San Diego1

Fillers and Botox are not replaced by lasers. Botox relaxes wrinkles and lines and fillers "fill" them.

Lasers resurface the skin but have no effect on dynamic wrinkles (the ones treated with Botox) and some moderate effect on static wrinkles caused by age and collagen breakdown. But this is dependent upon the type of the laser and the level of aggressiveness.

Full surface lasers (not the fractional lasers) require significant healing time and most people don't want to deal with an oozy mass of raw skin while that healing is in progress.

The fact that you are dealing with skin cancer should certainly be addressed and resolved FIRST! Should you require cancer removal surgery on your face, then some laser could help minimize scarring.

Lasers base their effectiveness on the delivery of heat, and to get tightening you have to have considerable levels of heat.
Fractional lasers such as the Lumenis DeepFX or the Fraxel CO2 or Syneron's ematrix, all tighten by both ablation(varporization of columns of tissue) plus the extended effect of heat which spreads out beyond the ablated columns.

The body's response is to tighten the collagen strands. Obviously the ablation itself will cause some tightening since the volume of skin tissue is lessened - although at a small percentage.

If the tissue laxity on your neck is significant, you likely will need surgery to get the effects you want. For those with minimal jowling and neck laxity, Thermage may be useful. But nothing will replace the effects of surgery for tightening when there is considerable sagging.

As for sleep wrinkles - you really can only combat them by changing your sleep position. High sodium intake tends to make sleep wrinkles on the face and chest more obvious since your tissue will hold more water.

That you had such an unpleasant experience is very distressing to hear. No one wants to have to deal with bruising on a long term basis. I hope my response below will help you understand the variables that affect the treatment experience and the projected results.

Please, don’t blame the product. Sculptra has the potential to do what no other injectable can achieve when it is used in the way it is intended in the amounts required.

Bruising:
Patients who undertake any type of injections risk bruising. The most common cause of multiple area bruising is age-related fragile blood vessel walls. Bruising is also brought on or increased by the use of a number of common over the counter pain killers such as ibuprofen or aspirin products, supplements such as Vitamin E, fish oils, St John’s Wort, ginko, ginger and garlic which all tend to act as natural blood thinners. Prescription blood thinners almost assure bruising and should always be disclosed prior to any injection treatments.

Certain health issues which cause a loss of blood platelets, which the patient may not even be aware of, will cause bruising as well. Any patient who experiences long term bruising who has not taken pain medications, OTC supplements or RX blood thinners may be well advised to visit their primary physician to rule out an underlying health issue they may have no other symptom of.

Pain during injection:
Everyone has different pain tolerance. Injecting any product into the face tends to be painful on some level and the needle size required to inject Sculptra is larger than that you would use with other injectables such as Juvederm or Botox. Some areas where Sculptra is injected CAN be quite painful and we try to prepare patients when an injection is being made in that location, generally in the area above the canine tooth where there is an abundance of nerves.

Required Sculptra sessions:
Sculptra works by creating a fibroblast response of the skin which creates “layers” of new collagen. Because the buildup is gradual and the individual patient response is unique, we will never attempt to fully correct at a first session since attempting to do so could create an undesirable result. Younger patients require less product, fewer sessions and have longer lasting results because they have a much stronger collagen generating system than someone who is in their 40s and beyond, who may require 3 or even 4 sessions depending on the volume loss we are attempting to reverse.

Duration of product:
Sculptra is mixed with sterile water prior to injection. Because the amount of product is very minimal, the “end response” is not the product itself, but your own collagen. It will usually take several months and 2 to 3 sessions for the average 50-something patient to arrive at their desired results and this will last on average 18 to 25 months and often longer. If a patient has only a single treatment, when more are clearly needed, then the response may not be evident enough to produce a satisfactory result.

Your personal experience:
We urge you to come to our clinic for a review of your treatment. If pain is an issue, in some cases we can offer a nerve block. As for bruising, list all your medications, supplements and if none of these appear to be a factor – then or now - your primary physician can run appropriate tests to rule out a hidden health issue.

It is always our sincere intent to provide full disclosure on treatment side effects, costs and requirements before commencing a treatment program. That somewhere along the way those elements were not fully communicated is troubling to us and we will certainly take steps to better manage patient expectations.


Recommendations:
For anyone contemplating facial injections, it is best to review the list of potential bruise-makers and if you find you are taking a vitamin or supplement or RX or over the counter medication which fall in the list, discuss how long you should stop taking them prior to treatment. For review of the most obvious list of offenders, visit http://www.mayoclinic.com/health/easy-bruising/HQ00355 and also
http://www.caleyes.com/webdocuments/medications-containing-aspirin.pdf

I am so sorry you have had such a miserable outcome.

As a matter of safety and reversiblity, the only injectable products that should be contemplated for under eye use are the hyaluronic acids as these can be reversed.

In this day and age, it is imperative that consumers do their "homework" about products and procedures. Off label product use is standard around the world, and most physicians are very careful in the choices they make to inject in areas outside of those approved in clinical studies. But in your case, the choice made exemplifies the need for more physician adherence to guidelines and product indications.

Thank you for sharing on this site. This will no doubt prevent a similar instance for someone else - or even for many.

The hyaluronic acids such as Restylane or Juvederm can be broken down by injections of hyaluronidase. The products naturally degrade on their own but you can get a quick reversal with this injection. Two and a half years the filler would be completely gone, so I'm suspecting you have some lymphatic stagnation or a blockage (unless the bags are from fat and then that is another issue altogether) Not everyone is a good candidate for under eye or tear trough fillers. If you have "bags" already, filler won't make them go away. I would recommend that anyone seeking fillers under the eye first discuss the intent with an ophthalmologist and have an exam to rule out the propensity for complications.

Most people don't bruise as you did...but many people are unaware of all the things that can make you more susceptible to bruising. The top offenders are medications and pain relievers or aspirin; then supplements like Vitamin E and fish oils. Next in line is injection technique. The under eye area is extremely delicate, so the injector must take care to inject slowly with the least trauma possible. Under eye fillers should really only be injected by ophthalmologists or highly skilled dermatologists or plastic surgeons who know where the "safe" areas are.