Plastic surgery is extremely personal, and I depend on you to help me know what the best course of treatment will be. Sometimes plastic surgery is the best answer, and sometimes less is more appropriate.

Many plastic surgeons use Botox and Restylane in their practices. While non-surgical, these products are complementary to what we Plastic Surgeons do. For example:

Forehead Wrinkles and Frown Lines

Relaxing the frown lines and forehead wrinkles has always been a part of the Brow Lift procedure. If you have droopy eyebrows that are pushing skin onto your upper eyelids, deep wrinkles running across your forehead, or vertical lines between the eyebrows that make you look angry (frown lines), a brown lift might be for you. On the other hand, if you have the frown lines the forehead wrinkles, but the eyebrows and eyelids are fine, Botox, Dysport and Xeomin, may provide you with an equally attractive result.

Lower Face Wrinkles

Lower facial wrinkles include the Naso-Labial Folds (NLF’s), Marionette Lines (ML’s), lip lines and other wrinkles found on the lower face. These areas can be treated with a Facelift, when coexisting with lower facial skin laxity, but when found in isolation, a face lift is more than what is needed. Dermal fillers like Restylane, Juvederm, Perlane and Radiesse can pinpoint the treatment to exactly where it is needed, without the downtime associated with surgery.

Naso-Labial Folds (NLF’s)

The Naso-Labial Folds are the lines that extend from the sides of the nose down to the lips. They are the result of muscle attachments to the skin, and are deepened when we smile. The more firmly the muscle is attached, the deeper the resulting fold. Filling the NLF’s with Restylane, Juvederm, Perlane or Radiesse can reduce the appearance of folds without affecting the ability to smile. Unlike botox, dermal fillers do not inhibit motion.

Marionette Lines (ML’s)

The Marionette Lines are a continuation of the NLF’s, extending from the corners of the mouth down to the jaw line. These too are reinforced when we talk and smile broadly. Like the Naso-Labial Folds, the Marionette Lines respond well to fillers. The ML’s often require more volume than the NLF’s for what would seem to be wrinkles of similar depth.

Lip Lines

Lip lines are the fine lines that radiate out from the lips. Often referred to as Smoker’s Lines, the lines are formed when we pucker our lips. Lip lines allow lipstick to bleed, and can make maintaining a clean line at the edge of the lip difficult. By carefully filling in the edge of the lip, a smoothed contour can be formed, and less lipstick bleed occurs. This can be done with or without Lip Augmentation, or purposefully adding volume to the lips.

Facial Wrinkle Correction Before and After Photos

This segment focusses on dermal fillers, and shows numerous before and after pictures illustrating the areas more commonly treated with fillers like Restylane, Juvederm, Perlane and Radiesse. Wrinkle relaxers, like Botox, Dysport and Xeomin can complement results in facial wrinkle reduction, but were not used for the areas shown in these before and after pictures.

Facial Wrinkle Correction Video

Today’s video is from a recent appearance on KRON‘s Body Beautiful during which I discuss how to use minimally invasive procedures to achieve maximum results. The (415) number in this video was for viewers to call during the live broadcast. If you have questions about dermal fillers or botox, give us a call at (925) 943-6353.

Facial Wrinkle Correction Video Contents

This Facial Wrinkle Correction Video includes:

• Liquid Facelifts or Facial Wrinkle Reduction
• The effects of gravity and aging on the face.
• Who is a good candidate for wrinkle reduction treatments?
• Before and After Pictures of Dermal filler treatments
  • Before and After Pictures of Howdy Doody Line treatment
  • Before and After Pictures of Naso-Labial Fold treatment
  • Before and After Pictures of Facial Wrinkle treatment
  • Before and After Pictures of Acne Scar treatment
  • Before and After Pictures of Lip Augmentation
  • Before and After Pictures of Non-Surgical Rhinoplasty
• Dermal fillers used include
  • Restylane
  • Juvederm
  • Perlane
  • Radiesse
• Neuromodulators can also enhance the results of fillers. For example:
  • BOTOX Cosmetic
  • Dyport
  • Xeomin
• The best areas to treat with fillers
• Temporary vs. “Permanent” Correction

Who Am I?

