Dear Dr. Seckel, I am interested in Restylane or Juvederm to fill my nose to mouth lines and lips. A friend of mine had filler and had lumps. Is there a risk of lumps with Restylane and Juvederm? I have heard that Restylane and Juvederm are the best fillers. How long do they last? What are the risks of Juvederm and Restylane? Does the shot hurt? Thanks, Betsy, Boston, Massachusetts.
Thank you for your questions about Restylane™ and Juvederm™. Both Restylane and Juvederm are excellent fillers and work well and are safe when used by an experienced dotor. To answer your several questions I am going to use an article I have published on Restylane™, Juvederm™, Radiesse™, Sculptra™ and Perlane™. results can be beautiful as seen in the before and after picture of my patient below:
Restylane™, Juvederm™, Radiesse™, Sculptra™ and Perlane™ are fillers which can be injected beneath the skin to remove facial lines, fill depressed areas and actually lift the skin in some areas. These fillers can dramatically rejuvenate the facial appearance and are widely used today in anti-aging facial skin care.
What are Restylane™, Juvederm™, Radiesse™, Sculptra™ and Perlane™ made of?
These soft tissue fillers are FDA approved, liquid or gel medications that are injected beneath the skin to plump or fill an area of the facial skin which is depressed, such as a line, fold or area of atrophy. Soft tissue fillers are used to plump facial lines and wrinkles, to camouflage a fold of skin around the mouth, and to fill depressed areas such as the cheek that occur during facial aging.
The new fillers are hypoallergenic unlike older collagen type fillers used in the past. Most are a form of Hyaluronic acid (HA) which is a normal “ground substance” in the skin which helps maintain fullness and moisture in youthful skin. Some HA products are cross linked or have larger particle size for longer lasting results. Some, newer longer lasting fillers are made of other types of materials which I will discuss below. The ingredient of the common facial fillers is:
• Restylane™-Hyaluronic Acid
• Juvederm™-Hyaluronic Acid-Cross-linked
• Radiesse™-Calcium Hydroxyl Apatite
• Sculptra™- Poly Glycolic Acid
• Perlane™-Hyaluronic Acid-Large particle
How Are Restylane™, Juvederm™, Radiesse™, Sculptra™ and Perlane™ Used To Correct Facial Aging?
Soft tissue fillers are injected into the skin to add volume. Think of fillers as skin plumping agents. With aging the skin loses collagen and becomes lax. Especially in the mid face and cheek area the face can develop depressions and make the face look gaunt. Fillers can be injected into these depressions to make the cheek look more full and youthful. Fillers can be used to plump the lips to a more youthful appearance;
Fillers are also injected into deep facial lines. The nose to mouth lines or nasal labial fold lines and marionette lines give the face an aged appearance. The fillers can be injected into the depth of these lines to plump the lines and camouflage the folds.
Recently, larger filler injections have been done to plump the cheek and fill and lift the jowl in a procedure called the liquid face lift, with dramatic results.
Are Restylane™, Juvederm™, Radiesse™, Sculptra™ and Perlane™ Injections Safe?
The FDA approved fillers discussed in this article are safe when used by an experienced physician in a carefully performed manner. Filler injections are not an easy procedure for a doctor to perform properly. Experience is required to get a good result. There can be side effects which will be discussed below under risks.
How long do Filler Injections Last?
Pure HA fillers maintain correction for 4-6 months. The longer lasting cross linked, large particle, calcium hydroxyl apatite and poly Glycolic Acid fillers can last nine months to a year.
Do Restylane™, Juvederm™, Radiesse™, Sculptra™ and Perlane™ Injections Hurt?
I use a combination of a topical anesthetic and nerve blocks to make patients comfortable during filler injections. Cooling the skin also helps numb the skin and prevent bruising.
Recently we have been mixing lidocaine-an anesthetic with some fillers and this also makes injection more comfortable.
What Are the Risks of Restylane™, Juvederm™, Radiesse™, Sculptra™ and Perlane™ Injections?
• Bruising-Bruising can occur especially when fillers are used around the mouth. Icing before injection helps prevent bruising. The herb Arnica Montana, taken as a pill is also used by some to lessen bruising.
• Swelling-Some degree of swelling is common at the injection site. Ice helps lessen the swelling
• Long lasting lumps or bumps-Some patients develop firm lumps at the filler site. This is more common with the longer lasting cross linked and non HA fillers. While longer lasting results are desirable, fillers must be injected in a smooth form.
Lumps are more common when irregular injection technique is used because of the inexperience of the doctor. Massage usually lessens the lumps and most are gone, even with long lasting fillers by nine months to a year.
• Eye Complications-injecting fillers around and beneath the eyelid is not recommended by the companies that make fillers and is thus an off label use. There have been very long lasting lumps, discoloration and other problems associated with filler use beneath the lower eyelid to correct dark circles under the eyes.
What Do Restylane™, Juvederm™, Radiesse™, Sculptra™ and Perlane™ Injections Cost?
Depending on the product used $600-$950 per syringe. One syringe will treat the nasolabial fold and possibly the upper lip. Two syringes are required for the nasolabial fold and marionette lines. The liquid face lift requires at least three and sometimes more syringes.
Warning-Do Not Have Restylane™, Juvederm™, Radiesse™, Sculptra™ and Perlane™ Injections around Your Eyes
Do not allow anyone to inject fillers into your lower eyelid to correct dark circles under your eyes. The companies that make fillers do not recommend this use, thus it is an off label use of a filler.
There has been a reported case of blindness following injection of filler beneath the eye in England.
Many doctors do inject fillers beneath the lower eyelid and get good results. I am sure good results are possible. However, many doctors do not have training in eye surgery and eye anatomy, and I believe it is dangerous for anyone without detailed knowledge and experience in eyelid surgery to do injections around the eyes.
Who Should Do My Restylane™, Juvederm™, Radiesse™, Sculptra™ and Perlane™ Injection?
The most experienced doctors who do filler injections are board certified plastic surgeons and dermatologists. Experience and skilled technique is very important to achieve a good result and avoid complications. Many people do filler injections; the company sells to anyone who is a licensed physician.
In my opinion you should seek out a board certified plastic surgeon that has a lot of experience and does filler injection several times every week. Ask the doctor how experienced they are and how many injections they do a week.
Soft tissue fillers are remarkable effective products when used by an experienced skilled physician. They are one of the most valuable, effective and best non-surgical facial rejuvenation methods available today. Do your homework and find an expert who can treat your unique face with the care it deserves.
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