Virginia Beach Dermatologists

How Safe is Fillers for Acne Scars and What is the Worst Situation Possible?

I am considering fillers. They suggested pdt laser too. Apparently, they thought surgery was out of the question. I got many scars, mostly mini ones but, one scar is pretty big enought to effect my confidence. I hear fillers are around $1000 and not exactly pleasant. Juvederm a good choice? With my skin tone, I don't think laser is a smart choice, plus, it is very expensive.

Fillers are quite safe for acne scars since they are not injected into any of the danger zones of the face such as the glabella. Juvederm Ultra would be the best one of the fillers available in the US. Treating acne scars with a hyaluronic acid filler will last longer than fillers injected into areas of tension such as the lips or naso-labial folds. So, the duration should be at the high end of the spectrum, probably 16 months or so. Do consult with someone with experience, a plastic surgeon or dermatologist, since these injections are superficial and risk the blue discoloration of the Tyndall effect. The cost is actually significantly less than $1000 and should be 1/2 or even 1/3 of that price. 

Some might advice a fractionated laser, however, if you have numerous acne scars. Generally, fillers are best for a few scattered acne scars.

Finally, you must mean PDT ( photodynamic therapy) with an Intense pulsed light...blue light or red light device. This is not a true laser. Also, as far as I know, it is not particularly effective for acne scarring, though it is a great modality for active acne. 

Arnold R. Oppenheim, MD

Virginia Beach Dermatologist

My Left Eye Lid Droops After Botox, Will it Get Any Worse?

5 days after I had botox I noticed that my left eye lid droops and feels heavy. This is quite scary, can this condition be permenant? Could I have receieved permant nerve damage from this procedure? How long before this goes away? It has now been over two weeks, can the drooping get any worse or has it gotten as bad as it can get? Can this problem effect my vision?

A droop of the eyelid , medically termed a ptosis, or colloquially quaz, named for the Disney version of Quisimodo, is a complication of Botox placed too close to the Levator muscle of the eyelid. By weakening this muscle, there is a subsequent drop of the upper lid. This is not permanent by any means. How long your quaz will last, depends on how much Botox infiltrated into the Levator muscle and its concentration. In most cases the ptosis lasts about a month but can last twice or even three times that period of time. It should not get worse than it is now. Generally there is no affect on vision....certainly not a permanent effect.

   A ptosis can be treated with eye drops called Iopidine ( apraclonidine). This works by activating small lid lifting muscles called Muller's muscles. Often, the eye can become irritated with this drug, however. At that point an over the counter eye drop called Naphcon can be used.

When lid ptosis was first studied, using expert and experienced injectors, the ptosis rate was judged to be about 5% of patients. The blame was placed on those affected patients: that they lacked a pseudomembrane that shielded the levator muscle. However, as physicians became more experienced it turned out that lid ptosis has more to due with imperfect technique, what aviators call pilot error. A realistic percentage is between 1-3% of patients. 

Arnold R. Oppenheim, MD

Virginia Beach Dermatologist

After Using Latisse for a Year With Wonderful Results Why Has it Stopped Working?

I have been using Lattis for about a year and a half with the most amazing results on my lashes and brows. However, In the last two months it has stopped working and my brows and lashes have fallen out. I am soooo disappointed. Can I get a refund? Any information would be greatly appreciated. Thanx!

If your eyelashes and eyebrows have suddenly fallen out, it is far more likely to be due to a condition called alopecia areata. With AA, the body seems to be trying to reject the hair as the lymphocytes send a stream of proteins called cytokines. These cytokines more or less paralyze the follicles, and the hairs, no longer able to grow, fall out. I would recommend consulting a dermatologist to fix this problem.

Good Luck.

Arnold R. Oppenheim, MD

Virginia Beach Dermatologist