Krauss Dermatology

Madeline Krauss, MD

1 Washington Street, Suite 401, Wellesley Hills, MA 02481 | Tel: 781.416.3500

Restylane®, Perlane®, Belotero®, Voluma® and Juvéderm® Fillers

Cosmetic Procedures > Restylane®

Hyaluronic Acid Fillers for Lines and Wrinkles

1. What are Restylane®, Perlane®, Belotero®, Voluma® and Juvéderm®?
These fillers are injectable products made of hyaluronic acid. Hyaluronic acid is a molecule that binds water and is normally found in the deeper layers of the skin. Restylane, Perlane and Juvéderm do not contain any animal products. They are unlikely to cause an allergic reaction. The specific filler used depends on the area and problem to be treated and a patient’s skin type. Perlane is a thicker, stiffer variation of Restylane. Juvéderm (Ultra and Ultra Plus) are softer, more malleable products.  Voluma® is used for cheek augmentation,  Belotero® is a fine filler excellent for superficial lines.  Hyaluronic acids have been used in this country for medical treatments in the eye and joints for years. These products have been used for cosmetic purposes in the US for about a decade, and for longer in Europe and Canada with excellent safety profiles.

2. When will I see results?
Results are generally noted immediately, although mild swelling and redness generally take 48 hours to resolve. Makeup may be applied immediately after a treatment. If more correction is desired, additional treatments can be performed at least 1 week after an earlier visit, leading to further improvement.

3. How long will the results last?
Benefits initially last about 6 or longer with most of the hyaluronic acid fillers, and for 2 years on average with Voluma®, though results vary. An additional treatment four months post the initial injection has been shown in a published study to lead to longer-lasting results. The longevity of these fillers results not only from the material persisting in the skin, but from stimulation of a patient’s own collagen production in the injected area.

4. Do the injections hurt?
The fillers now contain lidocaine which makes the procedure more comfortable, even around the sensitive mouth area.  For cheek and chin area (marionette lines) treatment we may utilize the cannula technique which also contributes to a very tolerable, no downtime procedure.  For more superficial lines, and treatment of the lip area, using topical anesthetic (lidocaine gel available in our office) can further help minimize any discomfort.

5. Are there risks to the procedure?
Transient bruising at injection sites can occur, particularly if you have had aspirin or ibuprofen (Advil) within 1 week, or alcohol within 48 hours of treatment. Puffiness, tenderness and/or redness may result for 1-4 days, and rarely longer. Small areas of firmness may be palpable, and rarely visible, but blend in with time. Very rarely prolonged swelling, redness, itching or firmness may last weeks or longer. Extremely rare side effects include compression/occlusion of blood vessels leading to formation of a scab, which can result in a shallow scar. Other rare side effects include dizziness, headache, rash, visual disturbances, infection, or reactivation of cold sores.

6. Who should not be treated with fillers?
You may not be treated with filler injections if:

  • You are pregnant or nursing.
  • You have multiple severe allergies or history of anaphylaxis.
  • You are taking a blood thinner such as Coumadin (Warfarin) or aspirin.
  • You have a bleeding disorder.
  • You have had a previous allergic or severe swelling reaction with Restylane, Perlane, Juvéderm, Belotero or another hyaluronic acid filler.

Patient Instructions for Hyaluronic Fillers

Pre-Treatment Instructions

  1. Avoid aspirin for 10 days. Avoid ibuprofen (Motrin, Advil) and Vitamin E for 5 days prior to the procedure, because these medications will make you more likely to bruise. If you have been prescribed one of these medications, ask your doctor before you stop taking it. Tylenol will not cause bruising and is preferred for the week prior to treatment.
  2. Alcohol is also a blood thinner and should be avoided for 2 days prior to the procedure to minimize bruising.
  3. You may choose to use Topicaine numbing cream (available for purchase in our office) or LMX 4 or 5% cream (slightly more expensive and available by special order at your pharmacy without a prescription) prior to the procedure to minimize discomfort. Apply the numbing cream 30 minutes prior to your appointment to the area being treated. After you check in for your appointment, apply an additional layer of numbing medication and rub into the skin. No more than a single 30 gram tube should be used in any given day to avoid the danger of lidocaine toxicity.

Post-Treatment Instructions

  1. Keep an ice pack on the area for 5 minutes in the office.  To avoid cold injury, we do NOT recommend you ice at home.
  2. Refrain from vigorous exercise for the rest of the day (walking is O.K.). Do not use any saunas or hot tubs.
  3. Do not massage or manipulate the treated area on the day or evening of treatment. You may wash your face normally.
  4. You may apply makeup as usual.
  5. If you experience discomfort or a headache, you may take Tylenol (acetaminophen). Wait until any bruises are resolved to take aspirin or ibuprofen (Advil).
  6. Swelling is generally most noticeable 1 or 2 days after the procedure. Sleep with an extra pillow to minimize this.
  7. Notify us if you have persistent swelling, redness or itching lasting more than 48 hours, or if any crust, scab or rash develops.
  8. If you have significant pain or unusual bruising from your procedure, we would like you to call the office.
  9. We can utilize the VBeam vascular laser to accelerate the resolution of bruising. Call our office to come in for a quick visit approximately 48 hours post your procedure for the best results.

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