Belotero Filler Treatment for Wrinkles and Fine Lines

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Dr. Corey S. Maas shows how Belotero can be used to treat fine lines appearing on the face.

So we have this preparation we're doing with Belotero filler. There's 1 milliliter that's delivered in syringes and even though this has a lower chance of Tyndall effect, according to the studies and even acknowledged by some company executives from the competitive companies, I still like to bring the solution down to around 5 milligrams per deciliter.

So I'm taking basically our connector here and I'm going to put the... connect this and put the Belotero HA into roughly 3 milliliters which is gonna be one part product, 4 parts solution, if you will, and I have four milliliters... dividing that by 4 gives us 22.5 milligrams divided by 4 is in the 5 milligram per deciliter range which is where I feel like it's optimal and then I'm just simply putting this in the solution. I don't think you can do this too much. In fact, I'll often have my assistant sort of sitting in the background doing this sort of mixing between the two syringes and making sure I don't have any parts of the HA that are more concentrated.

And then I'm simply drawing it into my delivery syringe, it's too hard in a big 5 milliliter syringe, and a 30 gauge needle which is really the key for fine lines. And these two little components been very successful for us in the absence of the Cosmoderm product which I think was obviously the ideal product for fine lines and I'm just going to draw this up in to the syringe. And the I'll often have my assistant, actually, will just take a 1 milliliter BD syringe that's got a screwed vessel for the needle on it, a locking vessel.

The key is getting intradermal. I should see a little wheel developing in the skin surface which is an indication that I am intradermal, and the more intradermal we are, the better effacement of the line it is. If I am sub-dermal or even deep dermal, what I'm going to do is push the line towards the surface and not really treat the line itself. And if it develops a little superficial wheel, I'm okay with that but as long as the line is effaced, that is the important thing. And so I'm just doing this with serial point.

Linear threading sounds appealing but it is so hard to do this with linear threading. And I think anybody that remembers the Cosmoderm days, knows that this serial point injection is a far superior way of treating a fine line. And then the patient themselves will massage this when we're done. If there's a little swelling, that's not a problem. If you start near the top of the lip, it's helpful because the indentation comes from the top. Ultimately in a lip like this you're pretty much laying down a layer along the entire upper lip surface intradermally, and that effaces all the lines.

The hydrating affect of the HA is also a large benefit and it really comes down to, in the end, how smoothly you can lay these products down with serial point injections. So I think the more optimal treatment for this is either serial fractional laser resurfacing or full laser resurfacing, which actually works much faster but has longer recovery time. But in the end, this sort of ultra-dilution method and mixing of an HA filler is what I find to me the optimal treatment methodology for perioral and other fine lines frankly. It doesn't have to be just in the perioral area for people who want to do this over being treated with some resurfacing method, all of which I think work very well. Peels, laser, even dermabrasion would work.

Send in questions/photos to

The Maas Clinic
2400 Clay Street
San Francisco, CA 94115
(415) 567-7000






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