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Our 5 physicians often answer questions from people like you posted on Realself.com about Juvederm, Radiesse, Restylane and Sculptra. We thought some of their answers might be useful for you.
Q: How can I get rid of deep undereye circles?
A: 1-2 units placed directly right under the eyelash margin to relax the muscle could improve the appearance. I would see a board-certified Dermatologist or Plastic Surgeon to be evaluated.
Q: Can Sculptra help treat a dent in the nasolabial area if other fillers haven’t worked well?
A: I would see someone who injects Sculptra frequently, because if injected appropriately it could help improve the appearance of the fold by building the cheek fat pads next to it.
Q: Can I have Juvederm Injections at 19?
A: Juvederm won’t “prevent” wrinkles per say, but can enhance volume if one has volume loss in a given area. Juvederm in the lips will provide a more fuller lip, and I would recommend treatment with a board-certified dermatologist or plastic surgeon for treatment.
Q: Is there a benefit of having Sculptra injections when young?
A: I like to use Sculptra to more naturally volumize the face, and commonly do use it for mid face atrophy and overall hallowness. Unfortunately nothing can really “prevent” aging if you will, as aging is something that is both intrinsically (ie: genetics) and extrinsically (ie: smoking, sun exposure) determined, but all of these treatments will help minimize the signs of aging.
Q: Can Sculptra cause an autoimmune disease?
A: There have been no reports that Sculptra causes autoimmune diseases, but I generally don’t recommend Sculptra in patients who may have a connective tissue disease (which Vitiligo is not) or are on immunosuppressant medications (as they may interfere with the collagen production Sculptra induces).
Q: Can Sculptra be performed safely with other fillers?
A: There are no published reports or known contraindications to avoid Sculptra and hyaluronic acid based fillers in the same treatment session or days apart. Of course you want these to be injected by someone is experienced in injecting both, and recommend either a board-certified Dermatologist or Plastic Surgeon. I commonly do both in my patients, even on the same day, as they are typically injected in different tissue planes, and commonly address different concerns.
Q: Can longevity be affected by the number of Sculptra injections?
A: In the PLLA studies, patients who showed improvement past 24+ months typically had 3-5 vials, which is why doctors typically say that is how many it takes to maintain those results. I typically inject the amount needed, whether it is 2-4 vials, 1 vial per month, until correction is achieved, and then wait 6 months to do the subsequent vial, and maintain those results by doing roughly 1 vial a year.
Q: Why can’t too much Sculptra be removed with liposuction?
A: Sculptra cannot be removed because it stimulates collagen production, so the results one sees are from collagen deposition, not fat which is what is removed with liposuction. Luckily the results from Sculptra are not permanent and gradually go away with time.
Q: Could I have developed an infection or nodule from Sculptra if I have a strong feeling one month post treatment?
A: It is difficult to comment on this without examining you, but if it is a nodule, an injection of 5-FU with or without steroids could help bring it down without the risk of a divet.
Q: Can Sculptra results be seen only 5 days after treatment?
A: Sculptra works by stimulating new collagen production. It typically takes at least 1 month to create enough collagen to have a clinical result, so after 5 days this is unlikely related to the treatment and just swelling that will go away. No studies have been done to determine whether fast metabolizer’s results are shorter, as Sculptra stimulates your own collagen it is not a synthetic filler, so you are not necessarily “metabolizing” it, but if you do lose weight secondary to your high metabolism, you will continue to lose fat in your face, just not the new collagen per se.
Q: Is Sculptra a good treatment for improving lines around the eyes to cheeks?
A: These lines are typically not as successfully relaxed with neuromodulators, as they are due from volume loss in the lateral cheek fat pad. I do use Sculptra commonly to volumize the cheeks, with great success in softening the resulting lines that form along the cheeks.
Q: Can swelling be an indication that you were injected with too much Radiesse?
A: Swelling from any filler, especially Radiesse can take up to 2 weeks to settle down, at which time one can definitively say whether there was overcorrection.
Q: Can Juvederm be used to remove brow lines and sunken under eye area?
A: You can always go back to the doctor who injected you and ask to have the product melted away with an injectable enzyme called hyaluronidase.
Q: Is it normal to be tender after Juvederm injections 5 weeks ago?
A: It sounds like you may have developed a cold sore, I would see a dermatologist so you can be evaluated and properly treated with anti-virals if it is in fact a cold sore.
Q: What’s Better for Lip Enhancement: Restylane or Juvederm?
I’m wondering which of these two products is better for lip enhancement. To my understanding, restylane is FDA approved for lip injection, while juvederm isn’t.
A: Restylane or Juvederm?
