For Mild Wrinkles to Deep Wrinkles and Scars…
Unfortunately, there is not magic wrinkle-removing cream or potion. Wrinkles can be treated with lasers, nitrogen plasma or similar procedures that tighten the skin and promote formation of new collagen to rejuvenate your skin. They can also be filled with a temporary filler or decreased by inactivating the muscles that cause them.
Here is what we offer for wrinkles, facial creases and scars:
Non-Surgical Office Treatments:
Surgical Office and Operating Room Treatments:
BELOW IS A QUICK SYNOPSIS AND SOME COMPARISIONS OF TREATMENTS:
Dr. Bentkover has used Botox® (Botulinum Toxin Type A) successfully for facial rejuvenation since 1995. Botox® and Dysport® (available in the US since May 2009) treat what are called “dynamic” wrinkles and creases through a process known as chemo denervation. The druges are injected with a very tiny needle in such a way as to block the signal from specific nerves to a particular muscle. They can precisely block the action of a muscle or muscles that cause specific dynamic wrinkles or creases in your face. Most patients see results within 5-7 days and most results last 3-4 months. For a more details on Botox® and Dysport® Treatments, please see our specific pages on this subject on this website (Just click here.)
Dr. Bentkover has over 30 years experience with facial fillers.
There are a number of cosmetic fillers available on the market for facial augmentation. Each has distinct advantages and disadvantages. If you have lines or wrinkles that you want treated in the office with minimal or no down time, you might consider a facial filler. 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. As new fillers achieve FDA approval, Dr. Bentkover carefully examines them for safety and effectiveness relative to existing products before recommending them to our patients.
Most often Dr. Bentkover uses Radiesse™, Juvéderm®, Hydrelle®, Perlane® or Restylane®. Dr. Bentkover also uses fillers in conjunction with Botox® and Dyport®. He is a member of the national Radiesse® Medical Education Faculty. As such, he teaches physicians techniques of Radiesse® injection. The Facial Fillers page of this website has a discussion of each of these fillers, including when and why Dr. Bentkover likes to use then. The appropriate choice and use of a facial filler requires a detailed understanding of facial anatomy, a clear understanding of how your face is aging and an eye for placing the filler where it will look natural.
TREAT YOUR WRINKLES & SCARS FROM THE BOTTOM UP!
Two different ways to decrease wrinkles and scars leaving you with smooth, rejuvenated skin and surgical scar revision for deep traumatic or post-surgical scars:
Both resurfacing technologies give consistent results for the right patient. In the opinion of many facial plastic surgeons, the “gold standard” for facial resurfacing is still carbon dioxide laser resurfacing. Dr. Bentkover started using has been doing this procedure since 1995. His results achieved for wrinkle removal and acne scars are very predicable, with very high patient satisfaction. Recently, he upgraded to the newer version of this laser, the Lumenis Ultra Pulse® Carbon Dioxide Laser with the fractionated Active FX® attachment. In his opinion, this is the best of the fractional lasers on the market.
In 2006 Dr. Bentkover became one of the first surgeons in New England to offer new, viable alternative to laser resurfacing, Portrait® Plasma Skin Regeneration. There are only about 500 of these machines in the US.
This exciting new technology enables Dr. Bentkover to treat fine lines and facial discoloration with a quick office treatment that requires only topical or local anesthesia. By 10 days after the procedure the pinkness is generally mostly gone! We really like the overall textural improvement we see with the plasma treatment. If you have deeper lines or acne scars, however, you will probably need the carbon dioxide laser.
For more details on these two technologies click here.
SURGICAL SCAR REVISION
Some extensive scars need surgical scar revision. Techniques such as injection of steroids (trimancinolone), application of topical silicone, re-excision, running W plasty, random broken line scar revision, tissue expansion or dye laser treatments arer used to decrease or camouflage scars. Often by just changing the direction of a scar with one of these techniques, it will hide better. We commonly treats surgical scars and traumatic scars with these techniques.
Dr. Bentkover will be able to recommend whether Portrait® Plasma, Carbon Dioxide Laser Resurfacing or a surgical scar revision is the right treatment for you. We do not expect you to be able to decide which treatment is best for you just by reading on a website. That is neither practical and nor advisable. Education and decision making is the role of a consultation.
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.
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™ 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
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 recomm
end 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.
Please also refer to the web pages on this website on Facial Resurfacing techniques: UltraPulse Carbon Dioxide Laser and Rhytec Nitrogen Plasma Portrait Skin Regeneration
A peel with a laser or similar device designed to remove the damaged upper layers of skin and allow the growth of new healthier, smoother, tighter skin.
For Fractionated Carbon Dioxide Laser Resurfacing or Portrait® Plasma Skin Regeneration the initial recovery is about 7-8 days. You may have some pinkness for 3 weeks or so after that. You can cover this with make-up.
Not usually. Our patients tell us that it feels like a bad sunburn the first night. They rarely take significant pain medication after the first night, and many take no pain medication at all. Our plasma patients take even less medication.
You can get some lightening with the carbon dioxide laser, but Dr. Bentkover usually dose a very nice job of “blending” the color. He has been using this laser since 1995. Portrait® plasma will even out your complexion by removing unwanted pigment but should not overly lighten your skin.
The differences in outcome can be subtle or very significant, depending on the amount of energy used, the depth of your wrinkles and/or the amount of excess pigment in your face. In a consultation Dr. Bentkover should be able to recommend which he thinks will be best for you. He needs to see you in person.