Hyaluronic acid fillers with cohesive polydensified matrix for soft-tissue augmentation and rejuvenation: a literature review

Abstract

BackgroundCohesive monophasic polydensified fillers show unique viscoelastic properties and variable density of hyaluronic acid, allowing for a homogeneous tissue integration and distribution of the material.ObjectiveThe aim of this paper was to review the clinical data regarding the performance, tolerability, and safety of the Belotero® fillers for soft-tissue augmentation and rejuvenation.MethodsA literature search was performed up until May 31, 2015 to identify all relevant articles on Belotero® fillers (Basic/Balance, Hydro, Soft, Intense, Volume) and equivalent products (Esthélis®, Mesolis®, Fortélis®, Modélis®).ResultsThis comprehensive review included 26 papers. Findings from three randomized controlled trials showed a greater reduction in nasolabial fold severity with Belotero® Basic/Balance than with collagen (at 8, 12, 16, and 24 weeks, n=118) and Restylane® (at 4 weeks, n=40), and higher patient satisfaction with Belotero® Intense than with Perlane® (at 2 weeks, n=20). With Belotero® Basic/Balance, an improvement of at least 1 point on the severity scale can be expected in ~80% of patients 1–6 months after injection, with an effect still visible at 8–12 months. Positive findings were also reported with Belotero® Volume (no reduction in hyaluronic acid volume at 12 months, as demonstrated by magnetic resonance imaging), Soft (improvement in the esthetic outcomes when used in a sequential approach), and Hydro (improvement in skin appearance in all patients). The most common adverse effects were mild-to-moderate erythema, edema, and hematoma, most of which were temporary. There were no reports of Tyndall effect, nodules, granulomas, or tissue necrosis.ConclusionClinical evidence indicates sustainable esthetic effects, good safety profile, and long-term tolerability of the Belotero® fillers, particularly Belotero® Basic/Balance and Intense.

In Situ Self-Cross-Linkable, Long-Term Stable Hyaluronic Acid Filler by Gallol Autoxidation for Tissue Augmentation and Wrinkle Correction

“…Hyaluronic acid (HA), a primary component of extracellular matrices in skin and various connective tissues, is regarded as one of the best ingredients to fabricate injectable fillers owing to its biocompatibility and low immunogenicity. − In addition, HA-based fillers can be removed through enzymatic degradation using hyaluronidase when unexpected events, such as displacement and side effects, occur. , HA-based filler composites can be categorized into monophasic and biphasic types, according to their chemical and physical formulation. Monophasic HA fillers can be homogeneously injected, but they usually show a low volumetric augmentation effect and short retention time due to their weak mechanical properties. − Although the mechanical stability of monophasic HA fillers can be improved by increasing the cross-linking density and molecular weight of the composites, a larger-size needle is required to compensate for the higher extrusion force during injection by the increased viscosity, which is closely related to acute pain. , In contrast, biphasic HA fillers containing specific size cross-linked HA particulates with noncross-linked HA solution maintain better stability in vivo . Chemically cross-linked particulates of biphasic fillers provide enhanced elasticity and better performance in volume maintenance compared with monophasic fillers, but they often form inhomogeneous shapes that roughen the injection site and are prone to displacement due to the weak polymeric network within the composite. , In addition, chemical reagents for HA cross-linking, such as glutaraldehyde, butanediol-diglycidyl ether (BDDE), 1,2,7,8-diepoxyoctane, and divinyl sulfone, can pose safety concerns involving inflammation, foreign body reaction, and toxicity after injection. , Therefore, there is a huge need to develop an advanced cross-linking system that provides a safe, long-lasting, and highly usable filler composite.…”

“…22−24 Although the mechanical stability of monophasic HA fillers can be improved by increasing the cross-linking density and molecular weight of the composites, a larger-size needle is required to compensate for the higher extrusion force during injection by the increased viscosity, which is closely related to acute pain. 25,26 In contrast, biphasic HA fillers containing specific size cross-linked HA particulates with noncross-linked HA solution maintain better stability in vivo. 24 Chemically cross-linked particulates of biphasic fillers provide enhanced elasticity and better performance in volume maintenance compared with monophasic fillers, but they often form inhomogeneous shapes that roughen the injection site and are prone to displacement due to the weak polymeric network within the composite.…”

Therapeutic application of hyaluronic acid for buco-facial harmony. A clinical case

“…En el caso clínico se utilizó RESTYLINE KISSE, que es considerado por los fabricantes como un biomaterial de entrecruzamiento intermedio y genera un efecto de volumen moderado, de ahí que sea recomendado en la zona de labios. Es necesario destacar que existen también otros biomateriales de relleno dérmico (10), sin embargo, el AH es actualmente el biomaterial de elección para el tratamiento de la región peribucal 106 por las razones que anteriormente se exponen (6,(11)(12)(13)17).Asimismo, en ocasiones el AH tiene un uso combinado con la toxina botulínica. La colocación de toxina botulínica tipo A en músculos específicos impide la contracción muscular y con ello evita la formación de arrugas (8).…”

Early ultrasound for diagnosis and treatment of vascular adverse events with hyaluronic acid fillers

“…[32][33][34][35] Nonetheless, the idea that the exact etiology of the ischemia is due to embolization of filler particles into the end arterioles has been disputed based on the fact that crosslinked HA gels exhibit high biological stability. [36][37][38] A further Abbreviations used: DUS: duplex ultrasonography HA: hyaluronic acid participant in the occurrence of ischemia may be the phenomenon of arterial spasm. The face has an extensive vascularity with numerous communicating branches between both direct and indirect linking vessels in the coronal, sagittal, and transverse planes.…”