Juvederm Questions Answered by Facial Plastic Surgeon, Dr. Steve Weiner
A: Hyaluronidase is the easiest solution for improving botched lip injections with Juvederm
A: Anyone who injects Juvederm or other fillers SHOULD HAVE HYALURONIDASE, don’t go to them if they don’t
A: Juvederm leaving swelling around the eyes is seen often
A: Upper lip lines is a difficult area to treat. Filler will help but laser, Infini, dermabrasion can be better
Upper lip lines are hard to treat! The easiest solution is using filler, but its not perfect and lasts for about 4-6 months. Belotero seems to be the best filler for the lip lines, if you inject them directly. Filling the vermillion border with filler helps and so does filling above the lip with a cannula horizontally. I think the most recent treatment, using the Infini, seems to be very promising, with very little downtime and risk. I’ve abandoned injecting Juvederm superficially because it becomes noticeable and the only filler I will inject superficially for the lines is Belotero.
A: Bump in lip after Juvederm can be dissolved with hyaluronidase
Sometimes it takes more than one injection to dissolve the bump with hyaluronidase. Just go back for another injection. One reason that it’s still there is possibly he/she didn’t want to dissolve all the Juvederm and was being cautious. Steve Weiner, MD, Facial Plastic Surgeon, Destin, Florida.
A: Never too late to use hyaluronidase for undesirable Juvederm results
If you are not happy 18 months after having Juvederm, you can try using hyaluronidase to dissolve it. There is very little downside to this other than it not working for you.
A: Laser teeth whitening is fine after Juvederm but….
I don’t recommend dental cleaning or drilling after fillers for a few weeks if possible. There are bacteria which get in the blood stream during those procedures which can infect the filler.
A: Filling eye hollows should be with blunt cannulas and Restylane
Blunt cannulas have significantly improved the filling in this area. Much less downtime-swelling/bruising, and removes the risk almost entirely of intravascular injection and blindness. Juvederm is not my choice because of issues with prolonged swelling/edema. Restylane has less affinity for water and therefore less edema. Look throughout realself and you will find people with the edema problem and it is almost always Juvederm. Most important is finding an experienced injector to avoid complications and get a great result. I do this at least 5 times a day. Steve Weiner, Facial Plastic Surgeon, Destin, Panama City, Fl
A: Using a laxative should not affect the Juvederm
I understand your concern because part of the substance and longevity of Juvederm is related to its hydrophilic nature. It absorbs water to keep its integrity. However, the small amount of dehydration which might occur with the laxative shouldn’t affect the Juvederm and if it did, drinking water will reflate it. Steve Weiner, MD, Destin, Panama City Beach, Florida.
A: IMO only inject around the eye with blunt cannulas, safer and much less bruising
There are many vessels around the eye and injecting with a needle IMO is not the way to fill the tear trough. Bruising is almost a sure thing with a needle and much less with cannulas. Also, entering a vessels is very difficult and near impossible with a large cannula. Please see my videos and blog. Juvederm is not preferred either, Restylane or Belotero is. Steve Weiner, MD, Destin and Panama City Beach, FL.
A: To remove Juvederm that is causing a problem, use hyaluronidase, not surgery
Hyaluronidase is a very safe and effective treatment to dissolve HA fillers like Juvederm, Restylane, Perlane, and Belotero. Usually it works within minutes to hours. Sometimes a 2nd treatment is needed. To remove surgically, there are risks of scarring, infection, nerve injury and need for more surgery which makes it a long second choice for your problem. Steve Weiner, MD, Destin and Panama City Beach, FL.
A: Swelling after Juvederm in the Lips
Depending on the technique, swelling can last up to a week. I would recommend that you wait and see the final result before you decide if you want correction or dissolving with hyaluronidase. I almost always use blunt cannulas for my lip enhancements because the swelling is minimized. Steve Weiner, MD, Destin, Florida
A: Juvederm is not the preferred filler for tear trough area
It seems to me that you need to try another physician. The right eye problem is related to Juvederm being injected there, not “a fat pocket”. Unfortunately, several people on Realself have had this experience with Juvederm in this area. Its a chronic edema, which doesn’t seem to improve all the way with hyaluronidase. See my videos on injecting with cannulas in this area. Steve Weiner, MD, Facial Plastic Surgeon, Destin, Florida.
