Radiesse vs Artefill for Jawline Contouring

Dr. Rivkin,

I have had great experience with Radiesse in scuplting the jawline, especially the jaw angles. Up to now, it has been thre most reliable filler for creating a sharp jaw angle. It has great thickness much like paste, but doesn't seem to last long enough.

I have heard that you are a fan of Artefill.

However, in an earlier post on here, you mention that for BONE CONTOURING, such as the jawline, jaw angles, or cheek bones, you prefer RADIESSE ?? Is this true, in terms of your opinion ?

The reason ARTEFILL seems interesting is that it's permanent. Can it match or surpass RADIESSE in terms of CONTOURING of the BONE STRUCTURE in the face, in areas such as the jawline, jaw angle, and cheek bone / malar area ?



hi
yeah, i've used both radiesse and artefill for the jawline and i have better results with radiesse. the line is sharper and the effect is more predictable with radiesse. i think that you should continue with radiesse for now, until a better permanent filler comes on the market (which should be within the next 6 months or so).
in a pinch, i will use artefill for these areas, but i will make sure that the patient knows that i cannot get the same sharpness, and they will have to come back for multiple touch up sessions as the artefill builds up.
hope that helps

Nasolabial Folds Improve with Cheek Augmentation

Hi Dr. Rivkin,
I had Restylane injections on the nasolabial lines one year ago. I was not very happy with the results. First, I did not notice a major difference and it felt lumpy to the point I could not wait for it to wear off. The other problem I have is that besides the lines the area is also depressed. I am wondering if another kind of filler is better for me and...............is there anything that can be done for the depressed area? And.........what about the little spider lines that come off the nasolabial lines.........can something be done with them? Thanks


hi,
it sounds like you have deep nasolabial folds, not just wrinkles. sometimes just pumping up the depressed area does not work. some people have a loss of volume above the fold - in the front portion of the cheek. this volume loss accentuates the depth of the fold. if you fill the cheek, though, the fold improves - it looks much less prominent and the midface regains some of the lost volume. a full midface area is very important to prevent the "saggy," tired appearance that comes from loss of cheek volume.
i would also not use restylane - it is a filler for more superficial lines. you should be using a thicker filler that goes deep, like radiesse. it will also last you alot longer as well.
in terms of the spider veins, i just got a new device called veinwave that works really well. it is a needle with a current. you put it on the vein and it destroys it. works well for small facial vessels.
hope that helps

Active Fx, Nose Job Steroids and Velasmooth vs Thermage

Hi Dr. Rivkin - thanks for your thoughts on active fx and body tightening procedures. Why do you feel active fx is a better treatment vs fraxel - would love your opinion!

Also - had a wonderful corrective nose job (he cleaned up the problems by another dr) by a great surgeon in Beverly Hills -it was my third nose surgery and it looks amazing. I am 1/2 armenian - thicker skin so I do have a little bit of scar tissue between the skin and cartialage so the refinement is a little off - would you recommend steroid injections to improve? It's been a couple of years since the surgery and am super happy with overall result!

Sorry - one last question for you! You mentioned that thermage for back area of leg is not that great but vela smooth is good. I am an avid runner - do pilates and yoga so in really good overall shape. I don't have any cellulite but am getting older (46 yrs) so notice the skin isn't as firm -it's muscular but a few lines on the back of my thigh area. I am also pretty small - 5 ft 4 and about 110 lbs - would you still recommend vela smooth vs thermage for that area??? I"ve always had really good legs and want to keep them firm firm firm!!!

Thanks - you are so helpful and still need to come in for a visit next time I'm in LA!


hi,
well, i have both fraxel and active fx. the active fx is a co2 laser, as opposed to erbium for the fraxel. what that means for you is that the effect is more intense with the active fx. it goes deeper and the healing response is more intense. so, one active fx treatment is equivalent to about 3 fraxels. but you get it over with all at once, instead of going through downtime 3 times. also, for problems such as deep acne scars, the fraxel just does not get the results that the active fx does, as far as i have seen.
i don't know if i would suggest an intervention if you are happy with the result of your surgery - there's always a risk whenever you do anything. so, if you're really happy, maybe leave it alone. steroids do work for that kind of refinement, though. so, if you want to, it would work.
for your legs, i would try the vela first - its alot cheaper than the thermage and it may be good enough. if not, then perhaps thermage would be a good idea.

