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Dermal fillers: Are there any differences?
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Many of the patients seen in my office are interested in improving the lines and wrinkles around their eyes and mouth. These are some of the most common changes associated with the aging face and skin. Fortunately, there are a wide variety of treatments that can help. These treatment options range from surgical procedures (facelift, eyelid lift or blepharoplasty, lip advancements, and corner of the mouth lifts) to conservative treatments such as laser resurfacing, BOTOX® and dermal line fillers.
Dermal line fillers have been increasing in popularity over the past 10 years. The most common fillers used today are made of a sugar substance called hyaluronic acid (Restylane®, Perlane® and Juvederm™) . This is a naturally occurring sugar that is manufactured in a way that keeps it from breaking down over a long period of time. It is not an implant nor does it come from other animals. Patients therefore do not need to be skin tested (as was the case with collagen). The filler in non-immunogenic, meaning your body does not recognize the substance as foreign and allergic reactions are extremely rare. Other dermal fillers such as Radiesse® and Sculptra® are made of different materials. Radiesse® is a calcium based filler and Sculptra® is made of poly-L-lactic acid.
Which filler is best for enhancing the lips?
Different physicians will recommend a variety of injectable fillers to help improve the appearance of the lips. I have found that the best results come from a conservative injection that defines the lips more than just adding volume. Perlane® has been the most beneficial lip filler in my patients. It is a little thicker than Restylane® and Juvederm®. When placed in the border of the lip (cupid's bow), patients achieve a well defined lip appearance without looking overdone. Perlane® is also very soft and does not tend to form "lumps" as much as other fillers. A well-defined lip is the goal.
If a patient already has well-defined lips and just needs additional volume, then Juvederm™ is the filler of choice. Juvederm™ is the thinnest of these fillers and when injected, it tends to spread out under the skin surface. This property makes it very soft and even after injection. However, because it spreads out more than Perlane®, it is difficult to give the lips good definition of the border (cupid's bow).
Which filler works the best for softening the cheek-lip grooves?
My choice for reducing the groove between the upper lip and cheek is Restylane®. This injection is performed a little deeper to the skin surface and thus requires a filler that can give the best volume. Restylane® is a medium thickness filler, but it comes in a pre-filled syringe that has about 20% more product more than Juvederm Ultra™ or Juvederm Ultra Plus™. Restylane® holds its structure very well and can last for up to 12 months in this area. Radiesse®, a calcium based filler, is another good choice for the cheek-lip grooves. However, it is a while substance that may be visible
The drawback to Restylane® is that is can be a little more "lumpy" than other fillers. It does not work well in superficial lines around the mouth and should not be injected very close to the skin surface.
Which filer is best for fine lines around the mouth?
Juvederm™, the thinnest hyaluronic acid filler, is the best choice for these patients. Because it is thin, it can be injected close to the skin surface. This allows very fine lines to be improved without being noticeable. Juvederm™ is also good for those very fine lines showing up in the skin of the upper and lower lips.
Overall, discuss your treatment goals in detail with your physician. Talk about the different fillers and decide which one would work best for you.
For more info: The Sandel Center for Facial Plastic Surgery in Annapolis, Maryland. Call Dr. Sandel at 410-266-7120. Go online at www.sandelcenter.com.
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