We are excited to be offering facial esthetics! We offer Botox/Xeomin, Belotero, Juvederm, Ravanesse, and Vsoft smooth threads.
Dr. Richman is an associate member of the American Academy of Facial Esthetics. She offers Botulinum toxin and dermal filler injections, PDO smooth threads, ands Botox/Xeomin treatment for Temporomandibular Joint (TMJ) pain and Migraine pain treatment. In addition, she offers trigger point therapy for neck and shoulder pain.
What is Botox/Xeomin?
Botox and Xeomin are injectable wrinkle muscle relaxers. It uses botulinum toxin type A to paralyze muscle temporarily. This reduces the appearance of facial wrinkles.
Treatment is minimally invasive. It’s considered a safe, effective treatment for fine lines and wrinkles around the eyes. It can also be used on the forehead between the eyes.
Botulinum toxin type A was FDA approved in 1989 to treat blepharospasm and other eye muscle problems. In 2002, the FDA approved the use of botulinum toxin type A for The FDA approved cosmetic treatment for moderate to severe frown lines between the eyebrows. It was approved to treat wrinkles around the corners of the eyes (crow’s feet) in 2013.
According to a 2016 clinical study, Botox/Xeomin is a simple, safe, and effective treatment for reducing forehead wrinkles.
In 2016, over 4.5 million procedures were performed using Botox/Xeomin to fight wrinkles. This type of procedure is the number one nonsurgical cosmetic procedure in the United States.
Preparing for Botox/Xeomin
Botox/Xeomin involves a non-surgical, in-office treatment. It requires minimal preparation. It would help to let us know about your medical history, allergies, or medical conditions before your procedure.
You might need to remove all your makeup and cleanse the treatment area before the procedure. You may also need to avoid blood-thinning medicine like aspirin to reduce the risk of bruising.
What areas of the body can be treated with Botox/Xeomin?
Cosmetically, the injectable can be used in the following areas:
Botox/Xeomin also received FDA approval to treat various medical problems, including:
How does Botox/Xeomin work?
Botox/Xeomin works by temporarily blocking nerve signals and muscle contractions. This improves the appearance of wrinkles around the eyes and between the eyebrows. It can also slow the formation of new lines by preventing the contraction of facial muscles.
It’s a minimally invasive procedure. It doesn’t involve incisions or general anesthesia. If you’re concerned about pain or discomfort, a topical anesthetic or ice can numb the treatment area.
During the procedure, Dr. Richman will use a thin needle to administer botulinum toxin type botulinum toxin type A injections to the targeted area between the eyebrows. You will usually need three-four injections on the side of each eye to smooth out crow’s feet.
The entire procedure takes approximately 10 minutes.
Are there any risks or side effects?
Minor bruising or discomfort may occur but should improve within a few days. Other side effects may include:
Contact your provider immediately if any of these side effects occur.
What to expect after Botox/Xeomin
Avoid rubbing, massaging, or applying any pressure to the treated area. These actions can cause Botox/Xeomin to spread to other body areas, do not lie down or bend over for three to four hours; this can negatively affect your results. Do not lie down or bend over for three to four hours when injected between the eyebrows; this. Doing so may cause the Botox/Xeomin to slip under the orbital rim. This could cause an eyelid droop.
There is little to no downtime expected after the treatment. You should be able to resume normal activities immediately in most cases.
It’s important to understand possible improvements and have realistic expectations. Noticeable results can be expected within 1-2 days post-treatment. The total effect of Botox/Xeomin typically lasts up to four months. It can also help prevent the return of fine lines by relaxing the muscles.
Additional injections can be administered to maintain your results.
How much does Botox/Xeomin cost?
The average cost of a botulinum toxin treatment such as Botox Cosmetic was $376 in 2016. Prices may vary depending on the number of injections and the treatment area's size.
Botox Cosmetic is an elective procedure. Health insurance does not cover the cost when used for cosmetic reasons.
Botox/Xeomin is FDA approved to reduce fine wrinkles around the eyes and on the forehead. It’s relatively safe and noninvasive.
Let us know about any allergies or medical conditions, and call us right away if you experience any side effects following your treatment. Results should last for about four months, and it’s possible to have additional injections to maintain the reduction of your wrinkles.
What are dermal fillers?
As we age, our skin loses subcutaneous fat and essential proteins - like collagen and elastin - which give structure to the face and make it look youthful, plump, and bouncy. But fortunately, there’s a treatment that can help with this. Welcome, dermal fillers.
These anti-aging injections can help restore a youthful look when the skin starts to age by smoothing out wrinkles and helping to change the shape of - and add definition to - facial features. Dermal filler injections - often just referred to as fillers - can also give volume to sunken areas (like the cheeks), fix under-eye bags, and enhance places like lips, jawlines, chins, and temples. So, they can be used to treat a wide range of problem areas, but how do fillers work?
