Long Lasting Facial Volume with New Generation Hyaluronic Acid and Poly-L Lactic Acid Injectables

It is OK to call this blog a “puff piece”; it is about the new generation of minimally invasive injectables that restore lost volume to the face and fill in deep lines and wrinkles. Plastic surgeons now have new and slightly different weapons in their arsenal to restore a youthful, firmer plumper appearance to the face.The injectable products, Voluma, Vollure and Volbella from Allergan and Sculptra ®from Sculptra Aesthetic not only restore volume but stimulate the production of collagen to firm and plump the skin.

The filler offerings changed dramatically in 2006 with the introduction of Restylane®. Plastic surgeons now had an alternative to injectable collagen. The hyaluronic acid injectables offered patients a whole new way to naturally and cost-effectively start to address facial aging. With the new fillers on the market, women and men discovered they could complement, postpone, or maintain their facelift with positive outcomes. Injectables offered additional benefits as they buoyed patients with new found confidence whether or not they were undergoing traditional surgery.

With the growing popularity of dermal fillers, patients began demanding longer lasting products. The newest fillers on the market provide relative longevity and targeted treatment. As these newer formulations are highly specialized, differentiating between filler products, even those manufactured by the same pharmaceutical company can be confusing for a patient.

Allergan offers 2 families of hyaluronic acid based products, Hylacross and Vycross fillers. Allergan’s latest offerings, Voluma, Vollure and Volbella differ from their injectable predecessors in that they are engineered with Vycross technology. Vycross technology employs high and low weight molecular hyaluronic acid chains to decrease the water absorption of these products This Vycross technology results in products that can last as long as 18-24 months in the case of Voluma.

Voluma is the first FDA approved hyaluronic acid injectable for a mid-face lift. It is used to enhance the cheeks. Voluma’s consistency is thicker than other fillers. Voluma defines and shapes the aging face, and the results are immediately visible.

Volbella has a lighter consistency than Voluma. Its hyaluronic acid structure makes it softer than its Hylacross cousins. Volbella was developed by Allergan to enhance the lips. It treats tiny feathery lines and defines the vermillion. It adds a degree of fullness to the lips as well. Volbella is fluid, smooth and supple. Volbella’s results, like Voluma’s, are immediately visible.

Vollure is a Vycross product that sits in between Voluma and Volbella and is used predominantly for nasolabial folds, the marionette area and for the pre-sulcus.

In my practice, Voluma and Vollure are injected with a soft cannula instead of a needle while Volbella requires a very fine needle. There is no downtime following these procedures. In addition, it is our experience that the use of the soft cannula greatly reduces the incidence of bruising and is much more comfortable for the patient.

Sculptra® is FDA approved for full facial correction. It stimulates the production of collagen and increases volume rather than filling fine lines. It works gradually rather than immediately as the poly-L-lactic acid molecule (Sculptra) is absorbed over a period of time and collagen is created from a bio-stimulatory effect. The Sculptra must be reconstituted in sterile water at least 4 hours but preferably the day before your injection. The injections of the reconstituted Sculptra will restore volume immediately; however, this volume will recede within hours or at most a day or two, and your face will return its original appearance. Sculptra will then begin its work beneath the skin stimulating collagen production and creating volume.

A series of three injections over three months is usually necessary to achieve correction with Sculptra® for most patients. Final results are very natural looking and last two years or longer. Sculptra cannot be used superficially so it is not good in sites such as the lips. Sculptra injections do have some “homework” associated with them as the patients must massage the injection site during the 5 days following the treatment. For patients requiring multiple sites to be injected or large volume replacement, Sculptra represents a very cost-effective alternative.