1. Botuline-A-Neuromodulators
  2. Hyaluronic acid
  3. Radiesse
  4. Combination Therapies


Wrinkles are a cause of dynamic muscular activity. However, a drug can be administered that allows for muscles to have less pull on the skin. Botulinum-A toxin creates a temporary reduction of nerve substances that allows for the tightening of the local muscle. The nerve (neuron) function is temporarily modulated (weakened). Because of the resulting decrease of muscle contractions, there is less pull on the skin, causing wrinkles to fade.

At Pasman Esthetics we use two TOP class products from this range of medications. Namely BOTOX® and Bocouture®.

Below you may read the instructions for BOTOX® and Bocouture®.


What is this medicine used for?

Bocouture is a muscle relaxant.

It works by blocking nerve impulses in all the injected muscles. This prevents the muscles to contract, resulting in a temporary and reversible slack. Bocouture is used for the temporary improvement of dynamic wrinkles in adults between 18 and 65 years.

When should this medicine not be used or when should you be extra careful?


  • Hypersensitivity to the active substance or to any of the excipients
  • Generalized disorders of muscle activity (e.g. myasthenia gravis, Lambert-Eaton syndrome)
  • Presence of infection or inflammation at the proposed injection site.

Be extra careful with Bocouture

There have been very rare reports of undesirable effects that might be related to the spread of the toxin to sites far from the injection site. Patients treated with therapeutic doses may experience exaggerated muscle weakness. The injection of BOCOUTURE is not recommended for patients with a history of dysphagia and aspiration.

The safety and efficacy of BOCOUTURE for the treatment of vertical lines between the eyebrows or lateral periorbital lines seen at maximum smile has not been studied in individuals younger than 18 years old. Therefore, the use of BOCOUTURE in individuals under the age of 18 is not recommended. There are limited clinical data from phase 3 studies of BOCOUTURE in patients over 65 years of age. Until further studies have been conducted in this age group, BOCOUTURE is not recommended for use in patients over 65 years of age.

Too frequent or too high doses may increase the risk of antibody formation, which can result in treatment failure even if the product is being used to treat other indications

Inform your doctor:

  • if bleeding disorders of any type are present
  • in case you are receiving anticoagulant therapy or taking other substances in anticoagulant dose
  • in case there are problems with the targeted muscles which display pronounced weakness or atrophy.
  • in case you are suffering from amyotrophic lateral sclerosis or other diseases which result in peripheral neuromuscular dysfunction
  • In case you have or had trouble swallowing
  • In case of past problems when botulinetoxine type A was injected
  • In case a surgical procedure has been planned.

Repeat injections with Bocouture

In case you have received repeated injections of Bocouture, the effect may increase or decrease. Possible reasons are:

  • Your doctor may follow a different procedure in the preparation of the solution for injection
  • Injections into another muscle
  • Non-response / failure of the treatment in the course of the treatment

Your doctor will explain and discuss the causes with you.

Patients or caregivers should be advised to seek immediate medical care if swallowing, speech or respiratory disorders arise

Usage with other medicines

Inform your doctor or pharmacist in case you are taking or have recently taken other medications. This includes medicines obtained without a prescription.

The effect of Bocouture can increase in case:

  • medicines are used to treat certain infectious diseases (spectinomycin off aminoglycoside antibiotics [eg. neomycin, kanamycin, tobramycin])
  • other drugs that relax the muscles are used (eg. muscle relaxants of the tubocurarinetype). Such drugs are for example used in general anesthesia. Before undergoing surgery, let your anesthesiologist know that you've been treated with Bocouture.

In these cases, Bocouture should be used carefully.

The effect of Bocouture can decrease in case:

  • certain drugs for malaria and rheumatism (known as aminoquinolines).

Fertility, pregnancy and lactation

There are no adequate data from the use of Botulinum neurotoxin type A in pregnant women. Studies in animals have shown reproductive toxicity. The potential risk for humans is unknown. Therefore, BOCOUTURE should not be used during pregnancy unless clearly necessary.

Effects on ability to drive and use machines

BOCOUTURE has a minor or moderate influence on the ability to drive and use machines. There is a potential risk of localised muscle weakness or visual disturbances linked with the use of this medicinal product which may temporarily impair the ability to drive or operate machinery.

