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Restylane®- Products & Applications

What is Restylane®?

Restylane® are ready-to-use hyaluron disposable syringes for the treatment of wrinkles. In 1996, Restylane® was the first hyaluronic acid available in Europe. In 2003, Restylane® was the first hyaluronic acid to be approved in the USA. The process for manufacturing Restylane® without animal ingredients was patented by the company Q-Med (Uppsala, Sweden). Q-Med was acquired by Galderma (Lausanne, Switzerland) in 2011.

The production process was called Non-Animal Stabilized Hyaluronic Acid, or NASHA® technology. Hyaluronic acid is produced with the help of bacteria (Streptococcus equi). The hyaluron chains are crosslinked with nine to eleven percent BDDE (1,4-butanediol diglycidyl ether). The unbound fraction of BDDE is very low (Guarise C., et al., 2019, J Appl Biomater Funct Mater). In NASHA® technology, filters with different pore sizes produce hyaluronic acid particles of different sizes. Another Galderma process for the production of hyaluronan is called Optimal Balance Technology™ (other name XpresHAn Technology™).

The hyaluronic acid particles produced with this method have the same size of approximately 400 micrometers. One percent of hyaluronic acid chain building blocks are cross-linked (Fallacara A., et al., 2017, Facial Plast Surg). Optimal Balance Technology™ creates a softer and more flexible hyaluronic acid. The NASHA® fillers tend to be firmer. These fillers are suitable for contouring the face, cheeks, jawline and chin. Similar to other manufacturers, fillers are available with or without the topical anesthetic lidocaine (three milligrams/milliliter). The concentration of subsequent Restylane® gels is 20 milligrams per milliliter. The characteristic values listed here may differ depending on the test conditions.

Restylane®

Hyaluronic acid received approval from the U.S. Food and Drug Administration (FDA) in 2003. The filler is manufactured using NASHA® technology. The product is injected into medium-deep layers of the skin.

Fields of application:

  • Moderate facial wrinkles
  • Lifting the lateral eyebrows
  • Filling of sunken upper eyelids (A-frame deformity)
  • Rejuvenation of the hands

Important characteristic values:

  • Duration of action (months): 6-12 (Fallacara A., et al., 2017, Facial Plast Surg).
  • Hyaluronic acid particle size (microns): 330 to 430
  • Modulus of elasticity (G’ in Pascal, at 30°Celsius and 0.7 Hertz): 565 (Sundaram H., et al., 2013, Plast Reconstr Surg).
  • Modulus of viscosity (G’ in Pascal, at 30°Celsius and 0.7 Hertz): 106 (Sundaram H., et al., 2013, Plast Reconstr Surg).
  • Quotient of viscosity and elasticity (tan delta value): 0.19
  • Water retention (milliliters per gram): 2.5-3 (Edsman K.L.M., et al., 2018, Dermatol Surg).

Restylane® Lyft™ (=Restylane® Perlane Lidocaine)

Restylane® Lyft™ is a solid gel made with NASHA® technology. Hyaluronic acid is suitable for correcting deep wrinkles and for cheek augmentation. The product was approved by the U.S. Food and Drug Administration (FDA) in 2019 to rejuvenate the backs of the hands.

Fields of application:

  • Hand rejuvenation for wrinkles and volume loss in the back of the hand area
  • Correction of volume loss in the face
  • Injecting sunken temples
  • Volume building of the cheeks
  • Improvement of the furrow between the wing of the nose and the corner of the mouth (nasolabial fold)
  • Raising the corners of the mouth
  • Treatment of wrinkles between the corner of the mouth and chin (mentolabial folds, marionette lines)
  • Injecting away the indentation on the lower jaw margin between the chin and the sagging cheeks (“prejowl sulcus”)
  • Removing a chin furrow
  • Structure of the jaw angles (“jawline”)

Important characteristic values:

  • Duration of action (months): 12 (Narins R.S., et al., 2011, Dermatol Surg).
  • Hyaluronic acid particle size (microns): 1000
  • Modulus of elasticity (G’ in Pascal, at 25°Celsius and 0.1 Hertz): 545 (Fagien S., et al., 2019, Plast Reconstr Surg).
  • Modulus of viscosity (G” in Pascal, at 25°Celsius and 0.1 Hertz): 69 (Fagien S., et al., 2019, Plast Reconstr Surg).
  • Quotient of viscosity and elasticity (tan delta value): 0.13
  • Cross-linking (percent): 1
  • Water binding (milliliters per gram): 2.8 (Fagien S., et al., 2019, Plast Reconstr Surg).

Restylane® Silk™

Hyaluronic acid has been approved in the USA since 2014. The filler is created using NASHA® technology. The viscosity of the gel is high and the ability to bind water is low. The hyaluronic injection is suitable for the treatment of fine to medium wrinkles on and around the mouth.