Both products work well for lip enhancement. In my hands I prefer Juvederm for most lips, while I prefer Restylane for other facial sites, depending on volume deficit. You are correct though, Restylane is the only hyaluronic acid presently FDA approved for lip enhancement. Your doctor will choose the best filler for you depending on the structure and size of your lips, the level of volume restoration you are aiming for, and their personal preference/experience.
Q: How Do I Fix my Over-filled Lips?
I just had Restylane injected yesterday and my immediate results were a tad too plump but was assured it was swollen. Now, the next day, they are ridiculously large. What can I do? I feel so foolish for messing with my face.
A: Swelling after Restylane in the lips
Swelling can be present for a week after filler injection. So I wouldn’t judge your results quite yet, but may want to notify your doctor so they reconsider the volume amount they inject in the future. If you are experiencing pain or itching, you should notify your doctor. Good luck.
Q: Restylane for Dark Circles?
What Are My Options Before Doing a Fat Graft? I always had dark circles. In the past few years, they got worse. I am so tired of trying to hide using makeup. After some research, I think that besides my genetic predisposition, the hollow under my eyes are worse than it used to be. Do you think that using a filler I would see some improvement? (I am realistic and am not expecting to get completely rid of it). I don’t want to do fat graft before trying a temporary filler. Also, any tips on helping me find a good doctor in my area? Thanks!
A: Lasers and injectables for dark circles
A component making your dark circles worse is underlying volume loss, which is contributing to the hallowness you can appreciate. Hyaluronic acid fillers can be used to restore this volume nicely in the hands of a qualified practitioner. Fillers won’t address the entire problem. Lasers may be used to stimulate both collagen production and reduce some pigment of the skin under your eye, which are also factors that can contribute to what appears as a ‘dark circle.’
Q: Can Radiesse be used for the back of the hands?
Can Radiesse be used for the back of the hands?
A: Radiesse for hand rejuvenation
Yes. Radiesse is a great treatment to help rejuvenate your hands. Radiesse injections on the back of your hand will revolumize your hands so they look more youthful. If you have sun damage on your hands as well, you should consider IPL treatments. The combo of Radiesse and laser will give you great results and remove the signs of aging from your hands.
Q: How common is lip augmentation in men?
What gender specific techniques or guidelines work best for men?
A: Male lip injections
Recently more men have been showing interest in lip augmentation. There are obviously difference in female lips and male lips and therefore men should find expert injectors who understand the aesthetic differences. Men can benefit from lip injections with Juvederm or Restylane, but your goal should be to achieve results that are very natural looking and not over filled.
Q: How does lip filler vary from person to person?
What characteristics make lip filler a good choice for someone? If someone is a good candidate for lip filler, then how do they determine what kind to use? Is longevity of the filler one of the major factors for choosing the right filler?
A: Best filler for lips
I prefer using either Restylane or Juvederm on my patients for lip injections. They create slightly different results, so an expert injector will be able to help you decide which one is best for you, depending on the results you are hoping to achieve from your lip augmentation. The longevity of the fillers are pretty equivalent. The lips are a delicate area, so please make sure you see a doctor is has a lot of experience with lip injections.
Q: How Safe is Botox when Applied to the Upper Lip for Smoker’s Lines?
Considering the fragility and the sensitivity of the skin area, is Botox a recommended option?
A: Fillers are best for smoker’s lines
Generally, smoker’s lines are treated with dermal filler like Restylane or Juvederm not Botox. Smoker’s lines appear due to a loss of volume in the area, so using fillers will restore the volume and decrease the appearance of the unwanted lines. In some cases, Botox can be used as well to treat the lines, but you should see an experienced injector to see what is best for your situation.
Q: Can Restylane lip injections cause the corner lip muscles to atrophy over time?
I have been getting lip injections with Restylane for three years. The corners of my mouth are thin and I resemble the Joker when I smile. Have the corners actually atrophied because too much was placed in the middle? Do I have to wait until all of the remaining dissolves before I can start again?
A: Restylane lip injections and the corners of the mouth
No this cannot happen. You need to see a more experienced injector who can modify the corners of your lips to give you the look you want.
Q: Which filler for marionette lines and is one syringe sufficient? Can a nurse inject?
My face is gaunt with loss of volume and several marionette lines when I smile. Would Juvederm work for this area? I’ve had Restylane in past and it made my skin appear blue and didn’t work that well. I’m hoping Juvederm will give a better result. Is one syringe enough (that is all I can afford at this time.) When I made the appointment, I was informed my plastic surgeon has a nurse do the injections. I trust my PS, but is this ok? Would one syringe be enough for marionette and a little in my lips?
A: Sculptra is best
I would suggest Sculptra as it seems you have lost a lot of fat in your cheeks, which is the underlying cause of the smile lines. I would suggest only letting an MD do your injections, especially if you move to a filler like Sculptra.
Q: What causes the bruising during lip augmentation?
How long can I expect the bruising to last after my lip augmentation? Why does this occur- is it due to surgeon technique or the filler itself?
