Miguel A. Gutierrez, MD

I find that washing off the Levulan makes little difference in the effectiveness of the treatment. The levulan that was applied to your face needs to be absorbed by your skin and metabolized to the active ingredient. It is that new chemical in your skin that reacts to the light. Our current standard protocol is to allow 1 hour of incubation because most people absorb and process enough product at that point to go ahead and treat with the light. However, if you are not getting much of a result it is usually due to one of two reasons. And I don't think it has anything to do with washing off residual unprocessed levulan or not. 1) did they scrub hard enough to ensure you remove all oil, and grease off your face with acetone? Just using acetone to wipe the face is not enough for everyone if they are very oily. I usually scrub hard almost like exfoliating the skin with the acetone soaked gauze. If they do not remove this barrier, you will absorb less in that hour, therefore you will not have a chance to prepare enough product to be activated with light. 2) your skin absorbs ok, but does the processing slower than others. This is unpredictable. So the only way to fix this is to incubate longer than 1 hour for those patients before treating with the light- maybe 1.5 or 2 hours. If you don't prepare the levulan in your skin and only had unprocessed product, it will not react to the light and you will see minimal redness. But more processing will mean not only more effectiveness, but more discomfort during and after treatment. So to answer your question: The face should be prepared well to allow minimal barrier before starting and allowed to "marinate" long enough so that the light activates enough product for the body site and patient in question. Washing after incubation only takes off unprepared product, which the light will not activate anyway. So not crucial in my opinion. But ok to do if you believe any residual levulan could block your light treatment. I hope that helps.

We use numbing cream for all of our microneedle patients. It is just too uncomfortable without any. If they use it for Fraxel, then they should have no problems giving it to you for this. Best!

You are noticing a very common issue, that our faces being asymmetric is actually the normal. The goal of therapy is to make you as symmetric as possible- meaning, reduce the differences between the right and left side. In your particular case, it is really difficult to say what the issue is or how best address the problem area without seeing photos. Mainly because most will want to assess your entire face, not just right vs left but also top heavy vs bottom heavy, and big side vs little side. Making some strategic adjustments with filler/toxin to one side AND balance you from top to bottom can make a big difference in helping you look your best. But to answer your specific question: there is no good way to use filler or injectibles to REDUCE your larger/plump side to match your smaller side. However, there are various techniques that expert injectors can use to help balance you out--not just make you chubby all over. But it sounds like it will be a process, and it may require you recalibrate your expectations for treatment as a whole face approach. Not just more volume or less volume. Best!

I don't think you will find a definitive answer for this that will make one product superior. Both approaches can give you good results. The question that you should asking your injector--Which product do YOU get better results with? This area is all about technique and adding the correct amount. I like Restalyne because I use cannulas to address this area. So, find an injector you feel comfortable with, and trust their opinion. Do not base your decision on cost. Base it on results and longevity. Best!

The short answer: maybe. Botox will help reduce the visible lines you see when you are raising your eyebrows (movement or dynamic line). It can help with lines or folds but may not remove them completely (non-movement line or static lines). My experience is the amount of sun damage in the area will determine how much will resolve, which of course is also age dependent. I would recommend waiting another week or 2 to see how much actually resolves. If the lines are still present and they bother you--then go see your provider to see what they can do. At that point, it is usually a filler procedure or resurfacing procedure or both. Additional botox will probably not help much with these (static lines) if the original treatment did not clear them completely. Lastly, cost can vary. Most offices that charge you per unit, will charge you every time they need to place the product since you are paying as you go (they put in what you need). If they charge per area, then there may be some flexibility when it comes to cost. Best!