Perlane Vs. Juvederm, Which is Best for Cheek Augmentation?

My cheeks look gaunt and my face is perma-tired looking. One doctor said I need juvaderm but another told me perlane. pls help me understand how to pick the right cheek injection (or alternative solution)

Doctor Answers 16

Many fillers are appropriate for cheek augmentation

There are several very good dermafillers currently available in the U.S. for cheek augmentation and more are on the way.  Often the type of filler chosen depends largely on the experience and preference of the injector.

In my practice I offer Hyaluronic Acid fillers (Restylane, Perlane, Juvederm)  these have are made of a jelly like substance that naturally occurs in the skin, eyes, and joints.  They have subtle differences in there consistency, thickness, and feel, but are more alike than different.  Another very good choice for the cheeks is Radiesse, which is more or a paste like filler made of a material normally found in the bones.  This filler is slightly more substantial and is better for cheek bone and chin augmentation.

Good luck in your search for information!

Bay Area Facial Plastic Surgeon
4.5 out of 5 stars 71 reviews

Perlane vs Juvederm: Enough to give you a HEADACHE

I know this is difficult for the consumer to understand so I like to make analogies to explain the difference.

When you have a headache and you want an aspirin, does it really make a difference if you are given Anacin, Bufferin, Excedrin, Ecotrin, St. Joseph's, Generic aspirin? (They all contain the same active ingredient - aspirin)

Probably not. Right? Some people would argue that Excedrin contains caffeine and is better for migraine sufferers and Bufferin is better for patients with a delicate stomach because it is buffered, but in the end they will all likely achieve similar results of relieving the headache.

WELL: Perlane and Juvederm have the same basic ingredient Hyaluronic Acid. They are made by competing companies and so each claims that theirs is better. Well Perlane is intended for a deeper injection whereas Juvederm comes in two forms Juvederm Ultra and Ultra Plus. The Juvederm Ultra Plus is intended for deep injection, so this is the one you want to compare to Perlane. The longevity of the results are likelly similar despite the claims and can range from 6 months up to 18 months or longer. Juvederm specifically has FDA approval for stating it lasts 12 months. In terms of volume Perlane contains nearly 25% more per syringe than Juvederm and this may factor into the cost as well.

In summary, the advice, experience and skill of your injector probably factor more into the decision than the exact product.

I hope this helps!

Otto Joseph Placik, MD
Chicago Plastic Surgeon
5.0 out of 5 stars 60 reviews

Either one will work!

Which paper towel do you like better for spills - Bounty or Brawn? Personally, I can't tell the difference - they both clean a spill up quite nicely. Juvederm Ultra Plus and Perlane are very similar hyaluronic acid fillers with identical results in my hands. While the company that makes each one may boast "cold-filtered", higher viscosity coefficient, I still cannot tell the difference. The difference will be in the doctor you chose.

Bobby Buka, MD
New York Dermatologist
5.0 out of 5 stars 7 reviews

Juvederm or Restylane for Cheek Augmentation Or...

Fat Grafting

Structural fat grafting is a powerful tool for correcting one of the primary processes of facial aging: the gradual loss of facial soft tissue volume, which primarily represents the atrophy of facial fatty tissue. The importance of restoring facial fullness cannot be emphasized enough, for without it, very few facial cosmetic surgical procedures are truly rejuvenating. As we age the skeletal features of the face become more obvious, and create subtle visual clues that tell the observer 'this is an older person'. Fat atrophy is often very obvious when it appears as hollowness in the temple area and as flattening of formerly full cheeks, but can also exist as more subtle changes that still convey an appearance of advancing age, such as the development of a hollow in the space between the upper lid and eyebrow, or as indentations in a formerly smooth and gently curving jawline.


A number of 'soft tissue fillers' are available for temporarily improving facial areas that have lost volume, are naturally thin or hollow, or have developed noticeable and bothersome lines and creases. The most popular fillers currently are hyaluronic acid products like Juvederm® and Restylane® which can be used to, among other things, plump up thin lips and to fill out nasolabial folds (lines that run from beside the nostrils to the area beside the corners of the mouth) and marionette lines (lines that run from the corners of the mouth towards the jawline). In this practice we have performed thousands of injections with these safe and reliable hyaluronic acid fillers. They are well-tolerated by almost all patients and they produce very few post-injection problems. The improvement generally lasts from four to eight months, the average being about five to six months. Of the available hyaluronic acid soft tissue fillers, I have been most pleased with the performance of Juvederm®.

Other injectable fillers are currently available which attempt to produce a longer-lasting soft tissue augmentation by incorporating substances that are more slowly metabolized or that cannot be metabolized by the body. These are sometimes referred to as 'semi-permanent' fillers. Some incorporate non-degradable biologic materials (e.g. Radiesse®, which contains calcium hydroxyapatite, the mineral component of bone) or non-biologic (synthetic) materials (e.g. ArteFill®, which contains polymethyl methacrylate, also known as Lucite) that are designed to persist in the body permanently. Another is Sculptra®, which consists of a synthetic polymer called poly-L-lactic acid, which is also used as an absorbable suture material.

