Dr. David W. Kim in San Francisco is an internationally acclaimed Facial Plastic Surgeon who uses advanced techniques and procedures that are the safest and most successful.


Non-Surgical Treatment Q & A’s

What are some of the unconventional areas where fillers and Botox can be used?

1) BOTOX for the Depressor Anguli Oris (DAO)

Patients are familiar with treatment for marionette lines with Juvederm/Restylane, but it is also beneficial to have small amounts of Botox injected in a group of muscles called the DAO. By doing so, this can subtly raise the corners of the mouth. When combined with fillers the benefits are enhanced with tissue support and muscle relaxation to prevent a downward pull.

Depressor Anguli Oris diagram

2) Fillers for the temples

Noticeable hollowing of the temples is a common sign of aging that can be helped by the use of dermal fillers. Juvederm, Radiesse and Sculptra are all great options for filling out the contours and restoring a youthful appearance to the face. Fillers in the temples tend to last longer compared to other areas of the face due to the lack of movement. Sculptra has results that can last up to two years with Juvederm/Radiesse lasting about a year. It is an often overlooked area that can make a significant difference when addressed.

3) Botox for extreme sweating

BOTOX helps control the symptoms of severe underarm sweating by temporarily blocking the chemical signals from the nerves that stimulate the sweat glands. When the sweat glands don’t receive chemical signals, the severe sweating stops. BOTOX is expected to temporarily stop the production of excessive sweat in the treated areas only. Your sweat doesn’t go anywhere or get backed up because the sweat simply is not produced in the areas treated with BOTOX. Remember, the rest of your body is free to produce moisture normally.

During the procedure at the doctor’s office, a small amount of BOTOX is injected into the affected underarm area through a very fine needle. The actual procedure takes about 10 to 15 minutes and lasts up to seven months. You should notice a significant reduction in underarm sweating within four weeks of your first treatment

4) Bunny Lines

Bunny lines are wrinkles formed on the sides of the nose when a patient animates. Depending on each individual’s unique expressions, some bunny lines are more apparent than others. Small amounts of Botox (two to four units) can be injected into these muscles to relax and prevent the deepening of lines over time.

5) Non Surgical Rhinoplasty

Fillers can be used to augment the nasal bridge without having to go through an invasive surgical procedure. A small amount of filler is used to create height and definition with immediate results.

Q: Is It OK for a Nurse to Inject Me Instead of a Physician?

A: Injectables can be administered by an experienced RN or MD.

Experience matters. I know of several nurse injectors who are skillful, meticulous and experienced. I also know of some physicians who occasionally perform injections, but do not have much expertise in this area. You need to do your diligence on the experience and performance of the practitioner whether s/he is an RN or an MD.

Q: Can Botox be used for forehead lines on a 21-year-old?

A: No age limitations, but 21 years old is pretty young for Botox.

There are no absolute age limitations although 21 years old is pretty young for Botox. If you receive treatment, I would be conservative in the amount used at first. I have treated some young patients with really severe frown lines (between the eyebrows) but not so much for horizontal forehead lines. It would all depend on an examination and evaluation though. Good luck!

Q: Is there a non-surgical facelift that works?

A: Nothing can replace a facelift.

There are alternatives such as fillers (“liquid facelift”), skin resurfacing or skin care, but nothing can replace the repositioning, lifting and fixation that occurs during a facelift. You can think of a facelift as a “curative” treatment while some other non-surgical approaches are more “Band-Aid” solutions.

Q: Can Radiesse be injected without Xylocaine?

A: Radiesse can be injected without Xylocaine.

It all depends on your pain tolerance. For our patients, we usually use only a topical numbing cream (which we obtain freshly prepared from our pharmacy for greater effectiveness). Like some of the other doctors, I will mix the Radiesse with a small volume of lidocaine to lessen the discomfort. I would say only about 10% of my patients end up receiving a lidocaine numbing shot before the procedure.

Q: What is the difference between fat transfer and Sculptra?

A: Fat transfer and Sculptra can work well, but both can cause problems.

Fat transfer typically leads to partial long-term fill. Some of the fat gets reabsorbed by your body and some will survive, so there may not be a uniform contour by the time all is said and done. Sculptra can also lead to bumpiness, but I have found it to be much less than fat, particularly if the Sculptra is diluted and injected a bit deeper into the tissue.

