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Hyaluronic acid is naturally found in the body. Restylane was the first hyaluronic filler (HAF) product approved by the FDA (in December 2003). Since its introduction, several other HAF products have received FDA approval, including Perlane, Juvederm and more recently, Elevess. These products have significant advantages over bovine collagen fillers, including no need for skin testing as allergic reactions are much less likely, compared to collagen. HAFs also last longer than the older collagen products, so treatment sessions can be spaced out further. Treatments with HAFs are much the same as with collagen replacement therapy.

The following before and after photos show you some of the results Dr. McCauliffe has acheived with HAF treatments. Most of these patients had between 0.4 cc and 1 cc total volume injected. In some cases larger volumes can produce even more dramatic effects.

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.


Before forehead crease treatment	After a small amount of Restylane


Before under eye crease treatment	After a small amount of Restylane


Before treatment of eye creases	Immediately after Restylane treatment


Before under eye crease treatment	12 days after Restylane treatment


Before treatment - upper lip & smile lines	Two days after treatment


Before treatment of deep upper lip creases	Several weeks later


Before treatment of lip lines (patient puckering)	After treatment (patient puckering)


Before treatment of lips and smile lines	After larger volume treatment


Before Juvederm for lip plumping	Immediately after treatment


Before treatment of mouth creases	Immediately after treatment


Before treatment corner of mouth	Immediately after