Hyaluronic acid fillers with cohesive polydensified matrix for soft-tissue augmentation and rejuvenation: a literature review

Background: Cohesive monophasic polydensified fillers show unique viscoelastic properties and variable density of hyaluronic acid, allowing for a homogeneous tissue integration and distribution of the material. Objective: The aim of this paper was to review the clinical data regarding the performance, tolerability, and safety of the Belotero (R) fillers for soft-tissue augmentation and rejuvenation. Methods: A literature search was performed up until May 31, 2015 to identify all relevant articles on Belotero (R) fillers (Basic/Balance, Hydro, Soft, Intense, Volume) and equivalent products (Esthelis (R), Mesolis (R), Fortelis (R), Modelis (R)). Results: This comprehensive review included 26 papers. Findings from three randomized controlled trials showed a greater reduction in nasolabial fold severity with Belotero (R) Basic/ Balance than with collagen (at 8, 12, 16, and 24 weeks, n=118) and Restylane (R) (at 4 weeks, n=40), and higher patient satisfaction with Belotero (R) Intense than with Perlane (R) (at 2 weeks, n=20). With Belotero (R) Basic/Balance, an improvement of at least 1 point on the severity scale can be expected in similar to 80% of patients 1-6 months after injection, with an effect still visible at 8-12 months. Positive findings were also reported with Belotero (R) Volume (no reduction in hyaluronic acid volume at 12 months, as demonstrated by magnetic resonance imaging), Soft (improvement in the esthetic outcomes when used in a sequential approach), and Hydro (improvement in skin appearance in all patients). The most common adverse effects were mild-to-moderate erythema, edema, and hematoma, most of which were temporary. There were no reports of Tyndall effect, nodules, granulomas, or tissue necrosis. Conclusion: Clinical evidence indicates sustainable esthetic effects, good safety profile, and long-term tolerability of the Belotero (R) fillers, particularly Belotero (R) Basic/Balance and Intense.