Blog with Dr. Irwin

Tag >> JuvedermRestylane

I got Juverderm under lower lip and chin couple days ago. I Have two large purple color bruises each side. How is that treated? How long it will take to go away? or is that treatable at all? Thanks for responding.

Any time a needle is used in skin there is a potential for a bruise!  The best option is to try and prevent them in the future.  Try these tactics.  No aspirin (unless required by a... more


Hi, I had juvederm about 5 weeks ago to my lip area and a tiny line one a wrinkle on my forehead. After the injection I had swelling which on my lips went down but on my forehead was around 2mm all around it. My nurse said it was swelling which could take a couple of weeks to settle and to leave it. 4 weeks after treatment I gently rubbed up and down once to help smooth it and it seems to have aggravated it more still being swelled. It isn't red but is a little uncomfortable. I can notice the swelling at certain angles and light. I am worried it will stay like this and hope the fluid around it will settle. By rubbing it whats the worse damage I could have done? I don't mind that the treatment wasn't successful but will I be left with this until it wears off. Thank you for your time and look forward to hearing from you
Generally, if you have waited a full week and it's still not good, it's time to go back to your doctor/nurse to have them look at it.   There is an easy way to eliminate Juvederm bumps... more

I had Juvederm in my nasolabial folds 8 days ago. It looked great; I had minimal swelling and it looked very natural. Today, I noticed that my smile is very noticeably crooked. It is normal on the left side, but sort of a half-smile on the right, and my cheek seems to be pushing "down". I already looked at pictures to see if this was an asymmetry I hadn't noticed before, but that is not the case. Is it possible the juvederm shifted? I look a little weird!
Only your doctor knows exactly where that Juvederm was injected.  You must call and go back to the office so he/she can look at it - it's really the only way to know.   A good office will... more

Hi - about 7 months ago I was a model for a visiting Italian doctor, who is highly respected in this field. I was injected with Juvederm for my marionette lines, but immediately noticed swelling on either side of my mouth (the lines were not filled either!) which I massaged over a week, but to no avail. They are still there, and make me look jowly (they throw shadows onto my skin). I was offered the enzyme to remove it, but was also warned that it can make the face saggy and it will require more filler to make good, which could result in a mess. So I am sitting it out, waiting for it to dissolve. My worry is that it is scar tissue, and will never disappear. What do you advise? Thanks so much!
My apologies that this took so long to answer!   In general, if there's too much Juvederm, there is too much!   Have it dissolved.   Your face will go back to where it was and that won't... more

Hello Dr. Irwin, With Juvederm, do I have to wait till the products is all gone to have it done again (around my nose and mouth) or can i get it done (maintain it) when I start to see some deflation? Don't like the look when it wears off complete and have to wait I guess.. I get use to my better face until the old one comes back lol..Ty :)

No, in fact I think it's better to schedule your next treatment prior to it's complete resolution.  If you do that, you'll gradually build more of a base and your results will keep... more


Dear Dr, Irwin I had my 1st series of Sculptra placed in my temple region and cheeks on August 11th 2011. ( one week ago) I am a 46 yr old female & have been a runner for years which left my face somewhat hollow. My question is this. I am reading many negative things about Sculptra. I guess I should have done my research prior to the injections. Nonetheless, I am thinking about discontinuing the next two series of Sculptra injections & was wondering if I could get Juvaderm Plus injected into my temples instead? If so, how long should I wait before having the Juvaderm injected into that area?

