What is Belotero®?

The hyaluronic acid Belotero® 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 the company Anteis. Hyaluronic acid is produced with the help of bacteria (Streptococcus equi). Similar to other hyaluron products, BDDE (1,4-butanediol diglycidylether) is used for cross-linking the hyaluron chains. The unbound content 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 al., 2013, Plast Reconstr Surg). The crosslinking is done in two steps. The hyaluron cross-linked in the first step is cross-linked again after adding another hyaluronic acid. The gel produced in this way is also called "cohesive polydensified matrix" (CPM®). The CPM® hyaluronic acid gel contains a portion of non-crosslinked long hyaluronic acid chains (Bezzola A. , et al., 2005, J de Med Esth Chir Derm). The hyaluronic acid gel of the CPM® series is distributed evenly and naturally in the tissue (Tran C, et al. 2014. Dermatology). The 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 skin layers, also known as the Tyndall effect. Compared to other tissue fillers, Belotero® products are more tissue compatible (Taufig A.Z., et al., 2009, J Ästhet Chir). The hyaluronic acid of the Belotero® range contains the local anaesthetic lidocaine (three milligrams per millilitre).

 

Belotero® Balance (other name Belotero® Basic)

Belotero® Balance is the first approved hyaluronic acid for injection from the Belotero® product range. In the USA, the hyaluronic acid injections are approved without local anesthetic. The local anesthetic increases viscosity (Micheels P., et al., 2018, J Cosmet Dermatol). The hyaluronic acid 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
  • Shapes of the lip contours
  • Highlighting the groove between upper lip and nose
  • Helps against wrinkles around the mouth
  • nasolabial fold injection
  • Reduce crow's feet
  • Injection of under eye rings
  • replenishing frown lines
  • Treatment of acne scars

Important parameters:

  • Concentration (milligram per milliliter): 22.5
  • Effective period (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 binding (millilitres per gram): 16.9 (Fagien S., et al., 2019, Plast Reconstr Surg)

Belotero® Volume

A sunken face or shadow at the temples or empty cheeks change the facial expression permanently. Belotero® Volume serves to build up lost volume. Thanks to its favorable flow properties, the hyaluron can be injected with very fine needles. Hyaluronic acid is injected deeply to build up volume. The hyaluron gel is long-lasting and well tolerated.

Fields of application:

  • Volume build-up of sunken temple region
  • Filling of sunken cheeks (hollow cheeks)
  • Refilling the fat pads
  • Raising the lateral eyebrows
  • Watering the tear ducts
  • Compensation of drooping jaws
  • Smoothing forehead wrinkles
  • Injection of chin creases
  • Modelling of the chin region
  • Contouring of the jaw angle
  • Lifting the tip of the nose
  • Lamination of nasal humps
  • Embellishment of the chin and jaw contour
  • Filling of fat pads (Ristow space)

Important parameters:

  • Concentration (milligram per milliliter): 26
  • Duration (months): 18 (Micheels P, et al., 2015, J Clin Aesthet Dermatol)
  • Modulus of elasticity (G' in Pascals, 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
  • Translated with www.DeepL.com/Translator (free version)

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 hyaluronic acid is distributed evenly and naturally in the tissue. The gel binds relatively little water and is characterised by a long-lasting effect.

Fields of application:

  • Injection of deep nasolabial folds
  • lip padding
  • Treatment of sunken corners of the mouth
  • Reduction of mentolabial folds (Merkel folds)
  • Smoothing deep facial wrinkles
  • Flattening of the skin appearance with acne scars

Important parameters:

  • Concentration (milligram per milliliter): 25.5
  • Duration (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

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

Fields of application:

  • Treatment of fine superficial wrinkles
  • Smoothing fine lines around the mouth (barcode wrinkles)
  • Getting rid of fine forehead wrinkles
  • Injection of fine nose wrinkles (Bunny lines)
  • Lamination of laugh lines
  • Injection of fine wrinkles in the chin and neck area
  • Reduce fine wrinkles in the area of the lower eyelid
  • accentuation of the padding on the lower eyelid (charming roll) in Asian eyes

Important parameters:

  • Concentration (milligram per milliliter): 20
  • Duration of effect (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

The hyaluronic acid was approved in Europe in 2018. The hyaluron is based on the CPM® technology. The fields 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 cross-linking and the ability to absorb water.

Fields of application:

  • Lifts hanging corners of the mouth
  • Smoothes perioral wrinkles
  • Rejuvenation of the oral area
  • Lip corrections
  • Helps to achieve a fuller lip red

Important characteristic value:

  • Concentration (milligram per milliliter): 22.5

Belotero® Revive

Belotero® Revive has been approved in Europe since 2019. The hyaluronic acid is produced with the Cohesive Polydensified Matrix Technology. The hyaluronic acid syringes contain the sugar alcohol glycerol (17.5 milligrams per milliliter). The hyaluron 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 to achieve an even skin tone
  • Leads to a healthy and natural shine 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 ducts

Important characteristic value:

  • Effective period (months): 9 (Hertz-Kleptow D., et al., 2019, Clin Cosmet Investig Dermatol)
  • Concentration (milligram per milliliter): 20

Belotero® Hydro

Hyaluronic acid is not cross-linked and is used to stimulate the formation of collagen. The hyaluronic acid syringes 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 of light skin spots
  • Increase of skin moisture
  • Increases the elasticity of the skin
  • Balances out skin irregularities
  • Removes fine wrinkles around the eyes

Important characteristic value:

  • Concentration (milligram per milliliter): 18

Author's statement

Author: Stéphane Stahl, MD, PhD. There are no financial relationships with the pharmaceutical or medical device industries that could have influenced the above text. Any reproduction, even partial, is permitted for personal use only. All texts used on this website are protected by copyright.

 

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