ArTIcLe | beST prAcTIce | neurotoxins
play an essential role in managing dynamic changes associated with hypertrophic muscle activity, and a range of dermal fillers can be used to reduce the appearance of static lines and folds.
Post-treatment recommendations and patient counselling post-treatment recommendations for patients receiving Juvéderm VOLUMA were similar to those for other hyaluronic acids and dermal fillers. Should a haematoma occur, it will be immediately apparent, and patients should be advised to expect bruising and discolouration a few days after treatment, and be assured that it will resolve over time. consensus participants recommended the use of ice or cryotherapy on the treatment areas for at least 10 minutes in the office after treatment. post-treatment instructions should be reviewed directly with patients and then provided in writing. Many of the participants advised conducting a telephone follow-up to provide reassurance to the patient and to uncover any potential problems. regardless, patients should be encouraged to call with any questions or concerns. They can be advised to continue intermittent use of ice for at least an additional 10–30 minutes and up to approximately half a day after treatment, but some consider this additional use of ice optional. It was agreed that patients should avoid massaging or
touching the area. patients who use arnica can continue to do so according to the instructions for the specific product(s). As a general precaution, sun exposure should be avoided, and patients should not undertake strenuous activities or exercise for approximately 24 hours. clinicians should provide patients with their usual recommendations regarding exercise after treatment with any hyaluronic acid product. patients can also benefit from sleeping with their heads elevated for 1–2 days to prevent compression of the injected areas. No specific food or dietary restrictions were noted.
Adverse events and precautions consensus meeting participants, who were all experienced users of Juvéderm VOLUMA, reported minimal adverse events in clinical practice. Although swelling was reported to be common within the first 48 hours after treatment, bruising was minimal, particularly when using the cannula technique. product migration, lumping, or infection were not reported. To reduce potential adverse events, it is recommended
that the midface and tear troughs not be treated in the same session because of the likelihood of increased
swelling. patients who are not suitable candidates for treatment should not be treated and can be reassessed later if the conditions precluding treatment are temporary. It is also important not to overcorrect, as with other hyaluronic acids. This can be avoided by careful prior aesthetic assessment, relatively conservative treatment at the first session, and subsequent re-treatment if necessary, to achieve the ultimate desired result.
Using Juvéderm VOLUMA as part of a multimodal comprehensive approach consensus participants described a variety of protocols used in clinical practice to provide comprehensive facial rejuvenation. Aesthetic evaluation of the entire face was stressed as being important in developing a comprehensive treatment plan to provide a harmonious and natural look. Specific methods depended largely on patient presentation and clinician experience. Some of the participants recommended first using a neurotoxin to reduce hypertrophic muscle activity, followed by Juvéderm™ VOLUMA™ treatment up to 1 month later. At that time, other Juvéderm products can be used to treat lines and folds. One of the benefits of that approach is to enable the clinician to assess the effect of malar enhancement with Juvéderm™ VOLUMA™ on the appearance of the nasolabial folds and periorbital area before embarking on treatment with other hyaluronic acids. The most important principle is to assess each patient as an individual and develop a tailored treatment plan4, 16
.
Summary Juvéderm VOLUMA is a smooth, highly cohesive, volumising 20 mg/mL hyaluronic acid gel indicated for the restoration of facial volume. The importance of volume loss in facial ageing and its aesthetic consequences in patients with congenital defects or HIV-associated lipoatrophy is now well appreciated. This understanding focused attention on the key role of soft tissue augmentation in facial aesthetic procedures. The properties of Juvéderm VOLUMA make it an ideal hyaluronic acid for volume restoration or volume creation in congenital defects for a number of reasons. It was designed for deeper injections with higher viscosity and robustness than that of other Juvéderm products. Initial results suggest that the effects of treatment with
Figure 6 Physician-
recommended advanced technique for injecting
Juvéderm™ VOLUMA™ with a 21- or 23-gauge needle16
26 ❚ November/December 2011 |
prime-journal.com
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