Fields of application:

  • Repair of lip wrinkles (upper lip wrinkles, smoker’s wrinkles)
  • Get rid of pleated wrinkles
  • Restore fullness of the lips
  • Emphasis on the cupid’s bow
  • Correction of the corners of the mouth
  • Rejuvenation of the lips and mouth region
  • Smoothing crow’s feet
  • Improvement of tear troughs (“nasojugal groove”, “tear trough deformity”)
  • Correction of the furrow between the wing of the nose and the corner of the mouth (nasolabial fold)

Important characteristic values:

  • Duration of action (months): 12 (Narins R.S., et al., 2011, Dermatol Surg).
  • Hyaluronic acid particle size (microns): 50 to 220 microns
  • Modulus of elasticity (G’ in Pascal, at 25°Celsius and 0.1 Hertz): 344 (Fagien S., et al., 2019, Plast Reconstr Surg).
  • Modulus of viscosity (G” in Pascal, at 25°Celsius and 0.1 Hertz): 79 (Fagien S., et al., 2019, Plast Reconstr Surg).
  • Quotient of viscosity and elasticity (tan delta value): 0.23
  • Cross-linking (percent): 1
  • Water binding (milliliters per gram): 2.7 (Fagien S., et al., 2019, Plast Reconstr Surg).

Restylane® Fynesse™ (= Emervel® Touch)

The filler is relatively thin (viscosity modulus low) and elastic (modulus of elasticity low). The tissue filler is manufactured with Optimal Balance Technology™. It is easy to inject with very thin needles. Hyaluron gel is suitable for the treatment of fine superficial wrinkles. Hyaluronic acid is characterized by its high ability to bind water. The greatest possible effect is seen after three weeks.

Fields of application:

  • Correction of fine superficial wrinkles
  • Lip wrinkles (upper lip wrinkles, smoker’s wrinkles)
  • Contouring the lip
  • Emphasis on the cupid’s bow
  • Raising the corner of the mouth
  • Reduction of nasolabial folds
  • Treatment of crow’s feet

Important characteristic values:

  • Duration of action (months): more than 6 (Cartier H., et al., 2012, J Drugs Dermatol).
  • Modulus of elasticity (G’ in Pascal, at 37°Celsius and 2 Hertz): 34.5 (Segura S., et al., 2012, J Drugs Dermatol).
  • Modulus of viscosity (G” in Pascal, at 37°Celsius and 2 Hertz): 18.6 (Segura S., et al., 2012, J Drugs Dermatol).
  • Quotient of viscosity and elasticity (Tan Delta value): 0.54
  • Water binding (milliliters per gram): 17.2 (Fagien S., et al., 2019, Plast Reconstr Surg).

Restylane® Refyne™ (= Emervel® Classic Lidocaine)

Restylane® Refyne has been CE certified since 2008. The hyaluronic preparation is produced with Optimal Balance Technology™. Hyaluron treatment with Refyne is performed in the medium-deep to deep layers of the skin. The hyaluronic acid is versatile. The injected hyaluronic acid binds a lot of water. The greatest possible effect can be seen after 3 weeks.

Fields of application:

  • Improvement of the furrow between the wing of the nose and the corner of the mouth (nasolabial fold)
  • Injecting the wrinkle between the corner of the mouth and the chin (mentolabial folds, marionette lines)
  • Injection of the corners of the mouth
  • Treatment of wrinkles on the cheeks
  • Lip augmentation
  • Removing the frown line
  • Correction of retractions at the lower jaw margin between the chin and the sagging cheeks (“prejowl sulcus”)
  • Removal of chin wrinkles (chin furrow)
  • Reduce crow’s feet
  • reduction of dark circles, tear troughs (“nasojugal groove”, “tear trough deformity”)
  • Injecting away upper lip wrinkles

Important characteristic values:

  • Duration of action (months): 6-12
  • Modulus of elasticity (G’ in Pascal, at 37°Celsius and 2 Hertz): 67.7 (Segura S., et al., 2012, J Drugs Dermatol).
  • Modulus of viscosity (G” in Pascal, at 37°Celsius and 2 Hertz): 20.3 (Segura S., et al., 2012, J Drugs Dermatol).
  • Quotient of viscosity and elasticity (tan delta value): 0.31
  • Cross-linking (percent): 6
  • Water binding (milliliters per gram): 9.7 (Fagien S., et al., 2019, Plast Reconstr Surg).

Restylane® Volyme™ (= Emervel® Volume Lidocaine)

Optimal Balance Technology™ is used to create the hyaluronic acid filler. The hyaluronic acid is characterized by high strength. The gel does not spread in the tissue. The filler is injected deep near the bone. Sunken skin areas are lifted and the tissue stabilized.

