Is Aquamid OK to Mix With Radiesse For Chin Enhancement?

Hi Dr. Rivkin,

I have had radiesse injections in my chin (as I have a very weak chin, specifically I have had 2 syringes)....
When Acquamid is FDA approved can I use it over my radiesse to get a permanent chin? I am assuming that some of the radiesse would have faded though some of it would still be there. I am worried about waiting for the radiesse to completely fade as I really really need a stronger chin.

So are there any risks in injecting acquamid over radiesse?
Thanks in advance.


hi,
good question.
the company does not recommend combining other fillers with aquamid.
reports from people who use alot of aquamid and, by necessity, have combined it with other fillers have been that it is no problem.
i have not had experience with the product outside the fda trials (where there was no mixing) but i do not see a reason why it would be a problem. companies usually recommend no mixing to avoid liability, but clinically we have not seen this to be an issue.
also, i expect that aquamid will be an excellent tool for facial sculpting and chin augmentation. the reports from abroad all attest to that.
hope that helps

Fraxel Repair Concerns

I am thinking of having fraxel repair on my face, neck, chest and hands. My main concern is the possibility of scarring or anything permanent that could go wrong. My doctor said she hasn't had any negative reactions to fraxel repair. Is there any need for concern?


hi,
the face is quite resilient, so i'm not concerned about that as much as the hands, neck and chest. make sure that your doc has had a good amount of experience treating those areas with the repair. the settings are different when you're not lasering the face. the skin is more delicate and burning is more of a concern in those areas. it is extremely rare to have permanent scarring from this kind of laser, though. we use the active fx, which is essentially the same technology. we had one patient when we first got the laser that had a very severe reaction (redness, swelling, pain for a couple of weeks) but have never seen anything even close to that since. we perform the procedure on neck, hands and chest all the time without a problem.
hope that helps

Silicone Disaster

Dear Dr. Rivkin:

Approx. 5 yrs. ago my derm. in Miami injected silkon in my laugh lines, crows feet & the 2 lines between my eyebrows (11). He did this 2 times. Fine results. He retired.
3 yrs. ago I went to a S. Beach Doc. He did the same thing plus put it in my lip line & mouth commas. Fine.
In the past 2 yrs., he has done this 4x's plus put some silicone where he put restalyne (near my cheeks/eye area). This Dr. wanted to fill my cheeks-couldn't afford another $3K.
Lately, I've noticed a tiny granuloma in my rt. laugh line.
Now, I have an obvious puffy (raised area) mark between my eyebrows (11) & the cheek area/stays red if touched too much. Appears to be getting worse.
Just found out this is not FDA approved for this type of use & have these granulomas.

Appreciate any help. Thanking you in advanced.


hi toni,
i'm sorry to hear this.
i do not use silicone for this reason.
i would go to see someone who has alot of experience with aesthetic injections. they can take a look at you and decide what the best course of action would be. the best way to figure out who that is, is to go on the allergan website and find the biggest users of botox in the miami area. these are the docs that have the most experience with injections.
most likely is that you will get some steroid injections in the areas that are swollen and that should help.

Jowls!

Hi Doc, im 38 male and i have jowels that i would like to get "stretched".
I don't want to have a face lift (although i would like to know more about what is involved in this) and would like to know what is the most effective and long lasting non invasive injection or treatment i can get.

Thanks for any advice. Barry


hi barry,
you have 2 choices for non invasive treatment of jowls.
1. thermage or a comparable radiofrequency device to tighten the skin will subtly reduce the appearance of the jowling. this will usually work, but results are subtle and it is not for severe jowls.
2. injecting radiesse into the area in front of the jowl, behind the chin. its usually called the pre-jowl sulcus. filling that up will re-create a straight line between the jowl and the chin, camouflaging the jowl.
hard to tell which you'd be a better candidate for without seeing your picture. i think that you are too young for anything surgical.

Artefill Between the Brows

Hi Dr. Rivkin,

I'll be getting a THIRD round of Artefill for my NL and marionette lines next week. Hopefully this will do the trick. The lines are improved but could be better. Even my doctor said he wishes there was 'more bang for the buck' with Artefill.

My question is, could Artefill be used for the vertical lines between the eyes (frown lines?)? I'm beginning to get a deep one near my right eyebrow!

Thanks.



hi,
i agree with your doctor - artefill re-touches are the bane of my existence. sometimes it stays, but for some people it fades and i need to re-inject it several times. it has to do with the collagen part of the artefill being absorbed and the body not replacing it with its own cells as much as anticipated.
i think that artefill in the glabellar lines between the brows is ok, but you have to be very careful. make sure that your doc is very experienced with injections and artefill in particular. and be conservative. its better to come in for a touch up or two than to put too much in.
hope that helps

Downtime for Active Fx and Tear Troughs

What is the downtime for the CO2 laser. I hear one week. Does that mean I will look like nothing has happened to me in one week? When can I wear make-up? When will I be presentable? When can I return to people I know and not have them ask what I have done?

