Erica W. Jang, MD, PhD, and Ji Young Lee discuss how YVOIRE® Y-Solution 720 redefines hyaluronic acid fillers by blending cohesivity and elasticity for natural, long-lasting results
The landscape of aesthetic dermatology is constantly evolving, driven by the relentless pursuit of superior clinical outcomes and enhanced patient safety. Hyaluronic acid (HA) fillers, a cornerstone of minimally invasive cosmetic procedures, have undergone significant advancements in recent years. Among these advancements, YVOIRE® Y-Solution 720 stands out as a prime example of a well-balanced filler that expertly combines high cohesivity and elasticity while minimising the use of cross-linking agents. This innovative approach directly addresses the limitations of previous filler generations and significantly reduces the risk of adverse events associated with excessive use of cross-linking agents, resulting in enhanced efficacy, longevity, and patient safety.
The interplay of cohesivity and elasticity in dermal fillers
There are many factors which can describe the characteristics of hyaluronic acid dermal fillers, such as storage modulus, cohesivity, complex viscosity, concentration, damping factor, and particle size. Among the rheological properties of fillers, elasticity and cohesivity are the most crucial.
- Cohesivity refers to the filler’s ability to remain cohesive and resist shear forces, preventing dispersion and ensuring long-lasting results with minimal migration. High cohesivity translates to longer-lasting volume and a reduced risk of undesirable filler migration or lumpiness.
- Elasticity refers to the filler’s ability to return to its original shape after being subjected to external forces, such as facial movements. A highly elastic filler offers immediate lifting and smoothing effects, creating a natural and aesthetically pleasing outcome. This contributes to a smoother, more natural appearance and allows the filler to adapt to the dynamic movements of the face.
Typically, fillers with high elasticity or storage modulus are classified as biphasic, while those with high cohesivity are considered monophasic. However, this method of classification is not scientifically accurate. Technically, all hyaluronic acid dermal fillers have biphasic properties since they consist of both cross-linked (solid) and non-cross-linked (fluid) HA. Therefore, labelling HA fillers strictly as biphasic or monophasic is misleading. Despite this, for simplicity, it is often said that biphasic fillers typically emphasise elasticity, whereas monophasic fillers tend to focus on cohesivity. Monophasic fillers possess particles with lower individual strength but achieve a lifting effect through the cohesive force of the particles binding together. In contrast, biphasic fillers have particles that are inherently firm, providing a lifting effect through their rigidity. Y-phasic fillers combine firmness and cohesivity, resulting in a more pronounced lifting effect on the tissue (Figure 1).
To achieve optimal clinical results, it is essential to consider both elasticity and cohesivity of dermal fillers simultaneously rather than separately. When both of these properties are enhanced, the filler demonstrates a superior ability to maintain its shape. A product that exhibits high levels of both cohesivity and elasticity can be described as a well-balanced filler product.
For a filler to withstand various physical stresses once injected into the body, it must possess both high cohesivity and high elasticity. If a filler product can return to the initial shape even after dynamic shearing forces and dynamic compression forces, it can endure dynamic facial expressions while providing its projection/lifting effect. If a filler were to endure those dynamic forces, it needs to have high cohesivity as well as high elasticity. When a filler is both cohesive and elastic, it can be considered well-balanced, ensuring it delivers the best possible clinical outcomes by maintaining its intended shape and functionality over time.
YVOIRE® Y-Solution: A well-balanced product
LG Chem’s YVOIRE® Y-solution achieves a superior balance of both cohesivity and elasticity, providing immediate lifting and long-lasting volume retention. This optimal combination results in a more natural appearance, minimised migration, and enhanced longevity, maximising patient satisfaction and clinician confidence.
LG Chem’s YVOIRE® Y-solution exemplifies a well-balanced product in the realm of dermal fillers, thanks to its innovative approach to combining high cohesiveness and elasticity. Developed to address the common shortcoming of lower cohesiveness in biphasic fillers, YVOIRE® Y-solution leverages the advanced S-HICE™ (Stable High Concentration Equalized) cross-linking technology. This cutting-edge technology surpasses traditional HICE™ methods by using sophisticated particle processes to enhance sustainability and cohesivity in the form of small, tightly bound particles. This technological advancement allows YVOIRE® Y-solution to function as a Y-phasic filler, successfully merging the high cohesiveness typical of monophasic fillers with the impressive elasticity of biphasic fillers, thereby greatly enhancing lifting capacity.
