Episode 41: Dr.Alexander Rivkin: Beyone Botox®: Beat the Grind
Dr. Alexander Rivken, a prominent cosmetic surgeon in Beverly Hills, California explains Botox® and its use to alleviate the pain and grinding associated with TMJ. Curious what Botox® can do for your neck? Lip lines a problem then listen to this episode of Beauty Now to get the information you need to get the right treatments for you. The best treatment for lines around your eyes plus many more tips for our listeners. How much Botox® is too much and how much is too little and other great facts from our expert.
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Teri Struck: Hi! I'm Teri Struck, host of “Beauty Now,” a weekly podcast that brings you the latest on everything luscious – lipo, lift, lasers inner beauty, outer beauty. Today, we have a special subject with TMJ, the things that cause you headaches, teeth grinding, and all that, we've got the expert, Dr. Alexander Rivkin from Beverly Hills, a cosmetic plastic surgeon.
Alexander Rivkin: Basically, what Botox is is that it weakens muscles. The main problem with TMJ is that you’ve got this overactive chewing muscle. This is just the cycle where you get stressed out and you grind and then you get more stressed out and the muscle grows, it keeps growing forward. If you break the cycle by weakening the muscle a little bit, just stop.
Usually, what happens, when people wake up after a perfectly fine night’s worth of sleep, they have just and ache in their jaw. They feel like they've worked out the muscles in their jaw. They have this pain maybe in the joint of their jaw, up by the ear. Sometimes even they have headaches when they wake up because muscle tensions are a big component of headaches, in general. So all that kind of stuff just muscle fatigue, it's just strange thing to have after a good night’s worth of sleep.
You got to be real careful about the neck. But when you have those neckbands, if you put small quantities of Botox on those bands, they tend to soften. You’ve got to be real careful about how much you do it, but it does work pretty well. So it's in certain people and those people that don’t have a lot of loose skin and just have those bands, it works really nicely. People that have a lot of loose skin, you don’t see as dramatic a change because you have to address the loose skin as well.
Teri Struck: Welcome, Dr. Rivkin.
Alexander Rivkin: Thanks! I appreciate being here.
Teri Struck: We all like to know about Botox. We all know that crow’s feet, forehead wrinkles, and all those kinds of things can be helped. But you're saying that you can help to alleviate the pain associated with TMJ?
Alexander Rivkin: Yes. It works really nicely for TMJ because what Botox is is that it weakens muscles. The main problem with TMJ is that you’ve got this overactive chewing muscle. This is just this cycle where you get stressed out and you grind and then you get more stressed out and the muscle grows, and it just keeps growing forward. If you break the cycle by weakening the muscle a little bit, just stop.
Teri Struck: So where do you inject it?
Alexander Rivkin: They’re the muscle that actually has the chewing muscle in the face, right next to the angle of the jaw, in the back next to the ear. It's a big muscle and when you clench down, you feel it pop out right in the back. That’s exactly where you inject it, in a bunch of little inject locations and it doesn’t hurt. Tiny little needle and it takes about all of about a minute and a half to do it.
Teri Struck: How much Botox do you use? I know from experience with my husband, who is a plastic surgeon, and he said you get about two to three people a bottle. How much of the bottle would it take to do?
Alexander Rivkin: [xx] and that’s a really good question because Botox is…people kind of go in and get Botox when they're doing it cosmetically or for any other kind of reason. They go in and they don’t really know they're unit or how much of the bottle is being used at a specific time. That’s real important to know, because when you go and say, I had 16 units, in a bottle there's 100 units, so you have 16 parts of a hundred. That’s an important information. So that’s how Botox is measured, that’s how we know how much you have. So I use about 20 units per side, about half a bottle in one treatment.
The interesting thing about it is that it's enough to stop the grinding usually within a couple of days, and then it relieves the pain, all that kind of stuff. But this is not enough to affect the way you chew, it's not enough to affect the way you smile, any of that kind of stuff. So people come in and they always worry about, “Oh, this is going to give me lockjaw” or “This is going to really affect the way I look or the way I feel.” It really doesn’t, it's great that way.
