By Dr. David Deng
The latest BDDE-free injectable hyaluronic acid available in Aesthetic Medicine aims to bioremodel the skin to restore elasticity and provides deep hydration at the same time. It is an ultra-pure grade hyaluronic acid (HA)A which does not contain the chemical cross-linking compound 1,4-butanediol diglycidyl ether (BDDE), produced through a patented bio-fermentation process. The formulation of HA with different molecular weights (H-HA and L-HA) contained in this product is based on the concept of Hydrolift® Action. This innovative approach is aimed at counteracting the reduction of HA in the skin, treating fine lines and wrinkles by restoring elasticity (H-HA) and providing deep hydration (L-HA).
Where can this be injected?
The Bio Aesthetic Points (BAP) technique is developed specifically to treat the face and neck. This injection technique involves 10 injection points (5 per side of the face) and similarly for the neck. It can also be used to treat the décolletage, hands and knees.
This product has to be injected in the deep dermal plane to provide maximum bio-stimulation. Therefore, some resistance is to be expected during injection of the product. If the product is injected in the correct plane, a bleb will be seen. If blanching is seen instead, the product is injected too superficially in the epidermis.
Who is suitable for this treatment?
Generally, patients who are in their 30’s and onwards are suitable candidates for this anti-ageing preventive treatment to maintain good skin health. Significant loss of HA, collagen and elastin start from the age of 30. Some younger patients who start to notice the first signs of skin laxity and ageing can have this treatment performed earlier.
As with all aesthetic treatments, a consultation is important to assess suitability of this treatment. In essence, if skin laxity and dry skin are the main concerns, this is an ideal treatment with low downtime and good results.
In certain circumstances, we can also advice patients to have this treatment performed first or in combination with other treatments such as lasers for pigmentation and scar resurfacing or high-intensity focused ultrasound (HIFU) for soft tissue laxity, to enhance results from these treatments.
How does this treatment compare to dermal fillers?
For patients who are new to aesthetic treatments and want a subtle improvement in their appearance by first rejuvenating the skin, this treatment will be more suitable as compared to dermal fillers which aim to replace volume loss from ageing.
However, if there is also significant facial volume loss or deep folds in addition to ageing skin, combination treatment with fillers for volumization may be required to yield more significant results.
How many treatment sessions are needed?
A comprehensive treatment consisting of two sessions spaced approximately 4 weeks apart. In each session, 2ml of product is injected using the BAP technique. In cases of more severe skin laxity, a third session may be recommended. Thereafter, maintenance treatment is performed at 6 monthly intervals.
What results can be expected?
As this latest injectable HA has one of the highest concentrations of HA (64mg/2cc) in the current aesthetic market, the stabilised HA lasts in the skin for about 4 weeks. It diffuses within the soft tissues right after injection, gradually hydrating the skin and improving skin elasticity over the course of 4 weeks. Individuals may notice that their skin becomes more hydrated and dewier from as soon as 1 to 2 weeks post-treatment. Improvement in fine lines and tightening of the skin occur over the course of 4 weeks with best results being evident from 8 weeks onwards. These anti-ageing effects can typically last 9 months or longer.
As with most aesthetic treatments, results will vary from person to person and depends upon the frequency of treatments, an individual’s skin age, lifestyle, and body’s response to treatment.
What are the pre-treatment requirements?
A prior facial assessment is needed to assess suitability for this treatment and to address any concerns that one might have with regards to the treatment. As with all injectable treatments, to minimise the risk of bruising, we should advice patients to avoid non-steroidal anti-inflammatories (NSAIDs), blood thinning medications such as aspirin and nutritional supplements such as vitamin E and fish oil for at least 10 days pre-treatment.
Is this treatment safe?
This latest HA product is highly bio-compatible and therefore safe. It is made from highly purified natural HA and stabilised without the addition of the chemical cross-linking agent BDDE. Non BDDE cross linking allows for the product to be highly spreadable in the soft tissues and hence reduces risk of long term lumpiness forming as compared to most HA fillers which contain BDDE.
What are the side effects?
As with any injectable treatment, there is a small risk of swelling and of bruising if small vessels are encountered during injection. If these occur, they are usually minor and will resolve in a couple of days with proper post-treatment aftercare prescribed.
How is the downtime like?
Downtime is minimal as the BAP technique only requires a minimal 10 injection points for the face and neck respectively. It is normal for there to be small blebs at the injection sites post-treatment as the product is to be injected intradermal. These blebs usually resolve in a few hours. In a handful of instances, the blebs can last up to 24 hours post-injection.
What is the appropriate aftercare?
After treatment, patients should be advised to:
- Not touch or apply makeup on the injection points for at least 24 hours to avoid infection.
- Avoid heavy exercise, alcohol intake, NSAIDs, blood thinning medications and nutritional supplements that can predispose to bleeding for at least 48 hours post-treatment to prevent bruising.
- Avoid UV exposure and apply sunscreen with at least SPF 40 protection to minimise the risk of post-inflammatory hyperpigmentation over the injection points.