Juvéderm
Encyclopedia
Juvéderm one of the newest of the so-called “injectable fillers,” is used by cosmetic, dermatological and plastic surgeons to soften deep folds and reduce wrinkles in the face
s of patients. The substance is largely 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
, Juvéderm’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, and to fill in hollow places and scars on the face. 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. Juvéderm is also used by physicians to plump lips, which also lose fat
and internal shape with normal aging.
, Juvéderm 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 Juvéderm injected into one nasolabial fold and Zyplast in the other. Using scientific measuring scales, Juvéderm 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 Juvéderm.
Before FDA approval, two other clinical studies on Juvéderm 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.
in New York
, found that one of the chief functions of hyaluronic acid is maintaining skin volume
and hydration, along with other body maintenance
functions and tasks.
Meyer and Palmer first isolated the substance
from the eye
of a cow and named hyaluronic acid by combining the Greek
word for glass
-- hyalos—and the uronic sugar contained in hyaluronic acid.
Hyaluronic acid later found uses in the baking
and food industry
in the 1940s and, by the 1990s, found its way into the medical field for use in joint pain, treating wounds, eye surgery
and, finally, in 1996, for facial tissue augmentation in Europe
.
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.
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 cell
s 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.
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.
Face
The face is a central sense organ complex, for those animals that have one, normally on the ventral surface of the head, and can, depending on the definition in the human case, include the hair, forehead, eyebrow, eyelashes, eyes, nose, ears, cheeks, mouth, lips, philtrum, temple, teeth, skin, and...
s of patients. The substance is largely 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
Food and Drug Administration
The Food and Drug Administration is an agency of the United States Department of Health and Human Services, one of the United States federal executive departments...
, Juvéderm’s prime use is removing nasolabial folds, or “smile lines,” creases of skin which run from the corners of the nose
Nose
Anatomically, a nose is a protuberance in vertebrates that houses the nostrils, or nares, which admit and expel air for respiration in conjunction with the mouth. Behind the nose are the olfactory mucosa and the sinuses. Behind the nasal cavity, air next passes through the pharynx, shared with the...
to the corners of the mouth
Mouth
The mouth is the first portion of the alimentary canal that receives food andsaliva. The oral mucosa is the mucous membrane epithelium lining the inside of the mouth....
. It is also used as a lip augmentation agent, and to fill in hollow places and scars on the face. However, all hyaluronic acid facial filler products are eventually absorbed by the body, usually within six to nine months, causing the patient
Patient
A patient is any recipient of healthcare services. The patient is most often ill or injured and in need of treatment by a physician, advanced practice registered nurse, veterinarian, or other health care provider....
to undergo repeat injections to maintain the younger look. Juvéderm is also used by physicians to plump lips, which also lose fat
Fat
Fats consist of a wide group of compounds that are generally soluble in organic solvents and generally insoluble in water. Chemically, fats are triglycerides, triesters of glycerol and any of several fatty acids. Fats may be either solid or liquid at room temperature, depending on their structure...
and internal shape with normal aging.
FDA testing
Before being released onto the U.S. marketMarket
A market is one of many varieties of systems, institutions, procedures, social relations and infrastructures whereby parties engage in exchange. While parties may exchange goods and services by barter, most markets rely on sellers offering their goods or services in exchange for money from buyers...
, Juvéderm was compared with Zyplast dermal filler, a bovine-based injectable facial filler made from collagen
Collagen
Collagen is a group of naturally occurring proteins found in animals, especially in the flesh and connective tissues of mammals. It is the main component of connective tissue, and is the most abundant protein in mammals, making up about 25% to 35% of the whole-body protein content...
. In clinical studies conducted at several U.S. medical centers to evaluate safety
Safety
Safety is the state of being "safe" , the condition of being protected against physical, social, spiritual, financial, political, emotional, occupational, psychological, educational or other types or consequences of failure, damage, error, accidents, harm or any other event which could be...
and efficacy
Efficacy
Efficacy is the capacity to produce an effect. It has different specific meanings in different fields. In medicine, it is the ability of an intervention or drug to reproduce a desired effect in expert hands and under ideal circumstances.- Healthcare :...
