Juvederm gone in a week?

Juvederm is comprised of hyaluronic acid (HA) which is naturally occuring chemical found in human skin.  In fact, HA is a sugar molecule.  It's physical correction of wrinkles is due to  HA soaking up water like a sponge and the molcule becoming larger.  It needs to be injected into the skin, typically into the deeper layers. Immediately after injection, there is some swelling and even minor bruising which can make the area treated appear more full.  This usually dissipates in one-two weeks. This effect may amplify the feeling of under correction after the swelling is gone.

Your response of not seeing or apprciating the product in the areas treated is  probably due to the Juvederm not injected in the proper level of skin and/or not enough product was used.  More commonly, it's due to the later problem.  Oftentimes, because of cost, not enough syringes were used.  In general for patients 40 years or older, it takes on the average at least two to three syringes to treat a bilateral anatomic area . With the number of anatomic areas that were treated, you probably need more Juvederm.

I hope this helps!

Stephen A. Goldstien, MD, FACS

It is highly unlikely that the Juvederm is gone, but there are a few possible explanations. If your doctor injected the Juvederm, especially the Juvederm Ultra too deeply, then the Juvederm may have flattened under the pressure of the overlying skin. That is why Juvederm needs to be injected at the correct level. Juvederm Ultra Plus is thicker and tends to hold up better even when it is injected fairly deeply.

Another possibility is that you just need more Juvederm. If you had very deep folds, then it may take a lot of tubes to get the desired correction. Patients frequently ask that we treat the areas they want treated within their budget...but that is not always possible. If the doctor was "trying to be nice", he may have spread too little Juvederm over too many areas leaving you with an inadequate correction in all the areas.

The other possibility, which I think is the most common, you may indeed have a significant correction, but you can't see it without before and after pictures. If the doc took before pictures, you might want to ask him to take some after pictures and show them to you side by side.

Michael Sinclair, MD
www.epilution.com

Initially after Juvederm, all the treated areas will appear more full because of the associated swelling.  This product attracts a lot of water in the skin.  After about 1 week, most of that swelling is gone, and it may appear as though there is no product left. It is very soft so you may not feel it either.  Probably, it is is not gone but you need more.  

One factor in how long Juvederm lasts is the layer of the skin where it was injected.  Placing the filler in the dermis / dermal-subcutaneous junction will result in a longer lasting result than if majority of it was placed in the subcutaneous fat.  Only a very experienced physician would be able to recognize this difference. 

Another factor of longevity is where in the face it was injected.  For example, If placed in an area where there is not a lot of movement like the infraorbital hollows, the product will last longer than in the lips where there is more movement.

I would think that much filler would be evident at only one week out.  One possibility is that the fillers were placed perhaps too deeply, and they will fail to achieve correction, and thus you see nothing.  Another possibility is that there really IS a correction, but without looking at before and after pictures side by side, it can be impossibile to appreciate changes.  Your friends' opinions of whether or not you look corrected are not reliable.  My advice would be to go back and have a sit down discussion with your doctor about what you think of your treatment.  When everyone calmly sits down to really figure out what went on, things can work out fine all the way around. 

You're probably saying, if I can't see it, then it really doesn't matter if it is there or not.  My first question is how many syringes were used.  You mention a lot of areas to correct.  I would use at least 3 or 4 syringes for this.  Any less than this, you will be spreading the filler out too thinly.  If someone comes to me and says I want all those areas and can only afford 1 or 2 syringes, I typically will ask which area is most important and fully correct it.  The filler is probably not gone, but the changes are so minimal that they are hard to see.

There are people who rapidly metabolize HA.  Usually this doesn't occur in a week though.  For those people, Radiesse is a good solution, except for the lips.

One other point, I prefer Restylane around the eyes because to me, Juvederm spreads more and the corrections are often less noticeable. 

Steve Weiner, MD  Facial Plastic Surgeon, Destin, Florida.