Artefill Nose Job Question

Hi Dr. I am considering have artefill put in the bridge of my nose for a rather large divet from skin cancer. When I went into a facility that used fillers I was told that because the skin on the bridge of my nose was so thin that I COULD have like a irritated reaction to the Artefill and they suggested a possible fat transfer. I obviously would have the allergy test done. If all went well with that, is it still possible I could have some kind of a reaction on the bridge of my nose. Possible redness or broken capillaries or something? Thanks much



hi,
well, it depends on how thin is thin.
i have to doubt that you are in much danger from artefill. i usually inject it very superficially and i have not had any problems. if they take it easy, injecting small amounts over 3 or 4 sessions spaced about a month apart, you should be ok. that's how i do it.
if you get some redness or broken capillaries, they should be able to zap them with a yag laser.


http://www.westsidemedicalspa.com/non_surgical_nose.html

More Blepharoplasty Questions

Dr Rivkin, I just browsed your website and have a question on the number of syringes typically needed to fill the tear trough area?


hi,
for the under eye treatment i usually charge as a procedure cost, not by how much i use. the reason is that i usually see people back one or two times to make sure that the contour is perfect. sometimes we have to do touch-ups or reduce a slight swelling with the enzyme. this way, i do not charge for touch ups or return visits.
the amount i usually use is about 0.3 to 0.5 cc depending on how deep and how extensive the tear troughs are. occasionally i use 0.8, but that is only for patients with really extensive indentations, coming around the eyes.

Sculptra vs Juvederm for Under the Eyes and Nasolabial Folds

I hear conflicting things on just how painful different fillers can be, and what kind of numbing agent for what area/filler used for what, and would like some thoughts on this.

I am scheduled for Sculptra (if I don't chicken out) in a few days in NL and undereye. I asked the nurse, and she said to come in 30 minutes before and they would apply a numbing cream to the areas.

Now, is that going to be enough for that scenario? I've heard elsewhere it WON'T be. What about Juvederm? in the same areas?


hi gayla,
the numbing cream should be just fine.
under the eyes really doesn't hurt much (i've had it done myself) and the NLs should be not a big deal if the injector is gentle and good.
the question i have is the choice of sculptra.
i know that some people use it under the eyes, but i prefer juvederm. and i think that i am certainly in the majority. juvederm gives a precision of effect that is really good and you see the results right away and they last for a year and a half to two years. sculptra is not as precise and you don't see results for a long time.
i do not use sculptra for the NL folds, but it makes sense if you have the time to wait for the effect (a few months) and the money (it is quite a bit more expensive than juvederm since you have to do 3 sessions).

Precision of Non Surgical Rhinoplasty

How precise are the results? Are injectable non-surgical nose jobs more precise than surgery? Since the changes are immediate?


hi,
well, i'm a bit biased since i developed the procedure, but i think that there is no doubt that non surgical rhinoplasty is more precise than surgery. the results are immediate and you can fill in that small contour irregularity or camouflage the bump exactly the way that it would look perfect - no more and no less. there is no guesswork like with surgery.
how will it heal?
how will the swelling come down?
will it scar?
is it going to look natural?
is the patient going to develop breathing problems 5 years after surgery?
all these are questions impossible to answer for sure ahead of time when you're going through surgery.
when you correct the nose non surgically, none of these questions arise and the there is no way that one can surgically make the detailed contour adjustment you can make with a filler.

http://www.westsidemedicalspa.com/non_surgical_nose.html

Retin-A and Skin Thinning Over Time

Hi doctor,
I have been using retin a for approx 20 years and have recently started to notice the blue veins in my face. I had heard that retin a causes thinning of the skin over time and I guess that's what this is.
So, a couple of questions:
If you stop using retinoids, the skin come back over time? In other words, will it repair itself?
Is there something else I could be using to help the skin recover?
I wasn't using retin a for wrinkles-I have had acne my whole life and this has kept it under control. What can I use instead. I am in my 50's now and still break out
Are glycolic peels and dermabrasion something to avoid as well now?
Any comments are most appreciated


very interesting question.
actually retin-a causes a thickening of the deeper layers of your skin, while causing a thinning of the topmost layer over time. the skin certainly does repair any injuries very effectively. the thickening effects are very beneficial, so i still think that retinoids are a good idea over the longterm. i would go for ones like a low strength tazorac. your derm can give you a good menu to choose from.
exfoliants like glycolic and microdermabrasion are very beneficial and should not thin your skin unless you do them several times a week. they will encourage new skin to grow.
hope that helps.

