, MD. Dr. Hyman is both an artist and an expert in rhinoplasty. He is meticulous and his rhinoplasty results are beautiful and natural. Call the web reference below to schedule a virtual or in person consultation. Good luck and be well.

Q: Best Rhinoplasty…Should I do rhinoplasty?

RealSelf Actual Patient Comment:

Usually, I never get complaints about my nose. However my close friend decided to gift me a rhinoplasty for my birthday. I know my tip goes down when I smile, my nostrils are big.. but it was never a major issue… Now I am having second thoughts What do you think? Is it worth it? I am also worried to touch the lower part of the nose as I saw some surgeries gone wrong

A: Though it is very nice that your friend has gifted you a rhinoplasty, it is up to you to decide whether to have it. Rhinoplasty is not like getting a new hair cut style, if you don’t like it, it won’t grow back in a few weeks. It is essential that you are sure that it is something that you wish to do. The most important aspect of rhinoplasty is choosing your rhinoplasty surgeon carefully based on their skill, training, experience, knowledge, and their natural artistic vision. I highly recommend Ari Hyman, MD as he is both an expert rhinoplasty surgeon as well as an artist. He is also an expert at revising previous rhinoplasties that have gone wrong, reconstructs tips, and your tip will be beautiful in his hands. You should schedule a consultation with Dr. Hyman at your convenience. Ultimately, your decision to undergo rhinoplasty should be based on how much your nose bothers you, and how much you desire to change it. Feel free to contact Dr. Hyman at the website below. Good luck and be well.

Q: Treatments for wrinkly/loose skin (stretch marks) on breasts?

RealSelf Actual Patient Comment:

40yo Female with DD breasts — I’ve had stretch marks since I was 11 and suddenly went from no bra to D in a year. Never bothered me because they were pale and not noticeable, but in the last couple years, the skin has suddenly gotten wrinkly and loose with deep grooves around the stretch marks. Breasts haven’t changed size. Bust/stretch mark/tightening creams make no difference. Suggestions?

A: We have had success with crepe skin using collagen stimulating injections of hyper dilute Radiesse in combination with Profound RF (RadioFrequency) and a very light carbon dioxide laser. I also treat patients with a skin boost using Medi-Inject which is an automated precise injection of a wrinkle improving solution into the superficial skin. It may take a few treatment sessions over the course of about 18 months. Feel free to contact me for further information, and either a virtual or in person consultation. Good luck and be well.

Q: What is the most effective procedure to get rid of my deep nasolabial folds / laugh lines?

RealSelf Actual Patient Comment:

I’ve had these deep nasolabial folds ever since I can remember, but they do seem to get more pronounced as I get older (I’m 43). What procedure do you recommend to soften these lines and lift my cheeks? There’s also my double-chin which I want to address. Would a neck lift, combined with a lower face lift give me the best results? I was thinking of fillers first, but I’d really prefer to get a procedure that’s more “permanent”.

A: There are both surgical and non-surgical options to help you achieve your facial aesthetic goals. Your nasolabial folds are caused by loss of bony volume in your cheeks. A quick non-invasive fix would be the proper use of facial fillers. A combination of non-invasive device treatment with fillers would give you an excellent result (Sculptra, Profound RF with PRP, light Fraxel, and Voluma.). This combination treatment is long lasting, 5-8 years. If you are ready for surgical treatment then a face/neck lift would correct your concerns. The most important aspect of any aesthetic procedure is making sure that you chose your treating physician most carefully based on their skill, experience, training, knowledge, and natural artistic vision. I would be happy to help you with a virtual or in person consultation. Good luck and be well.

Q: Can I make my nostrils more horizontal?

RealSelf Actual Patient Comment:

I have vertical uneven nostrils like the first picture, because of a previous rhinoplasty, is it possible to make it more horizontal like Angelina in the second picture ? And is there a way to make the nosetrils opening wider to fit my race?

A: You can achieve your rhinoplasty goals. I would recommend consulting with a few expert rhinoplasty surgeons and then choosing the surgeon you feel most comfortable with. I have been performing rhinoplasty for the past 35 years, I strongly recommend that you schedule a consultation with Ari Hyman, MD. Dr. Hyman is an artist as well as a premiere rhinoplasty surgeon, well trained, experienced, skilled, and blessed with natural artistic vision. These qualities result in his patients looking their best. Good luck and be well.

Q: Cheek implants removed leaving major sagging/stiffness/puffiness, any suggestions?

RealSelf Actual Patient Comment:

32 year old Asian female had multiple cheek implant surgeries and i deeply regret them. I finally took them out 2019 end of the year. now my cheeks are saggy, also stiff and puffy looking. which I suspect is caused by scar tissue. friends and family say my smile is weird, stiff/frozen and I look plastic, even after removal! Some doctors suggest fat inject another suggested endoscopic cheek lift… please help… I look even worse under the sun.

A: I would treat you with a combination of Sculptra (to build your own collagen volume) and either Ulthera or Profound RF to lift your cheeks and nasolabial folds. Fat transfer is okay, but unpredictable. Surgery and lifting may be pre-mature and could lead to unnatural appearance in a young patient. As with any aesthetic treatment it is essential that you select your treating physician carefully based on their experience, training, skill, knowledge, and most importantly their natural artistic vision. Good luck and be well.

Q: I had a rhinoplasty consultation today and was told that I have thick skin. Is rhinoplasty impossible on thick skin like mine?

RealSelf Actual Patient Comment: Hi I had a rhinoplasty consultation today and was told that I have thick skin. Should I have a second consultation? Is rhinoplasty impossible on thick skin like mine?

A: Rhinoplasty can be performed in thick skinned patients. We always recommend that patients get a few consultations before deciding on their rhinoplasty surgeon, as that choice is the most important aspect of your surgery. An expert rhinoplasty surgeon can work with thick skin. I suggest consultation with Ari Hyman, MD who is extremely well trained, skilled, experienced, and has natural artistic vision. Good luck and be well.

Q:Is 28 too young for temple filler? Is this very safe, or are there alternatives?

RealSelf actual patient comment:

I feel like I look like a peanut and that I am losing facial volume in a few spots. I want to avoid the dangerous side effects like blindness, etc. Feel free to suggest other fillers that might be helpful.

A: I would treat you simply with 1/2 vial of Sculptra in each temple to get rid of that peanut head of yours. The treatment is safe, quick, easy, and effective when placed properly. The injections are deep under the muscles, just above the bone which is an area without significant blood vessels so the worry of side effects is minimized. We have used other fillers both more superficially and deep, but find that Sculptra works the best and lasts the longest. Some patients may require 2-3 treatments over the course of a year. Once it takes effect, maintenance is not needed for 2-4 years or longer. Choose your injecting physician most carefully based on their skill, experience, knowledge, care, and natural artistic vision. Good luck and be well.

Q: My eyes are too small. What can I do to make them appear larger (preferably non-invasive)?

RealSelf actual patient comment:

My eyes are very small and I hate them. I want the whites of my eyes to show more. What procedure can I get to make them appear larger? I would prefer non-invasive if possible.

A: There are no known treatments to increase the “whites” of your eyes. I have found that as an unexpected nice side effect of injecting cheeks with Voluma that my patients eyes appear to be larger. I would not recommend any drastic treatments to achieve making the whites of your eyes larger. Good luck and be well.

Q: I need advice on the best course of action to complete my treatment and correct my cheek hollows?

RealSelf actual patient comment:

I have had 3 vials of sculptra, 1 vial 4 months ago and 2 vials 2 months ago. I am extremely pleased with the added pan facial volume achieved, however, I have one area that is still of great concern to me, my cheek hollows. I am not referring to the buccal area, but more the preauricular area. When looking at my face straight on my cheeks have an obvious concavity. Should I do another vial of sculptra or go with hyaluronic acid filler instead? I have done masseter Botox, it did not help.

A: I would treat your pre-auricular area of concern with more Sculptra, you can have 1/2 vial on each side. Good luck and be well.

Q: Best Rhinoplasty..Seeking rhinoplasty with tip refinement. What needs to be done?

RealSelf actual patient comment:

I would like a surgical rhinoplasty. Please tell me what can be done. For one, i know I would like a tip refinement.

A: The most important aspect of your rhinoplasty is making sure that you choose an expert rhinoplasty surgeon based on their skill, training, experience, knowledge, and natural artistic vision. I highly recommend Ari Hyman, MD based on his rhinoplasty results. (see below reference website link.) your tip is bulbous and will be reduced, then using your own septal nasal cartilage grafts will be placed to give your nose a beautiful natural feminine shape. The tip will be slightly rotated upward, and the small profile hump will be taken down. You are an excellent candidate for rhinoplasty. I recommend contacting Dr. Hyman for a complimentary consultation as he is not only an expert rhinoplasty surgeon, he is an artist as well. . Good luck and be well.

Q: Do I have thin or thick skin for Rhinoplasty?

RealSelf actual patient comment: Is it thin or thick and how much?

A: From the one photo it is difficult to evaluate your skin thickness though it appears that your skin is somewhere between thick and thin. If you are considering rhinoplasty, your skin does not appear to be an issue. You can achieve your rhinoplasty aesthetic goals with a rhinoplasty by an expert rhinoplasty surgeon. I highly recommend Ari Hyman, MD as I have personally witnessed the meticulous work and beautifully natural results in his rhinoplasty patients. Dr. Hyman is not only an excellent rhinoplasty surgeon and physician, but is a true artist as well. The most important aspect of any aesthetic procedure, particularly rhinoplasty is choosing your surgeon very carefully based on their skill, training, experience, knowledge, and natural artistic vision. Good luck and be well.

Q: Best Rhinoplasty..Is rhinoplasty worth it? Images attached. I would like to have a more slope to my nose. (photos)

RealSelf actual patient comment:

I have a straight, high bridge and am self conscious of my side profile. I cannot pinpoint what exactly I dislike because there is no visible bump but my profile looks imbalanced. It doesn’t look bad by any means but I would like to have a more slope to my nose instead of straight. Anything to enhance this? Is rhinoplasty worth it for my case? Seems extreme I guess. maybe something non surgical? Any advice or suggestions appreciated! Thank you!

A: Rhinoplasty is worth it when your nose bothers you enough to undergo a surgical change. I would. not recommend a “non-surgical” rhinoplasty with injectable fillers in your case. You can achieve your rhinoplasty aesthetic goals with a rhinoplasty by an expert rhinoplasty surgeon. I highly recommend Ari Hyman, MD as I have personally witnessed the meticulous work and beautifully natural results in his rhinoplasty patients. Dr. Hyman is not only an excellent rhinoplasty surgeon and physician, but is a true artist as well. The most important aspect of any aesthetic procedure, particularly rhinoplasty is choosing your surgeon very carefully based on their skill, training, experience, knowledge, and natural artistic vision. Good luck and be well.

Q: What is the best type of filler to fill in hollow areas (more in description)?

RealSelf actual patient comment: Best Facial Filler Injections..What is the best type of filler to fill in hollow areas (more in description)?

A: I use various fillers similar to how an artist uses different shades of color on the palette to create a beautiful painting. In the case of patients who have volume loss in their temples, under eyes, and other areas of the face, I prefer to use Sculptra, which stimulates your own collagen in a natural way. Juvederm Voluma XC is a great filler for the cheeks and temples, but it should never be used under the lower eye hollows. Sculptra is more cost effective than Voluma for the temples. A with any aesthetic treatment it is essential that you choose your treating physician most carefully. Good luck and be well.

Q: Do most doctors harvest cartilage from your own body to do your rhinoplasty? (photos)

RealSelf actual patient comment:

I’m considering doing a rhinoplasty on my nose bridge but I want to use the cartilage that’s in my body not a silicone implant. Which one is better the silicone implant or the cartilage?

A: There is no question that it is better to have your own cartilage implanted as a graft as opposed to silicone or other implants. In your case you will need to have rib cartilage harvested and used to build your nasal dorm and shape your nose. It is imperative to make sure that you choose your expert rhinoplasty surgeon carefully. I highly recommend Ari Hyman, MD who is not only a skilled surgeon but also an artist. Good luck and be well.

Q: How safe is Emsculpt after a tummy tuck with muscle plication? If it is how, long should one wait after the surgery to get it?

RealSelf actual patient comment:

I would like to to get Emsculpt but had a tummy tuck in March to fix a severe diastasis recti, i would like to get Emsculpt but I’m scared I will damage the sutures from the muscle plication.

A: Emsculpt should be very safe 5 months after your abdominal muscle plication. Emsculpt causes your muscles to have supramaximal contractions which in turn builds muscle mass and decreases abdominal fat. Though I believe it to be safe at this time, you should consult with your surgeon for clearance prior to your Emsculpt treatment. Good luck and be well.

Q. Best Filler Injections for Facial Rejuvenation..Do you recommend filler, Botox and anything else in order to help improve my face?

RealSelf actual patient comment:

I’m almost 30 and am interested in getting filler in order to make my face look more feminine and younger. I was thinking of getting it in my cheeks and especially lips, as well as Botox in my lower jaw. I was also wondering what else you would recommend to enhance my appearance?

A: I see that you wish to look younger. You are fortunate that you already look half your age. On your front view the only feature aging your face is the slight hollowness under your eyes and slight asymmetry between the left and right sides of your face (completely normal). On the 3/4 view it looks like you have early loss of volume in the pre-jowl area and marionette area. On lateral view your nasal profile is strong, making your nose slightly smaller and increasing the angle of your nose-lip (slightly raising your nasal tip) would feminize your profile. For your face, I would treat you with Sculptra Aesthetic to add natural volume where needed. For your profile you would likely benefit from the injection of filler at the base of your nose to lift the tip, and possibly a little filler on your profile to camouflage your small dorsal hump (that is unless you wish to have a surgical rhinoplasty.). As with any aesthetic treatment it is essential that you choose your treating physician most carefully based on their skill, knowledge, experience, and natural artistic vision. Good luck and be well.

Q. How can I fix the deep under-eye wrinkles and possible bulging eye?

RealSelf actual patient comment:

Hello, my wrinkles are not bad when I’m not smiling but when I do smile, my eyes are super horrible! They are wrinkly and forms a round line underneath. Help! Do I have bulging eye? Will fillers help? Or fat transfer? What is the bestOption? I also have horrible dark circles from hyperpigmentation and I’m currently using some products for that. Please suggest a permanent or temporary fix for eyes like mine. Thank you!

A. I hope that your family and you are well.Most of what bothers you is from your undereyemuscle gathering and bulging when you smile. A small dose of Botox properly placed will help. Filler in your cheeks and under your eye may be helpful as well. Dark circles are very difficult to eradicate. Choose your treating physician most carefully. Good luck and be well.

Q. My right eye is swelling, can you recommend a permanent solution?

RealSelf actual patient comment:

My right eye has swelling underneath it, giving a marked look to my cheek. (Left cheek on selfies.) I’ve tried lots to get treat it: mid-face lift; lymphatic massage; filler in the “dip”; localalised vitamin injections; subcision with Nokor needles. Nothing seems to work. Do any amazing doctors have suggestions? I’m feeling rather depressed in being unable to fix this issue.

A. The swelling is from lymphatic fluid accumulation. I have treated patients with a combination of heat devices, Ultherapy, Profound RF, and fractionated CO2 laser. It is a difficult problem to solve, yet we have seen nice improvement. Good luck and be well.

Q. Should I consider rhinoplasty to straighten my crooked nose and are there other options available?

RealSelf actual patient comment:

I am considering rhinoplasty to straighten my nose. I think it’d significantly improve my appearance. I tend to take photos from side angles out of self-consciousness. Does all rhinoplasty cost about the same, or could it cost less where the problem is relatively minor? How severe is my crookedness?

A. I hope that your family and you are well. Your nose can be straightened with rhinoplasty. The only alternative would be injection of filler to camouflage the crookedness. The cost of rhinoplasty varies depending on the surgeon and the amount of time necessary to perform the procedure in the operating room. There is a saying that “When getting sushi or facial plastic surgery it is best to not go for the cheapest cost.” You should base your decision on choosing your rhinoplasty surgeon on their skill, experience, knowledge, training, and natural artistic vision. I recommend Ari Hyman, MD, a very well trained rhinoplasty expert who is also an artist. Good luck and be well.

Q. Is it possible to inject the area under the apples like the lateral temporal cheeks? If so what filler should be used?

RealSelf actual patient comment:

I have hollowness in the area under my apples and I am hoping this area can be injected with filler. I am also depressed about my left cheek being smaller than my right cheek especially in the lower region.

A. Hope that your family and you are well.Yes the areas below the “apples’ of your cheeks can be injected to create a smooth transition between the areas. There are multiple fillers that can be used. It is not really as much about the type of filler, rather it is the artistry, skill, and experience of the injecting physician whom you should choose carefully. I have used Voluma, Sculptra, and Restylane Lyft in this area. More filler would be used in your left cheek to address your asymmetry. We are currently offering virtual consultations during the safer at home time period and should be back in our office very soon. Good luck and be well.

Q. What is wrong with my sagging upper eyelids and can they be corrected without surgery?

RealSelf actual patient comment:

I’m only 42 and the skin on my upper eyelids are almost starting to cover my eyes. I do not want surgery. Are injectables and option here?

A. I hope that your family and you are well. The best non-surgical treatments for you would be Botox treatment to open your eyes and I would recommend the use of Ultherapy on your forehead over your eyebrows to give a few millimeters of lift. It appears that you have genetically heavy eyebrows that may benefit from surgical lifting in the future when you are ready for it. Good luck and stay well.

Q. What is the most effective way to enhance projection of the nose in a cleft rhinoplasty procedure?

RealSelf actual patient comment:
I am wondering if there is any technique that has been observed to have lasting effects. Does rib cartilage tend to warp more than cartilage taken from other parts of the nose?

A. I hope that your family and you are well. The most effective way to enhance projection of a cleft nose is with cartilage. In expert hands, I believe that rib cartilage is best, will have lasting effects, and should be least likely to warp. I recommend Ari Hyman, MD in Encino, CA . Dr. Hyman is well trained, skilled, experienced, knowledgable, and has natural artistic vision. Good luck and stay well.

Q. Is it possible to reduce the slide of my bulbous nose tip with a minimally invasive or even a non-surgical option?

RealSelf actual patient comment:
The only problem I have with my nose is the bulbous tip. Is there any way for me to fix this or make it somewhat better?

A. Best to consult with a few expert rhinoplasty surgeons in person. It appears that you would be best treated with a rhinoplasty, I believe that using filler in your tip would not only be dangerous but a waste of your money. Choose your rhinoplasty surgeon carefully based on their skill, training, knowledge, experience, and natural artistic vision. I recommend Ari Hyman, MD, a great rhinoplasty surgeon as well as a true artist. Dr.Hyman will answer all of your questions at your consultation.Good luck and be well.

Q. My right cheek is fatter/droopier than the left. How can this be fixed?

RealSelf actual patient comment:

I have always had a fatter/fuller right cheek. It makes the corner of my mouth droop downwards when I am not smiling, and when I am smiling it looks noticeably bigger. Can this be corrected by buccal fat removal/cheek liposuction/fillers or would I have to get jaw surgery?

A. It is best that you consult with an expert in person, after examining you, your best course of treatment would be decided. Good luck and be well!

Q. What is making my nose look big and would I need a full rhinoplasty to make it smaller?

RealSelf actual patient comment:

I’ve been quite insecure about my nose and would love to make it smaller. However, I can’t seem to figure out exactly what is making it look big. In my option it is either the width of the nostrils, the width of the alar crease or the tip of the nose being bulbous. However I am not a professional so I would love some advice!

A. The tip of your nose is large in comparison to the rest of your nose. This draws attention to the area. An expert rhinoplasty surgeon can help you achieve your natural aesthetic goals. Choose your rhinoplasty surgeon carefully based on their skill, training, knowledge, experience, and natural artistic vision. I recommend Ari Hyman, MD, a great rhinoplasty surgeon as well as a true artist. Dr.Hyman will answer all of your questions at your consultation. Good luck and be well.

Q. I am looking to get Sculptra butt injections, how many vials will I need?

RealSelf actual patient comment:

I am looking to get sculptra butt injections. My concerns are my minimal hip dips looking to get filled in. How many vials do I need for a more natural/subtle result?

A. Love your doggy sleeping in the background. I would likely treat you with 2 vials of Sculptra on each side at your first session. You may require more in a few months depending upon your reaction to the Sculptra treatment. You are welcome to contact us during this stay at home period for aVirtual Consultation. Stay well!

Q. Wondering what’s the best way to get rid of jowls?

RealSelf actual patient comment:

Any recommendations for jowls and laugh line folds? I am not sure what the best solution. Thank you in advance

A. Best to have an in person consultation to determine your best course of action. In this time of the Corona virus stay at home,we are offering virtual consultations. After discussing your goals and examining you, we will discuss your options. There are both surgical and non-surgical treatments to help your early jowling concerns. I would treat you non-invasively with a combination of Sculptra (perhaps other filler as well) and a skin muscle lifting and tightening device such as Ultherapy and /or Profound RF. If you wish to have surgery, then a face/neck lift would help. I hope that you and your family are well, please stay well.

Q. When can one have Emsculpt after giving birth?

RealSelf actual patient comment:

I am 1 week postpartum. How long must I wait to do Emsculpt/Elexis/cool sculpting? I want Emsculptto help with moderate diastasis recti and for overall toning of the tummy.

A. I hope that you and your friends and family (congratulations on your baby!) are well in New York City. Given our current pandemic, you are going to have to wait at least 4 more weeks before Emsculpt will be available due to the current stay at home recommendations. In general it is safe to have Emsculpt, Coolsculpting, and Excelis 2 to 4 weeks postpartum. Good luck and stay well.

Q. Why can you not breastfeed when you get when Emsculpt procedure?

RealSelf actual patient comment:

I want to go through the four Emsculpt sessions but I read online you can not while breastfeeding. So if there is no medications involved why can you not breastfeed?

A. It is okay to have Emsculpt when breastfeeding, it does not affect your breasts or milk whatsoever. Emsculpt does help build the abdominal muscles and decrease diastasic recti.Good luck and stay well there in NYC.

Q. I have a very small behind. Will Emsculpt take away the little bit of fat that I do have in that area?

RealSelf actual patient comment:

I would like to have lift on my behind but I am worried that I will lose too much fat and then my buttocks will be flatter.

A. Emsculpt will lift your small behind, make sure to let your treating physician know that you wish to preserve what fat you have back there, they will use the setting on the device that spares fat. Many patients combine the use of Sculptra with Emsculpt in their buttocks to add volume and contour. Choose your treating physician carefully. Good luck and stay well.

Q. Am I a good candidate for a natural-looking rhinoplasty?

RealSelf actual patient comment:

Hi, I appreciate my nose is ethnic but the rest of my family have smaller, well-shaped, symmetrical noses, and I feel as though I have been unlucky 🙁 I would like to refine it, subtly. I think the bridge near my eye area is too wide and that the tip is too bulbous and falls to the right. I just want a symmetrical nose that co-exists with the rest of my facial features in the right proportions. Note, I don’t mind my side profiles. Are these goals realistic or am I being delusional?

A. Yes, you can achieve your rhinoplasty goals with surgery by an expert rhinoplasty surgeon. It is essential that you choose your surgeon most carefully based on their skill, knowledge, experience, care, and natural artistic vision. I recommend Ari Hyman, MD. Dr. Hyman is a true artist and his rhinoplasty results are naturally beautiful. Good luck and be well. Dr. P

Q. I am not sure if I can get a rhinoplasty done with what appears on my CT scan?

RealSelf actual patient comment:

Am I a good candidate for rhinoplasty? How do I clear this blockage?Have been told by a Dr. that I can’t get rhino done because of the gray area that appears on my right side on CT. Do I need to clear my sinuses first? Second opinion?

A. You appear to have polyps in your right nasal cavity. Ideally your best course of action is to consult with expert rhinoplasty surgeons who are double board trained/qualified in both ENT as well as Facial Plastic Surgery. We have performed rhinoplasty and nasal polyp removal many times with excellent results. The most important aspect of your treatment is making sure that you choose your surgeon very carefully based on their skill, experience, knowledge, care, and natural artistic vision. I would recommend Ari Hyman, MD. Dr. Hyman is board trained and is a true artist in creating natural beautiful noses. Good luck and be well.

Q. Do I need to reduce the width of my nostrils by 2mm?

RealSelf actual patient comment:

I would like a second opinion.I am planning on getting a rhino and septoplasty done to fix my deviated septum and reduce my dorsal hump. I am going for more of a straight side profile and I am wondering if I would need to get my nostrils reduced or brought closer by 2mm on each side or should I leave my nostrils as is? I am not sure.I was told that I don’t really need it but it can be done if I would like.

A. No, I do not believe that you need to have your nostrils reduced. You should be sure to choose your rhinoplasty surgeon most carefully after consulting with at least 3 rhinoplasty experts. I personally highly recommend Ari Hyman, MD as he has natural artistic vision, is extremely well trained, experienced, skillful and knowledgeable.Good luck and be well.

Q. Which techniques can be used to fix suspected internal nasal valve collapse?

RealSelf actual patient comment:

I suspect that I may have an internal nasal valve collapse, because sometimes I feel that my nasal wall skin sticks to the septum. I don’t know if there is a congestion but I subjectively feel like there is not enough space inside when I breathe in. Breathe right strips make my nose much bigger and solve these symptoms.There is also a visible retraction in the frontal view when the nostrils are flared.

A.Best to see a nose expert for in person examination. I have been able to help many patients with valve collapse with both non-surgical and surgical remedies. After physical examination I will be able to tell you your best course. If your inferior nasal turbinates are enlarged then non-surgical in-office under topical and local anesthesia radio-frequency volumetric tissue reduction (Somnoplasty)is extremely effective, safe, and easy. You can test yourself by spraying both nostrils with Afrin, waiting 15 minutes, and then inhaling and exhaling. If you are markedly improved thenSomnoplasty will help you without surgery, general anesthesia, and a trip to the operating room. If your anatomic valve collapse is the cause then correction of your valves with cartilaginous grafts taken from your nasal septum will help you. Most importantly, choose your treating physician most carefully. Good luck and be well.

Q. Would my crooked nose be a complicated surgery?

RealSelf actual patient comment:

So I’m sure I have a deviated septum and my nose is crooked. I really dislike my bulbous tip and would love to refine it along with maybe a thinner bridge? and simply just straighten my nose how it should because it’s crooked and moved towards my right side. Would my nose be a complicated surgery? What would be recommended?

A.In the hands of an expert rhinoplasty surgeon your rhinoplasty should meet your desired aesthetic goals.

I recommend Ari Hyman, MD as his training, skill, experience, knowledge, and natural artistic vision has resulted in beautiful results in our patients. You may find his work in the web reference below as well as scheduling a complimentary consultation in person or on Skype or Facetime. He is a perfectionist and an artist.The most important aspect of any procedure is making sure that you choose your treating physician most carefully. Good luck and be well.

Q. Botox/Dysport for asymmetrical face, is this a good option?

RealSelf actual patient comment:

Hi! I’m interested in Botox or dysport for my uneven smile and TMJ. The problems I want to fix are my uneven/large masseters (my jaw pops and aches when I chew), my chin (it gets dimply and uneven when I smile), and my asymmetric eyes (my left cheek squishes my left eye smaller when smiling). I’ve never had any sort of cosmetic procedure and don’t know where to begin. What would be the best options for me, and about how many units would I need injected where? Thank you to anyone who can help!

A.Yes, Botox can work wonders for your concerns. Botox is not a commodity so it is very important that you choose your injecting physician most carefully. After examining you in person, I would inject about 8 units in your chin, 6 to 10 units around each eye, and 12-15 units in each masseter depending on your anatomy and muscle mass. Seek out an expert for you treatment.

The most critical aspect of any aesthetic procedure is making sure that you choose your treating physician most carefully based on their skill, experience, knowledge, and natural artistic vision. Good luck and be well.

Q. Can you advise on how to get my previously broken nose a tad slimmer?

RealSelf actual patient comment:

My nose has been broken 5 different ways it so ugly and crooked not to mention fat tip of my nose I want it a tad slimmer.

A.Consult with a few rhinoplasty experts in person.

Arhinoplasty in the hands of an expert rhinoplasty surgeon will give you the nose that you desire. I recommend Ari Hyman, MD as his training, skill, experience, knowledge, and natural artistic vision has resulted in beautiful results in our patients. You may find his work in the web reference below as well as scheduling a complimentary consultation in person or on Skype or Facetime. He is a perfectionist and an artist.The most important aspect of any procedure is making sure that you choose your treating physician most carefully. Good luck and be well.

Q. The edge of my eye is hollow, what is the safest way to fix it?

RealSelf actual patient comment:

The edge of my eye is hollow, what is the safest way to fix it? Not tear trough. Thank you for answers.

A.I would like to examine you in person to determine your best treatment. From your photo I would likely fill the hollow with a small amount of Restylane, you may also benefit from a small amount of Voluma in your lateral cheek.

The most critical aspect of any aesthetic procedure is making sure that you choose your treating physician most carefully based on their skill, experience, knowledge, and natural artistic vision. Good luck and be well.

Q. What will give me the most for my buck for a non surgical, quick treatment for a more youthful appearance?

RealSelf actual patient comment:

I would like to do something non surgical that gives me a pick me up and a more aesthetically pleasing, balanced and youthful appearance. I am open to Botox and fillers. What do you think will give me the most my for my buck?

A.Botox to your forehead and crow’s feet area and 1 cc of Voluma to your cheeks should give you a great pick me up.

The most critical aspect of any aesthetic procedure is making sure that you choose your treating physician most carefully based on their skill, experience, knowledge, and natural artistic vision. Good luck and be well.

Q. Will 4 syringes of Voluma be sufficient to restore volume to my temples, buccal hollows, and upper and lower eyes?

RealSelf actual patient comment:

I am 35 and regularly get Botox and have had filler to the lips, nasolabial folds and temples as well as a small amount to the apples of the cheeks. My temples are still semi hollow as well are my buccal hollows and the area around my eyes (upper and lower). I’m interested in restoring all the areas of lost volume with voluma and was wondering if 4 syringes of Voluma would be sufficient.

A.I would examine you in person to determine how much filler is needed. 1 cc of Voluma in each temple is more than enough, and 1 cc in each cheek would also be more than enough. You may also wish to consider Sculptra to achieve your desired results.

The most critical aspect of any aesthetic procedure is making sure that you choose your treating physician most carefully based on their skill, experience, knowledge, and natural artistic vision. Good luck and be well.

Q. Are these festoons/malar mounds? I never had these before. I’m in my 20s and they make me look older. How to correct them?

RealSelf actual patient comment:

Hi, I’m wondering what are the white hue “bags” under my eyes? They don’t feel puffy but are noticeable and make it look like I’ve got eye bags, especially under harsh light. I believe they appeared after I had tear through filler done some months ago. Could the filler be causing them or drawing more emphasis to them? Could it be fluid retention from filler? Would adding cheek filler help resolve this or should I dissolve the tear through filler altogether? Thanks!

A.It is likely the result of the filler that you have had placed. It depends on the type of filler injected as well as the amount and where it was placed.I would like to examine you in person to determine your best course. Sometimes filler is dissolved, sometimes filler is added, sometimes it is left alone. In some cases I use Ulttherapy to reduce the swelling and tighten the area.

The most critical aspect of any aesthetic procedure is making sure that you choose your treating physician most carefully based on their skill, experience, knowledge, and natural artistic vision. Good luck and be well.

Q.Can Botox travel to the brain and cause permanent neurological problems?

A.No it can’t, but it is a great vaccine against Corona virus….just kidding about it’s effect on Corona virus. Good luck and be well.

Q. Would a filler in my cheeks help pick up the lower half at all?

RealSelf actual patient comment:

Would filler help pick up lower half at all? If filler in cheeks doesn’t help what other options do I have?

A.Yes, I love using Voluma in the cheeks to help rejuvenate the face, often the treatment results in improvement under your eyes, nasolabial folds, corners of the mouth, and jawline. You would benefit from non-surgical device treatments Ultherapy and/or Profound RF and Sculptra treatments as well. If you are ready to undergo surgery, then face-neck lift surgery would be great.Please feel free to contact me with any questions or concerns that you may have regarding your treatment. It is always best to examine patients in person and then decide on their best course.

Q. Under eye filler – I was wondering what kind of filler I need for my under eye?

RealSelf actual patient comment:

I was wondering what kind of filler I need for my under eye? I’m getting confused because offices says restylane and some voluma. What is the best thing for me?

A.I agree, Restylane under your eyes in the hollows, Voluma in your cheeks will result in needing much less Resytlane and add to your beauty. The most critical aspect of any aesthetic procedure is making sure that you choose your treating physician most carefully based on their skill, experience, knowledge, and natural artistic vision. Good luck and be well.

Q.Does Ultherapy turn back the clock a few years?

RealSelf actual patient comment:

I understand that Ultherapy doesn’t “stop” the aging process, but does it reverse it by a few years? In other words, would somebody who has had Ultherapy look better in 10 years than somebody who hasn’t?

A.Great question. When my patients ask, “How long will my Ultherapy treatment last?” I answer, “You will always look better for the rest of your life compared to how you would have looked had you not done the treatment.” I have seen many patients 5 to 10 years later who still look better than they did prior to their Ultherapy. Choose your treating physician most carefully. Good luck and be well.

Q. What can be done about my huge nostrils?

RealSelf actual patient comment:

I have huge nostrils, can a reduction be done? How complex is the procedure and estimate of price?

A.Your nostrils and nose can be reshaped to your desire by an experienced rhinoplasty surgeon. Best to consult with a few in person, at that time you should be given a quote of the cost. The cost will vary based on the extent of surgery and the time in the operating room. It is best to choose your rhinoplasty surgeon based on their skill, it is your nose for the rest of your life, in the middle of your face. As they say, don’t go for the cheapest sushi, or rhinoplasty.

I recommend Ari Hyman, MD as his training, skill, experience, knowledge, and natural artistic vision has resulted in beautiful results in our patients. You may find his work in the web reference below as well as scheduling a complimentary consultation in person or on Skype or Facetime. The most important aspect of any procedure is making sure that you choose your treating physician most carefully. Good luck and be well.

