Restylane®

Before and After Photos

Are You Interested in Restylane?
Hyaluronic acid, or hyaluronan, is a glycosaminoglycan that consists of regularly repeating nonsulfonated disaccharide units of glucuronic acid and N-acetylglucosamine. Hyaluronan is a naturally occurring biopolymer that is an essential component of the extra cellular mix of all adult animal tissues. The average person has about 12 grams of naturally occurring hyaluronan in their bodies. Hyaluronan is hydrophilic or water loving and forms gels or a hyaluronan matrix that can withstand compressive forces, create volume, lubricate tissue, and act to create tissue turgor.

Since 1989 this material has been used as a dermal filler. At first the filler was not stabilized and was quickly removed by the body. Restylane uses a biosynthesized hyaluronic acid isolated and purified from bacterial fermentation cultures. It is minimally cross linked and concentrated producing a small gel particle size with a very low level of impurities. Restylane gel maintains volume in the skin through isovolumetric degradation. In this process each molecule of hyaluronic acid binds increasing amounts of water as it degrades, maintaining gel volume and the size and shape of the implant for an extended period of time.

Restylane has been improved over the years with a reduction in the trace amount of protein by a factor of six since mid 1999. Delayed hypersensitivity reactions had been reduced to 0.02% by 2000 and with the virtual elimination of implant type hypersensitivity reactions no skin testing is required with the use of Restylane.

Full Correction
Restylane is limited to 1.5 ml per treatment site. Achieving full correction with Restylane is highly individualized and best approached slowly. Correction achieved with the first treatment will be improved with subsequent treatments when Restylane is already present. There is no need to overcorrect expecting that volume will be quickly lost, but 100% correction is often staged to avoid overcorrection and duck lips.

Once full correction is achieved it lasts for several months and reinjection takes less Restylane than the original treatment. It appears that more than 2/3 of the volume of the Restylane remains at 6 to 8 months after the initial correction. The areas that last the longest are the spots that move the least and conversely the areas with maximum movement may be expected to require retreatment sooner. Longer effects are noted when Restylane is used in combination with Botox as the sites move less.

Pre-treatment Recommendations
In an effort to minimize bruising it is helpful to avoid those drugs that affect platelets and prolong bleeding. These include aspirin, anti-inflammatory drugs such as ibuprofen, and herbs such as ginkgo biloba, St. John’s wort, and doses of vitamin E in excess of 400 IU daily for the two weeks before treatment. If you have a history of cold sores it is a good idea to use Valtrex 500 mg before treatment and 12 hours after treatment.

Treatment Anesthesia
Restylane injections are most often administered in areas that have been anesthetized. This can be a local anesthetic, a regional nerve block or if other procedures are being done Restylane can be administered while you are under general anesthesia.

Common Treatment Areas
Nasolabial folds are among the most commonly treated facial areas. These folds display a degree of natural asymmetry that is part of your normal expression and this must be taken into consideration at the time of treatment. The lateral oral commissure or corners of the mouth and the lines of Perliche or Marionette lines are often treated at the same time as the nasolabial folds and the lips.

Normal lip anatomy should be preserved and enhanced with fill along the mucocutaneous junction or white roll and along the philtral columns on either side of the cupids bow. Restylane is an excellent material for correction of the lips as it can be added in small increments and the effect produced as it is injected is often the effect that remains. The height of the lip and fullness of the central tubercle can be accented as well as the fullness of the lower lip lateral to the midline. Restylane is especially helpful for the fine lines that form with atrophy of the lips that are such a problem with lipstick running into the wrinkles across the white line or mucocutaneous junction. This injection beneath the vermillion border adds volume to the body of the lip while injection into the lateral commissure helps define the lip angles. Along the mandible the lateral mental hollows occur as jowls develop and although the jowl is not changed the mandible line is restored by a fill in the lateral mental hollows Botox is often used at the same sitting to weaken the depressor anguli oris, a small muscle that pulls the corners of the mouth downward. Weakening the depressor extends the effect of the Restylane and cheers a scowl.

Another area that benefits from a combination of Botox and Restylane is the glabella or central frown lines. The vertical glabellar furrows are weakened by Botox to the underlying corrugator muscle and softened by Restylane in the depths of the furrow.

Botox is commonly used to affect the relative strength of the muscles of the upper face. If used in the glabella and central forehead the corrugator and frontalis muscles are weakened, if the orbicularis occuli muscles below the lateral brow are weakened as well, but the frontalis above the brow are untreated and remain active a relative repositioning of the brow occurs with a higher arch and more lateral placement of the brow. This effect can be enhanced with Restylane volume added filling and raising the superior-lateral margin of the brow.

Crow’s feet are commonly treated with Botox then filling the residual lines while avoiding the sub dermal vascular collection of blood vessels seen prominently in this area. Tear troughs are another are that may benefit form a small amount of Restylane.

Other areas of the body may benefit from a filler. Atrophic earlobes, scars that have become depressed such as acne scars after sub-incision are possible applications of Restylane.

You may be interested in the Restylane website.