How does Volbella XC change the lips? The longevity of soft hyaluronic acid and precautions regarding nodules

Volbella XC is an injectable filler made by combining soft hyaluronic acid with the anesthetic lidocaine, used for lip volume and fine lines around the mouth[1][2]. In the U.S. approval trial, 80.3% of people showed at least one-grade improvement in lip fullness at 3 months, and 61.8% maintained the effect at 12 months.[1]. Caution is needed regarding nodules and delayed inflammation.[3].

What kind of hyaluronic acid is Volbella XC?

Volbella XC is a formulation with a relatively low hyaluronic acid concentration of 15 mg per mL.[2]It was approved in the United States in 2016 and is used for lip volume enhancement and fine lines around the mouth.[2].

To reduce injection pain, the anesthetic lidocaine is included from the start.[1].

How do the lips change, and what is the duration?

In most people, lip fullness increases by approximately one grade. In a U.S. approval trial cited in a Chinese research paper, 80.3% of people showed at least one-grade improvement at 3 months, and 61.8% maintained the effect at 12 months.[1].

In a trial comparing with another filler, the percentage of people who perceived "fuller" lips was 73.8% for Volbella XC at 3 months, compared to 59.8% for the comparison filler.[4]. The expected duration is 12 months, but it is gradually absorbed over time.[1][2].

Can it be used for under-eye hollowing?

Studies have also examined its use for under-eye hollowing. In a study combining it with other injections such as Botox to treat the upper and central face, increased satisfaction with the eye area was reported.[5].

However, this study examined the results of combination treatment and did not assess the effect of Volbella XC alone.[5]. The skin under the eyes is thin, and the appropriate filler and injection technique vary by individual.

What are the risks of swelling and nodules?

Post-injection swelling, pain, redness, itching, and bruising are common reactions and typically resolve naturally.[6]. In the U.S. approval trial, nodule sensation and bruising were most frequent.[1].

Important to note is inflammation that appears after time has passed. In a record of 400 people who received Volbella in the lips and under the eyes, 4.25% experienced prolonged recurrent inflammation.[3]. There is also a suggestion that fillers made by the same method as Volbella may be more likely to develop nodules with delayed onset compared to other fillers.[3].

What are rare but important serious complications to know about?

Serious complications are rare, but may be irreversible.[6]. If hyaluronic acid blocks blood vessels, blood will not reach the tissue and skin damage may occur.[7]. Visual disturbances have also been reported after injection into the forehead, nose, brow area, and eyelids.[8].

An advantage of hyaluronic acid is that it can be broken down with an enzyme that dissolves it (hyaluronidase), and prompt use is important when blood vessels are blocked.[9][7]. If you experience severe pain, skin color changes, or visual abnormalities after injection, contact the clinic where you received the treatment immediately.

What should be confirmed in a consultation before receiving treatment?

Volbella XC is most often used for people who want to add natural volume to their lips and mouth area.[1][2]. Based on the article alone, you cannot determine which filler and what amount would be appropriate for your lips or eye area.

In your consultation, confirm the volume and location of injection, whether you have received prior injections, how nodules or inflammation will be managed if they occur, and how the dissolving enzyme will be used if needed.