A: Bruising from filler injections
Bruising is due to the surgeon’s technique. However, even the best injectors will often have bruising. Bruising should last up to a week, but most likely only a few days.
Q: Can Juvederm be taken out?
I had virtually no “pads” under the eye tissue and now there are these “pads”, worse on the side where the most Juvederm was injected. I asked about this possible problem before the treatment and was assured that any “swelling” would go away within a week. I carefully followed all of the post injection instructions but these areas have not subsided. Can this stuff be removed? The photos I’ve taken on on my phone and I could email them to you from the phone if you provide an address.
A: Yes it can be removed
Yes it can be removed. I would go back to see your dermatologist and discuss your options. Good luck!
Q: How can I verify that the dermatologist is highly trained in specifically Juvederm to tear troughs?
How do I make sure that a plastic surgeon/dermatologist is highly trained in placing Juvederm in the tear trough area ? In the past, I have gone to board certified dermatologist and she was also a trainer for fillers. However, I had a very very bad experience. Websites usually have few testimonials. Nobody likes to discuss that they had a filler placed under their eyes. A person could be easily fooled. For future, how do I make sure that I won’t have a negative experience ? Thank you
A: Patient reviews, ask to see before/after pictures, ask to speak to another patient
I would look for online patient reviews, ask to see before/after pictures of the under eye area, and you could ask to speak with another long time patient.
Q: Will laser facial hair removal treatment diminish the effect of the Juvederm in same area?
I am planning to have Laser facial hair removal treatments (7) in the area above my lips. This is the same area that I have had the dermal filler, Juvederm. Will the Laser treatments cancel out the filling effect of the Juvederm or diminish its longevity in anyway or even not be effective at all? Thanks for your answer to what I think is a simple question that the folks at Juvederm can’t answer.
A: No, you can do laser hair removal and Juvederm together
No, you can do laser hair removal and Juvederm together, I do this almost every day. The company probably cannot comment as there has never been a formal study done, but it definitely can be done.
Q: No results with Juvederm, does it take a few days to set in?
I had 1 syringe of Juvederm done to my smile lines yesterday. I am a 34 yo with very subtle smile lines. When I came home I found out that the injections were done right into a line on one side (where I developed a hard pea sized lump) and quarter of an inch OFF the smile line on the other side (where there is no improvement at all). Overall there isn’t any improvement to my lines. My smile looks uneven. Is it normal? Will the filler “set” within the next few days?
A: Not normally, but give it a few days and discuss with your doctor
Not normally, but give it a few days and make sure to discuss your concerns with your doctor. It could be poor technique depending on the expertise level of your doctor.
Q: Is it possible I had fake Juvederm injected into my lips?
I had Juvederm previously by a reputable plastic surgeon and loved it. He is in Beverly Hills though and I wanted to go somewhere local.Today I had my lips injected at a Med spa by a nurse. Everything was great, she took her time and they look fantastic. I am worried because it only cost $299. This seems REALLY cheap! Is there any way this could be a fake product? I didn’t ask to see the syringe. I am worried about the long term effects if this is not real Juvederm. Do fake products exist?
A: Fake fillers do exist
While I would never claim and believe that a medical professional would inject a non-FDA approved product into a fellow human being, It seems beyond belief that someone would loose money injecting Juvederm which costs more than $300/syringe to the physician into your lips. Yes, there are over 50 different fillers available worldwide and yes they can be illegally obtained in the USA. Therefore, when getting ANY medical procedure, make sure you are going to a licensed medical doctor who you trust. You have only one face and it should last forever. Injecting unknown or non-FDA approved products into your face can have severe and dire consequences. Let’s hope there was a billing error.
Q: Radiesse nodule under eyes
I had Radiesse injected under my eyes 8 1/2 months ago. (Biggest mistake of my life!!!!!!) One eye continues to have a large nodule (pea-sized, tear drop shaped) that does not seem to be going away. I have had a series of steroid injections, but the nodule remains almost the same size. Will the nodule eventually go away on its own? If so, when? Should it be getting gradually smaller each month? (it’s not!) At what point should I consider surgical intervention? Please Help!!
A: Radiesse under the eyes
There is no simple solution to incorrect application of Radiesse. The vehicle dissolves away slowly, but the fibroplasia will probably limit the usefulness of surgical extrusion of the material after 1 to 2 weeks. Surgical excision would cause unnecessary scarring. Triamcinolone acetonide injections will reduce the swelling and fibroplasia but will not have a major effect on dissolution and may lead to fat atrophy. Radiesse dissolves away rapidly in some individuals, but the correction can last for years in others. Radiesse is excellent for volume loss correction when injected smoothly and deeply in areas where there is plenty of overlying soft tissue. In the infraorbital hollow, the cautious injector would consider a hyaluronic acid–derived filler so that hyaluronidase could be used in the event of any volume-related adverse events. This is a particularly important consideration in the case of a less-experienced injector. This case also highlights the dangers of nonphysician injectors and physicians working out of their specialty training.
