Blog with Dr. Irwin

Tag >> Fillers

Hi Dr. Irwin, im thinking about getting my tear trough treated with filler but am unsure what is the best one to go with ; Restylane or Juvaderm Vobella, which i believe is mostly used for lips but now can be used under the eye too. Please help

First of all, this area can be tricky and dangerous, experts only please!! Make sure your dermatologist, plastic surgeon or well supervised RN has been working a lot with fillers for at... more


Dr Irwin, what can you suggest about post botox prominent temple and forehead veins?Do they usually recede as the effects of Botox wears out?

It's very common for any type of injection in the face, not just Botox/Dysport, to cause temporary dilation of the veins in the area.   This usually lasts 20-60 minutes.  There are no... more


Is filler andbotox okay for people who have cancer

This is a both a complicated and uncomplicated question.  Okay ........I know that's confusing in itself!   The good news is that neither Botox or fillers affect the immune system so that... more


i had Voluma injections a month ago and there are no visible results whatsoever. The doctor says after the next round of 1800 dollars worth of injections, I should see some difference. What do you think?

I think this really depends on your age and the amount of deep volume loss you have.  Since Voluma is really meant to replace deep volume loss, you need to think of it more like Sculptra. ... more


Hi Dr.Irwin I'd like to know if it's safe to have HAs injected on top of where sculptra filler was injected? thank you Morgan

Thank you all for asking such good questions!   Just so you know....in my opinion, Artefill is not safe (ever) because it's a permanent filler (micron sized plastic beads) and when a... more


Dr.Irwin. 8 years ago i had my own body fat put in my cheeks. My cheeks seem to be still over filled. Is there anything to correct this? I enjoy reading your advice. Thankbyou

At this point in time, I'm sad to say there isn't.   Liposuction isn't generally recommend for this because it's too hard to get it even and the current fat busting technologies aren't... more


Dr.Irwin I read a question from Jennifer on Oct.21/2013 which described my exact problem after restalyne lip injections but I don't understand your answer and desperately need to! I had the injections about 5 years ago and like Jennifer I too developed lumps and also a purple/blueish discolouration above my lip on one side. I also developed a hole which oozed out a thick mucous white substance at times and more watery substance other times. As the substance came out, the lump near it got smaller however the hole never went away. Now I developed two more holes on the other side of my upper lip which oozed the same as the first hole and consequently diminished the lumps near those holes. However these holes aren't going away either. The skin above my upper lip is always red with spots of purple/blue discolouration and there is no longer a clear lip line. It is a horrible mess. I don't want to go out in public. I also know for certain it was restalyne and did get the hyaluronise injection to help reduce the lumps which at first seemed to work but over the years the discolouration came, the lumps reappeared and now the holes. I don't know who to see and desperately need help. Please clarify if your answer to Jennifer who posted a question regarding the exact same problem was that this is an infection or a cheap substitute product was used and more importantly if this can be fixed, how and by who. Please please reply to me I don't know where else to go. Thank you, Jen (coincidentally the same name as the original question asker!).

Jenn -  I hope you see this.  I didn't see your question at first and clearly this is a very important!

This rare complication is called a "biofilm."   You really need an expert injector... more


Hi Doctor! I had Juvederm injected to my lips just one suringe which is 1 ml and after 4 hours I worked out with weight about 30lbs average for my back and shoulder exercises and I work out 5 days a week. I read that working out right after the treatment can block the binding with the tissue but it was about Botox. Is juvederm the same thing? Will it be blocked from binding or will it dissolve fast?

Generally, here are some conservative, careful guidelines regarding all exercise, except walking (heart rate under 100):  More on filler problems here.

  • Botox/Dysport -  6-24 hours.  It
... more

Thank you for the opportunity to ask a physican questions about Sculptra, which I am considering having done. I am 75. My cheeks just beginning to look slightly "crumpled". I am lactose intolerant and have major gas and worse if I eat any at all. Will injecting a lactic acid product have the effect ingesting dairy does? Marsha Lady Lake, FL

You're welcome!   I'm glad you asked these questions.   There are no studies on this, but after many years of working with Sculptra, my observation is that as we get older, Sculptra still... more


I had a liquid lift -8000.00 of juvederm ultra - primarily to my midface. Within 3 weeks the entire structure broke down leaving dark bands below my eyes, furrows runningdown my face and deep folds running from my nose to my mouth . In fact i looked worse afterwards then before i did anything. Why would this happen? It appears that i was vastly over charged ..was I?

On the overcharge question, it's really impossible for me to say without knowing where you live (some areas much more expensive) and how many syringes were used.

I really hear you on... more


Hi Dr Irwin, I have been thinking about getting Sculptra done for 2 years now. I keep backing out and going back to filler that does not last long. I have just hit 40 and a fitness instructor.I am scared of getting bumps on my skin. How often does this happen on patients these days?

I can understand your cautiousness on this, because the web tends to foster fear-based thinking, some justified and some not.

Sculptra bumps are extremely rare, if the doctor providing the... more


i am 67 years old and i have deep wrinkles in the upper lip area "smokers lines"--is there any hope for me to repair this? i really appreciate your article--thank you

The answer to this is yes but with some qualifications.   The area will never be perfect again, but if  you would be happy with 60-80% improvement, then that could be quite realistic.

It... more


Hello Dr Irwin I have a question about fillers. I am looking at getting a juverderm filler however, I have just had a melanoma removed from my leg. Can fillers increase the chance of getting another melanoma. Thank you Alee

Thankfully, the answer to this is no.   Injectible aesthetic treatments don't affect your risk of having a melanoma recurrence or a second melanoma, as far as current data indicates.  Dr.... more


Hello dr. Irwin, I am 44 years old . Recently I found out that my face changed, oval of face poped down, I got saggy chin. Now I make biorevitalisation with Restlayn Vital. But that does not looks like very effective for my problems. Can I have your opienion about that please ? Thanks.

I'm sorry to say that, if you told your doctor clearly that you wanted more of a lift, the Restylane Vital is not a good choice, in my opinion.   This product is currently available in... more


I have high ANA auto immune markers. Am I a good candidate for Sculptra?

There are definately differing opinions on this in the medical community.   But...... in general, if you have certain autoimmune diseases like rheumatoid arthritis, Sjogren's syndrome,... more


Can I receive treatment like Sculptral during chemo therapy.for breast cancer? Any bad side efeects or interactions with typical chemo regiment?

In general, Sculptra during chemotherapy is not a good idea because it works by stimulating your own cells (fibroblasts) to make collagen.   During chemo, the cells all over your body tend... more


My dr. Hit an artery and blocked the blood vessel, it was 72 hours before he could determine what was wrong and was unsure how to treat. He injected something to dissolve the juvederm, now I'm left with deep purple, black bruising around the base of my mouth up to my nose with rash steaks to my forehead. He also had me start using a nitro paste 96 hours after, that burns severely when I put it on. I had a hyperbaric oxygen treatment 48 hours after the injection to clear the filler, however if had to pay for it and ins does not cover. I can't afford more treatments. What else can I do?

I'm glad you wrote, thank you for sharing this and I'm very sad this happened to you! 

My position on this is that any doctor, PA-C, ARNP or well-supervised nurse (please don't let anyone... more


Can you use a filler in forehead region of the face?

Yes, but this is not FDA approved and should only be done by experts, and usually/often with a blunt tipped canula rather than a needle.  This is because there are some critical arteries in... more


I just had Voluma injected and love the results. But concerned because I sleep on the side of my face. Will this flatten my cheeks?

If you look very carefully, almost all of us are flatter on the side on which we sleep the most. Sometimes it's subtle and sometimes quite different. When your doctor/nurse injects,... more


I went to a doctors office in which their RN injected filler into my lips and on the sides because I felt my lips were drooping downward. I have now noticed that I do not have the natural line on either side of my face when I smile. What did she do wrong? She used Restalyne. I look very bad when I smile. I have come to the conclusion that she did not know how to place the fillers. Can you tell me why my smile lines are not there when I smile? It is driving me crazy. I don't know if I need to go to another doctor to have whatever she did, dissolved, or just wait it out. I have been massaging my checks but I don't see an improvement. This was done in September. Thank you!

Generally, if your smile lines that run from the nose to the mouth are gone, she either put too much in or placed it poorly not respecting natural anatomical boundaries.  Hyaluronidase... more


I have a lot of facial veins. How does my doctor avoid sticking them.

For starters, many are relatively close to the surface and, with good lighting, your doctor can see them and go around them most of the time. For the ones that are running under the... more


I have vertical lip lines---on one side they are dynamic. My derm says they are moderate. The first time he used restylane on them, it looked good and it lasted nearly six months. Then he decides to put perlane in--was a lumpy mess. Finally, we get back to restylane but it stays puff looking and isn't dissolving evenly on the side with dynamic wrinkles. I know he overfills somewhat because my mouth looks like a duck for at least two weeks after. He says I need volume in the upper lip as well as the lines filled. Why does it get puffy and look uneven four or five weeks later?

