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Photo Credit: galderma.com


05-09-17 | Posted by

The newest crop of injectables hailing from global pharma giants Allergan (JUVEDERM) and Galderma (RESTYLANE) are changing the face of the so-called ‘Liquid Facelift.’ Whereas hyaluronic acid gel fillers used to be considered somewhat interchangeable like Coke and Pepsi, these novel products have distinct differences in how they work and where they can be used that set each of them apart.

In December 2016, Galderma introduced Restylane Refyne (for the treatment of moderate to severe, facial wrinkles and folds) and Restylane Defyne (for moderate to severe, deep facial wrinkles and folds). These new products to the US are marketed under the brand Emervel in Europe.

Dr. Steven Fagien, an oculoplastic surgeon in Boca Raton, FL, who conducted the first clinical trial on Restylane Refyne, “Refyne is a really nice soft product, similar to Juvederm Ultra, and adds more options to the Restylane family. The original Restylane and Restylane Lyft are more suited for structure, where they now offer “softer” varieties to use in areas where structural or more rigid enhancement is not preferred, such as the lips and nasolabial folds, which is where I like to use Refyne off label.”

“These new fillers from Galderma combine the particle technology of Restylane with the added cross-linking variability, which is what differentiates Restylane Refyne from Restylane Defyne.  The smaller particle size and less cross linkage allows for a smooth gel like Juvederm.  In the US, it is referred to as X-PressHAn technology,” he says.

To get a real lift with injectables usually means that you need a combination of the right products placed in the appropriate areas of your face. In most cases, that means using several fillers and often layering one on top of the other.  Hyaluronic acid is by far the filler of choice everywhere in the world, mainly because there is an exit strategy. This means that in the unlikely event that there is too much injected into one area, an enzyme called Hyaluronidase or Wydase can be injected to break it down quickly. In the case of some semi-permanent or permanent fillers that are not created from HA, you either have to wait it out until it dissolves on its own (which can take months to years), or have it removed through an incision that may leave a scar, in the case of some permanent fillers.



Different fillers are slightly thicker or thinner and, therefore, more appropriate for specific areas of the face or for correcting volume loss. For example, Voluma is a thicker filler that is not ideal for most women’s lips, whereas Juvederm is a perennial favorite for that area. Advanced injectors tend to use a combination of HAs and other fillers for maximum long lasting correction, which is where the true artistry comes in.

According to New York City dermatologist Dendy Engelman, “The differences between all of the HA fillers are based on particle size and how the particles are cross-linked (held together). Some of the newer fillers are made for very fine lines and thus have very small HA particles (like Restylane Silk or Volbella) & others are made for lifting the skin and thus have much larger particle size (Voluma and Restylane Lyft).”

With hyaluronic acid gels, you will need a touch up at about 9-12 months and some products may last as long as 18 – 24 months. Just like BOTOX, Dysport and Xeomin, dermal fillers are not a one shot deal. In fact, they are an integral part of a longterm maintenance plan, and are often combined with other aesthetic treatments for a more dramatic effect.

“The most common combination of facial treatments is injectable fillers for volume restoration and Botox for wrinkles,” says Baltimore facial plastic surgeon Theda C. Kontis, MD, FACS, the AAFPRS secretary-elect. “Rejuvenation of the face with these two modalities has been called a ‘liquid facelift’ but these treatments do not address skin laxity or the aging neck, so many patients are combining injectables with laser or radiofrequency treatments to the neck,“ she says.

If you want to bypass any bruising post injections, avoid Aspirin and other aspirin-containing drugs like Advil, Aleve, and Motrin for one or two weeks before and after treatment. Also, put a hold on Vitamin E, multi-vitamins containing E, and Omega 3 fish oil supplements.

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