Top 6 Are Questions to ask about Facial Fillers: Juvederm and Restylane

Facial fillers are one of the most common non-invasive treatments around the world.  In the United States, Juvederm and Restylane have become the two most popular hyaluronic acid type fillers.  Important questions to ask your physician:

• How much experience have you had with facial fillers in the lips, tear trough area, or nasolabial folds?
• Have you experienced any complications with fillers in the lips, tear trough area, or nasolabial folds?
• How would you treat the complications (nodules, bumps, overcorrection, undercorrection) if I developed any?
• Can you show me before and after pictures of the fillers?
• What options do I have for anesthetic before the procedure?
• Can you go over my post-procedural instructions before treatment?

Does your doctor perform the injections himself?   Is he even interested in performing the injections?  Many otherwise fine surgeons view fillers as a nuisance, or delegate this task for business reasons. 

Others are cavalier and will inject anything new, whether it is legal in this country or not, whether or not it has been proven safe (and no, that doesn't just mean FDA approval, as the many reports of granuloma formation for FDA approved substances shows).

Where and how fillers are injected will directly impact how you look the next 6 months of your life.  And if you are receiving ill advised injections such as silicone, for the rest of your life.

Once you have screened for credentials (i.e. board certification), you should have confidence that your doctor has your best interest in mind.  You should feel confident that he has a plan based on carefully listening to your needs.  You should feel confident that he is safe.  You should feel confident that he is aware of the risks and benefits of fillers, not only by themselves but as a plan for your overall rejuvenation over time.

Many patients have expressed dissatisfaction with their fillers in the blogs.  When you look more carefully, there are 60+ women who would benefit from skillful plastic surgery but instead have placed all their hopes in a few syringes of Restylane, an unrealistic and ill-informed plan destines to produce dissatisfaction when the results don't deliver.  Apparently nobody ever told them that their skin was sagging and that is why the $2000 they just spent for Restylane did not fix their problem.

Your doctor should discuss all the options with you, not just pump fillers.

If you don't get a definite yes on all these counts, you should move on.  It's that important.

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Hi Kerry,

There is a saying, "It's filler, not the filler" that determines your results.  In other words, choose your injecting physician carefully.  Ask if they are board certified in one of the cosmetic specialties (plastic surgery, facial plastic surgery, ENT, dermatology, oculoplastics), and ask how they received their training.  Ask them what kind of side effects or complications that they have seen.

 Restylane and Juviderm are both very good fillers.  They can both be reversed with hyaluronidase if too much is placed.  I have never needed to reverse Restylane while I have had two experiences with Juviderm where there was excessive persistent swelling.  Therefore I do not use Juviderm under the eyes.  So if you were my patient having both the eyes and nasolabial folds treated, I would recommend Restylane for you.  Good luck and be well.

Dr. P

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Both Restylane and Juvederm typically give good results in experienced hands for the naso labial fold area. Both products are soft and smooth, and after a few days, are minimally palpable.

My preference in the naso labial fold area is Juvederm Ultra Plus. In my opinion, when compared to Restylane, Juvederm is slightly softer, has less bruising and swelling, and in many patients last a couple of months longer.

In the under eye area or tear trough, make sure you discuss with your provider exactly what your goals and expectations are. In some patients, great results cannot be obtained with fillers. If you do the tear trough, my preference is Juvederm Ultra (it is even softer than Ultra Plus).

Expect to have some persistent, usually slight swelling for up to a couple weeks. The good news is the correction in this area tends to last along time, perhaps 12-18 months.

Best of luck.

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The first question should not be asked of your doctor, but rather to yourself: What is your primary concern, and what is it you would like to accomplish with the treatment?

Injectable fillers like Restylane/Perlane and Juvederm have revolutionized the non-surgical treatment options available to patients.  More cost-effective and longer-lasting than the previous generation of fillers, there has been a tremendous acceptance of these products as a weapon in the battle against the signs of facial aging.

Nevertheless, injectable fillers can't solve every problem, and it is important to understand their limitations.  Ask yourself what are the issues that concern you.  For early signs of facial aging such as mild to moderate-depth nasolabial folds, thin lips, or mild dark circles under the eyes, Restylane and Juvederm do an excellent job.  For more extensive signs of facial aging, even a boat-load of fillers may be insufficient to correct the problem, and surgical procedures are more cost-effective, often in conjunction with judicious use of fillers in a more limited fashion.

Your plastic surgeon should be able to properly advise you of the best option for your particular desires and facial features.  In any event, you should not be concerned about a lumpy or unnatural appearance if the right combination of surgical facial rejuvenation procedures and injectable fillers is performed  by an experienced surgeon.

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During your consultation you should ask your physician if they have experienced these types of complications and what they will do to correct the matter if such complications arise. You may also want to ask your physician if they use a topical numbing cream or nerve block.

Addressing your questions and concerns prior to your treatment will make things go much smoother and make you feel at ease. Choosing a physician that is experienced in this area is also very important.

Make sure you do your research and you choose your physician based on experience.