Volume in the Lateral Cheekbone Area - Radiesse vs. Sculptra

Hello Dr Rivkin

My question probably relates to Miss J's, but I didn't want to hi-jack her thread!
I recently saw a surgeon, specialised in fillers of various kinds, who, when I said I wanted to replace volume on the cheek towards the back of my face (ie along the cheek arch, towards my ears rather than at the front of my face), muttered something about it not being good to put fillers there.
Unfortunately I was too phased by other things going on at the time to press him on this. Perhaps you can clarify? I wondered if it ran into problems with the filler needing to be of a structural density, but getting too close to the surface of the skin? Is it in these situations where the filler can appear blue or lumpy?
Incidentally, he thought sculptra would be unsuitable for me, though again I'm not sure why, is it difficult to control the amount of volume it produces?

Many thanks for your help.


hi annalies,
it sounds like your surgeon just doesn't feel like doing filler in that area.
it is, technically, a fairly difficult area to put in filler if you're not that experienced at filler injection. and most surgeons do surgery - they are not that experienced in fillers.
there's no reason why you can't put radiesse in the lateral cheek bone area - i do it all the time. you have to be careful that its symmetric, bump - free and it looks natural. sculptra is ok, but you don't have quite the control over the contour that radiesse gives you.

Is this a good way to correct the dark circles under my eyes and N/L folds?

Is this a good way to correct the dark circles under my eyes and N/L folds?

Two syringes of Juve would be used.
Juvederm 30 would be used to fill out the upper cheeks (thus taking care of loss of volume there and helping the N/L folds).
Juvederm 24 would be used in the infraorbital crease filling in the crease itself.
I was told there would be some left over and I assume it can be used in the N/L folds themselves as well as in my '11's.
OK to proceed? I've had Botox with this injector many times and she is AWESOME at it. I trust her, but was not sure of the placement in the infraorbital crease. (I am not actually sure that is the correct name, but that is the general area she talked about - right at the bottom of the circles)
She showed me pictures of clients who had this done w/ great results and they were worse off than me to start.
ALSO- how long can the results last in these locations?


hi foxe,
yes, this sounds like a very good plan, especially since you will certainly have about half a syringe of juv. 24 left over for use in the NLFs and the 11s.
in terms of the injector.
you want to make sure to ask her whether the pictures she showed were of her work. you want to make sure that she is specifically experienced in this procedure. you also want to make sure that she is familiar with hyaluronidase - the enzyme that is used to dissolve juvederm either all the way or partially, if the results are bumpy or overdone. this area is tricky to inject technically, so reversing the effect is common.
the filler lasts for a year and a half or so.
good luck!

10 Minute Nose Job Fading after 3 weeks

Hey Dr,
i finally got this procedure done about 2weeks ago.
It looked fine for about a week. Then it started to gradually go back to the original shape. Im concerned since i was told this procedure would last 10 months but in 3weeks its already changing back to how my nose was before. Has anyone had this issue?


hi jean,
almost every single one of the 600 patients who have received the non surgical rhinoplasty procedure in my clinic has had this issue.
that's why i always bring patients back after 2 weeks to do a touch up and i do not charge them. i developed this procedure 4 years ago and other doctors have adopted it, but i have always stressed when teaching it that patients have to come back after 2 weeks. the initial effect is nice, but part of that is swelling and when the swelling comes down, one has to do a touch up. by 2 weeks most of the swelling is gone.

http://www.westsidemedicalspa.com/non_surgical_nose.html

Acne Scar Treatment and Injectables

I have horrible acne scars, and a friend suggested that injections of collagen could help? How expensive it this? Will it work and does it last?

