This presentation privdes facts and statistics for non-invasive procedure such as Macrolane. Macrolane is a Nasha Gel for volume restoration and contouring of body surfaces.

1. Macrolane Breast
Enhancement
Mr Adrian Richards
Consultant Plastic Surgeon
Aurora Clinics
UK
www.aurora-clinics.co.uk

2. )Procedures in millions(
0.0
4.0
8.0
12.0
6.0
10.0
2.01.0M
1.1M
1.9M
9.5M
1997 2006
Shift Towards Non-Invasive ProceduresShift Towards Non-Invasive Procedures
Non- Invasive ProceduresInvasive Procedures
0.0
4.0
8.0
12.0
)Procedures in millions(
6.0
10.0
2.0
1997 2006
Growth Rate = 118%
CAGR = 7.4%
Growth Rate = 747%
CAGR = 27.1%
Source: The American Society for Aesthetic Plastic Surgery, March 2007
 Non-invasive procedures account for majority of growth
 Non-invasive procedures = 83% of market

3. Cosmetic EnhancementCosmetic Enhancement
Patients who wantPatients who want
improvement in bodyimprovement in body
shape butshape but don’tdon’t wantwant
surgerysurgery
Surgical ProceduresSurgical Procedures

4. MINTEL Report 2007MINTEL Report 2007
Key findings
• Body shaping is outpacing market growth in the
surgical segment
• Less invasive surgical techniques are driving
growth and taking away the fear associated with
surgery
• Patient fear of cosmetic surgery going wrong still
presents a powerful obstacle to surgery

5. How Women Perceive
MACROLANE´s Advantages
• No hospital stay
• Less invasive
• Short recovery period with no time off from work
• A natural material in the body that is absorbed over time
• A look that is natural and unique for each woman,
tailored to their own appearance
Source: TDA/Q-Med focus groups in Rio de Janeiro and Madrid, 2006

6. What is Macrolane?
• Macrolane is a NASHATM
gel for volume restoration and
contouring of body surfaces
• CE-approved
• Developed from non-animal stabilized hyaluronic acid
(NASHATM
)

7. How is Macrolane different?
• Macrolane VRF is a thicker gel used for body aesthetics rather than
facial aesthetics and therefore creates greater volume with a slower
absorption
• Stabilized using the NASHATM
patented technology specifically for
use in Body Aesthetics
• Longer residence time than natural HA
• Biocompatible and safe
• Specifically developed for volume restoration and contouring of
body surfaces, including breast shaping

8. NASHATM
Safety Profile
• Pure and minimally modified by stabilization, the long implant
lifetime does not cause tissue incompatibility
– No rejection problems
• Side effects and post-treatment complications are rare, and
generally mild and transient resolving within a couple of weeks
• Patients injected with NASHATM
gel have not demonstrated any
allergic responses to the implants
– as assessed by analysis of blood samples or skin patch tests
• Used successfully in facial aesthetics for over 10 years
– Nearly 10 million procedures world-wide

9. NASHANASHATM
Research andResearch and
DocumentationDocumentation
NASHATM
Papers
 Olenius M, Aesth Plast Surg 1998
 Narins R et al, Dermatol Surgery 2003
 Carruthers A et al, Dermatol Surg 2005
 Wang F et al, Arch Dermatol 2007
Macrolane Papers
 Per Heden, poster, AAWC Monaco 2007
 Inami F, et al J Plastic Surg 2006
 Tengvar et al, poster, IMCAS 2008

10. Extensive Experience of Breast Augmentation
with Stabilized Hyaluronic Acid of non-animal origin
(NASHA™)
Inami F, Handa T and Handa K
Journal: Journal of Plastic Surgery (full citation: Inami F,
Handa T and Handa K. Mammoplasty with fillers. J Plastic
Surg 2006;49: 1335–41.)
Number of patients: 1100
Average volume: 35 mL per breast
Cannula used: 18 G, 12 cm cannula with lateral holes

11. Breast Augmentation with Stabilized HyaluronicBreast Augmentation with Stabilized Hyaluronic
Acid Gel of non-animal origin: Visualisation ofAcid Gel of non-animal origin: Visualisation of
tissue behind the Implantstissue behind the Implants
Objective:
To investigate the feasibility of monitoring breast
tissue behind implanted HA gel, using
mammography
Conclusion:
The presence of Macrolane in the breast does not
compromise the detection, diagnosis or
management of breast disease
Magnus Tengvar, Per Heden, Michael Olenius.
Poster presented at IMCAS, January 2008

12. Patient Selection
• Breast volume
• Skin quality
• Ptosis
– Grade 1
– Grade 2
– Grade 3

13. Body-tailored Product Concept

14. Patient ProfilePatient Profile
Age
18 – 24 years
Small under-developed
breasts
Developmental asymmetry
30 – 45 years
Post pregnancy
Weight loss
Aging change

15. Grade 2 Ptosis Right Grade 1 Left

16. Grade 3 Ptosis

17. Macrolane VRF Product RangeMacrolane VRF Product Range
MACROLANE VRF 30 MACROLANE VRF 20
10 & 20 ml plastic syringe 10& 20 ml plastic syringe
Terminally sterilize Terminally sterilize
20 mg/ml HA 20mg/ml HA
12G cannula or larger size 12G cannula or larger size
Medium restoration power Lower restoration power

18. Syringe Volumes
• 10 & 20 ml
• 12G blunt cannula

19. Dosage and Administration
• Recommended maximum volume per treatment site is
100 ml (per treatment session)
• No experience to date of more than 240ml injected at
one treatment session
• No overcorrection - treated area can be massaged
• Treatment time 45 minutes

20. Macrolane VRF
Treatment Procedure

21. Breast Volume Restoration
• 19 patients
• Screening mammography and ultrasound
• Initial 100 -120mls per breast
• Optional touch up 20 ml at 4 wks for asymmetry or unevenness
• Injection anterior to the pectoralis major muscle but posterior to
the mammary gland

22. Pre-treatment Precautions
• Procedure can be carried out in a minor operations room
• Normal precautions as for similar minor surgical
treatments should be observed
• Aspirin and non-steroidal anti-inflammatory drugs may
increase risk of bruising or bleeding at injection sites
• A pre-treatment of oral antibiotics is recommended

23. Markings and Equipment
Photos provided by Mr Chris Inglefield of London Bridge Plastic Surgery Clinic, London, UK

24. Incision is made with a
No 11 blade or using a
12g needle
Inject Macrolane VRF
using a 16g blunt
cannula
Deposit product when
withdrawing
Photos provided by Mr Chris Inglefield of London Bridge Plastic Surgery Clinic, London, UK

25. Before treatment 100cc Immediately after

26. Before
treatment
Immediately post
treatment
3 months follow
up

27. Pre Treatment Post 100cc @ side

28. Pre Treatment Post 100cc @ side

29. Pre Treatment Post 100cc @ side

30. Side Effects
• Pain 10-14 days
• Firmness 14 days
• Bruising rare
• Fever and malaise

31. Longevity
• 50% present at 12 months
• 80:20 rule
– 80% need top up at 12 months
– 20% at 18 months

32. Summary
• Suitable for patients who would not consider surgery
• Generally well tolerated
• Patient satisfaction high
• Long term follow up and further studies required

33. Thank You
Mr Adrian Richards
Consultant Plastic Surgeon
www.aurora-clinics.co.uk