Kimberly,
There are not any permanent fillers available on the market in the U.S. currently that are F.D.A. approved for facial lines. Artefill was available and you may be able to find some around, but the distributor in the U.S. went bankrupt and so it is no longer available. A new distributor may pick up the product in the future. The only other permanent filler available is liquid silicon. It is approved for retinal detachments, but some physicians are using it for facial lines and lip augmentation. I personally do not use silicon and have seen complications from it. There are some who support its use, but there are significant potential long term complications to consider. I do not recommend it. Its just not worth it. Sounds to me like you are on the right track with your current use of Restylane and Juvederm. You could consider Radiesse for the smile lines as it is a little longer acting and may build some permanent collagen, but it is not good for lips. There is a permanent implant available for the lips,but it is relatively new and its longevity and patient satisfaction has yet to be determined. Hope this helps.
Ed Buckingham
Tammy,
Great question. All of the fillers you mention, Restylane, Perlane and Juvederm hyraluronic acid fillers. They are great all purpose fillers for the face. They all inject very well, are smooth to the touch and provide great results. They differ in manufacturer and thickness. Restylane and Perlane are produced by one company, Medicis, and Juvederm (which comes in Juvederm ultra and Juvederm ultra plus by Allergen. Restylane and Juvederm ultra are comparable and Juvederm ultra plus and Perlane are comparable. The companies will define differences between there products by crosslinking, concentration etc, but for our conversation they are comparable. Restylane and Juvederm Ultra are the best for filling superficial lines. They are less thick and so therefore they can be placed through small needles and into a more superficial location. They both last between 6-9 months (sometimes up to 12 months) depending on the location of injection. Perlane and Juvederm Ultra Plus are thicker and more useful for filling up deeper folds or for volume augmentation. They may last a little longer. In general we tend to use Restylane and Juvederm Ultra for lips and superficial lines, Restylane for under the eyes and Perlane or Juvederm Ultra Plus for smile lines and marionette lines. We also use a product you didn’t mention, Radiesse. It is also a great filler for deeper lines. It lasts a little longer, 12-18 months, but is a little more firm to the touch.
Ed Buckingham
