Hyaluronic Acid Fillers (Restylane/Juvederm)

Injectable fillers such as Restylane-L®, Restylane® LYFT, Restylane® REFYNE, Restylane® DEFYNE, Juvederm® Ultra XC, Juvederm® Ultra Plus XC, and Juvederm® VOLLURE are stabilized hyaluronic acids used to smooth moderate to severe facial wrinkles and folds around the nose and mouth or shape facial contours in adults over the age of 21.  These absorbable (temporary) injectable wrinkle fillers are FDA approved for the correction of moderate to severe facial wrinkles and skin folds, such as nasolabial folds by injection into the dermis of the skin. Nasolabial folds are the wrinkles on the sides of your mouth that extend towards the nose or extending from the corner of the mouth towards the chin. They are commonly referred to as "smile lines" or "marionette lines."  Additionally, Restylane®-L, Juvederm® VOLBELLA, and Juvederm® Ultra XC have been FDA approved for augmentation/enhancement of the lips and smoothing of perioral lines in patients over 21 years of ageJUVÉDERM VOLUMA® XC injectable gel is FDA approved and indicated for deep, subdermal (subcutaneous and/or supraperiosteal) injection for cheek augmentation to correct age-related volume deficit in the mid-face in adults over the age of 21.  Restylane® LYFT is also approved for cheek augmentation and correction of age-related midface contour deficiencies in adults over the age of 21.

Hyaluronic acid is a naturally occurring substance that is found within all mammals.  It is a material that is contained in various soft tissues.  Hyaluronic acid can be synthetically produced from a process of bacterial fermentation, chemically stabilized, and purified for use as an injectable soft tissue filler (non-animal, stabilized hyaluronic acid).  The hyaluronic acid in injectable fillers is biocompatible and is a totally non-animal product; there is little risk of animal-based disease transmission or allergic reaction.  Restylane-L®, Restylane® LYFT, Restylane® REFYNE, Restylane® DEFYNE, Juvederm® Ultra XC, Juvederm® Ultra Plus XC, Juvederm® VOLBELLA XC, Juvederm® VOLLURE XC, and Juvederm® VOLUMA XCcontain 0.3% Lidocaine in addition to the hyaluronic acid.  Lidocaine is a local anesthetic added to these formulations to decrease pain at the injection sites.

Injectable fillers are customized for every patient, depending on his or her particular needs. These can be performed in areas involving the lower face, peri-orbital region, malar/cheekbone, peri-oral and lips. Injectable fillers cannot stop the process of aging.  It can, however, temporarily diminish the look of wrinkles and soft tissue depressions.  Injectable fillers may be performed as a singular procedure, in combination with other treatments such as BOTOX®, or as an adjunct to a surgical procedure.  Continuing treatments are necessary in order to maintain the effect of injectable fillers over time. Injectable fillers once injected will be slowly absorbed by the body.  The length of effect for tissue filler injections is variable.

Technique

Hyaluronic acid fillers (Restylane®-L, Restylane® Silk, Restylane® Lyft, Juvederm Ultra® XC, Juvederm Ultra Plus® XC and JUVÉDERM VOLUMA® XC) are usually injected when the patient is in the office, rather than requiring a hospital visit. Dr. DiBello personally performs all of the injection procedures and he will advise you as to which product(s) are best suited for your needs. The areas of the skin to be treated are first coated with a topical anesthetic, which is usually sufficient for the patient's comfort.  Hyaluronic acid is a hydrophilic agent, which means that it attracts water much like a sponge. This expansion contributes to the final volume that is achieved. Overfilling can lead to bumps and irregularities which, although rare, can represent a small, temporary cosmetic problem.  It is especially effective for the nasolabial folds, lip augmentation, and areas of contour deformities such as the cheeks. It is also an ideal adjunct for Botox® treatment and is frequently used in conjunction with Botox® to correct lines and creases that persist. 

