Christopher Manios, MD

Dear Tatka2809 

Thank you for your question. This complication is common and usually results when certain hydrophilic dermal fillers are used in this area. The best option for you is to dissolve it with Hyaluronidase. It is a safe procedure and I have not encountered any complications with it. I usually inject an amount consistent with the type of filler injected and the amount injected. If the patient is still unsatisfied, I have them return for further injections. I try not to be overly aggressive in removing the filler.  The end result is a patient who may come anyway from 1-3 visits and they are all pleased and have returned for repeat injections. 

Hope this helps

All the best,

Dr. Manios

Hi D3D4,

Thank you for your question. 

I agree with my London colleague it is very hard to determine what you need exactly with the pictures you presented. You also don’t have significant sagging. You can go with either route however, I believe that a surgical facelift would be a bit aggressive to treat you. Surgical facelifts these days are becoming reserved for older and older patients now with the advent of dermal fillers. I think you would be in this category of patients who would benefit from fillers and would get a satisfactory result. As far as costs are concerned, it really depends on how much fillers you need. The term liquid facelift doesn’t really have a quantifiable amount of filler. Rather it refers to the idea of lifting sag off the face. One patient may require a different amount of filler from another patient. Also you didn’t provide photos of your whole face so that we could perhaps give you a ballpark figure on the number of syringes you may require. 

I would recommend that you go and see a plastic surgeon or dermatologist in your area and have him/her evaluate you and you can also address your concerns with him/her and come to a treatment plan that you are comfortable with.

All the best,

Dr. Manios

Thank you for your question zuzu72.

I think the best answer to your question would be for you to go to a plastic surgeon or dermatologist and have them evaluate you. During that evaluation, you would have the opportunity to discuss how much larger you are looking for and what you feel makes you lips look slightly uneven. When it comes to lips, there are many options in regards to the technique and even the type of injectable to use. However, having that discussion with you in person would be the best way to clearly understand what you are looking for. The difference between a good injector and a great one is the ability to take your thoughts and create that into a result that satisfies what you are looking for. 

As far as technique, you can use cannula to address this issue. However, when I have a patient like you that feels that their lips are asymmetric, I tend to avoid using a cannula because I think to make you happy I would need to make sure that I carefully address this asymmetry.

Depending on how much larger you want your lips would, for me, determine which filler to use. For patients who want subtle enlargement, I usually reach for Volbella. For the maximal effect, I usually reach for juvederm Ultra Plus. Between these 2 extremes, there are a whole hosts of other fillers to choose from. 

I just think that you need to see a professional in your area in order to understand what you are looking for

Hope this helps,

All the best

Dr. Manios

Hi Kynfttr

Thanks for your question.

While liposuction is still considered the gold standard for getting rid of the double chin. There have been great advancements in non-invasive therapies. Probably the 2 most popular therapies are cool sculpting, Kybella, or a combination of the two. In this practice, you would come in for an evaluation to assess the degree of the double chin. In severe cases, a combination of Cool Sculpting first followed by touch ups by Kybella is most effective. In moderate to mild cases, I feel that Kybella works great. With both procedures, swelling is common side effect but should go down after a couple weeks. Kybella is a treatment that requires a couple of visits to the office. The great thing is that you would get evaluated prior to an injection to make sure that there are no areas of fullness or unevenness. The results in literature state that patients can receive up to 75% of their submental fat (double chin) removed by this procedure alone. Again, this speaks to how far non-invasive procedures have come.

I hope this helps!

All the best,

Dr. Manios

Hi Dawn

Thank you for your question.

In my practice, I find that the best option is Volbella. First, it is FDA approved for this area of the face and second it is a thin filler. The problem with using other fillers is that they are too thick and can overfill or make that area of the face look swollen. 

Of course, I would encourage you to visit your local provider and have him/her examine you to find out what is best and get an expert opinion from someone who can see you in person.

All the best to you,

Dr. Manios

Hi Alexis_11

Thank you for your question. Vollure injection for smile lines is a very popular procedure with fantastic patient satisfaction ratings. In my practice, I tell my patients to analyze their faces 2 weeks post procedure for any lumps or bumps. If they notice a big lump they would call me and I would massage down the lumps in the office. If the lumps are small, I would show them at the time of the injection how to massage them down. It is very rare in my practice to use hyaluronidase to dissolve vollure as the product is smooth and the inflammation is not as dramatic as with Juvederm Ultra Plus. If your practitioner didn’t show you how to massage your lumps, I would call him/her and request an evaluation.

Hope this helps

All the best

Dr. Manios

Hi Nicole 1008

Thanks for your question,

After injecting Kybella it is very common for patients to have noticeable swelling and some discomfort after the procedure for a few weeks. This looks to me to that you are having this issue. I usually recommend to my patients that they can apply ice to the area for the first 48 hours and afterwards can begin taking anti-inflammatory medications to help with the swelling (Tylenol, Motrin, aleve, etc) 

The swelling will subside. The medication is just breaking up fat cells in that area and as a result, your body is trying to clean up the debris. The body usually accomplishes this by sending cells to engulf the dead fat cells in your case. Because of this, swelling results and can last anywhere from 2-4 weeks in duration. 

If you are worried however, don’t hesitate to reach out to the physician who injected you and get their opinion and to make sure everything is going smoothly. They have the ability to look at you in person and perform a thorough examination.

Hope this helps

All the best

Dr. Manios

Thank you mouse1959 for your question

The term liquid facelift could mean a variety of things. It could mean Botox along with fillers, multiple fillers alone, botox with Kybella, or fillers with Kybella to name a few. Therefore there is no average cost as not everyone needs the same things. I would suggest that you see a properly trained cosmetic surgeon and discuss with him/her what you are looking for (that is what areas of your face that you wish to address) and then see what they say as far as number of syringes, Botox, Kybella, cool sculpting, etc. You can see a couple of different injectors and then you can get a sense of how much it will cost based on their evaluations.

Hope this helps!

Best of Luck

Dr. Manios 

Hello shazzasc

Thanks for reaching out. Botox does not interfere with the medications you take above. I am assuming that you are a chronic pain patient given the type of Morphine you are on. I do think that signing consents with you on pain meds may be a bit of an issue of you are not on chronic med pain meds. I do not think that you will have a problem with Botox but I would inform your physician injector both on the intake forms as well as verbally to just to make sure that they are comfortable injecting you. If patients are on chronic pain meds, they are less susceptible to being affected in their ability to make decisions; however, if you are on pain meds because of recent surgery or for a short time, I would recommend that you finish the medications that were prescribed to you and then go and get the injections

Hope this helps!

Best of Luck,

Dr. Manios

Thanks for your question babyboomer2!

Over the counter microdermabrasion systems should have no effect on the effects of HA fillers. Microdermabrasions are done to cause micro injury to the skin so that the body will repair the injury by laying down new skin. Fillers on the other hand are used to restore the amount of hyaulornic acid to the face in order to either soften lines or wrinkles or the add volume to the face. These procedures work together to improve both the appearance of the skin as well as make it more youthful. The only thing I tell my patients is to hold off on microdermabrasions for 2 weeks after filler injections because I want the filler to settle in and I want the swelling that occurs after injections to subside. Otherwise I think that one does not affect the other.

Hope this helps

All the best

Dr. Manios