Question:
I have an asymmetrical chin. Is it possible to have an asymmetrical implant put in to even out my chin or is there some other way to create more symmetry?
Answer:
In rare occasions it might be possible to carve an implant to attempt to improve symmetry, however the patient would need to have a weak chin to allow an implant and often there is other issues at hand. Asymmetry can also be due to soft tissue differences or even to mandibular growth disturbance that would require oral surgery. In general, small degrees of asymmetry are normal and should be ignored.
Posted by Dr. Buckingham
Question:
I like the idea of using my own fat from one part of my body to fill out another part. Can I choose where I have the fat removed? I have very large breasts and would like fat transferred from my breasts to my cheeks, which are pretty flat.
Answer:
It is possible to select the place to transfer fat from, but not the breast. The breast is made of fat and glandular tissue and so liposuction is not an appropriate treatment for this area. Fat can be harvested from different locations on the trunk or lower extremity.
Posted by Dr. Buckingham
Question:
There are so many different filler options available that choosing can be very confusing. Can you detail the main fillers out there and what they are most appropriate for treating?
Answer:
There are four main classes of syringe fillers available in the US. Hyaluronic Acid (eg. Juvederm, Restylane, Perlane), Calcium Hydroxyl Apetite (Radiesse), poly-L Lactic Acid (Sculptra) and Poly-methylmethacrolate (Artefill). The hyaluronic acid fillers can be used anywhere on the face safely including the lower eyelids and lips. They provide instant results with little down time, last between 6 months and 18 months depending on the injection location and are fully reversible with an enzyme injection. Radiesse also provides instant results with little down-time, but cannot be used safely in my opinion in the lips or under the eyes. It is not quite as soft and versatile as Juvederm and Restylane, but is an excellent deep tissue filler for say augmenting cheeks. Artefill provides instant results from the bovine collagen in the product and then as that dissolves a more permanent result from the PMMA beads that the body encases in collagen. In our experience however, the result is not a 1:1 ratio. You also must be careful since the results are permanent so are the complications. Sculptra is an excellent filler for replacing volume loss in the face. It is different in that it requires the body to form the collagen that the filler induces. Because of that it takes 2-4 injections over that many months. The results last at least 2 years however. It is the best filler for overall volume replacement. It is however in my opinion not as good as fat and fat is more permanent. Fat injection is however a surgical procedure and carries with it a recovery period that is not possible for some patients. If a patient can tolerate the recovery period though, fat can be injected anywhere in the face, with excellent results and longevity.
Posted by Dr. Buckingham
Question:
Can fillers be used on chicken pox scars? Which fillers would be most effective?
Answer:
Fillers can occasionally be used for chicken pox scars. Often the base of the scar needs to be released before the filler is placed. Usually we will use one of the hyaluronic acid fillers for this, Restylane, Juvederm. Since these fillers are temporary however, often we will recommend surgical excision of the scars as this offers a permanent solution and often the result is excellent.
Posted by Dr. Buckingham
Question:
I have acne scars that I would like resurfaced. There are a couple deeper creases but most of the scarring is diffuse and spread over my cheeks. Can this be fixed with laser skin resurfacing and how many treatments would I need?Â
Answer:
There are many options for the treatment of acne scars. Deeper scars are usually excised surgically as an initial step. The remainder of the skin is then resurfaced utilizing laser in most instances. The usual device is either a fractionated CO2 laser or a fractionated erbium laser. The erbium laser (Fraxel) requires a 5-6 treatments and the recovery from each is about 5 days, however make-up may be worn during this time. The CO2 laser (Matrix) can be adjusted to a more superficial or deep treatment which will affect recovery time and the number of treatments necessary. Often the acne scarring has caused generalized atrophy of the skin and soft tissue and so the result can be improved with the addition of a fat transfer or Sculptra.
Posted by Dr. Buckingham
