| PRIME PRoMotIon
Infiltration techniques In this study, 1 ml of Viscoderm® 20 mg/ml non-cross-linked HA was used in each session. Lidocaine 2% was administered approximately 1 cm from the labial commissures bilaterally, with 0.1 ml of product using a 30-gauge needle. Using the same puncture point, a 25-gauge needle
Figure 1 Injection using 27 G blunt cannula between the vermillion border and the white lip
and/or prolonged oedema have ever been reported — including in this study, our previous experiences, and in other studies using this material. Viscoderm® (IBSA Farmaceutici Italia) is a premium
quality HA manufactured according to GMP standards for active substances (EU GMP Part II) and recommendations from the World Health Organization. Manufactured synthetically through a process of Streptococcus equi fermentation, it has a molecular weight of over 1 million Daltons (1.4–2.1 x 106 Da) developed for use as an intradermal filler, and comes in three different concentrations (0.8%, 1.6% and 2%) as sterile 1 ml pre-filled syringes. Both during the study described and in those
previously undertaken, the side-effects observed included transient oedema, transient erythema, and ecchymosis associated with the infiltration technique and the material’s hygroscopic properties.
Materials and methods Twenty patients were recruited for the study (one man and 19 women) with a mean age of 55 years, who were in good health and had not undergone any aesthetic treatments during the previous 3 months. Photographic images were obtained using a polarised light source, followed by computerised processing of the wrinkles in the skin (Canfield Visia®), and using a normal digital camera, before treatment, 1 month after the second session, and 1 month after the third session. Infiltrations were performed on the vermillion border and lip contour twice every week for a total of three sessions.
was used to create the point of access in which the blunt cannula was introduced and, very slowly, a tunnel was created along the virtual channel between the vermillion border and the white lip (Figure 1). A total of 0.6 ml of product was infiltrated, initially using the anterograde technique, delivering a minimal portion in order to detach the tissue and minimise trauma, and afterwards using the retrograde technique. The remaining 0.4 ml of material was distributed inside the upper and lower vermilion borders by infiltrating the submucosal tissue and distributing it using the fanning technique, withdrawing the blunt cannula for all but the last 5 mm and then reintroducing it further down to perform two-to-three linear infiltrations for each half of the lip. The infiltration was always performed very slowly to respect the tissue and for the comfort of the patient.
Table 1. Average satisfaction scores with treatment Increased
Moisture Day 0
Day 30 Day 60
definition 2.94 2.64 2.42
3.64 3.35 2.66
Firmness Volume 3.14
2.50 2.42
2
1.93 1.83
4=unsatisfactory, 3=moderate, 2=good, 1=excellent
Table 2. Adverse events Side-effect
Pain during infiltration Pain after infiltration Erythema Oedema Pruritus
Discolouration Ecchymosis Other
Number of patients 8 0 1
7* 0 0 2
0 *Maximum of 48 hours
prime-journal.com | October 2011 ❚
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