Dr. Richmond is incredible! She is very thorough and takes her time. She is extremely knowledgeable and confidant. She has done multiple procedures on me, ranging from medical biopsies (she found a very early melanoma) to cosmetic procedures such as fillers, botox and laser treatments. I trust her fully and have referred several friends and family to her!
You should not have any risk of the iris changing color if Latisse is applied to the eyebrows only. The side effect of iris color change is primarily reported when bimatoprost, the active ingredient in Latisse, is used as an eye drop. This medication, trade name Lumigan, is placed directly in the eye as a treatment for glaucoma. If Latisse is not entering your eye, it should not change the color of the iris. I recommend Latisse frequently for my patients with thin eyebrows and have not had any problems. Good luck!
Only a small amount of dysport is typically needed to lift the corners of the mouth (I usually start with 2.5-3 units per side). This should be injected into a specific location within the depressor anguli oris (DAO) muscle. I recommend going to an experienced board certified dermatologist or plastic surgeon for this injection because misplacement of dysport in this area can cause the mouth to become temporarily lopsided. It is a great treatment when done properly. Good luck!
It is a little bit difficult to tell with these photos, but it appears that there is extra volume or a bump just to the left of the nose above your nasolabial fold and possibly under the lateral aspect of the left eye. It is less apparent on the right. Regardless of where your bumps are, I would want to know more about the inflammation that occurred previously. Hyaluronidase injections most likely will be recommended to dissolve the remaining Voluma and fix the contour irregularity. If it seems that an inflammatory reaction is present or has previously occurred, I sometimes will also treat with antibiotics such as doxycycline or minocycline and consider steroid injections in appropriate situations. Many patients with misplaced or overdone filler do extremely well with hyaluronidase. Keep in mind that you will lose all or most of the product in the area, so after dissolving your filler, you may desire more filler in the future to restore the baseline volume loss. Adjustment in placement of the filler for future treatments can be discussed with your practitioner. If there was a true inflammatory reaction, further injections of filler should be also be discussed in the context of risk of recurrence of the inflammation, but can be attempted in many cases. As a first step, I would recommend reviewing your concerns with the physician who performed the procedure so that they may provide you with a plan of care. Good luck!
Accutane does absorb best with fatty foods. I think a spoonful of a healthy oil would help if otherwise fasting, but may not be sufficient to achieve maximum absorption. Since patients are prescribed accutane twice daily, you can discuss this with your treating doctor and one option is to give a smaller dose in the morning to take with your spoonful of oil and a larger dose in the evening, to take with the larger meal. I would also consider something like a spoonful of peanut or almond butter in the morning. You should also look into a brand of accutane called Absorica, which also comes as Absorica LD (low dose), and is formulated with a lipid capsule to maximize absorption. You can try to get one of these options if this brand is affordable with your insurance. It should have better absorption than the generics regardless of the food intake. Best of luck!
I often will treat patients with accutane who are nonresponsive to standard topical therapies. It would likely be highly effective for your acne with lasting results. There are other options as well, such as stronger topicals, hormonal therapies, chemical peels, facials, etc. The benefit of accutane is the likelihood of durable long term results. It can cause an initial flare and possibility of temporary cystic acne. However, the majority of patients with milder acne do not have a severe flare, many patients do not flare at all. If a severe cystic flare does occur, oral steroids can be used for a short period to calm it down and it usually subsides by the second month of treatment. Accutane does have some potential risks and side effects and requires blood work monitoring, but the majority of my patients are very happy with their results and do well throughout the treatment period. It is often a great option. Good luck with your treatment plan!
