Juvederm -How many Mls is 'usually' needed - if I get more will it actual work or are my lines too far gone for fillers? (photo)

Dear Hughjars, Thank you for your very valid question. It is very important that your face is thoroughly analyzed first by a Board Certified Facial Plastic Surgeon who is very well versed with facial anatomy and with injectible principles, before any injections take place. Namely your injector must identify your best vectors for lift (everyone's vectors vary somewhat)  in order to use Voluma in the upper cheeks to indirectly lift your marionette lines. Subsequently the marionette lines are addressed with Juvederm, as is the pre-jowl area and the lips. In my practice a case like yours would take Voluma in the cheeks and two syringes of Juvederm to the marionettes and lips together. Sculptra could be used for your pre- jowl/ pre marionette area since that is so mobile, but Juvederm works well there too. I hope this information is helpful to you.  Best of luck in your quest !Dr. Anna PetropoulosBoston's North Shore, Danvers, MA

Every patient is different and requires different amount of product, however with that said- fillers- are not substitutes for surgery-- once the skin is sagging (cheeks, jowls, neck) - a facelift/ neck lift is indicated.

Dear hughjars, Typically 1-2 mL's of Juvederm are needed to have a noticeable result in the nasolabial area (marionette lines). If the doctor distributed just 1 mL for that area, plus the upper cheeks, it is not surprising that you don't see the results. When injecting into the mid face we typically use Voluma, and patients will use 2-4 mL's just for that area. I would recommend increasing the number of syringes she uses to get the result you are looking for. Good luck!

For the upper cheeks I prefer Juvederm Voluma. It sits on the periosteum  giving more of a lift to the mid and lower face, rather than chasing lines only to lower face. You're right, your pictures do look identical, I would say on average most people require 2-3 syringes when trying to achieve a certain result.  I would question the placement, return to your injector for evaluation. #juvedermultra   #marrionettelines   #LowerfacewrinklesBe well. 

Fillers can be used to lift and create volume.  When using fillers to lift around the mouth and jawline, often several syringes of different types of filler need to be used to create lift directly and indirectly to the area.  For severe volume loss, sculptra or fat transfer may be more economical due to the increased longevity.

From the photos it appears that you definitely need more than just one syringe to make any improvement.  I would consult a board certified dermatologist who is an experienced cosmetic injections.  Best, Dr. Green

The good news is that the outcome was expected given the amount of volume loss. It is always better to start with 1 vial and not overfill, especially if this was your first session. I would return for 1-2 additional cc's. It is hoped that the doctor had this discussion with you prior to the session. Dr Karamanoukian#RealSelf100

Every patient is different. There are those that require one syringe for several areas, and there are those that require 1 or more for each individual area that requires improvement.

I think more product in the marionette lines would help, and consider a little lip filler also to better define the lip and bulk the top.  A little lip lining would improve the definition.  1 syringe is just not enough for the volume loss present.  Also, consider some filler in the mandibular (jawbone) area.

If you are getting Juvederm, then you may need up to 3-4 syringes because it is a thinner filler. However, this would not be my filler of choice for the cheeks or the marionette lines. The cheeks require a thicker filler like Voluma or Restylane Lyft. And the marionette lines do much better with Restylane, or Restylane Silk, or if they are really deep, Voluma (off label area). Without seeing more of your face in the photo, I personally would have used Restylane or Voluma in your marionette lines. Juvederm is just too thin for the depth of line I see present. "This answer has been solicited without seeing this patient and cannot
be held as true medical advice, but only opinion. Seek in-person
treatment with a trained medical professional for appropriate care."