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Posts Tagged ‘radiesse’

Plastic Surgery Product Review: Radiesse Injectable Filler

Sunday, August 18th, 2013

 

While there are over a dozen injectable fillers available for human use in the U.S., many share similar chemical compositions. The vast majority are hyaluronic acid-based and, although they have different brand names and some differences in their duration of effects, they are vastly similar in their handling properties.

One of the very different injectable fillers is Radiesse whose composition is a combination of calcium hydroxlapatite particles and a sodium carboxymethyl cellulose gel carrier. It was FDA-approved in 2006 and has many similarities to other fillers such as its immediate effects, persistence of up to a year, a natural looking result and the stimulation of some temporary collagenesis as it resorbs.

But what really separates Radiesse from other fillers is its potential to really push or lift the tissues into which it is injected. Because it is a ‘stiffer’ material, it provides a greater push to the overlying tissues. More scientifically, it is it’s rheological properties of a high G prime or elastic modulus that enables it to be an effective lifting or supporting filler. G prime, the elastic modulus, is a measure of its firmness and resilience. A high G prime means that it is more resistant to external pressures and can hold its shape without being displaced or undergo shape distortion with facial movement. Thus the material stays where it is injected and has little tendency to spread.

As a result of these properties, the best use of Radiesse is for deep injections for facial voluminization as well as for the back of the hands. It is best thought of as a structural filler and is the closest a filler can get to resembling autologous fat injection grafting. Placement of Radiesse down to the bone in the preperiosteal plane allows the overlying muscles to be lifted  and refills the deeper fat compartments of the face. When placed over more prominent bony areas, like the cheeks, paranasal, chin and jaw angles, it can have more of a pseudoimplant effect.

Because of its tissue push capabilities, it creates a greater volumizing effect per ml of material than any other filler. Since it is available in up to 1.5cc syringes, it can provide a lot of correction in a cost effective manner.

Radiesse is the only FDA-cleared filler that is approved to be mixed with lidocaine by the physician at the time of injection. Besides the obvious benefit of the numbing effect, lidocaine adjust its rheological properties. This allows it to be injected with less force and decrease the risk of post-injection clumping.

Dr. Barry Eppley

Indianapolis, Indiana

Injectable Fillers and Their Incidence of Complications

Sunday, April 7th, 2013

 

Besides Botox, injectable fillers are the most popular form of non-surgical facial rejuvenation. While they have undergone major compositional changes since bovine collagen was initially introduced in 1981, their growing popularity is because they have an instant effect, are largely effective for the right indications and it is generally perceived that they have few complications.

With well over a dozen injectable filler options of different chemical compositions, complications can occur and the occurrence does differ based on the injectable filler type. The hyaluronic-acid based fillers occupy the largest number of available inbjectable filler materials because it has proved to be far superior to any collagen-based material in terms of its duration of effects and low incidence of inflammatory and aesthetic problems. Particulated fillers, that contain resorbable nor non-resorbable materials, do have a slightly higher risks of complications but it is generally believed to be only marginally higher.

In the online March 2013 issue of the Facial Plastic Surgery journal, a study was published that evaluated the incidence of complications from injectable soft tissue filler treatments. The study results were based on over 2,000 injected patients over a five year period, half of which were done with hyaluronic acid-baed fillers. The other half consisted of a mixture of Radiesse and Sculptra. Typical and self-limiting problems such as swelling and bruising were not counted as complications. Complications consisted of nodules or granulomas, cellulitis (infection) and skin necrosis. The total number of injectable complications were 14 or 0.7%.

Based on the material composition of the injectable filler, complication rates differed. Hyaluronic-acid based fillers had the lowest (0.2%), a slightly higher rate with Sculptra (0.7%) and Radiesse with the highest. (2.6%) While the authors admitted that patients with injected complications may have been missed, my experience is that patients who developed any of these skin complications would be highly unlikely to not let their injector know.