This IS a tough area because there are 3 problems: loss of volume, dynamic wrinkles (caused by muscle action) from kissing, talking, smoking, etc. and sun damage on top.  And to some... more


Dear Dr Irwin I would like to ask you for a product recommendation. I am concerned about loss of volume and sagging--while I know that nothing can stop this process and that a semi-surgical process is best, I was wondering if any cream would help at all, and if so, which one you recommend. Prresently I use in the mornings Skinceutical Phloretin CF and Eminence Blueberry Soy, and at night Retin A under Olay Regenerist (most of these I use because of your website recommendations). I cleanse with either cold cream or a fruit enzyme scrub. Should I incorporate a glycol acid product? Is there any product I could add to my regimen that would improve the appearance of the loss of volume? thanks! Frances

Frances, thank you for writing.  Sometimes I think it's easiest to think of a grape.  If you leave a grape out on the counter in the sun, it will lose volume and the surface will... more


dear dr Irwin, I had juvederm injected into my nasal folds on Monday. he numbed me first with licodaine shots under my lips. that night I noticed purple and next day swelling and went to many doctors . no one saw anything like this. finally I went to big doctor in city and its occlusion. blood clot and my face looks distorted , swollen white tiny pus pimples, dark spots scary. I had oxygen therapy, he removed the juvederm with shots, I put nitrate on face, warm compresses, steroids . anything else I can do. he scared me that I can losse the tip of my nose...im terrified. help!!!! the doctor who originally injected me was the first time I went to him. I used to go to different doctor and never had a problem. please tell me if theres anything I can do to save my nose....thank you,

My heart goes out to you and I'm so glad you went to the doctor in the city. He did all the right things to remove the Juvederm, the oxygen, the nitropaste, warm compresses, etc. You... more


Is Sculptra less effective the older we are?

To some extent the answer is yes. It's because Sculptra (made of lactic acid stuck together in chains) stimulates your own collagen production and the collagen is made by cells called... more


I enjoy your site so mucc and have noticed your advice to sometimes massage marrionette line etc. after derma fillers. how long after the procedure is this still of benefit and if its so moldable can it accidentally be squished or moved when propping the face up on your hands when tired or sleeping...I sleep resting the side of my face on my arm instead of pillow and worry all night! Thanks for any consideration to this, I had Juvederm a week ago, very small lump in marrionette line but afraid to touch it

Okay, I'm thinking maybe we had a misunderstanding on this one. The only filler that should be massaged is Sculptra and your doctor will give you specific instructions on this, if you... more


I have experienced upon occasion that someone will ask if I have had work done on my mouth, saying that they are just familiar with that look. Meanwhile I see these women on these Housewives of Vancouver or Jersey or where ever that look like freaks with their artificial mouths. Is there no product that is fine enough to give a more nature look to the upper lip?

I know exactly what you mean.  I cringe slightly almost every time I go somewhere because there will be a lovely woman with lips that look completely fake. Here's the problem, it's not... more


Please share your thoughts on some of the newer Radiesse fillers in comparison to Juvaderm. Thank you. Kathy

Well, Radiesse isn't all that new so both have track records now extending back at least 5 years.  I vote for Juvederm and here's why:

 

  • Radiesse isn't reversible if a mistake is
... more

Hi Dr.Irwin, I need help desperately please! I read a post to you from Dawn on March 24, 2013 regarding restalyne injections in her lips 7 years prior that resulted in large hard bumps on or above her upper lip which are extremely noticeable. I have the exact same problem and it's been 5 years since the injection of restalyne. In my case it was definitely restalyne and I did have the hydrolauranic(not sure of the name but the one they use to fix this) injection done but it seemed to work at first but over the years the problem continued to get worse. One day there was a tiny hole on the far side above upper lip and when I squeezed it a white gel like substance would come out. At times the substance would be very thick and other times runny but for days it continued to ooze out of this hole. This hole is still there and several times it oozed out what I think is the restalyne still somehow stuck in these lumps. My upper lip is a mess. Besides the lumps, it is red, you can't really see my upper lip line anymore and I have developed two more holes that won't go away. I would really like to send you a pic so you can see what I am saying. I don't know who to see or if anything can be done to fix this mess. Please help me.

Dear Jennifer, I hope you don't mind my answering here because you're not identifiable and I think others are having this problem also. To my knowledge, this can happen in three different... more


Hi Dr. Irwin, I have loss of volume in my mid-face, temple area. I would like to try a fat transfer. I have seen on this site,however, that you do not think it is currently producing reliable, consistent, results. I have heard other doctors express this same concern. My question for you, then, is this...If I do Sculptra now, will it prevent, or hinder me from being able to do a fat transfer in the future? Thanks so much for all you do. This site has been so helpful to me!

There's no reason I know of that it would be a problem, although there are no studies on this specific question. Sculptra is made of lactic acid molecules (L-polylactic acid) stuck... more


Hello Dr Irwin.. Thanks for all your help and tips .I am a 47 year old Africian americian female ...some people as bags under the eyes, for me it's that dept is their any filler I can use to fill up that dept to make under the eyes look more alive ? Thank you Karen,

Under eye bags are a tough one partly because we all lump a range of under eye problems in this category. So, I have a couple of questions for you?

1)  Is the bag right under the lash... more


Hi Dr. Irwin- The area between my nose and upper lip has elongated and has a very aging and unattractive look - coupled with a very thin upper lip. I have read about a surgical lip lift but I know that all surgeons are not in favor of this procedure, but am anxious to hear your opinion. If fillers are used instead, what are your suggestions please?? I do see a fine dermatologist with an expertise in fillers but do so trust your opinion !!!!!!! I am so upset that it's making me sick - HELP PLEASE !!!!!!!!!!!! Thank you so much !!! Sandy

This is a tough question and it's where the idiom "long at the tooth" comes from partly. MRIs done on, okay I hate to say this, but cadavers, seem to indicate some of this is actual... more


What do you think about this comment, made by (Dermatologist) Sam Shuster back in 2005? I've always believed UV exposure directly affected how quickly the skin thins (collagen loss), but he is suggesting this is false? Would appreciate your thoughts (Shuster's comments follow): "The fundamental defect of skin ageing is loss of collagen, the skin's main constituent, which is why ageing skin thins. The loss is one per cent a year throughout adult life and is equal in men and women. The reason female skin appears to age faster than male is that women have less skin collagen. This unfair difference is equivalent to 15 years of ageing! The loss of collagen with age is genetic; it has absolutely nothing to do with UV irradiation and occurs equally in skin that has spent its life covered or exposed. And, contrary to the advertising blurb for anti-ageing creams - which simply irritate the skin producing inflammation that swells the skin and conceals the wrinkles - nothing is known that reverses this loss of collagen. Ageing of the skin is not due to UV and it cannot be overcome by the products of the cosmetic industry."

Interesting but he's just not right. There are now literally hundreds of studies proving him wrong. All I have to do is to look at the skin of my patients who spent hours in tanning... more


Hello Dr. Irwin, My sister is a client of yours and told me about skintour.com Love it. I watched the juvederm injection video and was wondering how many syringes of juvederm you used. Am considering a filler and I too want to go conservative the first time around. My marionette lines are similiar to the patient you injected so trying to get a sense of what you consider conservative. Thanks so much.

Thank you for reading! I almost never inject fillers like Juvederm or Restylane at more than 1 or 2 syringes in a visit. I really recommend starting with one the first time unless your... more


Hi Dr. Irwin, I am 71 years old and I used retinol a for about 10 years but I quit using it, my skin is still in pretty good shape but it is beginning to sag can retinol help the sagging?

Sadly, the answer is no. Retinol and Vit A cousin creams (Retin A, Renova, tretinoin, etc.) are still the gold standard for repair of the sun damaged skin and will help prevent and reduce... more


I am 59 and have always had a very thin face. Had Juviderm for volumn 5 months agod, but on the cheekbone area have uneven skin. Will Fraxel help or should I just get more juviderm.

I just want to clarify this. If you are saying that you have a little lumpiness over the cheekbone area after your Juvederm, then only having more filler to even it out, letting it just... more


had juverderm last dec. to get rid of vertical lines over lips did not do thi can do at just made the area swollen(not lips)it is 8 monthe on and i can still feel thickness in the ares it is still puffy is there anything i can do i do keep massaging it. thanks jean

Dear readers, I see a number of patients with problems sent from other offices for me to try to correct. One thing I'm noticing is that many patients/consumers do NOT really know what was... more


Hi Dr. Irwin, I just had 2 vials of scuptra injected by a Dr. That is, a diamond provider and Top requested Physician trainer for Sculptra Aestheticâ„¢,so I am secure with the doctor. I am not secure about the fact that I had 2 vials at one treatment and was told that is all I needed.....I am 54 in August...everything I have read since I was injected yesterday talks about multiple sessions.. I also bruised a lot even though I took precautions by not taking products like aspirin..etc. I also started arnica about 3 days before? My main question has to do with the number of sessions not being the norm????