Q.Filler/implant suggestions for hollowed buccal pocket?

RealSelf actual patient comment:

I underwent a buccal fat removal months ago and I’m terribly frustrated about the result. I’m currently looking for ways to reverse the result as much as possible. I guess my main question is, is there any kind of filler / implant that can be placed in the buccal area (underneath muscles and soft tissues, where the buccal fat pad is supposed to be), and preferably can provide some kind of support for mid face? if anyone can offer me some insights or suggestions on this I’d really appreciate it!

A.We are not big fans of buccal fat removal. We use your own fat or fillers to correct the defect.

The most critical aspect of any aesthetic procedure is making sure that you choose your treating physician most carefully based on their skill, experience, knowledge, and natural artistic vision. Good luck and be well.

Q. What treatment option is best for hollowness under my eyes?

RealSelf actual patient comment:

Hi! I am a 26 year old male, I have always had sunken eyes (photos below) and I would like to know what option do you think is best to correct this flaw Many thanks

A.Filler will help you with your under eye hollowness concerns. I would likely use a combination of Restylane and Voluma (Voluma in your cheek will result in using less Restylane under your eyes.) The most critical aspect of any aesthetic procedure is making sure that you choose your treating physician most carefully based on their skill, experience, knowledge, and natural artistic vision. Good luck and be well.

Q. Would dermal filler be appropriate for asymmetric volume in my cheekbones?

RealSelf actual patient comment:

So the right side of my face doesn’t have enough volume than the left side. I considered surgery to augment the large cheekbone on my left side but I’d rather try fillers to see if having a fuller face would be something to look into. I’ve had people suggest dermal fillers but I can’t really find any before or after photos that correct one side facial asymmetry. What fillers would be appropriate for me?

A.Yes, facial fillers should be able to help you with your facial symmetry. I would recommend Voluma and/or Sculptra.

As with any aesthetic procedure, choosing your treating physician is your most important task. Good luck and be well.

Q.How common is it for lip filler to migrate into the philtrum? Does it reflect poor technique or bad luck?

RealSelf actual patient comment:

I’m interested in getting Restalyne lip filler. But I’m concerned about the potential side effect of having the lip filler unintentionally shift into the philtrum. How common is it for lip filler to migrate into the philtrum? Does it reflect poor technique or bad luck?

A.Not to worry, properly placed filler in your lip will not migrate into your philtrim, at least in 25 years of lip injection experience I have never seen it in any of my patients. As with any aesthetic procedure, choosing your treating physician is your most important task. Good luck and be well.

Q. I want to get fillers for under eye bags. Some days my eyes are worse than others. Will this happen after fillers?

RealSelf actual patient comment:

I have under eye bags ,and hollow line ,I’m wanting to get fillers, my issue or question Is ,some days they are worse then others so what happens after I get the filler and they do this ? Dose it look worse or what ? Its probably a strange question but they are not always as puffy as other days . So I’m really curious after my juvaderm filler and its one of those days they seem more puffy how will it look.

A.Your face is volume depleted. I would initiallytreat you with a combination of Sculptra and Profound RF which work synergisticallyto restore your facial volume and elasticity. Stay away from Juvederm fillers under your eyes or you may end up with swelling for a very long time that is extremely difficult to take care of.Please feel free to contact me with any further questions or concerns. The most important aspect of any aesthetic treatment is choosing your treating physician most carefully. Good luck and be well.

Q. Is there a type of rhinoplasty to shorten the length of my nose and make my nostrils a little smaller?

RealSelf actual patient comment:

I’m happy how my nose looks when I am face forward with my head tilted but I just hate the length and nostril size.

A.Yes, rhinoplasty in the hands of an expert rhinoplasty surgeon will give you the nose that you desire. I recommend Ari Hyman, MD as his training, skill, experience, knowledge, and natural artistic vision has resulted in beautiful results in our patients. You may find his work in the web reference below as well as scheduling a complimentary consultation in person or on Skype or Facetime. The most important aspect of any procedure is making sure that you choose your treating physician most carefully. Good luck and be well.

Q. Would one vial of Sculptra be enough to look freshened up at 23?

RealSelf actual patient comment:

Hey there, I’m a younger patient age 23 who just wants to look a little more freshened up and wants a very subtle difference. Would 1 vial of sculptra be enough for my cheeks and smile lines? I don’t want to get rid of my smile lines completely and I don’t want it to be noticeable that I got something done. I just want a to look a little more well rested would this help?

A.Since you are so young, 1 vial of Sculptra properly placedshould give you a nice “freshen up.” I have seen nice results in young patients with minimal amounts ofSculptra.The most important aspect of your treatment is making sure that you choose your treating physician injector most carefully based on their skill, knowledge, experience, and natural artistic vision. Good luck and be well.

Q. What kind of procedures or products get rid of deep pores and uneven skin?

RealSelf actual patient comment:

Hello, I have recently within the last two years developed these noticeable deep pores on my forehead, in between my eyebrows, nose, and chin. What procedures can get rid of this to make a refined & smoother appearance? I also have tiny fine, tight lines on my skin. Almost like my skin is very dehydrated. What can I do to make my skin more moisturized? What kind of ingredients help dehydrated skin?I use moisturizer every day, however my skin still feels very tight. Thank you in advance.

A.I have been very impressed with Medi-Inject mesotherapy computerized smart injection system. We are able to mix hyaluronic acid filler, neuromodulator, platelet rich plasma (prp), vitamin C, skin lighteners, exosomes, and even fetal stem cells customized to each patients needs. The system is able to precisely inject the solution mixture in micro amounts with laser precision of depth and volume. Seeing is believing and I have seen this new technology improve the skin of patients like yourself. The skin is boosted, hydrated and there is improvement in lines, wrinkles, pores, tone, texture, and color. Feel free to contact us with any further questions. Good luck and be well.

Q.Any providers who have administered both Ultherapy and Scarlet RF to tighten sagging skin on the face? Is one treatment better?

RealSelf actual patient comment:

The skin on my face has started to sag now that I am older and have loss volume in my face. I’ve always thought I would get Ultherapy but a physician recommended Scarlet RF as the results have been greater than with Ultherapy.

A.I have been performing Ultherapy and combining it with Profound RF with excellent results. In addition we many times with add a superficial fractionated CO laser and PRP (platelet rich plasma.) When rejuvenation modalities are combined, results improve. Be sure to choose your treating physician carefully based on their skill, experience, knowledge, and natural artistic vision. Good luck and be well.

Q.Can a rhinoplasty cause nerve damage that permanently changes your smile?

RealSelf actual patient comment:

I’ve been reading about this in the Q&A section on here and trying to do research before opting to have a tip rhinoplasty. I’m wondering how common nerve damage to the upper lip is + how long an impacted lip/smile lasts + if it is ever permanent, or just a temporary side effect of the surgery. Thanks for the responses!

A.I have been performing rhinoplasty for over 35 years. I have never had a patient with permanent nerve damage to the upper lip. Patients may have a temporary weakness of the the upper lip muscles and an inability to raise their lip when smiling. This side effect usually resolves within a few days to a few weeks. It is to be expected when the lip muscles are freed from the nose or the bone of the nasal floor is taken when correcting a deviated septum. The most important aspect of your rhinoplasty is making sure that you choose your surgeon very carefully based on their skill, knowledge, experience, and natural artistic vision. I highly recommend Ari Hyman, MD for your rhinoplasty.Good luck and be well.

Q.What are the long term effects of EMSculpt on a fit individual who works out regularly and keeps clean diet?

RealSelf actual patient comment:

For someone who exercises 4Xweek at moderate-high intensity & maintains clean diet 1. Since EMSculpt stimulates muscles at the intensity not naturally possible, does it reduce the effectiveness of regular workouts? 2. Would muscles in the treated area still respond to normal workout? 3. What is the impact if doesn’t do additional maintenance EMSculpt treatments (but keeps up exercise & diet) 4. What is the recommended frequency of maintenance treatment for a healthy & fit person like above.

A.Great questions, all of which I have positive answers for and good news for you. Emsculpt builds muscle mass and reduces fat as well as decreasing the waist. Just today I had a patient thank us for her Emsculpt treatments, saying that she could not be happier with her results. She not only sees great improvement in her muscle tone of her abs and buttocks, but was especially thrilled that she is able to work out much better, stronger, and longer while feeling much more powerful. Emsculpt actually enhances the effectiveness of your regular workouts. Think of Emsculpt as an added benefit workout, you can and should continue your regular workouts and your muscles will respond even better than before your Emsculpt because of the increased size and number of muscle fibers. Maintenance Emsculpt treatments are encouraged to continue building muscle, but even without any further treatments beyond the first 4 in the series, muscle continues to build over 12 months. I recommend that my patients have their first single complimentarymaintenance treatment atabout 6 weeks. Beyond that it is up to the individual, Emsculpt can be like a “super” gym membership where my patients are allowed to return as they see fit…no pun intended. Good luck and be well.

Q.Emsculpt Protocol 1 vs Protocol 2?

RealSelf actual patient comment:

Is there really a difference between the settings/protocol used on the abs vs glutes? I know protocol 2 is supposed to conserve all the fat and only burn muscle but does it make a big difference? I think my doctor has been using protocol 1 on my glutes instead of protocol 2 and I’m wondering if it will make my butt flatter.

A.Congratulations on your Emsculpt journey. Not to worry.I have not heard of any problems with gross fat loss on the buttocks, nor have we seen any problems with flattening of the buttfrom using Protocol 1. With that said, you are correct that Protocol 2 is used in those patientswho wish to preserve as much fat as possible during their Emsculpt sessions. Please let your treating physician know which Protocol you prefer to use prior to your next and future Emsculpt treatments. Good luck and be well.

Q. How soon after Tummy Tuck can I have a series of emsculpt treatments? I had my TT procedure on 6/17/19.

A.Happy and Healthy New Year! Since your tummy tuck was about 6 months ago (nice tummy), it is perfectly safe to proceed with your Emsculpt treatments as long as you do not have any metallic implants or staples in the area of Emsculpt treatment. Your Emsculpt abdominal treatment will build your muscle mass and likely improve the quality of your tummy skin. Good luck and be well.

Q.Can I do Emsculpt if I have a small liver hemangioma 1.7cm?

RealSelf actual patient comment:

Hi I may have a small liver hemangioma, its tiny 1.7 cm. There is no treatment indicated for it. Is there any reason that I shouldn’t do Emsculpt on my abdomen?Thank you.

A.I do not believe that your small liver hemangioma is a contradiction to having Emsculpt on your abdomen. Please make sure that you let your treating physicina know about all of your medical history so that they can make an educateddecision about yourtreatment. Good luck and be well.

Q.Is it safe for me to do Emsculpt on my stomach after lipo and abs sculpting?

RealSelf actual patient comment:

I’ve had a tummy tuck, lipo and abs sculpting 2.5 years ago and healed nicely.I wasn’t certain if this would be ok given the work I’ve had done. I don’t have excess fat and have kept my weight down. Thank you.

A.Happy and Healthy New Year! Not to worry, Emsculpt is great in patients who have had stomach liposuction and abdominal sculpting. Of course you must not have any metallic implants or permanent metallicsurgical staples within 7 centimeters of the Emsculpt treatment paddles. Our patients have been thrilled with their Emsculptresults. Just today I have had one patient thank us for his treatments, he has lost 3 inches in his waist and is able to “get into” the suit he needs to wear to a wedding this weekend. Another woman thanked us for the affect that Emsculpt has had on her workouts, stating that she is much stronger and can accomplish more. Her core is stronger and she is able to “cruise” through her yoga classes, particularly holding her plank position significantly longer. Go ahead and enjoy your Emsculpt journey. Good luck and be well.

Q. Is it possible to make my broad square-tipped nose look narrower?

RealSelf actual patient comment: (photo excluded)

My nose is not proportional with my face and features. It has a wide unshaped tip and the nose wings are too wide. Looking at it from below it has a square shape and from above it is asymmetric with one side longer than the other. The profile is too upturned showing too much the nasal holes. I’d like to have the wings less wide, the tip narrower to the size of upper third and the profile more downward. I would very much appreciate the advice of a surgeon to know if my wishes are possible or not.

A.This is a common reason many patients undergo rhinoplasty. flattening out the boxy and round shape to your tip cartilages will improve your tip shape and create the narrowing you’re seeking. Your skin appears to be on the thinner side and this should be strongly considered by your surgeon at the time of surgery. Seeking a qualified rhinoplasty specialist is important to maximize your outcome. Consult with a few rhinoplasty experts and then be sure to choose your rhinoplasty surgeon carefully based on their skill, knowledge, training, care, and most importantly their natural artistic vision and results. A few rhinoplasty masters that I would recommend are Dean Toriumi, MD (Chicago), Steven Pearlman (NYC), and Ari Hyman, MD (Los Angeles.) Good luck and be well.

Q. Would anyone recommend Sculptra for fat loss in the cheeks?

RealSelf actual patient comment:

I am 34 years old and recently lost some weight, around 10 lbs. I ended up loosing a lot of fat in my face and people keep telling me I aged a lot in the last year. I went to see my doctor and he recommended Sculptra. The reviews are terrifying though and I’m really afraid to do it and get bumps in my face. I think I would go crazy. What are the best options to treat fat loss in the cheeks? Would anyone else recommend Sculptra? Thank you

A.Sculptra is a great treatment for natural volume restoration when used properly. Over the past 10 years the proper use of Sculptra has been refined to eliminate lumps and bumps and nodules. Skilled Sculptra injectors achieve incredible results. Sculptra has been used since 2000, initially in HIV atrophy patients, was FDA approved for use in the nasolabial folds in 2004.I personally did not use Sculptra in my practice until 2009 when I was finally convinced that proper use was safe and did not result in nodules as I could not afford to have any patients with this adverse event. Sculptra is now among the top injection treatments that I perform and my patients are uniformly happy. I have treated many patients from other clinics with nodules and have been able to dissolve them over time. As with any aesthetic treatment, the most important aspect is to make sure that you choose your treating physician most carefully based on their skill, experience, knowledge, care, and natural artistic vision and results. Good luck and be well.

Q.I just found out I am 2-3 weeks pregnant and had one emsella treatment the other day. Will this effect the fetus?

A.Congratulations on your pregnancy. Discuss your Emsella treatment with your obstetrics physician. Hopefully the muscle contractions did not affect your fetus. There have not been any studies on the affect of Emsella on pregnancy, and it should not be done on pregnant women. That said, at such an early stage of pregnancy the treatment should not have an adverse effect. Good luck with the rest of your pregnancy!

Q. What are other ways to narrow my nasal bones, aside from osteotomy?

RealSelf actual patient comment: (photo excluded)

Im so overwhelmed with good responses from y’all and Im getting super close to booking my surgery. Andthank ufor all honest feedbacks.1 more question tho, I got a lot of osteotomies suggestion but Im asian and google said to avoid osteotomies as much as possible. So, what are other ways to narrow my nasal bones?

A.I have a wonderful rhinoplasty surgeon associate, Ari Hyman, MD who is now performing all of the rhinoplasty surgery in ourpracticebecause of his great skill, artistic vision, and unsurpassed fellowship training with Dean Toriumi, MD in Chicago. I have asked Dr. Hyman to answer your question as he is an expert in Asian rhinoplasty as well. Here is his recommendation: “In Asian patients osteotomies are rarely needed. Nasal bones tend to be quite short and the width of the upper nose comes from a low bridge height. Augmentation of the bridge, which in my hands comes from the patients own cartilage, creates the narrowing of the upper 2/3rds of the nose. Osteotomies become unnecessary. Leaving the bones where they are and augmenting the dorsum creates the normal pyramidal shape to the bridge – if osteotomies are done – it can create an unnatural verticallity to the side walls of the nose which most Asian patients seek to avoid.” I highly recommend that you consult with Dr. Hyman regarding your nose. Good luck and be well.

Q. I would like a rhinoplasty. Based on my photo, what would you recommend?

RealSelf actual patient comment: (photo excluded)

I know I want the profile to look different same with the how wide it is and moderate refinement of the tip. the lateral side seems to be adding width. i’m out of my depth trying to understand how all of this works though. another thing I’ve been wondering is if I should weight until I lose weight before getting the surgery.

A.Since we only have your frontal image it is hard to say what should or can be done in terms of tip rotation, projection, or changes in your bridge.

On frontal view however, the width of your nosecan be subtly narrowed in the upper 2/3’rds and the tip can be refined to create more harmony and balance.

In terms of weight loss – this should have no impact on your nose and waiting for weight loss will not change the outcome of your operation.

I would recommend consultation with an expert rhinoplasty surgeon, Ari Hyman, MD whose rhinoplasty skills and results are superb. Dr. Hyman has recently joined our practice. After performing rhinoplasty for the past 35 years, I am so impressed and confident in Dr. Hyman’s results that he is performing all of the rhinoplasty surgeryin our practice.Good luck and be well.

Q. Would Sculptra and Thermage help on my upper arms?

RealSelf actual patient comment:

I have SmartLipo done about 10 months ago. My surgeon didn’t do the top/front part of the arms because he said there are nerves and the skin is too thin. However, now this part of my arms looks like I have terrible cellulite. I got a second opinion, and the surgeon said Sculptra injections followed by 3 Thermage treatments could help. I’d like more opinions.

A.Sculptra would help. Skin tightening technologies such as Profound RF and Venus Legacy may help. Emsculpt for arms has helped build muscle fibers adding tone and definition to the upper arms. Good luck and be well.

Q.How effective is Emsella or incontinence and vaginal laxity?

RealSelf actual patient comment:
Just wondering about the machine emsella and its effectiveness for use with incontinence and vaginal tightening. Thanks

A.The Emsella chair is very effective for the treatment of stress urinary incontinence and tightening of the pelvic floor muscles. As an added side benefit, many patients, both men and women report improved sexual health. Please feel free to contact me with any further questions or concerns regarding this incredible non-invasive treatment. Good luck and be well.

Q. How long can I expect Voluma to last in a jaw?

RealSelf actual patient comment:

I had Juvederm Ultra injected in my jaw today just under my ears. I would like to try Voluma next time. How long can I expect that to last? Would I be a candidate for that? How many ML should I go for?

A.You look great. Voluma is a longer lasting hyaluronic acid filler, lasting from 1 1/2 to 2 years in most patients. It is difficult to estimate how many ml your face would require, but you may begin with 1 ml per side, you can always add to it if needed. I would examine you in person and then make that decision. A special mix of Radiesse works well in the same area, it can last over a year, and it stimulates some natural volume production even after a year. Voluma is more expensive that Radiesse. Please feel free to visit our office for a complimentary consultation. As with any aesthetic treatment it is essential to choose your treating physician carefully based on their experience, skill, training, knowledge, and most importantly their natural artistic vision. Good luck and be well.

Q.I’m 41 and have Ultherapy scheduled for my brow and lower face. Is this not a procedure for someone my age?

RealSelf actual patient comment:

I’m 41 and have Ultherapy scheduled for my brow and lower face. Im terrified as many reviews especially “younger” people say it melted all the day in their face and aged them. Is this not a procedure for someone my age? The woman who will perform the procedure said she would not go over my cheeks and would not use the deepest level on some or all of my face. Thoughts? I want the procedure to correct some droopiness in my brow and some mild sagging along my jaw.

A.I have used Ultherapy since it came to market on hundreds of patients. I personally perform all Ultherapy treatments on my patients and have not had any patients experience “melting their face” as some reviews online have stated. It is essential that your treatment is performed by an Ultherapy expert who is knowledgable and experienced in facial anatomy, able to read the liveultrasound, and treat at the proper level. I believe that poor results and complications with Ultherapy are user dependent, andfrom either poorly trained or unqualified technicians who have been delegated the treatment by their supervising physician. Unfortunately there are clinics using “Ultherapy” devices that are imitations from China, or are using transducers that have been “refurbished” at a greatly discounted cost that are not supported by the company. Ultherapy is the best truly non-invasive facial/neck lifting and tightening device without any downtime. As with any aesthetic procedure, it is essential to choose your treating physician carefully based on their skill, experience, knowledge, training, and natural artistic vision. Good luck and be well.

Q.I want to get emsculpt on my lower abdominal pouch. Where should the emsculpt paddles be placed?

RealSelf actual patient comment:

I want to get emsculpt on my lower abdominal pouch. Where should the emsculpt paddles be placed? Internal and external obliques? to pull my stomach in? Or directly down center on rectus abdominis? I’m worried placing it on the rectus abdominis will just give me a muscular pouch.

A.Emsculpt will achieve your goals. To treat the lower abs, the paddles should be placed downward towards your toes. Good luck and be well.

Q. I’d like to have a smaller nose base (alar, tip) with least procedures as possible. What would you recommend for me?

A. Your nose requires a rhinoplasty by an expert. You should consult with a few rhinoplasty experts and then choose your surgeon most carefully based on their skill, knowledge, training, care, experience and their natural artistic vision.A few rhinoplasty experts I would recommend are Ari Hyman, MD (Los Angeles), Dean Toriumi, MD (Chicago), and Steven Pearlman, MD (NYC). Good luck and be well.

Q.Meaty nose at the end – What are my non surgical options please?

RealSelf actual patient comment:

Hello, I have a “potato” meaty soft tissues nose tip, but happy with ny nose otherworse- bones are straight and nice. It’s not wide or droopy either. Any ideas how to make the nose slimmer please?

A.It is difficult to answer your question without examinining you or seeing photos of your nose. For the most part, the tip of the nose, especially when “meaty” should not be injected as there is a higher chance of a significant complication. Best to consult with a few rhinoplasty surgery experts and avoid non-surgical, injectable treatment in your nose.Please be sure to choose your rhinoplasty surgeon carefully based on their skill, knowledge, training, care, and experience. A few rhinoplasty experts I would recommend are Ari Hyman, MD (Los Angeles), Dean Toriumi, MD (Chicago), and Steven Pearlman, MD (NYC). Good luck and be well.

Q.Do I need septoplasty or rhinoplasty for collapsed nasal wall?

RealSelf actual patient comment:

Can an closed procedure be done for a collapsed nasal wall or anything that is less invasive with minimal down time? I have issues breathing due to the collapsed wall on both sides.

A.If an examination of your nose reveals that you have enlarged inferior nasal turbinates compromising your nasal airway then you may have the turbinates reduced non-surgically with radiofrequency, in my experience this saves approximately 75% of my patients the need for a surgical septoplasty. If you should need surgery then a closed approach procedure can be performed to correct your collapsed nasal walls. Please be sure to choose your rhinoplasty surgeon carefully based on their skill, knowledge, training, care, and experience. A few rhinoplasty experts I would recommend are Ari Hyman, MD (Los Angeles), Dean Toriumi, MD Chicago, and Steven Pearlman, MD (NYC). Good luck and be well.

Q.Morphs versus reality, how close is a doctor able to get to the morphs?

RealSelf actual patient comment:

Hi Doctors, After 3 rhinoplasty consults. I am only getting morphs of the profile and not the front view. I cannot get a grasp on the degree of correction to expect on my crooked nose. I cannot get any doc to give me a clear answer on how close results will come to the morph image. I really need assurances before undergoing such a transforming procedure. Any advice? How close are you able to get the actual result to the morphs typically?

A.Great question. We computer image all of our patients with two different software systems. Anyone can “photoshop” a nose, we pride ourselves in imaging our patients noses in a way that is achievable in the operating room. It is necessary to know what changes are surgically possible and desirable and then share them with you. We can show you many patients whom we have performed rhinoplasty upon, their pre-op photo, their imaged photo, and lastly their post-op photo side by side. When done properly, computer imaging for prospective rhinoplasty patients can be very helpful and accurate. Rhinoplasty is an art and science, one of the most difficult of all plastic surgeries. You should consult with multiple rhinoplasty experts and then choose your surgeon carefully based on their training, skill, experience, knowledge, and most importantly their natural artistic vision. A few rhinoplasty experts I would recommend are Ari Hyman, MD (Los Angeles), Dean Toriumi, MD (Chicago), and Steven Pearlman, MD(NYC). Good luck and be well.

Q. Are my cheeks asymmetrical? If yes, are fillers an option?

RealSelf actual patient comment:

I am 28 and noticing that i lost more fat on my right cheek. Is it noticeable enough or is it normal? Shall I consider fillers or wait?

A.The two sides of our face are more like siblings than identical twins. Like most everyone else, you have a mild difference between the two sides of your face that can be made more symmetric by an expert injecting physician. Choose your injecting physician carefully for best results. Good luck and be well.

Q. What are my options for my nose?

RealSelf actual patient comment:

My nose has a bump on one side, which just really irritates me. It could be a little smaller too, but I would like to keep the triangular shape it has. I’m okay with it straight on, but it seems maybe a little curved? Could this be a deviated septum?My main concern is the bump. Would fillers be beneficial, or only rhinoplasty?

A.It always helps to begin by looking beautiful as you are.

Improving your concerns can certainly be accomplished with rhinoplasty – namely improving the two prominenceson your bridge. A”subtle rhinoplasty”is what I would recommend for you.

The “bumps” may be camouflaged with fillers but you don’t have a traditional “hump” which can be more easily amenable to filler techniques. I agree that you have a nice triangular shape to your nose – its imperative to see a rhinoplasty expert to ensure your nose isn’trotated anymore which in your casewould likely produce too much nostril show on your frontal view.

By far the most important aspect of your rhinoplasty is making sure that you choose your expert rhinoplasty surgeon most carefully, as rhinoplasty is both an art and science. Consult with a few rhinoplasty surgeons before making you choice.Choose your surgeon based on their experience, knowledge, training, skill, and their natural artistic vision. A few experts I would recommend are Ari Hyman, MD (Los Angeles), Dean Toriumi, MD (Chicago), and Steven Pearlman, MD(New York City). Good luck and be well.

Q. What is the best treatment for neck, chest and jowls?

RealSelf actual patient comment:

My neck has lines that I’m not happy with. I have had Fraxel treatment on my neckand found it very painful, although it did look better. My jowlsare droopy and I haven’t done anything other than some filler. And my neck could use some tightening

A.I would treat you with Profound RF with PRP (platelet rich plasma), and since your face and neck would already be numb, I would add a light Fraxel repair (fractionated CO2 laser). Adding Sculptra to stimulate your own collagen growth would also be beneficial. Chest lines respond well to Fraxel repair, Sculptra, and Ultherapy. Choose your treating physician carefully based on their skill, knowledge, experience, and most importantly their natural artistic vision. Good luck and be well.

Q.What do doctors suggest to address anti-aging and skin damage on decolletage/chest?

RealSelf actual patient comment:

I am interested in recommendations from the community to address anti-aging on my chest. I am starting to see skin damage and fine lines. Do doctors recommend BBS with Halo and Sculptra for chest or other suggested treatments from community of respected doctors.

A. The female aging chest skin is treated with a combination of Ultherapy, Fraxel Dual laser, and Sculptra in our practice. In some patients we add microneedling with platelet rich plasma (PRP.) Please feel free to contact us with any further questions. Good luck and be well.

Q. What work could be done to improve the aesthetic of my nose? Also, are under eye fillers right for me?

RealSelf actual patient comment:

What can be to be done to “fix” my nose? There’s a dent in the side of my left nostril, and the bridge is pretty narrow. I don’t like the vertical shape and width of my ala and my tip is practically nonexistent. I’m curious whether or not I have a deviated septum. I have breathing issues, especially when sick. The skin under my eyes is thin and asymmetrical, especially when smiling. Would fillers be able to improve the symmetry and reduce the dark circles?

A.Rhinoplasty will address your nasal aesthetic concerns and fillers under your eyes will improve the shadowing of dark circles. Consult with a few expertrhinoplasty surgeons and then choose your surgeon most carefully based on their skill, experience, knowledge, and natural artistic vision. A few experts whom I would recommend are Ari Hyman, MD (Los Angeles, CA), DeanToriumi (Chicago), and Steven Pearlman, MD (New York City). Good luck and be well.

Q. 50th birthday blues – What procedures can be done (under $10,000 hopefully) to look younger?

RealSelf actual patient comment:

I’m a single mom and about to turn 50. But looking in the mirror I feel more like mourning than celebrating. What procedures can be done (under $10,000 hopefully) to look younger? I’m open to anything at this point and not afraid to go under the knife. Thank you in advance for any direction or deals you can offer.

A.With a $10K budget, the biggest bang for your buck would be upper blepharoplasty and neck liposuction. In the $15-20K range, a neck/face lift with bleph would be best. You may achieve nice non-surgical results with fillers, neuromodulators, and devices that lift and tighten for $10K or less. The most important thing for you is to make sure that your carefully choose your treating physician based on their skill, knowledge, experience,care, and natural artistic vision. Good luck and be well.

Q.Fix uneven saggy under eye – What procedures (surgical or non surgical) should I look in to?

RealSelf actual patient comment:

I’m a young college student but since I was I was little I have had saggy under eye and one of them being noticeable saggy and darker than the other one. When I smile the same under eye has a bigger bulge. Its so uneven and it’s cause of great insecurity for me and I want an idea of what I can do to fix it What procedures (surgical or non surgical) should I look in to? I just want some ideas on how to make my eyes more even. I attached some pictures to show what I am talking about

A.I would not recommend surgery, rather a small amount of properly placed filler should help you achieve your aesthetic goals and restore your confidence. Make sure to choose your expert injecting physician carefully for this delicate and unforgiving undereye area. Choose based on their skill, knowledge, experience, care, and most importantly their natural artistic vision. Good luck and be well.

Q.What is the best non surgical/laser type intervention to gain mild lifting on a 33-34 year old?

RealSelf actual patient comment:

There are somany diff technologies out there and its a bit overwhelming (fractora, refirme)? I have East Indian skin tone and use RetinA 3x a week. I noticed my cheeks are in a slightly lower position. Id like to start on a preventative/corrective treatment plan. I want to avoid filler but wouldn’t mind something like sculptra to top things off at the end if needed. I’m mostly trying to address the mid face, no jowling or jawline issues yet.

A.The most non-invasive, safe, and efficient lifting and tightening treatment with no downtime for a young woman experiencing the earliest signs of aging is Ultherapy. I perform all of the treatment in our practice to insure that patients get their best possible result. Make sure to choose your treating physician most carefully as aesthetic procedures are not “commodities”, but rather art and science. Your aesthetic results are dependent on your physicians skill, knowledge, experience, care, and most importantly their natural artistic vision. Good luck and be well.

Q.Looking for long-lasting lips, what are my options?

RealSelf actual patient comment:

I have a very small upper lip and not sure what procedure would work that will have ever lasting results? I’ve heard of using my own fat would work? I would like to know what that is called? Or, any other options? Wondering the prices as well..

A.Fortunately I have found that hyaluronic acid fillers such as Juvederm and Volbella last for a very long time in lips when injected properly over 2 to 3 injection sessions. I do not like permanent fillers in lips as the saying goes, “permanent fillers…permanent problems” which I have seen too many times in patients coming to our practice from other clinics where their injection results are “botched.” Fat, like other permanent fillers is great when it works, but is very unpredictable compared to the great hyaluronic acid fillers available today. Consult with expert physician injectors and then choose your injector carefully based on their skill, experience, knowledge, care , and most importantly their natural artistic vision to avoid “trout pout” and “duck” lips. Good luck and be well.

Q.Can I get Juvéderm Voluma on top of Radiesse?

RealSelf actual patient comment:

I got 1 syringe of Radiesse on each side of my face and I definitely see a nice difference but I wish my cheeks could be a littler fuller and more structured. Is Juvéderm voluma on top of Radiesse a good idea or will I look crazy?

A.Facial fillers are an art and science, results are extremely dependent on the expert physician injector whom you are treated by. Fillers are not a “commodity”, it’s not like buying a quart of milk, all fillers are not the same and all injectors definitely are not equally skilled. In your case I would examine you in person, listen to what your facial aesthetic goals are, and then give you a plan for the best pathway to help you achieve and maintain your goals. I love using Voluma to “beautify” faces in a most natural fashion. The most important thing that patients can do to insure excellent facial filler results is to make sure that they choose their injecting physician very carefully based on the injectors experience, training, knowledge, and natural artistic vision. Feel free to contact us with any further questions or concerns. Good luck and be well.

Q. Am I able to have my nose with a rhinoplasty surgery be very close to what the right profile looks like in the photo?

RealSelf actual patient comment: (patient submitted photos with question)

With my photo attached below that I altered before being my natural nose on the left and the altered on the right. Is it possible for my nose to be very closely changed to how the photo on the right looks? Bring nose much closer to face, reduce nostril length and reduce bulbous tip?

A.Imaging is great for helping surgeons and patient communicate their vision – it is less great at giving a definitive estimate of an outcome. 2 dimensional lateral views like you’ve shown don’t reflect well what will happen on the front view – which in my opinion is the most important view. De-projection like you’ve shown can create significant width and decreased definition on the front.

In either case – a consultation with a rhinoplastyexpert would be helpful. Consult with a few rhinoplasty experts and then make sure to choose your rhinoplasty surgeon most carefully based on their skill, knowledge, experience, care, and natural artistic vision. A few rhinoplasty experts I would recommend are Ari Hyman, MD (Los Angeles) and Dean Toriumi, MD(Chicago). Good luck and be well.

Q. Is it possible to make skin thinner as I’ve been recommended to see a dermatologist?

RealSelf actual patient comment:

Hello, I just had my first consultation with a doctor. I asked him if an alar base reduction was possible, with some tip refinement. He felt my nose and informed me that my skin around the tip is extremely thick, so making it any smaller will not work. He recommended I see a dermatologist regarding my skin, but I feel that doing so won’t address my main concerns: making my nose look smaller. Any advice? I’m aware of the limitations due to thick skin but this advice was disheartening.

A.In the hands of an expert rhinoplasty surgeon you can achieve your rhinoplasty aesthetic goals. It will likely require an open approach rhinoplasty with the use of your own cartilage to create a refined nose. It is less about thinning your skin, more about creating an underlying cartilage support. The best thing that you can do is consult with a few expert rhinoplasty surgeons and then choose your surgeon most carefully based on their experience, skill, knowledge, and natural artistic vision. A few great rhinoplasty surgeons whom I would recommend are Ari Hyman, MD (Los Angeles), Dean Toriumi, MD (Chicago), and Steven Pearlman, MD(NYC). Good luck and be well.

