Manuel A. Lopez, MD, FACS

Board Certified Facial Plastic Surgeon

(210) 495-5771 (LPS1)
(210) 495-2367          
Lopez Plastic Surgery
1314 E. Sonterra Blvd, Suite 5104
San Antonio, Texas 78258

Botox & Fillers

As we age our facial tissue not only descends because of the constant pull of gravity, but we also lose volume as our facial fat atrophies and our skin thins. Historically, we have dealt well with the descent of tissue by doing lifting procedures, but the deflation of the face has been poorly dealt with. Dr. Lopez addresses not only the descent of tissues with either a Facelift, browlift, eyelid lift, or necklift, but he also addresses the loss of facial volume by augmenting the facial tissues in areas that will provide a more youthful appearance. For the thinner areas of the face such as the lips and lower eyelids Dr. Lopez prefers to use Juvederm. Juvederm is a hyaluronic acid filler that in his practice lasts about 1 year. For areas of the face that are thicker, Dr. Lopez prefers Radiesse which is a calcium hydroxylapatite filler that lasts 14-18 months. For patients that desire more permanent or longer lasting results, Dr. Lopez prefers performing fat augmentation. Dr. Lopez uses the patient’s own fat cells usually from the abdomen or thighs and augments the areas of the face that have lost volume. For patients that prefer to not have a surgical procedure and still desire a longer lasting filler, Dr. Lopez recommends Sculptra which is poly-L-lactic acid and can last up to two years. Please click on the product or procedure for more information.


BOTOX

There are only a few nonsurgical treatments that Dr. Lopez considers to have truly youth-maintaining abilities. Botox is a medication when used correctly can help to maintain a youthful appearance in the face and especially the eye area. It is interesting that when Dr. Lopez questions his patients over the age of 60 weather they would have used Botox starting in their 30’s to prevent the wrinkles on their face; the answer almost uniformly is a resounding yes. However there are a significant number of people in their 30’s that state they want to age gracefully and allow the wrinkle to form. Of course that is until the wrinkle start forming. Botox is a wonderful way to prevent the lines of age from forming.

A common misconception is that Botox actually paralyzes the muscles in the face. Although, with extreme amounts of Botox, this can happen, Dr. Lopez injects just the right amount that allows his patients to have some limited activity but not so much that they have over-activity of the areas that are treated. Dr. Lopez emphasizes to the patient that Botox is not used to keep them from expressing themselves but simply to keep them from making facial grimaces and frowns that have become habits and are unintended. Most people will not notice that a Botox procedure has been performed but simply that the patient looks more rested or happier.

Botox – Frequently Asked Questions

1. What is Botox?
Botox is the brand name for botulinum toxin type A. It is the purified form of the toxin which when injected in small doses into specific muscles blocks the chemical signals that cause muscles to contract. When the muscles can’t tighten, the skin flattens and appears smoother and less wrinkled.

2. How was this found?
The FDA (Food and Drug Administration) approved Botox over 10 years ago to treat involuntary spasms of muscles around the eyes. Doctors noticed that patients were asking to be injected on the side that did not have spasms as well because they saw that not only did Botox get rid of the spasms, but it also made the wrinkles go away. Botox cosmetic was founded because of this observation. The Food and Drug Administration (FDA) has approved Botox as a temporary treatment for moderate to severe frown lines between the eyebrows.

3. How does Botox work?
Wrinkles may be caused when a muscle tightens. Botox is injected through the skin into the muscle. Botox prevents the nerve from releasing a chemical to make the muscle contract. When the muscle can’t contract, the wrinkles go away. After 3 to 4 months, the effect of Botox wears off and the nerve again releases the chemical to cause contraction of the muscle.

4. What happens over time?
Botox works for about three to four months. As the muscle returns to normal, you will see the wrinkles again. Dr. Lopez recommends that you are treated every 3 to 4 months to prevent wrinkle formation.

5. How Is the Procedure Performed?
The procedure takes only a few minutes and no anesthesia is required. Botox is injected with a very fine needle into specific muscles with only minor discomfort. It generally takes three to five days to take full effect and it is best to avoid alcohol at least one week prior to treatment. Dr. Lopez recommends if possible to stop taking aspirin and anti-inflammatory medications two weeks before treatment in order to reduce bruising.

6. Are there any side effects?
As with any medication there are potential side effects with Botox. Most commonly there may be pain, redness, bruising or swelling at the injection site. These are generally mild in nature. If placed by an inexperienced person you may develop a droopy eyelid or the eyebrows may descend. Very rarely you may develop headache or flu-like symptoms.

7. Who should not receive Botox injections?
Dr. Lopez will not inject Botox into patients who are pregnant, breastfeeding or have a neurological disease such a myasthenia gravis.

8. When can I resume normal activity?
You can return to your normal activities 30 minutes after your treatment. However, one should avoid strenuous activity for several hours afterwards because of an increased risk of bruising and avoid lying down for 2-4 hours.


FACIAL FAT AUGMENTATION

Facial fat augmentation is a procedure that involves moving fat from one area of the body to an area of the face to improve contour, correct defects, or enhance features. Dr. Lopez is experienced in placing fat throughout the face to restore the soft tissue volume of the face that is lost as we age.

The procedure involves harvesting fat through a liposuction canula (tube) from the abdomen or thighs. The fat is then very carefully prepared for re-implantation by spinning the harvested material in a centrifuge to separate the fat cells from the rest of the fluid. Dr. Lopez then injects the fat with a blunt needle and syringe into the desired locations such as the cheeks, under the eyes, or the lips. Dr. Lopez uses tiny incisions on the face that are typically closed with 1- 2 very small sutures.