Since each of us are individuals, it's difficult to say with any certainty without an in-person consult. However, a general rule of thumb is to expect 1 vial of Sculptra per decade. So... more


Hi Dr Irwin, Please could you help me? I have Rheumatoid Arthritis and take Methotrexate 10mg also Hydrocloquire The Methotrexate suppress my immune system, I have lost a lot of weight in my face and would like to have Botox and Dermal fillers and am wondering if they will be safe for me and also would it be possible to have them anyway.

Good questions! There is no known contraindication with Botox and those medications and patients with RA generally have no problem. With hyaluronic acid fillers of good quality like more


I had touch ups of dysport and restylane yesterday around 3:00 pm and am a huge exercise person. The person that did all the injections said it would be fine to go ahead and exercise today. I do heavy weight and interval cardio. Just wondered your opinion

There is no good data on this that I've ever seen but I disagree although it doesn't make the treatment less effective. We ask patients to abstain from really vigorous exercise for 24 to... more


I am thinking of getting my under eye area treated with a new filler product named Volbella. It is used mainly for the lips but I was told it is a better product to use under the eye area as it is a smoother product and causes less swelling. I'm a bit nervous to have this area done but I'm 50 yrs. old and always look tired due to the loss of volume in this area. I'm hoping this will help to bring some self-confidence back and stop people from asking "are you tired ?". What are your thoughts on using Volbella in the eye area? Your help would be appreciated!

You must be in the UK or Europe because this product isn't available in the US yet. It's in the Juvederm "family" of hyaluronic acid (HA) fillers. The marketing states it may last up to 12... more


My mom takes Restylane filler injection every 6 months on her doctor recommendation but it costs lot of money each time! so here is my question: is there any product (such as peptides or other skin care products) to make the the Restylane effect longer from 6 months to 9months or 1 year...?..Regards!

First of all, it's very sweet of you to be looking out for your mom!! She's lucky to have you. 

There's no product to put on the surface of the skin that will make Restylane last longer... more


Dr. Irwin, I plan to get Sculptra to fill in my cheeks due to weight loss after cancer surgery. Everyone tells me I don't look my age and that I have good skin. People think I'm around 63. Being that I'm 81 years old, will my body replace lost collagen? I heard someone say that at that age your body will not replace the collagen. As you are the pro.I await your reply. Thanks ever so much.

We all are wishing you the best after that surgery! A couple of things to think about.

Sometimes after surgery or chemotherapy, your body fat is just reduced too much. Is this a situation... more


Is there one filler better than another for filling hollows near the eyes? Thank you Amy G.

Hi Amy, yes and that's because even among the hyaluronic acid fillers, which are a little like comparing apples to apples, there are some differences. But first, fillers like Radiesse,... more


I had Radiesse injected under my eyes about 1.5 years ago. I have hated every minute of it. My right eye has dissolved faster than the left eye and worry that the skin has permenantely been damaged. I have bags under my eyes that were not there prior to this nightmare. The right eye, as stated before, is more dissolved than the left eye therefore the bag is smaller. Any advice? Do I go to a doctor to get additional fillers to balance out the uneveness or leave it alone until it is completely dissolved?

I'm so sad that you've had to go through this. You probably know this already but, in my opinion, Radiesse has very, very limited specific uses and it shouldn't be injected around the eye... more


Does your office use Belotera as a filler? I just read a very positive article about it. Thank you, Kelly

Just some basics - Belotero is a hyaluronic acid filler made by Merck and recently approved by the FDA in the U.S. It's been available in most other parts of the world for longer. Kelly... more


I have an aortic valve replacement (cow valve). The question is that if I can use restylane injections in the nasolabial area and if it is safe for my cow valve without getting an infection. Thanks so much.

In good clinics, before fillers are injected, the skin is first cleansed of makeup and then the skin is sterilized with alcohol or other sterilizing agents. If you have any replacement... more


Photo Rejuvenation (Red Light) in Conjunction with Ultherapy: Hi, Dr. Irwin. I stumbled across your site and am very impressed by what I see. I wanted to get your views on Photo Rejuvenation (Red Light Collagen Anti-Aging Therapy), particularly in conjunction with Ulthera. I am a 35 year old woman, and I have been using Ulthera on the face and neck since it came out. Before that I used Thermage. I get a treatment every 18 months (with lesser frequency on some body areas) with excellent results. I am interested in using Photo Rejuvenation as an adjunct maintenance treatment in between these treatments. Specifically, I wanted to get your views on whether I can use it shortly after an Ulthera treatment. I ask about compatibility because I am due for an Ulthera treatment on the face and neck shortly. The place I would go to for Photo Rejvenation uses a bed that treats the body and face at once. So, there would be a benefit to the body (which I treat less frequently with lasers) if I could do it shortly after Ulthera on the face. My concern, however, would be that the treatment would somehow diminish the effectiveness of Ulthera. I don't see that this would be the case. I can't see how this would interfere with Ulthera's collagen-building process and think it would only have a beneficial additive effect, but I wanted to get the views of a professional. I will additionally consult my doctor who does the Ulthera, but it's always good to seek a second opinion. Also, my secondary question is whether there is any research/evidence that the Photo Rejuvenation treatment degrades dermal fillers. I usually get some radiesse and restalyne shortly after my regular Ulthera treatments. I can't see that a mild treatment like Photo Rejuvenation that doesn't directly heat the structures under the skin would cause fillers to degrade more quickly but am not sure on that either. Thanks so much if you get a chance to answer these questions. -Jamie

Good questions! Let's take them one by one and then in combination.

1) The Ulthera, in my opinion, works as well as Thermage but often requires more treatments and is more painful. But... more


I am a 53 year old woman who has lost 70 pounds. I lost the weight a little too fast and now it is showing in my face. My face is too thin looking and it has lost a lot of volume. What would you suggest to make my face look full again? Thanks for taking the time to answer my question.

Congratulations on meeting your weight loss goal! When we are young, our skin has more elasticity and will literally bounce back better after a big weight change. You're right that it's a... more


Dr. Irwin, I had Restylane injected into my lips. The effects have been horrible. I have hard lumps in my lips that are extremely noticeable. The plastic surgeon that did the injections recommended that I have them cut out. I am 37 years old and have been afraid to do anything else. I have lived with this horrible life altering mistake now for 7 years. I am not reading about Hyaluronidase Injections to dissolve the lumps. Do you think this could work after all the time that has passed since the injections? Do I need to go to another plastic surgeon or is it better to seek the counsel of a Dermatologist? Thank you in advance for any information that you may provide to help remedy my situation. I look forward to your reply. Dawn

Dear Dawn,  I'm so sad that you had to suffer through this and I am wondering if, in fact, it wasn't Restylane injected into your lips.   The only substances in the U.S. that would last... more


I previously had filler in the nose to mouth lines after 2weeks it completely disappeared, after going back to the provider they said my body had absorbed the filler. They repeated the procedure and it happened again, I didn't return because the pain was intense during procedure. Have you heard of this before, I do get dehydrated quite a lot

Fillers are not all created equally, especially in Europe and other parts of the world where there are almost 100 hyaluronic acid fillers (not to mention all the other ones) made by various... more


dear dr irwin i am asian, 45 years old. i am looking for something to counter the sagging that all asians get (as opposed to caucasian skin, which is more prone to wrinkles). What product do you suggest? my regimen includes vit c in the morning and retin a in evening. other than that, moisturizer and sunscreen are my staples. thanks, frances

I hear what you're saying and I'd like you to think about a balloon.   A balloon generally  losess it's shape and sags because it loses air/volume.   For an aging face, the same is true - ... more


Can you do the Vampire Facelift if you did sculptra four months ago

In general, you will get more results and more consistent results after a series of 2-4 Sculptra treatments than with Selphyl (aka Vamppire lift), so I'm not sure why you would want to?  A... more


I have had several Juvederm and Botox injections. I do fine and it does not hurt, but when he is almost finished. I get very week almost pass out. I am having some more done Friday. Is there anyway I can prevent this? It does not hurt and I trust my doctor. They laugh at me and fan me and give me something to drink then I am ok. Why does this happen?

