Last time we talked about angry frown lines between the eyebrows and the beauty of Botox® and Dysport®. This entry I wanted to focus on those pesky lines on the sides of the mouth, affectionately referred to as “parentheses.”

Maybe first you only noticed them when you smiled. And then, slowly, without warning, they started to deepen and make themselves present no matter what expression you were making. Hmmm… time to start to thinking about fillers! These days, we’re lucky to have many different types of fillers available to us. But what’s the difference between them?

Hyaluronic Acid
This group of fillers, which include Restylane®, Juvederm Ultra and Ultra Plus®, and Perlane®, are composed of a natural sugar found in the skin. They are FDA approved for the correction of smile lines (nasolabial folds). Although it is an off-label (not approved) use, hyaluronic acid fillers provide natural, pleasing results when used for lip enhancement or to fill the marionette lines, where the corners of the mouth droop and turn down from volume loss. They are temporary fillers, with results lasting about 9 to 12 months.

Calcium Hydroxylapatite
Radiesse® is a substantial (thicker) filler that is FDA approved for moderate to severe facial wrinkles and smile lines. It can be used off-label (not approved) for mid/lower-facial and cheek volume replacement. Collagen production is stimulated with time, extending the effect. Results generally last longer than one year. It is not appropriate for lip enhancement.

Human Collagen
CosmoDerm® and CosmoPlast® are isolated from human fibroblast cell cultures. They are FDA approved for the correction of wrinkles. Although it is an off-label (not approved) use, they can be used for lip enhancement with natural results. Generally, the human collagen fillers last 3 to 6 months, so they may be a good option for patients who have never used fillers before.

Poly-L-lactic acid
Sculptra® is a synthetic form of natural lactic acid (poly-L-lactic acid) that is approved by the FDA to improve moderate to deep smile lines. Injection of Sculptra® into the skin stimulates fibroblasts, which allows the patient to produce his/her own collagen with time and extends the effect. Volume enhancement is gradual over several months, and results in a natural look. Sculptra® lasts 18 to 24 months, or longer in certain cases. Although it is an off-label (not approved) use, Sculptra® can be injected in the cheeks, temples, and lower face for great results. It is not for use in lips or around the eyes. Usually a treatment is performed every 6-8 weeks until full correction is achieved (on average 3 sessions).

Fillers are often used in combination with each other, as well as with Botox® or Dysport® for wrinkles associated with movement. And of course, with any treatment, make sure you see a board-certified physician experienced in aesthetic treatments to help you decide which combination will achieve optimal results for a fresher, younger-looking, and improved you.

Donna Bilu Martin, MD is a board certified Dermatologist at Skin and Cancer Associates practicing at their South Beach and South Aventura locations.

This post is not intended to be used for the purpose of medical diagnosis or treatment in any shape or form. Accordingly, any information contained within should not be construed as medical advice, evaluation, or consultation and should never be considered a replacement for a formal evaluation by a physician in the office. Therefore, the information and correspondence that is involved with this webblog does not constitute a formal doctor-patient relationship. Explanation of off-label services and/or products that are mentioned herein does not reflect an endorsement nor promotion and should not be construed as such.


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