Hello! I just HAD to ask you, being in this field of work and all, do you see any real hope for stretch mark removal in the(preferably near) future?


hi mama
that is an excellent question.
i am hoping, and there is increasing evidence, that active fx may help with some stretch marks, as long as they are not too severe.
fraxel does not seem to offer enough intensity, but the co2 laser seems like it can do some good. there is a new head for the active fx called the deep fx. i think that this head is necessary to get good results for stretch marks.
hope that helps

Polaris, Thermage, Fraxel, Active Fx for Resurfacing and Under Eye Hollows

Hi Dr Rivkin - I have a few questions that I hope you can answer for me.

I am 46 year old female and I have very good skin due to my armenian
heritage, living in Seattle for the past 20 years (although I grew up in California and spent many days on the beach with baby oil on my face) and taking good care of my skin. I am told I look like I'm in my early 30's.

Now for the questions: Two years ago I had a series of 6 polaris treatments on my face and jaw line and two follow ups since then. I am moderately pleased with the results - my skin does look good. But I have also had foto-facials, thermage tip for the under eye and radiesse for my upper cheek area. I am in need of an update polaris - should I consider thermage instead for tightening, fraxel laser (is the downtown really two weeks for fraxel) and I am starting to get some hollowness under my eye area and fine lines - should I try a filler like restalyne or juvederm for under eye area?

Thanks - I'm trying to keep up the anit-aging regime for as long as possible with out under going the knife!!

Laura



hi laura,
don't know much about polaris - i chose thermage for skin tightening. i think that the combination of thermage and fraxel is a good one for rejuvenation and skin tightening.
restylane is good for under eye hollows, but not so much for wrinkles under the eyes. if you have that, i would suggest substituting fraxel for active fx - the skin tightening is better with active fx. it also works under the eyes, unlike fraxel.
i would do the active fx first and then do the filler after. i do not think that polaris or thermage or anything else for that matter, does a good job under the eyes.
hope that helps

Sculptra for Cheek Augmentation

Hello Dr Rivkin

I am wanting to fill out my face a little in a very subtle way. I would prefer to do this permanently with my own fat but am a little worried about how uncontrollable this process seems to be. Can you tell me:
How controlled it is possible to be with Sculptra so that you don't get a fat face or strange shapes?
Also, what happens after 2 years? If it's collagen that's built up, why doesn't it stay there?
Also, If you don't like the effect Is there a way of reversing sculptra once it's in, or do you just have to wait for it to dissipate?

Thank you

Curlicue


hi curlicue,
these are good questions.
i agree with your assessment of fat injections - not very reliable.
sculptra is a good product - results are natural and it lasts for a couple of years - you will like it, as long as the person injecting is experienced and doesn't give you lumps.
the trouble is that you have to do multiple sessions - 2 or 3, and it gets expensive.
i have also wondered why the collagen doesn't stay. i'm not sure. it could be that, once the active ingredient stimulating the collagen growth disappears, there is a decrease in the collagen.
there is no way of dissipating sculptra.
cheers,

Smoothbeam for Acne Scars?

From your experience, have you seen any scarring or fat loss from the Smoothbeam laser? Do you think it is okay to spot treat with this laser?
Thanks

hi lacey,
i don't really like smoothbeam that much.
when i was choosing a laser for acne scars i chose fraxel because it is considerably more effective and alot less painful. i really do not see much of a reason to use smoothbeam - its an old technology that gives mild benefits.
its not really worth the pain for patients.

Fraxel and Sculptra for Large Pores and Cheek Indentations

Hi Dr. Rivkin,

I have fairly large indentations on both cheeks and also have large pores due to rosacea and aging. I had IPL years ago for rosacea and it might have contributed to the indentations on my cheeks. I have had restylane injected into these areas and it turned out fairly well up until the last time when one cheek indentation turned blue. It stayed blue for a long time until it was injected with a solution to take the restylane out.
My derm is now saying I should have fraxel done to help with the pores and then have sculptra injected in the indentations. Do these two procedures seem reasonable or would you recommend something else like another type of laser or peel and another type of filler?
I know it's hard to recommend without seeing me but I just don't want to end up worse than I already am. Thank you so much.
Chris

hi chris,
my recommendation would depend on the size of the indentations. if they're large (more than 2 cm or so) then sculptra sounds like a good idea. the collagen stimulation may help in the long term as well as for the duration of the effect of the sculptra. fraxel is also a good choice for the pores. another good choice is active fx. either way you will get improvement.
cheers

Large Pores and Dark Circles - Active Fx and Juvederm

Is there any surgical procedures to eliminate or greatly reduce either of these areas.
I have been given two different opinions so far by derms.
One did a micro laser peel on pores and under eye circles. Looked great for about two weeks. Then back to nothing. She recommends a stronger laser peel next time. She only did 20%.
I also had a consult with another derm. He offered that genetics are genetics. Nothing can be done for eye circles and the pores I am stuck with. He recommended a chemical peel once a month which would help to keep the pores open and clean, thus less visible.
I would love your input.

hi,
i think that there are more options than doing nothing or doing next to nothing.
if the under eye dark circles are due to indentations or loss of volume under your eyes (the "tear trough" area) juvederm can be used to fill that area up very nicely. the effect lasts for over a year and a half.
if you're talking more about the fine lines under your eyes, then i would suggest Active Fx. it will also take care of the large pores. this is a co2 laser that is new and very effective, especially under the eyes and for large pores.

