At long last, the FDA finally approved Perlane last month. (Actually it should have been approved years ago.) Its introduction into the filler market is significant for a variety of reasons, and it behooves injectors to become familiar with it.
Differs from Restylane Only in Particle Size
The reason the product should have been approved years ago is that it is basically identical to Restylane. Actually, it is chemically and structurally identical in every way, except the size of the particle.
To help imagine the difference, picture a cube of Jell-O pushed through a screen with small holes. All of the Jell-O is made from the exact same ingredient, and it all has the same exact concentration (20 mg/ml of hyaluronic acid). Now, picture the Jell-O going at high velocity through a screen door. (For those of you who don’t know my son Michael, it might be harder to imagine.) When the screen door has small holes, such as the screen in the back of my house, what comes out is Restylane. When the screen has larger holes, what comes out is Perlane. When the screen has even larger holes, one gets Restylane SubQ, and so on.
There are approximately 100,000 particles of Restylane in one milliliter of material, while there are only 10,000 particles of Perlane in one milliliter. There are 500,000 particles of Restylane Touch in 1 ml of this product.
The salient point is that no matter how the product is cut up, it is still the same product. In Europe, this is actually recognized, and all three products have the same CE number.
Designed for Injection into the Deep Dermal Plane
As with any filler, optimal correction depends on the product, the technique and the patient selection. When using Perlane, it is important to realize that the product is designed to be injected into the deep dermal plane. Thus, one would not want to use it for etching out fine superficial lines because injections placed superficially may result in the appearance of blue blebs and/or bumps on the surface of the skin. One would also want to think twice before using it in people who have thin skin with little subcutaneous tissue.
Using an Anesthetic
Because the molecule is thick, injection can be uncomfortable. For that reason anesthetic should nearly always be used. You can use a topical anesthetic in some patients, but I prefer injectable lidocaine with most of my patients because I am typically injecting large volumes (usually 2 ml or more), and I like them to be comfortable.
Longevity of Results
The longevity of the effects can vary from one site to the other due both to the amount of product injected and amount of motion that occurs in the site. In some areas, we can inject large enough quantities that we build a depot of product. In others, such as the nasolabial creases, there is constant muscle movement that pushes the product and disperses it. When we inject a filler in an area such as the tear trough with no motion, it stays for a longer time than it will in an area that is moving.
Technical Suggestions for Specific Applications
For Nasolabial Creases
Nasolabial injections can be among the most gratifying, because they provide excellent and relatively long-lasting, correction with durations of between 6 and 9 months.
When injecting into the nasolabial creases, either topical anesthetic or infraorbital nerve blocks are recommended for reasons explained earlier.
As injections proceed along the nasolabial crease, one should palpate the crease to insure that placement is in the area desired. Some injections with needles placed in the correct location can result in extravasation laterally, usually due to the pumping actions of muscles.
For Lip Augmentation
You can inject into the lips for lip augmentation. Lip augmentation with Perlane has both risks and benefits not seen with other hyalurons. The benefits include a long-lasting correction that can last up to 1 year. The risks include formation of blue blebs and bumps that may need to be digested or expressed; and, given the increased particle size, these may occur slightly more frequently than with Restylane.
Techniques are similar to those used for Restylane and other hyaluronic acids. A linear threading technique may be utilized to define the border of the lip, while injections into the body of the lip are used to provide volume.
When injecting the lips, it is important to inject the lateral border and make certain that the corners of the lip are buttressed. In some patients this may require injections into the marionette lines as well.
For Marionette Lines
Buttressing the marionette lines with Perlane is relatively easy to accomplish for moderate rhytids.
As with injections in this area with other products, it is worthwhile to grasp the crease between one’s thumb and forefinger and guide the Perlane into the plane where you want it to go. Injecting a small amount into the angle of the mouth on the inferior aspect and into the lateral aspect of the lower lip will help to achieve a more youthful appearance for this cosmetic unit.
Growing Universe of Choices
As the universe of soft tissue augmentation products continues to increase, the question of what product to utilize in your cosmetic practice becomes moot. The correct answer is that most of the FDA-approved products have unique niches in which they excel, and as each injector becomes experienced with the various products, he or she will develop a comfort level with each.
Perlane is technically similar to Restylane but it should be utilized for deeper tissue injections and is better at adding “structure.” I recommend that it be used by injectors experienced with Restylane and that it be combined with Restylane for patients who require correction of lines and the addition of structure due to lost tissue.
