Juvaderm, or more correctly, Juvederm, is a gel made from hyaluronic acid - a natural substance in the skin which helps to hydrate and add volume to the skin. Hyaluronic acid is the main component of the extracellular matrix, i.e., tissue which provides structural support to your cells. Hyaluronic acid gives tissue the ability to resist compression by providing a counteracting turgor (swelling) force by absorbing a lot of water. Juvaderm (or Juvederm) is made by a company called Allergen, Inc., a global pharmaceutical company based in Irvine, California. The company is listed on the New York Stock Exchange. It earns revenues totalling US$3.9 billion during the 2007 financial year. Allergan’s manufacturing plants are located in cities such as Waco in Texas, Westport in Ireland and San Jose in Costa Rica. The company also manufactures other popular products such as Botox, a neurotoxic protein which temporarily smooths frown lines.

On 5 June 2006, the U.S. Food and Drug Administration (FDA) first approved the Juvaderm/Juvederm dermal filler gel family of products. These gels represented a ‘next generation’ of hyaluronic acid dermal fillers that provide a smooth and long-lasting correction of facial wrinkles and folds. About 4 months later, on 26 September 2006, Allergan announced the launch of two new products, Juvéderm™ Ultra and Juvéderm™ Ultra Plus. But the product was not to be made available to the nation just yet. It was made available on a selective basis, through “experience” trials conducted by physicians with expertise in facial aesthetics. The Juvaderm/Juvederm experience trial involved physicians testing the Juvaderm products on willing participants at a various centers. The experience trial was designed to gain relevant information on physicians’ use of Juvéderm™ Ultra and Juvéderm™ Ultra Plus and evaluate the persistence of and patient satisfaction with the products in daily clinical practice. Juvéderm™ Ultra and Juvéderm™ Ultra Plus became available nationwide in the U.S. on 17 January 2007.

On 26 June 2007, Allergan announced that the FDA had approved label extensions for its Juvaderm/Juvederm products. The approval was given based on new clinical data which demonstrated that the effects of both Juvéderm™ Ultra and Juvéderm™ Ultra Plus could last for up to 1 year, which was longer than reported in clinical studies which supported FDA approval of other hyaluronic acid dermal fillers. This result generated a favourable response from both patients and physicians alike as many want fillers that are long-lasting and still reversible – now people could obtain a natural look that could still be adjustable over time as the face changed with age. Such features were not so readily available with the existing semi-permanent or permanent products in the market.

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What is the cost of Juvaderm? A Juvaderm treatment will cost from US$500 to US$1500 per treatment. This means you will get 1 pre-filled syringe of Juvaderm which you may or may not finish using in a session. Note that sometimes patients may use 1 to 2 syringes at a time.

As with pricing of any good, the exact price will depend on your doctor and the location of treatment. Generally, you may have to pay more in larger cities. However, a cautionary note: If you are offered a Juvaderm treatment at an exceedingly low price, it would be advisable to exercise a certain degree of caution to ensure that the substance you are paying for is actually Juvaderm.

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Juvaderm may not be right for you if you:

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Juvaderm is the only hyaluronic acid dermal filler developed using the proprietary Hylacross™ technology, an advanced manufacturing process resulting in a malleable gel that flows easily into the skin and creates a smooth natural look and feel. All other hyaluronic acid dermal fillers currently on the market are typically gels of granular consistency.

Juvaderm is made from non-animal dermal fillers. No allergy test is required when you opt for Juvaderm. Some other fillers are made from animal substances such as bovine collagen. Animal-based products pose increased risk of allergy to certain patients. For example, skin tests are required prior to use of bovine collagen-based fillers to screen out the approximately 3-5% of persons who are sensitive, or allergic, to it.

Allergan’s proprietary Hylacross™ technology also provides a high concentration of cross-linked hyaluronic acid. This enhanced the gel’s stability and resistance to degradation by heat and the body’s metabolism – resulting in longer-lasting treatments. Juvaderm has been established to be effective for up to 1 year. Some fillers last up to 6 months.

Juvaderm is the first hyaluronic acid dermal filler that has demonstrated its safety and effectiveness in persons of color. There were no increased risk of hyperpigmentation or hypertrophic scarring in patients of color.

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Juvaderm helps you to soften the fine lines, smoothen wrinkles and restore lost volume on your face. It may also help you minimise the appearance of thinning skin and lips. Popular areas of concern are places such as your “smile lines” (i.e. the nasolabial folds - the 2 skin folds that run from the side of your nose to the corners of your mouth), your “crow’s feet” (wrinkles in the outer corner of the eye), lips and cheeks. Other areas of possible concern may also include forehead lines, frown lines, brow droop, tear troughs, bunny lines, vertical lip lines, lip definition, marionette lines/jowls (mouth frown), lip volume, mental crease (chin wrinkles) and neck lines.