A: Blurred vision needs an Ophthalmology evaluation
It doesn’t seem like the visual changes are related to the filler…but it is remotely possible. You need to get an evaluation by an Ophthalmologist (an MD). Dissolving the filler won’t help at this point. Most likely there is something else going on that is coinciding with the filler injection. Steve Weiner, MD, Facial Plastic Surgeon, Destin, Florida.
A: Dilated vessels around nose are no problem for filler (Juvederm)
The enlarged vessels around the nose pose no problem whatsoever for using filler in the nasolabial folds. You might consider treating these very easily with the VBeam laser, 1-2 treatments will significantly improve them. Steve Weiner, MD, Destin, Florida
A: Dermal fillers for the temple and jawline will not cause hair loss
You don’t have to worry about using dermal fillers for these areas regarding hair loss. It doesn’t happen with fillers. Steve Weiner, MD Destin, Florida.
A: Lumps after Juvederm can occur to a small degree in lips, but not usually elsewhere.
Juvederm is a very soft filler and lumps are unusual but sometimes occur in the lips. With a little massage, these usually go down but occasionally need some hyaluronidase to smooth out. Steve Weiner, MD, Panama City Beach, Florida.
A: Very swollen after Restylane in lips..should improve but not sure if it will look much better
It appears that too much was inject for your lip enhancement. I think it should improve, but to the extent that it looks normal is questionable. The upper lip is now much larger than the lower and this is not the right ratio. Normal ratio is 40% upper, 60% lower lip. To minimize swelling in the future, I suggest blunt cannulas for your lip restylane injections, see video. You might need hyaluronidase to undue the poor correction. Steve Weiner, MD, Facial Plastic Surgeon, Destin, Florida.
A: Hyaluronidase will dissolve Juvederm as fast as anything
There is nothing other than hyaluronidase to breakdown the Juvederrm. With that amount of filler, you might need more than one injection. However, you might consider another doctors opinion. You actually might do better with more filler.
A: Uneven lips after enhancement with Juvederm gets better usually after a few days
Often there is asymmetric swelling after the lips have been injected. This can be due to bruising on one side or just slightly more trauma from the placement. It will usually get better. If still asymmetric after a week, it can be corrected with more filler or erased with hyaluronidase. It’s too early after 1 day to do anything. Using blunt cannulas is way to go with lip enhancement: safer, less bruising, faster recovery. Steve Weiner, MD, Destin, Florida.
A: Tear trough injection with dermal fillers is extremely safe w blunt cannulas
The tear trough has vessels which can be injured with injection with fillers. Blunt cannulas don’t have a sharp end to them so its very difficult to enter a vessel, particularly with cannulas that are 27g or larger. Eye injury would be the risk in this area so you need to go to a qualified physician for this injection. Most of the problems I read on realself are related to poorly performed tear trough injections. Necrosis happens when filler either enters a vessel or compresses it. Yes, the glabella, nose, and piriform aperature are the most common areas but it can happen anywhere, including lips. An experienced physician can also recognize these problem early and avoid any long term issues most of the time.
A: In my opinion, Juvederm is not the right choice for use under the eye
The problem with Juvederm is that it is very hydrophilic (loves water) and this can lead to prolonged swelling in this area. It can happen immediately or several weeks later. Restylane is a much better choice for this area. I don’t see much change in the pictures either. Often, the upper cheek has to be injected at the same time as the tear trough because it too has lost volume and is part of the reason for the loss of volume around the eye. It seems like 4 syringes in someone as young as you is a bit much as well. Make sure blunt cannulas are used as well, see video. Steve Weiner, MD, Facial Plastic Surgeon, Destin, Fl.
A: “Messing up” Juvederm after it was injected is unlikely
Rubbing you eyes 6 days after treatment is unlikely to change the filler. For the first 24-48 hours, I believe it is possible to affect the fillers and recommend not to rub or massage the area.
