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HARRY MITTELMAN, MD
SPECIALIZING IN FACIAL PLASTIC SURGERY

Frequently Asked Questions

Frequently Asked Questions with Harry Mittelman, MD

Here are frequently asked questions for Mittelman Plastic Surgery in Los Altos and San Jose Area. 

Q: I have a long philtrum, would a lip lift or Botox (lip flip) be good options for me?

A: First, you have a good lip shape and are correct that you have a long philtrum. Botox “lip flip” is an option but only lasts 3-4 months, will not shorten the length much and will likely not give you the desired outcome. Filler is also an option but again will not shorten the philtrum or increase the height of your upper lip as much as it will bring out. I think you would be a great candidate for a lip lift operation, which would help with your facial proportions as well as give you a fuller upper lip at rest!

Q: My face has lost volume what treatments would make me look more youthful?

A: Dermal Filler can give correct volume loss.To start, it helps to think of the face in 3 dimensions and multilayered, There’s the structural support (such as the cheek bones), the muscle layer (contributing to animation), the soft tissue layer (fat and tissue contributing to volume) and the skin (draped over all the underlying layers). Each injectable has different physiochemical properties and works to achieve specific goals in certain anatomical areas; there isn’t one magic filler, they’re subdivided into hyaluronic acid (Belotero, Juvederm, Voluma, Restylane), calcium hydroxyapatite (Radiesse) and poly L-lactic acid (Sculptra).  Each brand also has subcategories based on the concentration of product and whether it’s mixed with anesthetic. hyaluronic acid (HA) fillers, which are made out of a molecule naturally found in our skin (read: high compatibility with little to no reaction), are ideal for first-time patients and can be injected almost anywhere you can think to add volume or shape—nasiolabial lines, cheeks, lips, eyelids, eyebrows, forehead lines and nose. Their greatest advantage is that they’re the only filler category that’s reversible by an enzyme, hyaluronidase, which can ‘melt it almost instantly—this has been revolutionary in treating patients with filler mishaps, Radiesse, in the calcium hydroxyapatite category, has excellent lifting capacity when injected deep onto the bone and it has FDA approval for rejuvenation of the hand, and Sculptra, in the poly L-lactic acid category, is a collagen stimular that works gradually over the course of a series of treatments and works to repair the underlying skin structure over time for a natural-looking correction. 

We divide fillers into two broad categories—heavy/volumizing or light/superficial. Radiesse is the industry  go-to volumizing filler for the malar area [ed. note: cheek bones], the mid-face or the temporal hollow because the longevity is predictable, adding that other choices for these areas are the heavy hyaluronic acid fillers such as Juvederm Voluma XC, and for deep deposition, Perlane-L from the Restylane family of HA products.

Q: When getting rhinoplasty, I only had packing and a splint. Does not everyone get stents put in? What determines this?

A: Not all Rhinoplasty need a stent to be place inside the nose.  a broken nose or extensive reconstruction determines the use of a stent. Occasionally a stent, which is a firm piece of silicone that acts to stabilize the internal structure of the nose and prevent internal adhesion from forming. The Alar stent is a new method to resolve nasal valve collapse. This stent prevents collapse without the need for cartilage grafts or implants, which leads to quick healing.

Q: Should I have my under eye filler removed, fixed, or just wait and let it go away?

A: It would be best to have it dissolved and start again. Do not use permanent filler in the eye area.

Q: Can microneeding with PRP help my acne scars?

A: Micro Needling with PRP is a safe and very effective skin–resurfacing tool that creates micro channels in the skin to stimulate new collagen and elastin production. In addition, the treatment can reduce the appearance of wrinkles, treat acne scars and smooth out textural issues such as sunspots, stretch marks and hyper–pigmentation. Unlike lasers, the Micro Needling with PRP is safe for all skin types, including darker tones.

Micro-needling with PRP (Platelet Rich Plasma) The PRP is derived from the serum portion of the blood, which contains platelets. The platelets contain high levels of growth factors, which, when applied to the skin, will stimulate cell turnover.”

Micro Needling with PRP may also has a positive effect on the appearance of hyper-pigmentation, hypo-pigmentation, acne scars, traumatic scars and stretch marks and generally creates a fresher appearance or glow to the skin.

Q: Should I get microneedling done for my acne and scars or should I wait until I'm 25?

A: It is best to wait until your acne is under control and you have no active breakouts. Micro Needling with PRP and RF would be the best treatment for your acne scars. I recommend you have a consultation first before starting any treatments for scars.

