October 6, 2011

Can Dr. Steinsapir dissolve the liquid silicone that was injected in my face in Mexico?

Silicone oil has only one FDA-approved indication for use―repairing complex retinal detachments.  Liquid silicone, also called silicone oil, finds its way into off-label use as a medical-grade facial filler.  However, silicone oil has a number of side effects and it is not advisable for this use.  Dr. Steinsapir does not recommend getting liquid silicone injections, no matter how much more inexpensive the treatment may be, nor does he perform the procedure.  Fixing previous silicone injections is a complicated, involved process, and it is impossible to remove all of the oil.   Dr. Steinsapir has treated many patients damaged by these treatments but each situation is unique and a personal assessment is essential to learn what methods might improve your situation.

The perils of liquid silicone

Receiving silicone oil injections in Mexico ( or in the United States at “pumping parties” or from unscrupulous injectors) is a dangerous decision for several reasons.  Non-medical injectors are known to use liquid silicone illegally on the black market.  Although medical professionals using liquid silicone in an off-label fashion use medical grade material, on the black market the silicone is often not medical grade but rather industrial silicone oil, which was never intended for the human body.  There have been deaths from these types of illegal treatments.

Technically, since physicians may use FDA-approved products for non-approved uses, you can legally receive silicone oil treatments as a facial filler; but that doesn’t make it a good idea.  Injecting silicone oil into the face and other parts of the body like the buttocks is not a case of careful and thoughtful use.  It violates the very oath that every doctor takes to do no harm.  Unfortunately a few non-physicians and even physicians continue to use silicone oils this way.

Deaths related to silicone oil injections have been reported. Even small facial treatments into the lip and nasolabial fold over time can result permanent and irreparable facial disfigurement.

Don’t be fooled by the price

When it comes to financing cosmetic procedures, here is the bottom line: if you can’t afford safe, quality treatment from an actual physician (not an assistant, technician, traveling person with unspecified qualifications, the black market, or your own hand), then you are better off without any treatment.  Silicone oil injections have too many associated complications, including migration and permanent disfigurement

Instead of automatically assuming you cannot afford legitimate, trustworthy, FDA-approved fillers, consult a bona-fide, fellowship trained cosmetic surgeon to learn about the cost and payment options for a safe, dependable filler.  Silicone oil injections are cheap for a reason.  Anyone who tells you they are a good cosmetic option is misleading you and omitting the facts.

Fixing facial fillers

Unfortunately, silicone oil is a poor alternative to real hyaluronic acid fillers like Restylane® or Perlane® because it cannot easily be modified after the treatment.  The first step in addressing and removing unwanted silicone is to identify the exact source of the injected silicone.

  • Was it medical grade or industrial silicone oil?
  • What is the lot number and expiration date?
  • Where was it manufactured?
  • Did the injector take precautions and use sterile technique?

Removing silicone is difficult, which is why Dr. Steinsapir believes that it should not be used as a filler material.  Once you have identified the above information, the next step is to decide if surgery or some other approach is needed.  Silicone oil is permanent and can’t be dissolved so removing it may require invasive surgery.  The type and extent of your surgery will depend heavily on the location of the original injections, the type of silicone used, and the amount.  The benefit of removing the material must be weighed against the potential complications that might be caused by surgery.

It is important to choose an experienced and knowledgeable surgeon to perform your surgery.  Find someone you can trust and who will work with you to find a treatment plan that works for you and your individual situation.  Unfortunately, a decision to receive silicone oil in Mexico, or any other black market injector often results in a greater expense in order to have the foreseeable complications addressed.   In too many cases, there are no good options.  Dr. Steinsapir strongly encourages anyone considering a black market cosmetic treatment of any kind to take into account the fact that while the initial treatment may be less expensive than a proper visit to a cosmetic surgeon and paying full price for your procedure, the long-term costs of a decision like this far out-weigh the short-term savings.

