Dr. Robert J. Troell is a diplomate of six medical and surgical boards specializing in facial and body cosmetic surgery with offices in Las Vegas, Nevada, and Irvine, California. The founder of Beauty by Design Cosmetic Surgery and Med Spa, Dr. Troell is known for his expertise in facelifts, cheek and chin enhancement, rhinoplasty, breast augmentation, high-definition liposuction, and injectables (fillers and neuromodulators). Dr. Troell earned his medical degree with honors from the University of South Florida in Tampa, Florida. After completing an internship in General Surgery at San Diego Naval Hospital in San Diego, California, he spent a year as a General Medical Officer in the United States Navy and Marines in Okinawa, Japan, followed by California-based residencies in Otolaryngology-Head and Neck Surgery: one at the Oakland Naval Hospital, a second at Stanford University Medical Center, where he served as Chief Resident. He capped 12 years of intensive education and training with a fellowship in Sleep Medicine, also at Stanford University Medical Center, where he stayed on for the next five years to serve as a clinical instructor for the next generation of surgeons. His love of teaching continued even as he went into private practice, as he served as an adjunct clinical professor at Touro University Nevada College of Osteopathic Medicine until 2020. He has also been a visiting professor for the Department of Plastic Surgery at the University of Nairobi in Kenya and a clinical instructor for Solta Medical, the manufacturer of VASER Liposuction. Dr. Troell is a diplomate of the American Board of Facial Plastic and Reconstructive Surgery, the American Board of Otolaryngology – Head and Neck Surgery, the American Board of Facial Cosmetic Surgery and the American Board of Cosmetic Surgery. He is a fellow of the American College of Surgeons and a member of the American Academy of Facial Plastic and Reconstructive Surgery, the American Academy of Cosmetic Surgery, and is an oral board examiner for the American Board of Cosmetic Surgery. He frequently speaks at medical conferences and has published in a variety of prestigious medical journals. He also spent nearly a decade as the physician for the Las Vegas Wranglers Hockey Team. Dr. Troell was named Top Plastic Surgeon in Las Vegas in 2017 and has won multiple Best Doctor awards throughout the years, including being named one of the 10 Best Plastic Surgeons in Nevada by the American Institute of Plastic Surgeons in 2018 and 2019.
A: Good day! Thank you for your question. Botox and other FDA approved neuromodulators improve the wrinkles that you see when you animate your face, i.e. scowl , raise your brow, squint. Fine lines and wrinkles that you see when your face is in repose can be mildly improved by injecting Botox; however, often the best treatment for lines like "sleep lines" are skin resurfacing procedures, such as CO2 laser and radiofrequency microneedling. At my practice we use the top rated, per a survey on RealSelf, skin resurfacing technologies--DEKA for CO2 laser resurfacing, the Venus Viva and the Vivace for radiofrequency. Patients typically see excellent results after one treatment. Hope this helps address your concerns.
A: Good day! Thank you for your question. There are no scientific studies that have been conducted to verify the safety of Botox on breastfeeding mothers and their babies. While Botox and other FDA approved neurotoxins work locally and not systemically, it is highly recommended that you wait until you are finished breastfeeding before receiving treatment given the lack of research. If you have received Botox prior to getting pregnant and are planning to breastfeed, there should be no cause for concern as Botox is metabolized by the body, on average, within 3 months.
A: Hylauronic fillers will definetly plump those unwanted wrinkles and can correct the slight assemetry of your top lip. HLA fillers are great, because you can choose different fillers depending on the amount of plump you desire. Juverm, Restalyne, & Versa are my top picks. Permanent lip implants are also an option if you do not like filling those beautiful lips with fillers every 6-9 months. Consult a Board Certified Plastic Surgeon near you to pick the option that is best for you!
Best Wishes,
Dr. Robert Troell
Las Vegas, NV
A: There are multiple ways to enhance the lips. For your goal of plush doll like lips, I would recommend starting off with lip implants, see if the change is big enough for you, and go from there. Lip implants can be removed during an office visit if you change your mind, whereas a lip lift is permanent removal of skin. There are multiple size lip implants to choose from. The procedure to place lip implants is relitively quick in office procedure and has minimal downtime. If the initial swelling doesn't bother you, and you are used to the feeling of post lip injections, you may not have downtime. Lip implants are placed through a small incision at the corner of the lips. Once you have a lip implant placed, you can always opt to add a lip lift or injections at your leisure. Hope this helps!
Best Wishes,
Dr. Robert Troell
Las Vegas, NV
A: Good Day. Thank you for your question.
The first issue is to wait for at least 4-6 weeks after the injection for resolution of all possible swelling.
A patient discussion regarding treatment options follows. If there is adjacent soft tissue volume loss, correction of this volume loss with a filler may resolve the concerned appearance.
If there is no adjacent volume loss or no further filler is desired, than a nonsurgical approach with the injection of a steroid (triamcinolone or Kenalog) to the area of fullness is indicated. A repeat injection may be considered every 4-8 weeks. 5-FU can be injected alone or in combination with Kenalog as an alternative.
If these do not resolve the abnormality then surgical therapy is the last and finite procedure. If the fullness is at the lower eyelid area, an incision can be performed inside the eyelid to completely hide the incision. Since no all injectors are surgeons, a facial plastic or oculoplastic surgeon may need to be consulted to avoid additional complications.
Best of luck.