Individuals who drive vehicles and operate machines should be informed of the possible risks of asthenia, muscle weakness, dizziness and vision disorders, which could be caused by this medicinal product and could make it dangerous to drive vehicles or operate machinery.

How to use this medicine?

Bocouture should only be administered by doctors who have the appropriate specialist knowledge in the field of treatment with botulinum toxin. Your physician will inject the recommended volume of Bocouture in each of the injection sites. The total dose may be increased by the physician if the individual needs of the patient require it, on condition that a period of at least 3 months between the various treatments exists.

Dissolved Bocouture is intended for injections into the muscle. A reduction of the dynamic wrinkles typically occurs after three to five days, wherein the maximum observable effect is observed after day 10. The effect lasts for up to 4-5 months after the injection. The interval between two treatments should not be shorter than three months.

What to do in case you've received more Bocouture than you should

Symptoms of overdose:
Increased doses of Botulinum neurotoxin type A may result in pronounced neuromuscular paralysis distant from the injection site. Symptoms of overdose are not immediately apparent post-injection and may include general weakness, ptosis, diplopia, speech difficulties, paralysis of the respiratory muscles and swallowing difficulties which may result in an aspiration pneumonia.
Measures in cases of overdose:
In case of an overdose, the patient must be monitored medically for several days. If signs of intoxication appear, hospitalisation with general supportive measures is necessary. Intubation and assisted ventilation will become necessary until improvement if paralysis of the respiratory muscles occurs.

In case you have any further questions about the usage of this medicine, ask your doctor or pharmacist.

Possible side effects

As with all medicines Bocouture can cause side effects, although not everybody gets them. Global reports include the following:

An allergic reaction may occur with Bocouture. An allergic reaction can cause any of the following symptoms:

  • Difficulty in breathing, swallowing or speaking, due to swelling of the face, lips, mouth or throat.
  • Swelling of hands, feet or ankles.

If you have any of these side effects, please immediately notify your doctor or go to the emergency department of the nearest hospital.

Side effects may be related to the drug, injection technique or both. Botulinum-A toxin causes localized muscle weakness at injection sites. Drooping eyelids may be due to the injection technique and the effect of the drug. The side effects usually occur in the first week after injection and are temporary in nature.

The following reactions may develop at the injection site:

  • Pain
  • Sensitivity
  • Itch
  • Localised swelling
  • Bruising

Patients who fear injections, may suffer from the following temporary general effects:

  • Fainting
  • Circulation problems
  • Nauseousness
  • tinnitus

Other possible side effects

Based on clinical experience, information on the frequency of undesirable effects is given below. The frequency categories are defined as follows:

Very common: affects more than 1 in 10 users
Common: affects 1 to 10 in 100 users
Rare: affects 1 to 10 in 1000 users
Very rare: affects less than 1 in 10.000 users
Not known: can not be estimated from the available data

The following adverse reactions were observed when Bocouture was used to treat the vertical lines between the eyebrows. As an addition the side effects are announced which have been reported with a comparison product. This product contains conventional Botulinum toxin type A complex, which was used in some clinical trials of Bocouture.

These side effects are marked with an asterisk (*). It is possible that these effects also occur in Bocouture.


  • Headache
  • Disturbances in muscle activity (raised eyebrows)
  • A heavy feeling in the upper part of the face


  • eyelid oedema
  • Facial paresis (brow ptosis)
  • Infection of the eyelid*
  • Eye pain*
  • Blurred vision
  • Vasovagal syncope (fainting)
  • Tinnitus
  • Nausea
  • Dizziness*
  • Muscle twitching
  • Muscle cramps
  • Localised facial muscle weakness (drooping eyelids)
  • Dry mouth*
  • Influenza like illness
  • Bronchitis
  • Infection of throat and nose
  • Infections*
  • A tight feeling at the injection site
  • paraesthesia (tingling) at the injection site
  • photosensitivity*
  • Dry skin*
  • Skin nodules
  • Pruritus (itchiness)
  • Fatigue
  • Depression
  • Insomnia

Reporting suspected adverse reactions after authorization of the medicinal product is important. It allows continued monitoring of the benefit/risk balance of the medicinal product.

