Rejuvenating the perioral area with Belotero Soft by Dr Kiran Kandola, MBBCH FRCA MRCP(UK)

Consultant Anaesthetist, Medical Aesthetic Doctor and Merz Innovation Associate, Dr Kandola, shares his approach to the treatment of the perioral area with BELOTERO® Soft in a 37 year old female patient.

I have always been inspired by the Natural Sciences. Additionally, I am an extremely detail orientated and precise person. This makes my practice as a Consultant Anaesthetist a very natural fit for me. My clinical experiences in the NHS informs my patient focused approach to Aesthetic Medicine. I have also found that my skill using ultrasound and precise injectables in Anaesthesia continues to be of great help and relevance in Medical Aesthetics.

At a recent Anaesthetic and Critical Care meeting with a senior medical leader in my NHS trust, I suddenly realised why it was that I have always needed more – professionally speaking.

He said something which may well resonate with you too, so I shall share it. Addressing a few of us in a group at a coffee break (as is so often the way at professional meetings), he was sharing luminescent pearls of wisdom and as junior consultants we were listening intently. “Chaps, you know what you really have to guard against?” he supped thoughtfully at his coffee and ruminated with a furrowed brow, “Intellectual redundancy”. How can that be I wondered? As are you all, we are medical professionals working in a challenging environment, often making life or death decisions – what about that is intellectually redundant? He expanded; over time in any profession, we wedge our minds into narrower and narrower gaps, squeezing the essence of who we are out, contorting around the challenges of our day to day existence. His point was that we need to pause, reflect and refract. Refraction into the composite parts of who we are – in my case I have a huge interest in Anaesthesia but equally in more creative and communicative vocations. This is how I found a natural and enjoyable match in the field of Medical Aesthetics.

For me, this counterweight provides energy and interest to my professional life. In working with Merz Aesthetics and using their products I have found a company which is on my wavelength. Rigorous and Ethical Science in conjunction with a thoughtful and supportive group of colleagues, underpinned by an excellent range of products. Which neatly brings me to the exquisite BELOTERO® Soft.


BELOTERO® Soft is used to treat perioral lines with a blanching technique.1 I have also utilised superficial subcision in a comparable plane with a 29g cannula to augment the rejuvenation of the superficial dermis. My patient is a 37 year old and a perfect candidate for this treatment given that her perioral lines are not established at rest, they are dynamic. As such, BELOTERO® Soft ensures an extremely natural looking finish and is a linchpin in my arsenal of preventative treatments. The prevention rather than restorative treatment modality (preventing worsening of dynamic wrinkles or delaying them from becoming static) is clearly a hugely expanding field given the wider appreciation of Aesthetic Medicine in general and specifically an understanding that treatments grow and evolve with you over time; with the initial preventative ones, such as this, forming the backbone of future treatments.

When patients understand the rationale behind a preventative rather than restorative approach their mindset changes for the better; it is a healthier way to approach treatments psychologically and I take great pleasure in assisting them to maintain their freshness and confidence over time.

BELOTERO® Soft, along with Revive, forms the basis of my preventative strategy at my clinic (Just Skin Time, 108 Caerphilly Road, Cardiff, CF14 4AG) and I have excellent feedback to give you regarding them.

BELOTERO® Soft helps ensure maintenance of natural facial movement and appearance by virtue of its 3D tissue expansion and rheological tailoring.2,3 It is also distributed evenly in the superficial dermis, with consistent results – especially important when practicing the blanching technique.2,4

BELOTERO® Soft also has extremely high cohesivity, low viscosity and CPM (Cohesive Polydensified Matrix) technology.2 This makes it ideal for use in the blanching technique and also in the superfical reticular dermis, with studies suggesting it has optimal properties for this.2,5 Also, because BELOTERO® products generates a low immune response and integrate uniformly with the dermal tissue, I know I am practicing in the interests of my patients and providing them with optimal advice and care.4,6


My mode of treatment using BELOTERO® Soft in the perioral area consists of the blanching technique (0.01-5ml), aiming to evenly distribute boluses in a focused vertical plane along the dynamic rhytides. I aim to take a very shallow angle and pass the tip of the needle just into the skin – with the 30g needle tip still visible through a translucent sliver of skin and dermal tissue; I then proceed to inject and raise a tiny bleb. This vertical aspect of treatment is literally underpinned by subcision and injection of tiny droplets (0.01-5ml) via 29g cannula at 90 degrees to the vertical rhytides. Results are to an extent immediate, with a gradual improvement over a few weeks and lasting 6-12 months2 in my experience. When explaining the treatment to patients I ensure to mention swelling and bruising as there are multiple (albeit very small) injection points; I also make play of the fact that the perioral area is a dynamic area and the focus of communication, so to err on the side of slight under treatment in the first instance is prudent.

References: 1. BELOTERO® Soft IFU 2. Van Loghem J, et al. Clin Cosmet Investig Dermatol. 2021;14:1175-1199. 3. Sundaram H, et al. Plast Reconstr Surg. 2015;136(5Suppl):149S-163S. 4. Micheels P, et al. Dermatol Surg. 2012 ;38(7 Pt 2):1162-9. 5. Micheels P, et al. J Clin Aesthet Dermatol. 2017;10(1):29-36. 6. Edwards PC, et al. Clin IntervAging. 2007;2(4):509-19.