Guide To Fillers: Juvederm, Restylane and others
In my opinion, the ideal filler would last about a year or so. Adjustments could be made for normal aging and weight changes, and it would be completely safe. We don't have that product yet, but we get closer to the ideal every year.
What are fillers used to treat?
This depends somewhat on the filler, but the broad answer is lines and wrinkles. They can also be used to plump and define lips and fill hollow areas on the face. Here are some of the areas where they work best:
What are Restylane and Juvederm?
Restylane (Medicis) and Juvederm (Allergan) are sterile gels consisting of non-animal, cross-linked, hyaluronic acid (HA) and are made in a laboratory. HA is a natural sugar found in skin. They contain no human or animal DNA and have the best safety profile of all the fillers currently on the market. These products are FDA approved for use in the nasolabial fold and are used "off-label" in other areas. Juvederm causes less puffiness for the first few days after a treatment. In my opinion, it is also slightly smoother.
What are Perlane and Juvederm Ultra Plus?
These are still cross-linked hyaluronic acids like Restylane and Juvederm but are more dense (thicker) and with a higher molecular weight. Perlane is made by the company that makes Restylane. They are better for injecting into areas where a denser filler is needed like a deeper nasolabial fold, or for volume in the cheeks.
Other dermal fillers. There are a number of other fillers being marketed to consumers but none of them have the safety profiles or the consistency of results of the three fillers above. Still, there may be advantages to some of these fillers in certain circumstances.
How long will Restylane and Juvederm last?
Depending on the area treated, your skin, and the injection technique, Restylane and Juvederm will last 4 to 6 months. In some cases duration of the effects can be a bit shorter or longer. Juvederm Ultra Plus and Perlane are thicker and last approximately 6-9 months
How long do the fillers Restylane and Juvederm take to work?
It's immediate, but it can take a few days to "settle into" it's final shape. It often looks even better after a day or two. Many patients are surprised at how much better they look right after their treatment.
How much do Juvederm or Restylane cost?
Restylane and Juvederm are usually priced by the syringe. For example, filling out the nasolabial folds (the lines from the nose to the mouth) will take one or two syringes usually. One syringe will range from $450 to $600. Perlane and Juvederm Ultra Plus (the thicker versions) generally cost about $500 to $750 per syringe.
What do the filler treatments feel like? Is Restylane and Juvederm painful?
I demonstrated filler injections on the Oprah Winfrey Show and the Weekend Today Show. You can see clips from those shows to gauge how the person getting the treatment acted.
Many offices use a topical skin anesthetic to make you comfortable during the injections. The cream is applied and sits on the skin for 30-40 minutes prior to your appointment. The cream not only makes you more comfortable, it decreases the chance of bruising (by constricting blood vessels temporarily).
Most offices offer a dental block, which is done by numbing the skin under the lip with a flavored gel and then injecting a small amount of numbing solution (xylocaine) at the gum line (just like at the dentist). You will be numb for about 1-2 hours after the block. We also give patients a cold pack after the treatment to reduce any discomfort and possible swelling.
What will I look like right after my filler treatment with Restylane or Juvederm?
Most of my patients put their make-up on and go right back to normal activities. If you've remembered the no aspirin, Exedrin, Advil, Ibuprofen, Aleve (think ones that start with vowels) rule, then you should have very little bruising after your treatment provided your provider is gentle. A small amount of puffiness or mild swelling for a day or two is normal.
There is a small group of patients who really (really) puff after Restylane treatments, especially in the lips. Most of these same patients do not have this response to Juvederm and do fine after changing to it. Bruises on the lips are usually easy to cover with lipstick but bruises around the eyes or mouth can be difficult to cover especially if they are dark. Most cosmetic dermatologists can tell you right after the treatment if they think you are likely to have much bruising just from experience.
Do I need to come for repeat or maintenance treatments with Restylane and Juvederm?
Yes. All of these fillers require maintenance 1-4 times a year depending on which filler, the area injected, and your own particular body chemistry. You should be given an estimate on this at your initial consult.
Who should NOT use a dermal filler?
Do not use Juvederm or Restylane if you are pregnant, breast feeding or bruise easily.
All of the below increase bruising. To avoid swelling and bruising, you should:
What are the possible medical side effects of a dermal filler like Juvederm or Restylane?
What are the possible cosmetic side effects? · You may have swelling for 24-72 hours, especially with injections in the lips. The first time you try Restylane (especially Restylane), or Juvederm avoid planning social events for 48 hours.
Filler Q & A Discussion:
I had a lot of bruising around the mouth with my first filler treatment. Will it be that way every time?
Probaby not - unless you have to take aspirin or another blood thinner like Coumadin or Plavix for medical reasons. If you are taking them for medical reasons, don't stop them without your primary care doctor's okay. Remember not to take aspirin, Advil/ibuprofen, Aleve for 1 week before your treatment. Tylenol is fine. Also, if your dermatologist uses numbing cream to prenumb you for about 20-30 minutes it will help prevent bruising. The anesthetic cream constricts blood vessels making bruising less likely. Some dermatologists and nurses are too rough in their injection technique. A gentle touch helps to prevent bruising as does an ice bag to apply at the end. Your treatments should be almost bruise free.
My daughter's wedding is coming up. How long before the wedding should I schedule my Juvederm so I'm sure to look great before the wedding?
I recommend 3-4 weeks especially if this is the first time you've had a filler done. This gives you a week to 10 days to recover from any bruising should it occur. And, you can't tell the full effect of your Botox or filler for about a week. So the timeline would be like this: 3-4 weeks before get the full treatment; 2 weeks before assess if any touch ups or fine tuninng are needed and go in for that right away so you have a week to recover from a bruise should it occur; 1-2 weeks before you're confident that you look your best and nothing else is needed. Remember that everyone(!) seeems to get a little anxious before these events. Try not to let that anxiety focus on small issues with your face. You're beautiful just as you are!
What is the difference between fillers and Botox?
Next, learn more about the collagen stimulater filler that can last 2+ years called Sculptra.
See Dr. Irwin's expert answers to other reader's questions on fillers:
Could my Botox be moving? Prominent facial veins post Botox or fillers. Persistent brown spots - especially the stubborn ones. Pregancy and possible toxic ingredients in skincare. A fun story! I would like to purchase your skin care book, please let me know how. Is filler and/or Botox okay for people who have cancer?
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