Has Anyone Use the New HA Dermal Filler Called "Expressions" and What Are Your Comments?

Hi Dr. Moran, Thanks for asking! I have used Expression in the tear troughs, malar region, lips (and vermillion border), and of course NLF. I have found it has great outcome in all locations I have tried. It is a similar thickness and coloration to Restylane, so it works much better in the tear trough than Juvederm does, and I haven't used Juvederm there in years. I have not had anyone have any sort of Tyndall Effect. Because of the lack of hydrophilicity it is also great in this area because it doesn't overfill and swell up. I have not had to use any hyaluronidase on anyone who has received Expression from me, regardless of the area I've injected it. The additional benefit is that I find a lot of people need more than one syringe of filler for the tear trough area, but not quite 2mL. Given that Expression is 1.5mL it's been a great way to get more volume into that area, without so much extra expense for the patient. Personally, I really like Expression so far--I'm seeing great results, my patients are happy, and to date I've injected about 50 syringes. If I can be of more help, please let me know.

Thank you Dr. Rueckl, That was very helpful. I will try it in the tear troughs. I like the way it handles. One last question, how is the duration compared to other HA's?

Well, I have only been using Expression since December, so I can only go off what was told to me by my rep, which is that it should be consistent with the lasting times of other HA fillers (so 6-12 months depending on the location you are injecting it into). With that being said, I'm hoping that for some people the fact that we are starting with a bit more volume from the increase in mL, means that it might make it last just a bit longer. I'll keep you posted, but at about 4 months for some people, I'm seeing that they still have great volume and it doesn't look like any filler has gone away, regardless of the area I injected them with it back in December when I first started.

Thank you so much for letting us know about your experience with the new filler, Dr. Rueckl. If you are comfortable letting us know how it compares to Restylane and Juvederm cost wise that would be great. I'm sure I'm not the only one who would love to know!

Happy to answer! When I discussed the going-rate for Expression with the national reps it seemed to be in line with charges for Radiesse, since it's a larger syringe size. Thus, personally, for me, I charge $650 for Juvederm, $600 for Restylane, and will charge $750 for Expression. Which, really, is a great deal when you consider it's basically an extra half a syringe of product, compared to Restylane and Juvederm syringes. At my office that includes the injections being done by me, a board-certified dermatologist (and I'm a firm believer that only physicians should do injections), and includes pre-numbing block of lidocaine with epi. Unlike Juvederm and Restylane syringes, Expression doesn't contain a suspended lidocaine in it, so pre-numbing for patient comfort is key.

Yeah, that is pretty good cost wise.

Thanks for letting us know they aren't mixing lidocaine in with it. I'm curious why they opted not to do that, since it seems I've only heard good things about it in the other fillers.

Again, I really appreciate you filling us in! It will be interesting to see how this new filler is received by patients and what their thoughts are.

While adding lidocaine into fillers is good, it's not as good, in my opinion, as a block. The suspended lidocaine isn't as strong, and you have to remember that it's numbing the area while being injected, so if you prenumb with a block, that entire area is numb and you feel nothing, so the filler is more comfortable the entire time it's being injected. Injecting a numbing agent beforehand numbs a larger area, so if I have to put filler into the lips, it may require only 2-4 places to fully numb the entire lips. While injecting the filler, I may inject 10 areas in the lips, meaning you will feel every single one of those sticks. Additionally, lidocaine is good for patient comfort, but my blocks are lido plus epi. Epi squeezes capillaries for a short time, meaning there is less bruising and swelling, plus the advantage of less pain. So, in short (or long!), I don't know why Expression opted not to put lidocaine in (other than to say the creators of Expression also created Radiesse which doesn't have lidocaine either), but I don't use the suspended lidocaine in the Restylane and Juvederm as the only numbing agent for fillers in my office. I just think there are better alternatives!

I absolutely love all of this info you are sharing Dr. Rueckl!

My thought with a block is that there is additional risk that doesn't come when the lido is in the filler. I guess from a layperson's perspective I would think it would be better to tough out the needle pricks and have less injections overall. I can definitely see why some people would love not being able to feel any of it though. 

No problem, I am happy to share, as I believe the more knowledgeable a consumer is, the better off we all are! So, here's the scoop: when visiting a good injector, who is a board-certified plastic surgeon or dermatologist, there isn't additional risk for getting lidocaine prenumbing injections. Now, if you visit some other type of injector, like a nurse or esthetician, some of them cannot use lidocaine as a separate numbing injection, so there's no option but to use what's in the filler itself. Doesn't that kind of make you think though: "Hey, if this person can't do one type of injection, why am I trusting them to do another??" It does me. Also, when something hurts, patients tend to tense up, move their faces around, squish their bodies....this doesn't make it easy to do a great injection a lot of times. Besides that comment, I've done fillers for about 20 years and been involved in lots of FDA trials and studies for new fillers. I've never had a patient - not one - with any dermal filler injectable say, "I prefer to have more pain, and more possibility for bruising and swelling, so just put the filler in." Additionally, here's another thought. If you have a friend who looks great, and she says she got a filler, the first question you will ask is "Did it hurt?" My answer to that is that if she says "Yes, for the entire 20 minutes and then it stung like hell after," you're never getting it done. If she says, "Not a bit, I had a prenumbing block and felt 2 tiny injections for about half a second, then nothing and look how good I look," you'll be on the phone signing up for the procedure. Simply, injections do not have to be painful, nor do they have to cause a lot of extra swelling and bruising! Opt for a good injector and a numbing block, and I promise you, you will NEVER do the procedure without it again.

I can definitely see the benefits, especially with the epi - who wouldn't want to reduce the risk of bruising as much as possible!?!

I didn't know that some nurses/injectors weren't actually allowed to give the blocks. I just thought they opted not to use them.

I do think you might be underestimating what we ladies are willing to do to look good - I know many of us that wouldn't shy away from a friend who said the injections hurt like hell for 20 minutes then stung badly afterwards. We'd be like "Then you looked like that? Sweet - I'm in!!"  ;)

Again, great information and thank you very much for taking so much time to help us all understand better!! So appreciated!