Ask Dr. Barber

Every month Dr. Barber answers questions submitted by readers of Guilford Woman and Kernersville Living magazines.  If you’re interested in reading past articles, click here.

February 2019

Q. I get injections of Restylane® in my cheek fold about once or twice a year. I have never had any issues other than temporary bruising and swelling, however I read an article recently that talked about blindness that can occur as a result of filler injections to the face. I am now too scared to get injections again. The office where I have received the injections has never mentioned that blindness can occur. Are fillers safe, or do I need to stop doing them?

A. Fillers such as Restylane® and Juvederm® are compounds containing hyaluronic acid that is injected into wrinkles, such as where you get yours, the nasolabial fold, and also where there is a hollow area, such as on the cheek for example. Basically, fillers do as their name suggests, fills up a wrinkle or a hollow. The risk that you asked about, blindness, is a well described complication that can occur during the injection process, but fortunately it is extremely rare. In my practice, we have never seen this complication, in spite of having performed thousands of injections over the last decade. The blindness that has been reported with filler injections is unilateral, meaning only on one side, the side that the injection took place on. It is thought that it occurs because some of the injection material is injected into a small blood vessel that is in the area being treated. The pressure of the injection pushes the filler material deep into the blood vessel which, in very rare cases, fills one of the blood vessels that supplies the retina of the eye. The material gets stuck in the even smaller blood vessels in the retina, which stops the flow of blood to a segment of the retina. This causes the retina to develop irreversible hypoxic tissue damage that leads to blindness. The loss of vision occurs almost immediately, and to my knowledge there has only been one reported case where the blindness was reversed with treatment. There is a treatment protocol for trying to reverse the blindness, but unfortunately it has not been successful in most cases. There are recognized techniques during filler injections to minimize the possibility of injecting filler into a blood vessel, but even in the most experienced hands, this catastrophic event has been reported. However, experience does matter with filler injections and you should feel comfortable that your injector has experience and knows the techniques to minimize the chance of this terrible complication. So to answer your question as to whether fillers are safe, they are absolutely safe and millions of injections are carried out every year worldwide with a very low incidence of complications, including blindness. However, just as in almost everything we do on a daily basis, unexpected and unwanted events can occur, and you need to be an informed consumer and weigh the risks verses benefits of the procedure.

 

January 2019

Q. I am totally confused about what kind of skin care would be good for my face. I am a middle-aged woman who has some sun damage from my younger days, but otherwise fairly decent skin quality. My goal is to minimize wrinkle formation and help fade some of the brown spots on my cheeks. Nothing that I have purchased from the cosmetics counter has helped very much and I have spent a small fortune. Is there a skin care program that you recommend for most women?

 

A. There is no single answer for every person regarding what will repair damaged skin, or what will help maintain good skin quality. The skin care business in the United States is a multi-billion-dollar business, and unfortunately much of what is purchased by the consumer does not do what it advertises. (Read More)

 

 

2018

Q. I read about a new saline implant in your Q&A article in this magazine a few years ago called the Ideal Implant. I am interested in a breast augmentation and it sounds like a good alternative to silicone implants. However, at the time I read the article they were very new to the market and I was worried that they had not been in use long enough to know for sure that they are safe. Are you still using these new saline implants and if so, do you think they are good implants? (Read More)

Q. am almost fifty and have been using both Botox and fillers for my facial wrinkles for almost 8 years. I love the effect as it smooths my forehead lines and the fillers fill in the lines around my mouth. I am just a little concerned that I have been using these injectables for so long and I cannot find any information as to whether it is dangerous to be on these products for a long time. What is your opinion? (Read More)

Q. I desperately want a breast reduction and have even been approved by my insurance company for coverage of the procedure, however, I am so hung up on the potential risks of being put to sleep that I just cannot convince myself to proceed with the surgery. I would like to know your opinion regarding the safety of anesthesia for breast reduction surgery. (Read More)

Q. I have dark circles under my eyes that make me look tired. Is there anything that can be done to lighten my eyelid skin? (Read More)

Q. I had a facelift about two months ago and I can still see my scars in front of my ears. I am worried that they will be permanent. What should I do? (Read More)

Q. I grew up on the coast of North Carolina spending way too much time in the sun. I now have numerous scaly spots on my face and recently had a skin cancer removed. I have read about a cream that can be applied to the face to remove some skin cancers and the scaly spots on the face. Do you know anything about this? The cream is called Efudex. (Read More)

Q. When I was 39 years old (12 years ago), I had breast cancer and had a mastectomy with immediate reconstruction using tissue from my tummy. My reconstructed breast is doing just fine but my problem is that over the last 12 years I have gained some weight and my natural breast is now larger and droopier than it used to be. So unfortunately, my breasts do not match anymore. Is there a way to make them more symmetrical? I am very self-conscious when I put a bathing suit on because the difference is very noticeable. (Read More)

Q. I had a breast augmentation 9 years ago. I have silicone gel implants. One of my breasts is literally as hard as a rock and looks misshapen. I have not been back to a plastic surgeon because I had the surgery in another state. What is going on with this breast, and can it be fixed? (Read More)

Q. I had a breast augmentation last December. My right nipple area is completely numb. My left side is fairly normal. My surgeon said that the numbness will get better, but it has been four months and no change. What is your experience with loss of sensation in that area? (Read More)

Q. I have been keeping up with some of the reports on the association between textured surface silicone implants and the occurrence of breast lymphoma. I have discovered that the implant type that is most associated with this disease is the implant that I have. I am so worried now and wonder if I should have my implants removed? (Read More)

