Disclaimer: The below instructions are provided by Juvéderm. This is for medical professionals only, who administer dermal fillers in their clinics on their patients.
As a medical professional, you understand the importance of staying up-to-date with the latest advancements in dermal fillers. One such product that has gained significant popularity in recent years is Juvederm Voluma with Lidocaine. In this comprehensive guide, we will delve into the various aspects of Juvederm Voluma, including its composition, indications, contraindications, precautions, and method of use. By the end of this article, you will have a thorough understanding of this sterile, pyrogen-free solution and its potential benefits for your patients.
Understanding Juvederm Voluma: Composition and Sterilization
Juvederm Voluma with Lidocaine is a sterile, pyrogen-free solution composed of cross-linked hyaluronic acid. Unlike some dermal fillers, Juvederm Voluma is derived without any animal origin, making it suitable for a wide range of patients. The gel is presented in pre-filled, disposable syringes with graduated measurements. Each box contains two 1mL syringes, four single-use 27G/1/2″ needles specifically designed for use with Juvederm, an informative guide, and labels to ensure trackability.
Sterilization is a critical aspect of any medical procedure, and Juvederm Voluma follows stringent protocols in this regard. The contents of the syringes are sterilized using moist heat, while the 27G/1/2″ needles undergo sterilization through irradiation. These measures ensure the safety and efficacy of the product for use in clinical settings.
Indications for Juvederm Voluma
One of the primary uses of Juvederm Voluma with Lidocaine is to restore lost facial volume. This implant is specifically designed to address volume loss in the face, providing a natural-looking rejuvenation for your patients. The inclusion of lidocaine in the formula aims to reduce the discomfort experienced by patients during the procedure, enhancing their overall treatment experience.
Contraindications: Where Not to Use Juvederm Voluma
While Juvederm Voluma can produce remarkable results, there are certain areas where it should not be injected. It is important to exercise caution and adhere to the following contraindications to ensure patient safety:
- Periorbital Area: Juvederm Voluma should not be injected in the periorbital area, which includes the eyelids, under-eye area, and crow’s feet. These delicate areas require specialized treatments and should not be subjected to Juvederm Voluma injections.
- Glabellar Region: The glabellar region, which refers to the area between the eyebrows, is another area that should be avoided when administering Juvederm Voluma.
- Lips: Juvederm Voluma is not suitable for lip augmentation. For lip enhancement procedures, alternative dermal fillers specifically designed for lip injections should be used.
- Intravascular Injections: It is crucial to avoid injecting Juvederm Voluma into blood vessels. Intravascular injection can lead to embolization, vessel occlusion, ischaemia, infarction, and other severe complications.
- Overcorrection: Overcorrecting with Juvederm Voluma can have adverse effects. It is important to exercise caution and follow recommended guidelines to avoid complications.
Additionally, Juvederm Voluma should not be used in patients with certain medical conditions, such as untreated epilepsy, a tendency towards hypertrophic scarring, known hypersensitivity to hyaluronic acid, gram-positive bacterial proteins, lidocaine, or amide-type local anesthetics. The product should not be used during pregnancy, breastfeeding, or on children. It should also be avoided in areas with cutaneous inflammatory and/or infectious processes, and in conjunction with laser treatment, deep chemical peels, or dermabrasion. Surface peels should not be injected if a significant inflammatory reaction is present.
Precautions for Safe Use of Juvederm Voluma
When using Juvederm Voluma with Lidocaine, it is essential to follow specific precautions to ensure patient safety and optimal results. Here are some key precautions to keep in mind:
- Injection Technique: Juvederm Voluma should only be used for subcutaneous, upper-periosteal, or deep dermal injections. The depth and technique of the injection will depend on the area being treated. It is crucial to consider the inclusion of lidocaine in the product when planning the injection technique.
- Breast Augmentation/Reconstruction: Juvederm Voluma is not intended for breast augmentation or reconstruction. Alternative products and procedures should be used for these specific treatments.
- Infection Risk: As with any injection, there is a risk of infection. It is essential to follow standard precautions for injectable materials to minimize the risk of infection.
- Combining with Other Fillers: There is limited data available on the safety and tolerance of injecting Juvederm Voluma into an area previously treated with a non-Juvederm dermal filler. It is recommended to exercise caution and avoid injecting into areas with permanent implants.
- Non-Midline Areas of the Nose: There is no available clinical data on the efficacy and tolerance of Juvederm Voluma when used in non-midline areas of the nose, including the nasal tip and post-surgical/traumatic noses. Physicians should be aware of the increased risk of vascular compromise/injury in these areas and evaluate each case individually.