There have been some rare reports of localized allergic reactions, such as swelling, redness, itching or a rash, after the treatment of vertical lines between the eyebrows and other disorders.

The following very rare side effects have been observed during treatment with botulinum toxin for other conditions than vertical lines between the eyebrows:

  • Excessive muscle weakness
  • Swallowing difficulties
  • Swallowing difficulties which cause inhalation of foreign bodies, leading to pneumonia and, in some cases, death.

Such side effects are caused by the relaxation of the muscle far from the site of injection. They can not be completely ruled out when using Bocouture.

In case you have trouble swallowing, trouble with speech, have difficulty breathing, or if you suffer from any of the previously mentioned side effects, seek medical attention immediately or ask your relatives to do so.

Additional information

What is in Bocouture?

  • One vial contains 50 LD50 units* of Botulinum toxin type A (150 kD), free from complexing proteins. 0.1 ml solution contains 4 LD50 units* of Botulinum toxin type A (150 kD), free from complexing proteins when reconstituted in 1.25 ml.
  • Other excipients are: Human albumin, sucrose.

What does Bocouture look like and what are the contents of the packaging?

Bocouture is provided as a soluble, white powder for injection. If one dissolves the powder, a clear, colorless solution without particles is obtained.

Merz Pharmaceuticals GmbH
Eckenheimer Landstraße 100 60318 Frankfurt/Main Duitsland
P.O. Box 11 13 53 60048 Frankfurt/Main Duitsland
Tel: +49-69/15 03-1 Fax: +49-69/15 03-200
Merz Pharma GmbH & Co. KGaA
Eckenheimer Landstraße 100
60318 Frankfurt/Main
Tel: +49-69/15 03-1
Fax: +49-69/15 03-200
This medicine is authorized in the European Union under the name Bocouture.


What is this medicine used for?

Medicine Group: Botulinum toxin type A, the active ingredient of BOTOX, belongs to a group of drugs that is referred to as muscle relaxants..

Application of the product: BOTOX is used in both cosmetic medicine as well as in mainstream medicine for patients suffering from spasms of the face, one or more cramped muscles or sustained excessive sweating under both armpits that interferes with everyday life, in children with cerebral palsy, and in adults with local spasticity of hand and wrist as a result of a stroke (stroke, cerebral infarction), patients with overactive bladder with leakage of urine, sudden urge to empty the bladder and for whom other medicines (anticholinergics) do not help and leakage by a neurogenic bladder.

When should this medicine not be used?

  • in case you are allergic (hypersensitive) to botulinum toxin type A or to any of the other ingredients of BOTOX;
  • in case you suffer from a muscle disease such as myasthenia gravis or Eaton Lambert Syndrome;
  • in case you have an infection at the site of injection;

Take special care with BOTOX:

Adverse reactions possibly related to the spread of the toxin to areas of the body other than the site of administration with botulinum toxin are very rarely reported (for example, muscle weakness, impaired breathing, difficulty swallowing / aspiration of food or liquid).

Inform your doctor:

  • in case you have had trouble previously with receiving multiple injections into the muscles
  • in case you suffer from inflammation in the muscles or the proposed injection site (s)
  • in case you have had problems with swallowing, breathing disorders or aspiration (inhaling food or liquid in the airways)
  • in case you have glaucoma
  • in case you have had surgery or injury) to the head, neck / neck, legs or chest
  • in case you will soon undergo surgery
  • in case you previously had an allergic reaction after injection of botulinum toxin type A

Visit your doctor immediately:

  • if problems arise after treatment when swallowing, speaking or breathing
  • in case there is a severe allergic reaction

Usage with other medicines

Drugs that affect the signal transmission from the nerve to the muscle can influence the effect of BOTOX. Examples of these medicines include:

  • Antibiotics (used in infectious diseases)
  • Lithium salts (used to prevent mood changes)
  • Benzodiazepines (used for sleep disorders, anxiety and feelings of stress)
  • 4-aminopyridine (used to remove effects of certain muscle relaxants)
  • Guanidines (used to treat moderate to severe high blood pressure)
  • Corticosteroids (mostly used because of their anti-inflammatory and anti-allergic effect)
  • Cholinesterase inhibitors (used as a muscle relaxant)

A doctor must take into account the fact that BOTOX is used and adjust the dosage or the drug. Caution should be exercised when the following drugs are used:

  • muscle relaxants
  • antibiotics: polymyxine, tetracycline en lincomycine
  • Other medicines containing botulinum toxin may enhance the effect of BOTOX.
  • Inform your doctor if you are taking antiplatelet agents (aspirin-like products) and / or anticoagulants (blood thinners).
  • Inform your doctor if you are taking or have recently taken any medications. This includes medicines obtained without a prescription.

