The holiday season with all its parties, family gatherings, and New Year’s resolutions can be stressful for men and women of all ages because this is typically a special time when they want to look and feel their best despite all the stress frequently associated with holiday events.
Dr. Mark A. Bishara, M.D. P.A. and his staff at The Paragon Plastic Surgery and Medspa can help each individual man or woman look and feel their best for all holiday events coming up.  Dr. Bishara takes the time to cultivate individual relationships with his patients in order to assure that they receive their desired look.  He uses the term “patient” because he says, “I feel the term patient is a more personal and appropriate term because I am working with people in personal ways.”
In his new state-of-the art facility completed in 2014, he offers the full gamut of cosmetic procedures such as robotic hair restoration, breast augmentation, tummy tuck and a variety of laser procedures. The calming music and soothing décor of his new facility create an atmosphere to ease the nerves of any anxious patient.  “Sometimes patients come in extremely nervous, and my goal is to provide a calming, relaxing environment to reduce their anticipated anxiety,” he said.  Additionally, Dr. Bishara takes the time to listen, discuss and explain all treatment options before outlining an appropriate treatment plan.
In his Paragon office in Mansfield, Dr. Mark A. Bishara, M.D. P.A. offers “Wrinkle-Free Wednesday.”  Patients can come in for Botox and Xeomin treatments at discounted rates.  It’s easy to see why this is the most popular and busiest day of the week for Dr. Mark A. Bishara, M.D. P.A. and his staff.  He treats hundreds of patients seeking these non-invasive, preventive procedures from 8am until 8pm.  “We go through enough Botox to remove every single wrinkle from an elephant’s skin,” he grinned, “but my goal is for them to still look like themselves,” he explained.
Also, as an AAAHC certified facility and dual trained surgeon, he can provide acute care as well as cosmetic surgical services.  His goal is to make sure that every patient’s needs are satisfactorily and effectively met.  In the spirit of giving this holiday season, Dr. Mark A. Bishara, M.D. P.A. plans to open a combined clinic that will offer reduced rates for general surgical procedures including lumpectomy, advanced laparoscopic hernia and gallbladder procedures, and varicose vein ablation.
“The current medical system in this country is not sustainable.  Hospitals and surgery centers charging $11,000 for a 15-minute procedure is simply not feasible when it could be offered at a more reasonable price,” he said.  These large centers are sometimes bound to hold pricing high due their contracted rates with insurance companies.  As a responsible physician, he wants to provide clinical services that promote and foster a medical system that is sustainable and affordable.  That is why he has announced the addition of four advanced laparoscopic surgeons to the staff at the Paragon Surgery Center in Mansfield.  Surgical procedures are now being offered to all patients state-wide for a cash price that is often less than some deductible plans.  Although this system is intended to be cash based, some patients will still be able to submit the charges for reimbursement through their out of network benefits.
As his services continue to grow and expand, Dr. Mark A. Bishara, M.D. P.A. has two other locations for the convenience of his patients; Southlake and North Park.
As the holiday season and the new year approach, let Dr. Bishara and his staff help you look and feel your best.  Call one of his three convenient locations at 817-473-2120 or email to make an appointment and ensure that you enjoy the holidays knowing that you truly look your best!

What are dermal fillers?

Most of our patients know the benefits of using Botox or Xeomin for their fine lines, but fillers are an underutilized injectable that everyone needs to know more about.

Dermal fillers help to diminish facial lines and restore volume and fullness in the face.
As we age, our faces naturally lose subcutaneous fat. The facial muscles are then working closer to the skin surface, so smile lines and crow’s feet become more apparent.
The facial skin also stretches a bit, adding to this loss of facial volume. Other factors that affect the facial skin include sun exposure, heredity, and lifestyle.
Dermal fillers can be used to:

  • Plump thin lips
  • Enhance shallow contours
  • Soften facial creases and wrinkles
  • Improve the appearance of recessed scars

Dermal fillers can be very helpful in those with early signs of aging, or as a value-added part of facial rejuvenation surgery.

What dermal fillers won’t do

For some patients, surgery such as a facelift, brow lift, or eye lift may be the best approach. Non-surgical rejuvenation treatments, such as soft tissue fillers, cannot achieve the same results, but may help delay the time when consideration of a facelift becomes appropriate.