Dermal filler treatment involves a gel-like substance (natural or synthetic) being injected into target areas of the face with a cannula or needle. The filler plumps the skin from the inside out and works in place of lost fat and proteins to smooth lines and wrinkles and volumize hollow areas (hello, cheek fillers!).
Note: fillers are used on static lines, which, unlike dynamic lines, remain visible on the face even when it’s relaxed and expressionless. Dynamic lines are best treated with Botox/Xeomin.
There are different types of dermal filler substances (some temporary, some longer-lasting, some thinner, some thicker), including calcium hydroxyapatite, polymethylmethacrylate, and hyaluronic acid. Some semi-permanent brands of filler - including Sculptra, Ellanse, and Radiesse - work by filling out lines and wrinkles and stimulating the body’s collagen production. These fillers usually last upwards of one year.
But, hyaluronic acid fillers - including brands like Juvéderm, Belotero and Restylane - are the most popular and most commonly used. A naturally-occurring substance produced by the body, hyaluronic acid is a prized skincare ingredient with tremendous hydrating abilities. This type of filler is famous for many? Reasons, but one of the biggest is that it’s temporary (lasting roughly 6-18 months, depending on the brand and area injected). Should anything go wrong, a medically qualified practitioner can dissolve hyaluronic acid-based fillers with an enzyme called hyaluronidase.
Hyaluronic acid dermal fillers are also great for volumizing because of the hydrophilic (water-loving) nature of hyaluronic acid. The acid attracts and draws in water from the air, which keeps the skin moisturized. Just one gram can hold up to 6 liters of water. Yep, a whole 6 liters! How does this make it a good filler? The water it attracts and holds helps fill out the skin, creating the perfect plump.
Dermal fillers amounts and thickness
Different amounts of filler will be injected into the skin depending on the area being treated and the desired effect. Amounts roughly range from 0.5ml filler to 5ml of filler, and Dr. Richman will know the best dose to use for the desired goals. More filler will need to be injected for deeper wrinkles, and for fine lines, less filler will be needed. The same applies to lip fillers; more filler will give a bigger pout, and less filler will provide a more natural plump.
But it’s not just about the amount of filler that’s injected. It’s also to do with the thickness of the injectable used - or viscosity if we’re feeling technical! Again, depending on the face area that’s being treated, different consistencies of filler will work better. For cheek enhancement, for example, thick, heavy-duty fillers are more up to the job - something like Juvéderm Voluma - because they provide more structure. But, areas like the mouth and lips will only need thin, low-density fillers - like Juvéderm Volbella.
What are PDO Threads?
At this point, Botox/Xeomin is so ubiquitous that you probably have a friend (or two) who’s done it. Yep, for many people, injectable beauty treatments are, if not quite an extension of their skincare routine, no longer the “big deal” they used to be. Now, along with Botox/Xeomin and fillers, there’s another buzzy treatment gaining popularity: PDO threads. The minimally invasive treatment adds volume under the skin to tighten sagging, smooth fine lines and wrinkles, and strengthen the skin overall. (Think of it like adding feathers to a limp pillow to fluff it up.) There’s little to no downtime, and it’s (nearly) pain-free.
WHAT ARE SMOOTH THREADS?
Smooth threads are absorbable surgical polydioxanone (PDO) threads that can be used virtually anywhere on the face or body. Thinner than hair and made of protein, the threads are inserted below the skin to elicit a mild injury that the body responds to by adding structural proteins (fibrin, elastin, collagen), resulting in a smoother, plumper appearance.
This includes your lip area, near the eyes to treat crow's feet, on the forehead to treat the “11” lines, and around the mouth for marionette lines. Smooth threads can complement (or be used in place of) Botox to treat the lip area as an alternative to dermal fillers.
Some patients opt for barbed threads for heavier lifting (like a facelift effect). These sutures tend to be larger and have almost microscopic barbs etched into them, like the barb at the end of a fish hook. (Sounds scarier than it is, we swear.)
Dr. Richman recommends smooth threads for areas of tired, crepey skin, shared, around the eyes, the upper lip, the hollows of the cheeks, under the chin and around the mouth (e.g., laugh lines).
This treatment is excellent because it’s very versatile—you can have this treatmentittreatment anywhere on the face or body where you need a little smoothing or lifting. There are applications for all age groups.
Smooth threads can be done every three to four months (same as Botox/Xeomin treatments) and can be an excellent option for specific areas where Botox/Xeomin is not an option, such as cheeks. It’s also a milder alternative to a surgical facelift, which is both expensive and requires extensive recovery time.
OK, WHAT IS A SESSION LIKE?