I'm hoping that you don't believe even a quarter of what you read on the web!  It's really not always very accurate.   You may be very happy with the Sculptra since, when it's done well,... more


Hello Dr I, Would you explain why you don't like Radiesse? and the difference between two. i tryed juvaderm loved it but lasted on only 2 months and i don't have deep lines..what is your thoughts Ty

As I've mentioned before, there are many good doctors who use Radiesse and love it.  In my opinion, there is just as much variability in response to Radiesse as there is with Juvederm Ultra... more


How do I get rid of lumps on my decolletage after injections with restylane for sundamage. It has now been 4 weeks since the treatment and I am still lumpy? Would dermaroller help I have been massaging? Donna
It would be very upsetting to see lumps on your chest!  But lumps from fillers are generally easy to fix.  In my opinion, you should see your doctor.  It is very easy to inject the area... more

Hi Dr. I, I know you are not a fan of Radiesse but I was hoping you can give me your opinion on it. My mom had a syringe injected into her nasolabial folds. One side of her nose became very swollen, it formed a large cluster of white/yellowish bumps and the skin under/around the bumps turned greenish, grayish and was very painful. It was a horrible experience for us all. She looked awful and I feel the guilt because I recommended the place to her!!!! We contacted the doctor and he put her on 2 antibiotics, anti-inflammatories and valtrex. He explained that the product caused the veins in the area to constrict and therefore became inflamed. The explanation was along the line that her veins were sensitive and had a negative reaction to the product. It doesn't really make sense to me. I was hoping you could explain it better. I know that without seeing it its hard but does the explanation make any type of sense to you? It has been 15 days and after the cocktail of pills she had to take it dried up, formed a scab and fell off a few days ago. The area is still red and the pores on her nostril are very open and still tender to the touch. I have pictures if they would help. Words can't describe how terrible it looked, she couldn't leave the house for a week and a half. I wonder what your opinion is on the explanation the doctor gave us. I know it is hard to say without seeing it but have you heard of this type of thing happening with Radiesse? Thank you again for your time.

I'm am so sad this happened to your mom.   These problems are the reason I don't use Radiesse.

First the good news,  the fact that it's healing, the scab has fallen off and her nose is red... more


Hi Dr. I, Had juverderm done only 2 weeks ago, love it. The Dr. did a good job, but it seems to be fading already. Is Juverderm a mantence program if it doesn't last 1 year and can I go back again for touch ups? ty
Depending on your facial structure and your age, it's possible that you really just needed an extra syringe to get a good base in the first place.  Juvederm Ultra Plus tends to last longer... more

How long do fillers like Restylane/Juvederm last especially in the marionette lines?

I think there's a lot of confusion about this.  The very general answer is 4-9 months.  Also, fillers will often begin to last longer as time goes on if you get treated 2-3 times a year in... more


I am confused about which procedure would work for moderate facial lines. I am a 46 year old caucasian female. I don't have loose, sagging skin or wrinkles. The lines are mostly around my mouth but to the sides not above my lips. I do not smoke. AHA's and retin a cause an unnatural shinny waxy look on my skin so I prefer not to use them. What procedure would work for this issue? Thanks so much.
Since you don't have sagging (laxity) or wrinkles, these lines to the sides of the mouth are usually from the nose to the mouth (nasolabial fold) or the mouth to the chin (mesolabial or... more

Can you have Restylane on top of Juvederm? I had Juvederm into my cheeks to lift them a couple of months ago but it hasn't achieved the effect I hoped. I have found a practitioner who uses Restylane but is it ok to have that when it's so soon after Juvederm?
Yes.  These two products are compatible.   I often explain to patients that it's like comparing a Gala apple to a Fuji apple - they are just slightly different but still apples.  These are... more

Hello Dr. Irwin. Your website is very informative. I am getting married in 4 weeks and will be vacationing on a cruise ship which will be in the Caribbean for 3 days. I where wide brimmed hats and sunscreen. I have been thinking of having full facial Thermage. I am 48 and my skin is definitely sagging. I want to look a little better for the wedding especially because the photos will be a permanent record. My self esteem is not very good these days because of these aging changes. I know I will feel so much better if I could do a little something about this for the wedding day. If I had the procedure done very soon, will I see some improvement by the wedding day? Also, if I want to get some lines and/or lips filled with Juvederm, how long after Thermage do I have to wait? Thank you in advanced for your time.