Injectable fillers offer a very valuable and versatile option for facial rejuvenation. Of their many benefits is that few significant complications occur with their use and this current study supports that well known perception. But in the search for longer-lasting results, the particulated fillers are associated with a significantly higher number of serious complications because they leave behind more reactive substances. Keeping these complications low undoubtably requires a more skilled and experienced injector.

Dr. Barry Eppley

Indianapolis, Indiana

Common Questions about Facial Injectable Fillers

Tuesday, January 5th, 2010

 

1.      What is the difference between Botox and fillers since both are injected?

 

Because both Botox and fillers are ‘injectable’ and are used for cosmetic facial folds and wrinkles, they are often confused. But their chemistry and modes of action are completely different. They are best understood in appreciating the difference between static vs. dynamic wrinkling. Static wrinkles and folds are those that are present when your face is expressionless. Dynamic wrinkles are those that appear or get deeper when we have facial expressions. When we are young, we only have dynamic wrinkles. But as we age, some of those dynamic wrinkles become static ones as well. Botox and Dysport are muscle weakening agents that treat dynamic wrinkles. Fillers are used to plump up or soften static wrinkles.

 

These differences become apparent when you look at where Botox and fillers are primarily used. Botox and Dysport are largely used to stop the frowning between the eyebrows and the crow’s feet around the eyes….wrinkles caused by excessive muscle movement. Fillers are primarily used to treat the nasolabial folds (lip-cheek grooves) and to increase the size of the lip…which are more static or non-muscular problems.

 

In some cases, the two may be used together to get the benefits of both for a particularly problematic facial fold such as very deep vertical furrows between the eyebrows.

 

2.      What are injectable fillers most commonly used?

 

If you divide the face in hemispheres, Botox and Dysport are primarily used as a ‘northern’ procedure (forehead and eyes) while injectable fillers are a ‘southern’ procedure. (around the mouth and cheek-lip folds)

 

3.      There are lots of injectable fillers that I see advertised, but which is the best?

 

All commercially-available fillers are FDA-approved and are safe and effective for use in the face. The general question of which is best, however, is not the right way to make a distinction between the many fillers that are available.  Rather, one should look at which ones offers the best value…which usually means how long do they last? Generally, those fillers that last longest are preferred as they require less treatments to have their effects maintained. Examples of long-lasting injectable fillers include Juvaderm and Radiesse.

 

4.      Can injectable fillers be used for wrinkles?

 

While many think that fillers can be used to treat wrinkles, this is a bit misleading. Wrinkles tend to be more superficial lines in the skin which makes injection into them difficult. Most fillers are placed just under the skin. As a result, they work best for the lips and facial areas such as the nasolabial or glabellar furrows…folds of the skin, not wrinkles. This does not mean that fillers can not be used for some wrinkles, just not very fine ones.

 

5.      Is it painful to have a filler treatment?

 

Being stuck with a needle is not a pain-free experience. Some facial areas are more sensitive than others, such as the lips. Some form of anesthesia is helpful for all injectable filler treatments. Topical creams are somewhat helpful but I prefer local anesthetic nerve blocks, particularly around the mouth. Having as comfortable as an injectable experience as possible is important since long-term maintenance of the results require ongoing injection sessions.

  

6.      What is the recovery after being treated with injectable fillers?

 

The beauty of injectable facial treatments is that there is usually no recovery. Once can walk out without having any visible signs that something was done. Rarely is there any noticeable swelling or bruising. In my Indianapolis plastic surgery practice, patients will leave still being numb from the injections and will feel swollen, when in fact, they are not. In those few patients where small amounts of bruising may occur, it will not usually appear for hours or a day later.

 

7.      How long does the effects of a filler treatment last?

 

That will depend on what type of injectable filler is used. Fillers have quite variable lengths of persistence. Some last but three or four months, while a few may last up to a year.

