Lesley Clark-Loeser, MD

I am in complete agreement with Dr. Pozner.  In my experience, venous lakes respond very well to treatment with the Nd:Yag.  Your photo demonstrates a fairly typical response.  By the end of the first week, you will notice a significant decrease in the puffiness.  Generally, I will evaluate the for partial of complete clearance of the venous lake four weeks after the initial treatment.  

I absolutely agree with the previous responders that first on you list is verifying that Juvederm was indeed used for your treatment.  Although it is uncommon for a hyaluroinc acid filler, like Juvederm, to persist at 17 months, it is possible.  The two most acceptable methods for treating lumps due to unwanted hyaluronic acid filler are 1) hyaluronidase (approx $200), and 2) using a fine blade to make a small puncture or incision into the area and to manually express the residual material.  To answer parts 2 and 3 of your question, when used properly the hyaluronidase should not affect the surrounding tissue, and yes, I would return to your treating physician for re-evaluation.  Good luck.

Fillers and fractional resurfacing truly compliment one another in the perioral area.  Technically, it does not matter which procedure is done first.  Since you have had filler in your upper lip before, and have in mind the desired outcome from the filler; I would have your lips filled within the next week or so.  I say this because you have mentioned that you are scheduled for a non-ablative fractional resurfacing mid-April.  Ideally, I have my patients wait 2 weeks between these procedures, no matter which is being done first.  To optimize the outcome of the laser, plan to treat 3-5 times.  Best of luck!

I love treating brown spots and acne scars.  Personally, if my patient has both acne scarring and brown spots, I prefer to first treat with the fractional CO2.  However, it is important to note that if you have active acne, fractional CO2 can temporarily flare inflammatory acne.  If active acne is an issue, you may want to consider starting an oral antibiotic 1 week prior to the treatment and remain on the medication for up to 2 weeks.  Most fractional CO2 lasers have settings that can be adjusted to treat either/both brown spots and acne scarring.  One month after the first fractional CO2 if it is apparent that there are brown spots remaining, I will use a laser (could also be an IPL) to target just the residual brown pigmentation.  Successful treatment of the acne scarring will require more than one treatment with the fractional laser.  

Well, 30 units is 30 units no matter what the dilution.  So, if 30 units of Botox (Allergan manufactured and distributed) is injected properly to the glabellar complex, most women will have the desired outcome.  I note women because men often require more units.  A  2 week follow-up appointment with your physician is always a good idea to assess is additional Botox is needed.  Furthermore, I strongly encourage using a dermatologist, plastic surgeon, or occuloplastic surgeon to provide your future treatments.