My mission is to successfully guide and educate patients who are considering rejuvenating procedures.My goal is to identify and understand each person’s goals and desires and to produce results in accordance with their expectations.
Asked By: kkopylec
ANSWER
Hello, Thank for your question. Also, thank you for posting a reasonable question with an answer that is pretty straightforward. The vast majority of the swelling, I would say 90% minimum, will be resolved within four months after having the procedure. From 4 to 6 months, there will still be some changes most notably, probably in the small incisions that are made to introduce the instruments. It takes 4 to 6 or even up to 12 months for complete 100% total and complete healing and swelling resolution. However once again, I feel confident telling you, given there are no complications, which are rare when surgery is performed by a good surgeon, that you should benefit significantly and be well healed four months following Vaser liposuction.Best wishes,Dr. Mitchell
Asked By: Herince
ANSWER
Hello, Thank you for your question I understand that I am not the first Surgeon to answer your question. I do not ever read the other Surgoens answers to a given question prior to providing my own answer. I do not wish to answer with any bias or preconceived ideas. Because the answer to your question is pretty straightforward, I hope that the information I give to you is consistent with the other answers you have already received. Any good rhinoplasty/nasal surgeon should provide similar information that I am putting forward. First, I don’t feel that the amount of your collumellar show is too excessive. You have a very nice nose. I do understand this is subjective and the amount of your columella that can be an seen below your alar rim is bothersome to you. Fortunately the correction of this region is straightforward and effective. This correction can actually be completed under local anesthesia in an office-based setting and does not require general anesthesia. Anesthesia options should be provided to you however for you to choose from. The hanging collumella is either a result of excess skin and/or mucous membrane, elongated sepal cartilage, or both. In order to resolve your issue, the excess skin, mucous membrane and possibly long caudal septal cartilage (too much cartilage) will have to be excised (removed) and the two distal ends sewn together to make the hanging columella go away. It’s really as simple as that. I did review your photos and it appears you are pushing your columella up a little bit too high for he best aesthetic result. I do however understand your situation and once again it can be resolved pretty easily. I hope that I have provided you with some useful information. If you have any other questions for me please do not hesitate to reach out to me.Best regards,Dr. Mitchell
Asked By: HTDUNNE2013
ANSWER
Hello, Thank you for your question. I see you posted this almost a year ago. I am surprised you didn’t receive any answers. But because CO2 laser of the scalp is not such a commonly performed procedure maybe other doctors were not interested in tackling this situation. You did not indicate in your question/explanation when you had the hair transplant procedure performed. However, now that it’s at least a year later, if you still are suffering with contour irregularities on your scalp from the hair transplant surgery, and it still bothers you, then I believe you are a candidate for CO2 laser skin resurfacing on your scalp. While the face is by far the most common region to perform CO2 laser skin ablative resurfacing, the scalp also contains pilosebaceous glands (oil glands) which help in faster healing, which also make the scalp an acceptable region to perform skin resurfacing. You would have to shave any hair off of your head just before the procedure. CO2 is performed on bald skin. While the natural hair follicles and the transplanted hair follicles should be safe from damage from the CO2 laser, it is potentially possible that some of the follicles become damaged. The CO2 laser is attracted to water and it vaporizes the epidermis down into a level of the dermis. The hair follicles are deeper than the dermis. This would be done best under general anesthesia as the CO2 laser beam is painful during the actual treatment and localizing with anesthesia the entire scale while possible, I don’t recommend. You may also benefit from 2 or even possibly 3 good CO2 treatments separated by at least 6 months apart. You should have good, noticeable results with one treatment but there are never any strict guarantees and reaching your expectations might require more than one treatment. I hope this finds you well and that your situation has either resolved spontaneously or you have received successful treatments or that my answer helps you in moving forward with your continued scalp contour issue. Best regards,Dr Mitchell
Asked By: lindav61
ANSWER