, or effectiveness, 146 subjects were followed for 24 weeks. The subjects had Juvéderm injected into one nasolabial fold and Zyplast in the other. Using scientific measuring scales, Juvéderm 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
Area
Area is a quantity that expresses the extent of a two-dimensional surface or shape in the plane. Area can be understood as the amount of material with a given thickness that would be necessary to fashion a model of the shape, or the amount of paint necessary to cover the surface with a single coat...
treated with Juvéderm.
Before FDA approval, two other clinical studies on Juvéderm 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.
History
In 1934, medical researchers Karl Meyer and John Palmer, scientists at Columbia UniversityColumbia University
Columbia University in the City of New York is a private, Ivy League university in Manhattan, New York City. Columbia is the oldest institution of higher learning in the state of New York, the fifth oldest in the United States, and one of the country's nine Colonial Colleges founded before the...
in New York
New York
New York is a state in the Northeastern region of the United States. It is the nation's third most populous state. New York is bordered by New Jersey and Pennsylvania to the south, and by Connecticut, Massachusetts and Vermont to the east...
, found that one of the chief functions of hyaluronic acid is maintaining skin volume
Volume
Volume is the quantity of three-dimensional space enclosed by some closed boundary, for example, the space that a substance or shape occupies or contains....
and hydration, along with other body maintenance
Preventive maintenance
Preventive maintenance has the following meanings:#The care and servicing by personnel for the purpose of maintaining equipment and facilities in satisfactory operating condition by providing for systematic inspection, detection, and correction of incipient failures either before they occur or...
functions and tasks.
Meyer and Palmer first isolated the substance
Chemical substance
In chemistry, a chemical substance is a form of matter that has constant chemical composition and characteristic properties. It cannot be separated into components by physical separation methods, i.e. without breaking chemical bonds. They can be solids, liquids or gases.Chemical substances are...
from the eye
Eye
Eyes are organs that detect light and convert it into electro-chemical impulses in neurons. The simplest photoreceptors in conscious vision connect light to movement...
of a cow and named hyaluronic acid by combining the Greek
Greek language
Greek is an independent branch of the Indo-European family of languages. Native to the southern Balkans, it has the longest documented history of any Indo-European language, spanning 34 centuries of written records. Its writing system has been the Greek alphabet for the majority of its history;...
word for glass
Glass
Glass is an amorphous solid material. Glasses are typically brittle and optically transparent.The most familiar type of glass, used for centuries in windows and drinking vessels, is soda-lime glass, composed of about 75% silica plus Na2O, CaO, and several minor additives...
-- hyalos—and the uronic sugar contained in hyaluronic acid.
Hyaluronic acid later found uses in the baking
Baking
Baking is the technique of prolonged cooking of food by dry heat acting by convection, and not by radiation, normally in an oven, but also in hot ashes, or on hot stones. It is primarily used for the preparation of bread, cakes, pastries and pies, tarts, quiches, cookies and crackers. Such items...
and food industry
Food industry
The food production is a complex, global collective of diverse businesses that together supply much of the food energy consumed by the world population...
in the 1940s and, by the 1990s, found its way into the medical field for use in joint pain, treating wounds, eye surgery
Eye surgery
Eye surgery, also known as orogolomistician surgery or ocular surgery, is surgery performed on the eye or its adnexa, typically by an ophthalmologist.-Preparation and precautions:...
and, finally, in 1996, for facial tissue augmentation in Europe
Europe
Europe is, by convention, one of the world's seven continents. Comprising the westernmost peninsula of Eurasia, Europe is generally 'divided' from Asia to its east by the watershed divides of the Ural and Caucasus Mountains, the Ural River, the Caspian and Black Seas, and the waterways connecting...
.
Current usage
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 liquidLiquid
Liquid is one of the three classical states of matter . Like a gas, a liquid is able to flow and take the shape of a container. Some liquids resist compression, while others can be compressed. Unlike a gas, a liquid does not disperse to fill every space of a container, and maintains a fairly...
which the body metabolizes
Metabolism
Metabolism is the set of chemical reactions that happen in the cells of living organisms to sustain life. These processes allow organisms to grow and reproduce, maintain their structures, and respond to their environments. Metabolism is usually divided into two categories...
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
Gel
A gel is a solid, jelly-like material that can have properties ranging from soft and weak to hard and tough. Gels are defined as a substantially dilute cross-linked system, which exhibits no flow when in the steady-state...