Dr. Barry Eppley

Indianapolis, Indiana

Hand Rejuvenation with Radiesse Injectable Filler

Thursday, September 10th, 2009

Like the face, the hands are a visible reminder of a lifetime of environmental exposure and the constant stress of repetitive movements. On the back of the hand, aging becomes apparent as thinning or loss of volume between the flexor tendons, very evident and prominent veins, wrinkled skin, and numerous age spots and brown discoloration. Most of the skin rejuvenation methods, such as peeling and exfoliation and light therapies, can improve the texture of the skin but can not replace the ‘gaunt look’ of the aging hand.

Injectable fillers are the only option for adding volume to the dorsum or back of the hands. While all filling materials will work, those with the longest known volume retention are best. While fat can be used, it is not a practical in-office treatment method. Of the synthetic fillers, I prefer Radiesse in my Indianapolis plastic surgery practice.

Radiesse consists of 30% spheres of calcium hydroxyapatite in an aqueous carrier gel. Based on its experience in the face, it has proven to be durable and long lasting out to about a year. It is eventually absorbed as its ceramic spheres are gradually degraded. It can be easily injected into the thin tissue on the back of the hand. Because it can be now mixed with a local anesthetic, hand rejuvenation can be a near pain-free experience. Even though Radiesse is white in color, it does not appear that color when under the skin.

 Hand rejuvenation therapy is simple to perform and a fairly quick procedure. I do like to apply a topical anesthetic cream first to the back of the hands for about 15 or 20 minutes. By first using  a micro-roller and then applying the cream, the onset of skin anesthesia is more rapid and profound. The skin is then lifted on the back of an outstretched hand between the second and the fifth ray which leaves the veins behind and out of the way. About .65 ccs of Radiesse (1/2 syringe)  is then injected as a bolus into the back of each hand.  With the patient now making  a closed fist, the material is then massaged to spread it evenly throughout the subcutaneous space over the entire back of the hand. Another technique is to inject it in smaller volumes in three areas between 2-3, 3-4, 4-5 rays. Either way, keep massaging until the dorsum looks even.

The results of hand rejuvenation are immediate. It will typically last a year or so. There is no recovery and bruising is either absent or very minimal. I don’t give any particular restrictions afterwards other than not to do any strenuous or excessively repetitive hand movements for the rest of the day. With a simple 30 minute total treatment time and less than one day of recovery, one can have rejuvenated hands that last for the rest of the year. 

Dr. Barry Eppley
Indianapolis, Indiana

 

Botox and Injectable Fillers on Indianapolis Doc Chat Radio Show

Saturday, September 5th, 2009

On this week’s Doc Chat Radio show on WXNT 1430AM in Indianapolis from 1:00 – 2:00PM on Saturday afternoon, hosted by Dr. Barry Eppley Indianapolis plastic surgeon,  the very popular topic of injectable beauty treatments was discussed. With a guest plastic surgeon, the numerous injectable treatments of Botox and Injectable Fillers and their role in facial rejuvenation and enhancement was covered.

In the past, cosmetic plastic surgery was all about having surgery to reverse the effects of aging on the face.  Time was, once you were scared enough by what you saw staring back at you in from the mirror every morning, facelifts, eye tucks and the like were routine procedures with all of the associated bandages, expense and gossiping tongues.

Since the turn of the millennium, non-surgical injectable alternatives have burst onto the anti-aging scene in ways that never could have been predicted. The concepts of muscle paralysis, plumping fillers, and fat dissolving agents have made it possible to have smooth foreheads, fuller lips and softer laugh lines, and maybe some subtle tightening of the jowls and neck in a few simple visits to the doctor’s office.  Unlike surgery, injectable facial treatments are as much about the prevention of the effects of aging as they are about reversing what has already taken place.

