Injection Trends with Dr. Rivkin

Trina Renea 00:07 

Hey everyone, welcome to Facially Conscious. I'm Trina Renea, a medically trained master esthetician here in Los Angeles, and I'm sitting with my rock star co-host, Dr. Vicki Rapaport, a board-certified dermatologist with practices in Beverly Hills and Culver City, Rebecca Gadberry our resident skincare scientist and regulatory and marketing expert, and Julie Falls, our educated consumer who is here to represent you. We are here to help you navigate the sometimes confusing and competitive world of skincare. Our mission is to provide you with insider knowledge on everything from product ingredients to medical procedures, lasers, fillers and ever-changing trends. With our expert interviews with chemists, doctors, laser reps and estheticians, you'll be equipped to make informative decisions before investing in potentially expensive treatments. It's the wild west out there, so let's make it easier for you. One episode at a time, are you ready to discover the latest and greatest skincare secrets? Tune in and let us be your go-to girls for all things Facially Conscious. Let's dive in. Hi. 

Dr. Vicki Rapaport 01:24 

Hello! Good morning. Good morning, everybody. It's injection trend day today. It is. Injection trends. I love it. 

Trina Renea 01:29 

It's injection day. You do? Mm-hmm. 

Dr. Vicki Rapaport 01:32 

Fresh injection face. Yeah, well, just talking about it. So much fun. So much to learn. So much to learn. 

Trina Renea 01:38 

There is so many things now we've got to bring our bring Mr. expert Rivkin on this to talk about it that's right oh do we have Dr. Rivkin today?

Dr. Vicki Rapaport 01:50 

We do. 

Trina Renea 01:51

Oh, I'm so excited. Can I introduce him? 

Dr. Vicki Rapaport 01:52

Yes, please. Please do. 

Trina Renea 01:53

Okay So, Dr. Alexander Rivkin is a beloved dermatologist injector. Who attended the Yale School of Medicine and is the founder of Rivkin Aesthetic in here in beautiful, beauty-obsessed Los Angeles. He understands that many are nervous to go under the knife and he has perfected alternatives to invasive surgery and he has trained many injectors on his amazing techniques. He has actually been on The Today Show and The Doctors and even our own podcast, Facially Conscious and you can get his information about his practice on our website if you are interested. We welcome him back today to update us on all the new injection trends, which is always a very hot topic. Welcome Dr. Rivkin. Yay. 

Dr. Rivkin 02:36

Thank you.

Trina Renea 02:36

Welcome Dr. Rivkin. 

Trina Renea 02:36 

Welcome. Welcome back. Welcome back.

Dr. Rivkin 02:37 

It's a pleasure to be here again thank you guys. 

Trina Renea 02:41

Well, we really appreciate it. 

Dr. Vicki Rapaport 02:41 

I see that you're in your scrubs, so are you actually working on a Saturday? 

Dr. Rivkin 02:48 

No, I'm not. 

Trina Renea 02: 48

Okay, okay, good.

Dr. Rivkin 02:48

I wasn't sure if this is going to be on video or just audio, but I thought like, okay, whatever. He's representing. I was wearing like this. I was wearing a torn up white t-shirt, so I'm like, yeah, I should probably tear it. 

Dr. Vicki Rapaport 02:59 

I love how that made him laugh so hard. Are you working? 

Trina Renea 03: 06

When you get to his level, you are not working. 

Dr. Vicki Rapaport 03:07 

Right. Exactly. Exactly. 

Dr. Rivkin 03:07 

I'm too tired. I'm too tired to do that. I bet. And I have two kids. It's just the way it is. 

Trina Renea 03:13 

You've become quite the comedian on Instagram. I enjoy watching your show. I have to start watching it. Oh, he's so funny. It's a comedy show on his Instagram page. His kids have brought out the life in him. He does comedy in the office with his team. It's hilarious. I love it. I love it. Yes. 

Dr. Rivkin 03:34 

Wow, yeah, I don't know. I think comedy, it's very, I think it's very nice of you to say the word comedy. I don't know if it rises to that level. 

Trina Renea 03:44 

I mean, everybody laughs, it's great. 

Dr. Rivkin 03:47 

We laugh at quirky little things. 

Trina Renea 03:51

Yeah, it's funny. 

