Restylane SubQ Research Articles

Quantitative Evaluation of Volume Augmentation and Durational Changes in the Anteromedial Cheek with Hyaluronic Acid Fillers Using Three-Dimensional Measurement: 2-Year Results from a Comparative Split-Face Study.

Hyaluronic acid fillers are widely used for the augmentation of facial soft tissues. Hyaluronic acid fillers can be monophasic or biphasic and have different characteristics, especially regarding volumetric effects and maintenance potential. However, there is paucity of long-term quantitative and objective data on clinical outcomes following hyaluronic acid injection. In this study, the authors evaluated volumetric changes over 2 years and the maintenance potentials of both types of fillers on the anteromedial cheek using objective three-dimensional measurements. This comparative split-face study enrolled participants aged 30 to 50 years who received a midfacial injection of the test filler (Belotero Volume) on one side and a random control filler (Juvéderm, Restylane SubQ, or Yvoire Contour) on the contralateral side. The authors conducted three-dimensional scanning assessments at baseline and after 30 minutes; 3 days; 2, 4, 12, and 24 weeks; and 2 years. The volume augmentation effects for the anteromedial cheek of two monophasic fillers (Belotero Volume and Juvéderm Voluma) were maintained for at least 2 years (81 percent and 66 percent, respectively, compared to the volume at 4 weeks). Two biphasic fillers (Yvoire Contour and Restylane SubQ) maintained over 50 percent volume compared to the volume 4 weeks after injection. Monophasic fillers showed better outcomes than biphasic fillers; however, both types of hyaluronic acid fillers demonstrated superior efficacy, safety, and durability for volumetric augmentation in the anteromedial cheek. Objective data obtained using three-dimensional imaging analysis will enable dermatologists to better demonstrate the results of the procedure to patients, through the provision of visual aids. Therapeutic, II.

A Randomized, Active-Controlled, 52-Week Study of Hyaluronic Acid Fillers for Anteromedial Malar Region Augmentation.

Hyaluronic acid (HA) fillers for volume augmentation in the anteromedial malar region of Asians have been popular for many years. However, studies on their long-term effectiveness are lacking. This study aimed to evaluate the effectiveness and safety of HA fillers injected into the anteromedial malar region for volume augmentation for up to 52 weeks. Each anteromedial malar region of the subjects was treated with YVOIRE Contour (YVOC) in one side and Restylane Sub-Q (RESS) in the other and followed up at weeks 2, 14, 26, and 52. The volume using the mid-face aesthetic scale (MFAS) ranging from 0 (full) to 4 (very severely sunken) and the subject's satisfaction and adverse events were evaluated. Total 83 subjects were randomized and treated with YVOC and RESS. The LS means (standard error) of MFAS score in the YVOC and RESS groups were both 2.56 (0.05) at baseline, 1.32 (0.07) and 1.39 (0.07) at week 26, and 1.84 (0.10) and 1.89 (0.10) at week 52, respectively. The difference in the LS mean of MFAS score between the groups at week 26 was 0.07 (95% confidence interval, 0.01-0.12), showing the non-inferiority of YVOC to RESS. About 70% of subjects were still satisfied with the results at week 52. No specific safety concern was detected. The HA fillers injected for the anteromedial malar augmentation maintained the volume well for up to 52 weeks. Additionally, both YVOC and RESS show similar effectiveness and safety profiles.

Experimental study of hyaluronic acid gel fillers biodegradation in orbit

Recently, hyaluronic acid gel (HAG) fillers were proposed as an effective alternative treatment option for surgical orbital volume augmentation. Several authors reported about long-standing effect of the filler. To assess the features of HAG biodegradation after intraorbital injection in experimental environment. In the course of the experiment, 7 chinchilla rabbits (14 eyes) received a single 1ml intraorbital HAG injection (Restylane SubQ, Galderma, Sweden) using a cannula. The animals' orbits were examined by ultrasound scan after the injection and at 1, 3, 6, 9, 12 and 18 months. The animals were subsequently sacrificed for morphological study of orbital tissue containing the HAG filler. The HAG filler persisted in the orbit of experimental animals during the whole follow-up period. The volume of HAG depot and its density diminished gradually till the 18th month, after which the particles of HAG could still be detected with the morphological study and ultrasound. The HAG filler persisted in the orbit of experimental animals up to 18 months. Incomplete biodegradation explains the longstanding duration of the injection effect.

