Well with Arielle Lorre - 394: Aesthetic Hot Takes: Fillers vs. Sculptra, To Thread or Not to Thread and A Physician’s Opinion on Face Tape with Dr. Alexander Rivkin

Episode Date: June 9, 2025

Alexander Z. Rivkin, MD is a facial aesthetic specialist and Assistant Clinical Professor at the David Geffen / UCLA School of Medicine. He received his undergraduate degree from Columbia University and his medical degree from the Yale University School of Medicine. His practice, RIVKIN Aesthetics, is focused on developing and perfecting non-invasive, non-ablative cosmetic treatments. He is best known globally for pioneering and popularizing the Non Surgical Rhinoplasty procedure. He joins the show to discuss the subconscious ways our brains are wired to see beauty, and the ideal facial harmony. We also talk whether there are true botox alternatives (including his take on face tape), fillers vs. sculptra, threads, non surgical nose jobs and the most underrated procedures. This episode may contain paid endorsements and advertisements for products and services. Individuals on the show may have a direct, or indirect financial interest in products, or services referred to in this episode.Go to tryarmra.com/WELL for 15% off your first order.Go to ro.co/BLONDE to see if your insurance covers GLP-1s for free.Go to Ritual.com and get 25% off your first month for a limited time at ritual.com/BLONDEVisit justthrivehealth.com/discount/well for 20% off your first 90 day bottle of Just Thrive with promo code WELLVisit Puori.com/BLONDE for 20% off. Visit fatty15.com/WELL and use code WELL at checkout for 15% off their 90-day subscription Starter Kit. Produced by Dear Media.See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

The following podcast is a dear media production. In a world of ever-changing wellness trends and information, what does it mean to truly be well? I'm Ariel Lorry and I'm going to explore this with you. I am bringing you candid conversations that will equip you with everything you need to live your best life and look good doing it. Think of well as your go-to resource for all of the latest in wellness and me as your internet bestie. Well, let's get into it. Hi, everybody. Welcome to the show. I have such a great episode for you today because we are talking aesthetics and we're talking things that I haven't covered in the podcast before. So my guest is Dr. Alexander Rivkin. He is a facial aesthetic specialist. He's an assistant clinical professor at the David Geffen, UCLA School of Medicine. He received his undergrad degree from Columbia. and his medical degree from the Yale School of Medicine,

and he has a practice in Los Angeles called Rivkin Esthetic. So one of the things that he is known for globally is for pioneering and popularizing the non-surgical rhinoplasty procedure, which we get into a lot in this episode. And we also talk about really interesting things, such as the subconscious ways that our brains are wired to see beauty, things that we notice when we look at people that we, don't necessarily think of on a conscious level. We talk about facial harmony, whether there are true Botox alternatives, including his take on face tape. I was ready to debate him on this one. We talk fillers versus sculptra, which is something that people ask me all of the time, threads, non-surgical

nose shubs, of course, underrated procedures, and so much more. So please enjoy Dr. Alexander Rivkin. Welcome. Thank you. It's a pleasure to be here. I'm going to put you on blast right now in front of my whole audience. When we met in the lobby, I was like, nice to see you again. Dr. Rivkin didn't remember that he treated me a few years ago, which I am totally fine with. I understand. It's a good thing. You have so many patients. You're so good at what you do. So I don't expect you to remember somebody from many years ago. Thank you. Thank you. It's still embarrassing. No, no, no. I wasn't trying to embarrass you. And I also said to you, hopefully it's because I look so much better than I did three years ago. There you go. I'll tell you a little story. So I'm so bad at that kind of. I'm so bad at that kind of

kind of thing that at one point, this was years ago, I went after work, I went to like an art opening and a woman came up to me and she was like, hey. And I was like, oh, hello. I wasn't sure who it was and anything like that. She's like, you don't remember me. She's like, oh my God, you don't remember me. First of all, she goes, I am Brazilian. And so you have to remember, you know, because she's like, people remember me. I can't believe you're. She's like, and second of all, I was just in your office today. I'm like, oh my God, that's so embarrassing. Same day.