Unfortunately, the body treats these materials as foreign objects, and as a result the placement of non-degradable and synthetic materials may lead to inflammation, infection, migration and granuloma (an inflammatory cyst) formation - none of which are problems that you want to experience near the skin surface in your face. In general, the 'semi-permanent' injectables containing these materials are less likely to produce a result that looks and feels natural, and because of the potential complications I feel that they should never ever be injected anywhere close to the skin surface. We do not use any of these injectables in my practice.

If you are looking for a longer-lasting result than you are getting with Juvederm® or Restylane®, we have a much better solution for you: you own fat, currently residing somewhere that you don't need it. The improvement is designed to be permanent, and your body will not treat it as a foreign object. Your immune system won't attack it. The cost is about the same as several syringes of a 'semi-permanent' filler. And the quality of your facial skin may, in fact, actually improve in the areas where fat is grafted.

The ideal soft tissue 'filler'

One guiding principle of reconstructive plastic surgery is short and simple: "Replace like with like." Specifically, where tissue is missing, restore the defect with the same tissue whenever possible. If bone is missing, use a bone graft. If muscle is missing, use a muscle flap. So if fat is missing, the ideal solution is obvious.

Whether the goal is to restore volume to the lips or cheeks or temples, or to fill in a crease or depression such as the nasolabial folds or marionette lines (or all of the above), the ideal material is quite clearly the material that one wishes were there in greater abundance in the first place: your own fat. To be the ideal filler material it must also make sense from a cost perspective, which it does. The fat supply, from the standpoint of the volumes required for facial enhancement, is essentially limitless. A multi-area facial enhancement by fat grafting costs about the same as several syringes of ArteFill, Radiesse or Sculptra. And fat has the distinct advantages of not inciting an immune response, producing a more natural soft tissue consistency, and being well tolerated immediately below the skin (even within the deep dermis itself). So in my practice, there really is no place for the 'semi-permanent' soft tissue fillers.

The process is actually quite straightforward: fat is harvested from the abdomen, thighs, hips or buttocks using specially-designed instruments and a specialized technique, processed (by centrifugation, which eliminates all components of the harvested material which are not viable fat), and meticulously introduced into the facial areas to be enhanced using a second, smaller set of fat transfer cannulas. This procedure does not require an operating room and deep sedation or anesthesia - it can be performed in the office procedure room under local anesthesia and oral sedation.

A number of terms are currently used to describe varying techniques for harvesting and delivering fat in small quantities to produce long-lasting soft tissue augmentation: structural fat grafting, microfat grafting, lipostructure, orbital pearl fat grafting, etc. These terms all describe techniques for harvesting living fatty tissue with minimal trauma, refining the fat (in most cases) in some manner such as by centrifugation, and meticulously introducing the fat into the recipient area a small amount at a time to produce new soft tissue structure.

When is a graft truly a graft?

For fat grafting to truly represent 'grafting', the grafted tissue must gain a blood supply in its new location which provides a source of oxygen and nutrients and allows the tissue to persist indefinitely. If the grafted fat does not acquire a blood supply in the first few weeks after surgery, the body will gradually break it down and dissolve it, and no long-term benefit will be achieved in terms of soft tissue augmentation. Successful fat grafting surgery therefore requires a great deal of focus and attention to detail, to ensure that the fat which is harvested is viable tissue (i.e. not damaged by the harvesting process), and that the fat is delivered in such a way that the potential for ingrowth of blood vessels is maximal. If this process of blood vessel ingrowth (neovascularization) does not occur, then the injected tissue cannot truly be considered a 'graft' and is instead just another 'soft tissue filler' of limited duration.

Fat grafting has been performed by plastic surgeons for decades, but it is just in the last ten years or so that techniques and instruments have been refined to the point that it can be accomplished reproducibly and reliably, making it an increasingly important part of facial rejuvenation surgery. The term 'structural fat grafting' refers to a specific surgical technique in which small amounts (less than 0.1 cc at a time) of fat are carefully microinjected in a series of discrete layers to gradually 'build' new soft tissue structure. As there is space between each microinjection, new blood vessels are able to grow into the grafted fat, allowing it to persist long-term.

Structural fat grafting requires specialized training and specialized surgical instruments, as well as patience, finesse and attention to detail on the part of the surgeon. When performed properly, permanent and natural-appearing improvements in facial contours are possible. This revolutionary technique provides a means for restoring a youthful facial appearance that cannot be accomplished by means of traditional facial cosmetic surgery techniques, which have in the past focused primarily on skin excision for the purpose of 'tightening' facial features.

