How to work with dense fillers: an example based on HyalStyle Forte

Fillers of various densities are used to correct age-related changes in the face, which makes it possible to choose the most suitable preparation for each individual case – correct the shape of the lips, make adjustments to the area around the eyes and other areas. Of particular interest to cosmetologists are preparations of hyaluronic acid with a high density – they make it possible to correct facial volumes, but raise questions and doubts due to their viscosity and high percentage of cross-links. Such dense fillers include HyalStyle Forte, and estet-portal.com has tried to find out how to use it effectively and safely.

Why HyalStyle Forte is so dense

HyalStyle Forte is a monophasic gel based on highly purified hyaluronic acid treated with a special chemical agent (butanediol diglycidyl ether BDDE) that forms crosslinks in the acid molecule. Such bonds are needed in order for the hyaluronic acid molecule to acquire a three-dimensional spatial organization. Due to the acquired three-dimensionality after cross-linking, the hyaluronate molecule receives a high degree of swelling, becomes more resistant to the effects of substances that accelerate its degradation. The more cross-linked in the gel based on hyaluronic acid, the more elastic it is, the more its viscosity increases, the longer it remains in the tissues where it was injected.

HyalStyle Forte, marketed on our market by I-Cosmetolog, contains reticular hyaluronic acid at a concentration of 23 mg/ml   in physiological phosphate buffer solution and is characterized by a 14% cross-link content, which gives the gel a high density and viscous consistency.

What effect can be achieved using HyalStyle Forte viscous gel

Direct indications for the use of HyalStyle Forte are problems associated with a change in the proportions of the face: the introduction of the drug allows you to correct congenital or acquired asymmetry of features, correct the severity of the cheekbones, chin, correct the line of the superciliary arches and the contour of the lower jaw.

The drug is used for cosmetic correction of such age-related changes  faces like:

• deep nasolabial folds,
• puppet wrinkles,
• reconstruction of the lost volume of soft tissues in the temporal zone, in the cheek area,
• correction of the bridge of the nose.

The duration of action of HyalStyle Forte is 9 to 12 months, sometimes longer – it all depends on the individual characteristics of the patient's body.

However, care should be taken when determining the indications for the use of a viscous preparation. Dense preparations can exacerbate tissue sagging in the deformation type of aging. This type of skin allows contouring with a viscous filler only in a small amount to restore the proportions of the face, and only if the skin has not lost elasticity, the muscles are in normal tone, and the manifestations of ptosis are not stronger than the first degree.

How to properly inject a high viscosity filler

Dense preparations of hyaluronic acid – such as HyalStyle Forte – inserted periosteally to fix soft tissues and minimize “weighting”; skin cover. The doctor himself chooses whether to work with a cannula or a needle, depending on qualifications and preferences: the cannula reduces the risk of trauma to the blood vessels, and when using the needle, you need to keep it cut down, since the beveled part allows you to slightly shift down from the tip of the tissue located under the needle.

At all stages of the needle advancement deep into the tissues, when introducing a viscous filler, an aspiration test is mandatory to eliminate the risk of the drug entering the vascular bed.

To reduce the risk of misplacement, the high-density filler is injected retrogradely. Some possible  typing errors and their causes:

• contouring of the injected drug – the filler may have entered the dermis;
• disturbance of the skin relief, increased gravity of the soft tissues of the face – it is possible that the filler was introduced into the fat compartment, and it has mobility and began to migrate;
• hypercorrection – may occur when more than 2 ml of viscous gel is injected in one session.

What to do if there are complications with the introduction of a viscous filler

The most formidable possible complication during the introduction of fillers, especially with high viscosity, is occlusion of vessels or their compression. Signs of such a complication – a sharp change in the color of the patient's skin, which becomes a signal for the start of immediate action to prevent serious consequences.

If the skin becomes discolored at the injection site – arterial blood supply is disturbed, which means you need to quickly apply a warm compress. If the skin has acquired a gray-bluish color – a venous blockage has occurred, and cold must be applied. An emergency is the introduction of hyaluronidase strictly & nbsp; to the site of occlusion and taking NSAIDs. Further, symptomatic therapy is carried out, the volume of which is determined by the individual situation.

When it is necessary to solve the problem of gel migration or contouring of the injected filler, resulting granulomas or fibrous capsules, enzymatic hydrolysis using hyaluronidase will also help.

Strict observance of the rules for working with high-density viscous fillers, such as  HyalStyle Forte from I-Cosmetolog - its use only according to indications, as well as competent selection of patients for procedures, will achieve excellent long-term effects during facial contouring.