Congratulations on your wedding!   This is a little close to the time to see much with Thermage and it's tough to know without a picture if you have a good facial structure for it.   I... more


I had Juvaderm in my Glabellar Furrows and it looks as if nothing was put in especially on the right side. I also look like my right eye is swollen and I can feel some of the Juvaderm close to the corner of my eye which I assume is causing my eye to look swollen. I paid a $1000 dollars for 2 syringes and the fine lines around my lips do look better, I certaily don't feel I got a $1000 worth of improvement especially the way my Glabellar Furrows still look. I was told by the nurse at the plastic surgeons office that it would take care of this. The nurse is the one who did the procedure. Please help? Thanks

You bring up two good issues.  Was a good job done?  And, was the value for the money there?  Let's face it........this stuff is expensive and the responsiblity is with the doctor to make... more


Do you have any updates on how long radiesse lasts especially in the marionette lines?
This is my main issue with Radiesse and why I don't use it much.  In my opinion, the longevity of it is less predictable than with the Juvederm/Restylane products.   In some patients the... more

Dr. Irwin, I had Juvederm in my marionette lines three days ago. The right side looks great, the left is still a bit lumpy. Should I worry, is this normal? Or, do I need to go in and see the doctor?
Generally, I ask my patients to wait 7-10 days before calling our office.  This is because there is a some natural evolution of the product for about a week.  3 reasons - it absorbs... more

Hi Dr. Irwin, Can the tip of the nose be lifted without surgery?
Yes, a little with certain fillers.  This requires some skill.  Some of the better cosmetic dermatologists are good at it.  I think though that a facial plastics ENT (ear, nose & throat)... more

Hi Dr. Irwin, I Had Juvederm injected into the my smile lines two weeks ago and I still feel a burning/tingling sensation and puffiness, worse in the morning. If I am active it appears to get worse. Any suggestions for this water retention. I look like I was hit in the face on the right side. Thank you
Please go back to your dermatologist/provider and let him/her look at you.  A good office witll be very responsive and should invite you back (at no charge) so your doctor can see the... more

Would scuptra be a good choice to fill volume loss in my chin? I am 50 years old and the loss of volume in my chin brings out marionette lines. I have filled it with fat, restlene, and radiasse.Nothing has lasted more than 6 months. I have been told it is because it is such an active area. WIll scupltra last in this area. I was told it will last up to 2 years , But I was told radiasse would last 1 year too.

You bring up several good issues.  On the longevity issue, you are not alone in that fat transfer (while we all love the idea) is just not very predictable still.  As for Radiesse, I agree... more


I recently heard you speak on Pauls Choice blog radio and would like your opinion on what to do for hollowing under the cheek. I know there is sculptra, but I have heard it is not all it is cracked up to be and can leave little bumps under skin even 4 years out. I have good skin but because I am thin, need to do something. What injectable and/or laser should I consider? N

If you're nervous about Sculptra, find a good cosmetic dermatolgist (this is the key part) or very experienced nurse injector and start with the hyaluronic acids like Perlane or Juvederm... more


Does use of any treatment (for example -- laser - co2, fraxel, etc..., or injectibles - sculptra, rejuvaderm, etc.) prevent use by any other treatment (either same kind, ie. laser to different laser or different, ie. laser to injectable or vice-versa, etc.) at any point in the future?

Good question.  This is a little complicated for a blog but in general, no.  The exception is anything permanent like silicone, Artecoll/Artefill, and others available outside the United... more


Hi there, I am considering having sculptra to help with volume lost in my cheeks. After having the sculptra and due to economic issues could one (after 1 year) get Perlane or Radiesse injected into that same cheek area (where the sculptra was injected) for continued cheek volume? Thank you for your thoughts. LC

Good question.  There are no studies that I have seen on this.  But from talking to some of my collegues and my experience, here's what I'd recommend.