About Dr. Steinsapir

Dr. Steinsapir is a much sought after oculofacial surgeon.  He is an innovator in minimally invasive cosmetic and reconstructive procedures and has invented new methods for treating with BOTOX, Fillers and cutting edge reconstructive eyelid and midface surgery.  He specializes in high precision eyelid surgery and is a leader in correcting prior facial and eyelid surgery, including multiple revised cosmetic eyelid reconstructions.  He attended medical school at the UCLA and completed ophthalmology residency at The University of Chicago.  He is multiple fellowship trained including three years of fellowship training in oculofacial plastic surgery at UCLA, and a two-year cosmetic surgery fellowship in Rancho Mirage.  He is widely published and lectures to other surgeons nationally and internationally.  He is an associate clinical professor of Ophthalmic Plastic and Reconstructive Surgery at the Jules Stein Eye Institute at UCLA.  His private practice is located in West Los Angeles, immediately serving the Los Angeles and Bevery Hills communities.  Additionally, individuals from all over the country and the world regularly come to Los Angeles for his expert care.

To learn more about Dr. Steinsapir’s specialized Restylane treatments, please contact us today.

Services described may be “off-label” and lack FDA approval. This article is informational and does not constitute an advertisement for off-label treatment. No services should be provided without a good faith examination by a licensed physician and an informed consent with a discussion of risks, benefits, alternatives, and the likelihood of treatment success. Only you and your treating physician or surgeon can determine if a treatment is right for you.

September 9, 2011

I had facial fillers and BOTOX and now I look older

If this happened to you, there is no doubt that you are dissatisfied with your treatment and that it makes you feel old – the exact opposite of the reason you chose to undergo the procedure!  There are many reasons your treatment may not have turned out the way you expected it to, but it is not the fault of the BOTOX or the filler, whether it’s Juvederm®, Perlane®, Restylane®, or any other hyluronic acid filler.  Complications from non-surgical treatments like fillers and BOTOX are almost always the result of your surgeon’s talent.  Choosing a skilled surgeon to perform your injections is important, but once the damage is done, choosing a skilled surgeon to fix the problem is imperative.

The Truth About Treatments

As the effects of your BOTOX treatment begin to wear off after several months―Restylane wears off more slowly―your face will slowly regain the looks it had immediately before your treatment.  Restylane and BOTOX treatments will not make you look worse than your original pre-treatment appearance as they wear off, nor are they supposed to make you look worse when treatment is new.  Provided you did not let someone put silicone oil

in your face and treatment is provided by an experienced injector fillers and botulinum toxin A have few side effects.  But if you aren’t happy with your results, you do have options and it is not necessary to wait more than a year for the filler to wear off.

Options for Fixing BOTOX Treatments

Treatments like BOTOX and Restylane are popular because they are noninvasive treatments that together can smooth wrinkles, relax tense muscles, and fill in hollow areas.  BOTOX and Restylane will not permanently alter your looks.  BOTOX is a naturally-occurring purified protein that relaxes muscles, and Restylane is made from a biodegradable sugar-gel that occurs naturally in the body.  Both of these are eventually broken down and expelled from your body completely.

Generally with the botulinum toxin A products (BOTOX, Dysport, Xeomin), the issue is an unbalanced treatment.   These services typically freeze the forehead.  The treatment results can be improved by having the appropriate counter treatment along the eyebrow using Dr. Steinsapir’s Microdroplet method.  However, if your BOTOX treatment has caused eyelid ptosis, Dr. Steinsapir recommends finding an oculoplastic surgeon to help you with this particular issue.  Oculoplastic surgeons are trained to assess and follow upper eyelid ptosis.  They are familiar and have experience treating upper eyelid ptosis.  A prescription for Iopidine (aproclonidine ophthalmic solution) can be helpful in this circumstance.  This medication is a glaucoma medicine that can elevate the eyelid a couple of millimeters. The drops can also be used to assess the severity of the ptosis and predict the likely time frame for the resolution of ptosis.  Dr. Steinsapir recommends trying the drop twice a day for a week.  If the drop is working to open the eye, then it is likely that the ptosis will resolve in 4-6 weeks.