Same day. It's terrible. Well, I would imagine when you're looking at somebody, when you're working, maybe you're looking at them in a very analytical way. Right. Whereas when you meet somebody out, you're... Different context. Yeah.

Yeah. Yeah. You can use that in the future, by the way. Thank you. So I would love to start with, what is your beauty philosophy? My beauty philosophy is that there's... guidelines that we know about from scientific studies about what the eye likes to see. And those are relative guidelines.

And it's just kind of, there's things that are programmed within us in terms of aesthetic response through our brains. Like our eye likes to see certain things in certain proportions. And that goes across cultures, and that goes across the facial types and ethnic But that's not the whole story. The other very, very important part of it is that everybody's an individual and everybody's very much particular. And my friend Eva Shambam, she formulated this concept nicely in an idea called signature feature, right? So everybody has their signature feature or signature features that are the kind of defining aesthetic elements of their face. And so

enhancing that and just kind of working to really bring forth the person's unique beauty, that's my philosophy. I love that answer, but I want to rewind a little bit and talk about what are those things that we are programmed to like seeing when we see somebody's face. I mean, I know that when you look at somebody, you look at their eyes, right? So I would imagine that that's part of it. But what are those nuanced proportional things? Right.

Okay. So that's a really important part of it. We're animals, and so we are evolutionary program to select mates. And so when we look at someone, we evaluate subconsciously, just automatically, how healthy they are, how feminine or masculine they are, and how youthful they are. And so how they are in terms of reproduction. So a lot of times beauty is related to feminine reproductive potential. masculine reproductive potential. And there's a variety of signs that kind of clue our brains into what that reproductive potential is. And there's signs of youth that the eye looks for. And one of those

signs is, as you were talking about, your eyes, right? And so a face where the eyes are the central focus of the face is a face that's youthful. A face that is kind of oval in shape is a face that's youthful for a more feminine face. For a more masculine face, it's a different kind of shape. It's more of a square shape. And as we age, the face changes. For a feminine face, it becomes less feminine. That oval shape becomes kind of rectangular,

a little bit more masculine, and that emphasis around the eyes becomes less a focal point. When you look at someone's face that is older, your eye wanders around the face a little bit more. Whereas when you look at someone's face who's younger, your eye goes straight to their eyes. There's a reason for that. When you put something up on the wall, if you just put it up on the wall and you don't frame it,

it attracts a certain amount of attention. If you put something up on a wall and frame it, it attracts more attention. And so it's the same thing with the eyes. So when the eyes are framed by the cheeks and there's no distractions in other areas of the face, so shadows, lines, all that kind of stuff, then the eye of the observer, goes to that person's eyes and they're perceived as being youthful, healthy,

and fertile. Aside from that, there's also proportions that the eye likes to see. So, like, you know, we divide the face classically, we divide into thirds where it's like top third, middle, third, lower third. When they're about the same, that's something that's visually

pleasing to the eye. We divide into fifths this way and when those kind of fifths are about proportional and the same, the eye likes to see that. I feel like a lot of times when people go in to get aesthetic treatments,

I'll speak for myself. I hyperfixate on one thing and it's not necessarily the thing that's the problem, right? So can you speak to that? Because I'm sure you see that all the time in your practice where somebody comes in and they're like, oh, my lips are too small or I need filler in my cheeks, but they have deficiency in their temples or whatever. What are the most common mistakes that you see

when people come in thinking that they want one thing, when really they need something else? I think that's very common. When it's your face and you're looking in the mirror, you see certain things more so than others and you just kind of hyper-focus on certain things. You see the trees and not the forest. It's hard.

It's hard to see your own face in proportion, in perspective, and see the whole impression. Your eye naturally gravitates towards certain things that bother you for a variety of different reasons. And it's our role, as aesthetic providers to guide our patients into an understanding of what the overall impression is and where it would be beneficial overall to give our attention or to focus on. It's a conversation about like, well, tell me about how you feel when you look in the mirror.

