Catherine Durboraw, MD

• All I can say based on the picture that you have submitted is that this does not appear to me to be the result of a neurotoxin.  The unusual swelling above your eyebrow to me looks more like a dermal filler problem.  I would return to your doctor and find out if there was something else injected.  Botox, and all neurotoxins for that matter, are temporary in duration with completely reversible effects over time.   In 18 years of administering neurotoxins I have never encountered the problem with which you are dealing. 

It will take months to see a difference in your jawline after masseter muscle injection with a neurotoxin.  The  result from this treatment relies on atrophy of the muscle to shrink the muscle and reduce jawline width and this atrophy will be occurring over up to 6 months following the injection.  

It is not at all uncommon to feel a tightened sensation to your skin following Thermage.  This is related to the collagen contracture phase which can be appreciated very rapidly following Thermage.  

Early results with any of the neurotoxins can initially be spotty with some areas "taking" faster than others.  If you still have persistent uneveness after 10 days with Dysport you should return to your provider for a touch up.

To really answer your question I would need to see pictures of you and understand exactly where you were receiving injections.  From your description it appears your dissatisfaction is related to where the injections were performed not the dermal filler itself.  Radiesse when placed properly is a very effective and predictable dermal filler.  Always the potential downside to Radiesse when compared to the hyaluronic acid family of fillers is the fact that Radiesse cannot be dissolved in a situation like yours.  The best advice without seeing your pictures is to let it be resorbed by your body gradually over time. Efforts to remove it from your subcutaneous tissue may result in more problems than you have now.  I would be happy to review your pictures to give you more detailed advice.   

The answer to your question is yes.  Belotero is a great addition to our family of Hyaluronic acid fillers (HA's), offering the lowest density product available in the US and allowing us to treat areas like tear troughs and fine lines without the "puffiness" associated with denser HA's.  However, due to the superficial placement which the company recommends for this product it is much more prone to bruising.   It appears you were having your tear troughs treated in the picture, and this area in general is high risk for bruising.  I have gone to using blunt tipped cannulas in this area to help reduce risk of extensive bruising.  This bruising may take 2 weeks to resolve and remember that after the bruising resolves you will still have some tissue swelling which may delay your final result - so be patient.

There have been some recent reports on the use of Fraxel for burn scars and Fraxel may improve the distinct borders of the scars as you show in your pictures.  Unfortunately, Fraxel will not "make the scar go away", only softening the appearance of it.    However, my main concern here is the age of your daughter.  As she is still actively growing, her scars may naturally change during that time.  This may result in fading and softening of the scars or also may result in widening of the scars as she gets larger.  I would highly recommend deferring any interventional procedure like Fraxel until she is a bit older.  

Swelling is the variable in many facial treatments which are commonly performed and is often related to how your body responds to injury in general.  For example if you feel like you swell a lot when you have other types of injuries to your body, you can most likely expect that your face will respond in a similar fashion.  Regardless, Fraxel Dual is ALWAYS accompanied with some degree of swelling and the eyelids and periorbital area are always the worst as the deep tissue layers are very loose and allow the fluid to readily collect here.  Your settings with each treatment were very typical.  In my practice experience the swelling usually persists 4-7 days with gradual improvement during that time frame.  

Without seeing pictures of your skin it is hard to completely be sure but it sounds to me that you are developing post inflammatory hyperpigmentation.  It is important to treat this with topical steroids and often this can be a prolonged treatment.  Post-inflammatory Hyperpigmentation or PIH is your skin's response to the laser which is laying down pigment in the skin in the healing response.  Further laser treatments should be done very cautiously with conservative settings and with the concomitant use of topical steroids.  The good news for you is that with time and proper sun avoidance PIH does lighten but may not completely resolve.  Thanks

Not only is hydroquinone safe to use before Fraxel laser,  but in my practice it is required. Hydroquinone controls repigmentation following laser and will benefit your overall results  in pigment reduction long term following the laser.  With Asian skin in particular this is important as you are most likely prone to post-inflammatory hyperpigmentation which can occur after many different types of laser treatment.  This type of hyperpigmentation can be very difficult to control and hydroquinone along with mild topical steroids can be effective in controlling this problem following laser. Hydroquinone alone should not be creating skin or sun sensitivity.  You should check the particular formulation which you are using as it most likely contains something else which could be irritating your skin.