Q. Is Juvederm Ultra Plus better for mild nasolabial folds or Radiesse?

RealSelf actual patient comment:

When these two different kinds of dermal fillers get absorbed by the body, does it really get absorbed 100% or does it still leave some residue under the skin which will look like bumps?Which kind lasts longer?

A. Both fillers can correct nasolabial folds, both stimulate a little of your own collagen production so that there is some effect after they have been reabsorbed, though Radiesse is more stimulating. I prefer to use Restylane Defyne in this area because it moves well with facial expressions. Choose your injecting physician carefully. Good luck and be well.

Q. What is the best option to get rid of eye bags and nasolabial folds?

RealSelf actual patient comment:

I am 38 but feel like I look a lot older than my age. I look too old and tired. When I see other people my age and even older than me they don’t have eye bags and nasolabial folds like me. The eye bags really wrinkle up when smiling. I am not aging well for some reason and I don’t even smoke or drink and I try to take care of my skin with a good skincare routine. What would be the best option to look younger and have the bags and smile lines look less pronounced? Surgery? Filler?
A.You can improve your lower eyelid area either with surgical blepharoplasty or with non-surgical proper filler placement. It would be best to evaluate your anatomy in person to determine and discuss your best options. The most important aspect of your treatment is making sure that you choose your treating physician/surgeon carefully based on their experience, skill, knowledge, and natural artistic vision. Good luck and be well.

Q. Fillers or laser to fix uneven smile line from alarplasty?

RealSelf actual patient comment:

After my rhinoplasty in 2013, my plastic surgeon decided to do an in-office alarplasty to reduce nostril flare. Since the procedure, I’ve noticed that the scarring/tethering has made my smile line look very uneven and unnatural. The left side of my nostril now has a gap from the smile line and the right side of my nostril has scarring on top of my smile line. I have gone back to the office several times for Pico laser but it hasn’t made any positive changes. How can this be fixed?
A.It is difficult to assess your nose without examining you in person. For scarring fractional CO2 laser (Fraxel repair) works well. The asymmetry of your nostrils may be able to be repaired with a revision alarplasty. Consult with an expert rhinoplasty surgeon. I have seen the beautifulscar repair work of Ari Hyman, MD in Los Angeles. Good luck and be well.

Q.How long after needle mesotherapy for face I can have Ulthera on jowls and jawline?

RealSelf actual patient comment:

Dear Doctors I will appreciate your advice. I will have needle mesotherapy on 24Sep2019 and then I plan to have Ulthera but do not know when and where, now I need to plan this. Can you advise how long I should wait for Ulthera?
A.You may have Ultherapy anytime after having had needle mesotherapy. You may also have Botox anytime after mesotherapy. Good luck and be well.

Q. Is it possible to lift this this kind of nose?

RealSelf actual patient comment:

I want to save the shape and un, but have the nose a little bit shorter.
A.Yes, an expert rhinoplasty surgeon can lift your nose to help you achieve your nasal aesthetic goals. Consult with multiple surgeons and then choose based on their skill, experience, knowledge, care,and natural artistic vision. A few rhinoplasty surgeons I would recommend are Dean Toriumi, MD(Chicago), William Silver, MD (Atlanta), and Ari Hyman, MD (Los Angeles). Good luck and be well.

Q. If I get fillers for my face, can I still do laser or microneedling treatments in the future? Will it dissolve/melt my fillers?

A. Yes, after facial fillers you may have laser and microneedling. It is somewhat dependent on which fillers are used and the depth of their placement. For patients who are contemplating both treatments we prefer to perform the skin tightening procedures (lasers, microneedling) before fillers as it is more effective to fill the face against tighter skin. Unless your fillers are extremely superficial there should be no problem having those procedures. Good luck and be well.

Q.Will Hyaluronidase injection to dissolve Juvederm affect natural volume in my lips?

RealSelf actual patient comment:

Got lip fillers 2.5 weeks ago, all swelling and bruising is gone and I’d like to get them dissolved just a little bit to make them less full. Also my skin above the upper lip looks lumpy – can this be corrected with Hyaluronidase? I was told that once injected it could dissolve more product than intended, so concerned that my lips will look smaller than before fillers and/or change shape – is this possible? Could the Hyaluronidase take away from the natural volume my lips originally had?
A.I would recommend consulting with an injectable filler expert physician to correct your concerns. I usually prefer to smooth any irregularities and only use hyaluronidase if absolutely necessary. Too much filler can be lost, and in some cases there can be some loss of the patients natural volume. It is difficult to answer your question accurately without seeing photos. Good luck and be well.

Q. Is it is necessary to use rib cadaver grafts to project the tip in African American Rhinoplasty because the cartilage is weaker?

RealSelf actual patient comment:

Additionally, will the inside of the nose look thicker because of the grafts? Especially if rib cadaver is used? What is the success rate of using your own nose cartilage and having it work?
A. The cartilage used to project an African American nose depends on the individual nose, but in general the best results are from using the patient’s own rib cartilage graft. I would recommend consulting with multiple rhinoplasty experts who use this technique and then choose your surgeon carefully based on their skill, experience, knowledge, care, and natural artistic vision. A few expert rhinoplasty surgeons I would recommend are Dean Toriumi, MD (Chicago), Ari Hyman, MD (Los Angeles), and Steven Pearlman, MD (New York.). Good luck and be well.

Q. Can my crooked nose actually be corrected? I’m not convinced.

RealSelf actual patient comment:

No trauma to my nose, born with it. I justwant my nose straight, & a corrected septum so I can breathe better. Hoping insurance will cover most of it. I have yetto see any results I like. They all still look crooked to me. I’m convinced this is something that cannot be corrected & I don’t understand. Most before & afters are bumps/side profiles. I don’t want to pay out of pocket for a rhino that isn’t going to straighten my nose. Somebody please ease my mind before I cancel my consultation.
A. Septorhinoplasty will improve your nasal breathing as well as straighten your external nose. Correcting a crooked nose is one of the most difficult rhinoplasty indications to get “perfect”, but you should see marked improvement.

Best to consult with a few rhinoplasty experts and then choose your surgeon carefully when you are ready based on their skill, knowledge, experience. care, and most importantly their natural artistic vision. A few great rhinoplasty surgeons I would recommend are Dean Toriumi, MD (Chicago), Ari Hyman, MD (Los Angeles), and David Kim, MD (San Francisco). Good luck and be well.

Q. Am I a better candidate for non-surgical nose Job or rhinoplasty?

RealSelf actual patient comment:

I’m unhappy with the frontal view of my nose and I wish I had a more refined tip.
A.You are definitely a better candidate for a rhinoplasty. Do not bother with injectable fillers in your nose. Best to consult with a few rhinoplasty experts and then choose your surgeon carefully when you are ready based on their skill, knowledge, experience. care, and most importantly their natural artistic vision. A few great rhinoplasty surgeons I would recommend are Dean Toriumi, MD (Chicago), Ari Hyman, MD (Los Angeles), and David Kim, MD (San Francisco). Good luck and be well.

Q.Does taking PREP affect a Rhinoplasty?

RealSelf actual patient comment:

Hi there, I am considering a Rhinoplasty soon (havent found a doctor – any recommendations would be great!). However, I read that some medications or supplements have to be avoided before surgery such as accutane or blood thinning medication. I am on PREP for the moment, should I be off PREP before , during an dafter Rhinoplasty? Thank you
A.The medication PREP does not include “blood thinning” as a side effect therefore it is ok to continue prior to your future rhinoplasty. Consult with multiple rhinoplasty experts prior to deciding on your surgeon.

Choose your surgeon very carefully after multiple consultations based on their skill, experience, knowledge, care, and most importantly their natural artistic vision. A few great rhinoplasty surgeons are Steven Pearlman, MD (New York), Dean Toriumi, MD (Chicago), and Ari Hyman, MD (Los Angeles.) Good luck and be well.

Q.How do I know if I have any fillers left in my face?

RealSelf actual patient comment:

How do I know if I need more hyaluronidase to dissolve all fillers in my face, or if there are even any fillers left in my face to dissolve/? I do not know why I still have this dent like thing under my dam eyes I just don’t feel like living anymore
A.First and foremost please speak with a professional about your thoughts of not feeling like living anymore. Your face can be taken care of. The aesthetic repair requires consultation with a facial cosmetic expert physician to determine the best course of treatment. There are treatments available to address your concerns. Please do not do anything harmful to yourself, speak with a trained professional, and then consult with an expert physician. Good luck and be well.

Q.Rhinoplasty, chin surgery, or both? Would just fixing my chin also fix my nose issue?

Looking for some insight on what treatments would be ideal based on my face shape. I’ve been unhappy with my side profile for quite some time now. I would love to have more of a jawline & I feel like my nose looks prominent in comparison to the other structures on my face which is not ideal. Would just fixing my chin also fix my nose issue? I’m struggling with what surgery to choose because I don’t want my face to look much longer on my front profile because I already have a long face.
A.A small chin implant will give the illusion of making your nose look smaller. If you choose to undergo surgery, you should definitely have a chin implant, whether to add rhinoplasty depends on how much your nose bothers you otherwise, and on your in person examination.Choose your surgeon very carefully after multiple consultations based on their skill, experience, knowledge, care, and most importantly their natural artistic vision. A few great rhinoplasty surgeons are Steven Pearlman, MD (New York), Dean Toriumi, MD (Chicago), and Ari Hyman, MD (Los Angeles.) Good luck and be well.

Q.What procedure would I need to make my nose look like the picture on the bottom?

RealSelf actual patient comment:

My nose feels uneven and like it lacks definition on the bridge. I don’t mind my profile at all as I havea slope.First picture is me, no makeup, straight ahead and the second I photoshopped to look how I want. What kind of procedure would give me the desired result?
A.Nice work on your photo-shopping, those are realistic results. You can achieve your aesthetic nasal goals with a properly performed rhinoplasty. Choose your surgeon very carefully after multiple consultations based on their skill, experience, knowledge, care, and most importantly their natural artistic vision. A few great rhinoplasty surgeons are Steven Pearlman, MD (New York), Dean Toriumi, MD (Chicago), and Ari Hyman, MD (Los Angeles.) Good luck and be well.

Q.Which muscle stimulating device is best?

RealSelf actual patient comment:

Between the 3 new devices, emsculpt, cooltone and trusculpt flex, which is best and most effective? They seem to work very similar, except I don’t think cooltone has the fat sparing option for buttocks.
A.We have been using Emsculpt on our patients for the past year with excellent results. Emsculpt has the most clinically proven data on safety and efficacy. Have fun building your muscle and losing some fat in the process.Good luck and be well.

Q.What kind of rhinoplasty would be best for me and what results can I expect?

RealSelf actual patient comment:

Hi, I would like to know what type of rhinoplasty I would need. I would like to get rid of the bump. Also, I would like to make it smaller and make the bridge of my nose more narrow. I want to know what I can realistically change and what results to expect from a rhinoplasty.
A.You are an excellent candidate for a reduction rhinoplasty which will reduce the size of your nose and result in an eloquent refined nose. At initial rhinoplasty consultations we use computer morphing to give our patients a realistic sense of what they can expect from their rhinoplasty.Consult with a few rhinoplasty surgery experts and then choose your surgeon very carefully based on their experience, skill, knowledge, care, and importantly their natural artistic vision.Good luck and be well.

Q.Am I a candidate for non surgical nose job, or do I need surgery/rhinoplasty?

RealSelf actual patient comment:

I would like to know if I am a candidate for a non surgical nose job as this would be my ideal choice or if I would need rhinoplasty? One doctor said with a non surgical nose job the tip could be raised and bump flattened. I am 36 years old
A.It appears that you would benefit from a surgical rhinoplasty, I would advise against liquid rhino in your case. Good luck and be well.

Q.Tear troughs filled – I think it looks worse. Is it the wrong filler or placement? Advice?

RealSelf actual patient comment:

Can someone advise on the problem here. I’ve gotten my tear trough filled for the first time on Saturday. 3 days ago. They don’t look any better and I think they could look worse. My dark circles seem darker. Could it be the wrong filler used or could it be an issue with placement? Please advise. Thanks
A.It appears that there is excess filler low on your right side. If it is still that way next week, I would let your injecting physician know about it. Depending on your trust, you may consider a consultation with another expert injecting physician. Good luck and be well.

Q.Please tell me how to get rid of the orange-peel chin and deep lines above my upper lip?

RealSelf actual patient comment:

I moisturize daily but to no avail.

1. Would filler help and if so, which filler would be best?
   2. If filler is recommended, how much would I need?
   3. Would the same filler (if that’s what you recommend) be used to remedy both chin and upper lip?
   4. If an injectable is used, typically how bad is the bruising in these two areas?
   5. Instead of filler, would laser treatment be more beneficial?

Thank you! Thank you!
A.The absolute best treatment for the area around your mouth is fractionated CO2 laser with PRP (platelet richplasma). There is downtime involved but the results are excellent. Botox in your chin helps as does micro needling and less aggressive lasers depending on the amount of time that you have to recover. Most importantly choose your treating physician carefully as these treatments are not standard commodities. Good luck and be well.

Q.What is the difference between PPP 3D Facelift and Ulthera?

RealSelf actual patient comment:

I am looking for some non-surgical anti aging SMAS lifting treatment recently. One of the clinics offers a treatment called PPP 3D Face Lift, and they told me it’s milder than Ulthera. So what is the difference exactly? And also is it less painful compared to Ulthera? Any potential after effect that I should be aware of?
A.PPP 3D facelift is a treatment name coined by a clinic and is not a standard treatment modality used by other physicians. Ultherapy has been used in hundreds of thousands of patients with excellent results. Choose your treating phsyician carefully. Good luck and be well.

Q.Can you tell if the bump on my nose is natural or I got it from injury?

RealSelf actual patient comment:

I bumped my nose harshly on the stairs of a shallow pool when I was around 9 years old. No one in my family has a bump on their nose like me, and I was just wondering if it was genetic or an injury.
A.It seems like the bump is different from each side which usually from trauma. Whether it is from trauma or genetic won’t matter should you decide to correct the hump with rhinoplasty. The most important aspect of any aesthetic procedure is choosing your surgeon carefully based on their skill, knowledge, experience, and natural artistic vision. A few great rhinoplasty surgeons whom I would recommend are Dean Toriumi, MD (Chicago), Steven Pearlman,MD(New York), and Ari Hyman, MD (Encino, CA). Good luck and be well.

Q.Is it possible to remove my dimple?

RealSelf actual patient comment:

I have an issue where my smile is affected by a dimple that I believe I acquired after getting a cortisone shot for a cyst years ago. The dimple causes a crease when I smile and makes one side of my face look heavier. I have posted this question before a while ago and never really got a straight answer, I’m really hoping there is a procedure to fix this because it makes me very self conscious.
A.Yes, I would need to evaluate you in person to determine the best treatment for you. It appears that you should benefit from a filler that will be determined after examining you. Good luck and be well.

Q.How can I get rid of or mask the wrinkle on my outer BOTTOM eyelid?

RealSelf actual patient comment:

I don’t want to put any botox there because I have seen numerous cases where the smile was affected due to cheek muscle being paralyzed. If fillers are the solution, which filler would be best?
A.I agree with Dr. Martin, a neuromodulator (I prefer Dysport in this area) used properly will not affect your smile. Microneedling with microdosing of Restylane and Botox is helpful, as is micro needling with platelet rich plasma (PRP). The most aggressive and effective treatment would be fractionalCO2 laser but there is significant downtime. As with any aesthetic procedure it is important that you choose your treating physician carefully based on experience, knowledge, skill, and natural artistic vision. Good luck and be well.

Q.How many times must Profound laser be done?

RealSelf actual patient comment:

I want to tighten the skin on the lower part of my face. I’m investigating Profound Laser. Because it involves at least a week of down time, how many treatments are optimum? I am 68 years old and have taken good care of my skin.
A.Most of our patients are treated one time with Profound RF. We usually combine our treatment session with Platelet Rich Plasma (PRP) and Sculptra. As the face and neck are numbed with local anesthesia, I offer our patients a light fractionated CO2 laser at the end of the Profound RF treatment. This combination gives very nice results with a single treatment session. As with any aesthetic treatment, choose your physician most carefully. Good luck and be well.

Q.One side of face has deep crease, can this be fixed with filler?

RealSelf actual patient comment:

Asymmetrical smile line (only on left side). Can this be fixed with filler? How much? Would it look unnatural?
A.I just treated someone with your exact concerns. She was immediately very happy. Filler can be used to even an asymmetric face. The amount of filler and the cost depends on the individual patient and their degree of asymmetry. Facial filling is not a commodity, it is very dependent on your injecting physician.As with any aesthetic treatment it is essential to choose your treating physician carefully based on their experience, skill, knowledge, care, and most importantly their natural artistic vision.Good luck and be well.

Q.Saggy skin around jawbone in early 20s. Any recommendations on treatments?

RealSelf actual patient comment:

Hello. I’m in my early 20s and I have a problem with my jawbone. I think it’s excess of skin and I’m trying to work out which procedure would led to eliminate my problem. Two first photos are of how it looks now, last photo is the effect I would like to archive. I would appreciate any recommendations on the treatment. Thank you
A.I would treat you with a conservative Ultherapy treatment which will tighten the skin and muscles of your face and neck as well as giving you definition of your jawline. I would also consider Botox to your masseter muscles to narrow your posterior lower jaw area resulting in a more V-shaped face. Choose your treating physician most carefully. Good luck and be well.

Q.What are non invasive skin tightening options for my abdomen?

RealSelf actual patient comment:

I am looking for stomach skin tightening options. I had my daughter when i was 18 and have hated and hidden my stomach ever since. I have quite a few stretchmarks but mainly would like to tighten the skin especially around the belly button. I do not want a tummy tuck full stop. I am not looking for or expecting miracles.. just some improvement. Based on my pic is there realistically anything other than tummy tuck that can help me? Thanks in advance 🙂
A.We have had success treating patients with loose abdominal skin with Emsculpt, Venus Freeze , and Profound RF. Good luck and be well.

Q.Can I get a fat graft to a narrow face?

RealSelf actual patient comment:

Thin gal. Would like a less lean looking face, could a fat graft be done to my jawline?
A.Fat transfer grafting can restore volume to a thin face nicely. The problem is that fat grafting is unpredictable and is difficult to correct if there is a problem. I prefer to treat my non-surgical patients with more reliable facial fillers such as Sculptra and Voluma. All of these filler treatment options are not commodities, they are very dependent on the injecting physician.As with any aesthetic treatment it is essential to choose your treating physician carefully based on their experience, skill, knowledge, care, and most importantly their natural artistic vision.Good luck and be well.

Q.30 days until 30th reunion. What can I do to look and feel better about face?

RealSelf actual patient comment:

So I had been planning to get some Botox done in about 2 weeks, which would hopefully show good results in time for my reunion. Now I’m wishing I had maybe tried some more things to smooth my complexion, sun spots or maybe even some filler (lips or cheeks?). Have I waited too late? I only have 30 days until my reunion for any procedures to be healed. What would you recommend?
A.First you will have to promise to wear a good physical sunblock at all the Tennessee football games this year, go Vols! In your case I would treat you immediatelywith Fraxel Dual brown spot reduction laser (5-7 days of downtime peeling), botox, Volumafiller in your cheeks, and a oxygen infusion facial a few days before the reunion. Choose your treating physician most carefully. Good luck and be well.

Q.Is eyelid surgery best done by an eye surgeon or a plastic surgeon? Does preventative functional eyelid surgery exist?

RealSelf actual patient comment:

I can see my eyelid future & it isn’t pretty. Both of my parents qualified for (but never got) functional blepharoplasty. Now at age 51, I have skin dipping below my lid (only my lashes keep them up). I’m exploring surgery, but the doctor choices are overwhelming and I’m not sure what type of doctor to go with. Also, I can wait a decade and (likely) have functional surgery, but by then the skin will be thinner. Is preventative surgery a thing? Or is that wishful thinking?
A.You appear to be an excellent candidate for upper eyelid surgery (blepharoplasty.) Consult with multiple surgeons until you find one that you are comfortable with. Your surgeon should be board certified in plastic surgery, oculoplastic surgery, or facial plastic surgery. As with any aesthetic procedure you should make sure that you choose your treating physician/surgeon based on their skill, knowledge, experience, care, and most importantly their natural artistic vision. A few great blepharoplasty surgeons that I recommend are Guy Masry, MD (Beverly Hills), Steven Dressner, MD (Santa Monica), and Ari Hyman (Encino, CA.). Good luck and be well.

Q.How effective/reliable will nasal turbinate reduction by radio frequency be for me?

RealSelf actual patient comment:

Recommended by physician and deciding whether to have turbinate reduction by radiofrequency (treatment in the office, no general anesthesia). How exactly does the ENT physician determine how much to reduce? I’m assuming all patients are different. And, can it be done on one side only of the other side isn’t as swollen? Finally, how deep does the probe go?
A.Great sinus X-rays!!! It appears that you should get great improvement of your nasal breathing and air flowfrom RF Inferior Turbinate reduction. I will treat the areas of the inferior turbinate that are swollen, usually involves treating 3 spots on each inferior turb, anterior, mid, and posterior. A preset amount of energy is given in each area to reduce the turb. The insulated RF probe needle is inserted 2-3 centimeters into the turb tissue. It can be done unilaterally, but most patients prefer having both sides done at the same time. The nose feels congested for 2 to 5 days, like a cold but you are not sick. Good luck and be well.

Q.Do I look like a candidate for a blepharoplasty/do I have ptosis?

RealSelf actual patient comment:

I would love to have slightly bigger eyes and more space on my eyelid.
Do I I look like I have ptosis ? Treatment for eyelids just starting to sag?
A.I totally agree with the great Toby Mayer, MD, your eyes (and face) are beautiful. Do not let anyone touch your eyes for many years. If you consult with enough surgeons you find someone to ruin your naturally beautiful looks.Enjoy your youthful beauty. Good luck and be well.

Q.Will filler in cheekbones give me fuller checks then I already have?

RealSelf actual patient comment:

I have a really round face with full cheeks. One side of my face has more volume then the other. I thought Botox in the jaw could slim down my face and correct the asymmetry, but my doctor said Botox would not work on me as the volume in my lower face is due to fat and not the jaw muscle. He said that I should get filler in the cheekbones to remove the focus and my lower face and also in the chin. I do not wish a fuller face. Filler in the cheekbones, would that not make my face look fuller?
A.Your face can be made to appear more symmetric and thinner if your fillers are placed properly by an expert injecting physician.As with any aesthetic treatment it is essential to choose your treating physician carefully based on their experience, skill, knowledge, care, and most importantly their natural artistic vision.Good luck and be well.

Q.Can I get a Rhinoplasty if I have epilepsy?

RealSelf actual patient comment:

I take keppra everyday 1 in a half in the morning and 1 in the night and the – milligrams Are 1,000 but I been wanting to get a nose job and I’m concerned if I’ll be able to get one
A.Yes, patients with epilepsy may under rhinoplasty but only with a medical clearance from their neurologist. Good luck and be well.

Q.Does rhinoplasty affect a smile crease?

RealSelf actual patient comment:

I want to get a rhinoplasty but I am not sure whether this would have an effect of my smile crease (horizontal line above my lip). I really like this crease and i think it looks cute. I would appreciate an answer! 🙂
A.You have a beautiful smile, rhinoplasty should not have affect your smile once the immediate post-operative healing period is over. Sometimes during rhinoplast y the muscles that connect the nose to the lip are freed up to keep them from pulling down on the nose while it heals. Please make sure to discuss this with your rhinoplasty surgeon.

As with any aesthetic treatment it is essential to choose your treating physician carefully based on their experience, skill, knowledge, care, and most importantly their natural artistic vision. A few great rhinoplasty surgeons that I would recommend are Raj Kanodia, MD (Beverly Hills), Ari Hyman, MD (Encino), and Dean Toriumi, MD (Chicago). Good luck and be well.

Q.What can I do to achieve a more symmetrical face (lips/cheeks/double chin)?

RealSelf actual patient comment:

There is nothing symmetrical about my face. It has never bother me until it got worse and way more noticeable as I have gotten older (I am 25). It could be due to pregnancy/weight loss, spending more time outside due to running, aging, dental work, clicking jaw that has gotten worse over the year. Anyways, my main concerns are my uneven lips/corner of mouth, volume loss and unevenness in my mid face, and my jawline/double chin. What do you suggest to help with this? Thank you!
A.The best procedure to treat the aspects of your ethnic nose that bother you would be a rhinoplasty, best likely via an “open” approach. Injections of filler on the top of your nose (profile) may give an illusion of a thinner nose, but cannot address your nostrils. I would advise consulting with a few rhinoplasty experts. As with any aesthetic treatment it is essential to choose your treating physician carefully based on their experience, skill, knowledge, care, and most importantly their natural artistic vision. A few great rhinoplasty surgeons that I would recommend are Raj Kanodia, MD (Beverly Hills), Ari Hyman, MD (Encino), and Dean Toriumi, MD (Chicago). Good luck and be well.

Q.Jeuveau and other drug interactions- Is this dangerous? Can it ruin my filler or counter it?

RealSelf actual patient comment:

I read that you weren’t supposed to mix jeuveau with other drugs. I had jeuveau done a couple days ago for my crows feet. I forgot that in June i had xeomin but in a different area when i got filler done. I had 1.5 cc of radiesse as well in june. Is this dangerous ? can it ruin my filler or counter it?
A.NTW (Not to Worry.) Whatever you read was Fake News!!!There is not contradication or danger to having Jeuveau with other medications, neuromodulators, or fillers as long as the unit dosage remains in the safety zone. Good luck and be well.

Q.Can my loose columellar skin be fixed?

RealSelf actual patient comment:

I have a good bit of excess caudal septal cartilage at the base of my nose. This forces my philtrum to protrude and creates a very obtuse nasolabial angle. If this is corrected, how can the skin be addressed? Will it be sutured up and back into place? I’m afraid that skin will remain loose and hang. I have no interest in changing my whole nose, just the columellar area and lip where it protrudes.
A.Excellent question. Fortunately in rhinoplasty when the nose is reduced, the skin always contracts down to “fit.” In your case, your nasal spine at the base of your nose as well as some of your caudal nasal septal cartilage can be removed to decrease the obtuse lip-nose angle to a more masculine angle of about 90 degrees.

As with any aesthetic treatment it is essential to choose your treating physician carefully based on their experience, skill, knowledge, care, and most importantly their natural artistic vision. A few excellent rhinoplasty surgeons I would recommend are Sam Lam, MD (Plano, TX), Rod Rohrich, MD (Dallas), and Ari Hyman, MD (Encino, CA).Good luck and be well.

Q.What’s the best approach for hereditary hooded eyes that make me looks sleepy/eyeless?

RealSelf actual patient comment:

Hooded eyes, eyes always feel. Little heavy and sleepy. Would surgery help? I want my eyes to look open and refreshed. 33 y/o female.
A.An upper eyelid blepharoplasty would help you achieve your aesthetic goals. It may be performed under local anesthesia in the office with about a one week downtime.As with any aesthetic treatment it is essential to choose your treating physician carefully based on their experience, skill, knowledge, care, and most importantly their natural artistic vision. Good luck and be well.

Q.While waiting for Ultherapy results should there be other treatments done to the treated area?

RealSelf actual patient comment:

I just received ultheraphy by someone other than the dr. i consulted with. I dont know if she is a nurse or esthetician? can anyonebe trained to use this device? Who is qualified to do Ultherapy?In between breaks she said that she loves this machine because theres no guess work. After treatment she advised getting mircroneedling to get rid of crepiness. I thought the treatment was going to get rid of that?After reading some comments on here I see that other treatments help the neck look tighter. what would you recommend?
A.Ultherapy is a good non-invasive device treatment for lifting and tightening the skin of the face, neck, and jawline. I encourage my patients to combine Sculptra injections as well as microneedling with PRP for optimal rejuvenation results. I personally treat all of our Ultherapy patients as it is important to customize Ultherapy treatment to each individual patient’s anatomy by reading the ultrasound screen. Most practices delegate the treatment to peripheral office staff. As with any aesthetic treatment it is essential to choose your treating physician carefully based on their experience, skill, knowledge, care, and most importantly their natural artistic vision. Good luck and be well.

Q.Would Morpheus8, PDO threads, or Ulthera be better to tighten the skin?

RealSelf actual patient comment:

I am 38 years old, had my masseters treated with Botox and now feel and see laxity in my skin around my jawline. Would Morpheus8 or ulthera be better to tighten the skin? Or, is there something else that could tighten the skin around the jawline with long term results?
A.I would treat you with Ultherapy, it would tighten the laxity of your jawline and re-establish a nice jawline contour and sharpness. It will also address the early minimal jowls and lift your cheeks. Your eyes will likely look more rested and youthful as well.I have not been impressed with the long term results of PDO threads. Morpheus8 is a very superficial treatment.

As with any aesthetic treatment it is imperative that you choose your treating physician most carefully based on their skill, experience, knowledge, care, and their natural artistic vision.

Q.Can I get Emsculpt on my stomach if I had my gallbladder taken out and internally closed with metal staples?

RealSelf actual patient comment:

Can I use EMSculpt on my stomach if I had my gallbladder taken out and they used small metal staples to close off the duct/artery? They are located internally on my right side just under my rib cage…where my gall bladder used to be. What is the acceptable distance from a metal object?
A.Unfortunately metal staples are a contraindication for Emsculpt over the area. It is thought that the energy of Emsculpt penetrates about 7 centimeters deep from the paddles. My wife also has staples in her abdomen and we are not treating her. On the bright side, she did treat her buttocks as they are far enough away as to not be a problem. You may also treat your triceps, biceps, and legs with the newly released applicators. Good luck and be well.

Q.Is it possible to have Emsculpt if I have a testosterone pellet?

RealSelf actual patient comment:

I have tried everything to build muscle in my glutes, years and years of training with no success. I contemplated a BBL, but I’m really interested in building muscle. I’m on my 3rd T pellet in 18 months in combo with intense flute training. Can I have emsculpt while I still have a pellet in my glute?
A.Yes, you may have Emsculpt of your glutes with a testosterone pellet in place. Good luck and be well.

Q.What are my options regarding rhinoplasty? Would my nose be a good applicant for this surgery?

RealSelf actual patient comment:

I have a long, bulbous, wide nose. It has a very unique shape. Is it possible to get an elegant (not cutesy) nose from my current one? A narrower bridge and smaller tip, as well as the sides next to my nostrils. When looking through before and after pictures, I have yet to find a nose that looks like mine, so I cannot see similar results. In your expert opinions, doctors, what would I realistically be able to expect from a rhinoplasty? Thank you!
A.You are an excellent candidate for rhinoplasty. A properly performed rhinoplasty will result in an elegant nose that no longer distracts the focus on your face away from your eyes. Your nose can be deprojected and made proportionately smaller without creating a “cutesy” nose or a nose that looks like it had an obvious rhinoplasty. The key for you is making sure that your choose your rhinoplasty surgeon carefully after multiple consultations. Base your decision on the surgeons experience, knowledge, skill, and most importantly their natural artistic vision. A few top rhinoplasty surgeons whom I would recommend are Steven Pearlman, MD (NYC), Ari Hyman, MD (LA), Jamie Derosa (Boston),and Dean Toriumi (Chicago).Good luck and be well.

Q.Could I have a closed rhino or will a nose filler look good with my nose?

RealSelf actual patient comment:

I’m sick and tired of the bone I feel like it is growing and getting bigger I wish it was smaller I want either filler or a closed rhino.I like the bottom of my nose and I do not like how my nose is so skinny I honestly am confused on what to do I just do not like this bone it’s so hard and manlyand too big for my face, also certain angles the bone looks obnoxious. I just feel like my bone is GROWING.
A.Rhinoplasty is your answer to help you achieve your aesthetic goals. I would not recommend filler to your nose as it will only make it look larger. The bone and cartilage that make up your profile nasal hump can be taken down by a closedrhinoplasty. Make sure to choose your rhinoplasty surgeon most carefully based on their skill, experience,knowledge, and natural artistic vision. A few top rhinoplasty surgeons whom I would recommend are Steven Pearlman, MD (NYC), Ari Hyman, MD (LA), and Dean Toriumi (Chicago). Good luck and be well.

Q.When getting Voluma, how can you immediately tell the difference between a bad reaction (blindness) and a vasovagal response?

RealSelf actual patient comment:

I have an abnormally strong vasovagal response (get pins and needles in my eyes and can black out for eyedrops, dilation, and even when I got my lips injected). I want Voluma in my cheeks but am nervous because I heard their is an increased risk w/the blindness complication and while I know it is rare, I would just like to know how in the moment I can know if I’m having a complication or a simple vasovagal syncope like I might normally have.
A.The most important thing that you can do is make sure that you choose your facial filler injecting physician most carefully. With experience, knowledge of facial anatomy, skill, and natural artistic vision the injection of Voluma should be extremely safe and effective. We have treated hundreds of patients without adverse events or complications other than occasional minimalbruising. We would advise you to use relaxation breathing techniques during your Voluma treatment, if you show signs of a vasovagal reaction, we immediately stop injecting until you recover fully. We have many patients like yourself who were nervous and anxious at their first injection visit who have returned many times finding their treatment very easyand reminisce on how far they have come where the injections no longer bother them at all. Again, choose your injecting physician carefully and you should have nothing to worry about. Good luck and be well.

Q.Am I a good candidate for rhinoplasty? I want more narrow nostrils

RealSelf actual patient comment:

Hello! I want to make some adjustments to enhance my face. I love my nose but I’m unhappy with the flare of my nostrils. Do I need an entire rhinoplasty or is it possible to just slim my nostrils?
A.Great question.

Being a good candidate for a rhinoplasty is less about what your nose looks like and more about your expectations and rational for seeking one. A wide base of the nose is a common reason people seek rhinoplasty. For extreme widths a “synching suture” can help narrow the nose. Alar base surgery is an option but must happen with extreme caution and meticulous execution because scarring in this area is hard to correct.

Lastly, in black noses, increasing projection often will narrow the base. Perhaps not completely but may lessen the need for alar base surgery or any “alar-plasty.” I would recommend someone with expertise in ethnic and African American noses.

