radiesse Archives | The Aesthetic Clinique

Dr. Weiner’s New Treatment for the Aging Neck – “TriNECKta”

The aging phenomenon affects all the areas of the face and body. Sun exposed areas will be most affected due to the collagen destroying effects of UVA and UVB light. Dr. Weiner has developed a technique which addresses many different aspects of the aging neck, and, better yet, it’s all minimally invasive.

Pigmentation

Hyperpigmentation is a sign of UV damage and aging. It can be addressed with nonablative lasers, such as the Thullium 1927nm laser (Fraxel Dual/LaseMD). In some patients, there is also an associated redness, such as in poikiloderma. Redness needs a vascular laser such as the Excel V + laser. Skincare products are essential in maintaining results and must include a retinol, growth factor, and SPF.

Volume Loss

Much has been written about fat loss in the face, but this process will also affect the neck. Recent articles have validated safety with collagen stimulating fillers in the neck if done with careful technique. Deeper lines and wrinkles might also require a hyaluronic acid filler (HA) for improvement

Laxity

Loss of collagen, elastin, and gravity contribute to skin laxity in the neck. Radiofrequency seems to be the leader of the pack for tightening skin and building collagen and elastin. There are a couple different methods to use RF in the neck such as The Genius, FaceTite/NeckTite/AccuTite.

Hyperactive/hypertrophic Platysma

There is more literature supporting the platysma muscle becomes stronger as one ages. This leads to neck bands, jawline sagging, and corners of the mouth drooping. Strategic placement of a neuromodulator in the platysma can improve the appearance of the jawline and neck.

Excessive fat

Fat can accumulate in the chin area (double chin) and along the jawline. Methods used to improve the appearance of the fat in these areas includes: Kybella, Genius, FaceTite/NeckTite/AccuTite. If these procedures are done, the other procedures listed above will have to done on a different treatment day. Jowling can also be improved with these methods.

By combining these treatments, usually done in a series, multiple areas of the aging process can be addressed. Upkeep with future treatments and skincare is essential to maintain long-term results. To see if Dr. Weiner’s “TriNECKta” treatment is right for you, please call the office: 850-622-1214.

The Jawline – Beauty, Differences Between the Sexes, Aging, and Correction (reJAWvenation)

Nefertiti was recognized for her crisp jawline and smooth neck. Her bust is one of the most famous of the ancient Egyptian sculptures. A razor sharp jawline and well defined ascending ramus (or gonial angle) are hallmarks of beauty, both male and female. Jowling, submental fullness, blunting of the gonial angle, and an irregular jawline are all signs of aging.

While there are many commonalities between the sexes of what constitutes an attractive jawline, there are fundamental differences as well.

Males:

Broad/wide rami of mandible leading to a near vertical appearance on frontal projection
Approximately a 110-115 degree gonial angle (more acute than female)
Significant height of the body of the mandible
Wide defined, projected chin

Females:

V-shaped rami of mandible on frontal projection. A more masculine (vertical) ramus is also considered beautiful in some women (Such as Alessandra Ambrosio)
A more obtuse gonial angle of approximately 135 degrees
Shorter height along the body of the mandible
Pointed, less projected chin

There are considerable age related changes of the mandible.

Loss of bone along the body of mandible leading to loss of vertical height. This change is accelerated in an edentulous patient
Blunting of the gonial angle eventually leading to a curvilinear jawline
Narrowing of the male chin and widening of the female chin
Deepening of the gonial notch

The age related mandibular changes lead to loss of support of the soft tissue in the lower face – falling forward and downward. Jowling and submental fat is exaggerated. The upper neck skin shows more laxity as facial skin drops into the neck.

Correction of age related jawline changes with fillers- reJAWvenation

Dr. Weiner has perfected a correction using dermal fillers which he has coined “reJAWvenation”. It is based on restoring the age related loss of bone and leads to support of the lower face soft tissues. Filler is placed along the inferior border of the mandible as well as filling the gonial notch. The gonial angle is recreated. The lower aspect of the jowl is considered the new baseline and filling is made on either side to “camouflage” the jowl. Filler is also placed along the posterior aspect of the ascending ramus. The prejowl sulcus is filled, with emphasis to include the space beneath the inferior mandibular border. The chin must also be corrected to the male/female appropriate projection and shape.

reJAWvenation offers a quick (10-15 minute) correction of the age related changes to the jawline. Improvements in jowls, upper neck, jawline, and chin can be expected. There is minimal or no downtime. Even with facelifts, jawline volume is not typically addressed and needs to be corrected either during the procedure with fat grafting, or in the office, after healing, with fillers.

Dr. Steven F. Weiner’s 6 year Experience with Blunt Cannulas for Dermal Fillers

The value of volume replacement in the aging face is now universally recognized as one of the most beneficial procedures to restore youthfulness. The combination of sun exposure, aging, and genetics leads to collagen, fat, muscle, and bone loss. Reinflating the cheeks, lips, and tear troughs are routinely done by physicians across the world on a daily basis. Most of these patients will have a week or more of downtime – swelling, bruising, discomfort – but that doesn’t have to be. Blunt cannulas can minimize most of these side effects associated with filler injections and has become standard practice for Dr. Weiner for the past 6 years.

The benefits of blunt cannlas are:

There is only one insertion point to treat multiple areas. This equates to less intrusions through the skin and therefore a more comfortable procedure.
The tip is rounded and blunted. This very fact accounts for less bruising/swelling. When a blood vessel is encountered with the end of the cannula, the vessel is more likely to be gently displaced rather than punctured.
There is increased safety. A phenomenon termed “vascular occlusion” occurs when a filler is injected into a blood vessel. The filler then blocks the blood flow and can lead to necrosis (death of skin) or even blindness. It is much less likely to occur with blunt cannulas, particularly larger cannulas (23 or 25 guage), because they don’t enter blood vessels as easy as needles do.
Allows treatment in areas otherwise not easily accessible. Due to the safety of the cannulas, there are now areas of the face which are more easily treated. The superficial temporal area, supraorbital, forehead, piriform, periocular and lower eyelid are now routinely treated with cannulas whereas with needles, these areas were very precarious to inject.
Downtime is minimize. As a result of all the benefits listed above, most patients have significantly less healing time and are much happier after receiving their filler treatments with blunt “safety” cannulas.

If blunt cannulas have so much benefits, why are only 5% of the providers using them for dermal fillers? The art of using cannulas is not an easy one. Patience is required because directing the tip to the exact spot it is needed is not always easy. Remember, when the tip encounters an obstruction (vessel, ligament, collagen), it will need to traverse around it and not pierce it (as needles would do). This can be frustrating and lead to longer and less satisfactory results for the inexperienced cannula injector.

Dr. Weiner is one of the leading authorities on cannula injections of dermal fillers and has used them for over 6 years for nearly all of his injections. The cannulas provide a safe, comfortable, minimal downtime technique for volumizing the aging face, even with multiple syringes being used simultaneously.

The Temples Shouldn’t be Ignored When Filling the Face

The ideal facial shaped has been described as “heart shaped”, “V shaped”, or “Upside Down Egg”. A youthful face draws attention to the upper face and eyes. With aging, the lower face becomes “heavier” and more dominant, as laxity and volume loss set it. Instead of round or oval, the shape of the face becomes closer to square. The underlying cause for these changes is primarily loss of fat, muscle, and bone.

