Belotero In Clinical Practice

The Merz Institute of Advance Aesthetics has been hosting its Merz Innovation Partners in CPD-registered training sessions covering a range of topics including product knowledge and injection techniques. Wigmore Newsletter was invited to join one of their latest webinars where Dr Kim Booysen talked about the hero qualities in the Belotero range and key considerations when using fillers on your patients. 

In previous years, choosing your filler for your patient was relatively simple—you would use the hardest filler to go into the cheeks, and the softest in the lips. With the increase in the numbers of fillers on the market, and deeper knowledge of the scientific technology of fillers, we need to start digging a little further into our choices, and start considering the rheological properties of fillers and how they work in the tissue. 

Scientific differentiation of the Belotero HA Range 

While many might posture on online forums that all fillers are the same, that is definitely not the case. The first difference is what we might call the ‘old school v new school’ filler, where those fillers that have been on the market for a longer period of time tend to be biphasic, that is they have two phases, a combination of a gel and some solid particles. While the ‘new school’ fillers (the majority of current fillers) are monophasic, that is, they are just a gel. 

The Belotero range is a monophasic filler, but is differentiated further from its competitors, as it is a polydensified filler meaning it has multiple densities within its gel, compared to other monophasic fillers which have only one density. The higher density areas of the gel allow for lifting properties, while the lower density areas allow for the product to sink into the tissues and slink through the natural collagen and elastin, allowing for smooth integration. 

Rheologic tailoring—hero qualities 

The key qualities of a filler to consider are cohesivity, elasticity, and plasticity—hero qualities—and your need for each or a mix will depend on the indication you are treating and the patient. 

Cohesivity is about how the gel disperses in the tissue and can range from full dispersion to full cohesivity (1-5 on the Gavard- Sundaram scale). Belotero has high cohesivity across its range.

Elasticity is about the ability of the filler to resist sheer stress and return to its original shape after stress has been applied – particularly key for some indications as the face is mobile and just by talking and animating, we are exerting stress through our muscles. A product such as Belotero Intense will just keeping bouncing back into shape following the application of stress which makes it a favourite for treating mobile areas such as the lips and marionette lines. 

Plasticity gives a filler the ability to be shaped and moulded, which is necessary when wanting to provide contouring to the mid-face or constructing cheeks and jawlines. 

When choosing your fillers, you do not want a filler that just has one of these hero qualities, you will need a blend of at least two to give the best results. Belotero Volume has all three, which allows it to be used in multiple layers and in multiple ways. You can place it deep and then come more superficially and it will give you lift, mouldability but will also stay in place. 

Belotero Soft and Balance are more cohesive products with a little elasticity but not very plastic, meaning that they are great for superficial placement to treat fine lines or the vermillion border, as you do not want to mould the filler here, but you do want it to stay where it was injected. 

Choosing your product 

When choosing your product, think about the indication you are trying to treat, your patient and the hero quality you are looking for—what is going to be the most important aspect of your filler? 

For example, if you were treating someone younger on the mid-face, where you would not be looking at mouldability you may want to use Belotero Intense as you would get the high lift and elasticity you need. Whereas, if you were treating an older patient, you may need plasticity to give contouring to this area otherwise you might get too much lift that can look unnatural, so you might choose to use Belotero Volume or potentially use both Intense and Volume if you are comfortable with the sandwich technique. 

Finally, as with all medical devices, do make sure you understand the safety levels of the fillers you use. Merz makes available much of their research and scientific material to professionals, which allows you to speak with your patients with confidence.

If you are interested in attending future Merz seminars, please see the timetable at wigmoremedical.com