Restylane

RESTYLANE/PERLANE/HYLAFORM

NATURE OF THE PROCEDURE

Hyaluronic acid is a natural substance found in all living organisms. In humans, it is used to provide volume and fullness to the skin. It is one of the support structures of the skin. In Restylane, this type of hyaluronic acid is called NASHA (a patented non-animal stabilized hyaluronic acid in a clear gel). This product is biosynthetically produced, and it is not from any human or animal source. It is produced in the laboratory by a natural fermentation process.

Unlike Collagen, or other human or animal-based fillers, this product is 100% biodegradable, and ultimately does completely disappear from the body. The CORRECTION induced by the product however can last up to six to nine months.

Restylane, Perlane and Hylaform are fully FDA approved for the treatment of moderate to severe facial wrinkles and folds such as the nasolabial folds. Restylane has been used safely in over 60 countries prior to introduction in the United States, and it has been in widespread use by dermatologists since 1996.

All the filling products come prepackaged in a sterilized, disposable, one-use only syringe and needle.

DR. COVERMAN’S BACKGROUND

Dr. Coverman trained at the University of Washington, one of the top 10 hospital programs in the United States. He is Board Certified in Internal Medicine and Dermatology.

Dr. Coverman has been recognized by the Austin Business Journal as Austin’s Top Cosmetic Surgeon. He has trained many other local physicians including family practice doctors on how to perform sclerotherapy, Collagen injections, Botox treatments, and laser therapy. Dr. Coverman has served as laser instructor for Medical Alliance, and has taught plastic surgeons and dermatologists how to perform laser surgery on the skin.

In 1981, Dr. Coverman opened the first physician-supervised skin care clinic and spa in Austin, and in 1983, he was the first doctor in Austin to begin using lasers for the skin. Since then, he has usually been the first doctor in Austin to offer new procedures, new lasers, and new cosmetic therapies.

In 1981, Dr. Coverman became the first doctor in Austin to use Zyderm Collagen for treating wrinkles and scars on the skin. At that time, the original Collagen Corporation had asked him to participate in some of the final studies prior to the general release of Collagen for other physicians. Since then, he has remained the #1 user of Collagen for the treatment of wrinkles in Austin.

In 2003, Dr. Coverman was again chosen by Inamed, the producers of Collagen, to be the first doctor in Austin to use CosmoDerm and CosmoPlast injectable filler. He is the #1 user of these products in Austin.

In 2004, once again, Dr. Coverman was chosen by Medicis, the distributors of Restylane, to be the first doctor in Austin to use this exciting new injectable filler when it became FDA approved. Dr. Coverman is now an instructor for Medicis and will be training other Dermatologists and Plastic Surgeons how to use Restylane.

FEES

1st syringe (.7 cc) $500
2nd syringe (.7 cc) $450

All fees are subject to change. The fee is always what is current at the time of your actual treatment. Old fee schedules, handouts, or web site fees do not apply. Any quoted fees must be in writing and are only good for six months. No “verbal” quotes are accepted.

In general, one syringe treats one “area” such as the upper lip. The nasolabial folds (Marionette lines) are a second area. The lower lip is a third.

Sometimes there may be enough left from any given area to inject and “perk up” the corners of your mouth (commissures) at no additional charge. Dr. Coverman always recommends this.

We do not treat between the eyebrows (glabella). Use Botox or Collagen for that.

SCHEDULING

Because this is a biosynthetic product not from human or animal origin, no test dose is necessary. After your consultation, you may have treatment at any time.

Dr. Coverman must see all new patients prior to the first treatment session. At this time he will discuss your overall cosmetic concerns and develop a skin treatment program just for you. He will discuss all the current filling materials that he recommends such as Restylane, Perlane, Hylaform, Collagen, and CosmoDerm. He will also discuss other alternatives including the use of topical products, Botox, ablative and non-ablative lasers, microdermabrasions, and other techniques that might be appropriate for your care. He will also discuss specific procedures that he thinks are not a good idea. There is a fee for this visit.

Because there is a needlestick and the remote chance of bruising, do not schedule your treatment immediately before any big social event. If you have a big party on the weekend, try to schedule your actual treatment early in the week. Otherwise, your injections may be performed at any time, and you may immediately return to all normal activities.

There is a $150 non-refundable fee for missed appointments without a 24 hour notice.

PRETREATMENT

If you are taking aspirin in any form, non-steroidal anti-inflammatory drugs (NSAIDs such as Advil, Motrin, Aleve, and so forth), St. John’s Wort, or high dose Vitamin E - please stop these one week prior to your treatment session. These can cause increase bleeding tendencies and increased bruising. You may resume immediately after your treatment.

If you have ever had herpes or think you may have (cold sores or fever blisters), inform Dr. Coverman or our staff prior to scheduling your appointment. We will give you a series of anti-herpes pills to take the day before the treatment, the day of, and the day after. This should help to suppress or prevent herpes from flaring, but there are no guarantees. A herpes flare could cause pain, pigment, infection, and scarring.

