PracticalDermatology

Allergan’s JUVÉDERM® VOLBELLA® XC is here, and talk of its nuanced use will likely be on everyone’s lips at the upcoming Cosmetic Surgery Forum meeting in Las Vegas.

The FDA approved Volbella for lip augmentation and correction of perioral rhytids in adults over the age of 21 in June 2016. As of mid-October, physicians could purchase VOLBELLA XC after completing an online training program.

Volbella is new to the US, but European and Canadian doctors have been using the filler for years. The new lip filler is a member of Allergan’s Juvederm family. It is made with Vycross technology, which provides a high concentration of crosslinked hyaluronic acid for a smooth gel that flows easily into the skin. Other FDA-approved products in this family include JUVÉDERM® VOLUMA® and JUVÉDERM® ULTRATM XC products. Another member, JUVÉDERM® VOLIFT® is not yet FDA approved, but may be soon.

“It’s a soft filler like Belotero, but is less cohesive,” Hema Sundaram, MD, a dermatologist in suburban Washington, DC, says of Volbella. Based on the scientific properties of Volbella—moderate cohesivity and low-medium elasticity and viscosity—Dr. Sundaram likens its consistency to that of whipped cream. She has performed educational work and injection demonstrations with Volbella overseas. 

Volbella: How Long Will It Last?

Kevin C. Smith, MD FRCPC, a dermatologic surgeon at the Niagara Falls Dermatology & Skin Care Centre, Ltd in Niagara Falls, Ontario, Canada, has been using Volbella for close to four years. “The duration of cosmetic benefit with Volbella is about six to 12 months,” he says.

“If used properly, the results go well beyond the physical palpability of the implant,” adds Daniel Cassuto, MD, a plastic and aesthetic surgeon in Milan, Italy, who has been using Volbella since 2013. “My patients come back on average after 18 months and part of the result is there,” he says.

“Some colleagues in Europe report long-lasting results. There are also some study data indicating this,” Dr. Sundaram says. “As with any filler, longevity will depend on the areas injected. The lips and perioral region are very mobile, so fillers tend to last less long there and also longevity can depend on the individual patient and the injection technique that’s used.”

 Volbella Injection Pearls

“I inject it using a 50mm x 27ga TSK UTW cannula, just using a bit of lidocaine at the corners of the mouth,” Dr. Smith says. “This is much safer, simpler than needles, hurts way less, and produces a better aesthetic outcome.”

Hyaluronic acid fillers improve tissue quality better when thoroughly distributed in subcutaneous layers by a blunt cannula than by bolus placement, agrees Dr. Cassuto. “Undercorrection is a must whenever one is acquiring experience with new materials,” he says.

Volbella injects a lot more quickly than other fillers, says Omaha, NE-based dermatologist Joel Schlessinger, MD. “It is important that the first time you inject it, you don’t use too much pressure on the plunger or you could have significant filler introduced,” he says.

“I have really enjoyed the way that Volbella interacts with Cupid’s bow and philtrum areas as it produces more of a structural change than other fillers,” he says.

Still, he adds, the jury is out. “We have limited experience in the US. The initial impression is very positive, but I would like to see how Volbella performs over time.”

Volbella will cost more than other fillers, but the longevity must be considered when doing cost-benefit analysyes. “Prices may be higher but the results last longer, and this may be palatable to our patients,” Dr. Schlessinger suspects.

Volbella: Edema Risk Management

“Volbella gave me good results in superficial intradermal with no risk of Tyndall effect,” Dr. Cassuto says. “I would be very careful in sphincteric areas, i.e. lips and periocular, because many have reported edema, not immediately but during the days following injection.”

Dr. Cassuto has only seen one case of severe edema after injection with Volbella, and there were extenuating circumstances, namely severe dehydration/hangover in the patient after binge drinking the night after injection. “It resolved when fluid/electrolyte balance was restored,” he says.

“No other reactions in my cases,” Dr. Cassuto continues, “but I have treated infected implants from other practitioners, either because of ‘dirty’ injections or patients with overlooked infections elsewhere (e.g. teeth).”

Dr. Smith adds that post-procedure care is extremely important for aesthetic lip patients. “A lip patient should sleep with their head up on an extra pillow the night they are treated, to reduce the recumbent edema they will otherwise get in their lips,” he says.

Volbella Versus Volift

Another product from this same family of fillers, Volift, may be next to hit the US. Volbella and Volift are identical except for the dilution. “Volbella has a lower concentration of HA than Volift. It’s suited to superficial implantation whereas Volift is generally for midlevel implantation,” Dr. Sundaram explains.

“Volift is an excellent subcutaneous volumizer in areas with good skin coverage, “ says Dr. Cassuto. n

1. Sundaram H, et al. “Global Aesthetics Consensus: Hyaluronic Acid Fillers and Botulinum Toxin
Type A—Recommendations for Combined Treatment and Optimizing Outcomes in Diverse Patient Populations.” (2016). Plast. Reconstr. Surg. 137: 1410-1423.

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Joel Schlessinger, MD explains how the discussionbased atmosphere separates Cosmetic Surgery Forum from other educational venues.