Clinical Perspectives on the Injectability of Cross-Linked Hyaluronic Acid Dermal Fillers: A Standardized Methodology for Commercial Product Benchmarking with Inter-Injector Assessments.

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Version: Final published version
License: CC BY 4.0
Serval ID
serval:BIB_B53A5F32760A
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Clinical Perspectives on the Injectability of Cross-Linked Hyaluronic Acid Dermal Fillers: A Standardized Methodology for Commercial Product Benchmarking with Inter-Injector Assessments.
Journal
Gels
Author(s)
Micheels P., Porcello A., Bezzola T., Perrenoud D., Quinodoz P., Kalia Y., Allémann E., Laurent A., Jordan O.
ISSN
2310-2861 (Electronic)
ISSN-L
2310-2861
Publication state
Published
Issued date
26/01/2024
Peer-reviewed
Oui
Volume
10
Number
2
Language
english
Notes
Publication types: Journal Article
Publication Status: epublish
Abstract
The injectability of cross-linked hyaluronic acid (HA) dermal fillers is influenced by polymer concentration, polymer cross-linking type and degree, the presence of lidocaine or other functional excipients, types of syringes, and injection techniques. Finished product injectability constitutes a critical quality attribute for clinical injectors, as it strongly influences product applicability and ease of use in aesthetic medicine. While injectable product extrusion force specifications are provided by the respective device manufacturers, the qualitative informative value of such datasets is low for injectors wishing to compare product brands and technologies from an injectability standpoint. Therefore, the present study comparatively assessed 28 cross-linked HA dermal fillers (JUVÉDERM <sup>®</sup> , Restylane <sup>®</sup> , BELOTERO <sup>®</sup> , TEOSYAL RHA <sup>®</sup> , and STYLAGE <sup>®</sup> brands) using various injectability benchmarking setups for enhanced clinical-oriented relevance. Manual product injections were performed by three specialized and experienced clinicians, whereas automatic product extrusion was performed using a Texture Analyzer instrument. The various hydrogel products were injected into ex vivo human skin and into SimSkin <sup>®</sup> cutaneous equivalents to appropriately account for injection-related counterpressure. The injectability results revealed important variability between and within product brands, with a strong influence of the local anesthetic lidocaine, HA contents, and needle gauge size. Critical appraisals of the investigated products were performed, notably from manufacturing process-based and clinical ease of application-based standpoints, centered on respective experimental injectability quality levels. Generally, it was confirmed that each HA-based dermal filler product requires specific expertise for optimal injection, mainly due to differing viscoelastic characteristics and injectability attributes. Overall, the present study set forth evidence-based and clinical-oriented rationale elements confirming the importance for injectors to work with injectable products with which they are experienced and comfortable to optimize clinical results.
Keywords
aesthetic medicine, cross-linked hyaluronic acid, dermal fillers, ex vivo skin, hydrogel systems, injectability, lidocaine, medical device, needle gauge, product benchmarking
Pubmed
Web of science
Open Access
Yes
Create date
26/02/2024 13:29
Last modification date
09/08/2024 15:04
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