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Since 2006, Omaha’s Choice for Botox, Fillers, Testosterone Pellets and The OWL Diet!

Voluma – what you need to know

Juvederm_VolumaXC_logoVoluma is the latest “dermal filler” to receive FDA approval and became available to the public at the end of 2013.

What is Voluma made of?

Voluma is part of the Juvederm family of fillers.  All Juvederm products contain hyaluronic acid.  Your body responds well to the placement of hyaluronic acid (HA) as it is also naturally present in the skin.  Juvederm products are all clear gel products that are produced synthetically.  Hylauronic acid gel fillers vary from each other based on the percentage of HA that is present, and also how tightly they are crosslinked.  The greater the cross-linking and the higher the percentage of HA – the longer it will last in the body.  Fillers with a very low % of HA include Belotero and Restylane.  These 2 gel fillers are low in viscosity and easy to inject (great for beginner injectors) but have the huge disadvantage that they do not last as long in the patient (average of 3-5 months at best).  Juvederm is the #1 filler for a good reason – it lasts longer.

How long does it last?

The duration of benefit will vary greatly between individuals.  Voluma received FDA approval to be injected into the “mid-face” which means the upper and mid cheek areas.  When it is placed properly and an adequate amount of product is used, it may last for up to 2 years.  That will not likely be the result for most patients who limit their injection of Voluma to one syringe.  As a new product in the USA we will have to wait and see what our patients say about this.  My belief is that most people will still see benefit at one year, and some (lucky ones) will see benefit at 2 years.

How is it injected?

Like all dermal fillers, Voluma is injected using sterile needles.

How will it change my appearance?

Voluma adds instant volume to the mid and upper cheek areas.  Most women lose the attractive youthful curve of the upper cheek as part of the aging process.  By restoring this curve and adding cheek volume, patients look younger and more feminine again. Voluma is also the first dermal filler that has the capacity of lift as well.  This means that the jowl and lower cheeks receive a subtle but noticeable lift.  Anytime we can lift, it is always a good thing!  This is a non-surgical solution that helps people look about 5 years younger.

What happens on the day of the procedure?

Every doctor and med spa is going to approach this differently.  I have years of experience injecting fillers, and I have evolved techniques to minimize discomfort and the risk of bruising.  At Omaha Med Spa, “before photos” are taken of the face, especially at an oblique angle.  Following that, your face is cleansed to remove makeup and bacteria from the surface of the skin.  Careful note is made of any asymmetry that is present (is one cheek fuller than the other, or higher than the other side?).  We offer “numbing cream” which is applied to the skin and works quickly (within 5-10 minutes) to numb the skin.  Numbing cream is then removed and the skin cleansed a second time.  All Juvederm products can be purchased with the “XC” designation which refers to the presence of lidocaine in with the filler.  XC was a huge step forward for all Juvederm products as injection discombort is greatly reduced.  All of the Juvederm that I use has “XC”, and contains lidocaine.

Injectors wear gloves and open a sterile package of Voluma.  Sterile needles are provided with each syringe.  We then apply ice to the area just prior to injection.  Voluma is injected 2 ways.  The first way is to direct the needle at a 90 degree angle to the skin, over the zygoma bone.  As the needle passes through the skin the patient often hears a “crunching noise” which is entirely normal, and they may feel it when the needle tip hits the bone (also normal).  Once the needle is at the correct depth and location, a small amount is injected, and the needle removed.  The injector can immediately assess the benefit from each injection. Voluma requires minimal molding.  The other way to inject Voluma is to place it in the deep dermis, injecting horizontal lines of filler under the skin. By running the lines side by side, and layered in opposite direction, a cross-hatching pattern of filler is achieved.  This is the technique used to add volume over the mid cheek (below the bony zygoma and orbit).  Cross-hatching is then followed by molding to achieve a smooth result.  Any bleeding that occurs with each injection is controlled with light pressure and further application of ice.  Once the injections are completed, the skin is cleansed again, and a thin layer of Arnica Gel is applied.  Arnica is a plant based product that reduces redness, swelling and bruising.  Arnica gel may be continued frequently at home over the next week.  Further icing at home is optional and generally not needed.  Treated areas may feel mildly sore or bruised for several days.  All HA products are “hydrophilic” which means they stay fuller when you drink an adequate amount of water.

What is a fair price for Voluma?

Voluma is priced by the syringe and the charge includes the cost of the product, the office visit, and the injection performed by a trained and experienced injector.  A fair price is $950 per syringe.  As a new product in 2014, we are offering savings to all patients at Omaha Med Spa.  By purchasing 2 syringes of Voluma, a patient can Save a total of $500 off that Regular Price.

What are the risks of Voluma?

As with all injections there will be some mild discomfort at the time of injection, followed by swelling for 1-3 days, and then bruising that may or may not occur.  All of these side effects are temporary and easily managed.  As with any injection, there is also a small risk of infection.  This risk is higher in a person with poorly controlled diabetes, taking steroids (such as prednisone) or is on immune suppressing therapies (such as some of the treatments used for Rheumatoid Arthritis, Crohn’s Disease and Psoriasis).  If infection occurs the area will become red, warm, swollen and tender.  Oral antibiotics will be prescribed and often the Voluma filler has to be dissolved.  Severe infection could result in hospitalization.  There is also the rare risk of an allergic reaction to the filler.  When any filler is injected, we try to avoid veins and arteries – but there is a small risk of filler compressing a blood vessel or filler entering a vessel and travelling to another part of the body.  Lastly, there are reports of “malar edema” whereby the cheek swells when filler is placed.  This is rare, but I have had one case that required attention.  All of these conditions are treatable.


Since 2006, Omaha’s Choice for Botox, Fillers, Testosterone Pellets and The OWL Diet!

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