Dr. Sam Lam Plastic Surgery Forum

Hello,

I've got a few questions about temporary fillers. I noticed that a while back you received a question about restylane subQ. I was wondering:

1) Have you ever used it for the anterior cheeks and how does it compare to either perlane or radiesse?

2)Which do you find to give to most natural result for the cheeks while being least likely to cause lumps that develop later (granulomas?)

3) How do you avoid scarring in patients with brown skin (darker complexions being more likely to get a raised scar or pigment change mark from cannula injection)?

4) Is it possible to inject from the inside of the mouth and still reach the anterior cheek? I read somewhere about a transoral (correct term?) technique being used with restylane subQ but not sure if it only works in the lower face.

Thanks for your time,
Lyss

1) Have you ever used it for the anterior cheeks and how does it compare to either perlane or radiesse?
Restylane SQ is NOT approved for use in the U.S. so in short IT IS ILLEGAL TO USE RESTYLANE SQ IN THE U.S. Second, I was at a meeting for Botox in San Diego and talking to some Canadian docs who have a lot of experience with injections. They informed me that Restylane SQ has a very very very very very tiny market share because it does not work well. It is such a heavy product that it can migrate. Plus perlane already lasts so long that it is crazy. I have seen a year or beyond with it. I have no reason and no interest in probably ever using Restylane SQ based on this information. Let me see it when it becomes FDA approved then I'll decide. I like perlane over radiesse because it is reversible and i can move to a permanent like fat transfer anytime.
2)Which do you find to give to most natural result for the cheeks while being least likely to cause lumps that develop later (granulomas?)
all products mentioned above are good. i have experience with all of them. granulomas are not an issue that i have seen. lumps are another issue. i am good with all products but an experienced injector trumps any product.
3) How do you avoid scarring in patients with brown skin (darker complexions being more likely to get a raised scar or pigment change mark from cannula injection)?
i don't have that. i just added an African-American fat transfer to the before and after gallery for fat grafting tonight. check it out. bottom line is you are pretty darn safe.
4) Is it possible to inject from the inside of the mouth and still reach the anterior cheek? I read somewhere about a transoral (correct term?) technique being used with restylane subQ but not sure if it only works in the lower face. Yes, I used to do it but it is very inaccurate technique. If you want to hear me lecture go back about 2 years ago and watch my lectures on injectables under dr. lam's video lectures.
best,
sml

Thanks for the speedy reply.

So it looks likes perlane is the best way to go for temporary cheek augmentation as long as it is injected deeply enough to prevent visable lumps. I checked out the fat transfer on the African American woman in the before and Iafter section and it looks pretty good. I'm not ready for the permanent move yet, so I think I'll go a few rounds with a temporary filler. I'm currently trying to sort through what seems like millions of surgeons in NYC where I live to find one who has the skills, the artistic eye, and experience with all shades of skin. Seems like it should be easy in this big city but in reality- not so much.

Thanks again,
Lyss

P.S. What exactly is a granuloma and why does it form?

a granuloma is a reaction to a foreign substance. it really should not happen with almost anything that i do here.

Hi again,
Just a couple more question about granulomas. I've heard (and seen pictures)that they can form with restylane or other HA products. Why would one form if HA is found naturally in the body? Does it have to do with the injection site or depth? Are some patients more susceptible than others?

Sorry if I'm asking too many questions. Can you tell I was one of those kids who always asked "Why?" to the annoyance of most adults?

Lyss

i have heard of such a thing but i think it is extremely rare. usually it is not to the HA but to the antigen that surrounds it another words the carrier in which the HA is suspended. these reactions have gone down to less than 0.1% from 0.3% since 1999 when restylane cleaned out some of the carrier substance. that number actually has more to do with "allergy" than with granuloma. however, the process is similar in terms of your body reacting to something.
sml