Dr. Rivkin 03:51

Thank you. 

Trina Renea 03:51 

All right, so please tell us, there's so many different fillers now and modulators and how do you guys like keep up with which ones to use and how do the patients know what they need or who they're going to or what they're injecting? I mean, it's crazy right now. 

Dr. Rivkin 04:09 

No, I know. It's hard. It's hard to know. Like, okay, so you guys mentioned, before we got on, you guys just happened to just mention for a second for Philo, right? Yes. And so, I did a quick Google search on it. And the first thing that popped up was guess what group on. 

Trina Renea 04:33

No way. For real?

Dr. Rivkin 04:33

68% off on injection, organic filler at this, you know, at this Medispa.

Oh, my one milliliter of filler. I don't know what it which one for $319 and 68 cents. 

Dr. Vicki Rapaport 04:52 

Oh, that's dirt cheap. 

Dr. Rivkin 04:54 

Yes, it is dirt cheap. 

Trina Renea 04:59

Wait is that the group on price. 

Dr. Rivkin 04:59

Well that is the group on price.

Trina Renea 04:59 

Let’s talk about that how many people do you see who've gone to bargain basement places and then they come to you to have things done undone and done correctly and you know. 

Dr. Rivkin 05:11

A lot.

Trina Renea 05:11

Okay there we have it. So, I mean I have friends who ask me the reason I'm here is the ladies call me I'm a patient of Vicki's and a client of Trina's and my friends call me julie.com and say that I know everything I do everything I research everything and people one of the first questions a lot is how much something is and I get, that but I think when you start from that it can be a little dangerous I think you do your research and you find out the very best person who has the best reputation and then you can discuss price but I think if that's what is driving you it can be kind of dangerous. 

Dr. Rivkin 05:51 

I agree. I think it's I mean, it's tough. It's I mean, I understand. I get it. Also, the people are a little bit more wary of spending money these days. The economy is not as good as it, you know, as it used to be. Perhaps people are feeling like prices are high. And, you know, it's hard to stretch the money. And I understand that. But I think the temptation to, you know, take a crew or take a group on or to go to like, you know, the cheapest person for your face is that is something that you got to watch out for. Yeah, that's something that you need to like, you need to not do. I mean, for people, I mean, there's, in my clinic, people, you know, people come in, they'll be like, Okay, what should I do? And I tell them like, you know, three or four things that would be effective for them. And then they're like, well, you know, I really, you know, that's tough for me to do all that. It's okay, you do one thing now you do one thing, you know, later on, and that's all right, spread it out. But don't go to someone just, you know, just because they're the cheapest around and we that's always been the case for like 20 years of giving that advice. 

Dr. Vicki Rapaport 07:07 

Yeah, I also love that we asked you that question about this filler that I also don't have in my office and he is an expert. He didn't even know about it yet. He knows about it, but he doesn't use it. He Googled it, but he has the confidence to say, I don't know much about this. It's brand new. Let me look it up. He's going to do what he thinks is right in your face when you come and see him. If you have a dermatologist or you have a friend that looks really good, go to their dermatologist, get a consultation, but I just love that he's also so confident. He doesn't have to do every single trendy thing in his practice. 

Trina Renea 07:35 

Yes, right absolutely.

Trina Renea 07:36

Well, Profilo, the reason I brought it up is because a few people around that I know are doing it and clients of mine. And so, I like the look of when the little injections of filler are put all over the face, you get those little, they look like mosquito bites all over your face and then it smooths out and you look kind of glassy. And I think the look is quite nice. It wasn't FDA approved for a very long time to do that. And so, these ladies were doing it behind the scenes quietly. I don't know if it's FDA approved now, but you said there's another company that and you guys do it in your office, right, Vicki? 

Dr. Vicki Rapaport  08:21 

Yes, we do it.  It's skin V even it's from allergy and yeah, it's not a hot ticket item No, not nobody asks for it. Nobody knows about I don't they don't know about it. And then I think that just they didn't do a lot of marketing. We were sort of all excited a little bit when it came out as a skin booster. You know to give you glass skin and just a little extra added but as Dr. Rivkin was saying the mud it's not cheap So if you're going do something do something that's really going give you a bigger volumization or maybe a bigger laser, a bigger peel or better skin care But skin Viva is going help you for maybe three to six months.

