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Juvederm is one of the members of the “hyaluronic acid” (HA) filler category. All of the members of this category, i.e. Juvederm, Restylane, Perlane and Belotero, are all very similar. Except for a few minor differences, information about each member of this group can often be applied to all of the members of the group. Hyaluronic acid is a clear gel that is found throughout the human body and has a variety of functions to keep tissues properly hydrated and to keep joint surfaces lubricated. For this reason, the material is very compatible with our tissues, and problems with a reaction from an HA injection are very rare with Juvederm.
Best areas to treat with Juvederm:
Juvederm (and the other hyaluronic acid fillers) are excellent at treating the lips and lower eyelid areas. Many providers including myself use it for the very first line in producing fuller, more beautiful lips. Juvederm is also excellent at treating other areas of the face, though they don’t last as long as Radiesse or Artefill.
Erasing Juvederm with hyaluronidase:
There is one feature of the hyaluronic acid fillers that is unique and can be very helpful: They can be erased by injecting an enzyme called hyaluronidase. This causes Juvederm and the other HA fillers to quickly break down and the filler effect disappears within days. It’s very rare to need to remove fillers but this feature may be comforting for patients who are very conservative or even nervous about trying a filler for the first time.
When it’s maybe best to not use Juvederm:
Juvederm is a great filler, but it is one of the shortest acting fillers, with a longevity of 4-6 months in most areas, or up to a year in the lower eyelid regions. Also, if a large amount of volume is needed, then the most effective cost option may not be Juvederm. San Francisco is a region where some patients may need more volume due to ‘facial wasting’ which is common in HIV patients. For large areas such as sunken cheeks, an option like Sculptra will be a better value – it might take many syringes of Juvederm to fill the cheek areas in this type of patient.
Also, Juvederm is not best for the finest lines of the face. Filling fine lines requires a filler to be very superficial, and only Belotero is safe to inject right into the most shallow layers of the face. Juvederm, Restylane and Perlane can all cause a bluish hue (called the “Tyndall” effect) when injected superficially, so they are better suited for regions other than fine lines.
Keeping patients comfortable:
Juvederm treatments are very well tolerated in my office, with most patients reporting a pain level of 3-4 on a scale of 1 to 10. For the lip areas, commonly doctors will use topical anesthetic. More aggressive measures like injecting a local anesthetic “block” (like a dentist does) are very rarely necessary. There is some mild discomfort with the short 5-10 minute treatment, but patients routinely do very well keeping comfortable during the procedure.
Downtime & bruising with Juvederm:
Downtime with Juvederm treatments is very acceptable. In most areas of the face, bruising can happen (30-40% of patients get some minimal bruising) but this usually resolves in 3-5 days. Bruising is more common in undereye circle treatments with Juvederm, and can happen in as many as 70-80% of patients.
Difference between Juvederm Ultra and Juvederm Ultra Plus:
Juvederm treatments come in two different types, Juvederm Ultra and Juvederm Ultra Plus. They are extremely similar, though Juvederm Ultra is a bit thinner and flows a bit better. This allows Ultra to be used in thin areas such as the ‘white roll’ (the fine white line around the lips) and the thin skin regions of the lower eyelids. Juvederm Ultra Plus may last a bit longer, and is useful in the lips, smile lines, and other regions.