The hyaluronic acid filler and its properties are usually talked about when preparing to correct age-related changes in the face loss of volume, deterioration of skin quality and the appearance of wrinkles. The cohesiveness of such a gel is discussed if you want to achieve the best filling of superficial wrinkles and at the same time not worry about the safety of the procedure and the risks of side effects. From the point of view of estet-portal.com, the BELOTERO® hyaluronic acid filler has the optimal level of cohesion, which has been confirmed by a number of scientific studies and has been highly appreciated by practitioners.
Hyaluronic acid gel cohesiveness: when and why is this property especially important
Cohesiveness is the ability of a gel to adhere, resist deformation, and maintain product integrity. Fillers with high cohesiveness are not displaced from the injection site by the force of muscle contraction. This makes them ideal for correcting areas of the face with high mimic activity (Belotero Balance and Belotero Intense occupy a leading position on the Gavard/Sundaram cohesiveness scale).
Hyaluronic acid (HA) gels are produced using a number of different crosslinking technologies that determine their cohesiveness as well as other rheological properties. To assess the cohesiveness of HA gels, an experimental validated rating scale (Gavard-Sundaram Cohesivity Scale) was developed to assist clinicians in selecting the optimal preparation based on the aesthetic needs of each patient.
Fig.1 Gavard/Sundaram cohesiveness scale
Efficiency and safety the main qualities of a good hyaluronic acid gel
The effectiveness of the hyaluronic gel and its properties largely depend on the type of filler used, the anatomical site and the metabolism characteristic of a particular patient. To clarify the properties of the cohesive (single-phase) hyaluronic filler BELOTERO® Balance presented by Merz Aesthetics, special studies have been carried out.
In one of them BELOTERO® Balance was compared with six other FDA-approved hyaluronic fillers. Each product was analyzed and evaluated 3 times, and the average score for each product was calculated. Cohesivity was highest for BELOTERO®.reg; Balance.
The cohesiveness score determines the dermal integration of fillers, helps determine the depth of injections and, in combination with other rheological properties, select the optimal filler for a particular aesthetic indication.
Tissue integration capacity determines the degree to which the HA filler maintains the integrity of the dermal and subcutaneous structures and ensures a smooth treatment outcome. Rheological properties are key. They mainly depend on the composition of the filler and the manufacturing technology.
The Belotero HA line of fillers is based on the patented Cohesive Polydensified Matrix (CPM) technology. The essence of the KPM technology is that cross-linked hyaluronic acid undergoes partial dilution due to native hyaluronic acid. The result of such exposure is a cohesive polycompacted gel consisting of hyaluronic acid of different density. This ensures optimal distribution of the gel into the surrounding tissues, allowing large spaces to be filled with denser gel particles and narrower pericellular tissue spaces with low density gel particles. The gel easily integrates into the skin and provides optimal support for dermal tissues.
Cohesiveness also determines the quality of dermal integration of the hyaluronic gel. This indicator is especially important for preparations designed to fill superficial wrinkles. The study demonstrated that BELOTERO® Balance shows the most homogeneous distribution when injected compared to other hyaluronic acid fillers. Its optimal distribution in the reticular dermis is achieved by filling even the smallest gaps between collagen and elastin bundles, while maintaining the structural integrity of the dermal layer.
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