Speaking here at the 2005 South Beach Symposium, Jean Carruthers, M.D., addressed this new approach with the NASHA filler Restylane (Q-Med) that will modify how cosmetic surgeons address facial filling. While it is natural for the face to lose fat with the aging process, the typical process of reversal through cosmetic surgery often results in a pulled and drawn look. Alternatively, subdermal Restylane injections are able to "reflate" the depressed areas with true-to-life accuracy, Dr. Carruthers tells Cosmetic Surgery Times.
Injecting an energetic look A hyaluronic acid-based filler that is essentially a very complex sugar, Restylane is now proving that it can do more than simply replace the dermis."To treat a lateral brow that is pointing downward, Restylane is injected to reflate the brow pad," says Dr. Carruthers, cosmetic surgeon and clinical professor, ophthalmology, University of British Columbia. "Usually only 0.2 to 0.3 cc of Restylane is needed to elevate the lateral brow and bring it forward. We also advise the addition of Botox to arch and lift the brow."
Beyond the brow, Restylane also addresses cheek fat pads, which are important in women who lose their heart-shaped faces with time, according to Dr. Carruthers.
"The problems in the lower face originate in the cheek area, including smile lines," Dr. Carruthers says. "By replacing the lower dome in the cheek subdermally, one is able to reflate and smooth lines. It usually takes only 0.4 to 0.7 cc of Restylane to make an impact."
While Restylane is not permanent, longevity is notable with the subdermal approach. Injections in the cheek fat pads are showing a seven- to nine-month endurance, and in the lip area, a four- to five-month staying power.
"Lips and filler are magical together," says Dr. Carruthers. "By inflating the vermilion lines with Restylane you are able to form a buttress that fills the areas in between the vertical lines. Combining Botox with the Restylane polishes and enhances the aesthetic results and makes the filler last longer."
Opposing pain Clinical trials performed for the approval of Restylane by the U.S. Food and Drug Administration showed that erythema and bruising are results in about 12 percent of patients injected with the filler. While the pain factor may be tolerable, cosmetic surgeons may find that massage is a way to negate the pain, according to Dr. Carruthers.
"We've found that a medical massager used on the area prior to and during the injection process is helpful in reducing subjective discomfort and bruising," Dr. Carruthers says. "Those who are getting their injections for the first time may be more comfortable receiving a topical cream such as ELA-Max 5 (LMX5) (Ferndale) or a dental block, but once they've gone through the procedure they find that the massager method is just as effective."