Tag Archives: hyaluronic acid

Treating Age-Related Volume Loss in the Cheeks

Juvéderm Voluma® XC is a facial filler that uses a unique formulation of hyaluronic acid. It is designed to correct “age-related midface volume deficit.” In other words, it plumps up the cheeks! “XC” means there is a small amount of lidocaine in the product, which numbs the area during treatment.

Voluma XC differs from other hyaluronic acid fillers in several ways. First, it feels soft and natural in the skin. Second, Voluma XC may be less painful than other fillers because it is injected deeper into the skin where there are fewer nerves. Third, injecting deeper may also cause less bruising because it is injected under blood vessels. Fourth, the results typically last 9 to 12 months—some report up to 2 years. The duration of response is related to the area of the cheek treated and the dose. Follow-up treatments extend the duration of response.

Response to Initial Treatment

Immediately after treatment, 96% of 115 people treated with Voluma XC reported being “delighted” or “happy” with the results. Satisfaction was maintained by day 21.

Response to Initial Plus Follow-up Treatments

The volume of Voluma XC injected and the number of treatments extend the duration of satisfaction.

Table 1. Responders were those who achieved at least a 1-point improvement on the Mid-Face Volume Deficit Scale.

Table 1. Responders were those who achieved at least a 1-point improvement on the Mid-Face Volume Deficit Scale.

In a study of 235 adults initially treated with Juvéderm Voluma XC plus touch-up treatment available 30 days later, responders were those who achieved at least a 1-point improvement on the Mid-Face Volume Deficit Scale (Table 1). Six months after treatment, 76% to 83% of patients responded depending on the area of the cheek evaluated (Figure 1). Higher responder rates, up to 24 months, were achieved as the volume of Voluma XC injected and the number of treatments increased.

The Bottom Line

Figure 1. Month-6 response rates were 76% for zygomaticomalar, 83% for anteromedial cheek, and 77% for submalar regions.

Figure 1. Month-6 response rates were 76% for zygomaticomalar, 83% for anteromedial cheek, and 77% for submalar regions.

The development of newer hyaluronic acid fillers has created many products with subtle but important differences. Voluma XC requires special training and experience to use it correctly. If the person injecting your face doesn’t appreciate how Voluma XC differs from other fillers and lacks experience injecting Voluma WC, you will not get the full benefit for the money spent.

Further, if your doctor doesn’t have an artistic eye and an understanding of how Voluma XC can bring harmony to the anatomical changes that accompany aging, you could leave the office looking really fake.

Don’t look really fake. For consultation and more information about our approach to using facial fillers, including Juvéderm Voluma XC, to achieve the best look for you, contact Aesthetic Dermatology and Skin Cancer: Jeffrey H. Binstock, M.D. Drs. Binstock and Layton will answer your questions. Call our San Francisco office at (415) 956-8686, or in Mill Valley call (415) 383-5475.

Two New Treatments for Laugh Lines

Two new facial fillers—Restylane® Refyne and Restylane® Defyne—are now approved by the U.S. Food and Drug Administration and are offered as treatment options by Aesthetic Dermatology and Skin Cancer: Jeffrey H. Binstock, M.D.

Photo. The nasolabial folds commonly known as "smile lines" or "laugh lines", are the two skin folds that run from each side of the nose to the corners of the mouth.

Photo. The nasolabial folds commonly known as “smile lines” or “laugh lines”, are the two skin folds that run from each side of the nose to the corners of the mouth.

Both fillers target moderate-to-severe “laugh lines” in adults. This is the area known as nasolabial folds (NLF), which extend from the nose to corners of the mouth, as shown in the photo. Restylane Refyne is designed to treat moderate wrinkles and folds, while Restylane Defyne is meant to plump and fill deep-set lines.

Refyne is the softer of the two, better for thinner skin, Defyne is the thicker product with more  up lift and better for thicker skin. Both products can be used off label in other facial areas such as the oral commissures, marionette lines, cheeks etc.

Here’s What We Know about Refyne and Defyne

Both injectable products are based on hyaluronic acid—the most commonly used injectable for facial rejuvenation. They differ from other products in the class because of a unique manufacturing process called XpresHAn Technology, which gives a more natural-looking appearance due to “cohesiveness”—the ability of a filler to “stick to itself” and blend with the surrounding tissues.

Although new to patients in the U.S., both fillers were approved for use in Europe back in 2010. So, there’s lots of experience with them; and this positive experience has been confirmed in two studies in the U.S. These studies are referred to as “Natural Expression” and “Dynamic Strain.”

Natural Expression Study

In this study, the product selected (Restylane Refyne or Restylane Defyne) and the amount injected in each of 63 women was based on the assessment by an expert in facial aesthetic procedures. Following correction of wrinkles and folds along the NLF in the lower face, each woman rated the naturalness of their appearance of facial contractions during movement and at rest (natural expression).

There was broad agreement among 95% (60/63) of the women treated that attractiveness was enhanced. In addition, 89% (56/63) of women reported that attractiveness was enhanced, while 79% (50/63) agreed they looked younger.

Dynamic Strain Study

As in the Natural Expression Study, this study evaluated the naturalness of facial expressions following correction of wrinkles and folds along the NLF. It differs in that facial expressions were measured three dimensionally to objectively (and dynamically) record surface strain on the skin.

The results from 30 women (40 to 65 years old) showed a statistically significant reduction in the average peak dynamic strain for various standardized expressions one-month after treatment compared to before treatment.

Importantly, the women agreed. More than 8 out of 10 reported enhanced attractiveness. They thought they looked younger, with a naturalness of their expressions.

Both Restylane Refyne and Restylane Defyne were well-tolerated by the women taking part in the studies. Initial treatment injection site responses (redness, swelling, bruising, lump/bump formation, pain/tenderness) were predominantly mild-to-moderate in intensity and resolved in one to two weeks.

Which Treatment Is Right for You?

These products offer the latest advances in the ongoing effort to provide improved treatment for aging skin. But which treatment is right for you?

As treatments improve and become specialized, the role of an expert board-certified aesthetic dermatologist to recognize the best option and then to achieve the best results becomes ever more important.

For consultation and more information about our approach to using facial fillers to achieve the best look for you, contact Aesthetic Dermatology and Skin Cancer: Jeffrey H. Binstock, M.D. Drs. Binstock, Layton, and Physician Assistant Cullinane will answer your questions. Call our San Francisco office at (415) 956-8686, or in Mill Valley call (415) 383-5475.