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
