Cherry pies and hyaluronic acid technology

Volbella’s FDA approval can’t come soon enough, right?   We need a soft and spreadable hyaluronic acid (HA) filler with a friendlier personality for tear troughs and fine lines. Currently, we have the perfect HA for cheek and chin volume, in Voluma and Lyft, but now we need the perfect match for smoothing fine lines without the immense edema profile like Silk or the hydrophilic pull of Juvederm.

We are ready for you, Volbella!

Forehead rhytids, tear troughs and lips are screaming for Volbella.  With 15 mg/ml HA, it has less HA than other commercially available Allergan prodcuts and will cause less hydrophilic pull.

Let’s review the HA science behind what we currently have available now. I am going to mix the science with a baking analogy.  Stick with me (pun intended here).>There are a few things to remember when speaking about the main differences among HA fillers:  We call these rheologic properties (flow characteristics):

  •  G prime is gel hardness, how well it withstands deformation once it’s placed in the skin or compressed between two plates.  In other words, how hard is your pie?
  • Cohesivity relates to how well does it stick together.  How spreadable is it?  How sticky is your pie?
  • Cross-linking is the bonding of free HA strands to an agent in order to withstand breakdown of hyaluronidase over time.  It’s like the egg yolk, an emulsifying agent, that bridges products together, creating a bond.

 

Juvederm Ultra and Ultra Plus both have 24mg/ml HA.  The higher the HA concentration, the more hydrophilic a gel will be because there is more HA to pull water.  Ninety percent of Juvederm is cross linked, ten percent (2.4mg/ml) is uncross-linked.  Why do we need any uncross-linked HA, you ask? We need a little uncross-linked HA to aid in the extrusion and lubrication of the gel through the needle or cannula.

Juvederm Ultra Plus is harder and more cohesive than Ultra. Clinically, I really like Ultra in the lips because it will hold its specific linear shape well, especially in the vermillion border.   Itt’s not too hard of a gel to manipulate, either.  I don’t like Ultra Plus in the tear trough, for the exact same reason; it’s just too sticky (no spread) and a bit harder.  Ultra does not have a high G prime, nor does ultra plus compared to Voluma products; however, their cohesiveness lends to the way it holds its shape so well.

Ultra and Ultra plus have only high molecular weight HA, and what does that mean?

The cross-linking is like cherry pie lattice crust, all strands in one long piece.  Long pieces of crust, linked together, but with larger, more open areas for pie filling to fill in the spaces. This kind of pie is more sticky, right?  The pie is held together by the loose lattice work but it’s the stickiness of the pie that helps maintain it’s shape.  This is what we call Hylacross technology in the HA world.

 

Fresh Cherry Pie. Hot cherry pie fresh from the oven with lattice on a blue and white gingham background.

Using this same analogy because I love baking pies, let’s think of a cherry pie with more ornate lattice crust work.  This lattice crust is made up of shorter strands and longer strands of crust, therefore more crust forms the top of the pie.  The pie can be seen as harder because the crust work is stronger.  The shape it maintains is from the hardness and denseness of the crust.  Less obey gooey pie filling can get through the tightly knit crust.  This is the technology behind Voluma; it’s harder and less obey gooey than Juvederm.   This is called Vycross technology in the HA world.

 

Delicious homemade cherry pie with lattice isoleted on white

Voluma has less HA per mg, 20mg/ml but has high and low molecular weight chains which creates a tightly knit and smooth gel.  The tighter lattice work does not allow as much hydrophilic pull.  Voluma has a higher G prime (hardness) to maintain its ability to withstand pressure, is less cohesive that Juvederm but has the greatest lifting power of all the three products.  You can build height with Voluma because of it’s ability to be a harder product, just like a ornately constructed pie crust.

How does all this make sense when it comes to Volbella and what we need it to do. Let’s break it down.

Let’s start the HA concentration.

