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Belotero®- Production, Advantages & Products

What is Belotero®?

Belotero® hyaluronic acid was first approved in Europe in 2005 and in the USA in 2011. The Swiss company Anteis, based in Geneva, developed the hyaluron gel. In 2013, the company Merz Aesthetics (Frankfurt am Main) took over Anteis.

Production

Hyaluronic acid is produced with the help of bacteria (Streptococcus equi). Similar to other hyaluronic products, BDDE (1,4-butanediol diglycidyl ether) is used to cross-link the hyaluronic chains. The unbound fraction of BDDE is higher than other brands (Guarise C., et al., 2019, J Appl Biomater Funct Mater). Hyaluronic acid is characterized by a special manufacturing process.

The process is called dynamic cross-linking technology. Very long hyaluronic acid chains (842 kilodaltons) are cross-linked with short chains (162 kilodaltons) (Flynn TC, et a., 2013, Plast Reconstr Surg). Crosslinking takes place in two steps. The hyaluron crosslinked in the first step is crosslinked again after the addition of another hyaluronic acid. The gel produced in this way is also known as “cohesive polydensified matrix” (CPM®).

CPM® hyaluronic acid gel contains a proportion of non-cross-linked long hyaluronic acid chains (Bezzola A. , et al., 2005, J de Med Esth Chir Derm). The hyaluronic acid gel of the CPM® range distributes evenly and naturally in the tissue (Tran C, et al. 2014. Dermatology). Belotero® gels are very elastic (low modulus of elasticity) (Santoro S., et al., 2011, J Appl Biomater Biomech). This property reduces the risk of temporary blue discoloration of the skin after injection into superficial layers of the skin, also called Tyndall effect.

Advantages of Belotero

Belotero® products are more tissue compatible compared to other tissue fillers (Taufig A.Z., et al., 2009, J Aesthetic Chir). The hyaluronic acid in the Belotero® range contains the local anesthetic lidocaine (three milligrams per milliliter).

What products are available at Belotero?

Belotero® Balance (other name Belotero® Basic)

Belotero® Balance is the first approved hyaluronic acid for injections from the Belotero® product range. In the USA, the hyaluronic acid injections are approved without local anesthetic. The topical anesthetic increases viscosity (Micheels P., et al., 2018, J Cosmet Dermatol). The hyaluron gel is used for the injection of medium deep wrinkles. Due to its special flow properties, hyaluronic acid is also suitable for the treatment of fine wrinkles. Hyaluronic acid can bind water to a large extent.

Fields of application:

  • For fuller lips
  • Shaping the contours of the lips
  • Highlighting the groove between the upper lip and nose
  • Helps against wrinkles around the mouth
  • Injection of the nasolabial fold
  • Reduce crow’s feet
  • Under eye circles injection
  • Filling frown lines
  • Acne scar treatment

Important characteristic values:

  • Concentration (milligrams per milliliter): 22.5
  • Duration of action (months): 8-12 (Prasetyo A.D., et al., 2016 , Clin Cosmet Investig Dermatol).
  • Modulus of elasticity (G’ in Pascal, at 37°Celsius and 0.1 Hertz): 44 (Santoro S., et al., 2011, J Appl Biomater Biomech).
  • Modulus of viscosity (G” in Pascal, at 37°Celsius and 0.1 Hertz): 21 (Santoro S., et al., 2011, J Appl Biomater Biomech).
  • Quotient of viscosity and elasticity (Tan Delta value): 0.49
  • Water binding (milliliters per gram): 16.9 (Fagien S., et al., 2019, Plast Reconstr Surg).

Belotero® Volume

A sunken face or shadows at the temples or empty cheeks permanently change the facial expression. Belotero® Volume is used to build up lost volume. Due to its favorable flow properties, hyaluron can be injected with very fine needles. Hyaluronic acid is deeply injected to build volume. The hyaluron gel has a long shelf life and is well tolerated.

Fields of application:

  • Volume increase sunken temple region
  • Filling sunken cheeks (hollow cheeks)
  • Lifting the lateral eyebrows
  • Injecting the tear troughs
  • Smoothing wrinkles on the forehead
  • Injection of chin wrinkles
  • Modeling the chin region
  • Contouring of the jaw angle
  • Lifting the tip of the nose
  • Hide nose bump
  • Beautification of the chin, jaw contour
  • Filling of fat pads (Ristow space)

Important characteristic values:

  • Concentration (milligrams per milliliter): 26
  • Duration of action (months): 18 (Micheels P, et al., 2015, J Clin Aesthet Dermatol).
  • Modulus of elasticity (G’ in Pascal, at 25°Celsius and 0.7 Hertz): 300 (Gavard Molliard S., et al., 2016, J Mech Behav Biomed Mater).
  • Modulus of viscosity (G” in Pascal, at 25°Celsius and 0.7 Hertz): 57 (Gavard Molliard S., et al., 2016, J Mech Behav Biomed Mater).
  • Quotient of viscosity and elasticity (tan delta value): 0.19

Belotero® Intense

The hyaluronic acid is produced according to the CPM® process. The hyaluronic acid product is well suited for the treatment of deep wrinkles and tissue filling. The hyaluron distributes evenly and naturally in the tissue. The gel binds relatively little water and is characterized by a long-lasting effect.

