Of all the available fillers, Juvederm is easily the most recognized by our patients. Juvederm is produced and distributed by Allergan Inc®. Allergan has developed and maintained a strong direct to consumer (i.e., patient) marketing campaign including television advertisements, magazine and newspaper print, and a strong internet campaign. Juvederm XC Ultra Plus, like Restylane, is a hyaluronic acid dermal filler. It is based on a naturally occurring substance found in the cell walls of our skin, hair, and mucus membranes. Juvederm XC Ultra, like Restylane-L, does have lidocaine inside of its gel carrier, which improves patient comfort during the procedure. Juvederm XC Ultra Plus is the same parent molecule of Juvederm XC Ultra, but it has a greater degree of “molecular cross-linking”. Juvederm XC Ultra has 6% concentration of cross-linking, while Juvederm XC Ultra Plus has 8% concentration of cross linking. This increased cross-linking allows Juvederm to be much more durable. This durability translates into longer lasting results in our experience.
Juvederm is the undisputed heavyweight champion of all dermal fillers in its ability to absorb water and provide effacement of moderate and deep wrinkles. Pound for pound, Juvederm has the greatest degree of hydrophilic activity, or the ability to absorb water, as compared to Restylane, Radiesse, Belotero, etc. Juvederm is a very safe, very reliable filler that offers patients the opportunity to markedly volumize their face. Juvederm also serves a secondary role in that, because of its ability to absorb water, it serves over time to maintain moisturization of the deep dermis for months after injection. While the company cannot scientifically say that this product improves skin water volume, most master injectors agree that Juvederm does offer the skin excellent long-term secondary moisturization, especially in patients that use the product on a regular basis.
While Juvederm XC Ultra Plus is the undisputed champion at water absorption, it also has the distinction of offering next to zero tissue lift. In other words, unlike other fillers like Restylane and Radiesse, the Juvederm XC family cannot provide a lifting effect to the soft tissue it treats. It has a very low g’ value, with poor overall cohesivity and viscosity. As such, it cannot latch onto tissue and pull it up. However, it can act as an internal “water beacon”, and draw hydration into the deep dermis and subcutaneous planes, offering outstanding skin rejuvenation.
Juvederm XC Ultra Plus is incredibly useful in aesthetic plastic surgery of the face. We use it routinely in the following situations:
- Patients who want Kylie Jenner-looking lips. Look no further than Juvederm. Because of its incredible ability to absorb water, none of the other fillers can produce a pillowy looking lip like Juvederm XC. For patients that are looking to increase lip volume and produce a “wow the crowd” effect to their lips, Juvederm is again the undisputed champion. If you want Angelina Jolie lips, you want Juvederm.
- Deep inset marionette lines. For patients that have grooves in their lower face from their lips to their chin, Juvederm is an outstanding choice. Again, its ability to bring fluidity into a region allows for effacement and minimization of deep marionette lines.
- Nasolabial folds in patients without cheek descent. Some people have an empty appearing nasolabial fold even if their cheek is in perfect position. In this case, we will inject Juvederm into the nasolabial fold directly to provide a smooth, harmonious juncture between the cheek, nose, and lip area.
- Long term skin quality investment. For patients who want the ABSOLUTE BEST in dermal filler therapy, and who are willing to spend for it, we will commonly put 0.05ml aliquots of Juvederm into the moderate subcutaneous plane to provide long-term, 24-7 moisturization to the skin. Basically, in this instance, we use Juvederm as an internally injected moisturizer. For example, in patients that can afford the best plastic surgery available, we will commonly do our cheek injections with Radiesse Plus or Voluma, fill the tear trough’s with Restylane-L, and provide any other interventions indicated. Once complete, I will take 2-3 tubes of Juvederm XC Ultra, and microinject it into the moderate subcutaneous plane in a volume small enough so that it is not seen or felt. This small aliquot, however, will serve as a continuous internal moisturizer for the skin. This is also a fantastic adjunct for patients undergoing laser therapies to the face. In those patients, 1-2 weeks after laser, we will then provide full face Juvederm microinjections throughout the entire face. No question that this approach is expensive, but the long-term results are absolutely fabulous. We also commonly complex this approach with Rejuvapen microneedling. By combining internal moisturization with laser resurfacing or microneedling, we are able to produce a renewal effect to the skin on multiple levels without any significant increase in downtime. While there is no stopping Father Time, full facial microinjections of Juvederm to the face sure do slow down his effects on the facial skin.
Juvederm XC Ultra Plus is a very versatile filler, and can be used throughout the face. However, there are a number of areas where this filler should not be used:
- The lower eyelid. When Juvederm is injected into the lower eyelids, it will regularly produce an unsightly lumpiness to the skin. Avoid use of this filler in the lower eyelids.
- The cheek in patients who have a droopy cheek. Juvederm will not lift tissue. It will only volumize the area in which it is injected. As such, in patients who want a cheek lift, Juvederm XC Ultra will not effectively lift the area, but it will make you look like a chipmunk if you inject too much. For patients with cheek descent, we commonly use Radiesse Plus, or Voluma, to elevated the cheek as both of these injectables provide tissue elevation. Juvederm XC Ultra should only be used in this context as a microinjection to provide moisturization over the longer term.
Juvederm XC Ultra Plus is offered at $600 for the first milliliter injected, decreasing by $50 per milliliter to $450. Results are seen instantly, but will evolve and improve over 24-48 hours as water is absorbed into the gel. Patients will typically receive between 1-4ml per treatment.