Q: Will Restylane be damaged by IPL or Refirme?

A: It is safe to have IPL and/or Refirme if you have Restylane.

This is actually a fairly common combination of treatment for patients in my practice. There are minor risks for each procedure independently, but no evidence that these risks increase when both treatments occur in the same patient.

Q: Which is the better treatment – Fraxel or Active FX?

A: I prefer the FX system because it is more highly powered.

The FX system has a higher power source allowing for the energy to be delivered in shorter bursts. This creates less thermal heating and permits greater energy delivery in shorter durations and thus less discomfort. Both systems can lead to good results if performed appropriately, but for my patients who have experienced both, most seem to prefer the FX for comfort and results.

Q: Are These Tear Troughs, and What Can I Do About Them?

A: HA fillers can be used.

Sometimes tear troughs are genetic and can appear at an early age. HA fillers can be injected into the cheeks/tear troughs to smooth any pronounced hollowing. Conservative and gradual addition of fillers can help to enhance this area with minimal risk if done by a trained professional.

Q: Was Restylane Injected into a Vein/Nerve?

A: Follow up with your practitioner.

You may be feeling pressure on a nerve for a number of reasons, including swelling or the product, or possible trauma to the nerve from the needle. This rarely causes permanent damage. Follow up with your practitioner so that he or she can evaluate you in the office. In most cases this resolves on its own, and if the product is applying pressure, a neutralizer can be used to dissolve it.

Q: Why Do I Look Worse After Juvederm?

A: Follow up with your physician.

Unfortunately, some patients experience bruising and an undesirable result following treatment with a tear trough filler. You may be experiencing a Tyndall effect from the Juvederm, whereby the filler reflects light, resulting in a bluish tinge.

Have your practitioner reassess the area and discuss what some of your options are. Now that you are three weeks post-procedure, a follow-up is necessary.

Q: What About this Persisting Juvederm Lump?

A: There is a very slight chance the filler is still there.

In rare instances, the Juvederm filler stays around for longer than expected. Have your injector use a small amount of hyaluronidase to see if it will respond.

If it does not respond, you can look into other solutions with your provider.

Q: What about Juvederm Removal with Hyaluronidase Injections?

A: Hyaluronidase only breaks down hyaluronic acid.

Hyaluronidase does not dissolve collagen — only hyaluronic acid. If not used conservatively, it can break down natural hyaluronic acid in the skin, giving the appearance of increased loss in volume.

Using conservative amounts and starting slow are the keys to minimizing excessive hyaluronic acid breakdown.

Q: Is It OK for a Nurse to Inject Juvederm Instead of a Physician?

A: Juvederm and other fillers can be applied by an experienced RN or MD.

Experience matters. I know of several nurse injectors who are skillful, meticulous and experienced. I also know of some physicians who occasionally perform injections, but do not have much expertise in this area. You need to do your due diligence and look into the experience and performance of the practitioner, regardless of whether s/he is an RN or an MD.

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Why Dr. Kim Chose The Medical Field?

Dr. Kim's Philosophy On Beauty

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I Was Not Nervous

I Can Breathe Again

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Testimonial – Vanessa

Testimonial – Wanda

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Breathing Is Not Always Easy

Have You Seen It All?

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How Do You Keep Up With New Tech?

How Do You Treat Your Patients?

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How Much Downtime To Expect?

Many People Want Subtlety

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Millions Of People Can't Breathe

Most Drastic Example?

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People Should Be Treated Well

Reconciling Vision To Make People Happy

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Results Should Reflect Individual Desires

Talk About Philosophy On Beauty

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Talk About Your Personal Approach

The Asian Eye

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The Goal Is To Make Someone Happy

Transformation And Rejuvination

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What Do You Say To Someone Afraid Of Surgery?

Why Dr. Kim Got Into Surgery

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Dr. Kim's Professional Background

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Media Appearances

Thanks to his expertise, Dr. Kim has made numerous appearances on television, radio, in print publications and at professional conferences. He’s written and talked about topics ranging from mommy makeover to rhinoplasty to skin cancer removal. Please browse through Dr. Kim’s media coverage, which includes his groundbreaking “Study on Beauty.”