Hyaluronic Acid Fillers (Restylane/Juvederm)

Injectable fillers such as Restylane®-L, Restylane® LYFT (formerly known as Perlane®), Restylane® Silk, Juvederm® XC (Juvederm Ultra® XC and Juvederm Ultra Plus® XC) are stabilized hyaluronic acids used to smooth moderate to severe facial wrinkles and folds around the nose and mouth or shape facial contours.  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 and Juvederm®-XC have been FDA approved for injection of the lips in patients over 21 years of age.  Restylane®Silk is approved by the FDA for injection of fine lines around the mouth in patients over 21 years of age.  Restylane® LYFT and JUVÉDERM VOLUMA® XC injectable gels are 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.

Hyaluronic acid (HA) 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® Silk, and the "XC" forms of Juvederm® (Juvederm® Ultra, Juvederm® Ultra Plus and JUVÉDERM VOLUMA®) contain 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 face and eyelid region, forehead, 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, although a nerve block may be preferable for some patients. 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.  Results of cheek injections with  Restylane-L or 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

Learn more about Hyaluronic Acid.

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