There doesn't seem to be any problem at... more


how long is restylane supposed to last?
I think today is filler question day!  If you are using what I call the "mid weight" version - not the Perlane, it generally lasts 4-6 months.  Over time, if you are regular with... more

Hello Dr Irwin i am 52 years old and thinking of starting to use fillers like juvederm for my cheeks ,i was wondering how much is the cost for it? Thank you, Marie.
Marie -  This varies quite a bit by area and country.  In the United States, the range is usually $450-800 per syringe.  Areas like New York and Los Angeles tend to be at the higher end. ... more

DR Irwin, i got your message and will ask my question again. I am 50 years old but have skin that looks more like 40. I do have volume loss in my chin and this shows the marionette lines. I have been using radiasse for this area because I had a bad reaction to restylene. Would sculptra be a better choice for this area? I have had good results with radiasse but do not yet know how long it will last as I had it put in in September and added to it in December.

Everyone's face is so different that it's almost impossible to answer without seeing you but some general principles still apply.  Look at your cheek area.  Is volume loss in your cheeks... more


Radiesse injected in the upper cheek area and and 2nd injection a week later in lower cheek bone area. Nodules have now formed in this area after swelling for a number of weeks. I have since. I now have sagging cheeks, sagging/pouches either side of my mouth, all of which I did not have before. Could this be from the heaviness of the product? Once the product has left my face, should my skin return to normal or is there permanent damage due to swelling and sagging over a period of time? I am 37years of age. Thank you.

You bring up some good points.  But, first let me reassure you that your skin should return to normal once the product is gone.   I am assuming though that you have seen the doctor who... more


I have used radiasse in the area of my chin and marionette lines. Would sculptra be a better choice for this area?
Okay wonderful readers - you have to give me your ages!!  The answer to this really depends on your age and the depth of the crease. Sculptra can be a great solution but don't rule out the... more

Dr. Oz had a cosmetic dermotologist on yesterday addressing the issue of jowls- uck! She treated a woman on the show with RADIESSE- instant results and lasts up to 1 1/2 years. Was really quite amazing and was wondering what your thoughts are on this. Thank-you Dr. Irwin! Connie

This episode was a few weeks ago but I thought it was interesting.  I generally don't like Radiesse in the cheeks because I think it looks too stiff and a little wooden when the face is... more


Should one wait until your Botox has relaxed and all fillers out when you decide to have a facelift, so that the doctor can tell how much skin to lift?

I think it makes sense to let the more temporary fillers like Juvederm/Restylane/Perlane - all the hyaluronic acid fillers -  wear off so you can get the optimum result from the surgery. ... more


I want to get a dermal filler in my marionette lines. I was considering Radiesse for this area. Do you agree? If not what would you recommend for this area. I had Restylene last year and it caused horrible swelling. I am afraid to use that product again.

In your situation, Radiesse is a reasonable option. Just make sure your doctor is experienced and a board certified dermatologist or plastic surgeon.  It's not a guarantee, but it helps.

A... more


Can having filler along labial nasal lines cause shadows and furrows elsewhere? I had two syringes of Juvederm, on either side of my mouth and now appear to have a hollow the other side of the filler and also the bags under my eyes look slightly worse. Should I have more filler to counteract the hollows or will this just transfer the furrow to somewhere else? I am a 47 year old with fair skin which tends to be dry. I also have Botox to counteract corrugation on my forehead and crows feet and Botox for bunny lines down the side of my nose.
Without seeing you, it's really hard to comment.  This can happen sometimes depending on your original facial contours.  It's fixable and preventable the next time.  Please go back to your... more

Dr. Irwin, as I've aged, the distance from my nose to lip has lengthened and my lips have also flattened. Is there a non-surgical way to shorten the appearance between nose and mouth, and to make my upper lip go up and out so they're not so flat looking?

The answer to this is yes ........but depending on the exact anatomy.  You didn't tell me how old you are.  If you're 80, it will be much harder than if you are 50.  The bony structure of... more


I do not like the look of the nasolabial lines after the Juvederm application because they are hard and changed my smile. How can I get rid of it?
Yes, you can!  Please call your doctor.  There is an enzyme (hyaluronidase) that can be injected into the Juvederm (or Restylane) to dissolve it pretty much instantly.   It works on all the... more

I have marionette lines around my mouth. It is due to volume loss in my chin. I had a bad experience with Restylane, (massive swelling after the procedure that scared me into a visit to the ER). Would Artefill be a more permanent option? I also had fat put into this area but it only lasted about 3 months. Could a laser tighten the skin in this area to get rid of it. It is not to bad I am 50.

