What’s new in facial fillers: Juve’derm Voluma XC

There are many choice for facial fillers to correct fine lines, deeper wrinkles or to add real volume to the face. Juve’derm Voluma XC is the new kid on the block as a true volume filler for the midface and cheeks. The FDA approved Voluma XC for midface filling in early 2014, which makes it a fairly new product. Voluma is still a hyaluronic acid product like Juve’derm Ultra plus XC , Restylane-L, Perylane, or Belotero to name a few. Each new product even if made of Hyaluronic acid (H.A.), like many established products, still has to go through FDA guidelines to get approved so expect to see many different spin offs of hyaluronic acid over the next few years to fit specific needs for types of filling. Hyaluronic acid (H.A.) is a fancy chemical name for something your skin is naturally made of. Hyaluronic acid (H.A.) is a form of gel (think of jello) that our collagen and cells, blood vessels and nerves travel through as part of our skin. Hyaluronic acid is also known as hyaluronan. Oddly enough, back when I was a youthful general surgery resident much of my research related to collagen and hyaluronan. Little did I realize that many years later I’d be using these hyaluronan products all the time for cosmetic improvement for my patients.

So if hyaluronan is a regular part of our skin why are there so many product options. Of course one reason is pure competition by different medical product companies for parts of the market. Competition to make better products is always a good thing. More important for you the patient is to realize that each product is slightly different to fit different purposes. Voluma, to keep the concept simple, is a thicker denser form of hyaluronan than the other Juve’derm products so it can last up to 2 years, but is also designed to be placed deeper into the tissues to create a true volumizing of the face. Voluma is not meant to be used close to the surface under an individual wrinkle like Restylane or Juve’derm might. The differing densities of the hyaluronic acid products lets one be better for a real fine line and one be better for a deeper groove, and Voluma to be better for cheek augmentation as an example. There are other products like Voluma, Radiesse as an example, that can similarly be used for cheek augmentation. Both are great products, both work well, but any given patient might want one or the other for various reason, or any surgeon may prefer using one or the other. At my office I use both routinely and like both products a great deal. For the purpose of this blog we’ll focus on the H.A. product however.

Hyaluronic acid is a hydrophilic molecule. This means H.A. wants to attract water so depending on the density of the H.A. in the gel it pulls water toward it and holds on to water while the body slowly breaks down the product over a long period of time. This hydrophilic effect is what creates some of the extra volume creation by the product. It’s all pretty cool when you really think about it. We are using a natural occurring molecule that our skin looses with aging and we put it back in specific places and with specific products to get the youthful plumpness back into the skin; pretty awesome really. By changing the cross linking of the hyaluronan and the density of the product we get different degrees of water absorption (like a sponge holding water) and different rates of breakdown of the product. That’s why Juve’derm or Restylane might be great for lip lines, the Voluma would be a bit stiffer and denser and might not feel as smooth in that location. Voluma XC is an excellent midface filler and it’s great to have another option for patients. The XC designation just relates to the product having a little lidocaine anesthetic mixed in with it so the injections are less painful and the area injected gets a little numb quickly so it doesn’t feel achy after the injection. Most injectables we use in our office already has lidocaine in the product or we add it to the product prior to injection. Another nice touch is to use a topical anesthetic before injection that also makes it a more pleasant experience than a straight injection without topical anesthesia. The price of Voluma XC varies greatly from one office to another so it’s often wise to check with a given office what they are charging so you don’t pay a great deal more than you need to. Of course, balance this against the experience of the injector and office.