Cohesive Polydensified Matrix Hyaluronic Acid Research Articles

The gold protocol: A combined treatment approach for neck rejuvenation with calcium hydroxyapatite, botulinum toxin, and hyaluronic acid in the same session.

The signs of aging seem to be more visible on the neck compared to other locations, especially if a patient has already gone through facial rejuvenation procedures. Treatment of the aging neck imposes a challenge to the clinician, since one single approach is usually not enough to achieve the desired result, requiring multiple injections and sessions, which apart from being painful for the patients, is time-consuming for the clinician. To describe the use of calcium hydroxyapatite, incobotulinum toxin type A and Cohesive poly-densified matrix hyaluronic acid diluted in the same syringe and injected in the same session for neck rejuvenation. Fifteen women, older than 18 years, with cervical skin flaccidity grade 1-4 in a previously validated 5-point rating scale (Dermatologic Surg, 2016; 42, S94), who sought neck rejuvenation were injected in this pilot study with a single session with a combined hybrid mixture of calcium hydroxyapatite, incobotulinum toxin type A, and Cohesive poly-densified matrix hyaluronic acid and followed up for 90-180 days. At the 4-month post injection evaluation, 93.3% of the patients presented at least 1-grade improvement in the 5-point scale as evaluated by the investigator. No serious adverse events were reported, being most mild and transient in nature. CaHA, incoBonTA, and CPM-HA have complementary mechanisms of action and may be injected from the same syringe in the same session, boosting the final outcome, with high patient satisfaction, and ease of process for both patients and clinicians.

Treatment of deep wrinkles with superficial application technique of hyaluronic acid

Introduction: Throughout the aging process, the skin is subject to continuous structural, cellular and molecular modifications that affect not only its mechanical properties but also its biological and physiological functions, which clinically, it manifests with dry skin, loss of elasticity and the consequent appearance of fine lines, wrinkles and creases, representing a therapeutic challenge with a difficult solution. Objective: To describe the superficial application technique of cohesive polydensified matrix hyaluronic acid (Belotero soft®) for the resolutive treatment of superficial perioral, periorbicular and lateral wrinkles and creases of the face. Conclusion: The superficial and transversal application technique showed to be ideal for the treatment of wrinkles and superficial creases, without description of important adverse effects or Tyndall effect with the cohesive polydensified matrix hyaluronic acid that was applied.

Treatment of Deep Wrinkles with Superficial Application Technique of Hyaluronic Acid

Introduction: Throughout the aging process, skin is subject to continuous structural, cellular and molecular modifications that affect not only its mechanical properties but also its biological and physiological functions, which clinically is manifested by dry skin, loss of elasticity and the consequent appearance of fine lines, wrinkles and creases, representing a therapeutic challenge with a difficult solution. Objective: to describe the superficial application technique of cohesive polydensified matrix hyaluronic acid (Belotero soft®) for the resolutive treatment of superficial perioral, periorbicular and lateral wrinkles and creases of the face. Conclusion: The superficial and transversal application technique showed to be ideal for the treatment of wrinkles and superficial creases, without description of important adverse effects or Tyndall effect with the cohesive polydensified matrix hyaluronic acid.

A split-face comparative performance evaluation of injectable hyaluronic acid-based preparations HCC and CPM-HA20G in healthy females.