I am a Board Certified Plastic Surgeon in private practice in the San Francisco Bay Area city of Walnut Creek, California, for almost 15 years. The development of injectable therapies has revolutionized the way facial rejuvenation is approached. While no substitute for real plastic surgery, they do allow for real improvement in appearance of facial lines and wrinkles, in ways that were just not possible before.

More Wrinkle Correction Information

Information on facial wrinkle reduction is available in English and Español. Please follow the links below:

• Wrinkle filler & wrinkle relaxer information, including Before and After Pictures, on Dr. Mele’s main web site.
• Reducción de Arrugas y Cuidado de la Piel
• Five part series on Lip Augmentation

More Wrinkle Correction Videos

This is part 2 of 4 below are links to the rest of the series:

• Wrinkle Correction – Fillers, Botox and Plastic Surgery – Part 1
• Wrinkle Correction – Fillers, Botox and Plastic Surgery – Part 2 (You are here)
• Wrinkle Correction – Fillers, Botox and Plastic Surgery – Part 3 (Coming soon)
• Wrinkle Correction – Fillers, Botox and Plastic Surgery – Part 4 (Coming soon)

San Francisco Bay Area – Leaders in Wrinkle Reduction

San Francisco Bay Area Plastic Surgery patients have always been at the forefront of facial wrinkle correction with fillers. It began in the 70′s with the local development of Collagen, and carries on today with its replacement, hyaluronic acid or HA.

Wrinkle Fillers – Restylane, Juvederm, Perlane & Radiesse

Like collagen, HA is a normal component of the skin, and is also found in our joints. HA dermal fillers are sold under many brands names, with the most popular being Restylane, Juvederm and Perlane. These clear gels allow for the correction of moderate to deep facial rhytids (lines) with minimal down time and quick improvement.

Wrinkle Relaxers – Botox, Dysport & Xeomin

Botulinum toxins have been used for years for the treatment of blepharospasm, a disabling chronic spasm of the muscles around the eyes causing functional blindness. For many years it was the plastic surgeons “secret” weapon, and used off-label, but a few years ago Allergan received approval for a new indication – the cosmetic treatment of frown lines. BOTOX Cosmetic was born. Others have followed with similar approval and results including Dysport and Xeomin.

Facial Wrinkle Correction Video

Today’s video is from a recent appearance on KRON‘s Body Beautiful during which I discuss how to use minimally invasive procedures to achieve maximum results. The discussion includes the use of fillers like Restylane, Juvederm, Perlane and Radiesse, and wrinkle relaxers, like Botox, Dysport and Xeomin. The (415) number in this video was for viewers to call during the live broadcast. If you have questions about dermal fillers or botox, give us a call at (925) 943-6353.

This Facial Wrinkle Correction Video includes:

• Liquid Facelifts
• Freshening up for special occasions
• Dermal fillers
  • Restylane
  • Juvederm
  • Perlane
  • Radiesse
• Neuromodulators
  • BOTOX Cosmetic
  • Dyport
  • Xeomin
• The best areas to treat with fillers
• The best areas to treat with neuromodulators
• Who is a good candidate for wrinkle reduction treatments?

As a Board Certified Plastic Surgeon in private practice in the San Francisco Bay Area city of Walnut Creek, California, for almost 15 years, the development of these injectable therapies has revolutionized the way facial rejuvenation is approached. While no substitute for real plastic surgery, they allow for real improvement in appearance of facial lines and wrinkles, in ways that were just not possible before.

