YOUR BOTOX® TREATMENT

Botox injections are performed with or without topical anesthesia, whichever you prefer. The discomfort is usually minimal, and most patients require no topical anesthetic. A small sting is felt with each injection. The effects of Botox® are not permanent and should be repeated every 3-4 months to maintain the correction. To help you maintain your appearance, we offer our Botox® VIP Program of progressive discounts throughout the year for our regular patients.

We truly believe that Botox® is great maintenance!  For more details on Botox® Treatments please see our specific webpages on Botox® on this website.

If you take aspirin, ibuprofen, coumadin or any other blood thinners on a daily basis, please mention that at the time of your consultation.  If it is safe for you to stop this type of medication, we might ask you to do so.

FILLING YOUR WRINKLES & SCARS

The right facial filler for you depends the location to be filled, the depth of the area to be filled, and how long you want it to last.  Dr. Bentkover currently offer three different fillers...

ANNOUNCING

A PRICE DECREASE FOR RADIESSE®--OUR MOST NATURAL LOOKING AND LONGEST LASTING FACIAL FILLER--NOW MORE AFFORDABLE THAN EVER!

Radiesse™

Radiesse™ represents a new generation in facial fillers. It is a long lasting calcium based subcutaneous filler. It is injected just under the skin. Often, Dr. Bentkover feels that this subcutaneous injection into deeper creases is a more logical approach than an intradermal injection (into the skin) with collagen or Restylane™. In the nasolabial folds it can last twice as long as Restylane™ and twice to four times as long as collagen. Radiesse® is Dr. Bentkover's preferred deep facial filler.  He is a member of the national Radiesse™ Medical Education Faculty; he teaches physicians the techniques of Radiesse™ injection.

Dr. Bentkover uses Radiesse™ to augment a number of different areas:

• Nasolabial Folds - the deep folds between the cheeks and lips
• Marionette Creases and Oral Commisures - the deep lines around and below the corners of the mouth
• For filling deep depressions from acne scars or trauma
• Deep scowl lines between the brows - often used in conjunction with Botox® in this location
• To replace lost volume in the face related to aging in the cheeks and chin that causes "hollows" in your face
• For a temporary chin augmentation or cheek augmentation - representing for some patients an alternative to surgery with little or not down time
• For minor adjustments to a nose after rhinoplasty or where just a small amount of augmentation is all that is needed to change a profile
• For longer term lip augmentation in selected cases
• Deep tear troughs associated with flatt upper cheeks
  

Radiesse™ consists of tiny spheres (microspheres) of calcium hydroxyapetite in a water based gel. Calcium hydroxyapetite is a naturally occurring substance that is a basic component of bone, but it will not form bone when injected just under your skin The major advantages of Radiesse™ are that it usually lasts 10-18 months (depending on where it is injected and how much is injected) and is very well tolerated, leaving a normal feel to the skin. It also promotes the new collagen growth in the injected area. The results are immediate. Most patients prefer a local anesthetic prior to injection, but some require no anesthetic.

Restylane™ and Juvéderm™

These are intradermal fillers. They injected into the dermis (deep layer) of the skin. Restylane™ and Juvéderm™ are made from hyaluronic acid, a naturally occurring sugar (polysaccharide) normally found in the skin. Like collagen, they are injected into the skin as a cosmetic filler. The difference is that they last 6-9 months (about 3 months longer than collagen products) depending on the amount and location of the injections. Unlike the collagen products, however, they are not mixed with local anesthetic and may require a local anesthetic prior to injection. Restylane™and Juvéderm™ are Dr. Bentkover's preferred intradermal (superficial) fillers.

Dr. Bentkover likes to use Restylane™and Juvéderm™ in the following locations:

• The fine lines of the upper and lower lips-lipstick spill lines
• Fine lines between the brows
• Lip augmentation
• Some scar depressions and lines
• Tear troughs
  

Collagen

Dr. Bentkover has used collagen as a temporary filler for facial wrinkles, creases, scars and to augment lips since 1980, but generally prefers Radiesse or Restylane to collagen now. Collagen is injected into the dermis of the skin and generally lasts 3-6 months, depending on the site where it is used and the concentration used. When he uses collagen he prefers the newer human collagen (Cosoderm® and Cosmoplast®), a genetically engineered protein from a single human cell line. Unlike the older products (Zyderm® and Zyplast®) it does not require skin testing.