The upper face’s width is determined primary by the temples. Fat pads in this area are particularly susceptible to atrophy associated with aging and exercise. To reestablish the youthful facial shape, it is essential to reflate the temples. There is a contiguous fat pad in the preauricular area which follows similar volume loss as the temples and should be volumized simultaneously. When the lateral cheeks are given filler, the temporal deficits become exaggerated and more obvious. Patients must be counseled on their temples whenever cheeks injected.

Besides the overall facial shape change, the benefits of filling the temples are the lift given to the surrounding tissues. The brow, and upper eyelid will be elevated with temporal filler. Placement of filler along the orbital rim and lower forehead further enhances this effect. The ideal temple should be convex in a women and slightly concave in the male.

The filling of the temples is reserved for the experienced injector. Dr. Weiner’s choice for this area is Sculptra because of its safety and natural appearance. The only downside to Sculptra is that when placed along the bone in the deepest aspect of the temporal fossa, a large volume of product is needed for complete correction. To finish corrections after the deep Sculptra placement, a superficial layer of HA filler (Restylane, Juvederm) can be safely placed using large bore cannulas. The filler is placed immediately below the dermis in the subcutaneous layer or just below the superficial layer of the temporalis fascia.

To reverse the signs of aging and restore the upper face dominance, temple volumization is required. It must be considered for patients that have brow and eyelid heaviness as well. This is an area that is difficult to treat with higher than average safety risks, and should be reserved for the most experienced injectors.

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How Long Do Dermal Fillers Last…..It Depends!

It happens everyday. Patients ask how long they can count on their dermal filler lasting. The problem is, is that there is no quick and easy answer. There are a number of variables that factor into filler longevity, with the ultimate unknown being that there is no way that a physician can determine how one’s body is going to degrade a particular filler.

In the US, the majority of patients are injected with Hyaluronic Acid (HA) fillers. The commonly known HA fillers are: Juvederm Ultra, Juvederm Ultra Plus, Restylane, Perlane, Voluma, and Belotero. The differences between the HA fillers are their manufacturing process, and the concentration of the HA in the filler. The harder the HA is for the body to break down, the longer it will last. A larger particle of HA has less surface area then multiple smaller particles taking up the same space. Less surface area means there is less area for the cells to “chew up” the HA. In general, larger particles will last a little longer than smaller particles. Another factor in HA fillers is how tightly the particles are bound together. Cross-linking, adding bonds between molecules of HA, has been shown to significantly add longevity. All HA fillers are a combination of cross-linked and non cross-linked HA. Too much cross-linking leads to a filler that is very hard to inject, and has led to more complications (in a filler that is no longer on the market). Non cross-linked fillers last only 3-4 months and are hardly used anymore. One last variable in HA fillers is their ability to attract water, their hydrophylic properties. The more they attract water, the longer the HA filler gives a correction.

The fillers that are collagen stimulators, tend to lead to longer longevity. Fillers in this group are: Radiesse, Sculptra, and Bellafill. While studies have shown a very mild collagen response to the HA fillers, the visible volume correction with the HA fillers is the gel, not the collagen. With the collagen stimulators, the body responds to what is injected by creating an inflammatory response and lays down collagen. Until the particle is degraded by the body, collagen will continue to be produced. Radiesse is made of calcium hydroxylapatite, and is the shortest duration in this group. Artefill should be considered a permanent filler, because its component, Poly Methyl Methacrylate (PMMA), does not get broken down by the body. Sculptra has consistently given about 2-3 years duration in studies and in the authors experience.

The location in the face a filler is injected is one of the most important factors to determine longevity. Areas where there is more movement, there is faster breakdown. In order of increasing duration in the face, the order is (in the author’s experience):

Lips
Marionette
Nasolabial Folds
Tear Troughs
Cheeks
Temples

(Forehead, nose, earlobes are variable)

A couple more very important variables that should be mentioned. The more filler that is injected, the longer it will last. This applies to all the fillers. Also, filler doesn’t stop working all of a sudden. It takes months of gradual loss to notice a difference in volume. In fact, even when the patient believes there is no longer results, biopsies have proven that there is still filler present.

After all the above explanation, the author’s experience with the commonly used fillers is:

Lips: HA fillers give about 4 months, longer with recurrently injected lips.
Tear troughs: HA’s – about 9-12 months, Sculptra and Bellafill – years. Juvederm could last years and should never be injected in tear troughs.
Nasolabial: similar to tear troughs
Temples: HA’s – 12-18 months, Sculptra and Bellafill – years
Cheeks: HA’s – 18 months, perhaps 2 years with Voluma; Sculptra and Bellafill – years

Remember that individual results are unpredictable. These are generalizations and offer no guarantee as to how long a patient’s results will last. There are many variables that factor into longevity that are listed above, not to mention how each individual responds, degrades, a certain filler.

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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.

Radiesse Questions Answered by Dr. Steven F. Weiner, Facial Plastic Surgeon

[youtube=http://youtu.be/h19BX2nnbx4]

Dr. Weiner performing Liquid Facelift with Radiesse and Belotero

Q: Restylane Vs Radiesse for Cheek Enhancement?

A: For cheek enhancement, Radiesse will last a little longer than Restylane

Radiesse is the highest G prime filler on the market. This is a measure of lifting ability. It will last anywhere from 12-18 mos in most people. Restylane is a little softer with less swelling and slightly less G prime. Both are good choices. More important than the filler is the “filler” you choose. The results depend on the injector for the most part.

Q: Is It Possible to Combine Radiesse and Joliderm?

A: Juvederm and Radiesse can be used in same area

If you get one filler like Radiesse and want to get more filler, it’s ok to use any filler on top of that filler. There is no interaction between the 2. If you’ve done Radiesse first, it has swelling which can persist for 4-5 days so wait for that to calm down before adding more. I typically wait about 10 days before I will inject more filler in someone. In the video, you can see using Belotero and Radiesse in similar areas. Steve Weiner, MD , Facial Plastic Surgeon, Destin, Florida.

Q: 5years Ago I Had Radiesse Filler Injected into my Lips. 4 Years Later my Lips Have Hard Bumps?

A: Radiesse is not a lip filler because you get long term nodules

Radiesse has been a problem for people who got their lips injected. It creates the problem you describe, hard nodules in the lips. These need to be excised to improve. Radiesse is a great filler though, but not for the tear trough and lips. See my liquid facelift video with Radiesse. Steve Weiner, MD, Destin, Florida.

Q: I Have a Ridge After Radiesse!! What is It? and How Can I Make It Disappear? (photo)

A: Ridge after Radiesse in orbital rim area, try injecting saline with lidocaine to mechanically break up

I have some success with the very few episodes of Radiesse clumping by using a combination of Lidocaine and saline in the area. I vigorously move the needle in and out to try to break up the area. I has worked in all my cases. No other solutions other than cutting it out or camouflaging with another filler like Restylane. See my videos of using blunt cannulas with Radiesse in this area. Steve Weiner, MD, Destin and Panama City Beach, FL.

Q: Tear troughs to be injected with radiesse by occuloplastic surgeon?

A: Radiesse in tear troughs, not recommended.