More Wrinkle Correction Information

Information on facial wrinkle reduction is available in English and Español. Please follow the links below:

• Wrinkle filler & wrinkle relaxer information, including Before and After Pictures, on Dr. Mele’s main web site.
• Reducción de Arrugas y Cuidado de la Piel
• Five part series on Lip Augmentation

More Wrinkle Correction Videos

This is part 1 of 4 below are links to the rest of the series:

• Wrinkle Correction – Fillers, Botox and Plastic Surgery – Part 1 (You are here)
• Wrinkle Correction – Fillers, Botox and Plastic Surgery – Part 2
• Wrinkle Correction – Fillers, Botox and Plastic Surgery – Part 3 (Coming soon)
• Wrinkle Correction – Fillers, Botox and Plastic Surgery – Part 4 (Coming soon)

Dermal Filler to Treat Facial Wrinkles - Immediately after Perlane injections to Facial Wrinkles in the Naso-Labial folds with typical post-injection redness and swelling. The redness lasts about 24 hours, and can often be concealed with makeup.

Time flies when you are having fun, and I really enjoy being a Board Certified Plastic Surgeon in the beautiful San Francisco Bay Area. Clear sunny skies the weekend before Thanksgiving, and the rich diversity of the Bay Area’s culture remind me daily that it’s a great place to live, and to practice plastic surgery.

Experienced Hands

I am a board certified surgeon, who after completing my general surgery chief residency, spent three years as a fellow, specializing in plastic surgery right here in San Francisco. As a Board Certified Plastic Surgeon, my practice incorporates a wide variety of plastic and reconstructive surgery, but the majority of my time is spent performing cosmetic plastic surgery in Walnut Creek, San Ramon and Concord, California.

More Than 10,000 Procedures Performed

Time really does fly when you are having fun. A few years ago I performed my 10,000th procedure in private practice. Whether I am performing immediate breast reconstruction in the hospital, complex body shaping procedures after massive weight loss at an accredited surgery center, or a straight forward scar revision in my Walnut Creek plastic surgery office , the goals remain the same: maximum results, minimum recovery and happy patients.

Minimally Invasive Treatments

Sometimes less is all that is needed. A facelift is more than is necessary to correct moderate nasolabial folds (the lines that run from the sides of the nose to the corners of the mouth). As shown in the picture above, we have effective minimally invasive options in the form of dermal fillers like:

• Restylane
• Juvederm
• Perlane
• Radiesse

These provide a quick fix with minimal down time. They are called liquid facelifts, but they are not meant to be a substitute for facial plastic surgery. These dermal fillers reduce facial wrinkles in three ways:

• Physically filling the wrinkle
• Reducing skin folding by thickening the skin
• Coercing the body to build collagen

Correction – Right Where You Need It

The beauty of facial fillers is the simplicity with which they work. They do not require an extensive medical work up, and treatments are well tolerated. Brand-name fillers are supplied in pre-filled, single-use syringes that provide a sterile, consistent product. Since Restylane, Juvederm and Perlane are HAs, a normal component of your skin and joints, the risk of allergy is extremely low. They are great products to work with, and they work well, right where I put them.

Experience Counts

Now matter how great the product, the most important factor in having your wrinkles treated, is the person doing the injections. Precise correction is imperative. Enough filler must be used to maximize improvement. Too much will give unnatural results; too little leads to under-corection and minimal results. It is also important to place the dermal fillers smoothly to avoid lumps and bumps.

Injectables, by their very natural, are fluid. Care must be taken in the initial placement, and caution used in the hours after injecting to avoid displacement. Forceful squeezing of Restylane, Juvederm, Perlane of Radiesse can mold the result, for better or for worse. After a few hours, the gel is set, and displacement is unlikely.

Recovery After Injectables

Another attractive feature of injectable fillers is the relatively short recovery period. There may be some initial swelling and redness over the area injected, but this tends to resolve in a day or two. Bruising occurs in 10-15% of injections, and this can take several days to resolve.

Ice and elevation help speed the return to normal activities. It is important to inform your doctor if you are taking any blood thinners, and this includes over the counter pain medications like aspirin, ibuprofen (Motrin, Advil), Aleve, as well as, vitamin and herbal preparations like Vitamin E, Fish Oil, Ginsing, Ginko and many others. It is best to let your doctor know before you show up for your injection to avoid a delay in treatment.

