Hyaluronic acid: how to choose a drug? What manufacturers and cosmetologists are hiding

Home / Hyaluron / Korean, Spanish, Italian hyaluronic acid

Korean hyaluronic acid occupies a worthy place among the most used hyaluronate products. Cosmetic preparations from this manufacturer are a type of professional cosmetics that can be used at home and still achieve excellent results.

Beneficial properties of the substance for the skin

Thanks to haluronic acid, the face and body look fresh, toned and youthful. Hyaluronate is a natural component synthesized by the body. It is part of the dermis, vitreous body of the eyes, cartilage and joint tissue.

The role of hyaluronic compounds for the skin is very great:

Attracts and holds water molecules, providing hydrobalance;
Activates the natural synthesis of collagen and elastin;
Fills the intercellular space of the dermis;
Maintains the strength, firmness and elasticity of the skin;
Prevents the occurrence of inflammatory processes;
Protects from ultraviolet radiation and harmful environmental influences;
Prevents aging and thinning of the skin.

Cosmetics with hyaluron

Cosmetic preparations, as an alternative to cosmetic procedures, are becoming increasingly important for maintaining youth and preventing age-related changes. By retaining moisture in the intercellular space, cosmetic products have a targeted effect on deep hydration, maintaining tightness, firmness and elasticity.

Serum preparations should be applied to the skin immediately after cleansing and washing; a cream should be applied on top to block the evaporation of hyaluronic compounds.

Hyaluronic acid from Korea

Today, products with an active component in the form of hyaluronic acid extract are becoming very popular; Korea is a producing country.

Korean cosmetics include Mizon serums and essences, SCINIC creams, gel masks. The average price of such hyaluron is about one and a half thousand rubles per thirty milliliters.

Reviews of women who have used preparations from Korea based on hyaluronate confirm the focus of the cosmetic product on:

Moisturizing the skin (and the result is noticeable immediately), the feeling of dryness and stiffness disappears, peeling goes away and the cracking effect disappears, tone and color are evened out;
Preventing the risk of developing and eliminating shallow wrinkles - full saturation of tissues with hyaluron prevents early aging of the skin and smoothes out small folds, reduces the severity of stronger grooves;
Stimulation of regeneration processes - hyaluronic molecules actively participate in anti-inflammatory procedures, promote rapid healing of the wound surface, and normalize the activity of the epidermis;
Preventing free radicals from invading skin cells;
Additional enrichment with mineral components, which promotes nutrition, toning and strengthening.

The contained hyaluron does not cause allergic reactions, dermatological irritation, and has no contraindications for use, other than individual intolerance.

What is the origin of HA for cosmetics?

Once upon a time, HA of animal origin, obtained from pig ears or rooster combs, was used in cosmetics. I remember that the first HA we purchased for use in our products in 2002 was derived from piglets.

Today, HA is produced by bacterial fermentation, which produces a standard molecular size of 2 MDa. It is then “cut” either by enzymes or by hydrolysis to produce smaller molecules. The same thing happens in the human body - HA with a molecular weight of 2 MDa is cut into smaller pieces by enzymes called hyaluronidases.

Hyaluronate from Spain

Natural cosmetics from Natur Nua from Spain have also begun to be actively used in products to maintain youth.

The price of one hundred milliliters varies around three and a half thousand rubles.

Hyaluronic acid produced in Spain is used in the form of serums and ionized gold.

Such serums are aimed at:

Deep skin hydration;
Improvement of its microrelief;
Smoothing;
Elimination of small wrinkles;
Gives a radiant and fresh look.

To get a good result, apply a few drops of serum to previously cleansed and moisturized skin. Then apply moisturizing cream. Serum essence from Spain is also used as a mask. A special cosmetic napkin is impregnated with hyaluron and kept on the face for about fifteen minutes. After using it, moisturizing creams are applied.

Types of fillers used in aesthetic medicine

Fillers can be defined as substances introduced into tissue to fill a defect, such as a wrinkle. Depending on their chemical composition, they can be divided into two groups:

Biological fillers
. That is, completely natural substances that the body perceives as “its own” and, therefore, inert in relation to the body. Such fillers are characterized by faster or slower tissue resorption, depending on the preparation. Raw hyaluronic acid is a biological filler, but in this form it is practically not used.
Synthetic fillers
- partially or completely. Synthetic fillers are characterized by very slow absorption into tissues and they can also be permanent. Hyaluronic acid offered for aesthetic medicine contains a small percentage of synthetic impurities, which allows it to stay in tissues longer.