Q: Is microneedling effective on women in their 70s?

A: Micro Needling with PRP for  patients over 65 is a safe and very effective skin–resurfacing tool that creates micro channels in the skin to stimulate new collagen and elastin production. In addition, the treatment can reduce the appearance of wrinkles, treat acne scars and smooth out textural issues such as sunspots, stretch marks and hyper–pigmentation. Unlike lasers, the Micro Needling with PRP is safe for all skin types, including darker tones.

Micro-needling with PRP (Platelet Rich Plasma) The PRP is derived from the serum portion of the blood, which contains platelets. The platelets contain high levels of growth factors, which, when applied to the skin, will stimulate cell turnover.”

Immediately after the treatment, your skin will naturally start rebuilding new collagen and elastin for plumper, firmer skin.

Another benefit of Micro–Needing is that it allows your topical gels, creams and serums that you use at home to be absorbed more effectively

Micro Needling with PRP is an innovation in aesthetics for the treatment of the appearance of fine lines, acne scars and the skin’s texture, tone and color.

What Are the Benefits?

The benefits of Micro-Needling with PRP can include a reduction in the appearance of fine lines and wrinkles, younger-looking skin with fewer signs of aging.

Micro Needling with PRP may also has a positive effect on the appearance of hyper-pigmentation, hypo-pigmentation, acne scars, traumatic scars and stretch marks and generally creates a fresher appearance or glow to the skin.

Q: Can I get microneedling with salicylic acid peel at the same time?

A: Yes! We here at Mittelman Plastic Surgery Center perform MicroNeedling with peels, and have had amazing results. We also perform Micro Needling with PRP( Platelet Rich Plasma) and RF (Radio Frequency) Giving our patients optimal results.

Q: Does microneedling really work to tighten saggy skin? Can it also promote collagen to rebuild the skin around the eye?

A: Micro Needling with PRP is a safe and very effective skin–resurfacing tool that creates micro channels in the skin to stimulate new collagen and elastin production. In addition, the treatment can reduce the appearance of wrinkles, treat acne scars and smooth out textural issues such as sunspots, stretch marks and hyper–pigmentation. Unlike lasers, the Micro Needling with PRP is safe for all skin types, including darker tones.

Micro-needling with PRP (Platelet Rich Plasma) The PRP is derived from the serum portion of the blood, which contains platelets. The platelets contain high levels of growth factors, which, when applied to the skin, will stimulate cell turnover.”

The benefits of Micro-Needling with PRP can include a reduction in the appearance of fine lines and wrinkles, younger-looking skin with fewer signs of aging.

Micro Needling with PRP may also has a positive effect on the appearance of hyper-pigmentation, hypo-pigmentation, acne scars, traumatic scars and stretch marks and generally creates a fresher appearance or glow to the skin.

Micro needling can be used on all parts of the body, including the: face, eye area, neck, décolleté, arms, hands, legs, abdomen and back.

Q: I’m 40, will microneedling work to stimulate collagen?

A: As we age our body begins to lose volume, and our skin becomes loose and elastic. This naturally happens as the building blocks of collagen proteins that help keep our cells strong and connected begins to degrade and become weaker over time. As a result, gravity tends to have more influence on your skin cells, and over time this creates droopiness, wrinkles, and bands on your skin. This is the problem that micro needling aims to solve —and many have said that we do that job very well.

Micro Needling with PRP, also referred to as collagen induction therapy, involves using super-fine needles to create hundreds of tiny, invisible puncture wounds in the top layer of the skin. These wounds are called micro-injuries, and the micro-injuries that you create with micro needling stimulate the body’s innate wound-healing processes. If you’d like to read in greater detail about micro needling with PRP

Maintaining gorgeous and flawless skin while we age is not a myth. We have seen it with celebrities, socialites, and influencers. Always looking fresh, dewy, and flawless. Next time you look in the mirror you can see it for yourself as well! With PRP and MicroNeedling combined, you can attain the same beautiful skin as all the household names. MicroNeedling is a minimally invasive procedure that promotes collagen therapy and production. This treatment combats a myriad of skin blemishes such as scars, stretch marks, melasma, wrinkles, rosacea, and more. However, before your micro needling session even begins, a small amount of blood will be drawn from your arm. It will then be placed in a state-of-the-art centrifuge where it separates your own platelet-rich plasma (PRP), from your other blood cells. Your very own plasma will then be applied to your skin during your Microneedle treatment. To administer the Microneedling treatment as well as to make sure your body is able to absorb your PRP, a micro pen is used. This device contains very fine needles that are gently maneuvered over your skin.