Along  with this explosion of available injectable treatments have come the inevitable, unbelievable marketing claims, and so-called ‘expert’ injectors. But, like much of what you may read on the internet, in popular magazines, and hear in commercials , what can you really believe? How do you separate reality from marketing hype? How can you decide where-or if-injectable treatments fit into your needs and desires??

Today’s programs discussed all of these issues to help the listener discern whether and which of the injectable beauty treatments is right for them.

Plastic Surgery and Injectable Botox and Filler Treatment consultations with Dr. Eppley can be arranged by calling his Indianapolis suburban area facilities at IU Health North or IU Health West Hospitals at 317-706-4444 or sending an e-mail inquiry to: info@eppleyplasticsurgery.com.

Radiesse Injectable Filler for Facial Bone Enhancement

Wednesday, April 29th, 2009

Radiesse (formerly known as Radiance) is an injectable filler for cosmetic enhancement of specific areas of the face which is FDA-approved. Radiesse is made up of microscopic calcium particles (hydroxyapatite that is chemically similar to the mineral in bone) and suspended in a gel for injection. Radiesse is a safe material that is used in other medical applications such as bladder sphincter control, breast biopsies, and vocal cord injection and has proven to be very compatible with the body. Unlike collagen it does not require an allergy test and lasts in the range of 8 to 12 months. In rare cases, it may last even longer. It is purported that it will last longer when placed on top of bone, rather than just under the skin, but convincing studies have yet to be forthcoming about that belief.

Radiesse is a versatile injectable filler that can be used to improve numerous facial areas such as wrinkles in areas like the smile lines (or nasolabial folds) but also address cosmetic defects in the nose, augment and contour the cheeks, enhance the chin and contour the jawline. It is this ability to augment facial bone areas that makes Radiesse unique amongst the numerous facial fillers.

For those who desire cheek enhancement, due to a congenital flatness of the cheek profile or due to aging loss, Radiesse can add volume to cheeks because it can be used to treat the easily accessible, slightly curved surface area of the body of the zygoma. It can be directly injected with no structures of any importance between the cheek skin and the underlying bone. The result is an immediate fullness to the prominence of the cheek. It does not usually take more than 1cc or less per cheek area. While not as dramatic as that of a cheek implant, it does result in a noticeable enhancement of the cheeks. I have read published studies which show that a typical treatment for cheek augmentation  can last for over a year or longer but I would not expect it to last any longer here than elsewhere.

Radiesse offers a quick and immediate procedure for select nasal contouring. Commonly known as a non-surgical rhinoplasty, it can be used to build up the bridge of the nose to camouflage a hump, (straightening your profile) or to correct defects and shape the tip of the nose. Very small amounts of the material are needed to make these changes, substantially less than 1 cc. The trick to doing it is to make it reasonably comfortable given the sensitivity of the nose.

Radiesse has also been used with some good results to augment a weak chin and is a non-surgical option to a chin implant when immediate results are desired. This concept has also been extended to re-shape and contour the jaw line and chin. It does result is a smoother, firmer jaw line but it does take a lot of material to do so which makes it not cost-effective for most patients. Putting it over such large areas is probably exceedingly the capability of what injectable fillers are meant to do.

When Radiesse is placed down at the bone level, the potential for normal side effects such as irregularities and bumps is eliminated due to its deep location. During placement, working the material against the bone makes it easy to shape it and eliminate the risks of unevenness and irregularities.

Radiesse is a unique injectable filler because it lasts longer than other compositions such as collagen and hyaluronic acid compositions. While it does last longer, it still is not permanent and that significant issue must be taken into consideration when comparing it to more conventional methods of facial skeletal enhancement such as implants. In my Indianapolis plastic surgery practice, it is a method of injectable facial filling that is best used in those patients who want an immediate result (and understand that it is not permanent) or for those patients who want to use it as a trial facial bone enhancement to determine if eventual facial implants are a good option. In the advent that they don’t like the result, time will resolve those concerns without surgery.