The ideal filler should be characterized by the highest possible filling results, long-term effects, minimal damage to the body during its implantation, availability and, above all, safety. Hyaluronic acid meets all the requirements, so it is close to ideal.

Hyaluron from Italy

The main Italian products containing hyaluronic acid are serums from Lamik Cosmetic.

For a more effective result, in Lamik serum products, in addition to hyaluronic acid, other active substances are added in the form of:

Water - improves the effect of hyaluron;
Fructose provides additional sources for the normal synthesis of sugars, and hyaluron is a polysaccharide;
Tocopherol - vitamin E improves cell nutrition, prevents aging, normalizes metabolic processes, and participates in collagen synthesis;
Pantothenic acid - Vitamin B5 helps support skin health.

The serum is applied two to three times a day after comprehensive cleansing. Then moisturizer is applied.

Hyaluronic serums produced in Italy are able to tighten the skin, thanks to deep hydration they eliminate seasonal changes and prevent the early manifestation of age wrinkles, the dermis becomes soft and tender.

The price for hyaluronic products from Lamik varies around three thousand rubles. The review rating shows that the Lamik product line produces wonderful results.

Methods of use

Depending on the purpose of the procedures, the methods of injection with hyaluronic acid differ. It is customary to distinguish such methods as:

External. HA-based serums are applied to the skin superficially and penetrate through the pores. For this method, low molecular weight hyaluronic acid is used.
Internal. Substances are introduced into the dermis through injections. In this embodiment, high molecular weight HA is used.

Hyaluronic acid injections

The latter direction is especially popular in modern cosmetology. Thus, based on hyaluronic acid the following are carried out:

Biorevitalization. Moisturizes the skin and improves its condition. The duration of HA preservation in the skin is up to 2 weeks, the effect is up to 4 months. Injections are carried out in superficial areas.
Mesotherapy. Moisturizing and nourishing the skin. The duration of HA storage is up to 2 weeks, the effect is up to 4-5 months. Injections are carried out in the superficial and medial areas.
Bioreparation. Moisturizing, improving and rejuvenating the skin. The duration of preservation of HA is up to 3 weeks, the effect is six months. The substance is injected into the superficial and middle areas of the dermis.
Contour plastic. Filling deficiencies in soft tissue volume with hyaluronic acid. It lasts for up to 2 weeks at the injection site, and the results from its use last for up to a year. The composition is introduced directly into the problem area to a considerable depth.

Russian hyaluronate

Russian hyaluronic acid is widely used in serums, creams, and masks produced by Novosvit.

News about these drugs is not as widely advertised as about products produced in Italy, Spain or Korea, which does not at all diminish their merits.

Novosvit serum is intended for deep hydration, creating a lifting effect and eliminating fine wrinkles, has a targeted therapeutic, preventive and anti-aging effect, protects against dehydration and preserves youthful skin.

Unique developments by Russian dermatologists and cosmetologists make it possible to use Novosvit hyaluron and achieve prolongation of youth, eliminate dark circles in the eye area, as well as even out the color and thoroughly moisturize the layers of the dermis.

You can choose products with hyaluronic acid for any skin type.

The price of the Russian line of hyaluronic acid is quite reasonable: from 150 to 350 rubles. At the same time, reviews from both cosmetologists and women who have used Russian hyaluron speak about the effectiveness and quality of the cosmetic line.

Another popular drug produced in Russia is Libriderm serum. The price for a bottle of this miracle product varies within a thousand rubles. Targeted effect on rejuvenation, restoration of skin texture, elimination of age-related signs of aging.

An order of magnitude more expensive in price - about four and a half thousand rubles for thirty milliliters of serum, and the excellent quality hyaluron Sensation, developed at the Novosibirsk Institute of the Siberian Branch of the Russian Academy of Sciences. The line of products with hyaluronic acid has no analogues. Providing the effect of combating age-related skin changes, it allows:

Activate the natural synthesis of hyaluron and collagen;
Improve elasticity and firmness;
Reduce the severity of wrinkles;
Carry out skin lifting at home.

The result is aimed at preserving and prolonging youth.

