JuvÃ©derm is a useful product and fills a void, but problems with needle separation - whether due to operator error or product/syringe design - has spooked some practitioners. Allergan is working to resolve the issue and in the meantime, offers tips for injection technique that can help alleviate the possibility of needle and syringe separation.
Meanwhile, the company emphasizes several specific steps physicians should take to prevent separation with existing syringes (see sidebar).
"The first time it happened, the patient and I both jumped. The second time, I was angry."
Some doctors say they currently are leery of using the product. But others say injection technique can contribute to the problem, and express confidence that the issue will be resolved.
Formulation a factor
Juvéderm's viscosity may be a factor.
Due to the product's formulation, she says, "It's important to ensure the needle is tightly attached to the syringe hub to avoid the possibility of disengagement."
To that end, upon acquiring the product as part of its Inamed acquisition completed in March 2006, the company initiated design changes and currently has several development projects under way to ensure syringes and needles match Juvéderm's formulation. The projects will be completed by year's end, says Ms. Van Hove, who declined to give further details.
So far, incidents appear confined to Juvéderm Ultra, sources say.
Joel Schlessinger, M.D., reports that he has experienced needle separation twice in about 50 Juvéderm syringes. He is a board-certified dermatologist and general cosmetic surgeon and president, American Society of Cosmetic Dermatology and Aesthetic Surgery (ASCDAS).
Kenneth Beer, M.D., reports that in his practice, the Juvéderm problem occurred approximately five times in six months.
Juvéderm not alone
Needle separation "happens with other (filler) products as well, but the incidence with Juvéderm seems to be a bit higher" due to its viscosity, Dr. Schlessinger says.
He adds that the ASCDAS "will be discussing this event and ways to prevent it at our upcoming meeting in Las Vegas Nov. 29 to Dec. 1, as this issue is very important to us in the specialty."
Good technique can all but eliminate needle disengagement, he says.