Restylane, Juvederm, Perlane and Radiesse
Q: Should I try to massage Juvederm or Restylane at home if I think it’s out of place?
Dr Joel Says: Let the Swelling from Juvederm settle and see your Doctor.
Without examining the area, it’s impossible to give exact directions here on a “home massage technique” for Juvederm. Although this can be done in some situations, keep in mind that post-treatment swelling may be not only from the Juvederm itself, but also from bruising, and inflammation due to an injection 3 days ago.
In this situation, I would recommend seeing the Doctor that did this injection. If your Doctor wants you to massage this area and you’re not sure how to proceed, it’s best to have him examine the area and then guide you on how to massage it. He may also attempt to massage in the Juvederm himself, or allow swelling to subside before taking other action. In short, seeing your Doctor will help yield the best results.
If you can’t see your doctor now, be sure to follow up with him 10-14 days after the injection. By then, bruising and swelling is usually gone, and the long-term effects of Juvederm will be visible.
Q: My friend said she fainted when she got her wrinkles filled at the Doctor’s Office. Will that happen to me?
A: Fainting can happen when patients get injections
When patients get injections, some may get lightheaded. Other may get nauseous. A few even “faint” or lose consciousness. This is called “vasovagal syncope” by Doctors. Sometimes patients can get this reaction when seeing a needle, seeing blood, or when they feel the “poke” of an injection. With vasovagal syncope, blood vessels enlarge and heart rate slows. This causes less blood flow to important areas, such as our brains. The result is “fainting”.
What can you do to decrease the chance of this happening, especially if you’re prone to this? Here are some thoughts:
- Drink fluids and have a light meal 2-3 hours before your procedure.
- Your doctor may recommend a topical anesthetic before treatments, or even before he/she uses numbing injections to minimize discomfort.
- Occasionally, doctors may prescribe medication to decrease anxiety before a procedure. You’ll need someone to drive you to and from the office visit if you are prescribed this.
- It’s best to be seated in a reclinable treatment chair during injections. Occasionally, I’ll hear stories of patients injected while standing- if these patients faint, they can fell down and injure themselves. If a patient does faint, they are laid backwards, which allows blood flow to return to their head, and the fainting episode improves faster.
Patients recover completely from these episodes when they occur. Most Doctors who inject patients regularly find this to be an infrequent happening, but are ready for this to happen anyways.
Q: Can I get Radiesse removed once it’s been injected?
A: It’s hard to remove Radiesse completely.
Radiesse is a skin filler which can last longer than hyaluronic acid fillers (e.g., Restylane and Juvederm). It can improve lines and increase volume in certain areas for approximately 12-18 months. Radiesse is injected at a deeper level than collagen and hyaluronic acid products. In fact, if it is not injected deeply enough, nodules or lumps can form.
After Radiesse has been injected, there have been reports of nodule formation in some patients. This is most commonly seen for Radiesse injections in the lips. A very important point is that Radiesse should not be used in this area.
Can you remove Radiesse once it’s been injected? Answer: Only Sometimes.
Radiesse is a combination of a water based gel and calcium hydroxylapatite. The water based gel fills skin for up to 3-4 months. After that, the collagen that forms around the calcium compound causes long term filling.
It’s unlikely that puncturing a treatment area with a needle and squeezing will result in a lot of gel being squeezed out. This is especially the case for Radiesse that was injected at a proper depth. “Poking” an area that has misplaced Radiesse just under the skin may work for a few days after treatment.
After 2 or more weeks, if there’s a “lump” just under the skin, a small incision can be made, usually with a small scalpel after injecting a numbing medicine, and the Radiesse “lump” can be removed.
Removal of deeper Radiesse injections is a more involved procedure, and this may change the texture of the area afterwards.
Although complications can happen to anyone, you don’t want to deal with them if possible. The most important point here is that a Medical Doctor who has experience in Radiesse injections will give you your best chance of success. He or she will know how deep to place the injections, how much to use, and where not to inject.
