ArTIcLe | beST prAcTIce | dysmorphic disorder as such patients are also
unsuitable for treatment. The Juvéderm VOLUMA Instructions for Use
recommend that the product should not be used in sites previously treated with permanent implants, as more data are needed to confirm the safety of this clinical scenario17
.
The product is not indicated for patients who are pregnant or lactating, or those who have other conditions that contraindicate treatment. This includes patients with a tendency to develop hypertrophic scars, those with known hypersensitivity to HA, or patients whose skin exhibits inflammation and/or infection, such as acne or herpes.
Facial treatment areas Juvéderm VOLUMA is indicated for facial volume restoration and is not intended for more superficial use or where other Juvéderm products would be more suitable, such as the tear troughs, lips, or glabella areas23
. consensus
recommendations for the use of hyaluronic acid dermal fillers in these areas have recently been published1
. The
primary treatment sites for Juvéderm VOLUMA are the malar area and the chin. Volume loss in these areas becomes apparent with ageing, and volume restoration can provide results with a long duration and highly satisfactory outcomes.
A 55-year-old woman with facial volume loss This 55-year-old woman presented for aesthetic evaluation and recommendations for treatment (Figure 4a). before treatment, the patient’s aesthetic appearance was typified by the loss of the inverted triangle and the ogee curve in the malar area (Figure 4b). Malar volume loss is particularly apparent in the profile views. After discussion of treatment options and expected results, the patient received 2 mL/ side of Juvéderm VOLUMA. Figures 4b–4d demonstrate the results 3, 12, and 22 months post-treatment. Treatment with Juvéderm VOLUMA provided substantial volume restoration and helped restore the triangle of beauty. The results had a long duration with improvements in volume remaining apparent after 22 months post-treatment. These results are consistent with the physicochemical properties of the products and are particularly noteworthy as the ageing process and loss of volume would be expected to continue in an untreated woman of this age. Furthermore, the patient was very satisfied and returned every 6 months for botulinum toxin type A treatments of her upper face. She has received no additional hyaluronic acid treatments since Juvéderm VOLUMA. Other appropriate areas for treatment include the
jawline and pre-jowl sulcus. Some experienced clinicians inject a small quantity of Juvéderm VOLUMA at the very superior fold of the nasolabial areas. In general, however, the consensus participants preferred other members of the Juvéderm family for treating the nasolabial folds, temporal hollow, tear troughs, nose, and marionette lines. It was suggested that Juvéderm VOLUMA may prove valuable for rejuvenation of the hands, but further research is warranted to support its use in areas outside the malar region and chin. It was recommended that new users begin by initially restricting
22 ❚ November/December 2011 |
prime-journal.com Table 3 Results of the GAIS (n (%)) GAIS Rating 3
Very much improved 17 (81) Much improved Improved No change Worse
2 (9.5) 2 (9.5) 0 (0) 0 (0)
6
17 (81) 4 (19) 0 (0) 0 (0) 0 (0)
Time (months) 9
16 (76.2) 5 (23.8) 0 (0) 0 (0) 0 (0)
12
11 (52.4) 5 (23.8) 4 (19) 1 (4.8) 0 (0)
GAIS = Global Aesthetic Improvement Scale. Very much improved = optimal cosmetic result for the implant. Much improved = marked improvement in appearance, but not completely optimal for this patient; a touch-up would slightly improve the result. Improved = obvious improvement in appearance, but a touch-up or retreatment is indicated. No change = the appearance is essentially the same as the original condition. Worse = the appearance is worse than the original condition. Repeated measures comparison of time points: P>0.05 (Friedman’s test).
Source: Bechara et al15
Table 4 Patient selection: candidates for Juvéderm™ VOLUMA™ treatment
Potential candidates*
n Age-related facial volume loss (>18 years of age)
n Weight loss-associated facial volume loss
n HIV-associated lipoatrophy n Congenital anatomical defects: • Parry-Romberg syndrome • Maxillary hypoplasia
n Patients with sequelae of hemifacial paralysis
n Patients wishing to avoid surgical facelift
n Patients of any skin colour (Fitzpatrick I–VI)
Potential exclusions n Patients <18 years old
(aesthetic indications only)
n Older patients with substantially thinned skin (injections must be very deep or in combination with Juvéderm™ Ultra)23 n Patients with body dysmorphic disorder or unrealistic expectations
n Patients with very high cheekbones; round, big visage; or heavy, drooping skin n Patients with previous permanent implants
n Patients with specific contraindications to the product as specified in Juvéderm™ VOLUMA™ Directions for Use17
(e.g. pregnant,
lactating, tendency to develop hypertrophic scars, those with known hypersensitivity to HA, or patients whose skin exhibits inflammation and/or infection, such as acne or herpes)
*Patients of any age unless otherwise specified
treatment to the lateral portions of the malar area and chin, with the goal of achieving a smooth, natural aesthetic balance. Overall, it is essential to understand facial anatomy and formulate an overall treatment plan that considers the aesthetics of the entire face. Juvéderm VOLUMA can be used in combination with other Juvéderm products as well as with bOTOX® cosmetic to provide optimal outcomes1, 2, 5, 23
.
Procedures and protocols Pre-treatment: evaluation, counselling and preparation before treatment, taking a complete patient history to uncover the full details of previous aesthetic treatments and potential contraindications to treatment is essential. This is the time to fully explore the patient’s expectations and ensure the patient’s complete understanding of the benefits and risks of a variety of treatment choices, to select from the range of options, and to develop a comprehensive treatment plan. Standardised
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