1. What Is Hyaluronic Acid? The Ultimate Hyaluronic Acid Filler

The Ultimate Hyaluronic Acid Filler
1. What Is Hyaluronic Acid?
Hyaluronic
acid
is
a
GAG
(glycoaminoglycan). Its name comes from
the Greek “hyalos” (vitreous) in reference to
the vitreous body where it was discovered
and also from “uronic” because it has a high
level of uronic acid.
Hyaluronic acid is one of the principal components of the extracellular matrix of the connective tissue.
It is a disaccharide polymer composed of D-glucuronic acid, D-n-glucuronic acid and D-nacetylglucosamine connected to each other by glycoside bonds.
Discovered in 1954 by Karl Meyer and John Palmer, hyaluronic acid, also called hyaluronan, is an
extremely long polymer with linear and uniform chemical structure, ubiquitous and without species or
organ specificity.
In physiological conditions, it is found in the form of a sodium salt – sodium hyaluronate. Hyaluronan,
called native in tissues, has a molecular weight of 2.5 to 10 million Daltons. In the dermis it has an
average molecular weight of 2.5 million Daltons and is synthesized by fibroblasts.
In large part, hyaluronic acid is responsible for the viscosity of the connective tissue of the dermis.
Industrially, it is principally obtained by two different methods:
1. Extraction of rooster’s comb, after grinding, chemical treatment and purification.
2. Bacterial fermentation: the filaments of hyaluronic acid are synthesized by genetically
modified bacteria. Streptococcus equi.
Hyaluronic acid is essential to the hydration of the skin and its aesthetic appearance as it acts as a
plumper by retaining water. Unfortunately, hyaluronic acid of the dermis disappears with age.
Dermyal easily and effectively replaces it, while supplying an immediate increase in the thickness of the
dermis. It does not require any preliminary test and thus, may be injected at once starting from the first
consultation.
Dermyal makes it possible to fill in wrinkles as well as remodel the volumes of the face. Dermyal is
formed of hyaluronic acid obtained by bacterial fermentation, it has a high molecular weight (2 to 3
million Daltons) and is crosslinked in several steps with BDDE (butanediol diglycidyl ether).
Dermyal is a monophasic product: A single and homogeneous phase of crosslinked hyaluronic acid.
The tolerance of hyaluronic acids such as Dermyal which are used for filling wrinkles has been demonstrated in many studies which have shown the extreme rarity of adverse events in hundreds of thousands of patients.
Made in Switzerland
@
www.dermyal.com
2. The Company & The Product.
L A B O RAT O I R E S
COSMO S CIENCE
GENEVE
Cosmoscience Laboratoires is based in Geneva & since 1994 has developed
and marketed products in the fields of medical cosmetology
(www.exfolderm.com) and mesotherapy (www.mesomedica.com).
Cosmoscience Laboratoires is a company entirely devoted to developing innovative, efficient & totally
safe products for noninvasive medical aesthetic procedures.
Dermyal is a hyaluronic acid of the monophasic type, in which the crosslinking
with BDDE is carried out in several steps of variable intensity according to
presentation 18, 24R or 32 HR.
3. The Different Formulations & Their Indications.
Wrinkles result from the distinct modifications that occur in the structure of specific portions of the
dermis and the subcutaneous tissue. Four principal types may be recognized, including:
a) fine atrophic rhytides, type 1
b) permanent elastosic wrinkles, type 2
c) dynamic expression wrinkles, type 3
d) gravitational folds, type 4.
Each type of wrinkle has a strong tendency to develop in specific skin regions with characteristic
microanatomy.
Dermyal 18: for type 1 light to moderate wrinkles
Dermyal 24R: for type 2 and 4 moderate to severe wrinkles. The texture of
the skin is deteriorated macroscopically. The primary lines become unequal,
rough and deep. The secondaries flatten out, are deformed and progressively
disappear.
Dermyal 32HR: for type 2 and 4 severe to very severe wrinkles, the distended
skin is perceptible between the primary lines, which are very deep and very
spaced out. There are few or no secondary lines.
The type 3 expression wrinkles may benefit from the injection of Dermyal 24R or 32HR in possible
combination with a weak dose of botulin toxin, greatly diluted.
The Ultimate Hyaluronic Acid Filler
Made in Switzerland
@
www.dermyal.com
4. Procedure
A. Treatment session:
Be sure to carefully inform the patient again,
draw the areas to be injected, make photos,
remove makeup, disinfect, possibly apply
anesthesia.
After the injections, it is extremely important
to massage the injected areas. Apply a
cream with arnica or one that contains
vitamin K derivatives.
In the hours and days that follow the
injections and to guarantee optimal and
longlasting result, the patient should avoid:
sun, lack of sleep, stress, tobacco smoking,
consumption of alcohol, exercise in excess in
particular those involving the facial region.