Options for Fixing Filler Treatments

Dr. Steinsapir often sees individuals frustrated with treatments they received elsewhere.  Surprisingly, many people are not aware that the hyaluronic acid fillers can be adjusted using the enzyme hyaluronidase.  This enzyme is delivered with a small injection during a very comfortable office visit.  Dr. Steinsapir has helped people who put up with unsatisfactory treatments for much longer than they need to. These issues are easily dealt with using the enzyme in one or two visits.  It is the ability to make these adjustments that makes it feasible to provide many of the advanced filler services.  Do you have a hyaluronic acid filler issue that is not responding to hyaluronidase?  Some patients have been told they were injected with hyaluronic acid filler but in fact were treated with silicone oil.  Correction of some of these issues can be challenging and need to be approached on a case by case basis.

Restylane is a long-lasting, but not permanent sugar-gel facial filler that is preferred for improving facial contours due to its natural results, even in sensitive areas like dark circles under the eyes and the lip edge.  Restylane and Perlane offer the ability to modify results when necessary.  This includes treatments that were performed in the past and need fine-tuning.  The ability to adjust a treatment with the enzyme can take a good treatment and make it great.  In some cases, as the body slowly breaks down the material over time, slight irregularities may develop despite the initial quality of the treatment.  Sometimes, the answer is adding filler rather than subtracting volume.  For this reason, it is best to start with a detailed assessment with an expert like Dr. Steinsapir.

About Dr. Steinsapir

Dr. Steinsapir is a much sought after oculofacial surgeon.  He is an innovator in minimally invasive cosmetic and reconstructive procedures and has invented new methods for treating with BOTOX, Fillers and cutting edge reconstructive eyelid and midface surgery.  He specializes in high precision eyelid surgery and is a leader in correcting prior facial and eyelid surgery, including multiple revised cosmetic eyelid reconstructions.  He attended medical school at the UCLA and completed ophthalmology residency at The University of Chicago.  He is multiple fellowship trained including three years of fellowship training in oculofacial plastic surgery at UCLA, and a two-year cosmetic surgery fellowship in Rancho Mirage.  He is widely published and lectures to other surgeons nationally and internationally.  He is an associate clinical professor of Ophthalmic Plastic and Reconstructive Surgery at the Jules Stein Eye Institute at UCLA.  His private practice is located in West Los Angeles, immediately serving the Los Angeles and Bevery Hills communities.  Additionally, individuals from all over the country and the world regularly come to Los Angeles for his expert care.

To learn more about Dr. Steinsapir’s specialized Restylane treatments, please contact us today.

Services described may be “off-label” and lack FDA approval. This article is informational and does not constitute an advertisement for off-label treatment. No services should be provided without a good faith examination by a licensed physician and an informed consent with a discussion of risks, benefits, alternatives, and the likelihood of treatment success. Only you and your treating physician or surgeon can determine if a treatment is right for you.

July 19, 2010

I am thinking of getting lip filler but I am afraid of getting my lips overdone.

Lip augmentation is a great option for those with thinning lips, aging lips, lip lines, or volume deficiencies.  Lip fillers have the ability to change your appearance from aging and ordinary to youthful and sensual.  It’s surprising what a difference full lips can make on the face, which is why so many people overlook the important role their lips play when they consider how to improve their appearance.  Don’t forget that we use our lips to smile, speak, kiss, eat, and express ourselves.  The full lips associated with youth and beauty can make a great difference in how others perceive us and how we feel about ourselves.  Both men and women can benefit from lip fillers, provided that both the individual and the doctor determine that this is a suitable treatment option.

Lip Filler Before and After Photo

Lip Filler Before and After Photo

One major reason great candidates for lip fillers hesitate to seek treatment is because they worry about getting their lips overfilled.  Thanks to media hypes, sitcoms, and a few publicized incidents of poor judgment, this is a common concern.  The truth is that with just a bit of foresight and planning, you needn’t worry about overdoing your lip filler treatment.  There are many fillers available, and the ones best for the lips are very forgiving, enabling your doctor to easily adjust the treatment should you be unhappy with your results.