The fat augmentation procedure is performed on an outpatient basis with local anesthesia and some sedation if patients prefer. Even though the sutures Dr. Lopez uses are dissolvable, he removes any remaining suture material at approximately 1 week to ensure near invisible wound healing. Most patients are able to return to work within a few days to a week, although swelling may take longer to subside.

Harvesting the fat from the abdomen and thigh is meant to acquire sufficient material in a minimally traumatic fashion to restore volume to the face. Dr. Lopez counsels his patients before the procedure that the goal is not a flatter belly or sleeker thighs. In fact there is in general no appreciable difference in the appearance of the donor site because the amount of fat removed from the donor site is minimal compared to traditional liposuction surgery.

Facial Fat Augmentation – Frequently Asked Questions

1. What is Facial Fat Augmentation?
Facial Fat Augmentation is a procedure where a patient’s own fat cells are transferred from their abdomen or thighs to areas of their face to restore facial volume that is lost with age.

2. What is Facial Fat Augmentation used for?
Dr. Lopez uses Facial Fat Augmentation to fill moderate to severe facial wrinkles and folds in the areas of the face that have thicker skin such as the nasolabial folds– the creases that extend from the corner of your nose to the corner of your mouth. Facial Fat Augmentation is a procedure for patients that desire longer term correction.

3. Can Facial Fat Augmentation work for me?
You should also not choose a Facial Fat Augmentation procedure if you desire only short-term results.

4. How does Facial Fat Augmentation work?
Fat cells are harvested from the patient’s abdomen or thighs in a minimally traumatic fashion. The fat cells are isolated by using a centrifuge. The fat is then injected into the face with a small canula (tube) to restore facial volume.

5. Does Facial Fat Augmentation hurt?
Dr. Lopez uses both local anesthesia as well as sedation if the patient desires to minimize the discomfort of the procedure.

6. Are skin tests needed before a Facial Fat Augmentation?
No skin testing is required prior to the procedure as Dr. Lopez is using the patient’s own cells.

7. Should I tell Dr. Lopez what medications I am taking?
Yes. You should tell Dr. Lopez about all the medicines you are taking, even over the counter medicines or treatments. If you are taking blood thinners or medications that may interfere with clotting of the blood, such as aspirin, you might be more likely to have bruising or bleeding at the injection sites.

8. What can I expect to happen at a treatment session?

  • Dr. Lopez will answer all of your questions and prepare you for the procedure.
  • The face and abdomen or thighs will be cleansed with an antiseptic.
  • The fat will be harvested from the selected donor site and then injected in small amounts under the skin using a very fine canulas (tubes).
  • An ice pack will be applied to the treatment area after treatment to help reduce swelling.

9. What are possible side effects of Facial Fat Augmentation>?
The most common side effects are redness, bruising, or swelling. These side effects generally last for a few days up to a week and are dependent on the amount of volume restoration performed. As with all procedures that involve an injection through the skin, there is a risk of infection.

10. What can I expect after treatment?
For approximately 24 hours after treatment:

  • Avoid significant movement or massage of the treated area.
  • Do not apply makeup.
  • Avoid extensive sun or heat exposure.

After you leave the office, you may experience redness, bruising or swelling for a few days. You will be able to feel the areas where Facial Fat Augmentation was performed for some period after injection. Over time, the injected area will feel more and more like the surrounding tissue.

11. How quickly can I get back to my daily activities?
Most patients feel comfortable going back to their normal activities within a few days up to a week dependent on the amount of bruising and swelling.

12. How many treatments are required?
Generally, significant changes are achieved after the initial procedure. Dr. Lopez often suggests an enhancement procedure approximately 6 months after the initial procedure to achieve optimal results.


JUVEDERM INJECTIBLE GEL

As we age, our skin changes. Over time, the natural volume of youthful skin begins to diminish as wrinkles and folds form. To combat these changes, Dr. Lopez often uses Juvederm injectable gel. You don’t have to just sit back and let your face show the signs of aging. Approved by the FDA, Juvederm injectable gel is a “next-generation” dermal filler. Dr. Lopez prefers Juvederm for the thinner areas of the face such as the lips and lower eyelids. The smooth consistency gel helps to instantly restore your skin’s volume and smooth away facial wrinkles and folds.

Juvederm is a smooth consistency gel made of hyaluronic acid—a naturally occurring substance in your skin that helps to add volume and hydration. Dr. Lopez places Juvederm injectable gel under the skin to provide a smooth, natural look and feel. In fact, studies show superior results of Juvederm compared to collagen-based dermal filler. In addition, Juvederm injectable gel is the first FDA-approved hyaluronic acid dermal filler that is proven to be safe and effective for persons of color.

You should avoid the following for at least 24 hours after your treatment:

  • Strenuous exercise
  • Consumption of alcoholic beverages
  • Extended exposure to sun or heat

Exposure to any of the above may cause temporary redness, swelling, and/or itching at the injection sites. If you have swelling at the injection site, you can apply an ice pack for a brief period.


RADIESSE INJECTIBLE FILLER

Radiesse is made of unique calcium-based microspheres that are suspended in a natural gel that is injected into the skin through a simple, safe and minimally invasive procedure. It is FDA approved to safely correct wrinkles and folds around the nose and mouth, including the nasolabial folds. Radiesse is able to give an immediate correction in a treatment that can be performed over your lunch hour. The results are longer lasting as it stimulates your skin to produce new collagen. A great advantage of Radiesse over collagen is that no allergy testing is required prior to your treatment. It is Dr. Lopez’s experience that Radiesse last around 14 months. Hundreds of thousands of patients have experienced Radiesse. Through years of clinical studies and independent research, Radiesse has proven to be safe and effective.

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