The Aesthetic Surgery Journal ( 35:589-599, 2015) recently published an article by Few, J, et. al. on the long-term effects of Voluma (Allergan) for midface enhancement. This article coincidentally appeared just two months before another HA (hyaluronic) gel, Lyft (Galderma) received FDA approval for mid-face enhancement as well. Both products are “thicker” variants of hyaluronic gels which are intended to give more volume, last longer and must be placed deeper. Please note that Lyft is not a new product but is a rebrand of Perlane-L, a product that has been around a long time. Examples of other products and procedures that compete in this space include Sculptra and the patient’s own fat.
As a disclaimer, I personally use both products extensively in my practice and feel that both have their role in facial rejuvenation. There are two significant differences. If you look at both studies, you will see that Voluma lasts twice as long as Lyft. Approximately ¾ of correction persisted at one year for Lyft, while the same amount of correction was reported at 2 years for Voluma. Voluma is, however, also twice as expensive. Lyft does have approved indications for facial sites other than the cheek including the nasolabial fold area. As of now, the only approved indication for Voluma is for midface augmentation (cheek).
The initial reports and press releases on Lyft do not report the volume injected; however, in the Voluma study more than 5 cc’s of Voluma was injected initially with additional Voluma added at one month. The patients in both studies reported a significant incidence of injected related tenderness, swelling, etc. This is to be expected when you inject more than 5 cc and, in addition, all the injections are performed with needles and not soft cannulas.
My own practice is to inject a smaller volume of Voluma (1 – 3 cc’s) at each sitting. I find we not only get adequate correction, but it is also much less costly for the patient. Larger volumes of any filler are preferentially done with soft cannulae instead of needles for patient comfort and to decrease the incidence of bruising and tenderness.
Augmentation of lost volume is an important component of rejuvenation of the aging face. Both Voluma and Lyft represent two examples of injectables that may be used safely to achieve this goal.