Microneedling stimulates a healing response within the body by creating a controlled injury with those tiny needles. PRP with Microneedling treats the skin while prevents wrinkles, aged skin, acne scars, stretch marks, sagging skin, hyperpigmentation, UV damage, and even acne itself. The power of both these treatments combined creates drastic and long-lasting results.

Call us today to schedule your consultation 650-941-8888

Q: Told skin isn't as thick, cartilage edges in the tip can be seen. Why do drs give conflicting diagnosis for Rhinoplasty?

A: Thank you for your question and photos. First off there are many different ways to approach a nose and each surgeon will have their own approach with each approach having its advantages and disadvantages. With that said it is difficult to judge the thickness of your skin though pictures. Spreader graft can help with improving the nasal airway and provide a straighter dorsum. The nasal tip tends to drop/droop over time after surgery and a columella strut would be effort to prevent that from happening. Your ultimate goals would be an important factor deciding how to approach your nose.

Q: I am a good candidate for No-Surgical Nose Job and Chin Fillers?

A: Thank yo for your question and photos. The results you are seeking can most definitely be achieve with dermal fillers. I would recommend you contact a facial plastic surgeon for an evaluation.

Q: Not able to lift my inner brows ("Mr. Spock") look and asymmetry after botox brow lift?

A: Thank you for your question and photos. The full effect of botox should been seen within in 2 weeks of injection. Some corrective measure can be done to help soften the “Mr. Spock” look depending on how many units and where the injection were placed. It would be best to wait until the full effects of your initial injection had taken place and contacting your injector for touch ups. 

Q: Yesterday I bent over while dancing and dabbed forehead, did I mess up my Botox?

A: Thank you for sharing your story. Physical activity 6 hours after Botox treatment would not have any adverse effect if done correctly. Rest easy you will be fine. 

Q: Is Botox making my brows droop because I'm aging or is my doctor's technique at fault?

A: Thank you for your question. The eyebrow will naturally start descending as a person ages. Your Botox treatment may need to be tailor to adjust for this change. I would definitely contact your injector to express your concern. The eyebrow droop can be corrected or improved sometime by placing Botox in the muscles causing the downward pull of the eyebrows. 

Q: Can I get a Lower Blepharoplasty without epinephrine?

A: Yes a lower blepharoplasty can definitely be done without any epinephrine. The procedure can be done safely under local anesthesia without any epinephrine. Epinephrine is most commonly used in blepharoplasty to reduced the amount of bleeding during the surgery. This ultimately equates to the amount of post operative bruising. However when doing a blepharoplasty without epinephrine special device would be used to obtain hemostasis.  Show original message

Q: What kind of fillers would you recommend for 37 year old concerned about thin face/lost volume?

A: Thank you for your question and photos. You would an ideal candidate for facial fillers to provide a more youthful appearance by restoring lost volume. There are multiple different types of fillers on the market. You would be a great candidate for Voluma or Restylane Lyft for an instant result. These products can last upwards to a year. Sculptra would also work very well for you. The effects of sculptra is gradual and requires a series of treatment. The result can last more than 2 years. Please contact a facial plastics surgeon to further discuss your options. 

Q: How Can my Nose Be Fixed?

A: It’s difficult to provide a full evaluation of your nose with only one image, so a consultation would be needed for both better visualization of your specific anatomy and to feel exactly where bone and cartilage or lack thereof are causing the anatomic irregularities. That being said, however, it does appear that you have at least a dorsal hump. A dorsal hump can be removed by shaving the bone and cartilage along the profile of your nose. Depending on how much of the dorsal hump is removed, you may also need osteotomies, meaning the nasal bones would need to be fractured and reset to give the nose a more narrow appearance. The nasal tip cannot be fully evaluated with this image, but often times if someone wants a “boxy” appearing tip treated, a portion of cartilage can be trimmed to help refine the appearance. I would perform a surgery like this with an endonasal approach, meaning there would be no incisions on the skin, just some incisions on the inside of the nose.

Many offices offer digital image morphing so that you can get some idea of what the surgeon feels he or she can accomplish with surgery. That way, I believe that you can have a good discussion with the surgeon about your goals and make sure that they are addressed.

Q: I Want my Chin a Lil Bit Long. So if There is Any Exercise or Anything else for my Chin So Please Tell Me?