Skin revitalizers are used for skin quality improvement purposes. Hyaluronan hybrid cooperative complexes (HCC, Profhilo®, IBSA Pharmaceuticals) are an anti-aging treatment with a large amount of pure hyaluronic acid (HA) based on stable, cooperative, and hybrid complexes. Cohesive polydensified matrix Hyaluronic Acid (CPM-HA20, Belotero Revive®, Merz Pharmaceuticals GmbH) is a slightly cross-linked HA (20 mg/ml) with glycerol (17.5mg/ml). To evaluate the performance of HCC and CPM-HA20G for skin quality improvement in healthy female subjects. This was a split-face, single-blinded study that enrolled 24 healthy female subjects. Injections were given on three separate occasions. HCC was injected on the right cheek, while CPM-HA20G was injected on the left cheek. A battery of skin property measurements was used to evaluate the skin. Skin properties and overall satisfaction were analyzed using mixed models with the values at baseline, at week 1, week 8, and week 14 as an outcome and a random effect of subject and fixed effects of treatment, visit, and the treatment by visit interaction. Both products showed evidence of effect relative to baseline on surface hydration (AU), elasticity (N/m) TEWL (g/m2 h), and melanin (AU). CPM-HA20G also showed significant evidence of effect relative to baseline on water content (%), and HCC on pore count (n) and hemoglobin (AU). Satisfaction reported by the subjects themselves showed positive trends of satisfaction over time for multiple skin properties. There were no significant differences between the tested products in the observed skin characteristics over time. These devices are effective and safe treatments for skin quality improvement, especially moisturization, with high patient satisfaction and generally mild and transient side effects.

Facial Skin Revitalization with Cohesive Polydensified Matrix-HA20G: Results from a Randomized Multicenter Clinical Study.

Background:There is a growing interest in the application of hyaluronic acid (HA) derivatives in skin quality improvement. The aim of this study was to confirm safety and effectiveness of cohesive polydensified matrix-hyaluronic acid + glycerol (CPM-HA20G; Belotero Revive) in revitalization of early-onset photodamaged facial skin.Methods:A total of 159 subjects with early signs of facial photodamaged skin were randomized in a 2:1 ratio to multiple- or single-dose treatment with CPMHA20G. Effectiveness assessments included biophysical measurements of skin hydration; elasticity, firmness, and roughness; investigator- and subject-assessed Global Aesthetic Improvement Scales; and FACE-Q Skin Changes and Treatment Satisfaction questionnaires.Results:In both treatment groups, skin hydration improved from baseline to all follow-up visits in subjects with dry or very dry skin. This improvement was significant at week 16 after initial treatment in the multiple-dose group (P = 0.0013). Investigator- and subject-reported outcomes showed that the majority of subjects across all skin hydration types benefited from treatment, with higher satisfaction rates observed in the multiple-dose group. According to investigator-assessed Global Aesthetic Improvement Scale, 90.7% of subjects at week 12 in the multiple-dose and 74.6% of subjects at week 4 in the single-dose group were rated as at least “improved.” All related treatment-emergent adverse events were transient, expected injection-site reactions of mild to moderate intensity.Conclusions:Effectiveness of CPM-HA20G for skin hydration in subjects with dry or very dry skin was demonstrated up to 9 months after last injection. Overall, CPM-HA20G demonstrated effective and safe use in facial skin revitalization among subjects with early-onset photodamaged skin.

Consensus on the Use of Hyaluronic Acid Fillers from the Cohesive Polydensified Matrix Range: Best Practice in Specific Facial Indications.

BackgroundAs the treatment indications for the Cohesive Polydensified Matrix® hyaluronic acid (CPM-HA) portfolio continue to expand and diversify, injectors new to the range or those who are expanding the treatments they offer may be unsure of the optimal product and injection technique for specific facial areas. Each product in the CPM-HA portfolio has been intentionally designed to provide the best physical properties for a specific indication and target tissue. This document has been developed to provide a comprehensive, one-stop reference for clinicians using the portfolio.MethodsAn international panel of experts in the field of aesthetic medicine convened to develop guidelines on effective and safe injection technique when performing treatments with the CPM-HA range of soft-tissue fillers.ResultsConsensus members considered treatment indications in the upper, middle and lower face. Landmark deficiencies and anatomical considerations are described for each indication and consensus recommendations provided on the optimal product, injection depth and treatment technique. This is supplemented by the experts advice on avoidance of complications. Throughout, an evidence-based approach to selection of products and injection techniques is provided. The result is a fully tailored approach to a range of indications covering the full portfolio of CPM-HA products, including the newest addition for skin revitalization.ConclusionThe recommendations in this consensus document are provided to assist clinicians in the selection of CPM-HA products, administration techniques and depths of injection with the aim of providing seamless and natural treatment results, enhanced safety and patient satisfaction.