Hyaluronic Acid Wrinkle Fillers

The most popular category of wrinkle fillers is hyaluronic acid. Each type works in a slightly different way with varying results.
Side effects are rare but can include redness, swelling, and bruising at the injection site. The filler may also show up under the skin as tiny bumps. This is a problem that often improves over time.
How long the results last varies from several months to over a year or two. Some research shows that repeated injections may help stimulate the body’s own natural production of collagen. That will help reduce the number of lines and wrinkles. There is also some evidence that less filler is needed over time to achieve the same look.
Hyaluronic wrinkle fillers available in our office include:

  • Belotero Balance– BELOTERO BALANCE® temporarily smooths out and fill in moderate-to-severe nasolabial folds (the folds or wrinkles that go from the side of the nose to the corner of the mouth).  BELOTERO BALANCE® is a hyaluronic acid (HA) injectable filler that completely integrates into the skin tissue. While some fillers are designed to rebuild facial volume and structure, BELOTERO BALANCE specifically treats moderate-to-severe etched-in lines and wrinkles such as vertical lip lines above and around the lips. This is also a great filler for under the eyes.
  • Juvederm Ultra Plus– JUVÉDERM® is the first and only non-surgical hyaluronic acid (HA) filler FDA-approved to instantly smooth moderate to severe wrinkles around your nose and mouth for up to one year with optimal treatment.
  • Juvederm Voluma XC– JUVÉDERM VOLUMA® XC is the first and only FDA-approved injectable gel to instantly add volume to your cheek area to correct age-related volume loss in adults over the age of 21. It can provide you contour and a subtle lift for up to two years with optimal treatment.


  • RADIESSE® is a dermal filler that temporarily adds volume to help smooth moderate to severe facial wrinkles and folds. RADIESSE is a wrinkle filler used to plump the skin. RADIESSE is injected through a small needle and placed under the skin. Immediately, this filler works to add volume under the skin and over time, the benefits of RADIESSE continue by naturally stimulating your body’s own natural collagen. The natural results have been shown to last a year or more in many patients, making the treatment results both immediate and long lasting.


en Español

¿CUÁLES SON rellenos dérmicos?
La mayoría de nuestros pacientes conocen los beneficios del uso de Botox o Xeomin por sus líneas finas, pero rellenos son un inyectable subutilizado que todo el mundo necesita saber más.Los rellenos dérmicos ayudan a disminuir las líneas de expresión y restaurar el volumen y la plenitud en la cara.
A medida que envejecemos, nuestros rostros naturalmente pierden grasa subcutánea. Los músculos faciales son entonces trabajando más cerca de la superficie de la piel, por lo que sonreír líneas y patas de gallo se hacen más evidentes.
La piel de la cara también se extiende un poco, añadiendo a esta pérdida de volumen facial. Otros factores que afectan a la piel de la cara incluyen la exposición al sol, la herencia y el estilo de vida.
Los rellenos dérmicos se pueden utilizar para:
Plump labios finosMejorar contornos superficialesSuavizar las arrugas faciales y arrugasMejorar la apariencia de las cicatrices hundidasLos rellenos dérmicos pueden ser muy útiles en aquellos con los primeros signos de envejecimiento, o como parte de valor añadido de la cirugía de rejuvenecimiento facial.
QUÉ rellenos dérmicos NO HARÁ
Para algunos pacientes, la cirugía, como un lifting facial, levantamiento de cejas, o levantamiento de los ojos puede ser el mejor enfoque. Tratamientos de rejuvenecimiento no quirúrgico, como rellenos de tejidos blandos, no pueden lograr los mismos resultados, pero pueden ayudar a retrasar el momento en que la consideración de un lavado de cara se vuelve apropiada.
Rellenos de arrugas ÁCIDO HIALURÓNICO
La categoría más popular de rellenos de arrugas es el ácido hialurónico. Cada tipo funciona de una manera ligeramente diferente, con resultados variables.
Los efectos secundarios son raros pero pueden incluir enrojecimiento, hinchazón y hematomas en el sitio de la inyección. El relleno también puede aparecer bajo la piel como pequeñas protuberancias. Este es un problema que a menudo mejora con el tiempo.
¿Cuánto tiempo duran los resultados varía desde varios meses a más de un año o dos. Algunas investigaciones muestran que las inyecciones repetidas pueden ayudar a estimular la producción natural del cuerpo de colágeno. Eso ayudará a reducir el número de líneas y arrugas. También hay alguna evidencia de que se necesita menos de relleno con el tiempo para alcanzar la misma mirada.
Rellenos de arrugas hialurónico disponibles en nuestra oficina incluyen:
Belotero Balance- BELOTERO BALANCE® suaviza temporalmente fuera y complete los pliegues nasolabiales moderados a severos (los pliegues o arrugas que van desde el lado de la nariz hasta la comisura de la boca). BELOTERO BALANCE® es un relleno inyectable de ácido hialurónico (HA) que integra completamente en el tejido de la piel. Mientras que algunas cargas están diseñadas para reconstruir el volumen facial y estructura, BELOTERO BALANCE trata específicamente de moderada a grave arrugas y líneas grabadas en tales como líneas verticales de los labios por encima y alrededor de los labios. Este es también un gran relleno para debajo de los ojos.Juvederm Ultra Plus-JUVÉDERM® es el primer y único relleno no quirúrgico ácido hialurónico (HA) aprobado por la FDA para instantáneamente suave arrugas moderadas a severas alrededor de la nariz y la boca para un máximo de un año, con un tratamiento óptimo.Juvederm Voluma XC- JUVÉDERM VOLUMA® XC es el primer y único gel inyectable aprobado por la FDA para agregar instantáneamente volumen a tu área de la mejilla para corregir la pérdida de volumen relacionado con la edad en los adultos mayores de 21. Se le puede proporcionar el contorno y un ascensor sutil para un máximo de dos años con un tratamiento óptimo.
¿Cuál es RADIESSE?
Radiesse es un relleno dérmico que añade volumen temporalmente para ayudar a suavizar las arrugas moderadas a severas y pliegues faciales. Radiesse es un relleno de arrugas utilizado para rellenar la piel. RADIESSE se inyecta a través de una pequeña aguja y se coloca debajo de la piel. Inmediatamente, este relleno trabaja para aumentar el volumen debajo de la piel y con el tiempo, los beneficios de RADIESSE continúan estimulando naturalmente propio colágeno natural de su cuerpo. Los resultados naturales han demostrado durar un año o más en muchos pacientes, por lo que los resultados del tratamiento, tanto inmediatos y duraderos.

