Summary: With the proliferation of dermal fillers in the aesthetic workplace have come instructions from various manufacturers regarding dermal placement. Determination of injection needle location in the dermis has in large part been based on physician expertise, product and needle familiarity, and patient-specific skin characteristics. An understanding of the precise depth of dermal structures may help practitioners improve injection specificity. Unlike other dermal fillers that suggest intradermal and deep dermal injection planes, a new hyaluronic acid with a cohesive polydensified matrix may be more appropriate for the superficial dermis because of its structure and its high degree of integration into the dermis. To that end, the authors designed a small study to quantify the depth of the superficial dermis by means of ultrasound and histology. Using ultrasound resources, the authors determined the depths of the epidermis, the dermis, and the reticular dermis in the buttocks of six patients; the authors then extrapolated the depth of the superficial reticular dermis. Histologic studies of two of the patients showed full integration of the product in the reticular dermis. Following determination of injection depths and filler integration, the authors describe a technique (“blanching”) for injection of the cohesive polydensified matrix hyaluronic acid into the superficial dermis. At this time, blanching is appropriate only for injection of the cohesive polydensified matrix hyaluronic acid known as Belotero Balance in the United States, although it may have applications for other hyaluronic acid products outside of the United States.
Geneva, Switzerland; Rockville, Md.; Fairfax, Va.; and Cary and Chapel Hill, N.C.
From private practice; Laboratoire Viollier Weintraub; MedImage, Radiology Center; Cary Skin Center; and the Department of Dermatology, University of North Carolina at Chapel Hill.
Received for publication March 5, 2013; accepted April 30, 2013.
Disclosure: Dr. Micheels has been compensated for presentations about products manufactured by Merz Aesthetics at educational meetings in the European Community. He is also a consultant for Merz, Antéis, IBSA Pharma, Q-Med Switzerland, and Allergan. Other than his educational presentations, he has nothing to disclose that would represent a conflict of interest. Dr. Sarazin and Dr. Besse have no financial interests to disclose. Dr. Sundaram serves as a consultant and/or clinical investigator for Allergan, Antéis, CosmoFrance, Ipsen, Medicis/Valeant, Mentor/Johnson & Johnson, Merz, and Q-Med/Galderma. Dr. Flynn is a consultant for Merz and Allergan; he has received research support from Merz Aesthetics. The authors were assisted in development of this article by David J. Howell, Ph.D. (San Francisco), who was compensated by Merz Aesthetics for his contributions.
Patrick Micheels, M.D., Avenue de Champel, 6, Geneva 1206, Switzerland, firstname.lastname@example.org