Wrinkles & Scars

Your BOTOX® or DYSPORT® Treatment

Before the Procedure

To better understand your overall health, Dr. Bentkover will evaluate your medical history prior to the procedure. In addition, he will determine the exact location and size of the muscles to be injected in order to decide the most effective injection sites and dose. He will carefully explain the treatment and realistic goals for the treatment. He will answer all your questions, including questions about the low risk of the treatment. He will take digital photographs in order to be able to evaluate the effectiveness of your first treatment.

The risks of a Botox® or Dysport® treatment are very low: but if you have a neurological disorder (such as Myasthenia Gravis or Multiple Sclerosis), a neuromodulator like these drugs may not be for you. You should discuss the advisability of having a treatment with your neurologist before booking your appointment with us. If you take aspirin, ibuprofen, coumadin or any other blood thinners on a daily basis, you should stop this type of medication 10 days before the injections, if it is safe for you to do so.  If it is not safe for you to stop such medications, your risk of bruising, while small, will be higher with the treatment.

The Procedure

Injections are usually performed without topical anesthesia, but we have it available if you want it.  We can also apply ice before the injection to numb the area. The discomfort is minimal, and most patients require no topical anesthetic or ice.  A small sting is felt with each injection. The effects of the treatment are not permanent and should be repeated every 3-4 months to maintain the correction. To help you maintain your appearance, we offer our  VIP Program of progressive discounts throughout the year for our regular patients. Remember, we truly believe that Botox® and Dysport® are great maintenance!

Research has suggested that the long-term use of botulinum toxin injections may lead to a longer duration of each treatment's effect. Some of our long-term patients find they need injections less often than when they started the treatments. Patients over the age of 65, however, may not experience as dramatic a result, and some patients may be "partial reactors". Also, up to 16% of patients seem to be completely immune to the effects of the drugs, so-called "non reactors".  However, some patients who seem to be immune to Botox® my have a very resonable reaction to Dysport®.

Recovery: What to Expect

It usually takes 5-7 days to see the affects of the injections, but it can take up to 30 days. We check the affects of your first injection at 3 weeks.  We do this to make sure we have the right dose and injection sites for you. You may experience slight bruising around the injected area (especially in the crow's feet area) that fades and responds nicely to ice. Most normal activities can be resumed immediately. You may exercise the following day. We ask that you wash your face gently that night and do not rub the areas injected. Side effects are unusual but may include an allergic reaction, headache, flu-like symptoms, and temporary weakness of nearby muscles. Dr. Bentkover will explain all the risks associated at the time of your consultation.

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.  We offer a number of different fillers. 

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®, Perlane®, Hydrelle® and Juvéderm®

These are intradermal fillers. They injected into the dermis (deep layer) of the skin. These products are made from hyaluronic acid, a naturally occurring sugar (polysaccharide) normally found in the skin. They last 6-9 months depending on the amount and location of the injections. Hyaluronic acid fillers are Dr. Bentkover's preferred fillers for lip augmentation creases that are primarily from the dermis.

Common sites for hyaluronic fillers:

• 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

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.

Your Resurfacing with CARBON DIOXIDE LASER or PLASMA

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. He will often recommend that you establish a routine of deep cleaning, manual facials from a high quality aesthetician before either procedure. This will help prevent infection and the formation of milia (small white cysts) after the procedure. If you do not have an aesthetician of your own, we can usually recommend one.

If you are having laser resurfacing, we will recommend preparing your skin for at least 4-6 weeks 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® Plasma Skin Regeneration®, there is no significant skin preparation. But if you are on a retinol like Retin-A™ and Renova™ or any kind of frequent fruit acid treatments to your face (like glycolic acid or vitamin C), we will ask that you stop using these about 3-4 weeks before the procedure. The reason for this is that your epidermis acts as what is called a "biologic dressing" after the treatment, and these products thin the outer most layer of the epidermis, the stratum corneum. 
For both procedures, we recommend washing your face with a hexachlorophene soap starting two nights before surgery.
 

Method of Surgery

For laser resurfacing under local anesthesia or plasma resurfacing in the office, you will be offered prescriptions to calm your nerves before the procedure. With the laser, 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.  With plasma, we routinely do the whole face in the office.
 

Recovery: What to Expect

The recovery for both procedures is very similar. The treated area is usually covered with Aquaphor™ ointment for 7-8 days after surgery.  This is readily available at you local pharmacy.  It is important that you keep a thick layer of the ointment on your skin at all times until the skin has resurfaced, usually 7-8 days. This protects new skin and prevents the treated epidermis from coming off prematurely. We will show you how to use the ointment. Your skin may be pink for 2-3 weeks, fading gradually. Sometimes we will prescribe a mild steroid lotion to help this subside.  The skin may also be itchy.  Cotton gloves at night will prevent you from scratching off new skin.  You can usually wear a mineral make up in 8-9 days.  We stock ColorScience™ make-up for this purpose. Your skin will continue to tighten for a number of months as your body produces new collagen.   Collagen production does not even start significantly, however, for about 30 days.  Please be patient.  You will notice color changes in the first two weeks.  You will start to notice changes in the texture of your skin (e.g. wrinkles and smoothness) at about 3-4 weeks. Neither procedure should be 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 acetaminophen. The next day you will usually not require any pain medication.