Frequently Asked Questions about Hyaluronic Acid Fillers (HAF)
(Restylane, Perlane, Juvederm [Ultra & Ultra Plus], Elevess)
Q: What is hyaluronic acid?
A: Hyaluronic acid is a natural substance already present in your body that provides volume and fullness to the skin. It is a clear gel that when injected into the skin adds volume to lips and fills in wrinkles, depressed scars and skin creases. Treatments with these products can restore your skin's natural hyaluronic acid that you lose as you age, and thus provide a more youthful appearance. Small amounts of these products are injected into the skin with a very fine needle. The results are instantaneous and long lasting. Millions of treatments have been performed worldwide.
Q: Where can I learn more about these products?
To learn how you can earn up to $475 in rewards for your first five Restylane and Perlane treatments click here
A: More information on Elevess should become available when the product is released for use in 2008.
Click here for more information on fillers and to see before and after pictures of HAF patients treated by Dr. McCauliffe.
Q: Which areas of the face can be treated with HAFs?
A: HAF can be used for smoothing out folds and wrinkles, lip enhancements and shaping facial contours. The most common areas are the the nasolabial folds (from the nose to the angle of the mouth), the lips, lines around the lips and chin, and hollows below the eyes and mouth corners, although other sites can also be treated.
Q: What should I expect during HAF treatment process?
A: Unlike bovine collagen, no allergy skin test is needed, which means that you can have the treatment immediately. The injection session often takes less than 15 minutes. The time differs somewhat depending on the correction you want to have performed. The results are instantaneous. Prior to your procedure, a topical anesthetic cream is usually applied to the area to be treated. You can also choose to have a local anesthetic injection, which we highly recommend when the lips are injected.
Q: What will I look like after the treatment?
A: Immediately after the treatment, you can expect slight redness, swelling, tenderness or an itching sensation in the treated area. This is a normal result of the injection. The discomfort is temporary and generally disappears in a few days. After lip treatment, the lip(s) may become swollen and look somewhat uneven. This can persist for a few days (up to a week). If the discomfort continues, or the swelling doesn't subside in a few days please contact Dr. McCauliffe.
Q: Q: Are touch-ups necessary?
A: Rarely some unevenness persists for which a patient may request a touch-up injection. This is more common with correction of under eye creases than in other areas. We offer patients the opportunity to save a small amount of HAF for a later touch-up treatment, at a cost of $75. If you feel that you need a touch-up and do not have any "left-over" material, you will need to purchase another syringe (see prices below).
Q: What precautions will I need to take before and after my treatment with a HAF?
A: Before treatment: To lower your risk of bruising, it is prudent to avoid taking vitamin E capsules, fish-oil, herbal supplements, aspirin or aspirin-like medications (other than Tylenol [acetaminophen]) up to 10 days before treatment. If you have previously suffered from facial cold sores, there is a risk that the needle punctures could contribute to another eruption of cold sores. Taking anti-viral pills before and after treatment might help prevent this. After treatment: If you have had a lip enhancement, avoid puckering your lips for the first two days after the treatment. Until the initial swelling and redness have resolved, do not expose the treated area to intense heat (sauna, or sunbathing). A cool pack can be applied to the injected area on and off for a few hours to help minimize swelling after lips are injected. Avoid touching the treated area excessively after treatment. The area can be gently washed with soap and water, and light make-up can be applied. Rarely, if a small bump persists at an injection site beyond several days, it can be lightly massaged to flatten it out.
Q: Are there any other side effects associated with HAF treatments?
A: Injection-related reactions such as swelling, redness and tenderness might occur. Other types of reactions are very rare, but about 1 in 2,000 treated patients have experienced a localized allergic type skin reaction with Restylane (The frequency of this reaction with other HAFs has not been reported). These have usually consisted of swelling or redness at the injection site, sometimes affecting the surrounding tissues. This can be treated to shorten the duration of the reaction.. You should not receive hyaluronic acid injections if contemplating pregnancy or pregnant, or breast-feeding, as the risks are unknown. Skin infections or persistent bumps at injection sites have rarely been reported. Rare reports of skin ulceration have been reported in the medical literature. Although extremely rare, there have been a few reports of permanent blindness occurring when substances have been injected in the region between the eyebrows or close to the eyes.
Q: How long do HAF Treatments last?
A: HAF treatments are long lasting, but not permanent. The length of time a treatment maintains its effect is variable and depends on many factors, such as your age, skin type, muscle activity, and where and how the material is injected. Experience shows that Restylane, Perlane and Juvederm can be effective for up to six months for lip enhancements and even longer for treatment of wrinkles on the face. Restylane has lasted over a year in under eye creases. It is recommended that you plan on periodic visits to maintain the improvement. Most patients choose to have a follow-up treatment six to twelve months after the initial treatment. One of the great advantages of HAFs is that they are long lasting, but not permanent. Unlike permanent treatments or implants, HAF treatments leave you with the option of re-evaluating your needs when the initial effect has worn off. With HAFs you will always have the option of continuing or changing the combination of treatments. A follow-up can be performed at any time you like after the previous treatment. A more dramatic effect can often be achieved by adding additional HAF, before the effects from the previous treatment wear off.
