Hyaluronic acid gel (Restylane ®) is injected by the oculofacial plastic surgeon into areas of facial creases, folds, hollows and under wrinkles and lines. Initially it was a dermal filler and injected very superficially, virtually into the skin, but now it is injected under muscle much deeper as its use has expanded.

Is it painful?

A very fine 27 or 30 gauge needle is used which is very fine, and only rarely does a local anaesthesia block have to be given. The exception is the lips which are super sensitive and so local aneathesia nerve block helps. Other areas such as the lower eyelids and glabella region can be injected with only light topical anaesthetic gel or no aneasthesia required, similar to botulinum toxin injections.

Are there side effects?

Side effects of hyaluronic acid gel injections include:

bruising
redness
swelling
pain or tenderness
silvery appearance skin if injected too superficial or into lower eyelid high up
bumps either visible or palpable
asymmetry

These effects are usually of a very short duration. Generally Restylane is very inert and causes very little or no local inflammation. Depending on the areas injected and amounts used, a small amount of swelling may occur and persist up to three weeks in some patients. If there is persistent non-inflammatory swelling, bumps or asymmetry, the area treated can be reduced by a small injection of hyaluronidase. Lips swell after treatment. Normally the swelling lasts about 5 days.

Can more than one type of filler be used in the same area at the same time?

Yes, often an area is treated deep with Sub-Q or Perlane and more superficial with Restylane.

Can hyaluronic acid gel be given at the same time as botulinum toxin treatment?

Yes, many patients choose to have both treatments at the same time. The areas treated are usually complimentary but not identical.

Can hyaluronic acid gel be injected at the same time as a peel?

There is no reason why Restylane cannot be injected before the peel since different levels of the soft tissue are being treated. The chemical peel treats the epidermis and superficial dermis and the hyaluronic acid gel is injected deeper beneath the facial muscles.

If the patient has just had a chemical peel, they should wait at least 2 – 3 weeks before having Restylane.

If the patient is having laser treatment can they have Restylane treatment at the same time?

It makes good sense to have the hyaluronic acid gel injections before the laser treatment.

If the patient has just had laser skin rejuvenation, they should wait at least 2 – 3 weeks before having Restylane.

Can hyaluronic acid gel be used for patients who are pregnant or lactating?

This has not specifically been tested and is the decision of the patient and the surgeon.

When should Restylane not be used?

Hyaluronic acid gel should not be used in patients who have:

severe allergies and previous history of anaphylaxis to an ingested or injected drug or protein from hypersensitivity
into bone, tendon, ligaments
into blood vessels