The past decade has been an extremely exciting time for nonsurgical therapy for plastic surgery. Aesthetic plastic surgeons have added a number of safe, effective nonsurgical treatment offerings to their toolbox. At the forefront of these advances lies a class of injectable substances called dermal fillers. Dermal fillers are appropriately viewed by the public eye as safe and effective, offering reproducible results. These sentiments are clearly backed scientific and clinical outcomes literature. At Ocean Drive Plastic Surgery, we are proud to offer all major platforms of dermal fillers, and we take immense pride in our Ocean Drive Liquid Facelift.
While the public has accepted dermal filler therapy as a mainstay of facial rejuvenation, there is a general misconception that the filler platforms are essentially the same, and that the cheapest filler is the best value. The reality is that while Restylane and Juvederm are indeed similar, they actually have significant differences in how they function in the human face and body.
Restylane® and Juvederm® are both hyaluronic acid fillers. Hyaluronic acid is a substance found in the cell wall of ever skin, hair, and nail cell in our body. Because of this, no allergy testing is required for hyaluronic acid fillers, as no allergic reaction has ever been reported. Despite being members of the same chemical class, Restylane and Juvederm behave quite differently after being injected into the human face. The easiest way to define the difference is to understand the difference between hydrophobicity and cohesion. Hydrophilicity refers to how a substance absorbs water. Substances that are highly hydrophilic absorb water like a sponge. Substances that have low hydrophilic 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 generally as gprime (G’). Cohesion and G’ 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 resist deformation. When using a higher G’ filler in conjunction with appropriate plastic surgery techniques, you can create natural lift effects to the face and body because of the natural cohesive nature of the filler.
Restylane has a higher than average G’ or cohesiveness, and has some hydrophilic properties. Juvederm has a low cohesion, and a high hydrophilicity. From a clinical 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 filler therapy, we individualize what patients received based on their specific anatomy and goals. If patients have a deep sunken eyelid or a prominent wrinkle between their lower eyelid and cheek, a better choice of filler is Restylane over Juvederm, as Juvederm attracts a great deal of water, which can look puffy. Also, Restylane offers a small cheek lift effect (1-2mm). If someone comes in with deep furrow lines in their forehead and their brow is low, then Restylane provides a better result than Juvederm for brow lifting with fill. 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, if patients present with significant volume loss to their lip, then Juvederm is a better choice because of its ability to absorb water.
What is Radiesse?
Unlike Restylane or Juvederm, Radiesse is a calcium hydroxyapatite microsphere. No allergy testing is required. Of all commercially available fillers, Radiesse® has the highest cohesion by far!! Because of this, Radiesse offers the largest lifting effect of all the other filler platforms 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 in terms of G’, lifting ability, or overall safety. 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 whereas the other fillers last between 8-12 months. Also, Radiesse has been shown to caused secondary collagenesis, producing Type I healthy youthful collagen. Basically, this means that patients that undergo a series of Radiesse injections will develop a permanent organic result because your body will produce type I 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.
So, then what’s the right answer? Which is it? The answer is, there is not a single agent that is better than the other. For true experts in facial aesthetics, there is a spectrum of tools that can be used in the safest possible fashion for the best possible result.