B. Follow-up session:
If necessary, the patient is seen again 8 days
to 3 weeks after the first injection to verify
and/or correct.
In case of hypocorrection, a point reinjection
of Dermyal can be made. In case of a
hypercorrection giving rise to bulging, an
injection of hyaluronidase can be made. The
amount to be injected at the center of the
implant should not exceed ¼ of its volume.
5. Advices For Injections & Recommendations
Tracing linear technique: Simple, obvious and not as painful for the patient. Introduce the entire
needle tangentially in the dermis and inject while withdrawing the needle progressively from the skin.
According to the type of product used and the depth of the wrinkles, the injection will be done more
or less deeply.
Fanned out radial technique: Multiple retrotracing radial injection starting from a single penetration
point in the dermis. Deposit the product while withdrawing the needle slowly but not completely, then
rotation and reinjection of the needle in another direction in order to fill in the entire area to be treated.
This technique is more suitable when a plumping effect is sought in the cheeks or cheek bones.
Point by point technique: Enables correction by small strokes with precision and by injecting small
amounts where filling is necessary. More painful technique because there are multiple injections.
Multipuncture technique:
Minimal and superficial injections at the limit of the papule.
Multipunctures 2 to 3 mm in diameter with depth of approximately 2 mm.
It is advisable to inject sufficiently, but not too much, during the first consultation to obtain an
immediate visible result.
One to two touch up sessions per year will be sufficient, but by using an injection volume smaller than
the first consultation.
There is a cumulative effect of the product as the injections go along.
Recommendations: local anesthesia may be proposed to make the procedure more comfortable, for
example, by applying an anesthetizing cream on the site to be injected or by truncal injection of an
anesthetic. The use of prior anesthetic injection is recommended in fainthearted patients, particularly
for the lips.
6. Other Recommendations, Side Effects
Contraindications: Pregnant or breastfeeding woman, presenting skin problems of the inflammatory
and/or infectious type, such as acne or herpes.
Combination with laser treatment, chemical peeling or dermabrasion is prohibited during the same
session. One or two weeks of delay are essential.
Pathological history such as: tendency to develop hypertrophic scars, autoimmune diseases,
immunotherapy treatment, known hypersensitivity to hyaluronic acid are to be sought by precise and
detailed medical history of the patients.
Adverse side effects: After the injection inflammatory reactions may appear (redness, edemas,
erythemas…) that may be associated with itching or pain. These reactions may persist for one week.
Sometimes indurations or nodules may be observed at the injection point. In all cases, careful and
prolonged massage of the injected areas is very strongly recommended and protects against
the very rare delayed appearance of complications, such as inflammatory granulomas.
Very rarely, cases of coloration of the injection area may be observed; these are reversible.
The persistence of such reactions beyond a week or the appearance of any other side effect should
be reported to the laboratory responsible for marketing.
@
www.dermyal.com
Made in Switzerland
7. Results
Nasolabial wrinkles:
Periorbital wrinkles:
Forehead wrinkles:
Glabellar wrinkles:
Dermyal18
Dermyal18 & Dermyal24R
Cheek volume:
Periorbital wrinkles:
Before treatment
After treatment
Lip Volume:
Before treatment
After treatment
Dermyal32HR
Dermyal18
Deep wrinkles & scars:
Peribuccal wrinkles
& Vermilion:
Nasolabial folds:
Dermyal24R & Dermyal32HR
Dermyal18 & Dermyal24R
Bitterness wrinkles
& Oral commissure:
Lip volume:
Before treatment
After treatment
Before treatment
After treatment
Dermyal24R & Dermyal32HR
Dermyal24R & Dermyal32HR
With Dermyal, you will therefore obtain longlasting and immediate results, with a duration that varies
from 6 to 12 months, according to the products injected and according to the patients.
By respecting all the required precautions before any filling treatment, the reactions related to the
injection – such as slight redness and edema – only very rarely appear. The social and professional life
of the patient is not or is very little disturbed.
It is advisable to avoid intense facial expressions and excess chatting during the 2 hours following the
procedure in order to facilitate integration of the product.
The Ultimate Hyaluronic Acid Filler
To optimize the effect of Dermyal on the first treatment, a small touch-up is advised 1 month after the
first session.
L A B O RAT O I R E S
COSMO S CIENCE
GENEVE
54Bis route des Acacias
Ch 1227 GENEVE
[email protected]
www.cosmoscience.net
• Medical cosmetology & peeling solutions: www.exfolderm.com
• Aesthetic ectoplasty (mesotherapy): www.mesomedica.com
• Hyaluronic acid fillers: www.dermyal.com
Practitioner’s Copy