 Dr, Barry Eppley

Indianapolis, Indiana

Hand Rejuvenation with Injectable Fillers

Wednesday, August 27th, 2008

Do your hands give away your age? In many people, the hands are just as revealing as our faces about our age. But our faces understandably get much more attention and the hands are often forgotten. (but not unseen by others) As we age, our hands (particularly women) loose that once plump fullness and youthful look. Aging hands become thinner with vein and joint exposure, loose creapy skin, and brown spots over the back of them. These changes occur from chronic sun exposure and extensive use. While hand creams are a good first line of defense, they are not enough to produce a dramatic rejuvenating effect.
Adding volume back into the hands through injectable fillers is a good way to lessen the prominence of the veins and give a more plump appearance. The question is….which injectable filler? In my experience, you have 4 options…three off-the-shelf and one operative (which is only done if you are in the oprating room anyway for other procedures)
While all of the hyaluron-based injectable fillers (e.g., Restylane, Juvaderm) are extremely well tolerated, their effects are too short-term and do nothing to stimulate actual collagen tissue ingrowth so I prefer not to use them in the hands. The particulated fillers, such as Radiesse and Artefill, are better options as they last longer and may actually help stimulate favorable tissue ingrowth for longer-term results. Radiesse uses resorbable ceramic beads in its mixture so the effects are immediate but the beads are eventually resorbed over a year or so. It is also white in color although much of this is masked by the color of the skin. Artefill uses non-resorbable plastic beads in a collagen base which is much more likely to last longer and produce a better tissue-thickening result. Because both particulated fillers have a tendency for ‘clumpiness’ and irregularities, injection technique is critical and it is best to not inject too much at once. A
few staged treatments (spaced 6 to 8 weeks apart) slowly adding volume, and doing daily massage over the injected areas is the best way to ensure a smooth-looking result. Sculptra is another off-the-shelf filler option that is really like injecting ‘liquid plastic’ rather than a bead or particulated approach. Its material is resorbable over time and you have to be really careful about adding too much volume at once as it can cause local tissue reactions. Which one of these off-the-shelf injection materials is better for the hands is not yet known….and none of them are FDA-approved as of yet for use in the hands.
Another injectable option, which has been around for a long time with a track history of use in the hands…is your own fat. This is certainly the injectable filler option with the least potential for any downside with the exception that it has not historically lasted. In the past, I have done some beautiful results with it as it fills the depressed areas between the rays (fingers) quite well creating a nice plump hand. Five to seven ccs of fat per hand (which is much more volume than one could afford with an off-the-shelf- filler) is about what each hand needs. But the long-term outcome was disappointing. Now with improved purification and concentration methods, and with the addition of PRP concentrate (extracted platelets from the patient), fat is more likely to have a better long-term result. For this reason, this is my preferred method when the patient is in the operating room anyway…particularly if they are already having a liposuction procedure.
Hand rejuvenation, sometimes referred to as a ‘hand lift’ (erroneous term but catchy nonetheless), is based on the concept of restoring volume. Whether it is from a synthetic injectable filler or your own fat, short-term results appear to be quite good. Whether they will stand the test of time and what complications may yet emerge is not yet known. But at this point in time, I will give it at least a temporary thumbs up with the other four fingers still in neutral position.

