Radiess versus Juvederm vs Restylane

Why both are necessary. Why you may want both.

The past decade has been an extremely exciting time for advanced in nonsurgical plastic surgery care. Aesthetic plastic surgeons have added a number of nonsurgical treatment offerings to their toolbox.

At the forefront of these advances lies a class of injectable substances called dermal fillers. The term dermal fillers has entered the public eye as safe, effective, and reproducible. These sentiments are clearly backed scientific and clinical outcomes literature. We are proud high volume proficers of dermal filler therapy.

While the public has accepted dermal filler they, the public seems to think that all dermal filler are the same. For example, a patient presented either Restylane or Juvederm whichever was cheaper. The reality is that while Restylane and Juvederm are similar they actually have significant differences in the human face for maximal result for minimal cost.

Restlane and Juvederm are both hyaluronic acid fillers, hyaluronic acid is a substance found in the cell wall of ever cell in our body. Because of this, no allergy testing is required as no allergic reaction has ever been reported. Despite being members of the same chemical class, Restylane and Juvederm behave quite differently on a clinical basis. The easiest way to define the difference is to understand the difference between hydrophilicity and cohesion, Hydrophilicity, refers to how a substance absorbs water. Substances that are a highly hydrophilic absorb water like a sponge, substances that have low hydrophobic qualities resist absorption of water like raindrops, on a treated wood deck. Cohesion on the other hand, refers to how much a molecule adheres to surrounding molecules. This is also referred to as g-prime. Cohesion and g prime are the same. The higher the cohesion, the more lift a substance can provide because it will adhere to itself and to the surrounding tissue and using appropriate Plastic Surgery techniques you can create natural lift effects because of the natural cohesive nature of the filler.

Restylane has an extremely high g prime or cohesiveness but is poorly hydrophilic. Juvederm has a low cohesiveness and a high hydrophilicity. From a clinic standpoint what does this mean? This means that Restylane is better at lifting things and Juvederm is better at filling things. So when someone comes into my office, asking for dermal therapy. If patients have a deep sunken eyelid or a prominent wrinkle between their lower eyelid and cheek, the best possible filler for that area is Restylane because it wont make your lower eyelid puffy because it wont absorb water and it will also give you a small 1-2 mm cheek lift effect. If someone comes in with deep furrow lines in their forehead and their brow is low, then Restylane provides a better result than Juvederm If however, they have deep forehead lines but their brow position is good or normal, then Juvederm provides a better result than Restylane . From a lip standpoint, some patients have excellent lip volume but want a pouty lip look. In this case, Restylane is clearly the favorite filler. A low volume lip augmentation with Restylane will provide an outstanding natural result without creating a duck lip. However, in patients that need volume added their lips However, if patients present with significant volume loss to their lip, then Juverderm is a better choice because it absorbs water. You can get the same result with less cost because you can inject less Juvederm than you would Restylane .

What is Radiesse?

Unlike Restylane or Juvederm, Radiesse is a calcium hydroxyl appetite sphere. No allergy testing is required. Of all commercially available fillers, Radiesse has the highes t cohesion by far!! Because of this, Radiesse offers the larget unparallel lifting effect of any other filler on the market. For patients seeking cheek, chin or temple lift without surgery, Radiesse is by far the leader. None of the other fillers can compare to Radiesse for safety, efficacy, in lift effect. However, Radiesse, tends to be more granular than Restylane or Juvederm because of this, it is a very poor choice for the lower eyelid and for the lip. Another advantage of Radiesse as compared to the other fillers is that Radiesse tends to last about 1.5 year where as the other last between 8-12 months. Also, Radiesse has been shown to cause secondary collagenases. Basically, this means that patients that undergo a series of Radiesse injections will develop a permanent organic result because your body will produce collagen in response to Radiesse. This does not mean that Radiesse is permanent. This means that Radiesse stimulates your body to recreate the collagen that it previously lost. Short of surgery, this is your best possible result.

So, then whats the right answer? Which is it? The answer is, there is not single agent that is better than the other, for true expert there is a spectrum of tools that can be used in the safest possible fashion for the best possible result.