At long last, the FDA finally approved Perlane last month. (Actually it should have been approved years ago.) Its introduction into the filler market is significant for a variety of reasons, and it behooves injectors to become familiar with it.
Differs from Restylane Only in Particle Size
The reason the product should have been approved years ago is that it is basically identical to Restylane. Actually, it is chemically and structurally identical in every way, except the size of the particle.
To help imagine the difference, picture a cube of Jell-O pushed through a screen with small holes. All of the Jell-O is made from the exact same ingredient, and it all has the same exact concentration (20 mg/ml of hyaluronic acid). Now, picture the Jell-O going at high velocity through a screen door. (For those of you who don’t know my son Michael, it might be harder to imagine.) When the screen door has small holes, such as the screen in the back of my house, what comes out is Restylane. When the screen has larger holes, what comes out is Perlane. When the screen has even larger holes, one gets Restylane SubQ, and so on.
There are approximately 100,000 particles of Restylane in one milliliter of material, while there are only 10,000 particles of Perlane in one milliliter. There are 500,000 particles of Restylane Touch in 1 ml of this product.
The salient point is that no matter how the product is cut up, it is still the same product. In Europe, this is actually recognized, and all three products have the same CE number.
Designed for Injection into the Deep Dermal Plane
As with any filler, optimal correction depends on the product, the technique and the patient selection. When using Perlane, it is important to realize that the product is designed to be injected into the deep dermal plane. Thus, one would not want to use it for etching out fine superficial lines because injections placed superficially may result in the appearance of blue blebs and/or bumps on the surface of the skin. One would also want to think twice before using it in people who have thin skin with little subcutaneous tissue.
Using an Anesthetic
Because the molecule is thick, injection can be uncomfortable. For that reason anesthetic should nearly always be used. You can use a topical anesthetic in some patients, but I prefer injectable lidocaine with most of my patients because I am typically injecting large volumes (usually 2 ml or more), and I like them to be comfortable.
Longevity of Results
The longevity of the effects can vary from one site to the other due both to the amount of product injected and amount of motion that occurs in the site. In some areas, we can inject large enough quantities that we build a depot of product. In others, such as the nasolabial creases, there is constant muscle movement that pushes the product and disperses it. When we inject a filler in an area such as the tear trough with no motion, it stays for a longer time than it will in an area that is moving.
Technical Suggestions for Specific Applications
For Nasolabial Creases
Nasolabial injections can be among the most gratifying, because they provide excellent and relatively long-lasting, correction with durations of between 6 and 9 months.
When injecting into the nasolabial creases, either topical anesthetic or infraorbital nerve blocks are recommended for reasons explained earlier.
As injections proceed along the nasolabial crease, one should palpate the crease to insure that placement is in the area desired. Some injections with needles placed in the correct location can result in extravasation laterally, usually due to the pumping actions of muscles.
For Lip Augmentation
You can inject into the lips for lip augmentation. Lip augmentation with Perlane has both risks and benefits not seen with other hyalurons. The benefits include a long-lasting correction that can last up to 1 year. The risks include formation of blue blebs and bumps that may need to be digested or expressed; and, given the increased particle size, these may occur slightly more frequently than with Restylane.
Techniques are similar to those used for Restylane and other hyaluronic acids. A linear threading technique may be utilized to define the border of the lip, while injections into the body of the lip are used to provide volume.
When injecting the lips, it is important to inject the lateral border and make certain that the corners of the lip are buttressed. In some patients this may require injections into the marionette lines as well.
For Marionette Lines
Buttressing the marionette lines with Perlane is relatively easy to accomplish for moderate rhytids.
As with injections in this area with other products, it is worthwhile to grasp the crease between one’s thumb and forefinger and guide the Perlane into the plane where you want it to go. Injecting a small amount into the angle of the mouth on the inferior aspect and into the lateral aspect of the lower lip will help to achieve a more youthful appearance for this cosmetic unit.
Growing Universe of Choices
As the universe of soft tissue augmentation products continues to increase, the question of what product to utilize in your cosmetic practice becomes moot. The correct answer is that most of the FDA-approved products have unique niches in which they excel, and as each injector becomes experienced with the various products, he or she will develop a comfort level with each.
Perlane is technically similar to Restylane but it should be utilized for deeper tissue injections and is better at adding “structure.” I recommend that it be used by injectors experienced with Restylane and that it be combined with Restylane for patients who require correction of lines and the addition of structure due to lost tissue.