Pregnancy and lactation

There is insufficient data available regarding the safety of the use of BOTOX during pregnancy. The use of BOTOX should be avoided during pregnancy and during lactation. If you are pregnant or become pregnant while being treated, your doctor will discuss with you whether you should continue treatment.

There is insufficient data available regarding the safety of the use of BOTOX during lactation. The use of BOTOX should be avoided during pregnancy and during lactation.

Effects on ability to drive and use machines

Due to the nature of the diseases that BOTOX is used for, it is not possible to predict what effect BOTOX has on your ability drive or your ability to operate machinery. People who drive or operate machinery should be well informed about the risk of this medicine. Weakness (asthenia), local weakness, may cause dizziness or visual disturbances, which can make it dangerous to drive or operate machinery. If you are experiencing any of the above symptoms, do not drive or operate machines until these symptoms have disappeared. In some cases, you should consult with your doctor.

How to use this medicine?

BOTOX is intended for the injection into skeletal muscle, in the bladder wall via a specific instrument (cystoscope) or for injection into the bladder. It is also used in cosmetic medicine to treat excessive sweating, dynamic wrinkles and beautify facial symmetry.

There is no difference in dosage for the elderly.

BOTOX should only be administered by physicians with proven skill and expertise in the treatment area and the associated equipment. The dosage is determined by patient

What to do in case you have received too much BOTOX

Symptoms of overdose:
Symptoms of overdose are not immediately apparent post-injection and may include general weakness, drooping eyelids, double vision, breathing, swallowing and speech difficulties, and pneumonia.
Measures in case of overdose:
In case you have symptoms of overdose, seek immediate emergency medical attention or ask your relatives to do so. Medical supervision for several days and artificial respiratory support may be required.

In case you have any questions about using this medicine, ask your doctor or pharmacist.

Possible side effects

The evaluation of adverse reactions is based on the following frequencies:
Very common: affects more than 1 in 10 users
Common: affects 1 to 10 in 100 users
Rare: affects 1 to 10in 1000 users
Very rare: affects less than 1 in 10,000 users
Not known: can not be estimated from the available data

As with all medicines, BOTOX can cause side effects, although certainly not everybody gets them. Adverse reactions, possibly related to the spread of the toxin to areas of the body other than the site of administration with botulinum A toxin are very rarely reported (eg muscle weakness, difficulty swallowing or pneumonia by food or liquid in the respiratory tract, which can be fatal in some cases). Administering injections with BOTOX is not recommended in patients with a history of dysphagia (difficulty swallowing) and in patients with impaired swallowing. Rare reports have been made of irregular heartbeat and heart attacks, some of these patients have deceased. A number of these patients already suffered from heart disease. After injection of botulinum A toxin, heart failure can not be ruled out in patients with heart failure.

In general, adverse reactions occur within the first few days after administration and are transient. In rare cases, side effects can take several months or longer. Adverse reactions usually occur by diffusion of the toxin to other adjacent muscles, or by the administration of too large amounts. In both cases, this may result in a temporary weakening of these muscles. With each injection, it is probable that localized pain or bruise forming occurs.

The following adverse reactions were observed when Botox was used to treat the vertical lines between the eyebrows. These side effects are marked with an asterisk (*). It is possible that these effects also occur in Botox.


