hyaluronic acid Archives | The Aesthetic Clinique

Dermal Filler Providers Must Also Be Proficient With Hyaluronidase

The adoption of dermal fillers for age related volume replacement has contributed to the surge in aesthetic patients. As patients become more savvy, it becomes obvious that filler outcomes are dependent primarily on the provider and not the brand of the filler injected. Somewhere between 80-90% of the fillers used are based on Hyaluronic Acid, a naturally occurring substance found throughout the skin, and joints. (It is an interesting side note that the structure of HA is similar throughout all species.) One of the attractive qualities of HA is that there is an “antidote”, an enzyme called hyaluronidase, which can dissolve HA based dermal fillers.

There are several versions of hyaluronidase available in the US. There are animal based products such as Vitrase (ovine based), Hydase (bovine), and Amphadase (bovine). The one product, Hylenex, is actually a recombinant form of the human hyaluronidase. There is some risk of allergic reaction to the animal based products but not Hylenex (author’s preferred choice). The intended use of hyaluronidase is to allow for increased tissue permeability, thereby allowing for greater dispersion and delivery of products injected. It is also used when hyperosmolar fluids extravasate into the skin and in improving uptake of radiopaque solutions in the bladder. The primary reason it is used in aesthetics is to dissolve HA filler.

The reasons to dissolve HA filler are:

Poorly placed filler giving an aesthetically poor result
Where too much filler was placed
Filler that is infected
Filler is forming a granuloma
Filler is causing ischemia/vascular occlusion
Filler is causing visual changes or blindness

The are more and more fillers being introduced to the market each year. Each one has it’s own characteristics and nuances when injecting. There are also, many new injectors entering the industry daily. It is fair to say that the number of poor outcomes and complications is inevitably going to rise. Unfortunately, trainings are not being done for the indications and administration of hyaluronidase. It is beyond comprehension that there are many offices, I dare say, a majority, who either don’t normally have any or adequate doses of hyaluronidase.

It is absolutely imperative that a facility that injects HA fillers stock at least 1000 units of hyaluronidase. Doses of 400 units or more need to be injected in areas of vascular occlusion immediately to achieve optimal outcomes. If no response, additional doses need to be injected. If an ophthalmologic complication occurs, at least 1000 units needs to be injected immediately to have any chance for recovery of vision. Even with doses in the thousands of units, there should be no concern regarding loss of naturally occurring hyaluronic acid as it will replaced by the body’s normal regenerative process over 24-48 hours.

Unfortunately, the majority of providers have little or no experience with hyaluronidase and/or have none available in their facilities. It is beyond comprehension the lack of preparedness for not only reversing poor outcomes, but in resolving medical emergencies. The industry must rise up to educate about complication identification and treatment protocols. Poor outcomes and complications affect the entire aesthetics field and not just the individuals involved.

The Latest Trend “Prejuvenation” – Preventative Rejuvenation

It’s been touted for years by the aesthetic physicians – “Prejuvenation” – starting maintenance treatments in one’s late teens or early twenties. The Kardashians have popularized these minor cosmetic tweaks to stay youthful and refreshed with visits to their Beverly Hills physician, documented regularly on “Keeping Up with the Kardashians”. There is increasing pressure to get that perfect selfie for Instagram or to look cool and attractive on a “Snap”. Unfortunately filters don’t work well with videos unless you want to look like a cute puppy. Doctors are in agreement (for any disease process) that it is much easier to treat problems in their early stages than to reverse them after they have spiraled out of control. Small preventative treatments early on, can maintain and even enhance one’s looks for many years and avoid invasive surgical procedures in the future. The question is, which procedures should be considered for Prejuevenation?

Neuromodulators: These wrinkle improving injections take less than 5 minutes and have no downtime. Millions of these procedures are done each year and it is the most popular cosmetic procedure performed worldwide. Most often these are used in the younger population in the frown lines (glabella), forehead lines, and crows feet. Treating these areas before the lines set in at rest, known as “etched in” lines, is one of the fundamental concepts of Prejuvenation. (Suggestions: Dysport, Botox)

Dermal Fillers: Dermal fillers made from hyaluronic acid (HA) are used to improve the minor volume loss which occurs with age. In the more athletic patients, fat loss can be appreciated in the face as well as throughout the body. Supple enhancements can be added to the mid cheek and around the eye to stave off this premature volume loss. HA fillers are also used to plump up the lips to create a youthful appearance. (Suggestions: Restylane Refyne, Restylane L, Restylane Lyft, Sculptra)

