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The four members of the “hyaluronic acid” (HA) filler category are all very similar: Perlane, Restylane, Juvederm and Belotero. So for the most part, when we talk about one of these fillers, it’s applicable to all of the others. They are all made of a clear gel, hyaluronicacid that naturally occurs in most tissues in the human body, and works to keep our tissues moist and to lubricate the surfaces of our joints. Our body recognizes HA as a substance that belongs in the body, so these fillers only very rarely show an allergic reaction.
Facial areas where Perlane shines:
Perlane and all hyaluronicacid fillers are great for filling the lips, lower eye areas and smile lines. Perlane doesn’t last quite as long as some of the other fillers such as Radiesse or Artefill, but it’s still used in other regions of the face when warranted and when a shorter acting filler is still OK with the patient.
Perlane as a reversible filler:
All of the HA fillers actually can be erased with an enzyme called hyaluronidase. When injected into an areas previously treated with Perlane, hyaluronidase will actually break the Perlane down and make it vanish within a few days to a week. Fortunately, the need to remove fillers after injections is very uncommon, but some patients will be a bit more comfortable trying fillers for the first time if they know that the effect can be reversed.
When it’s maybe best to not use Perlane:
San Francisco is a great place to get filler due to the amount of qualified injectors. Perlane is a great filler, but it is one of the shorter acting fillers, with a longevity of maybe 8-10 months at best in most areas. And if larger volume augmentation (i.e. multiple syringes) is what is needed, then Perlane might not be the best bang for the buck. Larger facial regions like sunken & hollow cheeks will usually be better served with Sculptra.
Also, Perlane is better for deeper areas and larger shadows such as the smile lines. It doesn’t work well for treating the fine lines in the face, because fine line treatment requires a superficial placement of the filler, and of the HA fillers only Belotero should be injected superficially. All of the others (Restylane, Perlane and Juvederm) can potentially result in a bluish hue – called the “Tyndall” effect – when they are injected superficially.
Keeping pain low during the procedure:
In my office, I rarely have patients express concern over the discomfort of injection treatments. Usually they put the pain of Perlane treatments around a 3-4 on a scale of 1 to 10. It’s not uncommon to use a bit of topical (cream) anesthetics for lip injections, though sometimes we will go without even that. Perlane has lidocaine (a local anesthetic) in it, which helps tremendously with achieving a more comfortable treatment. Even at this mild pain level, Perlane treatments are quick; the discomfort is usually over in a matter of just a few minutes at most.
Bruising with Perlane treatments:
The minimal bruising that occurs with Perlane treatments is really well tolerated. Maybe 30-40% of patients have a bit of bruising for 3-5 days, but it is usually easy to cover with a basic foundation in 1-2 days.
Perlane vs Restylane:
There are two fillers made by the same company which are called Perlane and Restylane. They are extremely similar, though their microscopic ‘particle size’ is a bit different. This leads some to believe that Perlane may last a bit longer (maybe 1-2 months longer) while Restylane may be a bit easier to inject into finer areas. Both are excellent fillers and ultimately the preferred option is often a matter of preference on the part of the treatment provider.