Tell me how you feel when they're saying that they are bothered that they're looking older than they feel, I can give them suggestions on. some of the things that they can do to overall have an impression of a younger face. Because a lot of times volume loss is associated with looking older in shadows, you know, around the eyes or shadows in, you know, nasal labial folds and stuff like that. So correcting some of that stuff can really have a big impact on the overall impression of the face. And so I'm fortunate in that in willing my practice.

Now people come in and a lot of times say, what should I do? And then I can really guide them in terms of what I think would be the best and the most beneficial. And also, I mean, all this stuff costs money, you know. And so what would be the best bang for their buck? And I think that's really important. Yeah, it's like harmony, right? Facial harmony versus just fixating on that one thing. My best friend and I always joke, we wish that we had each other's eyes because I see her every week.

And I'm like, my crow's feet are driving me crazy. I haven't gotten Botox in 21 months now. And that to me is like my hyper fixation. And she's like, yeah, I don't know. It's not like really registering for me as like a problem. And she has this thing in her lower face. And I'm like, I don't even see them. We're like, we wish that we could trade eyes.

And I'm sure that if I came into you or another provider and said, what should I do? There would be some other things besides just like a little Botox and the crow's feet. Maybe that's it. Maybe that's all there is. Damn it. From here. That's what I'm saying. That's the only thing I see.

Oh, God. But I mean we're all so critical of ourselves, right? Isn't that silly? It's too bad. You guys know that I am traveling right now, and I really try to keep my travel supplements to a minimum. But I have a few things that I will not leave home without, especially when I'm on a long trip. And one of those is my Armoura Colostrum.

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GLP1 medications. What are some good Botox alternatives? because this is something that I get from so many people in my audience, whether they just don't want to keep doing Botox all the time, they can't afford it, they might be pregnant, they might be breastfeeding, they might just be taking a break, they don't want to do it yet. I mean, there are so many different reasons. And there are a lot of things that are touted as Botox Alternatives.

Some of them are, you know, more efficacious than others, although there isn't really a true alternative. But from your experience, what is the best thing that you're? you can do to kind of hold off on that. I don't think there's a single best thing, I'll tell you honestly. I think that botulinum toxin in general is an incredible tool. I mean, we have 3,000 studies on botulinum toxin, whether it's therapeutic or cosmetic. So the safety and utility of the drug is really established very, very well. Other things that help with skin quality, so retinol, for example, is really nice. And I think it turns skin over really quite well. It helps with skin quality, with skin collagen content, with fine lines.

And so I think that's something that is very, very useful and it has a very good effect. There's procedures that we do like microneedling, microneedling with radio frequency, and those kinds of things, they increase the collagen content of the skin. They improve fine lines. They improve the texture of the skin. You know, and then good products. Having a good sunscreen that you use on a regular basis, whether it's indoors or outdoors, is you should have something on that works to protect your skin. There's antioxidants and these kinds of products. Evidence for that is a little bit thinner, but, you know, I think that those could be also

somewhat useful. But I think anything that says, this is like the topical alternatives to Botox or buy this and you won't have to do Botox, I think that's pretty reliably not true. Yeah, so let's debate Face Tape, okay? Oh, my God. You know, okay, so I put up a post about that. But I actually don't think there's anything wrong with doing it at night, except, you know, if whoever is next to you in the bed thinks it's kind of weird thing.

Yeah, so I get a lot of pushback about this from doctors. You probably know my whole story. I had a horrible, horrible reaction to Botox, debilitating for months, couldn't function. Tried a few units again once I got better, had a horrible reaction again. So it's off the table now. So I'm in a position. that I never wanted to be in. And I've been looking for alternative.

So I came across face tape in desperation, not silicone tape, I wanna make that clear. But I always try to make it clear that I'm not comparing it as an equivalent to Botox. And it's not a panacea either. But for me who I wake up like this, I'm, I guess, expressive in my sleep. I never knew because for 10 years,

I was completely frozen. And now like I'll wake up with horizontal lines, and I sleep on my side, so I get lines on my side. So a few nights a week, I'll do the tape, and I wake up completely smooth. Is it going into my muscle and inhibiting movement 24-7? No. But if I have a podcast or if I have a shoot or something, or I just want to wake up smooth and try to kind of maintain that, it's been great for that. But there is only one that I like, I don't make any money from it, but adhesive-wise, I've tried different ones, and some of the adhesive are so harsh. So, so harsh. So there's one that's extremely gentle. It works over my skincare. I can do everything.