Teeth Gridning and Botox

I have been clenching my teeth for several years now, and have constant headaches, neckaches and facial pain, and have chewed the inside of my cheeks beyond recognition. Will Botox help with these problems? Will it make me jowl-y? I am only 37, but my family is prone to jowls. What are the possible side affects? Do you know anyone who is doing these types of injections in Nashville, TN? Sorry for the flurry of questions, but I am becoming desperate.


hi,
botox will certainly help.
not sure who does botox for teeth grinding in nashville - i'm afraid you're going to have to call around for that. i'd be happy to talk to whoever you choose and help them with the procedure, however. it will certainly not make you jowly. i would recommend no more than 20 units of botox in each masseter muscle. it should not give you side effects. the worst i have seen is a bit of bruising afterwards. the botox should not weaken your chewing or ge your smile.
cheers

Forehead wrinkles - Botox, Active Fx, Portrait Plasma

People always say I look angry or worried because I have wrinkles on my forehead. What wrinkle treatments will get rid of these forehead lines?

Botox, Botox, Botox!

Its still the best treatment out there for forehead lines. These lines are called expression lines - they are mostly caused by you raising your eyebrows over many years. As the muscles contract, they move the skin with them and crease the skin over time. Botox relaxes these muscles and lessens the intensity of these movements. Done properly, Botox relaxes the forehead without paralysis. The patient should always be able to move their face and the result should always be a natural appearance.

The other thing that helps is a resurfacing laser for the fine lines. Active Fx seems to do a good job. That's the one I have and I like it quite a bit. Other people like the Portrait plasma device. Fraxel is not intense enough for fine lines in my experience.

Microdermabrasion helps, but only when done regularly over a long period of time. Even then, it is a subtle change. Microderm is better for maintenance and skin health.

Under Eye Wrinkles - Active Fx and Botox

I have wrinkles under my eyes and crow's feet wrinkles on the outside of my eyes. What's the best treatment for these areas?



These are 2 different problems and I would suggest 2 different solutions. Wrinkles under the eyes are usually the result of skin laxity, sun damage and loss of skin elasticity. Crow's feet are caused by creasing of the skin from years of smiling and the motion of the muscles underneath the skin. Sun damage and loss of elasticity are involved as well, but motion is the most important factor here.

With wrinkles under the eyes, I would recommend Active Fx laser (I have absolutely no affiliation with the company - I just investigated lots of lasers and that is the only one that actually worked). In my experience, it is the most effective laser for under the eyes wrinkles. It is gentle enough not to damage the delicate skin, but there is enough energy to tighten the skin and really decrease the wrinkles. Fraxel, IPL and Erbium all do not really work. Chemical peels are not as precise.

In terms of crow's feet, Active Fx will help, but Botox is really the main treatment. It is quick, easy, effective and raises the side of the eyebrow a bit, opening up the eyes.

I just had perlane and am pleased. He injected chin creases and camouflaged my jowls. Now a friend tells me that fillers will cause your skin to sag. Someone said not unless it is overfilled. Well, how can you tell if it is overfilled? On my n/l and marionette lines he didn't get rid of them just improved them. I know he had to use one syringe on chin alone because of deep creases. He used a total of three which seems like a lot, but I think it took one to camouflage the jowls. My face doesn't seem stiff or bloated. Seems there is always someone out there to make you worry. Thanks a lot for any information.

hi,
that's a myth. fillers will not cause your skin to sag.
skin is very resilient and fillers dissolve slowly, so it has time to bounce back.
don't worry.
cheers

Thermage vs Facelift

I'm a 58 y/o w/w with a thin long face. I have significant nasolabial and marionette lines along with dropping jowls. I've seen before and after pic's showing the amazing differance thermage can make. But I've read that it's mainly for the younger patient that's just starting to get slight drooping in the neck and jowls. Do you think I'd be wasteing my money on trying thermage before getting a facelift

hi sharon,
tough to say without a picture.
if you'd like you can send one to arivkin@westsidemedicalspa.com
thermage may not be a great idea for you if you have anything more than minimal loose skin.
cheers,

hand rejuvenation - fraxel, restylane, radiesse

Hi Dr. Rivkin,

What is the best way to fill out aged thin hands and make them look plump and younger? I do not want surgery. Do you use a filler or another procedure and if so what works the best and lasts the longest?
Thanks so much

hi,
that's a tough question.
there's people doing hand rejuvenation with fillers, from restylane to radiesse. seems to work, but its a matter of whether it looks natural or not. i use lasers (fraxel, active fx) to smooth out wrinkles and stimulate collagen. i think this works well and leaves a natrual result. i personally do not think that fillers leave a natural result, but i could be wrong. if you are thinking of having someone do it, ask for their own before and after photos to be sure that the results look natural.

