Just as Botox did a short time ago, Restylane is creeping into our esthetic vocabulary.

Restylane is one of a group of “cosmetic dermal fillers” that acts in conjunction with Botox treatments. While Botox relaxes muscles that can cause frown lines, a filler literally fills in the grooves left behind from deep expression lines or skin folds.

Hyaluronic acid, the generic name for Restylane and a few lesser-known brands, plumps up the nasolabial folds between the nose and cheek, erases brow and forehead lines, smoothes pitted chins and obscures dark under-eye circles.

Other filling agents include collagen, fat and silicone. “But, hyaluronic acid is superior to other and older fillers such as collagen, both in its application and its finished product,” says Dr. Adelaide Hebert, professor in the Department of Dermatology at The University of Texas Medical School at Houston.

Restylane is a non-animal “stabilized” hyaluronic acid, free of animal proteins, which limits the risk to patients of allergic reactions.

“Restylane has a softer, smoother look and best of all, you don't have to pre-test the skin for allergic reactions that can come from other materials,” Hebert says.

Skin architecture

Hyaluronic acid resides naturally in the skin and body, explains dermatologist Dr. Craig Teller, adjunct professor at UT Medical School, so it interlaces with the skin's own collagen.

Collagen serves as the skin's steel pillars. Hyaluronic acid interacts with it, providing water retention as a volume enhancing component. “We find hyaluronic acid in all species, as we do collagen. However, collagen types differ among species,” Teller explains, which also accounts for some cases of hypersensitivity in people.

Hyaluronic acid has a longer-lasting effect and wears off gradually. While collagen is a worthy filling agent, it wears off more quickly—and suddenly. “By contrast, hyaluronic acid gives you instantaneous and long-lasting enhancement because it binds many times its weight in water,” he says.

Filling in the gaps

Restylane is injected into lined areas at several sites. Teller says it also is effective in sculpting and enhancing lips. Not only can it make lips fuller, but also fill in the vertical lines or “lipstick bleed lines” caused by smoking, pursing lips habitually, or sun exposure.

Dark circles and sunken eyes benefit from Restylane where the facial skin is its thinnest. Veins that show through thinned skin create the shadows beneath the eyes.

Skin loses some of its elasticity with age, particularly in the cheeks, resulting in skin folds and a hollowed appearance. Fillers can augment cheeks and smooth out crevices in the chin area, as well.

Hebert says that one of the more popular sites for Restylane or other dermal fillers is at the “marionette lines—creases that extend down the face from the corners of the mouth.”

It also fills in deep frown furrows on the forehead, both vertical and horizontal.

During and after injection

Restylane can be a more painful injectable than other materials used as fillers, but doctors can use local anesthetic creams and/or nerve blocks to dull the pain. Teller also uses a vibrating massager next to the injection area. Since there are only so many stimuli that the brain can absorb, the vibratory sensation serves as a neural smokescreen.

Temporary bruising or swelling is common the first few days and the face needs babying for up to a week. Hebert advises not to do anything that would tug on the skin or put pressure on the face, such as deep kissing, massage, or going to the dentist.

Restylane and other fillers typically last from four to nine months, with an average of six months. Some dermatologists recommend smaller treatments more often rather than waiting until the original treatment wears off completely. “Shorter, frequent visits are less stressful on the skin, the patient and the pocketbook,” Teller says.

Although Restylane has received more brand exposure, Teller says there are several other hyaluronic acids, with more coming on the market.

The price varies depending on the number of syringes used, which come preloaded in either 1cc or 4cc measurements. Usually, patients will need 1-3cc to treat nasolabial folds, Hebert says, which can run $400-$1000 per application.

Most patients can tolerate fillers, particularly hyaluronic acid, well. “However, keloid-prone [exaggerated scarring] patients may not be candidates,” she adds.

Teller says a person who has very deep lines or significant skin sagging receives better results with Sculptra (a significant volume filler) or a face lift.

“An experienced dermatologist or plastic surgeon can make the most reliable recommendations,” Hebert says and cautions interested patients to resist claims of expertise made by spas and salons.

“As with any procedure, seek an evaluation from a board-certified dermatologist who has had extensive experience in cosmetic procedures,” Hebert says.

UPDATED: 6-07-2005

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