David Colbert, MD

If you are looking for the bee-stung lips, it would be much easier to have Restylane, or Juvederm injections. It is possible to trim Alloderm implants, but I find natural Restylane fillers easier & far more natural-looking than permanent implants that won't age gracefully with your face.

I would try the microdermabrasion & do 5 sessions, 3 weeks apart. I think that's going to be far more effective than than doing a "parlor peel," or a having a facial done at a spa. If you happen to have acne scars, a Fraxel, or a deeper chemical peel might be appropriate for you. You should decide this with the guidance of a board certified dermatologist. Your goals should be clearly stated and your intervention should be based on those. At my new york dermatology group, it's the dermatologist (not the facialist/aesthetician) who decides how to treat acne scarring in the best manner possible. Good luck. --Dr. C.

Botox for crows feet generally does not result in puffiness. The Botox really only lasts for a maximum of 6 months. When Botox is done around the lateral eye, it slows the movement of the periocular muscles, so this can result in some temporary bunching of the muscles when we smile, but it wouldn't cause edema . I have heard some reports of this phenomenon, but I have not witnessed it at my practice.

I would advise having your ophthalmologist examine your eyes to rule out any other cause of periocular edema & you might also consider contacting Allergan (the manufacturers of Botox). It's possible that they may have some statistics on this condition to share with you.

It would be best to wait a week before having any treatments that could alter the Restylane. After a week the Restylane really "sets" and you can then proceed with whatever routines you like. Treatments that would avoid the area where the Restylane was injected are fine. Don't massage your face, don't have the type of facial that incorporates massage near the treatment area.

If you wanted a laser treatment, waiting a week after is fine and you could have Botox done on the the same day. If a person wants multiple procedures on the same day, the dermatologist will help decide the correct order of things. At my practice we sometimes do a Fraxel-Botox-Restylane "Lose a decade by Monday" treatment combo. That means we do numb the face with a special gel, then do painless Botox which is followed by Fraxel. Then we ice the face and do Restylane 30 minutes later. So as you can see, mixing some types of procedures is ok. Just consult with a board certified cosmetic dermatologist & they will guide you. Hope that helps!

It's a good idea to visit a board certified dermatologist & have them do a few Microdermabrasion treatments in their office the proper way. After you have experienced professional microdermabrasion & have achieved the results, you can speak with your dermatologist about your skincare needs & then consider what type of exfoliation is good for your skin. At my practice I like to utilize the Parisian Peel System. I also created an easy to use at-home microdermabrasion facial disc that compliments in office treatments, but I do realize that all home microdermabrasion products were not created equally. Some of my patients with more sensitive skin can only use my intensify facial discs once, or twice a week, while others can use up to 3 times a week. This depends on your skin-type & the product that you have chosen. There are microdermabrasion products that I would recommend highly & others that I would not trust. Speak to your dermatologist, and do your skincare product research wisely. As always let a dermatologist guide you there. A heart surgeon should always do your bypass!

A deep forehead furrow can be improved upon, indeed. Sometimes just a little Dysport injection accompanied by a little bit of Restylane filler will do the trick. If the line is vertical between the eyes-- this almost always works. If the furrow is horizontal & across the forehead, you may need more of both products. In any case there is a good chance that you will have a very nice result. Plan to repeat the procedure twice a year & you will note that it gets better each time you do it. Finally, it takes about 14 days to see the softening (or slow disappearance) of the furrow. If it is exceedingly deep, you may only get a 50% improvement. Then later, after the 2nd treatment, you may reach 75%. At my dermatology practice we take a good initial photo of your furrow to show to our patients later, so that they can see how good the results are. They're usually very pleased with the results.

Many MDs will treat post-fraxel hyperpigmentation with broad spectrum daily sunblock, hydroquinone 4% gel and one percent hydrocortisone & perhaps a retinoid.  Melasma is very difficult to treat.  I would be optimistic and go back to a dermatologist and slowly try to lighten them up with topicals. If you no longer trust the Fraxel, sometimes regular, light, Beta-Lift peels can be helpful as well.  Avoid the sun and always wear broad-spectrum SPF. If you drive a lot, put UV guards on your car windows. If you are light skinned, sometimes TCA localised peels can help.  

So go back to your dermatologist and come up with a plan. The Fraxel 1550 often has a specific melasma setting that works well if you use a bleaching agent for a month prior to using the melasma 1550 setting on the Fraxel. There is always hope & always a way for some improvement. Sometimes it helps to give the skin a long rest before trying something new. Best of luck to you.

You would have to contact your insurance carrier. Include pictures and medical letters from your Radiation oncologist and from your dermatologist. Accurately describe your condition and then it is up to your insurance carrier to make this decision. If you have excellent documentation & keep records of all the names of the insurance reps, you stand a better chance. Some carriers will approve & others will not. Be persistent and include medical journal articles which document that Vbeam is helpful in similar cases will be very helpful. Providing the carrier with all of your organized knowledge & research will lead to a better outcome. Good luck.
 

The Fraxel 1550 laser works very well for acne scars. The settings can be modulated for your degree of scarring. Other options are TCA peels, Jessner peels, Beta-Lift peels, regular Microdermabrasion and the use of retinoids. This should all be done with an experienced board certified dermatologist. The skin type and degree of scarring will dictate the type of treatment.

I would not recommend a TCA 25% peel for your back scars. In a darker skin tone, this could very well lead to hyper-pigmentation. As a safe and more effective option, I might recommend that you seek consultation for a Fraxel treatment of the scars. This would be a far more reliable way to achieve improvement and should only be done by a skilled laser surgeon.  This would also depend on the type of scars that you have on your back. Are they raised scars, or depressed? Are they light scars, or dark? Are they keloidal? This really requires a thorough consultation with a derm laser surgeon.  TCA 25% Peel is not likely to yield a good result on the back.