HYALURONIC ACID FRANCE INJECTIONS NAMES

It is a safe, reliable and simple procedure. Possibility of individual selection of the drug to obtain optimal results Belotero is available in 3 concentrations: Belotero Soft (for small superficial wrinkles), Belotero Basic (for medium and deep wrinkles) and Belotero Intense (for deep and pronounced wrinkles, as well as correction of the shape and volume of the lips) . Prevelle silk. Prevelle Silk is sold by Mentor Sogr. (Santa Barbara, California). The composition of this substance, synthesized by bacteria, is similar to the composition of Captique.

Medium-sized particles are used to make Restylane filler. Products containing large particles are best injected into the middle and deep layers of the dermis, while fillers that are made from small particles (such as Restylane Fine Line) can be injected more superficially. Preparations sold under the Juvederm brand do not have particle size markings.

As with all dermal filler applications, the effectiveness of the procedure and the results are highly dependent on the skill and experience of the practitioner. When Juvederm is injected superficially, the skin in the injection area may turn blue. When performing an injection in the area of the red border of the lips, the doctor must carefully monitor the volume of the drug used, since excessive administration of substance 3 can cause a change in appearance - protrusion of the lips (the appearance of a “platypus”). In addition, when Juvederm is injected superficially into the nasozygomatic cavity, blue nodules may appear; blue nodules and unwanted bulges cannot be eliminated with hyalutonidase. Glytone.

In other words, during the manufacture of these drugs, the mass of the active substance is not passed through a filter and is not sorted taking into account the size of the resulting particles. Thus, the drug consists of particles with a random size and shape. In order to choose the most suitable hyaluronic acid preparation, many factors must be taken into account. An expert assessment of existing publications regarding the above properties of drugs has not been carried out, so it is difficult to say what role these characteristics of substances play when choosing a filler. To assess the differences in the properties of killers manufactured using the “sorting by size” technology and fillers produced without the use of this technology, and in the duration of action of the drugs, the chains of hyaluronic acid, in which they are linked through ester bonds and ether bonds, more is needed data. The above differences will become more obvious and their importance will increase as new hyaluronic acid fillers are created, introduced and marketed and data accumulate. A discussion of the properties of various hyaluronic acid fillers produced by various companies is presented below.

Due to the lack of allergenic potential and the peculiarities of production, preparations made from hyaluronic acid can be stored at room temperature and there is no need to conduct an allergological study before using them. The advantages of hyaluronic acid fillers over collagen fillers are a longer duration of action (6-12 months), greater plasticity and a lower incidence of immune and allergic reactions. In general, when using any hyaluronic acid fillers, side effects are rare, they are typical and mild. Side effects include bruising, tissue swelling, swelling, acne, and (in very rare cases) severe hypersensitivity reactions, and rarely, due to swelling of the hyaluronic acid implant, arterial occlusion may occur, leading to disruption of blood flow. The main advantage of hyaluronic acid fillers is that after their use, skin nodules appear, which can be easily eliminated by injecting hyaluronidase into them.

Flaws. Side effects that occur rarely and are relatively mild include: Contraindications for the use of Hylaform are similar to those for the use of most fillers (for example, autoimmune and inflammatory diseases, a positive allergy history, previous anaphylactic reactions, immunosuppressive therapy, and pregnancy or breastfeeding ). Moreover, these drugs should not be used in the treatment of patients with allergic reactions to avian protein (for example, eggs). Hylaform is a substance produced almost completely hydrated. Thus, after injection, the filler does not increase in volume further.

Glytone (originally manufactured by Pierre Fabre (France), currently owned by the German pharmaceutical company Merz) is a filler that allows you to simultaneously solve several completely different problems. It perfectly fills wrinkles and restores volume, like a youthful face. Glytone has an antioxidant effect due to the presence of mannitol, which protects hyaluronic acid from breakdown and suppresses the action of free radicals. This ensures a previously unattainable duration of the effect of a hyaluronic acid-based filler of up to 12 months. and more. To prevent the aging process and to restore the density and elasticity of the skin, 4 forms of the drug are produced: Glytone 1 contains 14 mg/ml of native hyaluronic acid, 34 mg/ml mannitol and 3 mg/ml glycerol, intended for mesotherapy and biorevitalization, Glytone 2 contains 20 mg/ml (20%) native hyaluronic acid and 41 mg/ml mannitol, used to correct superficial wrinkles, crow's feet around the eyes, fine wrinkles around the lips, Glytone 3 contains 23 mg/ml (15%) native hyaluronic acid and 41 mg/ml mannitol, designed to eliminate deep creases and folds, such as nasolabial lines, marionette lines at the corners of the lips, horizontal creases on the forehead and tear troughs. Allows you to get rid of dark circles under the eyes, is also used to increase the volume and shape of lips, correct lip contour, Glytone 4 contains 24 mg/ml (15%) of native hyaluronic acid and 41 mg/ml mannitol, used to replenish lost volume of the cheekbones and middle third face, correcting the volume and shape of the chin, bridge of the nose, creating an ideal lower jaw line, eliminating “breasts”.

