Juvederm Use (and Misuse)

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Juvederm Use (and Misuse)

Richard O.Gregory, MD

Juvederm®, Hyaluronic Acid (HA), is Allergan’s filler approved in June 2006 for fine wrinkles and folds of the face. Any other use for it would be considered off label. Although it is not approved for any other use it is used widely (and safely) in other areas, but clearly this introduces other liability considerations. Although introduced in two forms, Juvederm Ultra and Juvederm Ultraplus, the latter being more crosslinked in order to create more stability, recently Juvederm Voluma was approved by the FDA and released for deep filling of facial atrophy, typically in the malar or cheekbone area.
Hyaluronic acid is a humectant (it attracts water) that normally is found in small quantities in the body, primarily in the skin but also in the joints as a lubrication and in other areas. It is reported that Hyaluronic acid can stimulate collagen production and increase the stability of native collagen in the skin. Juvederm HA is bioengineered (grown in a vat) by gram positive bacteria and then concentrated and purified for use in humans.
Juvederm is safe and effective when used appropriately as in the shallow creases of the midface and lips. There are risks and side effects mentioned below as with any treatment. It reportedly lasts up to 12 months (Juvederm Voluma may last up to 2 years, but keep in mind that its recommended use is different than Ultra and Ultraplus and should not be used interchangeably.)
Juvederm filler (as well as other injectable materials) can cause problems if used inappropriately. Bruising is sometimes seen especially in patients who have recently used aspirin as well as other blood thinners. Lumpiness can occur and is seen if injected very shallow in collections or aggregations. Precise injection techniques and "micro" massage may help prevent these aggregations. Recently, it was reported that intravascular injection of filler can cause blindness and ever death although this is extremely rare. Most of these complications or side effects can be minimized or avoided and easily managed if detected.
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Orlando Plastic Surgeon