Juvéderm Ultra Plus: Your Questions, Answered By An Expert

Happy end of February, everyone! For this week's article, we're focusing on answering reader questions about the injectable dermal filler Juvéderm Ultra Plus. Before we get into the questions, here's some background on what it is for anyone unfamiliar:

Juvéderm Ultra Plus is a type of dermal filler designed for use on moderate to severe wrinkles. It is commonly used on areas such as the marionette lines (the wrinkles that go from the corner of the mouth down to the chin) and the nasolabial folds (the wrinkles that slant up from the corners to the mouth to the nose). Like the rest of the Juvederm family of dermal fillers, it is made of hyaluronic acid, which is a naturally occuring substance that hydrates the skin and delivers nutrients. The effects of an injection of Juvéderm Ultra Plus last between nine to twelve months before it must be redone.

To answer your questions about this filler, we spoke with the lovely Carol Evanicky, the owner of Kalologie Medspa Austin.

How is Juvéderm Ultra Plus different from other types of Juvéderm?

Rachel asks: As a marketing person, I feel like I can recognize marketing nonsense when I see it. And the name Juvéderm Ultra Plus feels like some marketing nonsense. A lot of beauty stuff is all the same thing, just packaged differently, so is that true for all the different types of Juvéderm? They have a lot of different names and some are more expensive, but is it all really the same thing? If it is, hats off to them for being clever, I just want to know so I'm not paying more for the same thing!

Carol: Each of the different types of Juvéderm are FDA approved for specific areas of the face depending on the viscosity. Juvéderm Ultra Plus has been approved for injection to the mid to deep dermis to smooth out moderate to severe facial wrinkles and folds. Juvéderm Ultra Plus is more robust than Juvéderm XC but less so than say Juvéderm Voluma. There are several factors that go into making up each product and its properties, including the hyaluronic acid concentration, the gels' ability to absorb water, the firmness of the gel, and the gel's tendency to stick together and hold its form or shape. The different products have a specific structure depending on the job they need to perform.

Why is Juvéderm Ultra Plus made with hyaluronic acid?

Shanae asks: I thought hyaluronic acid was a skin care ingredient? Why is it in a facial filler that goes into your cheeks? Is the hyaluronic acid in Juvéderm Ultra Plus really different from the kind I can get from Ulta for twenty bucks? It's definitely way more expensive, so what makes it special?

Carol: All the Juvéderm products are dermal fillers that are made mostly of hyaluronic acid. Hyaluronic acid is a naturally occurring substance in the skin that delivers nutrients and increases moisture retention, softness, and volume.

Hyaluronic acid attracts the water molecules and nutrients that the skin needs to maintain a youthful appearance. In skincare products, HA boosts the effects of the serums and moisturizers. There are many factors that can dry out the skin and using a topical HA can combat them by working from the outside in. HA in a filler provides those same benefits, but from the inside out.

The difference is in the size of the HA molecule. For serums there are two different sizes, small molecules that can penetrate the skin and larger ones that form a barrier on the skin. Both are generally available in a cream form. For injecting, the molecules are much larger. They are in a gel form that is malleable and can be placed in a specific location. Cross-linking is the patented technology that is used to link the molecules in the Juvéderm collection of fillers. If the HA were not cross-linked the HA would begin to break down in a matter of days.

Is Juvéderm Ultra Plus more natural looking than Botox?

James asks: I was told by a nurse friend that Botox or Juvéderm, specifically the Ultra Plus kind, could be really helpful for my nasolabial wrinkles. I do not like Botox very much, since it seems like people freeze their faces so they look unnatural. I hate the idea of it being super obvious that I had work done, so I really don't want that. Does Juvéderm look more natural?

Carol: That is a bit like comparing apples to oranges. These products do two different things. Both give results that are very natural looking. Botox stops muscle movement, leaving a smooth even surface. Juvéderm Ultra Plus smooths out folds and wrinkles that are caused by volume loss. When paired together, they give a very rested and youthful result.

Who is a good candidate for this treatment?

Stephanie asks: What makes someone a good candidate for Juvéderm, or really any other type of filler?

Carol: Anyone who is unhappy with the folds and lines on their face is a candidate for Juvéderm. Not everyone is and I say more power to them! I have a cousin who has no desire to use any type of filler. She loves the lines on her face because she says they make her look wise. To me she is both wise and beautiful!

Does it hurt to have Juvéderm Ultra Plus injected?

Ana asks: Okay, how much does it hurt? I don't like pain.

Carol: Well, any time you have a sharp needle poked in your skin it hurts! A topical numbing cream can be used to minimize or even eliminate discomfort. Juvéderm also has lidocaine in it to reduce pain. Both of these help to ease the level of any discomfort a client may feel.

How do you decide on a provider?

Erin asks: This spa near where I work is offering a special on fillers for Valentine's day. I think that's weird marketing for a day that's about love, but I also like saving money. How can I vet them to find out if they're legit/ do a good job? I don't want to mess up my face.

Carol: Be sure to check out their social media. Do they have before and after photos that are recent? Look at the bio of the provider, are they medical professionals who have invested in continuing education? Check out the reviews and see what past clients have said. Don't just go for the lowest price. When investing in your appearance you need to do your homework.

What is a reasonable price point for Juvéderm Ultra Plus?

Erin asks: The markup on Juvéderm Ultra Plus seems like a lot. When I look at prices at medspas they list the price way higher than the product actually costs them (I went down a rabbit hole of looking at prices of the actual syringes). I get that people's time and training is worth money, but it still seems like a lot. Maybe I'm just cheap LOL. What do you consider to be a reasonable price point for it?

Carol: We charge $700 for a 1ml syringe. A client is not just paying for the syringe, they are paying for the skill of the person that is doing the injecting. Our injectors have years of experience and have spent thousands of dollars on their training and education. They are all medical professionals, know facial anatomy, and know what to do should a complication arise.

How important is it to go to a provider with a lot of experience?

Kathy asks: I'd like to get Juvéderm for my stupid marionette lines but all the providers that are well known in my area are hella pricey and I'm not made of money. I was thinking about getting it done by a nurse who isn't very well known but also doesn't charge an arm and a leg. Is that crazy/potentially dangerous?

Carol: Experience and training give the provider the knowledge of correct placement, how to naturally shape, sculpt, and most importantly what to do when a complication occurs. A less experienced provider may not know how to create the results that the client is looking for. We have had clients come in from other providers and we have needed to dissolve the existing filler and start over. An experienced provider really does not "correct", they dissolve and start over.

One thing to note is that even the most experienced injectors will have complications. That is just part of this field. An experienced injector will realize what is happening during a complication and can correct it. A less knowledgeable injector may not. It all boils down to education and time doing hands-on training. Knowing facial anatomy is vital in avoiding complications, however everyone is different and not all veins are in the exact same location on every person.