Q: Can I use more than one type of HFA?
A: You can combine different types of HFAs during the same treatment session, or switch between the different products from one session to the next. Sometimes Perlane or Juvederm Ultra Plus will be used for deeper filling and Restylane or Juvederm Ultra will be layered above the deeper material. Dr. McCauliffe has had a rare patient who has had more than usuall temporary swelling with one product, who didn't swell with a different HAF product. Having different HAF products available offers these and other advantages.
Q: How much do HAF treatments cost?
A: The total expense depends on the type product used and total amount injected. The current costs are: $310 for 0.4 cc volume of Restylane, and $490 for 1 cc of Restylane or 0.75 cc of Juvederm Ultra. Perlane costs $515 for 1 cc, as does 0.75 cc of Juvederm Ultra Plus. There will be a $30 fee if one of our nurses applies our anesthetic cream one hour prior to the treatment; $15 if our nurse applies an anesthetic cream purchased by the patient; no charge if the patient applies their own anesthetic cream. This is highly recommended before treatment. The cost of the HAFs are likely to fall as additional rival filler products become available.
Q: What is the difference between the different forms of hyaluronic acid (Restylane, Perlane, Juvederm Ultra & Ultra Plus, Elevess, Hylaform, Captique)?
A: All of these HAF products can be used for adding volume to the skin to improve the appearance of skin creases, scars and wrinkles. Restylane, Perlane, Juvederm, Elevess and Captique are all non-animal laboratory produced products. Hylaform is derived from rooster combs. Captique and Hylaform are softer than Restylane and are better suited for injecting the lips, although they don't provide as long-lasting results, and are thus much less popular. Juvederm comes in three different formulations, although only two are currently available in the US. Juvederm Ultra is used for volumizing and treating medium depth wrinkles, and Juvederm Ultra Plus for volumizing and treating deep wrinkles. Dr. McCauliffe is still waiting for evidence to prove that Juvederm Ultra anf Ultra Plus have any advantages over Restylane and Perlane, respectively. In general it is felt that Juvederm Ultra Plus and Perlane might last a bit longer than Juvederm Ultra and Restylane. Until Juvederm Ultra/Ultra Plus is proven to be "better"(e.g. last longer) than Restylane/Perlane or until it becomes more cost competitive, Dr. McCauliffe sees no reason to switch patients from Restylane/Perlane to Juvederm Ultra/Ultra Plus, particularly if the patient is participating in the Restylane Rewards Program. Restylane has been used more than any of these other hyaluronic acid products, so we have a better idea of its safety and effectiveness.
Q: What other filler substances are there?
A: There are several filler substances that have recently been approved by the FDA for cosmetic purposes. These other fillers may have longer lasting results than collagen and hyaluronic acid. However, because these agents have not been as widely used, we currently know less about their effectiveness and long-term safety compared to collagen and hyaluronic acid. These other filler products include polymethyl methacrylate-combined with bovine collagen [Artecoll™ & Artefill™], poly-L-lactic acid [Sculptra™ & New-Fill™], and calcium hydroxylapatite [Radiesse™]. The Rutland Skin Center does now offer Radiesse. Radiesse is best suited for deeper filling and volumizing the skin. It is useful for filling the concavities under the mouth creases, building up the cheek bone areas, and filling skin creases. Dr. McCauliffe does not use this in the lips. The major advantage of Radiesse over the HAF products is in longevity, lasting up to a year, sometimes longer. Disadvantages of this filler is that it is more likely to cause temporary swelling and bruising, and costs more. Dr. McCauliffe will offer treatments with other filler substances, when it becomes more apparent that they are safe and provide advantages over hyaluronic acid, collagen, and Radiesse.
Q: What do I need to do to before scheduling an appointment for HAF treatment?
A: Simply call the Rutland Skin Center (773-3553) to make an appointment for a consultation with Dr. McCauliffe. He will discuss many skin care issues and review with you various treatments that are available to help you maintain and restore your skin's healthy appearance. If he feels that you are a good candidate for HAF treatment he will ask you to schedule an appointment for this. If Dr. McCauliffe has previously informed you that you are a good candidate for this treatment, you can make a 30 minute appointment for treatment. If not previously discussed, you should ask to speak with one of our nurses regarding the application of an anesthetic cream to the treatment areas, prior to your appointment.