What You Should Know About Facial Fillers

"I want surgery, not a filler that I have to keep repeating"

We hear this all the time. Many people want to do cosmetic surgery once and for all, and never have to worry about their face again. There are two things we want such people to know. First, surgery and fillers are most often complementary, not mutually exclusive. Meaning that surgery and fillers often do different things. Some people will benefit more from one or the other, while other people may do best with both.

Second, aging doesn't stop with surgery. Why do people try to impose a static, one-time solution on a changing set of problems? It doesn't make sense. Surgery can help to modify a large underlying issue, but there is no substitution for good skin care and soft tissue augmentation (fill), when needed.

The Problem With Most Facial Fillers

There are many types of fillers used in the face, and most of them have infrequent, but real complications. For many fillers, the only way to manage those complications is to cut the fillers out. That can be a significant problem if the fillers are injected all over the face. Be sure to ask your injector (physician?) what the potential complications are of the filler you are receiving and what the options are if the results don't come out as intended. Will there be permanent bone resorption, permanent scarring? If the material always dissolves away, how long will you have to wait for the undesired effect to vanish?

Are the Hyaluronic Acids (Restylane, Perlane, and Juvéderm) Are Reversible?

The hyaluronic acids, such as Restylane, Perlane, and Juvéderm, however are 100% reversible (instantly dissolvable) with another injection of a totally safe enzyme known as hyaluronidase. In fact, our practice was the first in the world to use and publish the application of this enzyme to dissolve these fillers. Sadly, we receive no royalties for this discovery, but we are extremely pleased to have an eraser for the fillers, in the event that we need one.

Are the Hyaluronic Acids (Restylane, Perlane, and Juvéderm) Are Safe?

Restylane, Perlane, and Juvéderm are very safe. Hyaluronic acids are a natural part of everyone's body, and these materials have been safely injected into the eye to help with cataract surgery for decades. The hyaluronic acid fillers are eventually broken down completely into carbon dioxide and water. Rarely (reportedly less than 1 in 10,000), people may have a reaction to Restylane, Perlane, or Juvéderm, but if they do, the enzyme hyaluronidase will completely dissolve it without any further problems.

Which Is Best Restylane, Perlane, or Juvéderm?

All three hyaluronic acids, Restylane, Perlane, and the Juvéderms are excellent, but they have different properties which make them most useful in different parts of the face. In general, our experience has been that Perlane lasts longer than the Juvéderms which last as long as the Restylanes or maybe a hair longer for the Juvéderm Ultra Plus. The Juvéderms tend to "flow" better into the tissues, which means they require less post-injection massage and manipulation, but they also are less able to be manipulated into a three dimensional elevation, less "scluptable." This makes the Juvéderms best suited for deep depressions or broad planes, and less beneficial in fine detail areas; along bone edges, such as the angle of the jaw; or in rapidly rising mounds, such as the prominence of the cheeks. Perlane lasts about a third longer than the Restylanes and provides about a third more volume than the Restylanes for the same volume injected. So Perlane is excellent in areas requiring large, durable bulky volume. The Restylanes are our sharpest pencils.

How Long Will Restylane, Perlane, and Juvéderm Last?

The duration of effect depends upon the type of hyaluronic acid gel and where it is placed. On average, these fillers last 9 months to a year. We've published cases where Restylane (the shortest-lived hyaluronic acid gel) has lasted as long as 5 years and seen cases where it is gone in 4 months.

What Can I do to Make My Restylane, Perlane or Juvéderm Last Longer?

Avoid Facial Laser Treatments

We have found that nearly all kinds of facial laser treatments "melt" the hyaluronic acid fillers and cause them to break down much faster.

Keep Well Hydrated

We have now seen a number of patients who became severely dehydrated from illness or excessive exercise and suddenly lost hyaluronic acid filler volume. It is not completely clear why this happens. The hyaluronic acids pull water from the blood stream into them, and thus maintain their volume. It seems that if they hyaluronic acids lose their water volume, then they are broken down more quickly, and even if water balance is quickly re-established, the hyaluronic acid fillers are already being broken down by the body.

Avoid Deep Facial Massages

Deep facial massages or aggressive facial manipulation can lead to a movement of the hyaluronic acid fillers.

Minimize Excessive Facial Movement in the Areas of Injection

Excessive and frequent facial movement is the number one factor associated with rapid breakdown of the hyaluronic acid treatments.

Consider Botulinum Toxin Injections

Botulinum toxins effectively decrease muscle movement which will make any hyaluronic acid in the area last longer.

Where is the Best Place in the Face for the Hyaluronic Acid Fillers?

In our practice, we examine each person's face individually and assess what will maximize the existing attractive characteristics and minimize the impacts of age, injury, and undesirable genetics. We try to bring everyone up to their own maximum potential, not make everyone look the same. Not everyone benefits from filling the nasolabial folds (the lines from the corners of the nose that extend to the corners of the mouth) or plumping the lips into pouty, bee-stung protuberances that announce your arrival before your feet have entered the room. In fact, most people don't.

What can be accomplished with the hyaluronic acid gels is limited only by your and our joint imaginations. For many people, jaw lines can be squared and strengthened, jowls buried, noses straightened and smoothed, eye brows raised, aged temples softened, cheek bones accentuated, ear lobes rejuvenated, under eye dark hollows erased, chins augmented, and even aged hands restored.

In our minds, the best crafted facial sculpting with these fillers provides a gentle, but subtly discernable overall difference in the eye of the observer. We want your friends and colleagues to say "wow, you look great, really rested; were you away on vacation?" not "who did your lips?"

Click the links below for more information about Cosmetic Procedures for the Face and Eyes available at Plastic Eye Surgery Associates:

Restylane® | Juvederm® | Perlane®