Juvederm Ultra Injectable Gel® is a sterile, clear, colorless gel implant used in the treatment of moderate to severe facial wrinkles and folds. Juvederm is composed of highly cross-linked hyaluronic acid that is injected into facial tissue to smooth folds and wrinkles, especially around the nose and mouth. Hyaluronic acid is a naturally occurring compound that is normally found in the human body. The role of hyaluronic acid in the skin is to deliver nutrients, hydrate the skin (keep it moist), and act as a cushioning agent.

Juvederm Ultra injectable Gel® temporarily adds volume to facial tissue and restores a smoother appearance to the face. It is injected through a very small (30 gauge) needle into areas of facial tissue where moderate to severe wrinkling has occurred. Juvederm Ultra can also be injected into moderate or deep skin folds an into some scars, to create a better cosmetic appearance. Juvederm Ultra will help to smooth facial wrinkles and folds for an average period of 6 months. Most patients will need just one treatment to achieve optimal results, and the treatment can be repeated as desired.

Common side-effects after injection of Juvederm Ultra Gel® include:

redness at the site of injection(90%)	pain/tenderness od injected skin (90%)
firmness, swelling or lumpiness (85%)	bruising at or near injection sites (60%)
itching around the injections (34%)	discoloration od the skin (34%)

Theses side-effects generally do not require intervention, do not affect the long-term cosmetic benefits, and go away completely with a couple of days to a week.

As with any other type of injection, there is a small risk of infection. The risk can be minimized by talking the following precautions:

1. wash the face with facial soap and water prior to coming for your injections;
2. do not wear make-up to the appointment;
3. we will administer an anesthetic scrub prior to your injections;
4. do not touch, rub or apply cosmetics until the following day.

As with any other type of injection, there is a small risk of bleeding and bruising. This risk can be minimized by talking the following precautions:

1. unless medically necessary for heart disease or stroke prevention, avoid all aspirin, ibuprofen (Motrin, Advil), naproxen (Naprosyn, Aleve), arthritis drugs, St. John's wort and ginka biloba for a week prior to the injection appointment;
2. notify the doctor if you have had facial laser treatment, chemical peel or dermabrasion within 30 days before the treatment with Juvederm;
3. for the first 24 hours after the injections, avoid strenuous exercise, lifting, sun or sunlamp exposure, and alcoholic beverage.

As with any other type of injection, there is a small risk of allergic reaction. This risk can be minimized by taking the following precautions:

1. do not have injections of Juvederm if you are highly allergic to other substances;
2. do not have injections of Juvederm if you are on immune suppressant therapy (Cytoxan, Imuran, Methotrexate, or steroids) or chemotherapy for cancer.

Juvederm Ultra Injectable Gel® has not been studied or approved for injection of lips, for use during pregnancy, while breastfeeding, or in patients under the age of 18 years. Also, cosmetic benefit can be adversely affected in patients with extensive scars, history of keloid formation, and disorders of pigment.

Juvederm Ultra Injectable Gel® can be used in conjunction with Botox Cosmetic®

Robert F. Allen, M.D.