Avoiding regret with JUVEDERM VOLIFT XC: What you should know about nodules and vascular complications before treatment

Regret with JUVEDERM VOLIFT XC often stems from nodules or irregularities at the injection site, and rarely, vascular occlusion. Most swelling and bruising are temporary, but vascular occlusion can lead to skin necrosis or blindness, so it is important to confirm the response plan if it occurs. JUVEDERM VOLIFT XC is a hyaluronic acid formulation containing 0.3% lidocaine anesthetic.[1].

What kind of reactions appear after injection?

Most people experience temporary reactions such as swelling or firmness. In a trial of 122 people who received the same formulation as JUVEDERM VOLIFT XC (VYC-17.5L) in nasolabial folds, firmness was observed in 108 people, swelling in 105, irregularities in 100, and bruising in 69.[2].

Most of these reactions are mild and reported to resolve naturally.[3][2]A review of 19 randomized controlled trials found that swelling, irregularities, and firmness were more common when injected into cheeks or lips than into nasolabial folds.[2].

Can nodules appear later?

Yes. With formulations using the same Vycross technology as JUVEDERM VOLIFT XC, delayed nodules and inflammation have been reported. In records of 400 people who received Volbella under the lips or eyes, 4.25% experienced delayed inflammation that persisted or recurred.[4].

In a study of 7659 people, all 3 cases of delayed nodules were with Voluma or Volbella.[5]It is thought that smaller hyaluronic acid molecules may more easily stimulate the immune system.[5]Although these are not specific numbers for JUVEDERM VOLIFT XC itself, being aware that changes can occur over time will help you avoid unnecessary worry.

Can irregularities or palpable nodules be prevented?

The likelihood varies with the amount and depth of injection. Experts state that for formulations using the same technology, palpable nodules or lack of integration primarily occur when large amounts are injected at once or when placed in too shallow a layer.[6].

The Tyndall effect—a bluish translucency—is rare with hyaluronic acid.[7]Hyaluronic acid is characterized by being dissolvable with hyaluronidase, the enzyme that breaks it down.[6].

What happens if a blood vessel becomes occluded?

Although rare, this is the most serious complication. If hyaluronic acid enters or compresses blood vessels, skin necrosis or blindness can occur.[3]The guidelines of the Japanese Association of Plastic Surgeons recognize that injection for wrinkles is effective, while also noting the need for attention to these serious complications, assigning a recommendation level of 2 (weakly recommended).[8].

In a 38-year-old case where eye movement became impaired and nasal skin changes appeared after injection, immediate treatment with hyaluronidase and others led to recovery within several weeks.[9]This report emphasizes that prevention and immediate treatment are essential.[9]Some reports describe attempts at treatment by needle stimulation in skin where blood flow is difficult to restore.[10].

Why doesn't the nasolabial fold result look the way I expected?

Because the cause of nasolabial folds is not single. Multiple factors are involved in how nasolabial folds appear, and the injection method must be adjusted according to the cause and depth.[4].

When cheek sagging (skin laxity) is involved, the injection may be placed in the deep fat layer of the cheek rather than the fold line itself, to lift the tissue.[4]Not determining the amount based only on the line itself reduces the chance of an unfavorable outcome.

How long does the effect last?

The effect of hyaluronic acid is generally expected to last 6–12 months.[7]With Voluma, which uses the same Vycross technology and is used on cheeks and elsewhere, effect remained at 18 months, though it diminished over time.[11].

Duration varies depending on the formulation, injection site, and individual physiology. In practice, the timing of the next treatment is decided by observing changes in the result.

What you should confirm before treatment

There are three key points to consider. First, where the cause of the nasolabial fold lies and where injection is planned.[4]Second, the amount and depth of injection per session.[6]Third, the response plan if vascular occlusion or delayed nodule formation occurs.[3][9].

The cause of nasolabial folds and skin thickness vary from person to person. Ask your doctor at your consultation to confirm where and how much should be injected for your face.