» Cheek enhancement

Non Surgical Midface Lifting – Any Options Available?

Dr. Rivkin — Fri, 13 Jan 2012 19:20:28 +0000

Actually, there are excellent options available. The midface is probably the most important area of the face that “gives away” aging. The loss and descent of facial fat volume in this area is one of the first signs of facial aging. You can’t really lift the area non surgically, but there are significant things that can be done to improve the appearance. First, the tear trough and under eye area can be re-filled with Restylane and Radiesse. This is usually the first sign of aging and filling this area usually gives a dramatic improvement. 10 years in 10 minutes is not an exaggeration. Replacing the definition and prominenece of the cheekbones is also important and can be done with Radiesse or Sculptra. Volumizing the cheekbone area changes the shape of the face back to the heart shape of youth – wider at the cheekbones and narrowing at the jawline. Refilling sunken cheeks and temples is the next important step and Sculptra is a great injectable for that. The side benefit of Sculptra is that it improves the quality of the skin where it is injected. The pores are smaller and the skin becomes thicker and firmer. Filling deepened nasolabial and marionette lines with Juvederm or Radiesse is, of course, part of the equation. Hope that helps.

Non Surgical Facial Volume Replacement

Dr. Rivkin — Tue, 15 Nov 2011 22:35:03 +0000

What is currently the best filler for high volume areas if you are too lean to get autologous fat injections? Is it best to avoid cheek implants? Not able to take advantage of fat transfer. Do the fillers give a lumpy apearance on someone with thin skin? Does it encapsulate in large areas such as the cheeks?

Depending on which areas you are talking about, the optimal injectable agent varies.
The most common high volume area in my practice is the front area of the cheeks, just under the lower eyelids (malar area). This is one of the first areas to lose volume as we age. Volume loss here is a big component of how old people look. I usually use Radiesse here – it is a long lasting, smooth filler that keeps its shape very well when injected deep. This is important because as I fill that area of the cheeks, I want it to have the round shape that the patient had in their youth. I do not want to use a soft filler like Juvederm because it squishes down and the final appearance is of a flat, not round cheek. If the patient is unsure of the procedure, I will offer to use Perlane, a high density hyaluronic acid filler. It doesn’t last quite as long as Radiesse, but it does give that round shape and it is, most importantly, dissolvable at any time with an enzyme.
If you are talking about large surface areas like the soft part of the cheeks or the temples, I use Sculptra. This is not a filler at all, but a collagen stimulating agent. I like to think of it as a fertilizer for the skin. It pushes your skin to make more collagen and fill the area naturally. It takes 2 to 4 monthly sessions, but the results last 2 to 3 years or more.
With all of these injectable agents, it is possible to get a perfectly smooth and natural appearance without lumps. You just have to choose an injector who is very experienced at non surgical volume enhancement. Word of mouth, looking at the injectable companies’ websites for people who use lots of the filler and asking the doctor and his staff direct questions are the ways to determine their experience.
Good luck!

Ali Lohan’s new face

Dr. Rivkin — Sat, 17 Sep 2011 19:29:06 +0000

My commentary in the latest Monsters and Critics article on Ali Lohan

I can’t say that I know of too many teenagers whose lips suddenly double in volume as they “grow into their bodies.” Not that there’s anything wrong with lip augmentation…. well maybe there is if you’re 17 and your mom is telling you you have to get cosmetic procedures and starve yourself in order to succeed as a model (a purely hypothetical situation – I have no way of knowing if mom is pushing her into it or just standing by irresponsibly as the kid does it to herself) ….

http://www.monstersandcritics.com/lifestyle/consumerhealth/news/article_1662072.php/Ali-Lohan-s-new-face-examined-by-Plastic-Surgeon

Lipodystrophy-like volume loss of the face.

Dr. Rivkin — Tue, 13 Sep 2011 21:04:24 +0000

Hello Doctor,

I am a 25 year old male. I have two questions. One about implant/filler and the other about scar.
I have a light brownish skin complexion. I have been diagnosed with En coup de Sabre Morphea on the right side of the face 3 yrs ago. Because of this decease I have almost totally lost fat/muscle below my right cheek – just beside nose area. I also have partial lipoatrophy. So far I have not lost hairs although I have hair-fall problem for some years now. I also have a dark linear band type mark on the right side of forehead. This area is also depressed slightly but visibly. The disease progression ‘appears’ to have stopped but doctors say they are not sure about lipodystropy.

