1. EXPERIENCE WITH EUROPEAN BOTOX
AND DERMAL FILLERS
WHERE MY PREFERENCES STAND
JUNE 25TH, 2011

2. BOTULINUM TOXIN
• European Brands
• Azzalure ®
• Bocature ®
• Botox ®
• Dysport ®
• Neurobloc ®
• Vistabel ®
• Xeomin ®

3. AZZALURE ®

4. Azzalure ®
• Azzalure ®
• Azzalure®, botulinum toxin type A, has been available in
the U.K. and Ireland since the early 1990s as the brand
name Dysport®, which has licences for various
indications in 67 countries worldwide, including the United
Kingdom and many European markets.
• It gained approval for cosmetic use in the UK in early
2009 and is marketed for this indication, with dosing
specific to treat glabellar (frown) lines, under the brand
name Azzalure®.
• It is manufactured by the French company Ipsen and
commercialised by Galderma.

5. BOCOUTURE ®

6. Bocouture ®
• BOCOUTURE®, botulinum toxin type A, has been
available in the U.K. and Ireland since 2008 as the brand
name Xeomin ®, which is licenced in Europe for
blepharospasm and cervical dystonia.
• It gained approval for cosmetic use in the UK in July 2010
and is marketed for this indication, with dosing specific to
treat glabellar (frown) lines, under the brand name
Bocouture®.
• Bocouture® claims to be an innovative Botulinum type A
formulation, in which the complexing proteins have been
removed by an extensive purification process from the
botulinum toxin complex.

7. Bocouture ®
• It is widely accepted that the bacterial protein present in other
products play a role as promoters of an immune reaction, resulting in
a loss of effect and reduction in duration of activity. Studies show that
Bocouture®, without the complexing proteins, has the lowest content
of protein of all of the available botulinum toxins and furthermore
show that repeated application of Bocouture®, even in high doses,
does not induce the formation of neutralising anti-bodies.
• This means that Bocouture® is able to provide similar results to those
achievable with the other products without the risk of antibody
formation, providing continual long lasting effects. This could be
relevant when large doses are being used for medical indications, but
many industry experts questions the relevance when this product is
used for cosmetic purposes.

8. BOTOX ®

9. Botox ®
• Currently the number one non-surgical aesthetic treatment in the
U.S., Botox® is also the leading brand of botulinum toxin type - A in
terms of documented clinical trials and practical use around the
world.
• Botox® was the first botulinum toxin to gain a cosmetic
licence endorsing its use for glabellar lines and wrinkles. It
is approved for this indication in the U.S. and around
twelve other countries in the world, and was licenced for
this use in the U.K. in March 2006 under the brand name
Vistabel ®

10. DYSPORT ®

11. Dysport ®
• Dysport ®
• Dysport®, botulinum toxin type A, has been available in
the U.K. since the early 1990`s and has licences in 67
countries worldwide including the United Kingdom and
many European markets. It is manufactured by the
French company Ipsen.
• The product is licensed for cosmetic use in a number of
markets e.g. glabellar (frown) lines in Germany.
• It also gained approval for cosmetic use in the UK in early
2009 and is marketed for this indication, with a dosing
specific to treat glabellar lines, under the brand name
Azzalure ® by Galderma.

12. NEUROBLOC ®

13. Neurobloc ®
• Neurobloc ®
• Neurobloc® became available in the U.K. in 2001.
• There is limited experience in the use of this type of toxin,
and the product does not currently have approval for
cosmetic use anywhere in the world.
• As a result of this very few U.K. practitioners have any
experience in the use of this product for lines and
wrinkles.
• Generic name
• Clostridium botulinum type - B neurotoxin complex

14. Neurobloc ®
• Myobloc®
(rimabotulinumtoxinB) Injection is sold
in the US and approved in Canada.
• MYOBLOC is also being distributed as
NeuroBloc®
(Botulinum Toxin Type B) in the EU, Norway
and Iceland and as Myobloc®
(Botulinum Toxin Type B)
Injectable Solution in Korea.