Q: How do Juvederm and Restylane compare, safety-wise?
A: Both equally safe
Both Juvederm and Restylane are equally safe, they are both hyaluronic acid (HA) fillers so you should feel comfortable with either.
Q: What alternatives to Restylane do you recommend for lips?
Which filler is the least painful and longest lasting for lips?
A: Juvederm
Juvederm is the best for the lips, if you do not want Restylane. The technique and skill of the physician will help reduce the pain.
Q: Beside Hyaluronidase, can Restylane be removed surgery ?
Beside Hyaluronidase to dissolve Restylane, can Restylane be removed by surgery? I had injected Restylane 4 months ago, but now, 2 side at my cheek have blue bruise, seems like it will never fade away. But I don’t want use Hyaluronidase.
A: Hyaluronidase is the best option
Hyaluronidase is the best option, I do not think any physician would surgically remove the Restylane. If you really do not want hyaluronidase, then give it time, Restylane is not permanent and should last 6-9 months.
Q: Pain level of Restylane treatments?
How painful are Restylane injections for wrinkles around the mouth? Since it is a sensitive area, do they use a local anesthetic?
A: Yes, anesthetic is put into the product
Yes, anesthetic is put into the product, and can also be applied to your lips/face before the treatment begins. With this, they are not very painful. It also depends on whether you go to an expert injector as technique is relevant.
Q: Sculptra Pain Medication?
I am considering 2 vials of Sculptra to my cheeks and jawline for my initial treatment. What is the best pain med. that could be taken to endure the procedure? Should I ask for a script or is over the counter Tylenol enough for the pain?
A: You can use topical anesthetic and oral pain medication
You can use topical anesthetic, applied to your skin before treatment. Oral pain medication can also be used, just talk to your doctor they will prescribe you something.
Q: Can I get rid of Sculptra with sunshine?
A year after Sculptra and my cheekbones are still too big. If I go out in the sun leaving the cheekbones unprotected will they go down more quickly? Thank you.
A: No, sun exposure will not effect Sculptra
No, sun exposure will not effect Sculptra, it will go away naturally with time. please share your concerns with your physician.
Q: Is this normal swelling after Sculptra or should I be worried?
I had Sculptra injected yesterday in my temples, upper cheek area and it looks great, I know this is water/swelling and will go back down etc. However, I look like a chipmunk in my lower face as you can see in photo. Is this kind of swelling in the lower area “normal” for some people? If so, about how long until I can expect some relief and is there anything I can do to help it along? I have an ultrasonic (ultrasound) facial cleanser and know this is great for swelling, should I use?
A: Looks worse than normal, see your doctor
That swelling looks much worse than normal, you should go back to see your doctor asap to ensure it is not a hematoma. Although some swelling and bruising is normal, you should follow up with your physician if you are concerned.
Q: Sculptra in hands
I am considering in having Sculptra in my hands, due to my veins showing, I have very Very thin skin, and in the summer its worse. I am very concern about this because I am only 29 year old. Should I wait a little longer? Any advise? I have been to two doctor and due to my very thin skin they dont want to do it. Help
A: Sclerotherapy or Radiesse injections are better than Sculptra for your hands
There are many ways to limit the appearance of veins in the hands. Sclerotherapy will remove or decrease the diameter of hand veins and works very well. Injections of Radiesse or fat into the dorsal hands also works well. I do not recommend using Sculptra on the back of the hands. I have found that Sculptra has a high likelihood of causing hard bumps in the hands due to the constant movement of the tendons that control finger movement.
Q: How long after Active and Deep Fraxel procedures can I get Sculptra injections?
A: Sculptra and lasers can be performed at the same time
Sculptra injections are commonly done at the same time as the Active and Deep FX or any other laser procedure. The lidocaine mixed into the Sculptra provides some anesthesia to make the laser procedure less painful. I usually perform Sculptra treatments every 4 weeks. The treatment can be performed irrespective of the time of any laser procedure.
Q: Can Juvederm Ultra Plus injections in nasolabial folds cause broken capillaries and redness?
Four weeks ago I received 3 vials of Juvederm Ultra Plus in my nasolabial folds and cheeks (apex of zygoma). Not only do I now have exaggerated puffiness above the smile lines (closer to nose than cheek injection area), I have red skin discoloration throughout my nasolabial folds and many broken capillaries that never existed pre-treatment. My smile is now also quite hideous and looks like a Joker’s grin. Do you recommend that I get hyaluronidase injections to remove the filler?