A: I don’t think that transoral injection of Juvederm is a good idea
Injecting filler through the mouth invites all the bacteria in the mouth to possibly infect the filler. I am fastidious with my sterile technique to try to avoid bacteria with hospital grade cleansers. Addressing your problem in particular, you should see your physician immediately and/or an eye specialist – Ophthalmologist to see what is causing this problem. It’s possible that the injection was behind the orbital septum, thus leading to this swelling, which is not normal. I would see a doctor which uses blunt cannulas around the eye in the future. Steve Weiner, MD, Facial Plastic Surgeon, Destin, Fl.
A: Downtime for filler in laugh lines and around the eyes could be near zero if blunt cannulas are used.
I use to tell patients that they needed to plan their fillers about a week ahead of a big event. I no longer have that stipulation now that blunt cannulas have changed the game. There is minimal or no bruising with the cannulas. There might be some swelling, but this is more due to the characteristic of the filler absorbing water than the actual injection. Please see my videos and blog. Steve Weiner, MD, Facial Plastic Surgeon, between Destin and Panama City Beach, Florida.
A: VBeam is the best treatment for post Juvederm bruising, not DMSO
A very short painless couple passes with the VBeam is a great way to rapidly resolve a bruise after dermal fillers. It take a minute or 2 and will make the bruise go away in about 2 days. It must be done within 2 days of the procedure. By the way, blunt microcannulas reduce the chance of bruising significantly.
A: Nice replacement for chin implant in AIDS patient is Radiesse
Radiesse is a good filler to augment the chin. It can really act just like an implant. The only thing that must be diligently followed is sterile technique in an AIDS patient. I am with all my fillers but I’ve seen some docs who are a little lax in this department.
A: Hard lump under eye day after Juvederm is probably a bruise
Juvederm is a very soft filler. I’m not sure why the doctor massaged so hard in that area but its likely he created the bruise. It can take up to two weeks to resolve. If it still is hard there it might be the filler and at that time you can try hyaluronidase. I would always use blunt cannulas in this area to decrease bruising. Also I prefer Restylane over Juvederm for this area. Better lifting ability of Restylane. Steve Weiner, MD, Facial Plastic Surgeon, Panama City, Florida
A: Juvederm is never refrigerated. It can be stored after opening for 9 months safely.
There is a study which was done (I think it was on Restylane) which shows that there is no increased risk of infection if the unused portion of it was stored for 9 months and then used. It might be good longer, but the study only was based on storing for 9 months. Some docs will charge for the 2nd injection, I don’t.
A: Bumps after Juvederm in lips can be resolved with hyaluronidase
Bumps in lips after lip augmentation can occur with even the best injector after Juvederm. This is a very easy problem to fix with just a small injection with hyaluronidase. It usually will improve before you leave the office. See video on using a blunt cannula for the lips. I prefer this way to inject the lips so there is less swelling, less bruising, and less nodularity.
A: Wow, significant lumps after Juvederm in lips. Use hyaluronidase to dissolve.
I would immediately use hyaluronidase to dissolve this issue. I don’t know why you waited so long. I also would choose a different injector.
A: I disagree with the others. The Juvederm can still be there after 2 years in the eye area.
The swelling you have is very similar to the multiple people on RealSelf.com who have had problems with Juvederm when injected around the eye/tear trough area. The Juvederm is very hydrophilic and absorbs water leading to prolonged swelling. I would try hyaluronidase to dissolve it. It might take several injections to get it better. I would only go to a surgeon after exhausting these efforts. Restylane is my preferred filler for this area. See video using Restylane and blunt cannulas. Steve Weiner, MD, Facial Plastic Surgeon, Destin, Florida.
A: Juvederm is not the ideal choice for filler under the eye..prolonged swelling is possible
There are several patients on RealSelf that have similar complaints/problems with Juvederm when used for tear troughs. It is a very hydrophilic product (loves to absorb water) which leads to the edema around the eye. It can be dissolved with hyaluronidase, but it sometimes won’t make the problem go away immediately. It will get better! My choice for filler is Restylane using BLUNT CANNULAS around the eye. Less risk, less swelling, less bruising. Steve Weiner, MD, Destin, Florida.
A: Lumpy lips after Juvederm can be fixed easily with hyaluronidase
Its my experience that after nine days if a lump is present it will persist. Injecting a little hyaluronidase mixed with lidocaine can correct the problem, sometimes before you leave the office. I find Juvederm has a propensity to do that and Reatylane does it less.