  • Headache
  • Disorders of muscle activity (raised eyebrows)
  • A heavy feeling in the upper part of the face
  • Accumulation of fluid in the eyelids (eyelid edema)
  • Drooping eyelids (ptosis of the eyelid)
  • Inflammation of the eyelid*
  • Eye pain*
  • Blurred vision
  • Fainting
  • Tinnitus
  • Nausea
  • Dizziness*
  • Muscle twitching
  • Muscle cramps
  • Localized weakness in the face (drooping eyelids)
  • Dry mouth*
  • Flu-like symptoms
  • Flu (influenza)
  • Bronchitis
  • Inflammation of the nose and throat
  • Infections*
  • A tight feeling at the injection site
  • Itching or bruising at the injection site
  • Tingling sensation*
  • Sensitivity to light*
  • Dry skin*
  • Skin nodules
  • itch
  • Fatigue
  • Depression
  • Insomnia

If any of the adverse effects deteriote or if you notice any side effects not listed in this product information, consult with your doctor. There have been some rare reports of localized allergic reactions, such as swelling, redness, itching or a rash, in the treatment of vertical lines between the eyebrows and other disorders.

The following very rare side effects have been observed during treatment with botulinum-A toxin from conditions other than treatments of vertical lines between the eyebrows:

  • Excessive muscle weakness
  • Swallowing difficulties
  • Swallowing difficulties which cause inhalation of foreign bodies, leading to pneumonia and, in some cases, death.

Additional Information

What is in BOTOX

  • The active substance is botulinum toxin* type A. Each vial contains 50 Allergan units of botulinum toxin type A from the bacterium Clostridium botulinum.
  • Other constituents are human albumin, and sodium chloride.

BOTOX contains human albumin. Like all medicines made from human blood, there is a possibility to transfer infections. To reduce this risk, blood donors are chosen very carefully. Virus inactivation procedures are involved in the production process.

What does BOTOX look like and what are the contents of the packaging?

BOTOX is a white powder and is supplied in a transparent glass vial.
Each vial contains 50 Allergan units of botulinum toxin type A.
Each pack contains 1 vial.
Allergan Pharmaceuticals Ireland
Castlebar Road
County Mayo
For information and correspondence:
Allergan n.v., Terhulpsesteenweg 6D, B-1560 Hoeilaart, België.
Registered under RVG 32957
These instructions were last revised in October 2013

Hyaluronic acid, the number 1 anti-wrinkle ingredient

Do you know why baby skin always feels so wonderfully plump and soft? Besides a high concentration of subcutaneous fat, babies are born with a high concentration of hyaluronic acid. Both compounds provide an attractive full and smooth skin. Unfortunately, the amount of hyaluronic acid disappears into the skin as you age. Especially after your 40th birthday this loss is significant.

Is Hyaluronic acid a naturally occurring substance in the human body?

Hyaluronic acid is a naturally occurring sugar (= polysaccharide) in the human body. It exists in several places but has a strong preference for connective tissue, nerve tissue, and in the skin. Hyaluronic acid is one of the main components of the extra-cellular matrix, the tissue that provides structural support to cells within the human body. The average person has approximately 15 grams of hyaluronic acid in his / her body, of which one-third is converted (degraded and tempered) daily.

Why is hyaluronic acid important for the skin?

When aging your skin is unable to hydrate itself properly, resulting in a loosening of the skin (increased laxity). This loosening makes wrinkles and folds appear on the skin. Hyaluronic acid plays a critical role in this process. Because of its unique properties, healthy skin is able to bind large amounts of water. 1 gram of hyaluronic acid is able to bind from 1 and up to 6 liters of water to itself. It possesses a functional system that can adjust the speed to hydrate the skin on the basis of the humidity.

Furthermore, it plays an important role in the production of collagen. Collagen is an important protein that significantly supports skin structure. If the amount of collagen in the skin reduces, wrinkles form and more discoloration of the skin becomes visible. In contrast, an increase in collagen provides for a smooth and flexible skin. An increase of hyaluronic acid also partly allows for an increased production of collagen so that the moisture content continues to support a healthy skin.

You will never have that perfect baby skin again but it is possible to recover the amount of hyaluronic acid in your aging skin, providing a younger, more fresh look. The best means of achieving this is by injecting the correct hyaluronic acid filler.

Is it harmful to the body when injected?

Hyaluronic acid in principle causes no allergic reactions. In the past, hyaluronic acid was extracted from rooster combs which could have been the cause of an allergic reaction on the basis of the presence of chicken protein. Nowadays it is manufactured, aided by biotechology, just like medications are made. After a period of time it is degraded naturally by your body's own enzymes, the hyaluronidase enzymes.