Timing of Treatments

Dermal Fillers (Restylane, Juvederm, Perlane, Radiesse) and Muscle Relaxers (Botox, Dysport, Xeomin) last for months. If you are planning your wrinkle treatments around a specific date, do not procrastinate. Since swelling and bruising can last several days, it is ideal to have the treatments three weeks before your goal date. This provides time for correct, recovery and touch-ups in the event that it is necessary.

Dermal Filler Treatments

Dermal filler treatments are offered and performed every day in my office. For new patients, the procedure can be performed at the time of consultation, as long as there are no contraindications. If you are interested in finding out more about dermal fillers, give us a call at (925) 943-6353 or use the contact form on the left.

Also ask about Botox and Dysport. Since the Botox and Dysport not packaged for individual use, treatments are grouped around the first and third Wednesday of each month, or by special arrangement.

Botulinum Toxin

Botulinum toxin - Chemical Formula: C₆₇₆₀H₁₀₄₄₇N₁₇₄₃O₂₀₁₀S₃₂ Hard to believe that this reduces wrinkles!

The first standardized Botulinum Toxin was prepared for therapeutic use by Alan Scott, MD, a San Francisco Ophthalmologist, and Edward Schantz in the 1960′s. In 1980, Dr. Scott was the first to use botulinum toxin type a (BTX-A) to treat strabismus (crossed eyes) and blepharospasm (involuntary forceful squinting). He successfully treated many patients until 1986, when the inability to purchase liability insurance caused his US source to end production.

In December 1989, Allergan was the first company to receive FDA approval for the use of BTX-A for the treatment of strabismus, blepharospasm, and hemifacial spasm in patients over 12 years old. Thus Botox was born.

Botox was not approved for cosmetic uses until 2002; however, the cosmetic effect of BTX-A on wrinkles was published in the Journal Plastic and Reconstructive Surgery in 1989, by a plastic surgeon from Sacramento, California, Dr. Richard Clark

BOTOX Cosmetic® (onabotulinumtoxinA)

BOTOX Cosmetic was the First to Market for Wrinkle Reduction in the US.

BOTOX Cosmetic is manufactured and distributed by Allergan (Ireland, US, Costa Rica). Plastic surgeons have been using Botox “off-label” for years to treat wrinkles. BOTOX Cosmetic received FDA approval on April 12, 2002, to “temporarily improve the appearance of moderate-to-severe frown lines between the eyebrows” (glabellar frown lines or the elevens). The name for the wrinkle reducer was changed to BOTOX Cosmetic to provide legal “separation” from the Botox used for the treatment of other medical problems. To this day, Botox and all other forms of botulinum toxin, are only FDA approved for the reduction of the glabellar frown lines. Reduction of other wrinkles remains an “off-label” use

Dysport® (abobotulinumtoxinA)

Dysport (abobotulinumtoxinA) was the first Botulinum Toxin A introduced in the European Market, but Second to the US Market.

Dysport is manufactured by Ipsen (Paris), marketed by Medicis (Scotsdale) and distributed by McKesson (San Francisco). Dysport received FDA approval in late April 2009, and began shipping June 15, 2009.

Dysport has been a worthy competitor since its launch, and continues to offer efficacy at a reduced cost. Back by popular demand, the Dysport Challenge of 2010 has been extended, and the ante has been upped. The latest challenge is named “Think Outside the Bo**x” with the following details:

• Try Dysport by September 30, 2011 and get $50 back.
• If you have received BOTOX Cosmetic between 3 and 12 months before your Dysport treatment, get another $50 for making the switch.

Click here for a detailed comparison of -> BOTOX vs. Dysport.
Click here for more details about the -> Think Outside the Bo**x Offer.

