Center of Dermatology and Laser Surgery of Philadelphia
Written by Dr. Ringpfeil
| price / syringe | lasts (months) | # treatments | |
|---|---|---|---|
| Juvederm Ultra / Ultra Plus | $680 (1.0 ml) | 6-12 | 1 |
| Voluma | $880 (1.0 ml) | 24 | 1 |
| Volbella | $750 (1.0 ml) | 18 | 1 |
| Volbella (Half Syringe) | $480 (0.55 ml) | 18 | 1 |
| Vollure | $750 (1.0 ml) | 18 | 1 |
| Boletero | $680 (1.0 ml) | 6-9 | 1 |
| Restylane | $600 (1.0 ml) | 6-9 | 1 |
| Radiesse | $750 (1.5 ml) | 6-12 | 1 |
| Restylane | $600 (1.0 ml) | 6-9 | 1 |
| Artefill | $900 (0.8 ml) | Permanent | 1-2 |
Purchase of a full syringe is required. When only a partial syringe is needed, the remainder can be injected to another area.
You can now regain your youthful appearance by reducing deep facial wrinkles, restoring volume to eliminate darker areas under the eyes, and plumping your lips with Juvederm or Restylane – two of the cosmetic fillers that revolutionized the specialty of cosmetic surgery. Its younger cousin, Belotero Balance, has replaced injectable collagen.
With no downtime, contouring fillers replace what until the beginning of the millennium was possible to achieve only with invasive surgeries or facial implants.
The effect of Restylane, Juvederm, and Belotero Balance are appreciated within 1-10 days after injection. After several months, these synthetic hyaluronic acid fillers are naturally degraded by our body’s own hyaluronidase enzyme. To maintain results, these fillers need to be renewed every 6-9 months.
As we get older, we may crunch forehead lines because we use the forehead muscle to take weight off of the eyelids. In this case, Botox & Xeomin to the forehead muscle is not the right treatment. Instead, we would consider a chemical brow or lid lift by placing Botox & Xeomin here (corrugators) and here (tail of brow). If laxity is too pronounced for Botox & Xeomin to make a difference, surgical lid and/or brow lift should be considered.
Starting on the forehead, the frequent raising of the brows as part of our facial expression when we are younger can eventually lead to horizontal forehead lines. Botox & Xeomin distributed in small aliquots equally across this flat sheet muscle will relax these lines and will help you unlearn to subconsciously use this muscle. In people who have a predisposition to developing a Spock eyebrow, Botox & Xeomin may have to be placed here (lateral lower forehead) at the time of the first injection or with a delay of 14 days.
Moving to the glabella, the interaction between a bellied vertical muscle (point to the procerus) and 2 fan-shaped muscles that trail upward and outward (point to corrugators) creates one or two vertical lines that make us look angry. Placement of Botox & Xeomin to 3 or 5 different points in this area (pointing to the V created by these muscles) allows us to look relaxed again.
The downtime and durability of Restylane and Juvederm differ slightly due to the different amounts of cross-linked hyaluronic acid in each. I like both Restylane and Juvederm and in my opinion, both have their place. Although they can be applied to the same areas, I might favor one over the other. Restylane and its finer counterpart, Restylane Silk, work well for under eye troughs. Restylane Silk and Belotero Balance are great for etched lines, such as the vertical ones above and below the lips, as well as the ones that some people create around their mouth. Juvederm ultra plus is my favorite for deeper nasolabial troughs and nothing comes close to Juvederm ultra for reflation of a thinned lip.
Treatment with Restylane, Juvederm, and Belotero Balance is easy and safe for nearly everyone. Some swelling, redness, and bruising may occur and can last up to 14 days.
The only contraindication to these fillers is an allergy to numbing medicine which is factory premixed with these fillers except Belotero Balance. An allergy to hyaluronic acid is almost impossible, yet those with a myriad of allergies are not suited to receive filler injections as their immune system is already in overdrive. Avoidance of aspirin, ibuprofen, fish oil, vitamin E, and St John’s wort for 7 days prior to the procedure is the only preparatory step necessary.
Over the years, our facial contour changes. When we look in the mirror, it may seem like invisible weights are pulling down on our cheeks, giving us an unflattering “droopy” face. In reality, the natural fat in our cheeks that is abundant during our youth gradually degenerates. Muscle also loses its volume and the underlying bone becomes thinner and changes shape. The result is loss of midfacial contour (point to cheek bones and medial cheeks), accentuation of nasolabial folds (point to them), grooves on the side of the chin (point to marionette lines), and jowl formation (point to jowls). Lifting fillers, such as Restylane Lyft and Juvederm Voluma, restore volume to the cheeks to provide a subtle facial “lift” without having to undergo plastic surgery.
Restylane Lyft and Juvederm Voluma are safe and effective alternatives to a surgical face lift. These synthetically made hyaluronic acid fillers add volume and soften the appearance of facial folds by attracting water to the injected site. Results are seen as quickly as within 1-10 days after injection. These fillers are eventually degraded by our body’s own hyaluronidase enzyme.
The greatest difference between Restylane Lyft and Juvederm Voluma is the duration of their results. Restylane Lyft lasts for up to 12 months, while results with Juvederm Voluma can last for up to 2 years. These differences were measured in different locations and are not absolutely comparable.
In real life, we observe that fillers placed over the bone tend to last longer while those placed in areas with mobility degrade faster. Therefore, you can usually expect these fillers to last for up to 2 years to reflate the mid-face and for about 1 year when used to augment troughs created by movement such as nasolabial folds with smiling.
Few contraindications to Restylane Lyft or Juvederm Voluma exist. The most important contraindication is an allergy to an ingredient within the products, specifically lidocaine or xylocaine. Hyaluronic acid is one of the main building blocks of our skin and a true allergy to this molecule does not occur. However, if someone has many allergies including many dietary or pollen allergies, his or her immune system is on hyperalert and may reject anything offered to it. This person is simply not a candidate for filler placement.
Lifting fillers can cause bruising, redness, swelling, pain, tenderness, or itching at the injection site. If experienced, these effects typically resolve within 2 weeks. Bruising can be minimized with microcannula injection when possible. It is recommended not to take pain medication like aspirin or ibuprofen and blood thinning supplements such as fish oil, vitamin E, and St. John’s wort for 7 days before the intended procedure.
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