Non-irritating. And for me, it's been a good, not alternative, but option to help. Yes. No, because one of the main things about Botox or whatever, any of the kinds of botulatum toxin that we have is the preventative function, right? And the preventative function is just that the less you do this kind of thing, the less that, you know, these lines etch into the skin. Where at first, when you're younger, you're smooth when you're relaxed and you just make lines like this, but then as you get older, as you do this expression more and more, those lines etch into the skin. So even when you're relaxed, they're present.

So we're trying to prevent that. I think this is totally reasonable, you know? Because, yeah, at night, we have dreams. We do make facial expressions. We're like terrified about whatever it is. They were dreaming of that. Yeah. Somebody said that if you tend to run anxious, you're more of a razor.

And if you tend to run a little like angry or something or I don't, you scowl. I don't really do that. But I guess that I raised my eyebrows. house. And I usually put it on after my boyfriend goes to bed, but he doesn't care anyway. It's like so benign. It's three little strokes. But there's other things like silk pillowcases and things that like help to just not cause so much irritation and like smushing of my skin. I try to sleep on my back. I just can't. I would rather get eight hours and be comfortable on my side. So my training is in ear, nose and throat. So I used to be head and neck surgeon. And so one of the things we used to do is for

people that would come in with like heartburn or with post nasal drip, we'd tell them to sleep on your side. You can't sleep on your back. And they were like, well, you know, it's hard to do that. So we'd have to take a tennis ball and sew it into their pajamas. So they'd have a tennis ball on their back. And so they wouldn't be able to roll because it would be super uncomfortable. So, you know, you don't want to do that. You're just going to. That sounds horrible. It's not. It's not great. Now, I know that they have those pillows that you can lay there. And the only time I've ever slept on my back was when I got my boobs done, then when I got my boobs out and when I had my nose done, I think, whenever I absolutely had to. It's hard. Totally.

Yeah, yeah. There are like papers in the New England Journal of Benison talking about how silk pillows help with new lines. Big silk and big tape aren't going to be funding. But that's okay. These are not things that are like super risky interventions that you have to be careful about. I think it makes sense, you know. I mean, there's so many trends that I would understand being in your position, seeing a lot of this stuff and just being like, come on. I think that it also kind of depends on like who's posting it. What do they have to gain from it? I mean, there's a lot of variables. I mean, I just saw a page. who came in actually last week, and she had like sores on the, you know, a crows feed area. And I'm like, what's going on? And on both sides. And, you know, she was like, yeah, it's because of this tape that I'm using. And every time I take it off, it really, like, disturbs my skin.

I'm like, that's the wrong kind of tape there. So it's good that you found something that really works well. Yeah. Are there any other trends that you have seen going around that just drive you nuts? I mean, I know, like, some of the trendier things right now, are things like salmon sperm. Yeah. And I know that people like it topically, it's not FDA cleared, right, or approved here for injections,

but it's been in Korea for like forever. Right. It seems to work quite well. So it's polynucleotides. And yeah, I mean, it's not actual salmon sperm. Just like the sexy name. Yeah, people like the name. It does seem to be pretty effective, more effective when it's injected, but still pretty good.

pretty good. We use it with procedures like microneedling and also with lasers, both to make the effect better with collagen stimulation and to kind of help with the quality of the skin afterwards, but also to decrease downtime. So it works quite well from that standpoint as well. So I think that it's good and I think that these procedures make sense. Again, is there studies in New England Journal of Medicine documenting this?

