These marionette lines can be removed by the injection of Juvaderm, one of the more useful of facial fillers, and years get taken away from the face in an instant.

Following is a video which illustrates how the skilled Juvaderm injector does it:

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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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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 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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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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• Have severe allergies marked by a history of anaphylaxis or presence of multiple severe allergies
• Have a history of allergies to gram-positive bacterial proteins
• Have been using substances which can prolong bleeding, such as aspirin or ibuprofen (this may increase bleeding and/or bruising at the injection site)
• After the Juvaderm procedure, are considering a laser treatment, chemical peel, or any other procedure based on active dermal response (risk of inflammatory reaction at the treatment site)
• Have been undergoing immunosuppressive therapy (therapy to decrease the body’s immune response) (this increases risk of infection from injection)
• Are looking for a lip filler (Juvaderm has been subject to safety tests for this)
• Are in pregnancy, breast-feeding or under 18 years of age (safety test have not been established)

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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, 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, Juvederm Ultra and Juvederm 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 Juvederm Ultra and Juvederm Ultra Plus and evaluate the persistence of and patient satisfaction with the products in daily clinical practice. Juvederm Ultra and Juvederm 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 Juvederm Ultra and Juvederm 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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Five years ago, if you wanted to change the shape of your nose, the projection of your cheeks, the angle of your chin, the size of your bust, or the perkiness of your butt, your best option was to opt for surgical implants, which come in all shapes and sizes, textures and materials.

Of course, fat transfer for augmentation was also another option, but results would be determined by several factors such as the purity of the fat cells extracted for transfer, including the expertise of the surgeon performing the procedure, to name a few.

However, medical innovation is constantly progressing and it is no surprise that now, for a simple augmentation procedure, some may see the use of implants declining somewhat.

What if you just want a minor tweak of a feature? What if you don’t like the idea of surgery? What if you don’t have two weeks to take off for recovery? What if you can’t afford the cost of the surgery?

Well, there might just be a more valid solution to your woes — fillers.

Fillers first saw popular use to ‘fill’ soft tissues that lacked volume, be it due to aging or just the unfortunate circumstance of genetics or disease. Cosmetically, fillers were used to restore or provide volume such as to plump thin lips, enhance shallow contours on the face, soften facial creases and wrinkles, and even improve the appearance of recessed scars.

Over the years we have seen the introduction (and sometimes departure) of many popular filler substances in the aesthetic market – silicon, collagen and hyaluronic acid are some of the names we are more familiar with.

Silicone as a filler has been banned worldwide due to serious ill effects and complications while collagen injections are rarely used these days as they could cause an allergic reaction. Which leaves us with hyaluronic acid – which today is a common substance used in most popular fillers.

Fillers can be temporary or permanent. Temporary fillers (common brands include Restylane, Juvederm and Esthelis) usually last between six to nine months before being reabsorbed by the body, hence repeat treatments will be necessary, while permanent fillers (common brands include Bio-Alcamid and ArteFill) usually last a few years and do not require more than one follow-up treatment.

Permanent fillers have some risks and complications associated with them. One of the main issues with permanent fillers in the past was migration of the injected substance over the years due to the effects of gravity. However, this problem has been addressed by several medical companies that have introduced the use of new substances, as well as incorporated new technologies into the manufacturing of the product so that the permanent filler does not migrate, and can even be removed if the patient is not happy with the results.

Fill me up!

Today, the use of fillers for augmentation of facial and other body parts such as the breasts and buttocks have become a legitimate alternative to implants. Having said that, fillers were already one of the more sought after and popular minimally invasive procedures before augmentation came into the picture.

Fillers have improved with time and are now more stable, safer and can last longer. Because they are so easy to administer, patients like the fact that they can get such nice results with virtually no down time and swelling.

This plus point makes fillers a suitable option for augmentation – especially if surgery is not your thing.

Fillers can be administered in your plastic surgeon or dermatologist’s clinic and doesn’t require hospital stay – another big plus point as hospital stays also mean more cost. Performed under local anaesthesia, the procedure generally takes between 15 to 30 minutes (or longer if a larger volume is to be injected in areas such as the breasts or buttocks). Another big plus of opting for fillers over surgery is that the injection sites bear no scars, unlike surgery, where scarring can be an issue due to incisions.