A: Sometimes jowls can’t be changed much with just fillers
If your “jowling” is moderate or severe, there is not much hope for fillers correcting this. Early or minimal jowling can be helped by placing volume behind and above the jowls, and in the prejowl sulcus with Radiesse, Perlane, or Restylane. Otherwise, you would require surgical correction (facelift) to improve the jowls.
A: Often lines around the mouth area are due to loss of volume
If you lose volume in the cheek area, this will sage around the mouth and produce wrinkles. So it’s not unreasonable to try to attack the loss of volume in the cheek, buccal area, and preauricular area to help around the mouth. I can’t tell you if this is the right thing to do your situation. You might need a little bit around the mouth as well. My choice for volume is not Juvederm, it’s either Radiesse, Perlane or Restylane. Voluma will be coming and might be a good alternative too.
A: For the hollows under you eyes, Restylane or Belotero with Blunt Cannulas will help
You have soft tissue loss around the eyes. The upper cheek and tear trough need to be filled to give you a more youthful appearance. IMO, this is best done using blunt cannulas because of the reduced risks or bruising and vascular injury. Top choice for this area is Restylane, otherwise use Belotero. This is a quick procedure and there can be some minimal swelling over the next couple days.
A: Juvederm lip injections, 2 days out, not happy – I would wait another week
Because of swelling and possible bruising, the lips take about a week or little longer to “settle out”. You will most likely improve over that time. I can always be dissolved with hyaluronidase after waiting for all the swelling to go down. Hyaluronidase takes minutes to hours to dissolve the juvederm…it works very quickly. Good luck.
A: Headache after Juvederm in nasolabial folds is probably unrelated.
Listening to your story, I can’t see a connection between the Juvederm and the headache. I would see a physician to see if you have other reasons for a headache. There are probably over 100 reasons for a headache and I just don’t think that Juvederm is the reason in this case
A: No smell and taste is related to septoplasty not Juvederm
The most likely reason for having poor taste and smell is due to disruption of the cribiform plate or swelling from the septoplasty. All lidocaine from injection would be worn off after a few hours.
A: Blue around eye after Juvederm is 1 of 2 things
First off, I would never use Juvederm around the eyes. Your picture is hard to decide between Tyndall effect and residual hemosiderin. I would try hyaluronidase first. If no improvement, a pulsed dye laser would help remove the pigment, like the VBeam. You will need corneal shields to protect the iris and retina.
A: Getting filler done when sick is not a good idea
Fillers such as Restylane, Juvederm, Radiesse, and Perlane are foreign bodies place into the lower skin. If there is an infection in the body, it might get trapped in the filler and cause a localized infection. So if you are on an antibiotic and fairly sick, you should not get injected with filler. Also, having extensive dental work after filler should be held off as long as possible because there is bacteria in blood stream with the dental work. There are many reports of filler getting infected from a dental infection as well. If you are on a chronic antibiotic for acne, there is no problem getting injected while you are on it.
A: Volumization is needed to improve sunken cheeks and marionette lines
Volume, volume, volume is needed to improve you issue. You must go to a surgeon familiar with fillers and not just the cheapest or closest place to you. I would put more in the cheek area, buccal area, marionette jawline and fill the face out somewhat. Just attacking the marionette or nasolabial will look funny and won’t completely improve your problem.
A: There are no issues with compatibility of Juvederm and Restylane
Both products, Juvederm and Restylane can be used in the same area, without any worries. I don’t combine these 2 fillers much, but I do often use a deeper filler like Radiesse and combine it with Belotero or Restylane/Juvederm often. The only caution about combining fillers is when there is long standing silicon filler in place. If that’s the case, using filler, even in areas not close to the original injection can cause a granulomatous reaction, and it’s not recommended, or at the very least, let the patient know of the risks.
A: Bruising and swelling after Juvederm to lips
After getting lips enhanced with Juvederm, all people will have swelling and some will have bruising. I’ve decreased the downtime with using blunt cannulas for most of my injections, with some needle injections along the borders if needed. There is less pain, less bruising, and less swelling when using cannulas. Swelling usually will go down after cannulas in 1-2 days. If you are left with the dreaded “duck lips”, it can easily be treated with hyaluronidase when all the swelling is better. The VBeam is useful for decreasing the time the bruise takes to resolve. Please see my website for more details and my video.