How long can I enjoy the results of my treatment?

Depending on the thickness of the hyaluronic acid filler the cosmetic effect remains visible between six and eighteen months. There are many hyaluronic acid-fillers for sale which differ in physical and chemical properties. The many variables contribute to the ultimate performance of the agent. The anatomical sites to be treated largely determine which filler can be used. A thick, volumizing filler for instance should not be injected into a tissue area where many blood vessels and nerves pass through. This would put too much pressure on these structures with potential complications as a result. It is better to choose a thin hyaluronic acid in this scenario. The thickness of a hyaluronic acid-filler is determined by the concentration of hyaluronic acid and by the properties of the gel.

At Pasman Esthetics we have chosen the safest fillers that give the best results. We find it highly important that you are treated with top class products only, thus we work closely with the leading manufacturers in the industry.

Can I receive a second treatment?

Yes, you can be treated several times with a hyaluronic acid filler without any problems. Often it appears that repeated injections require less and less hyaluronic acid filler to achieve the desired effect. If you regularly repeat the treatment a good base concentration in the skin remains resulting in the skin to maintain its elasticity and hydration better. This keeps your skin at its best!

Benefits of Hyaluronic Acid by UVB Sun Protection

Some of the most damaging elements to the skin are the Ultra Violet-B rays from the sun. A healthy amount of hyaluronic acid provides a protective effect against the dangers of too much UVB radiation. UVB namely creates skin-damaging molecules which can be neutralized by hyaluronic acid. (In medical terms ensures hyaluronic acid for an anti-oxidative protection against free radical damage, thereby reducing the inflammation) If that does not happen, for example, by a shortage of hyaluronic acids, rise to the so-called sun spots in the skin.

What are the prime reasons for injection of Hyaluronic acid?

Creams and serums are on the market that contain with hyaluronic acid or hyaluronic acid salts. Unfortunately, these can not reach the deeper layers of the skin because the function of the skin acts as a barrier function. The only thing these creams can offer is an additional treatment of the superficial outer layers of the skin, the small scratches and fine lines. The injection of hyaluronic acids is intended for the treatment of deep wrinkles and to restore the loss of volume of the tissue.

On what locations can hyaluronic acid be injected into the face?

Hyaluronic acid fillers may be injected into the face at many different places. Depending on the desired cosmetic effect it is injected into the superficial or into the deeper layers of the skin. It can be injected from the forehead all the way down to the chin, from the nose to the lips and even the ears can be treated.

Can it only be injected into the face?

No, other parts of the body can be treated with hyaluronic acids as well, though only in specific cases.

What brands of hyaluronic acid fillers are used in our practice?

Pasman Esthetics uses the following brands:

Do you have more questions about hyaluronic acid fillers?

Please contact Pasman Esthetics and be informed extensively what hyaluronic acid fillers could mean for you.

Other functions of hyaluronic acid

Hyaluronic acid has various functions inside the human body, utilizing the numerous different chemical and physical properties of this compound.

Hyaluronic acid supports the soft-tissue function by means of:

  1. water retention
    Examples of this are the support joints, the resilience of cartilage, the vitreous humor of the eye (2% of the total of hyaluronic acid + 98% water)
  2. pressure resistance
    Water is only slightly compressible and passes this property also to hyaluronic acid-rich tissue, by binding a large amount of water (as mentioned above). This is true in general for large parts of the connective tissue. Another well-known example is the nucleus pulposus, the jelly-like core of the intervertebral discs, which thus are able to carry a large part of the body weight.
  3. Lubricant and padding function
    Hyaluronic acid is the main component of the synovial fluid and acts as a lubricant during all joint movements. The viscosity changes under the influence of certain mechanical forces. To be more precise, the viscosity decreases as the load becomes heavier. It is liquid, but due to the high molecular weight structure it is viscous enough not to be squeezed out of the joint and thus it carries out a padding function in the joint.
  4. Keeping clear of cellular "roads"
    For migrating ("walking") cells, hyaluronic acid maintains the "roads" free by widening of the intercellular space (distances between the cells). This ensures the migration of cells is supported.