Hyaluronic Acid Gel Biodegradation After Intrapalpebral and Intraorbital Injection in Experimental Study.

Amid the increasing clinical application of hyaluronic acid (HA) fillers in the ocular adnexa is a paucity of histological data concerning the fate of the injected material. The current study documents the in vivo biodegradation of HA deposited in the eyelid and orbit. The study included 22 chinchilla rabbits. The right upper eyelid of 12 rabbits received a single 0.2 ml Restylane (Galderma, Uppsala, Sweden) subcutaneous injection. In 10 different rabbits, the right orbit was injected with 1.0 ml Restylane SubQ (Galderma, Uppsala, Sweden) in the extraconal space. The rabbits in the eyelid group were euthanized at 2 weeks, 1 month, 2, 4, 6, and 9 months, while the rabbits in the orbit group were euthanized at 1 month, 3, 6, 12, and 18 months. Histological analysis was performed on the harvested samples. In the eyelid, the HA assumed a sponge-like structure that diminished gradually over time. At 9 months, the injected HA partially persisted, mainly in the peripheral areas of injection. A similar histologic pattern was observed in the injected orbits, with slow changes persisting at the eighteenth month. In both cohorts, clear signs of collagen deposition and pseudocapsule formation were observed around HA droplets, with no signs inflammation. HA injected subcutaneously into the eyelid and orbit of rabbits undergoes slow and gradual biodegradation, with HA persisting to no less than 9 months in the eyelid and 18 months in orbit. Neocollagen synthesis and lack of hyaluronidase activity could explain the unexpectedly prolonged HA persistence.

A randomized controlled trial testing a hyaluronic acid spacer injection for skin toxicity reduction of brachytherapy accelerated partial breast irradiation (APBI): a study protocol

BackgroundAccelerated partial breast irradiation (APBI) is a treatment option for selected early stage breast cancer patients. Some APBI techniques lead to skin toxicity with the skin dose as main risk factor. We hypothesize that a spacer injected between the skin and target volume reduces the skin dose and subsequent toxicity in permanent breast seed implant (PBSI) patients.MethodsIn this parallel-group, single-center, randomized controlled trial, the effect of a subcutaneous spacer injection on skin toxicity among patients treated with PBSI is tested. Eligibility for participation is derived from international guidelines for suitable patients for partial breast radiotherapy, e.g. women aged ≥ 50 years with a histologically proven non-lobular breast carcinoma and/or ductal carcinoma in situ (DCIS), tumor size ≤ 3 cm, node-negative, and PBSI technically feasible. Among exclusion criteria are neoadjuvant chemotherapy, lymphovascular invasion, and allergy for hyaluronic acid. For the patients allocated to receive spacer, after the PBSI procedure, 4–10 cc of biodegradable hyaluronic acid (Barrigel™, Palette Life Sciences, Santa Barbara, CA, USA or Restylane SubQ®, Galderma Benelux, Breda, the Netherlands) is injected directly under the skin using ultrasound guidance to create an extra 0.5–1 cm space between the treatment volume and the skin. The primary outcome is the rate of telangiectasia at two years, blindly assessed using Bentzen’s 4-point scale. Secondary outcomes include: local recurrence; disease-free and overall survival rates; adverse events (pain, redness, skin/subcutaneous induration, radiation dermatitis, pigmentation, surgical site infection); skin dose; cosmetic and functional results; and health-related quality of life.A Fisher’s exact test will be used to test differences between groups on the primary outcome.Previous studies found 22.4% telangiectasia at two years. We expect the use of a spacer could reduce the occurrence of telangiectasia to 7.7%. A sample size of 230 patients will allow for a 10% lost to follow-up rate.DiscussionIn this study, the effect of a subcutaneous spacer injection on the skin dose, late skin toxicity, and cosmetic outcome is tested in patients treated with PBSI in the setting of breast-conserving therapy. Our results will be relevant for most forms of breast brachytherapy as well as robotic radiosurgery, as skin spacers could protect the skin with these other techniques.Trial registrationNetherlands Trial Register, NTR6549. Registered on 27 June 2017.

