Celia Remy, MD - Account Suspended

Adding support to the top of the nose is possible certainly with filler. Bellafill can dissolve with Kenalog, however because the top of the nose is such a delicate area and has such a high risk if the blood supply is compromised. I prefer to use smaller PDO Threads. These threads create a sharper edge and you can layer them to get the height and structure you want. When you use the smallest ones you can get precise shaping. The concern for blocking a blood vessel is less, however if during the procedure could be stopped and possibly more layered in later if needed and if the blood has normalized. Fillers can be used, even in conjunction with small PDO threads. However, I would use a hyaluronic acid that does not create a lot of swelling that can be placed more superficially in the immediate subdermal plane. I have had more success with PDO threads recently however, you do not need a lot of volume, just a little structure to give it a slightly more upturned projection. You can get a nice straight slope from the bridge to the tip if desired. It depends a little on what shape you are looking for as well. I hope this helps! Dr. Remy

FIllers to straighten the jawline- create symmetry in the face where the jawline may be different on either side of the face, lengthening the jawline and even extending to advance the chin in those who it is indicated for - can create  wonderful definition. Fillers can be used, and fat grafting can also be used as a more permanent option. However - the fillers can give more precision depending on your particular anatomy. 

In fact most people lose the definition of the angle of the mandible and this allows the skin to  slide forward contributing to jowels.  SO it a common area to address when doing a full facial rejuvenation. When done properly- the filler should disappear into the face and not be notable with the natural movement of the face when speaking or laughing etc. 

I hope this was helpful! 




Dr R

The chest and shoulders tend to be more likely to keloid than other areas- but nothing is guaranteed, of course.

I would say that the Botox is not likely to create any problem. You probably have had small cuts, nicks, or bug bites that have not turned to a keloid and the Botox would considered less traumatic than those things and so you are probably fine with Botox.  


Juvéderm can be used in conjunction with something called PRP. PRP comes from your blood stream and contains a large number of growth factors and other cell mediators that help to calm inflamed tissue tremendously. We typically use if for our ablative or fractional procedures and we see the redness and burning sensation go from lasting 5-7 days, to about 12-24 hours when we place the PRP over the surface of the skin after the treatment.   

The hyaluronic acids have been mixed with PRP before it is injected, or they can be layered over each other. It will be up to the comfort of your doctor, but this has been a great option for our patients who have keloids. It is something we consider almost a preventative measure where keloids are concerned.  Be aware that the PRP can create more swelling than the filler alone for 4-5 days. But this is a fluid-based edema, not a reaction to something that creates the tissue/scar building process involved in creating keloids.  I would say that you could ask your provider to do a test spot in a hidden area with the Juvéderm, (and I would stick with the hyaluronic acids rather than other filler products certainly).  

If in the worst-case scenario, you do start to have any kind of reaction - there are steroid creams, and injectable steroids which can be cautiously and judiciously put into the area to knock out the response before it gets going too far.   

I hope that is helpful!  Best of luck to you!   

Dr R

 

That is a good question and the answer is sort of yes and no.  If someone has Grave's disease which is a specific type of thyroid problem - it can be worsened by botox, and it is considered a contra-indication.

However- with other thyroid issues- there is no clear problems.  So - for any patient who has an issue with their thyroid, it is valuable to discuss it with the doctor before they have any neuromodulator.

If there is any concern- it would not be unreasonable to do a small test dose first and then proceed cautiously.

 

Typically we only consider Graves disease to be a concern- but erring on the side of caution when you first start out could be an option if you are concerned.

 

I hope that is helpful!

 

Dr R

 

 

It is not uncommon to have some heaviness in the first 4-10 days or so with Botox. Usually it resolves in a few days after it starts.  There is support for the middle section of the brows and upper part of the nose from the forehead muscle. When it initially relaxes things can feel heavy, droop, and in some people, it can seem to have swelling. It does usually resolve- however- if after 15 days it has not resolved- then it is not likely to change on its own until the neuromodulator wears off.

However- in our office we have had some luck using a multipolar radiofrequency (Venus Freeze in our office, but there are other types) to “reactivate" some areas to some degree.  It is not 100% but there is no negative side effect or risk. In our clinic it has been helpful in about 90% of cases when done in that 3rd week after the neuromodulator was given. There are no studies on this- so there is not particular method. We typically will do 5 to 10 minutes over the muscle that is responsible for lifting the area that has drooped, once a every 2-3 days for 3 treatments.  It will typically start to work within a day.  It may not work. And it may not completely resolve the droop even if it does work.  But it cannot make anything worse.

For eye lid droop we also try allergy eye drops which are known to activate a different nerve/muscle junction to open the lid if it is drooping.  You could certainly get the allergy eye drops and see if any lifting of the lid is at all helpful for the center of the brow or nose.  It is not likely because they are different muscle groups- but it may be something you have at home. It will work within a few minutes if it is going to work at all.

 

I have my fingers crossed for you! Typically - it does resolve- so that is most likely- let's hope that's the case!

 

I hope that was helpful!

 

Dr R