For first timers receiving a filler, I will always use Juvederm or Restylane/Perlane. As mentioned previously, if there is any concern with the appearance, it can be treated and removed easily. Furthermore, Juvederm and Restylane last up to 6 months, and Radiesse up to a year; I think that patients should be experienced with the appearance of fillers from a previous treatment before seeking the longer-lasting filler. Some say that Radiesse can cause a more stone-faced or stiff appearance, but I have had fantastic results with both types of fillers. Also, there are areas considered off-limits to Radiesse, such as the lips and around the eyes, so if this is an area you want treated then you will have to use Juvederm or Restylane. It is okay to use both simultaneously for different areas if need be, although this may be a more expensive route depending upon how much product you require. DGC Disclaimer: This posting is intended to provide information to the original poster, but it is not intended to substitute for the advice of your personal physician. An in-person consultation is recommended for all patients considering medical and cosmetic therapies.
I have also treated these with good results with IPL; and I often combine this treatment with Retin-A or a similar cream. It can take up to a year for a scar to achieve its final appearance (which often results in a white flat scar); however, at this point, results from any intervention at that point are less effective, if at all. I agree with seeing your dermatologist to evaluate the quality and size of your scar and to see which interventions would be most appropriate for you.
More often than being directly related to the medication, patients often experience nausea as a result of the procedure itself. We call this a "vaso-vagal reaction." This is just a reaction to the procedure you're undergoing, as much as you are nervous about the procedure and how well you tolerate such a thing. This reaction, which can include lightheadedness, disorientation and weakness, nausea, and sweating, usually lasts only a few minutes (most patients are good to leave, in the infrequent instances this occurs, after about 10-15 minutes of rest and foot elevation). If you have this same reaction with other procedures, such as biopsies, blood draws, other injections or even ear exams, you should let your dermatologist or plastic surgeon know that this has been a problem in the past PRIOR to starting the treatment. This way, we can be prepared to help you in the event that it occurs, and we can coach you through it. Depending on the severity, we may even recommend against it. In any case, Botox is generally a short procedure and you As far as nausea from the medication itself, the duration of that cannot be determined ahead of time and this is an infrequent cause. Let your practitioner know how you are doing; communication is key.
Accutane is a great medication when applied to the appropriate patient--this includes patients with the severe cystic acne and the scarring that you have. It is a shame that you had such a breakout after taking what really amounts to a small dosage, although flares of acne are quite common in patients starting Accutane. For patients like yourself, I would consider trying the medication again at small dosages with an accompanying dosage of oral steroid to minimize the acne flare. You can discuss this with your dermatologist to determine if this is the appropriate course of action with consideration for your medical history. Otherwise, if the treatment course you are on is working well (the last picture looks a little improved, although it may be lighting), then you could certainly consider this course of treatment in the future.
If you have reservations about additional treatment, don't be hesitant to bring this up with your dermatologist (or any other concerns for that matter). As you can see, Botox in the right hands can do fantastic things, and if you had a good experience last time, I think you should continue.