When measuring hyaluronic acid concentration, unbound hyaluronic acid molecules, hyaluronic acid fragments and weakly bound hyaluronic acid molecules are taken into account. They remain in the skin only for a short time and have virtually no effect on the duration of the effect after filler injection. Unbound hyaluronic acid molecules facilitate the insertion between chains of hyaluronic acid molecules. In this case, one side of the steps remains unattached, resulting in incomplete modification.

Due to its low elasticity density, Restylane is well suited for the correction of deep and medium-depth wrinkles. In addition, due to its high density and other properties, the drug, after introduction into human tissue, acts longer than Hylaform and Captique. It is believed that the cosmetic effect after Restylane injection lasts for more than 6 months, and after Perlane injection - from 6 to 9 months.

Hyaluronic acid. Choosing a hyaluronic acid filler. Over the past few years, the use of hyaluronic acid fillers has become the new “gold standard” for the treatment of defects in cosmetic dermatology. Hyaluronic acid preparations have become used much more often than other types of substances for soft tissue augmentation. Hyaluronic acid, or hyaluronate, is a non-sulfated glycosaminoglycan that is normally found in the skin and other tissues (especially connective, epithelial and nervous tissues), filling the space of the extracellular matrix. Hyaluronic acid is present in all animals, so it is not immunogenic.

This term is used by manufacturing companies to denote the differences between the manufacturing technologies of various hyaluronic acid fillers. During the formation of bonds between hyaluronic acid molecules, chains of modified sugars form a gel. During synthesis, this gel is extruded through a special filter. As a result of this process, gel masses of various sizes are formed. The gel masses are believed to be separated by size. The larger pieces are found in Perlane or Restylane Sub-Q, while the smaller pieces are found in Restylane Fine Line or Restylane Lip.

Hylaform Plus is also currently commercially available in the United States. The substance included in Hylaform fillers contains an average number of bonds, so the drug is biologically compatible, soft and plastic. Hylaform filler's G' score is low compared to other hyaluronic acid fillers, making it the gentlest hyaluronic acid filler available. Due to its softness, the drug is most suitable for eliminating lip defects. Hylaform products contain 5.5 mg/ml bound hyaluronic acid molecules. Advantages.

Restylane consists of medium-sized gel-like particles of hyaluronic acid, while Perlane consists of larger particles. However, the concentration of hyaluronic acid in both fillers is the same. The Restylane family of products includes Restylane Fine Line, Restylane Touch, Restylane Lip and Restylane Sub-Q fillers. However, approval for their use in the United States has not yet been obtained. The composition of all these drugs is similar to that of Restylane, only the particle size differs. Restylane and Perlane come in clear gel form and have a shelf life of 18 months.

HYALURONIC ACID FRANCE INJECTIONS NAMES

For example, manufacturers recommend using denser fillers (large G' value and high cohesiveness), such as Voluma and Perlane, Glyton 4, Belotero Intence, to eliminate deep wrinkles, such as wrinkles in the nasolabial folds or wrinkles running from the corners of the lips to chin. It is also recommended to use these fillers to lift the lateral portion of the eyebrows, correct defects in the bridge of the nose, rejuvenate the earlobe area, eliminate sunken nipples and lift the tip of the nose. Less dense fillers, such as Restylane, Belotero Basic, are best used to correct defects localized in large areas (for example, in the cheekbones and cheeks). Low G' fillers such as Belotero Soft, Glyton 2 and Juvederm Ultra 2 should be used for lip enhancement. It is believed that the higher the content of hyaluronic acid in the preparation, the denser it is and the longer it lasts. In general, when comparing fillers manufactured by the same company (for example, Belotero Soft and Belotero Basic), this is true.

