Permanent appointment is our review series that examines the best new and notable cosmetic procedures in the field of aesthetics and determines if they are worth trying for yourself. This week our writer tried out the new RHA fillers.
Whether you’re a cosmetic treatment fanatic or a measured skeptic, interest in cosmetic enhancements shows no signs of abating. The number of non-surgical procedures performed in 2021 increased by 44% according to The Aesthetic Society’s Aesthetic Plastic Surgery Statistical Report. Dermal fillers came in as the second most searched non-surgical procedure with a total of over 1.8 million treatments. Given this steady increase in demand, it makes sense that the industry disruptive newcomer to the US filler market, RHA® Collection, is quickly becoming a favorite with physicians.
Since arriving in the United States in 2020, RHA (Resilient Hyaluronic Acid) remains the only FDA approved hyaluronic acid filler for dynamic wrinkles and folds. “A dynamic crease is when you move your face. We have a static expression when your face isn’t moving, but we’re not supermodels,” says Kaetlyn Boone, senior communications and public relations manager for the aesthetics at biotech company and distributor RHA Revance.Dynamic wrinkles are often the first signs of aging but, until now, most fillers were not suited to treat them as they were designed to increase volume deeper, still facial folds.
RHA’s exclusivity also makes it a benchmark in the industry. Where fashionable treatments tend to fall into the greedy hands of less experienced providers, RHA is available to a select number of practices. This means that only highly trained injectors will administer the innovative product. “The practice must be owned and medically directed by a board-certified plastic surgeon, cosmetic surgeon, dermatologist, or oculoplastic surgeon,” Boone says. “They must also agree not to promote coupons, lead with a sales or discount pricing strategy.”
As RHA continues to build a fan base among professionals and patients, I spoke with experts about what makes this filler different and what to expect when you receive it. In the name of science, I also received the treatment myself.
How is RHA Filler different?
Traditional hyaluronic acid fillers are made durable for injection by adding more cross-links between molecules. It helps to create a more durable but less flexible load. “If you have a thicker, [harder] filler, you want to put it on top of the bone and in areas that aren’t moving,” says Dr. Jessie Cheung, board-certified dermatologist and owner of Cheung Aesthetics & Wellness. RHA® is made to better mimic the skin’s natural hyaluronic acid, allowing it to lie flatter, follow facial movements and have greater treatment versatility. “The overall production of [RHA] goes through a somewhat more natural and gradual process. It’s called a preserved network technology,” says board-certified plastic surgeon Dr. Sachin Shridharani. “This preserved grating technology allows for more realistic composition.”
The enhanced mimicry of natural hyaluronic acid triggers less inflammation when injected, helping to extend the life of the RHA for up to 15 months. The average lifespan of hyaluronic acid fillers is six to 12 months.
What does RHA improve cosmetically?
Conforming uses of RHA include dynamic lines and wrinkles on the lower half of the face, such as nasolabial folds and smoker’s lines around the mouth. However, doctors can use filler in several “off-label” areas, including the lips.
There are currently four RHA formulas available, RHA 2, 3, 4 and Redensity, which vary in the best use case. Redensity is the newest addition to the collection and the lightest of all the formulas. It is intended to treat the most delicate superficial wrinkles, in particular the “kiss lines” around the mouth, without adding volume.
Comparatively, RHA 2, 3 and 4 are all approved for the treatment of dynamic wrinkles in the lower half of the face and differ mainly in the amount of volume they add. RHA 2 is ideal for moderate wrinkles while RHA 3 and 4 tackle more severe cases. “Think about [RHA 4] like something that’s going to fake some sort of higher cheekbones or create more structure and strength in the face,” says Dr. Shridharani. “RHA 3, for me, is my flagship product. I use it all over my face.
During my consultation, Dr. Cheung selected RHA 4 to accentuate my cheekbones and create symmetry in my jawline. She explained that while this formula is often used for severe volume loss, it is also helpful and looks natural for younger patients with intact structure looking to enhance natural contours.
