Tonight I participated in a live lecture on the web regarding Juvederm Voluma injection techniques. I guess they call this format a webcast or webinar.
I joined a few minutes late. But it seemed to start with a discussion of facial muscle anatomy followed by a discussion of facial fat compartments.
Here are my notes below for other Botox injectors and Juvederm Voluma injectors if interested. My personal technique is somewhat different because I use a cannula technique and he uses a direct needle technique. Cannula technique at this time is considered off-label FDA usage. But I feel that it is, in my hands, a safer technique.
Some Juvederm Voluma / Cheek filler highlights:
- Lateral support is important – at the level of the zygomatic arch.
- Females have fuller frontal cheek projection it seems than males.
- Anterior cheek injections can unfortunately reinforce the ptosis of the cheek.
- Cheeks become lower and more medial when smiling with age – age 40 vs age 50
- With volume loss in the submalar area – danger sign for “sausage” look with nasolabial filling
- The nasal flare shouldn’t be hidden with injections – avoid medial cheek injections.
- People who may look good in the frontal view, might not look good in the oblique view.
- Aspirate when injecting deep with Voluma
- With infection risk, there is granuloma risk.
- He labels the zymatic arch with v1, v2, v3
- v4 is the soft area of the cheek below v1, v2, v3.
- avoid treating v4 first because of lack of bone support.
- He uses a pull upwards and backwards = “pinch traction” so the skin cannot go back to it’s original tendency after placement of voluma
- A discussion of J1, J2, J3, J4. These are Juvederm locations.
- He talks about J4 as the vertical lip rhytids (lines) and talks about perpendicular injection to avoid elongation he says.
- At Voluma injeciton site #4, there are many dangerous sites such as parotid gland, parotid duct, or the transverse artery. He uses a fanning technique for injections.
- Look at patients on animation and when looking down. Animation meaning smiling.
- Avoid voluma intra-orbit.
- Malar crease – you can solve some of the ones which disappear when the patients smile.
Great presentation! There is always much to learn from other Voluma injectors.
Disclaimer: The above notes are not my thoughts. They come from a surgeon who works outside of the United States. They are interesting and I thought I’d share. The talk on Juvederm Voluma was brought to us by Allergan.