When Juvederm doesn’t seem to be working.

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 most women over 40,  a good percentage of the problem is actually coming from the volume loss in your cheeks as you mentioned yourself.  If that’s the case, then just filling the lines won’t give you a great result.  You will need some volume put back in your cheeks with Sculptra, or with the Juvederm Ultra Plus or Perlane (like Restylane).  These are more dense and hold up better in the cheeks.  Usually a combination of adding some volume back into the cheeks, filling the lines and putting some volume back into the chin area will work nicely.  Correct placement is also key, so try to find a very experienced injector.

Some doctors like Radiesse for the cheeks and get nice results with it.  To me it always looks a little wooden when people smile but some people love it. 

At 48, the bio-therapeutic treatments are unlikely to do much.  I’d vote no on those.   Dr. I

Dr. Brandith Irwin, MD

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