Chemical Peels: To keep the skin in top notch shape and to reverse early sun damage, chemical peels can exfoliate the superficial layers of skin. This renews the texture and pigmentation and leaves a youthful and glowing quality to the skin. (Suggestions: Illuminize, Vitalize, ZO 3 Step Peel)

Skin care: Great skin care is the basis for good looking skin. Most would agree that some type of Retin A or Retinol is essential for maintaining youthful skin. These products lead to increased turnover of the skin cells, improve dyspigmentation (pigmentation problems), thicken the skin, and create a more hydrated skin. Sun protection with an SPF should be part of one’s daily regime. It is also highly recommended to apply growth factors to the skin to reverse the aging process. (Suggestions: ZO Skin Health, Lifeline Stem Cell Skincare)

Prejuvenation is a trend that is here to stay. Preventative maintenance will prolong the need for more aggressive corrections in the later years. With short, no downtime procedures such as neuromodulators, chemical peels, fillers, and a good skin care regime, youthful, natural appearances will persist for years. Stay ahead of the curve with Prejuvenation.

The Cheek Challenge Results – Voluma Vs Restylane Lyft

There are currently 2 dermal fillers FDA approved for enhancing the cheeks – Voluma and Restylane Lyft. These are both HA (Hyaluronic acid) fillers which are injected into the deeper tissues of the cheek to volumize and lift the cheeks. By lifting the cheeks, the entire lower face is lifted as well, including the jowl area, nasolabial folds, and jawline. It is well known that for an aging face with volume loss, the mainstay of treatment starts with the cheek area.

There are 2 main distinctions between Voluma and Lyft. The first is G prime, which is a measure of resistance of a fluid to flow. What this translates into when injected into the body is it’s “lifting ability”. There is huge difference between the 2 with Lyft at 531 and Voluma at almost 1/2 of Lyft at 274. Although this is not important according to Allergan, the makers of Voluma, this was found to be significant in our challenge. The other factor is cohesivity. This has only been popularized since Voluma was introduced and it the pressure needed to “flatten” the filler. What this translate in the body is the amount of spreading of the filler in the body. Voluma is higher in this category (less spreading) when compared to Lyft, but it’s importance is not known.

When Voluma was introduced to the market, there was significant marketing on it’s “2 year duration”. What wasn’t discussed was how this FDA designation was obtained. Most people in the study were injected at 2 different times. Also, the average amount of filler injected was over 6 syringes. Lastly, only a minority of subjects had evidence of some correction at the end of 2 years. These important details are left out of most discussions with physicians, and certainly not what the public understands about Voluma. In addition, Voluma’s pricing is much higher than all the other fillers on the market, but justifies these prices due to it’s longer duration.

The “Cheek Challenge” was performed by Dr. Weiner to try to vet out whether there are significant differences between Restylane Lyft and Voluma. To try to keep the study similar to the FDA study, a total of 6cc was injected, 3 of Lyft on the right cheek, and 3 of Voluma on the left cheek. Follow ups and photos were taken at 1-2 month intervals for 1 year. There was no secondary injections because this is what most closely represents a real patient’s experience. Keep in mind this is only one patient but Dr. Weiner did challenge other physicians to do the same, similar to the “Ice Bucket Challenge”. There were about 4-5 other physicians which have also done the “Cheek Challenge”. Their findings have been similar per private discussions with them.

The Results:

Duration of improvement was the same. AT 12 MONTHS, THERE WAS NO DIFFERENCE BETWEEN THE RESTYLANE LYFT AND VOLUMA TREATED SIDES AND THE BASELINE PRE PROCEDURE PICTURES.
During the year, the patient noted that the Restylane Lyft cheek felt higher than the Voluma side.
During the year, the patient felt that the Voluma cheek dropped slighted.
During the first 1-2 weeks, more swelling was noted on the Lyft side.
There was no difference in pain between the 2 sides.
Noted improvements were seen in jowls, jawline, NLF, cheeks, and periocular area on both sides of face.

Although this is only a single patient, these results support multiple clinicians findings that Voluma’s duration is very similar to other HA products. Even with the use of 6 syringes, which is rarely used in a single patient, the duration did not exceed 12 months. Patients need to be counseled that 12 months is what can be expected for Voluma’s longevity. Less expensive and higher G prime filler, Restylane Lyft, seems to be a better choice for volumizing the cheek complex.

