Dermal Filler: Non-animal stabilized hyaluronic acid gel (Restylane and variants, Captique, Juvederm)

Generic name: Non-animal stabilized hyaluronic acid (NASHA) gel

Brand(s): Restylane (includes Restylane, Restylane Perlane, Restylane Touch and Restylane SubQ), Captique, Juvederm 18, Juvederm 24, Juvederm 24 HV, Juvederm 30

Maker / Website: Restylane is produces by Q-Med (www.q-med.com); Captique is produced by Genzyme (www.genzyme.com) and distributed by Inamed. Juvederm is made by Allergan (www.juvedermusa.com)

Cost: about $600 for 1 cc, typically 0.7-2 cc per treatment

Allergy test required: No

Durability: 6 to 12 month

Function / Purpose:
Different variants of NASHA are used for different purposes. Restylane, Captique, Juvederm 24 - moderate wrinkles and lip enhancement. Restylane Perlane, Juvederm 24 HV, Juvederm 30 - deep lines, facial contouring, and lip enhancement. Restylane Touch, Juvederm 18 - thin superficial lines. Restylane SubQ, Juvederm 30 - to replace fat loss in the face and create or restore a more defined facial contour.

Summary:
Restylane, Captique and Juvederm are made of non-animal stabilized hyaluronic acid (NASHA) gel. No allergy test is needed because hyaluronic acid occurs naturally in the body. NASHA is a clear gel, consisting of microspheres, that is injected into or below the dermis (the depth depends on the variant of NASHA) to provide desired augmentation.

Contraindications:
Hypersensitivity to NASHA or any of the inactive ingredients in its formulations

Details:
A process by which NASHA is made is rather sophisticated. A specially bioingeneered bacteria produce hyaluronic acid (HA) nearly identical to the one found in human skin. Then HA is purified and treated with a cross-linking agent, which firms it up and converts it into a stable gel. Finally, the HA gel is dispersed in such a way as to create injectable microspheres of varying size (Restylane, Captique) or a smooth-textured gel (Juvederm). The variant of NASHA products include the following:

• Restylane -- It has an intermediate gel particle size that makes it suitable for moderate wrinkles and lip enhancement. It is recommended that it is injected into the middle part of the dermis (middle layer of skin).
• Restylane Perlane -- It has a larger gel particle size and is used for deep lines, facial contouring, and lip enhancement. It is injected into deeply into the dermis.
• Restylane Touch - It has the smallest gel particle size in the product line and is used for the correction of superficial fine lines. It is injected into the upper dermis.
• Restylane SubQ -- It has the largest gel particle size in the product line and is used to replace fat loss in the face and create or restore a more defined facial contour. It requires a larger needle and is injected under the skin. It is promoted as an alternative to autologous fat injections.
• Captique - Similar to Restylane in particle size and recommended uses.
• Juvederm 18 - Used to treat fine lines and crows feet.
• Juvederm 24 - Used for forehead wrinkles, frown lines, and mild nasolabial folds.
• Juvederm 24 HV - Similar to Juvederm 24 HV but with higher viscocity. Used for deeper wrinkles and creases.
• Juvederm 30 - Used for deeper creases, more prominent facial lines and to add volume to the lips and contours of the face.