Radiesse is a thick filler and will tend to show in the thin skin around the eye. It’s great for filling the cheek, but not the area which is close to the eye. It also has a tendency to clump. So for tear troughs, Restylane or Belotero are the fillers I use. Also, to minimize downtime and the chance of bruising, I suggest using blunt cannulas for this treatment. Steve Weiner, MD, Facial Plastic Surgeon, Destin, Panama City, Florida.

Q: I got radiesse injections in my cheeks 6 days ago. Swelling progressively getting worse. What should I do? (photo)

A: The swelling you have after Radiesse is too much

You should see someone. Swelling does occur after Radiesse, but not to the extent you have and usually subsides in 3-4 days. Either it’s infected or you have an angioedema. Either way, see someone ASAP. My video shows a liquid facelift using Radiesse. Steve Weiner, MD, Facial Plastics.

Q: Is It Possible to Combine Radiesse and Joliderm?

A: Juvederm and Radiesse can be used in same area

Q: Getting Radiesse a Month Before Engagement Pary in May, Will I Recover In Time?

A: Recovery from Radiesse should be very quick, especially if you have it injected with blunt cannulas

Radiesse has a characteristic swelling for a few days after injection. There is nothing that can be done to combat that. However to get the fastest recovery, use blunt cannulas so there is minimal bruising and less swelling. You can see the video attached in which I injected about 8 syringes of Radiesse plus about 3 of Belotero (a liquid facelift) and then she left to go to work. The only bruising she had was from the Belotero which was injected with a needle for the very superficial fine lip lines. Steve Weiner, MD, Between Destin and Panama City Beach, Florida.

Q: Is 25 Years Old Too Young to Be Considering Radiesse Injections for Minor Nasolabial Folds? (photo)

A: Radiesse for a 25 year old nasolabial folds is quite alright

There really is no age limit as to when to get fillers. If you have a concern about your nasolabial folds then try some fillers. If you don’t like them, after about a year, you are back to where you started plus one year of aging.

Q: How to Get Rid of a Botelero (Fille) Ridge Lump?

A: Belotero is a hyaluronic acid so it can be dissolved with hyaluronidase

It would be unusual to have bumps from Belotero because its properties cause it to integrate with the skin and become rather smooth. However, it you do have ridges, the first thing would be massaging the area. If this weren’t to work, than hyaluronidase will work fine. Lasers don’t dissolve filler.

Q: Will Radiesse Help Achieve Sculpted Cheek and Eliminate Slight Jowl?

A: Radiesse is an excellent choice to help lift cheek and fill pre-jowl sulcus

I like Radiesse for those purposes. Radiesse has the highest G prime of all fillers which means it has the greatest lifting ability. You will need at least 2, maybe 3 syringes to get the improvement. See my video which goes over the liquid facelift which includes these areas with Radiesse.

Q: Is There a Way to Remove Lumpy Radiesse Be Removed from Tear Trough?

A: Radiesse in the tear trough – shouldn’t be done

The tear trough is very thin skin and you need a thin filler like Restylane or Belotero for that area. Hopefully after 2 weeks it will not be noticeable. It tends to swell for about 3 days so don’t be concerned at this point. If it’s still a problem at 2 weeks, try some saline to break it up. If that doesn’t work, it’s either time or surgical removal. Watch my video for injecting all over the face with Radiesse and Belotero…so called liquid facelift. Steve Weiner, MD, Destin, Florida.

Q: Do You Recommend Radiesse in One Cheek? (photo)

A: I’m 50:50 on this one. Right cheek looks too big, do you add to left to make symmetric?

I can see your problem from the pictures. Do you overfill both sides to get symmetric? If you wanted to see how it would look, I’d go with Perlane or Restylane, so it can be erased with hyaluronidase if you don’t like it. Video shows cheek injection with Restylane. Steve Weiner, MD Facial Plastic Surgeon, Destin, Florida

Q: Am I a Good Candidate for Chinn and Cheeekbone Enhancements with Radiesse? (photo)

A: Radiesse is great for chin and cheek enhancement

Radiesse is a very hardy filler, great for creating “pseudo implants” in the cheeks and chin area. If cannulas are used, bruising and swelling should be minimized. See my video which uses Radiesse all over the face. Steve Weiner, MD, Facial Plastic Surgeon, Panama City Beach, Florida.

Q: Radiesse 1st Treatment Scheduled, Concerns & Questions

A: Questions when rushing for a Cosmetic Procedure discount.

When you see a 50% off discount for a cosmetic procedure, please evaluate the situation before rushing to get it done. What are the qualifications of the Doctor? Is the Doctor doing the procedure? Have your friends seen this Doctor? What are the Doctor’s reviews? What’s the Doctors experience with fillers and Radiesse. Sometimes this is a perfectly legit way to try to expand one’s business but most of the time it’s a non Plastic or non Facial Plastic Surgeon or non Derm that is trying to undercut because he/she is trying to get into the business. Blunt cannulas are the way to go with the Radiesse for less bruising, less swelling, and less discomfort. There are no knock offs for Radiesse. There is a little more swelling with Radiesse than the other fillers like Restylane or Perlane and it’s not reversable like the HA fillers..something to keep in mind. See my video. Steve Weiner, MD

Q: No Improvement After Initial Radiesse Injections?

A: Flat cheeks not improved with Radiesse…you just need more

Radiesse is a filler that you don’t want to do too much in one treatment in the upper cheeks. Waiting a month for putting more in is appropriate. I don’t think that the other fillers are any better than Radiesse for the cheeks so I would go with the game plan your PS has laid out.

Q: Does Radiesse Cause Serious Diseases Such As Cancer?

A: Radiesse is made of Calcium Hydroxylapatite which is a naturally occurring substance

Radiesse is made of Calcium Hydroxylapatite which is found in bone and joints. It is great for volumizing, where there is large deficits, because it corrects about one and a half to one when compared to the HA fillers. I does not cause any types of cancers.

Q: Complications from Radiesse Rec’d 6 Wks Ago?

A: Painful nodules soon after Radiesse injections – sounds like infection

You are not describing a normal reaction to Radiesse. Your symptoms seem like there is an infection going on and should not be left untreated. Unfortunately, Radiesse can’t be dissolved like HA fillers so you have to aggressive antibiotics. It might need to be removed surgically if the infection can’t be cleared. This is a very rare problem. It is imperative that the physician use aseptic technique when adding lidocaine and during the injection as well as proper skin cleansing.

Q: Radiesse Injection Went Bad?

A: Problems after Radiesse injection – call you doctor ASAP

What you are describing is not normal after having Radiesse. My patients have almost no swelling at day 4. Having pus is very concerning. Very rarely is there an infection after injections but obviously you have one. Hopefully a fully trained physician performed you procedures and you can get help. Could it be viral?-yes, herpes can be stimulated from the injection, but for anyone at risk for this, I put on preventative doses of Valtrex. I have also seen agioedema after filler injections which this might be, but unlikely

Q: Lingering Numbness and Vision Problems After Radiesse?

A: Visual changes and numbness after Radiesse; you need an expert opinion

You sypmtoms are not normal. I’d see an Ophthalmologist ASAP. It sounds like the infraorbital nerve is bruised and possibly the vessels near it were injected. This is not something that can wait. All numbing from injection should be out of your system already. If an Ophthalmologist clears you, I’d feel much better.

