Standing Appointment is our review series that investigates the best new and notable cosmetic procedures in the aesthetics space and determines whether or not they are worth trying for yourself. This week, our writer tried the new RHA fillers.
Whether you’re a cosmetic treatment fanatic or a measured skeptic, interest in aesthetic enhancements show no signs of slowing down. The number of non-surgical procedures performed in 2021 increased by 44% according to The Aesthetic Society’s aesthetic plastic surgery statistics report. Dermal fillers came in as the second most sought out non-surgical procedure with a treatment total of more than 1.8 million. Considering this steady uptick in demand, it makes sense that the industry-disrupting newcomer to the U.S. filler market, RHA® Collection, is quickly becoming a physician favorite.
Since it’s U.S. arrival in 2020, RHA (resilient hyaluronic acid) remains the only FDA-approved hyaluronic acid filler for dynamic wrinkles and folds. “A dynamic fold is when you’re moving your face. We have a static expression when you’re face is not moving, but we aren’t mannequins,” explains Kaetlyn Boone, senior manager of communications and public relations for aesthetics at the biotechnology company and RHA distributor Revance. Dynamic wrinkles are often the first signs of aging but, until now, most fillers were unsuitable to address them as they were designed to boost volume for deeper, unmoving facial folds.
RHA’s exclusivity also makes it an industry standout. Where trending treatments have a penchant for falling into the eager hands of less-experienced providers, RHA is available to a selective number of practices. This means only highly qualified injectors will ever administer the innovative product. “The practice must be owned and medically directed by a board-certified plastic surgeon, cosmetic surgeon, dermatologist, or an oculoplastic surgeon,” Boone says. “They also must agree not to promote couponing, lead with a discounted selling or pricing strategy.”
As RHA continues to gather fans amongst professionals and patients alike, I spoke with experts on 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 the molecules. This helps create a longer-lasting yet less flexible filler. “If you have a thicker, [harder] filler, you want to put it on top of the bone and in areas that don't move,” says Dr. Jessie Cheung, board-certified dermatologist and owner of Cheung Aesthetics & Wellness. RHA® is manufactured to better mimic the natural hyaluronic acid in the skin allowing it to lay flatter, contour to facial movement, and have more treatment versatility. “The overall production of [RHA] is through a slightly more natural and gradual process. It's called a preserved network technology,” says board-certified plastic surgeon Dr. Sachin Shridharani. “This preserved network technology allows for a more realistic composition.”
The improved mimicry of natural hyaluronic acid triggers less inflammation when injected, helping to extend the life of RHA up to 15 months. The average lifespan of hyaluronic acid fillers is six to 12 months.
What Does RHA Cosmetically Enhance?
On-label uses for 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, physicians can use filler in multiple “off-label” areas including the lips.
There are currently four available RHA formulas, RHA 2, 3, 4, and Redensity, that vary in best use-case scenario. Redensity is the newest addition to the collection and the most lightweight of all the formulas. It’s meant to treat the most delicate, superficial wrinkles — particularly the “kissing lines” around the mouth — without adding bulk.
Comparatively, RHA 2, 3 and 4 are all approved for treating dynamic wrinkles on the lower half of the face and differ primarily in the amount of volume they add. RHA 2 is ideal for moderate wrinkles while RHA 3 and 4 tackle more severe cases. “Think of [RHA 4] as something that's going to simulate kind of higher cheekbones or create more structure and strength in the face,” says Dr. Shridharani. “RHA 3, for me, is my workhorse product. I use it all over the face.”
During my consultation, Dr. Cheung selected RHA 4 to accentuate my cheekbones and create symmetry in my jawline. She explained that although this formula is often used for significant volume loss, it is similarly useful and still natural-looking in younger patients with intact structure looking to enhance natural contours.
What To Expect The Day Of RHA Filler Treatment
Dermal filler’s reputation for being a low lift treatment holds true with RHA as there isn’t much pre-treatment prep required. However, Dr. Cheung advises against drinking alcohol, taking aspirin, eating ginger or other items that may increase bruising in the 24-hours before your appointment.
You can expect to first talk through your treatment goals with your provider who will determine where and how much filler you need to achieve the desired look. This was my first time considering filler, so Dr. Cheung prompted me to lead the conversation about my beauty hangups (tired undereyes), why I have a “good” side and my unconscious habits like sleeping on one side of my face. She ultimately suggested filler along my cheekbones to alleviate undereye hollowness 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 kicks in. Like many fillers, RHA is formulated with lidocaine to decrease 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 just psychologically felt weird. Dr. Cheung used distraction methods and chit-chat to comfort me with plenty of breaks in between. The treatment lasted no more than 45 minutes and I was out the door with a follow-up appointment scheduled for a month later.
Post-Treatment Care For RHA Filler
Expect some immediate swelling which typically peaks between 48 and 72 hours after. Dr. Cheung sent me home with reusable ice-packs and green lit the use of over-the-counter pain meds as-needed.
“I tell [patients] to have a couple days social holiday and to avoid exercise and salty foods for at least 24 to 48 hours just so they don't get more swelling,” Dr. Shridharani adds. I experienced moderate soreness and puffiness the first week which quickly resolved with ibuprofen and a strict icing schedule.
While the injection area may look out of sorts for the first couple days, be patient. Unevenness and lumpiness immediately after a treatment is completely normal. It may take up to two weeks for the swelling to completely subside and the filler to fully incorporate into the tissue to see those final, natural-looking results. Don’t be afraid to call your provider with questions or concerns. Admittedly, I was prematurely worried about the swelling and was glad to have Dr. Cheung’s attentive team available for reassurance.
Your follow-up appointment will likely be 2-4 weeks after the initial treatment where your provider can then accurately build more volume or make necessary adjustments.
How Much Does RHA Fillers Cost?
RHA, like most filler, is priced by syringe. Cost depends on the region where you live and whether or not you are injected by a physician or another qualified injector. Dr. Cheung, located in Chicago, charges $850 per syringe.
The amount of filler you need will also affect cost. “It depends on your age and how much volume you really need,” says Dr. Cheung. “Two to three syringes is a pretty good starting point. Five is probably my average for my patients.” Dr. Cheung adds that she usually uses between half to one full syringe on the lips. To achieve my results, she used four syringes total — one in each treatment area.
Who Is A Good Candidate For RHA Filler?
The question of who is truly the ideal candidate for filler remains controversial. RHA is FDA-approved for patients 22-years and older, but many still consider filler is only for a certain older age demographic. “Thinking about age in correlation to aesthetics is a bit of a challenging discussion,” says Dr. Shridharani. “It's important not to rush into doing fillers on teenagers, for example. That could be a slippery slope, but certainly individuals in their twenties may have some volume deficiency or want some corrective lip filler.”
Filler has both aesthetic and medical applications with the ability to soften signs of aging, dramatize features or correct scarring. “Hyaluronic acid also has benefits to the skin other than filling,” says Dr. Cheung. “It helps stimulate collagen production and even some fat, so there’s a net benefit.” Ultimately, RHA®’s claim to more natural results make it an approachable option for younger patients and first-timers.
Initially, I was hesitant about going through with the treatment as a young person. Would it mean I didn’t love myself? Would I end up looking “fake”? While its never a requirement to cosmetically alter yourself, receiving this treatment helped me dismantle internalized stigmas I unknowingly held. Not only do I absolutely love my results, I now have a deeper appreciation for the freedom to make informed choices about my body and appearance on my own terms.