Fillers

Fillers: Hyaluronic Acid and Radiesse

HYALURONIC ACID
Information Sheet

What are hyaluronic acid fillers?
 
Hyaluronic acid is a substance naturally found in the skin.  As a sugar molecule, it pulls water into itself and plumps the skin.  With age, the amount of hyaluronic acid in the skin diminishes.  Hyaluronic acid is a type of “filler” which can be injected into the skin to fill in wrinkles such as the smile lines.  In addition, it is sometimes used to plump acne scars and lips; however, these are off label uses, as the safety and effectiveness of treating areas other than the facial wrinkles and folds have not been established in controlled clinical trials.

What are some commonly used hyaluronic acid fillers and what their differences?  

•    Restylane and Perlane are hyaluronic acid fillers made by the company Medicis.  Restylane was the first hyaluronic filler FDA approved in the US (in 2003) for the treatment of nasolabial folds; it lasts around 6 months.  Perlane is an agent made of larger particles which is used to treat very deep wrinkles; it lasts around 6-9 months.

•    Juvederm Ultra and Juvederm Ultra Plus are hyaluronic acid fillers made by the company Allergan (which also makes BOTOX® COSMETIC). These products have a slightly more concentrated form of hyaluronic acid.  Juvederm Ultra was FDA approved in 2006 for the treatment of nasolabial folds; it lasts around 9 months.  Juvederm Ultra Plus is slightly thicker and is used to treat deeper lines; it lasts 9-12 months.   

Which product is best for me?

At the Dermatology and Laser Center of Oklahoma, we have used both of these products with excellent safety profiles and results.  In short, benefits of Restylane include its length of use in the US (since 2003) and the more flexible dosing that it offers (2 syringe sizes).   Benefits of Juvederm include its increased longevity, smooth flowing consistency during injection, and reduced postoperative swelling.  In our experience, both products have a similar feel and appearance following the procedure.

How do I prepare for the procedure?

To minimize the risk of bruising, avoid aspirin and nonsteroidal anti-inflammatory medications (such as ibuprofen and naproxen) for 2 weeks before treatment (unless you were placed on these medications by a physician).  In addition, vitamins C, E, garlic, St John’s wort, ginseng, and/or gingko biloba are also blood thinners and should be stopped 1 week before treatment.   Tylenol is NOT a blood thinner and is OKAY to take.  All products may be resumed after the procedure.

Are the injections painful?

Hyaluronic acid fillers require multiple needle injections in the areas to be treated.  Two forms of anesthesia are available: topical numbing cream and dental blocks.  Topical numbing cream is commonly used when treating the smile lines.  For most patients, this makes the procedure very tolerable.  Dental blocks are typically used when treating the lip area.   Similar to most dental offices, numbing gel is applied to the gums and then injections are given on the inside of the mouth.   With a dental block, patients feel little if any discomfort during the procedure.

What should I expect after the procedure?

The most common side effects following the procedure are bruising, swelling, and tenderness.  In most patients, bruising may last around 1 week and is most noticeable 2-4 days after the procedure (as it turns from red to dark purple).  Makeup can be applied though may not fully conceal bruising.  For swelling and tenderness, ice compresses are helpful during the first 24-48 hours.  Lumpiness is common during the first 2 weeks.  After 2 weeks, the product usually assumes a “softer” look.  Other side effects include but are not limited to persistent lumps, broken blood vessel formation at the site of injections, and very rarely allergy or infection. There are no limitations on activity, and it is okay to drive yourself to and from the procedure. 

RADIESSE
Information Sheet

What is Radiesse and how does it work?     
Radiesse® is a dermal filler made of calcium-based microspheres which are suspended in a water-based gel.  The calcium microspheres are composed of calcium hydroxyapetite, a biocompatible substance normally found in the mineral component of teeth and bones.  When injected into the skin, it provides immediate plumping and volume replacement.  Over time, the body gradually dissolves the product, and in the process, creates new collagen.  In most patients, Radiesse lasts 1 year or longer but is not permanent.

Is it safe?
Radiesse does not contain any animal- or human-derived components. Therefore, it has a minimal risk of allergic reaction and skin testing is not required.  Over time, it degrades into calcium and phosphate ions that are safely metabolized by the body’s own processes.  In the United States, Radiesse is FDA-approved for the correction of moderate to severe facial folds and wrinkles, such as nasolabial folds, and for the correction of the signs of facial lipoatrophy in HIV patients. In addition, there are US FDA clearances for oral/maxillofacial defects, vocal fold insufficiency, and radiographic tissue marking.

How many treatments will I need?    
For most patients, one treatment is sufficient.  However, if after 2 weeks, the level of correction is not to your satisfaction, please contact our office for evaluation of further volume replacement.

Do the injections hurt?
Numbing cream is applied to the skin prior to injection.  Radiesse is injected through a small needle.  In addition, the product is mixed with local anesthetic prior to injection.   With this approach, most patients tolerate the procedure very well.

What should I expect after the procedure?
The most common immediate side effects following the procedure are bruising, swelling, lumpiness, and tenderness.  In most patients, bruising may last around 1 week.  Makeup may be applied if desired at any time.  For swelling and tenderness, ice compresses are helpful during the first 24-48 hours.  Lumpiness is common and significantly diminishes over the first 2 weeks.   As the swelling and bruising diminish over 2 weeks, the product assumes a “softer” look.   Massaging the areas is helpful.  There are no limitations on activity, and it is okay to drive yourself to and from the procedure.

How do I prepare for the procedure?
To minimize the risk of bruising, avoid aspirin and nonsteroidal anti-inflammatory medications (such as ibuprofen and naproxen) for 2 weeks before treatment (unless you were placed on these medications by a physician).  In addition, vitamins C, E, garlic, St John’s wort, ginseng, and/or gingko biloba are also blood thinners and should be stopped 1 week before treatment.   Tylenol is NOT a blood thinner and is OKAY to take.  All products may be resumed after the procedure.