Q. I was recently diagnosed with a malignant melanoma on my shoulder. My husband found it and I unfortunately just watched it for a few months before going to the dermatologist. She biopsied it and ultimately removed it. I was lucky because it was called a superficial melanoma and the only treatment recommended was close follow up for the next five years. I was advised to use sun screen regularly, but I am wondering if there is anything else that I can do and how do I protect my children from this terrible skin cancer? (Read More)

Q. I am a 46-year-old healthy woman who has inherited from my father a neck that has no definition and seems to be full of fat. On a picture of my profile it is hard to tell where my face ends and my neck begins. I have had this neck for about 15 years, but it has gotten worse since I had children and gained some weight. Is there anything that can be done to restore some definition to my neck? (Read More)

Q. About a year ago, I had an upper eyelid lift by a plastic surgeon outside of Greensboro. Everything seemed to have gone well after surgery except that I am still not able to completely close my eyelids together. There is a gap between each upper and lower eyelid when they are supposedly closed. I really cannot see the gap myself, but my husband says it is very noticeable when I am asleep. In addition, my eyes are always dry, and I am constantly having to use drops to moisten them. My plastic surgeon says that it will eventually get better and that there is nothing that needs to be done about the issue. Is there anything that I can do to help this problem? (Read More)

Q. I am contemplating a breast augmentation in the next year or so. I am researching implant options and I remember reading in Kernersville Magazine a year or so ago about a new implant called the Ideal Implant. Can you tell me if you have experience with this implant and if you think it is a good alternative to the silicone gel implant? (Read More)

 

 

2017

Q. I had a breast augmentation about 10 years ago.  I am older now and having large breasts is not that important to me.  I am a long distance runner and the implants just seem to get in the way when I run.  I would like to have them removed but I have read online that removing without putting another implant back in will cause distortion of the breasts.  Is it true and is it possible to take my implants out?  (Read More)

Q. I am in my mid-twenties and I was born with a cleft lip. My lip was repaired when I was a baby and it looks fine to me. However my nose does not look normal and I was wondering if there is anything that can be done to improve its appearance? I have never had any surgery on my nose as far as I know, unless something was done when I was a baby. (Read More)

Q. I am the mother of 4 children and nursed all of them for nearly a year each. I have small breasts but my nipples are too big and honestly just look like they are stretched out. They were not like that before I had children so I think it is related to four years of nursing. Can this be fixed? (Read More)

Q. I had a face lift about 15 years ago and have been very happy. However, my cheeks are again beginning to sag, especially in the jowl area. I am 68 years old and do not think I want to go through another face lift. Is there an alternative to a full face lift to re-tighten my relaxed cheek skin? (Read More)

Q. I have heard that there are some technologies that will tighten the skin of the neck and face so that a face lift can be avoided. Is this true and does it work well? (Read More)

Q. I have heavy upper eyelids with too much skin hanging down. How can I find out if my insurance will pay for an upper eyelid lift? (Read More)

Q. I am contemplating having fat injections in my buttock area. I have seen a surgeon who has scheduled my surgery. However, I recently read some reports about problems with butt lift procedures using fat. Before proceeding, I just want to make sure the procedure is safe. What is your opinion regarding a Brazilian butt lift with fat? (Read More)

Q. I would like to know when I should replace my breast implants.  I had an augmentation about 10 years ago in another state.  I know that I have saline implants but do not know anything else about them.  When should I plan to replace these implants?(Read More)

Q: I had a breast augmentation with silicone implants about 2 years ago. My right side is perfect, but my left side is very hard and does not look natural. My surgery was done in another state and I have moved to the Triad area and do not have a plastic surgeon. What can be done to improve the appearance of my “bad side”? (Read More)

Q: I am 42 years old and have fine lines on my cheeks and around my mouth. I do not have any saggy skin on my face but I do hate the fine wrinkles. I grew up on the coast and abused my skin when I was a teenager. Now it seems that I am paying for this mistake. Is there anything that works to smooth fine lines on the cheeks and around the mouth? (Read More)

Q. Is there any way to get rid of the signs of aging on my upper chest? I have brown spots, red spots, and wrinkles. I confess I do go into the sun a fair amount. (Read More)

Q. I would like to have some filler like Juvederm® injected into my cheek folds that run from my nose to my mouth. These folds have progressively gotten more noticeable as I have aged. I read online that one of the complications of filler to the face is blindness, so I have held off doing the injection. Is this true and if so, is it very common? (Read More)

Q. I recently had the breast cancer gene test and was found to be BRCA2 positive. My mother died of breast cancer at 40 and I am now 36. My mammograms are clear so far but I have been advised to consider removing both of my breasts to protect myself from the disease. What is the best form of reconstruction for double mastectomy if I chose to go this route? (Read More)

Q. I recently moved to the Triad area after living in the Northeast for most of my life. I am interested in having some plastic surgery on my eyes but I do not know how to find the right plastic surgeon since I am relatively new here. Can you give any advice on making sure I pick a good doctor?. (Read More)

Q. A few years ago I had a facelift. Most everything went well except where the facelift scar went into my hair in the temple area. I now have a bald spot about the size of a nickel, but only on one side. It is not that noticeable except when my hair is wet. Is there anything that can be done to get hair to grow back? My plastic surgeon basically told me that it is not noticeable and not to worry about it.. (Read More)