Belotero fillers, according to clinical studies, are considered one of the safest fillers based on hyaluronic acid and help doctors meet the needs of each patient: for allergy sufferers and those who are afraid of pain, for those who want to have a fresh and youthful appearance at any age without the risk of looking unnatural. Advantages. Long-lasting effect - Belotero gel provides predictable, stable and long-lasting cosmetic results for up to 6-9 months.

Due to the risk of the needle getting into the eyeball, injections must be performed very slowly, pressing on the syringe plunger with medium force. The risk of the needle detaching and getting into the eye is greatest at the moment when the syringe becomes almost empty. At this moment, it is advisable to additionally inject the required volume of the drug from a new syringe into the nasozygomatic cavity, and use the remaining part of the substance from the first syringe to correct the defect in another area where the injection will be associated with less risk (for example, in the area of the nasolabial folds).

The binder used in the synthesis of Prevelle Dura, 1,2,7,8-diepoxyoctane (DEO), forms both ether bonds and ester bonds (known as a “double binder”). It is currently unknown whether any beneficial properties of dermal filler arise from the formation of ether bonds. The properties of the filler also depend on hydration. It has been established that hyaluronic acid is capable of binding 1000 times its own weight in water. The amount of water that was bound by the hyaluronic acid before being placed in the syringe affects how much water the filler will be able to absorb once injected into the skin.

Since Restylane and Perlane have low elasticity, they are better used for the correction of wrinkles of medium depth and deep skin defects than for the correction of lips or naso-zygomatic cavity. Restylane is ideal for eliminating nasolabial wrinkles and marionette lines, folds and chin, nasal defects, acne scars and other defects, as well as for lifting the tip of the nose. Flaws. After the injection of any hyaluronic acid fillers, bruising occurs. If the injection is performed by an inexperienced doctor, then the density and low elasticity of the filler are factors that complicate its implementation, and due to improper injection technique, protrusions and blue blisters may appear on the skin. Injections into the nasozygomatic cavity may be accompanied by the appearance of bubbles.

Juvederm Ultra and Juvederm Ultra Plus fillers contain 24 mg of hyaluronic acid per 1 cm3, however, the number of bonds between the chains of hyaluronic acid molecules in Juvederm Ultra Plus is greater, so this drug is more suitable for correcting the deepest facial wrinkles. Unlike Restylane, which consists of dense gel particles of approximately the same size, Juvederm is a soft gel-like substance consisting of particles of various sizes and shapes30 (using Hyalacross technology). Juvederm series preparations are available in the form of a transparent gel in 0.8 ml syringes. They are stored at room temperature. Juvederm Ultra filler is injected into the middle layers of the skin using a 30-gauge needle, and Juvederm Ultra Plus is injected deeper using a 27-gauge needle27. Needles must be tightly and carefully attached to luer-lock syringes, otherwise the needle may become detached during injection.

Hyaluronic acid acquired these properties thanks to a special production technology. The synthesis of Belotero occurs through the formation of a cohesive polydensified matrix and involves 5 production stages. The Belotero line is represented by 3 products: Belotero Soft contains 20 mg/ml hyaluronic acid, designed for the correction of fine superficial wrinkles and delicate areas of the face, neck, décolleté with thin skin, Belotero Basic contains 22.5 mg/ml hyaluronic acid, created for the correction of medium-deep wrinkles. folds and wrinkles, as well as correction of the shape and volume of the lips, Belotero Intense contains 25.5 mg/ml hyaluronic acid, used for the correction of deep wrinkles and folds, as well as for volumetric modeling of the face.

Hylaform is a preparation made from animal-derived hyaluronic acid isolated from the cockscomb. It is obtained by forming bonds between the hydroxyl groups of hyaluronic acid using divinyl sulfone. These bonds maintain the gel-like consistency of the substance. During the preparation process, the gel is passed through a mesh filter (described above).

The duration of the effect of using the drug can be increased by increasing the concentration of the acid and binding it to any substance. It should be remembered that there is a certain threshold value for the formation of acid bonds with substances. When using excessively bound hyaluronic acid, its biocompatibility changes.

The natural result of the correction is that Belotero is ideally distributed in the skin tissues and becomes part of you, so that you do not feel it. Belotero ensures a smooth transition between correction areas and non-injected areas of the skin, so the correction result looks very natural. Safety – Belotero contains hyaluronic acid of non-animal origin. Hyaluronic acid is a constituent of our skin, so it is naturally accepted by human skin and also does not require an allergy test. According to clinical studies, Belotero is one of the safest hyaluronic acid fillers.