A: Juvederm Ultra Plus can cause redness if placed too superficially
Yes, this is a common adverse effect. It usually is seen in patients who have received an excessive amount of an HA filler like Restylane™ or Juvederm™. It also may occur more commonly if the HA filler is placed too superficially in the skin. The good news is that the excessive blood vessels can be treated with a IPL or pulsed dye laser. If they are persistent or recur, then one can dissolve the HA filler with hyaluronidase or just wait for the filler to resorb.
Q: Juvederm injected ABOVE creases?
I had Juvederm injected today to soften my laugh lines. There was sagging cheek tissue above them, which bothered me. The doctor injected the filler ABOVE the crease, not in it, even though I expressed that I wanted more volume in the crease & in my upper cheeks. My actual parenthesis lines dont look much softer, but I fear this sagging ridge above them looks more pronounced as it is now filled, & my cheek bones look lower. He assured me this is how it is done?
A: Juvederm mistake can be corrected
If this is truly the care, it is most likely an error in medical judgment. It is correctable. One must first dissolve the filler using hyaluronidase placed expertly within the mis-placed filler. Then, your physician can inject the filler into the more appropriate area.
Q: Is Doing About “90″ Sculptra Patients in an Office, Enough Experience?
I am wondering if this is considered a lot of Sculptra injections. I keep seeing how you want to get someone who really knows how to administer the sculpture injection technique properly or it can cause problems. If so, what kind of problems?
A: Choosing an experienced Sculptra injector
I think 90 patients is a reasonable number of cases for the physician to feel comfortable with the product. Another important question is how long has the physician been injecting Sculptra. Since the product stimulates collagen over time, it would be good to chose someone who has been injecting Sculptra over at least a 2 year period so that they know how the results develop and how long the product seems to last. It takes a while for the physician to develop an artistic eye, know how much product a given patient will need, which faces are best suited for the product, etc. The main side effect that people worry about with Sculptra is the development of nodules. These are usually very small bumps under the skin, which typically do not show. Most go away by themselves over time. Nodules are largely technique dependent and also can develop if the patient does not massage the product afterwards as instructed.
Q: Will Juvederm work on shallow wrinkles?
I have significant nasolabial lines not just to my mouth, but down past my lips. I went to a local plastic surgeon, paid my $500 only to see absolutely no difference (except to my wallet). I went back to him and he said that the Juvederm I received isn’t really for the kind of lines I have, that it is intended for “folds” (this being after he’s paid). I think it has everything to do with technique and how it is injected, but since I really didn’t see any change, I’m wondering is he right?
A: Juvederm improves shallow lines but needs to be injected carefully
Juvederm can be used to improve shallow lines but one has to be careful. If Juvederm is placed too superficially it creates what we call a Tyndall effect and the product can actually be seen in the skin with a bluish cast. It can also be bumpy if placed superficially. This looks terrible! The problem is some lines are very superficial. The other available products like Restylane and Perlane also have this same problem. The other product available now for superficial lines is Prevelle Silk, but it only lasts about 2-3 months. Soon, a new product will be available for superficial lines called Belotero and it will last longer. Until then, what the physician can do is thin out the Juvederm with some lidocaine and use a tiny 32 gauge needle to try to improve the lines as much as possible but still avoiding the Tyndall effect.
Another approach is to laser these fine lines. This is the definitive treatment, but you’ll have to take time off for this treatment.
Q: Can Restylane injections damage my eyes?
I will be having Restylane injected for my under eye hollows. I am so afraid. I worry about retinal occulusion, and blindness. I also worry about long term effects. Can you give me your opinion about the procedure under the eyes?
A: Very limited complications from Restylane injections under the eyes
Although the injection of Restylane under the eyes is “off-label” (Not approved by the FDA), we have great results in the over 500 patients we have treated for this cosmetic indication. We have never had a complication that could not be easily fixed. The only complication that we have seen is a little lumpiness or blue tinge to the skin. If that occurs (as it has to less than 5 of our patients) we can use another medicine, hyaluronidase, to smooth out the lumps and take away the blue tinge. There has NEVER been a report of blindness from using Restylane to treat under eye hollows that I know of.
Q: How long does it take to see results from Restylane?
I had Restylane injections for Marionette lines 6 days ago. It looked improved at first, but now I don’t see too much of a difference. I called the MD office today and they said that the Restylane can take another week as it needs to absorb water. They said I should call next week if still no improvement. I went online and couldn’t find anything about this situation. Should I have gotten another product?
A: Restylane results should be seen immediately
When performed properly, results from Restylane are immediate. If they are not immediately perfect you need to see a dermatologic surgeon who is an expert in using facial fillers, like Restylane and others, to correct the problem.
Q: How long before Sculptra dissipates completely?