- Rikki, 23, from Los Angeles, CA




hi rikki,

collagen injections may help diminish the appearance of acne scars, but they are certainly not worth the expense, especially for someone with moderate to severe scarring. the duration of effect is about 3 months. other fillers are better, but they are also temporary and fairly expensive. that being said, there is some long term collagen stimulation effect that we are seeing with restylane / juvederm as well as with radiesse. the problem with fillers is that they do not work for everyone. some people have acne scars that are tethered down to the deeper tissues with scar bands and are therefore resistant to being lifted up via filler injection. your doctor will be able to tell you about your specific case.

i have had the most success with laser procedures like fraxel and active fx / deep fx. progress is gradual and improvements are subtle at first, but over time results are very good and, most importantly - permanent. modern lasers do not cause the kind of several week downtime we are all concerned about. the active fx, for example, involves about four days of downtime, and then you look like you've had a sunburn for a week or so.

the most important thing is to find a good doctor that you trust. get several opinions and go with the person that you feel will be the most skilled, attentive and available to you should problems develop. treating acne scars is a process and you are entering into a relationship with your doctor. choose your partner well.

Acne scar treatment: Fraxel, Active Fx or Coollaser?

I am still trying to figure out what is the right laser and/or treatments for me.

I have had acne for 2 decades and now want to get rid of the deep scars and wrinkles. I started about 4 months ago with 2 salicylic acid peel, spaced two weeks apart, then a vitalized peel followed by a photodynmaic treatment. To me, my skin got worse, there are now lines and scars where there weren't any before, my pores are huge now and my forhead is creased and looks like brittle parchment paper.

I am so freaked out I consulted with more skin specialists. One recommended taking a break and then doing Active FX. After all the horror stories on here, and my own experiences, I am hesitant. So I saw a specialist who invented the coolaser and he wants to do 2 cool lasers and then fillers and Botox at the same time. It's called the mini facelift. To me, that seems a shocker. Then, another recommended the Obagi NUDerm, Fraxel every month and Sculptra every six weeks.

After much thinking, I decided to embark on the Obagi Nu-Derm and am now flaking and red, swollen - look like a shedding, boiling lobster. I have a party next weekend, so they advised me to stop three days before and the skin should be back to normal.

But what do I do next?

Active FX, Fraxel, Coolaser, or could the Obagi Blue Peel be an alternative, after I prep the skin more with the Obagi Nu-Derm. Or could I do a laser? Is my skin too taxed for a laser now? When could I do a laser? I am shifting to babying my skin tonite. I am so mad that I started this - I totally ruined the summer ahead of me - and I live in sunny CA - but I feel I have to do damage control now. And - I am running low on money. Would a Blue Peel and some Botox do the trick? I am just horrified and scared of the laser recovery.

Any thoughts? Thanks so much for listening!

- Amy



hi amy,

acne scar treatment is a long and difficult road. there's lots of promises and very few real answers, but its an important goal that we are researching actively. the good news is that there are new, ever more effective treatments coming out regularly.

i agree with dr. klein. the best technology out there right now is active fx / deep fx. i also own the device and i have been very pleased with the results, especially for difficult to treat acne scars and fine lines around the eyes and mouth. it is the first minimally invasive laser to have really impressive results.

now, a bit of advice on how to make smart choices when it comes to laser treatment. you have done the most important thing - speak to multiple doctors. unfortunately, that will get you multiple, often very different opinions.

how to choose between opinions? well, first of all, try to find a doctor you trust and who is well respected by other physicians. advertising in cosmopolitan and "inventing" the "Coollaser" does not count towards that standard. if that doctor is the only one using this "coollaser" you may wonder if whatever he invented was worth inventing? the laser you choose should be the standard of care among physicians in the field. the coollaser is not, no matter how much it is advertised.

topical treatments such as peels will not significantly improve your acne scars, unless you were to go with a deep, invasive peel which would involve too much downtime. the fractionated lasers are the best way to get significant change without making you look like a tomato for 2 weeks.this is why i recommend the active/deep fx - as a fractionated co2 laser, it is the strongest laser we have that is office based. you will have 4 days of downtime, but then you look like you have a sunburn.

i have much more info on my website and there is a good amount of info on the web. feel free to contact me if you'd like to chat about this, since you are local to LA.

