The facial aging process is complex and volume loss is a substantial component. Replacement of facial volume loss can be accomplished through the use of autologous fat transfer, which is using the patient’s own body fat cells and transplanting them into the face, or through the use of syringe based fillers. The most common types of fillers used are hyaluronic acid (Restylane, Perlane, Juvederm) and calcium hydroxylapetite. (Radiesse) Poly-L Lactic acid (Sculptra) is another filler which can be used for volume loss however it requires multiple treatments to appreciate the results and therefore we do not frequently use it. We prefer to use Radiesse for subcutaneous tissue augmentation as the results are immediate and the longevity approaches that of sculptra. Autologous fat transfer is another topic for another Blog. We will talk more about the use of syringe based fillers.
We usually use a combination approach for overall facial rejuvenation with fillers. We utilized Restylane for the teartrough deformity of the lower eyelid, Radiesse for deep cheek augmentation, and then a combination of Restylane, Perlane and Juvederm for perioral rejuvenation. The tear trough or orbital groove is a hollow at the junction of the lower eyelid and cheek. It is responsible for giving the lower eyelids their bag-like tired appearance. Restylane is very useful for filling in this groove. By filling up the hollow it changes the way light catches the eyelid cheek junction removing the appearance of the tired eye and adding light and therefore a refreshed appearance.
The loss of volume of the lower eyelid usually extends into the cheek region as well into what is referred to as a malar groove. It is an oblique line that separates from the orbital groove and extends down the cheek. When present the cheek has lost is youthful fullness and become a series of lumps and hollows again creating unsightly shadows. In this area we prefer to use Radiesse or Perlane to add the youthful fullness back to the cheek.
The other common area for facial rejuvination is the perioral area including the smile lines, marionett lines, and the pre-jowl sulcus which is the hollow along the jaw-line just in front of the jowl. By adding volume to this area the lines of age are again filled out to a more youthful configuration. The pre-jowl sulcus being filled hides the appearance of the jowl and leads to a cleaner looking jaw-line.
Fillers are great because of their ease of use and limited down-time. Dramatic results can be obtained through their use, especially if a total facial approach is utilized.
Wow! That was a long and very good question regarding hyaluronic acid fillers, Restylane, Perlane and Juvederm. You are right to be confused because of all the different fillers. It is only going to get worse. The fillers do have differences microscopically regarding how they are processed, how much crosslinking there is between molecules and how much of the actual hyaluronic acid is present. Clinically there is a little difference in the feel of the product as it injects and some people feel there is a difference in how the product feels in the face as well. Regarding that Restylane tends to have a little more body than Juvederm which in my opinion is better for folds. Juvederm tends to feel a little softer, which is why some people prefer it for lip injections. In general though good results can be achieved with either product. Regarding Restylane vs Perlane. Perlane has more cross-llinking and is therefore thicker, just like the difference between Juvederm ultra and ulta plus. The thicker products are better for deeper folds and the thinner products for lips and fine lines. Selecting which product to use is done at the consultation and varies between patients. Regarding the Juvederm commercial, looking overdone is a product of technique and quantity. I believe that our patients achieve very natural results. Please feel free to look at our photo gallery and decide for yourself. We look forward to seeing you.
The tear trough is basically the hollow area under the eye. It gets that name because it looks like it could be a gutter that tears would flow into from the eye. It is basically a deficiency of bony or soft tissue anatomy in the lower eyelid region that leads to a shadowing and tired appearing lower eyelid. Fillers are very effective to fill in this area as is autologous fat transfer. Fillers are the temporary solution and fat is long term or semi-permanent. Fillers are performed in the office and usually only have a little minor bruising an swelling. As little as 24-48 hrs of minor evidence of the procedure. Fat transfer is perfomed with sedation and requires a few weeks of down-time, but the results last years. Fillers for the lower eyelids last 9-12 months. Both are great options depending on your goals.
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.
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.
