Question:
What’s the difference between Restylane and Juvederm? Is one better for facial wrinkles?

Answer:
Both Restylane and Juvederm are made of hyaluronic acid, which is a clear gel and is a naturally occurring substance found in our own bodies.  They differ in the way that it is manufactured and that Restylane goes through a process where the gel is essentially pushed through a screen creating very tiny particles of this gel, whereas Juvederm is processed in a way that creates a very smooth, non-granular gel.  There are differences in their chemical properties and viscosities and cohesiveness because of these different manufacturing processes, but overall they are relatively similar in their effect and longevity and I certainly use both of these products on a regular basis. 

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Question:
I have deep wrinkles above my lip. Would Juvederm be a good treatment for these?

Answer:
If you only have a few very deep wrinkles in the upper lid then Juvederm certainly is an excellent option as we can simply fill these deep lines with the product and it should last nine to twelve months.  If you have multiple deep lines across the upper lip then it gets to be rather difficult to fill these with Juvederm without giving the upper lip an overly plump appearance.  In that circumstance I typically recommend a deep laser resurfacing since this will permanently remove those wrinkles allowing you to start with fresh, smooth skin again.  Over many years these wrinkles will return, but this takes an extended period of time.

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Question:
I had Juvederm injected into my lips and they look good except on the underside of the upper lip, like if you are below me and looking up, my lip looks duck-ish. Will this improve at all?

Answer:
If it has been more than a week since your injection then it is doubtful that you are going to have a significant amount of improvement since all of the swelling should have resolved.  If you did have a bruise there then maybe you will have some additional improvement over the next week or so, but if it does not continue to improve I would recommend discussing this with your injector to see if there is anything that can be done about it.

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Question: My coworker recently suggested a Botox treatment to reduce the wrinkles around my mouth. I have heard this injectable is derived from the pathogen that causes botulism. Can Botox have negative side effects?

Answer: Well, your friend is correct that Botox is a derivative of the chemical that causes botulism but, used under very controlled circumstances, can do a wonderful job of improving lines on the face. The specific lines that you mentioned, which are the lines around the mouth, are much more difficult to treat with Botox since we do not want to overly relax the muscle around our mouth for fear that we would then cause difficulties with our ability to drink, eat, and speak and this obviously would not be warranted for a cosmetic improvement in wrinkles. I, therefore, occasionally use Botox in and around the mouth but much more frequently either recommend filler injections such as Juvederm and Restylane or will recommend a laser resurfacing, which can provide an excellent improvement in wrinkles around the mouth.

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Question: I am a 56-year-old female who had a midface lift about 7 months ago. I have noticed some of my skin still sags around my nose. Is there another alternative to help fix this problem?

Answer: I am personally not a big fan of using midface lifts alone to try and improve the smile line from the nose down towards the corner of the mouth. My personal experience is that a deep plane facelift would do a much better job of effacing this fold than a standard midface lift would. With that being said, an easy remedy for your problem is simply to fill this area with some Juvederm or Restylane or even consider Radiesse or Sculptra as well. Another possibility is to consider cheek implants if you have a significant degree of volume loss in that area.

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