The Aesthetic Concerns of Botulinum Toxin Type A in the Treatment of Neck Wrinkles: A Systematic Review.

The aged and unattractive appearance of the neck has a profound impact on the overall youthfulness and attractiveness of the face. Neck wrinkles are one of the manifestations of neck skin aging. Botulinum toxin type A (BTX-A) represents an effective means for aesthetic neck rejuvenation as novel facial rejuvenation technologies are progressively developed. The objective of this article was to review the pertinent clinical literature for descriptions of BTX-A treatments and evaluations of their efficacy and safety for neck wrinkles. The Web of Science, PubMed, EMBASE, Cochrane Library, and SCOPUS databases were searched from inception to April 30, 2020, for the existing literature, which is presented along with the authors' experience with neck wrinkles. Overall, 112 women between 24 and 65 years of age were included in 3 studies of monotherapy and 2 studies of multimodal combination therapy. BTX-A has been reported in combination with other approaches, including intensity focused ultrasound, cohesive polydensified matrix hyaluronic acid, and microfocused ultrasound. Only 1 of the 3 reports on monotherapy had a less than 50% satisfaction and improvement rate. Overall, BTX-A attained high patient satisfaction without serious and persistent side effects, notwithstanding the relatively limited sample size. The existing research cannot strongly prove the aesthetic effect of BTX-A in neck wrinkles. However, BTX-A is probably an effective technology in response to the growing demand for neck wrinkle treatment, whether in a single treatment or combined treatment.

Evaluating an incobotulinumtoxinA and Cohesive Polydensified Matrix® hyaluronic acid filler combination to treat moderate-to-severe periorbital and perioral rhytids.

To evaluate the effectiveness of treating mimetic facial lines with an incobotulinumtoxinA (INCO) and Cohesive Polydensified Matrix® hyaluronic acid (CPM-HA) combination. Subjects with moderate-to-severe lateral periorbital lines (LPL) and perioral lines at rest according to Merz Aesthetics Scales™ received 10U of INCO/eye and up to 10U to the perioral area. This was followed by intradermal injection of 1-3cc CPM-HA to the same lines. Primary outcomes were physician- and subject-rated improvement at 1month using the Global Aesthetic Improvement Scale (GAIS) and changes in line severity using the Merz Aesthetics Scales™ . The study included 10 women aged 42-74years with moderate-to-severe LPL and perioral lines at baseline. At 1month, treating physician GAIS scores indicated 45.0% of subjects were very much improved and 52.5% much improved; 75% remained at least improved at 6months. Subject GAIS results indicated 7 women rated themselves as very much improved and 3 as much improved. For LPL, improvements of ≥1-point on the Merz Aesthetics Scales™ compared with baseline were seen at 1, 3, and 6months in 86.8%, 74.3%, and 65.8% of subjects, respectively. For perioral lines, improvements of ≥1-point were observed for 89.2%, 86.5%, and 73.0% at 1, 3, and 6months, respectively. No treatment-related adverse events were observed. Combined INCO/CPM-HA filler in individuals with moderate-to-severe LPL and perioral lines was effective at improving overall appearance and reducing line severity in two highly mobile facial areas that are the first to show lines of aging.

