Restylane and Perlane and Hyaluronic Acid fillers that are pretty much the gold standard for soft tissue augmentation in the lips and lines around the mouth. Hyaluronic acid was first isolated from the bovine vitreous in the 1930’s.
About Restylane and Perlane
It is found in the extracellular space in humans and animals. It is known to create volume, lubricate and support tissues. It is also highly hydrophilic which means it has a high waterbinding capacity.
The half-life of HA or how quickly it turns over. It is usually less than 24 hrs. This is very quick! In order to clinically use HA to augment soft tissue it has to be stabilized.
Hyaluronic acid is comprised of repeating disaccharide units or sugar molecules. The majority of HA occurs in the skin (56%). This production decreases with age. Less HA produces a decreased ability to bind water which leads to loss of volume, more wrinkles, less firmness and a drier skin. Chemical structure of hyaluronic acid.
A Doctor’s Perspective
My favorite of the HA’s are Restylane and Perlane. In 1996 Restylane was the first HA to be stabilized by non-animal sources. NASHA (TM) stands for stabilized non-animal hyaluronic acid which was patented and and developed by Q-Med AB in Uppsala, Sweden. They modified the HA by less than 1% which makes this product highly compatible with a patient’s own natural HA.
There is less risk of inflammation and not being of an animal source it is less immunologic and hence more pure. Since it is not reactive and sensitizing we don’t need to do skin testing like was necessary with collagen. Another interesting fact about the NASHA gel is that as it is degraded with time it will hold more water. This means that the volume is maintained longer and the skin will continue to appear moist.
An important concept to understand about filler’s is it’s elastic modulus or G’.(1) The degree of cross-linking and the HA concentration of a filler determines it’s G’. The higher the G’ the thicker and firmer the filler will be and it provides more tissue lift and it will not spread as much.
These are usually injected in the mid-dermis or deep dermis. A low G’ means the filler is soft and has more tissue spreading and will move with facial movement. These are less palpable and I like to inject these into fine lines around the mouth and under the eyes. These are usually injected in the papillary dermis or just underneath the epidermis. Restylane and Perlane have a G’ of 514 and 549 respectively.
A lower G’ filler is injected more superficially and a higher G’ is injected deeper in the dermis or subcutaneous plane. Some can also be injected under muscle or on
top of bone.
Tissue tailoring means to place the filler in the correct location so as produce the best filling effect that is going to last the longest. My filler of choice for lip augmentation is Restylane and sometimes Perlane. It has been shown to be present in tissue up to 1 yr. after injection. It does not form nodules that you see with more permanent fillers and it can look natural. The vermillion border is usually filled but not too much as to make the patient look like one has duck lips. I usually inject it into the muscle itself and in the philtrum to produce a nice looking Cupid’s bow which turns up the lips in the midline. Lines around the mouth can also be softened with Restylane. Lip augmentation can be painful so I perform blocks for patient comfort.