What to expect on RHA Filler treatment day
The dermal filler’s reputation for being a low lift treatment holds true with RHA because there isn’t much pre-treatment preparation needed. However, Dr. Cheung advises against drinking alcohol, taking aspirin, eating ginger, or other items that may increase bruising within 24 hours of your appointment.
You can expect to first discuss your treatment goals with your provider who will determine where and how much filler you need to achieve your desired appearance. This was my first time considering a filler, so Dr. Cheung prompted me to lead the conversation on my beauty issues (under tired eyes), why I have a “good” side, and my unconscious habits like sleeping on one side of my face. She finally suggested filling in my cheekbones to soften the hollow under the eyes and my jawline to make both sides of my face the selfie side.
Once you’ve agreed on a plan, your provider will mark the treatment areas with a skin-safe tool and apply topical numbing cream. You may also be asked to apply ice to the area while the cream is working. Like many fillers, the RHA is formulated with lidocaine to reduce discomfort during injection. Dr. Cheung also used spot injections of lidocaine to further decrease sensation.
While I could feel some pinching, the most discomfort came from the pressure of the injected gel. Also, it’s just felt psychologically weird. Dr. Cheung used distraction methods and small talk to comfort me with many pauses in between. The treatment lasted no more than 45 minutes and I was out with a follow-up appointment scheduled for a month later.
Post-treatment care for RHA Filler
Expect immediate swelling that usually peaks between 48 and 72 hours after. Dr. Cheung sent me home with reusable ice packs and greenlighted the use of over-the-counter pain relievers as needed.
“I say [patients] to have a few days of social holidays and to avoid exercise and salty foods for at least 24 to 48 hours so that they don’t bloat further,” Dr. Shridharani adds. I had moderate soreness and puffiness the first week which quickly resolved with ibuprofen and a strict icing schedule.
Although the injection area may look weird for the first few days, be patient. Unevenness and bumps immediately after a treatment are completely normal. It can take up to two weeks for the swelling to completely go away and for the filler to fully integrate into the tissue to see those natural-looking end results. Don’t be afraid to call your supplier with questions or concerns. Admittedly, I was prematurely worried about the swelling and was happy to have Dr. Cheung’s attentive team on hand to reassure me.
Your follow-up appointment will likely be 2-4 weeks after the initial treatment, where your provider can then accurately increase the volume or make any necessary adjustments.
How much do RHA fillers cost?
RHA, like most fillers, is sold by syringe. The cost depends on where you live and whether or not you are injected by a doctor or other qualified injector. Dr. Cheung, located in Chicago, charges $850 per syringe.
The amount of filler you need will also affect the cost. “It depends on your age and how much volume you really need,” says Dr. Cheung. “Two to three syringes is a good starting point. Five is probably my average for my patients. Dr. Cheung adds that she usually uses between half and a full syringe on the lips. To get my results, she used four syringes in total – one in each treatment area.
Who is a good candidate for RHA Filler?
The question of who is really the ideal candidate for filling remains controversial. RHA is FDA-approved for patients 22 and older, but many still consider the filler to be reserved for a certain older demographic. “Thinking about age correlating to aesthetics is a bit of a difficult discussion,” says Dr. Shridharani. “It’s important not to rush to make fillers on teenagers for example. It might be a slippery slope, but for sure people in their twenties may be volume deficient or want a corrective lip filler.
Filler has both aesthetic and medical applications with the ability to fade the signs of aging, dramatize features or correct scars. “Hyaluronic acid also has benefits for the skin other than filling,” says Dr. Cheung. “It helps stimulate the production of collagen and even some fats, so there’s a net benefit.” Ultimately, RHA®’s claim to more natural results makes it an accessible option for younger patients and beginners.
At first, I was hesitant to take the treatment as a youngster. Does that mean I don’t love myself? Would I end up looking “fake”? Although cosmetic modification is never necessary, receiving this treatment has helped me dismantle the internalized stigma that I unknowingly held. Not only do I love my results, but I now have a greater appreciation for the freedom to make informed choices about my body and appearance on my own terms.