Teri Struck: So you were saying that people that grind their teeth, I'm one of them, and I'm very excited to try this because I actually chew a part of inside of my cheek which is really attractive. Probably [xx] to get injected there because I think you really have to go to a specialist that knows where to inject. The average plastic surgeon or even if they are board-certified, if they haven’t studied where to inject, in the jawline, then I wouldn’t go to them. If they’ve never done it, please find somebody that does know what they're doing.
Alexander Rivkin: It's so important with any of these kinds of [xx]. Any of these cosmetic procedures – whether they're surgical or non-surgical, whether it's lasers or whatever you do – it's so critical to go to somebody who is experienced in exactly the kind of procedure that you want done or the kinds of procedures that you're thinking about. If you go to a breast specialist to get your Botox, that’s not a good idea, and people do it all the time. So it's important to go to somebody who's experienced specifically in this kind of thing, which is injections.
Teri Struck: That’s true. I went to my OB-Gyn a couple of weeks ago, and I love my OB-Gyn, in case she's listening, but there it was, right up there, no Botox injections. I'm pretty sure that you want to go to somebody that actually studied the facial veins because there can be complications.
Alexander Rivkin: There can be complications. It's not that the complication is so serious. I mean, Botox is such a safe medication. The needles are so small. The procedures are so well worked out. The medication itself is so incredibly safe. But, in order to get maximum effect…because it's expensive, let's face it. It's something that insurance doesn’t usually pay for. You want the best results. You want to do it, the first time you get it, you want to get it right the first time.
Teri Struck: Let's talk about the cost a little bit. You're going to go in there and inject it in. It's pretty expensive, but then, how long will that last then?
Alexander Rivkin: Okay, that’s another interesting question. First of all, the way I usually do it is I have people just pay as if it was a cash procedure. But afterwards, I generate a letter that they’ve been sent to their insurance company and, unfortunately, it's the minority of cases where the insurance company actually helps the patient out. But, more and more, hopefully, that’s going to change, because really this is not a cosmetic issue as you know. This is a real health problem.
Teri Struck: I actually went to the hospital once who did it. I had such a bad headache for about three weeks. It was so painful.
Alexander Rivkin: Right!
Teri Struck: I think this will be really good if this can work. I'm really interested to know about this.
Alexander Rivkin: This is a health problem. It's those things that people really suffer about and it's something that really affects people’s lives every single day and it has a big impact on how they live. For insurance companies to just deny it and just decide that, “Oh, well, we're not going to pay for this.” It's silly because this is the only way to stop the pain, the headaches, and the grinding of TMJ.
Mouth guards don’t really work. All the mouth guards do is protect your teeth from getting ground down. Some people use drugs like sedating drugs to keep themselves from doing it. Muscle relaxant is terrible. This is the only thing that actually does the job and does the job within a couple of days. The cost of it, usually for people…in my clinic, for a treatment, it's usually $500.
Teri Struck: That’s not bad, $500, that’s pretty reasonable.
Alexander Rivkin: Especially with the economic times, I try to keep things as reasonable as possible. I mean, it's not last forever; it lasts for about three months. But, the good thing about Botox is that even though it lasts only three months, when you do it a couple of times with grinding and TMJ, your brain forgets that that’s your response to stress. So because you can't grind, the muscle isn’t sending a signal back to the brain saying I'm grinding because it's weak. For six months, if that continues, the brain gives it up and it doesn’t send the signal down to the muscle anymore to grind, and so you stop. Most of my patients, after two or three treatments of Botox, stopped grinding. Maybe occasionally, it will happen again and we do it in a few years. It's fairly effective that way.
Teri Struck: When patients are grinding, how do they really know when they wake up? It took me a long time to figure out that’s what I'm doing.
