Juvederm Ultra Plus is a hyaluronic acid dermal filler developed by Allergan and approved by the FDA for the treatment of moderate to severe facial wrinkles and folds. It is one of the most widely used fillers in the Juvederm range for nasolabial fold correction, lip augmentation, cheek volumization, and marionette line treatment. This article provides a clinical overview of Juvederm Ultra Plus — covering its formulation, indications, injection techniques, safety profile, and practical considerations for aesthetic practitioners.
Overview of Juvederm Ultra Plus
Juvederm Ultra Plus is formulated with a high concentration of hyaluronic acid using Allergan’s Hylacross technology — the crosslinking platform used in the original Juvederm Ultra and Ultra Plus products. Hylacross produces a smooth, homogeneous monophasic gel with high HA concentration, designed for mid-to-deep dermal injection. This is distinct from Allergan’s Vycross technology, which is used in the Voluma, Volift, and Volbella range and produces a different gel structure through blending of low and high molecular weight HA chains.
The product includes lidocaine, a local anesthetic, incorporated directly into the formulation. This reduces injection discomfort and improves patient experience without requiring a separate anesthetic step, which is a practical clinical advantage particularly in sensitive areas such as the lips.
Juvederm Ultra Plus has a thicker consistency than Juvederm Ultra, giving it greater lifting capacity and making it better suited for deeper lines, volume restoration, and structural support. Its gel integrates well with surrounding tissue post-injection, producing smooth, natural-looking results. Duration of effect is typically 9 to 12 months depending on the treatment area, injection technique, and individual patient metabolism, with some patients maintaining results beyond 12 months in lower-mobility areas.
For practices looking to add Juvederm Ultra Plus to their injectable inventory, it sits within the broader dermal fillers category alongside complementary Juvederm range products for other indications and depths.
Safety Profile and Regulatory Approvals
Juvederm Ultra Plus received FDA approval in 2006 for the treatment of moderate to severe facial wrinkles and folds, including nasolabial folds. It is also approved for use in numerous other countries across Europe and globally. The FDA approval was based on clinical studies demonstrating safety and effectiveness across a treatment duration of up to one year.
The hyaluronic acid in Juvederm Ultra Plus is biosynthetically produced and non-animal derived, which minimizes the risk of allergic reaction compared to animal-sourced HA products. Because HA is naturally present in the body, the biocompatibility profile is favorable and skin testing prior to treatment is not required.
Common adverse events are mild, temporary, and injection-site related: redness, swelling, bruising, tenderness, firmness, and lumps or bumps. These typically resolve within one to two weeks without intervention. Less common but more serious adverse events include:
- Vascular occlusion — the most serious complication of any HA filler injection, requiring immediate recognition and high-dose hyaluronidase treatment. Practitioners must have hyaluronidase immediately available at every injection session and be trained in vascular occlusion identification and management
- Delayed hypersensitivity reactions — can present weeks to months after treatment as swelling or inflammatory nodules
- Infection — uncommon when strict aseptic technique is followed; biofilm-related late reactions are rare but documented in the HA filler literature
- Skin discoloration or necrosis — associated with vascular compromise; early recognition and intervention are critical
Contraindications include known hypersensitivity to hyaluronic acid or any product component, active skin infection or inflammation at the injection site, and pregnancy or breastfeeding. A thorough medical history and allergy screening must be completed before treatment.
Indications and Treatments
Juvederm Ultra Plus is indicated for moderate to severe facial wrinkles and folds and is used across several primary treatment areas:
Nasolabial Folds
Nasolabial folds deepen with age as skin loses elasticity and mid-face fat pads descend. Juvederm Ultra Plus’s viscosity and lifting capacity make it well suited for mid-to-deep dermal injection in this area, producing significant fold correction with smooth, natural-looking integration. This is the product’s primary FDA-approved indication.
Lip Augmentation and Enhancement
Juvederm Ultra Plus is effective for lip body augmentation, vermilion border definition, and reduction of perioral lines. Its Hylacross gel integrates smoothly into lip tissue, producing soft, natural results. The included lidocaine reduces injection discomfort, which is a meaningful advantage in the sensitive lip area. Dosing should be conservative — overfilling the lips is a common error and more difficult to correct than underfilling.
Cheek Volume and Contouring
Volume loss in the mid-face leads to descent of soft tissue and a flattened or hollowed cheek appearance. Juvederm Ultra Plus can be used for deep tissue augmentation in the cheeks, injected in the supraperiosteal plane to restore volume and improve overall facial contour. For more significant structural lifting in the zygomaticomalar region, Juvederm Voluma — with its higher G’ and Vycross formulation — may be more appropriate depending on the degree of volume loss.
