Dima Ali, MD

Sofwave uses ultrasound energy to stimulate collagen and tighten the skin. It is FDA-cleared for lifting lax tissue beneath the chin and in the neck. The clinical evidence is encouraging: In an FDA-submitted study, 80% of patients showed improvement in the neck and under-chin area. A smaller published study found improvement in 92% of participants who noticed a difference in that area. Results develop gradually, generally over 2–3 months. However, it won't remove significant loose skin, tighten separated neck muscles, or eliminate prominent vertical neck bands. That is what surgery can do. To be honest, if that's the price you're being quoted, it's a very good price. One important distinction: If your concern is loose skin alone, Sofwave can help. If you have substantial hanging skin or prominent neck muscle bands, a surgical neck lift will generally accomplish much more. The trade off is cost, risk and downtime. My bottom line: I would have a hard time justifying $25,000 in surgery as the first step when you're 60, have good skin, and are primarily concerned about your neck. I'd give Sofwave a chance. It will improve your skin and better skin is never a waste. Hope this helps! Dr. Dima

PRF (Platelet-Rich Fibrin) can be an effective treatment for certain types of hair thinning, particularly when hair follicles are still present and producing thinner, weaker hairs rather than being completely inactive. PRF contains platelets, growth factors, fibrin, and regenerative cells that may help support follicle health, improve blood supply, and stimulate thicker hair growth over time. In my practice, we typically perform a series of six treatments spaced approximately one month apart. One of the most important things for patients to understand is that hair growth is slow. While some individuals notice changes earlier, it can take up to nine months to appreciate the full benefits of treatment, and improvement is often gradual rather than dramatic. The success of PRF depends on several factors, including the underlying cause of hair loss, the duration of thinning, age, genetics, hormonal influences, and whether follicles are still viable. An evaluation by a physician experienced in hair restoration can help determine whether PRF alone is appropriate or whether combining it with other treatments may provide a better result. In out office we typically combine it with oral/topical minoxidil and/or finasteride and red light therapy. I hope this helps! Dr. Dima

Yes, being a virgin is not, by itself, a contraindication to ThermiVa treatment. ThermiVa is a non-surgical radiofrequency treatment designed to stimulate collagen remodeling and improve tissue tone. Whether someone is sexually active has no bearing on whether they may be a candidate for treatment. The more important considerations are your anatomy, symptoms, expectations, and overall goals. It is also worth noting that the feeling of vaginal "tightness" can be influenced by multiple factors, including pelvic floor muscle tone, tissue elasticity, and individual anatomy. An examination by an experienced provider can help determine whether your concerns are related to tissue laxity, pelvic floor function, or simply normal anatomical variation. Based on the information you provided, there is no inherent reason that a history of virginity would prevent you from undergoing ThermiVa treatment. A consultation would be the best way to determine whether you are a good candidate and whether the treatment is likely to address your specific concerns. I hope this helps! Dr. Dima

ThermiVa may be an option in selected patients, but the first step is determining whether your symptoms are primarily related to hemorrhoids, tissue laxity, or another underlying condition. In our practice, we have successfully treated the anal canal with radiofrequency and have seen improvement in tissue quality along with reduction in the size and symptoms of certain hemorrhoids. The treatment works much the same way as it does in vaginal tissue -- by delivering controlled radiofrequency energy with ThermiVA to stimulate collagen remodeling, improve tissue support, and promote tightening over time. That said, we evaluate patients on a case-by-case basis to determine whether they are appropriate candidates and whether a surgical approach would provide a better outcome. The size, location, and severity of the hemorrhoids, as well as the degree of symptom burden, all factor into that decision. A consultation and examination would be necessary to determine whether you are a good candidate for treatment, but based on your description, it is certainly a discussion worth having with a provider experienced in this area. I hope this helps! Dr. Dima

Excessive sweating in the scrotal and groin area can be frustrating, especially when powders, topical products, and oral medications such as glycopyrrolate have provided limited relief. Scrotal Botox ("Scrotox") is absolutely a treatment option and is something we perform regularly in our practice with excellent results. By temporarily reducing the activity of the sweat glands, Botox can significantly decrease sweating in the treated area and often improves comfort and confidence as well. As for antiperspirants, some patients are able to use aluminum-containing antiperspirants in the groin region, but the scrotal skin is particularly sensitive and irritation can occur. For that reason, I generally recommend proceeding cautiously and discussing specific products with your treating physician before applying them directly to the scrotum. If your symptoms are localized primarily to the scrotum and have not responded adequately to conservative measures, Botox may be one of the most effective non-surgical treatment options available. An in-person consultation can help determine whether you are a good candidate and what level of improvement you can realistically expect. I hope this helps! Dr. Dima

