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Voluma: A revolutionary new cosmetic filler

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Doris Day, MD is a board certified dermatologist who specializes in laser, cosmetic and surgical dermatology in her Upper East Side practice.
Voluma: A revolutionary new cosmetic filler
by Delia von Neuschatz


“It’s a game changer in our rejuvenation opportunities and possibilities,” says dermatologist, Doris Day. “It is a paradigm shift in the way fillers are used,” says plastic surgeon David Shafer. “It will change the way I put volume in the face,” echoes dermatologist Cheryl Karcher.
David Shafer, MD, FACS is a double board certified plastic surgeon with an aesthetic surgery practice in mid-town Manhattan.
Cheryl Karcher, MD is a board certified dermatologist practicing on the Upper East Side.
What are these NYC physicians raving about? It’s a new dermal filler called Juvéderm Voluma XC, Voluma for short, and it seems poised to take the cosmetic procedure business by storm. Brought to you by Allergan, the makers of Botox, Voluma is the first and only injectable filler to receive FDA approval for volumizing the mid-face and cheeks.

These “Before” and “After” photos of one of Dr. Shafer’s patients show the results of Voluma two days after it was administered. The top row shows the overall improvement. The middle row displays the changes in the roundness and lifting of the cheek, and the bottom row illustrates the modification in the hollowness of the eye and tear trough. No injections were placed in the tear trough. Enhancement of the under-eye area is a secondary benefit. This patient had two syringes.
This malleable gel has been tried and tested long before the FDA gave it its blessing, however, as it has already been approved and used in no less than 72 countries over the past 5 years.

“The process of aging is the process of volume loss,” explains Dr. Karcher. Over time, the combination of fat and bone absorption results in sagging skin and a hollowing of the cheeks — and it is this age-related loss of volume which Voluma was specifically designed to redress. So, what exactly is Voluma and why are cosmetic doctors so excited about it?

Like Juvederm and Restylane, Voluma is a hyaluronic acid, or HA, a naturally-occurring skin molecule. Unlike the other HA fillers, however, Voluma has very low hydrophilic properties, meaning that it has a very low rate of water-absorption. While a product with a high rate of water absorption is great as a wrinkle filler, it is not always ideal as a volumizer due to the fact that there is little control over the end result.

Therefore, because Voluma will not expand after injection, it takes the guesswork out of how much to use, allowing for controlled, precise results. “What you see is what you get with Voluma,” says Dr. Shafer. If a patient is unhappy with the effects, though, the procedure is reversible, as are all HA fillers, with the injection of a dissolving enzyme.

Another advantage to Voluma is its superior lifting capability. The gel doesn’t spread out once it has been injected. It stays cohesive, resulting in a nice lift to the cheeks and jowls. Voluma changes “the way fillers are used from previously only inflating tissues to now lifting the face with a naturally appearing result," maintains Dr. Shafer.
Dennis Karr, one of Dr. Shafer’s patients, before receiving Voluma.
Dr. Shafer injecting Voluma during a training session he was conducting for other physicians. The filler is injected at a deep level on top of cheekbones. No numbing of the area was necessary as Voluma is laced with the numbing agent lidocaine. Mr. Karr received a total of three syringes.
The patient in mid-procedure after his right cheek was injected. Notice the smoothing of the nasolabial fold and under-eye area on the left – effects of Voluma’s lifting properties. “Other fillers are different and good too,” says Dr. Shafer, “and the advantages of Voluma may not come at the disadvantages of other products, but Voluma is filling a void that other fillers are not currently meeting.”
Then there’s also its longevity. Whereas other HA fillers last for 8-12 months, studies have shown that Voluma lasts for two or more years. An added benefit, according to Dr. Day’s own observations, is that the filler also stimulates collagen.

So, what are the downsides? As one can imagine, Voluma doesn’t come cheap. It is priced at $1,000 - $1,400 per syringe and most patients require 2 -3 syringes. Still, considering the product’s longevity, it provides good value for money. Injections can also result in some bruising and swelling – something that Dr. Shafer has noticed in 1% - 3% of his patients. A patient of Dr. Day’s reported some swelling, soreness and light bruising that was easily covered up with concealer. She said that when she went to work the next day, and none of her coworkers noticed anything out of the ordinary.

With Voluma, it appears that Allergan will become as indispensable to our cheeks as it has been to our foreheads. “I haven’t been this excited about a new product in a long time,” says Dr. Day, who, like Dr. Shafer, also trains other physicians in proper Voluma injection techniques. “Cheeks may be the new lips,” she concludes.
“With Voluma, you get immediate satisfaction, immediate age-reversal, an immediate mini-facelift,” says Dr. Karcher. The filler received FDA approval in October and already, “we are going through it like water,” she continues. “Voluma is new and is fantastic,” according to Dr. Shafer. “It is a safe, predictable, reproducible, longer lasting, with minimal swelling and little to no downtime,” he enthuses.
Dr. Shafer’s cheat sheet of cosmetic fillers

Hyaluronic Acids: Juvederm Ultra XC, Juvederm Ultra Plus XC, Juvederm Voluma XC, Restylane, Perlane, Belotero. (Only HA fillers are reversible. Reversible by Hyaluronidase, a natural enzyme that metabolizes hyaluronic acid.)

Hydroyapatite: Radiesse. Nice lift effect. Not reversible. Not for thin tissues.

Poly-L-Lactic Acid: Sculptra Aesthetic. Requires multiple treatments to achieve full effect. Good for generalized filling. When full effect is reached, lasts 2 or more years. Stimulates growth of patient’s own tissues.

Collagen - not used anymore. May cause allergic or immune reaction in some patients. Variable length of duration/effect.

Fat Grafting - uses the patient's own cells. Advantages are unlimited supply (in most cases) and is metabolically active. Disadvantages are that it’s technically more challenging and less predictable for less experienced doctors.

Silicone Injection - Permanent. May cause long-term problems/reactions. Not reversible and requires surgical excision, which may not even be possible in many cases.

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