Starting with the highest concentration, Juvederm Ultra and Ultra plus both have 24 mg/mL followed by Voluma with 20mg/mL, then Volift 17.5mg/mL, and lastly Volbella 15mg/mL   (Goodman, 2015).

In reference to G prime or hardness, Voluma has the highest G prime (398 Pa), followed by Volift, then Volbella, Ultra plus and lastly Ultra (207 Pa)  (Goodman, 2015).

Regarding cohesivity, Ultra plus (112 gmf) has the highest cohesivity, followed by ultra, Voluma, Volift and then Volbella (19 gmf)  (Goodman, 2015).

What we need is a lower concentrated HA with high and low molecular weight HA to yield a product with softer G prime and very loose cohesiveness (greater spreading effect). What does my new cherry pie look like?  It has fewer strands of lattice crust (concentration of HA), but the ones it has are long and short in length, giving way to more flexibility to the top of the pie.  It gives more freely under pressure but stays together.  It will maintain it’s shape until pressure is applied, which then it splats out but still sticks together rather than crumbling.

 

cherry pie

 

In all fairness, let’s talk about a different brand of HA fillers and cherry desserts! Not all HA’s are created with the same technology.  Currently, Galderma’s HA products namely Lyft, Restylane and Silk are created with particle size in mind. Particle size reminds me of a crumb cake.  I love crumb cake but under pressure it falls apart, right?  You can create a nice crumb cake with different sizes of crumbs. If you have big crumbs, you have big lift; this is Lyft.  If you have medium crumbs, you have moderate lift, this is Restylane.  If you have itty bitty crumbs, it lays down flatter and smoother, this is Silk.  There isn’t much cohesiveness to crumb cake or Restylane products but that’s why they are adored.  If you want lift with spread ability, you pick Lyft.  The big crumbs give big lift, but with pressure fall apart.  Silk could be the perfect fine line filler if it didn’t swell so badly and lasted longer, right?  The problem with particle size is that doesn’t seem to last as long in the skin under pressure.  In general, Restylane products give a nice initial result but crumble in time.

 

Homemade Cherry crumble and cherries on an old wooden table background.Selective focus.

 

My perfect filler would not be firm or overtly cohesive…it would be a little mini version of Voluma recipe!  This will be Volbella.  When we want a Volbella like product now, we blend Voluma, right? We change the recipe.  We add just enough saline to Voluma to get the consistency of a gel we want, lessening the lifting ability to gain more smoothness,  We blend Juvederm to hydrate and gain less cohesiveness.  My hope is that I can stop blending once Volbella comes out!

I hope my cherry pie analogy is helpful.  Just remember, Juvederm’s long (HMW) strands have more space amongst the coils of strands for hydrophilic pull into the gel.  It’s more cohesive than hard.  Voluma’s long and short chains of HA created a tighter lattice work which creates a harder product without as much fluid pull into the gel.   That, my friend, is baking science 101 for HA fillers!

Who wants a piece of cherry pie now?

References:
Goodman, G. J., Swift, A., & Remington, B.K. (2015).  Current Concepts in the Use of Voluma, Volift, and Volbella, Plastic and Reconstructive Surgery Journal, November Supplement, 139S-148S.
2017-03-06T19:42:28+00:00 By |Training|4 Comments

About the Author:

Haley Wood, offers her cosmetic patients a unique combination of experience, knowledge and personal attention. With almost a decade of experience in the field of Aesthetic Nursing, her areas of expertise include non-surgical facial rejuvenation with her distinctive injection technique.

4 Comments

  1. Rebecca Reinke June 1, 2016 at 10:14 am - Reply

    Love this, Haley.

  2. annie June 3, 2016 at 5:21 pm - Reply

    That was a wonderful breakdown on the what/how HAs work! How is Volbella different from Bolletero (Merz)?

  3. Ashleigh June 9, 2016 at 9:06 pm - Reply

    This was great! 👍🏽

  4. Christian Howell, RN CPSN July 20, 2016 at 10:49 pm - Reply

    Nicely done Haley!

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