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Robert Bacigalupi, MD

Board Certified Dermatologist

390 West End Ave, 1G, New York, New York

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11 Questions Answered

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QUESTIONS ANSWERED

Does Fraxel cause the skin to tan?

Asked By:AnonymousANSWERS (1)

Post procedure the skin is inflamed and irritated due to the resurfacing. In darker skin types including Asian skin, inflammation can appear dark or hyperpigmented.
When treating dark spots such as freckles and even melasma, an immediate darkening can be noticed before healing is complete.
Also, there can even be post-inflammatory hyperpigmentation where tanning can be noticed after wound healing but will go away with time. Sun protection and bleaching agents such as hydroquinone can help shorten the course. Hope this helped.

Robert Bacigalupi, MD

Board Certified Dermatologist

Any suggestions around the eyes; Botox or surgery? (photos)

Asked By:AnonymousANSWERS (1)

When evaluating around the around, there are different options. Botox is usually used between the brows or around the eyes to soften fine lines or prevent lines creating with movement from staying at rest. Underneath the eyes when dealing with shadowing especially due to weight loss, a filler can be used in the tear trough area to help soften the area of fat loss and camouflage the difference between the eyelid and cheek skin. Surgery is used for removal of fat pads when they enlarge with age often combined with skin tightening procedures but often for an older patient. From your photos, you seem to be concerned with some of the natural fat loss in your cheeks and under your eyes causing that shadow and line to be accentuated, and use of a filler (such as Restylane) can be helpful. It is always better to go to a board-certified dermatologist or plastic surgeon. Having an in-person evaluation would better be able to determine your needs. I hope this helps.
All the best,
Dr. Bacigalupi

Robert Bacigalupi, MD

Board Certified Dermatologist

Masseter muscle Botox? Any experience with this? How long to get results and with how much Botox?

Asked By:AnonymousANSWERS (1)

This is a great procedure for subtle, gradual change to reshape the face. It helps soften a boxed appearance of the jaw or a widened lower face. Performed correctly there should be no alteration of smile or a sunken appearance of the cheeks. It is best to start of with smaller doses depending on how strong you are and can gradually add. Smaller doses at repeat visits will slowly atrophy the muscle. Effects of botox tend to remain around 3 months but repeat injections with softening of the muscle will appear for much longer. It is always best to see a board certified dermatologist or plastic surgeon when seeking advanced techniques for botox injections in special locations such as these. There should not be issues with facial nerve injury for placement in the masseter.
All the best,
Robert Bacigalupi

Robert Bacigalupi, MD

Board Certified Dermatologist

Botox for face slimming?

Asked By:AnonymousANSWERS (1)

Yes this can be done!

Botox can be used in the masseter muscles in the cheeks to soften the appearance of a square jaw. This may take more than one treatment as the muscles get smaller and may require more units than used in other areas. This may also be combined with fillers in the upper lateral cheeks that may give a more contoured appearance of the face and the desired V shape instead of a more square appearance.

Botox of the lower face when dealing with muscles that coordinate movements of the mouth/lips and chewing should only be done by experienced injectors since diffusion can cause asymmetry. I would recommend going to only a board-certified dermatologist or plastic surgeon in your area who deals with many cosmetic patients for best results.

All the best,
Dr. Bacigalupi

Robert Bacigalupi, MD

Board Certified Dermatologist

Can I get severe dry eyes 3 years post LASIK? Could too much Botox cause my optical nerves to stop working? Tried everything.

Asked By:AnonymousANSWERS (1)

Botox works by blocking release of neurotransmitters that affect muscle movement. It wouldn't have an effect on sensory nerves so would not be causing irritation to your sclera. Also diffusion into the eye from intradermal placement isn't likely. I would say these two are unrelated. I am glad the sjogren's test was negative, but am sorry you are dealing with this. I would recommend following up with a board-certified ophthalmologist who may better lead you in the right direction.
Best wishes,

Robert Bacigalupi, MD

Board Certified Dermatologist

Which one is better Botox or Fillers?

Asked By:AnonymousANSWERS (1)

You are not too young and above the FDA-approved age group.

