Thank you for your question.
You state in your question that you have hemifacial spasm which you treat with Botox® and you’re
asking can you have Juvederm Voluma understanding that you have this other condition concurrently,
the hemifacial spasm.
Well, I can certainly share with you my approach to patients like yourself.
A little bit of background, I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial
plastic and reconstructive surgeon.
I have been in practice in Manhattan and Long Island for over 20 years.
I could tell you that the original use of Botox® and the group of doctors who first
used Botox® were actually oculofacial surgeons.
And the original use of Botox® was for conditions like yours, hemifacial spasm and a condition
called benign essential blepharospasm.
So this is something that I’m very familiar with and I’ve treated a lot of patients
with this muscle spasm conditions long before the indications for cosmetic eventually became
and made Botox® the number one non-surgical cosmetic procedure.
So let’s understand what the interaction is and why there would be a potential issue
but frankly speaking, we’re talking about two different classes of a filler or a way
to approach cosmetic problems.
Voluma is a filler.
It adds volume in the places in the places where you place it and of course Botox® is
a neurotoxin and it prevents certain muscles from contracting.
So I can understand that you can be a little concerned that maybe if you placed the filler
that it could cause some local issue that can worsen your condition.
So I would just share with you my approach to how I would use a filler like Juvederm
Voluma typically for somebody regardless of whether or not they have a facial spasm but
what relationship to the muscles this would be.
So when you talk about hemifacial spasm, you are basically looking at one side of the face
and the eye muscles contracting and the muscles that lift the cheek and the outer part of
the lip contracting in an uncontrollable way and are relaxed with Botox®.
If I were to place a material like Juvederm Voluma, my preference would be to place it
at a deeper level actually below the muscle, on top of the bone.
Basically, I would suspect that you’re asking about Voluma specifically because you want
to improve the midface area, the cheekbone area.
And so, I feel like there’s an advantage to the placement at the bone level in that
the muscles actually glide over the material and that the muscle doesn’t actually, negatively
impact the material but rather helps the material shape well with the bone structure.
It also allows for a significant amount of stability in terms of the longevity of the
material.
When I place it at the bone structure level, the material can actually last up to 2 years.
There’s an advantage there which means you don’t need necessarily as frequent injections
or as much volume if you need repeat injections earlier than the 1-2 year timeframe.
When it comes to the relative position in the soft tissue, let’s say you put it in
just the cheek soft tissue, the malar fat pad or just in the superficial level, potentially
if your spasm increased and you are constantly squeezing which is different from a person’s
normal facial movements, theoretically, there can be more, let’s say, pressure forces
and shearing, relative forces that can maybe displace and shift the material.
Theoretically, it’s hypothetical but it does have a certain validity based on the
anatomic placement.
So for me, from my point of view, I would put it at a deeper level.
From a medical perspective in terms of any interaction with the Botox®, I would say
there would be none.
And from a safety point of view, I think it’s completely safe to do.
And again, without knowing the rest of your medical history or any other details of your
situation, I would say, assuming everything else is good, that it’s not likely to be
problematic.
Speak to your doctor, the doctor who performs this, mostly likely a neurologist or an oculoplastic
or oculofacial plastic surgeon doing the injectables for the Botox®, then they may or may not
be doing the injectables for Voluma and other things.
So if you need to go to another doctor for the injectable filler, just run it by your
doctor who does the Botox® for you just to make sure that they don’t have any concerns
that I don’t know from the details from your question.
That’s just to be safe.
So I hope that was helpful, I wish you the best of luck and thank you for your question.