In preparation for your injection...

To minimize bruising, you should stop all anticoagulant medications or herbal preparations such as aspirin, ibuprofen, vitamin E, gingko, St. John's Wart, garlic or ginseng 1 week before your injection. If you have a history of mitral valve prolapse, you may be required to take antibiotics to prevent infection. Please notify us before your appointment if you have this diagnosis. If you have a history of herpes simplex cold sores around your mouth, you should also notify us before your appointment. The needle (not the filler) can (rarely) stimulate the virus and cause a breakout. To prevent this, we would put you on an appropriate anti-viral medication.

DECREASING YOUR WRINKLES & SCARS

WITH A RESURFACING TECHNIQUE

Before Surgery

Dr. Bentkover will carefully evaluate your skin and suggest which procedure he thinks will be most effective for you. Your choice of procedure may also depend on how much time you can take off from work or your regular activities. For laser resurfacing, he will usually recommend that you receive a deep cleaning manual facial or a series of facial from a high quality aesthetician before the procedure. This will help prevent infection and the formaion of milia (small white cysts) after the procedure. If you do not have an aesthetician of your own, we will usually recommend one. 

If you are having laser resurfacing, we will recommend preparing your skin for at least 1 month before surgery with a bleaching agent plus a retinol or one of our Obagi systems. Since the major risk of laser resurfacing is hyperpigmentation (increased brown pigment in your skin), these regimens are designed to protect your skin from this possible complication.

If you are having Portrait® Skin Regeneration, there is no significant skin preparation. As a matter of fact, if you are on a retinol like Retin-A® or Renova®, we will ask that you stop using this drug about 2 weeks before the procedure. We will also ask you to stop using any fruit acids like glycolic acid or vitamin C 2 weeks before the procedure. The reason for this is that your epidermis acts as what is called a "biologic dressing" after the treatment, and retinols remove the outer most layer of the epidermis.

Method of Surgery

For laser resurfacing under local anesthesia in the office, you will be offered prescriptions to calm your nerves before the procedure. Usually we will only treat small scars, the lower eyelids, crow's feet, upper lip, lower lip and chin under local anesthesia. A full face procedure will be done in the operating room at St. Vincent Hospital under general anesthesia or local anesthesia with sedation. The lasered area is usually covered with a special tape for 3-5 days called Flexzan and then copper a containing cream and lotion from ProCyte. Your skin will be red for 3-4 months, fading gradually. Lower eyelid usually resurface in about a week, the rest of the face in about 10 days. We stock Jane Iredale make-up for this purpose. Your skin will continue to tighten for 3-4 months as your body produces more collagen.

Rhytec Portrait® Skin Regeneration requies only a topical anesthesia for a low energy treatment and topical plus injected local anesthesia for a high energy treatment, even of the whole face. We may also prescribe something to calm you nerves before the procedure. Low energy treatments are usually done in a series of 3-4, spaced 1 month apart. After the procedure you will be asked to keep your face covered with a petroleum based product like Aquaphor™. Depending on the level of energy delivered to your skin, you can expect to see your skin turn brown between 1 and 4 days after the procedure. This brown mask will slowly peel over a few days. After it is all peeled, you may return to you usual skin care except for the use of retinols and fruit acids like glycolic acid or vitamin C. You should avoid those product for another 2 weeks or so. You skin will continue to tighten for a year.

Recovery: What to Expect

Neither procedure is very painful afterwards. You will feel like you have a bad sunburn the first night after surgery and might take a prescribed pain pill or extra strength acetominophen. Rhytec Portrait® patients often take no pain medication.  The next day you will usually not reqquire any pain medication. With laser resurfacing, it will take 3-4 months for all the redness to fade completely. It is a deep pink color and can be covered by a mineral basedmake up like Jane Iredaleå™. With RhytecPortrait® Skin Regeneration, there is less redness (really just a pinkness); and it should face quicker. The next day you will usually not reqquire any pain medication. Most redness is gone in 7-10 days. With a high energy treatment you may have some pinkness that perists for a month or so, but it is generally very faint and can easily be covered with mineral makeup. It might look like a very light sunburn. You can resume your normal skin care at about 7 days, except for retinols or fruit acids.  Our nurse will advise you on when to resume those products.