In addition, the drug has a fairly high G' index, due to which it is quite dense and low-elastic. Restylane is the most commonly used filler in the United States due to its safety, brand recognition, and ease of injection. The filler consists of approximately 100,000 particles per 1 ml (the size of each of them is about 250 microns)28 and contains 20 mg of hyaluronic acid per 1 ml. The indication for the use of Restylane is the presence of wrinkles of medium depth. Restylane is the first hyaluronic acid product to be approved in the United States in 200329. Perlane, another filler in the same line of drugs as Restylane, has been cleared by the FDA for the treatment of severe, deep wrinkles and skin folds.

However, this opinion is incorrect when comparing fillers produced by different companies. This is explained by the fact that not all preparations contain hyaluronic acid that is bound. Many fillers contain unbound hyaluronic acid and loosely bound chains and fragments.

When injecting Juvederm fillers, you can use a variety of injection techniques, including sequential serial injections and tunneling. Advantages. Juvederm Ultra and Ultra Plus are medium density preparations, so they can be used to correct wrinkles of various depths (medium depth or deep) and to eliminate scars. Juvederm Ultra is easily implanted into the red border of the lips. Due to the high concentrations of hyaluronic acid and the large amount of cross-linking, the effect after injection of Juvederm Ultra and Juvederm Ultra Plus lasts longer than after injection of fillers such as Hylaform. Like other hyaluronic acid products, Juvederm products rarely cause side effects, which when they occur are mild and temporary.

In addition, injections of Hylaform, as well as other non-anesthetic fillers, can be painful. However, Hylaform is a soft substance, so its injection is less painful for the patient than other hyaluronic acid fillers. The use of local anesthetics reduces pain during injection. It is believed that the cosmetic effect of Hylaform and Hylaform Plus lasts about 3-4 months. This is due to the type of bonds between the chains of molecules and the reduced concentration of hyaluronic acid compared to that in newer fillers (for example, Restylane and Juvederm). Captique (no longer commercially available) Captique (Allergan, Irvine, Calif.) differs from Hylaform only in that Captique is produced by bacterial fermentation rather than from cockscomb.

Juvederm is not fully hydrated in the syringe, so after injection it expands slightly due to the absorption of liquid. This must be remembered when injecting filler into the lips, and minor hypocorrection should be carried out. The duration of the effect after the injection of Juvederm Ultra is similar to that after the injection of Restylane and is 6-9 months, and the effect after implantation of Juvederm Ultra Plus lasts up to 12 months. Flaws. All products containing hyaluronic acid may cause erythema, swelling and bruising after implantation. The severity of pain that appears during injection due to the lack of anesthetic in the drug can be reduced by performing local or regional anesthesia. With careful observation and precautions, Juvederm can be implanted in the nasozygomatic cavity, but the borderline location of the eyeball must be kept in mind.

The disadvantages of existing hyaluronic acid fillers are increased injection pain and more pronounced swelling, erythema and ecchymosis than with other fillers. Choosing a hyaluronic acid filler. There are no skin allergy tests required before using hyaluronic acid fillers, and the risk of allergic reactions is minimal with FDA-approved products. The main factors influencing the choice of drug are price, availability, duration of correction and the size of the needle required to perform the injection, and all manufacturers are striving to develop an inexpensive, long-acting drug that can be administered with a 30-gauge needle or smaller.

Hylaform (no longer commercially available) Although Hylaform is no longer commercially available, it was decided to provide some information about it as it was the first drug to be synthesized using disulfide bonds. The information obtained from the use of this fundamentally new drug at one time was used to create many similar products, such as Captique and Prevelle. In the manufacture of similar drugs, similar techniques were used.

In other words, fillers whose hydration in the syringe was almost maximum will attract smaller volumes of water than fillers with lower hydration rates in the syringe. Fillers that were not fully hydrated before filling the syringe will increase in volume within 24 hours after injection. Thus, when using such fillers, minor hypocorrection is necessary. In addition, patients should be told that they will look even better 24 hours after the injection. Restylane and Juvederm are drugs that are not fully hydrated before filling the syringe. Captique and Hylaform are almost completely hydrated. The properties of the filler can be influenced by the technological process of “sizing” or “crosslinking”.

