Injectable hyaluronic acid (HA) fillers are flooding the market, challenging aesthetic physicians to determine which product is best for an individual patient’s soft-tissue volume loss or facial rejuvenation needs.
It's not so easy. Clinical data looking at product performance is lacking, according to authors of a recent paper published April 2019 in Plastic and Reconstructive Surgery.1
To help aesthetic providers better differentiate HA fillers, the authors collected rheologic and physicochemical measurements on 18 HA filler products, including Belotero Balance (Anteis, S.A. for Merz Pharma); Juvéderm products (Allergan); Restylane fillers (Q-Med AB/Galderma); and Teosyal products (Teoxane).
The authors looked at the impact of rheologic parameter elastic modulus (G’) and HA concentration on swelling factor and cohesion to differentiate dermal fillers. They also shared practical experiences about G′-based product selection when considering skin quality, degree of correction, injection depth and anatomical location, according to the paper.
They found G′ is a useful and consistent way to distinguish HA filler products.
They observed relationships between G′ and swelling factor and G′ and cohesion among products manufactured by the same crosslinking technology and the same concentration. But there was no apparent relationship between isolated HA concentration and swelling factor or cohesion.
Higher G’ fillers tend to be firmer, with a more elastic compression response. Lower G’ fillers tend to be softer and less elastic.
“… in general, higher G′ products are better suited for thicker skin and deeper injection planes, whereas lower G′ products are better for more superficial planes, although exceptions to these trends are also made based on technical experience,” according to the authors.
No One Filler Does It All
Aesthetic clinicians are using HA fillers in many ways to rejuvenate the face — from primary uses such as injections into the superficial to mid dermis to address perioral rhytids, to more recent uses, including correction of the temple and infraorbital hollows. No one filler does it all, they say. And those clinicians who understand how to select products based on G′ can use that knowledge to better correct soft-tissue volume loss and rejuvenate faces, according to the paper.
Of the 18 fillers studied, the filler with the lowest G’ was Restylane Fynesse, which the authors acknowledge they have limited experience using. The filler with the highest G’ was Restylane Lyft, which they say is good for injecting into the deep dermis, to treat moderate to severe nasolabial folds, for midface volume loss, for cheek augmentation and to build volume in the dorsal hand.
Q-Med AB/Galderma, Uppsala, Sweden, for provided data for all products presented. Åke Öhrlund and Per Winlöf (Q-Med/Galderma) provided technical expertise and scientific input; and Alessandra Nogueira, M.D., and Lynette Arlati, M.S.N., F.N.P.-B.C. (Galderma Laboratories, L.P., Fort Worth, Texas), shared clinical expertise for the article. The paper’s author S. Fagien is a paid speaker, consultant and clinical trial investigator for Galderma and a paid speaker, consultant and clinical trial investigator for Allergan. V. Bertucci is a paid clinical trial investigator, consultant and speaker for Galderma, Allergan and Merz and a consultant for Prollenium and Teoxane. E. von Grote and J.H. Mashburn were employees of Galderma Laboratories, L.P. (Fort Worth, Texas) at the time of article preparation.
Fagien S, Bertucci V, von Grote E, Mashburn JH. Rheologic and Physicochemical Properties Used to Differentiate Injectable Hyaluronic Acid Filler Products. Plast Reconstr Surg. 2019 Apr;143(4):707e-720e.