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Question: Is it true that Juvederm lasts longer than Restylane?
Answer: During the FDA trials, Juvederm got an indication for treatment of wrinkles up to 12 months whereas Restylane only got a 9-month indication. With this said, I have not really seen much of a difference in the longevity of these two products, and I feel that both of them are very good choices for injectable fillers.
Question: What are some of the fillers that use human-based collagen?
Answer: There used to be several different fillers that used human-based collagen but, honestly in these times, I have not used a collagen product since Restylane came out seven or eight years ago. My personal opinion is that the hyaluronic acid products are so far superior in consistency and longevity compared to human-based collagen products that I really have not had much use for those products since I have been using Restylane and Juvederm.
Question: What type of injectable filler is the longest lasting for filling out the wrinkles in the forehead? What, if any, complications are associated with injections of this particular filler?
Answer: Well, first of all, I typically do not recommend filling forehead wrinkles since, for the most part, these are dynamic wrinkles, which means that they are there due to overactive muscles, and I do not feel that filler injections tend to last all that long in these types of lines due to the activity of the muscle. I, therefore, typically recommend Botox to these areas as this will dramatically improve forehead lines and though it is a temporary solution, is extremely safe and effective. For patients that insist on a filler, I would first insist that they get Botox and should there be any significantly deep lines afterwards, we could consider filling these areas, but I would not recommend any sort of long-term filler for fear of complications in this area. I would, however, be willing to use a hyaluronic acid filler such as Restylane or Juvederm since these can be reversed should there be any concern about the viability of the skin. In other words, in some areas of the forehead or especially between the eyebrows, if the filler is placed in the skin underneath these wrinkles, it can cause so much congestion to the blood vessels that it prevents oxygenation of the tissue, which can lead to damage to the skin and resulting scarring. This could potentially be reversed if the filler was hyaluronic acid but can really not be reversed if the filler is a longer lasting filler such as a calcium-based filler.
Question: I have seen people who have gotten collagen in their lips and they look horribly disfigured. Are there better products now for enhancing the lips?
Answer: I am not sure that collagen was truly disfiguring or if the injector simply placed too much product in certain areas giving the illusion of a disfigurement. Ultimately, I highly prefer the hyaluronic acid fillers such as Juvederm and Restylane due to the fact that they are extremely safe and they are extremely natural appearing when injected appropriately and can last a relatively long period of time in the lips somewhere around six-plus months. These injections can be highly customized for each individual to give them the luscious lips that they desire.
Question: Which injectable filler would you recommend for crow’s feet? Do patients often get several areas of the face treated at the same time?
Answer: I would have to personally examine you but, for the far majority of my patients, I recommend Botox for the crow’s feet as in this area the lines are mainly due to excessive muscle motion more so than deep folds or lines that are present all the time. I have had some patients that have a combination of problems where they have significant deepening of these crow’s feet lines with smiling but even when they are not smiling they have a significant depth to them that can be filled with the filler. We will, therefore, provide a combination treatment of both Botox and a filler to give them the best result. Regarding the filler, I recommend the hyaluronic acid fillers such as Juvederm or Restylane and would recommend that virtually any other style of filler not be used in that area other than maybe collagen. I have found this combination effect to be very rejuvenating and long-lasting in my patients. Furthermore, you can get virtually any area of your face treated with Juvederm or Restylane and, therefore, we can treat multiple different areas of the face all at one time giving you a very long-lasting, rejuvenating effect.
Question: My face has aged tremendously this year, although I am only 46 years old. I have very pronounced smile lines and would like a facial filler to smooth them out. Is Juvederm recommended for these folds? How long will the procedure take and how long will the effects last?
Answer: Juvederm is an excellent option for the smile lines and is FDA approved for treatment of those lines. The procedure only takes about five to ten minutes and the improvement can last up to a year.
Question: My daughter is asking for work on her lips for her high school graduation present. Is this a procedure recommended for children so young?
Answer: If she simply wants fuller, more plump lips then this certainly can be performed on someone her age, and if she is under age 18 this will require the consent of a parent or guardian, but if she is over 18 she can obviously sign her own consent. Fillers such as Restylane and Juvederm are excellent at producing fuller and more luscious lips and are extremely safe and relatively long lasting.
Question: Over the years that fold that runs from the edge of my nose down to my mouth on both sides looks like it is sagging. I wonder if I can get this repaired without surgery. Is there something that could be injected into my cheeks to fill it out? Is anything like that permanent?
Answer: Yes you can definitely get something injected into the cheeks to fill them out and these would simply be filler injections. The most popular filler injection is a hyaluronic acid filler such as Restylane or Juvederm but you could also use Radiesse which is calcium based or even Sculptra. If desired you could also consider fat grafting since we can use a rather significant amount of volume from fat grafting and a portion of this can be considered a permanent filler. There have been permanent fillers on the market and most likely there will continue to be these options and for cheek augmentation I certainly can consider using these products to add volume to the cheeks. Another option would be cheek implants if your anatomy would benefit from such a procedure. Ultimately as you can see there are many options for your problem and that is why I feel a consultation with an experienced board certified facial plastic surgeon would allow you to select the best option for you.
Question: I heard that the injectable filler, Sculptra, can last 2 years. Is this true? Is this the only filler that lasts this long, and what can it improve?
Answer: Sculptra can definitely last two years or even longer, and in my personal opinion, I feel that it is best used as an overall volumetric enhancement of the midface, but I certainly know of others who use it in other areas of the face as well, including the smile lines. Other fillers that can last this long are Radiesse, which is calcium-based, though I do not think that it is nearly as reliable in its longevity as Sculptra is. Realize also, that the hyaluronic acid fillers, Restylane and Juvederm, can also last 2 to 3 years in certain individuals, but that is a relatively small percentage of the overall patient population that we see, and we cannot predict which patients will get this increased longevity of these filler products. Ultimately, I think fillers need to be highly customized for each individual’s desires, needs, and anatomic features, but overall I think that the hyaluronic acid fillers are the most reliable fillers on the market today.
Question: What type of injectable filler is most commonly used in the lips?
Answer: The most common type of injectable filler that I personally use in the lips is a hyaluronic acid filler, such as Juvederm or Restylane. These types of fillers are a clear gel, they are soft, and they are able to be highly customized in the way that the product is placed in the lip so that we can create a very natural appearing, luscious lip. They are also relatively long lasting, typically around 6+ months.