Trina Renea 08:55

Okay.

Dr. Vicki Rapaport 08:56 

And then you.

Dr. Rivkin 08:56 

Yes, I agree that’s how that's how we've been seeing as well because we had it and we got all excited about it for a little bit and then it's you know I think the benefit is just people come in with bigger questions. You know they don't usually come in that much saying, hey I want to you know I want to make my skin all I want to improve the quality of my skin some a few do but most the time when I see people they're like, okay I've got you know I've got big hollows here I've got you know I look really ragged and I want to just do the two or you know two or three most effective things that'll make me look younger. And this is a nice like skin weave is a nice touch but it's not going be like you know it's not going be transformative. 

Trina Renea 09:49 

Right, what would you say are the two, if somebody came to you and said, I have hollows and I, are there two things? You just said two things that, you know, are your go-to? What's new, what's happening? What are you doing mostly in there? 

Dr. Rivkin 10:05 

Well, it's, I mean, it's funny, because like, it's not new. Because it's still the same. It's still the same thing that that, you know, I was looking at. I don't know, I feel like it's that it hasn't changed majorly, because it's still, how do you make someone look younger? And how do you make someone look more beautiful? How you make someone look, there's ways to make someone look younger. And beauty is proportion and youth. Right. And so, and youth means that there's a shape of the face that's considered by the eye to be more youthful. And that shape of the face we lose as we get older. So, we have for women, it's more of kind of an oval shape, where it tapers at the, you know, as you come down with the cheeks, the cheekbones are wide and defined and it tapers as the face comes down to the lower third. As we age that, that relationship flips, or that relationship changes, because the volume that was up in the cheeks comes down to the lower face. And so, you have a face that used to look oval, now looks more square. For at least I'm talking about fem the female identifying faces. And so, bringing it back to more of an oval shape, does a huge amount of good. And it brings the eye of the observer back to the person's eyes. You know what I mean? Because you make that kind of shape. And then now they're not looking down at the bottom, they're not looking the eye of the observer isn't looking at, you know, maybe jowls, it's not looking at skin laxity, it's not looking at the bottom third of the face that where most of the signs of aging happen, it's looking up at the eyes, because he's because you've re-established that shape that the that the eye what we're just instinctively the eye wants to see. And the other thing is hollows. And so, hollows when you're talking about, when you're talking about aging, hollows distract from the eyes. So, if I look at someone face, and someone has a hollows in their cheeks or hollows in their temples, I'm looking I'm distracted, I'm looking at their hollows, I'm not looking at their eyes, you know, it's and so if you feel those hollows and you smooth and you smooth them over. Now again, the eye of the observer is focused on the person's eyes. And the person looks younger, you know. 

Trina Renea 12:48 

Okay, can I ask you question about that though. When you're doing that shaping, does it make the person look like themselves or do they look like a different version of themselves? Does it make them look like they were 10 years young before? Do you look at their 10 year before picture and say, oh, they had hollows then, so I'm not going fill it so much or like, how do you achieve them looking like themselves? 

Dr. Rivkin 13:15 

That's the trick. The devil's in the details, right? That's the trick. To be able to keep them looking and the short answer to that is you just can't be, you can't have too heavy a hand. You have to be conservative in how you do these kinds of things. You have to be subtle in how you change the contours of the face. And so, having them still look like themselves basically just involves not sticking a whole tub of filler into their face or not overdoing it. That's the most important thing. 

Trina Renea 13:58 

Which then makes me think like I always tell my clients I know who I refer to in Los Angeles that I call face sculptors because you when you're doing filler. You're going do that type of thing. It's been that kind of money. You want to go to someone who is a face sculptor They're an artist of at this. This is what they do all day long. And so, what kind of advice can you give the consumers that are not in LA coming to me? Who I can who you know, how do they find that in their city? Like a good injector. How do you know who you're going to? 