First, you’ll have a consultation with your doctor to decide how many threads or barbs are needed to achieve your desired effect. Then, one-inch absorbable surgical PDO threads are inserted via a very tiny needle into targeted areas. (Barbs require numbing, whereas smooth threads do not.) It takes maybe six seconds to insert a smooth, soft thread after an alcohol swab cleanses the area, and Dr. Richman usually places about six per session, so it’s a quick treatment. Barbed sutures take a few more minutes to insert, so those sessions (depending on the number of barbs inserted) might take 30 to 45 minutes.
DOES IT HURT?
Before treatment starts, we will apply a topical numbing agent and local anesthetic to the treatment site. The needle used during this treatment is so fine it will not cause any pain. However, we provide anesthesia to ensure you feel no discomfort during the treatment.
At most, you’ll feel a little slight pinch when the threads are inserted and pulled through the treatment area. Post-treatment, some people can experience a pulling sensation with barbed threads, which disappears after about two weeks. Usually there are no signs of the treatment except for the occasional bruise, which can be avoided by not taking aspirin or ibuprofen the week before your treatment.
Once the anesthetic has taken effect, your treatment will begin. The PDO threads are inserted via blunt tip needles, called cannulas or sharp-tipped needles. Once inserted into the appropriate layer of skin, they act as anchors as the skin is lifted upwards. Then, the excess threads are cut off.
With both smooth threads and barbed threads, you should look normal next day, but barbed threads may leave you feeling a bit sore.
WHAT ABOUT THE RESULTS?
You won’t see much right away (remember this is a preventative treatment), but improvement will come as the thread dissolves and the body lays down new collagen, elastin and, fibfiberr,in. It takes about four weeks to see the first results, with peak results at four to six months.
HOW MUCH IS IT?
A single area of smooth threads costs about $515, but it can be a little more or less depending on the number used. Dr. Richman likes to do a series of three sessions separated by a month.
IS THIS TREATMENT SAFE?
This treatment is completely safe. It is approved by the FDA. Moreover, hundreds of thousands of treatments have been performed and there are no reports of allergic reactions, sensitivities to the threads, or severe side effects or risks.
WHAT DO I NEED TO DO BEFORE TREATMENT?
Since PDO thread lifts are non-invasive, there isn’t a lot you need to do to prepare. However, you can take some precautionary measures to ensure the best results from your treatment. you can take some precautionary measures preventive Here are things you should avoid one to two days before treatment:
· Omega fish oil supplements
· Vitamin E
· High-intensity workouts
· Steam rooms and saunas
WHAT DO I NEED TO DO AFTER TREATMENT?
There are not a lot of special after-care requirements to this treatment. However, you should hold off on any dental treatments for the first two weeks after your PDO thread lift. Holding your mouth open for an excessive period can affect the results of your treatment. Moreover, you’ll want to sleep on your back for the first couple of weeks. This ensures you don’t put too much pressure on one side of your face.
You should forgo any facial with your esthetician for one-two months following, depending on whether you have had smooth or barbed threads placed.
WHAT AREAS CAN A PDO THREAD LIFT TREAT?
Because a PDO thread lift is so versatile, it can treat virtually any area of the face. These include the:
· Naso jugal folds
· Nasolabial folds
· Crow’s feet
· Under eye area
· Marionette lines
HOW LONG DO THE THREADS LAST?
How long the PDO threads last depends on several factors, including the thickness of the threads, the quality of the threads, and your body’s rate of metabolism. However, most of our clients find that the lines have dissolved within six to nine months.
WHEN WILL I SEE THE FINAL RESULTS?
The final results of your PDO thread lift will be seen within one to two months of your treatment. How long it takes you personally depends a lot on your age. Your age is one of the leading factors in how quickly your body produces new, healthy collagen. Collagen is the protein responsible for plumping up your cheeks, filling in fine lines, and smoothing out wrinkles.
HOW MANY TREATMENTS WILL I NEED?
Most of our clients enjoy satisfactory results after just one treatment. Come in six to nine months after your first treatment to determine if you need a follow-up treatment. After that, you shouldn’t need another treatment for three years.
AM I A GOOD CANDIDATE FOR A PDO THREAD LIFT?
If you’re looking to correct uneven pigmentation, lines, wrinkles, gaunt facial features, or skin laxity of the face, you are a good candidate for a PDO thread lift. You are a perfect candidate for this treatment if you want an instant facial lift but don’t have the time or money to commit to a traditional facelift.
Trigger point injections are used to treat extremely painful and tender muscles. Normal muscle contracts and relaxes when it is active. A trigger point is a knot or tight band in the muscle that forms when a muscle fails to settle The knot can often be felt under the skin and may twitch involuntarily when touched. The trigger point can trap or irritate surrounding nerves and cause referred pain - pain felt in another part of the body or in the teeth. Scar tissue and loss of range of motion, and weakness may form over time. A small needle is inserted into the trigger point, and a local anesthetic (lidocaine) or botulinum toxin is injected. Trigger point injections effectively relieve pain and may be combined with home exercise, heat, and cold.