Alexander Rivkin, MD
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Alexander Rivkin, MD
Plastic surgeon | Views: 244071

Friendname: AlexanderRivkinM.D.
Business Name: Westside Aesthetics
Website: www.westsideaesthetics.com
Location: 1033 Gayley Ave #104
los angeles, CA 90024
United States
Telephone: 310 443 5273
Languages Spoken: English

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Ask An Expert > Alexander Rivkin Message Board > Silicone implant or Artefill?
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Silicone implant or Artefill?
Hello Doctor,

I am a 25 year old male. I have two questions. One about implant/filler and the other about scar.

I have a light brownish skin complexion. I have been diagnosed with En coup de Sabre Morphea on the right side of the face 3 yrs ago. Because of this decease I have almost totally lost fat/muscle below my right cheek - just beside nose area. I also have partial lipoatrophy. So far I have not lost hairs although I have hair-fall problem for some years now. I also have a dark linear band type mark on the right side of forehead. This area is also depressed slightly but visibly. The disease progression 'appears' to have stopped but doctors say they are not sure about lipodystropy.

So, I wish to know the opinion of other doctors about it. First, what is the best laser treatment for an atrophic hyper-pigmented scar on the cheek caused by Morphea? Is there a way to remove or lightened it? Note: it is my report which says it is an atrophic hyper-pigmented scar.

Secondly, my doctor has suggested Artefill to fill the cheek depression. Is it the best option or should I go for silicone implant or for some other option? According to my doctor I cannot have autologous fat grafting because of partial lipoatrophy.

Thanks and regards

Plastic surgeon
Tijuana, Mexico
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  September 12, 2011 10:27 PM

Consider first a hyaluronic acid base filler as Restylane or Juvederm, to judge the results from a filler. The advantage of this type of fillers is that the results are not permanent and if you do not like them, that can be fixed. Artefill is a long lasting filler and it may end with granuloma formation. Fat grafting will be the best option for your case if you have a good donor area

Plastic surgeon
Miami, FL
United States
View My Professional Profile
  September 13, 2011 3:45 AM

From your very good description I might recommend enriched Fat grafting as a attempted therapy.

Plastic surgeon
los angeles, CA
United States
View My Professional Profile
Sculptra  September 13, 2011 2:05 PM

When patients come to me with large surface areas of volume loss, such as what you are describing, I think that Sculptra is the best option out there. Hyaluronic acid and Artefill are for lines and areas of small surface area. Sculptra is a collagen stimulator - if you can imagine a fertilizer that grows collagen. It is a thin
suspension, so it distributes evenly and smoothly within the tissues. The results are gradual, over three or four monthly sessions, but the effect is very reliable and lasts for several years. It is important to go to an injector who has extensive experience with Sculptra because there is a technique to injecting it safely and most effectively. This is an injectable that was used extensively for lipodystrophy among the HIV population and has demonstrated its ability to provide significant re-volumization of cheeks, temples and other large surface area regions.
As regards the hyperpigmentation, that should be correctable with the appropriate laser - which one would depend on what we see in the consultation.

Plastic surgeon
New York, NY
United States
View My Professional Profile
  September 14, 2011 5:22 PM

I agree with Dr Blinski, and would try fat grafting first. Stem cells can and may help the disorder you have as well as give you the fulness you seek.
Of course that is if you have fat on your body.
Personally I dont like artefill nor sculptra after having used them extensively for many years, but if fat grafting
fails they may be your best choices after all.
Good luck from NYC



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