Restylane or Juvederm doctor consultation - what to ask for best results?

I have only seen Restylane result in aggregation, or lumps.  I have never seen Juvederm form aggregates.  I would encourage you to avoid Restylane, especially in the lips. 

Consider Restylane and Juvederm to be essentially equal. What really matters is the talent and experience of the injector. Personaly, I do all of the eyelid tear trough injections in my practice and I have a highly skilled aesthetician whom I have trained and worked with for about 13 years do most of the nasolabial injections. Of course, I am also perfectly willing to inject the folds, but the price is a little higher in order to account for my time.

Does your doctor perform the injections himself?   Is he even interested in performing the injections?  Many otherwise fine surgeons view fillers as a nuisance, or delegate this task for business reasons. 

Others are cavalier and will inject anything new, whether it is legal in this country or not, whether or not it has been proven safe (and no, that doesn't just mean FDA approval, as the many reports of granuloma formation for FDA approved substances shows).

Where and how fillers are injected will directly impact how you look the next 6 months of your life.  And if you are receiving ill advised injections such as silicone, for the rest of your life.

Once you have screened for credentials (i.e. board certification), you should have confidence that your doctor has your best interest in mind.  You should feel confident that he has a plan based on carefully listening to your needs.  You should feel confident that he is safe.  You should feel confident that he is aware of the risks and benefits of fillers, not only by themselves but as a plan for your overall rejuvenation over time.

Many patients have expressed dissatisfaction with their fillers in the blogs.  When you look more carefully, there are 60+ women who would benefit from skillful plastic surgery but instead have placed all their hopes in a few syringes of Restylane, an unrealistic and ill-informed plan destines to produce dissatisfaction when the results don't deliver.  Apparently nobody ever told them that their skin was sagging and that is why the $2000 they just spent for Restylane did not fix their problem.

Your doctor should discuss all the options with you, not just pump fillers.

If you don't get a definite yes on all these counts, you should move on.  It's that important.

Facial fillers are one of the most common non-invasive treatments around the world.  In the United States, Juvederm and Restylane have become the two most popular hyaluronic acid type fillers.  Important questions to ask your physician:

• How much experience have you had with facial fillers in the lips, tear trough area, or nasolabial folds?
• Have you experienced any complications with fillers in the lips, tear trough area, or nasolabial folds?
• How would you treat the complications (nodules, bumps, overcorrection, undercorrection) if I developed any?
• Can you show me before and after pictures of the fillers?
• What options do I have for anesthetic before the procedure?
• Can you go over my post-procedural instructions before treatment?

Juvederm Ultra is slightly smoother to inject and slightly less likely to form a bump, compared to Restylane.  For "unforgiving" areas, like the lips and tear troughs, I think Juvederm is a better product because it has a smoother consistency.  For "forgiving" areas, like the nasolabial folds, marionette lines, frown lines, etc..., I think Juvederm or Restylane are fairly comparable, lasting about 6-8 months on average.

If cost is a consideration (and both cost about the same per syringe), I often recommend Restylane.  The reason is that Juvederm has 0.8cc in a syringe, while Restylane has 1.2cc in a syringe.  Therefore, you have more material to use with one syringe of Restylane, enabling more folds and wrinkles to be improved.  Unfortunately, Juvederm doesn't come in any other size, while Restylane also has a 0.4cc syringe (which is cheaper because it is 1/3 the amount of a 1.2cc syringe). 

Similary, if a person needs more than one syringe of product for correction, it takes 3 syringes of Juvederm (2.4cc) to equal the amount of product in 2 syringes of Restylane (total 2.4cc).  This means you have to spend money to purchase an extra syringe of Juvederm.

I think the decision of which to use between these two fillers should be a mutual one between you and your treating physician.  Treatment goals, area to be treated, cost, and amount of product required are all key factors.

Every doctor  and every patient are different. Both juvederm and restylane are hyaluronic acid fillers. My personal preference is to use juvederm. It lasts longer, and is easier to inject. The cost is about the same.

Different Strokes for different folks.

Fine lines around the mouth- Juvederm or Restylane (juvederm is smoother and lasts longer)

Nasolabial Folds - If the folds are deep without fine wrinkles use Radiesse, Juvederm or Fat. Both synthetic fillere are long lasting. Juvederm is easier to inject and less painful. Fat will last the longest and is all-natural.

Nasojugal Gooves - The creases below your eyes are best treated with Fat,Restylane or Juvederm. Both synthetic fillers do well although it is easier for the surgeon to apply Juvederm and shape it to the deformity. The best way to treat this area by far is fat injections. The volume necessary to adequately correct these depressions may sometimes be up to 4cc per cheek. That is only available at a reasonable cost when injecting your own fat.

Larger Lips - Juvederm or Restylane, although both will not last as long as if they are injected into other areas of the face.Fat is still great in the lips. It will last for a long time and the volume necessary is not a limitation.

This may seem like a simple question but the answer is quite complex. It begins by choosing an experienced and artistic injector. This is the first and clearly the most important step. Credentials are important but artistic ability is a major factor in skillful filler injection.