So, I wish to know the opinion of other doctors about it. First, what is the best laser treatment for an atrophic hyper-pigmented scar on the cheek caused by Morphea? Is there a way to remove or lightened it? Note: it is my report which says it is an atrophic hyper-pigmented scar.
Secondly, my doctor has suggested Artefill to fill the cheek depression. Is it the best option or should I go for silicone implant or for some other option? According to my doctor I cannot have autologous fat grafting because of partial lipoatrophy.
Thanks and regards

When patients come to me with large surface areas of volume loss, such as what you are describing, I think that Sculptra is the best option out there. Hyaluronic acid and Artefill are for lines and areas of small surface area. Sculptra is a collagen stimulator – if you can imagine a fertilizer that grows collagen. It is a thin
suspension, so it distributes evenly and smoothly within the tissues. The results are gradual, over three or four monthly sessions, but the effect is very reliable and lasts for several years. It is important to go to an injector who has extensive experience with Sculptra because there is a technique to injecting it safely and most effectively. This is an injectable that was used extensively for lipodystrophy among the HIV population and has demonstrated its ability to provide significant re-volumization of cheeks, temples and other large surface area regions.
As regards the hyperpigmentation, that should be correctable with the appropriate laser – which one would depend on what we see in the consultation.

Fillers vs Mid Face Lift at 35

Dr. Rivkin — Mon, 04 Oct 2010 18:42:34 +0000

I’m 35 years old and since I was young I’ve always had long/tear trough/cheek dents in my upper cheek area and lines that go from the corner of my mouth to the end of my chin/downturned mouth. When I was younger, it wasn’t as pronounced, but now that I seem to be loosing facial volume over the last few years, I’ve started getting very pronounced undereye hollows as well as my cheeks are starting to hang/droop. Would I be a good candidate for fillers or would a midface lift and/or lower eye procedure be more beneficial for me?

I think that you would clearly benefit from fillers. You are too young for surgical procedures, in my opinion. Surgery is, like any other intervention, temporary. Results will last 10 years or so. However, each time you do surgery, there is some scarring that remains under the skin, making subsequent operations in the same area more complicated and risky. Surgery should be delayed as much as possible with fillers and toxins. Doing a lift at 35 signs you up to a lifetime of revision lifts and other procedures that become more and more risky and less and less successful as you age.
All you really need, from what I can tell by the picture, is filler (either Radiesse or a hyaluronic filler like Juvederm or Perlane, or a combination of both) to re-volumize that diagonal area across your cheek. You are correct to observe that it is the volume loss that makes you look older than necessary. Replacing that volume and refilling the cheeks lifts the focus of your face back up to your eyes – the most flattering focal point of anyone’s face. Filling the cheeks also has the effect (partly real, but mostly an illusion of perception) of making the face look lifted.
It seems that you would also benefit from Juvederm filling of the tear troughs. This will eliminate the dark circles that you may be seeing under your eyes and make you look less tired. Its a quick procedure that has the added benefit of lasting 2 and sometimes even 3 years.
Needless to say, these filler procedures are somewhat tricky and should be done by an experienced, recommended professional.

I am honored to have been selected for the cover of this month’s MedEsthetics magazine!

Dr. Rivkin — Tue, 18 May 2010 17:02:37 +0000

First of all, it just goes to show that my mommy was right – I am special!

Actually, it is great to see the continued attention that non surgical facial sculpting is receiving.These procedures have been adoopted faster than I even expected back in the day (6 years ago) when it was all getting started.

Fillers and Botox have redefined the relationship that the average person has with the aesthetic field.

The last six years have seen a non surgical revolution and I look forward to all the new stuff we have yet to discover!

Cheeks – Radiesse vs. Fat Grafts vs Bone Grafts

Dr. Rivkin — Tue, 31 Mar 2009 23:29:00 +0000

Hi please can you answer these questions to the best of your knowledge and expertise, thanks

can radiesse be used into cheekbones so i could i get an exact match as the other cheekbone, could this lead to further problems?

If i was to get fat grafts to build up parts of scraped away cheekbone due to surgery would it be a surgical operation or can that be injected?

Could bone graft be done to a good standard to make a cheekbone look symmetrical compared to the other?

Regarding the pufiness in cheek due to surgery could this be liquid (edema) trapped in the cheek and muscles?

If it is scar tissue (i cant understand how scar tissue could have come about since the incision was made on the cheekbone), would it be ideal to get an mri scan could you see the scar tissue with this scan?

By injecting steroids directly onto the scar tissue in small doses could this lead to further problems, is there any other ways of reducing the scar tissue and pufiness in the cheek?

thanks

hi
i use radiesse to fill cheeks every day. it is easy, precise and effective. the worst side effect i have seen is a bruise. it lasts for a year or so.
i think that radiesse is more reliable than fat grafts and it is a heck of alot easier and cheaper. remember, no-one can tell you for sure how long a fat graft will last, no matter how good a technique is used.
radiesse is alot easier and cheaper than a bone graft.
it could be edema.
no mri necessary
steroids work very well to reduce scarring. i would do that over anything else. it is safe and easy.
hope that helps