Oddly enough, it's almost always young, healthy people with good hearts who have this problem with injections or blood draws. It's called a vasovagal response and is fairly common.  It's... more


i had Boletero on my cheeks which left me with big bag under my eyes the left one is even more obvious and on the side of my cheeks which looks horrible , i was told hyaluronic to remove the filler could make it worse and am too scared to try. The doctor has suggested i have 6 session of Tri_active Radio Frequency, is there any risk ?and can this melt my own fat on my cheeks ? I am desperate to have those bag remove but am also scare this has been 3 months now . What is your suggestion ? what should I do ? Thank you very much for your help Kind regards C

I'm sad this happened to you. If you had Belotero, a hyaluronic acid filler, injected which created too much volume (bags), then really consider the hyaluronidase to uncrosslink and smooth... more


Dr Irwin: I just turned 40. I recently lost some weight, and noticed the loss of volume/fat on my face, around cheek by the nose area...lots of ppl told me that I looked that I lost too much weight, I looked tired, etc...The skin center I visited suggested Juvederm and Sculptra...I prefer Sculptra based on the research that I did... but I also saw lots of complaints about this product. This is the first time that I get dermal filler, should I be conservative and go with Juvederm? I live at Columbus Ohio area, is there any good dr. that you recommend? Thanks a lot!! Jasmine

All good questions.  So two things that come to mind:

  1. Always start with the things that are more conservative and reversible (in this case Juvederm).   You want to see if you like the
  2. ... more

Hi, I write to you from London UK. I am in my 30's but due to the nature of my work need to look at youthful possible due to hd cameras and just the industry itself...i have found after losing weight that my face looks flatter, dark circles are more apparent and lack of volume in cheeks. I want something that can also be used in my chin if left over or lips. London is very pricey, who would you recommend in Europe...? Your advice is so appreciated, thanking you, S x

Thank you for writing and you bring up some things I've been wanting to say.   First of all, one of our goals here at SkinTour this year is to expand the resource guide for good doctors... more


Below are the eight I think are worth paying attention to.
... more

Bad bruising and redness in cheeks from Juvederm, seeking advice! Hi Dr., I am wondering if this is normal. I went to a great dr who previously injected some acne scars. It really was effective, However, 2 days ago he injected me again and it caused a lot of cosmetic side-effects (all of which the nurses i spoke to assured are normal, but i can not shake this feeling they are not). I have a very dark pin-point bruise on left cheek where the dr practically killed me it hurt so bad! there is spreading red area around this point. On the other side, there is a lot of redness and swelling, particularly by the side of my nose that looks awful. It makes me never want filler again. Should I go back in and see the dr next wk or wait a full 7 days? thanks. Love your site!

In my opinion and experience, mild to moderate brusing is normal BUT if that bruising is unusual for you, much worse than normal and/or painful, your doctor should see you right away or at... more


Hello, I am european girl and i would like to have same filler in my cheeks not to much. I woul like to look natural. I have one question please.how the doctor can make my eyes to look little enlongate, like asiatic people because i went to the doctor and she did the botox for my forehead and for what i ask she filled in the tail of the eyebrow but the same looking my eyes, thank you
In terms of the actual structural shape of the eye ........ i.e. whether more almond or round, the answer is no.  That is determined by the bone, muscles and the ligaments around the eye.  ... more

Dear Dr. Irwin, I am a doctor myself and had my first botox and dermal filler treatment exactly 2 weeks ago. I am in my early 40s and getting married at the end of December this year. No problems with the 1 area of botox (less is more approach), however it's a different story on the dermal filler and I would very much welcome your input please. I attended a doctor whose practice is limited to cosmetic non-surgical treatments, for the last 6/7 years and is well known, so I did not cut corners price-wise. They advised "Juvederm Four" for my 4 smile lines (2 on either side), thou I was quite adamant I wanted the lighter Juvederm product. Anyway, I went with their advice, 0.8mls and now have a problem! Post treatment, you could clearly see the 4 treatment areas - like 4 semi-circles. On the right side of my mouth, these have now settled quite a bit, however my left side hasn't and you can clearly see 2 semi-circles, about a cm, or so, apart. The outer one looks really bad, quite evident, and both are a bit more obvious/lumpy/raised at the bottom. You can really see the outer one, even more so in dim lighting. It looks a bit like a semi-circle bruise but when you stretch the skin it disappears. I am quite upset about it and returned to the doctor earlier this week (12 days post treatment), who told me that 0.8mls can't make "that much of a difference", and that my face was thin to start with and it was a good result. I can assure you it's not! I did read your dermal filler 'mistakes and how to fix the' prior to my follow-up (there was no post treatment advice or normally no follow-up, thou I did not know that at the time). I asked about the hyluronadase and my doctor told me they had only ever had to use it once (for lips that didn't even need it), and that I didn't need it either and it would dissolve my own HA and make things worse for me. I have not seen my family in 2 weeks and can't face seeing people (no pun intended!). Can massaging do anything? Should I just 'cut-my-losses' and go elsewhere to have this rectified? The wedding is so soon and this is distressing me. I cannot even go to the store in case I meet anyone I know. Thank you so much for your time, Alison.

Allison -

I'm so sad that this happened to you and it would be extremely distrssing to have this happen so close to your wedding.  So the first answer is yes....... cut your losses given... more


Hi! I have light asian skin type. After 18 years of acne, Accutane cured my acne. I am left with some minor-moderate scars in the temple, check and chin areas. I had four erbium lasers done with minimal results. The aestitician there told me to not waste my money on fraxel lasers as they are not as effective compared to erbium. Is this true? Also, a cosmetic surgeon mentioned to me that he could inject Silikon 1000 into the individual scars to level it out with the rest of my skin and create a more even texture. Please help! Thanks.

Yikes ....... I really can't recommend anything with silicone (link to reasons) and scroll down to the section "Other Dermal Fillers".  It's permanent and some patients react to it 10 years... more


Dear Dr. irwin, I recently had Belotero put on the top of my cheeks on top of the orbital bone but not above it, now I have puffiness and eye bags where I did not have them before is it because it attacts so much water to this area that it should not be used arounf the eye area for some people? and can I have undereye thermage to tighten this area ?

Belotero is new to the United States but not Europe, and is made by the German company, Merck.  It is a hyaluronic acid product and, in that sense, is most similar to Restylane or Juvederm... more


I had Juvederm filler 3 days ago, i have slight bruises on the marionette lines and in the cheek. will these go?..Also,i see that below the lower lip is over filled which i dont like. Can this be dissolved and how long should i wait. My dr.'s appointment is after 7 days from date of filler..is it too long.? should i fix an appointment sooner? I dont want to wait till its useless, esp. that there is also a bump on the corner below the lower lip. Thank you.

Two answers to this.  

1.  Most dermatologists would say that a small to medium amount of bruising, swelling and slight uneveness in the beginning is normal.   Waiting a week for those to... more


Have been hearing about the micro cannula for use in facial injections. There is supposed to be less bruising and swelling and has the ability of covering more area with less injections. Wanted to know what you thought. Also heard about the thermage CPT. Do you recommend this? Do yu see good results.

These are all the "rage" now in dermatology and I think they will end up in the long run, having some important but limited uses.    Bruising can still occur and so can swelling.  Also,... more


I had injections of restalyne in my chin and now have white bumps inside my mouth should I worry it has been about four weeks.
Okay - so I'm getting the sense that you haven't asked your doctor who did the injections about this?   Please call and explain the problem to her/his nurse and have them look at you in... more

Dr. Irwin- You said your office treats a lot of patients including those on immunosuppressant’s for organ transplant, arthritis, and psoriases. Are the bovine fillers such as Artefill safe for patients’ in this category? I take cyclosporine for psoriases? What about C02 laser resurfacing?

As I know you've probably discovered, there is very little to no scientific data on this.  Patients who were on immunosuppressants were usually excluded from the studies that were done on... more


Dr, I am 34 and I had Restylane vital fillers a few times before for my Nasal folds and they turned out great. But the last time I visited my Dr I asked him to inject me in my neck because I have a lot of deep lines. This turned out not to be a good idea! It's been 4 week and you can still see every drop that's been injected. I tried massaging them out with arnica oil, I tried sitting in my electrical sauna hoping the heat would soften it and then massaging and I also tried tripolar (hi frequency and heat rollers) The tripolar made a small difference. Now my question...will Hyaluronidase remove every little lump 100%? I can't wear any clothing where my neck is visible because everyone notices. And also WILL the product dissolve for sure and when? Kind regards Nadine

Hmmmm -  your question makes me wonder how much experience your doctor has with these products because, in general, most experienced injectors do not try to use hyaluronic acid fillers... more


Hi I'm 30 and my facial shape is round. I'm thinking about getting filler injected in my chin to give my face a better proportion. A doctor has suggested Sculptra. Does that work to lengthen or make the chin more pronounced? Is it the right product for what I'm trying to achieve?
In general, I almost never start with Sculptra since it IS more permanent.  Why not start with something more temporary and make sure you like the effect first?  A syringe of Restylane or... more

Do you have a make-up that you could recommend to cover up any bruising from juvaderm injections? Thank you, Angiet

If someone has a great answer to this, I would love to hear it!  We have tried many things in the office over the years.  What works best for us is to put a very thin layer of concealer on,... more


I had radiesse injected in the cheek area almost 5 months ago. The injector I went to used a threading technique and went thru the temple area. I expressed fear and concern about this method but was told there was nothing to worry about. Well ever since that night I have severe pain in the temples and across my forehead. I have been to countless Dr's and tests to try to alleviate the pain but am still on pain pills, ativan etc. All of which do not really help that much. I believe she also put some product in my temples which I did not ask for and I found this out after. I know it's hard for you to know the answer to this nightmare, but maybe you have some ideas as to what could have happened. Could the product be pressing on nerves in the temple to give me constant headaches?