Video of patient at end of 1 year with discussion and pictures.

Amazing Things That Can Be Done (By the Experts) With Dermal Fillers

This is the golden age for minimally invasive cosmetic procedures. Who would have ever thought 15 years ago, that procedures done in the office in a matter of 20-30 minutes could result in demonstrable improvements in one’s appearance with results lasting, in some cases, a year or more? Without the need for downtime, anesthesia, or significant costs, cosmetic procedures have flourished, with many people who never would consider enhancements, “dipping their toe” in these procedures. The concept of “preventative maintenance” has spurred the younger generation to start earlier, with smaller, less dramatic, but noticeable procedures as well.

At the forefront of the wave of cosmetic enhancements are dermal fillers. When Restylane was FDA approved in 2003, a revolution in the field was born. Although the main focus was to improve the nasolabial folds, the “smile” lines, in its inception, the broad “off label” use of it, along with subsequent FDA approval of other fillers, treatments have spread to just about every area of the face. There are now about a dozen dermal fillers on the market, with the majority of them based on hyaluronic acid, a naturally occurring substance that is found in skin and joints. Hyaluronic acid fillers (Restylane, Perlane, Voluma, Juvederm, Belotero) provide a soft, very well tolerated fill, with an extremely safe profile. There is also a level of security knowing that these fillers are generally completely reversible, using the widely available enzyme, hyaluronidase, that can dissolve hyaluronic acid, in minutes to hours.

Although less popular, it must be mentioned that there are other dermal fillers which are FDA approved, each with their own niche market. Radiesse is composed of microspheres of calcium hydroxyapatite, and is known as a very robust filler, that has a very high G prime, a measure of it’s lifting ability. Sculptra is composed of Poly L Lactic Acid (PLLA), also naturally occurring as a sugar in the body, and is known as a collagen stimulator. Its use is for global, long lasting, volumization of the face. The longest duration FDA approved filler is Artefill. It is composed of microspheres of Poly Methyl Methacrylate (PMMA) which is a synthetic molecule. Artefill is considered a permanent filler and works as a collagen stimulator, similar to Sculptra.

The understanding of the aging face has made great strides in the last decade. It is now widely understood that loss of volume is the primary cause of the aging face. Leading this volume loss is the shrinking of the multiple fat pads of face, primarily of the cheek and periorbital area. This is why aging often begins to show around the eyes. Gravity contributes to our aging problems and often manifests itself by the descending of these fat pads. Relegated to a less relevant problem than 15 years ago, is the aging related to excess skin. Plastic Surgeons have tightened loose skin for decades during facelifts, often leaving people appearing skeletonized and hollow, but without wrinkles. It is now understood that most of the redundant skin can be improve with proper volumization of the offending fat pads, and most facelifts incorporate this during surgery presently. (In the author’s opinion, most of the patients undergoing the knife could have had their concerns addressed using a combination of fillers and skin tightening devices.)

The common manifestations of volume loss are:

Temporal hollows
Loss of cheek volume
Tear trough deformity
Excessive crows feet and forehead lines
Low hanging eyebrows
Hollowness of the eye (orbit)
Jowls
Poorly defined jawline
Small lips
Dropping of nasal tip
Lip lines (smokers lines)
Corners of mouth dropping causing sad look
Saggy neck
Elongation and narrowing of the face

All the above mentioned aging effects can be improved with dermal fillers. Expertise is required to recognize exactly what areas need to be treated to replenished the lost volume, while still maintaining a natural appearance. It’s been shown that the brain can recognize less than a 1mm change in brow position. When corrections are not done properly, it is very easy for the brain to catch it. Poor corrections of the lips probably stands out in most people’s memory, where they are either too full, out of proper proportion, or there was poor attention to landmarks.

Experienced dermal filler injectors are no longer “chasing lines”, the symptom of aging. The goal is to lift and replenish lost volume by addressing the cause of the aging of the face. Of note, even the neck’s problems can be improved by properly injecting the face. Choosing a doctor that has experience in recognizing the areas affected by volume loss and has the knowledge and expertise to improve those areas is essential for optimal patient outcomes.

