Restylane, Perlane, Juvaderm and Sculptra Consultation/FAQ's
Smooth, lift and rejuvenate lines and creases of the Face-Mouth-Lips

Aging
Aging is a gradual process of volume loss and skin alteration.  As part of the normal aging process, we find our muscles, fat and bones of the face losing fullness and contour.  The overlying skin begins to suffer a loss of firmness and elasticity.

Fillers
Restylane, Perlane and Juvéderm are purified natural products that act as plumpers.  They are similar to the normal (Hyaluronic Acid or HA) found within our healthy skin which enhance volume and tone by grasping onto water and holding it like a sponge. Since HA products are purified and are synthesized, they carry a much lower risk of allergies or rejection by your body. 

With the aging of the skin there is a loss of the HA resulting in sagging and volume depletion. Imagine a partially filled balloon.  Without the extra water in our skin and loss of the deeper tissue fullness, our skin starts to show lines, creases and deep folds.
 

How do the HA products produce a contour improvement?

They work in two ways to fill and shape lips, lines and creases.
 
The HA products come in various forms depending upon the number of particles suspended in the solution.  Perlane and Juvaderm Ultra Plus are best for the deeper creases and contour changes around the mouth, jaw and cheeks.  These act a as platform onto which the smoother and slightly thinner Restylane or Juvaderm can then be added to complete the process.  Imagine the bottom layer as the bottom of a cake.  It rises up to form the base of the cake.  The top HA layer is like the icing used to finish off the shape and make the cake look pretty.
 

How many syringes of product will you need?
Typically, most patients require at least two syringes to start the process, but this will depend upon how many areas are to be softened and contoured. The more areas of concern require additional volumes to fill.  It is like waxing your floor.  Put a bit of wax in the middle of the floor and spread it out.  If the floor is small, you will be able to cover the entire area.  Larger floors will be inadequately covered or only have a very thin veneer of wax.  So too, the HA products can only be spread so far.  You may have a procedure and after a few weeks require additional HA to complete the contouring. 
 

How long does it last?
The manufactures note that the HA products may last 6-9 months.  However, certain areas of the face, such as the lips will have faster volume depletion due to their movement.  Each person is an individual, so predicting precise longevity is difficult.
 

Does it hurt?
Most physicians will only place a cream or ointment on the top the skin and then inject the HA products.  As you can imagine, this would be less than comfortable.
 
The process of numbing your mouth requires up to 1 hour by Dr. Rosenthal.  First, an ointment is put on to decrease the sensitivity and potential later bruising.  Secondly, a gel is placed on your gums and inner lips to numb these areas before a numbing liquid is injected, similar to a dentist.  Thirdly, more numbing liquid is placed deep under the skin to allow you the most comfort during the HA procedure.  Generally, the areas to be injected with the HA products are fairly numb to afford you the most comfort during the sculpting procedure.
 

Will I be bruised and swollen?
Since the HA products draw fluid into the skin, one can expect swelling for a few days.  They also affect clotting in the areas of injection causing some bruising.  The degree and extent of swelling varies and may last between 3-7 days on average.  Makeup can be used the day after the procedure to camouflage these areas. 
 

Are there potential risks?
With any procedure there are potential risks of complications.  These are generally few and infrequent.  Bruising that lasts a bit longer (longer than 7-10 days) than expected with swelling can occur.  The injections to sculpt your face require multiple entry points with a very fine needle (after the area is numb).  These pin points may stay around for more than 1-2 weeks, and there is always the rare occurrence where the mark(s) does not disappear.

The face is not even or symmetrical, and thus only relative symmetry can be obtained. No face is symmetrical before or after the HA products. Since the products fill the skin and hold fluid, there is a chance of having extra fullness or small thickenings in or under the skin.  Usually they disappear with time and massage, but there is the rare chance of their staying.  Allergic reaction or the HA products causing temporary or permanent discoloration to the skin is another rare complication.
 

What to expect:
The HA products enable Dr. Rosenthal the opportunity to artistically sculpt your face to a softer, fuller and more youthful appearance. By taking the time to properly numb your face, mouth and lips, Dr. Rosenthal can produce a natural fullness.  This transformation comes about by layering the products in such a way to lift, contour and augment your own tissues.
 

Lips
The pink lining of the lips began to sag and lose taughtness.  This is due to loss of muscle volume of the lips.  Restylane or Juvaderm can be used to build up and enhance your lip line and lip fullness. 
 

Corners of the mouth
These droop like other areas of face.  The HA products can subtlety elevate these folds.

Lip lines
Vertical and horizontal lines in the upper and lower lips can be softened and contoured.
 

Creases next to the mouth
Folds extending from the nose to the corners of the mouth and beyond are attributable do to the laxity of the cheek tissues. The HA products act as a scaffolding to re-support and contour these folds.  The deep folds are pleasingly softened with great care to not overfill them which would result in unsightly bulge.
 

Jaw line
When the jaw line sags a bit and is no long crisp and smooth, HA products can build up some of the depressions adjacent to the chin. 
 

Cheek-Forehead-Temples
Hollows in this area can be softened with HA products; however, deep cavities will require another product called Sculptra.
 

Sculptra
Unlike other fillers, actually causes your own skin to build up thickness.  The process requires 3-5 treatments which are spaced at 4-8 week intervals.  This product may last up to 3 years.  When contouring with Sculptra it can be used in the temple, cheeks, jaw and junction of the nose and cheek.  Sculptra is the best product for large area contouring. 
 

When do I see Dr. Rosenthal again?
We have a complimentary follow-up evaluation 2-4 weeks after the first treatment session.  This is to judge the contour improvement and to see if additional filling with the HA products is necessary to achieve the desired results.
 

Conclusion
HA products have revolutionized how Dr. Rosenthal can build up, create and rejuvenate your face in a caring and gentle manner.  A consultation with Dr. Rosenthal prior to the procedure allows for a proper evaluation and treatment plan.  The HA products do not replace good skin care, treatments and products supplies by our professional staff, nor are they a solution for those who are in need of surgically lifting and re-supporting your face and eyelids. 
We hope you will find the HA products as satisfying as those patients who have already benefited from Dr. Rosenthal’s artistic handing of these fillers.
 

Jeffrey S. Rosenthal, M.D.