Kenneth Francis MD
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Hyaluronic Acid Injectables (Restylane, Perlane, Juvederm Ultra, Juvederm Ultra Plus)

This second article in our series covering the use of injectable materials in plastic surgery for facial rejuvenation finds a tumultuous economic time around the world. Global economies are on the decline, and with them, individual discretionary income, previously earmarked for maintenance of a youthful appearance, has become limited. With unemployment rates at record levels and corporate downsizing in full swing, competition for a place in the work force is fierce. Yet, the ability to compete in the work force has long been associated, for better or worse, with maintaining a youthful, vibrant appearance. Many sociologic studies have confirmed the fact that the more youthful appearing, vigorous individual appreciates greater vocational and career opportunities. Perhaps, the answer to this paradox of lower disposable income and the greater need for maintenance of a youthful appearance is hyaluronic acid injectables.


Hyaluronic acid is a naturally occurring substance in human skin that maintains the skin's moisturization and fullness. It has been commercially available for injection into the skin for facial rejuvenation for many years now and maintains a long safety and effectiveness profile. The material can be used to fill specific wrinkles and lines in the face, as well as, to replace volume in areas larger than a wrinkle. The first hyaluronic acid product to receive FDA approval for cosmetic use in the face was Restylane, for injection into the nasolabial fold (deep crease/fold that occurs from the corner of the nostril to the mouth area) area. Restylane's sister product, Perlane, is used for filling deeper, larger defects/depressions and is comprised of a larger molecule hyaluronic acid. More recently, the Juvederm family of hyaluronic acid products received FDA approval for the correction of facial wrinkles in 2006. Juvederm Ultra and Ultra Plus have similar application to Restylane and Perlane. These products may be used for facial rejuvenation and work well for lip enhancement as well. The duration of effect is somewhat variable depending on which area of the face they are injected into and which product is used. In the nasolabial fold area they will last anywhere from 6-12 months. The lip, with its increased mobility, retains the products for a shorter 3-6 month time span.


The procedure itself is relatively innocuous and can be performed in 15-30 minutes depending on the amount of material used and the size of the areas being treated. Patients return immediately to their routine activities of daily living, including work. There is a slight risk of bruising or swelling, as with any injection, which may last a day or two, but is easily camouflaged with make up and/or lipstick. The results are immediate and impressive, natural looking, yet subtle, so it is not readily apparent to coworkers exactly why you look rejuvenated. So, keep yourself in the game and stay within your disposable budget by considering an injectable treatment.



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