Both products contain 24 mg/mL of cross-linked hyaluronic acid and 0.3 percent lidocaine. They are not different concentrations: What separates them is how tightly the hyaluronic acid chains are bonded together.
The original FDA summary of safety and effectiveness for this product line described the Ultra formulation (referred to as 24HV in that document) as highly cross-linked, and the Ultra Plus formulation (30HV) as a more highly cross-linked, robust formulation. The same document states that all the formulations in the line were made to a concentration of 22 to 26 mg/mL — a range, with the products distinguished by cross-linking rather than by how much hyaluronic acid is in them.
More cross-linking makes a gel firmer and more resistant to being flattened by the tissue around it. That is why Ultra Plus XC is described as the one for deeper folds and Ultra XC as the more versatile contouring product.
So if you have read that Ultra Plus is stronger because it is more concentrated, that is wrong against the FDA labeling: It is firmer because it is more cross-linked.
Both are cross-linked with BDDE, and both are supplied with lidocaine, which is what the "XC" denotes.
Dermal fillers are Class III devices approved through the FDA's premarket approval route. That means each approval names a specific use in a specific area, and it was granted on the basis of a clinical trial in that area. Both products sit under PMA P050047, originally approved on 2 June 2006, with the lidocaine versions approved on 7 January 2010.
Juvederm Ultra XC: The approved indication reads: "Juvéderm Ultra XC is indicated for injection into the mid to deep dermis for correction of moderate to severe facial wrinkles and folds (such as nasolabial folds). Juvéderm Ultra XC is indicated for injection into the lips and perioral area for lip augmentation in adults over the age of 21." The lip half of that was added on 30 September 2015 under supplement S044.
Juvederm Ultra Plus XC: The approved indication reads: "JUVÉDERM Ultra Plus XC injectable gel is indicated for injection into the mid to deep dermis for correction of moderate to severe facial wrinkles and folds (such as nasolabial folds)." There is no lip wording.
This is the fact most often got wrong: The 2015 lip approval names Juvederm Ultra XC only. The current approved directions for use for Ultra Plus XC contain no lip indication. Using Ultra Plus XC in the lips is off-label — which is legal and happens, but it means no trial was submitted to the FDA supporting it there.
Note also the age wording. The lip and perioral indication for Ultra XC specifies adults over the age of 21. The wrinkles-and-folds indication, as originally worded in 2006 and 2010, carried no explicit age wording.
The approvals only tell you what was tested and granted. In practice, injectors choose between the two on firmness.
Ultra XC, being the softer of the pair and supplied with a finer 30-gauge needle, is the one carrying the lip indication and is the one used where the tissue is mobile and the skin is thin — lips and the perioral area, and moderate lines and folds.
Ultra Plus XC, firmer and supplied with a 27-gauge needle, is described in the FDA record as the volumizing option for deeper folds. Deeper nasolabial folds are the approved and studied example.
Anything outside "mid to deep dermis, moderate to severe facial wrinkles and folds" — and, for Ultra XC, the lips and perioral area — is off-label for these two products: Other members of the Juvederm family hold their own separate approvals for other areas: Voluma XC for cheeks, chin and temples, Volbella XC for lips, perioral lines and under-eye hollows, Vollure XC for facial wrinkles and folds, Volux XC for jawline definition, and Skinvive for skin smoothness of the cheeks and for neck lines. Those approvals belong to those products, not to Ultra or Ultra Plus.
Both products were studied in the same 2006 pivotal trial in nasolabial folds, against a bovine collagen comparator - so the trial establishes performance against a 2006-era collagen product, not against any modern filler. Juvederm Ultra XC additionally has a separate lip dataset behind its 2015 lip indication. The follow-up windows and responder rates for each are set out in full on the page about how long Juvederm Ultra lasts.
One caveat applies to both: these pivotal trials were run by the manufacturer and submitted to the FDA in support of its own approvals, and the rating scales used across the Juvederm family are Allergan's own validated scales. That is normal for device approvals. It is still worth knowing whose trials they are.
Both come as 1.0 mL syringes. A smaller 0.55 mL fill, in the same syringe body, was approved on 13 March 2019 for Juvederm Ultra, Ultra XC and Ultra Plus XC. An earlier 0.4 mL configuration was approved in 2009.
Worth knowing if you are thinking in syringes: the FDA-approved labeling for Juvederm Ultra XC states that initial treatment of the lips and perioral area typically uses about 2.2 mL in total, with repeat treatment around 1.5 mL. The "one syringe" framing that dominates clinic pricing is a commercial and practical unit, not a dose derived from the trials.
Juvederm Ultra XC and Ultra Plus XC are hyaluronic acid gels, and hyaluronidase — an enzyme that splits hyaluronic acid — breaks them down, often within minutes to hours. That matters for two very different reasons: a result you dislike can be undone, and a blocked blood vessel can be treated.
Three honest caveats belong with that.
In the US, dissolving filler is an off-label use of hyaluronidase: The Hylenex label lists only fluid administration under the skin, dispersing other injected drugs, and urography as approved uses.
Repeat dosing is normal: Published guidance describes giving hyaluronidase in staged doses rather than one bolus for a suspected vascular occlusion, and firmer, more heavily cross-linked gels need more of it.
It is not a reliable rescue for filler-related blindness: In a review of 511 published cases, no treatment — including hyaluronidase — was significantly associated with visual improvement.
Fillers made from other materials, such as calcium hydroxylapatite or poly-L-lactic acid, are not affected by hyaluronidase at all. That difference is a real reason the hyaluronic acid class matters.
Which of the two are you using here, and why that one for this area?
Is that an approved use for that specific product, or off-label?
How much are you planning to use today, and how much would a full correction take?
What is the plan if it looks lumpy or uneven in two weeks?
Do you stock hyaluronidase on site?
Go to an emergency department or call 911 if any of these happen during or after an injection. They can mean filler has entered a blood vessel, and time is measured in hours.
Any change in vision: Blurring, a dark patch, double vision or loss of sight in one eye
Sudden severe pain, or pain out of proportion to the injection
Skin turning white (blanching), then dusky, purple, grey or net-like and mottled
Weakness, drooping, slurred speech, confusion or any other stroke-like symptom
Pain is not a reliable alarm on its own. In a survey of experienced injectors reporting their own intravascular injections, pain was mild or absent in 47 percent of events.
Swelling keeps growing after the first few days instead of settling
A lump appears and does not soften over a couple of weeks
Redness spreads outward from the injection site
Tenderness, firmness or swelling appears weeks or months later, which can be a delayed inflammatory reaction or an infection
The filler seems to have moved from where it was placed
The result is visibly uneven once the initial swelling has gone