Ask a doctor

Restylane Vs. Voluma for the cheeks. Which one gives better results?

I have a appointment to add a little bit of filler to my cheek and my doctor suggested using either Restylane of Voluma. I already had Restylane in my tear throughs with great results, but was wondering the difference between the fillers for adding natural volume to the cheek area and if one will give you better results.

Doctor Answers (14)

It's the painter not the brand of paint ... the brand of fillers may determine how long the results last.

+2
Hi NYCgirl80,

When discussing how natural the volume appears on your cheek area, depends more on the location and quantity of where the filler is injected, and not dependent on the brand of the filler.  

If I have a brand X paint and brand Y paint, if the painter paints a beautiful landscape with either brand of paint, the painting will be just as beautiful with either brand X or Y.  Let's say that Brand X has UV protection built into the paint so the color doesn't fade when exposed to UV rays from the sunlight.  Even though both paints start off equally beautiful, if both paints are hung on a wall exposed to direct sunlight Brand X's color will stay more vivid and colorful, while Brand Y's colors may fade without the extra UV protection added to the paint.

You can think of this analogy when discussing fillers.  If you search before and after photos on the internet for cheek filling, you will find good and bad results for any brand of filler.  This should dispell any myth that the results are linked to any particular brand of filler.  If you would look good with 1-2 cc's of Voluma, but the injector injected you with 4-5 cc's of Voluma (which would make you look weird and puffy) would you look better with 1-2 cc's of Restylane or Perlane or 4-5 cc's of Voluma?

Location and Amount
When it comes to injecting fillers for anything other than filling lines, it is really a type of live sculpting.  When injecting fillers to the tear troughs, for example, patients do not only look straight, but also up and down.  I will take my time to fill my patient at different eye positions or for the cheeks smiling and not smiling to see how the volume moves.  I also will fill in increments.  Between each increment of filler, the patient and I will check how the filler looks and moves with the face, and look for any spots which may be missing.  With Juvederm Voluma, Restylane-L or Perlane-L, there is lidocaine (a numbing agent) added to the filler, so after the first increment of filler is added, the patient is numbed in the areas to be volumized without any additional injection of lidocaine which may distort of artificially make the cheeks or tear troughs more filled than it actually is.  Additional increments of filler do not hurt since the lidocaine has kicked in and it allows the patient to focus on communicating with me on the results that they want.  One good result for one patient may be an overfilled appearance for another patient.  I don't assume that I know exactly what the patient wants, but I will guide them during the filling process to avoid any pitfalls or inject areas which may look weird or bad.  But in general, I feel most of my patients have a very good feel for where they want the filler and when we are finished I see the result that they were going for in their mind's eye, which is not 100% clear in my mind before we start, but may be only 80% clear.

This type of filling take much longer than filling a simply smile line wrinkle, and is a process.  However, the patient satisfaction is high, since the patient and I as a team fill the areas of concern to the patient's liking while constantly checking to make sure the filler is smooth and moves naturally with each increment.  Typically filling sessions can take at least 30-60 minutes or longer depending on how much filler is used.  My patients who have had fillers with other doctors often comment how the filler session seems to be a completely different method than the one's that they have had in the past.

Brand of Fillers
Juvederm Voluma is the newest filler on the market which uses Hyaluronic acid and is FDA approved specifically for Cheek augmentation.  Restylane and Perlane are FDA approved for smile lines or Nasolabial folds.  Restylane is marketed for smile lines to only last 4-6 months, before additional filler is added.  Perlane is the big brother version of Restylane.  The hyaluronic acid filler particles are bigger but the concentration of the hyaluronic acid is the same.  Juvederm Ultra and Juvederm Ultra Plus would be analogous to Restylane and Perlane, except they kept the same name Juvederm Ultra and added a Plus to the thicker version. For Restylane, they changed the name to Perlane even though they are the same filler with bigger particles.