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
Competition
Competition is a contest between individuals, groups, animals, etc. for territory, a niche, or a location of resources. It arises whenever two and only two strive for a goal which cannot be shared. Competition occurs naturally between living organisms which co-exist in the same environment. For...
driving the other fillers toward even more highly cross linked compounds
Chemical compound
A chemical compound is a pure chemical substance consisting of two or more different chemical elements that can be separated into simpler substances by chemical reactions. Chemical compounds have a unique and defined chemical structure; they consist of a fixed ratio of atoms that are held together...
, according to Professor Berthold Rzany, professor of dermatology
Dermatology
Dermatology is the branch of medicine dealing with the skin and its diseases, a unique specialty with both medical and surgical aspects. A dermatologist takes care of diseases, in the widest sense, and some cosmetic problems of the skin, scalp, hair, and nails....
at the Charité
Charité
The Charité - Universitätsmedizin Berlin is the medical school for both the Humboldt University and the Free University of Berlin. After the merger with their fourth campus in 2003, the Charité is one of the largest university hospitals in Europe....
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.
Mechanism of action
Juvéderm works well for cosmetic and plastic surgeryPlastic surgery
Plastic surgery is a medical specialty concerned with the correction or restoration of form and function. Though cosmetic or aesthetic surgery is the best-known kind of plastic surgery, most plastic surgery is not cosmetic: plastic surgery includes many types of reconstructive surgery, hand...
applications because hyaluronic acid can absorb up to 1,000 times its own weight in water
Water
Water is a chemical substance with the chemical formula H2O. A water molecule contains one oxygen and two hydrogen atoms connected by covalent bonds. Water is a liquid at ambient conditions, but it often co-exists on Earth with its solid state, ice, and gaseous state . Water also exists in a...
, 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
Elastin
Elastin is a protein in connective tissue that is elastic and allows many tissues in the body to resume their shape after stretching or contracting. Elastin helps skin to return to its original position when it is poked or pinched. Elastin is also an important load-bearing tissue in the bodies of...
to move more basic nutrients into the skin.
When the University of Michigan
University of Michigan
The University of Michigan is a public research university located in Ann Arbor, Michigan in the United States. It is the state's oldest university and the flagship campus of the University of Michigan...
organized a study on the dermal filler Restylane
Restylane
Restylane is the trade name for a range of injectable fillers with a specific formulation of non-animal sourced hyaluronic acid . Restylane was the first stabilized hyaluronic acid filler on the market and reportedly has been used in over 11 million treatments worldwide .In the United States,...
-- a close chemical sibling of Juvéderm—researchers found that hyaluronic acid stretches cell
Cell (biology)
The cell is the basic structural and functional unit of all known living organisms. It is the smallest unit of life that is classified as a living thing, and is often called the building block of life. The Alberts text discusses how the "cellular building blocks" move to shape developing embryos....
s 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 systemImmune system
An immune system is a system of biological structures and processes within an organism that protects against disease by identifying and killing pathogens and tumor cells. It detects a wide variety of agents, from viruses to parasitic worms, and needs to distinguish them from the organism's own...
reactions that result in facial lumps and bumps known as granulomas, bothersome reactions that are very difficult for physicians to treat. According to Allergan
Allergan
Allergan, Inc., is a global specialty pharmaceutical company. Their product ranges include ophthalmic pharmaceuticals, dermatology products, and neurological products.-Profile:...
, 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
Anaphylaxis
Anaphylaxis is defined as "a serious allergic reaction that is rapid in onset and may cause death". It typically results in a number of symptoms including throat swelling, an itchy rash, and low blood pressure...
, which is a potentially life threatening hypersensitivity
Hypersensitivity
Hypersensitivity refers to undesirable reactions produced by the normal immune system, including allergies and autoimmunity. These reactions may be damaging, uncomfortable, or occasionally fatal. Hypersensitivity reactions require a pre-sensitized state of the host. The four-group classification...
to some drugs and proteins.
Notable users
- Lisa RinnaLisa RinnaLisa Deanna Rinna is an American television host and actress. She is known for her roles as Billie Reed on Days of our Lives, Taylor McBride on Melrose Place, and most recently as the host of SoapNet's Soap Talk.-Acting:...
has said that using too much fillers was a mistake. Although she did not actually name Juvederm in the article, it is believed that's what she was referring to.