Juvederm wrinkle filler can achieve beautiful results

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.

I.P.

The "best filler" will depend on many factors including:

1. The length of time the filler will last.

2. The area on the face that needs to be filled.

3. Your skin type, thick or thin, if you have sun damage or acne scarring.

4. The amount of "fill" that is required (fine wrinkles, etched wrinkles, troughs and major volume - cheeks and mid-face).

Hyaluronic acid fillers have become the "gold standard"  these days.  I believe the other fillers still have niche roles and I still frequently use them. The reason that hyaluronic acid fillers have become so popular is because they are softer than the other fillers, they are more forgiving (harder to feel or see bumps) in thinner skin and soft tissue, they can last up to 12 or 18 months in some locations, they are cheaper than other longer lasting fillers and they can be reversed instantly with a solution of hyaluronidase if needed.  

The two major hyaluronic acid players are Juvederm (by Allergan) and Restylane (by Medicis).  The major hyaluronic acid fillers can differ in the "particle size" of the hyaluronic polymer, the cross-linking of the polymers and the final concentration of the hyaluronic acid in the syringe.  Juvederm has a wider range of particle sizes and Restylane has a more uniform particle size.  Both have similar concentrations and cross-linking of hyaluronic acid.  The variations of these products have greater concentration or cross-linking to achieve better and longer lasting correction at the expense of a thicker, less forgiving product in thinner skin.

The bottom line is that each of my patients is evaluated first, then I discussed the different filler options available for each area of concern and finally we select a filler to give the best correction for that area. I photograph each patient before and after the treatments to follow the patient's progress and document the length of time each correction lasts. I insist that patients return two weeks after a treatment so we can reevaluate the treatment area and determine if any additional corrections are necessary.

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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.

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