Xeomin® (incobotulinumtoxinA)

Xeomin has finished its Phase III Trials and received FDA approval. It is expected to be available in the Spring of 2012

Xeomin is the latest arrival in the botulinum toxin business. It is manufactured by Merz, and has just received FDA approval for wrinkle reduction of the glabellar frown lines. Like its predecessors, Xeomin had previously been FDA approved for the treatment of blepharospasm and cervical dystonia (painful contraction of the neck muscles causing abnormal head position). It is expected to hit the cosmetic market in Spring of 2012.

PurTox (anotherbotulinumtoxinA)

Other brands of BTX-A are certain to come, but PurTox will likely be the next. Manufactured by Mentor Corporation, a division of Johnson and Johnson, PurTox has completed all Phase III trials and is currently awaiting FDA approval.

So Which BTX-A is Best?

It remains to be seen how head-to-head consumer comparisons between Botox, Dysport, Xeomin and PurTox will play out. Will one prove itself supreme? Time will tell, and I will be here to let you know.

While the facelift is the gold standard for facial rejuvenation, there are many options to consider. This video segment, taken from my appearance on KRON4′s Body Beautiful, discusses the changes that occur in the face as we age. It reviews treatments like botulinum toxin (BOTOX Cosmetic, Dysport) and fillers (Restylane, Perlane, Juvederm), mini-facelifts and the facelift. San Francisco Bay Area residents were able to call in with their questions and have them answered live on the air.

The 800 number in the video below was only used for viewer questions during the live broadcast. If you have questions, or would like to schedule a consultation appointment, please call my Walnut Creek Plastic Surgery office at (925) 943-6353.

This video is provided for general informational purposes only. Specific recommendations can only be made after a careful history and physical examination is performed. Some of the topics covered include:

• Loss of facial volume as we age
• The effects of gravity
• Restoration of volume with fillers
• Reducing facial animation lines with Botox/Dysport
• What is a facelift?
• What areas of the face are addressed with a facelift?
• Is the neck included in a facelift?
• How is facial volume replacement addressed?
• Is it supposed to look tight?

The other segments of this broadcast can be found here:

• Rhytidectomy (Facelift) San Francisco – Part 1 of 4 (You are here)
• Rhytidectomy (Facelift) San Francisco – Part 2 of 4
• Rhytidectomy (Facelift) San Francisco – Part 3 of 4
• Rhytidectomy (Facelift) San Francisco – Part 4 of 4

Dysport®, the leading (aka only) United States competitor of BOTOX Cosmetic® (aka Botox), has extended the Dysport® Challenge another month. Now, through May 31, 2010, Dysport® is offering cash back to you for trying Dysport®. Details were originally revealed in my previous post, Take the Dysport® Challenge San Francisco Bay Area. Whether you are considering your first wrinkle reduction procedure, or are a Botox disciple, this is how it works:

In my Walnut Creek Cosmetic Plastic Surgery Office, during April and May of 2010, you can get $75 off any Dysport® treatment. Plus, another $75 off your second treatment whether you love it or leave it.

If you love Dysport® you can get another $75 off your next Dysport® treatment.

If do not love Dysport® you can get another $75 off your next BOTOX Cosmetic® treatment.

For all the details visit DysportUSA or click the logo at the top of this article.

The next Botox/Dysport Day in the office is Wednesday, May 19, 2010.

In case you haven’t heard, BOTOX Cosmetic® (aka Botox) has a competitor: Dysport®. BOTOX Cosmetic® was the first to market here in the United States, and has enjoyed a monopoly, until now. Dysport® was first to market in Europe, and has now made it across the pond.

Dysport® received FDA approval last year. It is very similar to BOTOX Cosmetic® in terms of onset of action and duration. While they are not equivalent, they are very similar. Both block unwanted muscle motion, and both reduce stubborn frown lines.

Dysport® came to market at a slightly lower price, but BOTOX Cosmetic® countered with customer loyalty, and discount coupons. The Dysport® people are once again trying to shake the status quo with the Dysport® Challenge™.

In my Walnut Creek Plastic Surgery Office, during March and April of 2010, you can get $75 off any Dysport® treatment. Plus another $75 off your second treatment whether you love it or leave it.

