I am so glad I finally decided to start getting my lips done. I have gotten Restalyne Kysse in March 2021, July 2021, and December 2021. It has made such a huge difference in my confidence and the way I feel about myself. One syringe each time doesn't make a massive difference to other people, but it made a huge difference in my eyes. I always have the NP, Jen do my lips. She does an amazing job each time.
I felt completely cared for and listened to throughout the process. No matter how minor, when you hear the word cancer it can be overwhelming. Dr. McGuire and his staff all listened and took the time to make sure I understood the process. The recovery process has been much more complicated than I prepared myself for. I had to have the flap repair done after he obtained clear margins and it was a much larger wound and healing than I expected. Dr. McGuire called him the evening of the surgery to check-in and I have to say that's the first time a doctor has ever followed up like that —impressive.
Hello - This is an excellent question and one that likely will receive many different answers! My opinion is this: these more expensive serums/lotions are the 3rd or 4th most potent anti-aging options currently available. Sunscreen is by far #1, followed by tretinoin, then either these products or an anti-oxidant serum like CE Ferrulic. Thus, these complement, but not replace, the more fundamental products. That being said, these products do have tangible benefit, but if the added benefit is 'worth it' to you is a value assessment only you can make. I would encourage you to look at the 'before and after' photos on the respective products' websites. If you look at the results and think 'wow, that is really great!', then I would consider a trial. If, however, you find the results very subtle, then I do not think you will be satisfied with spending the money on the products. Sorry if that is not a cut-and-dry yes or no, but like most things in life, the answer is some form of 'it depends'! All the best, Sean McGuire
Hello! Based on the provided photo which demonstrates mild facial asymmetry, the next step to me would be an in-person evaluation. As it stands, this would be a tall task for Botox to achieve the underlying goal - an overall aesthetic improvement - as slight asymmetry of the face is the rule rather than the exception. In an effort to achieve symmetry, you would run a sizeable risk of over-correcting and causes a more noticeable discrepancy. However, Botox is temporary and you could see what happens without long term side effects. But if you go for evaluation and the physicians says 'I don't think I can improve this', please factor that into your future decision making! All the best, Sean McGuire
Hello - Caveta - I am not sure what the 'official' answer should be but this is the most common reporting pattern in my experience. The pathology findings during the procedure are somewhat assumed to be the same as the biopsy unless otherwise noted. As the procedure is undertaken to remove the skin cancer found by the biopsy, this is a reasonable assumption. If the findings are appreciably different than the biopsy or change during the procedure- different type of skin cancer, high risk factors noted, areas of concern for another skin cancer - these occurrences tend to be documented. I hope that is helpful! Sean McGuire, MD
Hello - I imagine you have either had your question answered in the last 15 months or moved on, but just in case you haven't (or someone else has the same questions), I figured I would try to help out! Q: Are there any visual clues to the extent of skin cancer? A: Visual clues such as skin color, sheen, blood vessel density, and others go into estimating the skin cancer's size, but they only provide a rough estimate. Assessment under the microscope is much more sensitive than the naked eye and it is often the case that the microscopic extent of a skin cancer extends far beyond any visual clues would suggest. This is, in essence, why Mohs surgery exists. Q: Does taking two layers at the same time ever happen? A: Each Mohs layer represents the surgeon's best estimate to the extent of the skin cancer; it is intended to clear the tumor. As such, taking two layers at the same time, without assessing the first to determine if the second one is needed, does not make sense to me. Q: Do experienced surgeons require fewer layers? A: The national average of stages per case is somewhere around 1.6 and varies slightly year-to-year. I would venture to say 90% of Mohs surgeons average between 1.3 and 1.8 stages per case, regardless of case complexity, experience, and total number of cases performed. I have not seen a study correlating years in practice to average stages per case. From personal experience, I would say (generally) that younger surgeons err on the side of taking smaller layers, which may increase the number of layers required in some cases, but this same fact may also allow preservation of more unaffected skin, reduce the final defect size, and help minimize scarring. I hope that this is helpful! Sean McGuire, MD
Hello and that is an excellent question! Short answer - yes, it is rather common to have some sort of change in sensation above a forehead scar. Long answer - The reason for this is because the nerves that give sensation to your scalp actually exit the skull under your eyebrow and then head north to your hairline and beyond (see the attached link for a map of sensory nerves in this area). These nerves run in the skin and can be interrupted during Mohs surgery. Once a nerve is injured, it attempts to regenerate and repair the damage. During this time they are quite 'twitchy', meaning that they may be more sensitive, itchy, or tender. As the healing process continues, this will likely resolve but it can take several months or even up to a year. Your surgeon repaired the wound parallel to these nerves by going up-and-down rather than across the forehead, thus minimizing nerve damage and the extent of this side effect as much as possible. If the symptoms continue, worsen, or any other concerns arise, I always recommend discussing with your surgeon to evaluate your particular case. I hope this is helpful! Sean McGuire, MD
