An Injectable Wrinkle Filler to Smile About

Injectable Wrinkle

Learn about one woman’s experience with the injectable wrinkle filler Juvéderm — and why doctors recommend the product for smoothing smile lines.

When I met Deborah Loban, a 60-year-old woman who lives in Stratford, Connecticut, she was sitting in the office chair of New York City dermatologist Dr. Doris Day. She was completely relaxed, chatting, smiling, and laughing with her husband, Louis, and 28-year-old daughter, Rebekah. With such a calm demeanor, you’d think she was in for a social visit! But Deborah was actually about to receive her second Juvéderm treatment in two years to diminish her “parentheses” — the creases running from her nose to the corners of her mouth, otherwise known as the nasolabial folds.

Juvéderm, like Restylane and Perlane, is an injectable wrinkle filler made of hyaluronic acid, a sugar that’s found naturally in the body and helps give skin its fullness. Other injectables that are commonly used to fill smile lines or “marionette lines,” include products like CosmoDerm and CosmoPlast, which are a type of protein called collagen that’s also naturally found in your skin, cartilage, bone, and connective tissue. And then there’s Radiesse, a filler that’s made of a substance called hydroxyapatite, which is a component of bone tissue.

The main differences among the products are how they feel under your skin and how long they last. Radiesse can last the longest — up to two years — but some doctors have reported a risk of hard lumps forming under the skin that may be visible. Collagen products are the softest and best for treating shallow smile lines; however, they typically last only up to three months. Juvéderm and Restylane, which are in gel form, are often used for smile lines because these fillers are highly effective at treating deeper wrinkles and can also last from six months to a year.

After her first Juvéderm treatment, Deborah saw an immediate difference — especially a smoothing of her upper lip area, even though the injections were made in her parentheses. “It was amazing how it changed the appearance of my lips without the needle ever touching my lips,” said Deborah.” It also gave the corners of her mouth a lift. “I looked refreshed,” she said.

Even Deborah’s husband, who had the procedure done at the same time, raved about the results. “It really does work wonderfully well,” he said. “I’d do it again myself in a heartbeat.”

Because her first Juvéderm treatment gave her such positive results, Deborah was all too happy to go under the needle again after she began noticing “subtle” lines reappearing.

Just then, Dr. Day walked in. She described Deborah as a great candidate for the wrinkle treatment. “She has amazing skin texture,” said Day. “She just needs a little softening around the mouth.” On the wrinkle severity scale, on which 1 is mild and 4 is extreme, Dr. Day described Deborah as a 2 (about moderate).

Facial wrinkles are caused by collagen loss combined with the effects of gravity. And hyaluronic acid is a good treatment option because it’s natural and works by adding volume to the skin, explained Dr. Day.

Dr. Amy Wechsler, another New York City dermatologist who uses Juvéderm to treat smile lines on her patients, compares the effects to drops of water falling on a dry sponge — it instantly plumps from the inside out.

Not only will patients notice an immediate smoothing of their lines after the treatment, said Dr. Day, they will also see a “more pronounced difference in the next few months as the skin’s natural collagen restores itself.”

Deborah had been introduced to Juvéderm during a media event, where she agreed to participate in a research trial of the then relatively new product. “Everyone [from the research team] was excited because of its longevity,” Deborah recalled. The product is FDA approved to last one year from initial treatment. However, said Day, “I’ve seen it go longer.”

The benefits of hyaluronic acid, concurs Wechsler, are that “it has a smooth consistency and it lasts longer — and I love the ‘lasts longer’ part.”

Since being approved by the FDA in 2003, hyaluronic acid dermal fillers are now among the top five physician-administered nonsurgical aesthetic procedures in the country, according to the American Society for Aesthetic Plastic Surgery.

Wechsler estimates that the average total cost per injected syringe of Juvéderm is from $600 to $1,000, depending where you are in the country. For optimal correction, doctors can use up to two syringes (typically one per side).

During Deborah’s follow-up treatment, Dr. Day injected the hyaluronic acid several times into the upper and lower quadrants of Deborah’s mouth. She gently moved the needle around and then massaged the corners of her mouth to evenly distribute the gel. Because the needle that’s used is so thin, there was very little bleeding.

Deborah described the injections as feeling like small pinpricks, followed by slight stinging and tingling sensations. The entire procedure took only about a couple of minutes. “You want to inject just enough” to ensure longevity, said Dr. Day. “But you never want [it] to look overdone.”

Afterward, Deborah was given an ice pack to place against the injection sites to prevent bruising and swelling. The Juvéderm prescribing information lists the potential side effects as temporary redness at the injection site, swelling, bruising, pain or tenderness, firmness, and lumps or bumps. However, these should last no more than seven days.

“Patients feel 99 percent of the pain during the injection, and only slight soreness afterward,” says Wechsler.

According to Dr. Charles Boyd, a Detroit-based plastic surgeon, the fear of needles is what prevents most patients from trying a filler. But even for those patients who do opt for these treatments, the goal is to provide them with a more comfortable experience, he says.

As a result, doctors concerned about patients’ pain level, including Dr. Wechsler, had begun mixing an analgesic into their Juvéderm formulas. The downside, warns Boyd, is that altering the formula is not FDA-approved and has the potential to “water down” the product’s consistency, which may not give the patient the same amount of lift.

That’s why skin doctors who use Juvéderm were excited when the FDA approved Juvéderm XC, the first dermal filler to be formulated with the anesthetic lidocaine. Instead of using a topical numbing cream, ice, or nerve blockers, doctors can now administer virtually pain-free injections. The new Juvéderm formula “numbs the area within seconds,” says Dr. Boyd. “It’s almost instant.” The manufacturer of Restylane is also expected to gain FDA approval for a similar product.

In terms of fillers, “technology has come a very long way,” said Dr. Day. “We’re not just filling wrinkles, we’re adding contour and texture.”

Rebekah, who could easily pass for under 25, was particularly impressed by the results that both of her parents experienced. She said she’d noticed a more dramatic change when they got their initial treatments because their wrinkles had originally been much deeper. This time my mom just looks great, she said. It shows just how long-lasting the product is.

When smile lines become an issue for her, she declared, “I can’t wait to get it done.”