 For many, but certainly not all patients, the results can last up to six months. Juvederm® VOLBELLA XC is formulated with VYCROSS®, a proprietary filler technology from Allergan, which yields smooth products that have been engineered to address specific patient concerns and is reported to yield results that last up to 1 year.  Juvederm® VOLLURE XC is formulated with Allergan's proprietary VYCROSS® technology, which blends different molecular weights of hyaluronic acid, contributing to the gel's duration and yields results that are reported to last up to 18 months.   Restylane® REFYNE and Restylane® DEFYNE are two hyaluronic acid gel fillers for laugh lines (nasolabial folds & marionette lines) made with XpresHAn Technology™ that helps maintain natural expression in motion with results lasting up to 1 year.  Results of cheek injections with  Restylane® LYFT or JUVÉDERM VOLUMA® XC have been reported to last up to 10 - 12 months.

Benefits:

  • A natural substance that does not require pretesting for allergic reactions
  • Injections can last for approximately six months
  • Minimal discomfort
  • Very few side effects
  • Can apply makeup immediately and return to normal activities (but avoid exercise/exertion for 4-6 hours after treatment.

Other Considerations:

  • Temporary swelling, redness, needle marks and/or bruising may occur, but these resolve after a few days’ time.
  • Small bumps are infrequently visible or are palpable but generally resolve spontaneously or with gentle massage
  • After about three weeks, repeat injections may be desired to achieve an ideal result.

Treatment Areas

Lips:  Restylane®-L, Juvederm® VOLBELLA XC, and Juvederm® Ultra XC have been FDA approved for augmentation/enhancement of the lips in adults over the age of 21.  Juvederm® VOLBELLA XC is additionally approved for the smoothing of perioral lines (“smoker’s” or “lipstick” lines) in adults over 21 years of age. Dr. DiBello utilizes Juvederm® VOLBELLA XC for very conservative, less noticeable enhancement of the lips.  If you are looking to add more volume to the lips and have more noticeable results, then he would recommend either Restylane®-L or Juvederm® Ultra XC.  In either case, Dr. DiBello strives to provide you with the most natural appearing enhancement of your lips.  There is more swelling with lip injections (although much less with VOLBELLA) so you may feel self-conscious for the first 24 hours, depending on how much is injected.  While there is no Herpes virus in the products themselves, if you have a history of Herpes I (cold sores/fever blisters) then you should consider antiviral prophylaxis.  Let the office know beforehand and Dr. DiBello will discuss this with you.

Nasolabial Folds and Marionette Lines:  Restylane-L®, Restylane® LYFT, Restylane® REFYNE, Restylane® DEFYNE, Juvederm® Ultra XC, Juvederm® Ultra Plus XC, and Juvederm® VOLLURE are all FDA approved for the treatment of moderate to severe facial wrinkles and folds (such as nasolabial or smile lines) in adults over the age of 21.  Dr. DiBello uses Restylane-L®, Restylane® REFYNE, and Juvederm® Ultra XC for shallower folds and lines, or for superficial layering in thinner tissues.  Restylane® REFYNE has the added potential of preserving natural expression in motion and may last a little longer.  Dr. DiBello will recommend Restylane® DEFYNE, Restylane® LYFT, Juvederm® VOLLURE XC and Juvederm® Ultra Plus XC for deeper lines or folds, thicker skin, or deeper layering.   Juvederm® VOLLURE XC is reported to last up to 18 months, while Restylane® DEFYNE has the potential of movement with facial expressions.

Cheek Augmentation and Malar Deficiency:  JUVÉDERM VOLUMA® XC and Restylane® LYFT are both FDA approved for Cheek Augmentation and the correction of age-related midface contour deficiencies in adults over the age of 21. JUVÉDERM VOLUMA® XC is additionally approved for correction of age-related facial volume loss. Of the two, Restylane® LYFT is not as thick/heavy, is more forgiving, and consequently yields less swelling.  JUVÉDERM VOLUMA® XC is thicker/heavier to provide more predictable and noticeable enhancement of the cheeks and cheekbones, but will cause more swelling.

Cost

Juvederm® VOLBELLA XC: $450 per 0.65ml tube 

Restylane-L®, Juvederm® Ultra/Ultra Plus XC:  $550 per 1ml tube

Restylane® REFYNE/DEFYNE, Juvederm® VOLLURE :  $600 per 1ml tube 

Restylane® LYFT: $650 per 1ml tube

JUVÉDERM VOLUMA® XC:  $800 per 1ml tube

 *$100 discount for each additional tube  ($50 for VOLBELLA)
 
*All injections personally performed by Dr. DiBello

 

Learn more about Hyaluronic Acid.

To See This Procedure Animated, Click Here!