Is 1ml enough for my marionette lines? (I'm 29) but also have acne scarring. Also were my lines filled correctly? (photo)

I wanted the least done possible. I have acne scarring and marionette lines which I got filled with 1ml of juvederm. I can't really see any difference so I'm going back for another 1ml but is it the correct procedure for me and was it done correctly as I was surprised my to see little to no change...? I'm worried that if I do too much and say for example next year I can't afford it for whatever reason I will look worse than before.

Doctor Answers 6

Treatment with Juvederm

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Thank you for sharing your question and photos. You seem to be under-treated; however, it is better than having been over-treated. Usually for the areas you are concerned about, more than 1mm is required. Always have procedure performed by experienced doctors, not the cheapest. Good luck.

Acne Scars and Treatment

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Acne scars require a combination of lasers such as Fraxel and eMatrix, and injections with Restylane or Sculptra.  I wouldn't expect your acne scars to be corrected completely with one syringe of product.   I can't tell from the photos how many syringes would be required to correct your nasolabial area.  I would definitely consult a board certified dermatologist with experience with these procedures to get a realistic assessment of the results and cost.

Acne Scarring -- Requires a Combination of Fractional Laser Resurfacing, Fillers Like Bellafill, Subcision and Eclipse Micropen

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You need a cosmetic dermatologist who specializes in acne scarring/pigmentation and does a combination of treatments including: surgery, subcision, or TCA cross for deep or pitted "ice pick" scars; fillers like Bellafill or Sculptra or Radiesse for broad "boxcar" or "rolling" scars; Eclipse Micropen for all types of scars and improvement in texture and tone; lasers such as co2 laser resurfacing or Fraxel/Clear+Brilliant or radiofrequency such as Sublative or Viva to improve the scars and give long term collagen production. There are many options but you want someone who can customize a regimen for your short and long term goals based on your individual situation.  As for marionette lines, I suggest starting with 1 syringe but often people need more to contour the lips and chin which support the lines. Best, Dr. Emer.

Jason Emer, MD
Los Angeles Dermatologic Surgeon
4.8 out of 5 stars 207 reviews

Acne Scars

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Your pictures do show a bit of improvement in your "marionette" lines, but I agree with the answers already given. 1 cc is a very small amount. You will need at least that to further improve those lines.

As for your acne scarring, there are multiple procedures to correct that type of scarring, but what is done depends on the type of scarring you have. I can't really tell that from your pictures.This can only be done on a person to person basis with your doctor. CO2 laser resurfacing, in the right hands, can do a fabulous job for the majority of types of acne scarring. However, the results are only as good as the experience of the doctor doing the procedure. You are in luck, because one such person is Neil P. J. Walker FRCP in Manchester. Neil was trained in surgical dermatology at the Cleveland Clinic. He was a Fellow for both Philip Bailin and me in the mid 1980's where we did a significant amount of clinical research, and developed many laser procedures still being performed today. I don't know if he's still active with laser surgery but, if he is, he has the experience. If not, I'm sure he can refer you to someone who does. You may also want to check with him on your filler problem.            jlr

John Louis Ratz, MD
Lagrange Dermatologist

Facial augmentation

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Thanks for your question. Your question is tough to answer as their are many factors to consider. What type of filler was used? Was it an experienced injector? How was the injection done, needle or cannula? You likely didn't have enough volume placed as 1 ml is still a small amount. This is an advanced technique so be sure to get an experienced dermatologist or plastic surgeon consultation for recommendations and treatment options.

Alim R. Devani, MD, FRCPC
Calgary Dermatologist
4.9 out of 5 stars 16 reviews

How much Juvederm do I need

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Even though people worry about the amount of injectable in a 1ml syringe, it is actually less than a teaspoon of material. It just really doesn't go that far. With the photo that you "hate" if you were trying to get all those areas filled, you will need several syringes..... Fillers do require maintenance and you will need more filler in the future to maintain your look. You won't look "worse" next year should you not continue to do fillers but remember that aging will still take place and volume loss can continue too. 

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