Almost total Voluma absorption after only 5 weeks? What caused and does that mean hyaluronic products a no-go for me?

1 tube of filler between cheeks is not that much.  Often many syringes are need for "optimal correction."  If you diet, exercise, use medications that increase your metabolism or have alot of caffeine I have found that HA fillers do not last nearly as long.  It would be better to use other fillers that are longer lasting.  Have them injected using cannulas to limit complications.  Best, Dr. Emer.

I will attempt to answer your question from a community discussion standpoint.  Please see your own doctors in person for personalized medical advice.Much of what an injector does with fillers is an art, thus the amount, the products, the location, and the method of placement is all different.I am currently mostly a cannula injector when it comes to Juvederm Voluma and I still prefer the threading methods.  And for me, Voluma is not the only filler I use in the cheek.  I have found myself layering with Juvederm Ultra Plus XC, and also Belotero when needed for additional superficial shaping.  I used to inject this differently - using droplets of filler.  But my style changes from time to time and from patient to patient.  Thus I am speaking only from my experience, and my methods and thought process could be completely different from your plastic surgeon.  Please keep in contact with your plastic surgeon.  I think he/she would appreciate an open dialogue.  I am answering this question as a public academic exercise for myself to see how my answer compares to others and to personally build up information sheets for my own patients.  Thank you for giving me the opportunity to participate.Your comment about Voluma disappearing in about a month's period of time is a comment I hear from my own patients in my practice.  Much of the time, it isn't because they were fast metabolizers of Juvederm Voluma.  But most of the time it is due to at least these four factors:  1. The Juvederm Voluma softened over that time and lost some of it's original projection.  This almost always happens in what I've seen.  Then the Voluma spreads out and becomes more of a diffuse appearance - more rounded / less angular.  this is what I mean from the title - the Juvederm Voluma evolves over the first few weeks.2. The Juvederm Voluma, with gravity, sometimes shifts downwards.  Thus, it might get somewhat "lost" in the hollows of the cheek.  This is what I also mean from the title - the Juvederm Voluma evolves over the first few weeks.3. Some of the original swelling has gone down from the procedure itself (needles/cannulas/massaging), and thus it appears that some of the material is lost - but in fact the only thing lost is the swelling.4. Our patients sometimes gets used to the new look and had pleasantly "forgotten" the "before" look.  Thus the changes don't seem as dramatic.With all those four factors, additional Juvederm Voluma injections might solve the problem.  I have found that one syringe is useful in youthful patients with tight skin over their cheek bones.  But for most of my other patients, two syringes of Voluma helps me achieve the look (and duration) I want for my patients.  It is not uncommon for me to consider 3 or 4 syringes.You also mentioned in your question about Perlane.  The active ingredient in both Voluma and Perlane is hyaluronic acid.  If the Perlane results are still evident, this means that you are unlikely to be a rapid metabolizer of hyaluronic acid.  It sounds like from your question that you are satisfied with your Perlane results.  This means to me, even more so, that another syringe of Voluma might be your best solution before thinking of switching to a different material such as Radiesse or giving up on future Voluma injections.Calvin Lee, MDModesto, CaliforniaDisclaimer:  some of the discussion above involves off-label FDA usage of fillers.  And none of what I mentioned above is meant to be personalized medical advice.  I am just discussing a hypothetical situation posed by a person I have not examined.  Without a personalized examination, I am only guessing at possible solutions which I present above.

I am sorry to hear that your Voluma did not last.  From the areas that you mentioned, it seems that one vial is on the very low end of treatment and most likely is the cause.  Voluma is a fairly new agent in the USA.  The injection technique is unique due to its cohesive properties.  Prior to Voluma, most injection techniques employed a threading pattern, this is not the case with Voluma as it does better in small aliquots.  If you are comfortable with your surgeon, I would suggest that you go back to him or her and discuss your concerns.

The amount of filler you have had is not large and might not be enough to achieve the results you want.  It's difficult to give you an exact answer because so much depends on your age, the condition of your skin before treatment, etc.My feeling is that you probably need more filler.  The average voluma treatment I use is two syringes for midface correction alone.  Sometimes, patients need even more to obtain the results they envision.I would guess that you just need a bit more to be happy.  Talk to your plastic surgeon about this.

One syringe of Voluma may simply not have been enough for the area you wanted to fill or the amount of volume that you needed to add for best results. In many cases I use 2-3 syringes of Voluma, and may add one then more a few weeks apart so I can see how much volume I can get from one. But remember from the actual Voluma trial (where you see most of the before/after photos from) many of those people had up to 6 syringes of filler. People often don't have a good idea of how much volume is actually in a syringe or how far it will go. Small lines are easier to fill with less syringes than areas where you are trying to create actual volume. A 1cc syringe of Voluma has less than a teaspoon of material - it's just not a lot if you're trying to create a lot of volume in the central face split between two sides..... "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."