Facial Treatments in NYC

With the rise of social media and the onset of the “selfie” craze, there is no question that people have become more conscious of their appearance in recent years. While both men and women are increasingly interested in improving their appearance, many are reluctant to consider surgery as a viable option. For these reasons, injectable products have grown dramatically in popularity as a non-surgical option for facial refinement and facial rejuvenation among both men and women.

Injectable facial treatments performed by Dr. Rapaport are not only safe and straightforward, but they also require a minimal time commitment and involve little to no downtime, thereby allowing patients to come in before work, during a lunch break, or after work to get their strong facial muscles relaxed and/or the hollows in their cheeks or under their eyes filled. There are essentially two types of injectables used: neurotoxins including Botox, Xeomin and Dysport, which soften or relax muscles, and fillers, such as Restylane and Juvederm, which restore volume to flat or hollow areas.

A Case Study in Injectable Fillers: Voluma and Juvederm by Coolspa in New York

Facial Treatments Fillers-Case-Study

This patient is seen mid-treatment, having treated only the right side of his face (the left side of the photo). The patient was treated with 1 cc of Voluma to each side of the midface (2 cc total), ½ cc Juvederm to each marionette (1 cc total), and ½ cc Voluma to each pre-jowl sulcus (1 cc total). Note the subtle but pleasant enhancement in the midface area, reduction in the marionette fold (folds near the corner of the mouth), and the improved jawline. As you can see, there is no visible bruising from the injection and only mild redness at the injection site, which resolved within 30 minutes. This patient returned to work the same day.

What to Expect of a Facial Treatment Session

Dr. Rapaport develops individualized facial treatment plans based on the patient’s specific goals and preferences, a thorough facial assessment of the patient, and a detailed discussion of Dr. Rapaport’s recommended course of treatment. Dr. Rapaport typically prefers incremental treatments so that all improvements are gradual and natural. While most injectable treatments are performed in less than 15 minutes, a facial treatment session may last as long as 45 minutes depending on the extent of injectables used. With topical numbing ointments, numbing injections, and ice available to reduce discomfort, our patients find their facial injections to be minimally uncomfortable. To reduce the risk of bruising, Dr. Rapaport and his assistants apply gentle pressure to the site of injections. In rare cases when bruising does occur, the bruises are small and can be covered with makeup. Music and a relaxing photo display are played during injectable treatments, to provide patients with the most soothing experience possible. Patients generally have no issues returning to work or attending social activities within hours of the vast majority of injectable treatments; however, patients receiving lip enhancement, should expect some noticeable swelling for one or two days. Dr. Rapaport always recommends that patients avoid blood-thinning products including aspirin and Motrin for 3 days prior to injections to minimize the risk of bruising. With Dr Rapaport’s care and expertise, significant bruising rarely occurs and injections can even be performed very successfully on patients taking Coumadin and other blood-thinners.

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Botox/Dysport/Xeomin for Facial Enhancement and Restoration

The three neurotoxins, or muscle relaxers, currently available in the United States are Botox, Dysport, and Xeomin. Botox, the most well known of the three, has been around longer than the other neurotoxins. Just as “Kleenex” acquired the brand name for facial tissues, Botox acquired the so-called brand name for botulinum toxin type A, and therefore many people refer to all neurotoxins as “Botox”. There are small differences between the three neurotoxins, and possible advantages of each for treatment of different areas. At the time of consultation, you will be advised which neurotoxin is recommended for your desired result.

Eyebrows, Crow’s Feet and Facial Lines

Neurotoxins like Botox, Dysport, or Xeomin can be used in different quantities to completely freeze a muscle, or to more mildly soften a muscle or portions of a muscle. The dose of neurotoxin used depends on the patient’s anatomy and preferences, and is discussed individually with each patient prior to treatment. A high dose of neurotoxin generally lasts 3-5 months, while the effect of smaller doses may be even shorter lived. The glabella, or the area between the eyebrows where the vertical “11” lines appear when a person scowls, is among the most popular area to treat with neurotoxins. Patients who are prone to furrowing their brow, often complain of constantly appearing angry in front of their friends, co-workers, or children, and take great pleasure in fully relaxing the glabella. Neurotoxins are also used to treat the horizontal lines across the forehead and can be used to “freeze” the entire forehead, or to create an arch in the eyebrows through a variety of refined techniques. The “crow’s feet” or the fine lines around the eyes can similarly be eliminated or softened with neurotoxins. In addition to their widely known use of correcting already occurring lines and wrinkles, neurotoxins can also be used preventatively to inhibit new wrinkles from forming and existing wrinkles from worsening.

How Botulinum Toxins Work

Injectable Fillers

Options for facial fillers have become significantly refined over the last several years. The vast majority of fillers presently used are forms of hyaluronic acid (HA), a naturally occurring substance in all mammals that has been safely cloned in the laboratory. In its natural form, hyaluronic acid would be broken down and digested by the body in about 24 hours. To avoid such rapid metabolism, HA injectables have been modified through a process called cross-linking to increase their stability over time. HA fillers differ in both molecule size as well as amount of cross-linking. These differences give each HA filler slightly different characteristics, including variations in “thickness” and longevity in the body. The most popular HA fillers are Restylane, Perlane, Juvederm, and Voluma. During a facial rejuvenation consultation, Dr. Rapaport will advise each patient which type of filler is best for a given area. Voluma and Perlane are more “robust,” products and are therefore preferred for deeper injections especially near the bones of the midface. These facial injections provide subtle enhancement and definition to the cheekbones and help to restore the natural loss of volume in the cheeks that occurs with age. Restylane and Juvederm are “thinner” products compared to Voluma and Perlane, and are used more superficially, such as for lip enhancement or to fill the folds that develop beneath the nose and lips. Restylane Silk is the newest formulation of Restylane, designed specifically for the fine lines surrounding the lips. We are proud to be one of the first centers in the United States to offer Restylane Silk. Belotero a less viscous HA product, is favored for treatment of dark circles or hollowness in the lower eyelid, or “tear trough” area. We recently became one of the first practices in NYC to offer Volbella, a brand new HA that is very low viscosity and offers excellent results for lip enhancement and the improvement of fine lines.

Radiesse is a calcium based alternative form of injectable filler to HA products. Its unique characteristics as an injectable filler make Radiesse an ideal product for rejuvenation of the back of the hands, sunken temples, and ill-defined jawlines, where volume loss is particularly evident in older patients. Dr. Rapaport is highly sought out in New York for his great experience and incredible results with hand rejuvenation using Radiesse.

Sculptra works uniquely from HA and Calcium based products, in that it utilizes the body’s natural production of collagen to create improvement. Sculptra consists of microscopic particles suspended in water and injected beneath the skin. The microscopic particles are essentially micro-irritants, which the body responds to by forming new collagen, in the injected areas. Collagen formation creates volume and thickens the injected tissues thereby serving as an excellent foundation, particularly in the midface. Because Sculptra utilizes your body’s own system of collagen production, its effect is not immediate. It takes a full month for tissue growth to begin, and can continue for 4-6 months. The enhancement created by Sculptra can lasts for 2 years, or more. Sculptra was initially used as a facial filler for HIV positive patients, whose treatments caused very significant facial wasting. Sculptra has changed the lives and improved the confidence of many of these patients and Dr. Rapaport has extensive experience with virtually all injectables. His expertise has earned him recognition as a national trainer for several injectable products. He strongly believes in an individualized approach in choosing products. Dr. Rapaport prides himself on resisting an exclusive commitment to one company or product, so that he can provide patients with the best treatment possible.