Deep Orbital Sub-Q Hyaluronic Acid Filler Injection for Enophthalmic Sighted Eyes in Parry-Romberg Syndrome.

The authors present a consecutive series of deep orbital Sub-Q injections to treat enophthalmic sighted eyes in Parry-Romberg syndrome patients. Retrospective, interventional case series in 2 centers. Data were collected on patient demographics, Parry-Romberg syndrome onset age, previous orbital and eyelid surgeries, diplopia, ocular movement restriction before and after the injection, number of injections, interval between injections, indication for any top-up or dissolution of filler, and any other complications. In all cases, the hyaluronic acid gel used was Restylane Sub-Q + Lidocaine. A total of 8 injections on 3 patients with Parry-Romberg syndrome, and significant enophthalmos is reported. All injections were with deep orbital Sub-Q filler. All patients were females, aged 32, 24, and 52 years old while their symptoms started at 15, 16, and 30 years old, respectively. None had orbital surgery prior to the injection. Follow up period was 2, 7, and 5 years respectively. All presented a significant enophthalmos of 4 mm which reduced to 1 mm after the injection, and duration effect was 18, 24, and 20 months, respectively. We observed a significant improvement in enophthalmos, lagophthalmos, exposure keratopathy, and even ocular motility. Lagophthalmos improved from 1, 4, and 7 mm to 0, 1, and 2 mm post injection. Ocular motility improved with no onset of new limitation or diplopia. Lower eyelid retraction increased in 1 patient after orbital injection. No other complications occurred. Deep orbital Sub-Q hyaluronic injection for treatment of enophthalmos in Parry-Romberg syndrome is an useful option in sighted eyes.

Biophysical Characteristics of Hyaluronic Acid Soft-Tissue Fillers and Their Relevance to Aesthetic Applications

The purpose of this study was to present new rheologic data for hyaluronic acid filler products, correlate them with recent tissue integration studies, and provide a scientific rationale for selecting appropriate products for volume replacement within different tissue levels and anatomical zones. A brief overview of the methodology of filler rheology studies and data analysis is provided. Six U.S. Food and Drug Administration–approved, cross-linked, nonanimal-derived hyaluronic acid filler products and one hyaluronic acid product approved in Europe and elsewhere were studied: one cohesive polydensifiedmatrix hyaluronic acid (Belotero Balance, also known as Belotero Basic), two Hylacross hyaluronicacids (Juvéderm Ultra and Juvéderm Ultra Plus), one Vycross hyaluronic acid (Juvéderm Voluma), and three nonanimal stabilized hyaluronic acids (Perlane, Restylane and Restylane SubQ) [corrected].The elastic modulus, complex viscosity, and viscous modulus of each filler gel were quantified. Tan delta for each filler gel and also for calcium hydroxylapatite filler (Radiesse) was calculated at 0.7 Hz. Cohesive polydensified matrix hyaluronic acid (Belotero Balance) has the lowest elasticity and viscosity and the highest tan delta. This predicts its soft, flowing qualities and correlates with its homogeneous pattern of tissue integration after intradermal implantation. Nonanimal stabilized hyaluronic acid (Perlane and Restylane) has the highest elasticity and viscosity and low tan delta. This predicts its firm, less flowing qualities and correlates with a bolus-like pattern of tissue integration. Hylacross hyaluronic acid (Juvéderm) has intermediate elasticity, viscosity, and tan delta, correlating with its intermediate pattern of tissue integration. Rheologic evaluation reliably predicts tissue integration patterns and appropriate clinical applications of the studied fillers. Paradigms of layered filler placement can be designed to optimally address individual patient need.

Nonsurgical Management of Silent Sinus Syndrome With Hyaluronic Acid Gel

A 44-year-old woman was referred with 3 mm of left enophthalmos and a deep superior sulcus. She was diagnosed 6 months earlier with silent sinus syndrome and had undergone a left middle-meatal antrostomy with improvement of her hypoglobus but not of her enophthalmos and superior sulcus deformity. Two milliliters of Restylane SubQ (Q-Med AB, Uppsala, Sweden) was injected as a single bolus in the intraconal and extraconal posterior orbit via a standard transcutaneous inferotemporal approach using a primed green 21-gauge needle. Immediate reduction of enophthalmos by approximately 2 mm and superior sulcus improvement were noted. This remained stable at 6 months. The symptoms and signs of silent sinus syndrome can be effectively corrected with this minimally invasive nonsurgical option. To our knowledge, the use of hyaluronic acid gel for the treatment of enophthalmos in silent sinus syndrome has not been previously reported.

