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Which Injectable Filler is Best? Botox, Xeomin, Restylane, Perlane or Belotero

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    ”I think you're here today for some minimally invasive procedures. So let me take the opportunity to talk about some cosmetic injectable products that we have available that can improve a variety of conditions that maybe of concern.

    The first group we've talked a little bit about is Botox or the neuromodulaters, Botox and Dysport. Two products that have been around for a while now. Both of which control the hyper functional or over active muscles of our face which gives us angry scowls, deep crows feet lines, the little radial lines around the mouth and the bands in our neck, and they're very good treatments what we're using Dysport or Botox to really manage those nicely.

    The other broad category of injectable are cosmetic injectable fillers and there are whole groups of these fillers. We got a portfolio of them available now and let me explain them in brief.

    The main filler that we use for cosmetics injections generally is a hyaluronic acid, which is not an acid at all. It’s actually a sugar which comes as a gel in a syringe for us to use. The products names, which many people have heard include Restylane and Perlane, Juvederm and Belotero.

    There's some other ones that are not particularly prominent players in the area and those four main products we use for a variety indications in the face, but there are subtle difference as well. They're all very similar and most of them contain lidocaine. The Juvederm, for example, has a lower G prime, its a little less stiff of a gel and I like it in areas of transition like the commissure lines where it can spread out and have a little softer elevation or a depression or a transition in the face.

    In contrast, Radiesse or Restylane or Perlane have a higher stiffness factor G prime, and when I say this they're still a very soft but they do have a little bit more rigidity to them so they hold their structure. So in areas like the nasolabial fold or the lip boarder in many patients, Restylane or Perlane might be a better choice.

    They also have some differences in how much water they absorb. Juvederm is on the high end of the water absorption. Again, this is a great way of softening transition in areas where there's only soft tissue like around the marionette line. It can be used beautifully in the nasolabial fold for this reason, and holds a small amount of body water, again absorbed to the molecule for a period of time after the treatment. Restylane and Perlane holds less water and as a result, Ill commonly use this in the areas around the eyes, where we don’t need water retention. All of us know what it looks like to have sort of the watery bags after times with no sleep or little sleep. So there's specific indications for why we might choose a different product for different indication on the face.

    The last of the fillers that I mentioned, Belotero, the newer one, has a little bit different way of being cross-linked and it doesn't have lidocaine in it. The unique thing about Belotero is that it’s less visible when used close to the surface of the skin, which is effect called tyndall effect, seen in some of these products in fact all these this products.

    So with fine line treatments like the radial lines around the mouth sometimes the smile, deeper smile lines on the face for people who don’t want skin resurfacing or other options and just want a simple minimally invasive office treatment, Belotero for fine lines is a very good option. When I use

    Belotero for fine lines I’m taking lidocaine which is numbing anesthetic solution, mixing it in with the product and then we'll very carefully trace out each of these lines, and it can provide a very smooth effect again for radial lip lines and small lines around the face. So that's the HA fillers and in general context, they're all very good, very reliable, we don’t have to do skin testing any longer and the real beauty of the HA fillers is that they're adjustable. If we have a bump or an irregularity which is very uncommon, we can go back with a small enzyme injection called vitrase or wydase and make that bump go away almost immediately.

    The other broad category of injectable fillers are the volumizing fillers. So if you think that the HA fillers as ones that are helping to improve transitions, depressions or irregularities or enhanced lips, we think of the HA fillers,and then when we think of the other group they're more volumizing fillers. These are fillers that in general are used in the malar areas, sub-malar and temporal region, as well as in some cases along the jaw line, and these are stimulatory fillers, that's Radiesse, is one of them and Sculptra if other product that are generally used as volumizing fillers.

    I'll tell you a little bit about Sculptra. Sculptra is a polylactic acid product which is basically a milk sugar and it's delivered in to our office as a powder in a vial and we'll reconstitute that with water the day before the treatment.

    When the patients comes in, when you come in for your Sculptra treatment, we will have that ready-to-go, and it's a small series of injections in whatever area we're adding the volume or the enhancement that we're seeking and usually it's one or two vials within an initial treatment of Sculptra.

    All the benefit, all the swelling that which is pretty modest with Sculptra will go away in a few days and it leaves the small particles behind which stimulate the body to make collagen around each of those particles. After a couple of months we'll see the maximum benefit of that stimulatory collagen production and we can do a retreatment and over the course of somewhere between 3 and 5 treatments in most patients. We can achieve a natural, your own collagen based, volumizing effect. So the natural pathway or course of this is the patient, you, will be treated, gets swollen, all swelling will go away, you'll get a little build up, it will come back for a retreatment, get a little swelling all that will go away and a little more build up and over the course of the year we'll get to an end result with Sculptra.

    The other product that's out there is Radiesse. Radiesse is a tiny microscopic beads of calcium hydroxyapatite which is the same as our bone mineral. This is a eucerin gel but I still use lidocaine and mix it and make it very, very dilute and when we inject it, it’s very much like the Sculptra injection. These tiny little particles in contrast to Sculptra don’t go away right away, so you get an immediate volumizing effect when you do Radiesse and yet the body is still stimulated to make collagen around each of these beads.

    So in contrast to the Sculptra where it takes several treatments to get to the end point, Radiesse is usually one or two treatments to get to an end point that will last to year or longer for both products once a year or so to maintain that volumizing effect is the general timeline that we see for people getting facial volume enhancement. Both these products are safe, have been used for many years unlike the HA fillers however they are not reversible so we're very careful about it, and with Sculptra in particular, we're careful because in the studies that they get with trials there was an incidents of small nodules that were visible of about 16%, so great care is used with the sculptra to avoid the nodule effect that we talked about.

    That's an overview, the 40,000 foot view of what the fillers are like. I encourage you to ask questions, certainly bring in magazines or articles if you have them with you or if you want a reference. I’m happy to answer any of the questions that we have, you can certainly also visit my website we have written a dozen or more papers specifically on this topic and as always I welcome any question from a patient. This is Dr. Maas on Looking Your Best.”