Juvederm™, one of the newest of the “injectable fillers,” is used by physicians to soften deep folds and reduce wrinkles in the faces of patients. The substance is chemically closely related to the facial filler Restylane®; both are largely comprised of hyaluronic acid, a substance normally found in the skin, muscles, and tendons of mammals. Approved in June 2006 by the U.S. Food and Drug Administration, Juvederm™’s prime use is removing nasolabial folds, or “smile lines,” creases of skin which run from the corners of the nose to the corners of the mouth. It is also used as a lip augmentation agent, to fill in hollow places and scars on the face. Juvederm™ is being touted as “the next generation” hyaluronic acid facial filler and is said by physicians to be slighter smoother to inject and perhaps somewhat longer lasting in the body than Restylane®. However, all hyaluronic acid facial filler products are eventually absorbed by the body, usually within six to nine months, causing the patient to undergo repeat injections to maintain the younger look. Juvederm™ is also used by physicians to plump up lips which also lose fat and internal shape with normal ageing. Like Restylane®, Juvederm™ is extremely popular among consumers and medical providers alike because it results, in a younger, more refreshed looking face immediately.
FDA testing
Before being released onto the U.S. market, Juvederm™ was compared with Zyplast® dermal filler, a bovine-based injectable facial filler made from collagen. In clinical studies conducted at several U.S. medical centers to evaluate safety and efficacy, or effectiveness, 146 subjects were followed for 24 weeks. The subjects had Juvederm™ injected into one nasolabial fold and Zyplast® in the other. Using scientific measuring scales, Juvederm™ was deemed to provide a more persistent correction in the subjects’ facial folds. At the end of the study, the researchers asked subjects to judge which fold looked better to them. Eighty-eight percent chose the area treated with Juvederm™.[2] Before FDA approval, two other clinical studies on Juvederm™ were done on a total of 293 subjects in the United States. The safety profile and effectiveness was found to be similar to the first test.
Current usage
Juvederm™’s current competitive edge in cosmetic surgery is possible because, according to the manufacturers, Juvederm™ is “cross linked.” In hyaluronic acid’s natural form, the substance is a liquid which the body metabolizes in about half a day. Cross linking is a process that chemically binds the individual chains of the acid so that it is changed into a gel that lasts much longer once injected inside the face. Several other facial fillers used in Europe and the U.S. -- like Restylane®, Belotero® and Hylaform® -- are also cross-linked, with competition driving the other fillers toward even more highly cross linked compounds, according to Professor Berthold Rzany, professor of dermatology at the Universitaetsmedizon Berlin, Germany.
Mechanism of action
Juvederm™ works well for cosmetic and plastic surgery applications because hyaluronic acid can absorb up to 1000 times its own weight in water, thereby adding new volume under the surface of sagging skin. Older faces take on more youthful aspects because hyaluronic acid is known to bind with collagen -- the material that supports human facial skin -- and elastin to move more basic nutrients into the skin. Moreover, Juvéderm™ continues working as time goes on by adding even more collagen to the face, according to the manufacturer.[4]
When the University of Michigan organized a study on the dermal filler Restylane® -- a close chemical sibling of Juvederm™ -- researchers found that hyaluronic acid stretches cells in skin known as fibroblasts in a way that causes the skin to create new collagen. The new collagen helps decrease the appearance of facial creases and wrinkles. An unexpected -- and welcome -- finding cropped up: hyaluronic acid also seems to stop the breakdown of existing collagen.
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