How hydrolyphyllic is Restylane Silk compared to Juvederm ultra or Belotero, and could you list in order ?

hello, 
The best fillers for the cheek area are those that provide scaffolding and structure, like Perlane and Juvederm Voluma. The more hydrophilic fillers, like Juvederm Ultra and Restylane Silk, will attract more water, which make them attractive for areas like the lips. All fillers cause some edema, however, your injector should select a robust filler to provide more volume in the mid face. 

I appreciate your question.Restylane Silk, Juvederm Ultra and Belotero are all part of the Hyaluronic Acid family of fillers.  Hyaluronic Acid (HA) is a type of sugar (polysaccharide) that is present in body tissues, such as skin and cartilage.  It is able to combine with water and swell  - making it hydrophilic (attract water)  when in gel form.  Sources of hyaluronic acid used in dermal fillers are mostly created from bacteria fermentation and cross linked.  The linkages between molecules are both natural and synthetic.  Hyaluronidase, a natural enzyme in the body breaks down natural links faster than synthetic links.  The HAs with the least links breakdown the fastest.  Those with the greatest number of links are stiffer and last the longest.  The HAs such as Belotero and Restylane Silk have the least amount of linkage providing the shortest duration.  They are best used for delicate areas - fines lines, lips, peri oral rhytides, and tear troughs (under eyes).  Restylane and Juvederm come next.  Followed by Perlane (now called Restylane Lyft), Juvederm Ultra Plus and Voluma  The best way to assess and give true advice would be an in-person exam.Please see a board-certified plastic surgeon that specializes in aesthetic and restorative plastic surgery.Best of luck!Dr. Schwartz

Thank you for your question.  I would recommend that you use Voluma, Perlane or Radiesse in the cheeks.  Both Voluma and Perlane are reversible with an enzyme should your get an undesired result.  Belotero, Restylane Silk and Juvderm are better suited for thinner and softer regions of the face like the lips or tear trough regions. 

This is hard to rank as individual patients respond differently than others.  Juvederm is the most and the others are somewhere in between.  Belotero seems to integrate the best and doesn't cause much swelling in my hands.  I like injecting with cannulas to prevent any complications.  Best, Dr. Emer.

The best filler for the upper cheek area are actually Voluma, Perlane, or Radiesse. Voluma and Radiesse are the least hydrophyllic of the three, but they all work well in the upper cheek. Belotero and Restylane Silk are used around the mouth for lines.

There is somewhat more edema after injections with Restylane Silk in the lips.  However, this is lessened by using proper technique, which includes slow injections with minimal massage afterwards.  The reason for the swelling afterwards is suspected to be due to the high surface area of the HA particles, leading to more water absorption (hydrophilic). The edema subsides in about 48 hours and can be reduced with head of bed elevation and sometime oral steroids.

For upper cheek area along the
cheek bone my first choice is usually Voluma because it lasts the longest time
(1 ½-2 years), is reversible in the unlikely event that needs to be done and
does not draw in extra fluid like Juvederm and Restylane so there is very
minimal swelling. Belotero also does not draw in fluid as much but has the
shortest duration. Juvederm and Restylane/Perlane are in the middle. Restylane
Silk does cause swelling but lasts longer than Belotero – at least in my
patients. An experienced physician usually has all the filler options
available and will know which is the best option for your particular needs.

Dear letsthink:This is a wonderful question not easily understood by patients and many injectors."Hyaluronic acid (HA) is a type of sugar (polysaccharide) that is present in body tissues, such as in skin and cartilage. It is able to combine with water and swell (hydrophilic) when in gel form, causing a smoothing/filling effect. Sources of hyaluronic acid used in dermal fillers" are now mostly created from bacteria fermentation or historically from rooster combs (avian). "In some cases, hyaluronic acid used in dermal fillers is chemically modified (crosslinked) to make it last longer in the body. The effects of this material last approximately" 6 – 24 months. HA's have natural and synthetic linkages between molecules. Hyaluronidase, a natural enzyme in the body breaks down natural links quicker than the synthetic links which attribute to the quality, duration and characteristics of each product. Those with the least links breakdown faster but are the smoothest hydrators. Those with the greatest number of links are stiffer and therefore more projecting and last the longest. Different manufacturers process the molecules differently. Some are broken into smaller molecular clumps enzymatically, others are filtered through microscopic sieves to separate the molecule sizes. You can now see why HA fillers work differently a different levels of appropriate injection by the understanding and the talent or skills of the injector. Natural HA undergoes the quickest of the breakdown and can lead to poor hydration of the skin without the genetic stimulus of the body to create it. Those HA's such as Belotero and now Restylane Silk have the least amount of linkage providing the shortest durations (3-6 months) BUT the greatest hydration. These are best used in fine lines such as those around the lips and eyes. They are also useful for large areas such as multiple and long cheek lines or forehead creases as the achieve great smoothness while used sparingly.Restylane, Juvederm HA's come next. With greater projection, these HA's are used for the pink lip, the "white roll or edge" of the lip, wrinkles of the nasojugal, nasolabial and marionette areas in the dermis.Perlane, Juvederm Ultra Plus and Voluma with higher tackiness and projection are best used in deeper tissues for greatest elevation and fill. I use these fillers for deeper folds such as the nasojugal, nasolabial, marionette folds and atrophic upper cheek and weak chin or jawline. Please obtain your consultation for these and other injectibles from the most well experienced Board Certified injectors whether they are Plastic Surgeons, ENT, Dermatologists or Ophthalmologists. I hope this was helpful. All the best!

I dont think there is accurate data available to answer your question. RestylaneSilk is quite new but likely comparable to the JuvedermUltra and Belotero. More importantly the amount of edema is not entierly predictable and varies with individuals. Let your injector professional recommend what he/she is most comfortable with for your needs.