Hello, Thank you for your question. You indicate that you have moderately oily skin and that you’re going to be undergoing erbium ablative laser in one month. I see this question was posted in August 2019 so the time has passed. However I’m going to answer this very important question in case other people read this answer in the future. In most patients undergoing ablative facial skin resurfacing, whether it’s a CO2 laser or an erbium laser, it is recommended and many times the best treatment practice to pre-treat the skin beginning 6 to 8 weeks prior to the procedure. We pre-treat skin (prepping the canvas) for very important reasons, such as those who have oily skin. However there are other important reasons as well. The topical pre-treatment regimen typically will include tretinoin cream, like Retin-A and hydroquinone which is a skin- lightening product. Reasons for pre-treating the skin include faster healing and less risk of post inflammatory hyperpigmentation (PIH). The use of the tretinoin is to partially dry out oily skin and also to remove the dead top layers of the epidermis. This will allow the laser to penetrate the epidermis down into the dermis better and more evenly. The hydroquinone is important in those who have pigmentation issues or dyschromia‘s or have darker skin types such as Fitzpatrick two three and especially four skin types. The hydroquinone is thought to balance the melanin pigment better to prevent post inflammatory hyperpigmentation and to prevent post ablative pigmentation issues. I believe that oily skin is one good reason to pretreat skin prior to ablative skin resurfacing. Pre-treatment usually stops one week prior to the laser treatment. There really is no downside to pre-treating the skin but there could certainly be advantages to pre-treating the skin prior to these types of procedures. if you are undergoing ablative laser resurfacing you should certainly discuss a pre-treatment regimen with your surgeon.Best regards,Dr. Mitchell
Asked By: Ahmed Shiekh
ANSWER
Hello, Thank you for your question. I would like to reassure you that playing video games for extended periods of time, rubbing your eyes harshly due to itching or crying for some people, does not cause the eyes to become sunken. Skin allergies and allergies that affect the eyes can cause redness and swelling which is usually temporary until the allergy is treated and subsides. Genetics and the aging process are responsible for the appearance of our eye anatomy. The photo that you present does not show your eye clearly so giving you informed recommendations to possibly solve your condition is difficult to say. You can post better photos of your eyes and ask the question again or you can schedule a consultation with a plastic surgeon that performs eyelid surgery frequently. Face-to-face consultations are always the best way to obtain information and options regarding facial plastic surgery procedures. Best regards,Dr. Mitchell
Asked By: angelique666
ANSWER
Hello, Thank you for your question. Injecting the chemicals you are speaking of, even in low dosages directly into the lower eyelid fat pads is not recommended. It is very unlikely to cause a positive effect and can prove to be dangerous. There are no medical studies to demonstrate that injecting yohimbine hydrochloride and clenbuterol hydrochloride into the fat under the eyelids will result in fat pad dispersement. The only two viable options for treating obvious fat pads under the eyelids are to use temporary hyaluronic acid fillers to camouflage the fat pads or a lower eyelid blepharoplasty to directly, partially remove and contour the fat pads of the lower eyelids. This area is very sensitive. I think you risk causing damage or serious complications by injecting these chemicals into this region. You are not going to be able to find any responsible board-certified surgeon who is willing to perform the procedure you’re speaking of. With all due respect,Dr. Mitchell
Asked By: CassandraRiley
ANSWER
Hello, Thank you for your question. I understand that you’re not satisfied with the fullness to the sides of your lower lip. Because of the challenging nature of your complaint you may get various input from other surgeons and my suggestion is only an option to consider. I believe these fatty collections are at least subcutaneous fat, which means it’s fat just below the skin. While liposuction of the face is not a very common procedure, these areas under your lip might be treatable with very carefully performed microliposuction to the area. I would only let a very experienced, confident surgeon perform this procedure on you. I would have to see you and palpate these areas before deciding if micro-liposuction is even an option. I do not believe this fat (fullness) is below muscle in which case liposuction would carry more risk. I also do not believe that Kybella is a good option due to possible nerve injury from the Kybella. This is not buccal fat and removing your buccal fat pads will have no effect on these two mounds below your lips. I hope I provided you with at least a little insight into one possible treatment for this area below your lip that you are not satisfied with. Best regards, Dr. Mitchell
Asked By: Enthusiastic6483
ANSWER
