Using the BELOTERO® Range Dr Paula Mann (BDS) provides an overview of the BELOTERO® dermal filler range and explains why she uses the products to create predictable, harmonious results tailored to her individual patient needs
Why do you choose the BELOTERO® range?
I have been using BELOTERO® for the last five years with great results for my patients. For me, the difference is in the way the BELOTERO® range is created. For full face natural rejuvenatioi it is really important I can address the changes within the different tissue layers. The BELOTERO® range provides me with a rheologically-tailored portfolio, with each filler having its own unique benefits at varying injection depths. I can treat patients as individuals, not with a one size fits all approach. It is also vital to me that I use a filler with evidence of an established safety profile. I am confident in my choice as research has shown the BELOTERO® range of fillers demonstrate little or no immune inflammatory response in the tissue.1,3
Why is rheology so important?
BELOTERO® hyaluronic acid (HA) dermal fillers are the only fillers available to UK and Ireland practitioners manufactured using the patented Dynamic Crosslinking Technology (DCLT), leading to a Cohesive Polydensified Matrix (CPM). The resultant monophasic gel has variable densities of crosslinked HA. This gives excellent tissue integration as the filler will respond to the different areas of interstitial volume loss.4 For myself and my patients this is seen as a natural, smooth correction. By manipulating the three main important rheological properties (cohesivity, elasticity and plasticity), BELOTERO® has created a portfolio of fillers which are optimised in the superficial, subcutaneous and deep dermis or supraperiosteal layers.
How does this influence your use of the BELOTERO® range?
A filler with high cohesivity can integrate into the tissue without dispersing during movement, giving a smooth, precise result. In my opinion, fillers with high cohesivity such as BELOTERO® Balance and BELOTERO® Lips Contour are perfectly suited to the vermillion border and fine lines.5,6 Here the product will easily flow through a 30G needle and I can inject precisely in the superficial to mid dermis to create sharp definition or correction. Importantly, due to its excellent tissue integration will help prevent migration into the surrounding tissues.7 In those patients who have fine superficial lines, such as crow’s feet or on the décolletage, I inject BELOTERO® Soft directly into the superficial to mid-dermis. With its slightly lower concentration of HA and very high cohesivity it has the effect of ‘airbrushing’ imperfections and providing rehydration.8 BELOTERO® Intense and BELOTERO® Lips Shape are the most elastic of the range.
This is essential in very dynamic areas such as the lips, nasolabial folds and marionette region. I use a cannula or 27G needle to place these in the deep dermal tissue to augment and revolumise the lips and smooth deeper lines. Its elasticity makes it resistant to the shearing and compressive forces it encounters; it will project and volumise, while giving a beautiful, natural looking result.9 When restoring deeper volume loss or improving contour in 3D, such as the temples, cheeks and chin, I need a filler which is highly plastic to enable shaping and moulding. However it must be sufficiently elastic for lifting the tissues and maintaining a natural result in facial expression.
BELOTERO® used in combination or alone helps me achieve a natural looking, long lasting result
BELOTERO® Volume has a combination of both properties.9,10 To create a balanced, restored facial shape I prefer to inject this filler onto the periosteum of the cheek bone and chin using a 30G or 27G. In the sub-SMAS and deep subcutaneous layers of the anterior mid-cheek and sub malar areas, I would use a cannula for creation of smooth flowing contours and natural features. More recently, Merz launched BELOTERO® Lips Shape and BELOTERO® Lips Contour. These are the same formulations as BELOTERO® Intense and BELOTERO® Balance, respectively. Together, 0.6ml of Shape and Contour are a lip enhancement duo, designed to address the age-related changes in the two different lip tissues. Both myself and my patients absolutely love this combination treatment. I explain that together these fillers act like lipstick and lipliner.
The very elastic Lips Shape comes in a 0.6ml syringe and is perfect for natural volumisation of the vermillion. The highly cohesive Lips Contour 0.6ml is a sufficient quantity to inject in the superficial dermis of the vermillion border giving a sharp, more youthful defined border and reduction in perioral wrinkles.7
It is essential I can analyse my patients face and have the available tools to meet their needs; rejuvenating in an effective, predictable and natural way. The CPM fillers of the BELOTERO® range are not about painting by numbers for a generic look. The products have been specifically created to achieve natural looking, lasting results. I am confident I am using a dermal filler with an excellent safety profile,10 predictable, harmonious results and high patient satisfaction and trust.1,2
1. Prasetyo AD et al. Hyaluronic Acid Fillers with cohesive polydensified matrix for soft tissue augmentation and rejuvenation: a literature review. Clin Cosmet Investig Dermatol. 2016 Sep 8;9:257-80.
2. Buntrock H, et al. Efficacy, safety and patient satisfaction of a monophasic cohesive polydensified matrix versus a biphasic non animal stabilised hyaluronic acid filler after single injection in nasolabial folds. Dermatol Surg, 2013 Jul;39(7):1097-105.
3. Taufig A, et al. A new strategy to detect intradermal reactions after injection of resorbable dermal fillers. Jn Aestheitc Chir. 2009;2:29-32.
4. Tran C et al. In vivo Bio integration of three hyaluronic acid fillers in human skin: A histological study. Dermatology, 2014;228(1):47-54.
5. Instructions for Use (IFU) Belotero + Lips Contour
6. Instructions for Use (IFU) Belotero(R) Balance
7. Fischer TC et al. Hyaluron Filler Containing Lidocaine on a CPM Basis fir Lip Augmentaion: Reports from Practical Experience. Facial Plast Surg. 2016 Jun;32(3):283-8.
8. Micheels P, et al. Plastic Reconst Surg. A Blanching technique for the intradermal Injection of the Hyaluronic Acid BELOTERO®. 2013Oct;132(4Suppl 2):59S-68S.
9. Garvard Mollinard S, et al. Key Importance of Compression Properties in the Biophysical Characteristics of Hyaluronic Acid Soft tissue Fillers Jn Mechanical Behav Biomed Materials. 2016 Aug;61:290-298.
10. Micheels P et al, Treatment of Mid Face Atrophy by Injection of Cohesive Polydensified Matrix Hyaluronic Acid Volumiser. Jn Clin Aesth Derm 2015;8(3);28-34.