Restylane(tm) and now Juvederm(tm) are cosmetic surgical materials that have recently become household names. In this era of direct-to-consumer pharmaceutical company advertising and promotion, this is not so surprising. The current preoccupation with anti-aging formulas and cosmetic surgery has propelled the popularity of these two bio-chemicals. Riding on the heels of BOTOX(™) (botulinum toxin) for cosmetic use, Restylane(tm) has allowed doctors and other healthcare practitioners to administer significantly rejuvenating treatments for an affordable price and “over lunch.”

What Restylane(tm) and Juvederm(tm) actually are is not as commonly known as what they do. They are composed of hyaluronic acid. This is a substance that is part of the extracellular matrix of the skin. It is part amino-acid and part sugar and acts as a filling/cushioning material between cells. An interesting feature of it is that it binds to water molecules and swells to a much larger volume that the actual material itself occupies. Thus it forms a gel. Naturally occurring hyaluronic acid, if injected into your skin, is quickly broken down and goes away. Restylane(tm), Juvederm(tm), and other injectable hyalans differ in that they are “cross-linked” to increase their stability. This means that a gel of some hardness is formed that can last for months at a time.

A subtle difference between Juvederm(tm) and Restylane(tm) is that the former is composed of different size fragments of cross-linked hyaluronic acid while Restylane(tm) is said to be composed of more uniformly sized fragments. The makers of Juvederm(tm) contend that this gives their product increased smoothness of flow despite increased cross-linking, which would otherwise make their gel harder.

Both substances are injected mainly into the lips and nasolabial folds (the smile lines between the corner of the mouth and the nose). Lips can be increased in fullness, pouting, or get increased definition of the edges. Facial depressions that cause shadow-lines, such as the nasolabial folds are also good targets for these fillers. Other target areas included deep lines in the corners of the mouth and deep frown furrows.

Generally, these fillers are injected using a fine needle and syringe. Discomfort is minimized by using topical anesthetic, but dental anesthetic injections may be necessary to adequately numb the lips, which are very sensitive.

Good results can usually be achieved with 1-2 syringes. Both Restylane(tm) and Juvederm(tm) last approximately 6 months, although the makers of Juvederm(tm) contend that it lasts 2-3 months longer. In my experience, the fillers do not last as long in the lips as in the rest of the face. I believe that this is due to increased use of the lips with talking and eating.

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