Juvéderm Voluma is the newest HA (hyaluronic acid) soft tissue filler to join the family of FDA approved Juvéderm products in the USA. This is a very exciting and significant new introduction. Juvéderm Voluma has been available in Europe since 2005 and is used in over 60 countries worldwide. Juvéderm Voluma XC is the current form (XC means it also contains a local anesthetic agent for added comfort during the injection process).
Dr. McDaniel serves on the medical advisory board for Allergan for Juvéderm Voluma and has also studied the European and Canadian techniques of some of the Voluma experts. Dr. McDaniel is also one of the first physicians to offer Voluma to their patients in the country, as well as the first to offer Voluma in the Virginia Beach and Hampton Roads area.
Mid-face volume loss is something that occurs to all of us in varying degrees of severity and age of onset. It is a critical part of why people look older: because even when your skin’s elasticity is good and not sagging, the loss of volume causes significant changes in the appearance of your face. Even individuals with very dark skin who do not wrinkle still experience volume loss. The youthful face is typically characterized by a round, full mid-face across the cheekbone area. Although there are considerable ethnic and cultural differences, the hallmark of a youthful face is embodied by the central cheek structures.
The goal of surgical procedures such as facelifts is to ‘pull’ and thus tighten the skin, whereas Juvéderm Voluma ‘lifts’ by volumizing and pushing the skin up, thus lifting without removing skin surgically.
The key to restoring a natural looking, youthful face – especially in people in the 30-50 age range – is to re-inflate and re-contour the face with volume restoration. Juvéderm Voluma is important because it offers experienced cosmetic surgeons the ability to do just this – in a safe and efficient manner. It is a major new development for cosmetic surgery in the USA and it is going to profoundly change the way we treat many aging faces!
What does it do?
As the name implies, Voluma will help to restore the volume that is lost through the aging process and it is specifically indicated to restore lost mid-facial volume. This is especially important since the mid-cheek volume loss has a profound impact on how our faces age. Not only does it produce a sunken or hollow look to the cheeks, but perhaps more importantly the ‘fabric’ of the skin essentially ‘re-drapes’ as these central cheek fat pads diminish. One way to think of this is to imagine they are little airbags, and as we age, they deflate, causing the skin which they were holding up like a tent pole to rearrange or re-drape. Depending on many factors including skin laxity and health, the skin may sag, causing jowls and even contributing to the so-called ‘turkey neck’ or loose skin under the chin.
In contrast, for people who still have very good skin elasticity, this re-draping may be more directed to the nose-to-mouth folds creating an overhang and accentuating the smile and marionette lines- and thus contributing significantly to the tired/sad/old look that some people experience (even though they don’t feel that way!). By restoring lost mid-cheek volume with Juvéderm Voluma the impact is seen not only in the mid-cheek area, but also it can help ‘lift’ the skin upwards producing an overall more youthful effect in a very natural manner.
Who are the best candidates?
While theoretically anyone with facial volume loss may be a candidate for Voluma, I personally believe in the ‘less is more’ concept for facial enhancement. So in that regard, probably the more dramatic results tend to be seen in patients in their 30s, 40s and 50s who have mild to moderate facial volume loss without significant skin laxity and sagging (when there is a lot of loose, lax, sagging skin, non-surgical options are typically adjuncts or alternatives to surgery such as a face, neck or brow lift). However, having said this, many of my patients do not want surgery for various reasons related to recovery time, exposure to anesthesia, existing health problems, or concerns about complications. For those patients, even though they have more severe volume loss and skin laxity, Voluma offers the opportunity for looking more rested and refreshed – albeit not the same result as if they had chosen surgery + volume loss correction with fat or fillers.
How does it work?
HA fillers are all made from long chains of sugars which occur naturally in your skin which have cross linking to strengthen the filler material from degradation by the body’s own enzymes. Juvéderm Voluma is unique in that it has a special type of cross-linking called Vycross which, along with shorter chains, gives it very excellent lifting capacity which is of great importance for restoring lost volume as well as lifting the face. It also helps make Voluma last up to twice as long as current fillers (up to 24 months). Voluma is soft and silky smooth to inject and it can be gently shaped into desired contours and then it integrates into the skin along with your own natural HA and retains its shape.
What do people experience?
Visible results are immediate and long-lasting, and Voluma is associated with fewer adverse events than other facial volumizer fillers such as Sculptra® or Radiesse®. Most people resume normal activities immediately (bruising and sometimes also slight swelling are typically the most common side effects).
In a study conducted by Klaus Hoffmann, MD and associates at the Dept. of Dermatology, Ruhr University in Bochum Germany found that nearly all the study participants who received Juvéderm Voluma would recommend treatment to a friend (98+%) and that most would be very or quite likely to return for treatment (~93%).
How is treatment performed?
Typically, some topical numbing cream is applied 20-30 minutes prior to treatments and ice may be used (to minimize the risk of bruising) as well just prior to injections. The traditional injection technique uses small needles similar to Juvéderm Ultra and Ultra Plus. Additionally, special small blunt-tip cannulas may be used and are especially useful for volumizing the cheeks as they allow nice real-time visualization of the sculpturing effect while minimizing discomfort and risk of side effects such as bruising (a sharp needle is used to create a pilot hole for the cannula since the cannula cannot penetrate the skin; it is literally too blunt on the tip).
Are there any special techniques?
Yes. The cannula technique, which is not widely adopted yet in the USA, is used very widely in Europe and Canada where Voluma has been available for years. The use of the cannula technique has proven very popular for many reasons and we use a combination of both the traditional needle and the European cannula methods because we believe, like our very experienced colleagues overseas, that this allows us to maximize the potential for Juvéderm Voluma and to create very natural results. Juvéderm Voluma is also widely used by these experienced injectors in anatomic areas other than the mid-face and sometimes with dilution to make Voluma most suitable for special areas and techniques. These techniques have proven very useful to create beautiful results and are considered off-label in the USA since the FDA marketing approval/indications for use was granted specifically for mid-face volume correction and the original studies did not include the use of cannulas.
How long does it last?
Typically, Juvéderm Voluma lasts 18 months or more (it may last up to 24 months in some cases) so it lasts about twice as long as most other HA fillers. There is variability in duration of effects, and even though full correction fades, often a very pleasing effect continues for some time afterwards. Please discuss with your physician who will be injecting as the duration also depends not only on your skin, but also on the techniques and volume of Juvéderm injected.
Watch Dr. McDaniel discuss Juvéderm Voluma on WVEC!
Before and Afters
Click here to view more Before and After photos of Juvéderm Voluma.