Based on your photos, you appear to be a very reasonable candidate for lip enhancement. Strategic placement of hyaluronic acid filler can often improve lip definition, add volume, enhance upper lip projection, and create a more balanced, subtly upturned appearance while still looking natural. In addition to filler, a Botox lip flip may also be worth considering. A lip flip relaxes a portion of the orbicularis oris muscle, allowing the upper lip to gently roll outward and show a bit more pink lip without adding significant volume. For some patients, this can be a nice complement to filler or, in selected cases, a way to achieve a subtle improvement with little or no filler. Typically I will do the lip flip a couple of weeks before doing the filler. The key is conservative treatment that respects your natural anatomy. In my opinion, the goal should not be dramatically larger lips, but rather improved balance, shape, and support. When performed thoughtfully, both filler and a lip flip can enhance your lips without creating an overfilled or unnatural appearance. I would recommend consulting with an experienced injector who can evaluate your lips from both the front and side profile and discuss which combination of treatments would best achieve your goals. I hope this helps! Dr. Dima

Without examining you in person, it is difficult to determine whether the bump represents superficially placed filler, a small collection of filler, scar tissue, or normal lip anatomy. However, if the issue is a small amount of superficially placed hyaluronic acid filler, there are several potential treatment options. Saline injection is generally not a predictable or reliable method for correcting a focal filler irregularity. While it has been discussed as a way to hydrate or disperse filler, results are inconsistent and it is not something I routinely recommend for this purpose. Similarly, attempting to puncture or "poke out" filler with a needle can create additional trauma, swelling, or contour irregularities and should only be considered by an experienced injector in carefully selected cases. If the bump is caused by superficial hyaluronic acid filler, a very small, dilute and targeted amount of hyaluronidase is often the most predictable treatment. In experienced hands, it is usually possible to treat a localized area while minimizing effects on the surrounding filler, although no provider can guarantee that adjacent filler will be completely unaffected. I would recommend having the area evaluated by an experienced injector before pursuing any corrective treatment. In many cases, a conservative approach can improve the irregularity while preserving the overall shape and volume of the lips. I hope this helps! Dr. Dima

The timing you describe is not unusual. While Daxxify may last longer than traditional neuromodulators in some patients, the duration of TMJ symptom relief can vary considerably. Many patients notice a gradual return of jaw tension, clenching, or flare-ups before the treatment has completely worn off. The best indicator that it is time for another treatment is usually the consistent return of your baseline symptoms rather than an occasional bad day. Regarding the change in your smile, that can occur if some of the product affects nearby muscles involved in facial expression. Injector technique, injection depth, dosing, and individual anatomy all play a role. In many cases, treatment can be adjusted at future sessions to minimize the likelihood of a similar outcome. An injector comfortable enough to be injecting the masseter for TMJ needs to be very well versed in facial anatomy. If well versed in anatomy, one specific injection in the right area can be more effective (and have less potential side effects) than multiple injections. As for facial slimming, repeated treatment of the masseter muscles can lead to progressive reduction in muscle size over time. Some patients appreciate the slimming effect, while others eventually prefer lower doses, longer intervals between treatments, or a modified injection pattern to maintain facial balance. The goal is typically to achieve symptom relief while preserving a natural appearance and expression. I would encourage an open discussion with your injector about both the smile change and your concerns regarding facial slimming. If you're not happy with the answer, I suggest fining another provider. Hope this helps! Dr. Dima

Yes you can absolutely get penile fillers if you're uncircumcised with very nice results! Just make sure you go to an experienced doctor. I'm directing you to some before and after photos on our website. Dr. Dima

Based on your history, this is very likely related to the circumcision healing process and is a very common finding. While it may be noticeable to you, it is unlikely to have any significant impact on penile function or sensation. If the appearance is bothersome, one option that may improve the contour is Bellafill. The goal would be to add volume beneath the indentation and create a smoother transition with the surrounding coronal ridge. Bellafill is FDA-approved for up to five years, although many patients continue to see correction beyond that timeframe. Another option would be fat grafting, which is a more invasive procedure and generally involves a longer recovery. From your description, I think it is unlikely that this indentation is causing any functional problem. However, when a physical finding becomes a source of ongoing stress or concern, it can understandably affect how we perceive appearance, sensation, and sexual function. An in-person examination would be necessary to determine whether you are a candidate for treatment and which option would be most appropriate. Thank you for your question and I hope this helps! Dr. Dima