Be sure to view many before and after photos and speak to former patients before selecting a plastic surgeron

Michael Law, MD
Raleigh-Durham Plastic Surgeon
5.0 out of 5 stars 70 reviews

Non Surgical High Cheek Bones

The presence of high cheek bones is part of the so-called ideal appearance for women. For proof of this, you only need look at all the models in the fashion magazines. Flattened, drawn or fallen upper cheeks, on the other hand, make a face look more aged and tired. Cheek implants are a surgical approach to the problem.

The nonsurgical use of volumizing  agents to restore the cheeks or create them (in the case of individuals with long, thin faces who never naturally had them) has become quite popular in the last few years. We have found that, in addition to shaping the cheek areas themselves, cheek augmentation with the use of volumizing agents can serve to lift areas below the cheeks, in effect acting as a kind of minilift for the mid-face region.

Filling materials, such as Juvederm and Restylane, which are less viscous hyaluronic acid products, have certainly been used for cheek augmentation. However, because they are better suited for treating more superficial wrinkles and folds, a good deal of material is required for cheek augmentation and the results do not last more than a few months. Being more viscous, Perlane and Juvederm Ultra Plus, also hyaluronic products), tend to give more lift per syringe injected and also generally last several months longer before touch up is required. Radiesse, a calcium-based volumizing and facial contouring material, is my injectable of choice for this purpose. It gives immediate results, is hearty enough to provide the necessary volumization and contouring, and lasts considerably longer than its hyaluronic acid counterparts.

Nelson Lee Novick, MD
New York Dermatologic Surgeon
5.0 out of 5 stars 17 reviews

Options in fillers for cheek augmentation


Patients have several options when augmenting their cheeks. Typically this area requires a thicker filler for best results. In our practice, we have had good results with the use of Radiesse to this area. It is also possible to use a thick hyaluronic acid-base filler such as Perlane. Our patients, however appreciate the longer lasting results that they can see with Radiesse.

Pat Pazmino, MD
Miami Plastic Surgeon
4.5 out of 5 stars 68 reviews

Either Perlane or Juvederm for cheeks

Either Juvederm or Perlane would be appropriate for cheek fillers. They are both types of hyaluronic acids but they are made by different companies. I use both of these products in my office for the cheeks. I get great results with both. The most important thing is for you to find a physician injector whom you trust.

Julia Carroll, MD
Toronto Dermatologist

Cheek augmentation with fillers

Juvederm and Perlane (or Restylane) are all in the class of Hyaluronic aid fillers.They are safe effective but only last a certain amount of time, usually 6-8 months or less. If you really would like to have a noticable, high cheek (and in general that is a desirable feature of a feminine face) then you should consider a cheek implant.

They are permanent and in the hands of an experienced surgeon it is quiet safe. They are done through an approch from under your upper lip so there are no external scars. Recovery is realitively fast. It is very important to pick someone who has experience with this. Implants come in different sizes and shapes (made of the same material as chin implants) and they can be discussed with your doctor ahead of time. Good luck.

Andrew Pichler, MD
Sacramento Facial Plastic Surgeon
5.0 out of 5 stars 3 reviews

Perlane and Juvederm are both good fillers, it's the doctor skills are the difference

Perlane and Juvederm are both hyaluronic acid fillers. At our office, we have Perlane , Restylane, Juvederm Ultra, Juvederm Ultra plus, Juvederm Forma and the new V oluma (also from the Juvederm line). They are all safe products.There are small differences between these products and it allows us more versatility. We select the best product according to the facial correction we want to do. It can be a different choice from one patient to the next. It's more the skills of the injector that will make the difference in the final results.

Safety and natural results are very important and both lines of fillers can acheive that.

Suzanne Gagnon, MD
Quebec Dermatologist

Correction of Gaunt, Empty Face

As we age we not only lose facial fat but also facial bone resulting in the empty "table cloth too big for the table" look. While all conventional fillers may be used to correct this appearance there IS a difference between them which is important here.

Juvederm and Restylane, while great for superficial wrinkles are NOT up to the task of lifting cheeks and filling deep concavities and should therefore not be placed deeply. They will not hold up the cheeks not lift up empty cheek areas. These areas are much better filled with either Fat, Perlane, Juvederm Ultra Plus or Sculptra.

Radiesse is a very good filler when applied on top of the cheek bones.

Sculptra is the only product that has been shown to last beyond 2 years. It actually generates collagen but its effect is gradual and unlike other fillers, with Sculptra you do not see immediately what you have. Instead, you would need to wait 6-8 weeks to see how far your last injection session took you and opt or not for another injection. It is similar to fat in this regard where the amount placed does not necessarily equate the long standing amount of improvement.

Peter A. Aldea, MD
Memphis Plastic Surgeon
5.0 out of 5 stars 83 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.