Juvederm Questions Answered by Facial Plastic Surgeon, Dr. Steve Weiner

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Q: Is there any other option than Hyaluronidase to immediately reverse botched Juverderm injections to the lip?

A: Hyaluronidase is the easiest solution for improving botched lip injections with Juvederm

There really is no other great alternative to hyaluronidase. It my hands, it quickly, sometimes within minutes, dissolves the HA fillers like Juvederm, Restylane, and Belotero. I add it with lidocaine and use cannulas so it fairly well tolerated. Steve Weiner, MD, Facial Plastic Surgeon.

Q: Juverderm filler put in my top lip & a tiny bit in my bottom lip 3 days ago, caused uneven lumps and white patches. (photos)

A: Anyone who injects Juvederm or other fillers SHOULD HAVE HYALURONIDASE, don’t go to them if they don’t

There are rare emergencies when injecting filler which require using hyaluronidase. If there is a vascular occlusion, hyaluronidase needs to be available immediately. It is expensive and has a short shelf life so people that don’t have it are trying to decrease their costs. I would never go to someone that didn’t have hyaluronidase because no one wants to take care of someone else’s complications. So, for your problem, it looks like alot of correction/swelling for less than 1/2cc. I’m not sure what was injected. I wouldn’t inject anymore. Probably too early to decide if you want to remove it. Hyaluronidase doesn’t swell much at all and usually improves the problem within hours. Watch the video on the easy way to get your lips done, with cannulas. Steve Weiner, MD, Facial Plastic Surgeon.

Q: Had juvaderm injected into cheeks two months ago. Swelling under the eyes What other steps can I take? (Photo)

A: Juvederm leaving swelling around the eyes is seen often

When injecting around the eyes, blunt cannula technique and RESTYLANE should be used. Juvederm is too hydrophilic and moves too much for this area. Your only choice now is hyaluronidase but that doesn’t always work well with Juvederm and might need repeated treatments.

Q: Is it possible for Juvederm to not settle or is my injector just trying to cover up for bad work? (photo)

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.

Q: My Juvederm Lip Augmentation Lump Won’t Go Away! Its been 9 months?

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.

Q: Is it too late now to get the enzyme injected to remove Juvederm?

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.

Q: Is it Ok to have laser teeth whitening a few days after juvederm injections?

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.

Q: Will Juvederm XC work for my hollow eyes?

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

Q: Will Fleet phospho-soda oral solution affect my Juvederm because of potential dehydration?

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.

Q: Just Had Juvederm and Belotero Need Help?

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.

Q: Can Juvederm That’s Been Injected into the Nasolabial Folds Be Surgically Removed?

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.

Q: Im a 22 Y.o Girl Who Had Juvederm Ultra 4 Injected into my Upper Lip 2 Days Ago and They Are Swollen? (photo)

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

Q: Had jevederm injected in my tear drop area and on my cheek bone to give little more filler? (photo)

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.

Q: Can Filler Injections Cause Blurry Vision?

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.

Q: Are These Broken Capillaries an Obstacle in Getting Filler to Fix the Nasolabial Folds? (photo)

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

Q: Hi, Im a Male and Would Like to Get Filler in my Temples and in an Area with Beard Growth. Could Dermal Fillers Cause Hairloss?

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.

Q: Is It Normal to Get Bumps After Ultra Juvederm? and How Long Do They Last?

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.

Q: I Had a Restylane Injection for my Upper Lip Yesterday! Very Swallow and Pumpy? (photo)

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.

Q: Are There Any Solutions Besides Vitrase That Might Speed Up the Breakdown of Juvederm Ultra Plus? Thank You.

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.

Q: Uneven Lips After Juvederm. Embarassing! What Can I Do? (photo)

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.

Q: Necrosis from Dermal Fillers in Tear Troughs?

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.

Q: More Than 1 Syringe of Juvederm for Undereyes? (photo)

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.

Q: Is It Possible to Mess Up Juvederm After It’s Been Injected?

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.

Q: Could Juvederm Injected Inside Mouth into Upper Cheek Area Migrate Behind the Eye & Cause Excessive Puffy Lid and Sore Eyeball?

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.

Q: How Much Downtime for Injectable Fillers in the Laugh Lines and Possibly Under the Eyes (Sunken in Eye Sockets)?

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.

Q: DMSO for Bruising from Filler Injections?

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.

Q: Fillers for AIDS Patients?

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.