I wish I could say your situation is unusual but I've heard many similar stories!  Let's start at the beginning and think through this.  I want you to go back to the mirror because most of... more


Can fillers such as restylane be used on the nose to fill out imperfections? Thanks for any information. Bonnie

The answer to this is absolutely yes!  In fact, there are several dermatologists and plastic surgeons who have made this a special interest and published papers on these techniques. ... more


I am a 68 year old woman considering Juvederm XC. I have deep wrinkles around the chin area. Would it be feasible to have treatment?
Yes - Juvederm will work for deep wrinkles around your chin, but you would almost certainly need 2-3 syringes to lay down a good base.  Follow up treatments would probably require less.  ... more

Hi Dr. Irwin, Can you tell me if Restylane will show through (either in lumps or color) in someone with really thin skin? Thank you so much for this website and all the information you provide!! Bonnie
If it's placed correctly, it really shouldn't.  We treat many thin skinned at our office with this product and Juvederm.  If it's placed too superficially in the dermis (the layer of skin... more

DPlease help! I just had Restalyne for the first time 55 hours ago to help with the deep, dark circles under my eye. The well known doctor injected Restalyne under the muscle, using a threaded needle to inject the Restalyne into the corners or as near corners as possible. I have bruising on my left eye only, its ok, I can cover w/makeup. However, both eyes have tear drop shape pouches on the top of my checks under the eye. It looks terrible as they stick out, swollen. Will this go away what should I do? It is Sunday, had this done on Friday afternoon. I saw your site and wished you were in the NYC area. Please help and can you recommend a good doctore in NYC or New Have, CT? Please. Thank you so much. Louise

Dear Louise:

 I wish I could answer every question you, my wonderful readers, send!  I also wish I could do it quickly but that doesn't work with a job and children - something you all... more


What is the best filler for hollow checks? I am 57 and have good skin, but I see some hollowing in the middle of my upper center of my cheeks. I have a full face, but not fat. I do Thermage and it works great for me so far. I tred Radiesse, but I agree with your opinion that it looks a little wooden when smiling. It has worn off some since I tried it last year.
If you have only mild to moderate hollows, then try the more robust forms of hyaluronic acid like Juvederm Ultra Plus or Perlane.   These should last 6-9 months the first time and slightly... more

What is the best treatment for the under eye crinkles? Is it thermage or fillers or retin a or something else? Thanks, Bonnie

This is such a complicated question because it depends on sooooo many factors.  I'll try to make a long story short!  But, please see the section on eyes on this site.  

If you just have a... more


You discuss how long to wait after an injection to have Thermage or Fraxel, but is there any problem with having Thermage or Fraxel first and then an injection like Sculptra or Juvederm later? How long do you have to wait?

This is a hot topic right now because there is a synergistic aspect to combining various treatments well.  The problem is that there are virtually no studies at all on combining  treatments... more


Your site is a wealth of information, Doctor Irwin. I am 48, and have the typical sagging because the collagen in my cheeks bones is being lost. Therefore, I have double parenthesis down between my nose and mouth on the sides. I have had Juvederm, and the first time loved it, but the next time with the same doctor, had weird results. It is as if the filler just shifted where the sags were. So, I sought out a new doctor, and still was not happy with Juvederm. Now, it is time to do something about these sags I mention, and even another doctor recommends Juvederm. A consult with another spa mentioned anti-aging bio-therapeutic treatments. I am so overwhelmed, but want to fix my face. Your website is great. Do you have a suggestion. That is a lot to ask, as there is so much out there. Thank you.

