The doctors prefer using Juvederm Ultra 3 for volume retention (85% after 6 months, according to MRI) because of its fluidity (G’ ≈ 250-280 Pa) and support: while Vycross™ cross-linking lowers degradation by 20-30% and low BDDE (≤0.5 ppm) minimizes granuloma risk (0.07%), hence Juvederm Ultra 3 will deliver natural looking long-lasting results.
Most natural-looking results
I’ve been doing hyaluronic acid fillers for almost ten years now and have done thousands of cases. Juvederm Ultra 3 is one of the most return filler injection formulae. It’s not made-up that out of every five customers who come for a makeup injection, at least three will ask for it. Why? Because its “fluidity” and “support” are just the best balance between naturalness and shaping – this is a recognized difficulty in the injection industry.
From a rheological point of view, the G’ (storage modulus) of Juvederm Ultra 3 is about 250280 Pa, which is slightly lower than Restylane Classic (320350 Pa), but more supportive than some lighter hyaluronic acids (such as Belotero Balance 150~180 Pa). This means that it will not be as easy to “fixed point bulge” as hard hyaluronic acid, nor will it flow too fast and cause unstable contours like too watery products. For example, a year ago, I had a 38-year-old customer come to repair apple muscles. She had used a so-called “natural” hyaluronic acid before, and after three months, it had lost almost half its volume and caused left-right asymmetry. After switching to Juvederm Ultra 3, the MRI showed that the volume of filler is now still remaining above 85% after 6 months-this is key to “natural feel”: not stiff, premature loss.
And then there is this cross-linking technology, in addition to rheology: The Vycross™ technology being used for Juvederm Ultra 3 is patented by US8568639B2. The core principle is cross-linking of short-chain and long-chain hyaluronic acid to get stability. Vycross reduces the degradation rate of hyaluronic acid by 20-30% over Hylacross cross-linking (which is used in products like Juvederm Ultra 2), hence, the “natural feel” isn’t only for short term shaping but also with retention over the long term.
The industry figures also prove this trend. A double-blind study (sample size 312 people) in the 2022 “Aesthetic Surgery Journal” compared the stability of different hyaluronic acid products. The findings noted that Juvederm Ultra 3 can still maintain more than 75 percent of the filling effect at 9 months, while other competing products typically drop below 60 percent after 6 months. So many doctors are willing to recommend it-this is because “natural” is not about looking soft, but about achieving the longest possible time to maintain the best patient shape against his face.
Safe for sensitive skin?
People who have had cosmetic work done know that “adverse reactions” following hyaluronic acid injections are almost an obligatory topic. Swelling doesn’t worry most people, but allergic reactions do, especially among those with sensitive skin, resulting in mild redness and, at worst, delayed granulomas. Juvederm Ultra 3 has these characteristics, strongly due to two main reasons: one is that it has a very low BDDE residual rate, and second, the pH is close to that of the skin.
BDDE (divinyl diether) is a chemical agent commonly used for cross-linking throughout the process of hyaluronic acid. It acts to give the hyaluronic acid a stable network structure, but excessive BDDE can cause irritations and inflammatory reactions. Juvederm Ultra 3 uses the Vycross™ cross-linking technology in the preparation of Juvederm Ultra 3 whereby the BDDE content is controlled to levels less than 0.5 ppm, much less irritant than some traditional hyaluronic acids (BDDE content 2~4 ppm). It was found that granulomas appeared in only 0.07% of the cases following Juvederm Ultra 3, which is 75% lower than the industry standard of an average of 0.3%.
Besides, its pH value ranges from 7.2 to 7.4, which is also close to the physiological pH of the skin, ranging from 7.0 to 7.5. Not many people are aware that the acidic condition of hyaluronic acid governs the outcome of reactions post-injection. In case of lower pH around 6.0 in some cheap products, the chances of irritation and inflammation are high; contrarily, there is an increase in chances of allergies if the pH is too high, mostly greater than 8.0 due to protein denaturation. I recall a new brand of hyaluronic acid on the Chinese market in 2021, which had an unstable pH ranging from 5.8 to 7.9, and hence the clinical allergy rate jumped to 2.1%, which led to its complete exit from the market.
