Alexander J. Kaminsky, MD, MPH

You may want to clarify with that nurse who gave you the advice why she believes that fillers after a lower face-lift would not be good for you.  A lower face-lift procedure itself is not a reason to place filler in the tear-trough area and is actually routinely performed with great outcomes.  I believe you can can confidently seek treatment from a well skilled injector or from a plastic surgeon for your tear troughs. 

I hope this helps,

Dr. Kaminsky

Hi tjhunt,

There are several options of scar improvement on your nose, but it is difficult for me to say which one would be best based on the photo provided.  I would recommend a consult from a reputable board certified plastic surgeon as they can better assess the scar to see what procedure(s) including, fillers, subscision, peels, dermabrasion, thermal/RF energy devises, fat grafting, or surgical scar revision may be best for your goals.

I hope this helps.

Dr. Kaminsky 

Layla,

From your photos and story, this appears to be an issue of having a small defect in an already thin layer of fat tissue just above your abdominal muscles.  This is difficult to correct.  Kybella is a good medication for dissolving fat, however it is not a fine tool to target small areas or touch ups with predictable results as you would be expecting. It is also only approved for fat under the chin.  Use in the abdomen would be off-label which is not a deal breaker, but something to also consider.

This would be analogous if you had a small depression in your yard under the grass, conceptually would you fill underneath the divot to make it level with the surrounding grass (fat graft/filler) or take more dirt away from the depression to "smooth it out" (kybella) over a much larger area?

  In my opinion, you would need gentle volume replacement for those areas which could be accomplished with either delicate fat grafting as you previously had or precise placement of filler, which is also off label.  One new product that may work and is approved is Renuva from MTFbiologics which is an off the shelf fat graft.  This could accomplish your goal of getting rid of the defects without another donor site and not risk involving a larger area with possibly worse result.    

I hope this helps.

Dr. Kaminsky

The scar appears to have irregular edges, a different color than the surrounding skin, has widened  and looks sunken in.  With all of those factors, I dont see another good option other than to seek a consult from well regarded plastic surgeon for a scar revision.  A revision will not leave you scarless, however it may be able to greatly improve the scar you have. 

Best of luck,

Dr, Kaminsky

From the photos, it looks like you are asking about two different issues.  The first being the loss of facial volume from weight loss and the unhappy result from the fillers placed.  To address this issue, there are many variables to consider including has your weight loss been stable or are you continuing to loose weight, how much filer was injected, what type, what depth was it injected and was the injector skilled.  Congratulations on the weight loss, that is not an easy accomplishment.  I believe that in order to better assess the contributions of the filler, your weight has to be stable as we can then know that the volume being placed by filler is not being offset by further weight loss in your face.  If you weight is stable, then a well skilled injector can make honest assessments of how much volume loss you have and estimate how many syringes of various products it would take to realize your goals. 

 The second issue is the loss of your jaw line which may be from a loss of elasticity in the skin coupled with some of the skin stretching that occurred when you carried more weight. If this is the case, one of the best options for you would be neck lift combined with facial fat grafting to restore your jaw line and add volume to your face.  I would recommend a consult from a reputable plastic surgeon who would be able to better evaluate your anatomy and formulate a plan to achieve your goals. 

Dr. Kaminsky