Guide To Fillers: Juvederm, Restylane, Cosmoplast 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:

• lines from the nose to the mouth (nasolabial fold)
• lines from the mouth to the chin (melomental fold)
• lines above the upper lip
• frown lines (best combined with Botox Cosmetic)
• in the lips for volume and definition
• to restore volume to cheekbones or cheeks
• in some situations, under the eyes
• to fill out the backs of the hands and make veins look less prominent

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.

Cosmoplast and Cosmoderm. 

These are human collagen that is made from a single cell line (over 10 years old) and then extracted from the cells in a lab. It is not a cadaver or live tissue source. No allergy testing is needed with this product. Zyderm and Zyplast are made from bovine (cow) collagen and were the "first generation" collagens.  Allergy testing for bovine collagen is essential.

Other 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.

• Radiesse - calcium hydroxlapatite - Basically a constituent of bone and cartilage in a creamy, injectible form. Purports to last longer than HA but often seems not to.  More prone to complications especially bumps.
• Sculptra - poly-L-lactic acid - Think of this as a volumizer not a line filler.  It is best for the facial hollowing with HIV lipodystrophy, the hollowing that is genetic in some families, and for restoring volume for low body weight individuals.  It is especially helpful for patients who are 60 or older when plastic surgery becomes riskier for health reasons. It is also prone to bumps and is harder to inject so a very experienced dermatologist or plastic surgeon is needed. Link to Guide to Sculptra
• Fat - This would seem to be the ideal filler since it's your own.  But it can be unpredictable, sometimes lasting months and sometimes  years.  It can be lumpy. Be prepared for 2 weeks or so of bruising and swelling, and it's difficult to find dermatologists or plastic surgeons who are expert at it.
• Silicone, Artefill and Aquamid - I am strongly opposed to  these permanent fillers. They can look great initially but complications can occur 3 months to even 10 years later, and the complications can be permanent. These complications can be disfiguring and, in some cases, even life-ruining. If your doctor makes even a slight mistake, you may have to live with it forever.
• Other HA fillers. So far, these are Juvederm and Restylane imitators that don't have the same track record and may not be as safe. It's possible there will be some soon that offer a real advantage but until then, why use them?

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. Cosmoplast lasts 3 to 4 months usually and Cosmoderm an even shorter time.

How long do the fillers 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, Restylane, or Cosmoplast 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. Cosmoderm/Cosmoplast are usually about the same. Perlane and Juvederm Ultra Plus (the thicker versions) generally cost about $500 to $750 per syringe.

What do the filler treatments feel like?  Are they 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.

Link to Dr. Irwin demonstrating Restylane on the Oprah Show

Link to Dr. Irwin demonstrating Restylane on the Weekend Today Show

What will I look like right after my filler treatment?

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?

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 this product?

Do not use Juvederm, Restylane or Cosmoplast if you are pregnant, breast feeding or bruise easily.

All of the below, increase bruising. To avoid swelling and bruising, you should:

1. No aspirin, Exedrin, ibuprofen, Aleve or Advil for 1 week before and 2 days after. Tylenol is always fine.

2. No Vitamin E (multivitamin ok) or St. John’s Wort for 2-3 days before or after.

3. No exercise except for walking for 24 hours after the procedure.

What are the possible medical side effects?

· If you’ve previously had cold sores around the mouth (facial herpes simplex) , the treatment might provoke an outbreak. Be sure you have a supply of the oral tablets (prescription) Valtrex, Famvir or acyclovir.

. Do not use if you are pregnant or nursing because these products have not been tested for safety in pregnancy or nursing.

 

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), Cosmoplast, or Juvederm avoid planning social events for 48 hours.

· After the treatment(s) some common injection-related reactions might occur, such as swelling, redness, pain, itching, discoloration and tenderness at the injection site. These typically resolve spontaneously within 2 to 10 days.

· The results from your filler can last 2 to 9 months. The longevity of these products is variable and each individual may obtain a different result.

· Mild bruising or a slight blush might appear at the injection site immediately following treatment and may last for 2-10 days.

· The use of anti-inflammatory drugs or aspirin will almost always cause bleeding or increased bruising at the injection site.

 

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!

Link to Video Demonstration of Juvederm

 

From www.SkinTour.com and Dr. Brandith Irwin. Copyright 2008 SkinTour LLC. All rights reserved. Journalists, bloggers, and media may reprint this without permission so long as they include this credit box with the article.