Biological Properties of a New Volumizing Hyaluronic Acid Filler: A Systematic Review
January 2015 | Volume 14 | Issue 1 | Original Article | 50 | Copyright © January 2015
Derek Ho BSa and Jared Jagdeo MD MSa, b, c
aDermatology Service, Sacramento VA Medical Center, Mather, CA
bDepartment of Dermatology, University of California Davis, Sacramento, CA
cDepartment of Dermatology, State University of New York Downstate Medical Center, Brooklyn, NY
BACKGROUND: Hyaluronic acid (HA) dermal fillers are effective and safe for correction of facial rhytides. A new volumizing HA filler, 20
mg/ml HA dermal filler (Juvéderm® Voluma®, Allergan Inc., Irvine, CA), is the only HA filler with a FDA indication for facial volumization
due to age-related facial volume loss.
OBJECTIVE: Evaluate the biological properties, including biochemical, biophysical and rheological, of this new 20 mg/ml HA dermal
filler and discuss the importance of these properties in clinical applications.
METHODS AND MATERIALS: A systematic search of the computerized bibliographic databases Medline, Embase, Embal, Biosis, SciSearch,
Pascal, HCAPlus, IPA, and Dissertation Abstracts with key term “Voluma.” Four articles on the biological properties of this new 20 mg/
ml HA dermal filler were suitable for inclusion in this review.
RESULTS: Biological analysis of elasticity and viscosity values of this new 20 mg/ml HA dermal filler demonstrated intermediate
properties in three studies and high in one study compared to other HA dermal fillers. This 20 mg/ml HA dermal filler retained the
highest elasticity and viscosity values at temperature of 37°C. Histology demonstrated that this 20 mg/ml HA dermal filler has an
intermediate pattern of distribution within the superficial and deep reticular dermis.
CONCLUSION: This 20 mg/ml HA dermal filler demonstrated volumizing ability, and maintaining viscosity and free-flowing characteristics
for easy injection, tissue lifting, and molding. We hope future research incorporates biological properties analysis of this HA
dermal filler in clinical trials.
J Drugs Dermatol.
Dermal fillers offer a nonsurgical approach for reducing
facial rhytides and restoring facial volume. From 2000
to 2011, there were more than 13 new FDA-approved
injectable fillers.1 In 2013, there were 995,000 soft-tissue filler
procedures in the United States, an increase of 8.6% from 2012.2
Silicones and paraffins were initially used for aesthetic
procedures to restore facial volume and contours, but complications
such as granulomas and paraffinomas years after
treatment have made their use for aesthetic purposes less frequent.
3 The main ingredient of fillers currently available on the
market include hyaluronic acid (HA), poly-L-lactic acid (PLLA),
poly[methyl methacrylate] (PMMA), and calcium hydroxylapatite
(CaHA). HA dermal fillers have become more widely used
by physicians and a favorite for patients due to its immediate,
natural-appearing effects with minimal adverse events and recovery
Characteristics of HA Dermal Fillers
HA, a glycosaminoglycan disaccharide, exists naturally in
the body with approximately 50% of total HA is found in the
skin and has a half-life of three days or less.4-6 The highly
charged nature of HA provides its high solubility and high
water binding affinity.7 Currently available HA dermal fillers,
depending on its HA concentration, cross-link density, and
manufacturing process, has different hydration capacity at
equilibrium. This is important considering swelling may be a
post-injection complication in some high water binding HA
fillers. Previous versions of HA fillers have shown to be safe
and efficacious for correction of facial rhytides.1 HA provides
the flexibility of being reversible and correctable by using
injectable hyaluronidase. A review of currently marketed facial
fillers described that many adverse events for HA fillers
as mild and transient, and common adverse events include
swelling, erythema, and nodules.8