Juvederm VOLUMA Instant Cheek Augmentation in Chevy Chase, MD - Dr. Naderi

Hi, I'm excited to introduce Juvederm Voluma. We've done plenty of injections before, using Restylane, using Belotero, using Juvederm Ultra and Ultra Plus. Juvederm Voluma has been something that's been in the works for a long time. And as plastic surgeons, official plastic surgeons, we've been waiting for it to get FDA approved. It just got FDA approved in the United States very recently. And actually there's very few people that have this and offer it. Only a handful of facial plastic surgeons and plastic surgeons in the D.C. metro area have the Juvederm Voluma. As one of the clinical instructors for the company Allergan, where I go around and teach other doctors and dermatologists and other nurse injectors how to do injections, I was privileged enough to be able to experience this and be able to offer it to my patients a little bit ahead of everybody else. So our experience, I'm going to share that with other doctors, other injectors, and also for patients who are interested in seeing how this works. Now, it comes in a package just like the other Jupoderms that we've been used to. Two syringes, two 1cc syringes per package. It's got the really nice packaging of all Juvederms. It comes in the XC form which has lidocaine mixed in it. The lidocaine makes it a little bit more comfortable as injections are done. It's a hyaluronic acid just like the other two Juvederms. It's cross linked in a way that it is meant for deep injection. That is FDA approval is for cheeks, basically for instantaneous augmentation of the cheeks. So for people who are looking for a little bit of augmentation, a little higher cheekbones or who've lost volume in the area below the cheeks and want that youthful triangular, that youthful heart shaped face. This is fantastic. This is not meant for superficial lines. This is not meant for lips. I say that again, do not put this in the lips. This is not meant for tear troughs. Please, please don't put this in the tear troughs. And I've seen people put artifill and radies in the tear troughs. That should just never happen. This also should never be placed there. It's for deep injections on top of the bone and it does a fantastic job of augmenting that area. It's supposed to last about a couple of years, but like any other filler, after a portion of it dissolves about six Months to eight months to a year, anywhere around there. You want to replace some of that loss so that you maintain a certain look. You don't want to keep yo yoing up and down. And I'm going to demonstrate the injections. The injections are transcutaneous. You can go intraoral as well. But I think the intraoral injection places a little bit higher risk of inaccuracy, misplacement and even potential infection. The transcutaneous route can give you some bruises, but it's one of those things that you prepare for. We give our patients arnica, pineapple juice, bromelain, make sure they're off of any things of blood that thin the blood like flaxseed, fish oil, omega 3, ginkgo and kinacea, all those supplements, kinika type of seed supplements that actually make your blood thinner and make you bleed more. So we have people avoid that for about two weeks before. And I'm going to demonstrate the injection technique here. All right, so it's important to analyze the cheeks. It's a very broad term. What does cheek mean? There's multiple zones to the cheek, their mid face area or the anteromedial cheek. This is one part that a lot of people start losing volume. Especially people that need tear trough injections. They need volume here. She doesn't really need much volume here. You can see that she's a little bit fuller on this side versus this side. So maybe a couple drops over here. The most important thing is to understand. 85% of people have significant facial asymmetry. The other 15% have it to a certain degree. Nobody's perfectly symmetric. Perfect symmetry is impossible. But you got to have the eye and know where to inject these things. So we don't want really any injection here whatsoever. None here. Perhaps a few little drops here. Then we talk about the malar area or the actual cheekbones. And her cheekbones are okay, but we can augment it a little bit more to give her a little bit more of a lift there. And then you can go down to the zygomatic arch area. These are essentially accentuations of the cheekbones that come out in this direction. And a lot of women place shadows here and try to highlight this. So you can actually augment this as well. And ultimately, especially in older people, we're talking about the sub malar area. So if this was the malar area, this is the sub malar area or below the cheek, and you can augment this as well to create a nice round mouth. We've done tear trough Injections in the past. Again, it's important to create a nice natural look and know where to place it. If you just place everything in one area, it's going to look like a walnut sitting there. It doesn't look good. And I'm going to show you. So I've got the filler in my hand. You can see it's a clear gel like the other juvederms, the Restylanes, the other hyaluronic acids. A nice, very moldable substance. Not like Radiesse or Sculptra or Artifil. That's why I love hyaluronic acid. And I'm going to show you the technique. So the injection is transcutaneous. Going in, going down to the bone. I'm hitting bone right here, I'm feeling the bone and I'm placing a few little drops right there. And you can actually see it lift up. Just that little injection, you can actually see the sight. It improved that contour here. I'm going