Radiesse and Naso-labial 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?


hi,
radiesse usually lasts for about 10 moths to a year in the nasolabial folds. but it is not appropriate for all folds - its best for deeper ones. its a large particle size, so its not the best idea for finer lines. also, make sure that the person injecting it is experienced at radiesse injection - the material can bruise and swell. good injection technique helps to minimize this.
i do not schedule a routine follow up visit for everyone 2 weeks after the initial injection, but i certainly encourage patients who have any problems at the 2 week point to call me and come in. some problems that i correct are: bumpiness, swelling, not enough filler.

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,


hi,
i don't have this device, although i have the starlux. i got the fraxel fractional laser and have been happy with that. however, i am somewhat skeptical that a fractional device will help you with rosacea and skin tightening. i have a hard enough time seeing good results with thermage (whose purpose is just skin tightening) for skin tightening that i do not think that this device will do all 3 things. its an erbium laser, which is good for helping the fine lines a bit, but i do not think that it is powerful enough to make that much of a difference. i think that ipl / photofacial would be a better modality for your rosacea.
i could be wrong, but i don't think so.
just 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.
i would offer ipl or for the rosacea, thermage for the skin tightening and juvederm for the lines. i think that would work well.

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 is 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. its 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.
hope that helps

Botox price and where to get it

I am in my late 20s and looking to get my first Botox treatment for frown lines, forehead lines, and crow's feet. I don't want to get ripped off, so can someone please tell me - What is the normal cost of Botox? How many units of Botox do most people need to smooth wrinkles and prevent wrinkles? Does the cost of Botox fluctate depending on where in your face you get it injected?



The price of Botox and how many units are injected in each area really varies among physicians and geographic areas.

There is also conflict about who people should or should not go to for Botox treatment. Both to avoid getting "ripped off" and to get a good, natural looking result.

In my clinic, Botox is $12 per unit. I charge by the unit and encourage patients to know how many units they get in each area they have treated. I agree that charging by the "area" encourages under-treatment by the injector - they still charge the same whether they are using 10 or 20 units. In general, though, you should do your homework and find a Botox provider who is experienced, knowledgeable and has been around for a while with a loyal clientelle. Providers who are in it for the volume business and don't care about repeat clients or forming a relationship with their clients should be avoided.

Units I use:

Forehead: 8 to 12

Glabella: 12 to 20 (usually 16)

Crow's feet: 12 to 20 (usually 16 - and that includes a bit under the tail of the eyebrow to give a lift)

Chin: 8

Upper lip: 4

Jaw for Teeth Grinding / TMJ: 16 to 60 (usually 20 per side)

I wouldn't go shopping for champagne and caviar at JONS or K-Mart. I also wouldn't get Botox at the local mall. I would go to a doctor's practice - that way, if there's a problem, you have someone to speak to.

A quick note about an ongoing turf battle.

The doctor does not have to be Board Certified in Plastic Surgery. It doesn't take a rocket scientist to inject Botox (which is not to suggest that Board Certified Plastic Surgeons are all rocket scientists). It does take a bit of knowledge, a good hand and some common sense. Nurses, PAs and physicians who have decided to specialize in cosmetic procedures should have plenty of that. Board Certification just means the doc has completed a specialization in something. It does not mean that he/she is good at everything. There are plenty of Board Certified Plastic Surgeons who are always operating and therefore rarely inject. Theses people are not good injectors. There is no Board Certification for injection and laser procedures, by the way.

Kenalog Dent

About 3 months ago I had kenalog injected into my TT scar and also lasered (whisper). 1 month ago I had my second laser treatment. Last night I noticed a dent near my scar and the skin looks thinner there. I say thinner because I can really see alot of veins I didn't see before.
Googling this brings me to the kenalog? Is there anything that can be done to stop the dent from getting worse or fixing it?
I plan on calling my PS Monday but this is just really bothering me!
Thanks!

Melissa


hi melissa,
the dent is not going to be a major problem.
it does sometimes happen from kenalog injection, but its easy to fill it in. it generally will not get worse and worse. it just happens and then either improves on its own, or we fill it in. once it is filled in, collagen stimulation happens and we usually do not have to fill it in a second time.
hope that helps

Red after Chemical Peel and Blepharoplasty Question

I have had 4 deep chemical peels done to remove severe acne scarring over the past 7 years. After the last one my skin has stayed bright red. It has been almost a year now and it is not fading. I now have to always use a moisturizer with a green tint and thick waterproof makeup in order to cover it up and it still looks red in pictures. I won't even let my husband see me without makeup. I am scared to go swimming with my kids because the makeup might wash off. I had the chemical peels so I wouldn't have to wear so much makeup. What would be the best treatment to get rid of the red?

Also I am 37 and have droopy upper eyelids, they almost rest on my upper lashes. The are not crepey but just a fold. Is there something I could do other than eye surgery?


hi
that's a long time to be red.
you should not have to suffer through this without help.
i would go to your dermatologist and ask their advice about the redness.
i think that ipl photofacial or yag laser treatment would be a good idea for you.
you will probably need several treatments, but it is worth it.
by the way, you may want to speak to the office that did your last peel. this is a problem that they had a hand in causing, so they may want to take some responsibility in fixing it.
in terms of your eyes, i do not think that you are going to get away from a blepharoplasty - there's no way to tighten that skin non surgically. the good news is that it sounds like you have an issue that insurance may cover. when the skin folds over so much that it interferes with vision, medical insurance will cover the procedure. i would speak with an oculoplastic specialist.
hope that helps

Dr. Rivkin

The middle of this past May '08, I had injections in/under my eye hollows with Radiesse. I had a lot of bruising and swelling, but was told that this would go away, some of the bruises were very deep and purple and lasted nearly two weeks. But, they DID go away.

the end of the second week, I began to swell in a different way all under my eyes, on top of the cheek bone, and got weird discoloration at the sight of the injection. A brownish/reddish color. I went to the Dr. who did the injection and was given a prescription for oral steroids, as well as an antibiotic.

The swelling went away, but even now, mid July the discoloation is there and I need makeup to cover it...it is very noticeable..

do you have any solutions, adivce, or thoughts? what could this be?

thanks so much for you time

-pepper


hi pepper,
this is one of the reasons that i do not use radiesse under the eyes. i think this is pigment deposited as a result of prolonged bruising. i'm not sure how to make it resolve. perhaps hydroquinone cream? i use 8%, but it doesn't always work. steroid injections are also a possibility - i would start with kenalog 10.
hope that helps
azr