Dr. Rivkin 14:37 

I think there's no there's, there's just no shortcuts to doing your research, you got to do your research, you got to talk to people, you got to talk to people you know, and say, Hey, what's, you know, who, who is it? And people, I think these days, I'm encouraged that these days, people are gate keeping less, you know what I mean? They're not, they're sharing more about with social media, they're sharing more about, and with their friends in general, it's not like this, you know, deep dark secret that you go into someone to get injections, right? It's okay, we're all vain, we're all, we all, you know, we all do these kinds of stuff. And it's common. And so people will share with their friends now, you know, instead of being like, Oh, I do, like, you know, whatever, I drink olive oil, I drink a quart of olive oil a day, that's why I look so young, or like I ride horses, you know, as we've heard, you know, they're actually telling the truth about who they go to and what they do. And so that's nice. So, get friends like that. Like those are good friends that won't gate keep.  

Dr. Vicki Rapaport 15:43 

That's basically like friends like Julie, you have so much information. 

Trina Renea 15:48 

Dr. Rivkin, hi. Yeah, there you go. Now, several people who have had filler done under their eyes and it's like migrating and they're having it removed. Do you do it under the eye? Do you recommend that? Just as I'm aging, I almost am into this less is more thing for myself. And just some of the things that I worry about with filler and I'm wondering how do you address that. 

Dr. Rivkin 16:24 

I think it's, I think, okay, I think this is a really interesting point. And I think this is the thing that I think probably this is the most important thing that we're going to talk about. And the point you're bringing up is how popular social media and popular press are influencing what we know and what we don't know about aesthetics and about this field, right? So, right now there's all these trends that go through their little trendy cycles about like, oh, you know, under eye fillers, under eye fillers, terrible, never do it. Oh, fillers are terrible. Never do them. You know, oh, you know, toxin is terrible. Never do that. And so, there's all these like informational, mis-informational cycles that I see happening a lot because there's like a post on Instagram and then it goes viral and then everybody piles onto it. And now suddenly Vogue magazine is writing articles about how fillers are terrible and you should really just sit, you should really just sit on your butt and wait until you really until you want, you get a facelift or even worse advice. You should, oh, you're in your thirties. Well, you know, you should go get a starter facelift now and then, you know, and that'll be really good because you'll get good results. Seriously. It's crazy. The kind of information that's out there. 

Trina Renea 17:50 

A lot of the under-eye thing is from eye surgeons, plastic surgeons. I see them on Instagram saying, this is a result, and don't do it, and don't do it, and so, like, oh my God, alarmists. 

Dr. Rivkin 18:04 

Yeah. And I really, look, I know, I mean, I get it. In order to get clicks on Instagram, you got to be extreme and you got to say extreme things. And I think people are doing that to the detriment of this industry sometimes, you know, and also, oh, it happens to be that this is something that is, you know, kind of in the interest of the person doing it. And so, they go a little bit further in their posts than they would have if they're talking, for example, to me face to face. They never say these kinds of things because I'd call them out on it. The fact is that under eye filler is one of the, and I don't know about how you feel about Vicki, but under eye filler for me is one of the best, most rewarding and most effective things that I do. After doing the, after injecting the nose, I think that's my number two favorite, absolute favorite procedure. Cause you, your results are instant. People look five, 10 years younger in five minutes with a simple injection. It lasts forever. Like I have people seven years later and they're still fine. And it's reversible anytime. 

Trina Renea 19:15 

What do you inject in there? 

Dr. Rivkin 19:17 

A light hyaluronic, so either something like Restylane, Velour, you know, these kinds of things. Refine, they all work pretty well. They all work really quite well. But the under-eye area is a tricky area to inject. And sometimes over time, it's not that it migrates, but it's just that it collects, it breaks down a little bit and so it collects more water. It absorbs more water and it swells. And so, it has to be, and sometimes you have to adjust and that's okay. You just adjust. You just put a little bit of enzyme and dissolve, you know, part of it and then you're fine. I think it's just, you know, the people and then they talk about like, what should we call it? Oh my God. Now I'm blanking on the name. They're blocking. Oh, yeah, the lymphatic blockage. And I mean, yeah, if you pile on a whole ton of filler into the area, you can have that happen. But I think it's just if you do again same kind of theme, if you're conservative, you do a little bit, it really works well. 

Trina Renea 20:29 

So, you're saying that you can get a little bit of migration, it can cause a little shadowing, and all you'd have to do is have a little enzyme injected in there, would you go ahead and put more filler after that? 

