Juvederm® has become the most popular filler for lines and wrinkles on the face in the United States over the past few years. It is composed of hyaluronic acid (HA), which is a naturally occurring compound found in human skin and joints that replaced collagen as the predominant injectable filler in the early 2000’s. It has also found many other applications in other fields of medicine such as in orthopedics were it is injected into knees for patients who have chronic wear on the cartilage and in urology where it is used to reduced stress incontinence.
Protein vs. Sugar
Collagen is a protein that is commonly found in skin, tendons and ligaments among other things in the body. The product that was used for injection was derived from cowhide because cow collagen is almost identical to human collagen.
Since we eat cows, our immune system could be sensitized to cow collagen. As a result, humans have a 3% risk of allergic reaction to collagen injections; therefore, a test dose was given in the forearm and you had to wait 30 days to look for an allergic reaction before having the injections done. Hyaluronic acid is actually a carbohydrate with such a low incidence of allergic reaction that a test dose is not felt to be necessary. You can get Juvederm® injected at your first visit.
The main reason that HA’s took over as the main fillers from collagen is the amount of time that it lasts. In each case, the product is gradually broken down and eliminated from the body. With collagen, that process only took about three months. Juvederm® Ultra XC lasts up to a year, Juvederm® Ultra Plus XC generally lasts a little longer and Juvederm® Voluma can last up to two years. HA’s were the answer to patients request for a longer lasting filler.
Whereas collagen could not be removed or dissolved after it was injected in the case of an untoward event such as an intravascular injection, HA’s can be dissolved using and enzyme called hyaluronidase which can be injected into the area where the product was placed to eliminate it completely or partially. If the product is injected into a blood vessel, the lumen of the vessel may be occluded, cutting off the blood supply to the area of skin that is fed by it which can cause the skin to die. Re-establishing the blood supply may be critical to avoid skin loss and severe scarring. Symptoms include pain, severe bruising and a mottled or pale appearance to the skin. It is important to contact us in the event you ever experience these symptoms as soon as possible.
Juvederm® Ultra Plus XC
There is a second Juvederm® product known as Juvederm® Ultra Plus XC. The XC simply stands for the small amount of local anesthetic that is found in most Juvederm® products to reduce pain during the injection process. The Ultra Plus product is simply a larger HA molecule which takes longer to breakdown, so that it lasts longer. This can only be used in deeper creases such as the nasolabial folds which run from the sides of the nose to the corners of the mouth.