Pixel, Thermage and Fat Loss / Necrosis

I'm reading all the 'fat loss' posts on the forum and I'm wondering if there have been reports of fat loss from other types of laser treatments.

I've started pixel laser resurfacing with Alma Laser and I'm due next week for my 2nd treatment. I've seen an improvement, so much so that I may not even get a u/l bleph. The appearance of my eyes is amazing. I've got fine lines under there, but that's nothing compared to the tired/puffy looking eyes I had before. I'll take the fine lines and consider myself very lucky to have come this far.

What may possibly cause fat loss with laser? The settings? The passes?

Which lasers have been reported to cause fat loss?

I did not experience fat loss thus far, can I expect to? Or would I have seen loss by now (4 weeks after 1st treatment)

Would it be prudent for me to request the same settings as I had the first time with each pixel treatment? Would this continue to give results, and lessen my chance of damaging the underlying fat to the point of loss? Does Pixel even cause this damage to underlying fat?

My pixel resurfacing is scheduled 4 weeks apart, is that sufficient?

I would really appreciate any information and insight you can provide. I've asked my PS and he himself has used the pixel, as well as the girls in his office (who are of all ages) and they look fantastic, but I'm a little worried after reading about the unfortunate experiences of some great ladies here. Surely you can understand the hesitation, I hope Smile

Thank you in advance for any information you can provide.


hi,
i don't have the pixel, but i do have thermage and that's the original fat necrosis device. don't worry. the fat loss that you're talking about was caused by overly aggressive settings. the protocols have been adted and the machines have been recalibrated so that this kind of thing does not happen. the treatment interval you're on sounds good.
you're fortunate that you're getting such good results. enjoy.

Falling Face from Botox?

Its been about two weeks post botox to forehead, crows feet, glabella and for some reason, in the lower lid. My derm claims she put a drop there.
My whole face is falling. The little elasticity holding up my cheeks is gone and now I look droopy and tired. How long will this last? I am quite miserable. After 10 years of botox, never had this problem. WHat is causing this meltdown? Please help!

hi
tough to say without before and after pictures, but botox only lasts for 3 months.
any effect like this should only last for a month or so.
it is surprising, though - i haven't really heard of someone's face just dropping. you may have received too much botox and in the wrong areas. another opinion from a doc in your area experienced in botox would be a good idea. you can go on the allergan website to look up who uses alot of botox.

Fraxel or Active Fx for Acne Scars and Stretch Marks

Hi Dr. Rivkin,
I've heard that there are laser treatments available for acne scars and was wondering how effective they usually are.

Also are there any treatments that you know of to help reduce the appearance of birthmarks and or stretchmarks? Thanks!


hi jumby
yes, i think the active fx / deep fx and the fraxel lasers are both quite effective at reducing the appearance of acne scars. the active/deep fx is a better treatment because it is a one time procedure and it is more intense than the fraxel. there's alot of info on both lasers at my website, as well as throughout the net.
the active fx will probably be good for stretch marks, but i am still gathering information. preliminary reports sound very good.
hope that helps

Botox, SilkPeel, Elos IPL and LED

Hi,

Other than once going to a dermatologist (after a rhinploasty) to have diolite laser to help with some broken capilarries on my nose, I had never gone to a dermatologist. The diolite did work great.

I am 37, with I believe very good skin for my age - just some minor fine lines around my eyes and maybe just very slight rosacea, or was told so by one dermatologist. I do flush pretty easily, am very fair and believe have very thin skin. Without makeup, one can see any veins/broken capillaries easily and ofcourse would be great to not see them, but don't believe I have alot. I am just looking now to maintain my skin best I can & ofcourse anything that help improve is added plus!
I was considering trying just botox and LED -so went to see a dermatologist to discuss these 2.

