Sulagna Misra, MD

Hi! Thank you for this terrific question! Like my heading states, no all of these medications are the same-
Semaglutide is also known as Rebylsus (oral), Ozempic and Wegovy (Injectable). Liraglutide is also known as Saxenda (a daily injectable medication). Tirzepetide (Mounjaro or Zep bound) is a COMBINATION of two hormone targeting medications and works a bit differently than the others. ALL are used for glucose control primarily with a secondary finding of weight loss. Currently only Tirzepetide is approved for Obesity.
Not all are the same, so to choose the right medication for you, I'd speak with your trusted physician!

Great question! Yes, patients can take these medications after liposuction. While liposuction does remove fat cells, adipose (fat cells) have an AMAZING ability to expand in size (unlike alot of other cells) so fat can accumulate and recur after such surgical procedures.
have plenty of patients who have undergone weight loss or liposuction procedures that have had some egain and started injections. Speak with your physician to see if this is the right plan for you.

Currently three situations are occurring around coverage:
-Medical indications regarding coverage are constantly changing (this space is changing regularly as are he logistics and legalities around it)
-Insurance Coverage and whether that occurs (which varies from insurance to insurance and often does not follow true medical guidelines)
-Supply shortages (You may get the first two squared away but then not be able to find it anywhere available to start or continue treatment)
For this reason, the FDA allows for certain pharmacies to compound (or make) the medication during times of shortage, however you must be careful and utilize a trusted physician and pharmacy, with some knowledge of the FDA and compounding process, as some compounding pharmacies are doing the process wrong and harming patients.
My suggestion to all my patients is to:
1) Call you insurance and ask about coverage. Do not give too much information, you are simply asking.
2) Ask if you are required to have a PA (Prior Authorization) document completed and what that entails- you then can decide if you would even like to proceed with the PA process or go straight to purchasing.
3) For a large group of people, these medications ultimately (while currently extremely expensive) help patients SAVE money due to cutting down on consumption in a number of ways,a s I have plenty of patients that happily pay out of pocket.
Hope this helps!
Warmly,
Dr. Misra

Hi and thank you for your question! It is a terrific one, and one I get often.
Weight is complex and often involves stressors, environment, behaviors, genetics, culture, pleasure centers and more. The relationship people have with food is also very complicated, so the "path" that results in Obesity and Obesity related disease states is not the same for everyone, so getting off medication does not look the same for everyone.
Currently, regarding Tirzepetide (Mounjaro or ZepBound), there are ongoing studies to see what "maintenance" or getting off the meds looks like, but from my own personal experience, weight gain after stopping treatment depends on a number of factors and does not occur with everyone. In myown practice, part of the membership is to try and break old habits while creating new ones, and figuring out the role people have with food and beverage and redefining that is paramount to preventing weight regain- but I do not like to pathologize things that may be normal.
It is NORMAL to be afraid of weight regain after losing. It is NORMAL for some fluctuations to happen, but keeping in close communication with your physician about your fears, goals, dreams and having an understanding physician supporting you during this journey is key to achieving success. I wish you well! Weight loss is a transformative JOURNEY for a reason.

Hi- so sorry to hear you are suffering. For alot of people, acne needs more than just one approach to keep active acne at bay and help to prevent painful breakouts from occurring. Treatments also exist to help with scarring. Besides washes (unsure which washes you have tried as you have not specified) there are now many oral medications and topical creams specifically formulated for active acne that can be administered by a physician depending on what is causing you to break out. There are even laser therapies to help with painful lesions that also help prevent breakouts. For scar treatment, there are some wonderful chemical peels that can be implemented. Microneedling is also an effective treatment for scarring. Acne can be debilitating for alot of people for many reasons and even the slightest improvement can make you feel wonderful. It is important to get seen by a physician who can help figure out why you may be prone to breaking out and how to move forward with treatment. Best of luck, and hope this helps. Its important that people know there are many therapies available and face washes (while important as part of the process) may not be enough alone to target acne. Thanks for your question! It may help alot of people. -Dr. Misra

Hi! thanks for your question! Kybella is only FDA approved for the removal of submental (chin/neck area) fat. That being said, I know alot of people do use it "off label" aka in other areas for fat reduction. It is pretty well discussed that the goal of the face is usually never to remove fat (except maybe a few areas such as buccal fat) because fat/volume loss or aging are huge contributors to what causes less than pleasing aesthetic outcomes in the face. That being said, you likely may benefit from some filler strategically placed to smooth out that area and as you say, "flatted the corners of your mouth" giving you less of a shadow and instead draw attention to those gorgeous lips of yours! Hope this helps and thanks for your question!!!-Dr. Sulagna Misra

Thanks for this question! It's actually a great one. Alot of debate is currently going on about filling this area. It is a highly vascular, highly lymphatic area and we are seeing more people have problems with filler in this area. Some physicians even are saying to avoid filling this area at all. That being said, some people also have terrific outcomes with filling this area. The reason (boiled down to basics) for both is 1- the filler used (only recommend regular Restylane in this area as more often than not it does need to be dissolved and it is much easier to dissolve Restylane than other products due to how the products are made) and 2- the lymphatics and blood vessels in this area- lymphatic drainage is limited in this small area but lots of stuff often needs to drain into the lymphatics (think allergies or anything else that causes swelling or inflammation, tear ducts that need clear pathways etc). The area of the tear toughs is also very small- so very little product that may look great will migrate over time (all fillers migrate over time- its a consequence of use and aging) and often times people do expect that after a year or two filler is gone when in actuality we see filler lasting almost a decade after it has been placed. Putting all of this together, tear trough filler in some people can cause more issues in the long run for some people. That being said, if you love the look, I highly recommend you go to an oculoplastic surgeon and see if there is something more permanent you can do to achieve the same look without the adverse results. I know sometimes a hefty price tag and post-operative healing (downtime) is difficult to do but it might be your best option. Hope this helps!!! -Dr. Misra

Hi and thank you for your question! It does seem you have some fat pad protruding and if you know you suffer from allergies there definitely could be a combination issue going on as you do seem to have what are called "allergic shiners". Getting your allergies under control and possibly a lower blepharoplasty would help you look refreshed if that is what you are looking for. I would avoid filling this area as it might make your eyes look worse. You have beautiful eyes! I hope this helps-Dr. Misra

Hello and thank you for submitting this question. It seems the filler has migrated outside of the lips and that is what you are seeing in terms of the shadow. I do recommend that if this continues to be an issue for you that you get get it dissolved if it is a hyaluronic acid based filler (which it hopefully is!). Getting more filler injected in this area without dissolving some first will likely cause this to worsen beyond just a shadow and result in some less than aesthetically pleasing results. I hope this helps!! (For your information, filler dissolving is best done with ultrasound guidance so you may want to go to someone that specializes in this as you an target the area specifically). All the best!-Dr. Misra

Sorry to hear your frustration! Hyperpigmentation can be hard to treat. Often multiple treatments and different approaches need to be used to get optimal results, including a series of peels, skin brighteners with formulas that are compounded by pharmacies specifically for your skin needs, a series of laser treatments series etc. Try your best to use sunblock with an SPF 30 or higher and cover the area from sun with proper protective clothing. Good luck and I hope this helps!