Alexander Rivkin: Yes, that’s true. Usually, what happens, when people wake up after a perfectly fine night’s worth of sleep, eight hours or reasonable sleep, they have just an ache in their jaw. They feel like they’ve worked out the muscles in their jaw. They have this pain maybe in the joint of their jaw, up by the ear. Sometimes, they have headaches when they wake up because muscle tension is a big component of headaches, in general. So when you have muscle tension, it generates a headache. All that kind of stuff, just muscle fatigue, and it's a strange thing to have after a good night’s worth of sleep.
Teri Struck: In my experience, I went to the doctor and there's very little that he could do for me. He decided to take some Celebrex, which I'm glad I didn’t do, just because that’s not [xx].
Teri Struck: Yes, I'm really glad I didn’t do that. So when I saw what you were doing with Botox, I was like I really want to interview you because I think this is something that’s really important. I have a lot of girlfriends that have this. It's surprising.
Alexander Rivkin: It's very, very prevalent. So many people grind, whether a lot or little. Some people just grind their teeth just at night. Usually, most people just grind their teeth at night, and we really don’t know why. It's just during our sleep, whatever we dreamed about, the stress response is still there, and this happens when some people get stressed. Some people actually grind both during the day and at night.
Teri Struck: I'm one of those people. I start to chew [xx]. I'm letting all of my secrets out here. I actually have a little ridge inside my cheek because I'm chewing on it or something. I'm like, “What is my problem?” I really have to try to meditate not to do it and really think about it, but this doesn’t really helped.
Alexander Rivkin: Yes, everybody, from my office manager…I treat my office manager, I treat the lady that gives us flowers in the office. They all say that it's a life-changing experience. It's a funny thing, during the day – and you probably experience this – you know that you're grinding, you don’t like that you're grinding. It's like when you get stressed out, you grind and you think, “Oh, my God, I'm grinding.” You get more stressed out because you're saying, “Oh, I shouldn’t grid. I shouldn’t grind my teeth. I shouldn’t chew my cheek. They just keep spiraling forward.” You know, it's the only way.
Teri Struck: Then I take my tongue and then I feel where it has ground, and I'm like, “Why can't I just stop this? This is terrible.” I just went to the dentist and I have a little chip on one tooth and one on my other one from just doing my teeth and my cheek. So I'm going to be down there to get injected.
We're going to need to take a commercial break. We're going to be right back with Dr. Alexander Rivkin, and to talk about our teeth grinding, how we're going to get rid of that.
Teri Struck: Hi, I'm Teri Struck, host of “Beauty Now,” PersonalLifeMedia.com. We're talking today with Dr. Alexander Rivkin, and we're talking about Botox. There's so many amazing things that it can do. Welcome back, Dr. Rivkin.
Alexander Rivkin: Thanks. Thanks for having me.
Teri Struck: So we ended up talking about teeth grinding and that you could actually inject it by your ear. Is that right?
Alexander Rivkin: Well, that's where the muscle is. It's kind of below a little bit by the ear, and that’s where the muscle sits.
Teri Struck: He's saying it doesn’t hurt, listeners, so we'll see. But if you're grinding your teeth, I think this sounds like a really good solution. Tell us more about what other things Botox can do.
Alexander Rivkin: Obviously, Botox has been used for such a long time. One of the things, actually, that I'd like to mention is I still have people coming in to the clinic and being concerned about Botox and a little bit concerned about the safety of Botox. There's been reports in the media about health problems associated with Botox. They asked about being a poison and all that kind of stuff and I think it's important to address those kinds of things.
Botox is a protein, and it comes from bacteria. It's modified in the lab and it's diluted diverted down very, very much so that when you're receiving an injection of it, it's a very miniscule quantity. The way that they change it and the way that they modify it in the lab, it is supreme safe. So people say, “Wasn’t it poison?” Well, if you think about aspirin, if taken in significant quantities, aspirin is a poison. Aspirin can really kill you. So the way I measure what's dangerous and what's not is how much above the regular dose of a certain substance they need to take in order to really have a health problem? You need to take more Botox, more of a quantity of Botox to get a problem than aspirin.
