Dermal Filler Pearls: the Hyaluronic Acids

Abstract

Our preferred hyaluronic acid dermal fillers are Restylane, Perlane, and Juvederm. Each of these has a very high safety profile and are easier to inject than Radiesse. They are outstanding for lip enhancement, including the vermillion border, perioral rhytids, and for less severe glabellar and nasolabial folds or as a superficial fine tuning to deeper filling with Radiesse. The newer, higher viscosity hyaluronic acids, however, are excellent for deep lip augmentation, nasolabial folds, and deep rhytid filling. We have found excellent success treating nasojugal (“tear trough”) deformities with hyaluronic acids, which offers a nonsurgical option to cosmetic lower eyelid blepharoplasty (Figure 116.1). Patients require variable amounts depending on the desired outcome and severity of the folds. Injections deep (periosteally) or just below the orbicularis tend to cause less swelling and bruising below the eyes. The effects are potentiated by the concomitant application of Botox. We generally use the provided needle and find that direct injection with withdrawal of the needle as well as the described “feathering” technique both work well. We routinely perform the infraorbital and mental nerve blocks as previously prescribed, as lip injections are quite painful. Premark the perioral rhytids prior to the nerve blocks to ensure optimal filling.