Juvederm® in Norwalk, CT

Hyaluronic Acid Crosslinking

Every injectable with the Juvederm brand name is derived from Hyaluronic Acid (HA). HA occurs naturally in the skin and dermis and maintains a youthful, expanded hydrated quality. HA molecules in fillers, are cross-linked for stability and result in gels of different consistencies. The strength of a gel is dependent on the total number of crosslinks (both chemical crosslinks and natural entanglements). One important aspect of gel strength is Cmin. This is the concentration of HA in the fully swollen gel in an excess of the solvent. The stronger the gel the better is the lifting capacity and the expected duration. Stronger gels swell less and have a higher value for Cmin. G* is the complex modulus measured by rheology. It is a measure of the total resistance to deformation. Stronger gels have a higher resistance to deformation and a higher value for G*.

Lifting Capacity of Hyaluronic Acid Dermal Fillers Åke Öhrlund, Katarina Edsman, Cecili.a Sturesson, Lars Nord, Anne Helander Kenne and Jacques Näsström Q-Med AB, Seminariegatan 21, SE-752 28 Uppsala, Sweden

Voluma XC is the longest lasting and the thickest of the Juvéderm suite of products. Voluma XC has the highest lifting capacity.

Hylacross versus Vycross

Hylacross technology fillers such as Juvederm XC and Juvederm Ultra, have crosslinked molecules of the same weight. Vycross technology fillers such as Volbella, Voluma, and Vollure are made of crosslinked HA molecules of different weights. All are pre-packaged containing Lidocaine or Xylocaine, which is a local anesthetic, hence the ‘XC’ designation. Vycross technology is less hydrophilic which means that it attracts less water and therefore results in less swelling. All injectables require an effective therapeutic volume to obtain a measurable result. Undertreating with an inadequate volume may result in dissatisfaction and patients should understand that using an optimal amount of filler will give the best and the most durable result.

Voluma XC is injected close to the facial bones to primarily enhance the cheeks, chin and jawline. It can be placed right along the bone or into the deep fat compartments, usually in the cheek area. Voluma XC can last, in my experience, from 6 months to a year. Length of action is subjective depending on what is considered optimum correction, which can affect the need for more treatments. Most treatments start with a minimum 2 cc. or two syringes.

Juvederm XC and Juvederm Vollure are both suitable for the treatment of nasolabial folds and marionette lines. Vollure is longer lasting than Juvederm XC (up to 18 months versus six to 12 months) and it spreads less readily than Juvederm XC. Dr. Kirwan prefers Juvederm XC for lip augmentation.

Facial Filler Guide. In both images, Volbella (light blue) or Vollure (green) can be used in areas such as the lips, philtral columns, nasolabial folds and the hollows beneath the eyes. Blunt 25 and 27 gauge cannulas are used for injection of the lips, nasolabial folds, marionette lines, malar and temporal areas and along the jaw line. Bolus injections with a needle are used at the corners of the lips, angle of jaw, front of chin and along the zygomatic arch. Individual lines (rhytids)  are injected with a 32 gauge needle.

Summary:

• Voluma is ideal for lifting the cheek area and the jaw line because of its thickness and durability
• Vollure is good for treatment of nasolabial folds and marionette lines, because of its durability and even distribution.
• Volbella is great for unforgiving areas of thin skin such as under the eyes and for filling “smoker’s lines”, cheek, forehead and frown lines, because of its thin, delicate gel. Volbella can also be diluted with lidocaine to create an even thinner gel for fine superficial lines.

Fillers cannot replace facelifts and there is a tipping point where the therapeutic effect and the cost of fillers no longer compares favorably with surgery. Volume correction and the reduction of lines are ideal between the ages of 30 and 50. There is no hard and fast rule. Premature aging may mean that younger patients need fillers or surgery depending on whether they are at the beginning or the end of this age range. Younger patients may desire fillers to correct inherently thin lips or flat cheeks, weak chins or jawlines. Older patients may choose to continue with fillers simply because they do not want surgery. Fat injections using the patients own fat are a good alternative to fillers. They offer the advantage of permanent results as well as improvement in the overlying skin quality because of the repopulation of stem cells as part of the fat grafting injection procedure.

The Lip Flip

The Lip Flip is a series of Botox injections into the superficial part of the orbicularis oris muscle. This muscle compresses and puckers the lips. The injections are usually placed in the upper lip at the margin, although they can also be injected along the lower lip margin. Like all Botox injections, they take 3-5 days to take effect. The Lip Flip is often performed at the same time as a Fat or Filler injections to the lips. Commonly used Fillers are Vollure, Juvéderm Ultra-Plus, Juvéderm Ultra and Volbella. The Filler is injected along the vermilion white roll margin to evert the edge of the lip and can also be injected into the red body of the lip or vermilion to increase the volume of the upper and lower lips.