Dear Reader -  I'm so sad that this happened to you.  It sounds miserable!  As you know from reading this site, I am not a fan of Radiesse except for very limited uses.   And this is why -... more


Hi Dr. Irwin, I'd like to know which one is better for skin tightening. Thermage or Sculptra? Thanks

I'm glad you asked this because the best way to explain this is to picture a ball full of air.   First imagine that the air goes out of the ball.  The outer surface of the ball shrinks and... more


I am a kidney/pancreas transplant patient. I was hoping to use filler in my lips and around my eyes. What is your opinion on this?

Our office has worked with many transplant patients over the years.  In general, stick with the fillers that have the best and longest safety records -  Restylane and... more


Dr Irwin I lost two of my upper back teeth on the left side of my mouth five years ago and have since lost a lot of weight. This has caused a hollow in the left side of my face. Could you advise me as to what filler would be best to fill out this hollow and would I need many injections of the product? Thank you 36year old female

I'm glad you asked this because this problem is more common than you might think.  I just saw another patient last week with the same issue only it was her lower jaw.  You're absolutely... more


HI Dr I. Love your site! Was wondering, since people mention such vast differences of how long Juvederm lasts, i was wondering if they all come from the same supplier, for example LA or Asia etc.. Is it possible this could have an effect on how long it lasts too? I just don't understand why so many people are saying it lasted well over a year or even two years.. Gets confusing reading all the reviews. Many thanks.

I think I can help with this confusion with three points:

  1. Remember that Juvederm is a trade name for a hyaluronic acid cross-linked gel.  In the US, Juvederm, Restylane and Belotero are
... more

My dermatologist recommends injecting fat over other dermal fillers. She says it is more natural, lasts longer and most cost effective since she does in-office liposuction to harvest it. I haven't found any mention of it on your site. What is your opinion of fat injections as compared to the other dermal fillers?

The reason I don't recommend it more is because there are so many problems with it in the U.S. and in many other countries.  For example, since these are living cells, sometimes they don't... more


HI Dr Irwin. I am so confused about the length of time Juvederm Ultra xc lasts. I have read your reports and see you mention it lasts around 6 months, yet some Users and even Doctors say it can last up to two years or even longer. There are such different answers that it becomes very confusing. It is mentioned that areas with more movement don't last so long. But say you have injection in tear trough and then you have facial massage everyday then this would be the same thing. So what is the shortest possible time it could last and the longest? And will it not last so long if you have only one syringe instead of say 4 for example? And lastly does is break down slowly, or Suddenyl towards end of duration. Thanks so much for your time.

I'm glad you asked  because there is a lot of confusing information about this.  Generally the Juvederm Ultra (1 syringe) lasts about 4-6 months and the Ultra Plus (a little thicker)... more


Hi Dr. Irwin, I've recently seen Dr. Joel Cohen in Colorado, hoping he would okay the use of Sculptra for me (I would prefer to only need touch-ups once a year), but he won't use Sculptra on me and wants to use Juvederm/Perlane instead. I'm in my mid-forties, with faint lines around the mouth (naso-labial) and beginnings of folds in that area, as well as some fat loss just under the eyes/front cheek area and under the mouth on either side of my chin. He said during my visit that my issues are very mild and don't need much correction. His reason for not wanting to use Sculptra is that it's for volume loss and not for the depressions in the areas that I want to fill out. Based on what I've told you, do you agree with him?
I would trust Dr. Cohen's opinion.   Sculptra is not a "line filler," it is a volumizer.  Some 40 year olds need volume but many don't.    If changes are mild, 1-2 syringes of ... more

Hi Dr. Irwin. I had Juvederm injected over my right eyebrow two weeks ago. The Injector (visiting from Florida)was not a Board Certified Doctor. I had bruising and swelling. I now have about a two inch oblong bump on my brow bone. Can I use Hyaluronidase to disolve it? Or should I try to massage it out? What should I do? I don't want to make it worse.

Okay -  I'm trying to bite my tongue on this and I know you know why!!  Please, please don't let anyone who's untrained and not Board Certified or closely supervised by someone who is Board... more


dr Irwin it's been over 2 years I had sculptra injected by dr ____ ___________. I have the lumps from sculptra on the surface under my eyes. My gp said they have to be cut out by a plastic surgen. Why are doctors injecting sculptra under eyes? I'm disfigured and will end up with scars from this product? Can sculptra cause cancer? The company I contacted don't care... My name is margaritta from Brisbane Australia.

I am so sad that you had this experience.  As you know the company who makes this product (now Valeant)  is not recommending using this product around the eyes.  This is because a small... more


I had Restylane injected into my nasolabial folds about 3 years ago and still have a purplish hue skin color that is hard to cover with makeup. If I look at my skin under magnification I have some broken blood vessels. How can I get rid of this discoloration? Also I would like to have some filer in my marionet lines but do not know what filer to use. Can you make a suggestion? Joy

In our experience, there are usually three main causes for these.  One, some people are prone to these around the nose and nasolabial folds, probably genetically (look at your parents - do... more


Have you heard of using cannula needle for fillers?

Yes  -  there was a lot of discussion about using cannulas instead of needles for fillers at both the IMCAS meeting in Paris and the AAD meeting in San Diego this year.

To make a long... more


What do you think about using Radiesse for the jowls and around the mouth?

In the hands of an experienced doctor or injector, around the jawline and the jowlsRadiesse can give a nice support that looks very natural.   It can also be quite effective around the... more


Hello i just stumbled across this blog and thought you might be able to help me. I am 37 years old and have been getting fillers Juvenerm and Restalyin injected for the last couple of years, I now have puffy bags under my eyes from being over filled and a blue tint to the point where people ask me if i was punched. I was thinking of either going to another Dr. or possibly going with Artefill as one Dr. suggested, is there any advise you can give me about the current desolvable fillers or Artefill?

In general, if you have puffy bags and a blue tint under your eyes after hyaluronic acid fillers like Juvederm or Restylane, you have too much filler under there!!!  Please find a board... more


Dear Dr. Irwin, If one has RSD (Reflex Sympathetic Dystrophy)and/or fibromyalgia, are there any additional risks to having IPL? What about Botox or the filler injectables? Thank you for your time. Carrie
All three of these treatments are generally so safe that they are compatible with most medical problems.  It is important though to check with your doctor - in your case probably your... more

Hi Dr. Irwin, I have cleft lip and I was wondering if I could get lip filler done to balance out the asymmetrical lip ??? As I am very upset with the symmetry of my upper lip. Thank you
Generally, a cleft lip must be corrected with surgery.  Fillers can sometimes make the cleft look worse. Hopefully, you can find a good surgeon near you and, there are international... more

Dr. Irwin, My dermatologist recommended 1 treatment with 2 injections of Scupltra. I have been reading that normally there are 3 treatments so I am wondering if 1 treatment would be sufficient.
You didn't tell me your age!  So it really depends a lot on that and also where your body weight range is.   Low body weight women tend to need more.  And, the older we get, the more is... more

Dear Dr. I am russian with a naturally round face, rather flat, and prounounced cheeks. I had Sculptra injections in July this year in the cheek hollows and above the cheekbones, I was badly overfilled the day of injection that I hardly recognized myself. I hate the new volume in my face, it does not suit my face at all. I look so different, it has completely changed the natural anatomy of my face (now the widest point is above the cheeks up to the temple, which makes my face more angled, before or naturally the widest point was just below my cheekbones, having no angles and a round face). My former sweet and young looking face looks harsh and older. The high and overly pronounced cheekbones make me look almost agressive, and my eyes look smaller and more sunken, while the lower cheek next to the mouth look like a chipmunk. A lot of projection and volume next to the mouth and nose. My face feels almost stiff when smiling due to the huge volume and thikness increase. I am crying a lot, before i was a very good looking woman now I became invisible. I am really depressed and stoped going in public. How long I have to live with this? Will my face ever get back to what it was? Is there anything I can do to speed up the process? Mny thankd for your answer

First of all, I am so, so sad that this happened at all.  Sculptra can be lovely when it's done gradually over a period of months and the doctor doing it has a good "aesthetic eye." ... more


Hello Dr. Irwin I LOVE your site! With that said, I've taken the time to go through quite a bit of your blog to get my question answered and still cant quite pin down what I'm looking for. So here is a bit about me and my question will follow. I just turned 40. The left side of my face is significantly more lax in skin texture (very visible) than my right. The other problem is I have significantly more pronounced crows feet/lines under the left side of my eye opposed to the right as well. I'm hoping to get the left side to match the age on my right...at least the best I can. I HAVE started botox for all my problem areas. Great stuff. I've read great things about your thermage treatments and the tightening effects on the skin. I've also read great things on your DOT laser experience and results as well. My question is which one would you suggest to get the skin tightening results I so desperately want and also treat the pronounced crows feet? Thank you!