Dr. Rivkin 20:43 

Well, it depends, I mean, it's sometimes it's it really it depends. So, but one thing I wanted to just say is that it's not really when people say the word migration, everybody freaks out, right? Because then they imagine filler, like just kind of traveling throughout your face, like it was like it was a race car. You're yeah, like a European train going like, you got a filler has a URL path that's like all over your face. So, that doesn't that doesn't really happen. I think what we're seeing is more of more of as the filler breaks down more surface area is exposed to water in within the tissues and it absorbs more water and it swells, you know, in where it's where it's injected. Occasionally you can have because it's around the eyes of circular muscle, and it contracts all the time, you can have filler kind of move a little bit. But it's just I want to make sure people understand it's not like filler, because it is something certainly that you hear about in social media. That filler is like just goes all over the place and it's inflammatory. And it's just like, it causes cancer and does all sorts of crazy things and it doesn't. But yes, you just put a little bit of enzyme in and see what the result is. If the result is great, you're done. 

Trina Renea 22:07 

Have you heard of any new topical that actually will remove a little bit of the filler? Someone mentioned they just have that done to me. Yeah, what do you think of that? 

Dr. Rivkin 22:21 

Yes, I haven't used it because it reverses a little bit. And how much is a little bit and how much is not, I'm not sure. So, I haven't had a lot of experience with it. But I do know it exists, and I think it's effective. It just won't reverse a lot, but it will reverse a little bit. So, in those cases under the eye, I think it's not a bad option.

Dr. Vicky Rapaport 22:46 

Okay and I would say my perspective under eye filler is you know having the consult with the patient if they really have deep volume loss big fat volume loss, they need eyelid surgery or fat transfer I don't go I don't put filler in somebody who has big hollows and big deep circles. If somebody looks like they are you know a reasonable human and they understand the potential risks of filler I think filler is a really good option and it works beautifully in some in many patients in those that it doesn't work beautifully in exactly like you said you put a little bit of the hyaluronic acid and it goes back to where they were the first day so they just lost a little bit of money you know like it's not like and it doesn't look worse it doesn't look it just goes back to where you were. Sometimes they have enough confidence in you to do a little to do it again you just do a little less maybe use a little bit of a filler maybe you do a little bit of different location but under eye filler can be amazing and there is a famous actress who had a facelift and her eyes look terrible and that's a facelift. Those are facelift eyes so just facelifts can go bad as well. So, filler faces it's all about having the consult having the confidence in your injector or your surgeon and letting them take care of you if something doesn't work out because they will take care of you if something doesn't work out. Unless you use a Groupon and you go to a med spa and the injector isn't there anymore yeah right take your life. 

Trina Renea 24:11 

What are you guys as I thought on fat transfer that they're using as filler for the face now. What are your thoughts? And do you do that, Dr. Rivkin? 

Dr. Rivkin 24:20 

What do you mean, like nano fat and micro fat? Yeah. 

Trina Renea 24:23 

Taking out of the body and putting it in the face. 

Dr. Rivkin 24:27 

Oh, because, okay, I think our, and see, tell me what you think. Also, Vicki, it seems to me that our, our techniques for fat transfer have evolved over the years in a positive direction. I think it's more effective now. And I think it's a better procedure. But I still think it's not reliable. I think it's still I think it's difficult to predict how much of that nano fat or whatever, or micro fat is going to be absorbed and how much of it is going to stick around. But I don't, but I don't do the procedure. So, I'm not absolutely positive of that. So, and it's also, you know, I think, yeah, so that that's, so that's the question, I guess, for me is what if they're if I can do this with filler, it seems to me like it's a lot easier and quicker to do with filler. But with fat, I don't know, I just I guess there's still questions, I think, how long is it going to last? How much of it is going to stick is going to be absorbed versus not as I've heard too many patients coming in saying, Oh, you know, I had fat transfer. And two weeks later, it's all gone. I'm like, Oh, that's, that's a bummer. Because that was a major, that's what they go. 

Dr. Vicki Rapaport 25:56 

It's expensive. Yeah. So, when somebody has big volume loss, are you using sculpture or using hyaluronic acid fillers? 