Q: I Want my Face to Look Fatter and Rounder. It’s Long and Skinny, What Can I Do?

A: A rounded face is more youthful than a long and narrow face. Sculptra is your best choice

You hit the nail on the head. As we age your fat pads, bones, jaw, and muscles in the face all atrophy. This creates a longer and skinnier face which ages us. To recreate the more rounded appearance of a youthful face, fillers are the answer. Sculptra is great for this because it is a long last volumizer, which can be injected in multiple areas such as the temples, preauricular area, upper and lower cheek, jawline, and marionette area. I can’t be used too close to the eyes or mouth area because of nodule formation, and that is where an HA filler is good. Can this all be done with Radiesse or Restylane? Yes, but the expense would be much more than Sculptra, and the duration would be less.

Q: Radiesse on Actual Cheekbone? (photo)

A: Radiesse for volumizing face is a good choice

In answer to your question, it’s not uncommon to place radiesse deeply, even at the level of the cheek bone. However, i think that the majority of your problem with volume is in the lower cheek area. This area needs a little rounding out to give the face a more youthful appearance. I just think you might need some more, you have moderate volume loss in your picture. This area is just great to use the blunt cannulas for less bruising, downtime, and swelling. A great alternative to Radiesse would be Sculptra for volumizing the entire face, including temples, lower cheeks, marionette area, and pre-auricular (in front of ear) area. Dr. Weiner, Destin, Florida.

Q: Radiesse Injection Technique-internal (Through Mouth) Vs External?

A: Radiesse should not be injected through the mouth

When injecting through the mouth, you risk dragging oral bacteria along the needle and infecting the area where the filler is placed. There is no advantage to this technique. The absolute safest way to inject Radiesse in my opinion is using the blunt cannula technique. There risk of bruising, swelling, and vascular injury is minimized and results are optimized. Cleansing the skin with Hibiclens and alcohol will help prevent infection.

Q: Radiesse Was Injected into my Trough/cheek Area About Six Weeks Ago.

A: 2 reasons why correction of Radiesse has gone

Radiesse has typically more swelling than all the other fillers. So after about 3 days, the initial correction will look less corrected. Also, Radiesse is a combination of Calcium spheres and a liquid medium. The liquid will gradually absorb over a 3 week period. Collagen will take some time (maybe 4-6 weeks) to form. So there is typically a loss of correction which then comes back somewhat when collagen is formed.

Q: Percentage of Patients That Had No Radiesse Side Effects?

A: Very little side effects can be expected with Radiesse, especially with blunt cannulas

The stories on this site showing side effects from Radiesse are quite frankly not related to the product but to the person injecting. If not properly placed in a deep plane or too much is placed in a single area, you can have some issues. But, with an experienced injector, you will be able to resume normal activity the following day. I tell my filler patients to avoid exercise for the first day to minimize bruising. Using the blunt cannula technique, bruising is almost nil. You can expect slight firmness in the area injected for about 3 days, but usually this is not noticeable. Do not have Radiesse injected too close to the eye, and I wouldn’t do it in the nose.

Q: Is It Ok to Have Radiesse Nose Injection 5 Months After Restylane Nose Injection? Fly Immediately After Radiesse Nose Injection?

A: Injections of filler in the nose, not as safe as once thought

There are more and more reports of complications coming from nasal injections with fillers of vascular compromise. Prior nasal surgery puts you at particular risk. After knowing that, and you still want to get it done, I would only recommend using an HA filler (Restylane, Juvederm, Perlane) because there is a way to dissolve these products if a problem arises. Radiesse can not be dissolved and posses a problem if an issue happens. There is no problem with “mixing” fillers by injection the same area as a prior injection.

Q: Can Improved Radiesse (2010) Be Used Under the Eyes?

A: Radiesse good for upper cheek but not superficial

I have been using Radiesse for years in the upper cheek, particularly medially without issues. When you get into issues I believe is when you try to inject superficial near the eye. If you keep the volumes small, stay near the bone, and not too high, it works very well. By the way, the formulation for Radiesse is unchanged since it’s inception.

Q: Is There a Way to Speed Up Radiesse Absorption?

A: Radiesse has more swelling than other fillers for about 4 days

I warn my cllents about the swelling you get with Radiesse. It’s different than the other fillers. I have warned my clients about the “Joker” look (from Batman) after getting it around the mouth which always settles down. It really helps to turn up the corners of the mouth. It should get better. There is nothing to dissolve Radiesse however.

Q: Possible to Remove Radiesse Lumps in Lips?

A: Radiesse is not a lip filler

Radiesse should not be used to fill lips. It will clump most of the time. Usually these can be removed with small incisions overlying the bumps.

Q: Getting Radiesse from a Plastic Surgeon or a Gynecologist?

A: Radiesse is an unforgiving filler

Having longevity in a dermal filler is good and bad. Good, if the results are what you want; bad, if you have an issue. I would say that my patients are most satisfied with Radiesse when compared to the other fillers (a study done by Radiesse came out with similar results).

Having said that, if you are considering Radiesse, you need to have a very experienced injector. Unfortunately, there is no remover for Radiesse as there is for the HA fillers. You need surgery to remove Radiesse.

In conclusion, read Dr. Persky’s notes, and make an educated decision.

Q: Radiesse for Lip Wrinkles?

A: Best treatment is to resurface upper lip for lip wrinkles

For the optimal results for upper lip lines with a prolonged results, CO2 laser is what I recommend. The Fraxel re:pair is excellent for this. You can see an example in my pictures.

Just doing this area is very easy. No pain med, no sedation, topical and blocks will make you extremely comfortable. About 5 days of healing time are needed. Sometimes a second treatment will be needed.

Another option is fillers and Botox. I do inject Radiesse horizontally very lightly along the area above the lip which helps somewhat, but not in the lip or directly into the lip lines. HA’s can be injected into these lines, but sometimes can be seen. In the future, Evolence Breeze will be great for this.

Q: Best Method of Injection for Radiesse?

A: Very comfortable injections with Radiesse is easy

The physician numbs the face with topical anesthetic for about 20 minutes. He/She mixes the Radiesse with lidocaine. Apply ice to the face for about 15 seconds. You should have minimal discomfort. If that’s not the case. Dental blocks are not needed. In my opinion, the blocks have more discomfort than the injection, and people usually don’t like the numb feeling they get from it.

Q: Radiesse After Success with Juvederm?

A: I would stick with HA fillers for the tear trough

I think that HA’s are best for the tear trough area. Their longevity there should be about a year. Although Radiesse is shunned by many in this area, it can be done by a skilled injector without issues. By the way, my favorite for this area is Restylane. The key to this area is to inject conservatively.

Q: Feeling the Radiesse in Nasolabial Folds Normal?

A: Not normal after Radiesse, but not necessarily a bad thing

Radiesse typically will swell and feel firm for the first few days, and should not be able to be felt after about a week or 2. If you still feel it, it could be that there was too much placed in that area. Usually massaging the area can break this up. I would recommend that. Ultimately, it should get better on its own in about 9 – 12 months.