Fields of application:

  • Filling hollow temples
  • Filling hollow sunken cheeks
  • Correct receding chin
  • Emphasis on the chin line
  • Defining the jaw angle (“jawline”)
  • Correct nose without surgery
  • Injection of the furrow between the wing of the nose and the corner of the mouth (nasolabial fold)
  • Correction of the retraction at the lower jaw margin between the chin and the sagging cheeks (“prejowl sulcus”)
  • Removing a chin furrow
  • Treatment of wrinkles between the corner of the mouth and chin (mentolabial folds, marionette lines)
  • Correction of sunken upper eyelids

Important characteristic values:

  • Duration of action (months): more than 6 (Carruthers J, et al, 2009 J Drugs Dermatol).
  • Modulus of elasticity (G’ in Pascal, at 37°Celsius and 2 Hertz): 131.6 (Segura S., et al., 2012, J Drugs Dermatol).
  • Modulus of viscosity (G” in Pascal, at 37°Celsius and 2 Hertz): 20.3 (Segura S., et al., 2012, J Drugs Dermatol).
  • Quotient of viscosity and elasticity (tan delta value): 0.15
  • Water binding (milliliters per gram): 7.3 (Fagien S., et al., 2019, Plast Reconstr Surg).

Restylane® Kysse™ (Emervel® Lips Lidocaine)

The filler is slightly thinner than Volyme™ (low viscosity modulus) with moderate elasticity. The gel for wrinkle injection is created with Optimal Balance Technology™. The hyaluronic acid hardly spreads in the tissue and is therefore able to define the contours of the lips with pinpoint accuracy.

Fields of application:

  • Repair of lip wrinkles
  • Reducing the furrow between the wing of the nose and the corner of the mouth (nasolabial fold)
  • Smoothing wrinkles between the corner of the mouth and chin (mentolabial folds, marionette lines)
  • Raising the corners of the mouth
  • Lip augmentation
  • Lip modeling
  • Correction of the retraction at the lower jaw margin between the chin and the sagging cheeks (“prejowl sulcus”)
  • Treatment of the chin furrow

Important characteristic values:

  • Duration of action (months): more than 6
  • Modulus of elasticity (G’ in Pascal, at 25°Celsius and 0.1 Hertz): 156 (Fagien S., et al., 2019, Plast Reconstr Surg).
  • Modulus of viscosity (G” in Pascal, at 25°Celsius and 0.1 Hertz): 12 (Fagien S., et al., 2019, Plast Reconstr Surg).
  • Quotient of viscosity and elasticity (Tan Delta value): 0.07
  • Water binding (milliliters per gram): 7.2 (Fagien S., et al., 2019, Plast Reconstr Surg).

Restylane® Defyne™ (Emervel® Deep Lidocaine)

The dermal filler is produced with Optimal Balance Technology™. Restylane® Defyne has been CE certified since 2008. The filler is made with a local anesthetic. Hyaluronic acid is cross-linked to a high degree. It is characterized by its strength and long-lasting results. Nevertheless, the hyaluron can be injected with fine needles. The filler adds volume to the tissue and is suitable for treating moderate to severe facial wrinkles.

Fields of application:

  • Treatment of sunken temples
  • Volume building of the cheeks
  • Helps natural radiance for sunken face
  • Smoothing wrinkles between the wing of the nose and the corner of the mouth (nasolabial fold)
  • Fighting the furrows between the corner of the mouth and the chin (mentolabial folds, marionette lines)
  • Mouth corner lifting
  • reduction of dark circles, tear troughs (“nasojugal groove”, “tear trough deformity”)
  • Injecting away the indentation on the lower jaw margin between the chin and the sagging cheeks (“prejowl sulcus”)
  • Correction of a chin furrow
  • Contouring of the jaw angles (“jawline”)

Important characteristic values:

  • Duration of action (months): 12 (Narins R.S., et al., 2011, Dermatol Surg).
  • Modulus of elasticity (G’ in pascals, at 37°Celsius and 2 hertz): 213.8 (Segura S., et al., 2012, J Drugs Dermatol).
  • Modulus of viscosity (G” in Pascal, at 37°Celsius and 2 Hertz): 23.3 (Segura S., et al., 2012, J Drugs Dermatol).
  • Quotient of viscosity and elasticity (tan delta value): 0.11
  • Cross-linking (percent): 8
  • Water binding (milliliters per gram): 6.4 (Fagien S., et al., 2019, Plast Reconstr Surg).

Macrolane®?

Macrolane® is a transparent hyaluronic acid gel that was withdrawn from the market in 2012. The hyaluron was produced according to the NASHA method by the company Q-Med/Galderma. The Macrolane® product was approved in Europe in 2008. The hyaluronic gel was used to restore body contours.

Indications for Macrolane®

  • Improvements to the buttocks rounding
  • Hand chasing
  • Beautification of the labia
  • Funnel chest correction
  • Contouring the surface of the body

Macrolane® for breast enlargement without surgery

In 2011, the injection of Macrolane® for breast augmentation was banned. The French drug safety authority called for more scientific studies to prove the safety of the treatment on the breast. It was suspected that inflammatory processes and nodule formation could result from the injection of large amounts of hyaluronic acid. In addition, there was concern that the injected hyaluronic acid could complicate the evaluation of the breast cancer screening exam. As a result, the manufacturer advised against its use for breast augmentation in 2012. Macrolane® has been discontinued since 2012. Injection with Sculptra® or with autologous fat are good treatment alternatives.

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