Dr. Rivkin 26:02 

It depends if it's big volume loss. Well, it depends. I mean I'm using sculpture a good amount for I have used sculpture when it's this light large a big surface areas. This soft part of the cheeks and the temples and the cheeks It's just you're not the filler would be hyaluronic would be too expensive anything. Yes, Sculpture does a good job with all that but yes. I mean I I'll still refer for like when you say these super deep hollows and uh tear trumps. I agree with you I think that that You know Maybe for maybe for a consult for fat transfer that it may be a good thing, but it's just something that I wouldn't say that these fat transfer techniques have evolved to the point where they are comparable to filler. 

Trina Renea 26:58 

The other thing about the fat transfer, I had a client ask me is, if you do a fat transfer to the face and the fat, you know, cells that are alive and stay there, what if you don't like the look, you can't dissolve it? What do you do? 

Dr. Rivkin 27:17

That's my other problem with it.

Trina Renea 27:18

And then if you get chubby, will your face get fat? Because you have this fat. 

Dr. Rivkin 27:19 

And that's my third problem with it. That's exactly right. You're pointing out the exact issues with it because if you gain, I mean these are metabolically active cells. If you gain weight, they get bigger like any other fat cells in your body, right? 

Trina Renea 27:31 

That’s fat cells from like your stomach, so they're getting probably bigger even in your face. I don't know, but. 

Dr. Rivkin 27:38 

I mean, I don't know, they do change in size, which is, which is district that could be an issue. And also, yeah, and that's the other thing. If it's not just right, there's nothing you can do. That's a, that's a big problem. Yeah, because I'm, I'm correcting filler all the time, it has to be flawless, it has to be perfect. You're talking about, you're talking about aesthetics. And so, the inability to dissolve or to correct, aside from okay, we do another procedure to add to it, but the inability to, to bring it down, that's a big issue I think.

Trina Renea 28:18 

I think. So, what's that do you think so? 

Dr. Rivkin 28:20 

That's what I had use fillers that you can't correct, generally. I mean, sculpture may be a little bit. 

Dr. Vicki Rapaport 28:25 

I don't think there are a lot of dermatologists that do fat transfer. We usually refer them to the plastic surgeons. There are a lot of dermatologists who do fat transfer in the East Coast because that's just, they're actually trained during their residencies, but West Coast, definitely not. I don't know. I'm seeing myself send a lot more referrals out. 

Trina Renea 28:44 

Because a lot of patients come in that have done it on their face, it's pretty new. 

Dr. Vicki Rapaport 28:47 

Yes, Yes, I have and usually it's under the eyes under the eyes under the eyes and usually they look it's not that new no, it's been done for 30 years. 

Trina Renea 28:56 

Yes, but it's being talked about more and more. I, it's newer to the general public that they're doing like face filler. Instead of doing filler, they're doing fat. And I'm hearing it a lot more now than I ever have. 

Dr. Vicki Rapaport 29:11 

Back to the starter facelift at 30. I have never actually heard that. 

Trina Renea 29:19 

I heard that the other day 

Dr. Rivkin 29:21 

I don't think it's a they don't say 30, but I think in their 30s like late 30s. 

Trina Renea 29:27 

Oh, yes doing little one. Just a little quick. Oh, yes. Pretty. 

Dr. Rivkin 29:31 

I think it's, I mean, I hate to be dogmatic about some things, but I think that's kind of wrong for most people. I don't think that's right because I think that’s okay, if some there's people age in different ways, right? Some people age faster, some people age slower, some people have more skin laxity, and some people actually may be good candidates in their late thirties because they just did a lot of sun damage, a lot of skin laxity and all this kind of stuff. But those people are very rare, you know, to have this be a recommendation for most people that, hey, you know, start in your late thirties and then get one and then, you know, and then see how it goes. And then maybe in your forties, you get another one and then in your fifties, you get another, okay. I mean, it'll make Ferrari payments for somebody, somebody will get their Ferrari paid off, but still, that's not right. 

Trina Renea 30:23 

It’s not a procedure for prevention. Speaking about facelifts what's this liquid facelift can you explain that he's been doing that forever I know but we were going ask him about it on the show. 