With its proprietary, technologically advanced manufacturing process, Allergan has made Juvaderm a smooth, malleable gel that flows easily into your skin, thus giving you a smooth, natural look and feel. The gel’s malleability offers the physician a high level of control for facial contouring. Further, the smooth consistency of the formula also helps to minimise the discomfort that can sometimes occur during the injection procedure. All other hyaluronic acid dermal fillers utilize a gel particle suspension formulation – this does not accord the same benefits that Juvaderm does.

In addition to the gel’s malleability, Allergan’s proprietary technology has also enabled it to produce a gel with the highest concentration of non-animal and cross-linked hyaluronic acid of any dermal filler during its time. Such high cross-linkages increase the lifespan of the gel in the body, thus helping Juvaderm establish an effective period of up to one year with a single treatment. This represents an important attribute to patients and physicians alike, as most of them want fillers that are long-lasting and reversible – such fillers can provide a lasting natural look and yet still be adjustable over time as the face changes. Fillers without such cross-linkages, such as those semi-permanent or permanent products do not accord such flexibility as the face changes.

Juvaderm comes in different strengths, giving physicians the flexibility to customise each treatment to a patient’s particular need. Juvederm™ Ultra is a highly cross-linked formulation for more versatility in contouring and volumizing facial wrinkles and folds; Juvederm™ Ultra Plus is a more highly cross-linked, robust formulation for volumizing and correction of deeper folds and wrinkles.

Juvaderm has been demonstrated to be safe and effective in patients of all skin types and colors. There were no increased risk of hyperpigmentation or hypertrophic scarring in patients of color.

Hyaluronic acid content in Juvaderm has also been shown to stimulate collagen production. Collagen has great tensile strength, and is the main component of skin. It plays a role in tissue development, as well as skin strength and elasticity.

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Minimal recovery or downtime. As the injection procedure takes only about 15 minutes, you can go for a Juvaderm procedure and return home within the same day.

During the first 24 hours after treatment, you should avoid strenuous exercise, excessive exposure to sun or heat and consumption of alcoholic beverages to minimise the risk of temporary redness, pain, firmness, swelling and itching. Deeper injections may result in the injected area experiencing such effects for up to a week.

You may experience some temporary inflammation after your Juvaderm treatment. When you are injected with Juvaderm, your body interprets the injection as a “trauma”. The immune system’s natural reaction is to send phagocytes to the injected area to fight and prevent infection. This may cause inflammation. An ice pack may be applied temporarily if swelling does occur at the injection site. You could also take an anti-inflammatory medication such as Advil.

Clinical studies have shown that adverse events were usually mild to moderate in nature. The most common side effects occurred at the injection site – these include temporary redness, tenderness, firmness, bruising and swelling. However these side effects did not require intervention and usually lasted only up to seven days.

Side note: Dermal fillers, as a group (not specifically to Juvaderm), have been receiving negative press recently. On 18 November 2008, external advisers to the Food and Drug Administration (FDA) in the U.S. said that current labelling information on such products were inaccurate. Current labels depicted that most side effects were quickly noticeable and temporary. On the contrary, side effects such as scarring, tissue damage and other serious complications could take months to appear. It was felt that labelling should be modified to reflect what was being learned further about the products.

About 1.36 million women and 84,000 men opted in 2007 to get injections of animal collagens or chemicals to smooth facial skin and reduce signs of aging, according to the American Society for Aesthetic Plastic Surgery. The FDA received 930 reports of injuries, malfunctions and general complaints about wrinkle fillers from January 2003 to Sept. 20 of this year for products made by various companies. Members of the panel said the number is low because doctors and patients find reporting side effects cumbersome and often don’t.

The FDA report can be obtained here:

http://www.fda.gov/ohrms/dockets/ac/08/briefing/2008-4391b1-00-Index.html

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Juvaderm treatment is carried out by gently easing the gel into specific areas under the skin via injection. The smooth consistency of the gel allows your physician to administer it smoothly and easily. Further, a fine needle is used to minimise injection discomfort. Upon completion, the gel will temporarily add volume to the skin and may give the appearance of a smoother surface, thus smoothening moderate to severe facial wrinkles and folds. For more severe case, different grades of Juvaderm are available. More severe cases usually involve injections deeper into the skin.

Juvaderm should only be administered by a trained and qualified health care provider. Dermatologists, plastic surgeons, ophthalmologists, otolaryngologists (ear, nose, and throat doctors), or physicians specializing in cosmetic procedures are generally more experienced.

You will need to consult with your doctor prior to treatment. The doctor will examine the soft tissue of your face to assess the depth of wrinkles and folds to determine the type of treatment. The doctor may assess your wrinkles to range from mild shallow or just perceptible wrinkle to severe deep wrinkle with well-defined edges. Anaesthesia is not required, but it may be used by your doctor to numb the area to reduce discomfort during and after the injection.

Following the injection, your doctor may gently massage the treated area. The injection procedure takes only about 15 minutes and the results are immediate. However, the results may vary and the effect is temporary, usually lasting up to a year. As such, additional “touch-up” treatments may be needed to maintain optimal results.

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