15. VISTABEL ®

16. Vistabel ®
• Vistabel ®
• Botox ® was the first botulinum toxin to gain a cosmetic
licence endorsing its use for glabellar lines and wrinkles. It
was licenced for this use in the U.K. in March 2006.
• It gained approval for cosmetic use in France in early
2003 and is marketed there under the brand name
Vistabel®.
• With dosing specific to treat glabellar lines, it is also
marketed for cosmetic use in the UK under the brand
name Vistabel® and is the first brand of botulinum toxin
type A licensed for cosmetic use in the UK.
•

17. XEOMIN ®

18. Xeomin ®
• Launched in the UK and Ireland in 2008, Xeomin® is the
third botulinum toxin type A to be promoted in the UK.
Xeomin® claims to be an innovative Botulinum type A
formulation, in which the complexing proteins have been
removed by an extensive purification process from the
botulinum toxin complex.
• In contrast to the other commercially available
preparations, Xeomin® contains the pure 150 kD
neurotoxin.

19. Xeomin ®
• Studies show that Xeomin®, without the complexing
proteins, has the lowest content of protein of all of the
available botulinum toxins and furthermore show that
repeated application of Xeomin®, even in high doses,
does not induce the formation of neutralising anti-bodies.
• This means that Xeomin® is able to provide similar
results to those achievable with the other products without
the risk of antibody formation, providing continual long
lasting effects. This could be relevant when large doses
are being used for medical indications, but many industry
experts questions the relevance when this product is used
for cosmetic purposes.

20. MY PREFERENCE DYSPORT ®

21. DERMAL FILLERS
• European Brands
• AQUAMID ®
• ARTECOL ®
• ATLEAN ®
• BELOTERO ®
• Bio ALCAMID ®
• CRISTAL ®
• CRM ®

22. DERMAL FILLERS
• European Brands
• ELLANSE ®
• EMERVEL ®
• EVOLENCE ®
• JUVADERM ®
• MATRIDUR ®
• MATRIDEX ®
• NOVABEL ®

23. DERMAL FILLERS
• European Brands
• PREVELLE ®
• PURAGEN ®
• RADIESSE ®
• RESTYLANE ®
• REVANESSE ®
• REVIDERM ®
• SUCCEEV ®

24. DERMAL FILLERS
• European Brands
• TEOSYL ®
• VARIODEM ®
• ZYDERM ®
• ZYPLAST ®

25. AQUAMID ®

26. Aquamid ®
• Aquamid™
• This product was launched in the U.K. in 2003.
• Aquamid™ contains about 2 - 3% of cross-linked
polyacrylamide gel network and with the remaining part of
97 - 98% being water.
• The molecule is not dissolved in water, but "swollen" like
a sponge. The gel is in dynamic equilibrium with the
surrounding tissue, but still the polymer retains its ability
to hold water and remains elastic over an extended time.
•

27. Aquamid ®
• Aquamid™ has been used for aesthetic correction for
more than ten years in 30,000 patients in the previous
Soviet Union and Europe.
• Polyacrylamides have been used for many years in the
United States and Europe for treatment of drinking water,
and is also found in soft contact lenses, and tissue
implant material.

28. MY PREFERENCE DYSPORT ®

29. Atlean ®
• Atlèan™ ßTCP
• French company ABR Development (now part of Stiefel
Laboratories Inc.), the pharmacists who invented Sculptra
® launched their new volumising filler product, Atlèan™
βTCP, in the UK and Ireland in June 2007.
• As a result, you may only come across a few practitioners
using this product currently.

30. Atlean ®
• Atlèan™ is a tri-calcium phosphate product in the form of
a white gel which the manufacturer claims gives the same
volumising and sculpting visual effects as the poly-l-lactic
acid based filler, Sculptra™ but without the 4 - 6 week
wait to see the benefits. This is due to the fact that
• Atlèan™ also contains hyaluronic acid which gives an
immediate visible result, which lasts for up to 3 months,
whilst the tri-calcium phosphate helps to stimulate the
production of new collagen in the treated area for a longer
lasting result.
•

31. Atlean ®
• The manufacturer claims that the product can help cause
new collagen growth rather than just mechanically filling
depressions, making it a sculpting agent rather than just a
wrinkle filler; although the addition of a recognised wrinkle
filling agent (hyaluronic acid) into the product means that
patient satisfaction from an immediate visible result is
greater.
• What does it contain?
• A 1ml syringe of Atlèan™ contains 70mg of Tri-Calcium
Phosphate (TCP), 18mg of hyaluronic acid and 8mg of
carmellose sodium (a stabilising agent), within a 1ml of
buffered saline solution.

