I Had Restylane Last November, My Dr. Keeps Saying I Need More, Should I Believe Him?

The most important thing is the chemistry of confidence you have with your surgeon.  If you are not sure you can trust you doctor, it is time to get other opinions.  You have so many great choices where you live that there is no reason to feel stuck with a particular individual who makes you upset.  The reality is that you probably do need more volume.  Many doctor swear by Radiesse.  I personally do not like this product.  While I have used it, I switched over to Perlane when this product became available.  The hyaluronic acid fillers like Restylane and Perlane can easily be adjusted with an enzyme injection any time after treatment.  It is not possible to adjust Radiesse in the same way.  My advice is go where you are comfortable.

When we see patients in clinic for fillers, I typically estimate the amount of 'syringes' that a patient would benefit from. Generally, patients don't want as much as we recommend, because of costs, or other considerations. So we inject some filler and make gradual improvements. Patients sometimes return and want more filler, which is fine. Gradual correction over time is better than inadequate correction.

It sounds like you need to re-evaluate your provider. Typically, you would sit down and consult to first discuss what treatment and product would serve your needs, then plan and treat. Discussing pricing and what the expectations are, should always be done prior to having anything injected to avoid conflicts like you've described.  

There is no doubt that in well trained hands, fillers work.  Typically, the secrets to patient satisfaction relate to 3 factors: 1)  Injector technique.  With the introduction of family Doctors, Dentists, and others into the milieu of injectables, it is incumbent on the patient to look at credentials and training (look for a Board Certified Facial Plastic Surgeon, Plastic Surgeon, Dermatologist, or Occuloplastic Surgeon for your injectables),

2) Volume of filler. If you didn't receive enough filler in your nasolabial folds, you won't be happy, regardless of who your Doctor is.  It is up to the Doctor to make the correct call on how much is required.  More syringes leads to a higher cost, but remember that the Doctor has to have the ability to treat the problem you present with.  If a patient needs 3 syringes and is only willing to pay for 1, the odds of dissatisfaction are much higher.

3) Expectations.  Fillers will not give you a Facelift result.  If your are advised to consider a Facelift for your concerns, but choose a filler instead, the odds of success are lower.

Your story is not at all uncommon.  One of the most common "problems" with fillers is incompete or insufficient improvement of a line, fold or wrinkle.  It is important to discuss this fully with your physician (preferably before treatment).  Often it is necessary to use more than one syringe for deeper lines to achieve a better correction.

Radiesse is a very good filler as is Restylane, but they are different products with different uses.  Typically, Radiesse is better for deeper, more volumizing correction and also is longer lasting than Restylane.

If you are not confident in your physician, you should consider a second opinion.

It is very possible that your injector underestimated the amount of product you would need.  That being said, if you feel as if you can't trust your injector, a second opinion is always a good idea. 

The real question here is "what do you think?!?" You doctor may want to give you more restylane to make you look better. But that ideal is in his or her mind. What really matters is what you think of how you look. Do YOU think you need more? If you do, then get more. If not, be happy with the way you look. It's also OK to change your mind later.

Whether you need more or not depends only on you.If after the injection you are happy with the amount and the look then you do not need more restylene.However it will diminish in time and more will need to be added.

Choice of fillers really depends on how deep your lines are. Generally products like Radiesse, Juvedem Plus and Perlane are recommended for deeper lines. Sometimes it is difficult to predict how your lines will respond until the product is actually injected. While your physician may have thought Restylane would be sufficient, he may be recommending Radiesse due to your lack of response. Also if your physician has before and after pictures of your treatment, the improvement may be more evident in a side-by-side comparison. Generally with fillers the more you use the more improvement you will get, though it is possible to overfill. When in doubt you can speak to your physician more or you can seek a second opinion.

Pateints often need more filler than they think. I know that patients are a bit hesitant to get too much and rightfully so, so it is not uncommone for patients to come back for more after initial treatment.