How Can I Avoid Overdoing My Lips?

Seeking nonsurgical cosmetic treatment for the lips should be an extremely rewarding, low-risk experience as long as you do some research first and choose your doctor with care.  First, let’s look at some filler options.

With so many fillers available on the market today – Restylane, Radiesse, Perlane, Juvederm, Artefill, Sculptra, Matridex, and even silicone oil, to name a few – that have all been used as lip fillers, it can be easy to feel overwhelmed by the options.  However, not all of these fillers should be used as lip fillers under normal circumstances.  Hyaluronic acid fillers like Restylane, Juvederm, and Perlane are much more suitable for lip augmentation than permanent and semi-permanent fillers.  This is because they are much more forgiving, do not tend to lump, and can be simply and easily adjusted with the enzyme hyaluronidase.  Should you be dissatisfied with your treatment for any reason, experience an irregularity, or simply change your mind about what kinds of goals you have for your appearance, this enzyme can be injected to modify your treatment.

We have found that Restylane is usually the best fillers for lip volume deficiencies.  This is because the lips are very sensitive and can irregularities that may arise from treatment.  Fortunately, Restylane doesn’t tend to form bumps, and an experienced physician specialist can skillfully place Restylane for natural looks and long-term benefits.

I think I’ve already had too much lip augmentation.

Resolving this issue of course depends on the nature of the problem and the type of filler you received.  If you were treated with something like silicone oil, there is both good and bad news: this is a permanent filler.  If you like your results, that’s great, and you can expect them to last basically forwever.  If you don’t, well, it is virtually impossible to improve the lip.  Receiving treatment with a long-term filler is somewhat of a gamble because the long-term fillers have been shown to be less reliable than a filler like Restylane, and if you are discontent with your outcome then it’s harder to reverse.

If you feel you’ve had too much of a hyaluronic filler, adjustment will be very easy.  You can usually return to your original doctor to resolve the problem, unless the relationship has deteriorated or you are not confident in your original doctor’s skill level in regards to lip treatment.  In such cases, you should seek a second opinion.

If you were treated with a long-term filler like Sculptra or Matridex, treatment will be more challenging.  You may be able to a receive a saline injection to try to break up the filler.  In some cases excision is indicated as an appropriate treatment.  This will depend on the severity, location, and nature of your irregularity or other concern.

It’s possible that you are early from your treatment and simply experiencing some normal swelling.  Give yourself time to heal.  Wait a couple of weeks to let the swelling settle before evaluating whether or not your lip treatment was excessive.  If you have a bruise, you are likely experiencing swelling and need to let things settle down a bit before deciding to seek an adjustment.

How do I prevent a problem with my lip filler?

With some basic understanding of lip fillers and a carefully chosen cosmetic surgeon in Los Angeles to perform your nonsurgical cosmetic treatment lip filler, you really don’t need to worry about regretting your treatment decision.  Weigh your options with potential doctors and be sure to ask many questions about what filler he or she recommends, and how easy it is to modify treatment in the off-chance that you’re dissatisfied with it.  For example, you can feel great about a Restylane lip filler treatment because it has a strong history of working well as an ideal lip filler.  The benefits of Restylane can last for over a year, yet you needn’t worry that you’ll be stuck with results you don’t like because Restylane is both modifiable and not permanent.

Even more important than exactly what filler goes into your lips is the doctor you choose.  Find a cosmetic doctor with whom you are comfortable.  Your doctor should specialize in facial cosmetic surgery and nonsurgical facial treatment and be extremely knowledgeable about facial fillers.  You should feel at ease around your doctor and confident in his or her abilities.  How can you be confident?  Look into your doctor’s credentials, areas of specialization, experience record, and unretouched before and after photos.  What your doctor says should make sense to you.  Further, your doctor should personally perform all of your treatments without passing this job to an assistant or “physician extender.”

