Dr. Herzog Discusses Restylane and Perlane

Dr. Jo Herzog, M.D.

This is the third of a series of posts by Dr. Jo Herzog, who is educating us on several injectables, specifically those she demonstrated on my face during a recent Lunch & Learn event with Medicis.

Today, she will talk about restylane and perlane, specifically how and where she used them on me, how much she used, and the cost of each. This will help those who might be considering these procedures one day but have no idea what is involved.

Dr. Jo Herzog, M.D.

 I will begin with a recap of the last few posts relating to the products used on Jamie’s face for the Medicis Lunch & Learn. After using dysport (a type of botox) to relax the wrinkles that were mostly caused by movement of muscles, we went on to filling areas that needed volume. Today, we will focus on the best way to add volume to an aging face.

There are two things that we can do for deep lines, folds, and grooves in the face. We can fill in the lines, or we can fill in missing volume and pull out the lines.

Filling in lines: There are a few circumstances where an experienced injector might choose to “fill in” the lines instead of pulling them out. First, if a patient is relatively  young and has fine lines that are bothersome (without much loss of volume), these lines can be filled. Second, small lines around the mouth might be easily filled with small amounts of filler. Finally, a patient sometimes has a tight budget and would be happy with improvement that will fix what bothers her, even if she cannot afford to do the project in a way that might be optimal. There is nothing wrong with this approach as long as all parties realize why it has been chosen.

In Jamie’s face, she needed volume in the temples, cheeks, and under the eyes. I added volume in these areas first, then followed by filling in lines as needed. Once the biggest problem of volume loss was addressed, we saw that the lines that were bothering Jamie had already been “pulled out” somewhat and were less noticeable. This is how the “pulling out” effect works.

You want to avoid injectors that will fill lines endlessly while missing the real problem– volume loss. This is what we see with inexperienced injectors, so be wise when choosing which practitioner will perform these procedures.  I realize that some patients are on a limited budget and simply want the lines filled that bother them most.  They are usually happy with the results, and this is fine. I just make sure that my patients understand their options and what I consider the “optimal route” for getting the best look. When budget is an issue, patients who choose the least expensive route (with good results-not best), I am fine with this as long as they make this decision after being informed.

When I did Jamie’s face at the demo and began by injecting her temples and cheeks, she was a bit surprised, as she didn’t understand how lack of volume in these areas was aging her face. She had focused only on the small lines that she could see and was not aware of the other areas until I pointed them out. Like Jamie, many patients cannot see the need to fill volume in these areas until it is explained to them.

To add this volume to Jamie’s face, I used mostly perlane with a little bit of restylane. These two drugs are similar, but restylane is used  for the areas that need a softer filler. (Juvederm, made by another drug company, is very similar to restylane, and I will talk about in another time.)

I used restylane in the tear troughs (the dark hollows under the eyes) to add volume and lessen the dark shadows under Jamie’s eyes.  Restylane is a good choice for the tear troughs, as it is soft, should not form lumps underneath the skin, and does not cause the skin look purple (the tyndall effect). This procedure is relatively painless, but the risk of bruising for a few days is highest in this area. Some injectors use cannulas in this area to decrease bruising, but I have not yet been convinced that this approach improves the outcome for the patient.

After the tear trough injections, I used a small amount of restylane in the lips to add a bit more shape and volume. I used very little restylane, however, as Jamie did not want to look different, just rested. We could have gone much further with her lips and still maintained a natural look,  but this was not something that she wanted to pursue at the time.

We ended up using about three quarters of a syringe of restylane. When I use a full syringe, I charge $550 (about average for a dermatologist) for the syringe.  When I use restylane to touch up certain areas while using another filler,  I charge $125 for a quarter of a syringe. When using multiple syringes, we usually give a discount on each full syringe as well.

I chose perlane for the temples and cheeks. By adding volume, we elevated Jamie’s cheeks and “pulled out” most of the nasolabial lines (although I did use a tiny drop of perlane in this area).  This was the best way to add volume to her skinny face and rebuild some of the shape that had been lost over the years.

Because of time constraints and in keeping with Jamie’s desire for the minimalist approach, I was conservative in how much volume I added to her face.  I used a full syringe of perlane ($550) on her, where it would not be unusual to use twice this amount in one visit.  As I know this is expensive to some, next week I will talk about filler options where you can get more “volume for the money” if you choose to go this direction.

A great discount for restylane and perlane is now available on Gilt City.  Vouchers can be purchased and taken to participating dermatologists.  This is what I consider a “real deal,” as the drug company is reimbursing us (the doctors) for your discount. Therefore,  you are not having to worry about someone giving you a deep discount out of their pocket for the wrong reasons.

Next week, I will talk about other fillers that we didn’t use at the demo but which are excellent options.  I will tell you how to get the biggest bang for the buck when wanting to add volume. Remember, you can ask questions any time on Family Savvy, and I will answer them in future posts.

Take care, and stay beauty savvy!

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