JUVÉDERM® XC is currently the most popular wrinkle filler in the United States. Juvéderm™ Plus XC and Juvéderm™ Ultra Plus XC are manufactured by Allergan and have been FDA-approved since 2006. Juvéderm™ Voluma XC was FDA-approved in December 2013, but has been in use in other countries since 2005.
Juvéderm™ is the first "smooth consistency" gel and the only hyaluronic acid filler that’s FDA-approved to last up to one year with only one treatment. Juvéderm™ Voluma is indicated for cheek augmentation and has a newer patented technology that increases its longevity to 2 years and possibly even longer. Long-term retention studies are underway. For more information about the formulations of this popular filler, please call Desert Hills Plastic Surgery Center at (702) 260-7707 in Las Vegas today.
How Does Juvéderm™ Work?
Hyaluronic acid is a naturally occurring substance in the human body that acts as a cushion and a lubricant in the joints and other tissues like the eyes and the skin. As we age, the amount of hyaluronic acid in the skin decreases and contributes to wrinkle formation by decreasing tissue elasticity and hydration.
Hyaluronic acid naturally absorbs water, so injections under the skin add volume to erase wrinkles or fill hollows and depressions, restoring a more youthful look. Repeated injections of filler stimulate new collagen formation, while stopping ongoing age-related breakdown of collagen.
What Is Juvéderm™?
Juvéderm™ is a hyaluronic acid (HA) filler derived from bacterial fermentation and manufactured with a specialized "Hylacross" or cross-linking technology. This results in a clear gel that is smooth, soft, easily dispersible, natural, long lasting and easy to inject. (XC refers to the product being reconstituted with lidocaine for patient comfort during injection).
Juvéderm™ Ultra Plus has a higher proportion of cross linked HA, which makes Ultra Plus more viscous. Consequently, Ultra Plus is more suitable for adding volume and correcting deeper facial grooves and furrows, whereas Juvéderm™ Ultra is best suited for contouring and volumizing more superficial facial wrinkles and folds.
Juvéderm™ Voluma is manufactured differently, using a new “Vycross” cross-linking technology that increases its longevity to 2 years or longer. It is clear and easy to inject and tends to swell less than the other Juvéderm™ fillers.
Juvéderm is not "sized," in contrast to the other HA fillers like Restylane. Therefore it is smoother, less granular and less particulate, so it disperses evenly within the deeper layers of skin and is less perceptible.
Like other hyaluronic acid fillers, Juvederm is reversible in the event of overcorrection or minor complications, using the enzyme hyaluronidase (Wydase). Reversibility translates into more physician control over results and improves patient safety minimizing risks for complications.
Juvéderm™and Facial Rejuvenation
JUVÉDERM® Ultra is indicated for average depth depressions and wrinkles, and JUVÉDERM® Ultra Plus is indicated for deeper depressions and areas of volume loss. It is ideal for treating:
- Smile lines
- Nasolabial folds
- Lip lines
- Marionette lines
- Commissure depressions
- Downturned lines at the corners of the mouth.
The filler looks and feels very soft and natural. It works well to fill the prejowl space, minimizing the look of an early jowl, while strengthening the jaw line, and enhancing chin projection. Juvéderm™ is a very natural looking lip enhancer and can create a beautifully shaped lip that isn’t overdone.
Juvéderm™ Voluma is FDA-approved to treat the central and lateral cheek. By restoring deep midfacial volume, the nasolabial creases and tear trough depression affecting the lower eyelid are improved. It gives you a subtle lift, restoring a youthful profile. On a three-dimensional oblique profile view, Juvéderm™ Voluma restores the "ogee curve" of youth. The Ogee curve refers to a soft double-S contour of the face where the lateral brow and cheek are naturally fuller, with the concave aspect of the S-curve tending toward the mouth. Think essentially of a "heart-shaped" face. Patients look on average 5 years younger after treatment.
How Can I Get Juvéderm™ Treatment?
The procedure is commonly performed in the office setting using topical numbing cream or ice for discomfort. Nerve blocks are routinely used for lip injections, which are otherwise uncomfortable.
Juvéderm™ is also commonly used in surgery at the time of facelift surgery, where deep wrinkles around the mouth and in other areas are filled and softened to avoid persistence of a deep line or a noticeable reorientation of a deep line from the traction on the skin. Juvéderm™ Voluma can also be used during facelift surgery to highlight the cheek and restore mid facial volume loss with predictable results that are long-term, and potentially more reliable than fat injections.
