Ok, so you’ve had your fair share of stresses and worries…and with age, you’ve started noticing some facial wrinkles where there used to be none. You’ve heard that Botox®, Dysport®, Restylane®, Perlane®, and Juvederm® can all help in the fight against wrinkles…but how do these “miracle workers” actually work? And more importantly, which one is right for you? As a plastic surgeon, I hope I can clear up some of the confusion you may have about the products listed above so you have a better understanding of the available treatment options.

Of course, no blog of mine would be complete without a little scientific background first (and yes, I blame it on my physician-scientist training at Duke University School of Medicine!). Botulinum toxins, like Botox® and Dysport®, are purified substances derived from a bacteria. They temporarily RELAX muscles by blocking the nerve signals that help them contract. It follows, therefore, that any wrinkle caused by facial animation, such as smiling, chewing, frowning, or squinting, would be amenable to treatment by botulinum toxin. Currently, the FDA has only approved these toxins for treatment of wrinkles between the eyebrows. However, popular and well-studied, off-label uses include treatment of horizontal forehead wrinkles, crows feet along the side of the eyes, and bunny lines that run along the nose. Botulinum toxins typically work best in the upper third of the face but have also been used to help raise the corners of the mouth and to help correct a “gummy smile” (and if you’ve got one, you probably know it!).

As you’re reading this, I’m sure you’re probably wondering…what’s the difference between Botox® and Dysport®? Well…not much! They are both botulinum toxins type A and they both work by temporarily relaxing the muscles for 3-4 months. Botox® was the original botulinum toxin approved here in the USA and therefore, it has become a fairly recognizable name…kind of like Kleenex®. No one really mentions the word “tissue” after Kleenex® because the brand name is essentially synonymous with facial tissues. Likewise, Botox® has become synonymous with botulinum toxin. But, you can still pick up a box of Puffs® facial tissues just like your plastic surgeon may inject you with Dysport® to help you get rid of some of those frown lines. Studies have shown that Dysport® may have a slightly quicker onset and may diffuse over a larger area (which can be both an advantage or disadvantage depending on where you are getting injected). Both, however, have been in use for years and have a high safety profile and show similar efficacy and side effects.

So now that we are all caught up on botulinum toxins, let’s turn our attention to facial fillers. Facial fillers, such as Restylane®, Perlane®, and Juvederm®, work by FILLING in deep wrinkles and folds in areas that have lost elasticity or volume because of the aging process. Restylane®, Perlane®, and Juvederm® are all made up of hyaluronic acid, a naturally occurring substance found in your body. When injected into a deep fold or wrinkle, the hyaluronic acid acts like an inflated cushion to help support your facial structures by binding to water. When dermal fillers were first introducted, animal derived collagen fillers were very popular. However, hyaluronic acid based dermal fillers have now become the popular, go to choice for the correction of moderate to deep wrinkles and folds because of their longer clinical duration and less risk of allergic reaction.

I’m sure you’re thinking…what’s the difference between Restylane® and Juvederm® and Perlane® if they are all made up of hyaluronic acid? Well, the difference lies in how the hyaluronic acid molecules are cross-linked, the degree of cross-linking, and particle size. Larger size particles are associated with Perlane®, making it a good filler for deeper folds and wrinkles whereas smaller size particles are the hallmark of Restylane®. The thinner consistency of Restylane®, therefore, makes it a great filler for medium depth wrinkles and folds. Similarly, the Juvederm® family has two products: Juvederm Ultra® and Juvederm Ultra Plus®. Based on the name alone, you can fathom that Juvederm Ultra Plus® is more viscous and has a higher degree of cross-linking than Juvederm Ultra®. Currently, the FDA has approved Juvederm® and Restylane® and Perlane® for the temporary treatment of moderate to severe facial wrinkles and folds, such as the lines from the nose to the corners of your mouth (nasolabial folds). Restylane® is the only filler with FDA approval for lip enhancement. However, popular and well-studied, off-label uses for these hyaluronic acid fillers include the filling in of marionette lines, lipstick lines, chin/cheek reshaping, and the under eye or tear trough area. Expect results to last anywhere from 6-12 months.

There is another group of facial fillers made up of synthetic substances, such as Radiesse®, Sculptra®, and Artefill®. In the interest of time (and space!), we’ll save that discussion for another day!

I would be remiss if I don’t mention that if you’re seriously considering enlisting help in the fight against wrinkles, please see an experienced plastic surgeon who can fully evaluate you to recommend the best treatment options. Often times, you may need a combination of non-invasive techniques (i.e. various fillers and botulinum toxins) and surgical procedures to help you achieve your best look.

So until next time…

Cheers to good health,