Hi, 5 vials Nov/Apr 2008/09 & 2 vials Aug 2009 gave a wonderful result. 1 extra vial (8th) in Oct 2010 in cheekbones to raise a jowl ruined my face with over-large broad cheekbones. It’s now May 2011. What to do?
I’ve heard a touch-up up to 36 months later can rejuvenate original effect, so will Sculptra effect ever dissipate completely so I can start again without fear of this result springing back? If so, how many depressing years will that be?!
A: Wait before more Sculptra treatments and find a qualified physician
The results or effect from Sculptra slowly resolve over 2-4 years. At this time I would wait before considering more fillers so your face can come back to a more acceptable shape. While Sculptra is an outstanding filler which I use on many patients, it does take some artistic and medical expertise to inject. That is why it is so important to go to a qualified physician. Seeing a physician now can help you both decide on what treatment or treatments would be best in the future.
Q: Considering Sculptra: Worried about over-correcting and being unable to reverse results?
Is it possible to do 1/2 vial of Sculptra on the first treatment? I’d like to minimize the risk of over-correction, i.e. I’d rather do 5 treatments instead of 3 but i want to make sure that i get the results i am looking for.
A: You can use half a vial of Sculptra
It is not uncommon for me to use 1/2 of a vial per session in those patients that only need a minimal correction. I agree that when using a filler that can hold its effects for many years, it is important to start slow and make sure you are being treated by a physician who is experienced and expert in using fillers.
Q: Is it safe to have an Affirm treatment immediately after having Juvederm injections?
I am planning on having Juvederm injections in my cheek area. How long should I wait before having Affirm treatments?
A: Affirm laser and fillers
The Affirm is a non-ablative fractionated laser that improves fine lines and wrinkles. Although I respect both of the doctors that answered the question, they are wrong. I published a research study that proved that lasers do NOT affect fillers placed under the skin in any way.
Q: Dark circles under eyes: Laser and Juvederm side effects?
Dark under eyes: One month ago a plastic surgeon used a laser to correct extra blood flow and Juvederm for the hollows. My eyes have been irritated (burning, tension) since.
A week and a half ago the doctor said the laser probably caused dry eyes and I’ve been using extra strength eye drops day and night, but they’re still red and irritated.
Questions: Do you think it was the laser or could it be the Juvederm causing this discomfort? I don’t know if I should get the Juvederm removed or not?
A: Dry eyes after laser and Juvederm
There are many different lasers that can be used to improve the appearance of dark circles around the eyes and I don’t know what laser your surgeon used or the settings for that laser. In 20 years of using lasers to treat dark circles as well as blood vessels around the eyes I have never seen or heard of a patient that developed dry eyes. In our office we use the Q-Switched Ruby laser for dark circles and Cool Touch varia for blood vessels around the eyes and the Active and Deep FX fractionated CO2 lasers for wrinkles. We also use the Aluma or Thermage to tighten skin around the eyes.
It may be wise to get a second opinion for your problem.
Q: Should I have Restylane filler for my upper eyelid after asymmetry from blepharoplasty for lash ptosis?
In August 2009, I had a blepharoplasty done on both of my upper eyelids because I was experiencing discomfort from the eyelashes rubbing against my eye, and also because they were slightly inhibiting my vision. However, it left my right eyelid crease much higher than before causing a asymmetry. My opthamologist suggested using Restylane to fill in the right upper eyelid and help promote symmetry. But, I’m worried that the Restylane will push the eyelashes down again. Is this possible?
A: Eyelid surgery and fillers
Symmetry is beauty and a procedure that does not produce symmetry usually means that a second minor procedure to correct this is necessary. While going back to your first physician is always wise, sometimes a second opinion is helpful. Restylane, like any filler is only a temporary way to fix a problem. I have used Restylane in the eyebrow region but it is very tricky. The advantage is that if you don’t like the Restylane, it can be dissolved.
Q: Teosyal safe after Perlane?
Is it safe to use Teosyal filler if you previously had Perlane injected? Perlane was injected 3 months ago and wondering if there are any adverse reaction to using Teosyal in the same area (nasolabial)?
A: Using different fillers to correct skin folds
There is usually no problem using FDA-Approved fillers on top of each other or sequentially. Teosyal is NOT FDA-approved in the United States and cannot be used legally in the USA.
Q: What is the best alternative to a face lift?
Rather than get a facelift I would prefer a nonsurgical treatment. What do the doctors say works best for sag in jowls and loose neck skin.
A: Revolumizing the face with a filler
Revolumizing the face with a filler is the best alternative. Only your dermatologic or cosmetic surgeon can advise you if surgery is necessary or if the use of filling substances, such as Sculptra, fat, Radiesse, Juvederm, or Restylane will be best for you. At times a variety of fillers are used in one session.
Q: Best way to get rid of wrinkles – Professional strength solution?