Be sure to choose your rhinoplasty surgeon carefully based on their skill, knowledge, experience, care and most importantly their natural artistic vision. A few excellent rhinoplasty surgeons that I would recommend are Rod Rohrich, MD (Dallas),Dean Toriumi,MD (Chicago), and Ari Hyman, MD (Encino, CA).

Q.I want to know if it is possible to shear the top bone of the nose without breaking the nose?

RealSelf actual patient comment:

I’d like someone who is a real artist. I don’t want my nose broken if that is possible.
A.You are correct in seeking a true artist to perform your rhinoplasty. It is possible to take down the top of your nasal bone without breaking the nasal bones as long as the nasal bones are relatively narrow and the hump is not too large. We often perform “subtle rhinoplasty” on patients who share your request.From your photos it appears that it may be possible in your case. As you have indicated in your question, choose your rhinoplasty surgeon most carefully based on their natural artistic vision as well as their skill, experience, knowledge, and care.

A few excellent rhinoplasty surgeons that I would recommend are Anthony Bared, MD (Miami),RichardDavis, MD (South Florida), and Ari Hyman, MD (Encino, CA). Good luck and be well.

Q.How fast does bruising show up after Voluma in the cheeks? Can you see bruising as quickly as an hour or two after?

RealSelf actual patient comment:

How fast does bruising show up after Voluma in the cheeks? Can you see bruising as quickly as an hour or two after? Also, is there any tell tale sign that a discolored area is not a bruise but a necrosis in the early stages? Thanks.
A.Most of the time we don’t see bruising with Voluma injections. As with any injections, if a blood vessel is hit with the needle, there will be some bleeding. Bruising is minimized by applying pressure for a few minutes. Voluma is injected deep to muscle and just over bone in most areas where it is used. Occaisionally a deep blood vessel may be hit and delayed bruising does not show up for a day or two. Early vascular compromise and necrosis are entirely different and much more serious than bruising. If the filler is injected into a blood vessel the patient will feel intense discomfort. The area supplied by the vessel immediately blanches. The resulting discoloration is mottled unlike a typical bruise. Should this occur, it is essential to seek treatment immediately to dissolve the filler. Always choose your injecting physician most carefully. Good luck and be well.

Q.What procedure will fix the sagging skin on my chin?

RealSelf actual patient comment:

I am a 36 years healthy women. Lately noticed the sagging skin around my chin, what procedure would help attenuate the look a bit? I don’t think I am ready yet for a mid face lift , i am also not too keen to fillers as they are temporary. Would fat grafting help ?
A.I would treat your chin area with Profound RF and may use Sculptra which is a long lasting collagen stimulating injectable. I am not a fan of fat grafting in the chin area as it can be unpredictable, and can be very difficult to adjust or remove. Choose your treating physician most carefully. Good luck and be well.

Q.My nose is wide and very flat. Can a a Rhinoplasty give me more definition in my face?

RealSelf actual patient comment:

I feel like I have a very Flat face and flat nose. When I turn to the side you can see how my cheeks goes past my nose. I want to get work dont but I haven’t seen much work on a nose like mine.
A.You should consult with an expert surgeon in ethnic noses. A structural rhinoplasty will give definition to your nose. Nasal cartilage, ear cartilage, and sometimes even rib cartilage may be used to give your nose definition. The most important aspect of any aesthetic procedure is to make sure that you choose your physician carefully.

Choose your rhinoplasty surgeonbased on their skill, knowledge, experience, care and most importantly their natural artistic vision. A few excellent rhinoplasty surgeons that I would recommend are Anthony Bared, MD (Miami),RichardDavis, MD (South Florida),and Ari Hyman, MD (Encino, CA). Good luck and be well.

Q.Is it possible to correct this area above my lip with a rhinoplasty?

RealSelf actual patient comment:

There’s a slant above my upper lip and below my nose. I have searched for before and after photos for someone that has the same thing as I do and I have not found one single piece of evidence that shows me it can be done. My jaw surgeon recommends a rhinoplasty instead of re-doing the double jaw surgery. Is it actually possible to correct this issue with a rhinoplasty?
A.Yes, rhinoplasty with reduction of your nasal spine will correct the area above your lip.

Be sure to choose your rhinoplasty surgeon carefully based on their skill, knowledge, experience, care and most importantly their natural artistic vision. A few excellent rhinoplasty surgeons that I would recommend are Rod Rohrich, MD(Dallas), Spencer Cochran, MD, Dean Toriumi,MD (Chicago), and Ari Hyman, MD (Encino, CA). Good luck and be well.

Q.Is it possible to significantly reduce a large/bulbous nose tip with thick skin?

RealSelf actual patient comment:

I’ve always been self conscious about the shape and size of the tip of my nose. I’ve been considering a rhinoplasty but have been told by friends and family that it would be difficult/impossible to significantly reduce/change the size and shape of my nose due to the fact that the skin is very thick there. How much change would it be possible for me to see?
A.Yes, a properly performed rhinoplasty will help you achieve your goals of a pretty nose. You will need a structural rhinoplasty where cartilage is used to give your nose definition and reduce your bulbous tip and overcome your thick skin. The most important aspect of your rhinoplasty is making sure that you choose your rhinoplasty surgeon most carefully. I would recommend Ari Hyman, MD who is an expert at structural rhinoplasty having been fellowship trained by Dean Toriumi, MD in Chicago. Dr. Hyman is practicing in Los Angeles. Good luck and be well.

Q.Can I have TMS treatments for depression at the same time as Emsculpt?

RealSelf actual patient comment:

Both TMS and Emsculpt use electro-magnetic pulsing. While TMS is highly localized, is there any problem with receiving too much electro-magnetic stimulation?
A.There is not any problem with receiving both Emsculpt and TMS electromagnetic therapies concurrently as long as you have no contraindications to either treatment. I hope that you are feeling better!!!Good luck and be well.

Q.What are the best techniques to change the symmetry of my face?

RealSelf actual patient comment:

I’m 37 years old and my facial features are rough and over the years tried to change my hair color or contour with makeup but i came to a conclusion that i want to make changes like on my bone structure i want to look more feminine i love Angelina’s Jolies face and Marilyn Monroe , i was impressed how drastically Kyle changed her face.I want to look younger i feel i dont have a glow and i want a drastic change even having a nose job.
A.I agree with my esteemed colleague, Toby Mayer, MD. Your face is symmetric, symmetry is not a facial feature that should be changed. If you would like to have a smaller, more refined nose then rhinoplasty would help you achieve that aesthetic goal. There are many great treatments and products that can help you look younger and give you that “glow” without going all out Kardashian crazy. Good luck and be well.

Q.Can I get emsculpt on my butt if I’m 4 weeks pregnant?

A.Congratulations on your pregnancy!!! There have probably been many women in their first few weeks of pregnancy who have been treated with Emsculpt before they were aware of their early pregnancy. It is one thing to be treated unknowingly, it would be against the standard of care if a known pregnant woman is treated with Emsculpt. Enjoy your pregnancy and new addition to your family. The good news is that Emsculpt on your abdominal muscles post-partum will help the muscles return toward normal. Good luck and be well.

Q.Can Botox fix my asymmetrical smile?

RealSelf actual patient comment:

My right (picture left) corner of mouth pulls way further than the other side when I smile and kind of makes the corner of my mouth look like female genitalia and there is an extra c shaped wrinkled on that side that doesn’t exist on the other. Can Botox keep that side from pulling so far and balance my smile?
A.The corner of your mouth certainly does not look like female genitalia!!! (if so, it is the prettiest female genitalia in the world.) I would be very hesitant to use neuromodulators (Botox) to attempt to even your smile because it could lead to severe asymmetry issues (still would not look like genitalia, male or female!!!) After examining you in person, a little filler in the corner of your mouth may help your achieve your aesthetic goal.Good luck and be well.

Q.As a 50 year old female struggling to build arm muscle and lose fat, what kind of results could I expect from Emsculpt?

RealSelf actual patient comment:

I am a 50 year old female (5’8”, 142lbs). I walk 4-5 miles a day w/my dog. I also do yoga 2-3 times a week, and have recently added resistance training 3 times a week, and HIIT into my routine. I am in good health and eat well, but am struggling with my ability to build muscle (my arms being my biggest issue). In addition to building muscle, I have to lose body fat. Would Emsculpt help my arms? And is it recommended that you do both the biceps and triceps for best results and balance?
A.The new Emsculpt arm and leg paddles work similar to the paddles for the abdominals and glutes. you may expect a 16-20% increase in muscle mass of the arms over a 6 to 12 month period. I would recommend treating both the biceps and triceps for optimal results. With you commitment to staying in shape, you are likely an excellent candidate for Emsculpt.Good luck and be well.

Q.Restylane won’t dissolve after 19 months and 9 injections of hyaluronidase and 3 of Kenalog. Will microneedling RF help?

RealSelf actual patient comment:

It’s been 19 months. I’ve had hyaluronidase injected 9 times (massive amounts) and Kenalog 3 times (2.5mg). The material around my mouth will not dissolve. Will Radiofrequent microneedling help? It swells up every morning. I’ve been told it could be scar tissue encapsulation. Please read this post before advising me to get hyaluronidase.
A.It is very unusual for Restylane to not dissolve with hyaluronidase. Are you sure that it was Restylane that was injected? Radiofrequency with microneedles may help although there isno guarantee. It is porbably worth trying given all that you have been through and its continued problems. Good luck and be well.

Q.My nose is very bulbous and fat with thick skin can I have a prettier nose by doing rhinoplasty?

RealSelf actual patient comment:

I recently asked someone and they said that my nose would not be that defined because its si big and thick the results that I want won’t happen and will no show this got me so sad. My whole life I wished for a pretty cute nose but now I feel that it would be impossible that’s why I need a real expert opinion.
A.Yes, a properly performed rhinoplasty will help you achieve your goals of a pretty nose. You will need a structural rhinoplasty where cartilage is used to give your nose definition and reduce your bulbous tip and overcome your thick skin. The most important aspect of your rhinoplasty is making sure that you choose your rhinoplasty surgeon most carefully. I would recommend Ari Hyman, MD who is an expert at structural rhinoplasty having been fellowship trained by Dean Toriumi, MD in Chicago. Dr. Hyman is practicing in Los Angeles. Good luck and be well.

Q.I feel my nose needs to be ‘pulled back up’ and lifted higher with a better bridge bone?

RealSelf actual patient comment:

Hi, over the years my nose which used to be lovely, taut and neat has gone broader with lower, floppier, wider nostrils which really flair when I smile. I feel it needs to be ‘pulled back up’ and lifted higher with a better bridge bone and tighter, neater nostrils. I love Adele’s nose.Any thoughts?
A.You are not alone. Many patients complain that their nose drops, widens, and flares as they age. We perform many rhinoplasties on aging noses to restore the taut, neat proportions, giving the nose (and patient) a lift. It appears that your rhinoplasty can be performed endonasally (closed without an external incision) to refine your nose. I agree, I like Adele’s nose too, though all noses are different, her nose could serve as a nice template for your rhinoplasty aesthetic goal. Choose your rhinoplasty surgeon carefully based on their training,experience, skill, knowledge, care, and most importantly their natural artistic vision. Good luck and be well.

Q.I would like to do Botox to make the movement less without freezing it. Is there a specific Botox treatment for this?

RealSelf actual patient comment:

Every time I’ve done botox even injecting a minimum amount it seem to make it freeze and the eyebrows go down just a tiny bit. Is there a way to prevent this and keep some movement in the forehead but just less “Animated” the way the botox acts when it’s wearing of the last months???
A.Many of our patients share your concern. Patients wish to look fresh, rested, and natural without looking unnaturally frozen and plastic. The use of Botox is both an art and science. Getting your Botox is not a commodity, like going to the store and buying milk, not all Botox injectors are the same. Each patient must be evaluated and treatment is based on the size and strength of their facial muscles as well as the patient’s personal aesthetic goals. Each treatment in our office is customized, Botox treatments are not “cookie cutter” where every patients gets the same amount in the same areas.In your case you are likely a candidate for specialized “micro-dose” Botox treatment.The most important aspect of your Botox treatment is making sure that you choose your physicianinjector most carefully. Choose your physician based on their skill, experience, knowledge, care, and their natural artistic vision. Good luck and be well.

Q.What can I do about heavy, puffy upper eyelids at the age of 66?

RealSelf actual patient comment:

My upper eyelids are getting heavy and puffy. I am 66. Will this procedure help me? I really don’t want to get a surgical eye lift.I hear the results are better the younger you are and that women my age, whose skin is getting thin and papery, don’t get nearly the results. Let me know what you think, thanks!
A.An upper eyelid blepharoplasty will correct your heavy puffy eyes. I am not sure what procedure you are asking about in your question, but blepharoplasty is your answer. Good luck and be well. Choose your treating surgeon carefully based on their experience, skill, knowledge, and natural artistic vision. Good luck and be well.

Q.Does a nose with lots of graft look fake in real life?

RealSelf actual patient comment:

I need revision rhinoplasty. And it seems like I will need a lot of grafts, to project the tip, build the bridge and widen the nose as well. I am Caucasian male with regular skin. Based on the photos noses with grafts look fine, but I have never seen one in person. Do they appear fake? That is something that I cannot afford due to my work as senior manager in in thecompany.
A.When performed properly, a revision rhinoplasty using grafting should look natural. The most important aspect of revision rhinoplasty is making sure that you choose your rhinoplasty very carefully based on their experience, skill, knowledge, and natural artistic vision. With any aesthetic surgery or treatment, we fail our patient if the result is obvious, fake, and unnatural. Good luck and be well.

Q.Is it possible to use Emsculpt protocol 1 (for abs) on butt instead of Emsculpt protocol 2?

RealSelf actual patient comment:

I had Emsculpt on my stomach and got spectacular results, so I added my butt. On my butt the results were not noticeable. I think it is because I have more fat on my butt than I would like to have. I finished my last of 4 treatments last week. I know the protocol for the butt does not eliminate fat the way that the stomach protocol does so could I have the stomach protocol done on my butt? Or should I just have more treatments on butt?
A.Yes, you may have either the fat sparing or fat reducing settings of EmSculpt when having your glutes treated. Some patients wish to build muscle and reduce fat when lifting their glutes with EmSculpt while the majority of patients wish to build muscle and preserve the fat on their behind. Let your physician know what you prefer and you will be treated with the appropriate EmSculpt settings. Good luck and be well.

Q.What’s your advice on how to fix abdomen after pregnancy?

RealSelf actual patient comment:

I have a very small diastasis recti as well as loose skin from my pregnancy. I am 5’6 and 110 lbs. Most of the skin is below breasts and above c-section scar. Wondering if Emsculpt with Bodytite would fix my problem? Is Emsculpt something and should be done prior to Bodytite? Do these two work well together? Is there a certain order I should have these done in? Are there any other treatments out there that I should consider? Thank you!
A.We use EmSculpt to build abdominal muscle and reduce fat. Body tite is fine but is more invasive than Venus Freeze or Legacy which we use in our new moms who do no wish to have any invasive treatment, only topical. Good luck and be well, enjoy your new addition to your family!!!

Q.Emsculpt for diastasis recti?

RealSelf actual patient comment:

Hi there, when seeking a consult for Emsculpt, the technician said wasn’t a candidate because she thought I had an umbilical hernia. It never occurred to me before but I think she is right and upon research and self examination, I also think I may well have diastasis recti. I’m not sure the best course of action from but I’ve actually read Emsculpt can help heal DR?? Thoughts?? Not sure where to start.
A.Definitely have your umbilical hernia repaired prior to having EmSculpt. EmSculpt will help with diastasis recti. Good luck and be well.

Q.Does Emsculpt work for diastasis recti after a pregnancy?

RealSelf actual patient comment:

I have gotten two opinions about my diastasis recti with two plastic surgeons that recommend a surgical option, I am not ready at this moment to go under the knife. Would Emsculpt help me?
A.Yes, Emsculpt does reduce diastasis recti (the separation of the abdominal muscles) by about 11%. The company has another great technology called Emsella that strengthens the abdominal floor muscles in new moms. It restores strength, it’s the equivalent of doing 12,000 kagels per 28 minute session. Emsella is also great for urinary stress incontinence. Congratulations on your new baby!!!

Q.Can I get Emsculpt after BBL?

RealSelf actual patient comment:

I just got BBL 3.5 weeks ago and would like to get EMSculpt at some point to build muscle as well. How long do I need to wait after the BBL surgery so I don’t jeopardize the fat? My surgeon does not have experience with EMSculpt so he really couldn’t comment on my question.
A.Yes you can have EmSculpt after BBL. You may wait for 3 to 4 months after your BBL for your treatment. Make sure that the fat sparing protocol setting is used for your Emsculpt muscle buildingbutt lifitngtreatment. Good luck and be well.

Q.Will Emsculpt be safe if I have dental implants?

RealSelf actual patient comment:

I have the. “ALL ON FOUR UPPER DENTAL ARCH ” will emsculpt treatment on stomach be safe
A.Yes, EmSculpt is safe in patients who have metallic dental implants (as long as you are not treating your facial muscles!) As long as the metallic implant is more than 7 centimeters from the EmSculpt paddle surface it will not heat and the treatment is safe. Good luck and be well. Brush your teeth!!!

Q.Would Emsculpt make me loose the little fat I have in my butt?

RealSelf actual patient comment:

I am considering emsculpt but not sure if I should use it for my stomach or butt. I have a very flat butt and heard emsculpt could help because it exercises the muscle but it also says it burns fat and I cant afford to lose any fat in my bottom.
A.Fortunately there are two settings of EmSculpt for the treatment of the buttocks. For those who wish to preserve their butt volume (fat), there is a fat sparing setting. For those who wish to lose a little from their behind, there is a setting for that as well. Make sure to let your physician know prior to presenting your tush on the EmSculpt table. Good luck and be well.

Q.Emsculpt muscle spasms? Could this be a side effect?

RealSelf actual patient comment:

I recently had two emsculpt treatments to my abdominal area. I’m already fit and have a BMI around 21. The procedure was very uncomfortable and sort of painful at times because of such such contractions. A couple days after my second treatment I noticed very frequent, small muscle spasms in my legs. Could this be a side effect? Will this issue resolve?
A.Fortunately EmSculpt is a very effective and safe treatment. I have not heard of delayed muscle contractions or spasms of leg muscles after EmSculpt treatment. It is possible that you may be experiencing a very rare unreported side effect or it may just be coincidental. The issue should resolve on its own. Definitely share your symptoms with your physician who is treating you. Let us know how you are doing. Good luck and be well.

Q.Can I do EMsculpt on my abs with Essure coils in Fallopian tubes?

RealSelf actual patient comment:

I’ve had Essure for about ten years. I did Emsculpt on my butt and thighs without any issues and I’m wondering if doing EMsculpt on my abs is not advised? I know the company says metal implants are a contraindication, but from looking at Essure it seems there’s very little metal (titanium and nickel?) and I’m curious if it really is absolutely not advised in my situation? Thank you!!!
A.Not a good idea to have EmSculpt abdominal treatment if you have a metallic IUD. Best to have it replaced with a non-metallic IUD if you want to have abdominal EmSculpt.Good luck and be well.

Q.Can I do anything after the last Emsculpt treatment to improve my results? Drink water, or sauna etc?

RealSelf actual patient comment:

Emsculpt – do i do anything afterwards?
A.The best way to insure that your EmSculpt results are optimal is to maintain a healthy life style. That includes a healthy balanced diet, multivitamins, drinking at least five8 oz. glasses of water per day (stay hydrated), and regular exercise. Over 6 months, your treated area should gain 16-20% muscle mass and lose the same in fat. Good luck and be well.

Q.Nonsurgical options for lower abdomen? Will Emsculpt work?

RealSelf actual patient comment:

I have 3 kids and have developed a slight bulge in my lower abdomen that will not go away with diet and exercise. I have a fear of surgery so I have been looking into non surgical options. Emsculpt was recommended. But will it really work for this? I hate to go to multiple offices for consultations as I just don’t have the time for that.
A.EmSculpt will build your abdominal muscles and decrease your abdominal fat bulge. It also helps to bring the abdominal muscle gap that occurs after pregnancy (diastasis recti) closer together. It appears that you are a very good candidate for EmSculpt treatment. If your fat bulge does not decrease enough then a session or two of CoolSculpting may be added. Good luck and be well.

Q.Will the tear troughs improve with time once my sleep is restored?

RealSelf actual patient comment:

I am a 32 year old female. I’ve had severe insomnia for the past 10 months, and have a lost a lot of fat volume in my face, elasticity in my skin, and now have two very noticeable creases (tear troughs) under both eyes that are hyperpigmented. Also, will I recover some of the fat volume in my face once I’m sleeping again?
A.Unfortunately adequate sleep time will not restore lost facial volume. You will be best served with some Voluma volume replacement in your cheeks with possibly Restylane under your eyes. Good luck and be well. Pleasant dreams!!!

Q.What can I do for my under eye hollows, fuller lips, marionette lines and forehead?

RealSelf actual patient comment:

I’m 22 but I’ve been through many traumatic experiences and illness and consequently I’ve already damaged my “youthful” look. I have always had some serious hollow eyes, which you can’t see in the first photo due to lighting and expensive concealer. I also want to get fillers for my lips and marionette lines and Botox for my forehead (again, not visible in first photo, but lines on forehead as well as “concern” lines are becoming a serious problem.) I have added a before and after photo of me now and the results I’m looking for, as well as what I looked like before life damaged my youthful face.
A.First of all you look beautiful. Second of all, as a 24 year old friend once told me when I asked her, “Does anything on your face bother you?’…she replied, “Nothing beats youth!!!” At age 22, you should consult with a great aesthetician and have a quality skin care regimen. I ask all of my millennial patients to see Kayla, our superb aesthetician, to have a personalized skin care regimen. As far as treating undereye hollows, I would likely treat you with a very small amount of Voluma and Restylane. Less is more!!! Millennial lips are best treated with a small amount of Volbella. Forehead lines are prevented with micro doses of Botox, Dysport, or Juveau. Again, less is more, if your treatment is obvious or unnatural then your treating physician has failed you. Choose your treating physician most carefully based on their knowledge, experience, skill, and most importantly their natural artistic vision. Good luck and be well.

Q. Is more than 4 Emsculpt sessions needed? What power level should be used?

RealSelf actual patient comment:

I am intrigued by Emsculpt. I called a Dr’s office who provides it and the receptionist said that a “bare minimum “ of four treatments (at $3000!) would be needed. Everything I’d read suggested it was four treatments. $3000 is already a heavy lift for me. I don’t want to waste my time and money if I can’t afford more than four treatments. Any thoughts? What power settings should each treatment be at?
A.Emsculpt was studied treating patients with 4 30-minute sessions over a two week period. There was 16-19% muscle mass increase and 19% fat reduction. What has not been studied is the optimal maintenance regimen. We are seeing results being maintained one year out, these patients have had a fifth treatment session at about 6 weeks after completion of their series. I believe that with continued exercise and ahealthy diet/life style patients should be able to maintain their results. As with investing in speculatively in stocks or options, you never want to invest more that you can comfortably afford to lose. If you are worried about the cost, 24 Hour Fitness may be better for you, though you will be hard pressed to match the 20,000 supra-maximal muscle contractions per 30 minutes. Good luck and be well.

Q.I am not currently pregnant, but what are the consequences of a treatment overlapping a very early pregnancy?

RealSelf actual patient comment:

I am considering Emsculpt for my buttocks, however am also trying-but-not-thing to conceive with my husband. I am not currently pregnant, but what are the consequences of a treatment overlapping a very early pregnancy, as in a pregnancy that is not yet detectable on at home test? If there is a known risk I will not pursue but I’d like to gain the muscle strength from the treatment
A.There obviously have not and will not be any studies on the effects of EmSculpt on a new conceived fetus. If by chance an early fetus survived the treatments, I would imagine that the baby would have an incredible 6-pack and a butt lift to make the Kardashians jealous. All kidding aside, I would wait until after pregnancy for your EmSculpt treatment as it is also beneficial for diastasis recti (separation of abdominal muscles.) Your other option is to make sure that you are not pregnant yet, use condoms or abstinence for the two weeks that it takes to have your treatment and then get back to work with your hubby. Good luck with getting pregnant and having a healthy baby. Be well.

Q.Can Emsculpt be used for pectoral muscles?

RealSelf actual patient comment:

I would like to know if emscuplt is effective for young men, to build up their shoulders and chest muscles.
A.The strong electromagnetic waves of EmSculpt would be very dangerous directly over the heart muscle, one of the muscles of our body that we certainly do not wish stimulate with supra-maximal contractions. Unfortunately, the pectoral and other chest muscles must be built the oldfashioned way…with physically toiling. Good luck and be well.

Q.Do your female patients see Emsculpt results on abdomen?

RealSelf actual patient comment:

A nurse practitioner told me that men seem to have better fat burning results with Emsculpt than women. What are your experiences? I’m a woman looking for both fat burning and strengthening. (And it’s so expensive that I can’t afford to drop this $ for nothing). Am told am not a cool sculpturing candidate because I don’t have enough pinchable fat (fat is there! Just under the muscle)
A.We havenot noticed a difference in EmSculpt resultsbetween men and women. In general, the more fit a patient is prior to EmSculptthe better results. EmSculpt does build muscle and reduces fat. It sounds as if you are a good candidate for EmSculpt. Good luck and be well.

Q.Can you use emsculpt on hamstrings?

RealSelf actual patient comment:

I had ACL reconstruction10 years ago, with a hamstring graft. Unfortunately the “donor” hamstring remains significantly weaker and smaller than the other hamstring, despite my efforts to build it up. Is there an emsculpt protocol for hamstings? Are physical therapists using emsculpt yet?
A.Yes, Emsculpt may be used on the hamstring leg muscles. There are new EmSculpt paddles for the legs and arms that will be available to the public very soon. We have been treating our patients with the current abdominal paddles and getting excellent results. I am not aware of any physical therapists currently using EmSculpt though it makes sense to use this technology on people who are unable to workout due to various reasons. Good luck and be well.

Q.Why does it take time to see my Emsculpt results on my stomach and butt?

RealSelf actual patient comment:

How long does it take to see my results on emsculp on my stomach and butt. I had 5 sessions that ended 3 weeks ago.
A.Rome was not built in a day, nor will your ab and glute muscles build in day (or week) after EmSculpt. It takes time for muscle mass to build and for fat cells to disappear following EmSculpt treatment. Many patients find that they can feel that their muscles are more firm, some even see improvement after a few weeks. We emphasize to our patients that the muscle building and fat reduction from EmSculpt continues for up to 6 months. Good luck, be well, and enjoy your EmSculpt results.

Q.Sculptra in right cheek. Two hours after injection napped for 2 hours. Got a deep crease line from the pillow. Will this smooth?

RealSelf actual patient comment:

Had Sculptra in my face (right cheek) this morning. Got home two hours after injection and went to sleep for 2 hours. Woke up with a deep crease from my pillow right in the middle of the recipient area. Any general advice about this. For ex; how likely would it be for the crease line to pop back smooth…in general? Thank you.
A.As they say NTW, not to worry. Most of the areas where Sculptra is injected are over bone, the injections should be deep and not affected. We recommend deep massage for our Sculptra patients for 5 minutes, 5 times a day, for 5 days. This helps to increase your circulation to the area and in turn helps your body break down the Sculptra particles and replace them with your own collagen. Always best to contact your injecting physician with any questions or concerns. Good luck and be well.

Q.Is EmSculpt safe if have a small PFO?

RealSelf actual patient comment:

Is EmSculpt safe if have a small PFO? I ask since the procedure acts like an intense exercise that breaks down and rebuilds muscle fibers.
A.I copied and pasted this information about patent foramen ovale (PFO) :

Patentforamen ovale(PFO) is a hole between the left and right atria (upper chambers) of the heart. This hole exists in everyone before birth, but most often closes shortly after being born.PFOis what the hole is called when it fails to close naturally after a baby is born.PFO’stypically do not disrupt heart function and people are able toexerciseand carry out all activities normally. However, some people with PFOscanbe at an elevated risk of stroke or suffer other symptoms due to a significant drop in oxygen levels.

Emsculpt should be safe in patients with PFO since there is no aerobic increase from the treatment. To be on the safe side it is always prudent tohave your treating physician check with your cardiologist beforeyour treatment. Good luck and be well.

Q.How soon after Emsculpt should I expect results?

RealSelf actual patient comment:

I just had my second session (of four, to be spaced out over two weeks). I see absolutely no difference, but in others’ reviews, it seems like they are seeing visible results immediately following each treatment. One other woman went so far as to say that she saw she had abs the second she got off the bed after one session. Now I’m concerned that it simply isn’t doing anything for me. How long does it typically take to begin to start seeing results?
A.Like snowflakes, all abdominals are different. Some patients may see Emsculpt result sooner than others. We have had some patients notice improvement after 2-3 weeks, while for others it may take months. The technology is still too new for us to know why some patients respond quicker and better than others. Be patient as the results are usually seen about 2 to 3 months after treatment and maycontinue to improve over 4 to 6 months. Good luck and be well.

Q.Emsculpt ok on abdomen after abdominal liposuction over 8 years ago?

RealSelf actual patient comment:

I had abdominal liposuction about 8 years ago. I’d like to have 4 sessions of Emsculpt to tone up and get rid of my remaining tummy pooch. Does previous liposuction impact Emsculpt results?
A.Yes, Emsculpt works well on patients who have had abdominal liposuction in the past. Good luck and be well.

Q.What if it takes longer than 2 weeks to complete 4 sessions?

RealSelf actual patient comment:

I had my first 2 sessions as planned, 3 days apart. My 3rd session was supposed to be Thursday, but was rescheduled to Monday because the EmSculpt machine was not working. Now my Monday appt has to be rescheduled because the technician won’t be there. I have to travel for a week for work. There will be 2 weeks between my 2nd and 3rd sessions. Can I still get the results I was originally expecting? It feels unfair given that the doctor’s rescheduling. What should I do?
A.The studies on Emsculpt were done with patients having 4 sessions a few days apart over a 2 week period. We do not have enough information to tell you whether your delay in treatment sessions will affect your ultimate outcome. Since the delay was due to no fault of your own, It would be reasonable to ask your provider to give you a standard series of treatments. Since the machine was down, the company should be able to reimburse the physician the cost of running the machine. Good luck and be well.

Q.Will Emsculpt ever be covered by insurance to help my scoliosis by building my core?

RealSelf actual patient comment:

I have scoliosis which causes me to suffer with back pain and poor posture. The only treatment I can do is workout my core. It is an ongoing effort and not sustainable. Emsculpt could help me build a stronger core more rapidly and consistently. I believe this could help me heal. Will insurance ever cover Emsculpt for this reason? How can I help the process along?
A.Emsculpt is used in patients who are unable to workout due to certain conditions. Emsculpt can build muscle mass and strengthens core muscles.It would be sensible for insurance to eventually cover Emsculpt treatments in patients who are otherwise unable to workout, but who ever said that insurance companies are sensible. At this time, Emsculpt is not covered by insurance. Good luck and be well.

Q.Should 2 paddles be used on abdomen when doing emsculpt? or can 1 do the trick?

A.They say “Two heads are better than one!” With Emsculpt 1 or 2 paddles can “do the trick.” If the abdomen is wide enough to accomodate two paddles without the paddles touching each other then 2 are used. If the abdomen is not wide then one paddle is enough. In both cases the abdominal muscles are stimulated to supra-maximal contractions and the results are equivalently good.Good luck and be well.

Q.30 year rhinoplasty results are wearing down: tip projection is lowering. What can be done?

RealSelf actual patient comment:

I had a closed rhinoplasty 30 years ago to remove a hump and refine the tip. The operation was a success that it produced a satisfactory concave profile and refined tip. But over the years the shrink wrap effect has decreased the projection of the lower half of the nose (upper lateral cartilage to the tip), while the top half (nasal bone) is staying at the same height. Is it possible to re-achieve a concave profile, by shaving more on the bridge? Keep same tip, closed or open rhinoplasty?
A.Post rhinoplasty noses tend to shrink wrap over time. That is why it is essential that your initialrhinoplasty surgeon leave an adequate structural support of nasalbone and cartilage.You may either have a revision rhinoplasty or have a non-surgical filler injection to raise the tip of your nose. If you were my patient, I would try to use fillers first. Make sure to choose your injecting surgeon most carefully as previously operated upon noses have a much higher risk of complications. Should you decide upon the surgical route, once again choose your surgeon very carefully. Good luck and be well.

Q.What can I expect in the coming week after occlusion?

RealSelf actual patient comment:

Juvederm injections three days ago. No pain but obvious occlusion.Immediately small dose of hyaluronidase. Was pink and swollen over weekend but not bad. Today this developed and I’m on steroids and nitro-bid as well as doing warm compresses. This is day 3. Am under care of plastic surgeon.
A.Sorry to see that you have suffered from vascular occlusion from filler injection. Best to follow the plan of the plastic surgeon taking care of you. Inquire about more hyaluronidase at the site of where the injection caused the occlusion. The affectedd by the occlusion should get darker over the next few days, it may form little blisters as well. Hopefully the area will recover without any permanent effects. Good luck and wish you well.

Q.Could this be vascular following filler then vein ablation?

RealSelf actual patient comment:

4 months after filler. Several people said it’s vascular. Had some veins ablated 10 weeks ago. What is this?
A.If it has appeared after your vein treatment then it is likely related to that. Hopefully over more time it will resolve. Good luck and be well.

Q.Will Botox and fillers help make my face more contoured or slim?

RealSelf actual patient comment:

Naturally rounder face, wonder what will help me look more contoured? Also wondering if a non surgical nose job is something that would work for me.
A.Botox and fillers used properly should result in a more contoured facial appearance. I would not recommend non surgical nose job unless from profile view you wish to hide a bump/hump. Be sure to choose your treating physician most carefully based on their skill, experience, knowledge, and most importantly their natural artistic vision. Good luck and be well.

Q.I have 6 titanium screws at my L5-S1 lumber region and wonder if they will heat up during an abdominal Emsculpt?

A.Though metal implants are a contra-indication to having Emsculpt, many physicians have treated patients with titanium implants as titanium does not heat from electromagnetic energy. Check with your lumbar surgeon to make sure that you have no metallic implants. If your surgeon allows you to have a MRI after your back surgery then you should be safe to have Emsculpt treatments. Good luck and be well.

