Question: Can Restylane contour the face for more of an oval shape?
Answer: Restylane can definitely contour the face to create any sort of shape that is desired, but if you really have an issue with significant volume need, you may want to consider either facial implants or fat grafting since it would become quite expensive to use multiple syringes of Restylane to overall change the shape of one’s face. Most of the time we are using syringes of Restylane to improve upon slight depressions and folds and we can use anywhere from one to six syringes of Restylane to improve upon these areas and in effect change the contour of the face, but remember that 1 teaspoon is 5 cc, so this is just a little over 5 cc of product, whereas when we do fat grafting we may use anywhere from 10 up to 60 cc of fat doing full face rejuvenation. That is 10 times more volume of which a third to a half of this volume will be retained long term. So, as you can see Restylane is going to have a limited effectiveness to truly change one’s facial shape, but it is an excellent option for those that just need a little bit of tweaking in areas that are concerning.
Question: I have fine lines above my lip. What’s a good filler for this area?
Answer: I think the hyaluronic acid fillers Juvederm ULTRA and Restylane are the best options for fine lines of the upper lip. They can be used to fill small lines. They are very well tolerated and last a relatively long time and are overall a good value. They are also extremely safe and should any sort of an unexpected bumpiness or fullness occur, they can be reversible.
Question: Does Radiesse provide permanent or temporary relief of facial wrinkles?
Answer: Radiesse provides a temporary solution to facial wrinkles and folds and can last one to two years though in multiple patients I have seen them return within six months needing more volumetric enhancement. Due to this fact, we typically use the hyaluronic acid fillers Restylane and Juvederm over Radiesse, but occasionally someone will desire a significant amount of cheek enhancement and I will oftentimes discuss cheek implants, fat grafting, and Radiesse to those particular patients.
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 had a dent on my nose for the past five months. My rhinoplasty was a year and a half ago. The surgeon recommended Restylane, but that is not permanent. What other options do I have?
Answer: I think Restylane in that circumstance may be a very good option if it is a very small dent and the risk of performing any sort of revision surgery is outweighed by the mild nature of the deformity. If you are extremely interested in the longer lasting result then injection of Radiesse may last up to two years or even longer in certain individuals. And as a last resort, you could consider injection of silicone into that area, though it is certainly not FDA approved as an injectable filler. Other considerations would be to perform a rather minor surgical procedure in the office where a small amount of cartilage is harvested from the back side of the ear and then, through a relatively small and precise incision, a pocket is made in the area of the depression and this cartilage is placed within it. I have performed this on a handful of my own rhinoplasty patients with excellent results, and it does not demand a trip to the operating room.
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 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.