Beginner’s guide to your first filler treatment

Hello, Dr. Irwin I'm such a big fan and so grateful for all your unbiased expertise (my whole skincare routine is based on your recommendations and my skin has never looked better). I wasn't sure if I should bother you with my question about Restylane SubQ because I know it isn't used in the U.S but I wasn't able to find much info online and hoped you might be able to offer some invaluable insight. I'm a 30-year-old East Asian woman, and have always had a slim face without much volume. Sadly, I'm seeing nasolabial folds start to form and am considering getting dermal fillers to keep them from getting worse. I did a lot of research on the different types of fillers available and am leaning towards Juvederm/Restylane because they seem like the safest/most conservative choice for a first-timer like myself. Only problem is, the dermatologist I hope to be treated by doesn't offer Juvederm at his office and he uses Restylane SubQ instead. He's both certified and experienced and so far the doctor I like best but I'm wary about the SubQ (which hasn't been FDA approved to my knowledge). My question is, is SubQ safe/effective enough when used by an experienced doctor or should I stick with FDA-approved fillers? Thank you so much for reading my question!

Thank you! Your comment totally made my day. It’s really a pleasure to interact with all of you, and try to help with the craziness of our current technology. There’s so much great technology, but also so much “junk food” information. I also loved your question regarding a good first filler treatment. Let’s do this in two parts. I think it’s best to start with low-risk, high satisfaction services that can also be reversed, if you don’t like the effect. This way you can build trust with the doctor/nurse/PA-C or ARNP provider and their office.

Which products and services are best for a first treatment or treatments?

  • Start cautiously and small. My recommendation: Botox or Dysport with some in the frown lines (glabella), and in the crow’s feet area. This is a good way to start. Avoid the upper forehead and the lower face until you’ve built trust with your doctor/provider.
  • Start with ONE syringe of softer, more flexible filler (see below), especially if you are lower body weight to start.
  • Restylane or Restylane Refine in the lines or trough from the nose to the corner of the mouth (nasolabial folds). Start with one syringe only. This is FDA approved. Quite safe with experienced injectors. You may have some bruising, but if there is a large or painful bruise after, especially up by the nose, call your doctor asap.
  • Juvederm – The same thing applies as above. Both of Juvederm and Restylane above can be quite easily uncrosslinked (dissolved or just adjusted) with an enzyme (hyaluronidase).
  • Restylane SubQ is heavier and, in my opinion, not a great choice for a first treatment in a younger, low body weight patient.

What if my doctor/provider doesn’t have or stock the filler treatment product I’m interested in?

  • Restylane SubQ is NOT approved in the U.S. So where is the doctor getting it? And it’s illegal to import it! Ask the doctor where he/she is getting it? Why are they using a non FDA approved product here when we have plenty of options?
  • Most offices doing reputable aesthetic work in the U.S. carry both Juvederm and Restylane fillers. A few just carry one or the other. That can be just fine! It’s really the doctors/provider’s choice about what they think will serve their particular patient population best. Juvederm and Restylane products are quite similar – like comparing a Gala apple with a Fuji apple.
  • The difference is in the molecular weight, cross linking structure, flexibility, hydrating ability, and lifting capabilities of each individual product. This is the science of it.   Tailoring just the right filler product to YOU, a very specific individual. It’s NOT one size fits all.
  • The art of it is to look and understand every individual, beautiful face and enhance that… not to create a different person… in my opinion.

Hope this helps,  Dr. I




Dr. Brandith Irwin, MD

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Hi, I’m Dr. Irwin. I believe that consumers deserve a medically trained and unbiased skin care advocate.

  • All our content is written and researched by myself.
  • My medical office in Seattle has treated thousands of patients for 15+ years.
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