In many practices, Restylane injections have replaced collagen injections as the soft tissue filler of choice. Restylane (hyaluronic acid) typically lasts six or more months, whereas collagen lasts three months. Restylane and collagen are typically used for the same purpose, namely soft tissue augmentation of the face. Some of the most popular areas for soft tissue augmentation with Restylane include the lips, nasolabial folds (smile lines), marionette lines and the nasojugal grooves (hollowing beneath the eyes). It can also be used for filling in irregularities the face after trauma or surgery. Restylane injections are much more painful than collagen injections, so many physicians administer nerve blocks, so that the entire peri-oral area (the area around the mouth) is numb for a few hours. This is the same thing dentists administer before they work on your teeth. Topical numbing cream is also usually used. Restylane is also more painful than collagen when the nerve block wears off. I have patients who told me their lips hurt for several days after Restylane injections. The lips are also swollen for a longer period of time with Restylane (three or four days v. one or two days with collagen). Allergic reactions are almost unheard of and the manufacturer doesn't recommend a skin test prior to treatment. A skin test is necessary prior to being treated with collagen because collagen comes from cowhide; therefore, there may be cross-reactivity because a protein from another species (cow) is being injected. Restylane is made of a substance called hyaluronic acid, a substance that is naturally found in humans.
In my practice, I use Restylane in 98% of my patients that request a soft tissue filler. A few patients still prefer collagen. If I don't use Restylane and the patient doesn't specifically request collagen, I tend to use a product called Comoplast, which genetically engineered from human skin. No skin test is necessary, since it from human skin, not cow.
Restylane is a bit too thick for fine lines, so I will often place Restylane in the deeper portion of the fold and place Cosmoderm (a thinner version of Cosmoplast) on top of the Restylane closer to the surface of the skin. This results in a better result that just Restylane or just Cosmoplast or Cosmoderm alone.
A thinner version of Restylane (Restylane Fine Line) is not yet approved in the US, nor is the thicker version called Perlane.
