Lifting Capacity of Hyaluronic Acid Dermal Fillers

ke hrlund, Katarina Edsman, Cecilia Sturesson, Lars Nord, Anne Helander Kenne and Jacques Nsstrm
Q-Med AB, Seminariegatan 21, SE-752 28 Uppsala, Sweden.

Objective

Conclusions
Conclusions

The objective of this study was to investigate the lifting capacity of a number of different
hyaluronic acid (HA) dermal fillers.

The Restylane

products show an outstanding resistance to

deformation, resulting in an unbeaten lifting capacity.

Introduction

The high lifting capacity ensures that NASHA gels will stay where
injected to give full correction.

Lifting capacity
Lifting capacity is the desired effect of the gel implant in the body i.e. the capacity to lift tissue
and resist deformation after correction. Gel strength is a quantifiable property of the gel,
describing its ability to resist deformation.
To achieve correction and volume restoration, the gel implant must lift the tissue (Figure 1a).
A strong gel can provide the force required to lift the tissue and resist subsequent deformation,
resulting in the desired correction. A high lifting capacity requires a high gel strength.
A liquid or a weak gel will not resist deformation, and will therefore displace in the direction
of least resistance, resulting in deformation of the corrected volume (Figure 1b). A strong gel
will resist deformation and stay where injected, and will therefore prevent deformation of the
corrected volume (Figure 1c).
Wrinkle

Contouring

Wrinkle Contouring

C
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Results
As shown in Figure 3, the gel strength measured as Cmin is significantly higher for Restylane
products compared to the other HA-fillers. Obviously the NASHA stabilization process used
for manufacturing Restylane results in a very high gel strength, enabling the exceptional lifting
capacity.
Since the Restylane products are less modified than other HA-fillers, the high gel strength can
only be explained as being the effect of the ability of the NASHA process to preserve the
entanglements of the natural HA (Figure 2).

Wrinkle Contouring

D
e
f
o
r
m
a
t
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o
n

Figure 1. Illustration of the lifting capacity as an effect of the gel strength, a) Initial correction
of wrinkle and contouring, b) Deformation of weak gel implant and loss of tissue correction, c)
No deformation of strong gel implant leading to maintained tissue correction.

Crosslinks
Most HA dermal fillers are chemically modified with crosslinkers to improve the mechanical
properties and the duration in vivo. In traditional crosslinking most of the gel strength is
achieved by introducing chemical (synthetic) crosslinks. In the NASHA stabilization process
only a small amount of synthetic crosslinks are introduced to stabilize the natural crosslinks
(entanglements), see Figure 2. Both natural and chemical crosslinks contribute to the gel
strength.
Figure 3. The gel strength measured as Cmin (the resistance to swelling) for different HA-fillers.
More crosslinks (both
natural and chemical)

Methods

stronger gel

Determination of Cmin
less swelling

higher Cmin

higher resistance to
deformation
higher G*

Figure 2. Illustration of the NASHA stabilization process resulting in a low number of chemical
crosslinks and a large number of natural entanglements. Both natural and chemical crosslinks
contribute to the gel strength. Gel strength can be measured by Cmin and G* as explained
below.

Gel strength
The strength of a gel is dependent on the total number of crosslinks (both chemical crosslinks
and natural entanglements). The stronger the gel the better is the lifting capacity and the
expected duration.
In this study we have used the measure Cmin that demonstrate one important aspect of the gel
strength.
Cmin is the concentration of HA in the fully swollen gel in an excess of solvent. Stronger gels
swell less and have a higher value for Cmin.
G* is the complex modulus measured by rheology. It is a measure of the total resistance to
deformation. Stronger gels have a higher resistance to deformation and a higher value for G*.

Cmin is calculated as the concentration of HA in the product multiplied by the gel content and divided by
the swelling factor. The gel content is the fraction of HA that cannot pass through a 0.22 micrometer filter
when filtering a diluted suspension of the product. The swelling factor is calculated as V/Vo where Vo is the
initial volume of the gel and V is the volume of the fully swollen gel in 0.9% NaCl.

Materials
Table 1. Investigated HA-filler products
#

Produkt

Lot No

Manufacturer

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15

Teosyal Deep Lines

Teosyal Ultra Deep
Esthelis BasicTM
Fortelis ExtraTM
Stylage MTM
Stylage LTM
Stylage XLTM
Juvderm Ultra 2
Juvderm Ultra 3
Juvderm Ultra 4
Princess Filler
Renofill Perfectly Volume
Restylane Touch
Restylane
Restylane PerlaneTM

TS27-083502B
TSU-082903B
311103/3
510063/2
EMB090061
ELB083301
EXC083231
X24L506559
X30L509376, X30L504649
S30L482804
903015/2, 903006/2, 903008/1
410065/2
10254
10368
10312

Teoxane, Switzerland
Teoxane, Switzerland
Anteis, Switzerland
Anteis, Switzerland
Laboratories Vivacy, France
Laboratories Vivacy, France
Laboratories Vivacy, France
Allergan, France
Allergan, France
Allergan, France
Croma Pharma GmbH, Austria
Laboratories Renophase, France
Q-Med AB, Sweden
Q-Med AB, Sweden
Q-Med AB, Sweden

8th Anti-aging Medicine World Congress (AMWC) Monte-Carlo, Monaco - April 8-9-10, 2010