A: There are unfortunately no exercises that will change or lengthen your chin. A weak chin is the result of a relatively small mandible or sometimes can indicate occlusion problems with your teeth. If you do have a problem with your occlusion, then it is possible your would need orthodontic correction or even a larger surgery that involves cutting the mandible. If you do not have a problem with your occlusion, then a chin implant, most commonly performed with a small incision under the chin, if the best option.

Q: My nose is not symmetrical and not getting better result after Rhinoplasty?

A: If you had rhinoplasty almost 1 year ago, swelling should be nearly completely resolved by now and you should be able to see the “real” contours of your nose. That being said, however, thick, oily skin tends to retain swelling for a longer period of time and final results tend to be somewhat blunted as the underlying bony and cartilaginous contours are more difficult to see under thicker nasal skin. If your nose is asymmetric at this point, the best course would be to see the surgeon who performed the original surgery and discuss the asymmetries. If you would rather see a new facial plastic surgeon, make sure to bring pictures from before the original surgery and an operative report if available so that you can be evaluated in the context of what was actually done surgically.

Q: I Got Elbowed on my Nose 2 Months After Rhinoplasty?

A: It is possible that being hit in the nose as you’ve described may have fractured your nose and, in that case, may have shifted the nasal bones or cause some reactive bony growth as a healing reaction at a fracture line. The cartilage of the nose itself shouldn’t grow, but may shift as a result of the injury. Swelling of the skin and soft tissue covering the nose that normally lasts at least to some degree for 1 year after rhinoplasty will likely be set back somewhat as a result of the injury.

It would be best to have your nose evaluated to see if it was fractured and what if any additional treatment you may need.

Q: Hit My Nose With a Metal Bar. Hump On Nasal Dorsum?

A: If it is still early after the injury, you may have some soft tissue swelling that can cause an irregular appearance of the nose, however, that would improve over the course of a month. If the appearance of your nose has not improved over this time or if you feel a firm lump/bump/hump, it is certainly possible that you may have fractured your nose, causing either a bony or cartilaginous irregularity. In that case, a rhinoplasty can be performed. I can perform this rhinoplasty endonasally, a technique that avoids any external skin scars. This would be the optimal approach for what you are describing. Massage would not eliminate a bony or cartilaginous deformity.

Q: If I Have a Plate in my Neck Can I Still Have Ultherapy?

A: The plates are likely on the spinal column, which is much deeper than the deepest area of treatment reached by the ulthera device (4.5 mm).  Of course, you should pursue a consultation with a Facial plastic surgeon who can examine you and confirm this, but it shouldn’t be a problem.

Q: Is It Ok To Have an RN Perform Ulthera on me, Or Should It Be a Board Certified Doctor?

A: The FDA regulates who is allowed to perform treatments with medical devices, and many are limited to doctors only.  However, Ulthera can be performed by both doctors and nurses.  Regardless of the person performing the treatment, they must be trained appropriately in the use of the device.  As long as the physician provides appropriate treatment planning and oversight, it should be fine for a nurse to perform the treatment.

Q: Tracheotomy Scars and Neck Lift?

A: While the tracheotomy scar likely passes deep to the plane of the neck lift, and will act like an “anchor” unless a releasing procedure is performed, this should be possible at the same time as your neck lift.  However, as with any scar revision you are trading one scar (in the case of the tracheotomy, a scar performed under “non-cosmetic” conditions) for another one, albeit on that is performed with cosmesis as the primary consideration.  

Botox is not an option for this. 

Q: Lasting Pseudoherniation of the Buccal Fat Pad/peri-oral Mound After Second Botox Treatment to Masseters

A: It seems unlikely that injection into the masseter muscle would cause weakness elsewhere.  However, if there is any change due to the botox, i.e. the undesireable appearance of your “peri-oral mound”, then it will return to your normal pre-injected appearance in a few months.  On the other hand, if it is due to something else, then it may not improve. 

Q: What Type of Chin Surgery Should I Have to Correct my Chin?

A: Reviewing your photographs suggests that the vertical projection of your chin is deficient.  Our understanding of what people consider “aesthetic” tells us that the distance from the base of the nose to the oral comissure (line between upper and lower lip) should be 1/2 the distance from the comissure to the lowest point on the chin.  This is best assessed when viewing from the front.  In the picture you provided, it appears that this ratio is closer to 1:1.

Also, you may have too much anterior projection in just one area, leading to the “shelf” you describe.  Often these issues can be addressed with simple countouring of the bone and correction of the projection with implants.  Of course, your facial plastic surgeon will be able to provide more detail. 