Combination Approach to Tear Trough Deformities and Under Eye Appearance Using Microfocused Ultrasound With Visualization and Hyaluronic Acid Filler

Filler for tear trough deformities and improved under eye appearance has become a well-accepted procedure to treat fine lines, wrinkles, shadowing, darkness, and hollowness. Microfocused ultrasound with visualization–induced skin tightening can be a powerful modality to treat periocular laxity on its own. There is also considerable rationale for combining these 2 modalities for synergistic rejuvenation of the entire periocular area. This case series recruited participants with mild-to-moderate skin laxity in the periocular area and tear trough deformities. Participants received microfocused ultrasound with visualization therapy followed 3 months later by injection with Cohesive Polydensified Matrix hyaluronic acid gel. Photographs were taken at baseline, 3 months after microfocused ultrasound with visualization therapy, and 1 month after Cohesive Polydensified Matrix hyaluronic acid injection for rating by physicians and participants using the Global Aesthetic Improvement Scale. All participants also completed a satisfaction questionnaire. This pilot study enrolled 10 participants ranging in age from 35 to 55 years. After microfocused ultrasound with visualization alone, physicians rated 4 participants “much improved,” 5 “improved,” and 1 with “no change.” After participants had received both treatment modalities, physicians rated 9 participants as “very much improved” and 1 as “much improved.” Participant satisfaction was high with microfocused ultrasound with visualization alone and even higher with the combined treatment approach with all 10 participants reporting their periocular appearance “very much improved” at the end of the study. No treatment complications were observed. In conclusion, microfocused ultrasound with visualization in combination with Cohesive Polydensified Matrix hyaluronic acid gel was effective at improving appearance of the eye area in participants with periocular skin laxity and tear trough deformities.

A Randomized, Blinded, Prospective Clinical Study Comparing Small-Particle Versus Cohesive Polydensified Matrix Hyaluronic Acid Fillers for the Treatment of Perioral Rhytids.

Perioral rhytids are a bothersome sign of aging for many patients. Although multiple treatments exist, choosing an optimal modality may be difficult considering that rhytids in this region are fine and the anatomy dynamic. The authors sought to compare the efficacy and safety as well as patient satisfaction of a small-particle hyaluronic acid filler with 0.3% lidocaine (SP-HAL, Restylane Silk) and cohesive polydensified matrix hyaluronic acid filler (CPM-HA, Belotero Balance) in reducing superficial perioral rhytids. The study was double-blinded, and 48 patients with moderate to severe superficial perioral rhytids were enrolled. Patients were randomized to receive either CPM-HA in the left perioral region and SPHAL in the right or vice versa. Rhytid severity was measured by patients utilizing a linear analog scale, and by investigators utilizing a validated 5-point scale, for 180 days following treatment. Both SP-HAL and CPM-HA achieved a reduction in rhytid severity, and neither treatment group returned to baseline after 180 days. Investigator-reported scores for rhytid severity were significantly better for SP-HAL than CPM-HA and remained so at 180 days (P < .05). SP-HAL also proved significantly better for reducing rhytids according to patient scores, although this difference occurred between 120 and 180 days only. Adverse events included rash and mild acne for CPM-HA, and SP-HAL was associated with 1 postinflammatory nodule and 2 occurrences of Tyndall effect. Although both SP-HAL and CPM-HA are effective at reducing perioral rhytid severity and have similar safety profiles, SP-HAL possesses a longer duration of effect.

Interactive tissue reactions of 1064‐nm focused picosecond‐domain laser and dermal cohesive polydensified matrix hyaluronic acid treatment in in vivo rat skin