Teri Struck: I want to [xx] this, though. Let's just say, talk about the units and then would that be the whole bottle?
Alexander Rivkin: Yes, more than a whole bottle. Even if you injected two whole bottles, you wouldn’t have a health problem. That’s the thing. You need to inject at least ten times the amount that you would normally receive in a cosmetic injection, usually about 20 times, in order to really even come close to having any kind of absorption into the body. Even then, the actual effect would be miniscule, because of the small doses that are needed.
Teri Struck: Botox is used safely for about 20 for lazy eye and other different things and things like that. So I think they discovered that safely could use it for wrinkles.
Alexander Rivkin: Yes, that’s correct. I about 20 years that it's been in used. For the first five years, it was just used for lazy eye and ticks and stuff like that. Then, for the last 15 or so, it's been used for cosmetic purposes. There's been 15 million people around the world that have used Botox. Out of those 15 million, there has been not one Botox-related fatality, which, again, compared to aspirin, you can't say that.
Teri Struck: I did just learned about that latest scare that came out that said it would affect your memory. What do you think that?
Alexander Rivkin: [xx]
Teri Struck: Well, then, I did hear that mice or whatever, they have such small brains and a mouth that they used on them. It was like you're saying, it's like ten times the normal amount.
Alexander Rivkin: Of course! It's enormous! If you take ten times the amount that you should usually take of aspirin, if you take that, it will affect your memory as well. (laughs)
Teri Struck: Of course, there's those of us, “Well, who cares? Who are you again? I don’t care.” (laughs)
Alexander Rivkin: Exactly.
Teri Struck: One of the things that my girlfriends are asking about is that they're asking about Botoxing the neck. Can you tell us a little bit about that?
Alexander Rivkin: Yes. You got to be real careful about the neck, because you don’t want to put too much Botox on there. But when you have those muscle bands that sometimes people get with as they gain wisdom and as time goes on, the side effect [sp] of wisdom is neck bands. If you put small quantities of Botox in those bands, they do tend to soften. Again, you got to be real careful about how much you do it, but it does work pretty well. It's in certain people and in those people that don’t have a lot of loose skin and just have those bands, it works really nicely. People that have a lot of loose skin, you don’t see as dramatic a change because you have to address the loose skin as well.
Teri Struck: Then you should listen to my other [xx] Dr. Brent Molleken on necklift and then you can come get injected by Dr. Rivkin right after that. Even if you do get lift and tack, you still need injections in your face to soften your lines.
Alexander Rivkin: Absolutely. You still continue to make facial expressions, which is a good thing to do. Hardly am I going to come out and say, “You should be first [xx] like some of the Hollywood people that I see.”
Teri Struck: Like somebody gets killed right in front of you and you're like, “Oh, no big deal.”
Alexander Rivkin: Right.
Teri Struck: You can't make an expression. That’s a really good point. I really would like to tell our listeners, lighten up on it. I hope you pick the doctor that tells you, “You know, you’ve had enough” because it looks so bad when you do too much.
Alexander Rivkin: Absolutely. I hate to say this and I will reveal my…
Teri Struck: Please do.
Alexander Rivkin: …yes, this is a revelation. I'm going to reveal a little bit of my political leanings. I'm a Democrat and I…
Teri Struck: Oh, no! No, kidding.
Alexander Rivkin: …have to say that I do support Democrats [xx] and Obama. But, however, I was watching the debates, the last [xx] debate. It's interesting that…
Teri Struck: I know you're going to say.
Alexander Rivkin: You know, right?
Teri Struck: Yes.
Alexander Rivkin: I mean, it's something that…
Teri Struck: My husband said it, too. He goes, “Oh, my God! How much Botox has he had?”
Alexander Rivkin: Oh, my God! It was really unfortunate.
Teri Struck: I want to give him a little break though. Do you think maybe it was from his car accident that he…wasn’t he in the car accident with his wife or no?
Alexander Rivkin: I don’t know. I don’t know.
