- SUMMARY:
- Based on research data, all four common FDA-approved hyaluronic acid based dermal fillers (Restylane, Juvederm, Belotero and Versa) are effective and well-tolerated.
- Versa has a different manufacturing process that removes impurities and reduces adverse event.
- Versa has a lower price for medical practices from the manufacturer.
In 2022, four common FDA-approved hyaluronic acid (HA) based dermal fillers (Restylane, Juvederm, Belotero, and Versa) are on the market to correct wrinkles and folds. Let’s go over each of the botulinum toxins and find the difference between them. Although our focus is on the Versa Challenge, I will give you an unbiased opinion on the 4 dermal fillers. Then, you’ll understand why we decided on Versa.
(Disclaimer: This website and blog is about the Versa Challenge and there is a financial relationship to Versa.)
What are they?
| HYALURONIC ACID DERMAL FILLER | DETAILS ABOUT THE HYALURONIC ACID (HA) |
| JUVEDERM | FDA approved in 2008, Juvederm is a family of fillers manufactured by Allergan made with Hylacross technology. |
| JUVEDERM XC | XC initials indicates that lidocaine is added to the HA |
| JUVEDERM ULTRA PLUS | Thicker HA for correction of facial wrinkles and folds (Hylacross) |
| JUVEDERM VOLUMA | HA for deeper injection in the cheek and chin made with Vycross technology. |
| JUVEDERM VOLBELLA | Use for lips and under eye (Vycross) |
| JUVEDERM VOLLURE | Use for moderate to severe facial wrinkles (Vycross) |
| BELOTERO | FDA approved in 2011, Belotero is manufactured by Merz and is used for the correction of moderate-to-severe facial wrinkles and folds, such as nasolabial folds. |
| VERSA | FDA approved in 2017, Versa is manufactured by Prollenium and is used for the correction of moderate-to-severe facial wrinkles and folds, such as nasolabial folds. Versa is manufactured using a special proprietary method to ensure that the HA spheres are all perfectly rounded and are exactly the same size. |
| VERSA LIPS | FDA approved in 2020, Lips+ is manufactured by Prollenium and is used for the correction of lips. |
| RESTYLANE | The first FDA approved HA dermal filler in the USA in 2003. Restylane has a family of fillers manufactured by Galderma. This is the original HA filler made with NASHA technology. |
| RESTYLANE-L | Original HA filler with lidocaine (NASHA) |
| RESTYLANE LYFT | Formally called Perlane, this is used in the cheeks (NASHA) |
| RESTYLANE SILK | Used in lips (NASHA) |
| RESTYLANE DEFYNE | Made with new XpresHAn Technology for deeper nasolabial fold, marionette lines and chin |
| RESTYLANE REFYNE | For nasolabial fold and marionette lines (XpresHAn Technology) |
| RESTYLANE KYSSE | For lips (XpresHAn Technology) |
Which one is better?
This is a question that I get asked ALL OF THE TIME. For the sake of impartiality, let me show you a chart with many of the research publications that compare a dermal filler vs another.
| Comparison | Where | Safety Result | Efficacy Result |
| Restylane Kysse with lidocaine vs Juvéderm Volbella with lidocaine | Lips | Both products were well tolerated. | Both products achieved durable improvement in lip fullness and aesthetic appearance. A significantly smaller amount of Restylane Kysse was required compared with Juvederm Volbella to achieve optimal treatment effect. |
| Juvéderm Volbella XC vs Restylane-L | Lips and peri-oral | Severe injection site responses were reported less frequently with Juvederm Volbella than Restylane-L. | Juvederm Volbella XC was safe and effective for lip and perioral enhancement, with treatment effects lasting through 1 year. |
| Juvéderm Volbella with Lidocaine vs Restylane-L | Lips | There was less acute swelling and fewer severe injection site responses with Juvéderm Volbella with Lidocaine. | Juvéderm Volbella with Lidocaine was non-inferior to Restylane-L at 3 months. Investigator assessments showed significant improvements in lip fullness, perioral lines, and oral commissures with Juvéderm Volbella with Lidocaine versus Restylane-L at months 6 to 12. |