I don't feel I need to see any drastic results right away and risk adverse(minus fact I got my guts up to do a rhinoplasty - very happy with it, but end of my risk taking I think). The dermatologist recommended the following: First) Elos elight(believe that is IPL with RF?) 2) silkpeel 3)Botox and lastly 4) LED simply to maintain my skin. The dermatologist didn't feel I would be immediately satisfied by just LED and these are all extremely safe. But again, I am not looking for any drastic results nor results right away, and prefer procedures with less risks even if one has to continue with them longer.

I know you haven't seen me - But could you provide me your opinion of elos elight, silkpeel, and LED and any problems/risks you have seen with these?

Thank you in advance....


hi,
well, first off, LED is totally safe and has no complications at all. it takes multiple sessions, but does give subtle, nice effects.
botox is easy and a good idea for prevention as well as treating the lines that you do have.
silkpeel is like microdermabrasion and is safe and nice, but like led, needs a number of sessions.
it doesn't sound like you really need the elos that much - it would tighten the skin very subtly and would help with the rosacea, but you're saying that these are not big concerns risk with ipl is mild and is really only for people with darker skin.
hope that helps

Botox, SilkPeel, Elos IPL and LED

Hi,

Other than once going to a dermatologist (after a rhinploasty) to have diolite laser to help with some broken capilarries on my nose, I had never gone to a dermatologist. The diolite did work great.

I am 37, with I believe very good skin for my age - just some minor fine lines around my eyes and maybe just very slight rosacea, or was told so by one dermatologist. I do flush pretty easily, am very fair and believe have very thin skin. Without makeup, one can see any veins/broken capillaries easily and ofcourse would be great to not see them, but don't believe I have alot. I am just looking now to maintain my skin best I can & ofcourse anything that help improve is added plus!
I was considering trying just botox and LED -so went to see a dermatologist to discuss these 2.

I don't feel I need to see any drastic results right away and risk adverse(minus fact I got my guts up to do a rhinoplasty - very happy with it, but end of my risk taking I think). The dermatologist recommended the following: First) Elos elight(believe that is IPL with RF?) 2) silkpeel 3)Botox and lastly 4) LED simply to maintain my skin. The dermatologist didn't feel I would be immediately satisfied by just LED and these are all extremely safe. But again, I am not looking for any drastic results nor results right away, and prefer procedures with less risks even if one has to continue with them longer.

I know you haven't seen me - But could you provide me your opinion of elos elight, silkpeel, and LED and any problems/risks you have seen with these?

Thank you in advance....

Permanent Fillers

Hello Dr Rivkin,

I'm your average filler junkie who is tired of constantly spending $$$ for refills. I have put careful thought and research into all decisions regarding any procedure. Thus far, it's all good....

I am interested in your opinion on the use of Silikon 1000 and Artefill. It seems most people are thrilled with Silikon, but I definitely do not want any trouble down the road. I have researched Artefill and I feel like the general opinion is that it is okay, but not a favorite.

I guess my question is, for a more permanent result, is better still yet to come in the future?

Thanks in advance,

Twila

hi twila,
yes, there are definitely better options coming.
aquamid is a filler that is being used in asia, south america and europe. i am doing the fda trials here and it is good product. very safe and effective.
i use artefill and it works well in my hands, but i'm pretty experienced with fillers.
i would be very careful who you go to for permanent fillers. once in the body, you cannot take these things out.
i do not use silikon (liquid silicone). i think that it is too risky. i am just not sure what is going to happen to the stuff 10 or 15 years down the line. i think that artefill is a better option and aquamid will be a much better option once it is approved next year.
hope that helps

IPL Photofacial

Hi DR., I recently had Fotofacial performed for redness of the face and my skin after one treatment is much better. I had a lot of scabing on my face the flaked off in about 2-3 days. Now there is new pink skin where the scabs were. Will this skin lose the pinkness and regain my natural skin tone. There is a few little stripes that you can see and really would like to have all one skin tone. Did the operator of the IPL use it on too high of a setting. I was told I could return to work the next day yet I have taken a few days off from work so it will heal. I was not told that I would have any type of scabs or downtime. Should I have another treatment or is my skin to sensitive to the light? thanks, Mack


hi mack,
good questions.
i think you will be just fine, but be very careful of the sun and keep your skin well moisturized. your skin will re-pigment and look ok and the stripes should disappear. if you do it again, and there is no requirement to do it again, i would consider setting the machine to a bit lower energy.