The Effects of Penile Girth Enhancement using Injectable Hyaluronic Acid Gel, a Filler

Despites the debates on penile girth enhancement (PGE), demands for enhancement are increasing. Recently, various fillers have been widely used for soft tissue augmentation with proven efficacy and safety. To identify the feasibility and efficacy of PGE by injection of filler. Fifty patients with subjective small penis who visited Korea University Guro outpatient clinic were enrolled and prospectively followed. Restylane Sub-Q (Q-med, Upssala, Sweden) was injected into the fascial layer of penile body via 21G cannula with "Back & Forth Technique" and homogenized with a roller. From April 2006 to February 2008, 50 patients were enrolled and 41 patients were followed until 18 months after PGE. Changes in penile girth at midshaft were measured by tapeline at 1 and 18 months. Patient's visual estimation of residual volume (Gr 0-4), patient's satisfaction (Gr 0-4), and any adverse reactions were also evaluated. Mean injected volume was 20.56 cc (18-22). Compared with basal girth of 7.48 ± 0.35 cm, maximal circumference was significantly increased to 11.41 ± 0.34 cm at 1 month (P < 0.0001) and maintained as 11.26 ± 0.33 cm until 18 months. In patient's visual estimation, two patients complained the decrease as Gr 3 with focal depression at 1 month. At 18 months, all patients answered as Gr 4 without asymmetry. Patient's and partner's satisfaction score was 3.71 ± 0.46 and 3.65 ± 0.48 at 1 month and 3.34 ± 0.53 and 3.38 ± 0.49 at 18 months. There were no inflammatory signs or serious adverse reactions in all cases. Considering the property of material, methods, and follow-up results of 18 months, PGE using filler is a very effective and safe technique for penile augmentation.

Comparison of the Rheological Properties of Viscosity and Elasticity in Two Categories of Soft Tissue Fillers: Calcium Hydroxylapatite and Hyaluronic Acid

Two types of soft tissue filler that are in common use are those formulated primarily with calcium hydroxylapatite (CaHA) and those with cross-linked hyaluronic acid (cross-linked HA). To provide physicians with a scientific rationale for determining which soft tissue fillers are most appropriate for volume replacement. Six cross-linked HA soft tissue fillers (Restylane and Perlane from Medicis, Scottsdale, AZ; Restylane SubQ from Q-Med, Uppsala, Sweden; and Juvéderm Ultra, Juvéderm Ultra Plus, and Juvéderm Voluma from Allergan, Pringy, France) and a soft tissue filler consisting of CaHA microspheres in a carrier gel containing carboxymethyl cellulose (Radiesse, BioForm Medical, Inc., San Mateo, CA). METHODS The viscosity and elasticity of each filler gel were quantified according to deformation oscillation measurements conducted using a Thermo Haake RS600 Rheometer (Newington, NH) using a plate and plate geometry with a 1.2-mm gap. All measurements were performed using a 35-mm titanium sensor at 30°C. Oscillation measurements were taken at 5 pascal tau (τ) over a frequency range of 0.1 to 10 Hz (interpolated at 0.7 Hz). Researchers chose the 0.7-Hz frequency because it elicited the most reproducible results and was considered physiologically relevant for stresses that are common to the skin. RESULTS The rheological measurements in this study support the concept that soft tissue fillers that are currently used can be divided into three groups. CONCLUSION Rheological evaluation enables the clinician to objectively classify soft tissue fillers, to select specific filler products based on scientific principles, and to reliably predict how these products will perform--lifting, supporting, and sculpting--after they are appropriately injected.

