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New Hyaluronic Acid Filler for Subdermal and Long-lasting Volume Restoration of the Face
Figure 4: Durability and Filling Effect of Figure 5: Cheek Augmentation and Marionette Lines of a
Varioderm Products Patient Before and After Injection with Varioderm
Subdermal 1ml (Before and After 12 Months)
Efficacy after 1 month
Before After
11%
3%
0% Optimal
Good
Satisfactory
Poor
86%
Figure 6: Injection with Varioderm Subdermal 2ml in the
Naso-labial Folds (Before and After Nine Months)
Efficacy after 6 months
Before After
19%
4%
0%
0% Optimal
Good
Satisfactory
Poor
Ineffective
77%
Efficacy after 12 months
Figure 7: Varioderm Subdermal 2.5ml Deep Naso-labial
and Marionette Folds (Before and After 12 Months)
18% 9%
0%
Before After
Optimal
Good
Satisfactory
27%
46%
Poor
Ineffective
Biodegradation The Production Process for
The degrading process of cross-linked hyaluronic acid (cross-linked Varioderm Subdermal
with DVS) takes place from the surface of the material. At the same Sodium hyaluronate obtained by biofermentation is dissolved in water
time there is a steady but slower decomposition within the polymer and cross-linked using DVS until a degree of cross-linking of more
matrix. The material decomposes by two different mechanisms: than 70% is achieved; the degree of cross-linking is always monitored
enzymatic splitting by means of hyaluronidase, which happens only to for each batch. The DVS is subsequently completely washed away.
a small extent, and the much more vigorous decomposition by This cross-linked sodium hyaluronate is the reaction product with DVS
hydroxyl radicals, which serve as a source of active oxidation. (C2H3-SO2-C2H3). The hydroxyl groups of the disaccharide from
Enzymatic decomposition occurs very slowly. Viscous hyaluronic D-glucoronic acid and N-acetyl-D-glucosamine are cross-linked to
acids in a physiological common salt solution are broken down each other by sulfonyl bis ethyl bridges. Sodium hyaluronate and DVS
subcutaneously within a few days if the hyaluronidase cannot form a continuous network and an aqueous gel during the reaction.
penetrate the gel. Twenty per cent of the applied quantity of cross- The properties of the cross-linked hyaluronic acid depend not only on
linked hyaluronic acid is decomposed within 10 days; the the relative number of DVS bridges, but also on the cross-linking
decomposition of the remaining gel takes ≥100 days. The oxidation of positions in the hyaluronate chains and their spatial arrangements
hydroxyl radicals proceeds significantly faster in inflamed tissue. with each other. These can all be affected by the reaction parameters.
Degradation can be detected by lowering the viscosity. The The highly concentrated and cross-linked hyaluronic acid, which has
degradation reactions of the cross-linked hyaluronic acid are slowed a significantly higher viscosity compared with the initial mixture, is
down significantly by the blocking of access to the interior of the subsequently made into particles and stabilised to facilitate the filling
matrix compared with the non-cross-linked material.
2,3
Cross-linked of the syringes without the need for any dilution. This is described as
hyaluronic acid is metabolised in the liver into CO
2
and water.
5,10
a monophasic particle technology (MPT).
EUROPEAN DERMATOLOGY 67
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