Perlane is designed to be injected deeper for deeper smile lines, with some Restylane injected closer to the surface of the skin directly into the wrinkle (intradermal injection).  Since Perlane is has bigger particles of hyaluronic acid and is firmer than Restylane, it is also good for cheek augmentation.  However, there are no FDA studies to show how long Perlane lasts in the cheeks as compared to Voluma.  The Voluma marketing states that it lasts up to 2 years and in their study, ~60% is still left at the 2 year mark in their study subjects.

For Restylane, in the marketing material it states Restylane only lasts 4-6 months, but if used off-label in the lower eyelid area, it seems to be lasting 12-18 months.  I suspect that Restylane may actually still be in the smile lines vicinity at the 6 month mark, but may have been pushed above and below the line after repeated smiling.  Other patients report that their Restylane in the smile lines also lasted about a year, before it dissipated.  Without side by side comparison of Perlane versus Voluma, or at least a 2-3 year study for cheek augmentation using Perlane, we cannot say how long it lasts in the cheeks, but I think it lasts at least 12 months.  If we were to quantitatively measure how much is left after 2 years, I suspect it would compare favorably to Voluma.

Cost
Juvederm Voluma's MSRP as suggested to us by our Juvederm Reps is $1100 to $1600 per 1cc syringe.  In the study the amount of Voluma used was 1.2 mL to 13.9 mL, with a median volume of 6.6 mL.  This means the typical patient was using 7 syringes of Voluma to get optimal results.  In comparison, tear troughs typically only need 1 cc of Restylane to look good +/- 0.5 cc's.

Although I love the fact that the FDA study and the approval for cheek augmentation, I worry that many of my patients may not be willing to spend that much money per cc of volume in the cheeks.  Even rounding the price down to $1000 per cc of Voluma will cost the patient $6-7000 to get an optimal result, and most likely they may stop before they reach the optimal result.  On the high end, the same 6-7 cc's would cost $9600 to $11,200.  The selling point is that the Voluma may not need to be refilled for about 2 years, but if 60% is left at 2 years, I suspect patients may be returning at around 18 months as the optimal results begin to fade.  The touch ups would end up being a fraction of the original session.  If 60% of 6.6 cc's is left after 2 years, then the patient still has 4 cc's to start and would be add back another 2.6 cc's plus any facial fat loss from natural aging over the 2 years.

In comparison, Perlane costs $750 in our office and $1300 for a 2 cc syringe for patients who are more hollow and clearly need more filler.  6 cc's of Perlane would cost significantly less than Voluma.  If the average patient would need 6 cc's for an optimal result, I would prefer to us Perlane and be able to add a full 6 cc's instead of stopping after 3-4 cc's using Voluma if their budget does not allow it.

Great question, I hope this covers the topic with great depth.

Good luck on your upcoming filler session.

Best,

Dr. Yang

P.S. There is a new feature on Realself, which is the "Follow" button. It is similar to the "Like" button on Facebook. If you like my response or any of the doctor responses while you research on Realself, you should "Follow" them. You will get email updates, when the doctors you follow post any new answers to questions, post new photos, or have any new reviews.


New York Facial Plastic Surgeon
5.0 out of 5 stars 24 reviews

Voluma is a Juvederm product specifically designed for creating volume in the cheeks.

+1
Voluma is a Juvederm product specifically designed for creating volume in the cheeks. An in person consultation is required to identify the appropriate product per individual. 

Ensure you have an experienced injector working with you and have them recommend the correct product for the look you desire. 

Martin Jugenburg, MD
Toronto Plastic Surgeon
5.0 out of 5 stars 191 reviews

Voluma excellent for cheeks

+1
Restylane and Voluma are both excellent products.  Both products are made of the same material, hyaluronic acid.  However, Voluma has a special cross linking technology that allows it to provide extra lift and last up to two years.  For cheeks, Voluma is an excellent choice to restore volume loss due to aging.  As discussed below, Restylane is a good choice for treating the tear troughs.  