Dr. Rivkin 30:36 

So, I mean it's I don't love the term because it's okay, I don't love the term because I think people interpret it in ways that it's not, that it's incorrect, they talk about, because there'sagain, procedures that, that, that are kind of popularized, that I'm pretty skeptical of there's some people that do filler, behind the hairline, super laterally, almost behind the ear. And they do a bunch of filler there, thinking that if you're going to do that filler and expand that area, it's going to draw up the rest of the face into, like, it's going to be tighter, it's going to tighten up the rest of the face, if they do a bunch of filler all the way back behind. I, that's, that's kind of weird to me. I don't, I don't, I don't understand that. I don't think that's a thing, but there's a lot of people that believe this. 

Trina Renea 31:37 

Have you seen anybody that it worked on? 

Dr. Rivkin 31:40 

No, not really. I don't think so. I mean, that's my knowledge. 

Trina Renea 31:46 

Yes, right. A weird lump in the back of their head. 

Dr. Rivkin 31:52 

So, and I think um but that was the same. 

Dr. Vicky Rapaport 31:55 

Concept of the cheek filler right that it was going lift up your nasolabial fold and that is just not the truth But it does give you a beautiful full cheek and like a heart-shaped face but you know we used to just do filler in the nasolabial folds before we even knew about doing on the cheeks and then when we When we learned about doing on the cheeks we stopped doing the nasolabial folds because we said oh just do on your cheeks And then whatever's left Shadow wise you can do filler, you know coming in a secondary area, which I love but it doesn't really lift up your face to like make the nasolabial go away. 

Trina Renea 32:27 

Mm-hmm 

Dr. Rivkin 32:28 

Yes, I think that's it. I mean, and again, I think we're not our field isn't the field of oncology, right? We don't have a lot of really hard, you know, really good science we have. And so that sometimes the things that people believe in are a little shaky. And I think that's one of them, which is this belief that filler lift in the cheeks lifts the faith somehow that you can get this liquid facelift by putting a bunch of filler in the cheeks. And that's why I don't I don't love the term because we're not actually lifting anything, what we're doing is redirecting the gaze, we're redirecting where people look on someone's face, right? And that's the magic of what we do. And it's amazing that we can do that kind of thing, where we can put filler into places, augment certain places and play with light and shadow, to direct people's gaze, where we want them to look and away from the places where we don't want them to look. And that's fascinating. 

Trina Renea 33:31 

So fascinating. Wow. Okay, well, is there any trends that you can give us for 2025? Anything trending that you hear people talking about on TikTok and Instagram? 

Dr. Rivkin 33:46 

A lot, right? I mean, people talk about all sorts of stuff. What people are going to do with a zempic is really interesting, I think. Because I think that and how a zempic affects the body as the as well as the face and the hair I think is really interesting. 

Dr. Vicki Rapaport 34:07 

There's something here to hair loss. Yes, to extreme its extreme weight loss 

Trina Renea 34:12 

So, what about the, what were you going to say, sorry, because we, yes. 

Dr. Rivkin 34:18 

I was going to say, so not only is there weight, is there fat loss, but there's also muscle loss, there's hair loss, there's a lot of effects. And I think as those effects, we're understanding those kinds of effects. I think we're going to develop some interesting treatments and interesting directions in which the field is going to go. I think that's interesting. I think what's interesting the other thing is like bio-stimulatory treatments that actually work. Because again, talk about mythology. There is a lot of mythology around bio-stimulatory stuff. I mean, because there's a ton of money involved, right? 

Trina Renea 34:57 

Can you explain that means that word for that.

Dr. Rivkin 35:01 

Yes, so it's basically instead of the filler is kind of, you know, it fills, right, it occupies space within the face and replenishes volume, and it just kind of sits there. But there's other another type of things that people inject, which is substances that stimulate your own collagen into growing. And two of those are seem to really work well, which is dilute radius and sculpture, they really do, you know, they do legitimately a good job. But then there's a lot of other products that come on the market that get a lot of hype, and then disappear because it's kind of like because they're shown that they don't actually work. But there's so what settles out within this conversation of stimulants and kind of your own and people are attracted to it because oh It's your own collagen building, right? And so, there's like a bunch of sleepers, easy gel and PRF and PRP and this kind of stuff. And there's some of that is like some that works, right? But how much how much it works and how big of a benefit people really get out of them, I think is questionable. And then so, so I think we'll see, I think some good products are going to come out of it. They're not necessarily the products that people that we're using, aside from sculpture and dilute radius. But I think there's that some of those we have to like kind of, you know, work through some of those trends, some of those fads, and then thread. I don't know what's going to happen to threads. I don't use threads, they could use that much. 