I’m looking for a wrinkle treatment that really works. I’ve given up on the wrinkle creams and lotions, spending tons of money only to see my facial lines get deeper and my wallet get skinnier. I am aware of Botox and Restylane, but not many other wrinkle solutions (professional strength!!).
A: Superficial wrinkles and fine lines
Superficial wrinkles and fine lines – In addition to topical skin care with growth factor and antioxidant creams, a variety of non-invasive lasers have been found to be very helpful. These include the Affirm, CoolTouch, Fraxel, Active FX, Titan, and the like. Topical skin care takes at least 2 months to show an improvement. Depending on the type of laser, 1-6 treatments may be necessary to achieve the best effect. Topical skin care in addition to lasers works best.
Deep wrinkles, facial folds and creases – Surgery, such as face-lifts and the many names doctors call it like the “life-style lift” or mini-facelifts, are all very similar. The more invasive the procedure, the better and longer-lasting the results. Only your dermatologic or cosmetic surgeon can advise you if surgery is necessary or if the use of filling substances, such as Sculptra, Fat, Radiesse, Juvederm, or Restylane, will be best for you. At times a variety of fillers are used in one session.
Dynamic wrinkles – Botox or, when it is approved by the FDA in 2008, Reloxan are the only non-surgical methods for improving dynamic wrinkles. Endoscopic surgery may also work but is much more invasive.
Q: Can Botox be used to correct marionette lines? Is that possible?
What’s best for marionette lines? Botox or fillers? I’ve heard a small amount of Botox can be injected to correct marionette lines, is that true? If so, how about the tight feel it leaves? Is it safe? I had Botox in between my eyebrows and crow’s feet.I even like that tight feel it brings, but around the mouth area I feel it might be a different story. My doctor said I don’t need any correction to marionette lines, but suggested a small amount of Botox there if I really insisted.
A: Botox can reduce the appearance of marionette lines
In some patients, Botox can reduce the appearance of marionette lines. Fillers like Restylane, Perlane, or Juvederm can be used as well. Often times I will use Botox in combination with a filler to get the best result. Injecting Botox is this area is tricky and you can have complications which can be temporarily disfiguring so be sure to go to dermatologist or plastic surgeon that has a lot of experience with injectables.
Q: Is it safe to get hyaluronidase to resolve Restylane in the nose?
I recently opted for a Restylane injection on one side on the tip of my nose. This area is a little less full than the other side. I had the procedure done once before and it turned out great. However this time the doctor injected it to high into an area that did not need it and now my nose looks crooked. I would like to get the Hyaluronidase treatment to remove it yet I am worried about it damaging existing tissue since that area is already lacking in fullness. I have read conflicting reports.
A: Hyaluronidase excellent choice for removing Restylane
If you have already tried to mold the product into position and that hasn’t worked, dissolving it with Hyaluronidase is both safe and effective when diluted properly, injected in the right area, and depth, and injected by a specialized physician (dermatologist, plastic surgeon, etc). I have used the product without any complications.
Q: Can Elevess be removed?
I had Elevess injected into my chin to make it less pointy. I don’t really like the effect and there’s a lot of filler in my face that pulls on my lips. Is there anything that can be done to remove it?
A: Yes, it can be removed
Elevess is a hyaluronic acid(HA) based filler. Like other HA based fillers, it can be removed by having your physician inject hyaluronidase into the area. Depending on when you had the Elevess injected, you make still be experiencing some swelling, which could be contributing to the pull-down that you don’t like. I would wait at least 1-2 weeks if swelling is a factor, but your doctor can help determine that.
Q: Collagen injections for facial scars?
Can collagen injections| work on facial scars such as chicken pox scars? The old pock marks really bother me.
A: Collagen can help but there are other options
Collagen can help, but it doesn’t last very long and will need to be repeated every couple to few months. Restylane or Juvederm will last a bit longer. A long term fix is possible with laser resurfacing (fractional CO2, Fraxel restore, CO2), but this will be more expensive, may require multiple treatments, and will require some social downtime.
Q: Best treatment for shallow nasolabial wrinkles?
I have shallow nasolabial wrinkles, more like a slight indentation which leaves a shadow and makes me look old and tired. What could work for me? I am 44 years old, pale skin. I have used IPL, Titan and Botox on my forehead with great results. I am curious about fillers? Is it okay for slight indentation?? Everything I read about says deep folds.
A: Fillers are best for this
For shallow nasolabial folds, you could start with a syringe of Restylane (0.4cc), which is a small amount and is a great way to start if you are concerned about being overfilled. It will also offer the lowest cost. The other things you have mentioned (IPL, Titan, Botox) are not good for this problem. Juvederm Ultra is also an option, offering twice as much product, but at a higher cost.
Q: Permanent filler for tear troughs?
Is it effective to use a permanent filler like Radiesse or Artefill for my tear troughs and under-eye hollows? What are the risks?