Picosecond-domain laser treatment using a microlens array (MLA) or a diffractive optical element (DOE) generates micro-injury zones in the epidermis and upper dermis. To investigate interactive tissue reactions between MLA-type picosecond laser pulses and cohesive polydensified matrix hyaluronic acid (CPMHA) filler in the dermis. In vivo rats with or without CPMHA pretreatment were treated with a 1064-nm picosecond-domain neodymium:yttrium-aluminum-garnet (Nd:YAG) laser using an MLA or DOE. Skin samples were obtained at post-treatment days 1, 10, and 21 and histologically and immunohistochemically analyzed. Picosecond-domain Nd:YAG laser treatment with an MLA-type or a DOE-type handpiece generated fractionated zones of pseudo-cystic cavitation along the lower epidermis and/or upper papillary dermis at Day 1. At Day 21, epidermal thickness, dermal fibroblasts, and collagen fibers had increased. Compared to CPMHA-untreated rats, rats pretreated with CPMHA showed marked increases in fibroblasts and collagen fibers in the papillary dermis. Immunohistochemical staining for the hyaluronic acid receptor CD44 revealed that MLA-type picosecond laser treatment upregulated CD44 expression in the basilar epidermis and dermal fibroblasts. We suggest that the hyaluronic acid-rich environment associated with CPMHA treatment may enhance MLA-type picosecond-domain laser-induced tissue reactions in the epidermis and upper dermis.

Facial skin revitalization with CPM®-HA20G: an effective and safe early intervention treatment.

BackgroundHyaluronic acid (HA) fillers are popular for the treatment of signs of facial skin aging.ObjectiveThe objective of this study was to confirm the performance and safety of a new cohesive polydensified matrix HA filler ([CPM®-HA20G, Belotero Revive®, lidocaine-free], Merz Pharmaceuticals GmbH, Frankfurt, Germany) for the treatment of early signs of facial skin aging by use of biophysical measurements as well as subject and investigator satisfaction.MethodsTwenty-five healthy female subjects with signs of facial skin aging were enrolled in this open-label, rater-blinded, observational post-market clinical follow-up study, and received 20 micropuncture treatments of 50 µL CPM®-HA20G each into the lower cheek area at three injection visits 4 weeks apart. Objective biophysical assessments were conducted to demonstrate effects on viscoelastic properties of the skin, surface roughness, tone and radiance, and hydration, at baseline and at all follow-up visits up to 36 weeks.ResultsCPM®-HA20G significantly increased gross elasticity of the skin (at weeks 9 and 12), skin firmness (up to week 24), skin tone and radiance and skin hydration (all up to 36 weeks). Significant reduction of skin fatigue (up to 9 weeks), skin roughness (up to 28 weeks), and redness (up to 36 weeks) was also observed. Subjects and blinded investigator were highly satisfied with the treatment outcomes. The treating investigator reported a high level of satisfaction with the ease of injection and the clinical performance of the device. Moreover, data demonstrated a good safety profile of the device.ConclusionCPM®-HA20G is considered to be an effective and safe HA injectable for skin revitalization in patients suffering from signs of skin aging and loss of skin elasticity. It seems to be a perfect early intervention approach in patients that do not need volumizing treatment and a combination approach in older patients with more pronounced aging.

Multimodal Approach for Treating Horizontal Neck Wrinkles Using Intensity Focused Ultrasound, Cohesive Polydensified Matrix Hyaluronic Acid, and IncobotulinumtoxinA.

For the restoration of horizontal neck wrinkles, multimodal approaches using neuromodulators, intensity focused ultrasound (IFU), and fine line fillers are recommended. To evaluate the efficacy and safety of a 1-day, multimodal approach for horizontal neck wrinkles. Twelve female patients with horizontal neck wrinkles were treated with a combined treatment of IFU, cohesive polydensified matrix hyaluronic acid (CPMHA), and incobotulinumtoxinA. Therapeutic outcomes were assessed on Day 0 and 1, 2, 3, and 6 months thereafter. Horizontal neck wrinkles decreased significantly in length from a median at baseline of 269.75 mm (interquatile range [IQR], 235.35-302.94 mm) to 91.5 mm (IQR, 51.4-108.61 mm) at 1 month, 92.3 mm (IQR, 69.66-132.07 mm) at 2 months, 101.88 mm (IQR, 86-146.77 mm) at 3 months, and 109.48 mm (IQR, 85.06-148.17 mm) at 6 months after the combined treatment. The median global aesthetic improvement scale scores were 3.5 (IQR, 2-4) at 1 month, 3 (IQR, 3-3.5) at 2 months, 3 (IQR, 2-4) at 3 months, and 3 (IQR, 3-3) at 6 months. Post-treatment petechiae resolved completely within 7 days, and CPMHA-induced lumps disappeared within 1 month. The present data demonstrated that the multimodal, combined treatment used in the present study provides satisfactory and long-lasting therapeutic outcomes by targeting different pathogenetic factors of horizontal neck wrinkles.