Adjunctive Use of Hyaluronic Acid Gel (Restylane Sub-Q) in Anophthalmic Volume Deficient Sockets and Phthisical Eyes

This study aims to present the use of Restylane Sub-Q for orbital volume augmentation in patients with secondary volume deficiency either postenucleation or postevisceration or those with phthisical eyes. This prospective case series reviews clinical, photographic, and radiologic records of 16 patients with anophthalmic or enophthalmic orbits who underwent volume augmentation by injection with hyaluronic acid gel in the intraconal and extraconal posterior orbit. The technique is discussed in detail. The volume of hyaluronic acid gel injected ranged from 2 to 4 ml (mean volume, 2.3 ml) per orbit, with a mean reduction of enophthalmos of 3.7 mm (71.4%) at 1 week, 2.8 mm (59.9%) at 6 months, and 2.5 (51.3%) at 12 months, with follow-up of 94.1%, 68.8%, and 50% of the patient group, respectively. Follow-up after 12 months consisted of subjective feedback from the patient. With the exception of one patient, the mean subjective follow-up period was 14.7 months (maximum, 22.4 months; minimum, 1.6 months). The procedure was well tolerated by 15 of the 16 patients who all experienced an improvement in cosmetic appearance. There was one possible complication of orbital cellulitis (although not examined by our clinic); this patient did not attend further follow-ups. One patient had full correction of her enophthalmos, which was maintained over 12 months. Hyaluronic acid gel injections in patients with enophthalmic sockets appear to be a safe, tolerable, and minimally invasive alternative for orbital volume augmentation in the outpatient setting. However, as predicted, its affects are temporary, and volume does begin to decrease within 12 months of injection.

Large particle hyaluronic acid for the treatment of facial lipoatrophy in HIV‐positive patients: 3‐year follow‐up study

Facial lipoatrophy can be a stigmatizing side effect of antiretroviral (AVR) treatment for HIV-infected patients. We sought to evaluate the long-term efficacy and safety of a new formulation of hyaluronic acid that can be injected in larger amounts and into deeper skin layers during 3 years of follow-up. Twenty patients received injections of Restylane SubQ(). Refill treatment was offered at 12 and 24 months. Treatment effects were evaluated using ultrasound, the Global Aesthetic Improvement Scale, visual analogue scale (VAS) and the Rosenberg self-esteem scale. Seventeen patients remained at 36 months. Mean (+/- standard deviation) total cutaneous thickness increased from 6 +/- 1 mm at baseline to 12 +/- 1 mm (P<0.001) at 36 months. Response rate (total cutaneous thickness >10 mm) was 70%. Fifteen patients classified their facial appearance as very much or moderately improved. VAS increased from 39 +/- 25 to 70 +/- 20 (P<0.05) and higher self-esteem scores were reported. Local swelling and tenderness after treatment was common. Persistent papules found in several patients after treatment were removed effectively with hyaluronidase injections. Three patients, treated only at baseline, still had higher total cutaneous thickness scores at 36 months. Our results indicate that a large particle hyaluronic acid formulation is a durable and well-tolerated dermal filler for treating HIV-positive patients with facial lipoatrophy.

Deep Orbital Sub-Q Restylane (Nonanimal Stabilized Hyaluronic Acid) for Orbital Volume Enhancement in Sighted and Anophthalmic Orbits

To describe a new technique of injecting Restylane Sub-Q (Q-Med, Uppsala, Sweden) into the intraconal and extraconal posterior orbit. Retrospective review. Eight injections were performed in 5 patients using 2-mL Sub-Q in the intraconal and extraconal posterior orbit for orbital volume enhancement. Four injections were performed in sighted orbits and the remaining in anophthalmic orbits. The age range was 18 to 36 years; the follow-up time was 5 to 12 months. Orbital volume enhancement was achieved in all cases with an improvement in upper eyelid sulcus and skin fold. Enophthalmos reduction was 2 mm per 2-mL injection. The procedure was well tolerated. One patient experienced a vasovagal episode lasting 3 hours and 1 patient had postoperative pain. No such episodes occurred after I began injecting local anesthesia before performing the Sub-Q injection. One patient required hyaluronidase for migrating gel, which caused lower eyelid swelling. This small case series suggested the safety and tolerability of deep orbital Sub-Q. Injections are easily performed in the outpatient setting. The expected volume enhancement was achieved in all cases with no long-term adverse effects to date.