Small and fine, a line tends to occur from repeated muscle movement that etches a slight mark into the skin.  Those who smile, frown or squint a lot develop fine lines earlier than those who don’t make these facial expressions as often.  When skin is young it snaps back into place, but as we get older it loses elasticity, so that ability to spring back becomes harder and less frequent, causing more premature lines.
Thicker and more dramatic in nature, wrinkles are noticeable folds, ridges and creases in skin.  Wrinkles can be caused by age, collagen and elastin breakdown, too much sun exposure, medications and dry, dehydrated skin.  Wrinkles are different from lines in that they are more diffuse throughout the face.
Different fillers are good for different people.  When there is a loss of volume from deterioration of the bone or fat pads, the skin loses its scaffolding and signs of aging such as sagging skin and wrinkles are created.  By using fillers early, we can slow down the aging process and maintain a natural, youthful appearance.  Fillers stimulate collagen and add volume to plum wrinkles.  Collagen-stimulating fillers such as Radiesse  and Juvederm work on thick folds and wrinkles.  Volumizing fillers are important in maintaining a youthful appearance.
Injectable Toxins:
Injectable toxins like Botox and Xeomin work to smooth out the skin’s surface by temporarily stopping the contraction of the muscles that are responsible for creating wrinkles.  Neuromodulators prevent muscles from allowing the movement that creates the fold, and over time, often reverse the lines that may already be present in the skin.  Botox and Xeomin are great for patients that start to see a trace of a wrinkle when the face is at rest.  This helps prevent the etched lines that are more difficult to treat.
Fractional Lasers:
Fractional resurfacing lasers can be used on wrinkled skin that’s the result of sun damage.  Lasers work to help lessen the appearance of wrinkles and lines by plumping skin, increasing collagen production and removing the rough, aged outer layer to create a more youthful appearance.
A facelift can help out the lines and wrinkles by excising any excess skin, which tightens and freshens the appearance.  Fillers, micro fat grafts and neurotoxins may further enhance the results.

en Español


Pequeño y fino, una línea tiende a ocurrir de movimiento muscular repetido que graba una ligera marca en la piel. Los que sonreír, fruncir el ceño o entrecerrar los ojos mucho desarrollar las líneas de expresión antes que aquellos que no hacen estas expresiones faciales tan a menudo. Cuando la piel es joven que encaje en su lugar, pero a medida que envejecemos, pierde elasticidad, por lo que la capacidad para saltar de nuevo se vuelve más difícil y menos frecuentes, causando líneas más prematuros.

Una arruga
Arrugas gruesas y más dramáticos en la naturaleza, son pliegues notables, crestas y pliegues en la piel. Las arrugas pueden ser causadas por la edad, el colágeno y la elastina desglose, demasiada exposición al sol, los medicamentos y la piel seca y deshidratada. Las arrugas son diferentes de las líneas en que son más difusa a lo largo de la cara.