Superficial application technique with cohesive polydensified matrix hyaluronic acid for the treatment of lines and wrinkles

During aging, the skin undergoes structural, cellular, and molecular changes that alter its mechanical properties as well as its biological and physiological functions. These changes manifest as loss of elasticity, and turgor, with consequent appearance of fine wrinkles, lines, and creases that are difficult to resolve, being considered a therapeutic challenge. Objective: To describe the technique of applying cohesive polydensified matrix hyaluronic acid for the treatment of superficial wrinkles. Materials and methods: In this retrospective and observational study, the technique of superficial and transverse application to superficial wrinkles with cohesive polydensified matrix hyaluronic acid was performed in women with this type of wrinkles in the perioral, periorbicular and lateral regions of the face, which did not disappear after treatment with botulinum toxin, facial volumization with fillers and technology. The study was conducted over 22 months between 2016 and 2018. The degree of improvement was assessed by a questionnaire applied to the patients who observed paired standardized photographs taken in the previous period and one month after the treatment. Results: The technique was performed on 40 women aged 55 to 80 years, whose response to the evaluation questionnaire was improved between 90% and 100% after one month of treatment. Conclusions: The technique of superficial and transverse application to wrinkles with cohesive polydensified matrix hyaluronic acid proved to be an excellent option for the treatment of affected areas, without significant adverse events and/or Tyndall effect, with a high degree of patient satisfaction

A study evaluating cohesive polydensified matrix hyaluronic acid filler for the treatment of etched-in fine facial lines: 12 week data

A study evaluating cohesive polydensified matrix hyaluronic acid filler for the treatment of etched-in fine facial lines: 12 week data

Ultrasound and Histologic Examination after Subcutaneous Injection of Two Volumizing Hyaluronic Acid Fillers: A Preliminary Study.

This study examined the influence of hyaluronic acid (HA) crosslinking technology on the ultrasound and histologic behavior of HA fillers designed for subcutaneous injection. One subject received subcutaneous injections of 0.25 ml Cohesive Polydensified Matrix (CPM) and Vycross volumizing HA in tissue scheduled for abdominoplasty by bolus and retrograde fanning techniques. Ultrasound analyses were performed on days 0 and 8 and histologic analyses on days 0 and 21 after injection. A series of simple rheologic tests was also performed. Day 0 ultrasound images after bolus injection showed CPM and Vycross as hypoechogenic papules in the hypodermis. CPM appeared little changed after gentle massage, whereas Vycross appeared more hyperechogenic and diminished in size. Ultrasound images at day 8 were similar. On day 0, both gels appeared less hypoechogenic after retrograde fanning than after bolus injection. Vycross was interspersed with hyperechogenic areas (fibrous septa from the fat network structure) and unlike CPM became almost completely invisible after gentle massage. On day 8, CPM appeared as a hypoechogenic pool and Vycross as a long, thin rod. Day 0 histologic findings confirmed ultrasound results. Day 21 CPM histologic findings showed a discrete inflammatory reaction along the injection row after retrograde fanning. Vycross had a more pronounced inflammatory reaction, particularly after retrograde fanning, with macrophages and giant cells surrounding the implant. Rheologic tests showed CPM to have greater cohesivity and resistance to traction forces than Vycross. CPM HA volumizer appears to maintain greater tissue integrity than Vycross after subcutaneous injection with less inflammatory activity.

