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.
Skin rejuvenation to repair sun damage and wrinkles requires ongoing care and sometimes a little kick start. What I mean by that is that the place to start is will good skin care products. We offer our patients PCA skin care products. We believe that it is an excellent line and provide our patients with great results to improve their skin if that is all they want to do or to maintain their skin after a treatment.
The kick start to improving skin can be either a chemical peel or laser. It depends on the amount of downtime you can tolerate verses the degree of improvement to seek. The Fraxel re:store laser is a series of treatments in the office that provides for the least downtime, but also the lower end of results. It works very well for pigment, but only OK for wrinkles. The next step up from that is the Fraxel re:pair laser. It has a little more downtime, about 10-14 days without makeup, but is a one-time treatment in the office with very good results for both pigment and wrinkles. The last option is a deep chemical peel. We do this treatment in the ambulatory surgery center. It has 14 days without makeup, but offers the most improvement for your skin. We may also recommend Botox prior to your treatment and after to maintain the results in certain areas. Once your skin is healed we again recommend PCA skin care to maintain your result.
So, there are many different options that can be tailored for each patient. The most important things to consider are how long you want to wait for results and how much down-time if any you can tolerate. At your consultation we can explore all the options in more detail and determine which course of therapy would be right for you.
Thanks for your question. The frown lines between your eyes may be dealt with in a couple of ways. The first question to ask is are they there only when you scowl or do you have a line even when the muscle is relaxed. Lines that are their at rest are called static and lines there only with muscle activity are dynamic. You have to deal with the dynamic component to have any lasting success with the static line.
The dynamic line may be dealt with using Botox or a procedure call Relaxed Expressions. Botox is of course an injection. It is very easy, inexpensive and effective, however you have to repeat it every 4 months or so. Relaxed Expressions is a minimally invasive procedure that treats the nerve that goes to the muscle. It has the potential to permanently reduce the action of the muscle, but still leave you with some expression.
The static line can be dealt with using fillers such as Restylane, Juvederm or Radiesse or using a resurfacing procedure such as Fraxel or a chemical peel. Usually we use a filler, but if you have other facial skin concerns one of the other procedures may be more prudent.
We have further explainations of these procedures as well as before and after photos on the site. Please take some time to educate yourself further and feel free to call for a consultation anytime.
Thanks for your question about facial lines. In general facial lines are caused by sun exposure, age and muscle contraction. Wrinkles take two forms, lines that are only present with muscle activity ie. scowling or smiling, and lines that have become etched in and are present at rest, but may be made worse with muscle activity. Lines of the upper face such as the forehead and smile lines (crows feet lines) are very much a result of repetative muscle contraction. The lines around the mouth are also a result of muscle contraction, but are less able to be treated with muscle relaxation.
The treatment of wrinkles begins with good skin care. We offer a full line of PCA skin care products and can recommend the products which would be most beneficial. We then utilize Botox to treat the muscles responsible for the lines especially around the eyes, frown lines and forehead lines. Even if you do laser treatment or some other wrinkle treatment Botox will maintain your result and in some cases is all you need in addition to good skin care. Botox is less helpful for the lines around the mouth, but can be used in small quantities. For lines that are there at rest as well we utilize various methods of skin resurfacing and fillers. Skin resurfacing can be as mild as a light peel or we may utilize Fraxel, a deep peel or even dermabrasion in select cases. Facial fillers such as Restylane, Juvederm and Radiesse can be employed for deeper lines and folds.
Through this combination approach we are able to provide substantial benefits to aging facial skin without performing lifting procedures.
Please take some time to look at our before and after gallery and by all mean give us a call. We would love to see you.
Thanks for your question about Fraxel laser. The Fraxel re:store and Fraxel re:pair are really two completely different treatments with the only thing in common is that they are both fractionated, which means that they lay down tiny spots of treatment surrounded by normal skin which speeds healing. The Fraxel re:store is an erbium laser that treats pigmentation, fine liines, wrinkles, some redness, acne scarring and more. It is a series of 4-6 laser treatments done at one month intervals. Each treatment has about 1-2 days of swelling and 4-5 days of a mild redness called erythema which can be covered with makeup immediately. So the social downtime with makeup is about 2 days. The results for pigmentation are great and wrinkle improvement and other concerns is mild to moderate. The Fraxel re:pair is a CO2, carbon dioxide, laser. It is a one time treatment, but has more downtime. The patient’s skin is a little weepy and crusty for 7-10 days and you are required to wear ointment on your skin for this time period. You cannot wear makeup to cover it so the social down-time is more like 7-10 days. It provides nice improvement for wrinkles and pigmentation as well as other skin concerns. So the real difference is the number of treatments and down-time. We would be happy to talk with you more about your specific concerns and answer any other questions you have.
