Juvéderm’s current competitive edge in cosmetic surgery is possible because, according to the manufacturers, Juvéderm 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 Charité Universitätsmedizin Berlin Germany.
Much of Juvederm's competitive edge is actually its ease of use for physician injectors. A free-flowing product for injecting into sensitive areas makes the process much more pleasant for doctor and patient. The new addition of lidocaine integration has subjectively improved the experience for the patient. Nissan Pilest, board certified dermatologist, associate professor at UCI School of Dermatology, medical director of a private practice and Juvederm training physician in Irvine, Ca., relates that Juvederm is a prime selection for most patients.
Juvéderm works well for cosmetic and plastic surgery applications because hyaluronic acid can absorb up to 1,000 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.
When the University of Michigan organized a study on the dermal filler Restylane -- a close chemical sibling of Juvéderm—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.
Potential risks and side effects
Patients, physicians and researchers say usual, expected side effects include temporary redness, pain and tenderness during injections and swelling and bruising at the injection sites. The more serious side effects include immune system reactions that result in facial lumps and bumps known as granulomas, bothersome reactions that are very difficult for physicians to treat.According to Allergan, Juvéderm should not be used in patients with severe allergies, particularly those who have allergies to bacterial proteins or patients with a history of anaphylaxis, which is a potentially life threatening hypersensitivity to some drugs and proteins.