Botox is primarily used in the upper face to prevent muscle movement that will cause lines at rest. It can be used in conjunction with fillers in the lower face when correcting lips/mouth. Fillers are primarily used to soften wrinkles or skin folds or to replace age-related or exercise-induced fat loss.

For weight loss that begins to cause deepening of nasolabial folds, one can get started by placing filler in the furrows that are present. More often, a better treatment plan would be to replace some of the volume in the mid face and upper cheeks to help lift/soften those lines and replace the natural fat that was lost. Having a longterm plan where you add a little filler at a time will build on itself and return your face to the V or upside down heart shape that is very natural.

They wear off slowly and will not accelerate the aging process. In fact, an additional treatment of filler as a touchup several months later has an additive effect causing formation of new collagen and the effects will last even longer.

Most adverse reactions are associate with injections such as pain, swelling, bruising and are usually mild. You should always go to an experienced injector such as a board-certified dermatologist or plastic surgeon.

Robert Bacigalupi, MD

Board Certified Dermatologist

Ptosis from Botox injections - what can be done?

Asked By:AnonymousANSWERS (1)

There are several techniques to avoid ptosis, but it is a rare side effect. If it is your eyelid, there are drops that can help and this is usually transient in nature for a couple weeks due to diffusion of the product. If it is your brow, it could be from treating strongly or placement dependent. It is always recommended to go to a board-certified dermatologist or facial/ocular plastic surgeon. It is also usually recommended to see the original injector to voice your concerns since he/she knows exactly how you are treated and can tailor to your needs. Photos would be helpful to see exactly what you are speaking of in case carefully placed botox in other areas may help; however, observing until it wears off may be necessary. The filler is an option for people with heavy brows but not used to treat a side effect of botox since the filler will remain after the botox has worn off. Hope this helps.

Robert Bacigalupi, MD

Board Certified Dermatologist

Is there something to do to remove Botox? Or just to do it go away faster?

Asked By:AnonymousANSWERS (1)

Once injected, botox cannot be reversed.
However, if the issue is that one side was treated more aggressively, a very small touch up injection on the other side or in a different location may help lessen any obvious asymmetry.
Another possibility is diffusion to a surrounding muscle that may be causing the asymmetry with your smile.
The best thing to do would be to return to your treating physician so he/she can evaluate you in person to note the reason for your changed smile and tailor your treatment in the future.
If not severe, often a watchful waiting approach would be advisable to allow the effects to gradually wear off over the 3 month treatment period

Robert Bacigalupi, MD

Board Certified Dermatologist

Does this look like it could be subungual melanoma? (Photo)

Asked By:AnonymousANSWERS (1)

If there is a concern for skin cancer especially melanoma, one should always be seen by a board-certified dermatologist for evaluation in person and shouldn't rely on a photo consultation.

That being said, there are other benign reasons for streaking of pigment in the nails that are more common, and pigmented lesions including moles can darken with hormonal changes of pregnancy as well as other things such as medications. Streaking of the nail is caused by pigmented cells in the nail matrix that then grow out into the nail plate. From what is visible in the photo, the streaks look uniform. Dermatologists will look for hutchinson's sign, widening of pigment at the base of the nail and irregular pigment under the cuticle in the nail matrix, as well as discuss your risk factors including family history and sun exposure.

Sunbungual melanomas (or melanomas of the nail unit) often present at a later stage since patients delay evaluation. I would recommend you see a dermatologist; and, if it looks benign in person and a nail biopsy is not recommended, a photo can be placed in your chart so it can be monitored over time.

Robert Bacigalupi, MD

Board Certified Dermatologist

Botox for overactive brow?

Asked By:AnonymousANSWERS (1)

When treating asymmetry and treating one side of the face differently than the other, less is more. Botox does usually take 7-10 days for full effect, so touch ups are not done in first 2 weeks after the initial treatment to know the final result prior to adjusting. In this case where the treated side has less movement than the non-treated side, it may be best to have your treating physician to add a small amount on the other side for balance.

Robert Bacigalupi, MD

Board Certified Dermatologist