5 Non-permanent fillers
Belotero®/Esthélis® and Teosyal®
Summary and Key Features
• Belotero®, Esthelis®, and Teosyal® are three hyaluronic acid families produced in Switzerland
• Good clinical data are available only for Belotero® Basic and Teosyal® Deep Lines
• At 6 months Belotero® Basic and Teosyal® Deep Lines still show at least a one-grade difference after treatment of the nasolabial folds
• Belotero® Basic and Teosyal® Deep Lines have a good safety profile
Introduction
Switzerland is not only the home of high mountains and chocolate but also the home of two companies that produce three hyaluronic acid (HA)-based filler families: Belotero®, Esthelis®, and Teosyal®.
Hyaluronic acid dermal fillers
HA-based dermal fillers are currently the most popular, non-permanent injectable materials available for the correction of age-related changes of the face and beyond the face (wrinkles, and volume loss). HA fillers derive from bacterial fermentation from a specific streptococcus strain (Streptococcus equi), a bacterium non-pathogenic for humans. As natural HA does not persist in tissues for more than 24 hours, it needs to be chemically stabilized by cross-linking techniques. Most HA-based fillers are stabilized by 1,4-butanediol diglycidyl ether (BDDE).
How to differentiate the different HA fillers? There are certain possibilities:
Those with good clinical data and those without
Those for more superficial and those for deeper injections
Those with a few products and those with product families
Those easy to inject and those more difficult to inject
So let’s take these aspects and look at the fillers that will be discussed in this chapter. One small note beforehand: all of the HA gels discussed here are of non-animal origin (bacterial fermentation) and are cross-linked by BDDE.
Methods
For this chapter a Medline search was performed with the aim of identifying clinical trials on the fillers discussed here. To reduce bias only randomized controlled clinical trials (RCTs) with a study size of above 50 and case series with a study size of above 100 were included in this overview.
Belotero®
Belotero® is produced by the Swiss company Anteis SA and distributed by Merz Pharmaceuticals. The stabilizer is BDDE and according to the manufacturer two cross-linking processes are used leading to a cohesive and polydensified matrix, which is supposed to ease injection while maintaining long-lasting results. Belotero® offers three different formulations: Belotero® Soft, Belotero® Basic and Belotero® Intense (Table 5.1, Figs 5.1 and 5.2).
Figure 5.1 (A) A 56-year-old patient at baseline and (B) 14 days and (C) 182 days after a single injection of 1 mL Belotero® Intense.
Figure 5.2 Upper lip augmentation in a 45-year-old man: (A) before and (B) 4 months after 1.7 mL of Teosyal® Kiss.
We could find only one RCT for Belotero® Basic with an open extension phase, by Narins and colleagues. Furthermore we were able to detect two large German case series: one by Dirting et al focusing on Belotero® Basics and one by Pavicic on Belotero® Intense.
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