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For temporary lip augmentation, only one category of filler material is safe, which is a clear gel filler called hyaluronic acid. The brand names in this category are Restylane, Perlane and Juvederm (there are some other minor players, but those are all of the major ones). They last about 4-6 months for the most part in the lips. There is a bit (a 3-5 on a scale of 1-10) of discomfort with injection, but they seem to be tolerated fine in the office. Bruising happens in about 40-50% of patients and lasts about 3-5 days. This costs $600 per syringe and usually the job can be done with 1 syringe alone. For the first visit to the office, we offer a 20% discount to new filler patients.
For permanent lip augmentation, none of the artificial permanent fillers (i.e. silicone or Artefill) or the permanent lip implants (a silicone tube or a saline-filled tube) are a good idea in any way. The permanent fillers can harden over time and become a huge problem for the patient. Lip implants can often be felt and they actually protrude through the skin over time so many of them have been removed from the market over the years.
Filling the lips with one’s one tissues is really the only viable permanent option. This is done with fat grafting. The challenge here is that fat grafts tend to reabsorb in the face and therefore the patient and doctor have to decide if they want to do multiple smaller grafting procedures or one huge grafting procedure. Each has significant disadvantages – multiple procedures are expensive since fat grafting has to be done in a sterile operating room setting, and a single large session of grafting results in grossly overfilled lips that look nothing short of ridiculous for several weeks to a few months until they settle down. Each grafting session costs about $4,000 (this includes getting a bit of fat through liposuction, the surgeon’s fee and also the fees for the anesthesiologist and the operating room) so you can imagine that this gets expensive very quickly. Multiple grafting sessions do cost extra fees, so it can get really expensive to get the job done.
For lip fillers revisions are usually not necessary. If there are minor irregularities, they can almost always be massaged out. If the patient wishes to have more volume and we have already used the full syringe, then an additional fee for another syringe would apply. If, for some reason, the patient simply doesn’t like the augmentation from fillers then there is actually a material called ‘hyaluronidase’ that can be used to dissolve it. I haven’t ever had to do this with any of my injections to the lips but it’s nice to know there is a tool available for us for correction if we need it.
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You also need to consider your unique goals and the amount of volume required. For large amounts of volume, Sculptra is one of the most cost-effective cheek fillers, and is the longest lasting.
However, other fillers can be effective for more subtle improvements in the face. In that case, the duration of the filler usually takes priority in the decision. Juvederm and Restylane last anywhere from 6-9 months and is often a popular choice.
Radiesse is also used with success, and is more cost effective than Juvederm and Restylane for the amount of months of correction you can get.
If you are looking for a more permanent solution, fat grafting with a skilled Board Certified Plastic Surgeon can be a viable option as well. As always, it’s best to schedule a consult to discuss your goals, and from there decide the best course of treatment options.
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When done successfully, the injected fat grows a new blood supply and begins to receive the nourishment it needs to survive from your body. When this happens, results can and often are permanent. However there can be a percentage of fat that does not take and this is why touch-ups are sometimes necessary. It is important to discuss options in advance to determine the best course of action for your situation.
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Treatment options range from Botox, chemical peels, Thermage skin tightening, Juvederm or Dysport fillers, or even, depending on the severity of lines lower eyelid surgery.
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Over the course of the next 3-5 days you may then see some minor swelling, but after the 5th day that should be resolved almost entirely. As always, consult a Board Certified Plastic Surgeon before making any decisions regarding treatments, to discuss the best options unique to your situation.
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These objectives should be discussed, pros and cons. From there you can decide the best course of action to suit your unique needs, and treatments can usually be done in office, with effects lasting anywhere from four-to-six months.
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It has been used for many years in Europe, and might finally make its way through the US regulatory system in 2011. In many ways it is almost identical to Botox. It is also nearly painless, lasts just as long and has the same effect. In fact, it’s made of nearly exactly the same stuff, but is much more pure.
I had the chance to fly to Miami this past weekend to hear all about Xeomin, and to talk endlessly with German dermatologists who have had years’ worth of experience with Xeomin – to the point that for a few of them this is all they use. Why not use a product with nearly flawless purity? I’m very excited and will be watching for FDA announcements on the subject very closely, so that I can bring Xeomin to San Francisco right away.
In case you missed the previous post about the new injectable filler Belotero, please click here.
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Dysport relaxes muscles just like Botox, but works even faster! It’s useful to smooth:
- the frown lines between the eyebrows
- the horizontal lines of the forehead and
- the crow’s feet around the eyes
As a bonus, the manufacturer of Dysport is currently offering a $50 rebate for any Dysport treatment, and we will assist you with applying for that rebate when you come in. Please call us at (415) 398-7778 to schedule your appointment. Space is limited!
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After many years of use in Europe, Belotero would join Juvederm, Restylane and Perlane, as another great option for facial fillers for use in the U.S. if it gets approval. I had an opportunity to be one of the first physicians in the United States to use the product when I flew to Grand Cayman Island last summer to do just that.
I remember thinking to myself on the plane, “why does the world need another filler, especially in this category? What could possibly be so different about this newcomer?” On that trip, I chatted directly with European physicians who had many years of experience with Belotero. Of the (amazingly!) 120+ options for fillers in Europe Belotero has become their #1 pick.
I’m happy to say that I loved the product and am very excited about it. There are two amazing ways in which Belotero is different:
- it can be used very, very close to the surface of the skin and therefore we can now treat very fine lines of the face like never before. For example, some patients have vertical wrinkles in the mid-cheek that are sometimes called ‘sleep lines’ which were almost impossible to treat before but now have a solution with Belotero.
- Of all the other fillers in this category run the risk of having a bluish color to them after injection (sometimes called the Tyndall effect). The Tyndall effect has never been reported with Belotero, which opens up a whole new world for more aggressive treatment in thin areas of the face like the lower eyelids.
When will Belotero get FDA approval? Hard to say, but I’m hoping it will be soon. I’m proud to be one of the first physicians in the country with Belotero experience, and I’m thrilled to be bringing Belotero to my San Francisco Bay Area patients as soon as I can.