Captique does not contain lidocaine, so after injection the risk of moderate pain, bruising, swelling and redness of the skin is the same as after injection of other hyaluronic acid fillers. The drug was discontinued because parent company Allergan decided to promote the drug Juvederm. Restylane. Restylane (Medicis, Scottsdale, AZ) was the first non-animal hyaluronic acid filler approved for use in the United States. It is a gel of synthetic non-animal hyaluronic acid (NASH A), obtained by fermentation, which is carried out by a culture of equine streptococcus bacteria placed in a sugar-containing nutrient medium. The concentration of hyaluronic acid in Restylane is higher than in Hylaform and Captique.

The drugs have the same pH value, approximately 7.0, and the reason for the difference in the severity of sensations after injection has not been established. Juvederm. Juvederm (Allergan, Irvine, Calif.) is synthesized using a bacterial fermentation technology similar to that used to produce stabilized hyaluronic acid fillers produced by bacterial fermentation. The drug was approved for use by the FDA in late 2006. There are many fillers in the Juvederm series (Juvederm 18, Juvederm 24, Juvederm 24 HV, Juvederm 30 and Juvederm 30 HV), but only Juvederm 24 HV (also known as Juvederm Ultra) and Juvederm 30 HV (also known as Juvederm Ultra Plus) has been approved by the FDA and is commercially available in the United States. All drugs in this series differ in the concentration of hyaluronic acid, the number and regularity of cross-links between molecular chains.

The hydration rate of Captique is also similar to that of Hylaform. This means that the drug is released in a syringe almost completely hydrated. According to the developers, after the injection of Captique, patients feel a less pronounced burning sensation than after the injection of Juvederm. Flaws. The duration of action of Captique filler is not precisely established, but it is believed that it is 4-6 months. To date, only a few studies have been conducted that evaluate the duration of action of the drug. When injecting filler using 30-gauge needles, you need to apply quite a lot of pressure on the plunger of the syringe, so the manipulation is more difficult than injecting drugs such as Hylaform or Restylane.

However, there are less obvious scientific factors to consider when choosing a filler. One of the most important factors to consider when choosing a filler is its elasticity or G' (G-stroke). G' is a value that indicates the elasticity of the gel.

The risk of inflammatory changes can be reduced by reducing the rate of injection of any hyaluronic acid filler. To correct the shape of the lips, Restylane can be injected into the red border of the lips. According to the developers, Restylane and Perlane should not be used to correct defects in the lip area. However, Restylane Lip is available outside the US and is better suited for this area. Restylane injections, like all non-anesthetic filler injections, can be painful. Before administering the drug, it is recommended to use local anesthetics and/or block the alveolar nerves to reduce pain sensitivity. Restylane injections typically cause less burning than Juvcderm injections.

The smallest gel particles are used to create Hylaform Fine Line, the indication for use of which is the presence of superficial wrinkles. However, this drug was banned in the United States from the very beginning of its production. Hylaform, consisting of medium-sized particles (average size 400 microns), is intended for injection into the middle layers of the skin for the treatment of medium-depth facial wrinkles and fine, fine wrinkles. Hylaform Plus consists of larger particles (average size 700 microns) and is used to eliminate deeper wrinkles. In 2004, the FDA approved the use of 2 drugs from this series. They were Hylaform and Hylaform Plus (Allergan, Irvine, California).

This drug, like Hylaform, is intended for the treatment of periorbital and perioral wrinkles. It can also be used to increase lip volume and correct hollows in the area of shallow scars. No testing or cooling is required before using the filler, and injections can be performed as early as the patient's first appointment. Since Captique is made from hyaluronic acid, due to the lack of immunogenic potential and the presence of reduced allergenic potential, the incidence of side effects after its use is low.

They are stored at room temperature. Restylane comes in 0.4 and 1.0 ml syringes, and Perlane comes in 0.7 ml syringes. Both drugs are injected using 27-gauge syringes. Restylane implantation is performed using a linear threading anterograde or retrograde method. You should not inject the substance while removing the needle, as this may result in a superficial injection, which will cause bluish nodules to appear on the skin. A divergent threading injection technique can also be used when using Restylane to correct nasolabial folds or lip commissures. Advantages.

