When Dr. McMahan first entered practice in Columbus, Ohio in 1990, the only injectable fillers available had collagen as the primary constituent. Problems with collagen included a 3% risk of allergic reactions requiring a test dose prior to actual treatment, relatively short duration of effect and lack of an antidote to reverse possible negative consequences. The first hyaluronic acid (HA's) available was Hylaform®, which was a step up from collagen, but did not hold a candle to the current HA's on the market.
Juvaderm® Ultra XC
Juvaderm® Ultra was one of the next generation of HA's and has been around ever since. The 'XC' was added once the local anesthetic xylocaine was added to reduce pain with injections. Juvaderm®Ultra XC is approved by the FDA for treating moderate to severe facial wrinkles and lines such as the marionette lines and nasolabial folds as well as wrinkles around the mouth. Juvaderm®Ultra XC also has an FDA indication for temporary lip augmentation.
Juvaderm® Ultra Plus XC
Next in line of Juvaderm® products is Juvaderm® Ultra Plus XC, which consists of hyaluronic acid in the same concentration as Juvaderm® Ultra XC with a high level of molecular crosslinking for greater stability and longer duration of action. Juvaderm® Ultra Plus XC, like Juvaderm® Ultra XC, is placed in the mid dermis of the skin and has similar FDA indications except that it is used for deeper lines and folds rather than superficial wrinkles and is not approved for lip enhancement.
Voluma® XC is the first injectable product from Allergan, who also makes Botox® Costmetic, designed for deep placement into the tissues below the skin. It is FDA approved for placement in the cheeks to increase volume, particularly in the malar area or cheekbones. As we age, the soft tissue of the face sags giving a more rectangular shape while a youthful appearance is more angular with a wider, fuller upper face and a narrow jawline. Voluma® XC was developed for that reason; to enhance the volume of the upper face and potentially even give some lift to the cheeks. Once again, the XC means that there is a small amount of lidocaine in the product for numbing purposes.
The Juvederm® family of products, like the Restylane® group has a product designed for use just in the lips and lines around the mouth. Volbella® has a lower concentration of hyaluronic acid (15mg/ml vs. 20mg/ml) than the other Juvederm® products making it thinner, more pliable and better suited for areas with more animation due to muscle action like around the mouth.
At least for now, the final product in the Juvederm® lineage of products is Vollure® XC. It has an intermediate concentration of HA (17.5mg/ml) giving it a little less flexibility than Volbella® XC but more that the other Juvederm® products and a little less structural support. Like most of the Juvederm® fillers, Vollure® XC is intended for use to treat moderate to severe facial wrinkles in patients 21 years of age and older.