Hi, About 4 years ago I had Juvaderm in my tear troughs with a fabulous result. 2 years on and it was time to top up. I went to a different Dr who talked me into using Perlane this time. I had a terrible allergic reaction to the Perlane and had to have it all removed by HA injections. 8 months later we tested a tiny amount of Voluma which also reacted so again we removed it with HA. Never having reacted to Juvaderm should I try it again or is there another option to fill my tear troughs?
Reaction to Voluma & Perlane but Not Juvaderm?
Doctor Answers 7
Reactions to fillers
You may have reacted to the anesthetic which has been added to many of the hyaluronic acid fillers. I would consider trying a filler without the anesthetic just in case. Also, in general, if you do well with something, I'm not inclined to change things up (why mess with success?). Radiesse would be another option for you as it doesn't have hyaluronic acid. When treating a delicate area like tear troughs, make sure to go with a highly trained and experienced injector such as a dermatologist or plastic surgeon.
Filler injection 4 years ago
It is almost certain that any filler injected 4 years ago did not have lidocaine in it . This was added to create a more comfortable experience with fillers and occurred in Feb 2010 for Juvederm. Now Perlane / Restylane and Voluma all have lidocaine. True lidocaine allergies are rare, but they exist and can be tested for by an allergist.
Best Injectable Filler for Tear Troughs
Different fillers have different properties including how "hydrophilic" they are, or how much water they attract. In general, I have found Restylane and Belotero to be the most effective and natural appearing fillers for the tear trough areas. I do not use Juvederm anymore as it draws water and can look "doughy" and blue in the tear troughs. Furthermore, I always use a blunt microcannula when injecting into the tear troughs to minimize the chance of bruising, pain, and scary complications like blindness.
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Post Juvederm Reactions
Thank you for your question. I would be very cautious if you experienced any allergic reactions with any fillers. Get an evaluation by a board certified dermatologist or plastic surgeon with expertise in injectables. Other options can be discussed including fat transfer, which utilize your own fat to fill these areas, without risk of allergic reactions. I hope this helps.
Best product for tear troughs
First Radiesse is NOT indicated in thin skin areas such as tear troughs. It can cause secondary swelling and it cannot be removed like the HA products you mentioned. If you had no reaction to Juvederm Ultra I would do that again. The main concern is you want a soft product that won't swell too much. Perlane is thicker and may create more lift in that area than you want.
Reaction to Voluma & Perlane but Not Juvederm
Even though all of these are HA fillers, they are not the same. One other thing I might mention - both Perlane and Voluma have versions that have lidocaine in them. There is a chance, however slight, that it's the suspended lidocaine you are allergic to and not the HA product itself. Juvederm now has a version with suspended lidocaine in it, which was not available 4 years ago. Until you can determine exactly what you're having a bad reaction to, I would NOT use Juvederm XC, but the old non-lidocaine version of Juvederm instead. That's my assumption - it's the suspended lidocaine in the other two that's the issue for you.
Your reaction was not allergic, just excess water absorption
None of these products cause an allergic reaction; even if they have lidocane in them. If your reaction went away by injecting the antidote hyaluronidase, then by definition you did not have an "allergic" reaction. Tera troughs are very delicate and sensitive to swelling. You simply had too much swelling or water absorption in the area from the products. Perlane and Voluma are thicker and firmer than Juvederm and can cause more swelling and puffiness (more hydrophilic). I would return to using Juvederm Ultraplus XC which I have used extensively without any allergies. Just start with small amounts and fill to correction over several sessions.