Dr. Barry Eppley

Indianapolis, Indiana

Injectable Fillers – The Relationship between Cost and Longevity

Tuesday, August 19th, 2008

Injectable fillers provide a simple and immediate cosmetic treatment that is particularly good for the areas of the nasolabial folds (cheek-lip grooves) and for lip enhancement. While there are many different name brands of injectable fillers, they basically do the same thing (plump up the skin) even though there are some differences in what they are made of. These basic differences in makeup (collagen vs. hyaluronic acid vs particulated), while not conferring any different filling properties, are different in more than just the name also.
In theory, what you are primarily paying for with an injectable filler treatment is for how long it lasts. The least expensive injectable fillers, such as old-style Zyderm and Zyplast (pig collagen) or more modern Prevelle (hyaluronic acid), last about 6 to 12 weeks or less than three months. The longer-lasting fillers, such as Radiesse (dissolvable ceramic beads) and ArteFill (non-dissolving plastic beads), are by far the most expensive but they do last anywhere from 12 to 18 months after a single injection session. The real question is then…..how much are you paying for what length of time. (no true permanent injectable fillers exist at this time) You want to be sure that the price somehow correlates to how persistent the result is.
That can be a difficult task for any patient to decipher. Many times what a practitioner may charge may not necessarily correlate with the product’s behavior. But the purchase price to the injector (which does differ for all injectable fillers) is the same throughout the country for all syringes sold. Therefore, you can ask to see a price list or ask the price (per syringe) for the types of injectable fillers that they offer. This makes it easy to do comparison shopping…although beware that price may not be indicative of the injector’s experience or expertise.

 

Here in the midwest, very short-term (3 – 4 months) injectable filler treatments (one cc or a full syringe) will cost around $300 – $400,  medium-lasting (6 to 8 months)injectable fillers around $550 – $650, and long-lasting (9 to 18 months) injectable fillers around $850 – $1250. While these are price estimates for just one geographic area in the country, they do reflect the relative relationship between injectable filler cost and duration of action.
Dr. Barry Eppley

Indianapolis, Indiana

Injectable Fillers for Facial Nasolabial Folds

Tuesday, July 15th, 2008

One of the most common facial areas that bothers many patients is the development of the nasolabial folds, also referred to as the lip-cheek groove, or in a recent television commercial known as the parentheses. You can argue whether it is a fold or a groove but it is probably closer to a fold. It develops as the cheek tissue from above ages and begins to sag….falling over its border with the upper lip. The upper lip is ‘fixed’ so the overhanging cheek tissue creates the appearance of a deepening fold. With time, aging, and the anatomy of one’s face, this nasolabial fold extends south past the corner of the mouth and sometimes nearing the lower border of the jaw in extreme cases of skin laxity.This area is commonly treated by injectable fillers and in my practice as many patients wants their nasolabial folds treated as they want their lips enlarged.
The most common method for nasolabial fold reduction is with injectable fillers. Like all filling procedures by injection, the results from nasolabial fold reduction is quick, easy to do, and the results are immediate. I usually perform them under a local anesthetic block so the treatment is as comfortable as possible. While all of the injectable fillers will work, I think some are better for this area than others. And the ones that I think are best are those that last the longest and have the greatest ‘push’.
While all of the hyaluronic acid fillers such as Restylane or Juvaderm will work, they do not last as long as any of the particulated injectable fillers. Currently Radiesse (ceramic beads) and Artefill (plastic beads) are the only two particulated fillers currently available. The evidence is clear, not surprisingly because of their solid bead component, that they consistently last longer than any of the hyaluronic acid fillers. While beaded injections can cause lumpiness and irregularities, this is not a significant cosmetic issue (nor can it usually be seen) in the forgiving area of the nasolabial fold. Conversely, in the lips this is a different matter. Also, because the bead composition makes the injectable material more thick and viscous, I think it provides more push as it goes in resulting in a better cosmetic effect and having to use less injectable filler. Because of particulated fillers longevity and thicker volume, it is my preferred injectable approach to the nasolabial folds. This injectable treatment will give a 9 to 12 month result.
There are other treatment options for the nasolabial fold as well. The best way to eliminate them is the one way which is almost never done….cut them out. That gets rid of the fold immediately but also leaves a fine line scar which may only be acceptable in an older patient. The other more commonly done alternative is to use an implant. I specifically use an Advanta implant for those patients that want a permanent volume solution. A very small incision is made in the nose crease and at the end of the lower fold line. The implant is slide into place from one end to the other. This is a procedure that can be done in the office under local anesthesia. An implant approach to the nasolabial fold is a good solution for someone who no longer wants to do injections, doesn’t mind the concept of an implant in their face, or has very deep nasolabial folds which would take a lot of injectable filler volume. My experience with an implant in this area has been quite good but it is not a first line approach for most patients.
Dr. Barry Eppley