Multiple injections are performed using a very fine small needle just under the skin. Juvéderm™ Voluma is injected deeply onto bone or within the subcutaneous layer of the anterior cheek.
Is Juvéderm™ Right for Me?
Juvéderm™ will absorb water after injections and thus slightly expand within 24 hours after correction. Overcorrection is not advised. However, Juvéderm™ Voluma does not tend to absorb water and swell so optimal correction is desired at the time of treatment.
Juvéderm tends to be smoother, more natural, and less perceptible than many of the other HA fillers, so it is great for thin skin and for filling superficial lines. It can soften minor skin surface irregularities such as scars.
Juvéderm™ is Dr. Brown’s favored product of choice for smile lines, lips, and areas around the mouth and chin. Juvéderm™ Voluma is the product of choice for cheek and mid face augmentation as it is the longest lasting, most predictable filler available.
All the Juvéderm™ products are reversible in the event of overcorrection using hyaluronidase. This improves the safety profile of these fillers. Oftentimes, a combination of fillers is advised as some products work better in certain areas.
1-2 years of longevity is ideal and easy to maintain. Facial contours are always changing as a result of aging, gravitational forces, weight fluctuation, and facial movements. Yearly touch up or maintenance procedures are beneficial to enhance the result while accounting for any changes that have occurred over the year.
Naturalness is essential without overcorrection. If a little product does wonders, more product isn’t always better. You need to trust your physician to maintain a natural looking result to avoid stigmata of too much filler. A simian look with chubby cheeks, beady eyes, duck-like lips with fullness around the mouth, while neglecting your lateral facial shape is not natural, balanced, nor attractive. Trust your plastic surgeon to let you know when fillers will fall short or start looking unnatural, and it's time for a skin tightening procedure like a facelift. In addition, don’t neglect the lateral facial contours. Just because there is hair to hide the sides of the face, fullness centrally with skeletonization laterally is not a youthful nor natural look.
Dr. Brown utilizes a three-dimensional approach to enhance the contours of the face naturally with the addition of volume, in addition to “wrinkle-filling.” With just one treatment, you’ll get smooth and natural looking results that last 1-2 years or longer.
Longevity can never be guaranteed, as patients metabolize and tolerate injectable products differently. Expect some variability from person to person with respect to how long results last.
Risks and Side Effects
- Bruising, localized swelling, and temporary redness is common and variable.
- Perceptibility of the product can occur and is site and patient dependent. Patients with thin skin or severe hollowing may perceive the product, which can look bluish under the skin, also called the “Tyndall Effect.” This can occur with any clear product placed under the skin.
- Feeling the Juvéderm™ and/or seeing it through the skin is less common than with Restylane. Just because the product isn’t seen or felt doesn’t mean it isn’t there.
- Undercorrection or overcorrection, imperfections, asymmetries can occur. Overcorrection can occur when Juvéderm™ is placed along the lower eyelid hollow, also called the tear trough, because of its tendency to swell. If Juvéderm™ is used to treat this area, it needs to be done very conservatively and underdone to avoid fluctuating and noticeable swelling of the product.
- Early reabsorption.
- Lumps or nodules, granulomas.
- Hyperpigmentation or color change of the skin.
- Injection site scabbing.
- Skin Exfoliation.
- Delayed hypersensitivity reactions.
- Immediate-onset allergic reactions and anaphylactic shock.
- Intravascular injection is exceedingly rare and can lead to skin loss or other serious complications; stroke and blindness have been reported. Therefore it is critical that your injector understands the anatomy and is properly trained with an MD, RN, DO, PA, or NP degree.
Patients Who Are NOT Good Candidates for Juvéderm™
- Those with a history of bad allergies.
- Staph carriers or those with a history of recurrent skin infections or MRSA infections.
- Patients who have moderate to severe skin laxity and deep wrinkles, where a skin tightening procedure such as a facelift or brow lift would be a better investment with long-term improvements.
- Anyone with a history of a bleeding disorder or those who take blood thinners.
- History of allergies to local anesthetics such as lidocaine.
- Use at the site of skin sores, pimples, rashes, hives, cysts, or infection should be postponed until healing is complete.
- Patients with a history of cold sores should take a course of antiviral medication, as injections around the mouth could activate latent herpes viral infections or cold sores.
- Patients under 18 years old. Patients under 21 years old for Juvéderm™ Voluma XC.
- Pregnancy or breast-feeding.
- Immunosuppressive disorders, patients on steroids.
For more information about Juvéderm™, please get in touch with Desert Hills Plastic Surgery center online or by calling (702) 260-7707 to speak with a member of our friendly Las Vegas staff.