Jawline Definition using Radiesse

Hello dr. Rivkin,
Do you know what filler is normally used to give that smooth fuller look to the jawline and chin? my jawline has lost some volume and therefore it's thinner than before. have you done this procedure before? and approximately, how much does it costs?

Thank you:)


hi,
well, the price depends on how much filler one uses.
i usually prefer radiesse for the jawline because it lasts a while and it goes deep, for a smoother effect. duration of effect is about 10 to 12 months.
i have tried to use artefill after someone has been satisfied with the effect of radiese, but its difficult to get the contour with artefill as well as you can with radiesse. i would probably suggest sticking to temporary fillers at this point. preferrably radiesse until something better comes out.
cost of radiesse is about $800 per syringe, and you will need at least 2 syringes, probably 3 or 4. when it is multiple syringes like that, i give people a significant price break - it can get expensive. for 4 i would probably charge about $2400 (1 free). for 3 i would charge about $1900.
hope that helps

Active Fx / Deep Fx for Face and Thermage vs Velasmooth for Body

Good morning Dr Rivkin:

I am seriously considering active fx for over all skin refinement. I just read a couple of people who wrote into you complaining of bad scarring and pock marks - is this common? I know you have stated it is safe and has great
effects on skin. Just wanted to get your feedback on this.

Also- what about thermage for body tightening or have you seen the results of the vela -smooth?

Thanks so much!


hi,
i still think that active fx / deep fx is a great technology. if done correctly it should not cause any scarring or pigmentation problems. i have not seen scarring among my patients, although i have seen a case of temporary hyper-pigmentation that resolved. however, we do active fx daily, so one case is not a large percentage. ask any place you're thinking of going to how much experience they've had with the procedure. also, a doctor should either be doing the procedure or closely supervising the nurse or PA. this is not a laser that should be done at the mall.

thermage is very expensive. i tried their cellulite tip and i was not that impressed with the results. it was certainly not worth the price. skin laxity on the abdomen tends to respond well to thermage. the key with thermage is that, if there is a subtle laxity, the results will be good.
anything more than that will not really respond to thermage.
i think velasmooth is pretty good, as long as the person is exercising during the treatment period. it tends to improve the results. you need at least 8 treatments - 2 treatments a week for 4 weeks.

hope that helps

Peel Every Other Day? Skin Care Product Tips

Hi Dr. Rivkin

Thanks on behalf of all MMH'ers for guiding us and providing useful info and your time:)
I have light brown/olive skin with acne pigmentation/scars with a spot or two every now and then, and I've had a VI peel about 3 weeks ago with satisfactory results. My Aesthetician said I could do a light peel every other day at home to keep the results.

This sounds a bit weird, is it not harmful for the skin to peel it so often? Do you agree with the Aesthetician? If so, would you please tell me what peel is best and what prcentage so when she gives it to me I know I am doing the right thing.

Thanks v. much



hi,
i agree with you.
that is too aggressive.
i would speak to the doctor there to see what kinds of home products they recommend - there's lots of good products. but you should not be doing a peel every other day.
we use IS clinical, skinceuticals, pevonia and glo minerals as our primary ines.
you should be using a moisturizer, a good gentle cleanser, a sunscreen (perhaps as one product with the moisturizer), and an antioxidant like prevage or CE ferulic (skinceuticals). a topical retin-a at night is not a bad idea as well. every once in a while (like every 2 weeks to a month) you can go in and have a microdermabrasion or a light peel at the esthetician's office, or even do a light peel at home.
hope that helps

Artefill - Post Injection Care

Hi Dr. Rivkin,
I was wondering, after having an ArteFill injection, are you prevented from doing anything you did before the ArteFill injection?

More Specifically: Can you work out and excerise intensly?
Can you take any medications or pills such as Advil, Tylenol, Zyrtec (I take Zyrtec at least once a month).