If you love Dysport® you can get another $75 off your next Dysport® treatment.

If do not love Dysport® you can get another $75 off your next BOTOX Cosmetic® treatment.

For all the details visit DysportUSA or click the logo at the top of this article.

The next Botox/Dysport Day in the office is Wednesday, March 17, 2010. Happy Saint Partick’s Day.

If this is too soon, the April Botox/Dysport Day is April 21, 2010.

Unlike a facelift, the so called liquid facelift, fillers, cannot correct skin laxity, and unlike a browlift, Botox® and Dysport® cannot lift a sagging brow, but they can help with the wrinkles. I use both these wrinkle reducers to delay and sometimes to enhance the results of my surgical procedures. If you have lines that look like “elevens” between the eye brows, or folds that look like “parentheses” around the mouth, there are non-surgical treatments which can reduce the length and the depth of these lines, and it can be done during a short office visit.

Starting at the Top.

BOTOX Cosmetic from Allergan

Dysport from Medicis

Botox and Dysport can reduce the lines that develop on the upper face. Both products are FDA approved to reduce the frown lines we get between our eyebrows; moreover, they are used off-label, to do much more. In many cases, a skilled plastic surgeon can reduce the following:

• Transverse forehead lines
• Frown lines (the “elevens” between the eye brows)
• Laugh lines or crows feet (around the eyes)
• Mild brow ptosis (mild sagging usually of the outer eyebrow)

Botox and Dysport are not fillers. They reduce wrinkles at the source, by inhibiting the muscle action causing them. Care must be taken with these medications, to inhibit the offending muscle actions while always trying to preserve normal animation.

The Mid and Lower Face

Restylane from Medicis

Perlane from Medicis

Juvederm from Allergan

Radiesse from BioForm Medical

Since Botox and Dysport reduce expression, they are not ideal for the mid to lower face. We can look normal without the ability to frown, but we need to be able to smile. This is why fillers are ideal for the correction of the lines around the mouth.

The most popular fillers in the US today are hyaluronic acid (HA) based. HA is a clear gel, and a normal component of our skin and joints. There is no allergy to it, unless we are allergic to ourselves. The most popular HA fillers are:

• Restylane
• Perlane
• Juvederm

The most common areas treated with fillers are:

• The parentheses (nasolabial and marionette lines bracketing the mouth)
• The lips for enhanced fullness
• The fine lines around the mouth (smoker’s lines even if you don’t)
• Other mild to moderate wrinkles of the face

Radiesse is also a filler, but it is not an HA. It is white and gives a firm result. Good for deep lines like the nasolabial folds and marionette lines (i.e. the parentheses), but not as good superficially like in the lips where it may be seen or felt. Radiesse is also good for mild enhancement of the chin and cheek bones.

It is important to have a face-to-face evaluation with your plastic surgeon to determine if you are a good candidate for a procedure. This includes non-surgical procedures. When performed by a trained professional, the treatment should be simple and easy. If you are in the San Francisco Bay Area, and would like to have a consultation appointment in my Walnut Creek Plastic Surgery office, give me a call at (925) 943-6353. More information on non-surgical wrinkle reduction, check my main web site, www.DrMele.com .

Though not common, possible adverse reactions should be discussed with your plastic surgeon prior to initiating treatment. The most common problem with all these products is mild bruising, so you do not want to have your injections the day before you want your results. The results last for months, so allowing a couple weeks for the optimal results to develop is recommended.

There is some crossover between the botulinum toxins and the facial fillers. Sometimes deeper lines on the upper face may need a little filler to improve the wrinkle reduction and speed the results. Less frequently, Botox and Dysport are used on the lower face, to treat facial asymmetry, lip lines and neck (platysmal) banding. These are special cases and require careful selection in order to provide the best results.

$75 off coupons coming to a Plastic Surgeon's office near you.