Non Surgical Chin Enhancement

What filler is used?
Where is it injected(subQ, down to bone)?
How much is needed?
How long does it last from your experience?
Cost?
Does it affect your ability to have surgical chin implant inserted later?

Thanks


hi
i use either perlane or juvederm ultra plus or radiesse, depending on the patient and what we decide to use. the first 2 are hyaluronic acid fillers and don't last quite as long as the radiesse, but they can be easily dissolved with a bit of enzyme. radiesse lasts for about a year, and the other two last about 9 months or so.
i inject deep - close to the bone
amount needed depends on the patient - how large their chin is, how big a change we want to accomplish. i bring people back after 2 weeks for a touch up if necessary. i never put in more than 1 syringe of product in one session. cost is per syringe - $600 for juvederm or perlane, $800 for radiesse.
i don't think it affects whether you can have a surgical implant later on - you just have to wait until the filler is mostly gone.
also, there is a permanent filler - artefill - that you can use after you have tried out the effect with a temporary filler.
for more info, you can go to my website - i have written a bunch about this procedure.

Fraxel and Sun Exposure

My derm is recommending Fraxel. I am an avid sunscreen user, but get a moderate amount of sun exposure attending my children's sporting events and sailing on the weekend. (I am 48 and have a very light complexion with no hyperpigmintation on the face and just a little on the chest and hands.) I am inclined to wait until the Fall to do the Fraxel, since I read that sun exposure should be avoided for a least 3 months following treatment. What would you recommend under these circumstances. Also, can fraxel be done after fillers, or should it be done before fillers? Thank you.

hi,
good questions.
i would do fraxel before fillers, just to be on the safe side.
studies have not shown any negative effects of fraxel on fillers, but why take the chance.
in terms of sun exposure, i would say that waiting is not a bad idea if you're not sure as to whether you will be able to adequately protect your skin from the sun after the procedure. sometimes its just tough, so its not your fault. although you can look into very complete sunblocks, but you have to re-apply it - sunblock is only as good as how diligent you are in re-applying it.

Cheek Enhancement - Restylane SubQ vs Perlane / Radiesse / Juvederm Ultra Plus

Hello Dr. Rivkin,

I was recently reading an article about the use of Restylane SubQ in England as an alternative to cheek implants. Is this type of Restylane available in the U.S. yet? Also, do you have any opinions on this treatment?

Thank you,
Emii


hi emii,
restylane subq is not yet fda approved in the USA. i don't know that much about it, but it sounds like a concentrated hyaluronic acid filler, like perlane and juvederm ultra plus.
i routinely use fillers to do cheek enhancement. i honestly do not see any reason to do fat injection or silicone implants for cheek augmentation. fillers like perlane, juvederm ultra plus or radiesse last about 8 months to a year, are really easy to place and are very reliable. they are very customizeable to the individual (unlike premade silicone implants) and they do not have the swelling, down time, risk and expense of surgical methods. also, the claim that fat is permanent is simply not true. no one can predict how long fat will last - it is very variable depending on the individual patient.
the only catch is that you have to go to a physician who has some aesthetic sense and is able to do a good job. if the doctor isn't an artist, he or she will have a hard time making you happy.

Mouth Corners / Marionette Lines

My mouth droops at corners....kinda makes me look like a am frowning all the time Crying or Very sad
Top lip is thin, I am OK with fullness of bottom lip and dont really want to mess with that.
Any ideas that will make the corners turn up some?? Someone suggested Botox,but I would think that would make it worse
Would a filler on top lip only accentuate the problem?
THANKS!

hi
sorry for the delay
i think that botox would be a very good idea - the corner of the mouth is pulled down by a muscle called the dao muscle.
weakening it will raise the corner of the mouth. this should only be done by an experienced injector, however, since too much will cause problems.
i would put 4 units per side, divided into an upper point and a lower point.
the other option is filler.
a bit of juvederm or restylane in the marionette lines will also go a long way toward smoothing out that area. filler on top should be a good idea, just not too much.