A woman in her middle 60’s who is bothered by an aged appearance, but is on a blood thinner, Eliquis. After discussions, she elected to try nonsurgical facial improvement by replacing some of the age-related volume loss with Resilient Hyaluronic fillers, or RHA. These are one line of Non-Animal Stabilized Hyaluronic Acid fillers distributed in the US by Revance. Other NASHA lines include the Restylane line by Galderma and the Juvederm line by Allergan. The NASHA fillers have the benefit of being reversible with the ability to dissolve them with an enzyme, hyaluronidase. The RHA line has the added benefit of being especially flexible and resilient, which is a benefit in parts of the face that move.
In her case, I placed one syringe of Redensity (which would be RHA 1) in the “tear trough” area, where it is frequently used off-label in Europe. I then placed 2 syringes of RHA 4 (firmer but flexible) in the cheeks, and 1 syringe of RHA 2 (firmer than 1, softer than 4 but still flexible ) in the upper nasolabial creases.
She did not have much problem with bruising despite being on Eliquis and returned for Daxxify, a long-acting neurotoxin for frown lines and crow feet lines, where I have found that it excels in both strength of effect and duration over the short-acting neurotoxins on the market.
The overall effect of these two treatments is dramatic and does not require surgery.