Dr. Steinsapir is a cosmetic surgeon in Beverly Hills who specializes in minimally invasive treatments and is an expert in facial fillers.  In fact, he has served as a physician consultant to Medicis, Inc., who distributes Restylane and Perlane.  He is widely considered a leader in facial fillers because of his innovative methods like Deepfill Restylane, extensive experience, and practical artistic skill.  He is widely respected and a Clinical Associate Professor at UCLA in oculofacial surgery.  Please call us today for a consultation to find out how Dr. Steinsapir’s lip filling techniques can refresh your appearance.

October 20, 2009

Facial Fillers: A Solution to Non-Surgical Cosmetic Treatment

Twenty years ago, the only solution for removing the classic signs of aging like wrinkles, sagging skin, under eye hollows, and thin lips was going under the knife or hardcore chemical peels and laser. But today, a range of facial fillers can be injected to smooth out those facial lines, enhance lips, treat nasolabial folds, and remove furrows between the brows, taking years off the face to bring back that youthful look. What makes injecting facial fillers so attractive? Facial Fillers also known as “dermal fillers” or “injectables” offer a cosmetic treatment that is minimally invasive with little or no recovery time. Injecting fillers has become the most popular way to solve anti-aging problems in a non-surgical manner. With so many types of dermal fillers available today, choosing the right one can be overwhelming. The following sections provide useful information about some of the most widely used fillers.

What are the Main Ingredients That Constitute These Facial Fillers?
Most of the commonly used fillers are derived from Collagen or Hyaluronic acid. Collagen is a naturally occurring protein in mammals that is used to create injectable fillers that are either bovine-derived, porcine or human-derived. Bovine-derived collagen is extracted from the tissue of cows that have been raised in consistently monitored, disease-free environment. The Allergan, Inc. Zyderm® and Zyplast® product is produced from highly purified collagen collected from a closed herd of cattle. As there is a 3-8 percent chance of an allergic reaction to bovine collagen, an allergy test is required prior to undergoing treatment with this filler. The source of human-derived collagen products varies. However, the most popular of these products, Cosmoplast® and Cosmoderm® from Allergan, Inc., is sources from cultured human fibroblast cells that have been maintain in tissue culture for 10 years. These cells are the source of other human derived products used to treated burn victims and have an excellent safety record. A pre-treatment allergy test is not necessary with the human derived collagen products. Evolence® is the latest collagen product produced from porcine collagen with a useful life in the face of about a year. The longevity of collagen injections depend on patient’s lifestyle, physical characteristics, and the part of the body treated. Collagen is observed to disappear faster in areas that are directly affected by muscle movement. Only a professional doctor can help you to determine the right period required for retreatment to maintain the results.

Hyaluronic acid is a type of polysaccharide called a glycosaminoglycan. Also known as hyaluronan or hyaluronate, hyaluronic acid occurs naturally in the human body and is central to regulating cell growth and renewal. Hyaluronic acid is non-immunogenic, which means the body doesn’t consider it as a foreign substance, thus minimizing the chance of an allergic reaction. While allergies to these products do occur, allergy testing is not recommended do the low incidence of allergies to these products. Dermal fillers that contain hyaluronic acid offer a soft natural look and also have great longevity. Hyaluronic acid fillers have an added advantage in that they can be manipulated even long after a treatment using the enzyme hyaluronidase. The results are like have surgery but the magic wand was an office procedure and a treatment comfortably placed with tiny injections.

The Most Popular Facial Fillers
Restylane ®
Known as one of the most effective and popular fillers, Restylane dermal gel composed of hyaluronic acid. The non-animal biodegradable filler adds volume to the skin treating under eye hollow and dark circles. It smooths facial folds and wrinkles in areas surrounding the eyes and mouth. The effects of this filler easily last for a year or more depending on factors like age and skin type, and the initial treatment volume.

