Restylane® was the first hyaluronic acid injectable filler FDA approved in 2003, outperforming the previous collagen based fillers. Hyaluronic acid is a substance that is naturally present in the human body and functions in maintaining skin volume and hydration.
As we age, the amount of hyaluronic acid in the skin decreases and contributes to wrinkle formation by decreasing tissue elasticity and hydration. Hyaluronic acid can absorb up to 1,000 times its own weight in water, so injections work to add new volume under the surface of sagging, deflated, or wrinkled skin. Hyaluronic acid that is injected creates a “micro injury” that stimulates new collagen formation, thickening skin and smoothing wrinkles. It also has been found to stop the breakdown of collagen. Oral or topical preparations of hyaluronic acid have not been proven to improve the appearance of the skin.
To learn more about the rejuvenating effect of Restylane, please call (702) 260-7707 to arrange a visit to our Las Vegas office.
What Is Restylane®?
- Restylane is hyaluronic acid (HA) generated by the streptococcus species of bacteria. It is produced by natural fermentation in a sterile laboratory environment.
- Both Restylane and Perlane® are manufactured using sizing technology. “Sizing” is the process by which cross-linked HA is pushed through a specially sized screen and broken into pieces. The medium size pieces of HA are made into Restylane while the larger ones are made into Perlane®. Both products have the same concentration of hyaluronic acid,20mg/ml.
- Perlane® was FDA approved in 2007. Perlane is a thicker, firmer, more viscous, longer lasting version of Restylane. It tends to be bulkier and more perceptible so deeper placement is advised and it should not be used in the lips.
- Restylane and Perlane® are more particulate and firmer than newer HA products like Juvederm™. Juvederm has become more popular than Restylane in recent years for its smooth gel-like characteristics, softness, ease of injection, naturalness, and increased longevity. However, Restylane still may be preferred in certain areas by physicians and patients for more bulk or facial volumetric building. Because Restylane attracts less water and swells less than Juvederm, it may be preferred in areas that can easily be overcorrected such as the lower eyelid region.
- Restylane is formulated with lidocaine, improving patient comfort during the procedure.
- Hyaluronic acid products are broken down by the enzyme hyaluronidase. Therefore overcorrection or lumps can be dissolved or improved by intralesional injection of hyaluronidase. Potential reversibility in the event of a minor complication or cosmetic issue makes these products appealing for plastic surgeons and patients.
Restylane silk received FDA approval in June 2014. It also comes from the company Galderma, makers of Restylane, Perlane and Sculptra. It is used for lips and fine lines around the mouth and lasts 6 months. The benefit of Restylane Silk over Restylane is it’s more natural feel and fluidity, being supposedly less bulky and nodular than regular Restylane. We have our Restylane Silk in-service this month so we will see for ourselves how this new filler flows.
Restylane and Facial Rejuvenation
- Restylane is indicated for mid-to-deep dermal implantation for the correction of moderate to severe facial wrinkles and folds, such as nasolabial folds.
- Restylane is also indicated for lip augmentation in patients over the age of 21.
- Restylane effectively treats wrinkles around the mouth including vertical lip lines, marionette lines or depressions, downturned corners of the mouth, and smile lines.
- It can be used to augment the jaw line, chin, cheeks, and lower eyelid.
The procedure is performed in the office using topical anesthesia and ice if desired by the patient. A dental nerve block may be recommended for lip injections. Multiple injections using a very small needle are used to fill depressions, wrinkles, and shape the face. Many times more than one syringe of product is required to obtain correction.
A Restylane injection is well tolerated with minimal downtime. Mild bruising and/or swelling can occur but is easily covered with makeup so that most patients do not have to miss work-related activities. Pain and tenderness afterwards is mild. Patients should avoid medicines that can cause bleeding before the procedure to minimize risks of bruising. Also, don’t schedule immediate social engagements or events to account for the possibility of bruising or swelling. No exercise or strenuous activity is recommend for several days after the procedure.
Results lasts on average 6 months, but there is some variability from person to person.
Risks and Side Effects
- Bruising, localized swelling, and temporary redness is common and variable.
- Perceptibility of the product can occur and is site and patient dependent. Patients with thin skin or severe hollowing may perceive the product, which can look bluish under the skin, also called the “Tyndall Effect”. This can occur with any clear product placed under the skin.
- Feeling the Restylane and/or seeing it through the skin is always possible, but can be minimized by having the procedure performed by an experienced physician or nurse injector.
- Undercorrection or overcorrection, imperfections, asymmetries.
- Early reabsorption.
- Lumps or nodules, granulomas.
- Hyperpigmentation or color change of the skin.
- Injection site scabbing.
- Skin exfoliation.
- Delayed hypersensitivity reactions.
- Immediate-onset allergic reactions and anaphylactic shock.
- Intravascular injection is exceedingly rare and can lead to skin loss or other serious complications; stroke and blindness have been reported. Therefore it is critical that your injector understands the anatomy and is properly trained with an MD, RN, DO, PA, or NP degree.
Patients Who Are NOT Good Candidates for Restylane
- Those with a history of bad allergies.
- Staph carriers or those with a history of recurrent skin infections or MRSA infections.
- Patients who have moderate to severe skin laxity and deep wrinkles, where a skin tightening procedure such as a facelift or brow lift would be a better investment with long-term improvements.
- Anyone with a history of a bleeding disorder or those who take blood thinners.
- History of allergies to local anesthetics such as lidocaine.
- Use at the site of skin sores, pimples, rashes, hives, cysts, or infection should be postponed until healing is complete.
- Patients with a history of cold sores should take a course of antiviral medication, as injections around the mouth could activate latent herpes viral infections or cold sores.
- Patients under 18 years old.
- Pregnancy or breast-feeding.
- Immunosuppressive disorders, patients on steroids.
To learn more about Restylane, please contact Desert Hills Plastic Surgery Center or call (702) 260-7707 to talk with one of the members of our team in Las Vegas. Dr. Brown welcomes patients throughout Nevada and all over the United States.