Juvéderm Ultra Plus is the same as Juvéderm Ultra, although increased crosslinking of HA results in improved longevityup to 1 year without touch-ups. "It's never to be used in fine lines, in my opinion," Dr. Lupo said. It is best injected with a 30-gauge needle. This filler is extremely good in skin of color.
▸ Prevelle Silk (cross-linked HA and lidocaine). The added lidocaine decreases patient discomfort. There is very little swelling because of the low HA concentration, but as a result it does not last as long3 months or less. "It's inexpensive, and it's a good introductory filler for the hesitant patient," she said.
▸ Elevess (cross-linked HA and lidocaine). Elevess has the highest concentration of HA available on the market. "My personal opinion, based on my limited experience with it, is that it tends to be highly inflammatory as a result of this high concentration of HA," she said.
▸ Radiesse (calcium hydroxylapatite). This structural filler is great for men. It does cause a lot of same-day redness. "I do routinely mix it with lidocaine, and that is now FDA approved and has been found not to decrease its longevity," she said. It's a good choice for marionette lines and the pre-jowl sulcus, but avoid using it for the lips, she said.
▸ Sculptra (poly-L-lactic acid). The FDA cleared Sculptra this year for cosmetic purposescorrection of mild-to-severe nasolabial folds and wrinkles and contour irregularities. "The optimal patient for this is a younger lipoatrophy patient, because these patients still have enough of an immune response to actually get a good bang for the buck," she said. This filler is not reversible. The most common problem with Sculptra is the presence of nodules if it is injected too superficially, said Dr. Lupo.
▸ Evolence (porcine collagen). "In my opinion, it's a stiffer, more structural filler," she said. It works well in the nasolabial folds. Dr. Lupo always mixes it with lidocaine, though this makes it flow more quickly, so she uses a 30-gauge needle. It is a good choice for men with thick skin. Evolence has a low incidence of bruising and swelling.
Dr. Lupo reported significant financial relationships with a number of pharmaceutical and skin care companies.
A patient is shown before treatment with one syringe of Restylane.
The effect was prolonged for 3.5 years by performing periodic touch-ups.
Source Photos courtesy Dr. Mary Lupo