In terms of rejuvenation, the combination of Restylane for the lower face and Botox for the upper face is the gold standard.
A veteran of Restylane due to her involvement with the U.S. Food and Drug Administration's (FDA) clinical trial of the filler, Dr. Narins contends that the overall effect to areas such as around the eye, nasolabial folds and marionette lines are unparalleled to other HA fillers. While some may argue that these results come at a painful price due to the fact that HA fillers are formulated without lidocaine, the injection and aftermath of Restylane can be painless, Dr. Narins tells Dermatology Times.
Pain factor "In the (FDA) clinical trials we found that less than 12.5 percent of those treated with Restylane or Zyplast experienced swelling, bruising or redness in the study, and I'm experiencing similar results with my patients," says Dr. Narins, a New York dermasurgeon and clinical professor of dermatology and chief of the liposuction surgery unit, New York University Medical School. "The injections do not have to be painful."
Using the gateway of pain theory, pain can also be diminished by holding the patient's hand or "handesthesia," talking to the patient, also known as "talkesthesia," and by vibrating the skin that is to be treated, according to Dr. Narins.
"Technique is also very important to controlling pain. When treating the undereye hollows, the surgeon should also use serial injections against the bone to avoid discomfort, bruising or bumps" says Dr. Narins, who is also director of the Dermatology Surgery and Laser Center, White Plains, N.Y. and New York, N.Y. "A tiny 30 gauge needle is used to inject the product and this also minimizes discomfort."
In comparison, Hylaform (Inamed) and Captique (Inamed) are 5 milligrams per cc hyaluronic acids while Restylane is a 20 milligram per cc product, says Dr. Narins.
"This increased density probably accounts for Restylane lasting twice as long as the other products" Dr. Narins says, noting that these are the only three FDA approved hyaluronic acids available in the U.S. at this time.
Complete combination In terms of rejuvenation, the combination of Restylane for the lower face and Botox (Allergan) for the upper face is the gold standard, according to Dr. Narins. While Restylane fills in wrinkles and folds and enhances the lips, Botox erases lines due to muscle movement. When the frown lines are deep at rest, a combination of Botox and Restylane gives the best result. Botox can be used to get rid of the lateral eyebrow depressor while Restylane can be used to restore the volume lost in the area providing a greater lift than either substance alone. The same is true of vertical lip lines and the corners of the mouth.
"Other uses for Restylane include plumping up aging earlobes and hands," Dr. Narins says. "While the use of HA fillers may continue to evolve as we gain more experience and newer products are developed, the here and now of Restylane is allowing gains for cosmetic procedures–a profit with aesthetic benefits that can be reaped with little pain and discomfort."