Fraxel and swelling

I hear about bad swelling & pain stories following Fraxel treatments - how do I prevent my face from swelling? I don't drink alcohol or smoke & I walk 4 miles every day & eat lots of fruits & vegetables....
Please advice me, I am beginning to be afraid.
Thank you.

hi,
to minimize swelling after fraxel, there's several things you should be doing. first, you can start taking arnica montana the day of the treatment (i like the sinnech brand). next, after the treatment, be sure to use plenty of good moisturizer and stay out of the sun and use sunscreen. these are products that i provide my clients in a kit and your doctor should be able to recommend good products. swelling should really not be too bad - 3 to 4 days maximum. then you look like you have sunburn for a week. not such a big deal.

juvederm, artefill or fat under the eyes for eye hollows

Hi Dr. Rivkin,

Not being too familiar with the fillers OR fat grafting, and getting confused reading on them, I have a few questions.
I have what I feel are excessive undereye hollowing and darkness, I feel due to a combination of an agressive lower Bleph 13 yrs. ago. I was only 44 but had hereditary heavy puffiness. It looked great until about 4 years ago. I was very happy with it. Now I look very tired, just "hollow". Makeup just won't cover it, it's just too deep.
Is it a better idea to give something more temporary a try first, then go on to something more (hopefully) permanent like fat grafting for that area? Or is Artefill too new or last too long for that area, and is there something better milder, I guess you might say, to use for that area?
I know that's a lot of questions, but I just wanted to know what your thoughts might be in that case, in your experience.
Thanks!


hi,
i really like juvederm or restylane under the eyes. it lasts for a really long time (1.5 years) and the results are really smooth and natural looking if the person who does it is experienced in the procedure. it is, technically, a somewhat difficult procedure to perform. the advantage of juvederm and restylane is that they can be dissolved easily with an enzyme. so, adjustments after the procedure are easy to do.
artefill does not belong under the eyes. the chances of a bumpy result is too high and there is no way to get rid of it besides surgery.
fat grafting, when done very well, works nicely. however i have seen too many poor results. it is not always done very well and if you get a bad result, it is very difficult to fix.

Thermage, Refirme and Titan

How effective are Thermage and Refirme in tightening loose skin on neck and under chin/along jawline? And if they are both effective, how do you determine which method to use?

hi,
i think that these devices are good. i own a thermage unit and i have seen good results around the jawline and neck. i think that either one is fine. they both work by similar principles. the thermage is a one time procedure, and the refirme takes a few sessions. titan is similar - it takes several sessions.
results are subtle, but its the only technology like this that we have available.
hope that helps

I think the problem for me is the condition of my skin-(in an odd way, more attention seems to be drawn to my skin now that it has filled out)- something I need to work on improving. I have kind of medium- complected honey toned skin, can you recommend any laser procedures that can be used on medium/dark complected skin? Thanks again, Samia

hi samia,
glad to hear it.
with darker skin, options are more limited, as you know.
active fx would be my first choice for resurfacing, but with your coloration, fraxel may be a safer choice for now.
results with fraxel, though are quite good. make sure that you're going to someone with the sr1500 model - its an upgraded version of the fraxel.

Active Fx vs E-Max for resurafcing and tightening

I am considering having an Active FX treatment on my whole face and neck for wrinkles and skin tightening. One plastic surgeon told me that her Emax laser can achieve the same effects without the pain and trauma. What do you think?


not a chance!
the active fx is much more effective.
CO2 laser (the technology behind active fx) is the gold standard for skin resurfacing and has been so for several decades. "elos" technology is a marketing gimmick. the syneron devices work ok, but nothing special.
active fx downtime is about 4 days of mild swelling and redness, with a week of sunburn-like redness afterwards. not a huge price to pay for real tightening of fine lines and pores.
hope that helps

Vbeam or YAG laser for capillaries

Dr. Rivkin:

I have quite a few broken capillaries on my face and I have tried vbeam laser. I had three treatments so far and I don’t see
any difference at all. I actually have more broken capillaries now. Can you suggest a treatment for capillaries that would really show some improvement? What type of laser is best for this? Why did the vbeam not work for me at all?
I have also tried IPL before the vbeam and it helped for general redness but not much for the capillaries.
Thanks so much.

hi,
the vbeam is a pulsed dye laser.
i would use the yag 1064 laser for your capillaries. that is my preferred first choice for capillaries. most companies like palomar and lumenis make one.
hope that helps