Part 2: Refiners

     In the first section of this two-part series, we discussed Sculptra Aesthetic, a filler which helps in the restoration of facial volume. This is important for recreation of a youthful appearance to the contour of a person’s cheeks, mandible (jaw), temples and chin as well as for helping eliminate deep folds, lines and wrinkles. While Sculptra provides a cost-effective and reliable way to restore a more youthful fullness and appearance to an aging face, it can not be used more superficially in the skin. This means we cannot use Sculptra to treat fine lines, more superficial wrinkles, or around the lips. For that purpose, we need a filler that I classify as a refiner. In my practice this is most often Juvederm XC or Juvederm Plus XC. These two products can be injected in a more superficial plane to achieve the desired result.

Let’s start with the science behind Juvederm. This plant-derived product is comprised of hyaluronic acid. Hyaluronic acid is found in our skin but the actual amount naturally decreases as we age. This, in turn, contributes to the appearance of aging, sagging and wrinkling features. Because hyaluronic acid is naturally-occurring, no allergy testing is required before the administration of Juvederm as is required for other fillers such as collagen. This certainly makes for an added convenience. If the patient is off any of the medications that can cause bleeding (see my blog: Why Disclosing ALL Medications To Your Doctor May Be More Important Than You Realize from May 14, 2012), we can often treat the patient on the same day as the consultation.

Hyaluronic acid is a malleable gel that is injected into areas such as the nasolabial folds (creases from the corner of the nostrils to the corners of the mouth), the lips, the skin above and below the upper and lower lips (to soften lip lines), and into tear troughs (a ridge or “trench” that forms below the lower eyelid and above the cheekbone when loss of volume begins to occur). Part of the success of Juvederm can be attributed to its mechanism of action. The injected hyaluronic acid binds to the water in our skin (in fact, it binds 1,000 times its volume in water!) and creates a “filling” or “plumping” effect that has a very natural look and feel.

Naturally occuring hyaluronic acid is broken down by the body by an enzyme called hyaluronidase. Over time, hyaluronic acid products such as Juvederm are naturally broken down in the same fashion. This breakdown, however, occurs at a much slower rate because of the way injected hyaluronic acid is produced. During the manufacturing process, the individual molecules are made into chains which are then cross-linked together. This assembly of linked chains slows down the degradation by hyaluronidase.

You may have heard of some commonly used competitors such as Restylane or Perlane that are also hyaluronic acid temporary fillers. In our experience, Juvederm typically lasts longer (approximately 8-10 months) than its competitors and, in our opinion, feels smoother once injected. For this reason, it provides a higher rate of satisfaction for our patients.

Thus, the combination of Juvederm (a refiner) and Sculptra (a volumizer) allows for a unique and effective duo that provides a very effective contribution to one’s facial rejuvenation- attaining that natural, healthy, more youthful look you remember!