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Question:
I was bitten by a dog on my cheek when I was a kid. The scar still bothers me and I’m very self-conscious about it. It never healed particularly well and is now thinner but still a raised, very long line that’s whiter than the rest of my skin. Is there anything that can be done to improve it?

Answer:
White scars are difficult scars to improve. A raised scar however, can be improved upon. I have had good success in scar revision with the use of the Fraxel laser. The laser is effective in reducing the height of the raised scars and also decreasing the pigment in more red scars. White scars are less responsive to laser improvement of the scar.

Posted by Dr. Philip Schoenfeld

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Question:
I am investigating non-surgical alternatives to a facelift. Does this usually mean injectable fillers or would a fat transfer work? Are these considered permanent solutions?

Answer:
Many people are interested in non-surgical facelifts for a number of reasons.  In my practice non-surgical facelifts usually indicates the placement of a dermal filler or fat in order to fill the deflated facial tissue giving the face the appearance of being lifted, but, definitely being rejuvenated.  Dermal fillers are great because they are safe and extremely effective.  Unfortunately, most of the hyaluronic acids will last about a year, and they are quite expensive.  Fat is another alternative.  Fat will last for quite some time when injected into the face but, may require a touch up procedure.  A separate surgical procedure which can be performed under local anesthesia would be needed to harvest the fat prior to facial fat injection.  As you continue to age you will likely need to have small amounts of fat injected to replace the facial fat that you will lose as a result of normal aging.

Posted by Dr. Philip Schoenfeld

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Question:
I would like my chin to look like James Dean. Currently I have no chin, or it recedes so much it seems that way. Can I get exactly the chin I want with a chin implant?

Answer:
Chin implants come in many shapes and sizes. A preoperative evaluation with your surgeon will enable you and the surgeon to gauge which size and shape implant would best fit your face and effectively augment your chin. During surgery, sizers are used in order to visualize the result of chin augmentation prior to placing the final chin implant.

Posted by Dr. Philip Schoenfeld

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Question:
I have smoker’s wrinkles around my mouth. I would like to remove them without surgery. What is the best injectable filler to use in this area?

Answer:
Smoker’s wrinkles, lipstick bleed lines, and other wrinkles around the mouth are extremely challenging issues for both the physician and patient. Although dermal fillers such as Restylane and Juvederm will certainly help with filling the wrinkles and plumping the lips, which also decreases the wrinkles on the lipstick line, for really deep wrinkles, a laser treatment or medium to deep chemical peel may likely be required to effectively reduce the appearance of these lines. In cases where the lines are worse with excessive motion of the mouth, a small amount of Botox or Dysport will help with this as well. Your physician will be able to help you decide which procedures would be right for you.

Posted by Dr. Philip Schoenfeld

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Question:
I’ve always had very flat cheeks and have envied those with nice high cheekbones. Would implants be a good way to improve my flat cheeks? Are there any other options like fillers?

Answer:
There are several ways to address your concerns regarding your cheek bones. Although cheek implants are extremely effective in giving permanent augmentation to the cheeks, I prefer the use of dermal fillers such as Radiesse, and Perlane, or the use of autologous fat for the purpose of cheek augmentation. I feel like I have more freedom to sculpt the cheeks with the use of filler or fat as opposed to implants. I also feel that as we age our facial structure changes further and dermal fillers and fat injections allow me to change the amount and location of filler that needs to be injected to give you the best possible long term improvement of your face.

Posted by Dr. Philip Schoenfeld

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Question:
I am in my early fifties and about to become a grandmother, and I really need a little work done! I want it to look and be natural. Is it true that hyaluronic acid used in this kind of work promotes more collagen production?

Answer:
The question of whether injections of hyaluronic acid will promote new collagen formation is a good one. Most importantly, the injection of hyaluronic acid fillers such as Juvederm and Restylane is extremely natural looking. Recently, one of the non hyaluronic acid filler products was able to show that very small amounts of new collagen did form after injection of this product, Sculptra. What researchers have found is that injection of all dermal filler products appears to stimulate a cell in the skin called a fibroblast. The fibroblast produces some new collagen when stimulated, but, the volume effects are negligible.

Posted by Dr. Philip Schoenfeld

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Question:
I’m in my mid-60s and would like an eyebrow lift. However, I have a severe heart condition and am not sure if this is safe. Would I still be a good candidate?

Answer:
Although many cosmetic surgical procedures such as eyebrow lift can be performed with mild sedation and local anesthesia, I would strongly suggest deterring any elective surgery until your cardiologist feels that the risks are minimal, at most. Once they have given you the green light, then I am certain that your surgeon will take every precaution to insure that your browlift procedure is safe and successful.

Posted by Dr. Philip Schoenfeld

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Question:
I am trying to decide between a full facelift and a mid-facelift. I know the recovery is much longer with the full facelift. I would like to know what facial improvements I would get with the full facelift that I wouldn’t get with the mid-facelift.

Answer:
The improvements that you can expect with a full facelift compared to a midface lift are as follows. A full facelift is indicated when you have concerns with regards to the appearance of your neck and jowls. A midface lift is used when you have cheeks that need to be elevated. The midface can also be addressed with the use of dermal fillers and fat injections. The improvement in your appearance with these injectable fillers is remarkable. Injectable fillers and fat are not a substitute for a full facelift procedure.

Posted by Dr. Philip Schoenfeld

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