A: Bruising when getting under eye filler can be avoided with blunt cannulas
I’m sorry you were so bruised after fillers for the tear troughs. This can almost be avoided 100% with using blunt cannulas. The hemosiderin can be improved with a laser, but it’s not easy in that area because of the proximity to the eye. I would wait longer and see if the body can get rid of it. The number one problem I get asked about on Realself is filler around the eye. I would like to recommend that anyone who wants this area corrected go to someone that uses cannulas and has done a ton of these. It is very routine in our office, probably 5 per day.
A: Hyaluronidase breaks down HA fillers, not collagen
Hyaluronidase will not affect collagen. The body does have some natural hyaluronic acid but that will be replenished by the body after hyaluronidase. Some docs routinely use it when injecting local anesthetic because it makes the area of numbing larger. Bottom line is that the filler (Juvederm, Restylane, Perlane, Belotero, Prevelle) is mostly affected by hyaluronidase and it should dissolved rather quickly, minutes to hours.
A: Assymetry after Juvederm in Nasolabial Folds
It’s not uncommon for our natural nasolabial folds to not be symmetric. The sides of our face are sisters, not twins. Sometimes, putting more in one side can help balance this difference, but it doesn’t always work because expressions, boney structures, and soft tissue might be different preventing things from being exactly the same. Immediately afterward getting treated, sometimes there is assymetric swelling, but this usually resolves after a week. I would ask to add more to the left side, but I don’t think that you will get it exactly the same of both sides. It appears to me that when you smile, you are stronger on the left side, thus making the fold appear deeper.
A: Although you are only 19, I do think that your tear troughs need a filler, my choice is Restylane
Your case is fairly common, but not in your age group. I would treat your tear troughs with Restylane using the blunt cannulas to minimize swelling and bruising. I do not recommend Juvederm in this area. No surgery is recommended. See my video 🙂
A: Tyndall effect from Juvederm in tear trough needs to have hyaluronidase to correct
If the problem has been present for 2.5 years, it’s not going to go away on it’s own. Hyaluronidase will dissolve the remaining Juvederm and should improve the problem. I do not recommend Juvederm in this area. I also see more problems here on Realself with fillers around the eyes more than any other site of injection. It is key to get someone that is experienced in this area, and I always use blunt cannulas in this area to minimize bruising and swelling. One other thing that this could be is hemosiderin, which is a residual form bruising in this area. If it is hemosiderin, it is more difficult to treat, and topicals might improve it
A: Having Sex after Juvederm; ‘Instant results”, never thought about it in that sense
Juvederm and other fillers are very popular because the “cosmetic results” are seen immediately. Having sex right after treatment will not affect the results at all. You propably just need more Juvederm.
A: Swelling after having Juvederm in the tear troughs happens too much and should be avoided.
Why do a diagnostic procedure if you aren’t going to change what you do? Regardless if the ultrasound can show if there is or isn’t Juvederm in the area, my suggestion is to treat with hyaluronidase. There are too many complaints with Juvederm on this site so I have given up using it around the eyes and tear troughs. Restylane is a much better choice. Probably Belotero is good too, but haven’t had enough experience with it yet..
A: Your Juvederm injection was not done correctly and needs to be dissolved with hyaluronidase
A natural ratio of the upper lip to lower lip is between 1:1 to 1:2, most people think 1:1.5 is about right. In any event, your upper lip is now bigger than your lower lip instead of being smaller. Also, it was unevenly injected, so there is more on your left side. I think I would put some Juvederm in you lower lip and dissolve some of the upper lip Juvederm, particularly on the left side with hyaluronidase. See my video on blunt cannulas for lip enhancement.
A: Extreme redness after injection with a dermal filler in the nose is cause for concern
The concept of fixing small defects in the nose with filler sounds like a nice and easy solution. However, there are risks associated with it. It sounds like what has happened is the vascular supply of the nose has been compromised. If not recognized early, you have potential for skin necrosis (loss). Hyaluronidase, heat, massage, needs to be done in these cases. I have stopped doing the “5 minute nose job” because of more and more reports of this happening. The reason it happens is because the filler either goes into the vessels supplying the nose or compresses it. This can happen anywhere on the face and is one of the reasons that blunt cannulas are safer. Blunt cannulas can not enter a vessels so that eliminates the most common etiology of this problem.