Safety and performance of cohesive polydensified matrix hyaluronic acid fillers with lidocaine in the clinical setting - an open-label, multicenter study.

Cohesive polydensified matrix (CPM®) hyaluronic acid fillers are now available with or without lidocaine. The aim of this study was to investigate the safety and performance of CPM® fillers with lidocaine in the clinical setting. In an open-label, prospective, postmarketing study, 108 patients from seven sites in Germany and Denmark were treated with one or more lidocaine-containing CPM® fillers. Performance was assessed using the Merz Aesthetics Scales® (MAS). Pain was rated on an 11-point visual analog scale. Patients’ and physicians’ satisfaction as well as adverse events were recorded. Improvements of ≥1-point on MAS immediately after and 17 days posttreatment were observed in ~90% of patients compared with baseline. All investigators assessed ejection force, product positioning, and performance as similar or superior to the respective nonlidocaine products. Overall, 94% of investigators were satisfied with the esthetic outcomes and were willing to continue using the products. All patients except one were satisfied with the results, and all were willing to repeat the treatment. Mean pain scores were low during (<3.0) and after injection (<0.6). Except for one case of bruising, all adverse events were mild to moderate. CPM® fillers with lidocaine are safe and effective for a wide range of esthetic facial indications.

A multicenter trial of cohesive polydensified matrix hyaluronic acid

A multicenter trial of cohesive polydensified matrix hyaluronic acid

Correction of tear trough deformity with a cohesive polydensified matrix hyaluronic acid: a case series.

The tear trough or infraorbital hollow is a challenging area to treat, and only a few fillers are suitable for this delicate area. We report on a European case series of six subjects with mild to severe tear troughs who received treatment with cohesive polydensified matrix (CPM®) technology hyaluronic acid gel (Belotero® Balance). The product was injected as small depots (up to ten small boli 0.2 mL maximum each per side) at the supraperiosteal level along or below the orbital rim. Follow-up visits took place at 1, 3, 6, and 9 months after injection for independent evaluation of the clinical effect using the Merz Aesthetics Scale™ for infraorbital hollows and the Global Aesthetic Improvement Scale. Adverse events were also recorded. Mean hollowness scores were considerably improved compared with baseline in all subjects. In all women, the improvements remained throughout the 9-month study, with none reverting to their baseline score. Subjects’ satisfaction with treatment was very high throughout the study, and all women stated that they would repeat treatment with the same product. The CPM hyaluronic acid gel was well tolerated. CPM hyaluronic acid gel is a safe and effective treatment for the tear trough area.

A Blanching Technique for Intradermal Injection of the Hyaluronic Acid Belotero

With the proliferation of dermal fillers in the aesthetic workplace have come instructions from various manufacturers regarding dermal placement. Determination of injection needle location in the dermis has in large part been based on physician expertise, product and needle familiarity, and patient-specific skin characteristics. An understanding of the precise depth of dermal structures may help practitioners improve injection specificity. Unlike other dermal fillers that suggest intradermal and deep dermal injection planes, a new hyaluronic acid with a cohesive polydensified matrix may be more appropriate for the superficial dermis because of its structure and its high degree of integration into the dermis. To that end, the authors designed a small study to quantify the depth of the superficial dermis by means of ultrasound and histology. Using ultrasound resources, the authors determined the depths of the epidermis, the dermis, and the reticular dermis in the buttocks of six patients; the authors then extrapolated the depth of the superficial reticular dermis. Histologic studies of two of the patients showed full integration of the product in the reticular dermis. Following determination of injection depths and filler integration, the authors describe a technique ("blanching") for injection of the cohesive polydensified matrix hyaluronic acid into the superficial dermis. At this time, blanching is appropriate only for injection of the cohesive polydensified matrix hyaluronic acid known as Belotero Balance in the United States, although it may have applications for other hyaluronic acid products outside of the United States.