Diferentes rellenos son buenos para diferentes personas. Cuando hay una pérdida de volumen de deterioro de las pastillas de los huesos y la grasa, la piel pierde su andamiaje y los signos de envejecimiento, como la flacidez de la piel y las arrugas se creó. Mediante el uso de materiales de relleno temprano, podemos ralentizar el proceso de envejecimiento y mantener una apariencia joven y natural. Rellenos estimulan el colágeno y aumentar el volumen de las arrugas de ciruela. Los rellenos de colágeno estimulante como Radiesse y Juvederm trabajan en gruesos pliegues y arrugas. Rellenos para dar volumen son importantes para mantener una apariencia juvenil.

Toxinas inyectables:
Toxinas inyectables como el Botox y el trabajo Xeomin para alisar la superficie de la piel por la interrupción temporal de la contracción de los músculos que son responsables de la creación de las arrugas. Neuromoduladores impiden músculos de permitir el movimiento que crea el pliegue, y con el tiempo, a menudo invierten las líneas que ya pueden estar presentes en la piel. Botox y Xeomin son grandes para los pacientes que comienzan a ver un rastro de una arruga cuando la cara está en reposo. Esto ayuda a prevenir las líneas grabadas que son más difíciles de tratar.

Los láseres fraccionales:
Láseres fraccionales de repavimentación se pueden utilizar en la piel arrugada que es el resultado de los daños del sol. Los láseres trabajan para ayudar a disminuir la aparición de arrugas y líneas de engordar la piel, aumentando la producción de colágeno y la eliminación de la capa externa áspera, envejecido a crear una apariencia más juvenil.

Cirugía estética:
Un estiramiento facial puede ayudar a las líneas y arrugas extirpando el exceso de piel, que se contrae y se refresca la apariencia. Rellenos, micro injertos de grasa y neurotoxinas pueden mejorar aún más los resultados.

Fillers, Fat or Surgery: Which One should you choose?

Each option has its place when correcting the eyes.  Base your decision on what bothers you, your budget and the result you are looking to achieve.
Choose Fillers: to fix hollowing in the tear troughs if there is no loose skin.  Ideal patients are those who have a depression like a tear through in their lower lids, had too much fat removed during surgery, or are hollow under the eyes.  Fillers are reversible and no overcorrection is required.
Choose Fat: for longer lasting results.  Your plastic surgeon will remove fat from elsewhere on your body, clean it and then inject it under the eyes for volumizing effect.  Fat also blends the area between the lower lid and the cheeks.
Choose Surgery (Blepharoplasty): to correct loose skin or excessive muscle and/or fat in the lids.  Removing some of this volume and distributing the contours equally restores the look of the eyes.
En Espanol
Rellenos, grasa o cirugía: ¿cuál debería elegir?
Cada opción tiene su lugar cuando la corrección de los ojos. Base su decisión en lo que te molesta, su presupuesto y el resultado que se busca alcanzar.
Elija Rellenos: fijar vaciamiento en los valles de lágrimas si no hay piel suelta. Pacientes ideales son aquellos que tienen una depresión como una lágrima a través de sus párpados inferiores, había eliminado el exceso de grasa durante la cirugía, o son huecos debajo de los ojos. Los rellenos son reversibles y no se requiere corrección excesiva.
Elija grasa: para obtener resultados más duraderos. Su cirujano plástico eliminar la grasa de otras partes de su cuerpo, limpiarlo y luego inyectarlo bajo los ojos por efecto de volumen. La grasa también combina el área entre el párpado inferior y las mejillas.
Elija Cirugía (Blefaroplastia): para corregir la piel floja o muscular excesivo y / o grasa en los párpados. Extracción de algunos de este volumen y la distribución de los contornos igualmente restaura el aspecto de los ojos.

Dermal fillers are versatile tools for perfecting facial contours.
INJECTABLES ACCOUNT FOR MORE THAN HALF of the minimally invasive procedures performed today. Before Restylane (Medicis,, the first non-animal-based hyaluronic acid (HA) dermal filler, was introduced in the United States in 2003, botulinum toxin (Botox) was the most popular injectable in aesthetic medicine. Today, Botox has taken a backseat in growth to HA injections, which have increased to more than 1.3 million procedures per year.
As the demand for fillers has increased, the materials have too. Finding the right dermal filler is like choosing the right brush if you’re a painter. A free-flowing hyaluronic acid gel may be the perfect tool for painting a plumper lip, while a thicker filler with a higher molecular weight may serve you best for adding definition to the chin or cheekbones.