A: As reimbursement from insurance and medicare get less, more doctors will be injecting dermal fillers and Botox
Although legally, any MD, DO, Dentist, Nurse Practitioner, PA (with supervision), can inject Botox and Juvederm, it doesn’t mean that they are properly trained, or that you will get a good results. In life in general, you “get what you pay for”. Same is true with these treatments. If this is your face, which you wear 24/7, why chance the results with someone that went to a weekend or 2 training session or who does this on the side of his regular practice to make some “extra money”. Go to someone that does this full time, who trained for years on the anatomy of the face. More importantly, although rare, complications can occur, and at that point, you wished you’d gone to that Plastic Surgeon or Facial Plastic Surgeon. As an aside, “Botox parties” are usually not a good idea either. The facility is not properly equipted for emergencies, and the lighting and patient chair are suboptimal.
A: My experience with dermal filler for acne scars is that it doesn’t work well
Because scars are firmer tissue with adhesions, injecting filler into the scars does not “lift” them to the level of the surrounding skin. I find, like you, that if you inject below the scar that you end up with a scar which looks like a volcano, elevated, but with an indent in the middle. Lasers such as the Fraxel Dual, are much better for acne scarring.
A: Swelling from Juvederm and Botox should subside in about 48 hours
Swelling from the Juvederm and Botox treatment is mostly related to water being absorbed by the Juvederm. I can also be related to tissue trauma caused by the injections. To get the least tissue trauma, blunt cannulas are preferred. Bruising can also cause swelling. In general, without any significant bruising, swelling will be better after about 48 hours. The lips may take a little longer. Sleeping with your head elevated helps with reducing swelling. I tell my patients after they leave to expect to have swelling then to have a diminished result of about 10-15% from what it looks like just after I’m done.
A: To reduce bruising with Restylane or Juvederm, use blunt cannulas and avoid blood thinners
I have greatly reduced my incidence of bruising with the use of blunt cannulas for my dermal fillers. Although I will inject clients who are on blood thinners for medical reasons (coumadin and plavix), I recommend clients stay off any non-essential supplements and advil, aspirin, for their procedure. If a bruise occurs, the VBeam can be used to significantly reduce the duration of the bruise (see my pics in the VBeam section) and it is painless and given as a complimentary service if one occurs. I also tell clients to avoid strenuous activity on the day of the procedure.
A: Severe Swelling after Juvederm
This could be a few different issues, but the extreme swelling you have is probably angioedema. This will respond to steroids usually. The cause for this is not always known, but often related to someone that is taking an ACE inhibitor for their blood pressure. Other things that can cause this is a hematoma, rare allergic reaction, or too much filler placed.
A: Juvederm is great for lip enhancement
Juvederm gives great lip enhancement. It has minimal swelling and feels very soft. Using blunt cannulas, the injection is very comfortable and leaves very little bruising.
A: Bruising from Juvederm is much better using blunt cannulas
I know that I might sound repetitive with my answers on Realself, but using blunt cannulas has greatly reduced bruising for my clients, even in lip injections. I find no difference with the degree of bruising with Restylane or Juvederm In general, the more experienced the person injecting, the less bruising you will have.
A: Blunt cannulas are the way to go for Juvederm around the mouth!
Using this new innovative technique, you can get your Juvederm around the mouth with very minimal discomfort. I just use topical and have very comfortable clients. Even injecting the lips is relatively easy with blunt cannulas. Bruising is also significantly reduced or eliminated with blunt cannulas. I now inject exclusively with this technique and have been for the past 4 months. It’s the way to go!!!
A: Juvederm will diffuse slightly so correction is not precise
Juvederm tends to spread a little from the area of injection. This is good in some areas and not in others. To answer your question, the correction, which also involves water absorption, will not be exactly where you place it, but close.
