New Restylane Silk from Galderma:

Restylane Silk is a Hyaluronic Acid based product just like regular Restylane, but in smaller particles.   It's been in

Canada for 16 years, but received its US FDA approval on 6/14/2014 for lips and wrinkles around the mouth. 

Compared to most other products, it's not as volumizing but decreases the fine lines on and around the lips well.  It

is more likely to cause temporary swelling, and is instantly reversible.

Radiesse Plus from Merz Aesthetics

Radiesse is made of Calcium Hydroxyapatite microspheres suspended in a gel carriermade of carboxymethylcellulose.  It's a bit thicker

than most other Hyaluronic Acids such as Juvederm Ultra Plus, Restylane, Perlane, and Belotero and therefor can have more drastic

results.  It can also stimulate collagen production.  However, it can coalesce over time and create nodules under the skin.   While

steroid injections can help reduce persistence of unwanted results, this product is not instantly reversible.  Radiesse received its FDA

approval in 12/22/2006 for  correction of facial fat loss in HIV patients and for moderate folds and wrinkles such as nasolabial folds. 

It recently got approval in 2015 as Radiesse Plus which comes pre-mixed with Xylocaine (a numbing solution).

Belotero from Merz Aesthetics

Belotero is one of the thinner Hyaluronic Acid fillers on the market today.  It received its FDA approval in

11/14/2011 for wrinkles and folds especially around nose and mouth.  It works well for more superficial and 

thinner wrinkles and lines, especially around the lips and crow's feet.   It tends to last about 3-6 months and is

instantly reversible. 

Sculptra from Galderma:

Sculptra is a powder that is made of poly-L-lactic acid and needs to be reconstituted with water hours to days prior to the patient coming in.  Its function is to stimulate the body to produce collagen.  Therefore, the results are not appreciated for about 6 weeks after injection.  

It commonly needs to be reapplied for a total of three treatments to reach the desired result.  Sculptra received its FDA

approval in 8/3/2004 for restoration or correction of facial fat loss in HIV patients. On 7/28/2009, it received FDA approval

for shallow to deep NL folds and other facial wrinkles (for use in general population.)  The results are usually more even

than other instant fillers, and with facial movements, it behaves more like tissue rather than an injected gel.  The results

usually last beyond 2 years, and it is not instantly reversible.  It is contraindicated in lips, around eyes, and in patients

with history of keloids.

Juvederm Ultra XC from Allergan:

Juvederm Ultra is also a Hyaluronic Acid base product similar to Juvederm Ultra Plus XC and with the same FDA

approvals/dates, but has smaller particles.  Like Juvederm Ultra Plus XC, it uses Hyalocross technology to deliver a

smooth consistency gel into the area of treatment, but it's results are mildly softer and less pronounced.  It lasts on

average about 6-9 months and gives a more subtle result compared to its sister counterpart Juvederm Ultra Plus XC.

It is instantly reversible.

Juvederm Voluma XC from Allergan:

Juvederm Voluma is the newest filler on the market in the US.  It recently received its approval from the FDA in 10/22/2013, though it's passed its test of time as it's been used in Europe since 2005 and approved in over 60 countries.  Voluma is different from the other

HA fillers in that its Vycross cross-linking technology makes it give a more prominent lift and last up to two years

(as opposed to the 6-12 months longevity of most other fillers.)  While it's been FDA approved for use in cheeks,it's

commonly and successfully used in other areas of the face when applied properly.  As with all other HA fillers, its is

instantly dissolvable/reversible by using an enzyme called hyaluronidase. 

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Juvederm Ultra Plus XC from Allergan:

Juvederm Ultra Plus XC is a Hyaluronic Acid base product that received its FDA approval for moderate to severe facial wrinkles and folds such as nasolabial folds in 6/2/2006, and received FDA approval for  XC (Extra Comfort) which is the same gel but premixed

with lidocaine (numbing solution) in 1/7/2010.  It uses Hylacross technology to deliver a smooth consistency gel into

the area of treatment.  It's thinner in consistency when compared to Juvederm Voluma, but thicker than Juvederm

Ultra.  In our experience, its results are very comparable to Restylane Lyft (Perlane).  It lasts on average about 9-12

months, and as with all other HA's, it's instantly reversible. 

Restylane Lyft (Previously Perlane -L)

from Galderma:

Restylane Lyft is the thicker sister of Restylane, just as Juvederm Ultra Plus XC is the thicker sister of

Juvederm Ultra XC.  It has the same chemical composition as Restylane, just with larger particles.  It received 

the same FDA approvals/dates as Restylane.  Due to its larger particles, it lasts a bit longer than Restylane,

about 9-12 months, and is instantly reversible.

Restylane -L from Galderma:

Restylane is a Hyaluronic Acid base product that received its FDA approval to smooth facial wrinkles and folds such as nasolabial folds in 12/12/2003.  It is one of the only fillers in the market with a specific FDA approval for use in lips, which it received in 10/11/2011.

Then in 8/30/2012, it achieved FDA approval to be available premixed with lidocaine (a numbing solution), which

added the 'L' after its name.  It is thinner than Restylane Lyft (Perlane) and Juvederm Ultra Plus XC, and more

comparable if not mildly more delicate than Juvederm Ultra.  Because of its consistency, it is well suited for off

label treatment of under eye hollows and tear troughs (the sunken eye appearance), but doesn't seem to have as

much impact in areas of thicker skin (in our experience).  It lasts on average about 6-9 months and is instantly reversible. 

Fillers:


Filler products are gels that can be safely used to "fill' the grooves and the hollow areas of the face (or off label for other parts of the body).  Each filler product has its own particuar consistency, longevity, and result.  while one may be thick and hold its position and shape, another may be soft and have a tendency to flatten out which reduces formation of nodules.  There are three types of fillers on the market currently:


1-Hyaluronic Acids (HA) include products such as Juvederm Voluma, Juvederm Ultra, Juvederm Ultra Plus, Restylane, Restylane Silk, Perlane, and Belotero.  Hyaluronic acid is a naturally occurring, hydrating substance found in your skin.  As we age, we start to lose HA which causes the skin to lose structure and volume.  HA filler products can be easily dissolved by using a synthetic version of a naturally occurring enzyme in our body called hyaluronidase.  It's a great safety net if you are unsure about getting a procedure done, as you can instantly reverse it.


2-Calcium Hydroxyapatite (CaHA), i.e. Radiesse.  CaHA is a calcium-containing mineral naturally found in bone and teeth.  When injected as small microspheres, CaHA acts as a scaffold that promotes new tissue formation similar to its surroounding environment.  The deposited particles support fibroblastic growth and new collagen formation without calcification.  In other words, the properties of CaHA mimic the environment into which it is placed.  No osseous (bone) infiltration has been found  (Felderman 2005).  CaHA products dissolve over a period of one year.  There are no enzymes available to instantly reverse the product, but steroid injections can be used.


3- Poly-L-lactic acid, i.e. Sculptra, is the substance used for many years in absorbable sutures.  It stimulates the production of collagen which can last over 2 years!  There are no reversing agents for this product.