Dr. Vicki Rapaport 36:42 

My PA, Vicky Chen, does Threads. She loves him. She has great results. I don't do them myself. Yeah, I don't think they're good for the right person who understands it only lasts nine to 12 months, and maybe it's like a pre-facelift treatment that they do before they realize, okay, I just want to get a facelift. It really doesn't work. It just doesn't last. 

Dr. Rivkin 37:05 

We'll see. I think we're going to get hopefully better threads and maybe longer lasting things that actually, threads that do a good job. 

Trina Renea 37:12 

Do you have someone in your office that does it, Rivkin? 

Dr. Rivkin 37:15 

I have someone who does it, but she doesn't do it very often because she's very picky about who she does it with, because she wants to get a home run with everybody that she does. So, she's very picky about who she does it with, who's a good candidate. But the person who's not, the people who aren't that she consults with, she'll do fillers and she'll get a really nice result. 

Trina Renea 37:41 

Mm-hmm Okay. Well, thank you for today. That was a lot of amazing information. We appreciate you spending a little bit of time with us today on a Saturday. Yeah, you're going be rocking chair Go fun with your front. 

Dr. Vicki Rapaport 37:58 

Your boys, two boys, boy and girl, what do you have? 

Dr. Rivkin 38:01 

Two boys, five and six. 

Dr. Vicki Rapaport 38:02 

Oh my gosh. That's a lot. 

Dr. Rivkin 38:04 

It's a busy household. That's wonderful. 

Trina Renea 38:07 

I don't know how you're keeping them quiet right now. They must not be there. 

Dr. Rivkin 38:12 

They're downstairs, mom, they're playing, they're doing something rather, but they'll be coming bursting through the door in a second. 

Dr. Vicki Rapaport 38:18 

So, I have to say that his skin looks amazing. I know. Do you have a filter on? Do you have a filter on? Your skin is insane. 

Dr. Rivkin 38:24 

No, no, no. But I'm sitting in front of a window, so the light's pretty good. 

Dr. Vicki Rapaport 38:28 

What do you do you have any special product that you use on your face? 

Dr. Rivkin 38:32 

So, I think and this is something I'm constantly surprised at how many times people say they're not using retinol. I think it's just such a simple thing. 

Trina Renea 38:43 

We are just talking about that with Dr. Vicky, she's like, that's the one thing that I know that works. 

Dr. Rivkin 38:48 

Yes, it works so well. Like so at night, I'll use retinal and the prescription strength. 

Trina Renea 38:53 

Mm-hmm. 

Dr. Rivkin 38:53 

And then, and then during the day, it's a good, you know what I like, actually, there's a product called Pavis. Have you guys heard of it? We had her on our podcast. They were on our podcast screen. Oh, they're great. Are you selling it? I'm going to be selling it. Yes, I'm using it. I'm going to sell it. But it's a one thing it's got, it's got everything you need. Yeah, put this on you forget about the rest of your day. Yeah. For a guy, it's like the best thing. 

Dr. Vicki Rapaport 39:21 

Yes, and I'll tell you, you know, we I do a split face every morning I get into my special UV light and I put sunscreen on. I do a different one every day and I take a picture at noon. So, I get in at 8 I take a picture at 8 take a picture at noon I take a picture at 4 to see how long you're testing last and to this day Pavis is still the longer lasting one. Everything else has gone by noon on my face and I'm inside So I love the Pavis and it doesn't make me look white. So, what?  

Dr. Rivkin 39:52 

I wish it smelled a little bit better, I’m going to say. 

Trina Renea 39:55 

Yes, it's not bad though and it does make your skin feel so soft when you wash it off, oh my gosh your skin feels like glossy like so nice It is a good product. Mm-hmm. Well, we loved having you. 

Dr. Vicki Rapaport 40:13 

Coming back. This was an excellent, excellent episode and hopefully we'll have you back again. 

Trina Renea 40:18 

All right. I'd love to. Thank you so much. Thank you, darling. Have a great day. Have a great day. Have a great rest of the weekend. Bye-bye. 

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