Hyaluronic Acid-Based Fillers (Restylane, Juvederm, Perlane)
Brand names containing hyaluronic acid include Restylane, Juvederm and Perlane. Hyaluronic acid is a naturally occurring polysaccharide (carbohydrate) that exists in human tissue. These are the most commonly used facial fillers and can be performed in the office, or under anesthesia if used in combination with other plastic surgery procedures.
I use Juvederm routinely to make my patients’ lips look fuller or fix asymmetries. As personal preference, this is the product I like the most in the lips. I apply it in a specific way to make them look NATURALLY fuller. I do not like the “duck” look that I often see on women. I also use these products to treat the nasolabial folds (which often makes a significant result) as well as frown lines and crow’s feet.
Hyaluronic acid fillers are said to offer longer lasting results than collagen-based fillers. Restylane and Juvederm are FDA-approved for certain cosmetic purposes and used off-label for others.
Here are two examples of Juvederm enhanced, naturally looking lips
Calcium Hydroxylapatite (Radiesse)
Under the brand name Radiesse, each syringe contains CaHA particles that are suspended in a water-based solution (available in (0.3, 1, or 1.3 ml) to reduce the appearance of wrinkles and skin folds around the mouth and nose as well as fill certain scars. The filler is biocompatible, non-toxic, and non-allergenic; results last for up to six months or more.
Radiesse is FDA-approved for medical purposes and is used off-label for cosmetic treatment. It is not recommended around the lips because of its larger particle size. I most commently use Radiesse for the nasolabial folds and deep creases along the chin.
Synthetic Poly-L-Lactic Acid (Sculptra)
Synthetic poly-L-lactic acid, also known under the brand name of Sculptra, is a synthetic but biocompatible material derived from natural sources. Sculptra treats skin folds, indented chin, hollowed cheeks, and sunken eyes. Results last up to two years. People usually require multiple initial treatments to obtain a fully satisfactory outcome and then receive maintenance treatments in order to continue to see results. Sculptra is believed to stimulate collagen growth so it’s results are lasting.
Synthetic Polymethylmethacrylate Microspheres (PMMA)
in Bovine-Based Collagen (ArteFill)
Under the brand name ArteFill, synthetic PMMA microspheres suspended in bovine-based collagen can improve skin folds such as nasolabial folds. Results are immediate and continue to build over the course of time, lasting for up to five years. ArteFill was FDA-approved (October 2006) for treatment of nasolabial folds or smile lines.
This is one of my favorite products for the nasolabial folds. I often use it in combination with facelifts. The only downside is that because it is mixed with collagen, it requires a skin test prior to use. This is because 4% of the population has an allergy to collagen – however, the company that makes ArteFill reports that there have never been any allergic reactions to the collagen in their product.
Off-Label Treatments
In many medical treatment areas, including cosmetic injectables and fillers, you will often hear the term “off-label.” When the FDA approves a substance for medical or cosmetic purposes, it is for a very specific use. That FDA-specific use is printed on the label. But the FDA also allows physicians to use their own judgment. Physicians are allowed to prescribe fillers for newly discovered uses that were not originally included in the FDA-approval specification.
For example, Botox is FDA-approved for cosmetic use for lines between the eyes, but is commonly prescribed off-label for other areas of the face. Sculptra is FDA-approved for certain non-cosmetic uses, but is commonly prescribed for a number of cosmetic uses.
During the course of your cosmetic treatments, you may be prescribed a filler for a use that is not printed on the label. Cosmetic fillers are commonly used off-label, as many new applications are constantly being found.
Fat Transfer
In a fat transfer procedure, I will harvest fat cells from a discreet area of your body (belly, thigh, flank), prepare the cells, and then transfer them through an injection to the lip area, above or below the eyes, crow’s feet, nasolabial fold areas, and/or frown lines. I also will often use fat injections to augment areas in the face that have lost volume as part of a facelift procedure.
Because these are live cells from your body, fat transfer results are more unpredictable than dermal fillers, but in many cases last longer than those achieved through the use of traditional fillers.