Because the procedure is minimally invasive, patients can resume normal activity immediately after. However, do expect mild swelling or bruising, temporary numbness or redness, and an “over-filled” appearance to the treated area until swelling subsides, which could improve within a matter of hours or a few days, depending on the individual.

For now, the procedure is popular for breast augmentation; the procedure has even been dubbed the lunch hour “Boob Jab”. Patients can literally come in during their lunch hour, complete the procedure and return to work without feeling anything other than more self-confident about their new subtle but effective change.

This new technique uses gel-like fillers such as Macrolane or Restylane, that is injected into the breasts in the planes between the breast and muscles – which helps give the breasts an extremely natural-looking augmentation. It leaves no scar, the breast feels absolutely natural and there’s virtually no pain and no downtime.

The good age-old technique that used periphine or silicone bore risks. These included scarring in the armpits and nipples, forming lumps and becoming infected. As these are permanent treatments, in the long-term they cause other complications such as tender nodules and pain.

During the time the injected material is in the body, collagen regeneration and water retention is stimulated in the cells. This is good as collagen helps plump the skin and water retention in the cells does the same. This temporary filler lasts up to two years, where it will shrink and disappear, after which, patients will have to go back for a top-up treatment.

Many patients are now choosing this option for augmentation over implants, as it is relatively painless and is a less extreme alternative, allowing them to subtly target specific areas without necessarily increasing a cup size or telling their friends that they’ve had something done.

This new breed of patients want little changes rather than the standard implant that is round and protrudes quite obviously. Fillers are a good option for patients who have floppy breasts, or those who want to go from an A-cup to a B-cup. This technique also works well for patients whose breasts are starting to deflate.

There are limitations, however. The maximum enlargement one can achieve with this technique is one cup size. This is because a large volume would need to be used, and can end up costing quite a bit.

To achieve a ‘push-up bra’ look, 60cc of filler is usually injected, and to go up a cup size, about 100 to 150cc will be required. This procedure is not recommended for those who are pregnant or breast-feeding, however, as there is engorgement in the breasts during this time and this can cause some tenderness.

Another attractive feature about this augmentation option is that the patient has the control to say “when”. During the usual breast implant surgery, most patients are asleep and have absolutely no control over what the surgeon is doing.

Bottoms up

The technique can also be used on buttocks in the same way. Aside from just enhancing the contour of the buttocks to fill up specific defects or depressions, many patients also attempt to achieve the desirable Jennifer Lopez firm and round look.

The volume of product that can be injected varies per session according to the kind of treatment required. Fillers are administered in large volumes, using up to 10 vials per treatment.

The procedure for breast and buttock augmentation is generally the same. When it is over, patients are sent home with a course of antibiotics to avoid any infection, as well as a prescription for anti-swelling medication to keep any inflammation down. Mild painkillers are also prescribed if the patient feels any discomfort, though this is rare.

There are no ideal candidates for filler injections and anyone may be treated. However, the surgeon would consult the patient in at least two or three sessions prior to the procedure. Doctors would speak to the patient about what was motivating them (to have the procedure) and what they expect out of it. Additionally, as some fillers have contraindications, your surgeon should also perform a clinical evaluation prior to the procedure to avoid complications.

Technology is heading towards providing longer-lasting fillers, and where they don’t react negatively with the body. But longer lasting does not mean permanent.

While some might recommend you try temporary fillers first to see if you are happy with your new look before you opt for permanent fillers, surgeons should stick to non-permanent fillers. Permanent fillers should only be used by very experienced specialists. If the filler is injected wrongly for whatever reason, it is impossible to remove and it will give long-term recurrent complications.

The decision to have fillers for augmentation of body parts is extremely personal and you’ll have to decide if the benefits will achieve your goals and if the risks and potential complications are acceptable. Being beautiful pays off, especially when the procedure is done well.

But whatever reasons an individual may have in deciding to have fillers performed on their breasts, buttocks or face, it is important that they realise it is not designed to completely change their look, though it will definitely enhance their appearance and produce a number of positive effects.

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