Rohrich, Rod J. M.D.
From the Department of Plastic Surgery, University of Texas Southwestern Medical Center.
Received for publication April 24, 2013; accepted June 17, 2013.
Disclosure: Dr. Rohrich has no financial interest in any of the products, devices, or drugs mentioned in this article or Supplement.
Rod J. Rohrich, M.D., Editor-in-Chief, Plastic and Reconstructive Surgery, 5959 Harry Hines Boulevard, POB1, Suite 300, Dallas, Texas 75390-8820, firstname.lastname@example.org
This year is the tenth anniversary of the U.S. Food and Drug Administration approval of the first hyaluronic acid filler (Restylane; Medicis Pharmaceutical Corp., Scottsdale, Ariz.) in the United States. In the past decade, hyaluronic acid fillers have been used as a common strategy for the correction of signs of aging of the face, including facial wrinkles and exaggerated nasolabial folds. Several hyaluronic acid gels are now available in the United States, and those hyaluronic acids with descriptions of their common characteristics and differences, such as molecular weight distributions and nuances in manufacturing, are discussed elsewhere in this Supplement.
This Supplement discusses Belotero Balance (Merz Aesthetics, Greensboro, N.C.), the latest hyaluronic acid approved by the U.S. Food and Drug Administration (2011). In these pages, the authors consider a range of topics. The biomedical characteristics across all hyaluronic acid fillers and their clinical significance are examined in an article by Sundaram and Cassuto. An article by Flynn, Thompson, and Hyun describes the empiric data on molecular weights and responses to hyaluronidase by Belotero Balance, Restylane, and Juvéderm Ultra. Safety and efficacy data of the new hyaluronic acid are described in an article by Lorenc and colleagues. Other articles consider specific applications of Belotero: the use of hyaluronic acid in persons of color is described in an article by Downie, Grimes, and Callender, and a blanching technique for injection of Belotero is described in an article by Micheels et al.
Finally, a roundtable article encapsulates the discussion by experts representing plastic surgery, oculoplastic surgery, and dermatology, who gathered in February of 2013 to review the properties of Belotero and to discuss its clinical application and associated aesthetic considerations. This article summarizes key discussions and provides recommendations on the use of Belotero.
The roundtable document covers important patient considerations, including setting appropriate expectations and the usefulness of preinjection and postinjection photographs to document aesthetic corrections. A facial schematic may also be useful for documentation purposes and for patient education.
Finally, the article considers the issue of nomenclature as it applies to hyaluronic acids. Unlike drug names, where there are standardized names to refer to molecular agents, hyaluronic acids do not have chemical names. Instead, hyaluronic acids use the proprietary terms that the companies have developed, which often refer to the manufacturing process for the particular hyaluronic acid and result in a litany of sometimes confusing abbreviations—such as HA-1, HA-2, NASHA, among others—to describe products. Even Belotero is known by various names around the world. In this Supplement, authors have in many cases added “Balance” to Belotero, to limit confusion of this product with other Belotero products available outside of the United States. In general, Belotero Balance is the product available in the United States, whereas Belotero Basic is available in Europe.
None of the materials contained in this Supplement are considered to be practice guidelines or best medicine protocols, but are merely the authors’ collective experience and expertise in the prescribed area. These articles represent state-of-the-art studies by the authors and have been rigorously peer-reviewed and revised before acceptance.
I am grateful for the initiative, flexibility, and experiences of the Supplement’s guest editors, Steven Fagien, M.D., and Z. Paul Lorenc, M.D. I must also thank the panel of volunteer peer reviewers and the esteemed lineup of authors who worked on an extremely fast-tracked schedule to provide you with the best Supplement possible. Each one of these men and women went above what was asked of them to bring you this addition to our literature. I am in awe of their accomplishments on this edition.
The production of the Supplement has been supported through an unrestricted educational grant from Merz Aesthetics (Greensboro, N.C.). Although consideration is given throughout the Supplement to the various hyaluronic acids available on the U.S. market and to clinical strategies and techniques common across the hyaluronic acid category, the focus is necessarily on Belotero. The intent of this Supplement is to expand the scope of the medical literature about this new soft-tissue filler. Any opinions expressed in the consensus article are the opinions of the expert authors and may or may not be concordant with product labeling. We are grateful for the generosity of our supporters and appreciate their help in promulgating this science to all of our readers. The content of the Supplement was not dictated or influenced by the sponsors, and all financial declarations/affiliations of the authors have been intentionally and redundantly disclosed and printed in this Supplement.
Finally, I owe many thanks to our publishing team at Lippincott Williams & Wilkins; the staff and associates of Medical Education Advocates (Atlanta, Ga.); and my remarkable editorial staff, especially managing editor Aaron Weinstein. Their efficiency, dedication, and creativity consistently ramp up the quality of Plastic and Reconstructive Surgery and have made the Journal and its supplements publications of which we can all be very proud.
Plastic and Reconstructive Surgery is fortunate to be part of an ever-growing body of knowledge about the aesthetic use of hyaluronic acids. The use of hyaluronic acids is increasingly dynamic, with certain fillers and particular techniques better suited for certain uses than others. Physicians’ continued experiences with these products and evidence-based articles such as ones that appear in this Supplement enhance physicians’ knowledge and augment their clinical skills. We sincerely hope that this Supplement helps readers more fully understand the nuances of hyaluronic acids in general and of the new hyaluronic acid Belotero in particular.