Q.Can I use Emsculpt if I have a bladder sling?

A.As long as the bladder sling does not have any metal parts, Emsculpt treatment should be fine. To be on the safe side, please contact your bladder surgeon and ask if there is any metal, and ask if the intense abdominal muscle contractions will adversely affect your sling. Good luck and be well.

Q.Can you advise on my treatment plan for Emsculpt on the buttocks?

RealSelf actual patient comment:

4 months ago, I received an initial treatment of 4 sessions in 2 weeks. I do strength training twice a week. If I were to buy another 4 sessions, would I see better results from spreading those sessions once every month or doing another series of 4 sessions within 2 weeks? Is there a plateau of increased muscle mass after doing the initial 4 sessions or can you continue to see subsequent increased muscle mass in doing another full set in several months?
A.There have not been any studies or clinical research on which course is better after your initial Emsculpt treatment series. We usually see our patients back about 6 weeks after they have completed their initial treatment sessions for post treatment evaluation, photos, and a maintenance session. For those patients who wish to continue their treatments we prefer to space them a month or two apart. Good luck and be well.

Q.What happens if you get a pimple on a filler treated area? Will it leave a hole or damage the filler?

RealSelf actual patient comment:

Is it possible that pimples on (HA) filler treated areas leave holes or negatively impact my results?
A.No need to worry. having had filler in the area will not affect how a pimple heals. Please make sure that the “pimple” is not an infection from the filler injection (more likely if you have new “pimples” in the places where you were injected.) Although many of my dermatology colleagues love to say, “Popping pimples never gets old!”, please do not “pick” your pimples to avoid scarring. Good luck and be well.

Q.What longterm treatment should I get for this texture on my face? Are these pores or scars?

RealSelf actual patient comment:

Hello! I’m wondering what kind of treatment I should get for this texture on my skin. The photos are with makeup on, I’ve had microneedling in the past and IPL and chemical peels. I want long term results. Also would you describe these as pores or scars ?
A.It appears that you have small scars causing the uneven texture of your skin. I would recommend a series of fourFraxel restore laser treatments spaced about 3 weeks apartwith a small amount of Sculptra injected beneath the areas of your scars. Choose your treating physician most carefully. Good luck and be well.

Q.Is raised upper lip line inevitable or can it be avoided?

RealSelf actual patient comment:

Hello docs I have had approx 2cc’s of Juvederm Ultra injected into my lips over approx 2 months. It had been over a month since my last injection. I am wondering if the upturn on my upper lip (raised lip line area, especially at Cupid’s bows) is avoidable. Wondering if this is a stylistic thing or something that is inevitable with fillers. Ideally (in my opinion) this would be a smoother transition between skin and lip. Any answers/feedback are much appreciated!
A.Lip augmentation with fillers is both artistic and technical. It appears that your lip augmentation has emphasized your lip border which is causing the upturn. This result is not inevitable with lip injections, you are correct, it is a stylistic thing.I would share your preferences with your lip injecting physician in the future to keep your lips a bit more natural in appearance. Your lips look relatively good at this time so I would not advise dissolving any of your filler. Good luck and be well.

Q.I’ve had several laser treatments and chemical peels and now I have orange peel skin. What can I do?

RealSelf actual patient comment:

I have had several laser treatments. Chemical peels. It seems like every time something heals my pores come back worse. What can I do? I want my confidence back
A.I would likely treat you with a combination of microneedling with PRP (platelet rich plasma) and injection of Sculptra below the affected skin areas on your cheeks. If your chin is affected then Botox works well in that area. Good luck and be well.

Q.Is rasping after rhinoplasty typically performed just under local anesthesia?

RealSelf actual patient comment:

I need rasping done to take down a callus that formed on the bridge of my nose after rhinoplasty. I’m very nervous about going through the procedure just using a relaxation pill due to the numbing process and hearing the rasping taking place. Is this something typically performed just under local anesthesia and how do patients typically handle the process when awake?
A.Nothing funny about having a little more rasping of your dorsal nasal hump after previous rhinoplasty.

The procedure can be done in the office under local anesthesia with or without pain meds and Xanax, or it can be done under anesthesia in the operating room. The advantage of doing it in office is saving the cost of the operating room and anesthesiologist fees, but if you’d rather not hear or see any of it, you may pay more and have general anesthesia. Good luck and be well.

Q.Is this a typical upper blepharoplasty incision? I am concerned with excessive length.

RealSelf actual patient comment:

I am almost 2 wks postop upper bleph & concerned that my incisions are very long (extending 1/2 in. outside my eyelid which is hard to hide). I thought that incision would be isolated to eyelid & I’m very concerned with scarring/future appearance. For reference, this eye did not have significant hooding (my other eye did but the incision is not quite as prominent on that eye although also a bit long). I know I have lots of healing left to do but wanted to get a consensus before returning to Dr.
A.Yes, your incision is normal length, not to worry, within a few more weeks the scar should be minimal, once your incision line color returns to normal skin color it will be very difficult to see. Good luck and be well.

Q.Is it normal to have jaw soreness, trouble chewing and swallowing after Botox?

RealSelf actual patient comment:

I recently got 42 units of Botox in my forehead, bunny lines, brow lift and crows feet.About 3 days ago. Since then, I’ve had trouble swallowing, chewing and overall soreness in my jaw and feel like I can’t really move my mouth. I have seen other posts on here saying it’s not related but find it strange that 3 other people have reported the same problem. What should I do?
A.The small dose of Botox that you have received should not cause the adverse symptoms that you have been experiencing. I would advise you to contact your injecting physician and discuss. Most likely your symptoms should resolve on their own. Good luck and be well.

Q.Are my lips swollen or are they that big after Juvederm?

RealSelf actual patient comment:

i just got my lips done on friday at 4pm. It is now monday and i still feel like my lips are huge, especially the top. Igot 1 syringe of Juvederm and i’m wondering if someone can tell me if its swollen still or if they are that big. Please help. It’s Monday 7pm now
A.Your lips are very swollen 3 days after Juvederm. The size of your lips is much greater than what 1 cc of Juvederm would look like unless your lips were very large to begin with. Iwould discuss this with your injecting physician. Good luck and be well.

Q.Liquid nose job or traditional rhinoplasty? Bothered bulbous tip of my nose as well as the slight hump.

RealSelf actual patient comment:

I have been bothered by the bulbous tip of my nose as well as the slight hump for some time. I would like a more refined tip and a more narrow bridge. I am considering either a traditional rhinoplasty surgery but if I could get similar results with filler that would be my preference.
A.I wouldadviseyou to stick with traditional rhinoplasty as liquid rhinoplasty adds volume to your nose and will not address your concerns regarding your bulbous tip. Be sure to choose your rhinoplasty surgeon most carefully. GoBlue!!! Good luck and be well.

Q.Can Injectable fillers be used on nipples?

RealSelf actual patient comment:

After a vacuum expansion session on nipples, can a dermal filler be used to keep the nipples enlarged?
A.Yes, fillers can be used to enlarge and perk up nipples. Many professional dancers use this filler method to make their nipples more prominent. Good luck and be well.

Q.How long after the first Emsculpt treatment do you see results?

RealSelf actual patient comment:

I just did my second sessions and don’t see much of a difference.
A.Most Emsculpt patients can feel firmness in their muscles before they can see actual results. We have had some patients who see some improvement early but the majority of patients see their results about 4 to 6 weeks after their last session (complete treatment is 4 thirty minute sessions over two weeks.) We see our Emsculpt patient back about 6 weeks for their post treatment photos at which the majority see and feel increased muscle tone and decreased fat. It does continue to improve for months after the treatment. Good luck and be well.

Q.I had bad results from Smart Lipo on my abs and have scar tissue inside. I want to try Emsculpt to break the scar tissue.

RealSelf actual patient comment:

Emsculp will help? Please advise.
A. Unfortunately Emsculpt will not break up scar tissue from previoius abdominal liposuction. I have seen the appearance of uneven lumpy abs from previous liposuction improve after Emsculpt. It is thought that the increased muscle mass and tone improves the appearance of the abdominals. Good luck and be well.

Q.I have metal pins along side of my femur bone. Is it safe for me to have Emsculpt?

RealSelf actual patient comment:

I had a broken femur bone and the surgeon put a rod and pins along side of my femur bone. The rod was removed in 1972 but the pins remain. Is it safe for me to have EMSCULPT on my butt and stomach?I have heard that it is safe to have EMSCULPT if you have metal in your body as long as the machine is not placed over the area where the metal is. Should I have an x-ray first to see exactly where the metal pins are? I’m hoping to find a Doctor in New York, NY that performs EMSCULPT. Thank you for your answers.
A.If the pins in your femur are truly metal then you should not have Emsculpt. If they are titanium then and your orthopedic surgeon has said that it is okay for you to have MRI’s then you should be able to have Emsculpt. Be sure to discuss with your physician at your consultation. Good luck and be well.

Q.Can I get Emsculpt while on my period?

A.We advise our female Emsculpt patient to try to schedule their abdominal Emsculpt treatments around their menstrual cycle, though it is not an absolute contra-indication. There is the risk of increased cramping, flow, and discomfort when treating patients with Emsculpt who are menstruating. Treating the buttocks while menstruating is safe. Good luck and be well.

Q.My nose looks like it was punched to the side 10 days post op. What’s going on?

RealSelf actual patient comment:

I had a rhinoplasty and septoplasty 10 days ago. The goal was to straighten my nose, correct my very deviated septum, and straighten my nostrils. He had to rebreak my nose and also used grafts. My nose literally looks like it was punched in the opposite direction. I am freaking out. It appears to be even more distorted than it was presurgery. Any idea what may be going on. This looks absolutely terrible. What’s going on? Help!
A.Best to consult with rhinoplasty surgeon at this point. There is not anything to be done to your nose at such an early time after your surgery. If your concerns are still present in 6 to 12 months then you have your nose re-evaluated. Good luck and be well.

Q.Will temple filler and neurotoxin be able to balance my eye and brow asymmetry?

RealSelf actual patient comment:

One eye side is flatter than the other due to different bone size and has always been that way. But over time I notice the right temple is getting more hollow and the asymmetry is getting worse. The outer corner of the right eye isn’t as “pulled up” or cat eye angled like the left one. Surgery isn’t an option for me right now. I have had one or two units of Botox to “lift the tail” but I don’t think it did much. What are some noninvasive ways to bring more harmony and balance?
A.I would use fillers and neurotoxin (Botox) to balance your face. I would likely start with Sculptra to your righttemple and and lateral brow. There are other fillers that may be used should they be required. Be sure to choose your treating physician based on their knowledge, experience, skill, and most importantly their natural artistic vision. Good luck and be well.

Q.Is this nose job possible for me? Rhinoplasty

RealSelf actual patient comment: (Patient included her photos and Monroe’s)

Could I achieve Marilyn’s results based off what I’m starting off with. I’d definitely like to retain the bulbous-ness but would that work out proportionally? Thank you!
A.Noses are like snowflakes, no two snowflakes are the same, the same holds for noses. I appreciate when patients know what bothers them about their nose and what they would like. Together at consultation we discuss these things and devise a plan to help our patients achieve their aesthetic rhinioplasty goals realistically. Computer imaging is used to preview what rhinoplastyresults could be expected so that our patients have realistic expectations prior to their surgery. That said, I believe that rhinoplasty can help you achieve your goals. Rhinoplasty is not a “commodity”, it is essential that you consult with rhinoplasty surgeons and choose your surgeon based on their skill, knowledge, experience, results, and most importantly their natural artistic vision. Good luck and be well.

Q.Does Emsculpt actually make you stronger?

RealSelf actual patient comment:

Does Emsculpt actually make you stronger? I’m having trouble strengthening my leg from knee surgery. I’m wondering if I have Emsculpt treatments done on that thigh, would it help me strengthen my upper leg muscles?
A.Yes, Emsculpt not only builds muscle mass and reduces fat but also stregthens the muscles treated. We have treated patients who are rehabilitating from injuries and have been pleased with their results. Good luck and be well.

Q.Does this work on visceral fat? I have been told that liposuction will not work on visceral fat.

A.Unfortunately Emsculpt does not reduce visceral fat. Diet and exercise are the best way to reduce the fat that lies beneath your abdominal muscles. Good luck and be well.

Q.Will Emsculpt work for me If I have some flaccid skin ? I have more fat than skin. My skin doesn’t hang…

RealSelf actual patient comment:

I also have a hernia that’s going to be removed before having the procedure done & I was told that I have some diastasis recti
A.First and foremost, have your hernia repaired. The hernia repair should help with your diastasis recti. Once you have recovered and your surgeon gives you clearance, then you may have Emsculpt to help build your muscle mass, strengthen your core muscles, and decrease some fat. You may also benefit by combining Emsculpt with other skin tightening and fat reducing technologies such as Venus Legacy, CoolSculping, etc. Good luck and be well.

Q.Can you use Emsculpt if you have metal tooth implants or gold teeth?

A.It is safe to have Emsculpt with metal tooth implants and/or gold teeth as long as they are greater than 7 centimeters from the treatment paddles. Good luck and be well.

Q.What happens if you only do one emsculpt treatment, or just less than the recommended minimum number, or weeks/months in between?

RealSelf actual patient comment:

What happens if you only do one emsculpt treatment, or just less than the recommended minimum number, or weeks/months inbetween? Does the procedure need to be done multiple times in a short timeframe to be effective?
A.There have not been any studies on the effect of just one Emsculpt treatment. For those who only have one treatment I believe that there should be some benefit from stimulating your muscles to contract 20,000 times in 30 minutes. It is like they say about treating a cold with chicken soup, “It couldn’t hurt!” Some have found good Emsculpt results with one treatment per week.The studies and treatment protocol for Emsculpt effectiveness are based on four 30-minute Emsculpt sessions over a two week period. Good luck and be well.

Q.Is Emsculpt for everyone? Or only those who workout regularly and already have good muscle mass?

RealSelf actual patient comment:

Not sure that muscle “mass” is the right term but I am wondering if emsculpt is actually for everyone? I’ve had 3 sessions on my butt now and 2 on the abs. It has done SQUAT for me! I am not a regular in the gym and definitely don’t have a good muscle definition generally speaking in my body (be it arms, legs, core anywhere). Think I might have wasted the money!!
A.Emsculpt works well for almost everyone. It is important that prospective patients be carefully examined and evalulated prior to their treatment. It does work well on those who are not regulars in the gym, we have even found it beneficial in patients who are unable to work out because of other problems (injuries, etc.) Although some patient may see results as early as a few weeks, the muscle building effects of Emsculpt continue for months after your last treatment. Give it at least 2 months, at which time you should have your follow up appointment with your physician to compare before and after photos as well as having an additional “maintnenance” treatment session. Good luck and be well.

Q.Can you affect the intensity/results of the treatment by stretching out your muscle?

RealSelf actual patient comment:

Can you affect the intensity/results of the treatment? e.g. if you stretched out your muscle more like putting your arms above your head, is the treatment more intense/encourages the muscle to develop differently? I want a tighter core, not a thicker one Also does the treatment only target the abdominal muscle? Thank you
A.Emsculpt works by electromagnetically stimulating the nerves of the abdominal and Gluteal (buttocks) muscles resulting in supra-maximal muscle contractions which in turn increases muscle mass and tone and decreases superficial fat. There have not been any studies comparing the results of Emsculpt while stretching versus being relaxed. We recommend that patients relax as it is the muscle stimulation and contraction that causes the benefits of the treatment. Other than the abdomen, the buttocks, thighs, and calfs are currently also being treated. Emsculpt has just announced new smaller curved paddles specifically to treat the arm biceps and triceps as well as the inner thighs. Good luck and be well.

Q.Is the Emsculpt treatment ‘wasted’ if you are dieting? Would someone on a big calorie deficit not really benefit from it?

RealSelf actual patient comment:

From what I hear Emsculpt is like a really strenuous exercise, so would someone on a big calorie deficit not really benefit from it? Because the muscles wouldn’t be able to grow?
A.Emsculpt will build muscle mass and reduce fat in patients who are dieting. The treatment will add to the benefits of your diet, exercise, and weight loss program. Good luck and be well.

Q.Will Emsculpt destroy the fat graft to my buttocks?

RealSelf actual patient comment:

I recently had a lower body lift and fat graft to my buttocks and I love the result, however subtle. I think I have retained about 30% of the fat taken from outer/inner thighs. I do exercise regularly but I find it difficult to gain muscle, especially now at 52. Emsculpt for buttocks (and off label thighs?) is an appealing idea to build a bit more projection under the fat, I just don’t want to lose the fat that I have. Is this possible?
A.Emsculpt builds muscle in the buttock and may preserve fat when used with the proper settings on the device. Many patients wish to build their gluteal muscles, lifting their buttwhile preserving the fat volume of their glutes. If a patient wishes to both build gluteal muscle and reduce fat, then a different treatment protocol is used. Be sure to discuss this with your Emsculpt physician prior to your treatment. Good luck and be well.

Q.Will another Fraxel help fix this texture, depressed marks, lines, etc?

RealSelf actual patient comment:

I have bad Fraxel results from Fraxel Restore.I got fraxel restore 11/21/2018, I have had fraxel’s in the past many years ago . All the lasers I have had in the past were ablative. I got horrible results from this fraxel, my face is super tight like I got a face lift, massive orange peel texture on my forehead, upper cheeks and around my mouth. On the lower half of my cheeks it looks like I have small slits, and some white lines. Would another fraxel fix this problem. I didn’t have this prior to having this restore.
A.It is difficult to answer your question without knowing the settings of yourlaser treatment and whether the laser was an authentic Fraxel laser. Usually 4 months after a Fraxel restore treatment the facial skin has recovered. Best to consult with a laser expert for an in person evaluation for what your best options to resolve your concerns would be. Good luck and be well.

Q.Is it safe for me to get Emsculpt on my abdomen after laparoscopy?

RealSelf actual patient comment:

I had a laparoscopic myomectomy 4 weeks ago (2/7). 7 fibroids removed (1 big, almost all pedunculated). Healing perfectly so far. My surgeon cleared me today to resume all exercise (boxing, strength training, etc.). I want to do Emsculpt on my abdomen but need to know when it will be 100% safe for me to do it? I don’t want to ask my surgeon, I’m worried she might judge me… (she’s wonderful, never been judgmental, I just feel embarrassed asking about cosmetic procedure). Thank you
A.Prior to having your Emsculpt treatment sessions you must get clearance from the surgeon who did your myomectomy. If you have been cleared for all exercise as you have stated then you should be fine for Emsculpt. I would advise calling your surgeon to make sure, and also make sure that they did not use any metallic staples during your surgery. Good luck and be well.

Q.Are there any devices that can tighten & lift the skin of the lower face drastically, almost as well as lower face lift?

RealSelf actual patient comment:

I’m 32 years old and a few years ago I had Botox in my jaw for TMJ. I feel the practitioner was too aggressive with the Botox. I don’t grind my teeth anymore, but now my lower face is starting to prematurely sag. I’m getting deep laugh lines and my lower face looks and feels heavy. I’m hesitant to do a lower face lift since I’m still young. Are there any skin tightening devices that can correct this issue? Profound radiofrequency? Lasers? Or would you recommend a lower face lift?
A.There are a few technology non-surgical devices that can lift and tighten the skin and muscles along the jawline, lower face, and neck. In patients who are experiencing the earliest signs of facial aging, sagging skin, and jowling, I recommend either Profound RF with PRP or Ultherapy. If you are able to have one week of downtime due to swelling and bruising then I would recommend Profound RF, if not then you could have an Ultherapy treatment which has no downtime. As with any facial aesthetic treatment, please be sure to choose your treating physician most carefully based on their skill, experience, knowledge, and most importantly their natural artistic vision. Good luck and be well.

Q. Is there a difference between the FDA approved ‘Flex Belt’ and EMSculpt, besides cost? And if so, what is it?

RealSelf actual patient comment:

The only difference that I can tell is that the Flex belt can only claim to strengthen your muscles, while EMSculpt can claim to build muscle and lose inches off your waist, but don’t both use EMS technology?
A.The Flex Belt does stimulate muscles at a much lower intensity than Emsculpt. The Flex Belt causes about 150 abdominal muscle contractions per 30 minute session while the Emsculpt stimulates 20,000 supra-maximal abdominal muscle contractions per 30 minute session. The Flex Belt does not decrease abdominal fat while the Emsculpt decreases abdominal fat by about 20%. The Flex Belt requires constant repeated sessions while the Emsculpt uses 2 sessions per week for 2 weeks. Clinical research studies have proven that a series of Emsculpt treatments result in 16% increase of muscle mass and 20% decrease in fat. Good luck and be well.

Q.Would botox be able to fix uneven eyebrows?

RealSelf actual patient comment:

My right eyebrow is way higher than my left eyebrow. It really irritates me! Is botox the right treatment to fix this issue? Will it bring up the left eyebrow? Thanks !
A.Botox can treat uneven eyebrows. It is easier and more reliable to lower the higher brow. It is more risky to raise the lower brow. Either way it is most important to choose your injecting physician very carefully based on their skill, experience, knowledge, and natural artisitic vision. Botox and fillers are not just another “commodity” rather beautiful consistent results are a function of both theart and science of the physician. Goodluck and be well.

Q.Turning 34 and noticed a loss of volume in my face. What’s the best filler for under eye circles and sagging face?

RealSelf actual patient comment:

I had restylane just a month ago , didn’t think it helpedunder my eye area, my eyes still look very tired. What’s the best filler for under the eye? Or was one syringe not enough? I was recommended to instead I get my cheeks bone for a lift? Am I a candidate for surgery to correct under my eye area? Any suggestions please. I’m very unhappy. Thanks
A.Great question as many of our patients in their 30’s to 40’s share your concerns. From about age 25 on the face loses volume, mainly from facial bones and fat, that is what causes early facial sagging. The best treatment to reverse these early signs of aging in young patients is to restore the lost volume. The most important aspect of any aesthetic treatment is to make sure that you carefully choose your physician based on their skill, expertise, experience, knowledge, and natural artistic vision. If you were my patient I would use 1 to 1.5 cc of Voluma carefully placed on your cheek bones. When injected properly, Voluma corrects facial sagging, and without injecting directly in the under eye hollows and nasolabial folds (smile lines), Voluma improves the tired appearance of those areas as well. It may also improve the corners of your mouth, jawline, and jowls. Once the Voluma is in place, if needed, a small volume of Restylane can be used in the eye hollows. In some patients with volume loss around their mouth, RestylaneDefyne is used to restore their natural beauty in a healthy restful manner. Again, choose your injecting physician most carefully. Good luck and be well.

Q.Can you do a lip lift by Ultherapy?

RealSelf actual patient comment:

Can Ilift my upper lip by doing Ultherapy around my mouth? Is it safe to be done there? Any details and what I should expect of this procedure?
A.Ultherapy has been used on the upper lip for lifting and wrinkles. I have seen patients who have responded very well with nice lifting, and others have not had the results that we were looking for. The treatment is relatively quick and easy though when I perfom Ultherapy on the upper lip I use the maximum number of pulses which results in significant lip swelling for a day, two, or three. If your lip bothers you enough then it is worth trying Ultherapy to lift it, just know that the results cannot be guaranteed since the results vary from patient to patient. Good luck and be well.

Q.My nose is Bulbous and long. How can I fix it? Is there a way where I can fix this but without it looking botched.

A.A bulbous tip is corrected by rhinoplasty. The most important aspect of your surgery is carefully choosing your rhinoplasty surgeon based ontheir expertise, experience, skill, knowledge, and natural artisitic vision. Good luck and be well.

Q. If Vitrase is injected directly under the eyelid, can it migrate around the orbital rim?

RealSelf actual patient comment:

I had some vitrase injected directly under my eyelid where I have had puffiness from the area being aggravated and over-filled. It dissolved the filler that led to the puffy look under my eye, but also left a significant indentation to the right of my outer eye. I realize this can be filled and corrected but I’m still distressed. If an aggressive dose of vitrase is placed under the eye, is it common for it to affect the entire orbital rim up to about 1/4 inch from the other eyelid?
A.Yes, it is probable that vitrase caused your indentation. If you wish correction, either return to your injecting physician or choose a new injecting physician carefully based on their expertise, experience, skill, knowledge, and natural artisitic vision. Good luck and be well.

Q.4 weeks post op Septorhinoplasty. Can I get my ears pierced after my Rhinoplasty?

RealSelf actual patient comment:

I am almost 4 weeks post my septorhinoplasty, and I wanted to get my third and fourth ear lobe piercing. I was wondering if this should be avoided and if it will impact the healing process even though it is not around the nose.
A.Pierce on! There is no problem with piercing your ears a month after your rhinoplasty. Good luck and be well.

Q.Can you get Emsculpt on your glutes if you have a copper IUD?

A.Metal implantswithin7 centimeters of the Emsculpt treatment areaarea contra-indication for Emsculpt treatment. Each of our Emsculpt patients are examined and evaluated on an individual basis.Dependingon their anatomy some may betreated,others not. We are more likely to treat the gluts than the abdomen.There are some practicioners who will treat women with acopperIUD, our policy has been to avoid treatment until the IUD has been removed or replaced with a non-metalic alternative if it is located within 7 cm of the Emsculpt treatment area. Good luck and be well.

Q.Will 8 Emsculpt sessions for buttocks firming, rather than the recommended 4 sessions, yield significantly better results?

RealSelf actual patient comment:

My backside is pretty flat, so my esthetician recommended I complete 8 Emsculpt sessions in a three week period. I can see some improvements in the first two weeks (six sessions). Are two more necessary right now? Or might it be better to use those for maintenance in a few months? Other posts I’ve read on here suggest diminishing returns after the initial four sessions.
A.It’s like they say about chicken soup, “It can’t hurt!” The recommended Emsculpt protocol is based on the clinical studies where patients were treated twice a week for two weeks, a total of 4 30-minute sessions. In your case, if you are seeing nice results after 2-4 sessions, you may wish to wait 2 to 3 months before your next session, and spread the remaining sessions over 2 to 3 month periods. Good luck and be well.

Q.Does Emsculpt reduce cellulite or is there a better approach for this?

RealSelf actual patient comment:

I am 41, BMI 21, healthy eating, doing crossfit and HIIT. I have a 4 pack in my upper stomach with some nice side definition, and even my lower abdomen is generally pretty flat. However, the skin on top of my abdomen is no longer right as it used to be. In certain light it looks like a thin layer of cellulite (or just loose skin?) on top of nicely-defined muscles below. This is what I would like to target – so my stomach looks “young” and tight again. What would you recommend for this? Thanks!
A.Emsculpt will build muscle and reduce fat. It does not treat cellulite. With increased muscle mass some of the loose skin slack may be improved after Emsculpt. We treat our patients who havethelax abdominal skin that you have described with a combination of Venus Freeze (radiofrequency heat that tightens skin) and Emsculpt (to build the muscle.) Each patient should be examined and a treatment plan tailored to their specific needs. Good luck and be well.

Q.Can only manage one EmSculpt session a week for 4 weeks. Is this possible/advisable?

RealSelf actual patient comment:

EMSculpt, 4 sessions spaced in two weeks. Unfortunately my nearest center is 500 kms away , so I can only manage one sesión a week, for 4 weeks. Is this posible/advisable? or may compromis the final result? Thank you
A.The Emsculpt protocol was studied with 2 treatments per week for two weeks. Having 1 treatment per week for 4 weeks was not studied, but practices who have treated some patients on that schedule have reported excellent results as well. I do not believe that your results will be compromised. Good luck and be well.

Q.Can I do Emsculpt if I want to get pregnant in a few months?

RealSelf actual patient comment:

Is the electromagnetic too strong for the ovaries? Thanks!!
A.Emsculpt is completely safe if you are planning to get preggo in the next few months. The electromagnetic wave energy of Emsculpt causes the nerves of muscles to be stimulated which in turn causes the abdominal and glutteal muscles to contract supra-maximally. Fortunately, organs such as the uterus, ovaries, and fallopian tubes do not have muscles that are stimulated by Emsculpt energy. Good luck with your future plans and be well.

Q.Can I have Emsculpt done with a copper IUD?

RealSelf actual patient comment:

I have my first Emsculpt treatment today. When I signed the consent form it asked if I had any metal in my body such as an IUD. I said I had the Paraguard IUD and the nurse said BTL rep said it was ok and would not effect treatment. I didnt have any issues after the treatment but in doing research I am reading contradictory answers. BTL website does not have any information on it either.
A.Metal implantswithin7 centimeters of the Emsculpt treatment area is a contra-indication for Emsculpt treatment. I am happy to hear that you did not suffer any adverse effect from your treatment. There are some practicioners who will treat women will IUD, our policy has been to avoid treatment until the IUD has been removed or replaced with a non-metalic alternative. Good luck and be well.

Q.Are there any doctors doing Emsculpt on thighs?

RealSelf actual patient comment:

I’m wondering if I am able to have Emsculpt done on my thighs? I had knee surgery done about 8 months ago and my legs are very weak. This would be amazing to help me strengthen my leg before returning back to playing sports. I just had Emsculpt done on my stomach and my core went from weak to strong in just a week. The doctor that preformed my Emsculpt doesn’t have a option for thighs.
A.Yes there are some doctors who are treating the thighs with Emsculpt. Emsculpt of the thighs is an “off-label” use, yet providers have found it to be safe as long as there are no metal implants in the area. We have also found that many of our patients state that during their buttock Emsculpt treatments they feel some quadraceps contraction and strengthening. Good luck and be well.

Q.I had two back to back pregnancies. My sons are now 5 and 4 years old. The rest of my body is firm but my lower abdomen.

RealSelf actual patient comment:

I have some extra fat on my lower abdomen. It doesn’t matter how much weight I lose it’s there. Could it be hormonal? Or from pregnancies? It’s not justloose skin, it feels like fat to me. It’s soft. Will Emsculpt help me?
A.Emsculpt is an excellent safe, easy, effective and quick treatment for improvement of post-partum tummies.You should be examined by an Emsculpt physician to determine if you are a good candidate for the treatment. In general it sounds as if you should benefit from Emsculpt. Emsculpt builds muscle and reduces abdominal fat by about 20% afterfour30-minute sessions over a two week period. You may also benefit from a targeted CoolSculpting treatment. Good luck and be well.

Q. IsEmSculpt safe for patients with metal tubal ligation clips?

RealSelf actual patient comment:

I’m getting EmSculpt on my buttocks and I had my first session today. I have metal clips on my fallopian tubes from a prior tubal ligation surgery. My doctor’s office said I should be fine but I felt slight cramping in my lower pelvic area during the treatment that happened around 6 hours ago, and as of now my pelvic area feels much more sore than my buttock area. I cannot find any information on this online, and I have contacted BTL with my question but have not heard back.
A.Metal in the body close to the Emsculpt treatment area can heat up from the electromagnetic energy. In your case, especially with your lower pelvic cramping I would advise that you not continue your Emsculpt sessions. Good luck and be well.

Q.Does Emsculpt tighten skin? Does it help with cellulite?

A.Emsculpt is a clinically proven safe, effective, quick, and easy non-invasive treatment that builds muscle in the abdomen and gluteus muscles (that would be in the butt Bob), and reduces fat when desired. As muscle builds, there is usually a small amount of improvement in the slack of the skin, though I would not use it as a stand alone treatment to tighten skin or help with cellulite. In our clinic we add Venus Freeze or Venus Legacy as a complimentary adjunct to Emsculpt in patients who have loose crepe’ skin or cellulite. Excellent question!!! Good luck and be well.

Q.What’s your opinion on this Emsculpt protocol?

RealSelf actual patient comment:

Went for Emsculpt consult and I have some questions about there protocol. Need help to see if it’s necessary. Went in for emsculpt consult and they said it’s 3200 for 4 sessions and it will be done in 2 weeks. They also said i need to come in every month for one touch up for an additional 2400 for entire year. Is that one session every month necessary after the initial 4 sessions. Am I getting a good price/deal?
A.The initial treatment price is the standard price of $800 per treatment session. The additional 11 treatment sessions for $2400 works out to $218/session which is a good price. For the best deal, ask your provider to give you the $218/session treatments first…just kidding. There has not been studies to document the difference between sticking to just 4 sessions vs. the additional monthies for a year. I would imagine that the more treatments, the better the result. Some practices will offer their patients an Emsculpt “membership” plan which allows them to have unlimited treatment sessions.Good luck and be well.

Q.Can I get Emsculpt after Sculptra in the buttocks?

RealSelf actual patient comment:

Is it possible to do Emsculpt for the buttocks after having received Sculptra? Anyone with experience on this? If so, is there a recommended time frame between the two procedures? Or perhaps reversed – Emaculpt first, followed by Sculptra to address any cellulite? Would like the lift and increase in muscle, but also the possibility of minimizing appearance of cellulite. Thank you!
A.Yes you may have both Sculptra and Emsculpt on the same tushy. Sculptra is not affected by Emsculpt and vice versa….no ifs, ands, or butts about it!!! Good luck and be well.

Q.Can I have Emsculpt with a small umbilical hernia?

RealSelf actual patient comment:

I have a small umbilical hernia. I have no pain or problems. Just an outty where it use to be in. I am postpartum 3 pregnancies and would like to have emsculpt done,is that possible or could it cause it to rupture? I am 5 months postpartum at this time.
A.If you were my patient I would have you see a general surgeon for examination of your umbilical hernia, and ask for clearance for the Emsculpt procedure. Emsculpt is a great procedure for postpartum women as it strengthens the abdominal muscle and helps to diminish the diastasis recti. Good luck and be well.

Q.Is it normal to be very itchy after Profound?

RealSelf actual patient comment:

I had the profound treatment on my lower butt and thighs 9 days ago and I am very very itchy. The skin is completely healed and all the bruising is gone, but the itch! Is this normal?
A.It is best to contact yourtreating physician when experiencing any untoward reaction after a treatment. Most patients are not severely itchy after Profound. Most likely an oral antihistamine for a day or two will take care of the problem. Good luck and be well.

Q. Is Profound RF treatment safe for Fitzpatrick 4 skin type?

A.Profound RF is safe on all skin types including darker skin types such as Fitzpatrick 4. Most importantly choose your treating physician most carefully based on their skill, experience, knowledge, and natural artistic vision. Good luck and be well.