Q: Tips for Avoiding Radiesse Pain

A: Radiesse is not painful for my patients

I routinely add lidocaine to all my Radiesse injections. This significantly decreases my patient’s pain. Also, by applying Pliaglis, a new topical anesthetic, there is virtually no pain. Applying ice before also helps. The lidocaine added will give short term pain relief as well, while the patient is driving home. After it wears off, the painful time period has usually lapsed.

Q: Radiesse for Nasolabial Folds

A: Radiesse is great for nasolabial folds

I think that Radiesse is great for the nasolabial folds. It will give a long term correction of about 12-18 months. A couple things that are particular to Radiesse is that it:

Swells more than the other fillers, but this goes away after a couple days
Causes slightly more bruising because you have to use a large needle to inject it

I do add lidocaine to the syringe, so it is a fairly comfortable injection. I love Radiesse for the marionette lines. It seems to have more structural support than any other filler and is great to turn a downward corner of the mouth, upward. One syringe of Radiesse is 1.3cc’s.

Also, Radiesse corrects about 30% better than Restylane. So, you get about 50-60% more correction per syringe of Radiesse over Restylane. You also get more longevity. So overall, it is the most economical filler.

Radiesse is made of microscopic calcium particles and a gel. The gel will dissolve and leave the particles which cause collagen stimulation. The new collagen is what leads to it’s longevity. I sometimes will layer a thinner filler like Juvederm or Restylane on top of the Radiesse. I think of Radiesse as a foundation, and the other 2 as finishers

Restylane Questions (50) answered by Dr. Steve Weiner, Facial Plastic Surgeon

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Q: Is Belotero BALANCE or Restylane better for tear trough?

A: Both Belotero and Restylane can be used for the tear troughs…Restylane will last longer I suspect

You’ve chosen the 2 fillers I use for the tear trough. I mainly use Restylane but have used Belotero for people who could not tolerate much swelling afterwards. Belotero absorbs less water and therefore has less swelling afterwards but this decreases it longevity as well. Most important is that blunt cannulas are used to decrease the bruising, swelling, and risks. See video. Steve Weiner, MD, Facial Plastic Surgeon. Destin, Florida.

Q: Is reusing Restylane injection safe?

A: Studies have shown that Restylane is safe to store at least 9 months after it was used initially

After using a portion of a syringe of Restylane, it is safe to store up to nine months without risk of infection if the needle is changed out before storing and replaced again before using it. Some docs will give to the patient but I always do the storage myself to ensure proper temperatures (room temp) and sterility is followed. Steve Weiner, MD, Facial Plastic Surgeon, Destin, Florida.

Q: Tyndall effect, overfill, or bruise? (photo)

A: Looks like you have been overfilled in the tear trough area with Restylane

Don’t worry about using hyaluronidase. I wouldn’t do anything other than that to treat this area. Either he is inexperienced with this or trying to bill you more. Using hyaluronidase should fix the problem pronto.
Steve Weiner, MD, Facial Plastic Surgery, Destin, Florida.

Q: Filler to outer lip line left me with blue tinted lips and it’s lumpy 4years after

A: Lumpy lips and blue tint 4 years after Restylane – Try hyaluronidase

Although it is unlikely that there still is filler in your lips, it sounds like there might be. I would give hyaluronidase a try. If this doesn’t work, the vbeam might be helpful for improving the color.

Q: I had lip fillers in September of last year and I’m not happy. How can I correct them? (photo)

A: To correct lips which you are not happy with use hyaluronidase to dissolve

Hyaluronidase is very quick to dissolve hyaluronic acid fillers, which I assume you had. I would start back at square one and get someone else to fill them. Hyaluronidase needs to be injected into the areas of filler just as if you are getting filler.

Q: Restylane injection under eyes. How long for bruising and bags to clear up? 12/17/2013–1/3/2014

A: Under eye injections should be done with blunt cannulas and expert injector

Having under eye injections is a procedure with the most complaints on realself for fillers. It needs to be done with cannulas to decrease bruising, swelling, and other side effects. You might have too much filler or improperly placed filler which needs hyaluronidase to dissolve. Get it redone with cannulas and a very experienced injector.

Q: My doctor hit a vein between my eyes with restalyne. I have purple vein lines will they go away? (photo)

A: Using Restylane in the glabella and a vein was hit, now with prominent vein – you must go back to Doc

It looks like the vein in your forehead is more prominent than it was before the procedure. This means that there is more pressure in the vein either from being occluded or from external pressure. This needs to be addressed by your doctor soon. I think it probably needs to be dissolved with hyaluronidase. This area is particularly prone to vascular problems and should only be injected by the most experienced physician. Steve Weiner, MD, Facial Plastic Surgeon, between Destin and Panama City Beach, FL

Q: Which Filler is Safer, Restalyne or Juviderm?

A: Both Juvederm and Restylane are equally safe

Both are safe. My overwhelming preference is for Restylane. Restylane has a higher G prime which will lead to more lifting ability. It also is much better for tear trough area because it is less hydrophilic (less water absorption). It also gives more structure to lips that are small and lack definition. Juvederm tends to spread as well leading to correction in a general area and not exactly where it’s placed. I do use Juvederm in the temples placed superficially. Overall there are more applications in my opinion for Resty.

Q: How Do Doctors Handle Uneven Restylane Results?

A: Uneven Restylane results could be result of asymmetry unrecognized before the treatment

Most often, the asymmetry which is seen after filler is something that was pre-existing. That’s why photos are very important. The patient often looks at the area treated much more critically than prior to the treatment. If indeed it is due to the filler, that all has to be negotiated with the office. Since you are one month out, the swelling should have already subsided, but if you were only a few days out, I’d tell you to wait 2 weeks before we re-inject. Steve Weiner, MD, Facial Plastic Surgeon, Panama City Beach, Florida.

A: Restylane will help for acne scars, but don’t expect great results

I have been only mild impressed with fillers for acne scars. The problem is often the skin is tethered down and the filler doesn’t lift the depressed area well. For a quick fix, its the only thing available. Besides lasers, there is TCA cross and radiofrequency devices such as the INFINI by Lutronic. See my blog about acne scars. Steve Weiner, MD, Facial Plastic Surgeon, Destin, Florida.

Q: Skin Necrosis from Dermal Injection?

A: Skin necrosis on bridge of nose can occur from dermal fillers. Need to be evaluated ASAP

The nose is particularly prone to skin necrosis, especially if you had previous rhinoplasty or any scarring. The vascularity can be compromised with filler by compression of vessels or by direct intraluminal (inside) injection. The first signs are blanching, which occurs almost immediately. Later signs are a blue reticular pattern that can occur in areas far from the actual injection point. Late signs are dying of the skin which is dark or black. You must catch things early in order to avoid necrosis so its best to see someone right now for evaluation. No one can tell what’s going on without seeing you. I don’t inject the nose anymore after seeing at meetings the number of complications in this area. Steve Weiner, MD, Facial Plastic Surgery, Destin and Panama City Beach, Florida.

Q: How Many Days Will It Take for Hyaluronidase to Stop Functioning and After How Many Days Can I Perform Filler Injection Again?

A: After hyaluronidase to remove poorly injected filler, wait about a week to re-inject.

Hyaluronidase works very quickly. Sometimes you will see improvements before leaving the office. You could probably get filled in a couple days, but waiting a week is definitely safe. Good luck. Steve Weiner, MD, Facial Plastic Surgeon, Panama City, Florida.