Thank you!   It would be interesting to have you look back at photos when you were 16-25.  Can you see the asymmetry even back then or younger?  Some people have an inborn (genetic)... more


I got Juverderm under lower lip and chin couple days ago. I Have two large purple color bruises each side. How is that treated? How long it will take to go away? or is that treatable at all? Thanks for responding.

Any time a needle is used in skin there is a potential for a bruise!  The best option is to try and prevent them in the future.  Try these tactics.  No aspirin (unless required by a... more


Can you use fillers in your gums to hide grey teeth inplants?

The answer to the above is no.  And, in my opinion, injecting fillers into the face through the mouth raises safety issues.  Think about it!  The mouth is one of the most bacteria laden... more


Can you comment on fillers for men, especially around the cheekbone area? How does a man avoid getting a feminine look from fillers?

Good question - I'm guessing a lot of men are concerned about this.   Basically, if you study the face shape and contours of good looking men there is quite a variety, isn't there.  But... more


Hi - about 7 months ago I was a model for a visiting Italian doctor, who is highly respected in this field. I was injected with Juvederm for my marionette lines, but immediately noticed swelling on either side of my mouth (the lines were not filled either!) which I massaged over a week, but to no avail. They are still there, and make me look jowly (they throw shadows onto my skin). I was offered the enzyme to remove it, but was also warned that it can make the face saggy and it will require more filler to make good, which could result in a mess. So I am sitting it out, waiting for it to dissolve. My worry is that it is scar tissue, and will never disappear. What do you advise? Thanks so much!
My apologies that this took so long to answer!   In general, if there's too much Juvederm, there is too much!   Have it dissolved.   Your face will go back to where it was and that won't... more

Dr. Irwin, thank you for answering my question regarding the use of Botox and Juvederm to correct the wrinkles above my upper and lower lips and around my mouth. I had the procedure done. The doctor used 1 unit of Botox in 5 points around the top and bottom lip and then filled in the wrinkles with Juvederm. It worked wonderfully and it's 12 hours later and there are no issues with pursuing my lips! I do have, however, a small lump in my upper lip directly in the center. Will this go away?
I'm so glad you had a good result and kudos to you for taking the time to find a good doctor!  Sometimes that is the hardest part.   If you have a small bump in the middle, it could either... more

Hello Dr. Irwin, With Juvederm, do I have to wait till the products is all gone to have it done again (around my nose and mouth) or can i get it done (maintain it) when I start to see some deflation? Don't like the look when it wears off complete and have to wait I guess.. I get use to my better face until the old one comes back lol..Ty :)

No, in fact I think it's better to schedule your next treatment prior to it's complete resolution.  If you do that, you'll gradually build more of a base and your results will keep... more


How much does a syringe of Radiesse cost? I was quoted $1000. How much does that cover? I want my lip folds and around the mouth to be treated. I think the price is outrageous.
That seems high to me unless you live in the poshest area of a large city like New York, London, etc.  See my article on the Average Costs of Cosmetic Procedures to get a better idea of... more

Dear Dr, Irwin I had my 1st series of Sculptra placed in my temple region and cheeks on August 11th 2011. ( one week ago) I am a 46 yr old female & have been a runner for years which left my face somewhat hollow. My question is this. I am reading many negative things about Sculptra. I guess I should have done my research prior to the injections. Nonetheless, I am thinking about discontinuing the next two series of Sculptra injections & was wondering if I could get Juvaderm Plus injected into my temples instead? If so, how long should I wait before having the Juvaderm injected into that area?

I'm hoping that you don't believe even a quarter of what you read on the web!  It's really not always very accurate.   You may be very happy with the Sculptra since, when it's done well,... more


Dear Dr. Irwin, I had Sculptra injected to my cheeks 2.5 month ago, and I developed a visible lump. I have two other lumps under the skin (not visible), and now I'm getting worried. I was told before treatment, that the lumps would disappear after a while, but after reading Sculptra horror stories I got very worried. My doctor is supposed to be very experienced, she has done a lot of Sculptra treatments in denmark, but she didn't treat my lumps, she just told me they would disappear with time. Can I trust that, and how many more lumps can I expect to get within the next year. I hope I will get an answer! Sincerely, Worried woman from Denmark

As most of you know I think Sculptra (when done well) is a wonderful product.  The results are noticeable, but not puffy and sometimes you can get an almost facelift like effect with... more


Dear Doctor Irwin, I recently got the vertical lines in my upper lip filled and apart from thje fact that I was bruised for a week, I noticed that my lips for some reason now look smaller. I always used to pride myself in the fact that I had full lips and now they just seem "different"....is that normal?
Again, this is tough to say without seeing you but here are some thoughts.  In general, as we age, the upper lip gets longer and loses it slight concave (like a gentle ski jump) shape. ... more

Can any or some of these steps to reduce/minimize deep marionette lines be done if you are taking blood pressure medication..?? Thank you,

Be sure to let your dermtologist know, but no - there is generally no problem at all with blood pressure medication and fillers.   Dr.... more


Hello Dr I, Would you explain why you don't like Radiesse? and the difference between two. i tryed juvaderm loved it but lasted on only 2 months and i don't have deep lines..what is your thoughts Ty

As I've mentioned before, there are many good doctors who use Radiesse and love it.  In my opinion, there is just as much variability in response to Radiesse as there is with Juvederm Ultra... more


This question from a reader in Chattanooga - so sorry - I accidentally deleted your exact wording on this one! :)

Dear Readers -  I will do an article on this procedure soon - it will be posted in resources.   I'm trying to finish one on sensitive skin first!  In the meantime, unless money is no... more


Hi, Your website is a great read and full of infromation. I am a 38 year old male and have developed deep lines running parallel to my nose of both sides of my face. I am trying to sleep on my back to stop these but wanted to know what type of product I should use for sensitive skin to tighten up my skin again around my nose area? In Ireland and the infromation is not great for men!! Thanks J

Thank you! The kind of lines that you describe are often from sleeping with our faces scrunched on the pillow a certain way each night.  Changing position frequently and trying to sleep on... more


Dear Dr. Irwin, I've found your website very informative. I appreciate all your posts and articles, they have been quite helpful. I have one question I would like to ask though. I am a man and I have been considering fillers and a good maintenance program so that I can stay looking as young and fresh as possible for as long as possible. So my main concern is going to a qualified doctor that knows the appropriate way to administer fillers to a masculine face and keep it looking masculine and not "enhanced" or "feminine". I say this because I see men that look like they have been overdone and that isn't the look I'm going for. I'm guessing you are informed about the medical community and who does good work with men in keeping them young and fresh so I had to ask who you might recommend me to go see to have these procedures, or Botox and dermal fillers. The goal for me is to retain my natural features and prevent further wrinkles and restore the fullness to my face lost from years of exercise and of course sagging from age. Any suggestion on a doctor in the Orange County or Los Angeles area that is qualified and known for working well with men and keeping their facial features masculine would be greatly appreciated. Doctor, thank you again for your informative and educational articles and I look forward to hearing your input. In Health, M

You raise a good point.  There are some facial characteristics that are culturally labelled masculine or feminine traditionally.   So if the doctor doing your work isn't sensitive to that,... more


Dr. Irwin, I had juvederm injected into my lips. This was to help smooth the lines around my mouth and slightly enhance the volume of my lips. After the injections my lips had swelled a great deal. I truely looked like a duck. On the sixth day after the injections I woke up to very pretty slightly larger lips and was pleased. Here is my delima. After the injections I expected the swelling and the hardness around my lip line. However, I did not expect the continued burning and itching of my lips. One day later after I seen my beautiful lips my world fell apart. Today, During the day, my lips began to swell once again with burning and itching. I am worried that I am either having an allergic reaction or my lips will never stop swelling. I called the person who did the injections and she thinks I am having an allergic reaction to the facial produts that I am using. Three days ago when I called to tell her what was going on she told me to stop all of the facial products I was using and to use Benadryl for itching and Ibuprophine for the swelling. I have done all of that and today my lips are swollen once again. I called the Person and explained what was going on and quite frankly she is stumped and has no clue how to correct this. Can you help me please? I can't stand this incessant burning, itching and swelling. I work outside in extreme heat four close to ten hours a day, always were a hat. I dont know if that has something to do with it. The person who injected me knew of this fact but she and I are completely confused as to what is going on.

