Cohesive Polydensified Matrix^® cross-linked hyaluronic acid volumizing gel: a magnetic resonance imaging and computed tomography study

Figures & data

Figure 1 HA gels can be injected in the deep reticular dermis with a 27 or 25 G microcannula.

Notes: Light blue arrows indicate position of HA gel, and red line indicates depth of dermis.
Abbreviation: HA, hyaluronic acid.

Table 1 Definitions used to describe the properties of gels produced with different crosslinking technologies

Crosslinking terminology	Definition
Cohesivity^Citation13^–^Citation15	The force that unites molecules of a gel or a fluid. Cohesivity keeps the gel from spreading in the surrounding tissues.
Elasticity^Citation13^–^Citation15	Physical definition: The resistance to applied shear forces. This value is characterized by the modulus of elasticity, G′. This gel property corresponds to the degree of forward projection or tissue support that the filler can provide Intuitive meaning: The ability for a substance to recover its original shape, after cessation of an externally applied force (eg, a rubber band snapping to its original length)
Plasticity–malleability^Citation13^–^Citation15	Plasticity characterizes the malleability of a substance, in other words the possibility to remodel or reshape it. At present, there is no physical measure or measuring scale for this property
Resistance to dynamic compression^Citation13	Resistance to dynamic compression is described by two notions: elastic modulus E′ (E prime) and normal force Fn The compression parameters have been recently highlighted in the literature for better characterizing the mechanical properties of HA soft-tissue fillers^Citation13 The introduction of these new parameters provided additional tools to study the behavior of fillers (in addition to the data obtained by previous research under shear-stress conditions) The normal force Fn describes the behavior of fillers under static compression stress. The elastic modulus E′ describes the behavior of fillers under dynamic compression condition The knowledge of these new parameters is very important for better predicting the clinical outcomes, especially the volumizing capacity of fillers

Abbreviation: HA, hyaluronic acid.

Table 2 Treatment history of the six subjects injected with CPM HA volumizing gel

Subject	Date	Treated area Injection volume (mL)	Total injection volume (mL)	Needle/cannula Injection technique
CE registration study patients
1	First treatment February 27, 2010	Cheek hollows Right: 0.80 Left: 1.20	Cheek hollows Right: 1.10 Left: 1.70	27 G cannula Retrograde fan technique
	Touch-up June 17, 2010	Cheek hollows Right: 0.30 Left: 0.50		27 G cannula Retrograde fan technique
2	First treatment August 25, 2010	Cheek bones Right: 0.80 Left: 0.80 Upper NLF Right: 0.20 Left: 0.20	Cheek bones Right: 0.80 Left: 0.80 Upper NLF Right: 0.20 Left: 0.20	27 G cannula Retrograde fan technique
3	First treatment June 21, 2010	Cheek hollows Right: 0.80 Left: 1.20	Cheek hollows Right: 1.60 Left: 2.40 Mental crease: 0.30 Tear trough Right: 0.50 Left: 0.50	27 G cannula Retrograde fan technique
	Second treatment November 6, 2012	Cheek hollows Right: 0.80 Left: 1.20 Cheek bones Right: 0.70 Left: 0.70 Mental crease: 0.30 Tear troughs Right: 0.50 Left: 0.50		27 G sharp needle Point by point 27 G cannula Retrograde fan technique
	Third treatment February 17, 2014	Jolidermis^® Volume Cheek bones Right: 1.00 Left: 1.00	Cheekbones Jolidermis^® Volume Right: 1.70 Left: 1.70	27 G cannula Retrograde fan technique
Private patients
4	First treatment November 4, 2013	Cheek hollows Right: 0.80 Left: 0.80 Cheek bones Right: 0.20 Left: 0.20	Cheek hollows Right: 0.80 Left: 0.80 Cheek bones Right: 1.20 Left: 1.20	25 G cannula Retrograde fan technique 25 G cannula Bolus technique
	Second treatment November 18, 2013	Cheek bones Right: 1.00 Left: 1.00		25 G cannula Retrograde fan technique
5	First treatment December 16, 2010	Cheek hollows Right: 0.70 Left: 0.70 Tear troughs Right: 0.10 Left: 0.10 NLF Right: 0.20 Left: 0.20	Cheek hollows Right: 3.00 Left: 3.00 Tear troughs Right: 0.20 Left: 0.20 NLF Right: 0.60 Left: 0.60	25 G cannula Retrograde fan technique 25 G cannula Retrograde linear technique 25 G cannula Retrograde linear technique
	Second treatment February 24, 2011	Cheek hollows Right: 1.60 Left: 1.60 NLF Right: 0.20 Left: 0.20		27 G cannula Retrograde fan technique 25 G cannula Retrograde linear technique
	Third treatment September 1, 2011	Cheek hollows Right: 0.70 Left: 0.70 Tear troughs Right: 0.10 Left: 0.10 Upper NLF Right: 0.20 Left: 0.20		27 G cannula Retrograde fan technique 27 G cannula Retrograde linear technique 25 G cannula Retrograde linear technique
6	First treatment February 28, 2010	Cheek hollows Right: 2.00 Left: 2.00	Cheek hollows Right: 2.00 Left: 2.00 Cheek bones Right: 0.70 Left: 0.70 Marionette lines Right: 0.30 Left: 0.30	27 G cannula Retrograde fan technique
	Second treatment June 27, 2012	Cheek bones Right: 0.70 Left: 0.70 Marionette lines Right: 0.30 Left: 0.30		27 G cannula Retrograde fan technique