Marionette Lines
Marionette lines run vertically from the oral commissures toward the chin, contributing to a downturned or stern facial expression. Juvederm Ultra Plus can soften these lines through targeted volume placement, improving the overall lower face appearance. Linear threading or serial puncture technique at the appropriate depth is typically used in this area.
Practical Tips for Clinicians
Patient Selection
Juvederm Ultra Plus is appropriate for patients with moderate to severe facial wrinkles and folds, those seeking lip augmentation or mid-face volume restoration, and individuals who have experienced facial volume loss due to aging. Patients should have realistic expectations about outcomes and understand that results are temporary, typically lasting 9 to 12 months before maintenance treatment is needed.
Contraindicated patients — those with active infection at the injection site, known HA hypersensitivity, or who are pregnant or breastfeeding — should not be treated. Patients on anticoagulant therapy or blood-thinning supplements have elevated bruising risk and should be counseled accordingly before proceeding.
Injection Techniques
Technique selection depends on the treatment area and desired outcome. General principles apply across all areas: inject slowly with controlled pressure, avoid overcorrection, and assess results at two weeks once swelling has fully resolved.
- Nasolabial folds and marionette lines — linear threading or serial puncture into the mid-to-deep dermis. Linear threading is efficient for longer folds; serial puncture allows for more precise correction in irregular areas
- Lip augmentation — inject at the vermilion border for definition, and into the lip body for volume augmentation. Maintain natural upper-to-lower lip proportions and avoid overcorrection — the lidocaine in the formulation can temporarily reduce patient perception of fullness during the procedure
- Cheek contouring — supraperiosteal injection using a bolus or depot technique for volume restoration and lifting effect. Blunt-tip cannulas are appropriate in this area and reduce the risk of vascular trauma
Side Effect Management
Common injection-site reactions are self-limiting and managed conservatively. Ice applied before and after treatment reduces swelling and bruising. Patients should avoid strenuous activity, excessive heat, alcohol, and pressure on treated areas for 24 to 48 hours post-treatment.
Vascular occlusion requires immediate intervention — do not wait for symptoms to progress. Signs include blanching, pain disproportionate to the injection, or mottled skin discoloration. Initiate high-dose hyaluronidase immediately, apply warm compresses, and follow established vascular occlusion management protocols. Every practitioner performing HA filler injections must have hyaluronidase on hand and be trained in emergency management before treating patients.
Combining with Other Treatments
Juvederm Ultra Plus can be combined with neuromodulators, other Juvederm range products, and energy-based treatments as part of a comprehensive facial rejuvenation plan. When combining modalities in the same session, neuromodulator treatment is typically performed first or concurrently with filler. Ablative or resurfacing procedures are generally scheduled as separate sessions. Using Juvederm Voluma for deeper structural support alongside Ultra Plus for fold correction is a common and effective layered approach in the mid-face.
Clinical Value for Aesthetic Practices
Juvederm Ultra Plus offers a combination of attributes that make it a reliable, high-utility product for aesthetic practices. Its FDA approval, well-established safety record, and broad indication coverage — spanning nasolabial folds, lips, cheeks, and marionette lines — mean a single product addresses a significant portion of the most common patient treatment requests.
The inclusion of lidocaine in the formulation reduces the need for separate topical anesthetic steps in many cases, streamlining treatment workflows. Its 9 to 12 month duration reduces treatment frequency compared to shorter-duration HA fillers, which can improve patient retention and reduce the per-outcome cost of treatment over time.
For practices already stocking other Juvederm range products, Ultra Plus integrates naturally into a layered treatment menu — complementing Voluma for structural support, Volbella for delicate perioral work, and Volift for mid-face indications requiring a longer duration of effect.
Conclusion
Juvederm Ultra Plus is a well-established, FDA-approved HA filler with a broad indication set, a favorable safety profile, and a predictable duration of effect. Its Hylacross gel formulation, lidocaine inclusion, and versatility across multiple facial zones make it a practical core product for aesthetic practices at any stage of building their injectable filler program.
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Juvederm Ultra Plus Frequently Asked Questions
About the Author: Doris Dickson is a specialist writer for Health Supplies Plus, focusing on the aesthetic medicine industry. She diligently researches cosmetic treatments and products to provide clear, concise information relevant to licensed medical professionals. Her work supports Health Supplies Plus’s commitment to being a reliable informational resource and trusted supplier for the aesthetic community.
Disclaimer: The content provided in this article is intended for informational purposes only and is directed towards licensed medical professionals. It is not intended to be a substitute for professional medical advice, diagnosis, or treatment, nor does it constitute an endorsement of any specific product or technique. Practitioners must rely on their own professional judgment, clinical experience, and knowledge of patient needs, and should always consult the full product prescribing information and relevant clinical guidelines before use. Health Supplies Plus does not provide medical advice.