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:
What’s the best injectable for the lips? I’m looking for something natural, not overfilled.

Answer:
I feel that the best injectable for lip augmentation is a hyaluronic acid filler such as Juvederm or Restylane.  This is a clear gel that can be highly customized in the way that it can augment the lip area.  As such, we can create very nice volume and yet give patients a very natural appearance.  Most patients get about six months of longevity, sometimes nine months and then a repeat injection can be performed.  I would highly recommend seeking out a very experienced injector since there is a significant art to lip augmentation and when the injector does not fully understand the implications of lip enhancement you can end up with rather awkward looking lips as opposed to a natural, luscious smile.

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Question: I am a vegan that only likes to use items that are all-natural and mirror elements that are already in my body.  Are there injectable fillers that are derived from natural substances or mimic their action?

Answer: The hyaluronic acid fillers are the most commonly used fillers in the world and hyaluronic acid is a gel-like material that is made up of sugar molecules all linked together and then cross linked, and these are found naturally in all mammalian tissue, so it is essentially the same chemical that is already found inside of our bodies.  Overall, these fillers, such as Juvederm and Restylane, work extremely well, are very well tolerated by patients, last a relatively long time, and are overall affordable.  In fact, they are so good at creating a natural rejuvenation that they are most likely going to overtake Botox as the number one used cosmetic treatment in America.   

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Question: It’s been a full day since I had Restylane injected into my lips and I now have duck lips and severe bruising. What can I do?

Answer: Since it has only been one full day, I would not get too concerned as this occasionally happens with lip injections.  The bruising is going to add more swelling and the swelling is going to give you more of a duck lip type look and you, therefore, just need to be patient and allow the swelling and bruising to subside.  You can accelerate the process by keeping your head elevated, staying active, and intermittently icing the lips, but it may take about a week for all the swelling and bruising to go away and at that point, your lips should look like they did immediately after the injection.  Hopefully, this will give you the look that you desire but, if it does not, Restylane is reversible with the injection of hyaluronidase.

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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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