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« Plastic surgery recession vs. vanity? | Main | Medical Spa MD Membership Launches! »
Wednesday
Dec242008

Dallas Plastic Surgery: Lecture on Restylane, Perlane & Radiesse.

Reader Comments (9)

I would tell you to use restylane not Juvederm in the periorbital region. Juvederm will pull too much fluid to the area of the lower lids and can cause puffiness. I had used Juvederm in the periorbital area for about a year but feel somewhere between 10 to 15% of my patients were ending up with puffiness to their lower lids. Sometimes, I would not see the puffiness until a few months after the injection.

Some of the theory is that the Juvederm is more hydrophilic thus you may get more water drawn to the area which can cause it to look like the area was overfilled. This fluid draw occurs after you inject. Another theory is that the Juvederm can interfere with lymphatic drainage in the area.

I still use Juvederm Ultra and Ultra Plus in most areas as I feel it is softer than Restylane especially in the lips (I still wish they gave 1cc syringes). I have been injecting the periorbital area with Restylane for about 3 months now and have not seen the puffiness seen with the Juvederm.

12.24 | Unregistered CommenterLH

I absolutely agree- I have used restylane in the tear trough for 4-5 years now, and it is very predictable. Juvederm
does "grow" 5-10% of the time, resulting in an overfilled, gelatinous look, a few weeks later.

I prefer Juvederm in the lower two thirds of the face, though.

12.25 | Unregistered CommenterMike Nayak

Great video. I use Juvederm infraorbitally because it comes out smoother with less bumps. Easier to message. It just looks better than results with Restylane. You must underfill with Juvederm.

12.26 | Unregistered CommenterJEE

See that is the problem. When you underfill with Juvederm you do not always get the same amount of water drawn to the area. Then you have a patient that still needs some added.

I just think it is easier to use Restylane because what you see is what you get. I agree that the Juvederm flows easier and it is easier to massage but I do like the Restylane a little better.

I hope these conversations are helping others. I really enjoy and appreciate JEE's input. Remember take what you learn from us and then employ it and develpoe a technique you feel comfortable with.

12.26 | Unregistered CommenterLH

I respect LH so much, I may try Restylane under the eyes again.

The other reason that I like Juvederm is that patients leave the office after their treatment very happy.
We take immediately after photos and show them the before and after before they leave after their injections.
They come back in two weeks for more before and after and touch up.
I usually have some left for touch up.
I am not getting much bruising anymore because we use a lot of ice and I only inject 4-6 times under each eye. Touch up is very acceptable if you don't bruise them.

If we inject too much, we can always use Hyaluronidase. We use very small amounts and have not had to use it often.

12.27 | Unregistered CommenterJEE

I do not know if this has been discussed, if it has just point me there.

Do you keep? and how long?

Open vial Botox in refrigerator. I know of some freezing and thawing it prn.

Partial Juvederm syringe for touch up on same pt. I have seen up to six months in refrigerator.

What is safe? Potency decrease?

12.27 | Unregistered CommenterFlorida PA

I have heard that Botox will keep up to 2 weeks once reconstituted. I keep it at around 6 degrees centigrade (I think) in the refridge. There is specific recommendations in the package insert. We have a thermometer in the refridge with the Botox. We use 100 units every day, so it is only an issue on weekends and holidays.

Keeping fillers for touch up . . . I have heard up to 6 months, but I do not keep over 2 months. I tell patients 4-6 weeks. No official info on this. Would be interested in what others have HEARD and what others DO.

12.27 | Unregistered CommenterJEE

JEE,

The only place I use Restylane is under the eyes. I use Juvederm and Radiesse every where else. As far as storage of the HA's there are no studies I can find on storage once opened.

I do keep a touch up syringe in the fridge just in case. what I do is transfer it to a small insulin syringe that I then inject with. I will usually only use 0.1cc or less for a touchup.

Florida PA,

The package insert says to use Botox within 4 hours of mixing but there are studies for mixed Botox lasting as long as 6 weeks and not losing any potency. I never worry about it any more as ours do not last long enough to worry about.

I have been debating if I want to try bacteriostatic saline to mix my botox with. It is less painful. Try it on yourself. Use a TB syringe and make a wheal on your left arm with saline then try bacteriostatic saline on the other side. The bacteriostatic side should be less painful because the benzoyl alcohol acts as an anesthetic. Ther are now studies showing that botox is not as fragile as originally thought.

12.27 | Unregistered CommenterLH

LH,

Keeping Botox around too long is usually not an issue, as mentioned by JEE, weekend or holiday at most. I have seen the studies you mentioned about long term potency, and also have seen some state 44% decrease in 12 hours (I bet these were sponsored by Allergan).

As a side note, I have never used anything but bacteriostatic solution for reconstitution. You never know if it will sit for awhile.The analgesic effect is probably mild to moderate at best, but I do it to decrease chance of bacterial contamination in case it has to sit for a few days.

The reason I posed the question was this; I took a vial to a VIP and used 50 units, gave a friend 20 units 5-6 days later and was going to use the remaining for my glabella (wrinkle due to my "thinking face"). Went back to the vial at 12-13 days old and it was turbid so I tossed it. I used aseptic technique and kept it cool during transport and storage. Wondered if it was my fault or others have seen this.

JEE,

Why transfer to insulin syringe? Hard enough to push in what they give you. Even with a larger bore needle I would assume the assembly would be "flimsy".

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