Dornechia George Carter, MD

For first timers receiving a filler, I will always use Juvederm or Restylane/Perlane.  As mentioned previously, if there is any concern with the appearance, it can be treated and removed easily.  Furthermore, Juvederm and Restylane last up to 6 months, and Radiesse up to a year; I think that patients should be experienced with the appearance of fillers from a previous treatment before seeking the longer-lasting filler. 

Some say that Radiesse can cause a more stone-faced or stiff appearance, but I have had fantastic results with both types of fillers.  Also, there are areas considered off-limits to Radiesse, such as the lips and around the eyes, so if this is an area you want treated then you will have to use Juvederm or Restylane.  It is okay to use both simultaneously for different areas if need be, although this may be a more expensive route depending upon how much product you require.

DGC

Disclaimer: This posting is intended to provide information to the original poster, but it is not intended to substitute for the advice of your personal physician. An in-person consultation is recommended for all patients considering medical and cosmetic therapies.

I have also treated these with good results with IPL; and I often combine this treatment with Retin-A or a similar cream.  It can take up to a year for a scar to achieve its final appearance (which often results in a white flat scar); however, at this point, results from any intervention at that point are less effective, if at all.  I agree with seeing your dermatologist to evaluate the quality and size of your scar and to see which interventions would be most appropriate for you.

More often than being directly related to the medication, patients often experience nausea as a result of the procedure itself.  We call this a "vaso-vagal reaction."  This is just a reaction to the procedure you're undergoing, as much as you are nervous about the procedure and how well you tolerate such a thing.  This reaction, which can include lightheadedness, disorientation and weakness, nausea, and sweating, usually lasts only a few minutes (most patients are good to leave, in the infrequent instances this occurs, after about 10-15 minutes of rest and foot elevation).

If you have this same reaction with other procedures, such as biopsies, blood draws, other injections or even ear exams, you should let your dermatologist or plastic surgeon know that this has been a problem in the past PRIOR to starting the treatment.  This way, we can be prepared to help you in the event that it occurs, and we can coach you through it.  Depending on the severity, we may even recommend against it.  In any case, Botox is generally a short procedure and you

As far as nausea from the medication itself, the duration of that cannot be determined ahead of time and this is an infrequent cause.  Let your practitioner know how you are doing; communication is key.

Accutane is a great medication when applied to the appropriate patient--this includes patients with the severe cystic acne and the scarring that you have.  It is a shame that you had such a breakout after taking what really amounts to a small dosage, although flares of acne are quite common in patients starting Accutane.  For patients like yourself, I would consider trying the medication again at small dosages with an accompanying dosage of oral steroid to minimize the acne flare.  You can discuss this with your dermatologist to determine if this is the appropriate course of action with consideration for your medical history.  Otherwise, if the treatment course you are on is working well (the last picture looks a little improved, although it may be lighting), then you could certainly consider this course of treatment in the future.

If you have reservations about additional treatment, don't be hesitant to bring this up with your dermatologist (or any other concerns for that matter).  As you can see, Botox in the right hands can do fantastic things, and if you had a good experience last time, I think you should continue.

I think Accutane would be a viable next step for you.  Ten years is a long time to be on Bactrim, and it sounds like discontinuing the medication is not an option for you.  Many--most--patients have a long term remission after completing and approriate course of Accutane, although a few may need to repeat courses. 

Botox in the glabella only will relax the frown muscles, but, as a previous poster mentioned, these will do nothing for the forehead or crow's feet.  I would have this procedure done at least one month prior to the big day, in the event that you need a touch-up.  For complete and effective treatment, treatment usually extends across the upper medial eyebrows as well as the glabella.

With that said, consider what you are asking for.  Botox prevents you from moving muscles of facial expression; in your photographs, you want to look refreshed and young, but certainly not expressionless so don't go overboard. You want to look your best, but I highly doubt that frowning, the very motion you are trying to eliminate, will be a part of your wedding day.  Have Botox done with caution and by an experienced professional, or wait until after your wedding day.

Congratulations!

Botox, as well as many other medical products, require pretty strict storage requirements with monitoring, and reconstituted Botox is not indicated to last for very long.  Aside from concerns about non-medical professionals having a home supply of a neurotoxin, the storage in a home refrigerator is questionable.  Frequent opening of the door, as well as the addition and removal of room-temperature items can lead to temperature fluctuations beyond what is indicated (the same reason it is recommended that you do not put eggs on the door of a fridge). 

Additionally, I agree with the comments previously posted.  If you obtained this Botox outside of a medical professional's office (I can't imagine one that would send you home with it), only goodness knows what its' true constitution is.  Many products are sold on the grey market and may be of questionable efficacy and safety, and administration by an untrained individual may lead to unintended adverse effects. 

It is important that you have this lesion evaluated by a professional.  Moles infrequently develop cancers within them, yet it does indeed occur.  The tenderness could be something benign, such as minor irritation perhaps when you comb or cut your hair, or it could mean something more.  You should be aware of the time course of changes in your moles, including whether it has changed size, shape, color, or doesn't appear to heal.  We often refer to this as the ABCDE's:

A:Asymmetry

B: irregular Borders

C: Color changes, including darkening or lightening or greying

D: changes in Diameter, growth

E: Evolution or Elevation--I tend to lump bleeding/non-healing lesions, as well as singular lesions that itch or are tender.  I would caution one to be wary of not only the elevated lesions, but to be aware of the flat ones as well. Most melanomas are still flat when they are discovered, and elevated ones (nodular) are particularly serious.

Be prepared to provide as much of this history as you can when you see a board certified dermatologist for evaluation.  They may be able to diagnose you after exam, or a skin biopsy may be necessary.  In general, patients should do self exams at regular intervals, remembering to check between toes and beneath toenails as well.  Everyone should wear sunscreen to decrease the likelihood of cancers, and a regular exam by a professional for any concerning lesions, and annually, is also sound preventative care.

Traction alopecia is sadly very common amongst Black patients of all descents, as well as any persons who exact a lot of tension on the hair, such as ballerinas who pull their hair in a tight bun.  Unfortunately, it is poorly recognized, and we must do more to educate each other about the problem.  If caught very early, before follicles are scarred, a degree of hair growth may be achieved.  If the follicles have scarred over, it will not be possible to regain the hair growth in these areas.  This can be determined by your dermatologist.

As far as treatment options, just as Dr. Rogers suggested, we often recommend minoxidil and do scalp injections of Kenalog to reduce inflammation and stimulate hair growth.  Sometimes scalp massage may increase blood flow to the area and help somewhat.

Traction, and most types of alopecia, are not only dependent upon taking care of the root, but also maintaining the hair shaft as well.  Moisturizing shampoos, regular conditioner and hot-oil treatments are definitely a plus.  Some may take hair vitamins, such as biotin, to stimulate hair growth.  Decreasing to eliminating the major stressors on the hair is also key.  I would avoid braids, weaves, tight buns, and other stressful styles, and I often discuss with patients hairstyles that they can use to minimize hair damage.  Too frequent and strong chemical relaxers may also be a problem, and discussing transitioning to natural hair (which may or may not include texturizing as a bridge) may be in your future.  This can be done in a way that optimizes your sense of style and minimizes stress on the hair follicle and shaft.

I would definitely talk this over with your dermatologist, sooner rather than later, because all too often patients approach us after much damage has been done.  There are also other types of alopecia to be considered alongside traction, so an evaluation is necessary.  Best of luck.