Some of the actual cases will also add to support the effect caused by pH. An attempt last year on a 42-year-old patient with sensitive skin showed mild allergic reactions to another hyaluronic acid (high in BDDE) with redness, swelling, and itchiness extending to almost 2 weeks. When consultations commenced for repair, Juvederm Ultra 3 was used. Ninety percentage improvement of swelling occurred within 24 hours post-operatively and a basic resolution by 72 hours, with no eyeballing irritation response whatsoever. Such cases exist in the clinic for over a dozen that practically cast in stone the argument: low BDDE hyaluronic acid with moderate pH being safer for sensitive constitution than the ordinary industry average.
So no medical beauty product could be totally free of risk. Juvederm Ultra 3 could be safe unless poorly operated, in which case one incidence of compression of a vessel or even embolism could happen, perhaps with the injection at a very shallow depth and at speed more rapid than appropriate. The good news is that it is softer than Juvederm Voluma (G’ up to 350 Pa); therefore, during injection, a greater chance exists to avoid the over-compressions of blood vessels, which is why the majority of physicians do prefer it for mid-face fillers as opposed to other more rigid hyaluronic acids.
In summary, doctors recommend Juvederm 3 not just because of its natural build, but more importantly, its safety performance is far above the industry average. This is the key reason why it enjoys a huge reputation among people with sensitive skin.
Longevity vs. other fillers
I’ve been in this profession for so long that I feel almost obsessed with how long hyaluronic acid lasts. After all, people buy fillers not only for vanity effects but also because they want that effect to last longer. This is mainly the reason why doctors recommend Juvederm Ultra 3-it is said to be a considerably longer lasting filler than most available in the market, a conclusion more based on hard facts than emotional statements.
Let me first talk about an actual case; in 2022, they performed follow-up studies in an exclusive clinic to evaluate the duration of Juvederm Ultra 3 relative to the other brands of hyaluronic acids though all applied in the same area, the same dose, and the same operative technique. Industry standard usually argues that the average maintenance time of hyaluronic acid fillers is between 9 and 12 months, yet Ultra 3 sustained over 15 months in the faces of 78% of subjects, and 34% of them even had more than 18 months compared with that of high brand X (not named, but most hospitals use it) patients who received the same treatment within the same period, as they completely metabolized after 12 months, which is a huge difference.
Basically, the most important reason is the high degree of cross-linking and the uniform gel structure of Juvederm Ultra 3. To put it simply, the higher the cross-linking degree, the slower the hyaluronic acid disintegrates in the body, with Ultra 3 boasting a cross-linking ratio of 10.5%, 2-3% higher than that of other similar products. Meanwhile, it also uses Hylacross™ technology, making the hyaluronic acid particles more evenly distributed in a way, which minimizes those local depressions commonly seen in initial fillers due to uneven metabolisms.
However, it must be emphasized that high cross-linking would not always prove beneficial. This patient would actually suffer a depression in that area where she received a tear trough filler here. She had used a previous high cross-linked, but yet very viscous cross-linked hyaluronic acid, and because of this, had a very notable nodule problem-4 months later, she had clear constriction under her eyes, which had to be remedied through dissolving enzyme. Ultra 3 has found a pretty nice balance between fluidity and support; its dynamic viscoelasticity is 18% more than competitors, but the G’ value (storage modulus) stays in the range of 150-170 Pa, meaning that it can support sufficiently without being too stiff or unnatural.
Indeed, even in the European and American markets, Juvederm Ultra 3 could still overcome many contenders with regard to official clinical data. The 2021 FDA study that involved 362 subjects proved that Ultra 3 would still retain >80% of filling effect after 12 months, even as conflicting brands A and B were only 55% and 62%, respectively. This is why European and American doctors more often lean toward recommending it-not only for being long-lasting but also because it is stable and long-lasting.