| Juvéderm Volbella with Lidocaine vs Restylane-L | Lips and peri-oral | Juvéderm Volbella with Lidocaine results in less short-term swelling and disruption in daily activities than Restylane-L. | Investigator assessments showed significant improvements in perioral lines and oral commissures with Juvéderm Volbella with Lidocaine vs Restylane-L |
| Juvéderm Ultra XC vs Belotero Balance | Peri-oral | No unexpected adverse events occurred. | Juvéderm Ultra XC subjects showed a higher response rate and a greater improvement in their perioral lines than Belotero Balance subjects for up to 6 months. |
| Juvéderm Ultra vs Restylane® | Correction of moderate NLFs | Juvéderm Ultra had fewer severe responses than Restylane. | Juvéderm Ultra is noninferior to Restylane |
| Belotero Basic/Balance, Restylane vs Juvéderm Ultra Plus XC | NLF | Adverse events were unremarkable across all HAs, with injection site erythema being the most frequent adverse event. | All three HAs provided essentially equivalent results, except for 4-week evenness results, which favored Belotero. Injection volumes of the three HAs were also similar. |
| Juvederm ULTRA PLUS™ vs Perlane(®) | NLF | Both treatments were well tolerated. | Both fillers achieved a clinically relevant NLF correction. However, Juvederm ULTRA PLUS™ displayed greater longevity, with this correction maintained in a significantly larger percentage of NLFs after 6 months (physician’s evaluation) or 9 months (subject’s evaluation) |
| Revanesse Versa | Facial Volume | HA treatment was shown to be safe. | Good – excellent volume enhancement was noted almost immediately after the HA injections, improving patient-reported quality of life aspects. |
Our conclusion based on the data is that all four are effective and safe. Anecdotally, a patient’s response to the specific filler can be specific to that individual. The duration of the filler varies from one individual to the next. The duration also varies depending on the area injected.
Syringe size
Another common question is: How many syringes do I need?
Different fillers come in different sizes. The price from the manufacturer also varies depending on the size of the syringe. All dermal fillers are one-time use by ONE patient. They should not be shared or stored for later use. Some medspas sell “half syringes”, which should cause consumers to take pause to consider the sterility of your “half syringe.”
Here are the various syringe sizes based on the filler type.
| HYALURONIC ACID DERMAL FILLER | SYRINGE SIZE |
| JUVEDERM ULTRA | 1mL |
| JUVEDERM ULTRA PLUS | 1mL |
| JUVEDERM VOLUMA | 1mL |
| JUVEDERM VOLBELLA | 0.55mL & 1mL |
| JUVEDERM VOLLURE | 1mL |
| BELOTERO | 1mL |
| VERSA | 1.2mL |
| VERSA LIPS | 1.2mL |
| RESTYLANE-L | 0.5mL & 1mL |
| RESTYLANE LYFT | 1mL |
| RESTYLANE SILK | 1mL |
| RESTYLANE DEFYNE | 1mL |
| RESTYLANE REFYNE | 1mL |
| RESTYLANE KYSSE | 1mL |
Revanesse Versa and Lips+ contain the most amount of HA filler within a syringe (1.2mL per syringe).
Hyaluronic Acid Concentration
Different fillers have different concentrations which affect the duration, elasticity, and softness of the filler. Here are the various concentration amounts based on the filler type.
| HYALURONIC ACID DERMAL FILLER | HYALURONIC ACID CONCENTRATION |
| JUVEDERM ULTRA | 24mg/mL |
| JUVEDERM ULTRA PLUS | 24mg/mL |
| JUVEDERM VOLUMA | 20mg/mL |
| JUVEDERM VOLBELLA | 15mg/mL |
| JUVEDERM VOLLURE | 17.5mg/mL |
| BELOTERO | 22.5mg/mL |
| VERSA | 25mg/mL |
| VERSA LIPS | 25mg/mL |
| RESTYLANE-L | 20mg/mL |
| RESTYLANE LYFT | 20mg/mL |
| RESTYLANE SILK | 20mg/mL |
| RESTYLANE DEFYNE | 20mg/mL |
| RESTYLANE REFYNE | 20mg/mL |
| RESTYLANE KYSSE | 20mg/mL |
Revanesse Versa and Lips+ contain the highest amount of HA concentration within a syringe.
Conclusion
All four HA dermal fillers are generally accepted to have similar efficacy and safety. Due to the various sizes of filler beads, some larger bead fillers have a longer duration of effect in the face.
We decided to participate in the Versa Challenge, because Versa has an additional layer of purity in its manufacturing which reduces complication, and has similar efficacy and safety compared to other HA dermal fillers. Finally, the Versa Challenge offer of $299 for a 1.2mL syringe provides patients a great opportunity to try a different hyaluronic acid dermal filler.