Teri Struck: See, I'm trying to give him a break, even though I have to say…
Alexander Rivkin: It was pretty classic for both, actually, because flat forehead, and then on the sides, you get that little peak in the eyebrows, and you don’t have to do that if it's Botox.
Teri Struck: I'm pretty sure it looked like Botox.
Alexander Rivkin: It looked like it to me as well.
Teri Struck: A little bit botched and he probably just wanted to look really great for the debate. So if you want to look really good for a party, go to your doctor and say, “I want to look great. I don’t want to look wrinkled.” But please, give me the appropriate amount, not just [xx].
Alexander Rivkin: Absolutely.
Teri Struck: I was guilty of that before, because I'm like I love being wrinkled-free. That’s the point of this whole show. But, you know, now, I used so much less and I do have expression on my forehead and on my eyebrows and all that now and I'm glad because I look so much better.
Alexander Rivkin: Absolutely. Certainly. It's just as important. This is a classic thing about any of these kinds of aesthetic and cosmetic procedures is that if you look like you’ve had something done, it's not worth it. It's not worth having, it's well not worth doing it. So you’ve got to look natural. It's a graceful way of looking the best you can, not necessarily trying to look like you're 18.
Teri Struck: The lips, too, when you over-inject the lips, it looks so bad especially when I go to Southern California, LA. I did [xx] there so I can talk about it, I grew up in Newport Beach. It looks really bad, and I'm somebody who has to have lips. I can tell when other people, I'm like, “Oh, my God. I don’t want to look like that.” You want to underdo and just make I'm look prettier.
Alexander Rivkin: Absolutely, and it's something that I see a lot. Lip is an art. You got to go to somebody who really knows what they're doing in terms of creating lips that are very natural. The one thing that I always say about lips, people come in and they say, “I wish there is something that lasts longer. I'm sick of doing this every seven months or so with Restylane or Juvederm.” This guy wished, “I want to try something differently, something longer lasting injectable.” No way. No way should you be doing anything else [xx].
Teri Struck: Good point. I did a show on lips, there's that Radiesse and some doctors don’t know that you should not put Radiesse on your lips. I mean, it's a disaster for women.
Alexander Rivkin: It's a disaster.
Teri Struck: Disaster.
Alexander Rivkin: Disaster. Absolutely. There's some people that do Radiesse and all those kind and the kind of stuff – lumps, you can't reverse it. That’s a thing about Juvederm and Restylane, put an enzyme in, it's gone. Anything that happens, you can dissolve it. You can always go back. You don’t have to go for a year or six months to seven months looking like you have lumpy lips.
Teri Struck: That’s a disaster. Even really qualified board-certified surgeons had to learn the hard way that you don’t do that.
Alexander Rivkin: Absolutely.
Teri Struck: I think you really need to go to somebody that does injectibles and really knows their stuff, so you really do know your stuff. I do, too.
Alexander Rivkin: There you go.
Teri Struck: I like that.
Alexander Rivkin: Very good. Yes, it's true. You got to go to a specialist, go to somebody who knows what they're doing.
Teri Struck: Wow! We've already talked about teeth grinding. I want to just end with one last thing. Around the eyes, what do you like around the eyes? That’s another problem with too heavy on a filler around your eyes, you can weight them down and look terrible. What do you do?
Alexander Rivkin: Yes. That’s true. The eyes are the most important part of a face. Really, it's the part that people look at, it's the part that really tolerates the least amount of unnatural appearance throughout the face. It's the focus of the face, so it's really important to get that right. First step with the eyes, not too much Botox in the forehead. If you put too much Botox in the forehead, the eyebrows come down, you get this hooded look. You start looking like Frankenstein and it's not cute. So you lighten up on the Botox on the forehead so that your eyebrows don’t come down.
The other thing about the eyes is you can open up the eyes a little bit by lifting the tail of the eyebrow, putting a little bit of Botox around where you regularly put Botox for crow’s feet. If you put a little bit more up near the eyebrow, it lifts up the eyebrow and opens up the eye.
