Under Eye Lines - Profractional vs Active Fx

What is the best treatment for undereye lines? I get botox for crows feet, but it doesn't help with lines under the eyes. I was told by a plastic surgeon that surgically it is a very difficult area to treat. I'm wondering what is the best treatment non-surgically. Thank you.


hi,
i agree.
these fine lines are tough to treat, and surgery is not the way.
i have had some success injecting botox close to the eyelash margin. i use a very small amount.
the only other treatment that i think works is laser. and the only laser technology that i have seen that makes a difference is fractional CO2. active / total fx is the device i have and it works quite well. fraxel re:pair is another option. these are intense lasers and there's a week downtime or so, but they're the only things that work.
cheers


Thank you very much for your reply. It has been recommended by a doctor (not a plastic surgeon) who performs my botox injections that the Profractional Laser may help. He said 4-5 treatments would be required over a period of several months, and the downtime would be about 3-4 days. Is this the same laser that you are referring to? Thanks again.


hi,
i don't own the profractional laser, and i'm not completely sure of how it performs against the fractional CO2 or the fractional erbium fraxel. it is a different kind of laser from these other 2. it is a YAG laser.
i have the lumenis fractional CO2 and its pretty invasive - a week of downtime, but 1 or 2 treatments. i don't know if the profractional is going to be intense enough to get the job done under the eyes.
i would do some more research about it.
hope that helps

Under eye lines - Active Fx or Botox

What is the best treatment for undereye lines? I get botox for crows feet, but it doesn't help with lines under the eyes. I was told by a plastic surgeon that surgically it is a very difficult area to treat. I'm wondering what is the best treatment non-surgically. Thank you.


hi,
i agree.
these fine lines are tough to treat, and surgery is not the way.
i have had some success injecting botox close to the eyelash margin. i use a very small amount.
the only other treatment that i think works is laser. and the only laser technology that i have seen that makes a difference is fractional CO2. active / total fx is the device i have and it works quite well. fraxel re:pair is another option. these are intense lasers and there's a week downtime or so, but they're the only things that work.
cheers

Thermage Concerns

Hi DR. Rivkin,
I just read a thread on horror stories as a result of Thermage.
Do you have any other suggestions for non surgical face lifts?
I especially need it for my jowls and loose neck.
Thanks!


hi,
most of the thermage horror stories are about the older version of the machine. people were running the settings too high or they were putting their patients under anesthesia and causing damage to their skin. today's thermage machines are quite safe. i have never seen a serious problem with my thermage treatments. the only complaint has been that the results are sometimes not consistent. some people get really good results, while others don't see enough of a difference. even the ones that don't see a big difference, however, are happy after a second treatment.
i say all this because there is nothing else that i know that tightens skin around the jawline, jowls and neck skin better than the radiofrequency technology of devices such as thermage. its not a great device, but its what we have right now.
cheers,

Creams, Potions and Cat Poo

Dear Dr. Rivkin,

I have a questions and hope that you find the time for a reply.

1) Do creams, tonics, lotion and so on really make younger or prevent aging?
2) If some of that works, what does?
3) Are there any real results or is it marketing and our hopes that they work?
4) And... do face exercises make a face look younger or prevent or slow aging or do these exercises rather cause wrinkles?

What is your take on this?



hi,
your question is a good one.
i think that if you put cat poo in a box, put a ribbon on it, sell it at sephora and price it at $250, it will fly off the shelves.
yes, some topical creams certainly help. first and foremost is sunblock. moisturizer is second on the list daily use of these two will go a long way toward keeping your skin healthy and looking good. a good cleanser that is not too harsh (i think that IS clinical and skinceuticals make good cleansers and moisturizers) is good. at night, a retin-a cream is an excellent way of keeping the skin cells active and fresh. also, a vitamin c or prevage like antioxidant is good. much of the rest of this "growth factor" and salmon oil and nanotechnology creams are hype, in my opinion.

i think that most face exercises cause wrinkles. i have seen a couple of people that do specialized ones that seem to have firmed up their jawline, but i am very skeptical.

Active Fx vs IPL photofacial

Hello, I hope that you can answer my question.
Some background info:
I am 38 years old and 2 days ago I had my 2nd round of IPL Photofacial . I want to reduce the size of my pores, reduce facial redness and improve my skin texture on my inner cheeks (it's coarse). My dermatologist said I have mild sun damage and that I should see improvement from 3 Photofacials. I also have mild acne and will have 3 silk peels right before the Photofacial each time. My aesthetician recomended that I use retinol regularly to help reduce the coarseness and pores on my face too.
I haven't seen improvement in my pores and skin texture yet and I have a few minor scabs on my face from the Photofacial and laser where the dr removed some broken capillaries 2 days ago. My face still looks a little red too. So to me, my skin looks even more rough right now!
I have 3 questions:
1) How effective is the Photofacial for reducing pore size and smoothing mild coarse skin?
2) What kind of results in general should I expect from 3 treatments?
3) And will the retinol help smooth coarse skin? How long does it take to see results with retinol?
I really want to repair the sun damage that I have and do my best to prevent any further damage in the future so I have been wearing a facial sunblock (Minus Sol 30+ SPF) for 3 years now and I recently started putting sunblock on my neck, chest, arms and hands.

One final question:

4) If I wear sunblock regularly now at age 38 and once or twice a year I get a followup Photofacial, will any of the damage I already caused come back or new damage still appear? I want to make sure that my skin doesn't get worse than it already is!