You sound miserable!  And, very understandably, discouraged.  While true allergic reactions to Juvederm or other hyaluronic acid fillers are rare, they can occur.   First, PLEASE MAKE... more


Hi Dr. I, I know you are not a fan of Radiesse but I was hoping you can give me your opinion on it. My mom had a syringe injected into her nasolabial folds. One side of her nose became very swollen, it formed a large cluster of white/yellowish bumps and the skin under/around the bumps turned greenish, grayish and was very painful. It was a horrible experience for us all. She looked awful and I feel the guilt because I recommended the place to her!!!! We contacted the doctor and he put her on 2 antibiotics, anti-inflammatories and valtrex. He explained that the product caused the veins in the area to constrict and therefore became inflamed. The explanation was along the line that her veins were sensitive and had a negative reaction to the product. It doesn't really make sense to me. I was hoping you could explain it better. I know that without seeing it its hard but does the explanation make any type of sense to you? It has been 15 days and after the cocktail of pills she had to take it dried up, formed a scab and fell off a few days ago. The area is still red and the pores on her nostril are very open and still tender to the touch. I have pictures if they would help. Words can't describe how terrible it looked, she couldn't leave the house for a week and a half. I wonder what your opinion is on the explanation the doctor gave us. I know it is hard to say without seeing it but have you heard of this type of thing happening with Radiesse? Thank you again for your time.

I'm am so sad this happened to your mom.   These problems are the reason I don't use Radiesse.

First the good news,  the fact that it's healing, the scab has fallen off and her nose is red... more


Hi Dr. I, Had juverderm done only 2 weeks ago, love it. The Dr. did a good job, but it seems to be fading already. Is Juverderm a mantence program if it doesn't last 1 year and can I go back again for touch ups? ty
Depending on your facial structure and your age, it's possible that you really just needed an extra syringe to get a good base in the first place.  Juvederm Ultra Plus tends to last longer... more

How long do fillers like Restylane/Juvederm last especially in the marionette lines?

I think there's a lot of confusion about this.  The very general answer is 4-9 months.  Also, fillers will often begin to last longer as time goes on if you get treated 2-3 times a year in... more


I live in chicago and am trying to find and "artist" who is good with all fillers, botox etc. I am a redhead and I have had a fat transfer where placement is not ideal. It is important to have someone who can help with volume and poor skin tone(large pores, fine lines etc.). I am 48 and my skin looks much older than it should. I have had some great things done and some bad things done and would like to just find one person to work with in all areas. Thank you

This is such a tough one and I know women all over the country/world are struggling with this right now. I think demand for high quality services in this "new beauty" area has outstripped... more


I was wanted to know if I can use a laser on my face due to the fact that I have a silcon chin implant and a small drop of silcon on the bridge of my nose.
Generally the silicone, both the implants and the injectible forms, are placed quite deeply.  Below the dermis or in the deep dermis.  Depending on the laser, the level of would be higher... more

What do you think of arteform? Particularly for slight hollows in the undereye area?
I'm thinking you might mean Artefill even though you wrote Arteform??  If I'm mistaken, please write again.   Artefill is a terrible idea in general and especially under the eyes.  It is a... more

I had Juvaderm in my Glabellar Furrows and it looks as if nothing was put in especially on the right side. I also look like my right eye is swollen and I can feel some of the Juvaderm close to the corner of my eye which I assume is causing my eye to look swollen. I paid a $1000 dollars for 2 syringes and the fine lines around my lips do look better, I certaily don't feel I got a $1000 worth of improvement especially the way my Glabellar Furrows still look. I was told by the nurse at the plastic surgeons office that it would take care of this. The nurse is the one who did the procedure. Please help? Thanks

You bring up two good issues.  Was a good job done?  And, was the value for the money there?  Let's face it........this stuff is expensive and the responsiblity is with the doctor to make... more


Dr. Irwin, I had Juvederm in my marionette lines three days ago. The right side looks great, the left is still a bit lumpy. Should I worry, is this normal? Or, do I need to go in and see the doctor?
Generally, I ask my patients to wait 7-10 days before calling our office.  This is because there is a some natural evolution of the product for about a week.  3 reasons - it absorbs... more

Hi Dr. Irwin, Can the tip of the nose be lifted without surgery?
Yes, a little with certain fillers.  This requires some skill.  Some of the better cosmetic dermatologists are good at it.  I think though that a facial plastics ENT (ear, nose & throat)... more

Would scuptra be a good choice to fill volume loss in my chin? I am 50 years old and the loss of volume in my chin brings out marionette lines. I have filled it with fat, restlene, and radiasse.Nothing has lasted more than 6 months. I have been told it is because it is such an active area. WIll scupltra last in this area. I was told it will last up to 2 years , But I was told radiasse would last 1 year too.

You bring up several good issues.  On the longevity issue, you are not alone in that fat transfer (while we all love the idea) is just not very predictable still.  As for Radiesse, I agree... more


if you are over 65(Like 66) can one still use a filler for around the mouth?

Yes!  FDA approved fillers can be used safely indefinately as long as you don't have an individual adverse reaction to them (these are rare).   I'm not sure I've ever had a request by... more


I have just read and enjoyed your book! There was a very small paragraph on putting filler into the channel under the eye to smooth it out which mentions this can be dangerous and may cause blindness - can you tell me any more about this? Many Thanks

I really have to say yes and no.  The eye area is not FDA approved for any filler to my knowledge although it's often done as an "off-label" use.   This is a tricky area and my concern is... more


Hi there, I am considering having sculptra to help with volume lost in my cheeks. After having the sculptra and due to economic issues could one (after 1 year) get Perlane or Radiesse injected into that same cheek area (where the sculptra was injected) for continued cheek volume? Thank you for your thoughts. LC

Good question.  There are no studies that I have seen on this.  But from talking to some of my collegues and my experience, here's what I'd recommend.

There doesn't seem to be any problem at... more


Hello Dr Irwin i am 52 years old and thinking of starting to use fillers like juvederm for my cheeks ,i was wondering how much is the cost for it? Thank you, Marie.
Marie -  This varies quite a bit by area and country.  In the United States, the range is usually $450-800 per syringe.  Areas like New York and Los Angeles tend to be at the higher end. ... more

how long is restylane supposed to last?
I think today is filler question day!  If you are using what I call the "mid weight" version - not the Perlane, it generally lasts 4-6 months.  Over time, if you are regular with... more

Dr. Irwin, I have used cosmoplast before, but, it is not available anymore. What do you think of Preville? Jevederm? Are they comparable? thank you

The nice quality that Cosmoplast had was how well it filled smaller, more subtle lines without causing any bumps or ridges.   The only comparable product in the United States right now is... more


DR Irwin, i got your message and will ask my question again. I am 50 years old but have skin that looks more like 40. I do have volume loss in my chin and this shows the marionette lines. I have been using radiasse for this area because I had a bad reaction to restylene. Would sculptra be a better choice for this area? I have had good results with radiasse but do not yet know how long it will last as I had it put in in September and added to it in December.

Everyone's face is so different that it's almost impossible to answer without seeing you but some general principles still apply.  Look at your cheek area.  Is volume loss in your cheeks... more


HI Dr. I, I was wondering what you recommend for overall volume for my face? I lost about 20 pounds 3 years ago, along with turning 40. I have high cheek bones but my eyes and mouth area make me look gaunt and older. I have used fillers for the smile lines and that does help but I need an overall plumping. From your sight I know a laser would be the next thing to do, but which one would give the most volume? I have a month off coming up incase downtime is required but I am interested to get your opinion since I follow your sight closely ;) Thanks for your help.
I think this is a common misconception - that a laser can create volume  - so thanks for asking this!  Lasers are best used on the face for color problems (too red, brown spots), or ... more

I want to get a dermal filler in my marionette lines. I was considering Radiesse for this area. Do you agree? If not what would you recommend for this area. I had Restylene last year and it caused horrible swelling. I am afraid to use that product again.

In your situation, Radiesse is a reasonable option. Just make sure your doctor is experienced and a board certified dermatologist or plastic surgeon.  It's not a guarantee, but it helps.

A... more


Can having filler along labial nasal lines cause shadows and furrows elsewhere? I had two syringes of Juvederm, on either side of my mouth and now appear to have a hollow the other side of the filler and also the bags under my eyes look slightly worse. Should I have more filler to counteract the hollows or will this just transfer the furrow to somewhere else? I am a 47 year old with fair skin which tends to be dry. I also have Botox to counteract corrugation on my forehead and crows feet and Botox for bunny lines down the side of my nose.
Without seeing you, it's really hard to comment.  This can happen sometimes depending on your original facial contours.  It's fixable and preventable the next time.  Please go back to your... more

What is the best treatment for vertical lines over the lips?

I wish there was one "slam/dunk" treatment for vertical upper lip lines.  They can be 80-90% corrected but it takes a little time, money and patience.  There really is no one treatment... more


Dr. Irwin, as I've aged, the distance from my nose to lip has lengthened and my lips have also flattened. Is there a non-surgical way to shorten the appearance between nose and mouth, and to make my upper lip go up and out so they're not so flat looking?

The answer to this is yes ........but depending on the exact anatomy.  You didn't tell me how old you are.  If you're 80, it will be much harder than if you are 50.  The bony structure of... more


Why don't you use sculptra in the lips. I would like to have my lips made a bit fuller but really don't want to spend 400 every 6 months.
Sculptra becomes bumpy in or around the lips where the muscles around the lips are strong.  The same can be true around the eyes.  Lumpy lips is not a good look!  Dr.... more

What about the filler Selphyl. Is it the best filler? How long do the effects last and is there downtime?