Radiesse, a filler with collagen stimulating properties

The Filler used by CELEBS!

Some celebs just look too good for their age. You know that they have done something about their wrinkles, but you can not say exactly what. Usually the filler Radiesse is the answer. For example, the wrinkle-free skin of mega star Jennifer Lopez has been often associated with the filler Radiesse.

Why is it so successful?

Although Radiesse was initially fabricated in 1995 as an agent for the treatment of urinary incontinence, Italian physicians began using it in 2001 for cosmetic facial treatments. From 2004, Radiesse gets licensed officially to be used medically as a skin filler for cosmetic medicine. In 2010 Radiesse is included in the portfolio of cosmetic firm Merz and it grows into a worldwide success. To date, more than 5M units have been sold! In addition to many (inter) national winning titles for "Best filler" in the last few years, 191 medical papers have been published, more than any filler to date! Radiesse has proven its value within the extensive range of cosmetic fillers as the ultimate means for the liquid facelift.

Why is collagen so important?

In healthy young skin collagen account for 70% of the weight of your skin. But as we get older, the skin quickly loses its organized structure and the activity of the fibroblast cells reduces. Fibroblasts are cells in the skin that are responsible for the production of collagen. A decrease of this fibroblast activity leads to a reduction of the collagen production so that the skin-structure collapses. The supporting tissues decay; it loses its stability and support, and the skin wrinkles. Your skin becomes weak, dehydrated and gets a translucent parchment like color.

What is the composition of Radiesse?

Radiesse contains 70% glycerine-water-methyl cellulose-Gel and 30% particles consisting of Calcium hydroxylapetite (CaHA). CaHA is a natural component in the human body and is a constituent of your bones and teeth. The Gel-components are used around the world, inter alia, in pharmaceutical and medicinal prostheses which have been deemed safe by the FDA.

The double effect of Radiesse as a cosmetic filler.

When Radiesse is used as a cosmetic dermal filler, it has a double effect. On the one hand the gel makes for an increase in volume of your skin and thus reduces wrinkling. On the other hand, the CaHA particles promote production of all important collagen fibers. This new network creates a firmer skin structure and tighter facial contours. The wrinkles are lifted and your skin will regain its healthy youthful appearance. Radiesse is your skin enhancer for the longer term and thus fits into the cosmetic palette of the liquid facelift.

Are there problems to be expected with the degradation of Radiesse?

No; the cellulose-gel-matrix is broken down in the basal components of glycerine and water and are recycled or excreted through the body in a natural way. The CaHA particles are broken down into calcium and phosphate molecules by the cells of the immune system These are also recycled naturally within the body. We can therefore speak of a safe bio-compatible agent.

Safety Profile

Radiesse has the same safety profile as cosmetic hyaluronic acid fillers. Long-term studies (respectively 39 and 52 months) have demonstrated that adverse effects are very limited and are often traced to injection-related events.

When should you choose Radiesse?

Radiesse is a safe and versatile soft tissue filler with an average durability of between one and two years, resulting in high client satisfaction. These properties make Radiesse the product of choice for patients with skin problems, for example:

  • the center part of the face (cheeks)
  • reduction of subcutaneous fat (lipoatrophy)
  • reduction of the subcutaneous cell-matrix
  • strong wrinkling at an early age
  • decrease of the contour of the jaw line
  • Skin Recovery in other areas such as the neck, decollete, hands, earlobes etc.

The three V’s of Radiesse:

Volume recovery, with immediate 1: 1 correction
Value for money, by prolonged operation
Versatility, because of the correction of the supporting fabric by a double action

When NOT to use Radiesse?

Radiesse is a fairly thick filler and thus has some limitations

Usage is not recommended for:

  • The lips; these contract often allowing a greater risk of clots.
  • The tear trough, with its many delicate structures has an increased chance of compression.
  • In case you suffer from a skin infection until the infection is resolved

The usage is contraindicated in:

  • the Glabella (area between the eyes and the eyebrows); a thicker filler creates a higher risk for blood flow disorders due to compression of the blood vessels.
  • The presence of previously applied permanent fillers combined with Radiesse can cause a significant inflammatory response.
  • Patients with severe allergies manifested by a history of anaphylaxis, or history or presence of multiple severe allergies; patients with known hypersensitivity to any of the components.
  • Patients with bleeding disorders.
  • In case of pregnancy or when breastfeeding.