32. ELLANSE ®

33. Ellanse ®
• Ellansé is a new and unique non-animal, non-bacterial
and non-human derived dermal filler family which are said
by the manufacturer to be cost-effective by requiring less
product, compared to others, for the same indications.
• The Ellansé family (S, M, L, E) has four distinctive
duration formulations to choose from, from 1 to 4 years or
more.
• Ellansé is composed of totally smooth polycaprolactone
(PCL) microspheres (diameter of 25 – 50 μm) suspended
in an aqueous carboxymethyl cellulose (CMC) gel–carrier
and is constituted of 30% PCL microspheres suspended
in 70% gel carrier.

34. EMERVEL® RANGE
A complete range of products, with and without lidocaine,
well differentiated for specific indications, to provide physicians
the optimal choice to best meet patients needs
Optimal gel textures thanks to a perfect balance :
Science behind the concept

35. Key concept : Crosslinking
• ButaneDiol Diglycidyl Ether : well known
crosslinker - Purification through dialysis
Residual BDDE < 2ppm (FDA limit)
• HA (bacterial origin) modification by
crosslinking
− Crosslinking
• Bind the polymers chains together
− Grafting
• Fix the BDDE to HA only from one side
• Does not modify the Texture (in red)
Only the crosslinking could modify the
texture of gel 35
CH2OH
CH2OH
CH2OH
CH2OH
HO2HC
HO2HC
HO2HC
HO2HC
NaOH/H2O
BDDE
O
R
O
OHOH
O
R
O
OHOH
O O
OHOH
O
OH
R
OH
OH
O
OH
R
OH
OH
CH2OH
CH2OH
CH2OH
CH2OH
HO2HC
HO2HC
HO2HC
HO2HC
CH2OH
CH2OH
CH2OH
CH2OH
HO2HC
HO2HC
HO2HC
HO2HC
NaOH/H2O
BDDE
O
R
O
OHOH
O
R
O
OHOH
O O
OHOH
O
OH
R
OH
OH
O
OH
R
OH
OH
HA

36. EVOLENCE ®

37. Evolence ®
• Launched in the UK at the beginning of 2005,
EVOLENCE™ is a new, collagen-based dermal filler
manufactured by ColBar LifeScience (now part of
OrthoNeutrogena, a division of Ortho-McNeil
Pharmaceutical, Inc., a Johnson & Johnson company). It
was officially launched in Europe in October 2004 at the
13th EADV Congress in Florence, Italy.
• It is intended for the correction of wrinkles, nasolabial
folds, scars, atrophy from disease or trauma, defects
secondary to rhinoplasty (nose surgery), skin graft or
other surgically-induced irregularities and other soft tissue
defects or deficiencies.

38. Evolence ®
• What does it contain?
• The highly purified collagen in EVOLENCE™ is derived
from porcine (pig) tendons.
• Due to their high degree of compatibility with the human
body’s immune system, porcine collagen materials are
often used in human medicine, e.g., in heart valve
replacements, implantable lenses, and surgical wound
dressings.
• How is it made?
• Using their patented Glymatrix™ technology, they firstly
break down the source material into pure collagen
molecules.

39. NOVABEL ®

40. Novabel ®
• Novabel® is not a hyaluronic acid based injectable
product but is in fact a patented, plant-based or alginate
composition from sea algae which it is claimed results in
an easier injection with much less swelling, making results
more visible.
• An 18 month study has shown excellent safety results
according to the company. Early indications are that
results should persist for 12 months or more.
• The product will be available through trained UK cosmetic
practitioners towards the spring and summer of 2010.
Information will be updated at that time.