I'm not recommending Selphyl at this time.  There are two issues with any new filler: safety and how well does it work? I think it's pretty clear that Selphyl is safe as long as blood... more


I do not like the look of the nasolabial lines after the Juvederm application because they are hard and changed my smile. How can I get rid of it?
Yes, you can!  Please call your doctor.  There is an enzyme (hyaluronidase) that can be injected into the Juvederm (or Restylane) to dissolve it pretty much instantly.   It works on all the... more

I have marionette lines around my mouth. It is due to volume loss in my chin. I had a bad experience with Restylane, (massive swelling after the procedure that scared me into a visit to the ER). Would Artefill be a more permanent option? I also had fat put into this area but it only lasted about 3 months. Could a laser tighten the skin in this area to get rid of it. It is not to bad I am 50.

I wish I could say your situation is unusual but I've heard many similar stories!  Let's start at the beginning and think through this.  I want you to go back to the mirror because most of... more


Should I consider doing Selphyl?

Posted in Fillers2010 on Aug 13, 2010 | Permalink

Dear Dr. Irwin, What do you think of the procedure where they use your own blood and derive part of it to use as a filler via injection? Selphyl is the name of the method. Thanks you, Sharon Newton Albany, Oregon

The marketing machine for this product is beginning to rev up!  I can tell because I've been getting a number of questions about it.   It's buyer beware. 

My opinion is that it's way... more


Dr. Irwin, I have been a regular visitor to your website since hearing you on Paula Beguon's radio show. I feel like I can't go wrong having the both of you in my corner. I'd really like to pursue getting dermal fillers. However, you have not included any Virginia cosmetic dermatologists on your 'trusted' listing. I did take a virtual tour of the Washington D.C. 'trusted' facility because I reside in Northern Virginia. What makes me hesitant about the D.C. facility is that they list so many things they specialize in. I've read almost every blog you've responded to and what stays with me the most is your insistence that it all goes back to the injector and his/her skill. I don't see how anyone can be skilled in so many procedures? Any suggestions? Linda

Thank you!!!  As you all know, I am revising the regional guide but it's SLOOOOW because I feel like I need to check possible additions with several different sources.  In Virginia, I'm... more


Does the use of botox or dermal fillers have any potential to slow down the deepening of existing wrinkles?
Yes!!!  If the wrinkle is being caused by an over active corrugator muscle (the "frown" muscle), then relaxing the muscle with Botox will not only make the lines improve but also prevents... more

Dr. Irwin , I am a fifty eight year old woman that has had aortic valve replacement and am on blood thinners. I want to have filler injections for the lines that go from my mouth to my chin. I am very self conscience of these lines and so much want to have this taken care of . My question is can this be possible since I need to be on the blood thinners?

I'm going to assume for this answer that you're on coumadin/warfarin.   It's very safe to use a filler like Juvederm or Restylane while you are on coumadin BUT you will very likely... more


Can fillers such as restylane be used on the nose to fill out imperfections? Thanks for any information. Bonnie

The answer to this is absolutely yes!  In fact, there are several dermatologists and plastic surgeons who have made this a special interest and published papers on these techniques. ... more


I am a 68 year old woman considering Juvederm XC. I have deep wrinkles around the chin area. Would it be feasible to have treatment?
Yes - Juvederm will work for deep wrinkles around your chin, but you would almost certainly need 2-3 syringes to lay down a good base.  Follow up treatments would probably require less.  ... more

I am 45 and have a deep marionette line on one side of my mouth that is about ½ inch in length. I had Sculptra injected and while it did soften the line it is still very noticable. Is there anything else I can have done that will help improve this?

I'm always fascinated by how asymmetric we all are.  It sounds like the line is just on the one side.  Usually the side of the face with more lines is the "sleep side" where we spend more... more


What is the best filler for hollow checks? I am 57 and have good skin, but I see some hollowing in the middle of my upper center of my cheeks. I have a full face, but not fat. I do Thermage and it works great for me so far. I tred Radiesse, but I agree with your opinion that it looks a little wooden when smiling. It has worn off some since I tried it last year.
If you have only mild to moderate hollows, then try the more robust forms of hyaluronic acid like Juvederm Ultra Plus or Perlane.   These should last 6-9 months the first time and slightly... more

Your site is a wealth of information, Doctor Irwin. I am 48, and have the typical sagging because the collagen in my cheeks bones is being lost. Therefore, I have double parenthesis down between my nose and mouth on the sides. I have had Juvederm, and the first time loved it, but the next time with the same doctor, had weird results. It is as if the filler just shifted where the sags were. So, I sought out a new doctor, and still was not happy with Juvederm. Now, it is time to do something about these sags I mention, and even another doctor recommends Juvederm. A consult with another spa mentioned anti-aging bio-therapeutic treatments. I am so overwhelmed, but want to fix my face. Your website is great. Do you have a suggestion. That is a lot to ask, as there is so much out there. Thank you.

Thank you!!   It really helps to know your age but I wish I knew your facial structure as well.  So let's talk a little about the causes of those deep lines from the nose to the mouth.  In... more


The advice I usually here is to see a "cosmetic or plastic surgeon" rather than a dermatologist for many of the procedures you recommend. Besides being more costly, why wouldn't I see what seems to be a more skilled physician when I'm thinking about altering my face. I know that they do do botox, and laser resurfacing, etc. I'm quite confused about the best physician. Thanks, Janis

I think this is very confusing for people.  Dermatologists are specialists who are experts in the care of skin, hair and nails.  We do 4 years of college, 4 years of medical school, 1-3... more


-------------------------------------------------------------- So confused as to which is best, Restylane or Juvederm?! I've read articles/reports that say Restylane lasts longer and others claim that Juvederm lasts longer. I'm mainly interested in what is best for the nasolabial folds. Additionally, when I began to research I see there are 2 different Juvederm treatments, Juv.Ultra and Juv. Plus. Is Restylane the same, are there different concentrations? Please help!

It IS confusing, isn't it?  And, there are "new" products all the time which make it seem even more so.   Here's my opinion after years of experience.  I tell my patients that comparing... more


Is there a product or exercise to get rid of the small little lines around my mouth? These make my lipstick look funny.

There are 5 issues to think about for this area.  But first, what causes these is the constant movement of the lips (so exercises don't work), sun damage and loss of collagen, fat and bone... more


Aspirin and fillers

Posted in Fillers on Sep 26, 2009 | Permalink

I am allergic to aspirin products. I have an anaphylactic reaction to them. I read that if you have an anaphylactic reaction to anything you cannot use fillers. Is that true? Thanks, Joanne
That is not true for the fillers that I use - Juvederm, Sculptra, Restylane and Cosmoplast.  Be sure to let any doctor you see know this though.  Dr.... more

Fixing a frowning mouth!

Posted in LipsFillers on Aug 18, 2009 | Permalink

What is the best treatment to correct the turning down of your mouth as you age? Does Botox help this any, or would just a filler be best? And how many units of Botox are generally injected in each site of injection? I am trying to calculate cost. Teresa

Botox should never be used in the lower face except by an expert injector because it can cause facial drooping (like a stroke only temporary) or problems with chewing and drooling. I will... more


Dr.Irwin- I had juvederm injected into the upper lip area to smooth lip lines that are hereditary. My first injections left the areas in approximately two weeks, and the second series left one area more plump that the right side leaving my face asymmetrical. I also had lots of injection problems with hematomas, purplish blistery knots, and swelling that lasts to this day. Continuing to this day (three months later) at this end of the day my lips swell leaving me very self conscious. Can you offer any advice on what the problems may have been, and what I can do to stop the swelling. I do not want to return to this physician (who is board certified in Dermatology). Please help if you can.

It helps me to know your age and how deep the lines are.  In general, I don't like Juvederm for upper lip lines, unless they are quite deep for these exact reasons. It tends to be too full... more


Is this a Juvederm Problem?

Posted in Fillers on Jul 04, 2009 | Permalink

In March 2008 my doctor injected juvederm under my eyes and just above my cheek. Within a few months I developed "pillows" just above the cheek that have a bluish cast. An aesthetician says it could be from the Juvederm; my doctor says no. I still have them over a year later. Do you have any idea what causes this and how I can get rid of them. Thank You Debbie

Wow - this one is tough without being able to see  you. If the Juvederm had been done more recently, I would say yes, it could be the Juvederm. Because, sometimes the hyaluronic acid... more


Swelling from Juvederm

Posted in Fillers on May 19, 2009 | Permalink

using numbing cream, i had juvederm filler injected into my lips, 30 minutes later my lips swelled really bad.my practiononer gave me antihistamine, piriton afterwards.this morning, the swelling in my lips has gone down,the both sides of my face are now swollen. i have continued taking antihistamine as required, will the swelling eventually subside???

It's hard to respond to this because I wasn't there, but generally, that would be an unusual reaction for Juvederm.  Since it involved more of your face than just the areas injected, one... more


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