Hyaluronic acid treatment of facial fat atrophy in HIV‐positive patients

Facial lipoatrophy can be devastating for HIV-infected patients, with negative effects on self-esteem. In this study, we treated facial fat atrophy in the nasogenian area with hyaluronic acid (Restylane SubQ; Q-Med AB, Uppsala, Sweden). Twenty patients were included in the study. Treatment effects were evaluated at baseline, and at weeks 6, 24 and 52 using ultrasound, the Global Aesthetic Improvement Scale, the Visual Analogue Scale and the Rosenberg Self-Esteem Scale. Mean (+/-standard deviation) total cutaneous thickness increased from 6+/-1 mm at baseline to 15+/-3 mm at week 6 (P<0.001), and declined to 10+/-2 mm at week 52 (P<0.001 vs baseline). The response rate (total cutaneous thickness >10 mm) was 100% at week 6, 85% at week 24 and 60% at week 52. At week 6, all of the patients classified their facial appearance as very much improved or moderately improved. They also reported increased satisfaction with their facial appearance and had higher self-esteem scores. At week 52, 15 of 19 patients still classified their facial appearance as very much improved or moderately improved, although the mean total cutaneous thickness had gradually declined. Our results indicate that Restylane SubQ is a useful and well-tolerated dermal filler for treating HIV-positive patients with facial lipoatrophy.

Injectable Hyaluronic Acid Implant for Malar and Mental Enhancement

The use of a thicker injectable implant version of one of the hyaluronic acid dermal fillers (Restylane SubQ, Q-Med, Uppsala, Sweden) is described. A group of treated patients has been studied for more than 1 year. Restylane SubQ was injected to the submuscular plane of the upper cheeks and chin to observe efficacy of augmentation and side effect profile, and further observations were made of the duration of benefit. Patient details--72 patients were treated, 68 for upper cheek augmentation, 2 for chin augmentation, and 2 for both areas. Four patients received second injections 8 weeks after the first to increase augmentation. Patients all showed a persistence of benefit during the posttreatment observation period of up to 64 weeks. Four patients had minor side effects that resolved with local treatment and time. Four patients had second injections to complete augmentation without complications. Restylane SubQ is a useful injectable agent to augment and lift upper cheeks and recontour chins. Further efficacy studies seem justified.

Injectable Hyaluronic Acid Implant for Malar and Mental Enhancement

BACKGROUND The use of a thicker injectable implant version of one of the hyaluronic acid dermal fillers (Restylane SubQ, Q-Med, Uppsala, Sweden) is described. OBJECTIVE A group of treated patients has been studied for more than 1 year. Restylane SubQ was injected to the submuscular plane of the upper cheeks and chin to observe efficacy of augmentation and side effect profile, and further observations were made of the duration of benefit. METHODS Patient details—72 patients were treated, 68 for upper cheek augmentation, 2 for chin augmentation, and 2 for both areas. Four patients received second injections 8 weeks after the first to increase augmentation. RESULTS Patients all showed a persistence of benefit during the posttreatment observation period of up to 64 weeks. Four patients had minor side effects that resolved with local treatment and time. Four patients had second injections to complete augmentation without complications. CONCLUSIONS Restylane SubQ is a useful injectable agent to augment and lift upper cheeks and recontour chins. Further efficacy studies seem justified.

A Multicenter Study of the Efficacy and Safety of Subcutaneous Nonanimal Stabilized Hyaluronie Acid in Aesthetic Facial Contouring: Interim Report

Non-animal-stabilized hyaluronic acid (NASHA) gel may offer longer-lasting cosmetic correction and lower antigenic risk than other soft tissue augmentation agents. To assess the efficacy and safety of the NASHA gel Restylane SubQ (Q-Med AB, Uppsala, Sweden) in aesthetic facial contouring. Fifty-seven adult patients seeking cheek and/or chin augmentation received subcutaneous and/or supraperiostal injections of Restylane SubQ (20 mg/mL) at 114 treatment sites; 13 of these patients received "touch-up" injections at 20 sites. Efficacy was assessed subjectively using a 5-grade Global Aesthetic Improvement Scale at 1, 3, 6, 9, and 12 months after the initial treatment. At 3 months post-baseline, patients and investigators independently considered the treatment sites to be improved in 96.4% and 100% of cases, respectively. Patient- and investigator-assessed response rates (proportion of patients showing moderate or better improvement) were 84% and 95%, respectively. The majority of reported adverse events were treatment related (local injection-site reactions, implantation complications, skin tightness, and skin induration), but these were generally of mild intensity and short-lived. Restylane SubQ is well tolerated and maintains aesthetic correction of the cheeks and chin for at least 3 months after subcutaneous and/or supraperiostal treatment.

