ArTIcLe | beST prAcTIce |


Table 1 Physical and chemical properties of the Juvéderm family of products Juvéderm® ULTRA 2


Juvéderm® ULTRA 3 Property Total HA concentration


(Juvéderm® ULTRA; Juvéderm 24HV)


24 mg/mL


High molecular weight HA Major component Degree of crosslinking Indications/primary uses


≈6% HA = hyaluronic acid; NLF = nasolabial fold. product is of higher viscosity than other Juvéderm


products (Table 1). Juvéderm VOLUMA, which is also homogenised during production, maintains the cohesivity and gel structure typical of the Juvéderm family of products (data from Allergan, Inc.). Thus, Juvéderm VOLUMA is both highly cohesive and viscous, two properties that are essential for an effective volumising agent. These properties of Juvéderm VOLUMA may


distinguish it from other products used for volumisation in clinical practice. For example, product mobility and lumpiness at the injection site have been reported with restylane SubQ14


24 mg/mL


Major component ≈8%


Lips, NLFs, superficial lines Deeper lines and folds Juvéderm® ULTRA 4


(Juvéderm® ULTRA PLUS; (Juvéderm 30) Juvéderm 30 HV)


24 mg/mL


Major component ≈6%


20 mg/mL


Minor component < 5%


Areas with minor volume Facial volume restoration loss or requiring greater lift (e.g. severe or extreme NLFs)


Data on file, Allergan, Inc results of the GAIS at 1 month and 6–18 months


post-treatment revealed that the majority of patients were very much or much improved; 98% at 1 month and 81% at the 6 and 18 month assessments (Table 2)4


. Nearly . Additionally, Juvéderm VOLUMA


retains the important properties of reversibility and resorbability, which differentiate it from calcium hydroxylapatite and poly-L-lactic acid, also used for volumising (data from Allergan, Inc.). collectively, the attributes of Juvéderm VOLUMA make it an ideal agent for volumising and contouring larger areas of the face, such as the malar region and the chin.


Literature review To the knowledge of the authors, clinical results with Juvéderm VOLUMA have been reported in two published clinical trials to date.


Retrospective aesthetic trial based on the results of a retrospective analysis of 102 patients, Juvéderm VOLUMA has shown to be effective and safe as a treatment for restoring facial volume4


. The


patients in this study were primarily female (n=93), who received midfacial injections of Juvéderm™ VOLUMA™. The injected dose of Juvéderm™ VOLUMA™ was based on the degree of volume loss (Figure 3)4


. Most injections


were in the central and lateral midfacial region (submalar/ subpalpebral and malar areas). The mean total volume of Juvéderm VOLUMA injected was 4 mL (range, 2–8 mL). The investigator’s assessments of the aesthetic benefits were based on the five-point Global Aesthetic Improvement Scale (GAIS: 1=very much improved; 2=much improved; 3=improved; 4=no change; 5=worse)15


.


Assessments were based on evaluated pre- and post-treatment standardised digital photography. patients also rated effectiveness on a five-point scale (1=very good; 2=good; 3=not very good; 4=quite bad; 5=very bad).


20 ❚ Juvéderm


VOLUMA was designed to be


more viscous and robust than other products in the


Juvéderm family. It is therefore highly suitable for deep injection and


volumising. November/December 2011 | prime-journal.com


all patients (98%) noted that they would recommend the treatment to friends. The vast majority also felt that the treatment was beneficial and helped them feel more attractive, better about themselves, and more confident. The nine adverse events that occurred in eight of the 102 patients (8%) were temporary. They included swelling (n=1; 1%), haematoma (n=3; 3%), over-correction (n=4; 4%), and hypersensitivity (n=1; 1%). Haematoma was considered to be related to the procedure, and the other events were deemed to be associated with the product. Overall, Juvéderm VOLUMA was well tolerated.


Prospective trial in HIV-associated lipoatrophy The use of Juvéderm VOLUMA to treat HIV-associated lipoatrophy was investigated in an open-label study of 21 males who had at least a moderate degree of lipoatrophy16


.


The product was injected into the buccal, malar, and/or submalar areas. The total duration of the study was 12 months. Global improvement on the GAIS, patient satisfaction, quality of life, and safety were assessed. based on an evaluation of pre- and post-treatment


standardised digital photography, 90.5% of patients were very much or much improved on the GAIS 3 months after treatment (Table 3)16


. Note that at 6 and 9 months, of the


patients evaluated, 100% were very much or much improved, and at 12 months, approximately 76% of patients retained this level of improvement. The mean total volume of Juvéderm VOLUMA injected was 5.3 mL ± 1.5 mL (range, 3–8 mL). In addition, patients exhibited statistically significant (P<0.05) improvements on a number of the quality of life assessments after treatment. These included improvements in aspects of daily living activities, symptoms and feelings, leisure, work and school, and personal relationships. Most patients (90.5%) stated that they would recommend this treatment, and 95.2% rated the treatment as beneficial. Adverse events were transient and included mild erythema (38%), swelling (19%), and discrete bruising (19%). None of the events were severe16 The results of the two trials, as well as the collective


.


experience of the consensus participants, indicate that the clinical effect of Juvéderm VOLUMA can be expected


Juvéderm® VOLUMA™


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