At long last, the FDA finally approved Perlane last month. (Actually it should have been approved years ago.) Its introduction into the filler market is significant for a variety of reasons, and it behooves injectors to become familiar with it.
Differs from Restylane Only in Particle Size
The reason the product should have been approved years ago is that it is basically identical to Restylane. Actually, it is chemically and structurally identical in every way, except the size of the particle.
To help imagine the difference, picture a cube of Jell-O pushed through a screen with small holes. All of the Jell-O is made from the exact same ingredient, and it all has the same exact concentration (20 mg/ml of hyaluronic acid). Now, picture the Jell-O going at high velocity through a screen door. (For those of you who don’t know my son Michael, it might be harder to imagine.) When the screen door has small holes, such as the screen in the back of my house, what comes out is Restylane. When the screen has larger holes, what comes out is Perlane. When the screen has even larger holes, one gets Restylane SubQ, and so on.
There are approximately 100,000 particles of Restylane in one milliliter of material, while there are only 10,000 particles of Perlane in one milliliter. There are 500,000 particles of Restylane Touch in 1 ml of this product.
The salient point is that no matter how the product is cut up, it is still the same product. In Europe, this is actually recognized, and all three products have the same CE number.
Designed for Injection into the Deep Dermal Plane
As with any filler, optimal correction depends on the product, the technique and the patient selection. When using Perlane, it is important to realize that the product is designed to be injected into the deep dermal plane. Thus, one would not want to use it for etching out fine superficial lines because injections placed superficially may result in the appearance of blue blebs and/or bumps on the surface of the skin. One would also want to think twice before using it in people who have thin skin with little subcutaneous tissue.
Using an Anesthetic
Because the molecule is thick, injection can be uncomfortable. For that reason anesthetic should nearly always be used. You can use a topical anesthetic in some patients, but I prefer injectable lidocaine with most of my patients because I am typically injecting large volumes (usually 2 ml or more), and I like them to be comfortable.
Longevity of Results
The longevity of the effects can vary from one site to the other due both to the amount of product injected and amount of motion that occurs in the site. In some areas, we can inject large enough quantities that we build a depot of product. In others, such as the nasolabial creases, there is constant muscle movement that pushes the product and disperses it. When we inject a filler in an area such as the tear trough with no motion, it stays for a longer time than it will in an area that is moving.
Technical Suggestions for Specific Applications
For Nasolabial Creases
Nasolabial injections can be among the most gratifying, because they provide excellent and relatively long-lasting, correction with durations of between 6 and 9 months.
When injecting into the nasolabial creases, either topical anesthetic or infraorbital nerve blocks are recommended for reasons explained earlier.
As injections proceed along the nasolabial crease, one should palpate the crease to insure that placement is in the area desired. Some injections with needles placed in the correct location can result in extravasation laterally, usually due to the pumping actions of muscles.
For Lip Augmentation
You can inject into the lips for lip augmentation. Lip augmentation with Perlane has both risks and benefits not seen with other hyalurons. The benefits include a long-lasting correction that can last up to 1 year. The risks include formation of blue blebs and bumps that may need to be digested or expressed; and, given the increased particle size, these may occur slightly more frequently than with Restylane.
Techniques are similar to those used for Restylane and other hyaluronic acids. A linear threading technique may be utilized to define the border of the lip, while injections into the body of the lip are used to provide volume.
When injecting the lips, it is important to inject the lateral border and make certain that the corners of the lip are buttressed. In some patients this may require injections into the marionette lines as well.
For Marionette Lines
Buttressing the marionette lines with Perlane is relatively easy to accomplish for moderate rhytids.
As with injections in this area with other products, it is worthwhile to grasp the crease between one’s thumb and forefinger and guide the Perlane into the plane where you want it to go. Injecting a small amount into the angle of the mouth on the inferior aspect and into the lateral aspect of the lower lip will help to achieve a more youthful appearance for this cosmetic unit.
Growing Universe of Choices
As the universe of soft tissue augmentation products continues to increase, the question of what product to utilize in your cosmetic practice becomes moot. The correct answer is that most of the FDA-approved products have unique niches in which they excel, and as each injector becomes experienced with the various products, he or she will develop a comfort level with each.
Perlane is technically similar to Restylane but it should be utilized for deeper tissue injections and is better at adding “structure.” I recommend that it be used by injectors experienced with Restylane and that it be combined with Restylane for patients who require correction of lines and the addition of structure due to lost tissue.