The evidence is a little bit thin, but it seems to be, the reports from Korea are quite good. And so I think it makes sense. Other stuff, like, I think there's a lot of misinformation about fillers on social media, and I think that's unfortunate. Sometimes it comes from the kind of surgical side of our industry. And sometimes the problem with social media is that the more extreme, the opinion, the more traction it gets. And so sometimes people will say and talk about things in a fairly nuanced way and say, well, you know, okay, there's fillers that when done correctly, they have a really good results, but then if you every six months get a syringe a filler on a regular schedule with some of these med spots,

that that's not great and it can lead to a bizarre appearance. I think that's a rational statement. Sometimes those kinds of nuanced statements, they get edited down to be more extreme. And so you have people seeing statements that are less than accurate, not from the fault of the surgeons necessarily, but just because that's the way it gets kind of edited down with how it's presented. Because these fillers are great tools, but you have to use them correctly. When you use correctly and when you use conservatively, it really works very, very well. And so there shouldn't be a fear of them. There should just be a concern about making sure that you go to someone who's experienced,

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the people who have had a profound impact on me because on WithWit, very little is off limits. Subscribe so you don't miss any of the amazing conversations to come. New episodes of WithWit are available every Tuesday on all platforms. I would love to talk a little about fillers versus biostimulators because, you know, Sculptra is so trendy right now as well and everyone's like, oh, it's natural. So what is the difference and what are the best applications for both? So we have these great tools.

So in terms of fillers, mostly it's hyluronic acid fillers. In terms of biostimulators, it's either sculptor at this point or dilute radius, which is calcium hydroxyapitine. I see the hyluronic acid fillers as more precise and more specific in terms of what you want to do. And sometimes that's important. I do a lot of facial sculpting, so I want to emphasize certain things or smooth certain areas or get more definition. For example, in the jawline, in the chin, and the nose. I want very specific effects. And that kind of thing can only be done with a filler

because like just getting an edge or getting a specific contour. When we're talking about a more general volumization, then I think biostimulatory kinds of products, I think are quite good. So when you have volume loss in the cheek, volume loss in the temple, and you want to add volume to a larger area

more broadly and softly, and that's kind of the aesthetic, effect you want to achieve, those biostimilators work really quite well, assuming people are okay with coming back a few times, because it's not one time. You've got to do it for most of them three sessions, sometimes two, but mostly three sessions. And they stimulate your oncology into growing. It's a little bit variable depending on the person. So sometimes, you know, you get more of an effect, sometimes you get less of an effect, depending on just sort of the physiology of the person. But I think they really make sense.

And there's a lot of attention now in our industry in expanding that portfolio of tools and in exploring of how they work best, how to make them work even better. And I think that's great. And so when we get more of those tools, I think that'll be exciting. But I think you have to have the guidance of your injector to know which one is more appropriate for which kind of indications because it's not just one thing for everything. You mentioned noses. You pioneered the non-surgical nose job. So let's talk a little bit about that because I think in all the years I've been doing this and all of the providers I've had on, I don't think we've ever really discussed that specifically. So who is it good for? What can you accomplish? Who is it not good for?

So non-surgical nose job or non-surgical anaphystasy is by far my favorite procedure that I do. It's very rewarding. People just are so happy with their results because it's something where I can be very, very precise about the effect I want to achieve. And it saves people in operation. So for so, so long, people have understood that the only way to change the contour of the nose is through surgery. Now this procedure is here where in five years, minutes, you can really significantly change the contour of the nose. And in a way that's so precise and so specific, that in some cases, not with everybody, but with a lot of people, it's more precise

and better than surgery. And so, again, every tool and every kind of procedure that's a good procedure has its uses. And so for some people, surgery is certainly the way to go. And I have a series of people who I would refer to who I know do a really good job with rhinoplasty. And then they refer non-surgical patients to me because, you know, maybe they've already had surgery and they just want correction of a small thing and it has to be very, very precise. And it's something that is very difficult to do surgically. And it's something that's very easy to do non-surgically. And so they'll refer to me and we, you know, we do that. For patients who need reduction in their nose, that's not a patient for non-surgical rhinoplastics. Now, there's a caveat to that. People who

have a bump or people who have a tip that's coming down, they look at their nose and they think they have a big nose. Sometimes they don't actually have a big nose. It's just that when you have a bump or you have a tip that's coming down, your nose looks bigger because it stands out from the rest of your face. Right. So it attracts more attention from the eye because it's irregular. It's not the contour that the eye expects.