Abbreviations: CPM, Cohesive Polydensified Matrix^®; HA, hyaluronic acid; NLF, nasolabial fold.

Figure 2 Subject 1 before treatment (A) and 48 months (B) after injection of CPM HA volumizing gel.

Abbreviations: CPM, Cohesive Polydensified Matrix^®; HA, hyaluronic acid.

Table 3 Amount of product injected and estimated remaining amount (mL)

	Magnetic susceptibility artifact			Total amount injected (mL)	Estimated remaining amount (mL)
	Flair	EG 3D-T1	3D-T2 FS
Subject 1	NA	NA	NA
Cheek hollow
Right				1.10	0.90
Left				1.70	1.60
Subject 2	R–/L+++	R+/L++	R–/L+
Cheek bone
Right				0.80	–
Left				0.80	0.20
Upper NLF
Right				0.20	–
Left				0.20	0.15
Subject 3	R+++/L–	R++/L–
Cheek hollow
Right				1.60	2.10
Left				2.40	–
Mental crease				0.30
Cheek bone
Right				1.70	1.40
Left				1.70	–
Tear trough
Right				0.50	0.41
Left				0.50	–
Subject 4	R++/L+++	R+++/L+++	R++/L+++
Cheek hollow
Right				0.80	0.70
Left				0.80	0.65
Cheek bone
Right				1.20	1.15
Left				1.20	0.80
Subject 5	R++/L++	R+++/L+++	R++/L++
Cheek hollow
Right				3.00	2.50
Left				3.00	2.00
NLF
Right				0.60	0.60
Left				0.60	0.70
Tear trough
Right				0.20	0.30
Left				0.20	0.40
Subject 6	R+++/L+++	R+++/L+++	R+++/L+++
Cheek hollow
Right				2.00	1.60
Left				2.00	1.70
Cheek bone
Right				0.70	0.50
Left				0.70	0.40
Marionette lines
Right				0.30	0.10
Left				0.30	0.10

Abbreviation: 3D-T1, T1-weighted 3D images; 3D-T2, T2-weighted 3D images; FS, fat saturation; NA, not applicable; NLF, nasolabial fold; –, no treatment.

Figure 3 Axial T2 image showing HA in nasolabial folds.

Notes: A slight extension of the product in the subcutaneous fat of the cheek and along branches of the facial vein and artery on the left side of the face can also be observed.
Abbreviation: HA, hyaluronic acid.

Figure 4 Axial T2 images with fat signal removed.

Notes: In the right panel, the injected product residue is circled. Diffusion of the gel into the deep fat compartment was observed, particularly on the left side. This may have been due to subcutaneous injection in the nasolabial folds. A small amount of product was also found to have diffused along the vessels.

Figure 5 Subject 5 before treatment (A) and 15 months (B) after injection of CPM HA volumizing gel.

Abbreviations: CPM, Cohesive Polydensified Matrix^®; HA, hyaluronic acid.

Figure 6 Axial T2 image of Subject 5 showing diffusion of HA gel into the deep fat compartment and along the vessels, most notably on the left side.

Abbreviation: HA, hyaluronic acid.

SundaramHRohrichRJLiewSCohesivity of hyaluronic acid fillers: development and clinical implications of a novel assay, pilot validation with a five-point grading scale, and evaluation of six U.S. Food and Drug Administration-approved fillersPlast Reconstr Surg2015136467868626397245

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