Restylane^® and Juvéderm^TM

What are Restylane^® and Juvéderm^TM?

These fillers are composed of hyaluronic acid, a sugar molecule ("glycosaminoglycan") that is found naturally in our bodies, a connective tissue component of skin. They are manufactured using recombinant DNA from bacterial sources, as opposed to an animal source for collagen. They have received FDA approval for the treatment of facial wrinkles.

How are Restylane^® and Juvéderm^TM different from collagen?

Restylane^® and Juvéderm^TM are fillers which have replaced collagen in my practice and in most doctors' practices because these fillers last longer, about six months, compared to three months for collagen. Juvéderm Ultra PlusTM may last even longer, up to a year.

Another advantage over collagen is the fact that no allergy test is required because hyaluronic acid it is a natural component of our tissues and is not derived from an animal source.

Which facial areas respond best to Restylane^® and Juvéderm^TM?

Nasolabial creases: The "parentheses ( )" creases or folds on either side of your nose extending to the corners of your mouth respond very well to fillers. The nasolabial creases are a tell-tale indicator of age and can make your face appear tired. With the help of Restylane^® and Juvéderm^TM, patients enjoy significant facial rejuvenation for six to nine months.

Lips

Restylane^® and Juvéderm^TM pass the "kiss test" quite well for patients that are seeking both a natural look and feel. Most of us desire the youthful advantages of fuller lips. With the help of fillers, thin lips can regain their youthful "cupid's bow" shaped upper lip and renewed fullness in the lower lips.

Where to inject and how much:

When it comes to lip enhancement references to Goldie Hawn in First Wives' Club come up frequently. Many patients tell me "I don't want to look like Angelina Jolie." Patients don't want to be ridiculed. They don't want to have an unnatural appearance.

It is important to understand the optimal aesthetics of the lips. Ideally, the lower lip is fuller than the upper lip. This relationship is evident in most models. The lower lip is composed of two lateral segments, whereas the upper lip has three – two laterals and a central, which give the pleasing "Cupid's bow" contour of the upper lip. It is important to recognize this ideal lip shape, to avoid a "sausage" lip appearance. It is also important that the filler is placed in the red "vermillion" part of the lip. If it is injected too high, an unnatural fullness is created just above the lip, creating a simian appearance (if you don't readily recall what this looks like, just Google "ape"), which is unflattering. I have seen this look in patients treated with Gore-Tex (PFTE) in whom the implant is a little too high.

Restylane^® and Juvéderm: How long do the effects last?

The effects of these fillers are temporary, usually ranging from six to nine months. Restylane^® and Juvéderm volumes are limited to one or two ccs, more than this becomes prohibitively expensive. Also, there is no possibility of long-term survival of the filler. When the cost-per-volume of filler is considered and the duration, fat injection is more economical in the long term.

The temporary nature of these fillers is both a positive and a negative. It is a negative obviously because treatments need to be repeated. However, if there is any untoward effect of the fillers such as conspicuous nodules, these are going to resolve in time.

Are Restylane^® and Juvéderm compatible with fat injections?

Yes. A patient who has had fat injection in the past can have Restylane^® and Juvéderm afterward and vice versa. A patient may decide to have a quick injection of hyaluronic acid in the office, as an appetizer so to speak and commit to a fat injection "entre" later. Alternatively, a patient treated with fat injection may have a quick touch-up in the office with hyaluronic acid at a later date to increase fullness or to compensate for any fat that has dissolved. Of course, a touch-up fat injection is also possible.