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  • Fraxel Laser Skin Treatments

    "I just wanted to thank you for the wonderful service you gave me when I was in southern Cal a few weeks ago. You were the only office that responded to my email, and actually I'm grateful. I love my Fraxel & will plan more treatments. Thanks again for your professionalism, your friendly atmosphere and your patient care."

    Sincerely, PG

Hi Dr. Rivkin,
I had Juvederm put in my lips and a scar on my left cheek (and forehead) on Friday around noon. I am experiencing some facial swelling on most of my face below my eyes. The swelling on my lips seems to pretty much be gone, however, the rest of my face looks fat. I understand the swelling where my scar was injected, but the rest I don’t understand. Do you think this swelling is a side effect of the dental block? My mouth is also tender in the four corners deep inside where the block was injected and when I smile I feel like I have cotton balls in the top corners of my mouth like next to the nostrils. It’s been about 56 hours since the block and Juve and I’ve applied lots of ice and it doesn’t seem to be going down. Any insight/advice? Will this go away?
Thank you in advance!

P.S. I also had Juve put into a small scar on my forehead and there isn’t an ounce of swelling there, so I have doubts about it being the Juvederm.

yes, i definitely think that this is a consequence of the dental block, not the juvederm.
i have seen this too many times. it is not anyone’s fault – you just have a sensitivity to lidocaine and you should not get it again. there’s plenty of other injectable numbing agents, so that’s not a big deal.
the swelling will go away. i like to give people a 5 day course of steroids called a medrol dose pack. it will make the swelling go away very quickly. otherwise it can stick around for a few days to a week.
hope that helps

Hi Dr. Rivken,
I have had one Fraxel treatment. I had a light brown spot on my cheek and over my lip before treatment. After treatment they have gotten darker and new ones have appeared. There are also lines on the top of my cheeks (where the blades and level was changed). My skin is darker below the line where the higher levels were used. I was given bleaching cream and was told the pigmentation needed to come to the surface. I am very concerned more brown spots will surface and they will not fade.
Should I continue with the Fraxel? It has been 6 weeks and the brown spots have not gone away yet.
Thank you for your help.

the spots will fade with time, however i would certainly wait until they are faded before doing any more fraxel. i would also carefully evaluate the settings on your fraxel treatment. first, make sure that your doctor has the upgraded sr1500 fraxel – it is a safer machine, especially for people who are prone to hyperpigmentation like you. then, make sure that your next treatment is less intense, and they spread out the energy over more passes.
last, i would make sure that you are out of the sun and on daily bleaching cream for 2 weeks prior to your next fraxel treatment.
hope that helps.

here’s the next question:

Hi Dr. Rivkin,
Is there anything I can do to give the appearane of a moreprominent brow bone? I had an upper bleph and brow lift and the area below the outside partof me eye between the crease and brow line looks flat. Can a filler stay suspended in that area? The skin is firly firm in that area.

i have tried to create more prominence to the brow with good success using fillers like radiesse and artefill. the change is subtle, but is definitely there. with the fillers, especially artefill, it takes a few sessions, but it is worth it because fillers are really the only way to expand that area. there aren’t any implants for the brow, nor will there be, considering that this area has alot of important vessels and nerves running through it. this particular situation is more complex since it is a post operative area. the scarring may make it tough to impossible to lift the skin up. but you never know until you try and i have often been surprised in the past.

I signed up on a forum site to answer questions from people, so I thought I would include some of the more interesting questions here as well.

Here is the first one:

I have been toying with the idea of having the area around my mouth and chin filled to reduce the lines going from my mouth to chin – sort of giving me an appearance of a frown. I also have a little bit of fat loss in that area that adds to this – anyway I guess you could say that after researching various fillers – pros and cons and reading the messages on this boards I am more confused than ever.

I had considered Sculptra but am not sure if this is right for this area and also am concerned about lumps etc….. I am slightly scared of the permenant fillers (Artefill) as I am worried that they are too new to really determine their safety and of course as they are “permenant” any mess ups are there for good. Some of the others, such as Juvederm and such seem to only last a couple of months making the “pain/cost” factor quite high for the length of time it lasts.

Understanding that you can’t really recommend anything without seeing a person, can you point me in the right direction of what I should consider and ask when thinking about doing this?

There is so much “stuff” out there that I am really confused as to the differences in these products. Perhaps there are others on the board who are confused who would welcome some info on how to approach this.


this is a really good question – there are many options for fillers these days. This is good because you can really select a treatment that suits your anatomy, your mindset and your budget. however, it does tend to get confusing, trying to figure out just what would be best for you.
if i had to guess, i would start off with juvederm in your nasolabial folds. it is a very soft and natural looking filler and it lasts about 6 to 8 months. the stuff on the net you hear about it lasting 2 months or so is mostly rare cases of poor injection technique or just unusual people.
i think sculptra would be quite expensive, although it would last longer. you’d have to come in 2 to 3 times at close to $1000 a pop and it would last about 2 years or so. not bad, but most of my patients don’t want the hassle and expense.
radiesse is very good, but i get more bruising and swelling than juvederm, and it lasts about 10 to 12 months. its about $200 more per syringe.
also, either radiesse or juvederm stimulate collagen, so even after the filler has been broken down, the lines come back a bit more shallow each time.
hope that helps,

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