• Off-Label Use of Juvéderm Voluma XC in Infraorbital Hollows

    Written By: Lynda Seminara
    Selected By: Deepak P. Edward, MD

    Journal Highlights

    JAMA Facial Plastic Surgery
    Published online April 5, 2018

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    Hyaluronic acid (HA) fillers for infra­orbital hollows include Restylane and Belotero. Another HA-based filler, Juvé­derm Voluma XC, has higher viscosity and longer duration than Belotero, Restylane, and several other Juvéderm products. The G´ value (a measure of firmness) of Juvéderm Voluma XC is lower than that of Perlane, Radiesse, and Restylane, giving it a softer feel that may make it suitable for the lower eyelids. However, it has a higher G´ than other Juvéderm products, allowing it to better maintain its shape and resist spreading. In a study of Voluma XC for infraorbital hollowing, Hall et al. experienced acceptable safety and high patient satisfaction.

    This observational study was con­ducted at a private practice for facial surgery. Participants (age range, 21-85 years) underwent injection of Juvé­derm Voluma XC to the tear trough, nasojugal fold, and/or palpebromalar groove. Injection sites varied according to anatomy and volume loss. Main out­come measures were patient-reported FACE-Q scores, adverse events, and the need for additional treatment.

    Overall, 101 patients (202 eyes) were treated; mean follow-up time was 12 months. The mean injection volume per patient was 1.0 mL. Most patients received 0.5 mL on each side, disbursed evenly throughout the orbital rim and zygomaticomalar depression, with some gel placed toward the septal confluence. All injections were in the supraperiosteal or submuscular plane. To minimize swelling, the authors generally do not inject more than 1.0 mL of HA gel in a sitting. Therefore, it is expected that some patients will require additional treatment, which is explained before the initial injection.

    Most patients (89%) were female, had Fitzpatrick skin type 1 to 4 (98%), and had infraorbital hollow scores of 2 to 4 before injection (88%). Adverse events after injection were bruising (10%), contour irregularities (2%), swelling (3%), and the Tyndall effect (1%); most were mild and transient. Administration of hyaluronidase was required in 3 patients (3%). Eighteen patients (18%) needed more product within 3 months. Satisfaction rates for patients who completed the FACE-Q Satisfaction With Eyes or Satisfaction With Decision survey were 71% and 66%, respectively.

    A familiar criticism of Juvéderm Ultra and Ultra Plus in the infraorbital region is the propensity for excessive swelling and the Tyndall effect. The authors reported that, in their experi­ence with Juvéderm Voluma XC, these problems were not common.

    The original article can be found here.