down to the submalar area again. There are some big blood vessels here, but unfortunately nobody can see them. So it bleeds. Don't panic, just hold some pressure. You may have to hold the pressure for up to a minute or so, but it does a nice job. And you can see it starts filling up here. Remember we talked about a few drops here? Definitely nothing down here, but a few drops here. So let's go up here. Are my hands blocking the view or are you good. Right there? So how much have I used? Oh, point two. Not much @ all. It does a nice job in younger people. When the skin is tighter and more elastic, less is more the older you get. In your 50s, 60s, 70s, you need a lot more to be able to stretch the skin and give it a nice look. So in an older patient you may need five syringes, where in a younger patient you may need only one or two. So I'm going to walk this up now. See this area right there? This could benefit from a little augmentation right there. And I'll walk it up a little bit this direction. Real lower, higher cheekbone here, Right here. Again, you have to develop an eye and sense for the three dimensional nature of the face. And you got to be able to see which direction you're heading. A lot of people I've seen mark the face and put a lot of magic markers and crayons and all sorts of pencil marks there. The problem is if you go through the mark with your needle, you can actually tattoo the skin. That's how tattooing is done. So you don't want to mark the skin and tattoo it, but if that's what you need to do, that's what you need to do. And you can kind of see right now, see this beautiful, nice full mound you're getting. See the depression on this side and you can see the fullness here. Is that visible? Good. Perfect. Now, this has lidocaine. You don't have to finish one side. You start one side, let the lidocaine kick in, go to the other side and come back that way. When you go back to the side, if you need to fine tune it a little bit, it's already numbed up. Okay, so we're going to start here again. Sub malar area right here. You felt that one, huh? I did, yeah. Well, problem is they're not very comfortable. But it's quick. Topical numbing can make it a little bit more bearable. But the lidocaine will kick in and she will feel better soon. I'm going to tilt her head a little bit my way just to be able to see exactly where we need to go. And it's very normal for one side to feel a little bit different than the other side. Again, nothing is symmetric in our bodies or face. Nerves, muscle, bone, everything is different from side to side. An important concept to understand. And it's obvious she feels a little bit more on this side. But the beauty of the lidocaine is it'll start kicking in and she'll start feeling more comfortable. So I'm going to take a look at her. She's more in this area. See, again, the two sides are not going to start out symmetrical. So don't think that your injections have to be exactly the same on both sides. That's almost never the case. If one cheek is a little bit higher, it's normal for one cheek to be higher than the other. You may have to inject the other one higher to match it. It's normal for one cheek to be wider than the other. You have to give the other side a little bit more width. These are all normal things. But the kind of bleeding that she's having so far, this shouldn't really bruise much at all. This is just normal types of bleeding. However, if a big blood vessel gets in the way, you will have some bruising. And I tell people you want to give yourself a week or two at least before any major event. If you go into somebody's wedding anniversary, don't do this a few days before that event. But for more normal things, you can cover with makeup and go back to work. Alright, so I'm not done yet, but I'm going to set her up and take a look at. So I've sat her up several times and checked side to side, make sure both sides are looking as symmetric as possible. And our final dose will be right here. Really haven't bled much and getting from this either. So there's no major bruises and we're going to actually sit her up and take a look. So to be able to look at the cheeks now, you can actually see where the injections were. The redness of the cheeks are right here. But now she just looks like she put on five pounds of weight to the face. We don't want weight on the body, but five pounds away to the face just makes people look younger. She is young, but now she's got fuller cheeks, higher cheeks and you can actually see this nice mound right here. She doesn't need to put on makeup, she doesn't need to put shadows here. She just now naturally has that same thing here. And actually if you look from the 3 quarter view, the goal is to have a nice round mound and she has it. It's perfect. The tear troughs are even improved because it pushes the cheek up and supports the tip trough. It looks fantastic. She can put on some makeup tonight, go out and that's pretty much. So essentially this was Juvederm Voluma. And again, this is not something that if you haven't had injection experience with, you want to go into immediately. It is firmer. I've heard of patients that have come back and complained of other physicians placing it too superficially and they feel the lumps and bumps. It does take some practice and that's why the company is only sending this out to plastic surgeons and facial plastic surgeons in the beginning and then the rest of the injectors and the public will also be privy to it. But make sure when you're looking for somebody in the next year or two, they have experience with this type of an injection. Thank you.