Juvéderm Family

Hylacross and Vycross Technology

The first Juvéderm HA filler was approved in Europe and Canada in 2000 and by the US Food and Drug Administration (FDA) in 2006. The HA is derived from Streptococcus equi bacteria and does not contain animal proteins. A proprietary cross-linking technology, designated Hylacross, was employed to generate a smooth homogenous product using a higher concentration of HA (24 mg/mL) and a greater duration of effect than other products available at the time of release ( Fig. 6.1 ). The high concentration and high cohesivity of these agents resulted in increased durability and lifting capacity, respectively. The HA used is predominantly high-molecular- weight HA. Compared to the technology used by the Restylane products, Hylacross agents are comprised of cross-linked HA that is produced as monophasic gels and are not passed through sizing screens/sieves. As a result, the Hylacross products are not as granular in consistency as the Restylane products, which can be visualized when magnified. Currently, two Hylacross formulations are commercially available: Juvéderm Ultra and Juvéderm Ultra Plus, which are differentiated only by their cross-linking (6% vs. 8%, respectively). These products are more hydrophilic than the Vycross products.

The Vycross collection of fillers utilize a different technology to blend high- and low-molecular-weight HA to produce a more efficiently cross-linked and smooth homogeneous gel that balances cohesivity and G′. The cross-linking agent, 1,4-butanediol diglycidyl, allows for more efficient and tight binding using a lower HA concentration, which results in improved duration (resistance to degradation) and less swelling due to less space being available for water uptake. With optimization of gel properties, different Vycross products can be used for different planes of injection, anatomic location, and specific indications. In addition, compared to Hylacross fillers, the lower cohesivity of the Vycross agents allows for malleability. The Vycross collection of fillers includes Juvéderm Voluma (20 mg/mL), Juvéderm Vollure (17.5 mg/mL), Juvéderm Volbella (15 mg/mL), Juvéderm Volite (12 mg/mL), and Juvéderm Volux (25 mg/mL). With this range of products and their individual properties, an injector may employ the entire Vycross platform to tailor the lift and spread to address treatment needs.

Each product within the Juvéderm family of fillers is noncytotoxic, nonirritant, nontoxic, nonsensitizing, sterile, biodegradable, nonpyrogenic, viscoelastic, clear, and colorless.