Are you troubled by:

• Facial lines and wrinkles?
• Deepening lines from your nose to the corners of your mouth?
• Thin lips?
• Vertical “smoker's lines” above your lips?
• Acne scars or pits?
• Help to camouflage jowls
• Create fuller “cheek bones”

If you want a smoother, younger-looking face—with virtually no downtime—consider Juvéderm. This next-generation hyaluronic acid facial filler was introduced in the U.S. by Allergan, Inc. in January 2007.

What is Juvéderm?

“Juvéderm is a smooth injectable gel made of hyaluronic acid—a naturally occurring substance in your skin that helps add volume and restore moisture. This facial filler comes in two versions:

• Juvéderm Ultra is formulated for contouring and volumizing moderate wrinkles and folds.
• Juvéderm Ultra Plus is a more robust formulation for treating deeper wrinkles and folds.

“Juvéderm is also the first FDA-approved hyaluronic acid facial filler that's proven safe and effective for people of color.”

Do you administer Juvéderm injections, or does a nurse do them?

“I do all the injections myself. I don't feel comfortable having somebody else do it for me. I know it's very popular to have physician extenders such as nurse injectors. There are all kinds of ways for people to run a profitable practice, but at the end of the day, if I have a patient who's unhappy, it's my problem. I can't take the chance that an injection, or any other procedure done in my office can go awry.

“When patients come to my office, see them, evaluate them myself, take my own photographs and then I'm the one who injects them. I also follow up with them personally. I don't delegate these responsibilities. I think it's smart medicine, and I happen to like my patients too. I want to be the one to take care of them. Doing all of this myself has probably has helped me develop my technique better also, because I see the results personally. Usually, all my Juvéderm patients are happy.”

Do you do anything to numb the area before a Juvéderm treatment?

“Yes. I always give ‘field’ blocks or nerve blocks. There are various nerves in the face where I can inject a little anesthetic to make the patient much more comfortable during the treatment. I do that every time because it makes the treatment a much more enjoyable experience. It allows me to take my time and really concentrate on doing things right, not on relieving the discomfort by stopping as soon as possible. I also think that makes people more willing to come back and do it again.

“I usually give intraoral, or in-the-mouth, injections. First, I spray a little something to numb your gums, then I inject the nerve, which you shouldn't really feel. We wait about 10 minutes while the anesthetic takes effect, then I inject the Juvéderm. Doing it this way makes my patients much more comfortable.”

How do you inject Juvéderm?

“That all depends on the area being treated. I think most of us use similar techniques for the lips and laugh lines, but there are some areas that doctors disagree on. In a plastic surgery journal, there was recently a debate over how deeply facial fillers should be injected. I don't always inject Juvéderm into the soft tissues—I like to keep it deep, right along the bone area. For instance, if I put Juvéderm in the tear trough, I'm basically putting it under the periosteum, which is the covering on the bone. It's got a nice, happy little home there and it seems to last for a long time.

“I want to leave the filler right along the bone, because if I don't, you'll get little bumps and it won't look good. When I put it near the bone, the filler is kind of camouflaged. There's a little fullness there, but you can't tell it was injected. It looks good and it's long-lasting.”

How soon after a Juvéderm treatment can you see the results?

“Basically, juvederm results can be seen immediately. That is, patients might have a little extra swelling at the time of the injection, but not much, and it doesn't last long. You will essentially see the final result in a day or two.”

Is there normally any downtime after a Juvéderm treatment?

“No, not more than I've already mentioned.”

Does Juvéderm have any side-effects?

“According to Allergan, Juvéderm's possible side-effects are usually mild to moderate. I have personally NOT seen any with Juvederm myself, but I know that they can occur.

“When side-effects occur, they typically last a week or less and include temporary injection site reactions like redness, pain, firmness, swelling and bumps. And as with all skin injection procedures, there is a risk of infection.”

How long does a Juvéderm treatment last?

“Juvéderm has just gotten the FDA's OK to say that a treatment can last for up to a year. But in my experience, how long a facial filler treatment lasts depends on where you inject it. A facial filler seems to last a long time in places that don't have a lot of motion.

“For the nasolabial folds, Juvéderm is great. And it seems to last a very long time in the tear trough area. Frankly, nothing really lasts a year on the lips-at least not in my experience.”

What results can you expect from Juvéderm?

“Juvederm will add fullness to the lips and cheeks and it can act like an eraser for jowls and nasolabial folds. I don't think we've had a single patient get juvederm and not be satisfied.”