Introduced in Korea in 2018, the YVOIRE® Y-solution lineup includes Y-solution 360, Y-solution 540, and notably, Y-solution 720, each product containing lidocaine and presenting varying HA concentrations — 12mg, 20 mg, and 20 mg, respectively. YVOIRE® Y-solution 720 stands out as a testament to the ideal balance of cohesiveness and elasticity, offering superior performance for aesthetic applications by ensuring durability and effective lifting, thereby delivering optimised clinical outcomes.
To explore the features of a well-balanced product, the rheological properties of YVOIRE® Y-solution 720 and its similar commercially available products were compared (Table 1). The elasticity and cohesivity of these fillers are determined by manufacturing parameters such as cross-linking conditions, particle size reduction methods, and HA concentration. Variations in these parameters account for the differences in elasticity and cohesivity observed across different brands.
YVOIRE® Y-solution 720 demonstrates a superior balance of elasticity and cohesivity compared to its competitors, achieving a high lift capacity while using a relatively low amount of cross-linking agent (BDDE). As shown in Table 1, YVOIRE® Y-solution 720 exhibits significantly higher lift capacity (71064) than other products in its class despite having the lowest MoD of many of its competitors. This exceptional lift capacity is a result of its well-balanced formulation, which simultaneously optimises both elasticity and cohesivity. The data clearly indicate that YVOIRE® Y-solution 720 achieves high performance without compromising on the amount of cross-linking agent, demonstrating efficient utilisation of the cross-linking technology to enhance both the filler’s elastic and cohesive properties. This unique combination contributes to its superior clinical outcome, offering excellent long-lasting results.
Minimising BDDE: A safety-focused approach
Conventional manufacturing methods often rely on high concentrations of BDDE (butanediol diglycidyl ether), a cross-linking agent, to achieve high cohesivity and elasticity. However, this approach is associated with several risks, including granuloma formation, inflammatory responses, delayed adverse events, tissue necrosis, and allergic reactions1–4. Incomplete BDDE degradation can lead to the formation of granulomas, localised accumulations of immune cells that manifest as unsightly lumps or nodules. Excessive BDDE can trigger significant inflammatory responses, resulting in redness, swelling, pain, and prolonged healing times. Although relatively rare, allergic reactions to BDDE are possible. The effects of excessive BDDE may not be immediately apparent; delayed reactions, such as inflammation or granuloma formation, can occur weeks or even months after the procedure. In severe cases, excessive BDDE can lead to tissue necrosis (tissue death).
A critical aspect differentiating YVOIRE® Y-Solution 720 is its significantly reduced reliance on BDDE, a commonly used cross-linking agent. Excessive BDDE can lead to several adverse clinical events, primarily due to its potential for incomplete degradation and its consequent inflammatory effects. Table 1 provides a compelling comparison, illustrating that YVOIRE® Y-Solution 720 achieves a substantially higher lift capacity (71064) compared to competitor products yet boasts a considerably lower MoD (Modification Degree, a direct indicator of BDDE concentration) of 3.3 mole%. This reduction in BDDE concentration demonstrates a commitment to patient safety without compromising on the efficacy and long-lasting effects of the filler.
By significantly reducing BDDE usage while maintaining superior performance, YVOIRE® Y-Solution 720 directly mitigates these risks, enhancing patient safety and minimising the potential for complications.
YVOIRE Y-Solution 720 and S-HICE cross-linking technology
By achieving a superior balance of cohesivity and elasticity while significantly reducing BDDE usage, YVOIRE® Y-Solution 720 delivers demonstrably superior clinical outcomes. The higher lift capacity, coupled with the lower MoD, indicates a more efficient and safer cross-linking process that leads to enhanced longevity and reduced risk of adverse events. This combination of high performance and enhanced safety underscores YVOIRE® Y-Solution 720’s position as a leader in HA filler technology, offering practitioners a powerful and reliable tool to achieve optimal aesthetic results while prioritising patient well-being.
How does it work? The answer is its cross-linking technology. This innovation was enabled by S-HICE cross-linking technology. This superior performance is directly attributed to LG Chem’s innovative S-HICE (Stable High-Concentration Equalized) cross-linking technology. Conventional cross-linking methods often rely on high concentrations of BDDE (butanediol diglycidyl ether) to achieve the desired properties. However, high BDDE levels are associated with several potential adverse events, including granuloma formation, inflammatory responses, and delayed adverse reactions.
S-HICE technology offers a solution by employing sophisticated particle engineering techniques. This results in smaller, uniformly sized HA particles that exhibit enhanced inter-particle interactions, leading to superior cohesivity. Simultaneously, the precisely controlled cross-linking process ensures the desired elasticity for immediate lifting. The net effect is a remarkable balance of cohesivity and elasticity achieved with significantly reduced BDDE usage. This translates to superior clinical results, a minimised risk of adverse events, and an enhanced safety profile for patients.