Juvederm ™
This injectable gel is the first FDA-approved hyaluronic acid dermal filler which restores your skin’s volume and addresses moderate to severe the facial folds, like “smile lines” or nasolabial folds. This filler is made up of cross-linked hyaluronic acid and effects last for an average of 6 months. Other hyaluronic acid fillers are granular in nature, but the smooth consistency of Juvederm ™ allows the injection to be administered with relative ease. Due to the enhanced ability of this product to flow in the face, it is best to discuss with your treating physician where this product will work best.

Perlane®
Another hyaluronic acid based filler – Perlane, with larger molecules and large concentration of hyaluronic acid, making it more effective to treat deeper wrinkles and larger folds. Though it is only FDA approved to last up to 12 months, it has found to be longer-lasting than Restylane ®. This product is the best of the hyaluronic volumizers for deeper lines or more active points of facial movement.

Botox ®
This facial injectable is made from Botulinum Toxin Type A and designed to eliminate facial wrinkles. It commonly treats areas like frown lines between the eyebrows, “crow’s feet,” and creases on the forehead. It primarily addresses the periocular region and its effects last up to 6 months. While Botox is not a filler, it is often used in combination with fillers to achieve results that previously could only be accomplished with surgery.

Zyplast® and Zyderm®
The first collagen based fillers approved by the FDA are made of purified bovine-derived collagen and are used to enhance facial contour and reduce fine lines and deep wrinkles. Zyderm® subtly smooths crow’s feet or fine lines around the lips. Zyplast® is used to treat deeper folds such as brow wrinkles or frown lines, and provides volume and contouring to your face. The longevity of this product is limited compared to the new hyaluronic acid fillers. The product contains local anesthetic making quite comfortable for lip edge treatment. Prior testing is needed to screen for potential allergies before actual treatment.


Radiesse ®
Formerly known as Radiance, Radiesse is made of calcium-based microspheres, the same component of bones and teeth. The filler stimulates the body to produce new collagen around the microspheres, which makes it last longer. It is utilized to correct moderate to severe wrinkles and contour the facial features. Radiesse® filler is the first FDA-approved one-year dermal filler that restores and corrects the signs of facial lipoatrophy in patients with HIV. Initially the manufacture claimed longevity of 5 to 8 years, however, clinical experience suggests that this product lasts 12-18 months when used as a facial filler.

ArteFill®
ArteFill® which is known as Artecoll® outside of United States is a dermal filler that offers longer lasting results than other cosmetic filler injections. It is made of polymethylmethacrylate (PMMA) microspheres that are suspended in bovine collagen and is mainly used to treat static facial lines, enlarge lips, fill in facial imperfections, and diminish nasolabial folds. It not only acts as a dermal filler, but its microspheres also stimulate the body to produce its own collagen. As the injected collagen slowly degrades naturally, the newly produced collagen replaces it. This leads to long-lasting, almost permanent results. Due to a tendency to form lumps, the product is not recommended for lip or lower eyelid treatment.

Silicone oil
Silicone oil has only one FDA approved indication for use in the repair of complex retinal detachments. This material finds its way into off label use as a medical grade facial filler. However, silicone oil has a number of side effects. Consequently it is not advisable to use liquid silicone for facial filler. Silicone oil is occasionally used by non-medical injectors for illegally black market treatment. Often the silicone oil used is not medical grade but rather industrial silicone oil, which was never intended for the human body. There have been deaths from these types of illegal treatments.

Benefits and Risks Involved in Injecting Facial Fillers
The biggest advantage of these fillers is that they do not require any invasive surgery and require little recovery time. While the results of fillers do not last forever, their longevity is sufficient to offer a practical alternative to surgery. In many case, the result of filler service can be better than what can be accomplished with actual surgery. Periodic top off allows the effects of service to be maintained. Side effects like bruising, swelling, lumpy firmness, and tenderness are seen in 5% of treatments. The incidence of allergic reaction varies with the products used and should be discussed with the treating physician.
Before undergoing an anti-aging treatment, it is important to consult a well-qualified and a board certified cosmetic surgeon, to help you to understand which FDA-approved filler is the best for you.