Q: Post Restylane Lip Injection?

A: Restylane for lips, minimal swelling after 1/2 syringe, that’s good not bad. Blunt cannulas are great for the lips.

Most patients will have some swelling after their Restylane injection in their lips because the product is hydrophilic, loves water, and therefore pulls in water and swells a little. If you had blunt cannula technique and only a small amount of filler, the swelling should be minimal. Some of my patients go right out to lunch or dinner. Please see the attached links and videos. Steve Weiner, MD, Facial Plastic Surgeon, Destin, Florida.

Q: Can Restylane Be Used in Lips for Patients Under 21?

A: Restylane can be injected in lips if you’re under 21

The reason Restylane stated that you needed to be 21 was because their FDA trials were done on people 21 years and older. So that’s what they got approval for. It can be used off label for people under 21 in their lips, and anywhere else, as long as its within the standard of care. Hope you have a doctor who uses cannulas because there is much less bruising, swelling, and discomfort doing it this way. See my blog below!! Steve Weiner, MD, Destin, Florida.

Q: If Sculptra is at All Risky for Someone with Autoimmune Issue(celiac), Would Restalyne/Juvederm Be Suitable for Facial Plumping?

A: Volumizing a face can be done with fillers other than Sculptra, like Radiesse, Restylane, see video

Sculptra is an ideal volumizer because it is long lasting. The problems with autoimmune disease were that on retrospective review, with the old dilution, that people who got granulomas had a higher frequency of having autoimmune disease. I don’t believe that celiac disease was one of those found. You can probably have Sculptra, but Radiesse is a great volumizer, along with Restylane or Belotero. It will cost more to use fillers other than Sculptra, and results won’t last on long, but you can do it. I have a video attached which shows a “Liquid Facelift” using Belotero and Radiesse. Steve Weiner, MD, Sculptra Trainer, near Destin, Florida.

Q: Rippling and Lumpiness in Injection Site from Filler?

A: Swelling and lumpy filler around the eyes should gradually resolve.

I tend not to like Juvederm around the eyes because of its characteristic to draw in water which can lead to prolonged swelling. It should get better, but if not, hyaluronidase will help dissolve it. Bruising can take up to 14 days to improve. I like to use blunt cannulas which leads to less swelling and bruising. Sometimes some mild massage in the lumpy areas can help out uneveness.

Q: Risks of Repeated Injections and Damage to the Skin with Dermal Fillers?

A: Long term use of dermal fillers is actually good for the health of your skin and maybe for you in general

At the most recent Multispecialty Cosmetic Symposium in Las Vegas, several Plastic Surgeons noted that the skin was much more youthful appearing when they were doing facelifts in patients who did filler. I think that doing filler with needles around the tear troughs is not the state of the art and only cannulas should be used there. This will decrease the bruising and swelling after the procedure. I have written a blog recently discussing that HA fillers might actually help with cancer prevention and increase your longevity. Please read it. Steve Weiner, MD

Q: Restylane in my Lips – Will It Take 2 Weeks to See the Final Result? (photo)

A: I agree that after about 2 weeks from lip filler is your final result.

Restylane typical has some mild swelling after injection particularly around the eyes and lips. This is due to the product absorbing water and from the “trauma” of the injection. This usually takes 2 weeks to completely settle down. Sleeping more upright helps to relieve some swelling. The total volume from one syringe of filler is 1 cc. This is one fifth of a teaspoon, which isn’t much. You might want another syringe in your lips. It’s my practice to wait two weeks before reinjecting after filler so I know where I’m starting at again (the new baseline). Keep in mind that it is impossible to go from someone which has no lips to real full lips in one session without looking strange.

Q: 10 Days Since Restalyne Under my Eye. I Still Have a Little Lump. How Can I Tell if It’s Excess Filler or Bruising? (photo)

A: After 10 days, lumps from bruising around the eye should be almost gone and most likely is the Restylane.

It’s very hard to tell from the pictures anything about the “lump” you describe. However, if it were due to bruising, it should be almost gone by 10 days and shouldn’t be just appearing. It most likely is related to a clump of filler which could be dissolved with hyaluronidase. Around the eyes is a difficult injection and should be done with the most skilled injectors using blunt cannulas.

Q: Restylane Lip Injection Getting More and More Swollen? (photo)

A: Severe swelling that you have after Restylane looks like a rare side effect called angioedema

Angioedema is a rare rapid excessive swelling that some people get after any type of manipulation on the face (dental, trauma, injections). It most often occurs, in my experience, in people which are taking “ACE inhibitors” for their blood pressure but occurs with other medications or for unknown reasons too. There is a hereditary form of this condition too. It will respond to high doses of steroids and antihistamines. Will this happen again? Not always, but to help prevent it from happening again, you should take steroids before and after any procedure you have on the face or dental area. You should see an internist to look for the root cause of the problem and switch medications if possible.

Q: Injecting VOLUMA After Injecting Restylane? (photo)

A: No problem with mixing fillers like Restylane and Voluma

The current trend is to use multiple different fillers in the same patient. There is absolutely so problem with having different fillers in the same or nearby areas. Each filler has its unique qualities which make them better in certain applications/areas. The more robust fillers for lifting and filling are: Radiesse, Perlane, Voluma, and to a lesser extent Restylane. Juvederm and Belotero, are softer, more diffusing fillers. Sculptra is unique in that it volumizes and thickens the skin. More of a global fill. By the way Voluma is not widely available in the US at this point.

Q: Two Lines Appears Under my Eyes After Eyes Filler? is It Normal? (photo)

A: Swelling around eyes after fillers

My guess is that you got Juvederm in the tear troughs, which in my opinion is a mistake because it leads to prolonged edema. Other thoughts are that too much was placed in the area. My guess is that is will improve but not resolve and should probably be dissolved. The biggest area of complaints on RealSelf.com is related to filler around the eye. I can’t stress this enough..you need to go to an experienced physician in this area and shouldn’t use Juvederm. Also, blunt cannulas should be used. Steve Weiner, MD, Santa Rose Beach, FL

Q: Restylane Touch Ups After Lip Augmentation?

A: Touch up with Restylane can certainly be done at 2 week follow up for your lips

Touching up with Restylane in the lips should be no problem at the 2 week mark. I usually like to wait that amount of time because if there is any swelling or bruising, it is gone by then. If you have remaining Restylane from your previous procedure, its up to the doctor whether there is an injection fee or if it is complimentary. I use blunt cannulas for the lips..less swelling, less bruising.

Q: Would You Recommend Dermal Fillers for Under Eye Hollows? (photo)

A: I would recommend filling your eye hallows (tear troughs) with Restylane

By the looks of your picture, it appears to me that you would greatly benefit from tear trough and upper cheek filling with Restylane. I would use blunt cannulas in this area to avoid bruising and vascular risks. It should give you about 9-12 months worth of improvements. I would start with about 1 syringe per side. You might need more but that can be evaluated after about 3 weeks. See my video please.