Fields of application:

  • Injection of deep nasolabial folds
  • Padding the lips
  • Treatment sunken corners of the mouth
  • Reducing mentolabial folds (Merkel wrinkles)
  • Smoothing deep facial wrinkles
  • Leveling the skin texture for acne scars

Important characteristic values:

  • Concentration (milligrams per milliliter): 25.5
  • Duration of action (months): 18 (Pavicic T., et al., 2010, J Drugs Dermatol).
  • Modulus of elasticity (G’ in Pascal, at 37°Celsius and 0.1 Hertz): 76 (Santoro S., et al., 2011, J Appl Biomater Biomech).
  • Modulus of viscosity (G” in Pascal, at 37°Celsius and 0.1 Hertz): 26 (Santoro S., et al., 2011, J Appl Biomater Biomech).
  • Quotient of viscosity and elasticity (tan delta value): 0.35

Belotero® Soft

Belotero® Soft is produced using the CPM® process. Hyaluronic acid is used to treat superficial layers of the skin. The hyaluron is very supple (high Tan Delta value) and is used for the treatment of fine wrinkles.

Fields of application:

  • Removal of fine superficial wrinkles
  • Smoothing fine wrinkles around the mouth (barcode wrinkles)
  • Get rid of fine wrinkles on the forehead
  • Injection of fine nasal folds (bunny lines)
  • Conceal smile lines
  • Injection of fine wrinkles in the chin and neck area
  • Reduce fine wrinkles in the area of the lower eyelid
  • Emphasis of the padding on the lower eyelid (charming roll) for Asian eyes

Important characteristic values:

  • Concentration (milligrams per milliliter): 20
  • Duration of action (months): 6 (Falcone S.J., et al., 2009, Dermatol Surg).
  • Modulus of elasticity (G’ in Pascal, at 37°Celsius and 0.1 Hertz): 7 (Santoro S., et al., 2011, J Appl Biomater Biomech).
  • Modulus of viscosity (G” in Pascal, at 37°Celsius and 0.1 Hertz): 9 (Santoro S., et al., 2011, J Appl Biomater Biomech).
  • Quotient of viscosity and elasticity (Tan Delta value): 1.27

Belotero® Lips

Hyaluronic acid was approved in Europe in 2018. The hyaluron is based on CPM® technology. The areas of application are similar to the use of Belotero® Balance. The manufacturers have not published any characteristic values for the hyaluronic acid. It is therefore assumed that the gel differs from Belotero® Balance in the degree of crosslinking and the ability to absorb water.

Fields of application:

  • Raises hanging corners of mouth
  • Smoothes perioral wrinkles
  • Rejuvenation of the mouth area
  • Lip correction
  • Helps to achieve a plump lip red

Important characteristic value:

  • Concentration (milligrams per milliliter): 22.5

Belotero® Hydro

Hyaluronic acid is non-cross-linked and is used to stimulate the formation of collagen. The hyaluronic injections contain 21 milligrams per milliliter of glycerol. Glycerol, which occurs naturally in the body, binds the hyaluronic acid and thus prolongs its effect (Choi E.H., et al., 2005, J Invest Dermatol).

Fields of application:

  • Improvement of the skin texture
  • Reduction Light Skin Spots
  • Increase skin hydration
  • Increases the tone of the skin
  • Evens out irregularities of the skin
  • Eliminates fine wrinkles of the skin around the eyes

Important characteristic value:

  • Concentration (milligrams per milliliter): 18

Belotero® Revive

Belotero® Revive has been approved in Europe since 2019. The hyaluronic acid is produced using Cohesive Polydensified Matrix technology. The hyaluron syringes contain the sugar alcohol glycerol (17.5 milligrams per milliliter). Hyaluronic injections improve the moisture, elasticity and firmness of the skin. The combination of glycerol and hyaluronic acid improves skin revitalization (Korponyai C., et al., 2017, Acta Derm Venereol).

Fields of application:

  • Improves the elasticity of the skin
  • Increases the firmness of the skin
  • Helps even skin tone
  • Leads to a healthy and natural glow of the skin
  • Reduces the roughness of the skin
  • Reduces skin redness
  • Reduces the depth of wrinkles
  • Suitable for facial rejuvenation
  • Treatment of light tear troughs

Important characteristic value:

  • Duration of action (months): 9 (Hertz-Kleptow D., et al., 2019, Clin Cosmet Investig Dermatol).
  • Concentration (milligrams per milliliter): 20

Other suitable topics:

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