41. Novabel ®
• *** IMPORTANT ANNOUNCEMENT ***
• Sales and marketing of Novabel® temporarily
suspended.
• Merz Aesthetics has suspended sales of its new flagship
facial shaping product, Novabel®, amid concerns
following reports of a few patients treated with the product
in the infra-orbital region who suffered adverse reactions.
• In a letter out to its customers, Merz said; “Given the
unique composition of Novabel an effective treatment has
not yet been identified to quickly resolve these events.
• Reported: 30th June 2010

42. PREVELLE ®

43. Prevellle ®
• Having launched Puragen in late 2005, designed for the
treatment of moderate to deep lines and wrinkles, Mentor
Corporation went on to launch Prevelle™ in the UK in late
2007, a sister product aimed at fine lines and wrinkles
around the mouth, eyes and forehead.
• Despite this joint portfolio Mentor is keen to highlight that
the products are in fact distinct and technologically
different, however they are meant to complement one
another.
• Given the recent introduction, you may only come across
a few practitioners using this product currently.

44. REDEXIS ®

45. REVANSE ®
• Revanesse ® and Redexis ®
• Revanesse® and Redexis® are two monophasic, non-
animal hyaluronic acid based dermal filler brands
manufactured in Canada by Prollenium and distributed in
the UK by Boston Medical Group Ltd since 2010.
• Generic name
• Non-animal hyaluronic acid gel.
•
Dextranomers (as found in the Redexis products) break
down into sugars within 2 years.
•

46. SUCCEEV ®

47. Succeev ®
• Succeev® is a mono-phasic Hyaluronic Acid based
dermal filler from Sanofi-Aventis Medical Aesthetics (the
makers of Sculptra ®.
• It includes three formulations, ONE, TWO and THREE,
for the correction of different types of wrinkles, from fine
lines to deep wrinkles and lip augmentation.
• Succeev® One targets the superficial dermis to treat fine
wrinkles
• Each pack contains 2 pre-filled syringes of 0.8ml of
hyaluronic acid.

48. TEOSYL ®

49. Teosyl ®
• Teosyal ®
• The Teosyal® range, manufactured in Switzerland by
Teoxane Laboratories and distributed in the UK by
Lifestyle Aesthetics, consists of several monophasic
hyaluronic acid based products of non-animal origin,
which are highly biocompatible, offering patients
immediate and long-lasting results.
• The Teosyal® range has a reduced protein and bacterial
endotoxin level resulting in less hypersensitivity reactions.
• Teosyal® was launched in the UK in 2005.

50. VARIODERM ®

51. Varioderm ®
• Varioderm™
• The Varioderm™ range, manufactured in Germany by
Adoderm GmbH and distributed in the UK by Medical
Aesthetics Group, was launched in the UK in April 2008.
As a result, you may only come across a few practitioners
using this product currently.
• It consists of a range of very highly cross-linked, pure
non-animal hyaluronic acid fillers available in 4
concentrations.
• Generic name
• Non-Animal Hyaluronic Acid (NaHA) gel.

52. Varioderm ®
• Varioderm™
• The Varioderm™ range, manufactured in Germany by
Adoderm GmbH and distributed in the UK by Medical
Aesthetics Group, was launched in the UK in April 2008.
As a result, you may only come across a few practitioners
using this product currently.
• It consists of a range of very highly cross-linked, pure
non-animal hyaluronic acid fillers available in 4
concentrations.
• Generic name
• Non-Animal Hyaluronic Acid (NaHA) gel

53. Evolence ®
• *** IMPORTANT ANNOUNCEMENT ***
• Johnson & Johnson announced their intention to discontinue the
manufacture and marketing of EVOLENCE® products.
• Patients and medical professionals who may currently be using
EVOLENCE® products can be assured that they remain effective for
the approved indications with a favourable safety profile.
EVOLENCE® products will continue to be supported for medical
inquiries and adverse event reporting, in accordance with regulatory
requirements.
• Reported: 3rd Nov 2009

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THANK YOU FOR YOUR ATTENTION