Q: I Had Restylane Injected on 4/14/13 Underneath Both Eyes. Now Have Very Large Lumps! Does This Look Right? (photo)

A: Lumps around eyes after Restylane are usually related to poor injection technique

From your photo, it looks like too much Restylane was placed in too small an area. This can be dissolved with hyaluronidase. It is of upmost importance that the undereye injection be done by an experienced physician. This is the number one area for people’s dissatisfaction on RealSelf.com. I can’t stress this enough. Also, using blunt cannulas is the best way to treat this area for less swelling, less bruising, and less risk.

Q: Am I a Good Candidate for Restylane Under the Eyes? (photo)

A: Are you a candidate for Restylane under the eye..YES

You have pseudoherniation of fat in your lower eyelid. This is caused by a combination of factors. For you and your age, my recommendations are blunt cannula augmentation of the upper cheek and tear trough. This will improve your situation with minimal downtime, cost, and discomfort. I would start at 1 syringe on each side with Restylane. Add more if needed after 2-3 weeks. I have never had the blueish Tyndall effect with cannulas because I inject below the muscle. It takes only a couple minutes per side and bruising is rare. Please see my video. Steve Weiner, MD, Santa Rosa Beach, Florida.

Q: Candidate For Restylane Under Eyes? (photo)

A: Tear troughs are a great place for Restylane or Belotero from experienced injector

It looks like you have a fairly deep tear trough. Fillers are great to improve this area. I would make several recommendations:

Go to someone that does this often. There are too many people with bad outcomes in this area because of poor injection technique
Use only Restylane or Belotero. Other fillers will lead to nodules, or swelling.
The injector should use blunt cannulas to minimize bruising and risk.
Don’t overfill. It’s better to get two treatments because it was underfilled the first time.
Stop all blood thinners 3-4 days before, aspirin – 10 days. Although I inject people on aspirin and even Plavix, if the injector is using a needle, you must decrease the chances for bruising.
Avoid strenuous activity for the rest of the day you are injected.

Q: Am I Too Young for Nasiolabial Fillers? ~ 18 Years Old

A: Filler for nasolabial fold in 18 year old is fine

There is no problem with getting fillers at age 18. I would make sure that it’s not a problem with your cheeks needing filler before filling the nasolabial folds. Its not a permanent solution, so if you don’t like it or can’t afford further treatments you will go back to baseline in about 9 – 12 months.

Q: I Have Blueshift Bruises Appearing Above my Top Lip After Having Restalyne Could It Be Necrosis? (photo)

A: After Restylane in lips, bruising is fairly common but less with cannulas

The lips tend to bruise with dermal fillers but when the injection is done with cannulas, there is much less chance. Necrosis is a rare complication with fillers, and again, the blunt cannula technique will reduce this chance even further because an intra-vessel injection is almost impossible. I don’t see any evidence of necrosis in your picture. Warning signs are immediate blanching of the area and area around the injection. It then turns mottled, with bluish hues within several hours.

Q: Restylane Applied Under my Eyes to Get Rid of the Dark Circles Under the Eyes? (photo)

A: Bruising from Restylane under the eye can be minimized with blunt cannulas

Addressing your exact question is tough without seeing you in person. If the problem is a shadow from loss of volume, more Restylane will help. Restylane won’t help dark circles from pigmentation. Also, sometimes residual pigmentation from a prior bruise can take a long time to resolve. I always use blunt cannulas in this area and rarely get a bruise. It’s also a lot safer too.

Q: Uneven Restylane Lip – Should I Go to a Different Doctor? Should I Dissolve or Add More to One Side? (photo)

A: Uneven lips after Restylane will usually even itself out after about a week.

Sometimes after lips are injected with filler, they appear uneven. This is possible for a number of reasons. First, they weren’t even to start with. Second, there is assymetric swelling or bruising. Third, there was an uneven amount of Restylane or Juvederm placed. The best thing is to wait about a week before doing any modifications. Sometimes adding a little to the less filled side will be sufficient. Sometimes you need to dissolve a lump with hyaluronidase. But, most of the time, nothing needs to be done, and it all looks OK after a week. It’s important to have the doctor take good before pictures so that pre-existing assymeties can be evaluated.

Q: Can I Get Restalyne Now and Have Fraxel to my Face a Few Months Later?

A: Fraxel Dual or re:store (or any other laser) has no effect on your dermal fillers such as Restylane and Juvederm

It is quite alright to get filler now and then get Fraxel Dual a few months later. There will be no change in the results of the filler and it will not adversely affect the Fraxel. There are a number to studies to support this.

Q: Restylane and Blindness?

A: Restylane injected around the eye is extremely safe with blunt tipped cannulas

Restylane is my choice of dermal filler for injecting around the eye. I can not confirm or deny the 2 cases you state of blindness from injecting Restylane around the eye, I just don’t know. This horrible complication has occurred with other dermal fillers and has been discussed at several meetings I’ve been too. It has nothing to do with the brand of filler injected and can occur with any of them. It has to do with an intravascular injection that travels retrograde from a vessel around the eye back to the retinal area. It would occur rather quickly (ie, in the office). HOWEVER, this complication is near impossible or impossible if blunt tipped cannulas are used. There is practically no way to enter a vessel with a blunt tipped cannula so injecting filler inside a vessel is extremely difficult. I also am constantly moving the cannula so as not to put too much product in one place or more than a minute amount if I’m near a vessel.

Q: What Might Affect the Amount of Swelling and Feel of Restylane in the Lips?

A: Swelling after Restylane in lips could be a small collection of blood, of product, or related to the injector

Technique is so important when injecting lips with dermal filler. It is the most unforgiving area because a little issue can be very obvious, unlike the marionette or nasolabial area. I feel that the less trauma you cause when injecting, the less downtime the patient has and the happier they are. In my hands, that means using blunt cannulas. There is less bruising and swelling when injecting with the cannulas. In your particular instance, you need to see you doctor so he can look and feel your lips to see if there is an accumulation of Restylane or a small hematoma (blood collection). If there is a “bunching” of the Restylane, hyaluronidase will solve the problem rather quickly. In very rare instances, a condition called “Angioedema” can occur with is marked swelling that is rapidly progressive. In cases of AE, one needs to be treated quickly so the swelling does not progress, with high doses of steroids and antihistamines. Please see my video too.

Q: Swelling After Restylane Injection? (photo)

A: Swelling after Restylane under eye is minimized with Blunt Cannula technique

Your picture shows moderate to severe swelling after your injection in the tear troughs. I’m not sure if this is related to the manipulation or the injection itself, but it should improve gradually. I highly recommend the blunt cannulas for this area because you get minimal or no swelling in this area. If the swelling persists, hyaluronidase might be needed to decrease the amount of Restylane in this area.

Q: Can Restylane Injections Damage my Eyes?

A: Restylane injection under the eye is very safe to correct tear troughs and hallows with blunt cannulas.

Restylane is a great filler to improve the under eye hallows and tear troughs. It is extremely safe. Using blunt cannulas, this is even safer because the vessels around the eye will be even more difficult to enter. Blunt cannulas also lead to less bleeding, less swelling, and less bruising in this area. I have been doing this procedure since early 2011 with the blunt cannulas and urge you to get a doctor that is experienced with this technique for your treatment. Most questions and problems with fillers on Realself.com stem from injections around the eye so you need to do your research. Please see the attached video to see how quickly this is done.