Choosing Your Tools

While today’s HA fillers are all non-animal sourced and stabilized, they do have some important differences, including the manner in which the molecules are cross-linked, the particle size and their affinity to bind water (hydrophilic properties). These distinctions determine a filler’s hardness or resistance to deformation. Picture squirting out the contents of a tube of toothpaste. If the paste retains its shape without flattening, the material reflects a high G prime; a runny liquid that rapidly loses its peak formation has a low G prime.
Restylane (Medicis, demonstrate stiffer qualities, which translates to a higher lift capacity. The stiffer quality of these fillers provides not only lift but also structural support. These would be more suited for creating a cheekbone, increasing chin projection or temple lifting.
Other fillers, like Juvederm (Allergen,, are softer materials that are ideal for filling lips, nasolaboial folds and finer lines.
Juvederm, one of the more hydrophilic fillers, is a popular tool for imparting a soft shape around the lips but is not as well suited for treatment around the eyes. Restylane, which is not quite as hydrophilic, might work better for treating the tear troughs and the nasojugal folds.
For defining the border around the lips or filling fine lines, both Restylane and Juvederm are good choices. Many physicians prefer the softness of Juvederm for filling the lip.

Typically, HA fillers can last anywhere from six to 12 months. Expect fillers to dissipate more quickly in areas subject to more motion, such as the lips, where they generally last five to eight months. In more stationary areas, such as cheekbones, effects can last up to 12 months. In the periorbital area, treatments with HA fillers have been reported to last as long as two to three years.

Collagen-Stimulating Volumizers

While HA fillers are a top choice for specific indications, such as fine lines and icepick acne scars, collagen-stimulating fillers, such as Radiesse (Merz Aesthetics, and Sculptra (Valeant Aesthetics,, can help create volume across a larger region with results extending to 24 months or longer.
The stiffer quality of these fillers provides not only lift but also structural support.

Managing Complications

With modern HA fillers, the potential for allergic reactions is very low, and no skin testing is necessary. That said, injecting fillers can yield potentially significant complications if not managed properly.
The most common complications are bruising and swelling at the injection site, which can last up to a week. To reduce bleeding and bruising, ask patients if they are taking any anticoagulant medications or supplements, including ibuprofen, aspirin, fish oil, omega-3, vitamin E and herbal supplements, including ginkgo biloba, as these may induce more bleeding.
Another common problem is injecting too much of a product or injecting into the wrong plane. HA fillers are somewhat forgiving in that you can use the enzyme hyaluronidase to dissolve the HA when patients are not pleased with the results. This not true with non-HA fillers, such as Radiesse, Artefill and Sculptra.

The Future Of Fillers- Juvederm Voluma XC

Though dermal fillers have been part of cosmetic medicine for almost 30 years now, there are still some truly innovative materials entering the market. Voluma XC (Allergan,, an HA filler, will soon offer U.S. patients effects that last 18 months or more and a high G prime for more lift and fill with less product.
JUVÉDERM VOLUMA XC injectable gel is the first and only filler FDA-approved to instantly add volume to the cheek area. Juvederm Voluma is the Juvederm specialty product for volumizing. It is designed for injection in the deep dermis to treat age-related facial volume loss. Voluma has the optimal thickness of a volumizer while still retaining the smooth nature of the Juvederm family.
It gives you a subtle lift, helping to restore contour and for a more youthful profile, for up to 2 years, in patients over the age of 21. It’s different than JUVÉDERM® XC and works on a different area of the face. JUVÉDERM® XC smoothes out moderate to severe wrinkles and folds around the nose and mouth, like parentheses. JUVÉDERM VOLUMA XC, however, adds volume to the cheek area.
As new fillers continue to come to market, the trend toward specialized products that treat specific concerns and regions of the face continues to grow. In the future, physicians can look forward to a growing variety of materials that smooth, volumize and fill the skin with fewer complications and longer results than ever before.

Dr. Mark Bishara offers minimally invasive procedures, such as injectables- for patients. These treatments are designed to provide subtle enhancements that can improve your targeted problem areas, while allowing you to return to work and your regular activities the very same day. Dr. Bishara is proud to offer a wide range of enhancing, minimally invasive procedures such asBotox, Xeomin, Juvederm Ultra Plus XC and Radiesse.  Juvederm Voluma XC will be available soon. We will keep you updated or call our office for more information at (817) 473-2120.