Warning for people with Herpes Simplex (cold sores):

Patients with a history of previous herpetic eruption may experience reactivation of the herpes.

After your treatment

Immediately following a treatment session with RADIESSE dermal filler redness, bruising or swelling may occur in the treatment area. These signs usually go away in a short period and are generally mild in nature. An ice pack may be applied to the treatment area to help reduce swelling. Any bruising resolves within 10 days. After the treatment you will receive a medical discharge report which further explain both the short-term constraints as well as some medical tips.

When is the skin improving effect of Radiesse visible?

After one to three months the fibroblasts become strongly agitated and the production of new collagen is well underway, allowing for a visible strengthening of your skin. Because of the extra amount of collagen, the skin layer is well supported once again. You can feel it yourself, the skin is firmer and regains its healthy attributes. The skins feels naturally soft and it feels like your body's own tissue. The effects last a long time, but are not permanent. Everything is eventually broken down by normal biological means within your body. Because the treatment is simple and practical, and the results are both immediately visible and long-lasting, more people become convinced that RADIESSE volumizing filler is the best choice for maintaining a more youthful appearance.

The science behind Combination Therapies

BAN + Fillers = More beautiful with longer lasting results

In order to enjoy the beautiful results of a skin filler for a longer period, a popular technique is increasingly used : use a Hyaluronic acid filler in combination with a Botulinum toxin-A Neuromodulator (BAN).

The injection of a dermal filler is one of the most commonly performed, minimally invasive cosmetic procedures of which 2.3 million procedures are were performed in the United States in 2014 1. Hyaluronic acid Fillers are most commonly used because of the natural properties of the substance and because of the excellent compatibility with the human body.

However, the duration of your cosmetic improvement by using hyaluronic acid fillers is limited by the speed of the natural degradation. The duration of the cosmetic effect is not only determined by the material properties of the hyaluronic acid but also because of the surrounding tissues. Highly important here are the frequent contractions of surrounding muscles in the areas where the filler is injected. If we reduce these muscle contractions, the degradation of hyaluronic acid becomes much more gradual. This leads to a better, longer lasting clinical outcome.

In recent years studies in a number of aesthetic clinics in Europe have been completed regarding the satisfaction of individuals after they had received the various injectable therapies. It was measurable that the individuals who had received both BAN and a hyaluronic acid filler were significantly more satisfied compared to those who had only received an hyaluronic acid filler. These individuals gave a significantly higher rate of satisfaction in the category: "a visibly better result after 10 days and after 30 days". They were also significantly more satisfied with the desired outcome than those who had undergone a single treatment.

Following these somewhat subjective studies, Turkish plastic surgeon Dr. Ismail Küçüker of Ondokuz Mayıs University in Turkey published a study in January 2016 in the medical journal "Plastic and reconstruction Surgery 2". His conclusion was that Chemo-denervation by botulinum neurotoxin-A can prolong the effect of Hyaluronic acid Fillers by lowering of the muscle activity in the treated area.

For this study, dr. Küçüker and his colleagues studied a region between the ears of live rabbits which corresponds to the region of the human forehead, an area which is frequently injected with a filler. In one side only a hyaluronic acid filler was injected and on the other side a hyaluronic acid filler along with a Botulinum toxin-A Neuromodulator was injected. MRI scans compared the two treated sides after three months. The area injected with a hyaluronic acid and a BAN was 50% greater than the side with just the hyaluronic acid filler. Due to the addition of the Botulinum toxin-A the rate of degradation of hyaluronic acid was decreased by 42%. The difference was not only measurable but also visible, supporting the clinical experiences of many cosmetic physicians and clients. Combination therapy provides a better and longer lasting result.

For clients of Pasman Esthetics this means that we always evaluate the surrounding muscle tone of the area that is to be injected with hyaluronic acid. Where appropriate and medically possible muscle tension is reduced using Botox or Bocouture.

1 Plastic Surgery Statistics 2014, American Society of Plastic Surgery
2 Plastic & Reconstructive Surgery: January 2016 - Volume 137 - Issue 1 - p 109–113