Ali Ghafouri, MD

Exosomes communicate with skin cells to improve cell regeneration and signal certain functions, like producing more collagen and wound healing. Understandably, stem cells are impossible to get into the skin without an incision or injection, whereas exosomes contain smaller molecules that are potentially more readily deliverable.Aesthetic procedures such as microneedling or laser services serve to provide an open gateway for exosomes to received deeper in the skin. In most cases you will start to see results from such treatments within 3 months. The exosomes should be considered a type of "booster", if you will to aesthetic services to rejuvenate the skin.

It is very important to go to a very experienced injector when considering filler for this very delicate area. In most cases a HA filler that is not exceptionally hydrophilic is a great choice. Belotero and Restylane-L are commonly used for this area. Your injector will decide on the appropriate product based on the severity of the deficit. When filler is properly injected to fill the tear trough, it should look very natural.

ActiveFX resurfacing is a great treatment option to smooth skin texture, tighten laxity, and reduce sun damage. You can expect to be very red and swollen the first 24-48 hours. You will become crusted with a very bronzed appearance. Most of the crusting will gently and naturally slough off in days 4-10. Once all of the crusting has shed, you can wear tinted mineral sunblock to camouflage the residual redness.

After any ablative skin resurfacing, the skin is very compromised and in need of delicate care. Unfortunately, some patients unintendedly may scratch their face while healing. The mark may remain for several weeks, but should eventually fade nicely.

Everyone has some asymmetry in facial features, some more prominent than others. As we age it may become more visible because of facial bone and volume loss. The good news is we can create significant balance in nearly all areas of the face with dermal fillers. In the jaw and chin, we specifically like to use either Restylane Volux or Radiesse fillers. Both options will last a year or longer. A few treatments may be required to achieve the desired results.

Thank you for adding the photos. First, I am sorry you had such an adverse response. We have treated many patients with Morpheus8 in our office who had previously had filler ( including Bellafill) in the tear troughs. This is definitely a rare response to the combination of treatments, especially because the filler was placed 2 years prior. In most cases we see the opposite response. Some patients feel the Morpheus8 dissolved filler in the tear trough. Morpheus8 is also often used to reduce under eye festoons. I would recommend asking your provider for your treatment records. You can reach out to the clinical advisors at Inmode (the maker of Mopheus8). Hopefully your provider followed the recommended settings for the delicate skin around the eyes. Also keep in mind that Bellafill is not indicated to be used under the eye. I have seen many patients who have had positive results from other providers using this product in the tear trough, however, I have also seen many who did not have favorable outcomes. It is very important to do your research on the products your provider is recommending. Bellafill is a wonderful product we offer in our practice. We have many patients who are thrilled with the results of Bellafill. The key is that you are seeing a very well experienced injector who will use the product responsibly.

While the spot in the photo could be a minor scar from being nicked during a dermaplane. However, based on the size of the mark, I'm certain you would have known that you had been nicked. Sudden growths or marks should always be examined by a dermatologist. The peace of mind will be well worth the doctors visit.

If you are concerned with how long and thin your face appears, some carefully placed dermal fillers can help add balance. For patients with a long thin face, treating the cheeks with filler can help "shorten" the face. Filler along the jaw can also help create balance. Our eyes see symmetry as beauty. Minor enhancements can create more symmetry in your unique features. I recommend scheduling a consultation with an experienced injector to discuss your facial features and how to best balance them.

As a patient, you have the right and the responsibility to know exactly what is being injected into your body. I encourage patients to ask questions about the product and do their own research. Some questions you may want to ask is the name of the product, the expiration date, and lot number. If you feel uneasy or are not getting clear answers about the products, find another provider. Sometimes patients will go against their better judgment for a great deal. There are times when the "deal" turns into an even more expensive and unfortunate "issue" to deal with. Just to reassure you, filler is commonly mixed with saline to allow for more even distribution of the product, especially over a large area.

I think you will be happy to know there is a very simple option to help create the facial balance you desire. A little filler in the cheeks will add volume and more defined structure. Adding the volume on the cheek bone will have a sliming effect for the rest of your face and will make your face not look so long. I recommend a HA filler the first time. If for any reason you are not loving your new look, it can be easily dissolved. Most likely you will love the subtle but beautiful new look and will want something a little longer lasting the for a second treatment. Request Radiesse for a longer lasting option.