Kent V. Hasen, MD
Naples Plastic Surgeon
5.0 out of 5 stars 32 reviews

You might also like...

Fillers for cheek augmentation

+1
Voluma is an excellent (and one of my preferred) fillers for adding volume to the cheeks.  The advantage is it's capacity to lift soft tissue to contour the face and it's longevity (up to 2 years or longer).  Radiesse and Sculptra are other excellent choices.  The other hyaluronic acid fillers provide less lift and contour and don't last as long in this region.  It's important to realize that most cheek augmentation should be done at the level of the bone (under muscle) for a completely natural result.  Fillers such as Restylane and Juvederm ultra are not designed to be injected in this region and won't effectively lift the soft tissue of the cheek.  They are better for injections in the deep skin, lips, etc.

Joseph A. Eviatar, MD, FACS
New York Oculoplastic Surgeon
5.0 out of 5 stars 29 reviews

Filler Comparison

+1
Restylane, Voluma, Sculptra, and Juvederm all work extremely well for filling in the cheek area and volumizing that area. The tear troughs are more delicate and I only use Belotero or Restylanr. The most important question is a patient's facial anatomy and the doctor's expertise at matching these to facial injections. That is the art that comes with years of experience in facial injections. 

Michele S. Green, MD
New York Dermatologist
5.0 out of 5 stars 33 reviews

There are subtle differences between filers

+1
I actually use all the FDA approved fillers. I have found that in my hands, I can use each to their best advantage to achieve the result my patient needs. It is like having different shades of color in a palette. Restylane, in my opinion, is best in the tear trough. I would never use Voluma in this area. Interestingly, I have always done cheeks BEFORE I do tear trough in most patients. I find cheek enhancement actually improves the tear trough area without needing to inject it (or at least needing less). The bottom line, is do your homework: not just on the filler, but on the FILLER.

Mary P. Lupo, MD
New Orleans Dermatologist
5.0 out of 5 stars 9 reviews

Restylane Vs. Voluma for the cheeks. Which one gives better results?

+1
Voluma is a hyaluronic acid filler that would last two years, its great to help volumnize and contour the cheek. Restylane is also a hyluronic acid filler that works well for smaller areas like tear troughs or crows feet and would last 8-12 months, 

Kenneth B. Hughes, MD
Los Angeles Plastic Surgeon
5.0 out of 5 stars 237 reviews

#Restylane vs. #Voluma for the cheeks. Which one gives better results?

+1
Voluma is currently the best hyaluronic acid filler for cheek augmentation, in my opinion. It's also the only FDA approved injectable for the cheek area. Restylane tends to be too thin and does not have the 2+ year lifespan that we see with Voluma. I hope this information is helpful for you.

Stephen Weber MD, FACS
Denver Facial Plastic Surgeon

Stephen Weber, MD, FACS
Denver Facial Plastic Surgeon
5.0 out of 5 stars 44 reviews

Voluma or restylane

+1
Voluma or perlane should be adequate for the cheeks. Restylane is a product that doesn't last as long. Good luck with your choice.

Steven Wallach, MD
Manhattan Plastic Surgeon
4.5 out of 5 stars 18 reviews

How to choose the best filler for cheek volume

+1
When comparing the various fillers, it is important to understand the difference between "stimulatory" fillers and "wrinkle" fillers. When treating problems due to volume loss such as cheek hollows and sagging skin, I will almost always use stimulatory fillers such as Radiesse or Sculptra. They are injected deeper, beneath the skin, and will generate more volume to create a much better lifting effect for sagging skin. They work by stimulating your skin to produce more collagen, which is why they are so effective for problems due to volume loss, and give longer-lasting results too. Restylane is a hyaluronic acid gel which is injected more superficially in the skin rather than beneath it. It should not be used to create volume.

Mitchell Schwartz, MD
South Burlington Dermatologic Surgeon
5.0 out of 5 stars 8 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.