A. Experience! There are differences between fillers that make one a better choice over another depending on the circumstances. Seeking out a board certified dermatologist or plastic surgeon who also does a lot of injecting is imperative for optimal outcomes. I use almost all the currently FDA approved fillers in my practice. A long time favorite is Restylane. Restylane was the first hyaluronic acid filler to be FDA approved for use in the US in 2003. Restylane is very safe, effective and versatile. It can be injected into the lips, under the cheeks, into the temple and eyebrow, and of course, the nasolabial fold. It is a bit stiffer than Juvederm which can be an advantage in some areas. I love to use it to line the lips and define the cupid's bow. I find that it swells a little less than Juvederm when injected under the eyes. It flows well through a longer needle so you can do fewer sticks. Finally the newer Restylane L version is virtually painless because of the addition of lidocaine, an anesthetic.
Q. I Have a Deep Horizontal Wrinkle on Both Sides of my Chin. Can Botox Help?
A. As a general rule, Botox is used first in the upper one third of the face (the crow's feet, frown lines, and forehead lines) and filler complements the neuromodulating effect of the Botox. In the lower two thirds of the face, volumizing with filler is the primary, non-surgical anti-aging tool. Botox can be used to complement the effect of the filler. The lines you describe are called the marionette lines or folds (depending on the severity). When they are severe, it looks like you are always sad or frowning. Perlane is a great filler in this area. It is by no means, however, the only option. Perlane is a large particle hyaluronic acid filler, related to Restylane. It also comes as Perlane L, which has added lidocaine to reduce the discomfort of injections. Botox is used adjunctively here. We inject the mentalis muscle and the depressor angularis oris (the DAO) in conjunction with the filler to increase the duration of the correction. As always, be sure you go to an experienced board certified dermatologist or plastic surgeon for optimal results.
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