Juvederm is my favorite wrinkle filler

When we graduated medical school, our professors told us "primum non nocere", first don't harm people.  I interpret this as meaning that the treatments we give our patients should be safe.

I am proud now that the reports of granulomas with Artecoll and Radiance are surfacing that not one single patient of ours has ever been injected with that substance.  Now that  silicone horror stories are well-known, not one patient has ever been injected with silicone in our office. 

While many patients will continue to be injected by the newest fillers with non-natural components such as methyl methacrylate beads, plastic spheres, liquid silicone, silicone gels, we will not inject them in our practice, because it simply does not make sense to put a permanent or semipermanent non-biologic material into the face in my opinion.

I am impressed with the safety and effectiveness of hyaluronic acid fillers.  Prevelle is a lighter hyaluronic acid with a little lidocaine in it for sensitive patients or patients with little or no recovery time. 

You can see by the posts that occasionally the heavier hyaluronic acids such as the Juvederm series and Restylane or Perlane, wonderful fillers which we use daily, can cause swelling for several days, so this should be factored for patients who are on camera (i.e. newscasters) or have important social obligations immediately following their injections.

So while you can argue which is the best filler, please avoid the bad ones.

Overall, the most versatile, long lasting, and effective filler currently is Juvederm. I like it because it comes in two concentrations, Ultra and Ultra Plus, that can be used for finer or deeper lines. After injection, this product has excellent longevity (upwards of 6 months), is soft and supple, and causes minimal skin reaction. It can be used anywhere, including the lips, and, worst case scenario, it can be dissolved with hyaluronidase.

Radiesse is an excellent choice for deep nasolabial folds, for 'non-surgical' rhinoplasty, and for deep injection augmentation of the cheeks and chin. It is unpredictable in the infraorbital region and definitely should not be injected in the lips.

Restylane is equally as versatile as Juvederm, with great short-term results, but perhaps only 10% of my patients still have results after 4 - 6 months. It generally lasts only 1 - 2 months in the lips.

For permanent results, Artefill is the one and only choice. Presently, I am using it only in the nasolabial folds and marionette lines, but with excellent results.

Sculptra stimulates collagen production, resulting in filling and overall volume restoration / augmentation over time (and requiring 3 - 5 injection sessions spaced 4 - 6 weeks apart). It is not a traditional, 'what you inject is what you get', filler. It works best for patients with criss-cross crepey wrinkles and diffuse lower face hollowing.

Juvederm or Restylane in combination with a very low dose of Botox works well for fine vertical lines extending from the lips, although CO2 laser resurfacing really works best.

Smiling is the best non-invasive wrinkle filler.

Of the temporary fillers mentioned by others (Restylane, Juvederm, and Radiesse, etc.), I believe that a patient's own fat is the best "wrinkle filler."

Fat transfer returns volume to the face, and has the advantage of being a permanent filler. The stem cells in the fat also work over time to improve the tone and texture of the overlying skin.

I do not use Sculptra in my practice because of some extremely mutilating granuloma reactions and infections that I have seen experienced by other physicians. For those of us needing a quick fix, certainly Restylane, Juvederm, and Radiesse are all great wrinkle fillers.

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I am a board-certified plastic surgeon practicing in the Los Angeles area for 20 years. I have a vast experience with dermal fillers.

For "marionette lines" (medically-termed labio-mental rhytides), I prefer Juvederm Ultra Plus or Perlane. These fillers give substantial and lasting support to the heavier tissues in the marionette area. The skin here is thicker and the muscle activity is quite powerful, so a more supportive filler is required.

Also, many of the marionette lines, feather out to the inner cheek area and upward toward the corners of the mouth, so a natural result can be created by blending the filler throughout these areas, rather than just simply "filling" crevices.

It is a very artistic and 3-dimensional process in my hands and it is amazing how it can immedicatly take years of of your face! It is very satisfying for me to do this, especially since I can relate to the needs of my patients and I am a consumer of the same procedures that my patients desire.

The fine "lip lines" can be filled with a finer, thinner filler, which can vary according to the skin thickness of the lip, the extent or depth of the lip wrinkles. I like Juvederm Ultra for thicker skin and Evolence for thinner skin.

More importantly, I love to not just "fill lines" but to shape the lips with a natural contour (not duck lips), including the bows of the lip, the philtral columns and the philtrum-the beautiful part of the upper lip around the cupid's bow region.

The lower lip also can benefit from some filler in the center to provide fulless and volume. The filler is used almost like a "makeup" and "highlighter" on the lips or a gloss on the lips, making them full and blended to a natural contour. We have all seen the overdone, hideous lips of patients that were just pumped up and not treated as works of art.

Truthfully some patients are very afraid of having the body of the lip filled with dermal fillers, because they specifically fear looking like a freak, or having an "obvious" lip filling result. If I truly feel from my aesthetic assessment that the patient will benefit overall from having the body of the lip filled to naturally recontour the entire area around the mouth and lips - then I explain why to them, and give them a mirror to show them what I plan and tell them I can stop at any time.

During the treatment, I tell them that they will have an opportunity to look at what I have done, and we go slow and steady so that they feel they are in control and they affirm they like the result. This has worked well for me and for my registered nurses who are also professionally trained by me to do dermal fillers under my supervision.

My nurses have been trained by me and worked with me in the operating room, where I make many changes in an attempt to restore a patient to a youthful, but more importantly, a natural and pleasing result.

Additionally, we take our time and try to make this sensitive area as painless as possible and we have formulated customized and reliable techniques to make this event as gentle and supportive as possible.

Although the market is flooded with facial fillers, my plastic surgery practice in Santa Monica strictly limits facial filler use to Juvederm for the lips and Radiesse for the mid face and lower face, including the nasolabial folds and marionette lines.

Meticulous care is crucial to injecting into the deep dermal plane or intradermal plane.  This expertise makes the difference between a great result and an average result.

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There are many fillers on the market today.  Many of them work fine. 

I prefer to use Juvederm for most of my patients. I will use Radiesse as well, but not in the lips. Juvederm is a hyaluronic acid sugar and can be used in many places.  It is soft and forgiving.

Additionally, it will last 6-8 months in many areas, perhaps less in the lips. The nice thing about this is that it will not persist for years as the rest of the face ages, and if someone does not like having a filler, it will go away in time.

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