What is the downtime for restayline in the tear troughs? I have seen photos of nasty bruising. What is your rate of bruising?

I am coming to visit and am so excited. Just need to get my ducks in a row to plan my downtime. Thanks for your help!



hi
1. yeah, downtime is 1 week - the first 4 days are the worst - you have to put on hydrating cream (like vaseline), but after that you look like you've had a bad sunburn. i wouldn't count on looking like nothing has happened in a week. the sunburn look will fade with time, but everyone is different in how fast they recover.
2. make-up after the first 4 days is ok
3. you should be presentable after a week or so.
4. i would give it a week to a week and a half before ging back to your friends.
5. restylane - should be no downtime at all. occasionally i get a small bruise, but that is usually coverable. nasty bruising = poor technique. no swelling, mild redness immediately afterwards.
hope that helps!
see you soon.

Numbness After Botox

Hi Dr Rivkin,
I had botox for the 1st time about 4 weeks ago for the lines between my brows. Left side had the bigger/deeper line. It felt like a nerve was maybe hit with the first injection. Felt it from the brow to the left side of my nose. Anyway a lot of my left side is numb (my upper left side on my forhead, left eye (but I can open and close eye, however it does feel dry and a little scratchy..i am putting an ointment in eye at night), my upper lip and the roof of the inside of my mouth.
My plan is just to wait it out and with time the botox will where off, but just wanted to check with you to see if you think thats an ok plan or if I should see someone. Also I was injected with 20c. It that a lot or the average amount? ANd one more thing...have you ever heard of this happening and do you think it was cause by hitting the nerve or I just have a bad reaction to botox? Thank you for your time.



hi,
that is a pretty severe reaction for botox to the glabellar area.
i would go back to your doctor and get it checked out.
no matter what, this will go away with time. it may be wise to do a brief course of steroids called a medrol dose pack. that should decrease any irritation of the nerve and spped the healing process.
20 units is a normal amount.
i doubt that its a reaction to botox - but i would have to look at you to be sure.
hope that helps.

Acne Scarring and Active Fx vs Fraxel

I have had about four fraxel treatments. There are improvements, although small, with each one. Will Active FX give me better results, or Fraxel repair?
Could you rate all three in terms of effectiveness for acne scarring? Thanks.
Last question - what should I expect to pay for Active FX from the eyes down, i.e. under eyes, all cheek area and around the mouth? Thanks.


hi gita,
i think that yes, total fx (a combination of active and deep fx) will give you better results than fraxel for acne scars. it is more intense and the results are better.
of course the downtime is about a week for active / total fx, but the results are worth it. there is not much difference between active fx and fraxel re:pair, so it doesn't much matter which one is used.
prices vary depending on where you get it done. i would charge about $2750 for a full face active fx, $3250 for total. with the discount that we have going now, the total fx comes out to cost $2750.

Under Eye Fat Transfer

Hello doctor:
I am scheduled for a mini facelift as well as fat transfers for undereye hollows and wrinkles. My surgeon feels that the result with fat is superior to other fillers as well as giving a longer lasting result. Have you seen good results with fat as a filler when used under the eye area. He will also be injecting around the orbit as I do have a bit of atrophy there as well. Any feedback would be greatly appreciated ! Thank you.


hi,
if you are going to be doing a mini facelift anyways, fat transfer sounds like a good idea, especially since it sounds like you have volume loss that is more than just the typical tear trough. i have seen excellent results with fat transfer, so as long as your surgeon is experienced (specifically at fat transfer) and conservative (you can always touch it up with juvederm or restylane), it sounds like you should be fine.
hope that helps

Cheek Enhancement with Radiesse and Sculptra

Hello Dr. Rivkin.

I thank you for reading my question. I have lost weight and have hollow-ish cheeks now (I want look of higher cheekbones). I had radiesse but did not last very long, and towards the end it became slightly uneven.
I have recently read about Sculptra. How is this product? Will I get immediate results or a couple of sessions? Can it be used under eyes too?


hi,
if you're speaking about the cheekbones, as opposed to the soft part of the cheek below the cheekbones, i think that radiesse is still your best bet. it holds its shape better than any other filler i know and it can be injected deep against the bone.
i would use sculptra to fill out the soft part of the cheeks. the problem with sculptra is that it is a collagen stimulator as opposed to a filler. it takes 3 sessions spaced a month apart to generate good results. the duration is long - about 2 years, but itis not immediate.
i would never use sculptra under the eyes - it is not precise enough and juvederm or restylane gives a result that lasts for 2 years.
hope that helps