Prevelle Silk has an average G' rating, which indicates the medium hardness of the substance. The substance is not inferior in its rigidity to Juvederm, but it is softer than Restylane. The frequency of cross-linking in Prevelle Silk is higher than in Hylaform, so the severity of Prevelle Silk is slightly higher than that of Hylaform. 1 ml of gel contains 5.5 mg of cross-linked hyaluronic acid molecules, with an average particle size of 300 microns. Prevelle can be used to eliminate scars, shallow and medium wrinkles, and correct lip defects.

BELOTERO. The drug was created by Anteis S.A. (Switzerland), currently the owner of the brand is the German pharmaceutical company Merz. Belotero is a line of smart hyaluronic acid fillers for safe and natural results. The drug is a monophasic poly-densified gel of stabilized hyaluronic acid with a high degree of homogeneity and the unique ability of uniform distribution in tissues.

The duration of action of the substance has not been established, but it is believed to be about 4 months. Prevelle Silk contains 0.3% lidocaine. In the USA, the drug was approved for use in 2008. It can be used to correct lip defects, since the injections are less painful. Side effects that occur rarely and are relatively mild include redness, swelling and itching. Advantages.

HYALURONIC ACID FRANCE INJECTION

This polysaccharide is capable of binding a volume of water 1000 times greater than the volume of the polysaccharide. The mechanism by which the biological effect of hyaluronic acid occurs is predictable. The substance increases volume and hydration with a water-containing flexible structure that adheres to collagen, elastin and cells. With age, the concentration of hyaluronic acid in the skin decreases, which leads to a decrease in tone, increased dullness and yellowness of the skin. The viscoelastic properties of hyaluronic acid give the skin a plump, youthful appearance. The half-life of natural, unmodified or unbound acid is approximately 24 hours. It is for this reason that bound hyaluronic acid is used in the creation of dermal filler.

The effect after the injection of an incompletely modified substance is less durable than after the injection of a fully modified drug. Moreover, chains of hyaluronic acid molecules can link two types of steps. One type involves ether bonds and the other involves ester bonds. The ether linkages are formed by 1,4-butanediol diglycidyl ether (BDDE, the binder used in Restylane, Juvederm and Belotero) and divinyl sulfone (DVS, found in Prevelle Silk, Captique and Hylaform).

It, like Hylaform, contains 5.5 mg of hyaluronic acid per 1 ml. In 2004, the filler was approved by the FDA for the treatment of moderate to severe wrinkles. Because it is produced by bacterial fermentation, it is slightly less flexible than Hylaform, but is not as dense as Restylane. Captique was supplied as a sterile gel placed in a 0.75 ml syringe. The injection is performed intradermally using a 30-gauge needle, requiring several injections. Captique, like Hylaform, is no longer available. Advantages.

Hylaform's G' value is low, so the substance is not very dense and feels natural to the touch after being injected under the skin. The filler is plastic and soft, so it is ideal for correcting defects of the lips, the periorbital part of the naso-zygomatic area, eliminating smoker's wrinkles and performing cosmetic manipulations in large areas, such as the cheekbone and jaw area. Hylaform is very easy to administer through a 30-gauge needle with gentle pressure on the syringe plunger. Side effects after using filler are rare, they are mild and temporary.

The value is measured the moment the gel is placed on the plate. The second plate is placed above the gel, after which a transverse force is applied to the system. The measured resistance to deformation is the modulus of elasticity or G'. The G' value can serve not only to determine the cohesiveness of the hyaluronic acid filler, but also to select the optimal area for its injection.

Hyaluronic acid must be bound in such a way that its biocompatibility and the required duration of the effect of use are maintained. Hyaluronic acid is rapidly metabolized in the liver, resulting in the formation of water and carbon dioxide. Hyaluronic acid in the skin is broken down by hyaluronidase, undergoes mechanical degradation due to the movement of facial muscles and is destroyed by free radicals. Oral administration of antioxidants should theoretically increase the duration of action of hyaluronic acid fillers, but evidence for this hypothesis is lacking. There are 2 main types of hyaluronic acid fillers: animal-derived hyaluronic acid (e.g. Hylaform), bacterially fermented hyaluronic acid (e.g. Restylane, Belotero, Glytone, Juvederm, etc.). Preparations of animal origin are expensive, so hyaluronic acid, which is part of most products, is obtained synthetically using bacteria. There are also hyaluronic acid fillers containing lidocaine.

Since Hylaform and Captique stopped being produced. Prevelle Silk hundred