Robert S. Bader, MD, FAAD

I am unclear of your concerns. Subcision is used to improve slightly depressed acne scars that are tethered down. By cutting the tethers, the slightly depressed scars can elevate, sometimes requiring a filler in addition.

There are no contraindications regarding prior history of fat transfer.

The short answer--of course. Mohs' micrographic surgery has the highest cure rate, removes the least amount of uninvolved skin, and can (and should) be repaired on the same day.

There are alternative methods for treatment, which you can discuss with your Dermatologist.

In most cases, a skin biopsy is intended to be diagnostic--to make a diagnosis--and not cure a cancer. It is common for tumors to grow back after a skin biopsy. Some tumors are slow growing and low risk, such as basal cell carcinoma, so delaying treatment for 1-2 months usually will not make any difference. For faster growing tumors, removal should not be delayed. If the tumor is already growing back, I recommend that you have the removal sooner if possible. 

Side effects from Restylane are extremely rare. Bruising is one of the most common unwanted side effects and can be minimized by discontinuing blood thinners prior to injection. Aspirin and aspirin-containing products should be discontinued 10 days prior to injection when possible, while others at least 3 days prior. Some physicians recommend taking Arnica orally prior to treatment, although this is rarely necessary except in those who are extremely prone to bruising. Some patients do experience some swelling in the area, which is most often the result of the hydrophilic (water-pulling) properties of hyaluronic acid. This temporary swelling can last days or even one week or longer. 

The newer Restylane products do contain the numbing agent lidocaine, which one can be allergic to. Allergy to lidocaine is extremely uncommon and no prior testing is required. 

Infection after treatment is very uncommon, but possible. This can be difficult to treat and often required 4 or more weeks of antibiotics and often the Restylane must be dissolved as the bacteria can adhere to the hyaluronic acid molecules.

Lumps and nodules that are felt after treatment is not a side effect, but usually due to poor injection technique. In most cases, these nodules can be felt, but not seen so no treatment is needed nor recommended. Some may choose to massage these, which often is quite helpful. 

Having cancer is not a known contraindication for having Botox, although this has not been actively studied. I recommend that you discuss this with your Oncologist. I have found that some do not have a problem with it, while others are more conservative and do not want their patients to have it. Ultimately, one should go over the risks, or more accurately--the "hypothetical risks",and the benefits, or more accurately--"the hypothetical benefits".

I tend to look at it from both sides of the fence: 

1. Botox is a toxin and toxins can't be good, right?  Botox has not been studied in regards to cancer risk, and may or may not affect any cancer.  Therefore, one can argue the following: Why use a toxin that has not been studied in this population?

2. The "Mind-Body Connection": The affects that one's attitude has on one's overall health has been poorly studied in regards to cancer. Certainly we know that stress negatively affects many medical conditions, but what effect does it have on the development, progression, and regression of cancer? One can argue that doing something like Botox, which likely has no negative impact on nearly all cancers, has a positive impact on one's quality of life--making one feel better about themselves, having a more positive attitude, etc. This in and of itself may be more important than any "potential" negative impact that Botox may have.

I wish you the best!

drbader