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Aesthetic Dermatology Fillers
New Hyaluronic Acid Filler for Subdermal and
Long-lasting Volume Restoration of the Face
Michael J Weidmann
Klinik/Praxis am Forsterpark, Augsburg
Abstract
Over the past few years, the focus in the field of aesthetic medicine has gradually shifted towards minimally invasive procedures. As more
and more patients are refusing to take prolonged absences from their work, the use of filler materials, botulinum toxin A, peelings, laser,
fat implantation and other minor surgical corrections has significantly increased. Minimally invasive volume restoration of the face
through long-lasting resorbable fillers is nowadays more attractive and important to patients.
Keywords
Hyaluronic acid, minimally invasive filler procedures, subdermal volume restoration
Disclosure: The author has no conflicts of interest to declare.
Received: 13 March 2009 Accepted: 27 March 2009
Correspondence: Michael J Weidmann, Klinik/Praxis am Forsterpark, Willy-Brandt-Platz 3a, 86153 Augsburg, Germany.
Using combinations of filler materials, botulinum toxin A, peelings, acids. According to the first method, a partly cross-linked portion of
laser, fat implantation and other minor surgical corrections, it is hyaluronic acid is suspended in a non-cross-linked hyaluronic acid
possible to achieve optimal clinical results for individual patients (bi-phasic products such as Restylane, Perlane, Hylalform, etc.) in
over a period of two years. These methods can cumulatively achieve order to make the substance injectable. According to the second
the same result that would have previously been achieved by method, hyaluronic acid is first partly cross-linked (around 1–20%),
surgical procedures. In the course of the ageing process the and the final product, which is described as a mono-phasic product
treatment stages that are necessary for each individual can be (Juvederm, Esthelis and Teosyal), is then sucked into a syringe. The
applied without creating an irrevocable outcome for the patient, latest development in the field of hyaluronic acids is a highly cross-
which may occur when invasive surgical procedures are used. linked hyaluronic acid (over 70%) that has no suspension at all and
still has the best injectability features. The author has used one of
It is necessary for the treating physician to master all of the new these newly developed hyaluronic acids (Varioderm
®
Subdermal,
minimally invasive techniques in order to give patients optimal Adoderm Company) for volume restoration on the face for more than
advice tailored to their specific needs. Physicians should never two years. When injected properly, this hyaluronic acid has proved to
choose a technique just because they are proficient in it if the be effective for a significantly longer period of time (12–18 months
technique does not represent the optimal solution for a particular after one single injection). The only disadvantage was a slightly
patient’s needs. increased swelling tendency during the initial phase. There were no
subsequent complications. In our view, this substance represents an
Despite the fact that fat and fillers have now been in use for decades interesting new development in the field of fillers.
and despite many new developments in this sector, even minimally
invasive methods can have side effects and contraindications that Hyaluronic Acids –
must be taken into account in specific cases and need to be fully Natural Occurrence and Properties
explained to patients. Since the 1980s, hyaluronic acids have been widely used as a
material for the manufacturing of implants. Hyaluronic acid is part
The use of permanent fillers such as polyacrylates has become of a class of substances that form the extracellular matrix of the
increasingly controversial over the past few years due to the skin. To a large extent, hyaluronic acid can bond to water.
5,10,11
appearance of granulomas. Hyaluronic acid affects the controlled permeability of cells; it
separates various cells and compensates for the hydroxyl radicals
Hyaluronic acid is the gold standard for treatment, but in applications formed during the inflammation process.
2,3
High-molecular-weight
and clinical evaluations we found that the approximate effective hyaluronic acid has the property of being able to absorb more
duration with first- and second-generation hyaluronic acids (and water with increasing degradation (isovolumic degradation).
5
By
even the numerous ‘new hyaluronic acids’ that have been developed using cross-linking technology, it is possible to produce a polymer
in the past few years) was only three to four months. Nowadays, with a higher molecular weight of between 5 and 6 million but with
there are three different technologies for manufacturing hyaluronic the same chemical structure.
1
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