I could not find your previous answers for thses questions, so if you could kindly elaborate on these:
What is, in your opinion, a best filler for shallow marionette lines near your mouth that are becoming more apparent with each smile. Would you recommend Juvaderm over Restylane due to its smoothness or longevity? I had Restylane in my tear troughs and although it helped with the hollowness it left a bluish tinge that took months to dissipate. Do I understand correctly, from your previous posts, that Radiesse is too thick of a filler for these areas? Secondly, what would you use for NL folds (not so much lines) that are close to the nose due to some sagging of the cheek area? I had Radiesse done the first time and it worked very well for more than a year but the second time it did not make a difference (1cc of Rad. was used for both lines and cheeks). Should I add a bit more Radiesse near the nose/cheek area or would Juvaderm would be a better choice?
Again. thank you so much for answering these questions.
I don’t think there is one Best filler. It really depends on what the patient wants. If a patient wants a filler which will last the longest, and feels that this is the best type of filler for them. These patients don’t want to keep repeating the injections for their smile lines every 6-9 months, then that patient would not feel that Restylane or Juvaderm is best for them. They may feel that Sculptra, Radiesse, or Artefill is a better fit for their goals.
If you want a filler which has more flexibility and the potential to be dissolved if overfilled, even though it doesn’t last longer than a year, then the hyaluronic acid fillers (Restylane or Juvaderm) will look like the best filler for that patient. Since it can be dissolved, an injector could potentially be more aggressive in trying to fill a line/wrinkle, knowing that if it were over done, it could potentially be reversed. No harm, no foul. If the same were done with a longer acting filler, then this would be a big problem since it may not be easily reversible with steroids, and potentially an incision may be needed to remove the excess filler.
For smile lines, I can’t say that Restylane or Juvaderm is clearly better. Juvaderm seems to last a few months longer than Restylane, but there are patients who swear by Restylane and report that it lasts longer than 4-6 months. Restylane comes in 1.0 cc, but usually they give a little extra which looks more like 1.2cc; while Juvaderm is 0.8cc, and they don’t give any extra. That extra 0.4 cc of restylane may make the difference between using one Restylane versus 2 Juvaderm.
For smile lines, between Restylane or Juvaderm, just go with which ever filler your injector feels most comfortable with.
I had Restylane in my TT and although it helped with the hollowness it left a bluish tinge that took months to dissipate.
Do I understand correctly, from your previous posts, that Radiesse is too thick of a filler for these areas?
The bluish tinge is called a Tyndall effect (http://en.wikipedia.org/wiki/Tyndall_effect) which is also the reason veins look blue, even though red blood flows through them, or the sky is blue. If the restylane is injected above the muscle (orbicularis oculi muscle) just under the skin, the tendency for the blue tinge will be greater, than if it is injected deeper down towards the bone, or at least deep to the muscle. Since everyone’s anatomy is different, and there are people who are so thin in the tear trough area, that there may not be very much muscle there, then the Tyndall effect may still be in play.
Radiesse should not be used in the tear trough area. It is mainly used for smile lines and facial sculpting/volumizing of the cheeks and jawlines. Even the Radiesse company, instructs us not to use it in the tear troughs or in lips, since it tends to lump in these areas. The same is true for Sculptra, do not let anyone inject sculptra in the tear trough area.
Secondly, what would you use for NL folds (not so much lines) that are close to the nose due to some sagging of the cheek area?
The NL folds right by the nose, is also called paranasal folds. Para- means “next to” -nasal means nose. The paranasal folds tend to take much more filler to fill than the remainder of the nasolabial fold (smile line). If the patient really wants to fill this area, they should be prepared to use a lot of filler, since it seems to require a lot of filler for a little improvement. Some surgeons will instead use a hard implant, like Porex/Medpor, paranasal implants to try to push out that area, but it is not a perfect procedure.
I had Radiesse done the first time and it worked very well for more than a year but the second time it did not make a difference (1cc of Rad. was used for both lines and cheeks). Should I add a bit more Radiesse near the nose/cheek area or would Juvaderm would be a better choice?
Faces change year to year. I don’t think lack of satisfaction is from which filler “failed” but more that not enough volume was used. I’ve had patients who reported that they used two restylane with no improvement, but when they switched to juvaderm for the third syringe, that did the trick, so they think that juvaderm is somehow magical. I have also had different patients who have used two juvaderm, with little improvement, but when they used an additional syringe Restylane, then they got the result that they wanted. Maybe, each patient just needed 3 syringes to get their desired results.
Spreading the two syringes radiesse into the cheeks may have not left enough filler to actually fill the smile lines. In my experience, one syringe for each cheek already is shows a very mild improvement, let alone spreading it over the cheeks and the smile lines.
Faces continue to age, so the same amount of filler last year may not be enough this year. If you lost weight, or went through menopause, these other factors may change how your face improves with the fillers.
If the added costs of filler are not getting you the improvements that you want, and it is beginning to feel like a “money pit,” then sometimes surgical procedures such as Fat transfer/fat grafting, or a facelift can achieve what you are looking for with longer lasting results.