Frequently Asked Questions about Hyaluronic Acid Fillers (HAF)
Restylane [Classic, Silk, Lyft (formerly Perlane), Refyne, Defyne, Kysse and Contour], the RHA Collection [Redensity & RHA-2, 3, and 4], Juvederm [Ultra, Volbella, Vollure & Voluma], and Belotero
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?
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. For fine lines Restylane Silk, Kysse, Refyne; Redensity & RHA 2; Juvederm Volbella and Belotero Soft are generally recommended. For lips and moderate lines Restylane Silk, Kysse, Refyne or classic Restylane; Redensity or RHA 2 and 3 or Juvederm Ultra or Volbella are recommended. For deeper creases, hollows and for cheek restoration Restylane Lyft (formerly known as Perlane), Restylane Contour, RHA 4 and Juvederm Voluma are recommended. Restylane Contour and Juvederm Voluma are well suited for restoring cheek (mid face) volume.
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. Most hyaluronic acid fillers include an anesthetic that will leave the treated area numb for 1-2 hours. For instructions oh how to apply numbing cream before your procedure see:
www.www.rutlandskin.com/Anesthetic%20cream.pdf
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: 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. The touch-up needs to be done within 30 days of the initial treatment. 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 is also relatively rare with the other HAFs. Reactions at filler treatment sites have rarely been reported after vaccinations, viral illnesses and dental procedures. These have usually consisted of swelling and redness at the injection site, sometimes affecting the surrounding tissues. This can be treated to shorten the duration of the reaction. 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. You should not receive hyaluronic acid injections if contemplating pregnancy or pregnant, or breast-feeding, as the risks are unknown.
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 the Restylane & Juvderm family of products lasting up to six months for lip enhancements and even longer for treatment of wrinkles on the face. Restylane Lyft & Contour, and Juvederm Voluma have lasted up to two years in cheek volume restoration and for under eye hollows. 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 Lyft or Juvederm Ultra Plus will be used for deeper filling and Restylane Silk or Belotero 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: $500 for 1/2 cc of Restylane Eyelight, $600 for 1 cc of the Restylane Silk, Lyft and Classic; $630 for for 1cc of Restylane Refyne, Defyne and Kysse; and $650 for 1cc of Restyland Contour. RHA Collection products (Redensity & RHA 2, 3, 4 cost $530 per 1 cc syringe. Belotero and Juvederm Ultra & Ultra Plus fillers cost $650 per 1 cc syringe. Juvederm Voluma, Vobella and Vollure that are $700 per 1 cc syringe; and Volux is $730 per 1 cc syringe. Prices are subject to change without notice. If you wish to receive a Juvederm or Belotero product we ask that you pre-pay as we special order those products as very few of our patients use them. There will be a $30 fee if we apply our anesthetic cream 20-40 minutes prior to the treatment; $10 if we apply an anesthetic cream purchased by the patient; no charge if the patient applies their own anesthetic cream. This is recommended before treatment. For instructions oh how to apply numbing cream before your procedure see:
www.www.rutlandskin.com/Anesthetic%20cream.pdf
Q: What is the difference between the different forms of hyaluronic acid (Restylane, RHA Collection, Juvederm, and the Belotero family of fillers?
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. The Restylane, Juvederm, RHA Colection and Belotero families are all non-animal laboratory produced products. Some of these fillers are thicker and if injected close to the surface can leave bumps and a slight bluish discoloration. These problems are lessened by using thinner fillers (Restylane Silk, RHA Redensity, Juvederm Vobella and Belotero Soft). Classic Restylane, RHA 2 and 3, and Juvederm Ultra and Vollure are of medium thickness whereas the most robust (thicker and longer lasting) of these fillers are Restylane Lyft, Contour, RHA 4, and Juvederm Voluma & Volux. Classic Restylane, Silk, Kysse and Refyne, Redensity and RHA 2 or Juvederm Vobella, Ultra & Vollure are best for lip plumping and moderate creases. Restylane Lyft, Contour RHA 4 and Voluma are best for deep creases & hollows, and cheek restoration. Volux is formulated for the jawline.
Q: What other filler substances are there?
A: There are several filler substances that have 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 offer Radiesse ($600 for 0.8 ccc and $750 for 1.5 cc syringe), that must be preordered before your appointment. Prices are subject to change without notice. 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 is in longevity, lasting up to 12, sometimes longer. Disadvantages of this filler is that it is more likely to cause temporary swelling. Dr. McCauliffe will offer treatments with other filler substances, when it becomes more apparent that they are safe and provide advantages over hyaluronic acid 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 medical assistants regarding the application of an anesthetic cream to the treatment areas, prior to your appointment.