Teri Struck: Would that be on top or below?
Alexander Rivkin: It's below.
Teri Struck: Below.
Alexander Rivkin: So what that does, because the reason is that’s the muscle that brings the eyebrow down. You weaken the muscle that tugs the eyebrow down, the eyebrow comes up. So when you do that kind of thing, you open up the eyes. The second to the last thing is when people have dark circles under their eyes, commonly is because there's an indentation underneath the lower lid called the “tear-through.” It's a tear-through indentation basically. It's the loss of volume, right within that area of the tear-through. It is the simplest procedure to just fill that with Juvederm. Again, Juvederm or Restylane, and the dark circles simply disappear.
It takes five minutes, it lasts, and the interesting thing about it is that for some reason, the [xx] that usually last for six months everywhere else in the face lasts for two years underneath the eye. So it's a fantastic procedure and it's very easy to do. It's something that a lot of people don’t really know too much about because they think under the eyelid, they think, “Okay, I got to do surgery.” But really, you don’t because these days, a lot of the time that you think you have to do surgeries, a lot of times, you don’t. You can do with fillers.
Teri Struck: What about it, though, if you have an eyebag? Don’t you think you do a surgery for a bag [xx]?
Alexander Rivkin: Well, sometimes yes, sometimes no. Sometimes you can put a little bit of filler underneath a mild eyebag and it disappears. You do with perception. So you think about, “What is it that makes an eyebag looks like an eyebag?” It’s the fact that underneath the eyebag, there is an indentation. You fill in that indentation, you make the skin go smooth from the cheek up to the eye, there's no eyebag. It's a camouflage kind of thing.
Teri Struck: There's so much good information. I want to get to what you say. One last thing because we have to go, but I wanted you to talk about Botox above the lip. Why do you do that?
Alexander Rivkin: Above the lips is a good idea, minimal amount of Botox. I put four units the first time, maximum, the smoker’s lines that people get even when they're not smokers sometimes. The expressive line is the most natural easiest way to smooth out the upper lip. Later on, if that’s not enough, we can always put a little bit of filler in there to increase the volume and to also help with the lines. But Botox, four units, it's the first thing I do, it works nicely usually.
Teri Struck: What you're saying, too, is – and I tell my friends and my listeners – is that Botox is not a filler. Botox relaxes your muscles and then sometimes you need a filler on the same day around the Botox.
Alexander Rivkin: Correct, and it's important to know the difference between the two. Botox only relaxes the muscles, a filler raises up the skin. You do use them in different areas and for different reasons but they can really work fantastically well together. One of the areas, for example, is between the eyebrows, they work fantastically well.
Teri Struck: Everybody gets that.
Alexander Rivkin: Yes.
Teri Struck: I mean, most people do. We don’t like you if you don’t get that. Even my daughter who goes to USC has that little brown line right there, little line. But I told her she has to wait, she has to wait, better behave here.
Alexander Rivkin: That’s right.
Teri Struck: I really enjoyed finding all these information about you today. You can go to PersonalLifeMedia.com and we're going to link Dr. Rivkin’s website up to ours so that you can find him in Beverly Hills. Or, you can find another doctor in your area and, hopefully, you’ve listened to today’s show and do your research and interview.
If you'd like transcripts of today’s show, you can go to PersonalLifeMedia.com and we'll send them to you. If you have any personal questions for me, it's [email protected].
Thank you so much, Dr. Alexander Rivkin, for being with us today. We've learned a lot. I only chewed my cheek once during the show. I'll be there to get that injection, too.
Alexander Rivkin: Wonderful. That's good to hear. It's been a real pleasure talking to you. Thanking you very much.
Teri Struck: You, too. Thank you so much. We'll have you back. There's so much about fillers. I think we can't learn enough about it. Thanks a lot.
Teri Struck: That will be great. Anytime.
[musical interlude - You Had A Little Work Done by Mark Winter (http://www.mark-winter.com/)]
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