Yoash R. Enzer, MD, FACS - Account Suspended

There are many products available to consurmers and that can be purchased on the internet which claim to remove moles and other facial growths.  And I get it.  Going to a doctor is expensive, there are often long waits, and if you have insurance, that can be a big hassle too.

But many of us in dermatology and the facial aesthetic field have seen bad scars from these products, and your photos are a perfect example.  Just like when you skin your knees, a scab develops with the top layer of the skin are lost.  And you will heal, but there is a good chance you will be left with an indentation or discoloration (lighter or darker) in the area.  Ultimately it may end up being more noticeable than the original mole.

Perhaps seeking out a skin or wound specialist at this point could be helpful in making the final scar appearance less noticeable, but at this point it may be too late.  The damage was done a long time ago.

I am sorry this happened to you, and I'm sure if you knew it would turn out this way you would not have done it.  Hopefully it will be a lesson or message to prevent others from making a similar decision in the future.

Sincerely,

Yoash R. Enzer, MD, FACS

Many people have dark circles under their eyes.  This makes the person look tired and sad.  In past years the only solution was a surgery called blepharoplasty.  These days many if not most patients prefer to have the dark circles treated with filler products.  The use of fillers in this area is not approved by the FDA for any product, however, it is very commonly done by many physicians in the country.  I am sure you could find someone who is a recognized expert where you live.

I wish you well,

Yoash R. Enzer, MD, FACS

The majority of people are born with a facial asymmetry, with one side bigger than the other.  It is very important that the treating physician look for, and recognize this asymmetry before considering any treatment.  Most are very subtle, and can be easily correctly to near perfect with fillers placed in key areas.  In fact, I believe this is one of the top elements to facial beauty, and if you look at photos of "beautiful people" you will see that their symmetry is near perfect.

Of course filler will not correct any dental problems.

Sincerely,

Yoash R. Enzer, MD, FACS

While we always try to avoid bruising when it comes to facial fillers, the fact is that it is guaranteed to happen in a fairly high percentage of patients.  There are techniques the physician can do to avoid bruising, most notably the use of CANNULAS instead of needles.  There are also steps the patient can take to minimize the chances of developing bruises, such as avoiding Aspirin, Non-Steroidal Medications (Ibuprofen, Advil, Aleve, Naprosyn, Motrin, etc) for at least two weeks before a treatment, and some herbal supplements such as Arnica and Bromolain (or eat pineapple).  In fact, I believe that if the bruising comes out several days later, it is highly suggestive that the patient is taking blood thinners such as aspirin or ibuprofen products.

Yet reassuringly, all bruises will go away, and I am certain yours will too with no adverse effects.  Sometimes Vitamin K creams or Arnica will help speed up the process, as well as warm compresses.

Sincerely,

Yoash R. Enzer, MD, FACS

Associate Professor of Dermatology and Surgery (Ophthalmology)

Alpert School of Medicine at Brown University

Most patients have a stable surgical result by about 3-4 months, and what you see at that point is very predictive of the final appearance.  Your photograph suggests a relatively prominent eye, and these are the most challenging patients when it comes to lower eyelid surgery.  We would have to see how the lids look when you look up and to the side, and check to see whether there is any tethering of the lid after surgery.  However it appears that you have more of an issue that just excess fat left over on one side.

The goal of cosmetic lower lid surgery is to blend the lower eyelids smoothly into the upper cheek.  I see lots of folds in your lower lid - cheek complex, and I do not believe this can be adequately addressed with transconjunctival blepharoplasty alone.  This may be a source of disappointment to you as well, and you may want to seek second opinions, as well as discussing this with your original surgeon.

Sincerely,

Yoash R. Enzer, MD, FACS

Clinical Associate Professor of Surgery (Ophthalmology) and Dermatology

Alpert School of Medicine at Brown University

Neuromodulators such as Botox/Dysport/Xeomin can be a very effective tool to open a person's eyes.  They work by weakening muscles.  So any muscle that closes the eyes can be weakened, and thus make the eyes more open.  

The main muscle that closes the eyes is called the Orbicularis.  Neuromodulators can be placed in key locations of this muscle to open the eyes.  This has to be done very carefully so as to keep it from spreading to adjacent muscles.  Also if too much is injected, you will not be able to close your eyes, and this could become a very serious medical problem.  Therefore this procedure should only be performed by a physician who is an expert in the eye area.

Yoash R. Enzer, MD, FACS

Clinical Associate Professor of Surgery (Ophthalmology) and Dermatology

Alpert School of Medicine at Brown University

Most people have some facial asymmetry.  It is important to recognize this fact, and take it into account when evaluating a patient, such that the appropriate products and volumes can be administered to maximize facial symmetry.  The more symmetric and properly proportioned a face, the more attractive the person.

This may be acheived with neuromodulators like Botox alone, or in combination with filler agents.  Botox can be used to treat a prominent masseter muscle (the muscle that protrudes from the corner of the jaw when you bite down) very effectively.  Please note that it is considered off-label for this purpose, meaning the product is FDA-approved, but not for that use.

Sincerely,

Yoash R. Enzer, MD, FACS

Associate Clinical Professor of Dermatology and Surgery

Alpert School of Medicine at Brown University

Many people have a fold in the outer corner of their upper lip, and sometimes it gets more noticeable after a lip filler treatment.  If you are bothered by such a fold, it can be easily corrected by placing a little filler there in addition to the filler in the red part of the lip.  I do this routinely to give a nice shape to the lip.

Hi-

I am sorry to hear about the problems you've had after fillers under the eye area.  You are not alone in patients who have had problems like this, and you were lucky to find a doctor who could remove the product.

Before deciding how to make the area look better, I would recommend you make sure as much of the nodules have been removed as is possible.  The body can continue to react to the product, and these nodules can grow.  Once that has been done, one has to assess the degree of soft tissue volume loss.  Is there any internal scarring that is pulling down or restricting the lower eyelids?  I would expect there to be a significant amount of internal scarring as a result of the reaction to the product, as well as the surgery to remove it.  This makes any further procedures to enhance volume in the area much more challenging.  Fat grafting will not survive as well, and it will be more difficult to place hyaluronic fillers smoothly in the area.  In other words, this is probably a very complex problem now, and not a standard filler patient.  I would recommend you seek out an Oculofacial Plastic Surgeon who is very experienced in repairing "botched" surgery.

Yoash R. Enzer, MD, FACS

Hi-

There are multiple reasons that a scar can be noticeable, and the important point is that the surgeon or doctor identify those reasons before proposing a treatment.  Otherwise, he/she is throwing all sorts of treatments at you without necessarily understanding the cause of the problem.  This results in many patients either getting no improvement, or in some cases being made worse.  Any improvement is a matter of luck.

In your case, the scar is visible because it is widened and indented.  The skin may be darker, or this could be artifact from the indentation.  An in-person consult would be needed.  Therefore your best options are either excising the scar and trying to convert it to a flat narrow line, or fill it in from below the skin, probably with fat grafting.  And then look at the skin color, and lighten it if necessary with a combination of pigment laser treatments or lightening creams.

I hope this helps to answer your question, and good luck with finding the right doctor to help you.

Sincerely,

Yoash R. Enzer, MD, FACS