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How hydrolyphyllic is Restylane Silk compared to Juvederm ultra or Belotero, and could you list in order ?

Dr. Dean Kane Q & A. lid botox Q: How hydrophilic is Restylane Silk compared to Juvederm Ultra or Belotero. Could you list in order? The reason for this is I want a filler that is not permanent that will not cause a lot of edema, especially if I have it injected in the upper cheek area. Thank You. A: This is a wonderful question not easily understood by patients and many injectors.​ “Hyaluronic acid (HA) is a type of sugar (polysaccharide) that is present in body tissues, such as in skin and cartilage. It is able to combine with water and swell (hydrophilic) when in gel form, causing a smoothing/filling effect. Sources of hyaluronic acid used in dermal fillers” are now mostly created from bacteria fermentation or historically from rooster combs (avian). “In some cases, hyaluronic acid used in dermal fillers is chemically modified (crosslinked) to make it last longer in the body. The effects of this material last approximately” 6 – 24 months. ​ ​HA’s have natural and synthetic linkages between molecules. Hyaluronidase, a natural enzyme in the body breaks down natural links quicker than the synthetic links which attribute to the quality, duration and characteristics of each product. Those with the least links breakdown faster but are the smoothest hydrators. Those with the greatest number of links are stiffer and therefore more projecting and last the longest. ​ ​Different manufacturers process the molecules differently. Some are broken into smaller molecular clumps enzymatically, others are filtered through microscopic sieves to separate the molecule sizes. ​ ​You can now see why HA fillers work differently a different levels of appropriate injection by the understanding and the talent or skills of the injector. ​ ​Natural HA undergoes the quickest of the breakdown and can lead to poor hydration of the skin without the genetic stimulus of the body to create it. ​ ​Those HA’s such as Belotero and now Restylane Silk have the least amount of linkage providing the shortest durations (3-6 months) BUT the greatest hydration. These are best used in fine lines such as those around the lips and eyes. They are also useful for large areas such as multiple and long cheek lines or forehead creases as the achieve great smoothness while used sparingly. ​ ​Restylane, Juvederm HA’s come next. With greater projection, these HA’s are used for the pink lip, the “white roll or edge” of the lip, wrinkles of the nasojugal, nasolabial and marionette areas in the dermis. ​ ​Perlane, Juvederm Ultra Plus and Voluma with higher tackiness and projection are best used in deeper tissues for greatest elevation and fill. I use these fillers for deeper folds such as the nasojugal, nasolabial, marionette folds and atrophic upper cheek and weak chin or jawline. ​ ​Please obtain your consultation for these and other injectibles from the most well experienced Board Certified injectors whether they are Plastic Surgeons, ENT, Dermatologists or Ophthalmologists. ​ ​I hope this was helpful. All the best!
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