- Autoimmune Diseases and Immunosuppressive Therapy: Juvederm Voluma should be used with caution in patients with a history of or currently suffering from autoimmune diseases or deficiencies or those undergoing immunosuppressive therapy. Specific monitoring and evaluation of these patients are necessary, including a skin test for hypersensitivity if the disease is active.
- Allergies and Hypersensitivity: Patients with a history of severe and/or multiple allergies should be evaluated individually and monitored closely. A skin test for hypersensitivity or suitable preventive treatment may be recommended before injection.
- Bleeding Risks: Patients on anticoagulation medication or substances that can prolong bleeding should be warned about the potential increased risks of bleeding and hematomas during injection.
Remember, a maximum of 2mL of Juvederm Voluma should be injected into each treatment area during each session. It is crucial to exercise caution and adhere to recommended dosage guidelines. The safety of injecting more than 20mL of Juvederm dermal fillers per 60kg body mass per year has not been established.
Additionally, the presence of lidocaine in Juvederm Voluma warrants caution when combining it with certain drugs that reduce or inhibit hepatic metabolism. It should also be used cautiously in patients showing symptoms of cardiac conduction disorders.
Potential Adverse Effects and Undesirable Reactions
Like any medical procedure, the use of Juvederm Voluma is not without potential adverse effects. Patients should be aware of these possibilities and report any unusual symptoms to their medical practitioner. Some potential adverse effects include:
- Inflammation: Patients may experience temporary inflammation, such as redness, edema, erythema, itching, pain on pressure, or paresthesia. These symptoms typically subside within a week.
- Hematomas: Hematomas can occur at the injection site, although they are relatively rare.
- Staining or Discoloration: If Juvederm Voluma is injected too shallowly or in thin skin, it may lead to staining or discoloration at the injection site.
- Poor Filling/Restoration Effect: In some cases, the desired filling or restoration effect may not be achieved. This can vary depending on individual factors and the technique used during the procedure.
- Severe Complications: Rare but serious complications can occur if dermal fillers are injected intravascularly, leading to temporary or permanent vision impairment, blindness, cerebral ischaemia or cerebral haemorrhage, skin necrosis, and damage to underlying structures. If any of these symptoms occur, the injection must be stopped immediately, and the patient should receive prompt medical attention.
- Abscesses, Granuloma, and Hypersensitivity: Immediate or delayed hypersensitivity, abscesses, and granuloma formation have been reported following hyaluronic acid and/or lidocaine injections. Patients should report any persistent inflammation or other side effects to their medical practitioner.
Method of Use: Posology and Administration
Administering Juvederm Voluma with Lidocaine requires a healthcare professional who is knowledgeable and experienced in the anatomy of the treatment area. Before treatment, it is essential to ensure that patients are informed about the indications, contraindications, incompatibilities, and potential adverse effects associated with dermal filler injections.
To ensure a safe and effective procedure, follow these steps:
- Disinfection: Thoroughly disinfect the treatment area before injection to minimize the risk of infection.
- Needle Preparation: Screw the needle clockwise into the syringe until the cap is in the correct position.
- Product Flow: Once the protective cap is removed, press the plunger until the product flows out of the needle. If blanching occurs, stop the injection and massage the area until it returns to its normal color.
- Dosage: The amount of Juvederm Voluma used should be determined by the healthcare professional’s experience and the specific defect being corrected. Avoid overcorrection to minimize the risk of tissue necrosis and edema.
- Touch-up and Repeat Treatments: In some cases, a touch-up or repeat treatment may be necessary to achieve and maintain optimal correction. It is recommended to wait a minimum of 2 weeks between two injections.
- Post-Injection Massage: Massage the treated area after the injection to ensure a smooth and even result.
Storage and Disposal
To ensure the efficacy of Juvederm Voluma, proper storage conditions must be maintained. The product should be stored between 2°C and 25°C. Always check the expiration date printed on the product packaging before use. Do not use the product if the contents appear separated or cloudy.
It is crucial to dispose of used needles and syringes in designated containers following relevant guidelines for proper disposal. Never attempt to straighten a bent needle; discard it and replace it with a new one. It is also important to manage the storage and disposal of Juvederm Voluma in compliance with applicable regulations and guidelines.
Juvederm Voluma with Lidocaine is a versatile and effective dermal filler for restoring lost facial volume. By following the guidelines and precautions outlined in this comprehensive guide, medical professionals can ensure safe and successful treatments for their patients. Remember to exercise caution, stay informed about the latest advancements, and prioritize patient safety and satisfaction. With proper knowledge and expertise, Juvederm Voluma can be a valuable addition to your clinic’s range of aesthetic treatments.