Thank you for your question.
You submitted a question without a photo and you state in your question that you had 6
syringes of Juvederm placed for acne scars and that you’re going back for a touchup.
And you’re offered, I believe, Juvederm Plus or Juvederm Ultra Plus and you are asking
is it okay to have 2 different types of fillers or is it better to stick with the one you
started with.
Well, I can certainly give you some guidance with this question even in the absence of
a photo.
A little bit of background, I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial
plastic and reconstructive surgeon.
I’ve been in practice in Manhattan and Long Island for over 20 years.
I use a lot of fillers in my practice and we treat a lot of acne scarring.
And in fact, the application of this whole spectrum of fillers includes not only fillers
in the Juvederm family but also in the Restylane.
We also treat acne scars with platelet-rich plasma (PRP), platelet-rich fibrin matrix
(PRFM), regenerative medical technology as well as fat grafting and so certainly I am
very familiar with this question.
To begin with, it is very good to hear that you are satisfied with the result.
The challenge with acne scarring is of course diagnosing the scar or type of scar and using
the right strategy to maximize the outcome.
Chances are that with having undergone 6 syringes of Juvederm prior to that, you were getting
a lot of injections intradermally like within the scar and probably some sub-dermal under
the skin.
And the difference between the 2 products has to do with the relative thickness and
viscosity.
There is basically a direct correlation.
The thicker the product, the longer it lasts.
However, the thicker the product, the better it is to place deeper.
The reason is very straightforward.
When you are more superficial, let’s say putting aside acne scars but let’s use an
example like lips or fine lines or wrinkles, if you use a thicker product, it just doesn’t
fit very well and can create like an elevation that’s undesirable.
When you place the material deeper, it can really work out very well.
We actually do a procedure called structural volumizing where we routinely use Juvederm
Ultra Plus to augment and enhance the cheekbone, the jawline, the chin.
We place it deep at the bone level, under the muscles and it lasts a long time and it
provides correction for a longer period.
So, I think that the reason your doctor is probably considering Juvederm Ultra Plus may
be based on the assessment of the response of certain areas of the acne scarring which
didn’t hold up well with the Juvederm Ultra.
So which means that the natural thinking for a physician is if something less thick didn’t
provide correction, maybe something thicker will and that’s straightforward.
The coexistence of the product is no problem at all.
The products are all in the family of hyaluronic acid and as I mentioned earlier, it is routine
for us for acne scarring to combine hyaluronic acid with platelet-rich plasma (PRP).
This is something that every doctor approaches acne scarring and particularly every doctor
approaches from the lens of their experience and their experience using certain products
and strategies.
So there is never a right or wrong but there often is a general concept as to how to manage
particular types of issues.
So, I think it’s perfectly fine and I think you should put together more clarification.
Speak to your doctor about why the choice was made to go to Juvederm Ultra Plus.
I would suspect it’s not about the longevity but rather about its ability to maintain its
shape in certain areas where it might be of greater benefit.
So I hope that was helpful, I wish you the best of luck and thank you for your question.