Thank You


Hi,
Nope, you can do anything you want!
Afterwards, I wouldn't take Aspirin or Ibuprofen for a couple of days. Also, I wouldn't manipulate the area very much for a few days, but you can touch it and wash your face - that's all okay. Keeping the area clean is important for the first day or two especially.
Hope that helps

Active Fx to Correct Texture after Chemical Peel

I am much too young for a facelift of any kind. But in March I had a chemical peel done to my face that left my skin with a rough texture/orange peel look. Do you know about this side effect? I have tried many other procedures such as micro-dermabrasion, smoothbeam and creams to fix or help my skin but nothing is working.

When I take my skin and stretch it back a little, my skin looks smooth again though. So this is my I am considering a facelift. I am most interested in focusing on the apples of my cheeks and a bit below that, towards my mouth. What are your thoughts on this?

I was also considering a rhinoplasty as a have a bulbous nose and would possibly like to thin it out very, very slightly. My main concern is the facelift, but the reason I mention this is because I was curious whether having a rhinoplasty along with the face lift, would allow you to tighten the skin better in the areas I desire.


Thank you for your time.



I do not think that a facelift will help you.

The problem that you are describing has more to do with the texture of your skin than with overall skin laxity. I have heard of this kind of thing happening, but I do not really use chemical peels, so I have not experienced it among my patients.
It takes a lot of energy to change the texture of your skin once this kind of thing has happened. Microdermabrasion and creams will not help. Smoothbeam is an okay choice, but even that is not potent enough, in my opinion, to change the topography of your facial skin. The only laser that I have seen to really have an effect is the active fx. I would suggest that you do a bit of research on that laser - it should help tighten your skin a bit and smooth out the orange peel effect.

Regarding your nose, it sounds like you would be a candidate for non surgical rhinoplasty. It would be a shame to undergo surgery for a subtle effect such as the one you're talking about. It can be achieved with a few steroid injections.

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

Lip Injection Pain

I went a couple days ago to get my lips plumped up with Juvederm. The MD applied a topical anesthetic and then proceded to give a local one like you get in your gums at the dentist. It was so painful that I fainted. I didn't even get to have my lips done.

I'm too scared to go back and finish the procedure but I paid a lot of money. Is there any way this can be completed with out me having to pass out from the pain? Should lip injections hurt this bad?

It sounds like you passed out from the pain of the lidocaine injection (dental block) that is supposed to make your lips numb.

Your doctor was doing all the right things, but lidocaine does burn when injected. There are ways of reducing that pain. I mix bicarbonate with septocaine (instead of lidocaine) to do my dental block injections. It doesn't hurt nearly as much and it still makes the lips very numb. You should find out what the doctor is using for his numbing block and perhaps have him add bicarbonate (it is the acidity of the lidocaine that makes it hurt so much) to the solution prior to injecting. Also, you should wait a few minutes for the topical anesthetic to really kick in before doing the local block.

Once you guys find a good way to numb your lips, the rest should be completely painless!

Web reference: http://www.westsidemedicalspa.com/thin_lips.html

Should I get Botox or fillers?

I am in my mid-30s and have just noticed some new wrinkles on my forehead as I tend to raise my eyebrows a lot. If they are new, slight wrinkles and not deep do you think I will need a filler or should Botox be enough?

It sounds like you are only just starting to see expressive lines on your forehead. This is a perfect time to start with Botox because you can really have a good preventative effect. My recommendation is small doses of Botox (8 to 12 units) -- enough to weaken the muscles and reduce the lines but not so much that you are paralyzed. Over time, if you do a little Botox regularly, you will delay new lines from coming up.

Board certification in plastic surgery is important for facelifts and in dermatology for skin cancer. For Botox, however, experience is what counts. You can tell who is an experienced injector from the Allergan (Botox company) website and go there. And try to have the most experienced injector in the office do the injections. If that's the doctor, great. If he operates all the time and his nurse injects every day, however, have her do it.

Web reference: http://www.westsidemedicalspa.com/botox.html

Thermage Supervision

Does an aesthetician need the presence of a doctor when performing Thermage on the stomach? I don't believe that the aesthetian I saw had a lot of experience with this procedure.

