The safety and effectiveness of correction of any area of the face with fillers depends on several factors, the main of which are the quality and correct choice of the drug, the work of the doctor itself and the feasibility of the procedure. Fillers based on hyaluronic acid have long established themselves in the aesthetic medicine market as safe products that allow you to eliminate imperfections in various areas of the face. Merz Aesthetics' new cohesive-poly-densified matrix (CPM) technology, developed by Merz Aesthetics and implemented in the Belotero line of fillers, provides the product properties necessary for successful facial correction at any insertion depth. More details about the features of this technology, Belotero preparations, as well as other important aspects of the use of fillers in an interview for estet-portal.
There are many fillers on the market today. What characteristics distinguish a really high-quality drug?There are many reasons why a specialist chooses a particular product based on hyaluronic acid. I believe that the most important characteristic of a product is safety, as well as the availability of documentation confirming it. This is the main criterion. With a wide range of fillers available with proper safety documentation, the next criterion is the properties of the gel. Their choice depends on the depth of injection of the drug. So, for deep injection, it is better to choose a denser gel with very high plasticity and elasticity, while homogeneous and liquid gels are suitable for surface injection. Thus, the properties of the drug must be selected in accordance with the indications.
How is cohesive polydensified matrix (CPM) technology different from other methods of crosslinking hyaluronic acid?
Belotero
products are unique because of the use of this technology. I call KPM technology the next generation of HA because it includes multiple cross-linking steps. In the first step, native high molecular weight HA is cross-linked with BDDE. And most companies stop at this stage - they get denser gels with a high degree of cross-linking and thinner gels with a low degree of cross-linking. In the production of Belotero, 2 additional steps are added during the dynamic cross-linking process to ensure the unique properties of BELOTERO gels. This is the basis of the KPM technology implemented by Merz scientific laboratories. The monophasic densified matrix obtained by a standard cross-linking procedure is expanded and stretched to form interstitial spaces. Unbound HA molecules are added to these interstitial spaces, resulting in a new cross-linking reaction when contacted with the remaining BDDE. As a result, this phase produces a cohesive poly-densified gel composed of HAs of various densities, allowing it to easily integrate into the skin and provide optimal support to the dermal tissues.
The essence of the CPM technology: as a result of its application, a cohesive polycompacted gel is obtained with zones of high and low density.
How KPM-technology affects the result of the injection procedure?
The dynamic crosslinking technology described above is used in the manufacture of all Belotero products. However, there are certain differences in the steps of this process depending on the product. For example, Belotero Soft and Belotero Balance are characterized by a low degree of primary cross-linking and, accordingly, a rather low bond density. Such gels are characterized by uniformity, liquid consistency and high cohesiveness - these characteristics make these preparations ideal for intradermal administration. If you need a superficial filler injection to correct fine wrinkles on thin skin, you need to use a very liquid and homogeneous gel that will not be noticeable and will not lead to the appearance of lumps and other irregularities on the skin. This requires excellent integration of the filler into the tissue.
Other properties of the gel are equally interesting, for example, in the correction of more pronounced wrinkles, such as nasolabial folds, or in lip augmentation. In this case, the filler should be more elastic. For example, for the deepest insertion, the Belotero Volume filler is designed, which is characterized by the highest plasticity, lower elasticity and cohesiveness.Why do you choose Belotero for the correction of delicate areas on the face?
Different gels can be used in different ways. When you start working on a new area for you, for example, the nasolacrimal or supraorbital sulcus, I would advise you to start with Belotero Soft: carry out the procedure and see if swelling appears. If yes, then this procedure is not suitable for the patient. If there is no swelling, at your next visit you can use Belotero Balance to fill the nasolacrimal or supraorbital sulcus. After that, you can gradually make adjustments when using these products.
What are the main advantages of Belotero preparations, and what opportunities does the doctor discover for himself by acquiring and using them?
I think the most important advantage of Belotero is the extremely low chance of an immune response. Granulomas form around some HA-based gels, as can be seen from histological studies. Since the introduction of Belotero, no such cases have been recorded. Of course, the possibility of such phenomena is not excluded, but the risk of an immune response and the appearance of granulomas is extremely low.
Belotero fillers are quality products. In addition, their manufacturer is a very active pharmaceutical company
Merz Aesthetics
, which pays a lot of attention to the training of doctors using its products. Since the use of safe work techniques is no less important than product safety, Merz Aesthetics regularly organizes various conferences, symposiums and workshops. The company also has an amazing website, the Merz Institue of Advanced Aesthetics, with online learning modules that allow you to learn anatomy and get the important information you need to work safely.What complications do you consider the most dangerous?
Today, the number of injection procedures in the world has increased significantly. Therefore, we are aware of some cases of very unusual complications. Most doctors know that the patient can go blind after an injection. But there are also cases of intracerebral administration of HA, even when using a cannula. Such a complication is very unusual and strange, but at the same time extremely interesting and serious. For me, the most serious possible complication when working with fillers is blindness.The most important benefit of Belotero is the extremely low chance of an immune response.
Which do you prefer to use for fillers - cannula or needle - and why?
Recently, Dalvi Humzah (my colleague from the UK) and I published the results of a cadaver study in the Aesthetic Surgery Journal in which we compared the use of a needle and a cannula. And we saw that the cannula is a safer and more accurate instrument. Personally, I prefer using a cannula, because in this case I am sure of the safety and that the product will be introduced exactly at the target anatomical level.
On the other hand, a lot depends on the doctor performing the procedure. Therefore, if you are used to working with a needle, such a tool is likely to be safer in your hands. But if you are just starting to learn, I would recommend using cannulas. By learning how to work with these tools, you will understand that they are better than needles. Cannulas are less traumatic, do not damage the anatomical structures, they are much more difficult to get into the artery than a needle.
If the filler was in the lips before, wouldn't it be harder to inject with a cannula than with a needle?
No, I don't think so. Due to its homogeneous structure, HA will easily "miss" cannula. Over time, after a large number of injections, it is possible that not only the gel itself, but also the collagen fibers formed in the tissues, will complicate the injection process. Due to the stimulation of fibroblasts in the tissues, the process of neocollagenesis is triggered, and for this reason, insertion of the cannula can be more difficult. But if you are accustomed to using this instrument, then tissue resistance will not be a problem for you, because you know how to get around such obstacles and place the cannula exactly where you need it.
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