And so therefore it looks bigger. So the funny thing is in those kinds of patients, I add to their nose, right? And I make it look smaller. Because it's straighter, because it's more of what the eye expects to see, it blends into the rest of the face and it looks smaller. This is the kind of thing that gets me really excited about the things that we do, right? It is that in doing these non-surgical procedures, in doing facial sculpting, we are directing the gaze of the observer to the to the areas that we want the observer to see and away from the areas that we don't want the observer to see, right?

So we are guiding the gaze. And so it's a little bit of illusions. We work with illusion. We work with perception. It's not necessarily obvious the effect that we're trying to achieve. And this is a great example of when you add to someone's nose, but you're making it look smaller because it's straighter and it blends into the rest of the face. I think that's kind of cool.

And then you probably see their eyes first. And then you see their eyes first. No, but that's absolutely right. Because the nose, you have a bump in the nose or you have a nose that's kind of maybe off center. And then when you look at their face, you see their nose. You make it straight or you make it straight on the profile, straight on the front. Now you're looking at their eyes. And that is always the most beautiful part of someone's face.

So that's kind of cool. When somebody hasn't had surgery, a lot of times it's somebody with a bump or somebody with a tip that's coming down that wants to make a nose straighter on the profile. But then the other bigger, actually, component of people that come in to see me at this point are people who have already had surgery. And then they want to, they've had rhinoplasty, the result was maybe a good result, but then over the years, you know, scarring happens. And the nose is the feature of the face that over time after rhinoplasty can change contour in a way that doesn't look quite as natural anymore as it did before. And so they come in to see me and they want to maybe correct small contour regularities, small kind of, you know, asymmetries, that kind of thing. And again, it's something that's very, very precise.

And it saves them an operation, especially a revision operation for rhinoplasty is complicated. You know, it's expensive. You know, there's more risk involved, there's downtime. So if you can do that in five minutes, it's great. Yeah, so you mentioned risk. There are risks with the non-surgical rhinoplasty, right? So we don't want the listeners to just run and go to any med spa or group on

and be getting filler in their nose because it can be a higher risk area, right? So what are some of the things that people should look out for? If you're thinking about non-surgical rinoplasty, you have to go to somebody who's a very experienced injector and a very experienced injector specifically with non-surgical rhinoplasty. I try to be very specific about how I talk about this. There's a lot of stuff on social media that's not very specific. In general, filler injections in the face are very, very safe procedures.

But there's always some risk. to anything that you do. So of all the areas of the face, the nose is the highest risk. And so when you go to somebody for non-surgical rinoplasty, you want to make sure that this is a person who's experienced with injectables, experienced non-surgical rinoplasty, who understands how to prevent complications,

who understands how to manage complications. And that kind of information is not so easy to come by, but it's, I think experience is the key. Of all the procedures that you do, this is the one that you don't want to choose someone based on price. You know, because you can have complications with this. And, you know, you can have a complication where it doesn't look quite like how you want it to look, where maybe the top is a little bit thick or it's just not quite right. And that's kind of an

easy complication to manage because you can just, that's the nice thing about hyluronic acid fillers, you can dissolve them. But there's other complications that are more serious. So you can have issues with blood flow to the tissues, schemia and necrosis. And extremely, extremely rarely, there have been cases of blindness reported, and when those cases of blinders are reported, they're reported in this area. So glabella and nose. A lot of those cases are cases that have happened in Asia and have happened with practitioners who shouldn't be injecting, like, nail salons or hair salons and things like that. That risk very, very, very small, but it exists. And so you want to minimize it as much as possible. I take a ton of precautions to make sure that never happens,

It's never happened in my practice over 20 years. Do it daily every day, several times a day, because it take a lot of precautions. And so I think that's important to keep in mind. And that happens from filler going into a vein or an artery? Yeah. We think it happens because filler gets into an artery and goes backwards into the ophthalmic circulation. Those, we were not quite positive as to the exact mechanism of why blindness happens. This is our kind of thinking of how it happens.

