Juvederm Voluma, Immediate Volume Restoration By Dr Manuel Pena, Naples, Florida

JUVEDERM VOLUMA Long lasting “volume restoration”

HIST0RY OF FACIAL FILLERS

• Paraffin wax injections late 1800s to mid 1900s• Fat injections late 1800s. “Revisited” late1990s• Silicon 1960s (some still going on)• Collagen (Bovine). Late 1980s/ porcine mid 2000s• Fat Grafts “Lipostructure” late 1990s• Poly-L-Lactin (Sculptra) is a Stimulator not a Filler. early 2000s• Polyalkilamide Microspheres (Artefill) semipermanent 1990s• Calcium hydroxyapatite (Radiesse) mid 1990s• Hyaluronic Acid early 2000s

AUTOLOGOUS FAT GRAFTS

• Benefits over injectibles:• “unlimited/ generous donor volume”• Theoretically “permanent” (natural facial volume loss

continues)• Naturally replaces what was lost (your own fat!)

• Benefits of injectibles over fat:• Does not require a surgical procedure• Fat grafts can be “unpredictable”

“SCULPTRA” POLY-L-LACTIC ACID

•Not a filler• “stimulates” collagen• Takes 4-6 weeks for effect•Usually takes 2-4 “sessions” to achieve full correction• Last 2-3 years!• “stimulatory effect” varies from individual to individual

HYALURONIC ACID

•Original use in United States was in orthopedic surgery. Used to replace the cushion in joints especially the knee joints. Injections last between 6 months and 1 year and can be repeated several times

HYALURONIC ACID

• Restylane/Perlane• Hydrelle (Off market)• Juvederm/ Juvederm Plus• Belotero• Prevalle • Hyalaform• Juvederm Voluma Late 2013• Etc.,etc.,etc.

CHANGES IN AGING FACE

• Volume loss FatBone skeletal remodeling Dermal thinningMuscle thinning? controversial

• Elasticity losslines and crease become permanent

• Changes in skin texture and dyschromias

THE OGEE CURVE IN MIDFACE ENHANCEMENT

The typical youthful midface follows the shape of an ogee curve.1

With age, the midface flattens, and the skin may begin to sag.2

Restore the ogee curve for a more youthful look.1

1. Swift and Remington. Clin Plast Surg. 2011

1

BOTOX VERSUS FILLERS

• Botox relaxes the muscles that cause the overlying wrinkles

• IT DOES NOT FILL! Can use a filler on wrinkle afterwards if still present

• Primarily used for wrinkles and lines in upper ½ of face

crow’s feet

frown lines (elevens)

transverse forehead lines

• Can be used around mouth

“smokers lines”

elevates corners of mouth, softens chin dimples

HYALURONIC ACIDS FOR LINES

• Juvederm Ultra XC (XC means it has lidocaine in it)my favorite and most versatile filler

• Juvederm Ultra Plus XC (thicker)• Restylane (I use this in hollows of eyes/tear troughs)• Perlane (thicker)• Belotero Balance (fine lines).. Short lasting

HYALURONIC ACIDS FOR VOLUME

• Juvederm Volumamore elaborate cross linkingmore “push”results up to 2 years

LIFT THAT LASTS

Responder Rates Through 2 Years2

As Assessed by Evaluating Investigator

1. JUVÉDERM VOLUMA™ XC Directions for Use, 2013; 2. Data on file, Allergan, Inc.

67.1% of patients maintained a clinically significant response through 2 years with optimal treatment1,2

JUVEDERM VOLUMA

• For volume enhancement in the cheeks• For the “Apple”• For the “Apex”• For the “Hollow”

•Not for lines and wrinkles •Not for subdermal or intradermal injection•USE THIS DEEP!