Hello, Thank you for your question. Congratulations on quitting smoking after 20 years of use. That is a very difficult addiction to break and it’s never too late to quit but a very wise choice you made. You are obviously and rightfully proud of yourself and relieved as you should feel. Now you desire to reverse the signs of aging which have been contributed to from cigarette smoking. I am not going to get into depth regarding the three D’s of of the aging face, however the three D’s of the aging face are decent, deflation and deterioration. In answering your question I am going to focus on the perioral region. The perioral area includes the lips and surrounding region. Besides the “deflation” of your lips, your skin has also taken a beating and “deteriorated”. The skins deterioration manifests by skin dryness, dullness, lines and wrinkles as well as pigmentation abnormalities. I have reviewed your photograph. You are considering a lip lift or lip implants or possibly even both. I understand that you have had fillers and fat transfer but the results have not persisted. I understand that you’re looking for a more permanent result. There are few procedures that we perform that are permanent however the two procedures that you’re talking about, both a lip lift and lip implants are actually potentially permanent procedures. I have answered quite a few questions regarding the subnasal lip lift. If you research my Realself Q and A regarding the subnasal lift lift you can gain more information there. The most important factor regarding a subnasal lip lift is that you have enough skin length measured from the bottom of your nose to the top of your lip in order to be a candidate for this procedure. It certainly appears that you have enough length between the bottom of your nose in the top of your upper lip in order to support a subnasal, bull-horn excision lip lift surgery. Undergoing the procedure will result in a shorter distance between your nose in your lip which will bring your face into greater harmony or better balance and in addition it will give you a more prominent upper lip. One significant downfall to undergo any lip lift is if you begin with not having enough skin from the bottom of your nose to the top of your lip. If you attempt to remove the skin or too much skin is removed there will be an abnormally short distance from your nose to your lip and this will be a defect that is nearly impossible to correct. It will result in disfiguration. The advantage to having the lip lift is to give you a more normal distance between your nose in your lip and at the same time providing you with a full or more prominent upper lip. You can have the lip lift in isolation or you can even do this at the same time as a lip implant. Also, the scar resulting from the lip lift can be noticeable in some people. The current best implant on the market that can be inserted into the lip is made by Surgisil. Unfortunately it is not FDA approved in the United States for lip implantation. It is called Perma facial implant in the United States and it is called Perma lip implants in the UK in Europe where it is CE approved for lip implantation in those countries. So while in my opinion and experience it is very effective and a “permanent” choice for a fuller lip you must understand that when it’s used in your lips in the United States it’s considered an off-label use. That does not mean that it can’t be used in your lip you just have to understand and be aware that it’s not FDA approved for certain reasons which go beyond the scope of this this answer. The clear advantage to the implants is that it is a permanent fullness of your lip. If for any reason you choose you don’t want the implant any longer or you don’t like it it can be relatively, easily removed. I think that the lip implant is an excellent alternative to having to refill your lips with semi-permanent fillers which do not last very long. There are also advantages to the fillers. Essentially having the implant in your lip is like having 1 mL of filler permanently placed into the lip. The implant will correct the deflation component of the aging lip. Potential complications could involve placement issues or potential infection or the rejection of the implant. If that were to happen you would lose the implant. Finally, you might look into CO2 laser resurfacing to correct your skins deterioration from sun exposure and smoking effects. CO2 ablative resurfacing is an fabulous treatment to remove lines, wrinkles and correct some pigmentation abnormalities. You can also resurface the scar created from the subnasal lip lift. I hope that my answer has provided you with some useful information. If you have any questions please reach out to me anytime.Best regards,Dr. Mitchell
Asked By: Janie Stanbury
ANSWER
Hello, Thank you for your question. You really need to wait until after the surgery has been performed to ask your doctor how long you should wait to fly. You state that you have a 5”x 2“ mass on your rib cage. You have not even had the surgery yet potentially. You’re not sure how well the surgery is going to go, if there will be any post-operative bleeding, wound healing issues or infection. With your question as stated, I would say safely you will need to wait a month following the surgery to fly so far away unless you aren’t afraid of seeking medical care where you are headed in case of a complication. If however the surgery goes well and the sutures come out 7 to 10 days following surgery and there are no complications, you can probably fly within two weeks following surgery. please ask your surgeon this question.Best regards,Dr. Ryan Mitchell
Asked By: Corrine75
ANSWER
