Juvederm plus should not be injected above the mid-dermis. If done os, it can cause a strange blue appearance due to the Tyndall effect.
Juvederm is meant for the mid to deep dermis for best effect and Juvederm Ultra Plus for areas the require a more substantial lifting. Thus Juvederm Ultra Plus should be injected in the deep dermis and subcutaneous tissue.
It all depends where you need it
Dermal fillers, such as Juvederm, can be injected in many places. The goal is to injected in the correct plane for the specific application. If you inject too superficial, then it is visible through the skin. If you inject too deep then you really do not notice a difference and it is metabolized by the body faster. This is why it is important to have it injected by someone with experience.
Juvederm can be injected in different layers of the skin
Depending on the goals of the treatment it can be injected SUPERFICIALLY in the upper dermis for line filling such as around the mouth or lip lines OR deep for treatment of folds or for volumizing of the cheek bones, in the casses we usually use Juvederm Ultraplus.
Can be injected at multiple levels
Juvederm can be used at multiple levels in the facial tissues. It can be injected right on top of the facial bones to add fullness and correct indentations such as the tear trough deformity ( the indention right below the eye) or in the fatty tissue of the cheeks ( to help restore fullness) . It can also be used in the deep dermis (the deepest layer of the skin itself) to help correct fine lines. It should not be used in the most superficial layers of the skin, however, where it can be visible.
Juvederm in Skin or Under Skin
It is in the deep part of the skin but not under the skin. It should not be in the superficial part of skin or can leave a blue colored line.
The medical terminology for this area is 'Deep Dermis'
Depth of Juvederm injection beneath the skin
It really depends where you are injecting it, what your goals are, and what product you are using such as Juvederm Ultra or Ultra Plus.
In the tear trough area, many physicians prefer a deep injection to avoid visiblity. In other areas such as cheek enhancement injections are also at a deeper level.
However, around the mouth, injection on a more superficial layer immediately beneath the skin is desireable.
Juvederm and Injection Depth
The skin has 3 layers: the epidermis (which is the pigmented skin), the dermis and then the subq. Juvederm is typically injected in the dermis.
So it is skin in the skin technically, just one layer of the skin. It can also be injected in the superficial subq, but its results are less dramatic and go away faster.
The filler is usually injected just below the skin but can also be injected deeper and a little less deep- layers. It depends where it is injected and what is required.
I try to keep it at the deep dermis or just below the dermis for the best effect. If injected to superficially, it may be easily visible and palpable.
Like Goldilocks, it must be just right!
Juvederm should never be injected above the mid-dermis. This would result in the Tyndall effect: bluish papules or lumps under the skin.
It can be correctly injected into the mid-deep dermis, in the subcutaneous plane, or just above the bone, very deeply to augment the cheeks. A well- trained, core aesthetic physician with knowledge of anatomy, HA fillers, and a good artistic eye will know exactly where YOU need it.