Combination Fillers

Restylane, Perlane, CosmoPlast, JUVÉDERM, Radiesse

"The Coverman Lip"

NATURE OF THE PROCEDURE

There are many new exciting "fillers" to augment aging, wrinkled scarred and sagging skin. Depending upon your medical history, needs, and previous experiences, some of these may be better than others. Even more exciting is combination therapy! Using hyaluronic acid (Restylane, Perlane or JUVÉDERM) Dr. Coverman can inject the base of your wrinkles and give fullness and support. He can then inject CosmoPlast (human based collagen) or Zyderm (animal based collagen) in a thin layer over that. With this innovate layering technique a more full complete and targeted correction can be performed. In addition, having two different substances layered over each other may even be synergistic - the result will last longer and be more pleasing than either one alone.

"The Coverman Lip" - Dr. Coverman is widely known in Austin for his techniques in lip enhancement. He has been among the first to use many of these fillers, and during this time has made lip augmentation his signature procedure.

All of these fillers are basically the same - they create fullness or correct tissue defects (scars or wrinkles) by elevating them. Restylane, JUVÉDERM, Perlane, and Hylaform use hyaluronic acid. CosmoPlast uses human collagen. These are substances already in your body. Zyderm (the "gold standard" - in use for over 25 years) uses animal collagen.

Radiesse® is one of the newest semi-permanent fillers. It is made from calcium hydroxylapatite in an aqueous gel carrier. This material has also been used in vocal cord repair and bladder repair. It forms a substance like bone and generally lasts 12-18 months. As with any injected material there is a rare chance of allergy, but no test dose is necessary since this is a very natural like substance.

The technique is a bit different - this product is injected deeper underneath the dermis to "lift" and give support to the skin. It is thus excellent for correcting wrinkles especially at marionette lines and the nasolabial folds. It can add volume to hollows in the cheeks and other similar areas. It will slowly dissipate, and at some point after a 12-18 month period, repeat treatments will be necessary at additional charge.

Anybody can buy and inject these. INSIST on someone with experience! The best, most natural, most long-lasting correction is highly technique-dependent. Go to someone (to quote Darryl Royal) "who's been there before."

FEES

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, 1 cc treats one "area" such as the upper lip and lower lips. The nasolabial folds (Marionette lines) are a second area.

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.

SCHEDULING

Because CosmoPlast (human collagen) and Restylane, JUVÉDERM or Perlane (hyaluronic acid) are naturally found in the body, no test dose is necessary. After your consultation, you may have your treatment at any time.

Dr. Coverman or Jennifer Jordan must see all new patients prior to the first treatment session. At this time they will discuss your overall cosmetic concerns and develop a skin treatment program just for you. They will discuss the current filling materials that they recommend such as Restylane, Perlane, JUVÉDERM, Hylaform, or CosmoDerm. They will also discuss other alternatives including the use of topical products, Botox® Cosmetic, ablative and non-ablative lasers, microdermabrasion, and other techniques that might be appropriate for your care. 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%. Please ask us which products we recommend. Many over-the-counter products such as Ela-Max are not strong enough.

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

TREATMENT DAY

All fillers are injected using a very narrow gauge skinny needle. We 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 most discomfort is over 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.

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 is immediate and visible.

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.

REPEAT TREATMENTS

Neither Dr. Coverman nor his staff can promise or guarantee how much percentage of improvement there will be per area, per session or after all sessions. Despite meticulous injection technique, everyone's body is different. This may involve issues of habitual facial expression, sleeplines, smoking, and even the body's metabolism of the product. In general, the Collagen and Cosmoplast type of products tends to last three to four months, and the literature suggests that Restylane will last four to six months. Juvederm and Perlane may last six months or longer. Radiesse may last 12 months. Dr. Coverman does not recommend any filler that lasts longer than this for the reasons stated above. If you want that - you will have to go elsewhere. There is plenty of literature available on-line (inamed.com, medicis.com, allergan.com) There are various chat rooms and other such discussion sites available, and you are encouraged to read this commonly available literature regarding how long these products typically may last.

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 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. 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 was "beading?" You are stuck with it. As you age, your skin will thin, and these "permanent" products may show. Remember... "permanent fillers can cause permanent problems."

All of these other procedures sound very appealing and "permanent." That is there appeal - and that is their downfall. 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 the result?
What is the experience of the person injecting this material?

The use of many of these materials are highly "technique" dependent. Dr. Coverman was the first (1981) and is among the leading users of filling substances in Austin. 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.

Top