Juvederm Dissolved Within 7 Days?

Question

I have had almost 2ml Juvederm Ultra 4 injected in my marionette and nasolabial lines to miraculous effect. The day after (once the swelling had subsided) I was completely thrilled with the results. With every passing day, however, the results declined - and where originally I could feel the "pockets" of filler like a thickening under my skin - this was completely dissolving. Seven days now, and not a trace left. Pictures before and after filler are identical. What happened?

Harold J. Kaplan, MD · Answer

Hi Diva.  Juvederm typically lasts 6-8 months when injected into the nasolabial folds.  In many cases, patients mistake the initial swelling for actual product. 

	It's highly unlikely that the product has dissolved, rather it's much more likely that the welling subsided.  Your concerns are exactly the reason we schedule a 2 week check up with every injection patient.  We want to be able to see the effects and remind patients of previous discussions.

	It's possible that you need more than 2 mL.  We see that very often when treating both the basolabial and marionette lines.

Kenneth Hughes, MD · Answer

Juvederm should not dissolve after 2 weeks, no matter what variant.  It is possible that the Juvederm was diluted to a great extent and much of the original volume is gone.

Sam Naficy, MD, FACS · Answer

There are 2 forms of Juvederm. Ultra and Ultra Plus. Ultra is softer and may breakdown faster however 2 weeks sounds unlikely. What happens as the product hydrates after a few days it is softer and you may not be able to feel it, as you could when it was first injected. If you did not have the Ultra Plus you could consider it the next time. It is a more robust product and will give more "lift" and last longer.

Steven H. Williams, MD · Answer

Thanks for your question.  Sorry to hear that you haven't had a more positive experience.  Juvederm is a hylauronic acid filler that softens non-dynamic (think wrinkles not caused by muscles) wrinkles.  Typically patients experience some swelling post-treatment that can last anywhere from a day or two to a week.  Usually after this swelling subsides patients have a stable improvement in their wrinkles for anywhere from 6 months to a year.

	It is a little unusual that you don't seem to have lasting results.  Sometimes variations in metabolism or depth that the product was injected can make the length of improvement vary.  Certainly a week is too quick.  Talk to your injector and review the photos.

	I hope this helps.

Paul S. Nassif, MD · Answer

In general, Juvederm will last an average of 6-7 months, and sometimes longer depending on the patient. The initial result you noticed could be due to swelling, as there is no way the product would dissolve within a week. Your injections may have been performed improperly. I would recommend visiting your provider and communicating the issue with him or her. I hope this helps, and I wish you the best of luck.

Steven Wallach, MD · Answer

Juvederm does not disappear after a week. I can not offer a resolution to your problem because I did not do your procedure and I have not seen you before or after your procedure. Best to ask your doctor.

Stephen M. Lazarus, MD · Answer

Hi,

	
		Is it possible that you've mistaken the diminishing early post-injection swelling with the absence of product?
	
		Did you get the "real" product? I always purchase the product directly from the Allergan company. I show my patient the sealed and expiration dated package before opening it.
	
		Was the Juvederm placed in the proper location? If placed too deep it will not be effective.
	
		Return to your provider for a follow-up, Juvederm doesn't dissolve that quickly.


	Thanks for your question and good luck!

Steven Swengel, MD · Answer

Juvederm is a great product and should remain in place for 6 months or more. The fact it disappeared so quickly makes me suspicious it was placed too deeply. When placed in the dermis it stays. When into the fat it dissipates quickly. There ar those with 'heavy' cheeks and deep melolabial folds who are not good candidates for HA fillers in those folds as the depth and the force vectors will not allow HAs to remain in place

Benjamin Barankin, MD, FRCPC · Answer

It is essentially near impossible for real Juvederm to have dissolved so quickly as you describe. Certainly everyone metabolizes Botox and fillers like Juvederm or Restylane at different rates, but 1 week would be unprecedented...presumably you saw a dermatologist or plastic surgeon who properly injected you with real Juvederm and at the right depth.

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