Dysport® is the only FDA approved competitor to BOTOX Cosmetic®. To celebrate the launch of it’s new botulinum toxin, Dysport®, Medicis will be offering $75 rebate coupons to patients receiving Dysport® (botulinum toxin type A) wrinkle reduction. The coupons will be available after the Labor Day Weekend, beginning September 8th, and continuing through October 31st, 2009.

“Botox Day” is the usually third Wednesday of each month (e. BOTOX Cosmetic® and Dysport® will both be available. Other days may be available upon request, call the office for details (925) 943-6353.

If you haven’t heard about Dysport®, please see the post mentioned above. While Dysport® has been available in Europe for years, Medicis has only recently received FDA approval for its use in the US. Expect to hear move from them in the near future. The informational literature and advertisements for the United States have just now passed FDA review, so you will be hearing more about Dysport® soon.

Dysport® and BOTOX Cosmetic® are not fillers but are good for reducing wrinkles on the upper face. Fillers. like Restylane®, Perlane®, Juvederm® and the newest addition Hydrelle® are better for the mid and lower face.

Happy wrinkle reduction San Francisco.

I previously posted articles on what’s new in Plastic Surgery San Francisco including two new cosmetic plastic surgery products: Hydrelle® and Dysport®. Well, there is new information to share with both products. The scoop on Hydrelle® is here … Dysport there.

Hydrelle®: the first FDA approved wrinkle filler with numbing added.

Hydrelle® was featured on the hit television series The Doctors.

I have had a chance to use Hydrelle® and it is easy to work with. It is very similar to Restylane®, Perlane® and Juvederm®. If you are familiar with these dermal fillers, the results last for about the same amount of time; however, Hydrelle® is more concentrated.

The Good, the Bad and the Ugly

The good news is that Hydrelle® requires about half the volume of the other products for wrinkle correction. Similar correction, half the volume. Moreover, the local anesthetic (0.3% lidocaine), which is added to Hydrelle®, really cuts down on the discomfort of the injections. While I almost always use a local anesthetic block to administer the current HA fillers, with Hydrelle® I rarely need to block the area before treating.

The bad news is that the concentrated product tends to swell more than the others dermal fillers. This is most apparent the first day or two, and then it settles down. Also, if you are allergic to sulfites (red wine or dried fruit) this product is not for you.

The Ugly

EDIT: Three to four weeks after injecting a patient with Hydrelle® they developed two large sterile abscess on the cheeks which required weeks of antibiotics, steroids, and surgical drainage to treat. This complication is rare, but other examples can easily be found on line. The injection was in the nasolabial folds and technique used was as recommended by the manufacturer, and the same technique I use with the other HA fillers (Restylane®, Perlane® and Juvederm®) This patient’s cultures were negative and they were not allergic to Sulfites.

If I continued to use Hydrelle®, I might go the rest of my career without seeing this extreme reaction again; however, the only way I can be 100% certain the Hydrelle® will not cause more problems in my practice is to no longer use the product. Good, safe and time tested alternatives are available with and without Lidocaine: Restylane®, Perlane® and Juvederm®.

The FDA is currently reviewing this and other reports of adverse reactions submitted regarding Hydrelle®, and for now it remains on the market. I was very excited about this product as it seems to fill better than the other fillers; however, I will no longer be offering Hydrelle® in my Walnut Creek Plastic Surgery office.

I have used HA fillers since they became available in the US, and I have never seen this type of delayed onset and prolonged recovery with any other HA product, and I hope I never do again. Complications can occur with any procedure, so if you develop redness, lumps, pain, increasing swelling, or any other signs of an adverse reaction, be certain to contact your plastic surgeon immediately.

All adverse reactions, for any product not just Hydrelle®, should be reported to the FDA. The FDA’s online submission form is here. My patient sample size is too small to draw any conclusions, and the FDA is there to compile this data and make the appropriate recommendations. If you have had an adverse reaction, you should submit it. The FDA will compare the number of adverse reactions to the number of units sold to see if it is an acceptable number.

Please understand, my results may not be typical, and others will hopefully never have this type of reaction. My only goal in suppling the above information is to improve patient safety.