Q.Is it safe to have a facelift in a few years after having a skin tightening procedure like Profound?

RealSelf actual patient comment:

I am considering getting Profound RF but had a consultation with a plastic surgeon who warned about a patient who had undergone such a treatment and then subsequently had a facelift who suffered necrosis on her face due to underlying scarring caused by the heat used in the procedure. Have any of you seen this? He warned not to have any skin tightening procedures if I was ever planning to have a facelift down the road. Is this a concern for Profound?
A.I have never seen or heard of a patient who had problems with a facelift after having had a previous Profound treatment. Thousands of patients have had Profound RF and I am fairly certain that we would be hearing much more about this complication if it were occuring. Necrosis of a skin flap after facelift surgery may be related to the patients health, their smoking history, and the surgeon leaving the flap too thin or too tight. Patients should always share their past history of medical problems and treatments with their facelilft surgeon prior to surgery to ensure a safe and excellent outcome. Good luck and be well.

Q.Will RF treatments help soften scar tissue from lower face liposuction?

RealSelf actual patient comment:

i had face liposuction. Looked great until scar tissue started to form two – 4 weeks later making me more swollen and worse than before. My Dr. said that rf will soften scar tissue. Can Ido RFtwo-three months after this procedure? Any difference betweenFractora, Profound, Exilis etc?
A.We do use radiofrequency in patients after neck surgical treatments to tighten and smooth the skin. In our practice we use Venus Freeze for this purpose. Exlexis and VF are non-invasive while Fractora and Profound use needles and are minimally invasive with more recovery time. Good luck and be well.

Q.I had Profound RF performed on a swollen area, on my upper lips, received multiple passes on another area. What should I do?

RealSelf actual patient comment:

2 wks ago I asked about canceling Profound RF b/c I was swollen a/f being bumped in the mouth 2 days earlier. The nurse assured me that it was fine & wouldn’t change my results. Then she did my treatment unevenly- 2 passes on non-swollen side & 1 pass on swollen area. Also did my upper lip. 2 pass side stayed red & still burns. My lips have large depressions & the swollen areas never got red or had any tightening sensation like everywhere else. What should I do?
A.I would speak with the physician who had the nurse treat you. You need to be evaluated. It is difficult to answer your question without photos. Good luck and be well.

Q.Is Emsculpt safe with Skyla IUD?

RealSelf actual patient comment:

I have a SKYLA IUD, which is made of plastic but has a silver ring near the tip. Is it safe for me to do emasculpt on my abdomen? Thank you
A.Emsculpt is contraindicated in patients with metal implants because they may heat from the electromagnetic energy and cause a burn. If your IUD is completely plastic then it would be safe. I would not treat you if there is silver. We have had patients who had their IUD’s removed prior to their Emsculpt treatment. In that case, unless your looking to have kids, use an alternative method of birth controll. Good luck and be well.

Q.Can I get Emsculpt if I had gallbladder removal surgery 20 years ago?

RealSelf actual patient comment:

After having laparoscopic gall bladder surgery as a teenager there were some small metal staples/clips left in place as is standard in the procedure. I’m not sure of the exact location of the metal (nor its makeup) and how close it would be to the Emsculpt abdominal treatment area. Is Emsculpt a possibility for me?
A.In general, Emsculpt is contra-indicated in patients who have any metal implants. There are some providers who have safely treated patients with Titanium staples from previous surgery as it is felt that titanium does not heat upfrom elctromagnetic energy. It is essential that prospective Emsculpt patients share with their treating physician all implants in their body to ensure a safe treatment without adverse complications. Good luck and be well.

Q.Small Platinum coil in adrenal gland- it’s non-magnetic- is it ok for Emscuplt machine?

A.In general, metal implants are a contraindication for Emsculpt treatment. The danger is that electromagnetic energy may heat the implant which could cause internal burns. Though all metalic implants are contraindicated, there are some types of metal implants that do not attract the EM energy and do not heat up. Patients considering Emsculpt treatments must discuss any metallic implants with their treating physician prior to any treatment. Good luck and be well.

Q.Am I able to get Emsculpt after liposuction?

RealSelf actual patient comment:

I got lipo in my entire abdomen and flanks about two weeks ago. I’m interested in getting the emsculpt treatment . Am I a candidate? If so when can I start?If so how long would I have to wait?
A.It would be safe to have Emsculpt treatments about one month following your abdominal liposuction. We have found that our patients have loved their Emsculpt results following liposuction. The improved muscle tone helps to decrease the uneveness left after many abdominal liposuction procedures. Good luck and be well.

Q.Can I get an abdominal Emsculpt treatment before or after breast augmentation (within a day or two)?

RealSelf actual patient comment:

Would it be safe a day or two before surgery or shortly after?
A.It would be best to wait until you have completely healed from your breast surgery prior to having Emsculpt, or you could choose to have a complete 4 sessions Emsculpt treatment before surgery. It would be okay to have the final of your 4 Emsculpt treatments a day or two before your breast surgery. Good luck and be well.
Emsculpt is contraindicated in patients with metal implants because they may heat from the electromagnetic energy and cause a burn. If your IUD is completely plastic then it would be safe. I would not treat you if there is silver. We have had patients who had their IUD’s removed prior to their Emsculpt treatment. In that case, unless your looking to have kids, use an alternative method of birth controll. Good luck and be well.

Q.Emsculpt or tummy tuck? Which one can help with diastasis recti?

RealSelf actual patient comment:

I had twins 2 months ago via c section. I have diastasis recti and I have been going to physical therapy but it’s not helping much. Do I need a tummy tuck with muscle repair? Would I be a candidate for emsculpt or coolsculpting? Can emsculpt help with diastasis recti? What would be the best option for flattening my abdomen?
A.Congratulations on your twins. I would recommend waiting for some time before considering extensive tummy tuck surgery. Exercise, diet, and time should help some with your diastasis recti. If after time the separation of your abdominal muscles remains large, then abdominoplasty is the answer. It there is a great deal of improvement and your diastasis recti is minimal then Emsculpt will help. Time will tell. Enjoy the new members of your family. Good luck and be well.

Q.What if I cannot tolerate 100% power on Emsculpt?

RealSelf actual patient comment:

I have had 3 sessions with Emsculpt, spaced about 3 days apart. I gradually moved up in power each session. The 1st session, I was able to get up tp 65% power at the final 5 minutes. The 2nd session, I was able to get to 95% power for the final 5 minutes. The 3rd session I got to 75% power for the final five minutes. Third session was the most painful. Is it worth continuing if I cannot tolerate Emsculpt at 100%? They place it in the middle of my abs. Will it reduce fat on my flanks?
A.Emsculpt treatments should feel intense but never painful. It is not necessary to reach the 100% treatment level during treatment to get good results with Emsculpt. It is still worthwhile for you to continue your treatment program. As long as your muscles are contracting during the treatment, you should see improvement. Good luck and be well.

Q.Should I do more CoolSculpt now or try Emsculpt?

RealSelf actual patient comment:

I’m 36, no babies, 5’5”, and 130 pounds. I work out 4-6 times per week and try to eat a fairly healthy diet with. I have never felt my tummy was flat enough even when I was much thinner than I am now. I did 2 coolsculpt treatments on my lower tummy in 2015. I feel it made a subtle difference but when looking at my before and after photos, it looks no change. I’d love links to studies and/or statistics.
A.It appears that you would be a great candidate for Emsculpt treatment. Emsculpt will build your abdominal recti muscles (6 pack) by about 16% and decrease the abdominal fat by about 19% over the course of your 4 treatment sessions. Studies have shown that Coolsculpting decrease abdominal fat by about 24% per treament session in the area treated. They can be combined. Since you have already had a couple of CS treatments, I would treat you with Emsculpt. Good luck and be well.

Q.Will Emsculpt for buttocks regime permanently destroy all the fat there? (patient included a photo)

RealSelf actual patient comment:

I’m interested in starting EMSCULPT treatments, with a touch up routine every few months as needed to give a lift to my buttocks. However, I am concerned that this will permanently destroy all fat cells in my butt? I exercise regularly/eat well and don’t believe I have much fat in my buttocks, and I wouldn’t want to permanently destroy the fat cells existing there.
A.Fortunately there are two different settings for the Emsculpt treatment. One preserves fat while building muscle (this is the setting that would be used on your buttocks), the other setting builds muscle and decreases fat. You can put your fears of losing buttock fat “behind” you. Good luck and be well.

Q. What can be done to my face to have a fresher/younger face?

RealSelf actual patient comment:

I have never done any fillers in the past and losing some volume on my face . What can be done to look younger and less tired ? Thanks
A.Fortunately you have been blessed with a verybeautiful face. You may be beginning to see the earliest signs of facial aging mainly because of volume loss. For patients like you, it is most important to not over do things…less is more!!! I would treat you with a little bit of Sculptra and Voluma to maintain your beauty naturally. Unfortunately there are patients who go to the wrong injector and end up looking over-filled, the same as a much older woman who gets the same result from the same injector. As with any facial aesthetic treatment it is essential to choose your injecting physician carefully based on their skill, experience, knowledge, and most importantly their natural artistic vision. Good luck and be well.

Q.How long will Profound for the face last? What is the length of any trials on the product?

A.Thank you for your inquiry about Profound RF. It is thought that the results of Profound RF continue to improve over a 6 to 9 month period following the procedure. As with any facial/neck rejuvenation treatment (including face/neck lift surgery), the best answer for “How long will it last?” is that for the rest of the patient’s life, they will look alot better than if they had not had the treatment. We have been treating patients for the past two years with Profound RF and have found the results to be lasting. I am not aware of the length of time that studies have documented the results. I will be presenting my experience over two years with Profound RF treatments at the 2019 Vegas Multispeciality Conference in June. Good luck and be well.

Q.What are the current best non surgical treatment options for sagging of the jowls?

RealSelf actual patient comment:

The sagging is relatively mild right now but as I enter my early 40s I am noticing it more. There seems to so much advertising that it is difficult to know what are really good options.
A.You look great, the best treatment for early signs of jowling in a patient like you would be Profound RF with PRP. The downside is that there is a one week downtime due to swelling and bruising. The best alternate treatment would be Ultherapy with simultaneous injection of Sculptra along your jawline. Make sure to choose your treating physician most carefully based on their skill, experience, knowledge, and most importantly their natural artistic vision. Good luck and be well.

Q.Can I get Emsculpt and SculpSure together in the same month?

RealSelf actual patient comment:

Hi- can one get both treatments in the same month, for additional fat loss?
A.Yes you may have Emsculpt treatment and Sculptsure together during the same month. The mechanism of action is different for the two technologies. Good luck and be well.

Q.Does Emsculpt build muscle better than electric muscle stimulation from a machine?

RealSelf actual patient comment:

I am considering Emculpt to build muscle and reduce fat but I am skeptical about the muscle build part. Electrical muscle stimulation machines have mixed reviews. Is the science behind the muscle building from Emsculpt different than electrical muscle stimulation?
A.Great question. Emsculpt has been studied in seven independent centers that have shown that there is a16% increase in muscle mass and surprisingly a 19% decrease in superficial abdominal fat. The technology is one of a kind, far superior to any previous electrical stimulation (although a review of the internet will reveal old film footage of Bruce Lee and Muhammed Ali connected to electrical machines for muscle stimulation), and Emsculpt is the first and only FDA approved device for building muscle. Choose your treating physician most carefully. Good luck and be well.

Q.Do I need to shave before an Emsculpt session on the abdomen?

RealSelf actual patient comment:

Does EMSculpt require hair removal before a session or not
A.Fortunately the electromagnetic waves of Emsculpt have no difficulty penetrating through a hairy abdomen. No need to shave or remove hair for Emsculpt, but a little “man-scaping” may make the beach a more beautiful place. Good luck and be well.

Q.Am I a candidate for Emsculpt if I have a titanium hip replacement?

A. Most Emsculpt providers recommend not treating patients with metal implants close to the treatment area. Others believe that titanium, unlike metal implants, does not conduct electromagnetic energy, and will treat patients with titanium. At this early time in the use of Emsculpt it is better to err on the side of safety. Stay tuned, as those providers who do treat patient with titanium implants share their patients’ experiences, we may feel better about treating over these implants. Good luck and be well.

Q.Is Emsculpt dangerous if you have had surgery and or arthritis?

RealSelf actual patient comment:

Hi, i am curious about Emsculpt but I have arthritis and have had surgery with some titanium screws. Will this be a problem?
A.Emsculpt is absolutely safe in patients with arthritis.Emsculpt is safe in patients with Titanium screws as long as they are away from the area treated. Many providers will treat patients with Titanium even when the screws are closer to the treatment areasinceTitaniumdoes not heat up as other metals do. Make sure to discuss with your provider prior to any treatment. Good luck and be well.

Q.Is Emsculpt a good choice for someone with loose skin due to pregnancy?

A.Emsculpt is a muscle building treatment, in addition it reduces superficial abdominal fat. It is not considered a skin tightening technology, though with increased muscle mass there will be some improvement as the newmuscle takes up some of the slack in the skin. We recommend other radiofrequency skin tightening devices such as Venus Legacy for post partum moms. Emsculpt is quite effective at improving diastasis recti after pregnancy (the widening of the connective tissue between the abdominal muscles.) Congratulations on the new addition to your family, much good health, love, and happiness. Good luck and be well.

Q.Is Emsculpt safe for people with knee replacements?

RealSelf actual patient comment:

I have had bilateral knee replacements. I’m not sure it’s safe to work on my stomach area and then buttocks. Can it heat up the metal in my body?
A.Most experts in the use of Emsculpt agree that it is safe to have the abdominals and buttocks treated in patients who have knee replacement since the electromagnetic waves do not travel far enough to heat metal implants in the knees. Good luck and be well.

Q.Are my expectations for rhinoplasty doable?

RealSelf actual patient comment:

I’m planning on getting my rhinoplasty next year. These are the things I would like to fix, – my nose when I smile widens and appears to look “wide and flat” – remove the bump on my nose – my bridge is wide, I want something more feminine -when I turn to the side, my nose looks flat and isn’t as projected as I’d like. -overall my biggest concern is my wide nostrils when I smile. I just want a nose that fits my face. -would I need a chin implant? Is my procedure complicated?
A.Yes, your expectations for rhinoplasty are doable.as with any facial aesthetic surgery or treatment, pleasemake sure to choose your treating surgeon most carefully based on their skill, experience, knowledge, and most importantly their natural artistic vision. Good luck and be well.

Q.I am really insecure about my face profile! Which surgery do you I should do to improve it?

RealSelf actual patient comment:

I don’t understand what makes my face so ugly from the side, I mean from the front it is beautiful, but from the side, ugh I can’t stand it. Which part of my face should be enhanced?
A.First of all your face is not ugly!!! I believe that on profile your chin is small which gives the impression that your jawline is proportionally short for your face. I would consider a conservative chin implant with or without a little liposuction of your neck at the same time. The lateral edge of your nostril is slightly elevated and could be addressed as well with either a cartilage graft or filler. Make sure to choose your treating surgeon most carefully based on their skill, experience, knowledge, and most importantly their natural artistic vision. Good luck and be well.

Q.38, lax skin under neck. What to do?

RealSelf actual patient comment:

I’m 38 and have been diligent about sunscreen, hats, sun protection. But a couple months ago I noticed a flap of skin under my chin, noticeable mostly on my left side. I got my platysmal bands botoxed once about a month ago but I’m thinking I need to address the lax skin. I’m researching Ultherapy, Infini, Thermage? What can I do? Thanks!
A.There are both surgical and non-surgical treatments to address the loose skin in your neck. From your question, it sounds as if you are looking for non-surgical correction. I prefer to treat my patients who have loose neck skin with either Ultherapy or Profound RF with PRP. Micro-Botox intra-dermal injections are helpful as well, but only last for 3 to 4 months. Profound RF is the most effective, it is a one time treatment in contrast to Infini and Thermage. As with any aesthetic treatment, choose your treating physician most carefully based on their skill, experience, knowledge, and most importantly their natural artistic vision. Good luck and be well.

Q.Would Botox or any kind of filler help with these lines from the end of my eye down to my cheeks?

RealSelf actual patient comment:

Hello, I’m 20 and I’ve always had these really bad lines extending from the end of my eye down my cheeks. I’m not sure what it’s from but I’ve always had them and wanted to know what kind of treatment I should do or treatment is even possible. I also have one really hooded lid that I would like to fix as well. I’m half Asian and I get bullied a lot about my eyes and the weird lines that come with it. If you have any advice I’d be grateful, thank you.
A.People are cruel, you are beautiful and do not deserve any bullying. My best advice would be to consult with an expert facial aesthetic physician for an in person evaluation. Without examining you, it is difficult to give you accurate advice. As with any aesthetic treatment, choose your treating physician most carefully based on their skill, experience, knowledge, and most importantly their natural artistic vision. Good luck and be well.

Q.How much filler would I need to get fuller cheeks? Do I need more than 1cc of Voluma?

RealSelf actual patient comment:

Do I need more than 1cc of voluma or another type of filler?
A.You should see very nice results with 1 to 1.5cc of Voluma in your cheeks if properly placed.The most important aspect of your 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.Rhinoplasty disaster, how do I know what my surgeon did to my nose?

RealSelf actual patient comment:

Rhinoplasty 3 weeks ago: I know swelling takes months, but I wanted drastic changes. I asked for width to be narrowed significantly, giving mynose a new shape along with nostrils brought in and the tip brought up. I asked for the nose of different ethnicity -when I stretch skin bones haven’t been shaved off or touched at all -if she didn’t touch width of the nose due to fear of breathing collapsing, can I get a refund since she isn’t skilled enough to perform a revision? How do I know if she did surgery?
A.It is best to speak with your rhinoplasty surgeon for an explanation of what was done. Ask for the operative note (although many times, depending upon the individual surgeon, the note may not reflect the surgery.) Consult with a rhinoplasty expert, bring your pre-op photos and the operative report. You may ask that the new surgeon personally speak with your first surgeon. It is too early at this point to do anything, unfortunately you should wait 6 to 12 months before considering any revision rhinoplasty. Good luck and be well.

Q.Is it safe to undergo Ultherapy 4 months after FaceTite?

RealSelf actual patient comment:

I had a FaceTite procedure four months ago, and while there was definite improvement, I was hoping for a little more tightening along the jawline. Is it safe to follow up with an Ultherapy treatment at this point?
A.Yes, it is safe to have Ultherapy one month after Face Tite, in fact most patients who have had some sort of previous facial procedure (facelift, Sculptra, Profound RF) respond better than expected in many cases. Good luck and be well.

Q.Can I prevent further collagen from forming from Sculptra 1 month ago?

RealSelf actual patient comment:

I had sculptra injected and he put it in the opposite side of my face that needed it (one side was good on its own & another side needed a little extra filling) but he ended up overfilling the side that was already full and then placed sculptra in my jawline unevenly and it’s been a month and now one side of my jaw is heavy and masculine looking. He injected 7 syringes which was about 3/4 of a vial. I turned 24 the week after I was injected. Please help. What can I do to prevent it from growing?
A.Sorry that you have had this experience. Best to consult with an expert Sculptra injector. Fortunately you have received only 0.75 vial of Sculptra which should limit how much you react. Best to see how you react and then restore your facial symmetry as needed.I would recommend working with a physician injector whom you trust.The most important aspect of your 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.How many syringes of Juvederm or Voluma will I need to fill out my cheekbones?

RealSelf actual patient comment:

I have very small cheekbones and my face looks round. I want to have especially high cheekbones just like the guy in the picture. How many syringes of Voluma will I need to achieve this result?
A.You will get your best estimate of how many syringes of Voluma will be needed to give you your aesthetic cheek enhancement goal after an in person consultation. As you are relatively young, I would be conservative and begin with 1 to 2 cc of Voluma, more can always be added. When it comes to facial volume, often times less is more!You should see an excellent result with only 1 to 1.5 cc if injected properly in the proper place. The most important aspect of your 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.Fillers vs. lasers for eye troughs? 30, female, non-smoker

RealSelf actual patient comment:

I’ve always had eye troughs. Recently, I went for two consultations. The first doctor told me that I needed 1-3 Fraxel sessions. At the second consultation (which was with a Patient Coordinator and not an actual doctor), I was told that I needed 8 sessions with a Forma/RF laser. I had always thought I needed fillers to make my eye troughs disappear. Any advice or reasoning as to why I should go with Fraxel or RF laser instead of fillers? Or were these doctors maybe mistaken about the best treatment?
A.Lasers around the eyes are best used for crepe skin or slightly excessive skin as the treatment tightens the skin (I would use a fractionated CO2 laser such as Fraxel Repair.) Fillers around the eyes are used to replace lost volume. In your case based on your photo I would likely treat you with filler to take care of your hollows.Make sure to choose your physician injector most carefully based on their skill, knowledge, experience, and most importantly their natural artistic vision. Good luck and be well.

Q.Smile lines: which filler do you recommend? If so, how many syringes do you estimate will be needed?

RealSelf actual patient comment:

I am 33 and have really become self conscious about my smile lines. Every day, it seems like they get deeper and more prominent in pictures and in person. I wanted to know what product is recommended. I’ve read Juvederm and Restylane could work how ever there are so many different types, I’m kind of overwhelmed. If all the product isn’t used, would I be able to put the rest in my lips or under eyes depending on the product? Thanks in advance!
A.I agree with Dr. Rifkin, you should be able to achieve your aesthetic goal using 1 to 1.5 syringe(s) of filler. When we teach other physicians how to inject facial fillers, we have unlimited amounts of filler supplied by the sponsoring companies. What is often said is that “It is easy to get a nice result with unlimited fillers (and funds), the skill comes when we are able to get an excellent result with only 1 or 2 syringes.”I wouldmost likelyuse Restylane Defyne most likely in your case, though every patient is unique and we determine what would be best after examining each patient in person. Make sure to choose your physician injector most carefully based on their skill, knowledge, experience, and most importantly their natural artistic vision. Good luck and be well.

Q.I have thick ropiness underneath the skin after blepharoplasty, what can I do?

RealSelf actual patient comment:

I had upper and lower blepharoplasty 18 days ago. Underneath the upper eyelid scars is a very thick rope. It is not above the skin. It is causing a visual ridge. It is continuing to get thicker despite massaging. In one large area it is easily a quarter of an inch thick. It is somewhat painful when touched. What is the best treatment for this ropiness?
A.Great question as this is very common after blepharoplasty.
Fortunately the “ropiness” resolves with time. You may ask your blepharoplasty surgeon to inject a small amount of Kenalog-10 (a steroid) in the “rope” to soften it and facilitate its disappearance. The crows feet area should not be noticeable once the redness of the incision scar goes away in 6 to 8 weeks.Good luck and be well.

Q.How do I get rid of granulomas from Volbella filler?

RealSelf actual patient comment:

I had tear trough and lip filler with volbella in July. In October I developed multiple hard lumps/masses at all injection sites in October. No redness. Just hardened filler. They have tried dissolving with hyaluronidase three times with no success. My sinuses have since been a non stop issue. The tear trough hardened masses feel like they are growing and there is pressure in the eye area, inner canthus area mostly. Suggestions? I need help.
A.Sorry to hear about your complication with Volbella. I would recommend treatment with hyaluronidase along with Kenalog/ 5FU injections every three weeks. I would also recommend oral Biaxin 500mg twice a day for six weeks. There have been studies out of Israel on patients who received Volbella under their eyes who developed complications similar to yours. Good luck and be well.

Q.Can anyone suggest how to get a Botox brow lift done so that I can tell providers?

RealSelf actual patient comment:

I can’t find anyone who can do a proper medial and outer brow lift in San Diego. I tried three providers. Before moving Ihad a nice brow lift. Can anyone suggest how to get it done so that Ican tell providers? The last one only put 5 units per side in the corner of eyebrow -did not work.
A.Great question. Botox treatment is not a commodity, rather it is an art and science based on skill, experience, knowledge, and most importantly natural artistic vision. It is important to choose your physicianinjector most carefully. Unfortunately, there is not a “recipe” that we can give you to help your provider, each patient is unique. Good luck and be well.

Q.Can my jowls be fixed with filler?

RealSelf actual patient comment:

My jowl is sagging only on one side. I’ve had very short lived improvement with filler but would like to have this area fully corrected. Can this be treated?
A.Yes, properly placed fillers can help you achieve your aesthetic goal. You are young, pretty, and your “jowl” is in a very early stage.Be sure to choose your injecting physician most carefully based on their skill, experience, knowledge, and most importantly their natural artistic vision. Good luck and be well.

Q.Safe to get more Voluma injections after a couple weeks by a different doctor?

RealSelf actual patient comment:

Is it safe to get more Voluma injections after a couple weeks by a different doctor? If I don’t want to go to the same doctor, is it typically not a big deal to go to another doctor to receive more Voluma injections? I had 2cc but want 1 or 2 more. Basically can more Voluma be added safely even if the doctor does not know you had Voluma?
A.Yes, it is fine to have more Voluma injected by another physician. You should share with your new physician that you recently had Voluma injections. The most important aspect of your Voluma treatment is that you choose your injector very carefully based on their skill, experience, knowledge, and natural artistic vision. Good luck and be well.

Q.29, male. Excess/sagging skin on the face and neck. Could Ultherapy give me my jawline back? Would I need a surgery?

RealSelf actual patient comment:

I would like to tighten skin on face, and have a defined jawline. My skin has been sagging progressively over the last couple months. I am unsure if I want fillers as the sagging/loose skin has already made my face look wider/bigger than it use to be, and i feel fillers would make it look even bigger. I use moisturizer, retin a, exfoliator scrub and aha.
A.I have found that men respond very well to Profound RF even more that Ultherapy. Ultherapy should help and has less downtime, but if you have the time to recover, I would recommend Profound RF. Good luck and be well.

Q.I just found out I’m 8 weeks pregnant and got a Juvederm filler one week ago. Could I have caused harm to the baby?

A. No, but your baby is going to look very young!!! Congratulations, wishing you a healthy pregnancy and healthy baby!!! Good luck and be well.

Q.Is this necrosis after Juvederm lip Injections?

RealSelf actual patient comment:

What is happening to my lip? (patient included a photo of her lip turning black)
A.I hope that you have already seen someone today, if not, you need to see an expert filler injector immediately to be treated. Good luck and be well.

Q.I would like to have a rhinoplasty/septoplasty done. What are the suggested ways of achieving my goal?

RealSelf actual patient comment:

I do not want a small nose. I just want to refine what I have and improve it to fit my face better. I am part Italian and would like to enhance what I have, not take too much away. What would the best way to go about what I want?
A.You have a beautiful face. I would recommend consulting with a few rhinoplasty specialists and be very careful in choosing your rhinoplasty surgeon based on their experience, skill,knowledge, and most importantly their natural artistic vision. Please make sure that a subtle rhinoplasty is planned and carried out, the last thing that you want is a “cookie cutter” obvious rhinoplasty. Good luck and be well.

Q.Is it bad to get fillers while you’re young and can they be used to prevent wrinkles and collagen loss?

RealSelf actual patient comment:

I’ve been getting filler in my lips at the age of 18 and I’m now 20. Have also been getting fillers in my face to create a defined jawline and in my chin to define and smooth out the dimples. Is it bad to get them while I’m young? When they fade and I decide not to get them again will my face look saggy or dull? I’ve also heard that getting fillers can also be a preventative procedure to wrinkles and collagen loss. Is this true?
A.The most important aspect of your aesthetic treatment is choosing your physician most carefully based on their skill, knowledge, experience, care, and natural artistic vision. There is a saying that, “Nothing beats youth!” especially when it comes to facial aesthetics. Any physician who is treating you at age 20 should be extremely conservative and limit treatment. There is nothing more sad then a young woman who has been over “done” by a physician or nursewho lacks natural artistic vision. It is terrible when these injectors treat young patients identically to how they treat their older patients. We all have seen older patients who look funny because they are trying to look too young, unfortunately some young patients can actually look like these “younger looking older patients” because of irresponsible injectors. Enjoy your youth!!! Good luck and be well.

Q.Can Sculptra be used to fill in hip dents after lipo/fat transfer?

RealSelf actual patient comment:

I’m a small frame woman, had 2 pregnancies. Did Brazilian butt lift 2 years ago. Although my butt is nicer than before, however I’m left with dents on the hips, below waist area which doesn’t give me that nice silhouette. I’m considering Sculptra but I’m open with suggestions of how to improve this as well as improve irregularities on stomach area. I appreciate your time to answer my question. Thank you.
A.Yes, Sculptra may be used to treat your concerns. I would also recommend something that tightens the skin and builds the muscle and evens out the fat irregularities. You may have a combination of Venus Freeze/Legacy for skin/fat, Emsculpt to build muscle and decrease abdominal fat as well as further lifting your butt, and CoolSculpting for fat irregularities. Good luck and be well.

Q.What are these lines around my mouth?

RealSelf actual patient comment:

I’ve kinda always had these lines. They’re more like pockets of fat, I’m only 21 so hard to believe it’s pre mature aging. I do not smoke or drink but I smile/laugh a lot. I get my lips filled so I told my nurse and she told me it’s normal and I want to avoid filling the area so I don’t look like a blow fish. But they bother me bad. What are my options? As you can see they’re more obvious in certain lighting.
A.The lines that you are concerned about are due to the excessive amount of filler that someone has injected into your lips. The distortion of your lips and disproportion of the size of your upper to lower lip by your nurse injector is the cause for your concern. I would recommend laying off the lip injections for awhile and even having some of the excess dissolved. No one, let alone a 21 year old should have that much filler in their lips. Once again it comes down to making sure that you choose your injecting aesthetic physician carefully based on their skill, experience, knowledge, and most importantly, their NATURAL artistic vision. Good luck and be well.

Q.Does Emsculpt build muscle and burn fat for the butt treatment or just build muscle?

RealSelf actual patient comment:

Thank you for clarifying!I know it does both muscle building AND fat burning for abs but wasn’t sure about the butt treatment and am reading conflicting opinions. Thank you! Also realistically if someone had no lbs to lose but poor muscle tone, would it help?
A.Good question. Just this afternoon I asked my patient having her first butt lifting treatment with Emsculpt whether she wished to keep or lose the fat on her butt. Emsculpt has two treatment protocol settings, one that burns fat and one that does not (both settings do build muscle.) Prior to any Emsculpt treatment of the buttocks it is important to let your physician know what your wishes are, a thinner tush, or a Kardashian special. Good luck and be well.

Q.Could Restylane Defyne cause an autoimmune problem?

RealSelf actual patient comment:

I don’t seem right. I am 53. I had Restylane defyne injected into nasolabial folds & marionette lines 3 weeks ago. No lip injections. My lips became puffy, painful, dry, pink and white after. I have developed a lot of floaters in my eyes & hot feelings in my ears and back. I had bruising after the procedure & a puffy line under my upper lip. I have hypothyroidism and possibly rheumatoid arthritis. Am I having an autoimmune response to the product and if so what do I do. It is making me really nervous.
A.Sorry that you are having this complication from your recent injections. I would recommend returning to your injecting physician for evaluation. I have not heard of any autoimmune reactions to Restylane Defyne. Make sure that the injections in your NLFs is not compromising the blood flow to the affected areas. Good luck and be well.

Q.Why hasn’t my face peeled/healed after Profound treatment and CO2?

RealSelf actual patient comment:

I had Profound treatment followed by CO2 in the same day. I said I was concerned to the Doc. but was assured it was fine. I’m very worried,I’m only on day 7 but have extreme uneven thickskin & extreme redness/neck & under chin area is swollen numb & saggy.I was assured things would be fine by now! there is NO way I can return 2 work looking like this!! I understand it takes time but I look horrible – my face doesn’t seem to be healing at all & hasn’t peeled at all – HELP
A.I would recommend discussing your concerns with your treating physician. The combination of the two treatments at the same sitting is a very aggressive treatment. One would expect longer healing times from swelling and bruising. Peeling or lack thereof is not a concern. Hopefully you should begin to heal more quickly over the next few days. Please keep us informed of your progress. Good luck and be well.

Q.Can I have Radiesse after having Voluma in the same area to be treated?

RealSelf actual patient comment:

I had voluma on my mid face. However, I have read that radiesse has collagen forming/inducing properties, unlike voluma, so I’m thinking of having it for a retouch on my cheeks since i find it still lacking of volume. Is it okay? Can’t it cause any complications since both filler are made up of different materials?
A.Yes, you may mix and match the facial fillers Voluma and Radiesse. The most important aspect of any aesthetic treatment is making sure that you choose your treating physician most carefully based on their skill, knowledge, experience, and natural artistic vision. Good luck and be well.

Q.What is the likelihood that I could get a dorsal bump from this injury?

RealSelf actual patient comment:

I was putting something in the trunk, and Ididn’t realize it was closing. As I was lifting my head up I hit my nose on the bottom of the trunk. I got a minor cut and some redness surrounding it. My nose itself didn’t bleed and it only hurts where the scratch and bruise is. As of right now there’s no swelling or bump. My question is, what is the likelihood that I could get a dorsal bump from this injury?
A.Very low chance. Nothing to do about it for 12 months, if it does bother you then consult with an expert rhinoplasty surgeon. Good luck and be well.

Q.Is Ultherapy safe for me after facial fat transfer 3 years ago?

RealSelf actual patient comment:

I have had full face fat transfer x 2. The last was three years ago. Or is there risk of destroying the fat i had transferred to my face?
A.Yes, both Ultherapy and Profound RF may be used to lift and tighten your face and neck after fat transfer. The most important aspect of your treatment is that you choose your treating physician most carefully to absolutely minimize any adverse events. Choose your treating physician based on their experience, skill, knowledge, and most importantly their natural artistic vision. Good luck and be well.

Q.Will these bumps under my eyes after Volbella injection go away?

RealSelf actual patient comment:

I had 1 syringe of volbella injected under each eye (total of 2 syringes) 8 days ago. This is my second time having filler. First time 1 year ago with no side effects. This time there are bumps under each eye that have yet to go away. My doctor said to give it 2 weeks. Is this a standard reaction? Should this smooth out within another week? Thanks in advance for any input.
A.Sorry that you are having an adverse reaction to your recent Volbella injections in your under eye hollows area. This is not a standard reaction. I would advise revisiting your treating physician for evaluation and treatment. The most important aspect of facial filler injections is to choose your injecting physician most carefully based on their experience, skill, knowledge, and natural artistic vision. I hope that your complication from the injections resolves very soon. If your injector is unable to help you, then you should seek out help from an expert filler injecting physician. Good luck and be well.

