Restylane/Restylane Lyft/Juvederm in New York
Frequently Asked Questions
What are these products and how long do they last?
Restylane, Restylane Lyft, Voluma, Juvederm Ultra and Juvederm Ultra Plus are injectable forms of hyaluronic acid, a natural product found in the body. They do not require skin testing prior to use and usually last between six and twelve months. They are commonly used on the cheeks, nasolabial folds, lips, and areas around the mouth and chin.
Where do you usually use Restylane as a filler?
Restylane is a brand name for a hyaluronic acid filler. It is a fairly thin product that will last about six months and sometimes longer. It seems to last longer in areas such as the lower eyelid tear trough region. I like to use it in the tear troughs where I often mix it with lidocaine. I do this because it thins the product out a bit to allow a more even placement and to minimize the risk of lumpiness, which can be more common in the lower lid region since the tissues are so thin. Others will use Restylane in the nasolabial folds and lips as well. Juvederm Ultra can also be used in a similar fashion.
What filler is best for my tear troughs?
Tear troughs are found at the lid-cheek junction as a depression or groove. Interestingly and anatomically, it is not found exactly at the orbital rim bony prominence. The tear trough, in my opinion, develops over time as the tissues thin out and can become more noticeable with orbital fat herniation as well. I prefer using a diluted Restylane product for filling of the area. By diluting the Restylane, it becomes more malleable and is less likely to create lumps. In some individuals, I will perform a lower lid blepharoplasty and release the soft tissue along the tear trough. The tissue that is released is called the arcus marginalis. Sometimes I will use some of the fat from the herniated lower lid fat pockets to redrape over this area. This can camouflage the area very nicely.
What product should I have injected into my cheeks?
For the most part, I have abandoned the use of malar or cheek implants. I have found filler products as an excellent and reliable alternative to fill the cheek and also gently improve the nasolabial folds. The hyaluronic acid fillers like Restylane Lyft, Voluma, or Juvederm Ultra Plus are all thicker products that can be nice fillers for this region. These products usually last about six to nine months, and sometimes longer. Sometimes, I will use the patient’s own fat to fill the cheeks. This can provide a permanent result once the fat has “taken.” Of course, not all fat “takes,” but in general I will say that between 60-75% of the fat usually takes, and sometimes more.
What products should I have injected into my nasolabial folds or marionette lines?
Nasolabial folds are the folds adjacent to the nostril extending along the side of the mouth, and often seem prominent when one smiles. Marionette lines are those similar to what a puppet would have along the mouth down along the sides of the chin. These develop as the face ages and the soft tissue deflates. I prefer to use fillers like Restylane Lyft and Juvederm Ultra Plus to fill out these depressions. Again, fat can be used in a similar fashion, which may lead to a more permanent result. This can also be combined with facelifting techniques for some patients whose facial improvement may not be satisfied with these products alone.
Can I have filler placed to augment my chin?
I have treated some patients with a weak chin by using filler product. I have even lengthened the chin gradually with filler. Of course this is not a permanent solution. Usually a chin implant or a sliding genioplasty is a better choice for a permanent improvement.
How do I treat my jowls?
Jowls are the depressions and sagging tissues along the jawline in older patients. This consists of loose skin near points of retaining ligaments. The skin elasticity weakens and the tissues deflate. In younger patients, fillers like Restylane Lyft, Juvederm Ultra Plus, or Voluma can be used to fill the depressions and camouflage the area. Fat injection is an alternative as well. As for older patients, usually a facelift or necklift often combined with fat injection is a good solution. On some occasions, if the jowl is more fatty in consistency, conservative liposuction is an alternative as part of a facelift.
Which products can be used on my lips?
To me, the goal of lip augmentation is to provide a natural result. I hate the “duck look” that some people get when their lips are overdone. Patients are always concerned about developing this, but I think it takes a lot more filler than people think. I often use hyaluronic acid fillers like Restylane Lyft, Juverderm Ultra or Ultra Plus, or even Restylane. Many times I will use one syringe only to treat the lip line. Patients often want more filler and I will often add some in the muscle layer of the upper or lower lip along with sculpting the area along the philtral columns and Cupid’s bow. They can be done very elegantly and very naturally.
Are fat injections better than other filler products?
Fat injections are a great alternative to the absorbable hyaluronic fillers. Fat can be permanent and in most cases, more than 60-75% will “take” after injection. The procedure is more invasive because of the fat harvesting, and this aspect usually requires anesthesia.
What if I feel lumps or want the product removed?
The great thing about the hyaluronic acid filler products is that if lumps develop from uneven injection or inadequate massage, or the patient just does not like the result, the hyaluronic acid product can be dissolved with hyaluronidase. Injecting hyaluronidase is a fairly easy procedure, but may need to be repeated a few times. I will often inject the areas of concern and have the patient return two weeks later for follow-up to see if it needs to be treated again.
What is Voluma ™ XC?
This is one of the newer hyaluronic acid fillers in the Juvederm family. It was recently FDA approved for cheek volume enhancement. It is cross-linked a bit differently then some of the other hyaluronic acid fillers, and in some studies it has been reported to last up to two years.