Dr. Alexander Rivkin believes that no one should be forced to go under the knife for cosmetic treatment or enhancement. A Yale-trained facial cosmetic surgeon and UCLA faculty member, Dr. Rivkin has harnessed modern medical technology to provide his patients with alternatives to invasive surgery. Based in southern California, Dr. Rivkin is now an aesthetic injection specialist and inventor of the Non-Surgical Nose Job, his signature procedure for non-invasive correction of cosmetic nasal irregularities. He divides his time between clinical research into alternative cosmetic solutions, patient care, physician education, international lectures, and media appearances, including the TODAY Show, the Tyra Banks Show, and Elle magazine.
Dr. Rivkin has performed more than 1,000 Non-Surgical Nose Jobs using temporary fillers and has pioneered treatments such as the Non-Surgical Chin and Cheek Enhancement, Non-Surgical Jowl and Eye Lift, and the Non-Surgical Facelift. Now that he has had success with over 100 patients using the FDA-approved permanent filler Artefill, he is initiating a study to document its long-term effects. In addition to recession-friendly Rhinoplasty, he has used Artefill to provide permanent implant-free volume correction to the chin and cheeks. Dr. Rivkin took some time out with TIA to explain the ins and outs of non-surgical cosmetic procedures and future developments in the field. More information about Dr. Rivkin's practice is available at WestsideAesthetics.com.
What findings/experiences led to the development of non-surgical facial procedures?
The main event that led to the development of these techniques was the FDA approval of longer-lasting injectable fillers, starting with Restylane and Radiesse. These are still two of the most popular filling agents and the ones commonly used for facial sculpting procedures. Prior to this approval, the only filler we had to work with was collagen, and the short duration of effect made doing facial sculpting or contouring unappealing.
How does non-surgical Rhinoplasty change the shape of the nose?
Non-surgical Rhinoplasty is a procedure where small amounts of filler are placed in strategic locations to camouflage bumps, raise the nasal tip, or add height and definition to a nasal bridge. The filler is injected just under the skin, so there is no risk of breathing issues. Making a crooked or bumpy nose straight makes it appear smaller because it blends into the rest of the face.
How do the effects of chin and cheek augmentation differ from surgical procedures?
Non-surgical chin and cheek augmentation is more subtle than surgery since less volume is put in. However, it is more precise because you are putting volume only exactly where you want it. Frequently, with chin and cheek augmentation, putting volume in exactly the right place is absolutely necessary to achieve the natural, smooth result that patients are looking for. I do all of the non-surgical procedures conservatively, knowing that the patient will be coming back 2 weeks later for a possible touch up. This way, there is minimal chance of overfilling the area treated.
Why is Juvederm the filler of choice for non-surgical eye lifts, and Botox for face/brow lifts?
Juvederm is best for the eyes because it is soft and smooth, as well as dissolvable. If necessary, one can inject Hyaluronidase and dissolve the filler if there is a bump or irregularity after the injection. Under the eyes is an area where there is a lot of muscle movement. Because the eyes are the focus of the face, it is an area where any filler result must be perfectly smooth. Botox is used to raise the eyebrows because it weakens the muscles that lower the brows.
What is the cost difference between the non-surgical nose job and traditional Rhinoplasty?
Temporary: $1,000; Permanent non-surgical: $2,000; Rhinoplasty: $8,000 to $15,000.
What are the active components of Mesotherapy, and how does this treatment work?
I don't do it and I don't like it. Not only are the ingredients too unregulated, but also the results can vary and cause bruising.
How long has Artefill been around? What exactly is in it?
Artefill was FDA-approved in October of 2006. It is composed of refined, purified bovine collagen and a surgical plastic called Methyl Methacrylate. The plastic has been used in surgery for many decades and we know it to be safe.
In what cases are other fillers more appropriate than Artefill, and vice versa?
Artefill is the only FDA-approved permanent filler. All other fillers are temporary. If someone is thinking about surgery, Artefill would not be a great idea in certain zones, since it would make surgery in the surrounding area more complicated. With permanent non-surgical Rhinoplasty, I tell clients that surgery is not recommended following an Artefill injection so they should decide which way they want to go.
Can Artefill be used to remove wrinkles permanently?
Sure - Artefill will fill the wrinkle permanently, but it will not stop its progression. So, if it is getting deeper with time, the wrinkle will continue to get deeper. It’s kind of like setting the clock back - you can't stop time, but you can set it back.
What are the risks associated with Artefill?
There are reports of lumps developing after time has gone by, but the material has been reformulated since then. I have not heard such reports about the new formulation. The main risks are (temporary) bruising or redness from the injection and putting the injection in the wrong place. We always worry about the material migrating, but I have not heard any instances of this with the new formulation.
What is the focus of your study on Artefill, and what sorts of long-term effects have you seen?
My focus is to demonstrate the safety and efficacy of Artefill in correcting mild to moderate contour irregularities in the nose. I think we will show that there are no side effects, that the material corrects smoothly and naturally, and that the results last for a very long time.
What is your outlook on the future of the anti-aging industry?
It is an exciting field with new innovations and research happening at a fast pace. The challenge is to separate real developments from hype and quackery.