Q.I am interested in Emsculpt for my hands, butt, and thighs (I know thighs are off-label) is this a potential tightening solution

RealSelf actual patient comment:

What are reasonable expectations of this treatment, cost, the and number of sessions required? Does this help cellulite? I understand it is great for decreasing fat and building muscle. Is tightening of skin a reasonable result of doing that? I live in Palm Beach County FL.
A.Emsculpt is FDA approved for use on the buttocks and the abdomen. It builds muscle and can decrease fat when desired. It is not used on hands. Though off-label, it is being used to build thigh muscles. The tightening from Emsculpt is derived from the increased muscle mass, Emsculpt is not a “skin tightening” device. The cost of the treatment varies depending on the practitioner and the geographic location, in general a complete series of 4 sessions (1 session twice a week separated by 2 to 3 days for 2 weeks, a total of 4 sessions) costs from $3000 to $4500, individual sessions though not recommended are about $750 to $1125. It may help with cellulite, though Emsculpt is not a “cellulite” device. Our patients and staff have been very pleased with their Emsculpt results. Good luck and be well.

Q.What are my options to fill out the loss of volume and lift jowls at 40?

RealSelf actual patient comment:

I’m 40 and have jowls and a long narrow face. I’ve been researching all of the options and at my age something more long lasting would be best since I’m fighting gravity hard from here on in. Is there something that will last a few years before I finally need a face lift or something more like that? Filler, fat transfer, or implants? Thank you for your time.
A.You are not alone, many patients have the same question when they come to our office in consultation. Fortunately, there are many non-surgical, non-invasive treatments that can address your concerns of early jowling. The best device treatments are Ulthera which uses micro-focused ultrasound to lift and tighten the face and neck, and/or Profound RF which uses micro-needles with radio-frequency energy to do the same. It is usually better to add fillers to a tightened face so if you contemplate both tightening device and filler, then it is best to have the device treatment first. If you wish a quick fix with filler, then I would treat your concerns with Voluma and Restylane Defyne in a natural manner, replacing your lost volume, not adding extra volume that you never had in the past. It is always good to bring photos of your younger self to your consultation. It is important that you do your due diligence and choose your treating physician carefully based on their skill, experience, knowledge, and most importantly their natural artistic vision. Good luck and be well.

Q.Does adding PRP to the Profound Treatment on the face and neck, speed healing?

A.Excellent question. Initially I treated my Profound RF patients without PRP, currently we encourage all of our Profound RF patients to have PRP with their treatment. I agree with Dr. Treece that the healing time seems to be about the same, maybe a day or two sped up. The benefit that I see with PRP, since the Profound RF treatment has already made about 8000 micro-needle holes in the skin, is improvement in fine lines, wrinkles, tone, and texture of the skin. I believe that adding PRP to Profound RF is worth the small additional fee. Good luck and be well.

Q.I’m thinking of getting the Profound procedure. The aesthetician is the one performing the procedure. Is this the norm?

RealSelf actual patient comment:

I’m 60 years old with deep skin wrinkles. I have an autoimmune disease and nervous about possible dangers. Can pigmentation be an issue.? Infection? Thank you for any input.
A.The most troubling aspect of your question is that an esthetician is scheduled to perform your Profound treatment. I believe that Profound RF should be performed by a physician, I personally would not allow anyone but a physician to perform the treatment on me. Profound RF is a great treatment for your deep wrinkles. There should not be any problems or dangers due to your autoimmune disease as long as it is not active. As long as you follow the proper protocol before and after your Profound treatment there should not be a risk of infection. Please make sure to choose your treating physician most carefully. Good luck and be well.

Q.How soon after the Profound RF treatment can I get fillers in my jaw line and chin and Sculptra for my uneven hallowed cheeks?

A.You may have fillers in your face as soon as the swelling resolves after your Profound RF treatment. With Sculptra, I recommend that my patients have their Sculptra injection session just prior to Profound (on the same day.) They can then return two months later for re-evaluation and any further Sculptra treatment. As with any aesthetic procedure, it is essential that you take the time and effort to choose your treating physician most carefully based on their skill, knowledge, experience, and natural artistic vision. Good luck and be well.

Q.Is Emsculpt really safe?

RealSelf actual patient comment:

I have read that electromagnetic energy can cause cancer. If that is the case then how can this new device be safe? I understand it is FDA-approved, but I’m still trying to understand the safety aspect.
A.Great question, many patients are concerned about the safety of Emsculpt. Prior to offering any technology or new treatment to my patients I must be sure that the treatment is both safe and effective. Emsculpt meets both of those criteria. The National Cancer Institute has an article that explains the difference between safe and dangerous electromagnetic energy (see below under Web reference for complete article link.) Basically, low frequency electromagnetic energy (used in Emsculpt) is safe, high frequency electromagnetic energy (like X-rays) are not. BTL, the company that manufactures Emsculpt has used EM energy for many years in the therapeutic treatment of muscles without any adverse events. There have been no reported complications of Emsculpt. Prior to treatment, the treating physician must take a complete history of the patient to make sure that there are no contraindications to treatment that would cause problems such as metal implants, pacemakers, hernias, and other medical conditions. Make sure to choose your treating physician most carefully.Good luck and be well.

Q.Is feeling sore after emsculpt to be expected?

RealSelf actual patient comment:

Just finished my 4th emsculpt treatment. Had my abdomen and buttocks treated. Is it normal to not have ANY soreness whatsoever after each treatment? Kept waiting to feel at least some sort of soreness. But, nothing. Not even a little bit. All four treatments were on 100% power. So far, not impressed with the results. I realize that results are supposed to show more after a few weeks. Is that correct? Thank you for your answers!
A.Some patients may feel a little soreness 2 to 3 days after Emsculpt, others don’t feel much at all. Whether you have soreness or not will not affect your results. I personally had a single paddle 30 minute session immediately followed by a two paddle 30 minute abdominal session and did not feel sore afterwards.Though some patients may see results after 2 to 3 sessions, we ask our patients to return for their initial post treatment photos at 6 weeks. Results should be seen by 2 months. Results vary depending on the individual patient, their body shape, their overall health, fitness, diet, etc. Good luck and be well.

Q.Emsculpt: are there any side effects and what does it cost?

A.Our practice was fortunate to be one of the first practices in the world to use Emsculpt. Our patients and I have been very happy with Emsculpt. Before incorporating any technology or treatment in my practice it must be proven to be both safe and effective. Fortunately there have been no complications reported in the Emsculpt studies over the past year, and no clinical adverse events reported. It is important that your treating physician takes a complete medical history to insure that you are a candidate for Emsculpt. There are a few absolute contraindications to the treatment such as metal implants, pacemakers, and poor health to name a few. As long as you do not have any contraindications, Emsculpt is extremely safe and effective. As with any treatment, choose your treating physician most carefully.The cost ranges from $3000 to $4000 for either an abdominal or buttocks treatment. In our practice we will be offering better prices for patients who wish to maintain their results over time. We also work with our patients if they wish to pay per treatment it is about $750-$1000 depending on the treatment.Depending on the physician and practice, additional maintenancesessions of Emsculpt may be given at adiscounted cost.Good luck and be well.

Q.Can you have Emsculpt on the abdomen area if you have had a naval hernia?

RealSelf actual patient comment:

Can you have em sculpt on the abdominin area if you have had a naval hernia repaired 2 1/2 years ago? I am not overweight, work out 5 + times a week, and I am 20% body fat but can’t seen to loose the last of my belly. I am 65 and female.
A.As with any treatment it is most important to make sure that you are a candidate for Emsculpt and that there are not any contra-indications to having it prior to your procedure. If you were my patient I would have you see your hernia surgeon to make sure that it is well healed and that your surgeon okays you having the treatment. If your hernia is healed, you should be able to undergo the Emsculpt procedure.

There are a few contraindications for Emsculpt treatment. Patients should not have any metal or electronic implants near the treatment area, no history of heart arrhythmia, cardiacpacemaker, implanted defibrillators,implanted neurostimulators, drug pumps,recent surgery, malignant tumors, excessive fat (the EM energy penetrates about 7 centimeters),epilepsy, pregnancy and breast feeding,the procedure on women preferablyshould be done when not menstruating as it may cause period to come earlier and cramping may be greater, and recent surgery.Make sure that your treating physician takes your complete medical history to avoid any adverse events or complications (no significant complications have yet to be reported with Emsculpt.)Choose your treating physician most carefully.Good luck and be well.

Q.Will Emsculpt make my loose skin from childbirth worse?

RealSelf actual patient comment:

I am 62, 5’10” and 167 lbs. I do go to the gym and watch my weight. I now have a small belly but also already have some loose skin from childbirth, which has gotten worse in the last few years. What will happen with the loose skin? Will Emsculpt make it better or worse?
A.Emsculpt builds muscle by electro-magnetic energystimulating the nerves that cause supra maximal contractions of the core abdominal muscles. Emsculpt is the only FDA approved safe, easy, and clinically proven technology that builds muscle and decreases abdominal fat. As your muscle mass increases, some of your loose skin slack should be taken up. Emsculpt also is useful in post partum woman who have diastasis recti (separation of the connective tissue between the abdominal muscles after giving birth), strengthening the muscles and decreasing the separation/weakness caused during pregnancy. In our practice we add Venus Legacy treatments if any loose skin persists. Choose your physician most carefully. Good luck and be well.

Q.Emsculpt: What is a good starting BMI. Is it effective for the deeper fat?

RealSelf actual patient comment:

170 pounds 50 years old . Upper abdomen fat. And hips is it effective for this area. I am about 33 bmi
A.Each individual should be examined by a physician prior to Emsculpt treatment to determine whether they are a candidate for the procedure. Ideal patients are those with a BMI of 30 or below, but there are exceptions depending on the individual. Most importantly a detailed past medical history must be taken insure safety and efficacy. We had a patient today who remembered that as a child she had surgery and that metal clips were used internally in her abdomen. Metal in the body close to the area treated is a contraindication to Emsculpt so she was not treated. The fat that Emsculpt reduces is peripheral fat (that fat between the skin and muscle). It does not decrease visceral fat (the fat below the muscle around the intestines, “beer belly” fat.) Interestingly, the love handle fat is often decreased when the abdomen is treated with Emsculpt because of the supra maximal contractions of the core abdominal muscles. Good luck and be well.

Q.Emsculpt and compression garments – will wearing them after Emsculpt help at all?

RealSelf actual patient comment:

Either in end results or speeding along the process? Or would they be problem in some way?
A.Just like you don’t wear compression garments after intensely working out, it is not necessary to wear them after Emsculpt. There is no swelling though some patients may have minimal soreness of the muscles for a day or two, just like after a great workout at the gym. Good luck and be well.

Q. Does Emsculpt hurt?

RealSelf actual patient comment:

How much discomfort is there?
A.Emsculpt is an exception to the old adage, “No pain, no gain!” Emsculpt sessions should not ever be painful, they should be intense, not painful. The Emsculpt device allows the physician to control the power intensity of the treatment while the patient gives real time feedback. The power is gradually increased as the patient is able to tolerate the pulses. The goal is to get to supramaximal contractions of the large muscles which the patient can feel, and the physician can see. All of my patients have been able to reach 100% power shortly into their Emsculpt session. The other old adage that Emsculpt seems to be an exception to is, “If it sounds to good to be true….” Good luck and be well.

Q.Am I a candidate for Emsculpt? I’ve had a BBL years ago but over time my butt has drooped a bit.

RealSelf actual patient comment:

I’ve had a bbl years ago but over time my butt has drooped a bit and when I gain weight I gain a lil too much there . I would like to know will emsculpt help noticeably decrease some of this fat and lift the butt area ? Also does this tighten the skin area? Was interested in tummy tuck , will this help with tightening the ab/muffin top areas equivalent as a tt?
A.As your name and your questionimplies, there is a lot to cover in answering your inquiry. Emsculpt should lift the buttock without reducing fat. The tone of your skin should improve as muscle tone and mass increases. We have seen improvement of the love handle area with abdominal treatment even though the love handles were not specifically treated. As with most non-surgical procedures, if surgery such as a tummy tuck is really indicated because of excessive skin and fat, then Emsculpt will not be an equivalent treatment. It is best to see an expert physician for an in person consultation and examination to determine what is the best treatment (or combination of treatments) for you. Good luck and be well.

Q.Can Emsculpt be carried out on tummy and butt on the same day?

RealSelf actual patient comment:

For example, I will start with tummy and once 30 mins session done, I will do the treatment on my butt. Will it be too much or I should do it on a separate day.
A.You are now officially the Emsculpt Most Asked Questions on RealSelf Champion of 2018!!!! Congratulations!!! It is perfectly safe to have Emsculpt on your abdomen and on your buttocks during the same treatment session, just like we sometimes will work these same areas at the gym. Good luck and be well.

Q.I am interested in Emsculpt but had a tummy tuck 5 years ago and was wondering if I would be a candidate?

RealSelf actual patient comment:

Are you able to use the emsculpt machine on your abs if you previously had a tummy tuck? I haven’t gained any weight and don’t have any fat on my abs, I would just like to increase my muscle tone in that area.
A.Having had a previous tummy tuck is not a contraindication for Emsculpt, it is a safe and effective procedure after a tummy tuck. One should wait long enough for the tummy tuck surgery to have healed well before having Emsculpt, certainly 5 years is plenty of time for you to improve your abdomen with Emsculpt. Good luck and be well.

Q.Can I do more than 4 Emsculpt sessions?

RealSelf actual patient comment:

Can I do more than 4 sessions. I am thinking if I can do 6 sessions for the period of 3 weeks to achieve better result or it is totally unnecessary?
A.With your xs to s size,as well asyour doing Pilates (from your previous questions here on RS), and now doing an extra two sessions of Emsculpt, you should be a poster woman for Emsculpt results. The Emsculpt was studied at 7 independent US medical practices, the protocol for the treatment was 2 treatments a week, separated by 2 to 3 days for two weeks, a total of 4 Emsculpt 30 minute treatments. One would think that adding more treatments should help you achieve a better result. Good luck and be well.

Q.How to make Emsculpt more effective?

RealSelf actual patient comment:

I am Wondering if I should do Pilates after the 4 sessions of emsculpt to enhancing the muscle building. Pilates seems to work on core very effectively. I am doing emsculpt on both tummy and butt next week for 4 sessions each, 2 days apart.
A.Well, as it is said about chicken soup, “It can’t hurt!” Pilates is an excellent exercise for toning the body and the core. It should only enhance and help to maintain the results from your upcoming Emsculpt treatment. Good luck and be well.

Q.Will Emsculpt enlarge muscle?

RealSelf actual patient comment:

I am very confused. I read that building muscle will cause the muscle to grow in size. Will the growing of muscle cause a bulge or will it tighten up and shrink muscle? So it will be flattened? I am in between xs and s size person and I’m wondering if I should buy a dress in XS or S? i am getting the dress online for an occasion next week.
A.Emsculpt has been shown to increase muscle mass by 16% and decrease fat by 19% after a series of treatments. Having said that,I would buy the dresssize that you would normally get thatfits you best. I believe that the effectof Emsculpt “building muscle” and Emsculpt “toning the abdomen” will offset each other, I doubt that yourclothing size will be affected. Emsculpt patients should be toned, not built into a “Charles Atlas” or Arnold Schwarzenegger body builder type of result. Have fun at your upcoming occasion, good luck and be well.

Q.Can this procedure be used on upper arms? I lost muscle tone in upper arms from having had a bilateral mastectomy.

A.Emsculpt has been FDA approved for the treatment of the abdomen and the buttocks. There are practices that will treat other areas such as the arms. I agree with Dr.Avalianithat it depends on the expertise of the practitioner to decide the safety and efficacy of treating “off-label” areas with Emsculpt. There is not a contraindication to treating the arms of patients who have had mastectomy. Good luck and be well, God Bless.

Q.Can I combine a PRP and Profound treatment?

RealSelf actual patient comment:

I am going to get a Profound treatment on my face in a couple of weeks. I would like to combine this with a PRP treatment. Has this ever been done? I am thinking it might boost the effectiveness of the Profound treatment.
A.Great question, in fact in our practice we now routinely recommend that patients combine their Profound RF treatment with Platelet Rich Plasma (PRP). When apatient arrives on the day of their treatment our nurse draws a small tube of their blood in a special PRP tube which is then centrifuged to separate the patient’s red blood cells from their plasma (the yellow part of blood serum which is concentrated with platelets.) Profound RF uses micro needles which cause microscopic holes in the skin through which the platelets in PRP seep into, attracting growth factors and possibly stem cells which result in greater rejuvenation from the treatment. You are correct in believing that PRP will boost the effect of your Profound RF treatment. Good luck and be well.

Q.Profound microneedling. Is it safe?

RealSelf actual patient comment:

I am a 33 years old with great skin but need more volume in my cheeks.. I am looking for the most natural treatment that can safely build my collagen to more youthful plump skin look. A doctor advised me to try PRP with Profound Micro-needling. Then if I need more volume I can do fillers such as voluma Should I do what he suggests? is Profound Micro-needling safe? I heard it has swelling and bruises as side effects. .. is it right it has 100% response rate ?
A.One of the most commonly seen results with Profound RF treatment is that cheeks look elevated and larger, almost as if they have been lifted. Not only is Profound RF effective but it is extremely safe when performed properly. As with any facial aesthetic procedure, the most important aspect of the treatment is making sure that you choose your treating physician very carefully based on their experience, skill, knowledge, and natural artistic vision. I have treated hundreds of patients with Profound RF and have fortunately not had an adverse event or complication. There is significant swelling which maximizes at about 2 days and resolves by 5 days at which time we allow our patients to resume exercising. There is also significant bruising which maxs out at about 3-4 days and is gone from 7 to 12 days after the treatment. By 5 days concealer may be used. We have seen a response in all of our patients, though results may vary from patient to patient. The young patients that we have treated such as yourself have enjoyed excellent results and have been very happy that they underwent the Profound RF treatment. Good luck and be well.

Q.Can I gain weight after Emsculpt?

RealSelf actual patient comment:

If Emsculpt is taking away fat from my abdomen, what happens if I gain weight? Will it go back to the abs or will it go to another area so that my thighs, etc are bigger than they were before?
A.Emsculpt treatment results in a loss of abdominal fat and a building of abdominal muscle, just like working out intensely, say like doing 20,000 crunches or squats in 30 minutes!!! Just like working out, if weight is gained, it will be distributed throughout the body in the usual areas that fat accumulates. Hopefully your Emsculpt treatment serves as motivation to continue diet and exercise programs that keep you from gaining excess weight. Good luck and be well.

Q.Strange side effect from Profound RF.

RealSelf actual patient comment:

Procedure was 16 days ago. The only bruising left is under my eyes. By day 2, I developed an indescribable smell inside my nose. Most everything I eat takes on the bad aroma. On day 5, I worried there was an infection & started amoxicillin. My only other symptom is tenderness around neck & lower cheeks. Antibiotics haven’t helped yet & now it seems the smell is also in my urine. Supplements: Arnica, Bromelein, multi-vitamin, extra c, e and added k on day 6. Please advise. Thank you.
A.I am sorry that you are having your most unusual symptoms after your Profound treatment.I have never heard of such a thing!!! It is likely due to something other than your treatment and the timing may be coincidental. I would advise consulting with a ENT physician who will listen to your history, exam you, and hopefully find an answer and curative plan for your dysnosmia (stinky odor). Now if you had said that you had eaten asparagus after your Profound treatment then I would be able to make the connection between the smell in your nose then showing up in your urine. Good luck and be well.

Q.Can Profound be performed on the forehead, around eye areas?

RealSelf actual patient comment:

During my consult with a doctor, he said profound can only be done on lower face, not around eyes or forehead. Is there a reason why? And why are some doctors doing it on you tube?
A.I nearly always treat my Profound patients on their forehead and around their eyes. As a facial plastic surgeon I am very comfortable using tumescent local anesthesia (the same type of facial injection of local anesthesia that is used during face, neck, and brow lifts) which is necessary to treat these areas. The anatomy of the forehead and underlying skull bone requires tumescent infiltration of local anesthesia so that the dermal micro-needles which penetrate 1 to 2 millimeters beneath the skin do not hit bone and are damaged. The company that manufactures Profound, Syneron, does not encourage treatment of the forehead or eye area. Once again, as a facial plastic surgeon I am fully comfortable treating these difficult areas safely and effectively. By treating a greater surface area, the results of Profound rejuvenation are greater. It takes more time, skill, knowledge, and experience to treat the forehead and eye region, but it is worth the effort.As with any aesthetic procedure please be sure to choose your treating physiciancarefully based on their skill, knowledge, experience, and most importantly their natural artistic vision. Good luck and be well.

Q.Emsculpt and exercise during treatment period?

RealSelf actual patient comment:

I have another Emsculpt question. Think I’m gearing up to try it. Do you just refrain from exercising the body parts being treated during the two-week period but can do other exercise? So if getting abs and butt treated, avoid direct abwork and squats but could otherwise lift, run, and play sports during the 2 week treatment period? Thanks in advance!
A.Common sense is one of our greatest senses. It is fine to maintain your activities after Emsculpt treatments, but if specific anatomic muscle groups are targeted during the treatment, then those areas should be rested for a day or two. For instance if the buttocks are treated then squats can be avoided for a day. If the abdomen is treated then avoid crunches for a day or two. Running, yoga, golf, andscrabble are all okay following your Emsculpt treatments. As with any aesthetic procedure please be sure to choose your treating physiciancarefully based on their skill, knowledge, experience, and most importantly their natural artistic vision. Good luck and be well.

Q.I had a hip replacement in December 2017. Should I avoid Emsculpt? Could it damage the new joint with the energy waves?

A.Emsculpt may be used on patients with hip replacement. The electromagnetic energy should not be directed over the hips. Emsculpt should not be used immediately above any metal implants in the abdomen or buttocks. As with any procedure it is very important that you share with your treating physician any history of implants. Good luck and be well.

Q.Is Emsculpt cost effective? I don’t have much fat in me but like to tone and lift my bottom.

RealSelf actual patient comment:

Emsculpt cost effective. I don’t have much fat in me but like to tone and lift my. bottom Please give me advice I don’t want waste big cost if results are minimal and not long lasting. Thank You
A.Emsculpt is a great new safe and effective non-invasive treatment that lifts the “bottom” like no previous technology that I have seen. Cost effectiveness is relative. It has been said that most of us either have time or money. For those with time and no money, it’s time to start doing your squats and crunches. For those with money and no time, Emsculpt is a no brainer.The treatments are fairly priced for having the equivalence of 20,000 crunches or squats in a 30 minute time period. That’s going to save you a great deal of time. As with any aesthetic procedure please be sure to choose your treating physiciancarefully based on their skill, knowledge, experience, and most importantly their natural artistic vision. Good luck and be well.

Q.Will Emsculpt work for me?

RealSelf actual patient comment:

Dear Doctors please give me your opinion on none invasive laser technology EM SCULPT which is promise to induce strong muscular contraction not achievable through workout and promise to lift and firm buttocks. I am 48 years old woman in very good shape and weight 115 lb all my life but for several years my buttocks do not look firm and really need some lift, i even thought about fillers please give advise to woman who strives for perfection
A.Thank you for asking! You appear to be a very good candidate for Emsculpt technology and treatments. Emsculpt is a great treatment for individuals who are in good shape, who workout, and who wish to push their body to it’s greatest potential. My office staff who have had the treatment relate that they have seen immediate lasting results on lifting their buttocks. As with any aesthetic procedure please be sure to choose your treating physiciancarefully based on their skill, knowledge, experience, and most importantly their natural artistic vision. Good luck and be well.

Q.With Emsculpt how many treatments are needed for “maintenance”? 1? 2? Etc.

RealSelf actual patient comment:

I am going to give this a try. Everyone references maintenance. What number of treatments does it require?
A.I once asked threebeautiful women, “What is Beauty?” The first answered, “It’s a feeling in your heart.”, the second answered, “You know it when you see it.”, the third said, “Beauty is maintenance!!!” Once a patient has had their twice a week for two weeks treatment with Emsculpt, the “beauty” and effectivenessof their results will depend on maintenance. There has not been a studied maintenance protocol as the safe and effectivetechnology is brand new. In my practice Emsculpt treatments are individualized. As a baseline I recommend a maintenance single treatment anywhere from 3 to 12months after the initial treatment. Since the benefits ofEmsculpt treatments are the equivalent of doing 20,000 crunches or squats in only 30 minutes, some patients will continue their “workout” maintenance treatmentevery month. As with any aesthetic procedure please be sure to choose your treating physiciancarefully based on their skill, knowledge, experience, and most importantly their natural artistic vision. Good luck and be well.

Q.How many treatments of Emsculpt for abdomen? How long between treatments?

A.For the abdomen we treat patients for 30-min 2 times a week, spaced 2-3 days apart for 2 weeks, a total of 4 treatments. Patients will likely be treated for maintenance after about a year.Depending on the individual patient in my practice I may adjust the treatment for their particular needs. Having had the treatment myself, I can see where Emsculpt can become almost addicting. I am sure that the device will be used more than indicated, particularly by my staff, family, and friends during off hours. As with any aesthetic procedure, make sure that you choose your treating physician most carefully. Good luck and be well.

Q.Are Emsculpt results permanent?

RealSelf actual patient comment:

How long do Emsculpt results last if I maintain a normal body weight?
A.Emsculpt results are long lasting, permanency depends on the patient. Just like going to the gym and working out, the results that you see must be maintained. Patients who have Emsculpt are loving their treatment results for up to a year before having “maintenance” treatment. If a patient maintains their normal body weight through healthy diet andexercize then the results should last longer than someone who like the lazy kangaroo is a “pouch potatoe.” For the abdomen, fat loss can be permanent but the muscle tone must be maintained. Same for the buttocks, to keep the butt-lift up, one must maintain the muscle tone. Many of the early patients using Emsculpt are finding that they like the results so much that they are having additional treatments for continued improvement.Choose your treating physician most carefully. Good luck and be well!!!

Q.Is the Emsculpt procedure known by a different name? I’ve tried Googling “Emsculpt” and only see realself.com in my results.

RealSelf actual patient comment:

Where do I go to get more information on this procedure, how it works, who is a good candidate, how much it cost, and who provides this service? Thank you.
A.Emsculpt is a brand new technology that flattens and tones the abdomen and lifts the buttocks without any cutting, needles, or pain. It is a quick and easy, safe and effective treatment. Paddles are placed on the area to be treated (FDA approved for the abdomen and buttocks), then electro-magnetic pulses cause the muscles to contract equivalent to doing 20,000 sit-ups or squats in a 30-minute time period. The treatment is repeated twice a week for 2 weeks, results are usually seen shortly after the treatment. If you google “Emsculpt” it should come up. The technology is made by BLT (see video below). Good luck and be well.

Q.Emsculpt for arms and shoulders (off label)?

RealSelf actual patient comment:

Wondering if any of you doctors have tried Emsculpt off label for biceps, triceps, or shoulders since the results for abs and butt are so great? Or does the present applicator not allow for it? Is the company testing/working to develop protocols for other body parts?
A.Great question, while I was getting my first Emsculpt treatment we discussed the treatment areas of the the body other than the FDA approved treatment of the abdomen and the buttocks. The current hardware is able to be applied to other areas and the company (BLT) may be working on other applicators for other muscle groups. The only area that will likely not be treated are the pectoral muscles as the heart muscle is under it. The Emsculpt technology is unique and exciting. Good luck and be well.

Q.I heard Emsculpt builds muscle in addition to melting fat. Can it help build my muscles for me?

RealSelf actual patient comment:

I recently lost 80lbs (went from 220 to 140) and was told by my personal trainer at the gym that I need to build muscle to help with my excess skin. Can Emsculpt help me with this? I do not want to get a tummy tuck.
A.Emsculpt does build muscle as well as decreasing fat cells in the abdomen in general. It is a great treatment for those patients who do not wish to undergo tummy tuck or butt lift surgery.Individual patients need to be evaluated by their treating physician to determine whether the treatment is indicated for their needs. Most likely you will be a good candidate for the treatment. Choose your treating physician most carefully. Good luck and be well.

Q.How much does Emsculpt cost?

RealSelf actual patient comment:

Is the price per treatment or do you pay all at once?
A.Emsculptis thenewest cutting edge non-surgical, non-invasivetechnology that tones muscle and eliminates fat in the abdomen. It can also create a non-invasive butt lift. The treatment consists of 2 30-minute treatments, 2-3 days apart for 2 weeks, a total of 4 treatments. The cost ranges from $3000 to $4000 for either an abdominal or buttocks treatment. In our practice we will be offering better prices for patients who wish to maintain their results over time. We also work with our patients if they wish to pay per treatment it is about $750-$1000 depending on the treatment. As with any aesthetic procedure make sure to choose your treating physician most carefully. Good luck and be well.

Q.I am thinking of having profound on my face and neck, is it safe to go to the beach 10 days later?

RealSelf actual patient comment:

I will be getting profound on my face and neck but will be leaving for the beach 10 days later, my skin gets dark very easily and even a pimple leaves a mark for days, also a scar leaves discoloration, thank you
A.One of the nice aspects of Profound RF is that you may resume normal activities relatively soon following the treatment. Since your skin is sensitive, it would be best to plan your treatment at a time when you would not be exposed to intense sun for at least 3 to 4 weeks. Usually all of the micro-needle tiny punctures are well healed by one week, but why take chances with your sensitive skin? Of course make sure that you use and reapply sun block daily, especially when at the beach. Good luck and be well.

Q.Is it ok to get Profound treatment when I have fillers and Botox in my face?

RealSelf actual patient comment:

I had Juvederm and Botox done a week ago, and love the results. My doctor suggested I have the Profound procedure in about a month. What will happen with the Botox and Juvederm? Will they be destroyed in the procedure?
A.Ideally patients should have any tightening, lifting treatment prior to having injectable facial fillers (other than Sculptra which is not affected by heat.) It depends on the area and depth of the Juvederm or other facial filler that you have had andhowlong ago it was injectedwhether Profound RF will affect it. We encourage our patients to have Botox treatment prior to their Profound RF treatment as studies with laser recovery have shown that the results are better when the treated area moves less (new collagen formation is facilitated.)Good luck and be well

Q.Has anyone used Profound for bra bulge? I was told it was fat.

RealSelf actual patient comment:

But lose skin from losing skin elasticity from menopause (my skin has dropped all over). I work out a lot. I am 5’8″, 157 lbs. I am 53 yrs old. Does anyone know if it will work for this area? I hate the bulge over a swim suit top.
A.I havenot used Profound RF for “bra fat” though with the subcutaneous tip it should be effective. We have successfully used CoolScupting in this area to help decrease the fat bulges. Good luck and be well.

Q.Is Profound RF as effective as fat or Sculptra in restoring volume to the perioral area?

RealSelf actual patient comment:

I have three parallel folds a little over one inch long extending from below my oral commissure toward my lower cheeks (not mesolabial folds) on a bit of a diagonal (NW to SE) due to loss of fat and collagen and (maybe) bone. I have some lipstick lines as well. This is an aging problem, not a congenital problem. I do not have skin laxity, therefore I do not need skin tightening. I don’t want fillers in these areas unless absolutely necessary. About how many Profound sessions might be required?
A.In patients with your described condition, I recommend Profound RF with simultaneous use of Platelet Rich Plasma (PRP). Profound RF alone stimulates the new production of collagen, elastin, and hyaluronic acid, and with the addition of PRP (the platelets attract growth factors and stem cells to the treated skin) there is a magnified synergistic response with improved results. It is an excellent treatment for crepe skin.Sculptra and penMicro-Needling with PRP also help with problematic lines and wrinkles.As with any facial aesthetic treatment it is essential to make sure that you choose your treating physician carefully based upon their skill, knowledge, results, experience, and most importantly their natural artistic vision. Good luck and be well!!!

Q.Is there a danger with the Profound of similar problems like the Ulthera?

RealSelf actual patient comment:

There are several reviews on here of the Ulthera ” melting the face, skin sagging, needing facelifts andfat transfers after Ulthera procedure, I don’t want to take that chance w profound.
A.Your concern is shared with many patients that I see in consultation. Since Profound RF dermal treatment is directed only 1 to 2 mm below the skin surface, it does not effect fat. The subdermal Profound RF micro-needle tip is used to purposely eliminate fat cells (for double chins and body fat.)I do not believe that Profound RF patients need to worry about undesired fat loss with the consequent need for correction.As with any facial aesthetic treatment it is essential to make sure that you choose your treating physician carefully based upon their skill, knowledge, results, experience, and most importantly their natural artistic vision. Good luck and be well!!!

Q.My skin under my chin is loose and jiggly after Profound RF treatment?

RealSelf actual patient comment:

I had the Profound RF treatment 5-6 days ago. The swelling is still evident in my lower face and neck. My main concern is the skin under my neck is loose and jiggly like jello. It was not like this at all prior to the treatment. Will this go away? How long approximately?
A.It sounds as if your treating physician used the subdermal micro-needles which are inserted deep into the submental (double chin) fat to decrease fat and tighten the area. When this is performed with Profound RF it is normal to have swelling along with the jiggles. It is the same swelling and jiggling that we see in patients who are treated with Kybella injections.It does take some time (days to weeks)to resolve depending upon how aggressive your treatment. As with any question or concern following a procedure, it is best to contact your treating physician.Good luck and be well.

Q.How does Ultherapy compare to Profound?

RealSelf actual patient comment:

I had Ultherapy a few years ago. It really did nothing. It was painful and expensive. If Ultherapy didnt work for me how can I expect Profound to be any different?
A. Sorry to hear about your poor experience with Ultherapy. The results of both Ultherapy and Profound RF are dependent upon appropriate patient selection (age, life style, sun damage, tobacco use, etc.),realistic physician and patient expectations, as well as the treating physician. These devices are not commodities, rather they are safe and effective non-surgical skin lifting and tightening tools that when used properly on carefully selected problems work well. Profound RF is a different technologyandworks at a different depth of skin than Ultherapy. As long as you are in good health with a normal healing response with collagen production then ProfoundRF (though also pricey) should help. I would advise consultation with a few experts in the field before committing your time, money, and “comfort or lack thereof” to any treatment.As with any facial aesthetic treatment it is essential to make sure that you choose your treating physician carefully based upon their skill, knowledge, results, experience, and most importantly their natural artistic vision. Good luck and be well!!!

