Guide To Fillers: Restylane, Juvederm, Voluma, Sculptra, and More!

Several years ago I said, “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 really are there now.  We have fillers that last that long, can be adjusted fairly easily, and are safe for 99.9% of patients who use FDA approved fillers.

What are hyaluronic acid fillers? They 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 the skin. They contain no human or animal, 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 several other areas, and are also used “off-label” which means the FDA did not approve it for that particular area.  Ask your doctor about “off-label” use, if you’re not sure.

The filler line-up has really expanded.  Here’s a brief summary of each.  Fillers all have slightly different uses and properties based on their molecular weight, amount and type of cross-linking, elasticity, etc.

  1.  Galderma owned fillers are Restylane Lyft, Restylane Defyne, Restylane Refyne, Restylane and Restylane Silk.  Basically, Lyft is the “stiffest” and is used mostly for lifting. Defyne has a heavier weight but is more elastic so it supposedly conforms to facial movement better.  Refyne is a lighter weight but similar to Defyne.  Restylane is mid-weight and Silk is very light and was formulated mostly for lips.  More may be coming soon.
  2. Allergan owned fillers are Voluma, Vollure, Volbella (Vy-cross technology), and Juvederm Ultra Plus, and Juvederm Ultra.  More may be coming.
  3. Merz – Belotero is light and usually used for lips or fine lines.
  4. Teoxane (Swiss company) – Teosyal HA fillers are just beginning to be used in the U.S. Very similar to many of the products named in 1 & 2.
  5. Sculptra– poly-L-lactic acid – Think of this as a collagen builder, not a line filler.  It is best for the facial hollowing, especially the temple area, and volumizing.  Particularly nice for restoring facial volume for low body weight individuals.  When mixed, injected, and massaged correctly, it does not form bumps.  But, a very experienced dermatologist or plastic surgeon is needed. See Dr. Irwin’s Guide to Sculptra for more information.  There is a diluted version that may be used for body sites.
  6. Radiesse – calcium hydroxlapatite – Basically a constituent of bone and cartilage in a creamy, injectable form. Purports to last longer than HA but often seems not to. Like Sculptra, it generates collagen.  More prone to complications and bumps then HA fillers.  It cannot be adjusted if mistakes occur.  There is a diluted version that may be used for body sites.
  7. Fat – This would seem to be the ideal dermal filler since it’s your own tissue.  But it can be unpredictable, sometimes lasting months and sometimes years.  It can be lumpy. Be prepared for 1-3 weeks of bruising and swelling, and it’s difficult to find dermatologists or plastic surgeons who are expert at it.
  8. Belafill, Silicone – I am strongly opposed to these permanent fillers. Belafill (was Artefill) is tiny plastic beads.  They are not adjustable. 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.

What are fillers used to treat?

This depends somewhat on which dermal filler you’re using, 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 (marionette lines)
  • lines above the upper lip
  • hollows in the temple area (experts only please)
  • in the lips for volume and definition
  • to restore volume to cheekbones or cheeks
  • in some situations, under or around the eyes (experts only please)
  • to fill out the backs of the hands and make veins look less prominent
  • other uses which can be customized
  • body sites – dilute Sculptra or Radiesse generally.

How long will HA and other fillers last?

Depending on the area treated, your skin, and the injection technique, these fillers will last 4 to 6 months.  In some cases, the 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 fillers take to work?

It’s immediate, but it can take a week to “settle into” its 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. Sculptra because it builds your own collagen takes 2-3 months and usually an initial series of 2-3 treatments.

How much do fillers 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. Syringe cost varies by filler and region.  This approximately $500-$1,000 per syringe.

What do the filler treatments feel like?  Are they painful?

I demonstrated injecting dermal fillers 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 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).

Some 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 treatment?

Most patients put their make-up on and go right back to normal activities. If you’ve remembered the no aspirin, Excedrin, 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. Tylenol is fine, as long as you’re not allergic.

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 dermal fillers require maintenance 1-3  times a year depending on which filler, the area injected, and your own particular body chemistry. Your provider should give you an estimate on this at your initial consult.

Who should NOT use fillers?

Do not use Juvederm or Restylane if you are pregnant or breastfeeding or if you bruise easily.

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

  1. Aspirin, Excedrin, ibuprofen, Aleve and Advil for 1 week before and 2 days after. Tylenol is always fine.
  2. Vitamin E (multivitamin ok) and St. John’s Wort for 2-3 days before or after.
  3. Exercise (except for walking) for 24 hours after the procedure.

What are the possible side effects of fillers?

  • 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 fillers if you are pregnant or nursing because these products have not been tested for safety in pregnancy or nursing.
  • Allergic reactions are very rare.
  • Be sure to read your doctor’s consent form carefully for more detail on your filler.

 Filler Q & A Discussion:

I had a lot of bruising around the mouth with my first dermal filler treatment.  Will it be that way every time?

Probably 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 pre-numb you for about 20-30 minutes it will help prevent bruising. The anesthetic cream constricts blood vessels making bruising less likely. A gentle touch with the injector 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 getting the  full treatment;  2 weeks before assess if any touching up or fine-tuning is 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 seems 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!