A: Get a very experienced injector for permanent fillers
First, Artefil is the only permanent filler FDA approved in the USA. That being said, none of the fillers are FDA approved in this area. The tear trough area can be one of the trickiest and unforgiving areas to use fillers.
With that in mind, I do not recommend Artefil for this area. Radiesse is a good option, but not necessarily the best. Radiesse, if injected improperly, cannot be removed (except surgically, same with Artefil).
If a hyaluronic acid based filler, like Restylane or Juvederm, is used, and you don’t like the results, it can be removed easily by injecting a medication (Vitrase) that dissolves the product completely.
Results with these 2 fillers in the tear trough area can last 9 months to well over 1 year. Make sure you do your research and seek out a very experienced injector.
Q: Besides Sunken Cheeks, What Other Areas Respond Best to Sculptra?
I understand that sunken cheeks respond very well to Sculptra, what other areas respond well to Sculptra? I specifically want to use it on nasiolabial folds, the prejowl area and anterior cheek.
A: Best areas to treat with Sculptra
Sculptra is great for volumizing nearly the entire face. For a person who wants the nasolabial fold treated, the product is placed there but also in the upper mid cheek to lift the fold. This gives a prettier result than just treating the fold. Similarly, the prejowl area is often treated, but also along the entire jaw line to “pull back” the jowl. The anterior cheek is also a great area for Sculptra , as are the temples. All of the treatment helps to smooth out, lift , and rejuvenate the face. Areas that are not good for Sculptra are the lips and close to the eye.
Q: Can Restylane Travel into Other Parts of the Face?
I got injections three days ago, ( 1cc total ), mostly into my right nasal labial fold. A few months ago I had 2cc total ( by the same person), injected into both nasal labial folds and into the outer parts of my under eye area. The right is really a problem. I noticed the fold looks hollow again but just above the fold is a buckle as if the filler has moved. I’ve been pushing it back down but I don’t know if that is harmful. I’ve had injections before and this was never a problem.
A: Uncommon, but possible.
Although uncommon, fillers can migrate. I would go back to the person who injected you to be assessed. If it was a hyaluronic acid based filler it can easily be melted with some hyaluronidase.
Q: Lump from Restylane Under Eye?
I had a Restylane injection under eyes 3 years ago and it looked wonderful. 18 months later a lump “Almond size” appeared and still there 2 years after it appeared. What to do? The Dr injected cortisone 3 times a year ago and still nothing. What to do?
A: While possible, it’s best to get it checked out.
I have seen Restylane surface, especially under the eye area, up to 3 years after being injected. When it truly has been Restylane, it has responded well to hyaluronidase injections. I should be evaluated by a cosmetic dermatologist or plastic surgeon to determine if it truly is Restylane, or perhaps a nodule from another product or something different altogether.
Q: What Affects the Amount of Swelling and Feel of Restylane in the Lips?
I have had my lips injected with Juvederm and Restylane many times, always by the same nurse. I never had severe swelling in the past. This is the first time my lips are sore, and this time i feel the product in my lips. One side of my top lip feels like it has a huge lump in it.. I have scheduled another appointment with her to check the results this Saturday. I am worried and wondering what could have caused such different swelling and hardness.
A: Re-evaluation by your injector
The area around the mouth is a very vascular area prone to more bruising and swelling. Being re-evaluated by your injector would be a good idea. They will be able to determine if the swelling is simply from a hematoma (collection of blood) or a true collection of product resulting in a lump. If it’s product, it can easily be melted with hyaluronidase.
Q: Is It Safe to Continue Restylane in the Nose if I Have Red Spots 3 Months After Injections?
I had primary rhinoplasty 5 months ago. At 2 1/2 months post rhinoplasty I had restylane injected bridge and upper third as my nose was scooped. Since the injections I have spider veins and red spots on nose. I have thin skin and because of my rhinoplasty I am concerned about compromised blood circulation to my skin. Should I continue these injections or stop and consider a revision instead? If I continue the injections long term will it make a revision in the future difficult?
A: Exercise caution and reconsult with your plastic surgeon.
I would exercise caution with injecting too much Restylane in the nose. Very small vessels provide circulation to the overlying skin, and vascular compromise can result from injecting to much product. Prior surgeries in the area can also distort underlying anatomy. Also, if one has thin skin, to much underlying product may ultimately become apparent. I would consider reconsulting your original facial plastic surgeon for alternatives, given your defect.
Want more information about Juvederm, Radiesse, Restylane or Sculptra?
Please contact Goldman Butterwick Fitzpatrick Groff & Fabi, Cosmetic Laser Dermatology at 858.657.1002 for more information on fillers and to schedule a consultation. We are located in the UTC area of San Diego, minutes from La Jolla, Del Mar, and Downtown San Diego.
