Juvederm® is a clear viscous gel produced by Allergan Corporation for the purpose of reducing lines and wrinkles in the face. It is composed of hyaluronic acid (HA), which is a naturally occurring compound found in the skin and joints. Hyaluronic acid is frequently injected by orthopedic surgeons into the knees of patients who have certain degenerative joint diseases to avoid or to delay the need for corrective knee surgery.
Juvederm® is produced using the patented Hylacross™ crosslinking technology which makes it smoother than other available injectables used for treating facial lines. By crosslinking the molecules, it is more resistant to breakdown by the body’s immune system so that it lasts longer. Juvederm® is the most highly cross-linked HA on the market. It is the only hyaluronic acid which the FDA will allow advertising that states that results may last up to a year.
FDA Approved Areas
Juvederm® is most commonly used in the folds around the mouth that extend from the sides of the base of the nose, known as the nasolabial folds. It is also frequently used in the folds that extend from the corners of the mouth down along the sides of the chin (marionette lines). These are probably the most common areas that are treated with hyaluronic acid injections. The FDA has also approved Juvederm® for vertical lip lines and to treat the depressions at the corners of the mouth (commissures) which can give the appearance of frowning.
Off-Label Use of Juvederm®
Other lines and wrinkles on the face, or other areas of the body, can be treated with Juvederm® and, for these purposes, it is considered an ‘off-label’ use. This means that it can be used, but not advertised. Common areas include cheek wrinkles, chin lines, other smile lines and frown lines in the brow that do not respond completely to Botox® or Dysport® injections. Juvederm® is also commonly used to perform lip augmentation.
XC stands for a small amount of local anesthetic (lidocaine) that has been put in the gel since 2010 to reduce pain with the injections. Prior to the addition of this anesthetic, it was common to first inject lidocaine prior to treating lip lines or for lip augmentation. Since it was added to the product, most patients prefer not to be pre-injected either because of the pain with these injections or because their lips are completely numb for up to two hours.
Juvederm® Ultra Plus XC and Voluma®
Juvederm® Ultra Plus XC is a little thicker gel which contains larger hyaluronic acid molecules and is used for deeper folds of the face but not for finer lines and had the advantage of lasting longer than Juvederm® Ultra XC.
Juvederm® Voluma, which was recently approved by the FDA, is an even thicker gel used to add volume to the cheeks and reportedly can last up to two years. Injections are performed in the office as a relatively minor procedure. Bruising is a risk with any type of injection so it is recommended to avoid taking medications that can thin your blood such as aspirin for 10-14 days before the procedure.