A: Juvederm Ultra Plus is a great choice for smile lines
I think the physician was spot on. Nasolabial lines are very well corrected with Juvederm Ultra Plus. It should give about 1 year in duration, but you might not want for the correction to completely go away. So about 9 months later or so, a touch up might be needed.
A: Around the eyes, I use Restylane for a filler and have seen no issues with scarring
I agree with the others that scarring does not appear to be an issue with injectables around the eye. The most important factor is the experience of the filler. This is the area where most of the issues I’ve seen on Realself have stemmed from. I also almost always use Restylane around the eyes.
A: Injecting the corner of the eyes is great for Juvederm
There always seems to be a slight loss of fullness in this area. Injecting a filler in this area, a small amount, leads to a great enhancement around the eyes.
A: Juvederm can be injected very comfortably without dental block
Juvederm, particulary the new XC version which contains factory added lidocaine can be injected rather painlessly with just topical and no dental block. I feel the dental block adds more pain and can lead to swelling which makes the correction harder to do (don’t know what is caused by the block and what was there before). I ask my patients to apply ice for about 1-2 hours, but to be careful because you will be numb and don’t want to create a problem by freezing the skin.
A: Typically, no downtime after getting Juvederm
In most cases, you can resume your normal activities after Juvederm except I don’t recommend stenuous physical activity until the next day. Swelling and redness is usually very mild or minimal after the injection. Most of the time there is very little bruising. Occasionally, you can have a bruise which is hard to cover with make-up. Evolence will give less bruising and swelling than Juvederm, if that is a concern.
A: One other thing to consider
There is a condition call Angioedema. This is fairly uncommon, but does occur. It is abnormal swelling as the result of trauma (the injection). It can happen to anyone, but most cases occur in people that take ACE inhibitors (a type of blood pressure medication).
If it is angioedema, steroids and antihistamines will help. It can occur again with subsequent injections, so you must alert your physician if you choose another physician. Steroids can help, even if it is not angioedema. Most likely, I agree with Dr Beraka, that it’s a hematoma. I just wanted you to know all possibilities.
A: Sounds like Tyndall Effect after Juvederm
If Juvederm is injected too superficial, it can cause a bluish hue to the skin. If nicking the skin doesn’t do the trick, injecting Wydase can dissolve the Juvederm and you can start over. My experience has shown that scars don’t always get a lot better with filler, but some do.
A: The risk is very small but is a possible infection
Studies have shown that Restylane can store for 9 months without leading to any increased risk of infection.
However, these were stored in a physician’s office, and the needle was replaced with a clean needle before storage. I don’t ever let my patients take home a portion of an unused syringe of filler.
I would not inject any syringe in which I was not sure of it’s origin and storage. Just my opinion and my controlling my risks.
A: I prefer Radiesse or Perlane for cheek augmentation
I agree with all the other responses. I would just add that my choice is Radiesse or Perlane in this area, but Juvederm is fine as well. There are 2 camps with Sculptra: Docs who use it and ones who don’t. I’m in the camp of not using Sculptra, but that doesn’t mean it shouldn’t be used.
Steve Weiner, MD Facial Plastic Surgeon Destin, Florida
A: It varies
My policy is to not charge for the remainder of the syringe to be injected. I also charge a flat fee per syringe, no matter what area it is placed. I think that is something that needs to be discussed up front. Please keep in mind that I feel it is most important to pick the right physician rather than shop for the lowest price. The physician you choose is hopefully someone your friends have seen, had a good experience with, and is well qualified to do the procedures. (I personally teach the injections to other physicians for Evolence and Juvederm.)
A: Juvederm probably not gone, but correction is hard to see
You’re probably saying, if I can’t see it, then it really doesn’t matter if it is there or not. My first question is how many syringes were used. You mention a lot of areas to correct. I would use at least 3 or 4 syringes for this. Any less than this, you will be spreading the filler out too thinly. If someone comes to me and says I want all those areas and can only afford 1 or 2 syringes, I typically will ask which area is most important and fully correct it. The filler is probably not gone, but the changes are so minimal that they are hard to see.
There are people who rapidly metabolize HA. Usually this doesn’t occur in a week though. For those people, Radiesse is a good solution, except for the lips.
One other point, I prefer Restylane around the eyes because to me, Juvederm spreads more and the corrections are often less noticeable.