Guide To Dermal Fillers: Restylane, Juvederm, Voluma, Sculptra
By Dr. Brandith Irwin, MD
In my opinion, the ideal dermal 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 dermal fillers on the market (particularly Juvederm and Restylane) get closer to the ideal every year.
What are dermal 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:
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 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.
Other dermal fillers. There are a number of other dermal 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.
How long do these 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 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. One syringe will range from $450 to $600. Perlane and Juvederm Ultra Plus (the thicker versions) generally cost about $500 to $750 per syringe.
What do the filler treatments feel like?
Are Restylane and Juvederm 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 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.
What will I look like right after my filler treatment with Restylane or Juvederm?
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 dermal fillers require maintenance 1-4 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 dermal fillers?
Do not use Juvederm or Restylane if you are pregnant or breast feeding or you bruise easily.
All of the below increase bruising. To avoid swelling and bruising, you should avoid:
Shannon Braslavsky is licensed as an Adult Gerontology Nurse Practitioner in the state of Arkansas. In addition, she is also the owner of Refine Medical Aesthetics which specializes in Botox, Fillers, Peels and most non-surgical injectables.