RestylaneRestylane

“The Filler of the New Millennium”“The Filler of the New Millennium”

Physician Name, MD

IntroductionIntroduction

“How Happy are You with Your Appearance”?

-Consumer Poll in March 2003

• Nearly half gave a score of 5 or less on a scale of 10

• Only 1 in 4 adults Americans consider themselves attractive

• 30% indicate they would change something about their looks

Epidemic of AgingEpidemic of Aging

• Increasing percentage of US population aged 45 years or greater.

• Population over 45 will increase 20% from 2000-2025

• 59.2 million people in America between the ages of 45-59

• Aging Baby Boomers will have substantial impact on aesthetic marketplace

Facial AgingFacial Aging

• Thinning of the dermis and atrophy of fat pads• Loss of elasticity• Greater visibility of bony landmarks, blood

vessels, wrinkles and furrows• Transverse forehead lines• Lowering of the eyebrows• Descent of the corners of the mouth• Ptosis of nasal tip

Aging in the Lower FaceAging in the Lower Face

• Increase prominence of the nasolabial folds• Deepening of the nasolabial groove• Ptosis of commissure• Thinning of the lips• Flattening and lengthening of the upper lip• Lateral mandibular groove• Prejowl depression• Less defined cupids bow• Perioral rhytids

The 4 “R”s of Facial AestheticsThe 4 “R”s of Facial Aesthetics

• Resurface

• Relax

• Refill

• Redrape

Recontouring with FillersRecontouring with FillersFillers provide patient with fuller, youthful face and Fillers provide patient with fuller, youthful face and

can soften the appearance of agingcan soften the appearance of aging

• Permanent-Lasting over 12 months-Non-degradable-Remains in the tissues-Appearance can become

distorted due to aging process

-Long-term side effects:Granulomas, asymmetry, lumpiness, migration

-Must be removed if effect is undesirable

• Non-Permanent– Lasting under 12

months

– Degradable

– Temporary in case patient is not satisfied

– Side-effects usually mild and transient

– Animal vs. Non-animal

Permanent Fillers May Cause Permanent Fillers May Cause Permanent ProblemsPermanent Problems

Think twice before you ask your doctor for a permanent solution:

“Forever is a long, long time”

Science of Hyaluronic AcidsScience of Hyaluronic Acids

History of Hyaluronic AcidHistory of Hyaluronic Acid

• 1934: Meyer and Palmer first isolated hyaluronic acid from bovine vitreous humor

• 1970s: First used therapeutically in human medicine and surgery

• First product containing HA (for use in eye surgery) and (treatment of osteoarthritis)

• 1980s: Biomatrix, Inc. developed second-generation hyaluronic acid derivatives (hylans) through cross-linking (stabilization), greatly increasing tissue residency

Hyaluronic AcidHyaluronic Acid

• Has a simple chemical structure and is identical in all species and tissues; thus is non-immunogenic

• Found in all vertebrates and synthesized by some bacteria

• Ideal biomaterial substance of use as a filler

• Highly hydrophilic – “Loves water”

• Rapidly metabolized in the body

Stabilization of HAStabilization of HA

• Unmodified HA has a half-life in the body of 24-48 hrs

• Stabilization increases the length of time it exists in the skin.

• Modification should be minimal so that the body sees the material as native.

• HA must be cross-linked to stabilize the molecule

Physiologic Functions of HAPhysiologic Functions of HA• Important component of the extracellular space• Maintains proper structure and tissue function by:

– Creating volume through high water binding capability– Protecting and lubricating tissues, joints and tendons– Affecting cell integrity, mobility and proliferation– Filtration and regulation of protein distribution– Transportation of nutrients to and from cells

• Importance of HA in the skin:– Maintains volume and viscoelasticity– HA concentrations decrease with age1

1. Longas MO et al. Carbohydr Res. 1987;159:127-136.

Concentration/Distribution of HAConcentration/Distribution of HA• Average concentration of HA in human body:

200mg/kg• Largest distribution of HA is in skin: 56%

.

56%27%

8%

1%8%

Skin

Connective Tissue

Muscle

Intestines

Other

Distribution of HA

Differences between Animal and Non-Differences between Animal and Non-Animal Based HA ProductsAnimal Based HA Products

• Source and Purity:– NASHA™ products (from bacteria) are more pure than animal-

based HA products (from chicken combs)

– Animal based products may require skin testing

• Stabilization:– NASHA™ product modified 1%

– Hylaform® products modified 20%

• Biocompatibility:– Due to lower degree of cross-linking, NASHA™ products are

more biocompatible than Hylaform® products

– Increased biocompatibility indicates longer tissue residency

Non-Animal Based HA ProductsNon-Animal Based HA Products• NASHA™ - Patented form of non-animal based HA

– Source: Bacteria (streptococcus) fermentation process– Purity: Minimal and well-defined impurities– Stabilization: Achieved by adding small amount of organic

solvent• Degree of cross-linking is 1%• Product remains biocompatible

– Concentration: 20mg/mL of HA for all products– Degradation: Maintains initial volume through process of

isovolemic degradation• Bead contains 5x more HA than needed for volume maintenance • As stabilization bridges (or cross-links) disappear, water bonds in its place• More volume is maintained with less product

NASHA-NASHA-based on three considerationsbased on three considerations

• To provide pure hyaluronic acid

• To stabilize the molecule by the minimum possible modification-for longer duration and minimal tissue disturbance

• High clinical performance as well as safe use with minimal side effects. The hyaluronic acid is virtually unchanged and therefore similar to native hyaluronic acid

Isovolemic degradationIsovolemic degradation

• The NASHA-gel is slowly degraded over time

• Isovolemic degradation. The initial volume of the material is maintained throughout the degradation phase

• The less concentrated the gel becomes – the more water each molecule is able to bind

Isovolemic degradationIsovolemic degradation

Restylane Restylane ““ The Filler of the New Millennium” The Filler of the New Millennium”

• Biocompatible• Non-antigenic• Non-pyrogenic• Non-inflammatory• Non-toxic• Non-animal

• Stable after injection• Non-migratory• Long-lasting but

resorbable• Natural looking• Forgiving• Not too expensive

INSTANT

RESULTS