Indianapolis, Indiana

Lip Augmentation with Injectable Fillers

Tuesday, July 15th, 2008

The most common method for lip augmentation is with injectable fillers. While other more surgical options exist such as lifts and implants, making the lip bigger by injections are quick, easy to do, and have instantaneous results. (notice that I did not say painless!) While five years ago, only two injectable filler options existed (collagen and a first-generation hyaluronic acid filler, Restylane), the choice between them was pretty clear. But as of today, there are now eight commerically-available injectable filler options and more are sure to come in 2009. With so many choices, it is impossible for any patient to know which injectable filler is best for the lips and certainly some physicians are in a quandry as well.
The simple answer is…..none of the injectable fillers is the best. Each has their own individual advantages and disadvantages although certain trends amongst them are clear. First, understand that no injectable filler has ever been FDA-approved for use in the lips in the United States although it is common practice. Technically, the use of injectable fillers in the lips is ‘off-label’ use. Why it has never been approved by the FDA is a regulatory technicality and processing issue from the manufacturer, not one of safety. Lip augmentation probably accounts for nearly half of all injectable filler use for many years so its safety track record is well established. Secondly, the composition of the injectable filler is critical to understanding its effectiveness and safety in the lip. Lip tissue is different from skin as lips are like fingers, we use them alot and they are very sensitive to touch and feel. For this reason, non-particulated fillers such as collagen and hyaluronic acid fillers are best suited for the lips. Those injectable fillers with particles (Radiesse and Artefill) should not be placed in the lip as their risk of irregularities and nodules (foreigh-body reactions) is definitely higher.
I would say that the hyaluronic acid fillers ( boned sugar molecules) are the gold standard for lip augmentation.

 

All injectable fillers will work for lip augmentation and their effectiveness is the same no matter the marketing name or manufacturer. The only difference between them is……how long do they last and how much do they cost? In short, the question is an issue of value with their use. The only way to figure out how long hyaluronic acid lip injections will last is to know the concentration of hyaluronic acid in the product and how well it is cross-linked together. Both issues which a patient can not determine. As there are no studies that directly compare one hyaluronic acid product to another in a prospective lip augmentation study (someday there will be but none exist as of now), patients have to guided by what their physician injector tells them.
In my experience, some hyaluronic acid (HA) fillers last longer in the lips than others. The range of persistence is anywhere from 4 to 12 months. For the sake of simplicity, for example, the newest hyaluronic acid filler Prevelle (HA concentration of 5 mg/ml) lasts about 3 to 4 months while Juvaderm (HA concentration 24 mg/ml) lasts around 8 to 9 months in my experience. And, not surprising, the cost in my practice is also different with the longer lasting one priced higher. (as it should be) With such an array of HA injectable fillers, I have found that it is now possible to ‘get what you pay for’. You can now choose your injectable lip augmentation result pretty much on the price you want to pay. Some HA injectable fillers cost more than others but they last longer too.
Dr. Barry Eppley

Indianapolis, Indiana


Dr. Barry EppleyDr. Barry Eppley

Dr. Barry Eppley is an extensively trained plastic and cosmetic surgeon with more than 20 years of surgical experience. He is both a licensed physician and dentist as well as double board-certified in both Plastic and Reconstructive Surgery and Oral and Maxillofacial Surgery. This training allows him to perform the most complex surgical procedures from cosmetic changes to the face and body to craniofacial surgery. Dr. Eppley has made extensive contributions to plastic surgery starting with the development of several advanced surgical techniques. He is a revered author, lecturer and educator in the field of plastic and cosmetic surgery.

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