Q: Dark Circle Under One Eye From Restylane. How Long Will it Stay? (photo)

A: Restylane around eyes can lead to bruising, but much less chance if blunt cannulas are used

As a long time Realself.com physician, I must say that the eye area gives the most questions regarding fillers. Unfortunately, several people have had lumpiness, blueness, swelling, and bruising in this area. You, the patient, must go to the most qualified physicians to get good results with filler around the eye. You must have Restylane and not Juverderm, Sculptra, or Radiesse. I have been using blunt cannula’s for about 1.5 years in this area and the bruising has been minimal. It looks to me that the filler was place too superficially and should be removed with hyaluronidase. Without actually seeing you, it is possible that this is residual from a bruise, which can unfortunately take a very long time to resolve because the hemosiderin (pigment in blood) can sometimes persist even after the initial bruise is gone.

Q: Is One Standard, Full Size Syringe of Restylane 1 ML?

A: Restylane comes in 0.4, 1.0, and 2.0 ml syringes

There are actually 3 different sizes of Restylane. As stated above there are 0.4, 1, and 2 cc syringes. Keep in mind that a teaspoon is 5cc, so 1cc is actually 1/5th of a teaspoon. Any other sizes are not from the company in the US and are either made up by the physician or purchased outside of the US. The size which most people feel is standard is the 1 ml syringe.

Q: What Type of Certifications Must a Doctor Have in Order to Inject Restylane?

A: Certification for Restylane injection by Physician not needed

As far as I know, any physician can inject Restylane. However, certain malpractice carriers, hospitals, or group practices might set their own set of rules. This makes it so important to go to the physician that is recommended to you by your friends, or has the credentials behind him. If you just go to the lowest priced physician, you might not get the result you were hoping for. Keep in mind, the lowest priced Restylane might be the least busiest doctor, and he/she is using pricing to bring in patients.

Q: Allergic Reaction to Restylane 18 Months Later, Should I Be Concerned?

A: Reaction 18 months after Restylane

One possible explaination is a smoldering infection that was quiet for a long time but got activated for some reason. This could be the result of bacteria being “dragged in” with the injection, or bacteria in the blood stream that got caught in the Restylane. Antibiotics would help is this was the problem. See the doc who placed the Restylane for more advice.

Q: Why Are Veins Appearing After Restylane in Nasolabial Folds and Nasogenian Grooves?

A: New appearance of purple splotches is a concern after dermal filler

I would go to your physician and have him look at this. It’s hard to advise you without a photo but what you can possibly have is occlusion of the vessels around the nose. This can lead to the overlying skin dying from poor circulation. It can usually be improved if recognized early by Hyaluronidase, heat, blood thinners and nitro paste.

Q: Can Restylane Be Used to Fill Eye/Cheekbone Area?

A: Restylane is great for under eye and cheek rejuvenation

Restylane is my preferred filler for the under eye and upper cheek filler. It can help fill in the hallows and replace mid cheek flatness that occurs with age. My preference is to be conservative in this area and reinject after 4 weeks if needed rather than inject too much at the initial treatment. I’ve seen too many unhappy patients which have been over injected. Bruising is slightly higher in this area vs. other areas.

Q: Does Restylane Increase Collagen Production?

A: Restylane increase collagen in area of treatment

Restylane does help in stimulating collagen in the treated area. One frequent finding is that fillers tend to last longer the more you use them, and this is mostly due to the collagen production. The same can be said for all fillers too.

Q: Is Q-Med Filler Similar to Restylane?

A: Q-Med has licensed the filler to Medicis in the US

Q-Med makes several different fillers and does license the rights to Restylane and Perlane to Medicis in the US. I agree with all the comments below concerning safety and outcomes. My favorite saying is “The results don’t depend on the filler, but the filler (injector).”

Q: How Long Can Open Restylane Last if You Are Getting Touch Ups?

A: One study says opened Restylane lasts 9 months

There has been a study on the sterility of opened Restylane. The study concluded that an opened Restylane syringe stays sterile for at least 9 months.

Q: Restylane vs Juvederm

A: The physician is more important than the dermal filler brand

I agree with Dr. Persky. Either is a good choice. My preferences are:

Eyes – Restylane
Lips – Juvederm
Nasolabial and Marionette – Either, but I lean towards Juvederm.

Remember, it’s the Doc that’s most important. A physician trainer for other physicians is a good choice, but not necessarily a requirement. Steve Weiner, MD Facial Plastic Surgeon.

Q: How Long Should I Wait Before I Get my Restylane Injections “Topped Up”?

A: My style is to not wait until it is completely gone

This is more of a question about doctor’s style. There is no right answer. My style is to touch up the previous injection when the correction appears to be waning. It makes more sense to me to walk around with a full or near full correction most of the time then to have swings from full correction to no correction. There is no problem with putting a different filler on top or using the same filler. In some areas, like the lips, sometimes a mild enhancement is done initially. Then, before it is gone, I will enhance the lips further than the original results if the client desires large, full lips. This avoids the “coming out” with real big lips, dividing it up over time.

Q: Can Restylane Be Combined with Other Fillers to Lessen Side Effects?

A: Severe Swelling can be Angioedema

There have been cases of angioedema after injections with dermal fillers. This is an abnormal swelling, not just the usual minor swelling one gets after HA dermal fillers. The cause is usually unknow, but frequently it’s related to someone taking an ACE inhibitor antihypertensive (usually the medication name ends in -ace). It doesn’t always happen to a person who has had it before and it only very rarely will occur in someone taking ACE inhibitors. It can also run in families. There are measures you can take to help prevent it in the future like taking steroids before and after.

To have an actual allergy to HAs is extremely rare.

If you suspect angioedema is the problem, this should be worked up by your internist.

Q: Cause of Allergic Reaction to Restylane?

A: A granuloma is not an allergy

Granulomas are when the body reacts to a substance and considers it foreign material. The is an intense inflammatory response, but not an allergy. This creates redness and swelling. Steroids are usually given to reduce the swelling. Sometimes, dissolving the filler with hyaluronidase will resolve the problem too.

You can form granulomas with any filler. Also, it doesn’t happen every time you get the same filler.

Interesting, I was told that Radiesse forms the least amount of granulomas of the fillers, but I can’t substantiate that. Radiesse does form more nodules than other fillers, which is bumps that are not swollen and do not hurt.

I don’t have any personal experience with the granulomas, but have been to several meetings where they were discussed.

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

Steven F. Weiner, MD demonstrates the Liquid Facelift

Questions Answered by Dr. Weiner on Radiesse

This is Dr. Weiner from The Aesthetic Clinique, demonstrating a Liquid Facelift. A Liquid Facelift is when dermal fillers are used to replace lost volume in the entire face which has occurred due to aging, exercise, and/or weight loss. With no incisions or cutting, you can lift the skin around the eyes, upper cheeks, and improve the jawline and upper neck by just injecting fillers. He uses Radiesse, Belotero, and Xeomin to improve the tear troughs, temples, upper and lateral cheeks, preauricular area, jawline, jowls, nasolabial folds, lip lines, frown lines, crows feet, bunny lines, and forehead wrinkles. She had minimal bruising, and went to work later that day. Blunt microcannulas were used in all but the lip line area (the only area which bruised). www.theclinique.net 850.622.1214