UPDATE: I can no longer recommend this product. I would suggest using Restylane®, Perlane® or Juvederm®. All three are now available with Lidocaine, all three seem to have fewer adverse reactions and superior customer service. Details here.
Sometimes called the liquid facelift, injectable fillers have made there mark in cosmetic plastic surgery. While they cannot do what a facelift does in terms of removing loose skin, they can fill the deeper lines around the nose lips and mouth. These lines are one of the three main areas corrected by a surgical facelift. For my patients with only these lines, a filler is a quicker and less expensive option. For my patients with these lines plus jowls and loose neck skin, correcting the lines can often postpone the need for a facelift.
Additional information and educational movies about injectable fillers and facelifts can be found on my Walnut Creek Plastic Surgery Website. Here are the links: Injectable Dermal Fillers Walnut Creek and Facelift Walnut Creek. Below is a brief review of the injectable dermal fillers that are currently available.
Dermal fillers are some of the most commonly used cosmetic products in facial plastic surgery. They can be used to reduce wrinkles and add volume. Dermal fillers are also used to augment lips, cheeks and chins. And now a new dermal filler is coming soon to San Francisco Plastic Surgery offices.
The King is Dead; Long Live the King!
Collagen® is no longer manufactured by Allergan. It was the king of facial wrinkle injections and plumped lips for decades. Now there is a new king. The generic term for these is Hyaluronic Acid (HA).
Hyaluronic Acid has replaced Collagen® because HA is softer and longer lasting. You may know them by their brand names: Restylane®, Perlane®, Juvederm® and the soon to be available Hydrelle®. Hydrelle is the first HA preparation made with lidocaine (a numbing agent) mixed in.
While Radiese® is also an injectable dermal filler it is not a HA and it is not as versatile. Its use is limited to deeper wrinkles and to augmenting the cheeks and chin. It is not recommended for fine lines or lips. It is bright white and firm to touch as opposed to HA fillers which are a clear gel.
So What is Hyaluronic Acid
Hyaluronic acid (HA), like collagen, is naturally found in our skin and joints. It used in many commercially available moisturizers, and several manufactures purify it for the treatment of wrinkles. While HA is a good moisturizer when applied to the surface of the skin, the real benefit of HA is wrinkle reduction by direct injection.
HA is supplied in pre-filled sterile single-use syringes. It is a clear gel that can be injected directly into the dermis (deep skin) to provide immediate improvement in the appearance of wrinkles. It can also be used to enhance facial features, the most popular being the lips. Unlike Collagen®, which was quite firm, HA’s are soft, and softness is a big benefit for lips.
The biggest downside to current wrinkle reductions with HA’s is that it needs to be injected. Injections can cause discomfort and sometimes bruises. There is some mild swelling and redness associated with the treatments, but this resolves quickly. To help reduce the discomfort associated with the injections, all major HA manufactures/suppliers (Medicis and Allergan in the US) have added Lidocaine to their HA product. While Hydrelle®, was the first FDA approved combination of HA and numbing agent, Perlane®, Restylane® and Juvederm® are now also available with Lidocaine.
San Francisco Bay Area Plastic Surgery
So what can you expect from HA injections? Currently in my San Francisco Bay Area Plastic Surgery practice I prepare for HA injections by carefully cleaning the skin and then blocking the area with a Lidocaine injection. With the area now numb, I can concentrate on wrinkle correction, and you can feel comfortable.
What will be different with Hydrelle®? Hydrelle® numbs as it’s injected. The lidocaine in the Hydrelle® will not help with the first pass. Unless the area is blocked as above, the first pass will be felt. However, with deeper wrinkles, multiple passes over the same area are common. For these repeat injections, the site would be numb from the first pass, and any discomfort minimized. The advantage is that only the treated area is numb.
Collagen® also had lidocaine added and it worked pretty well. Being a Board Certified Plastic Surgeon who practiced through the transition from Collagen® to the first HA Restylane®, I can tell you many of my Collagen® patients made the transition to HA’s and preferred the block over the lidocaine in the injectable. This is especially true in the upper lip. For some, anesthetizing the area with a local block will still be better, but it is nice to have options.