Experienced with Restylane due to her involvement with the U.S. Food and Drug Administration (FDA) clinical trials of the filler, Dr. Narins contends that its overall effect on areas such as around the eye, the nasolabial folds and marionette lines is unparalleled, compared to other HA fillers. While some may argue that these results come at a painful price because HA fillers are formulated without lidocaine, Restylane injection and its aftermath can be painless, Dr. Narins tells Cosmetic Surgery Times.
Pain factor "In the (FDA) clinical trials we found that less than 12.5 percent of those treated with Restylane or Zyplast experienced swelling, bruising or redness in the study, and I'm experiencing similar results with my patients," says Dr. Narins, a New York dermasurgeon and clinical professor of dermatology and chief of the liposuction surgery unit, New York University Medical School. "The injections do not have to be painful."
Using the gateway of pain theory, pain can also be diminished by holding the patient's hand, or "handesthesia"; talking to the patient, also known as "talkesthesia"; and by vibrating the skin that is to be treated, according to Dr. Narins.
"Technique is also very important to controlling pain. When treating the undereye hollows, the surgeon should also use serial injections against the bone to avoid discomfort, bruising or bumps," says Dr. Narins, who is also director of the Dermatology Surgery and Laser Center, White Plains, N.Y., and New York City. "A tiny 30 gauge needle is used to inject the product and this also minimizes discomfort."
By comparison, Hylaform (Inamed) and Captique (Inamed) are 5 mg per cc hyaluronic acids, while Restylane is a 20 mg per cc product, Dr. Narins says.
"This increased density probably accounts for Restylane lasting twice as long as the other products," Dr. Narins says, noting that these are the only three FDA-approved hyaluronic acids available in the United States at this time.
Complete combinationIn terms of rejuvenation, the combination of Restylane for the lower face and Botox (Allergan) for the upper face is the gold standard, Dr. Narins says. While Restylane fills in wrinkles and folds and enhances the lips, Botox erases lines from muscle movement. When the frown lines are deep at rest, a combination of Botox and Restylane gives the best result. Botox can be used to treat the lateral eyebrow depressor while Restylane can be used to restore the volume lost in the area, providing a greater lift than with either substance alone.