It may be that it has something to do with vascular malformation that this person in particular has that make them more susceptible to something like this happening. We're not sure. And we're investigating it with my colleagues quite a bit. We talk about it and try to figure this out. All over the world, there's a lot of attention being paid to. Why does this happen? What is the mechanism?

What can we do about it? So that's what we're thinking. So I'd love to talk really briefly about some of your favorite underrated procedures. It sounds like this might be one of them. Just because I would imagine when people go to get filler or get an aesthetic treatment done, it's not the first thing that they're necessarily thinking unless they're coming to you, maybe for some people. But I would imagine overwhelmingly people are thinking lips, cheeks, things like that.

What are some other underrated procedures or areas of the face that you like to treat? Whenever somebody talks about, hey, what's your favorite procedure? What do you think about this procedure? You know, what do you think is the coolest procedure? I'm almost going to say the nose because I love the kind of, I mean, I have people in my office cry tears of joy after non-surgeic rhinoplastity every week. It's the coolest thing. I mean, it just changes people's lives.

It's wonderful. But overall, I think also what's really underrated is the temples. Because people don't look at their temples that much and don't come. kind of at this point, not yet. I think that, you know, unfortunately, the filler companies are very much invested in, you know, making people self-conscious about certain parts of their face.

So that may change, and people may be looking at their temples a lot more, because now there's an indication. So now as soon as there's an FDA-approved indication, there's all sorts of advertising about it. And now, suddenly people are going to be like, oh, my God, temples. But I think the temples are really important in how, in the impression

of age of someone's face. When there's hauling in the temples, I think it's a giveaway. And so a lot of my conversations in the clinic are, oh, you know, I just feel like I'm looking older and I'm having this kind of stuff going on and there's heaviness here and there's just kind of, you know,

and we talk about that kind of thing. And I find that I'm oftentimes talking about their temples, they're surprised that I'm mentioning that area. And I'm like, you know, you just got to trust me if we do this you're going to see a big result and then i do one side and i show in the mirror so that they can see the contrast and they're bowled over by how intense that change really is so i think the temples are really quite important the other area that i think is not frequently mentioned is the forehead so to my mind for a female identifying person

attractiveness equals femininity, fertility, and youth. Right? And so those three components together. And I think that an important aspect of femininity is a forehead that's convex. Just a little bit of convexity, a little softness in the forehead. Because when we're younger, we have that convexity in the forehead. As we get older, it gets flattened or else gets even concave. and that is a masculinizing kind of feature.

When you correct that, again, the effect is really impressive in terms of how the overall impression of femininity. So I like that quite a bit. How do you correct that? Same filler. A filler? Yeah. So you can go.

But you said glabella, that's. But that's down here. That's over here. So I'm talking about up here still an area that has its risks. It's not, it's an area that is that you need to be careful with. But it can be done. Usually I use a cannula and I'm going down on top of the bone. And so I'm going underneath the vasculature. Again, there's ways of doing things safely because there's chatter about like, well, you know, you shouldn't do the forehead because it's a risky area to inject.

I mean, there's ways. There's ways of making sure that you're doing this in a safe manner. And the results are really worthwhile. What about the flip side of that? What are some overrated procedures? I think that sometimes in our rush to, to identify procedures that are alternatives to filler, we attach a little bit more weight to certain things that are maybe a little bit more questionable. And I think threads are a good example of that. I know practitioners that I respect quite a bit

that like threads and that do threats. So I certainly don't mean to say that you should never do threats because I think there's a place for threads. I just think that sometimes there's kind of an overestimation of the efficacy of threats. And I want to see some more long-term results of threads that show that this effect really persists over time. Because I think there's a little bit of wishful, and this is the thing about our industry,