Q: Cosmetic Fillers in Cheeks Yesterday, Surgeon Massage Area Really Hard to Spread it Out Evenly?

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

Q: Are You Guys Just After Our Money? (photo)

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.

Q: I Had Juvederm Injected into my Lips and Have a Large Bump on my Top Lip. You Can SEE THE PRODUCT Under the Bump. (photo)

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.

Q: Will the Lumps in my Lips Caused by Juvederm Ever Go Away? (photo)

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.

Q: Got Under Eye Filler 2 Yrs Ago at Least and I Am Still Wearing Dark Shades and Feel Ashamed of my Swollen Look? (photo)

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.

Q: I Had Juvederm a Year Back. Now I Have Pillow Like Bags on the Left Cheek. Cheek Seems Falling?

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.

Q: Lumpy Upper Lips After Juvederm, What Are My Options? (photo)

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.

Q: 2 Syringes Jowl Area Barely Noticeable? (photo)

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.

Q: Fillers in Cheeks and Side of Face to Help Decrease Smile Lines?

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.

Q: What Can I Do About my Hollow-set Under Eyes and Wrinkles at 24? (photo)

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.

Q: Depressed over juvederm lip injections?

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.

Q: Juvederm and Possible Headaches?

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

Q: Possible Bad Reaction to Numbing Cream After Topical Application for Juvederm Injections? (photo)

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.

Q: Juvedurm in Tear Troughs Caused Permanent Bruise/dark Circle Under One Eye? (photo)

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.

Q: Dermal Filler and Tetracycline?

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.

Q: Advice/Treatment Options for Sunken Cheeks/Marionette Lines? (photo)

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.

Q: Compatibility Juvederm/Restylane?

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.

Q: Juvederm Yesterday for Wrinkles and Thinning Upper Lip. Bruised but Worry About Duck Lip? (photo)

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.

Q: How Long Will It Take to Heal from Hemosiderin Staining Resulting from Juvederm Injection to the Under Eye Area? (photo)

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.

Q: Juvederm Removal with Hyaluronidase Injections?

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.

Q: More Juvederm on One Side? (photo)

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.

Q: 19 Yo Juvederm in Tear Troughs? (photo)

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 🙂

Q: Tyndall Effect After Juvederm? How Long Will This Last or is It Something

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

Q: I Had 0.8ml of Juvederm Injection for my Laugh Lines and After 8 Hrs I Had Sex with my Husband?

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.

Q: How to Treat Eye Swelling After Juvaderm Injections?

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..

Q: Had Juvederm Injected in Upper Lip and Verticle Lines, Duck Looking. Should I Get It Removed? (photo)

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.

Q: Non-surgical Rhinoplasty Redness Nightmare! Allergic Reaction?

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.

Q: Can a Primary Care Doctor – Internal Medicine, Inject Juvederm Fillers and Botox Cosmetic?

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.

Q: Juvederm for Acne Scars Left Skin with Bumpy Appearance – is This Common?

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.

Q: How Long Does It Take for Swelling to Go Away from Juvederm/Botox?

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.

Q: How Can I Prevent Bruising from Restylane or Juvederm?

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.

Q: Extreme Swelling After Juvederm- Is This Normal? I’m Very Worried. (photo)

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.

Q: Juvederm Lips

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.

Q: Juvederm 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.

Q: Real Pain with Juvederm Injections Around Mouth. Can This Be Avoided?

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!!!

Q: How Precisely Can Juvederm Be Injected? Volume ONLY at Place of Injection?

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.

Q: Juvederm Ultra Plus for Indented Smile Lines?

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.

Q: Juvederm for Undereye Troughs with a History Severe Scarring?

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.

Q: Does Juvederm Help Lines in Eye Corners?

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.

Q: Juvederm with a Dental Block Cause More Swelling?

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.

Q: Downtime for Juvederm on Nasolabial Folds?

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.

Q: Lower Lip Asymmetry and Lumps After Juvederm

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.

Q: Juvederm Bruising on Nasolabial Fold

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.

Q: Risks of Using a Stored Syringe of Juvederm?

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.

Q: Can Juvederm Add Volume to Sunken Cheeks?

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

Q: If my Doctor Saves my Leftover Juvederm Vial, Do I Have to Pay for my Next Injection?

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.)

Q: Juvederm Gone in a Week?

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.