I would start with a board certified Dermatologist, Plastic surgeon, Facial plastic surgeon or Oculoplastic surgeon. These are the specialists that are most highly trained in understanding the facial anatomy. It is important to understand the anatomy not only to achieve great results but also to avoid severe complications.

Next you need to choose the correct product to be used in the correct location. This should be done in combination with your trusted physician and will be based upon your needs, their personal experience as well as the scientific evidence from studies performed using these products.

For example, studies are now showing that Restylane may last up to 18 months in some patients, and that Juvederm can last up to 12 months. Lastly, with all products injected in the skin there is a risk of bruising, redness and swelling. So you will need to plan your injection accordingly to your social/personal schedule.

If you follow these rules, look at both credentials as well as examples of the patient's your physician has personally treated (not pictures from websites or from the companies), you should be able to get a good idea of what to expect and have a great experience with these wonderfully safe and effective products.

With all due respect, please be mindful of the skill and artistry that nursing brings to the table when performing injectable procedures. Most of the blogs and questions that I come across on this very website pertains to physician- administered treatments wherein the patient was dissatisfed or left without enough information.

This does not imply that any one specialty is better than another; however, there should be due respect for all licensed practitioners. What is far more important is the training and experience behind one's reputation rather than the title.

As a patient/consumer, always ask about training, experience, whether or not they attend seminars & workshops to update their skills and techniques, and ask to see before and after photos. Be certain that your registered nurse, nurse practitioner, physician assistance, or physician involves you in the education process and treatment plan.

Juvederm is slightly more of a smooth product but clinically patients usually obtain equivalent clinical results with smooth surfaces after both Restylane and Juvederm. The level of placement should not be too superficial with either product so the result should be smooth. Injections around the under eye areas are injected usually below the muscle which is under the skin. Lumpiness should not occur. Bruising which is temporary is the same for both fillers. It comes down to which filler the individual prefers, but there is no consensus that one is better than the rest.

During your consultation you should ask your physician if they have experienced these types of complications and what they will do to correct the matter if such complications arise. You may also want to ask your physician if they use a topical numbing cream or nerve block.

Addressing your questions and concerns prior to your treatment will make things go much smoother and make you feel at ease. Choosing a physician that is experienced in this area is also very important.

Make sure you do your research and you choose your physician based on experience.

The first question should not be asked of your doctor, but rather to yourself: What is your primary concern, and what is it you would like to accomplish with the treatment?

Injectable fillers like Restylane/Perlane and Juvederm have revolutionized the non-surgical treatment options available to patients.  More cost-effective and longer-lasting than the previous generation of fillers, there has been a tremendous acceptance of these products as a weapon in the battle against the signs of facial aging.

Nevertheless, injectable fillers can't solve every problem, and it is important to understand their limitations.  Ask yourself what are the issues that concern you.  For early signs of facial aging such as mild to moderate-depth nasolabial folds, thin lips, or mild dark circles under the eyes, Restylane and Juvederm do an excellent job.  For more extensive signs of facial aging, even a boat-load of fillers may be insufficient to correct the problem, and surgical procedures are more cost-effective, often in conjunction with judicious use of fillers in a more limited fashion.

Your plastic surgeon should be able to properly advise you of the best option for your particular desires and facial features.  In any event, you should not be concerned about a lumpy or unnatural appearance if the right combination of surgical facial rejuvenation procedures and injectable fillers is performed  by an experienced surgeon.

I agree with Dr. Persky. Either is a good choice. My preferences are:

• Eyes - Restylane
• Lips - Juvederm
• Nasolabial and Marionette - Either, but I lean towards Juvederm.

Remember, it's the Doc that's most important. A physician trainer for other physicians is a good choice, but not necessarily a requirement. Steve Weiner, MD Facial Plastic Surgeon.

Hi Kerry,

There is a saying, "It's filler, not the filler" that determines your results.  In other words, choose your injecting physician carefully.  Ask if they are board certified in one of the cosmetic specialties (plastic surgery, facial plastic surgery, ENT, dermatology, oculoplastics), and ask how they received their training.  Ask them what kind of side effects or complications that they have seen.

 Restylane and Juviderm are both very good fillers.  They can both be reversed with hyaluronidase if too much is placed.  I have never needed to reverse Restylane while I have had two experiences with Juviderm where there was excessive persistent swelling.  Therefore I do not use Juviderm under the eyes.  So if you were my patient having both the eyes and nasolabial folds treated, I would recommend Restylane for you.  Good luck and be well.

Dr. P

Probably the only thing other than seeing or knowing a patient of the doctor doing the procedure is to see a picture of one of their patients.  It is incredibly important to see the doctor's work and it is very important to look at the pictures with a very careful view as many of these are done with makeup that can cause a 'photographic cure' meaning that the makeup conceals or enhances the results.

Ask for their experience and any particular recommendations they may have (special training, research credentials, volume credentials by the companies that produce these products).  Typically, the more they inject, the better they are.

Lastly, make sure that the doctor is the injector.  If they hand it off to a nurse or other staff member, I'd go elsewhere.  I do all my injections of botox and fillers and feel that it is essential for patients to have the doctor rather than an underling in the office.  Good luck!