I have a syringe of Juvederm that my doc used for a touch-up last May 2008. It is nearly full, and I want to use the remainder. Is there any risk to this? The expiration date is on September 2009, and I have kept the syringe at room temperature with its cap on, in a biohazard bag.
Risks of Using a Stored Syringe of Juvederm?
Doctor Answers (10)
Bellew SG, Carroll KC, Weiss MA, Weiss RA. Sterility of stored nonanimal, stabilized hyaluronic acid gel syringes after patient injection. J Am Acad Dermatol. 2005;52:988–90.
Davis K, Bottone EJ, Lucas D, Lebwohl M. Sterility of refrigerated injectable collagen syringes after injection of patient. J Am Acad Dermatol. 1992;27:959–61.
Culligan PJ, Koduri S, Heit MH, Rackley R, Thomson RB, Schwabe L, et al. The safety of reusing injectable collagen: A multicenter microbiological study. Int Urogynecol J Pelvic Floor Dysfunct. 2002;13:232–4.
Stored filler syringes
I do not store used filler syringes. There is a risk of cross contamination if accidentally injected into someone else, and the product may be contaminated after being stored.
Do not use your product
I do not save any residual fillers as there is a risk of infection during storage once its been opened. Especially since you have kept it at room temperature, more bacteria might have grown. Delayed infections can occur after the placement of your product. Do not use your product.
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Stored syringe of Juvederm
My policy is not to store filler material for my patients at the office because of the potential risk of infection and of mixing up patient samples. The fact that your syringe of material has been sitting around for nearly 1 year at room temperature makes it that much more of an infection risk. I would strongly advise against it.
Storing previously used Juvederm is not recommended
Reusing previously injected Juvederm really depends on the physician. It is generally not recommended to do this practice. I never reuse previously used Juvederm. In my opinion, Juvederm is sterilized for one time use. Injecting Juvederm later only invites an increased risk of infection whlie it sits in the stored environment. No matter where you store it, the Juvederm will accumulate bacteria and when reinjected will only increase the risk of infection. I would be careful going to a physician that does this in my opinion.
Consulting a Board Certified Facial Plastic Surgeon would be something that I would recommend. We specialize in the face and are highly qualified to help you with this.
I would not do it.
Thanks for your question.
Two main things:
First, it is not recommended to use Juvederm and then save it for future use. Although, it isn't recommended, I and many other doctors use Juvederm on our patients and then store a little remaining for a touch up or future use, but within the following 4-6 weeks. We all store the Juvederm in our offices, in the refrigerator, and will discard them after this time period. I am sure some doctors keep it longer, but 6 weeks is my maximum. The reasoning for this does include a risk of bacterial infection, but it mainly due to not putting a patient at risk for this or other possible future complications of possibly degraded Juvederm. The risk for all of this is admittedly very low, but it's just our personal policy.
Second, this syringe has been used a year ago. Although the expiration is in 2009, injecting something that has already been opened and exposed to bacteria 1 year ago is not generally wise. I understand your wish to use what you have, but I am sure that the expiration date applies to previously unopened syringes.
Ultimately the choice of using this syringe lies with you and the injector, however, be aware that there may be risks to doing so and it is not generally recommended.
Do Not Recommend Storing Syringe
I do not recommend storing syringes at all. I realize that most physicians are big-hearted and want to help their patients out, but it is probably taking on too much risk both from a health standpoint and a liability standpoint.
The expiration date on the box applies to an unopened syringe. So I would not trust this.
I used to keep the old collagen syringes up to six months and did not feel comfortable doing that. However, at least with collagen my practice was backed up by a study in The Journal of Dermatologic Surgery which showed that the material did not support bacterial growth (even if it was added) for at least a year. Until reading Dr. Weiner's answer I did not know there was a similar study regarding hyaluonic fillers.I would like to read this study and perhaps my attitude might change...but only slightly. Even if this were so, i.e. hyaluronic fillers last six months, I would still be uncomfortable injecting someone with it.
Hyaluronic acid is a polysaccharide. That means it is a sugar molecule and more prone to bacterial overgrowth than collagen which is a protein molecule.
When I have old hyaluonic acid syringes around I look at it, the material has largely dried out. I certainly would not want that injected into my face and neither should you.
Careful of Fungal or Bacterial Contamination
Juvederm and hyaluronic acids are "sugar" structures. They do not store well since bacteria and fungus love to eat and grow on sugar. Therefore, you could be injected with fungal and bacterial residue, even if it looks fine.
Collagen, a protein structure, used to be saved for reuse in the frig (on the same patient) by many physicians.
I would not recommend the same for "sugar" structures.
Safest not to use it.
Could cause a problematic infection.
Juvederm; Injecting a Used Syringe Almost One Year Later
Personally I won't inject a patient with something that has not been kept in my office. If the syringe was kept here, then I would consider using it.
The risk of possible contamination with resulting infection is not worth taking the chance of injecting fillers that have not been properly stored in a physicians office.
The risk is very small but is a possible infection
Studies have shown that Restylane can store for 9 months without leading to any increased risk of infection.
However, these were stored in a physician's office, and the needle was replaced with a clean needle before storage. I don't ever let my patients take home a portion of an unused syringe of filler.
I would not inject any syringe in which I was not sure of it's origin and storage. Just my opinion and my controlling my risks.