Generic Name

Juvederm

Mechanism

• Viscoelastic HA Matrix: Cross‑linked sodium hyaluronate forms a cohesive gel that restores volume by displacing fluid into surrounding tissue.
• Tissue Integration: HA attracts water, increasing tissue hydration and promoting collagen synthesis through fibroblast stimulation.
• Duration of Effect: Degraded by hyaluronidase over 6–12 months; duration depends on product viscosity (Juvéderm Ultra, Ultra XC, Voluma, Volbella, etc.).

Pharmacokinetics

Indications

• Facial Rejuvenation
• *Nasolabial folds,* marionette lines, perioral lines (Juvéderm Volbella, Ultra)
• *Cheek augmentation* and *mid‑face volume loss* (Juvéderm Voluma)
• *Forehead and glabellar lines* (Juvéderm Ultra XC)
• Non‑facial Applications
• *Lip augmentation* (Juvéderm Ultra, Ultra XC)
• *Temporal hollowing* correction
• *Traumatic tissue defects* and *acne scars* (Juvéderm Ultra XC)

Contraindications

• Contraindications
• Known hypersensitivity to sodium hyaluronate, carbopol, or other formulation components.
• Active infection, inflammation, or ulceration at planned injection site.
• Uncontrolled connective‑tissue disorders (e.g., systemic lupus erythematosus).
• Warnings
• *Vascular Occlusion*: Use of a fine needle, aspiration testing, and vigilant technique to avoid intravascular injection.
• *Post‑injection edema and bruising*: May necessitate cold compresses and anti‑inflammatory therapy.
• *Pregnancy/Breastfeeding*: No data; use only if clearly needed.
• Precautions
• Verify previous filler use (e.g., other HA fillers) to avoid cumulative volume excess.
• Avoid anticoagulants (warfarin, DOACs) 48 h before procedure unless medically indicated.

Dosing

• Typical Volume
• *Cheeks*: 2–4 mL per side (Voluma).
• *Nasolabial folds*: 0.5–1 mL per fold (Ultra/Volbella).
• *Lips*: 0.25–0.5 mL per side (Ultra/Ultra XC).
• Technique
• Use a 27–30 G needle or cannula; perform multiple micro‑injections (wedge, linear threading, fanning).
• Mixing: Blend HA gel with preservative‑free lidocaine (if pain reduction required).
• After‑care: Ice, elevation, and gentle massage to distribute filler evenly.
• Adjunctive (if vascular compromise suspected): immediate hyaluronidase (0.5–1 U/mL) injection.

Adverse Effects

• Common (≤5 %)
• Injection site pain, tenderness, swelling
• Bruising, hyperpigmentation
• Lumps or irregularities (modifiable by massage or hyaluronidase)
• Serious (≤0.1 %)
• *Vascular occlusion* → ischemia, ulceration, vision loss
• *Anaphylactic reaction* (rare)
• *Infection* (facial cellulitis, abscess)
• *Granulomatous foreign body reaction* (delayed reaction)

Monitoring

Clinical Pearls

• Avoid “over‑filling”: The aesthetic lift is subtle; more product may produce a “frozen” look and higher risk of vascular occlusion.
• Use aspiration + “touch‑back” technique to confirm non‑vascular placement.
• Hybrid injections: Combine HA filler with small amounts of non‑cross‑linked HA seroma‑fillers to achieve smoother transitions at deep and shallow layers.
• Hyaluronidase availability: Keep a 0.5‑U/mL vial in the same area as injectable; dose 0.5‑1 U per 0.5 mL of filler per site.
• Post‑procedure sedation: For patients with needle phobia, local anesthesia using lidocaine‑prilocaine spray can reduce discomfort without compromising the procedure.
• Patient education: Advise on the typical 6‑month “refresh” window, but remind that individual metabolism may truncate or extend longevity, especially in highly active patients or smokers.
• Documentation best practice: Record exact product name (e.g., Voluma XC), lot number, volume per site, and injection depth to aid future treatments and traceability.

--
• References – FDA label, European Medicines Agency (EMA) approval dossier, and peer‑reviewed literature on hyaluronic acid filler safety and efficacy.