How can dermal fillers be categorised?
Two important ways of grouping dermal fillers are in terms of biodegradable and non-biodegradable and also particulate vs non-particulate (or homogenous) dermal fillers.
The most popular dermal fillers today are biodegradable, non-particulate dermal fillers such as
Juvederm Ultra and Juvederm Vycross range (including Voluma, Volift, and Volbella)
Restylane, once the market-leader for dermal filler, is a bio-degradable, particulate filler. Its high cohesivity means that it holds its shape particularly well allowing the clinician to build up areas of the face. On the flipside however, the nature of this type of product requires the clinician to heavily mould the product (which is often unpopular) into the desired shape and lumps can be common.
What is the Juvederm Vycross range?
Juvederm Vycross is Allergan’s most recent released range of dermal filler products which are longer-lasting, smoother to inject, biodegradable, and reversible. They represent the latest technology in dermal fillers moving things forward from its highly successful Juvederm Ultra range.
- Juvederm Voluma – for improving mid-face volume (such as cheeks) and non-surgical rhinoplasty. The most cohesive and elastic of the Vycross range and the first in the range to be released a few years ago.
- Juvederm Volbella – for longer-lasting results in dealing with under eye hollows and crows’ feet. This product is the least cohesive and least elastic out of the Vycross range making it preferable for the tear trough treatment because it’s easy to get it into the areas it’s needed with smooth results.
- Juvederm Volift – the most recent of the range to be released. Great for longer-lasting results for depressions in the nasolabial folds but also creates fantastic definition/sharpness for lips.
- Juvederm Retouch – a smaller sized Volift aimed at giving patients that little bit extra when a full 1ml syringe isn’t required.
What are the key differences between Juvederm Ultra and Juvederm Vycross?
The Juvederm Vycross range is a more expensive product to buy-in and in turn you will charge your customers more for it. It’s important therefore that you know how to justify it to your customers so they understand the benefits.
1. Longer-lasting due to its unique make-up of high and low molecular weight HA (Voluma up to 24 months, Volift up to 15 months, Volbella up to 12 months)
2. Better results because it’s easier to shape and mould once injected due to a greater degree of range in the balance elasticity and cohesivity
3. Creates less swelling at the area it’s been injected due to lower HA concentration drawing less moisture and causing less reactionary inflammation
4. Better ability to create lift and projection due to relative improved elasticity for each of Voluma, Vycross, and Volbella.
5. Smoother and easier to inject (lower extrusion force required) as not as viscous compared to Ultra.
6. The patient pays less over a one year period if you price your Vycross treatments so that they are less than two Ultra treatments combined at 6 month intervals.
What are the variables which influence the performance of a dermal filler product?
There are several key variables which make each dermal filler product do its own job when injected. These include:
• Cross-linking of hyaluronic acid
• Concentration of hyaluronic acid in the product
Why is the cross-linking of hyaluronic acid important?
Biodegradable fillers (such as Juvederm Ultra) become reabsorbed by the body quickly without the molecules being cross-linked. This is because the body’s native enzyme hyaluronidase works to breakdown the filler. BDDE is the chemical compound used therefore to cross-link the molecules which sustain the HA thus preventing the body from breaking it down quite so quickly. This ultimately allows durations of 6-24 months depending on the dermal filler.
In addition, the greater the level of cross-linking and the greater the concentration of HA, the more elastic and cohesive the dermal filler will be. This can be seen as a pro or a con depending on what you’re looking to achieve for the patient. See more information below.
What are the pros and cons of higher concentration levels of hyaluronic acid in a dermal filler?
Higher concentrations of HA may initially seem appealing due to the ability to create more lift and structure as well as a better longevity of the treatment. The flipside however is that HA attracts moisture which in turn creates swelling for the patient. In addition, the greater the level of HA the more likely there will a reaction by the body leading to inflammation and possible granuloma formation.
As a comparison, in lab conditions, Juvederm Ultra 3 can take up to four times its own weight in water compared to the Vycross range which only take up it one times its own weight. These comparative extremities are not seen in patients however because of the constraints of the surrounding tissue.
What is the significance of cohesivity in a dermal filler?
Cohesivity of a dermal filler refers to the extent to which the product can be spread and moulded to create the lift and shape you want for your patient. Cohesive products are made up of a tighter molecular structure. Restalyne as a particulate filler is extremely cohesive meaning that with a lot of moulding and force it can be used successfully to create new contours and shapes within the patients face but it does mean difficultly for the clinician in working with it and a prevalence of lumps. All Juvederm products are less cohesive than Restylane but are easier to work with to create the desired shape. A more cohesive product is called for when creating new facial contours e.g. in the eyebrow or creating lift e.g. with cheek enhancement. The cohesivity of a product is measured by the amount of spread under vertical compression.
Why is the elasticity of a dermal filler important?
Elasticity of a dermal filler refers to the extent to which the product bounces back and re-shapes itself back to its intended shape. Traditionally, the more cohesive a product was, the less elastic it would be. Higher elasticity comes in handy when trying to create lift as an example because the moulded filler keeps returning effectively to its desired shape.
What’s the difference in terms of elasticity and cohesivity for the Juvederm Vycross range?
The key difference with the Juvederm Vycross is that it uses a unique combination of high molecular weight hyaluronic acid (HMWHA) and low molecular weight hyaluronic acid (LMWHA). This has been important for Allergan because it has allowed them to deliver a range of products which preserve high cohesivity associated with high molecular weight HA but simultaneously allow for it to be re-shaped more easily, a characteristics associated with LMWHA. This unique combination specifically refers to 90% of the content being LMWHA as opposed to traditional fillers being 100% HMWHA. This allows the product to be more easily moulded to create facial contours and to integrate into the skin more naturally. By contrast those products with 100% HMWHA are much are harder to mould to create the shape you desire.
Where does this leave the Juvederm Ultra range?
The Juvederm Ultra range remains a great range of dermal filler products. It’s cross-linked for decent longevity of results (typically up to 6 months) and has relatively high cohesivity allowing the clinician to create lift for the patient. However, the trade-off with high cohesivity is that it’s more difficult to spread the product into the areas where you want it and the trade-off with high HA concentration is water attraction and possible inflammation. Is it as good as Juvederm Vycross? Well, no and ultimately it’s anyone’s guess as to whether Allergan will phase it out as the Vycross range is further developed. For the time being however it’s still very much a staple of the dermal filler market giving great results and at a cheaper cost to the patient.
SkinViva Training Manchester
SkinViva Training Ltd offer a range of professional training courses for cosmetic and medical skin treatments.
Their courses in cosmetic treatments directed at suitably qualified and registered medical professionals who wish to learn and build on their skills in delivering these procedures. See FAQs for the current list of who can train.
Most start with the Foundation BOTOX® & Dermal Fillers course, but once they are practising, delegates are keen to develop further skills. The Lip Enhancement Course is also a popular option for further learning and advancement.
SkinViva Training was established by by Dr Tim Pearce MBChB BSc (Hons) MRCGP. The SkinViva Training team upholds high standards of clinical training providing a combination of fully-supervised practical experience together with essential theory.
For further information, to discuss which course is right for you, to enquire about availability or to book a training course please call 0161 850 2491, or email firstname.lastname@example.org.