there's some wishful thinking going on, right? And so there's a role for threads, but I'd like to see it become more defined because I think people are kind of throwing threads in just kind of willy-nilly sometimes. And I think threads are particularly not a great idea for the nose. And I've dealt with complications of that. There's not a lot of precision to threads in the nose. And I don't think it's a great idea. The other thing that I think is kind of, again, so, yeah, so you say what are things that

are like not great? I think some of these wishful thinking concepts are what we're talking about. So there's people that talk about, well, if you put filler into here all the way behind here that, like, pulls it. He's pointing out his, around his hair line. Oh, yeah, sorry. So behind, like, yeah, behind the hair length, if you put a bunch of filler behind the hairline,

if you put a bunch of filler behind your ear, like that somehow pulls things. And that there's this concept of like, oh, well, if you put filler into, like, you know, your cheekbone, that like lifts up, somehow magically lifts up your jowls. That's just not the case. I think you had another person talking about that here. And it's absolutely true.

So I think if we can just kind of stick to, evidence-based suggestions, that's nice. But yeah, there's some wishful thinking stuff that happens. Yeah, I think that there was definitely a trend. I mean, I'm not in the industry, but just from being on the outside and seeing a lot of people and living in L.A., I think there was a trend for a while of trying to lift with filler. I don't know if people are still doing it as much or if enough people have, you know, had the experience of realizing, oh, this doesn't work.

Yeah, I think that's not a great. there's a trend back towards more natural. I agree. I agree. There was the thought that, like, well, if I put enough, if I just put enough into the cheeks and the cheekbones, that will lift a gel. And we were talking about mollificent territory there in order to really lift a gel.

And nobody wants that. So I think that's fillers. Fillers don't lift. They fill. They will volumize. And when they do that, there is some change in the regional area

that where you're putting it into where the skin or the position of the skin may change subtly, but it's not something that lifts. And I think that people have, again, with wishful thinking, they'll like go, they'll like pull up on the skin, put some filler

in there and be like, okay, you know, that really lifts. Well, filler is not a thumbtack, right? I mean, it's not going to like, it's not anchored into your bone. And so it's not going to lift. It's just not, doesn't happen. It's just to like a little bit of like, you know, but it'll be jettily under your skin. Is there anything coming down the pipeline

that you can tell us about, any new products, any new procedures that we can be looking forward to? I'll tell you one thing that I'm hoping is coming down, but I don't have anything concrete to tell you that it actually is. Devices and procedures to actually tighten the skin, it's been a lot of years and a lot of. a hope and not a lot of results. We've seen devices and procedures that can improve the quality of the skin. We've seen some of them that can maybe do fairly subtle tightening, but we haven't

seen anything that's really impressive. So I'll tell you, hopefully, and I know everybody knows that there's a ton of money, there's a pot of gold waiting for the person that invents something that really works. And so people, I know people are working on it. I'm personally excited about different categories of fillers that are being investigated these days by a variety of companies. Avvy is working on a bunch of very interesting fillers. I know that there's a few other companies that are working on interesting stuff. And they work in a little bit different ways than the fillers that we're used to now. And they're also biostimulatory in stimulating different components. Like we stimulate collagen, but then there's products that perhaps

stimulate elastin and other components of the skin that I think will be really interesting. interesting to see. So I'm excited about that stuff. Me too. Well, thank you so much for coming on. Tell everybody where they can find you. So on Instagram, it's doctor. Dot Rifkin, DR.com, and then on TikTok, it's the same thing. Hopefully TikTok will continue to be someplace that people go. I don't know. Yeah. Everyone loves TikTok. Thank you so much. Thank you. I really appreciate being here. I hope you enjoyed that episode. If you liked the episode, and if you like the show in general, please take a second to rate, review, and subscribe. It goes such a long way in supporting the show. Follow the show over on Instagram at well.pod. You can also follow my personal Instagram at

Ariel Laurie. I'm always sharing great clips from the episodes. And we also have full episodes on YouTube as well if you want to watch an entirety. Thanks for listening. note that this episode may contain paid endorsements and advertisements for products and services. Individuals on the show may have a direct or indirect financial interest in products or services referred to in this episode.