Hello, Thank you for your question. I understand that you are 32 years old and you are considering Bellafill for hollow temples and to improve deeper nasolabial folds. I also understand that you have previous experience using other temporary fillers. Because of the temporary results and the requirement that you refill frequently to maintain your appearance is expensive you’re considering replacing the temporary fillers with a permanent option. I assume you have been satisfied with the cosmetic results from the other fillers you’ve used and I think this in part makes you a good candidate to use Bellafill now. You know first hand how fillers work and appear when injected into your areas of concern. Unless I am treating acne scars, I usually recommend for a patient who has never used any volume replacement to at least try a temporary filler first to make sure that he or she is satisfied with the filler experience and appearance of having a filler placed into his or her face as opposed to starting out with a permanent option such as Bellafill. I have been injecting Bellafill for quite a few years and I am satisfied with the filler overall and my patients have also been satisfied with the filler. I have had very few complaints, none have been overfilling or significant appearing nodule issues. I think that the long-term safety of the Bellafill is very good. The long-term results, long-term safety and efficacy of Bellafill through multiple clinical studies and post market surveillance indicates clear evidence of the long-term safety with Bellafill through 12 years. Bellafill was approved by the FDA to treat nasal labial folds in October 2006 under the trade name of Artefill and I know it’s popularity is steadily increasing for patients in your position. whatever it is we read from the company regarding Bellafill is in terms of injecting it into the nasal labial folds and not into other off-label regions. Bellafill is FDA approved for nasal labial folds as well as acne scars and you should be aware that using the filler in your temples would be an off label use. I would like to mention possibly a better option for the hollow temples and that would be silicone implants. There is a temporal shell implant made by Implantech which is an ideal, permanent solution for temporal hollowness due to genetics or trauma. It’s soft and flexible and the silicone temporal shell provides soft-tissue volume (muscle enhancement) for an aesthetically pleasing appearance. They come in various sizes and they can be trimmed or customized by your surgeon during the procedure so they fit you just right. These implants are very nice and they are safe. They are inserted through a small temporal incision and they can always be removed relatively easily if for some reason you decide you don’t want them anylonger. Bellafill however is another option and it would need to be injected smoothly and carefully in this region. Personally I would dilute it and have my patient treat post-injection similar to Sculptra. What you are worried about in your question is a delayed onset nodule (DON). Lumps, masses, nodules, regions of induration, delayed hypersensitivity reactions, sterile abscesses and granulomas are all terms used to describe a delayed onset nodule. A granuloma is actually a histological diagnosis and no lump or nodule should be named is this unless there is histological evidenece. Delayed onset nodules are more common in immune reactive patients and particularly those with active autoimmune diseases. It is important that you choose the correct practitioner to inject this particular filler because the complication rate is greater for less experience practitioners. If a patient develops a delayed onset nodule the treatment varies. If it’s only palpable but not visible you might want leave it alone with careful watching and waiting. If you do develop a significant nodule or an inflamed nodule that requires treatment, various options exist to treat the nodule depending upon the time of presentation of the nodule after the filler was injected as well as its visibility and inflammation type. I am going to state with an educated opinion but little personal experience with D.O.N. that you have at most a 1% chance of developing a significant nodule sometime in the future after the injection of Bellafill. I hope this information provides you with some guidance in going forward with your desires regarding permanent options for restoring facial volume. I think you should certainly research silicone temple implants before you choose to put Bellafill in this region. Bellafill can always be used in the future but it is very difficult to remove. Silicone implants are not difficult to place in this region and they are relatively easy to remove. If you have any questions please reach out to me at anytime.Best regards,Dr Ryan Mitchell
Dr. Ryan Mitchell continues to receive overwhelmingly positive feedback for his expertise in various plastic surgery procedures, particularly in , , , and . Patients commend his professionalism, artistic skills, and the natural results he achieves. Many appreciate his attentive care, efficient staff, and reasonable prices. Despite some post-operative discomfort and swelling, patients are generally pleased with their outcomes and Dr. Mitchell's approach.