Optimizing treatment outcome with Restylane SubQ: The role of patient selection and counseling

Restylane SubQ has been developed to meet the growing demand for minimally invasive cosmetic procedures that correct loss of facial soft tissue volume and provide a nonpermanent solution for facial rejuvenation. This new product in the Restylane product family is based on the same non-animal stabilized hyaluronic acid (NASHA) gel as all other Restylane products, but contains larger gel particles than existing products. This characteristic allows for optimal volume expansion when injected subcutaneously or supraperiostally. Possible indications for Restylane SubQ include cheek augmentation in young patients with flat malar bone as an alternative to cheek implants. Other indications could be midface rejuvenation in patients who either feel it is too early for a face lift, or who are ready for a face lift but are unwilling to undergo surgery. Another possible use could be chin augmentation-pure augmentation as an alternative to chin implantation, or simply rejuvenation of the chin profile to enhance projection in patients with early chin ptosis. A common principle in all these possible indications is that the aesthetic outcome obtained with Restylane SubQ largely depends on appropriate patient selection and counseling. Facial tissue structure is an important consideration when selecting patients for treatment with Restylane SubQ, since treatment success is dependent on adequate soft-tissue cover for the injected product, as well as soft tissue support to prevent mobility.

Transdermal injection of Restylane SubQ for aesthetic contouring of the cheeks, chin, and mandible

Initial experience in transdermal administration of Restylane SubQ for augmentation of the cheek and chin suggests that the product is easy to administer via this route and that it provides a stable aesthetic result. Local adverse reactions are consistent with those expected of an alloplastic filler material and appear to be related to the injection procedure/site rather than to the product itself. In the event of overcorrection or the appearance of superficial irregularities (nodules), any excess material can readily be removed by needle aspiration. Several measures can be taken to increase the likelihood of a satisfactory aesthetic outcome and minimize the risk of treatment complications with Restylane SubQ. One such measure is to deposit the product in small aliquots at multiple sites (using a multiple tunneling technique) to avoid pooling within the soft tissues. Treatment sites with poor soft-tissue cover pose a challenge because of the high risk of surface irregularities. In cheek augmentation procedures, Restylane SubQ should be placed below the zygomatic arch where the subcutaneous tissue is more fibrous, thereby providing a possible barrier to implant mobility. The chin appears to be particularly well suited to volume augmentation with Restylane SubQ because its dense fibrous tissue creates naturally occurring pockets for product placement. In summary, transdermal administration of Restylane SubQ is a convenient, noninvasive procedure for chin and cheek contouring and for rejuvenation of the mid and lower face.

Restylane SubQ, a non-animal stabilized hyaluronic acid gel for soft tissue augmentation of the mid- and lower face

For people requiring large volumes to shape facial contours, add volume to a sunken midface, or correct asymmetry, the options today are limited. Fat injections for adding volume, solid implants for cheeks and chin enhancement, face lift and injectable permanent or semi-permanent products are some of the alternatives used. With the trend towards less invasive and nonpermanent alternatives to plastic surgery, the use of injectable filler materials for facial rejuvenation and correction of soft-tissue defects is becoming increasingly popular. These materials provide volume expansion within the dermis, thereby smoothing out overlying facial wrinkles and enhancing facial contours. Ease of application, minimal procedural discomfort, and rapid patient recovery make injectable fillers well suited for outpatient use. Ideally, a filler material should be biocompatible, nontoxic, nonimmunogenic, and nonmigratory. Several biomaterials have been developed, such as bovine collagen, autologous and allogeneic human collagen, autologous fat, fibroblasts, and hyaluronic acid. However, although they are largely biocompatible, reabsorption and lack of sustained cosmetic effect are major drawbacks. Non-animal stabilized hyaluronic acid (NASHA) offers a longer-lasting aesthetic effect than bovine collagen or avian hyaluronic acid in facial soft-tissue augmentation, and a potentially lower risk of inflammatory reactions. Restylane SubQ is a new NASHA product indicated for deep subcutaneous or supraperiostal injection to replace volume loss in facial adipose tissues and create more defined facial contours.