Thank you so much for your feedback.

hi,
photofacial works well to reduce brown pigment and redness.
that's it.
i do not think that photofacial will impact your pores or change the texture of your skin, even in 5 sessions.
changing the texture of your skin is very difficult. retin-a is an excellent idea - i think that an anti oxidant like prevage is also good.
the thing is that it will take a while.
i use active fx laser to shrink pores and refine skin instead of photofacial. it works well, but there is about a week of downtime after the procedure.
wearing sunblock regularly will help.

Juvederm in Glabellar Lines

I've been told there's some risk with using filler between the eyebrows for the lines there. I've botoxed there but it doesn't do anything for the lines.I've also used a small amount of Juvederm but not enough to see a difference as we used most of the vial of my marionette lines. What would you suggest and could you address any risk associated with fillers there. Thx.


hi,
you're right - injecting the glabella takes some skill and, if overdone, can lead to some complications. it is an area where the skin is not as well supplied with blood vessels as in other areas of the face.
if too much filler is injected, it can interfere with blood supply to the skin and some temporary redness swelling or even a skin infection. i had one case of this about 4 years ago and it taught me to be very conservative in this area.
however, if you choose an experienced injector and he or she is careful, you should get a great result. i use juvederm for this area - that way if there's any problem, i can dissolve the juvederm with an enzyme called hyaluronidase.

Fillers - Which Ones Go Where?

Good morning Dr Rivkin - I have a few more questions for you before I
decide on a specific treatment.
I was going to try the active fx and then I saw my estetician for a foto-facial and she recommended a chemical peel from obagi vs the active fx treatment. I don't have any deep lines just a few fine lines - what do you think? The down time is the same but the pricing is significantly different. Also I have had the fotofacials for yrs now - love them but the nasal veins keep reappearing - what else should I try for them?
One last thought - I've done radiesse in my upper cheeks - loved it and it's been over a year and want to re-do - is perlane a better option -what's your first choice? Also what injectable is best for tear through in eye area, lips,and nasal labial folds?
Thank you so much for your amazing advice and guidance!!


hi,
ok, in order:
1. well, the chemical peel isn't going to be nearly as intense as the laser, but if you only have a few fine lines, that may be a better way to go. it may be all you need.
2. nasal veins - tough problem - i have seen that veinwave does a really good job at eliminating them. sometimes they come back, but less often than with 1064 YAG laser.
3. radiesse is the way to go for the cheeks. that is by far my preferred filler for facial sculpting. it goes deep and gives a very natural result.
4. tear trough - juvederm or restylane only. they are reversible and smooth. i prefer juvederm
5. lips - juvederm or restylane for the same reasons - i prefer juvederm
6. nasolabial folds - depending on the depth of the folds - i am trying evolence and so far it looks good. i also like radiesse for the deeper folds and juvederm ultra plus for the more superficial lines.

Permanent Non Surgical Nose Job Questions

Dear Dr. Rivkin,

Was wondering what your thoughts were on permanent fillers to the nose and aging. I believe the nose droops with age and that cartilage can still grow. How will this affect a permanent filler ?
Also is a permanent filler injected deep to the bone ? for example if one has a dent and the filler fills it up, is that filler fell like it's part of the underlying structure or more the skin ?
In addition ( sorry for all of the questions), how do you handle patients that come from other countries that can not come back in two weeks for a touch up ( post swelling)?
Thank you for your time


hi,
good questions.
1. i think that you are correct - the nose does change with age, but more slowly and subtly than the rest of the face. i try not to put too much filler in the tip - i do not want to increase the weight of it as the nose ages. but from the reports that i have read, artefill and aquamid both integrate well into the skin.
they should not become lumpy or irregular as tissues move with time. i don't get concerned with the bridge, since that area really does not move with time.
2. fillers for the nose should be injected just above the bone, but never deep to it. this way, the result is smooth and natural looking. filler (temporary or permanent) always feels like its part of the skin, not the bone or cartillage.
3. i ask them to make a mini vacation out of it - they see me at the begining when they arrive and then 5 days or 7 days later when they are leaving the country.
hope that helps

Non Surgical Nose Job

I have a schnoz issue that I want fixed...but I don't want surgery because I hate being put under. It really freaks me out. I am thinking about having a non surgical nose job, but I am wondering what type of dermal filler is normally used for this. Do most doctors use the same fillers or does it vary? What are the options?
Thanks much!


Hi,

Well, your options will depend on your schnoz issue.

Radiesse is the filler that usually works the best in most areas. It lasts for 10 to 12 months, there's no allergic reactions, minimal bruising or swelling and it looks quite natural. All this applies only if, of course, the procedure is done correctly by an experienced doctor. Radiesse cannot be reversed, but I usually do the procedure over 2 sessions, spaced 2 weeks apart. This way I avoid the risk of over filling and I have very rarely had dissatisfied patients (maybe 3 or 4 out of more than 600).

When I teach this procedure, I recommend that doctors learning it should start with Restylane or Juvederm. These are hyaluronic acid fillers that can be reversed easily, so if the result is unsatisfactory, it can be easily reversed. The doctors can then proceed to Radiesse once they feel comfortable with the technique. Restylane or Juvederm are good for minor adjustments of contour - they will not work for lifting a nasal tip or giving a significant amount of extra height to the nansal bridge. These fillers last about 6 months or so.

Another option is Artefill. This is a permanent filler and should only be used by doctors who are expert in the procedure on patients who have tried out the temporary version and know that they like the effect. Artefill cannot be removed, so watch out!

Hope that helps.