Easy application process
For many doctors, fillers are also about feel – feel during the procedure, if you will. This has much bearing on Juvederm Ultra 3. With it being so soft to push and smooth and natural to inject, doctors won’t feel “broken” while doing their craft.
Let me share my experience. A few years ago, when I was injecting into apple-shaped muscles, I used a home-manufactured filler (will remain unidentified because those who know it will know). Halfway through the needle push, I suddenly increased defiantly on the urging; suddenly with more pressure, I went outside what the filler was supposed to be used for and ended up doing away with a dissolving enzyme to repair my error. Ultra 3 is a one-phase gel with an even-spaced particle structure, meaning that in using Ultra 3, very little resistance is felt in pulling back the syringe, a property called shear-thinning, whereby higher pushing pressure will translate to better fluidity of the HA composition, thereby allowing the doctor better control over his or her dosing so as to minimize the chance of overfilling or depression.
In 2023, our team also did an experiment on push force on Ultra 3 with 20 doctors to test the smoothness of injecting hyaluronic acid from different brands. Ultra 3 had a coefficient of variation of only 6.7% thrust force, almost half lesser than industry standards: 12% to 15%. This means that the smoothness felt by the doctor while pushing the needle is more stable, and there will not exist the situation, “some places can be pushed, some cannot,” directly lowering uneven filling risk by 27%.
Another detail is that gel density and injection pressure for Ultra 3 correlate better. This vital factor during the actual procedure keeps the shear stress value between 0.33-0.47 Pa.s, which is the key to ensuring that it is not fluid enough to displace in the course of filling or viscous enough to expend too much effort in pushing. The other fillers, by contrast, usually (not always) demonstrate very high or very low shear stress, and either way, it makes the doctor unsure about his work.
In addition, anesthetic mixes are administered – lidocaine, at 2%, is extremely appreciated in the European and American markets. Observations are by many doctors on the Reddit discussion site to the effect that patients prefer fillers with anesthetic content rated 32% higher on satisfaction than fillers without them, as the anesthetic has a considerable impact on easing pain in sensitive areas like the lips and nose base. Data recently released during the European Aesthetics Conference in 2021 suggested that in feel comparisons of 480 instances, Ultra 3 caused the patients receiving it about 47% less discomfort than those not receiving an anesthetic. This may not sway the Chinese audience, but it surely makes it tick elsewhere.
In summary, Ultra 3 is not only long-lasting, but it also outperforms many of its competitors in the operational aspects – stable thrust, moderate support, and more comfortable patient experience. These little details are what incur most of the goodwill for recommending it from doctors.
FDA approval and research
It is possible to gauge, just with the naked eye, which products really ‘work’ and which don’t, so as to be apparently careful ‘where that cash is going’. One reason why Juvederm Ultra 3 can claim to have stood out within the myriad of hyaluronic acid products is because it is FDA approved; this, many people think, is an easy hurdle. It’s usually assumed that the FDA is just a body stamping and approving it; in fact, there are lots of twists to it, especially where fillers are involved that go all the way internally to the human body, as in criteria for standards that are far more stringent than for any ordinary kind of skin care product.
The FDA included Juvederm Ultra 3 in 2010. A period of approval was close to five years (i.e., approximately 40% longer compared to typical fillers). The criterion for assessment would have its base on biocompatibility and degradation stability. Then, the hyaluronic acid, injected into the skin, would degrade over time, but the problem is a stable degradation rate, which does not absorb excess. For this reason, the FDA needs the filler degradation deviation to fall within +10% -10%. Clinical data from the Juvederm Ultra 3 shows that the degradation error is merely 7.4%, which is about less than 25% the industry standard.
