Restylane™ - Related FAQ's

Q: My doctor injected Restylane into my smile folds but one looks weird when I smile. It was done a week ago and is not getting better. Can this be improved?

A: Some people have unusual muscle insertions into an area of the cheek for them to be able to smile, and it can apply much pressure to the dermis and fillers once placed there. Big smiles can squeeze the filler to an adjacent area. If this has occurred, then your doctor can dissolve the Restylane by injecting hyaluronidase on the one side that looks unnatural.

Q: Are there differences in fillers? I want to have my smile folds treated and one doctor said I should use Radiesse and another said Restylane. Which is better?

A: There are multiple fillers from which to choose. There are some variables though such as the depth of injection needed, the location of the region (some can swell more than others) and the amount that is needed that might change the provider's mind as to what the best filler is for that particular situation. Juvederm Ultra and Restylane are thought to be comparable but I find somewhat more swelling in the lower eyelids with Juvederm than Restylane. Restylane has a stiffer property, the G prime, and if an area needs lifting especially, then the Restylane might be better than Juvederm. Perlane is a larger particle than Restylane so it is designed to be placed more deeply than Restylane, as Juvederm Ultra Plus is injected deeper than Juvederm Ultra. Radiesse is a more viscous substance with a much greater Gprime than Restylane or Juvederm, but this is lessened, purposely at times, by adding some local anesthetic to the Radiesse. Either the Radiesse or Restylane will probably be good for you if your doctor so indicates. If you have never had this done and are very concerned about the appearance, keep in mind that the Restylane, Perlane and Juvederm fillers can be dissolved by Hyaluronidase, an enzyme that is injected into the filler, and this quickly flattens lumps. This dissolving, however, is not available for Radiesse!

Q: My friend was treated with a filler for her "11" creases on the forehead between here eyebrows. She just didn't want Botox. She developed an immediate redness on the forhead and the doctor has been following her for some scabbing. He said that a blood flow might have been compromised. I have an appointment for fillers in my smile folds (I go every year) next week and now I'm worried. Is this common?

A: This complication is very rare, but as it is known, physicians do not use thick fillers in the glabella (between the eyebrows) for this reason. This dates back to the days of collagen (from cowhide) injections and we didn't use Zyplast in this region. Thin fillers, used carefully, such as Restylane and Juvederm Ultra, off-label, can be used carefully in this area.

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