Q: Can Fascia or Acellular Dermis in Rhinoplasty Cause Infection ?

A: As with any surgical procedure, infections are some of the most common complications experienced by patients.  While this is true, the overall infection rate for most cosmetic procedure is very low.  However, infection rates tend to be slightly higher when foreign material is implanted.  While it is possible for the implanted material to have harbored an infectious agent that caused an infection after its placement within the body, what is more likely is that the implant material acts as a “safe harbor” on which bacteria can hide from the body’s immune system, preventing the body from clearing the infection easily.  Of all implanted materials, fascia or acellular dermis (alloderm) will integrate into the body much better than other materials (i.e. silastic, goretex, medpor), and therefore infections in the presence of these materials often respond to antibiotics.  Remember, and regardless of the presence or absence of implanted material infections can sometimes occur, and usually resolve with antibiotics but sometimes requires removal of an implant.

Q: Droopy Eyelids from Botox?

A: Hi,  what you’ve experienced is Eyelid Ptosis, or drooping of the eyelid due to inadvertent relaxation of the levator palpebrae superioris muscle.  this is one of the muscles responsible for raising the eyelid, and so weakening this muscle results in the droop that you are experiencing.  this can occur due to transit of the botox/dysport through a structure called the orbital septum, that separates the contents of the orbit from the surrounding tissues.  The exact reason why this occurs is not completely understood.  Luckily the effect of Botox is temporary and the ptosis usually lasts much briefer than the wrinkle reduction effects.  Also, if the droopy eyelid(s) bother you significantly then there are other eye drops that your physician can prescribe that can improve things.

While some plastic surgeons report  different rates of this complication, it is believed that this can occur after between 5 and 10% of Botox injections to the brow region.  Most plastic surgeons with years of experience in Botox and dysport injecting can avoid this complication 99% of the time, which is why it is very important that you choose someone trained and qualified in Botox/dysport injection-Ideally this would be a facial plastic surgeon.

Q: Is It Safe to Get Pregnant After Botox?

A: Botox cosmetic is pregnancy category “C”, meaning that NO human or animal studies have been done.  However, the theoretical risk is quite low.  Botox is thought to remain in the area(s) injected, and therefore transit to the fetus would not be likely, especially months afterwar your injection.  Also, any Botox that entered your bloodstream via reabsorption in March would be long gone prior to July.  While no one can say that it is perfectly safe unless large scale human studies had been done, it is very unlikely that Botox can cause a problem under the circumstances you have described.

Q: Can Botox Migrate to the Retina if Injected on the Forehead and Cause a Blind Spot?

A: Injections of other medications, especially steroids but even fillers, can enter a blood vessel and result in embolization or thrombosis of a vessel.  It this were to occur to the central retinal artery, then it COULD cause blindness.  However, this would be very difficult to accomplish unless you were injecting deep into the orbit, or trying intentionally to inject into another artery that supplies this area.  None of the superficial facial or forehead vessels do this, and so injection of material into these areas is considered safe practice.  

And while these concerns may exist for other materials, the theoretical risk of Botox causing a similar problem is even lower.  Even though Botox has been shown in animal studies to transit the nerve via axoplasmic transport and end up in the cell body in the central nervous system (CNS), the amount of Botox that can make it to the CNS is miniscule and there has never been shown to be any real impact of this phenomenon.  Also, it has never been shown to occur in humans anyway.

Read Our Reviews

“I have been going to Dr. Mittelman for various procedures since 1999. He is personable, easy to talk to and absolutely sane about what to do and when. I appreciate his calm advice as much as i do his surgical skills, which are_the best_ A special note about the staff – they are considerate and…”

Hank B.

“I had my upper eyelids done by Dr. Mittelman. I was expecting improvement, but I think the results are fabulous. Dr. Mittelman and I talked a lot about what I was hoping to get out of the surgery and what he thought was possible. I had some wrinkles and heavy “hooding” that made me look…”

Mary S.

“Over the years I have had different procedures done by Dr. Mittelman. I prefer to have the smaller surgeries as I go along the way, they are less invasive and provide more natural results. Dr. Mittelman has delivered excellence in professionalism each and every single time. H is an excellent plastic surgeon, more like a…”

Jaqueline D.

“Dr. Mittelman, the master of administering BOTOX with fabulous results! His staff is super friendly and their office is extremely diligent in providing a safe, sterile, and clean environment, particularly during these unprecedented times – COVID-19”

KM from Monte Sereno

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