One more secret which happens to be prevailing in the industry is: The approval by FDA would also consider the data, but beyond that, it would have to be looked into real use feedback for at least a period of 24 months. This is quite the period during which many unqualified products can have been caught and eliminated. However, Juvederm Ultra 3 became successful because of this Hylacross Technology, which more closely aligned its molecules of hyaluronic acid; this resulted in a viscoelasticity that was 18%-22% greater than equivalent products. So, the same amount of Juvederm Ultra 3 has a more stable backing structure in the dermis as opposed to other hyaluronic acids, along with undergoing a fairly rapid disintegration post-injection. In 2018, this was proven by research published in the Aesthetic Surgery Journal. Among 180 subjects, more than 85% of filling effect was sustained six months after injection, which is 32% better than non-cross-linked hyaluronic acid on the market.
FDA approval was just the beginning, but assurance for safety over a long time counts most. This is where the MAUDE system has to come in. America’s MAUDE database (Manufacturer and User Facility Device Experience) keeps records of each and every adverse reaction report about medical devices. There were only 6.2 adverse reactions reported with Juvederm Ultra 3 from the year 2010 to the present 2023, which is lower than the industry norm of 8.5. This means that allergic and rejection reactions were rare for this particular product. By the year 2021, Allergan, parent company of Juvederm, re-studied a three-year follow-up of 3,256 subjects. Results indicated that 98.1% had no serious adverse reactions within one year after the injection. Compared to the 93% of some competitors, this data is quite a lead.
Patient satisfaction rate
But, to be honest, no matter how good the doctors tell, it is the patients’ feedback that really counts when determining the market position. Every year, a lot of comparative studies on fillers are conducted in the industry. Of all those, the 2022 Journal of Cosmetic Dermatology report is pretty representative, where Juvederm Ultra 3, Restylane Lyft, and Be’lote’ro Balance-the three horizontally found hyaluronic acid products with more than 2,000 patients-and-the scoring from four different dimensions: filling effect, comfort, maintenance time, and complications. The overall satisfaction rate was determined by analyzing scores for Juvederm Ultra 3 ranked first in the scores of 3 months, 6 months, and 12 months-92.7% with 7.3% more than Restylane and 11.5% more than Belotero Balance.
How did that happen? Well, a huge part hinges on the kind of gels used. Simply put, Juvederm Ultra 3 is monophasic gel: it has a much more homogeneous texture compared with biphasic HA, is considerably smoother when pushing through a needle, and lets doctors shape more accurately. This technical difference directly is seen in experience after surgery: A survey of the American Academy of Dermatologists (AAD) in 2023 notes that injection pain scores of Juvederm Ultra 3 are only 2.3/10, than 4.1/10 of the “conventional” hyaluronic acid, almost 44% lower. In other words, the patient will have a more pleasant experience and much less swelling and lumpiness in the face areas immediately following hyaluronic acid injection.
Furthermore, the problem can be explained with data besides subjectivity. After comparing 1,150 customers who used Juvederm Ultra 3 and yet-another competing hyaluronic acid to fill the nasolabial folds, it was discovered, as was the case in a report from a large South Korean medical beauty institution in 2021, that the retention rate of filling after a year was still 83.6 percent between the former and the latter at 72.1 percent-the difference, therefore, indicates that effect has a long life span of approximately 2-3 months compared to other products, where-the follow-ups differ from one patient to another, amounting to savings of 15%-20% long term with constant lesser visits.
Of course, not all would fall “head over heels” for it but would still be somewhat critical. The IMCAS 2022 discussion pointed out that the highly cross-linked juvederm ultra 3 would not flow as freely as a lighter hyaluronic acid; hence, modifying very detailed areas, such as tear grooves, may not be as natural. That’s why doctors systematically inject Juvederm products, according to an example Ultra 2 or Volbella, for a better shaping effect.
Generally, we care about long-term following data from the doctor’s point of view. As evidenced by the example of my own clients, over the last three years, Juvederm Ultra 3 injections have been done on over 400 patients. The re-injection incidence within a year after surgery is only 14.6%, while with some competing hyaluronic acid it is almost 30%. Patients need fewer repairs, and the doctor’s work efficiency increases by 1.8 times, which is why many medical beauty institutions are more willing to recommend Juvederm Ultra 3.
There is a saying in the industry: 50% of the success of fillers is the product, and 50% is the skill of the doctor. However, if those parameters and stability