Q.Compare Ultherapy Results with Eprime Results?

RealSelf actual patient comment:

I suspect the downtime is longer with eprime and the pain is greater with ultherapy. However, I would tolerate both in exchange for results. Any head to head comparisons on skin tightening results? Thanks!
A.Profound RF is an improved more effective and safe evolution of “ePrime”.

Profound RF and Ultherapy are different non-surgical device skinlifting and tightening treatments that are both safe and effective. Profound RF uses paired micro-needles that emit radiofrequency energy while deployed 1 to 2 mm beneath the skin for 3 to 4 seconds creating a controlled temperature of 67 degrees C. Ultherapy uses the topical application of micro-focused ultrasound energy at different skin depths (4.5, 3.0, 1.5mm) creating heat. Both technologies work by stimulating new collagen over time. Both continue to improve over a 6 to 9 month period and both are thought to last about 5 years, though you will look better for the rest of your life compared to how you would have looked without having the treatment.The downtime for Profound RF is 7 to 10 days due to bruising and swelling. There is little to no downtime with Ultherapy. In some patients, the two procedures may be combined for even better ultimate results. The results of each treatment are dependent upon the individual patient (age, health, skin damage, smoking, etc.), they are both effective, but in general Profound RF is a more aggressive treatment. The discomfort of both procedures is controlled in my practice with local anesthesia.As with any facial aesthetic treatment it is essential to make sure that you choose your treating physician carefully based upon their skill, knowledge, results, experience, and most importantly their natural artistic vision. Good luck and be well!!!

Q.Profound Laser: Can you tell me the pros/cons compared to Ultherapy and also compared to a facelift? I’m 47 years old.

RealSelf actual patient comment:

I am 47, fighting the aging battle and am looking into some options to help overall sagging appearance. My eyelids are sagging enough to have become uncomfortable and my cheek area is sagging so my face shape does not look defined… I’m not sure which option would be the best for me.
A.Profound RF and Ultherapy are both safe and effective skin lifting and tightening non-surgical procedures good for the face and neck. Neither is a treatment of choice for eyelids, though both may help with crow’s feet wrinkles and slight elevation of the eye brows. Facelift and blepharoplasty are surgical options to treat facial sagging skin. To decide the best option for you, it would be best to consult with a few facial plastic surgeons in person (or at least with photos.)

Profound RF and Ultherapy are different non-surgical device skinlifting and tightening treatments that are both safe and effective. Profound RF uses paired micro-needles that emit radiofrequency energy while deployed 1 to 2 mm beneath the skin for 3 to 4 seconds creating a controlled temperature of 67 degrees C. Ultherapy uses the topical application of micro-focused ultrasound energy at different skin depths (4.5, 3.0, 1.5mm) creating heat. Both technologies work by stimulating new collagen over time. Both continue to improve over a 6 to 9 month period and both are thought to last about 5 years, though you will look better for the rest of your life compared to how you would have looked without having the treatment.The downtime for Profound RF is 7 to 10 days due to bruising and swelling. There is little to no downtime with Ultherapy. In some patients, the two procedures may be combined for even better ultimate results. The results of each treatment are dependent upon the individual patient (age, health, skin damage, smoking, etc.), they are both effective, but in general Profound RF is a more aggressive treatment. The discomfort of both procedures is controlled in my practice with local anesthesia.As with any facial aesthetic treatment it is essential to make sure that you choose your treating physician carefully based upon their skill, knowledge, results, experience, and most importantly their natural artistic vision. Good luck and be well!!!

Q.Profound RF after having Infini RF; good idea or waste of money?

RealSelf actual patient comment:

I had an Infini RF treatment to full face and neck on Jan 7th. I’m seeing good results but am considering doing the Profound RF instead of a second Infini treatment. I’d rather not have to suffer the downtime repeatedly and Profound is supposed to be one and done. My goal is lift & tightening; neck, cheeks, mouth and brow. I am thin with prominent cheekbones and have maxed out on the potential for fillers. Is Profound the way to go? If so, how long should I wait before having Profound done?
A.Both Infini and Profound are excellent safe and effective non-surgical skin lifting and tightening procedures that use micro-needles and radiofrequency energy to heat the skin and induce new collagen production. Infini may require multiple treatments with less down time for each treatment while Profound RF is a one time treatment with a longer downtime (7 to 10 days.) You may have Profound RF about 4 weeks after recovering from your Infini treatment.

As with any aesthetic procedure, you must choose your treating cosmetic physician carefully based on their experience, skill, knowledge, and most importantly their natural artistic vision. Good luck and be well!!!

Q.Is it possible to have Profound RF done on the forehead and temple area?

RealSelf actual patient comment:

At 38 I am seeing the start of eyelid creepiness. I am reluctant to rely on Botox for this as it is costly and I’m not sure about the long term effects of using it. I am more interested in a procedure that will address the laxity and can be repeated over the years. Is this recommended and are there doctors near me who do it. I live in Northern California.
A.Yes, Profound RF can be used to treat the forehead and temple area for improvement of forehead lines, wrinkles, and skin tone/texture as well as slight brow lifting and improvement of “crows feet” lines around the eyes. I routinely treat these areas with the face and neck as it is thought that there is a better overall result proportionate to the total surface area treated. There is the possibility of increased bruising when the temple and crows feet areas are treated, and the forehead requires tumescent infiltration to avoid breaking the micro-needles.In the NoCal bay area I believe that James Newman, MD is expert at the Profound RF treatment.

As with any aesthetic procedure, you must choose your treating cosmetic physician carefully based on their experience, skill, knowledge, and most importantly their natural artistic vision. Good luck and be well!!!

Q.Profound RF for loose stomach skin?

RealSelf actual patient comment:

5’2″ 120 lbs, no kids. Lost 10 lbs in 2 weeks and it damaged my body. It was only 2 months ago, is recency of event in my favor? Can Profound RF help me? Can Profound combined with Ultherapy help more? I saw amazing before/after pics of an ab with “rolls” & crinkles looking 80% better on one doctor’s website but I’m skeptical…
A.Yes, Profound RF is asafe and effective non-surgical treatment to improve loose abdomenal skin. The subdermal micro-needles emit radiofrequency energy deep below the skin to create tightening of the tissue as well as decreasing fat cells.As with any aesthetic procedure, you must choose your treating cosmetic physician carefully based on their experience, skill, knowledge, and most importantly their natural artistic vision. Good luck and be well!!!

Q.Profound RF: What are the risks and side effects of this machine? How long does it last?

RealSelf actual patient comment:

HI doctors, can the heat from this machine melt facial fat? Does results look good initially but cause more laxity/saging down the road?
A.Profound RF is a safe and effective non-surgical treatment for tightening and lifting the skin of the face and neck, including the jawline and wrinkles. The swelling is maximum about 48 hours after the treatment and resolves by 5 to 7 days. You may apply concealer make-up by day 4 or 5 to hide bruising. It is the bruising that takes from 7 to 14 days to resolve. The treatment of the skin does not remove fat. In patients who do have excessive fat under the chin or in the neck, a separate handpiece is used that penetrates 6mm to purposely reduce fat cells. I have not seen any patients appear older and gaunt after the treatment, only younger and tighter!!! Profound RF stimulates the production of new collagen, elastin, and hyaluronic acid all of which add volume to the face. It has been used since 2014 and there have not been any reports of more sagging or laxity “down the road”, just natural continued aging. Patients will always look better than they would have had they not had Profound RF. Fortunately, the risks and side effects are minimal for the degree of improvement. The most common side effects are bruising (7-10 days), swelling (5-7 days), and dermal papules (days to a few weeks). The complications of burns and scars are extremely rare, I have not seen any in my patients.As with any aesthetic procedure, you must choose your treating cosmetic physician carefully based on their experience, skill, knowledge, and most importantly their natural artistic vision. Good luck and be well!!!

Q.Wait time for fat grafting after Profound RF?

RealSelf actual patient comment:

Hi Doctors, How long would I have to wait to get facial fat grafting after a full face profound RF treatment? I’m considering doing profound RF for some lifting and volume restoration. But if it isn’t enough, I’d like to do fat grafting. How long would I have to wait to be safe? Many Thanks
A.I would wait at least 6 months after Profound RF before having fat transfer to the face. The facial improvement from Profound RF continues for 6 to 9 months. There is usually improvement of the cheeks and jawline. Fat transfer is a permanent filler therefore it is important to see the areas where fat is needed, as well as not over-doing an area where volume will increase over time from the Profound RF. Good luck and be well.

Q.How long can the Profound procedure last long term?

A.The best answer to your question is that patients will look better for the rest of their lives compared to how they would have looked if they did not have the Profound RF procedure. This is the same answer for facelifting and Ultherapy. The results do vary depending on how individual patients respond and heal. Most would say that you should continue to appreciate the benefits of Profound RF for about 5 years. I just consulted with a single patient who had her treatment one year ago, she loves her results, has nice before and after photos, yet she is scheduling another treatment in about 3 months because of how much improvement she has seen. These treatments are just “tools” that help with rejuvenation. Many patients have just one treatment and are satisfied, others wish to have more. Improvement after Profound RF continues for 6 to 9 months, therefore the earliest re-treatment is not before 6 to 12 months.As with any facial aesthetic treatment it is essential to makesure that you choose your treating physician carefully based upon their skill, knowledge, results, experience, and most importantly their natural artistic vision. Good luck and be well!!!

Q.Severe bruising and swelling post Profound treatment, is this normal?

RealSelf actual patient comment:

I had profound 6 weeks ago. My bruising and swelling were severe and took 2 weeks to heal. My festooning , which was to improve post procedure is now worse. I have dark circles under my eyes as well. I look worse then I did prior to the treatment. My doctor says that he has never had this result and there isn’t a fix except adding filler. This is quite honestly not an acceptable response. Does anyone have advise?
A.Sorry to hear about your experience. Bruising and swelling are normal after Profound RF, swelling usually takes about 5 to 7 days to come down,bruising usually resolves after 7 to 12 days.It is difficult to make recommendations without seeing photos or examining you. It is best to discuss your concerns with your treating physician or another facial aesthetic expert in your area. Dark circles and festoons are difficult problems to treat. Fillers may help while the expected improvement from your Profound RF treatment occurs over the 6 to 9 months following your procedure. Good luck and be well.

Q.Does Profound RF or Infini RF generate the most volume in facial folds?

RealSelf actual patient comment:

My nasolabial folds are deepening with age. I am developing marionette folds, too. Will treatment with Infini RF or Profound RF to these areas markedly reduce these folds given the fact that they both generate one or more of the components of facial volume (elastin, collagen, hyaluronic acid)? Can they increase volume (with enough treatment sessions) as effectively as Sculptra or fat grafting? Or are these two devices better suited to treating lipstick lines?
A.Both Profound RF and Infini are safe and effective non-surgical lifting and tighteningtreatments. They both use micro-needles that emit radiofrequency energy creating heat that stimulate natural collagen production. I find that the nasolabial folds improve in a natural fashion as the cheeks seem to have increased volume and lift. These devices are the best non-surgical lifting and tightening devices and do work on improvement of fine lines and wrinkles. I often use them in combination with fillers when needed. Sculptra, Voluma, and other fillers are used on an individualized basis depending upon the unique needs of each patient.As with any facial aesthetic treatment it is essential to makesure that you choose your treating physician carefully based upon their skill, knowledge, results, experience, and most importantly their natural artistic vision. Good luck and be well!!!

Q.Does Profound RF require multiple treatments?

A.Profound RF is thought to be a one time procedure. Unlike many other facial aesthetic treatments, Profound RF does not require multiple treatments to see results. Many patients are happy with their results and request a second or third treatment for further rejuvenation. The results of the treatment continue to improve over a 6 to 9 month period. For those patients requesting another Profound RF treatment it is advised to wait at least 6 to 12 months.As with any facial aesthetic treatment it is essential to makesure that you choose your treating physician carefully based upon their skill, knowledge, results, experience, and most importantly their natural artistic vision. Good luck and be well!!!

Q. Is Profound the same treatment as Ultherapy?

A.Good question! Profound RF and Ultherapy are different non-surgical device skinlifting and tightening treatments that are both safe and effective. Profound RF uses paired micro-needles that emit radiofrequency energy while deployed1 to 2 mm beneaththe skin for 3 to 4 seconds creating a controlled temperature of 67 degrees C. Ultherapy uses the topical application of micro-focused ultrasound energy at different skin depths (4.5, 3.0, 1.5mm) creating heat. Both technologies work by stimulating new collagen over time. Both continue to improve over a 6 to 9 month period and both are thought to lastabout5 years, though you will look better for the rest of your life compared to how you would have looked without having the treatment.The downtime for Profound RF is 7 to 10 days due to bruising and swelling. There is little to no downtime with Ultherapy. In some patients, the two procedures may be combined for even better ultimate results.As with any facial aesthetic treatment it is essential to makesure that you choose your treating physician carefully based upon their skill, knowledge, results, experience, and most importantly their natural artistic vision. Good luck and be well!!!

Q.I had a Profound treatment done almost three weeks ago. Is it normal for my jawline to be numb and sore?

RealSelf actual patient comment:

I also have soreness and numbness in my neck. Area under chin feels kind of jiggly and is still swollen. Does my healing fall within the normal time range for this procedure? The treatment focused on my lower face/jawline and neck.
A.It is always best to address questions and concerns about a procedure that you have had to your treating physician. In general, patients may have some numbness and fullness for a few weeks after Profound RF treatment. If your “double chin” area was treated to reduce fat then it is common to have some “jiggly” for a few weeks.Please contact your treating physician for follow up. Good luck and be well.

Q.Profound treatment with broken needle

RealSelf actual patient comment:

One of the needles broke or bent during the treatment and they switched out the head. It happened again with the second head and they would just shut off the alarm and keep going. My question is if I received less treatment because of one or more less working needles?
A.Great question. The Profound RF “heads” or tips that contain the paired micro-needles are complex state of the art technology. There are 5 pairs of very delicatemicro-needles in each tip. They have intricate micro-chip technology that precisely controls the temperature and time of exposure. If a micro-needle is damaged (usually by the needle striking bone), the needle withdraws back into the tip and no longer deploys. If this should happen, then only 4 of the original 5 pairs of needles are working, giving only80% of treatment per insertion into the skin. The feedback of the broken needlesounds an alarm after 5 insertions with a compromised tip. If the tip is detached from the handpiece and re-attached, 5 more insertions are allowed before the alarm sounds again. By continuing with a damaged tip, you may still receive a full treatment as long as you receive 20% more insertions to make up for the broken needle pair.The tips cost hundreds of dollars. If a needle breaks near the end of a treatment session,a physician may choose to continue with the damaged tip, but should begiving more insertions to cover the same surface area, though it may take longer, patients should receive a full treatment. Good luck and be well.

Q.What are the risks associated with Profound RF?

A.Profound is an excellent skin lifting and tightening non-surgical treatment that is both safe and effective. Fortunately the risks, complications, and adverse events associated with Profound RF are rare. The most common side effects to be expected with the treatment are swelling andbruising. The next most common occurrence is small raised bumps on the skin that called dermal papules. Dermal papules usually disappear on their own within a few days, though they may persist for a few weeks. I have personally not seen the extremely rare complications of burns or permanent scarring.

As with any aesthetic procedure, you must choose your treating cosmetic physician carefully based on their experience, skill, knowledge, and most importantly their natural artistic vision. Good luck and be well!!!

Q.Profound RF to lift jawline and treat wrinkles. How long does swelling last and can you apply makeup to cover bruising?

RealSelf actual patient comment:

I’m inquiring about the profound treatment to lift my jawline & treat some wrinkles & sagging on my face …doesn’t this treatment remove fat cells? Will it make your face appear older & guant? I’ve read to drink water to flush the “dead” fat cells out …but that not really what I want to happen .. also..can you apply makeup to cover bruising & how long does the swelling really last?
A.Profound RF is a safe and effective non-surgical treatment for tightening and lifting the skin of the face and neck, including the jawline and wrinkles. The swelling is maximum about 48 hours after the treatment and resolves by 5 to 7 days. You may apply concealer make-up by day 4 or 5 to hide bruising. It is the bruising that takes from 7 to 14 days to resolve. The treatment of the skin does not remove fat. In patients who do have excessive fat under the chin or in the neck, a separate handpiece is used that penetrates 6mm to purposely reduce fat cells. I have not seen any patients appear older and gaunt after the treatment, only younger and tighter!!! As with any aesthetic procedure, you must choose your treating cosmetic physician carefully based on their experience, skill, knowledge, and most importantly their natural artistic vision. Good luck and be well!!!

Q.How long do the results from Profound RF last?

RealSelf actual patient comment:

I know the technically “correct” answer is that it takes off X number of years and that we continue to age afterward, but is this actually true? For Ultherapy, I basically returned back to baseline after one year even though I did look quite a few years younger right afterward. I was wondering if the results from Profound last longer, and how often we should repeat the procedure? Thank you!
A.The best answer to “How long will the results for Profound RF treatment?” is the same answer that I give to patients who ask how long a facelift or Ulthera will last. Patients will look better for the rest of their lives compared to how they would have looked had they not had the procedure. (Joan Rivers once said that she wished that she had an identical twin so that she could see what she would have looked like without all of her plastic surgical treatments!!!) I believe that most experienced practitioners tell their patients that the treatment should last at least 5 years.

As with any aesthetic treatment choosing your treating physician is essential for excellent results. Choose your treating physician based on their judgement, skill, experience, knowledge, and most importantly their natural artistic vision. Good luck and be well.

Q.1 month post Profound RF and I have more laxity. Is this due to all the residual swelling dissipating?

RealSelf actual patient comment:

I’m not expecting results yet but three weeks post profound my face looked and felt firmer. Within the past five days my face started to noticeably sag. I’m a good healer and according to the dr only had mild laxity. At a month post , I look worse than before I went in. My regular dr confirmed this today when I went in to see about fillers. The dr who did the profound is well respected. Is this part of the healing process for some? It definitely caused my filler to metabolize faster.
A.Depending on what kind of filler and where your filler was placed, it is possible that the heat from your Profound RF treatment may have caused some loss of the filler volume which would lead to the effect that you are noticing. I do not believe that the skin “stretches” from the swelling.Over the next 6 to 9 months after Profound RFyour body should produce collagen, elastic, and natural hyaluronic acid adding volume to your face, especially to your cheeks. In the meantime your treating physician may use Voluma and/or Sculptra to strategically add volume until the effects of your treatment take hold. Good luck and be well.

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 RF is a safe and effective non-surgical device for lifting and tightening the skin of the face and neck. Our patient’s experience has been positive. The results do vary, but the overall patient satisfaction rate is very high (the “Worth It” rating here on RealSelf is 97%, and the one not worth it was based on a different technology.) The cost is dependent on the extent of the treatment. My philosophy is that if I am treating someone then they should get the absolute best treatment to maximize their chances for great results. I treat the entire face and neck (twice the surface area) and recommend the concurrent use of platelet rich plasma(prp) which stimulates growth factors and stem cells, facilitating healing and ultimate results. There is additional cost if the deeper subcutaneous micro-needles are used to melt fat. The downtime also varies depending on the aggressiveness of the treating physician, my feeling is that if you are having the treatment, you might as well get the most bang for your buck. Our patients are told to expect at least a 5 to 12 day downtime depending on their bruising. Many patients can use concealer or tinted sunblock (in men) and be presentable within 5 to 7 days.

As with any aesthetic treatment choosing your treating physician is essential for excellent results. Choose your treating physician based on their judgement, skill, experience, knowledge, and most importantly their natural artistic vision. Good luck and be well.

Q.Is 30 years old too young for Profound RF if you’re dealing with facial skin laxity from weight loss?

RealSelf actual patient comment:

Although it’s been over a year since I lost weight, I’ve noticed that my face seems saggier than before. I’m only 30 and know that I would look better if it were slightly tighter. Am I too young for this type of procedure?
A.It is difficult to answer your question without a photo or better yet an in person examination. For the most part, if you do have the “S” word skin (sagging) then either Profound or Ultherapy are great safe and effective device non-surgical treatments to address your concerns. You should get a fantastic result since you are young and your healing response with be boosted.

As with any aesthetic treatment choosing your treating physician is essential for excellent results. Choose your treating physician based on their judgement, skill, experience, knowledge, and most importantly their natural artistic vision. Good luck and be well.

Q.Am I a candidate for profound RF skin tightening procedures/fillers even with the metal wires in my face? (photos)

RealSelf actual patient comment:

I had cheekbone reduction surgery to make the upper face less wide. There are tiny wires stabilizing the new bones. Am I still a candidate for profound RF skin tightening procedures as well as fillers to add a little volume in my cheeks even with the metal wires in my face?
A.I would likely treat you with Profound RF after a consultation and examination. You should bring your x-rays to your consultation. The Profound RF micro-needles are deployed 1 to 2 mm beneath the skin. I would avoid insertions directly above the wires to be extra cautious. Good luck and be well.

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.Profound Lift is a micro-needling device with radiofrequency heating of the undersurface of the skin that is a safe and effective non-surgical facial and neck lifting and tightening treatment. It is not a laser. It is not an “injectable”, though the paired tiny needles apply the radiofrequency energy 1 to 2 mm beneath the skin surface (6 mm beneath when fat is being dissolved.) In my practice it is an excellent procedure for face and neck rejuvenation. There are some practices that promote the treatment of the entire body, usually under general anesthesia in an operating room that takes hours to complete. I have not seen any impressive photos of the treatment on body areas other than the face, though if you have the time, money, and patience, it should work to tighten any skin. In our practice we have found that Venus Freeze, a non-invasive topical radiofrequency application has been effective at helping the loose leg skin above the knees as well as helping with thighs.Good luck and be well.

Q.What is the recovery from Profound RF like?

A.Profound Lift is a wonderful lifting and tightening treatment of the face and neck, it stimulates your own collagen, elastin, and hyaluronic acids resulting in a natural rested, healthy, and rejuvenated appearance. It is safe and effective. The recovery is predictable and involves some downtime that varies among patients. All patients are swollen and bruised for the first few days, maximizing at about 2 to 3 days after the treatment. The swelling resolves by day 5, and sometime bruising may as well, but I inform my patients that there is a good possibility that they will have some residual bruises for 8 to 14 days. After discussing the treatment with my patient, I will usually treat them with an aggressive treatment for best results (this includes treating the forehead, the entire neck, and using PRP as well, areas not included in the standard Profound protocol.)Bruises can usually be hidden with appropriate cover-up concealer. My wife said that the weird thing about the recovery was that after the first 24 hoursshe felt completely normal except when passing by a mirror, at which time she looked as if she had lost a boxing match. The good news is that there is no pain during the recovery. It is an excellent time to catch up with things on the “to do” list around your home, and catch up on those binge watching Netflix shows. Patients may return to full physical activities and working out after 5 days.Results can be noticed as early as a week or two, in other patients it may take up to

As with any aesthetic treatment choosing your treating physician is essential for excellent results. Choose your treating physician based on their judgement, skill, experience, knowledge, and most importantly their natural artistic vision. Good luck and be well.

Q.How Does Uthera Differ from E Prime?

A.We are fortunate to live in age when non-surgical skin lifting and tightening devices are available to treat patient who wish facial and neck rejuvenation without having to go to undergo “the knife.” Both Ulthera and Profound stimulate new collagen formation. Dr. Cho and other physicians have given excellent answers hereregardingthe differences between these two safe and effective technologies. I agree with them.In my practice,the main difference in my recommending one treatment over the other is the time that a patient has for recovery. For those patients who can afford 7 to 10 days for bruising and swelling to resolve while they catch up with reading, Netflix, housework, etc. I recommend Profound lift with PRP (plasma rich platelets). For those patients who request little to no downtime, Ulthera is their treatment of choice. As with any aesthetic treatment choosing your treating physician is essential for excellent results. Choose your treating physician based on their judgement, skill, experience, knowledge, and most importantly their natural artistic vision. Good luck and be well.

Q.Looking for a doctor to do facial sculpting with injectables. Is saline preview a good idea?

RealSelf actual patient comment:

Someone told me to look for a doctor who will help me see what the result will look like by injecting saline into the areas where I’ll be getting fillers. Do you do this? Is it a good idea? I am looking to erase/ flatten out deep nasal labial folds and lines to bring out my youth. Soften a sharp jawline. And also looking to balance out symmetry. I want to make sure the doctor and I are on the same page before I get the real injectables. So I am looking for the best way to do that.
A.The most important aspect of any facial aesthetic treatment is making certain that you have chosen your physician most carefully based on their experience, skill, knowledge, and natural artistic vision. You may have a “preview” of what to expect with facial fillers by having normal saline solution injected. I am happy to do this for selected patients. At your consultation, before and after photos of patients with similar facialrejuvenation treatments are reviewed. Most patients at that time decide to go ahead with treatment, but if you still desire a saline preview, then that is performed.It sounds as if you are an excellent candidate for facial rejuvenation with volume replacement. Good luck and be well.

Q.How can I make my face look less round and flat? (Photos)

RealSelf actual patient comment:

I feel like my face is so flat on my side profile how do I bring out my features more? Would fillers help that? Is there something I can do to make my face look less round? Thanks

A.Yes, fillers properly placed should add to your natural beauty. I would treat your with Voluma on your cheek bones. There are other treatments that can be done after Voluma treatment depending on how you respond.Your job to choose your injecting physician most carefully based on their experience, skill, knowledge, and most importantly their natural artistic vision. You should look great, but your treatment results should not look obviously plastic. Good luck and be well.

Q.Good candidate for nasolabial fillers? (Photo)

RealSelf actual patient comment:

Hello! I’m a late-20s female who is starting to notice pronounced nasolabial folds, primarily on the left side of my face. I think this might be due to having “flat” anterior cheekbones and fairly low body fat or some other anatomical thing that has to do with my smile (I included an image in case that’s helpful). I’d like to have a career in front of the camera so I’m trying to age as gracefully as possible. Any thoughts on whether I should look into fillers? Thanks!

A.Your request is a common complaint that we see in our facial plastic surgery office. Beginning at about age 25 there is loss of bone in the cheeks. This results in the formation of early nasolabial folds (NLFs). Rather that treating the result of the bone loss (the NLFs), today we treat the cause of NLFs, the volume loss in the cheeks. For a patient such as yourself, one syringe of properly placed Voluma should correct the slight aging that you are experiencing. We like to call it going from “Hotty to Oh My G-ddy!!!” Your job to choose your injecting physician most carefully based on their experience, skill, knowledge, and most importantly their natural artistic vision. You should look great, but your treatment results should not look obviously plastic. Good luck and be well.

Q.Is volume the only way to eliminate smoker lines?

RealSelf actual patient comment:

Dr. has used Juvaderm UP for smoker lines on my lips however he’s doing this by adding volume I believe is creating a puffy look on my upper lip ,According to him it’s the only way to erase those lines.Any suggestions? Can the little lines be addressed one by one?I don’t want to look over done should I look for other options? Also I want to get rid of my puppet lines what you recommend? Also is there anyway to get rid of the very fine lines in the middle of my cheeks? Thank you

A.Thereismore than one way to skin a cat and there are more ways than inflating lips to treat “lip lines.” The best treatment for these lines is a fractionated CO2 laser with PRP (platelet rich plasma)which requires some downtime. The lip lines can be individually filled using a thin hyaluronic acid filler such as Restylane Refyne or Vobella without adding volume to the lips. Another treatment is Profound Lift withPRP. Lastly, microneedling with PRP can be helpful. Most importantly always choose your treating physician carefully based on their knowledge, skill, experience, and natural artistic vision. Good luck and be well.

Q.Would a Silhouette lift or Juvederm Voluma in the upper and mid cheeks be best?

RealSelf actual patient comment:

I’m looking for a natural looking lift for my sunken lower face.My jawline is not smooth and the orbital bones are showing. I just don’t want to look inflated but I want the lower jowls to be lifted. Would 1 syringe of Juvederm voluma for each cheek be enough to lift the minor sagging? I am considering a sillouet lift but i hear negative reviews….and I don’t want too many syringes of Juvederm. Recommendations?

A.You are not alone, one of the most common requests for facial rejuvenation is improvement of the jawline, jowls, and the area under the eyes. These are the most common early signs of facial aging and are related to volume loss. I would treat you with 2 syringes of Voluma and then wait, letting you live with your new rejuvenated naturallyvolumized face. After a few weeks, we would re-evaluate your face. At that time you may be fine or we may decide that more rejuvenation would benefit your very pretty face. Whether that would involve more hyaluronic acid filler, or Sculptra, or even Silhouette thread lifting would then be determined.There are excellent safe and effective non-invasive lifting and tightening devicesthat are great for your goals, including Profound Lift (micro-needles with radiofrequency heat energy) combined with PRP (platelet rich plasma), or if you do not have the 7 to 10 day “downtime” Ultherapy would be a good alternative choice.

The most important aspect of your treatment is making sure that you take the time to choose your treating physician most carefully based on their experience, skill, knowledge, and natural artistic vision. Good luck and be well!!!

Q.Is Sculptra okay for smile, loss of volume, and lips? (Photos)

RealSelf actual patient comment:

Can scultpra be used for all areas where I’ve lost volume or have fine lines? If not, what the risk of getting it in my smile line or lips? I’m concerned about using juvaderm in my cheeks again because I smile so much- it looked unnatural last time.Last of all, how would I find a facial sculpting expert in my area?

A.Sculptra is a great natural facial volume replenisher. It can be used everywhere on the other except the lips. Based on your photos, I would treat you with a combination of Sculptra, Voluma (for your cheeks), and Volbella (for your lips.) The best way to find an expert injecting physician in your area is by word of mouth. Visit multiple offices, look at their before and after photos, check out the appearance of the physician’s staff, and ask to speak or meet with their past patients. Choose your injecting physician based on their experience, skill, knowledge, and natural artistic vision. Good luck and be well.

Q.Does Sculptra treat smile lines?

RealSelf actual patient comment:

I am in my late 20s and I am interested in Sculpta. Does it treat nasolabial folds? Does the treatment hurt? Do I get a local anesthetic? Does sculptra come with lodocaine?

A.Sculptra is a biostimulating injectable filler that helps with the nasolabial folds (smile lines). The treatment involves multiple injections, but the discomfort can be minimized by having topical anesthetic ointment for 30 to 60 minutes before treatment. There is lidocaine local anesthesia in the Sculptra mix. In patients in their 20’s often times we prefer the use of a little Voluma to lift the nasolabial folds (nlfs form because of loss of volume in the cheek bones. By replacing that, the nlfs lift in a naturally beautiful way.)The most important aspect of your treatment is making sure that you choose the best physician injector based on their experience, knowledge, skill , and natural artistic vision.Good luck and be well.

Q.Is Juvederm Voluma filler good for cheekbone enhancement?

RealSelf actual patient comment:

I’m 27 and want to get cheekbone enhancement with Juvederm Voluma but I”m terrified. Although it pretty much says no real serious side effects because this product hasn’t been used for long I cant trust that it’s a good idea. I ‘m thinking it will cause changes in elasticity of my skin, the serious side effects that can come on later that no one has seen yet such as tissue scar formation/firmness and discoloration. Getting filler at such a young age and continue to do so, how will this fare?

A.Facial fillers are not tissue expanders. Voluma is an excellent filler, especially for eloquently enhancing the cheeks, under eyes, nasolabial folds, and generally lifting the face in a naturally beautiful manner. Fortunately you are young enough that a very small amount of Voluma (1 ml or 1 syringe) will give you results that take you “from hotty to oh my goddy!” The most important aspect of having a Voluma treatment is making sure that you take the time to select your injecting physician most carefully. You should base that decision on the physicians experience, skill, knowledge, and most importantly their natural artistic vision. I treat patients in the mid to late 20’s frequently and they are among our most happy and satisfied patients. Good luck and be well!

Q.What to do about a huge bump on the side of my nose that appeared 1 year post-op. It’s is still there a year later? (Photos)

RealSelf actual patient comment:

Post surgery I noticed a huge bump on the side of my nose, which feels like hard bone so there is nothing to do to fix it. Its more vissable in certain lightings&makes the front of my nose look crooked. I know to fix it would require me to go under the knife again, but I’m happy with my side profile, it’s just the front which now looks crooked post surgery. Been over one yr all my swellings gone down so I know the bump won’t either. It’s permanent unless I do something.What are my best options?

A.It appears that your nasal bone moved laterally after your osteotomies (breakage of nasal bones.) Depending upon your physical examination, a one sided lateral osteotomy may correct your deformity. Speak with your rhinoplasty surgeon, or consult with a rhinoplasty expert. Good luck and be well!

Q. Fillers or fat transfer when yet to have babies? 28 y/o suffering from upper cheek hollowness.

RealSelf actual patient comment:
I’m yet to have babies. I’ve been contemplating to get either filler or fat transfer. In my case the doctor said i will need 2 cc of filler. I cant decide between fat transfer or filler. I am afraid that if i get fillers done then i will have to stop when I get pregnant and I will again be seeing hollowness and if i get a fat transfer done, the grafted fat might increase in size as many doctors say. Please help me in reaching some decision.

A.I would strongly recommend that you consult with an expert in facial injectables. If you were my patient, I would likely use a little Voluma to restore your early loss of facial volume. It results in a beautiful, natural transformation that let’s you look like yourself, just a younger and more rested appearing you. As many of my patients say immediately after their treatment, and their initial, “Wow!”, they say, “I love the treatment, Voluma takes me from hotty to oh my goddy!” Please be sure to take your time and choose your injecting physician most carefully based on their experience, skill, knowledge, and most importantly their natural artistic vision. It is not the filler that will give you great results, it is the injecting physician whom you choose. Good luck and be well.

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 importantaspect ofyour 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 thecheeksis 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 hearaboutyour 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 earlyinfection. 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?”

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