Voluma is the latest filler to be FDA approved – What makes it different? Dr Steve Weiner explains

Front view before and after 12 syringes of Voluma: cheeks, temples, marionette lines, and preauricular area.

45 degree view after 12 syringes of Voluma injected.

45 degree view before and after 12 syringes of Voluma: cheeks, temples, marionette lines, and preauricular area.

Voluma, 12 syringes injected, 90 degree photo

After 12 syringes of Volume, 90 degree view. Injected cheeks, temples, marionette lines and preauricular area.

[youtube=http://www.youtube.com/watch?v=XERvczwIOOg]

[youtube=http://www.youtube.com/watch?v=wd9r3Tw43YU]

Juvederm Voluma was approved by the FDA today for treatment of age related volume loss in the cheek area. This is the first filler to be approved for this purpose. Its main component is Hyaluronic acid which is also found in Juvederm Ultra, Restylane, Perlane, and Belotero, all FDA approved fillers. Juvederm Voluma is a thicker, more viscous version of Juvederm Ultra which gives it more “substance”. The technical term for this property is called “G prime”. The higher the G prime, the better ability for the filler to lift and support skin and surround structures. Compared with Juvederm Ultra, Juvederm Voluma has about 10 times (10X) the G prime. A comparison graph is shown below (from Going With the Flow: An Overview of Soft Tissue Filler Rheology and Its Potential Clinical Applications, Part II by Hema Sundaram, MD, FAAD):

As seen in the chart, Radiesse, Perlane, and Restylane have higher G primes than Juvederm Voluma. Although these others are not approved for volume loss of the cheek, they are all used commonly “off label” for this application.

Being very thick/viscous, Voluma will need to be injected with large bore needles or blunt cannulas. It is mixed with lidocaine (numbing medication) from the factory, so the procedure is very well tolerated. It’s longevity is longer than most fillers, lasting up to 2 years in their clinical trials. At 2 years, 76% of patients were still satisfied with their Voluma results. (It was 90% at 6 months). Also, at 2 years, the average patient’s perception was that they looked 3 years younger since the Voluma treatment. (It was perceived as 5 years after 6 months).

Obviously, the volume needed for correction varies from patient to patient, depending on their degree of volume loss. During the clinical trials, the average volume needed for correction was just over 6cc. Some patients needed up to 13 syringes.

An advantage of Voluma over Radiesse, Artefill, or Sculptra is that Voluma can be “erased” or dissolved with an easily obtained enzyme called hyaluronidase. Although it is seldom used, it can give patients the piece of mind that their results don’t have to last for a year if they aren’t happy with it.

Initially, Voluma is being released to a select number of physicians who are very experienced injectors. These physicians will then become trainers for the other physicians with less experience. Dr. Weiner has been chosen as one of these initial users of Voluma, and it should be available at his office in November.

Dr. Weiner is Facial Plastic Surgeon who laid down his scalpel in 2005 and now concentrates on minimally and noninvasive cosmetic procedures. His website is http://www.theclinique.net His YouTube is: http://www.youtube.com/user/StevenFWeinerFacial

Do Dermal Fillers (Restylane, Juvederm, Belotero) fight cancer?

I stumbled across a very interesting article last night. It discussed how the naked mole rat had some very unique qualities. I has a very long life span for a rodent, up to 30 years vs. 3-4 years for most species, and it doesn’t get cancer!

After studying tissue cultures from the rat, they found that it had an unusually high level of Hyaluronic Acid (HA or HMW-HA) per Dr. Gorbunova and Dr. Seluanov, professors at the University of Rochester in New York. Apparently this is needed for the rat to burrow because the rat has no hair and it acts as a sort of “tissue lubricant”. To determine if this was the substance leading to the longevity and anti-cancer protection, they were able to genetically modify the rat so it didn’t produce high levels of HA. Sure enough, the rats started to be susceptible to cancerous tumors!

Is it possible that the Hyaluronic Acid fillers we are using to improve wrinkles and volumize the face (Restylane, Juvederm, Belotero) are having more benefit than making us look good? It is very possible. Human studies will be conducted soon. Get ahead of the curve and get some possible cancer prevention and look younger at the same time by visiting Dr. Weiner at the Aesthetic Clinique in Santa Rosa Beach, Florida for your dermal fillers.

http://www.medicaldaily.com/articles/16694/20130619/cancer-cure-naked-mole-rats-hyaluronan.htm