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Belotero®- Production, advantages & products

What is Belotero®?

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

Manufacture

Hyaluronic acid is produced with the help of bacteria (Streptococcus equi). Similar to other hyaluronic acid products, BDDE (1,4-butanediol diglycidyl ether) is used to cross-link the hyaluronic acid chains. The unbound proportion of BDDE is higher than in 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). Cross-linking takes place in two steps. The hyaluron cross-linked in the first step is cross-linked again after the addition of another hyaluronic acid. The gel produced in this way is also known as “cohesive polydensified matrix” (CPM®).

The 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 from the CPM® range is distributed 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 injections in superficial skin layers, also known as the Tyndall effect.

Advantages of Belotero

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

What products are available from 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, hyaluronic acid injections are approved without a local anesthetic. The local anesthetic increases the viscosity (Micheels P., et al., 2018, J Cosmet Dermatol). The hyaluronic gel is used for injecting medium-deep wrinkles. Due to its special flow properties, hyaluronic acid is also suitable for treating fine wrinkles. Hyaluronic acid can bind water to a large extent.

Areas of application:

For fuller lips
Shaping the lip contours
Highlighting the groove between the upper lip and nose
Helps against wrinkles around the mouth
Injection of the nasolabial fold
Reduction of crow’s feet
Injection of dark circles
Filling frown lines
Treatment of acne scars

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)
Viscosity modulus (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 retention (milliliters per gram): 16.9 (Fagien S., et al., 2019, Plast Reconstr Surg)

Belotero® Volume

A sunken face or shadows on 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 up volume. The hyaluronic gel has a long shelf life and is well tolerated.

Areas of application:

Volume build-up in the sunken temple region
Filling of sunken cheeks (hollow cheeks)
Lifting the lateral eyebrows
Injecting the tear troughs
Smoothing forehead wrinkles
Injection of chin wrinkles
Modeling of the chin region
Contouring of the jaw angle
Lifting the tip of the nose
Concealing nose humps
Enhancement of the chin and jaw contour
Filling of fat deposits (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)
Viscosity modulus (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

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

Areas of application:

Injection of deep nasolabial folds
Plumping up the lips
Treatment of sunken corners of the mouth
Reduction of mentolabial folds (Merkel wrinkles)
Smoothing deep facial wrinkles
Smoothing the complexion of 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)
Viscosity modulus (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 skin layers. Hyaluron is very smooth (high tan delta value) and is used to treat fine wrinkles.

Areas of application:

Removal of fine superficial wrinkles
Smoothing fine wrinkles around the mouth (barcode wrinkles)
Getting rid of fine forehead wrinkles
Injection of fine nasal wrinkles (bunny lines)
Concealing laugh lines
Injecting fine wrinkles in the chin and neck area
Reducing fine wrinkles in the lower eyelid area
Emphasizing the cushion 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)
Viscosity modulus (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 hyaluronic acid. It is therefore assumed that the gel differs from Belotero® Balance in terms of the degree of cross-linking and its ability to absorb water.

Areas of application:

Lifts drooping corners of mouth
Smoothes perioral wrinkles
Rejuvenation of the mouth area
Lip corrections
Helps to achieve a full red lip

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 acid 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).

Areas of application:

Improvement of the complexion
Reduction of light skin spots
Increase skin hydration
Increases the elasticity of the skin
Balances out irregularities in the skin
Eliminates fine skin wrinkles 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 hyaluronic acid injections contain the sugar alcohol glycerol (17.5 milligrams per milliliter). Hyaluronic acid injections improve the skin’s moisture, elasticity and firmness. The combination of glycerol and hyaluronic acid improves skin revitalization (Korponyai C., et al., 2017, Acta Derm Venereol).

Areas of application: