Juvederm Voluma is the newest addition to the Juvederm family in the United States. This dermal filler was developed by Allergan® to specifically treat the midface, or cheek region. As we just described above, Juvederm XC Ultra is NOT designed to lift the sagging cheek area. Rather, it is intended to fill areas of moderate to deep wrinking by having a low cohesivity while simultaneously having a high degree of water absorbancy. When Juvederm XC is injected into the midface for lift, men and women tend to look unnatural, resembling the “chipmunk cheek” look. Because of this, Allergan® developed and launched a second type of filler known as Juvederm Voluma.
Juvederm Voluma is designed to treat the sagging midface, or cheek area. It is FDA approved for treatment of malar (aka cheek) atrophy. This novel molecule does not rely upon cohesivity and g prime to achieve lift like other dermal fillers. In the case of Voluma, the dermal filler is a gel which has randomly sized cross-linked molecules that are based on hyaluronic acid. Essentially, the random sizes of the hyaluronic acid molecules interact in the deeper facial planes with your soft tissue to create lift. This is recognized as a different mechanism than all of the other dermal fillers available, and it has some strengths and weaknesses.
The big strength of Voluma is that it does have a hyaluronic acid as its foundation molecule. Because of this, the effects of Voluma can be reversed and the filler itself can be removed with the injection of an enzyme called hyaluronidase. To be clear, this means that if you don’t like your Voluma injection, your plastic surgeon can literally remove it with a second injection. It typically takes about 3-5 days for the product to completely dissolve, but it will dissolve. The other great strength of Voluma is that as a hyaluronic acid based filler, it does integrate seamlessly into soft tissue, and when appropriately injected by a plastic surgeon, it does create natural, beautiful results. Also, Voluma has been shown to last up to two years in duration following injection, although the length of longevity is variable amongst individual patients.
The liability of Voluma, however, is also due to its molecular makeup. As this molecule does rely upon a random molecular size to generate lift, the amount of lift you receive with Voluma appears to be very dose dependent. In other words, patients who use low volumes of Voluma (less than 3cc) do not typically receive the same degree of lift they would receive with Radiesse Plus, or Restylane Lyft. Since both the Restylane and Radiesse products rely upon individual molecular lift, the presence of a single molecule or a million molecules will create lift. Voluma, on the other hand, requires a baseline volume to be injected to get the maximal lift effect, and the amount needed can vary widely from patient to patient.
As stated previously, Voluma is FDA approved for treatment of sagging cheeks. During the FDA clinical trials, patients appeared to get the best results using, on average, 5.6 milliliters of Voluma. When used at this volume, patients did get a significant lift effect, and the product lasted at least 18 months in most cases. Our practice has had a similar experience as the FDA trials. We have found that patients are most content with Voluma when it is used in higher doses, such as 5-7 milliliters. When used in this volume, this filler can and does provide outstanding lift, and will last over 18 months. However, many patients do not want that degree of filling, as one of our most common concerns from patients seeking dermal therapy is “looking overdone”. Lastly, many of our patients do not require such a large degree of correction, especially men and women under the age of 55.
We find Voluma to be best suited for older patients who require significant correction. In other words, we try to use Voluma in patients who need significant volumization, usually over 6 milliliters injected. In this scenario, the product can last up to two years, and offer an excellent result. Overall, this is a very safe filler that offers effective volumization to the midfaces, especially in higher injection volumes (greater than 6 milliliters). The only knock on Voluma is cost. At $800 per cc, Voluma is our most expensive dermal filler platform.