Thank you!!   It really helps to know your age but I wish I knew your facial structure as well.  So let's talk a little about the causes of those deep lines from the nose to the mouth.  In... more


-------------------------------------------------------------- So confused as to which is best, Restylane or Juvederm?! I've read articles/reports that say Restylane lasts longer and others claim that Juvederm lasts longer. I'm mainly interested in what is best for the nasolabial folds. Additionally, when I began to research I see there are 2 different Juvederm treatments, Juv.Ultra and Juv. Plus. Is Restylane the same, are there different concentrations? Please help!

It IS confusing, isn't it?  And, there are "new" products all the time which make it seem even more so.   Here's my opinion after years of experience.  I tell my patients that comparing... more


I know this may seem like an odd question, but are there any procedures that are safe for a patient going through chemo and antibody treatments? I am 51 years old, have been battling cancer for three years and just feel like I need a bit of a lift. I was considering Thermage to lift the lower face area as I have slight sagging along the jawline. Thank you!

I think this is a great question.  I love general dermatology as well as the cosmetic and often see patients from the Swedish Hospital Tumor Institute which is across the street from me in... more


I am thinking of having Botox (for frown lines) and Juvederm Ultra Plus (for nasal labial folds) but am concerned because I often get hyperpigmentation. My skintone is light to medium olive and I use Elestrin estrogen replacement therapy (gel). I had a good deal of PIH after laser therapy a few years ago to correct hyperpigmentation. After several months of using Lustra my skin did look good but it took a long time. I also get hyperpigmentation marks from minor skin blemishes that often last a long time. Should I be concerned about the needle marks from both products above and is there anything that could be done to help with the outcome?
I can see why you would be concerned about this but the answer, fortunately, is no!  The needles used for Botox and Juvederm are usually the size of an acupunture needle and are so tiny... more

lst visit to dermatologist resulted in injection of radiesse in lower eye area. Puffiness still existed. 2nd visit to dermatologist resulted in injection of restylane. Puffiness still exists. What should I do now to get rid of the puffiness under the eyes. I am a 56 yr old woman in fairly good health. thank you

I think this is a situation where you need a second opinion from someone good in your area.  If you don't know who to turn to, see our recommendations on this site, ask your primary care... more


Hi! I was wondering if the nurse who injects my juvederm (several times now for the past 2 months!) could be using something different than the juvederm? I don't get to see where she gets the product or what it looks like since I am lying down. The reason I ask this is because it seems like every time I get more juvederm, it looks like my lines are coming back and the filler is decreasing. I'm 39 years old and my lines (nasal labiofolds and near sides of mouth) were not that bad to begin with. Sorry for the long explanation....I'm just a little concerned. Thanks, Kris
Dear Kris.  Yikes - I certainly hope not!  In our office, we always have the boxes of Juvederm, Restylane, Botox, etc. right out on our counters where our patients can see them.  I would... more

Hi Dr Irwin, I have purchased your book - I have been a fan of yours ever since. I recently had juvederm injections under the eyes. Seventy two hours later I drank alcohol - four glasses of wine. I drink alcohol very infrequently and usually limit my consumption to no more than two glasses of wine. I become very dehydrated after drinking alcohol - which is why, amongst other reasons, I usually don’t consume more than two glasses of wine. Would this effect the operation of the juvederm? Or is the precaution about alcohol consumption related to bruising? I was advised to not drink alcohol for at least twenty four hours after treatment.
I'm assuming you had a nice result because you didn't mention any problems with the Juvederm after drinking the alcohol!   72 hours later, that wine really shouldn't affect the Juvederm at... more

Dr.Irwin- I had juvederm injected into the upper lip area to smooth lip lines that are hereditary. My first injections left the areas in approximately two weeks, and the second series left one area more plump that the right side leaving my face asymmetrical. I also had lots of injection problems with hematomas, purplish blistery knots, and swelling that lasts to this day. Continuing to this day (three months later) at this end of the day my lips swell leaving me very self conscious. Can you offer any advice on what the problems may have been, and what I can do to stop the swelling. I do not want to return to this physician (who is board certified in Dermatology). Please help if you can.

It helps me to know your age and how deep the lines are.  In general, I don't like Juvederm for upper lip lines, unless they are quite deep for these exact reasons. It tends to be too full... more


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