Injectable
Fillers

Injectable fillers are used to plump up fine lines, wrinkles, some scarring, and augment the lips by restoring volume and definition.

Restylane

Restylane is a purified, non animal product comprising stabilised hyaluronic acid gel “NASHA” - a naturally occurring substance found in skin and which decreases with age. These gels are principally used for volume enhancement. It is absolutely safe, requires no pre-testing, and has very few side effects. Recently, local anaesthetic was added to the formulation which has made the whole process more streamlined as nerve blocking injections are no longer required. The gel itself is quite viscous, and is supplied in single use, pre-packed syringes. Restylane works directly in the skin (as opposed to Botox, which works on the underlying muscle) to literally fill out / plump out wrinkles and add volume and moisture. It binds water and this gives the skin a more youthful, hydrated look.

The Procedure

This is an office based procedure, and takes about 20-30 minutes to complete. The gel is injected into the deep layers of the skin, directly beneath the wrinkle, filling up the wrinkle, not unlike polyfiller! It has no effect on the muscles of facial expression. It can be used to fill deep lines on the face (including the naso-labial lines), as well as the wrinkles mentioned under Botox.

In my practice, I tend to focus on the following areas for soft tissue filling:

Lip augmentation
Filling naso-labial and marionette lines

The effect is instant (although there is some mild swelling which settles overnight) and generally long lasting (upwards of 6 months). The gel is completely absorbed after this period, leaving no scarring or residue in the skin or lips. It is widely used across the world, with an outstanding safety record, and despite the plethora of other fillers that have recently flooded the market; few have the track record of Restylane.

Products Available

There are a number of "variations" of Restylane, all manufactured by Qmed, and all comprising the same "NASHA". They vary only in thickness, and so can be used for a variety of purposes:

Restylane Touch: 0.5cc syringe. This is the thinnest gel, used for fine lines.

Restylane: 1cc syringe. Moderately thick. Good all purpose filler, and I use this widely.

Perlane: 1cc syringe: Thick. Used where more volume is required as in very thin lips or very deep lines that require a lot of volume.

Restylane LIPP: 1cc. Similar to perlane in thickness, with particular advantages in lip augmentation

Sub Q: 2cc. Very thick and used for soft tissue augmentation of the face: chin and cheek augmentation. This is injected with a special cannula, not a fine needle, as is the case with the other products.

Restylane Vital: 2cc pen. Very “thin”, non cross-linked gel, injected in minute quantities over the face, upper lip fine lines or neck and upper chest area for better hydration of the tissues. You need at least 3 treatments spaced about 4 weeks apart to improve the skin quality over time.

Juvederm Ultra

This is a competitor product to Qmed's Restylane range – 3D non animal stabilized hyaluronic acid gel for soft tissue augmentation in the face.

Juvederm Ultra, made in France and marketed through Allergan (the company that manufactures
Botox) is giving the Restylane range a run for its money! For every product in the Restylane range, there is a Juvederm Ultra equivalent. Despite claims to the contrary, I am not convinced that either Juvederm Ultra or Restylane have any significant advantages over each other, and there indications overlap completely. Both are used for minor soft tissue plumping in the face, most often lip enhancement and filling of nasolabial and marionette lines. The gel contains an anaesthetic, so no supplemental nerve blocks are required. The process is very smooth from an injector's point of view, and once can expect the result to last between 9 months and a year, depending on depth and site of placement. I mostly use the Juvederm Ultra Smile (previous called Juvederm Ultra 3) in the lips and tear troughs. Where I am seeking significant volume enhancement, I tend to use Perlane (thicker form of Restylane) and this is usually in the nasolabial & marionette lines as well as the corners of the mouth. Like the other gels, complications may include pain and bruising at the site of injection.

Please note that I neither recommend, nor keep any injectable gels that contain any permanent components. Whilst it is appealing not to have to repeat facial injections, the reality is that most, if not all permanent gels, come along with a host of potentially permanent problems, not least of which is the development of soft tissue granulomas – chronic inflammatory nodules that may take a few years to develop and which are very difficult to treat once established.



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Member |  International Society of Aesthetic Plastic Surgery (ISAPS)
Fellow  |  College of Surgeons of South Africa (Plastic Surgery)
Member |  International Member of THE American Society of Plastic Surgeons
Fellow  |  Royal College of Surgeons
Member |  Association of Plastic & Reconstructive Surgeons of SA