Juvederm - what's the right formulation for lip enhancement?

In short, there is no "best" form of Juvederm for lip augmentation.

Juvederm 18 is the lightest or thinnest form of Juvederm and is not used in the United States.

Juvederm Ultra is equivalent to Juvederm 24 HV.  Juvederm 30 HV is equivalent to Juvederm Ultra Plus.  (HV stands for high viscosity.)

Whether a physician uses Juvederm Ultra or Juvederm Ultra Plus is not as important as to how it is injected.  The amount, direction, and depth of the injection will have the most significant impact on the final result.  Make sure your physician is experienced in injecting the lips and has the proper training and credentials.

In general, Juvederm Ultra Plus is better for restoring volume while Juvederm Ultra is better to address fine vertical lines.  The Juvederm Ultra Plus may last slightly longer than Juvederm Ultra.

Be sure to communicate your goals to your physician.  Only by understanding your goals can your physician try to meet and exceed your expectations.

In the United States Juvederm is available in two forms, Juvederm Ultra and Juvederm Ultra Plus. The Juvederm Ultra Plus is slightly thicker than the Juvederm Ultra. 

In other countries Juvederm is available in three basic forms.  There is Juvederm 18, Juvederm 24 and Juvederm 30. 

• The Juvederm 24 and Juvederm 30 were also available in a high viscosity formulation.  These products have the letters HV in the name of the product.
• The Juvederm 30 HV is  equivalent to the Juvederm Ultra Plus in the United States. 
• The Juvederm 24 HV is equivalent to the Juvederm Ultra in the United States. 
• Juvederm 18 is not available in the United States but it is very similar, just slightly thinner than Juvederm 24.

In the ideal setting the practitioner would make a determination as to how much enhancement is necessary.  He would then be able to choose whichever product would best allow him to obtain the desired result.  If the lips need a lot of volume enhancement the thicker products might do a better job.  If filling out finer wrinkles was the goal, then one of the thinner products might do a better job.

The thicker Juvederm products tend to last a little longer. The length of time that the product will last is much more dependent on how much the client move their lips with day to day activities such as talking and eating.

The most important factor in determining which product to use is the injectors comfort with each product.  An experienced injector will know in advance what kind of result he can obtain with each of the products that he has experience with.

The variety of Juvederm used is really less important than correct technique.  Understanding the changes that occur to the lip is essential and addressing these changes is crucial to making a patient happy.

Anatomic Changes to the Lips

As the aging process progresses, several factors come into play with the lips:

1. The vermillion border or junction between red and white lip thins out, and becomes less full.
2. The white portion of the lip elongates, and the red portion of the lip deflates, inverts, and becomes less obvious.
3. Vertical lines begin to show on the upper and lower lip.  This is generally more obvious in woman, partly due to thinner skin in women than in men, partly due to the exfoliative properties of repetitive shaving with men.
4. The corners of the mouth or oral commissures turn down ward and a relative hooding of the upper over the lower lip occurs.

Technique

My preference is to use Juvederm Ultra for the aging changes mentioned above.  I use Juvederm Ultra Plus for younger women who seek more volume to the lips.

• For the changes mentioned above, my first goal after achieving local anesthesia is to restore the vermillion border.  A relatively small amount of Juvederm is required to do this. 

The Juvederm is threaded just under the deeper layer of the skin (dermis), using a tapered technique, placing a larger amount centrally than laterally.  After this has been achieved, the vertical lines around the mouth are addressed.  It is very imporatnt to avoid overcorrection; the soution shouldn't create a secondary problem. 

• The next goal is to create subtle central fullness into the body of the lip. 

Two points are chosen just lateral to Cupid's bow (the peak of the upper lip) on each side, and a central point is chosen on the lower lip to achieve fullness.  After creating the desired level of volume, the remainder of the syringe is used to correct and elevate the down turned corners of the mouth.  This technique generally requires one syringe of Juvederm and achieves a very pleasing but subtle result.

Lip augmentation is a very fun procedure with immediate results!  Juvederm Ultra Plus is a denser, thicker, product when compared to Juvederm Ultra.  

I prefer to use the Juvederm Ultra Plus when I augment the lip.  I feel that the product tends to last longer and give a nice smoother result.  

If the patient has vertical lip lines, or wrinkles surrounding the mouth, I like to combine the treatment with Botox.  I find that the Botox really smoothes out those lines, and it also tends to lengthen the duration of the Juvederm filler. 

A nice nerve block before treatment really helps to make the augmentation very easy on the patient.  Again, the type of Juvederm used really is physician preference.

Hope that helps.

Dr. Sofie

The numbers reflect the thickness of the product, with higher numbers for thicker formulations.

In the US, only Juvederm 24 and Juvederm 30 are available.

• Juvederm 24 is called Juvederm Plus
• Juvederm 30 is called Juvederm Ultra Plus
• They differ in the thickness of the gel

Typically, I prefer to use Juvederm Plus in the lips, but one size doesn't fit all, and I have had great results for lip enhancement with both products. It is important to discuss with your doctor what your lips look like "before" and what you hope to acheive "after."

When Juvederm was released in Europe and Canada, it was available as Juvederm 18, 24, and 30. Both 24 and 30 were also available in HV.

Basically these different numbers mean a different viscosity, or "thickness" of the Juvederm. They are all hyaluronic acid products.

In the U.S., Allergan, the manufacturer, only released Juvederm Ultra and Juvederm Ultra Plus.

• Ultra used to be known as 24 HV 
• Ultra Plus was the 30 HV

This is all quite confusing to the consumer, but the important thing to know is the US FDA approved Juvederm Ultra and Ultra Plus. One is thicker (Juvederm Ultra Plus) than the other; otherwise, there is very little difference.

I prefer using the Ultra in the lips as I find it flows quite smoothly and does not tend to lump. However, both Juvederm Ultra and Ultra Plus are very safe and effective agents for soft tissue augmentation, and I have used them for quite some time in my practice with terrific results.

Generally, I can get them to last about one year!

Always remember that when selecting an injectable agent for your face, you want something that is temporary and forgiving. Permanent fillers such as Artefill can cause permanent problems!

And always look for a doctor who has been properly trained, is board-certified in dermatology, plastic and reconstructive surgery, facial plastic surgery or oculoplastic surgery. And you want to make sure that the doctor you choose is well known and has years of experience in lip augmentation. You never want to bargain shop with your face.

I hope my answer has not added more confusion.

In the United States, the two Juvederm versions widely available are Juvederm Ultra and Juvederm Ultra Plus.

In my practice, I use Juvederm Ultra for lip augmentation. This filler contains hyaluronic acid, which currently is the most commonly used filler. By comparison, Juvederm Ultra Plus also contains hyaluronic acid, but has a thicker consistency. I normally use Juvederm Ultra Plus for deeper lines from the nose to mouth (“Smile Lines”), and from the mouth corners down (“Marionette Lines”).

Some doctors have commented that Juvederm Ultra feels softer in the lip area compared with Restylane. I feel both products get very good results.

Lip augmentation may last as little as 4 to 5 months, since we are constantly moving our lips, and this causes faster break down of Juvederm. Most other areas treated with Juvederm maintain a full appearance for 6 to 10 months.

Even more important than the choice between Restylane and Juvederm is who’s performing your injections. Lip augmentation is where the art and science of medicine come together.

So Remember- It’s Your Face! Find a Medical Doctor with extensive experience in lip augmentation for best results.