Dr. Coverman strongly recommends that a numbing cream be applied one hour prior to the treatment. Although this won’t block all discomfort, often it can improve this by at least 50%. You may purchase some of these over the counter (Ela-Max) but we recommend Betacaine LA. This is a patented product that is compounded by Medical Center Pharmacy in Tampa, Florida. We have tried almost all other similar products on the market, and this is by far the best. By law, this must be dispensed directly to the patient, and this will be shipped promptly directly to your home. For your convenience, we will fax the prescription for you. We will need your credit card information in order to do this but we immediately SHRED that information and do not save it anywhere.

In addition, we have now discovered an equally good numbing product that you may purchase here at the office called Triple Anesthetic Gel.

If you find that it is too painful to have your upper lip injected, Dr. Coverman can do a nerve block at no additional charge that will make the entire upper lip numb for a few hours.

SAVE the numbing cream! It can be used again for this treatment, other treatments like it, or for waxing, hair removal, even insect stings and sunburns. You will always find a use for this cream. Never put it on a fresh burn, infected skin, inflamed skin, or ANY weeping, open, or oozing skin. Never apply to any undiagnosed rash. For any questions, always ask Dr. Coverman.

TREATMENT DAY

Restylane/Perlane/Hylaform is injected personally by Dr. Coverman using a very narrow gauge skinny needle. He does not use nurses, assistants or PA’s. He will ask you to point out the sites that you would like treated, and the procedure only takes minutes. Even with the numbing cream there will be a brief pinprick needlestick. The discomfort is over virtually immediately upon completion of the procedure.

Women may apply make-up and go back to normal activities. There is a chance of pinpoint bruising, and there is the possibility of some minimal swelling as the material is injected. Since some of this is water for dilution, the “swelling” often goes down immediately. You may resume all normal activities.

POST TREATMENT

No special instructions. Do not sunburn. In general, always avoid smoking. Avoid pursing your lips on straws or water bottles.

COMPLICATIONS

There is of course a needlestick, and because of that there can be pinpoint bruising. Usually, this clears within a few days and can normally be covered by make-up. There is some immediate overcorrection which may be visible to others, but this goes down quickly. The correction with Restylane is immediate and you may resume all normal activities. Dr. Coverman will discuss these and other potential complications with you at your office visit.

It is theoretically possible to be allergic to ANY product injected into your skin. Although extremely rare, there is the remote possibility of hypersensitivity which would present as swelling, redness, tenderness or hardness. This should fade.

Another remote complication could be the inadvertent injection into a dermal blood vessel that was unusually superficial in your skin. If this vessel were to be blocked, there could be a superficial sore, ulcer, or area of necrosis (tissue death). If so, it would generally be relatively small, but a scar could form.

FOLLOW-UP

There is no special follow-up. You do not need to come back to be rechecked unless you perceive any complication. Please schedule your normal injection visits well in advance so that you can get the appointment time that you wish.

OTHER FILLING SUBSTANCES

You will be hearing about other new filling substances in the print, TV or Internet media. BE VERY CAREFUL! Some of these products such as Radiance (Bioform) or Silicone are not yet FDA-approved for wrinkles. They may be FDA-approved for other uses, but be very careful when you read the “pitch” or other advertising by physicians using these products. If they are “FDA-approved” make sure they are FDA-approved for what your treatment is to be. Some of these may be used for vocal cord repair, urinary incontinence or filling tissue defects from AIDS, but that is not the same as treating wrinkles. Please remember, “the worst thing about Collagen is that it doesn’t last forever; the best thing about Collagen is that it doesn’t last forever.” You really don’t want something that “lasts forever” or is “permanent.” What if the injection is asymmetric? What if we hit an inapparent subcutaneous “pocket” that left a visible lump?” What if there were “beading?” You are stuck with it. As you age, your skin will thin, and these “permanent” products may show.

Radiance (Bioform) is currently used for stress urinary incompetence. The product is calcium hydroxylapatite microspheres in a gel carrier. It basically creates bone. I am not sure putting bone in your lips or directly under your skin is a good idea. What happens when you get older and your skin naturally loses some subcutaneous fat and support? Will this material be visible or shift? What if you don’t like where it was placed?

The same applies to liquid silicone and Artecoll. All of these procedures with small microspheres and plastic particles sound very appealing and “permanent.” That is there appeal - and that is their downfall. When and if these products become FDA-approved FOR WRINKLES, then Dr. Coverman will be among the first to use them, and will use them as aggressively as he currently uses CosmoPlast/CosmoDerm, Zyderm Collagen, and Restylane.

Although some of these products don’t require a test dose, although they may be widely promoted, although you may see glowing magazine reports about them, always ask the following questions:

• Is the product FDA approved?
• Is this product FDA approved for the purpose that I am using it for?
• How long has it been out and what is its track record?
• Is it too permanent? What if I don’t like what I see?
• What is the experience of the person injecting this material?

The use of many of these materials are highly “technique” dependent. Dr. Coverman is the leading user of filling substances in Austin. He has had more experience in using injectable filling substances than any one in Austin, beginning in 1981 with his first use of injectable Zyderm Collagen. You should always trust experience, technique, and history of knowing what is best and what might not be best despite media hype. When Dr. Coverman feels it is safe for you to use the products, he will offer them.

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