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COSMETIC FILLERS

Chasing Botox: Juvederm


CONSUMER BRIEF: The field of cosmetic wrinkle eradicators and facial fillers continues growing rapidly. The company that turned Botox into a household name has developed a dermal filler -- Juvederm -- that is generating huge amounts of interest among both patients and doctors.

When a woman (who asked for anonymity) went to see plastic surgeon Michael E. Decherd, M.D. at the San Antonio Plastic Surgery Institute, she thought perhaps Botox could make her lips a bit fuller.

"But I learned Botox is not intended for the lower half of the face," says the 39-year-old newspaper employee with two daughters in elementary school.

Juvederm Before Photo Juvederm After Photo












A 47-year-old patient shows her new look (right) two weeks after Juvederm injections.
(Photos, courtesy of Michael Coverman, M.D.)


Lips

Instead of Botox, she opted for Juvederm injections into her lips and the deep fold between her cheek and her lips.

"The results look fabulous and made my lips large enough to wear brighter shades of lipstick without smearing any on my teeth," she told CosmeticSurgery.com. "I didn't want to look like Angelina Jolie; I just wanted fuller, natural-looking lips."

She reports being in the physician's chair 45 minutes waiting for the topical anesthesia to take effect; the actual injections -- which she says were painless -- took 20 minutes, after which she went shopping.

"I had some swelling but it went away by the next day and on the third day, I had the fuller lips and reduced facial lines I wanted.

"I know it looks good because people are telling me I look great!"

Wrinkles, Wrinkles, Wrinkles

Juvederm is one of the latest, "next generation" injectable fillers to be approved by the FDA. The substance is intended to treat:

  • Forehead lines
  • The glabellar lines, the deep folds between the eyebrows
  • Nasal furrows
  • Cheek wrinkles
  • Volume to the lips

Many more men and women are turning away from surgical facelifts and toward injectable dermal fillers -- even if it involves going back to the physician for repeat injections.

Current trends seem to indicate that facial fillers are the hot ticket among many consumers of cosmetic surgery procedures. While the number of surgical procedures dropped by 8 percent from 2000 to 2004, non surgical procedures rose by 36 percent during the same period, according to the American Society of Plastic Surgeons (ASPS.)

And when the America Academy of Facial Plastic & Reconstructive Surgery (AAFPRS) polled their 1300 members surgeons, they found a 69 percent increase among women -- and a 91 percent increase among men -- opting for non-surgical procedures since 2000.

Physicians say patients are turning in droves to dermal fillers because the procedures are quick, provide virtually instant results, do not require general anesthesia and do not take the patient out of his or her life for a period of healing and recuperation. All but a handful of facial fillers are absorbed by the body, meaning additional injections are necessary every six months to a year to maintain the rejuvenated look.

Fine Lines

A handful of FDA approved cosmetic facial fillers perform the same functions as Juvederm but have undesirable side effects. Some require allergy testing while others dissipate too quickly or are difficult for the doctor to use. But manufacturers, ever eager to please patients, develop newer and better fillers that remove fine lines, wrinkles and heavy skin folds. Juvederm is produced in a lab and contains no animal or human components so no allergy testing is necessary. Risks include possible bruising, swelling and infection, all of which are minimized by using a board certified dermatologist or plastic surgeon.

A University of Michigan university study on Restylane -- a chemical sibling of Juvederm -- showed the dermal filler was actually a triple threat. Restylane replaced lost collagen, stimulated new growth and slowed the loss of existing collagen. Because Juvederm and Restylane are related, Juvederm may offer the same effects. Before the study, most experts thought Restylane's physical volume caused the improved appearance in skin.

"From where I sit, asking to choose between Juvederm and Restylane is like asking to choose between BMW and Mercedes Benz," says board certified Austin dermatologist, Michael Coverman, M.D.

"However, I can say that Juvederm is soft and silky and a bit easier for the doctor to work with," says Dr. Coverman. "Areas corrected with Juvederm seem to be fuller, rounder and smoother."

Collagen

The key to most dermal fillers is replacing collagen, the main connective tissue under the surface of the skin. We show aging in our faces when collagen fibers become damaged, old or dissipated. Then, the substance collapses, leaving wrinkles or heavy folds of skin in its place. Half a decade ago, facial plastic surgery was the best way to tighten facial skin to produce a more youthful look. Juvederm is mostly hyaluronic acid, a substance which also helps retain water, meaning facial skin becomes soft and smoother, thanks to the hydration.

Cosmetic Fillers

"I inject a lot of Juvederm in the lips, in the hollows under the eyes, in the 'Marionette lines' (the downturns at the corners of the mouth) and in the smile lines next to the mouth," says Benjamin J. Bassichis, M.D., a board certified plastic surgeon in Dallas. "Depending on the patient, I find Juvederm lasts six to nine months; it tends to last longer in locations away from the mouth where there is not so much movement."

Dr. Bassichis is on the Juvederm National Education Faculty and trains other physicians on using Botox and Juvederm.

Allergan says Juvederm lasts somewhat longer in the body because the substance is chemically cross-linked.

"I explain cross-linking by asking patients to imagine Juvederm as a hammock," says Dr. Decherd. "In this hammock, the fibers not only run up and down, they also run across, making the hammock stronger."

Some patients and doctors like Juvederm because it can be used in several locations on the face and has a better comfort level than other fillers.

"Juvederm is also good for scar corrections and is not permanent facial filler which is a good thing in my opinion," says Dr. Coverman. "Some permanent fillers are now available and a few more are coming up for FDA approval.

"Permanent fillers can turn into permanent problems," says Dr. Coverman. "If you don't like the changes, you must wait two years for the substance to dissolve."

Allergan also offers Juvederm Ultra and Juvederm Ultra Plus, fillers that are said to be technogically advanced to provide more volume for deeper facial folds.




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