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Company Q-Med AB (Uppsala, Sweden)
Family of Three Products
Restylane – this is the product launched in 1996 in
Europe that pioneered and popularized HA fillers.
Long considered the gold standard, there are many
other competitors in the marketplace today. It was
approved in the US in 2003, and in China in 2009. Like
all the currently available products this is a non-animal
stabilized hyaluronic acid (NASHA) cross-linked with
1, 4 butanediol diglycidyl ether (BDDE), which contains
100,000 gel beads per ml, is hydrophilic and its metabolic
by-products are water and carbon dioxide. Like all the
HA’s Restylane’s breakdown is isovolumetric, thus it
retains much of its initial volume during degradation,
which takes about nine months in the nasolabial fold.
Over 11 million injections have been carried out around
the world. A lidocaine-containing preparation is now
available in most locations.
Perlane – this product is chemically identical to
Restylane, but contains larger particles and only 8000
beads per ml. Generally it is injected deeper than the
mid-dermis and clinically may last longer than nine
months. A preparation containing lidocaine is now
available.
Macrolane – this is based on Q-Med’s NASHA
technology and was approved in Europe at the end of
2007, the Middle East and Asia in 2009. It is specifically
marketed for body shaping where there is less tissue
cover (the VRF20 preparation) and more tissue cover
(the VRF30 preparation). Follow-up treatment is
recommended at 9-12 months with about 50% of the
initial injection volume advised. Breast injection is an
exciting new application; however after several years, the
cost may exceed that of breast augmentation surgery.
Product
RESTYLANE ® - INDICATIONS AND SUMMARY TABLE
Restylane
(small particles)
Perlane
(large particles)
Macrolane
VFR20 VFR30
Concentration (mg/g) 20 20 24
Cross-linking (percent) 6 6 1%
Needle (gauge) 27 27 22 - 25
Indication
Superficial and
mid dermis
Superficial and
mid dermis
Subcutanoues tissue /
not in the face
Duration (months) 9 9-12 9-12
Company Teoxane (Geneva, Switzerland)
Teosyal Family of Seven Products
By precisely controlling the chemistry of their various
preparations, Teoxane has created a family of HA’s
for a variety of clinical indications. The cross-linking is
BDDE like the Q-Med products. They have sold over 1.5
million syringes since the company’s founding (personal
communication with the CEO, April 12, 2010) and
clinical use is accelerating. Widely available in Europe,
clinical trials will likely begin in the US late this year
or early 2011. Like other HA’s progressive absorption
results in the end products water and CO2 and it can
hold up to 1000 times its weight in water. With so many
products it may be a bit daunting to know when and how
to use each. Start with just a couple and learn them well
before trying all of them on a regular basis.
GAMME TEOSYAL ® - INDICATIONS AND SUMMARY TABLE
TEOSYAL ® Product Meso
First Global
Deep
Ultra
Touch Up
Kiss
Lines Action
Lines
Deep
Concentration (mg/g) 15 20 25 25 25 25 25
Cross-linking None 1+ 3+ 3+ 3+ 4+ 4+
Needle (gauge) 30 30 30 30 27 27 25
Indication
Rehydration/
superficial
dermis
Superficial
crow’s feet/
perioral
Mid dermis/
facial wrinkles
Mid dermis/
facial wrinkles
Deep
injection/
wrinkles
Deep
injection/ lip
contours and
volume
Duration (months) 2-3 6 6-9 6-9 6-9 6-9 9-12
Deep
injection/
wrinkles
18 IPRAS Journal www.ipras.org Issue 1