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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 <strong>IPRAS</strong> Journal www.ipras.org Issue 1
Merz Pharmaceuticals (Frankfurt, Germany) Belotero Family of Three Products – Intense, Basic and Soft These products are described as being made with Cohesive Polydensified Matrix (CPM) technology. The first cross-linking with BDDE creates a monophasic gel of adjacent strands of stabilized HA. The second crosslinking step is also carried out with BDDE and leads to a monophasic gel with different zones of HA chain density. Satisfaction rates in the nasolabial fold were 81% at six months and 66% at nine months in a study of 114 subjects published in July 2008. BELETERO ® - INDICATIONS AND SUMMARY TABLE BELETORO ® Product Soft Basic Intense Concentration (mg/g) 20 22.5 25.5 Cross-linking 2+ 2+ 2+ Needle (gauge) 30 27 27 Indication Superficial dermis Mid dermis Deep dermis Duration (months) 3-6 6-9 6-9 Allergan (Irvine, California, USA) Juvederm Family of Products This is the only HA product cleared by the FDA for a 1-year duration. The formulation has a smooth consistency, high concentration and high degree of cross-linking. In addition, it has gained great market share in the US in a short time due to high physician and patient acceptance. JUVEDERM ® - INDICATIONS AND SUMMARY TABLE JUVEDERM ® Product Ultra Ultra Plus XC (lidocaine .3%) Ultra and Ultra Plus Concentration (mg/g) 24 24 24 Cross-linking 6% 8% 6 and 8% Needle (gauge) 27 27 27 Indication Superficial and mid dermis Superficial and mid dermis Superficial and mid dermis Duration (months) 9-12 12 9-12/ 12 Mentor (Santa Barbara, California, USA) Prevelle Family of Products This is the newest family of products on the market with only the Silk variety available in the US. Prevelle Shape (Puragen) was approved in the EU in 2006, while Lift was approved in the EU in the fall of 2009 and is just beginning to reach clinical practice now. The particle size is much smaller and allows for a lower extrusion force (ease of injection) and smoother contours. While not studied in the tear trough during formal clinical trials, early clinical reports have been favorable. Prevelle Lift is unusual for an HA in that it has a very high G’ (modulus of elasticity) making it very firm like Radiesse. PREVELLE ® - INDICATIONS AND SUMMARY TABLE PREVELLE ® Product Silk Shape (Puragen) Lift Consistency Soft Moderate Firm Concentration (mg/g) 5.5 20 22 Cross-linking (percent) 12 3 (double cross-linked) 2 Needle (gauge) 27 27 27 Indication Superficial and mid dermis Superficial and mid dermis Superficial and mid dermis Duration (months) 4 – 6 4 – 6 12 Issue 1 www.ipras.org <strong>IPRAS</strong> Journal 19
Page 1 and 2: ISSN: 1792-457X Issue 1 www.ipras.o
Page 3 and 4: I IP PR RA AS S JJO OU UR RN NA AL
Page 5 and 6: I P R A S M A N A G E M E N T O F F
Page 7 and 8: I N L O V I N G M E M O R Y Obituar
Page 9 and 10: S U R V E Y R E P O R T Personal re
Page 11 and 12: I N T E R V I E W : P I O N E E R S
Page 13 and 14: surgical principles. However, it is
Page 15 and 16: S U R V E Y R E P O R T The status
Page 17: S UE R V E Y R E P O R T Current St
Page 21 and 22: S U R V E Y R E P O R T PLASTIC AND
Page 23 and 24: Facts and Figures In India, 35 perc
Page 25 and 26: I P R A S W E B S I T E IPRAS Compl
Page 27 and 28: Century. Added to that and the many
Page 29 and 30: “Support IPRAS, support our Afric
Page 31 and 32: “The world’s best reconstructiv
Page 33: IPRAS Journal Management Editor: IP

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