Regions of the Midface

ASSESS │ INJECT │ MAXIMIZE

VISUAL EXAMINATION OF THE MIDFACE

• Concavity

• Prominence of bony landmarks

• Visibility of musculature

• Flattening of the cheek regions

CHARACTERISTICS OFVOLUME LOSS

A FAMILY OF FILLERS FORMULATED FOR DIFFERENT FACIAL AREAS

JUVÉDERM VOLUMA™ XC injectable gel is indicated for deep (subcutaneous and/or supraperiosteal) injection for cheek augmentation to correct age-related volume deficit in the midface in adults over the age of 21.

JUVÉDERM® XC injectable gel is indicated for injection into the mid-to-deep dermis for correction of moderate to severe facial wrinkles and folds (such as nasolabial folds).

HOW MUCH VOLUMA?

•Average correction is 2.3 ccs• Immediate results •Not Hydrophilic/ minimal post procedure edema•Fill to correction. No need to undercorrect

TOO MUCH VOLUMA?

Or in undesirable position?

Hyaluronidase! The “ERASER”

One of the few things in life that we have… “do overs”

VOLUMA MALAR FILLING

ACHIEVE A MORE YOUTHFUL LOOK

Unretouched photos of paid model taken 1 month after treatment. A total of 3.5 mL of JUVÉDERM VOLUMA™ XC was injected into the zygomatic arch, anteromedial cheek, and submalar region.

In the clinical trial, the total volume of JUVÉDERM VOLUMA™ XC injected ranged from 1.2 mL to 13.9 mL, with a median of 6.6 mL, to achieve optimal correction for all 3 subregions.1

Before After 1 month

1. JUVÉDERM VOLUMA™ XC Directions for Use, 2013.

Individual results may vary.

ACHIEVE A MORE YOUTHFUL LOOK


Unretouched photos of a different paid model taken 1 month after treatment. A total of 4.8 mL ofJUVÉDERM VOLUMA™ XC was injected into the zygomatic arch, anteromedial cheek, and submalar region.


After 1 month


Before

JUVÉDERM VOLUMA™ XCVOLUMIZETHE MIDFACE● Zygomatic arch● Anteromedial cheek● Submalar region

JUVÉDERM® XCFILLWRINKLES & FOLDS Nasolabial folds Vertical lip lines Oral commissures Marionette lines


Unretouched photos of paid model taken 1 month after treatment. A total of 8.6 mL ofJUVÉDERM VOLUMA™ XC was injected into the zygomatic arch, anteromedial cheek, and submalar region.A total of 1.0 mL of JUVÉDERM® Ultra XC was injected into the NLFs. A total of 3.3 mL of JUVÉDERM® Ultra Plus XC was injected into the NLFs, marionette lines, and oral commissures.







Unretouched photos of paid model taken 1 month after treatment. A total of 7.8 mL ofJUVÉDERM VOLUMA™ XC was injected into the zygomatic arch, anteromedial cheek, and submalar region.A total of 1.9 mL of JUVÉDERM® Ultra XC was injected into the NLFs and oral commissures. A total of 3.6 mLof JUVÉDERM® Ultra Plus XC was injected into the NLFs, marionette lines, and oral commissures.





Unretouched photos of paid model taken 1 month after treatment. A total of 3.8 mL ofJUVÉDERM VOLUMA™ XC was injected into the zygomatic arch, anteromedial cheek, and submalar region. A total of 0.7 mL of JUVÉDERM® Ultra XC was injected into the oral commissures. A total of 3.4 mL of JUVÉDERM® Ultra Plus XC was injected into the NLFs, marionette lines, and oral commissures.



CONSIDERATIONS FOR THE MALE MIDFACE1

Compared with the female cheek, the male cheek has…

• More anteromedial fullness

• A broader-based malar prominence

• An apex that is more medial and subtly defined

ASSESS │ INJECT │ MAXIMIZE

1. Swift and Remington. Clin Plast Surg. 2011.

THANK YOU!

Juvederm Voluma, Immediate Volume Restoration By Dr Manuel Pena, Naples, Florida

Health & Medicine

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