Q: What is better for treating wrinkles: Collagen or Hyaluronic Acid?
A: It depends on the location and depth of the wrinkle, among other things!
Recently, many physicians who treat patients regularly with skin fillers have been using collagen-based fillers less. Fillers which contain hyaluronic acid are more commonly used these days. Examples include Restylane, Juvederm and Perlane. I use hyaluronic acid fillers virtually every day in my office.
Collagen fillers have been available for over 20 years, first as Zyderm, then more recently as Cosmoderm, which does not require skin testing like Zyderm does. Zyderm 1 has the thinnest consistency. Zyderm 2 has a greater “thickness”, and Zyplast is the thickest collagen-based filler of the Zyderm family.
Results with Zyderm and Cosmoderm last for about 3-4 months. In many treatment areas, hyaluronic acid fillers will last 6-9 months, sometimes even longer. When used to increase lip volume, however, these fillers may last only 4-6 months. We’re moving our mouths a lot during the day, and, as a result, the filler can diffuse away faster.
If you’re getting good results with collagen, it’s not unreasonable to keep getting injections with the same product. However, many physicians now use Restylane and Juvederm with great results that usually last longer than collagen. If you’re ready to try a hyaluronic acid filler, discuss this with a medical doctor who consults and treats patients him- or herself for best results.
Q: Can injections of Restylane or Juvederm make my acne worse?
A: Usually not, but it is possible.
If you’ve had a skin filler (e.g., Juvederm, Restylane, Perlane) injected in an area that’s prone to acne, there’s a chance of acne worsening in that area for a few weeks. This is because inflammation is one of four main causes of acne. The other main causes of acne are increased oil production, increased acne bacteria, and increased skin cell turnover, which results in blocked pores.
Think about the filler process: a needle goes into the skin, a skin filler is injected through the needle, the filler absorbs water, and then the area may be pressed on to mold the filler. All these actions can cause inflammation. This inflammation can be enough of a stress to your skin to cause an acne breakout.
By the way, many treatments can act as acne “stressors”, and make acne worse. I always tell my acne patients that even their new acne skin care regimens can temporarily make acne worse before it gets better. This is why it’s important not to give up after only a week or two of trying a new acne treatment plan.
Talk with your doctor about treatment for skin cysts. Sometimes, a cyst may need to be drained. Sometimes, it’s best just to let the area heal. Again, a good acne treatment plan can help decrease the occurrence of acne with time.
If there’s a lot of active acne in an area you’d like to have injected with skin fillers, it’s often a good idea to wait until the area is less irritated. Injections when there’s a lot of acne can increase risk of skin infection.
Remember - It’s Your Face! For best results, consult a Medical Doctor with expertise in treating acne patients and who injects skin fillers him- or herself.
Q: Can I get bumps around my mouth from Juvederm?
A: This usually doesn ’t happen long term when an Experienced Medical Doctor treats you.
During the first 10 days time after a Juvederm injection, I always tell patients to expect:
- Bruising, which may be uneven on one side, can cause sore, soft bumps, and make your lips look unusual for several days. Bruises usually improve in 10-14 days, unless you’re taking a lot of aspirin or a “blood thinner” like Coumadin.
- Swelling, which can also make your lips look different. I always say to expect swelling for about 10 days. Elevating the head of your bed, and applying ice packs for 20 minutes at a time on the treated area can help. Avoiding direct sunlight, alcohol, and strenuous activity can help keep swelling down also.
Sometimes, small bumps are near the surface. Your doctor may advise you to massage small lumps gently after your treatment. These can be due to Juvederm causing “lumps” just under the skin.
Some fullness around your mouth may be there deliberately to fill areas which have lost volume over time. Although you can feel them, no "lumps" should be visible long term.
I always recommend follow up 10 days after Juvederm injection. I take “after” photos and compare them with “before” photos. If a patient needs more Juvederm or needs another course of action, I discuss this with the patient then. If your doctor wants to see you sooner, or you have plans to see her sooner, that’s fine as well, but the long term effect may not be visible yet.