Restylane™, Perlane, and Juvederm™ Injectable Gel are Hyaluronic acid-based products that are great facial line fillers. Hyaluronic acid is a natural substance found in the human body. Although Restylane, Perlane and Juvederm were approved for injection to the nasolabial folds, off-label use of these products has revolutionized facial rejuvenation. Unlike Collagen they do not require allergy testing, and they may last from 6-12 months depending upon the product used. There may be some minor bruising and swelling of the treated regions that will often resolve in a few hours to a few days. The products can also be dissolved if the patient is not satisfied with the result.
Areas of Treatment:
1) Cheek Augmentation and Elevation – Injectable fillers like Restylane™, Perlane, and Juvederm™ can be used to augment the cheek region and create malar prominence. Recently, Voluma™ XC was approved for cheek enhancement. Recent studies suggest that this product can last up to two years. In Dr. Wallach’s practice these products have replaced the use of cheek implants for the majority of his patients. This is great for patient with hypoplastic (small) cheeks or for patients that have facial wasting. Cheek hollows can also be filled with these products. With cheek enhancement, often times this can improve the upper nasolabial fold as well. The use of fillers for the cheeks is also a great adjunct to facelifting techniques.
2) Chin and Jaw Line Augmentation/Rejuvenation - Injectable fillers can soften the appearance of early jowling along the lower border of the face. It can also be used to augment the chin for some patients or even soften the step-off that some patients obtain with chin implants.
3) Earlobe Rejuvenation – One tell-tale sign of aging is a thin earlobe that occurs with facial soft tissue atrophy. Placing a small amount of filler into the lobe can help to rejuvenate the lobe. “Plumping the earlobe” can be combined with trimming of a hanging earlobe during a facelift and this can significantly improve the ear’s appearance.
4) Hand Rejuvenation – Commonly as a person ages, there is soft tissue wasting of the hands and the skin often has “sun spots.” The hands can look thin with a veiny and bony appearance. Injectable fillers like the Hyaluronic acid products can be used to improve this “wasting’ look. This can be combined with light based systems to treat the sunspots. An example of the light based system includes Broad Band Light (BBL) or what many know as Intense Pulsed Light (IPL) to improve the hand’s appearance.
6) Nasal Contour - Some nasal augmentation can be performed with filler material. This can be applied to the nasal dorsum or the tip. Dr. Wallach believes that in most cases a better more permanent result occurs after a formal rhinoplasty, but he will use the facial injectables for minor irregularities.
7) Peri-oral Rejuvenation – The perioral facial aging can be improved with injectable fillers.
a) Lip Augmentation – Lip augmentation by filing the white roll or injecting the lip muscle can augment it nicely. Filling the white roll of the lip can improve vertical lip lines that occur with age, sun exposure, and smoking. Injecting the vertical lines directly can improve them as well. This can also be combined with neuromodulator injections and laser peels.
b) Marionette Lines -Treating the marionette lines that run on the side of the mouth to the chin can be improved as well.
c) Peri-oral Commissure – The peri-oral region can be filled to improve the downward appearance of the corners of the mouth that occurs with age.
8) Peri-orbital Rejuvenation - The eye region is often the first area that shows facial aging, and hyaluronic acid injectable filler products can be used with great success in this region.
a) Upper Eyelids – If the upper eyelids appear hollow from aging or after a blepharoplasty, injectable fillers can be used in this region to give a more youthful upper eyelid contour. Often Restylane™ is the preferred hyaluronic acid in this area because of its small particle size. This can be combined with neuromodulators like Botox™ and Dysport to enhance the appearance.
b) Lower Eyelids – The lower eyelid and especially the tear trough region at the nasojugal groove, and the area between the lid-cheek junction are great areas to treat with filler product. Restylane™ is a great product to treat this delicate area because of the small particle size. This area is prone to bruise more than other regions because the tissues are thin and there area is very vascular. Treatment can also compliment the results of a lower lid blepharoplasty. Neuromodulators like Botox™ and Dysport can be used to treat the crow’s feet along the lateral eyelid as well.
c) Eyebrow and Corrugator Region – The eyebrow region can be treated to provide more fullness and lift the sagging brows and lateral hooding that commonly appear in the upper eyelid region with age. Neuromodulators like Botox™ and Dysport can help raise the lateral brow as well. Areas such as the “11” lines that are produced by overactive corrugator muscles are often best treated by the neuromodulators. However with repeated motion lines can appear “etched” and injectable fillers can fill these lines to soften them.
9) Temporal Region – Some patients develop temporal hollowing with age. This area can also be treated with facial injectable fillers.
Liquid Face Lift – The liquid face lift is a marketing phrase that refers to a non-surgical procedure incorporating both facial filler material such as Restylane™, Perlane™, Juvederm, Radiesse, and Sculptra along with using the neuromodulators, Botox™ or Dysport. As our knowledge of facial aging has evolved, these products have become more important. The filler materials can be used to fill the depressed cheeks that as a side benefit may improve the nasolabial folds (creases along the sides of the nose and mouth) indirectly. The nasolabial folds can be injected directly as well. Facial wasting along the sides of the mouth can also be treated by filler injections to treat the marionette lines. Jowling can be camouflaged to some extent with filler injections, and jaw line deformities can be improved as well. Areas around the eyes such as the tear trough can be filled to soften the “double-bubble” deformity of the lower lid -cheek attachments that appear with increasing age. In addition, cheek hollows and lines of the upper face can be filled. Temporal hollowing can also be treated in a similar manner. Even brow elevation can be accomplished with fillers. In addition, the neuromodulators such as Botox and Dysport can treat overactive frontalis muscle that causes transverse forehead lines, overactive corrugators that lead to “11” lines, and lateral crow’s feet lines that are caused by the overactive orbicularis muscle. Treating the lateral brow with neuromodulators can create lateral brow elevation. In addition, the neuromodulators can treat some neck bands due to overactive platysma muscles. Lip lines, chin puckering, and overactive depressor anguli oris muscles of the lower lip region can also be treated. The key in using these products for facial rejuvenation is to not over do it. Some patients are over treated by their injector possibly because the injector has not been trained properly in aesthetic rejuvenation or the injector does not offer other procedures such as face lifting, brow lifting, or eyelid lifting procedures. Inevitably some patients look “puffy” or like marshmallows. Too much product can make someone look as unnatural as someone who has had too much surgery.
If you would like more information about Dr. Wallach and his success with New York City Restylane, Perlane and Juvederm procedures, we hope you will not hesitate to contact our Manhattan offices at (212) 861-6400 or by mail at 1049 5th Avenue, Suite 2D in New York, NY 10028; or using our contact form to request additional details.
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