When you're considering an expensive treatment like Thermage, you should at least speak to a doctor prior to the procedure. Thermage doesn't work for everybody in every situation, and an esthetician's opinion as to whether you are a good candidate for this procedure is really not conclusive.

Physician supervision is always mandatory for Thermage. In California, aesthticians are not allowed to perform Thermage at all. In my practice, the nurse does the treatment, but most of the patients come talk to me prior to having the procedure done. That way, if they are not good candidates, I can steer them towards something that may help them more.

The question is always what constitutes supervision. If the nurse (or esthetician in Oregon, I guess) is experienced, then the doctor does not have to be in the room. However, if they are just learning, it would make sense for the doc to keep a close eye on them. There are no laws about this, however.

Hope that helps.

Web reference: http://www.westsidemedicalspa.com/thermage.html

Radiesse and Nasolabial Folds

For the nasal crease between the nose and mouth, how long would you say radiesse would last? And does it require a touch up a few weeks after the initial injection?

Radiesse usually lasts for about ten months to a year in the nasolabial folds. It's not appropriate for all folds, however, only deeper ones. Because of its large particle size, it's not the best idea for finer lines. Ensure that the person injecting it is experienced, as the material can cause skin to bruise and swell. Good injection technique will help minimize this.

I don't schedule a routine follow-up visit for everyone two weeks after the initial injection, but occasionally patients will encounter bumpiness and swelling or feel they need more filler, and in those cases I always encourage them to come back after two weeks.

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

Rosacea, Fine Lines and Skin Tightening

Hi, I'm 45 years old, the clinic I go to has recommended 3 treatments because I have complained about slight rosacea, vertical lines on cheeks and above lip and some loose skin on the lower sides of my cheeks and chin..................
the machine they use is called Fractional Non-Ablative Skin Resurfacing with the Palomar Starlux System, the treatments are $900.00 a piece.
Would this help these problems, is it worth the expense....Would 3 treatments do it?
Thanks so much.

Although I don't have this device, I do have the Starlux. I have been happy with the Fraxel Fractional Laser, however, I am somewhat skeptical that a fractional device will help you with rosacea and skin tightening. Honestly, I have a hard enough time seeing good results with Thermage (whose very purpose is skin tightening!). I simply don't think that this device will do all three things. It's an Erbium laser, which is good for helping the fine lines a bit, but I don't think that it's powerful enough to make that much of a difference. In my opinion, IPL/photofacial would be a better modality for your rosacea.

Make sure that you speak to a doctor at the clinic - if you're going to shell out that kind of money, you want an MD telling you that yes, this is the right procedure for you.

For the best results, I would target treatments, offering IPL for the rosacea, Thermage for the skin tightening and Juvederm for the lines. Sometimes one size does not fit all!

Chest Sun Damage and IPL vs Peels vs Active Fx

Hi Dr. Rivkin,
I have sun damage on my chest from years of sunbathing when I was young - which I no longer do.
I also have flat white acne scars in the same area, which show up even more due to the darkness of the skin caused by sun damage.
I had one IPL treatment but did not notice even a slight improvement and it was around 500.00 to have it done.
I was told by the woman who gave me the treatment in my dermatologist's office that microderm would work just as well.
I have always been self conscious about my scars, and feel like there has to be something that will be effective on them and the sun damage.
Can you look at my album photos and advise me on the best procedure and how many I will need? Also, the estimated cost if possible.
Thank you,
Pamela

Hi Pamela,
I do not think that microdermabrasion will do much, but it certainly will not hurt and it may help over time.

There are some decent chemical peels out that may work - Vi peel is something we've been doing in the office - seems to give good results so far. It's pretty cheap - $300 or so some of the more aggressive lasers may help with the hypopigmentation - active fx is a good one. there is some downtime with these lasers, however. its expensive - about $1000 or more.

Another option is to try the IPL again on higher settings, making sure that you are not suntanned at all prior to treatment. you can pre-treat with a hydroquinone cream for 2 weeks and that should let your doc use higher settings.


http://www.westsidemedicalspa.com/IPL_photofacial.html
http://www.westsidemedicalspa.com/activefxlaser.html