The clinical implications of YVOIRE Y-Solution 720’s superior rheological properties and reduced BDDE usage are substantial: enhanced lifting and volumising, prolonged duration of results, improved patient safety, versatility across diverse applications, and potentially improved cost-effectiveness compared to traditional fillers. This combination makes YVOIRE Y-Solution 720 a powerful tool for practitioners seeking both optimal aesthetic results and enhanced patient safety. It establishes a new standard for HA filler technology, effectively redefining the expectations for performance, safety, and patient experience.
Biphasic fillers typically involve milling hyaluronic acid (HA) to a specific size, followed by sieving. This results in larger base particles compared to monophasic fillers, which utilise a finer grinding process. Imagine the biphasic filler as a structure similar to bricks stacked together. While exhibiting high elasticity and resilience to external forces even with lower BDDE usage, biphasic fillers demonstrate lower inter-particle cohesiveness.
In contrast, monophasic fillers employ a finer grinding process, resulting in significantly smaller base HA particles. To continue the analogy, monophasic fillers resemble clay-like consistency. While less elastic than biphasic fillers, their increased surface area and stronger inter-particle forces contribute to higher cohesiveness. However, achieving comparable elasticity in monophasic fillers necessitates a relatively larger amount of cross-linking agent. Although less elastic, the superior cohesiveness of monophasic fillers promotes excellent tissue integration, leading to smooth and natural-looking results.
While increasing the cross-linking agent concentration or HA concentration could partially address the limitations of these traditional manufacturing processes, increasing the cross-linking agent concentration presents significant safety concerns, a factor that is not aligned with LG Chem’s product development philosophy. Similarly, increasing HA density, while enhancing firmness, can lead to excessive stiffness and various undesirable side effects.
LG Chem’s Y-Solution fillers utilise a refined biphasic process. Following an initial sieving, the particles undergo a second sieving through a finer mesh, resulting in smaller, more uniform particles. This approach minimises the need for increased cross-linking agent usage while simultaneously achieving both the elasticity of biphasic fillers and the high cohesiveness and tissue integration characteristic of monophasic fillers.
Consequently, Y-solution fillers exhibit a superior balance of elasticity and cohesiveness, resulting in exceptional shape retention and resistance to spreading. This optimised manufacturing process allows for the creation of a filler material with an ideal balance of both key properties.
Clinical implications: Optimised performance and enhanced patient outcomes
The superior balance of cohesivity and elasticity, achieved through S-HICE technology, translates into a series of clinical advantages for YVOIRE Y-Solution 720.
- Enhanced lifting and volumising effects: The immediate lifting and volumising effects are superior to those observed with traditional fillers. The well-balanced properties ensure a natural and aesthetically pleasing outcome, with minimal migration or distortion. These benefits have several advantages in various areas, including cheek augmentation, where its balanced properties allow for both subtle volume restoration and effective lifting, resulting in a more youthful and natural appearance.
- Prolonged duration of results: The high cohesivity ensures that the filler remains in place for an extended period, resulting in longer-lasting aesthetic results with reduced need for touch-up treatments.
- Improved patient safety: The reduced BDDE concentration significantly lowers the risk of adverse events associated with high concentrations of this cross-linking agent.
- Versatility and adaptability: YVOIRE Y-Solution 720’s exceptional properties make it suitable for a wide range of applications, including cheek augmentation, lip augmentation, nasal reshaping, and more. The text suggests specific injection techniques that can enhance the clinical results even further.
- Cost-effectiveness: Due to the reduced amount required for effective treatment, compared to fillers that rely on higher BDDE concentrations for higher lifting capacity, YVOIRE Y-Solution 720 can lead to cost savings for both practitioners and patients, making premium aesthetic treatments more accessible.
In summary, YVOIRE Y-Solution 720 represents a significant advancement in the field of HA dermal fillers. Its superior balance of cohesivity and elasticity and minimised BDDE usage, enabled by the innovative S-HICE technology, delivers superior clinical results with improved safety. This advanced filler offers practitioners a reliable and powerful tool to achieve optimal aesthetic results while prioritising patient safety and satisfaction.
LG aesthetics
LG Chem began its R&D in hyaluronic acid in 1990. Its non-animal origin HA has been marketed in various medical fields since 1995, such as injections for ophthalmic surgery and osteoarthritis. In 2010, LG Chem acquired KFDA approval as the first Korean pharmaceutical company in Korea with YVOIRE® Classic.
YVOIRE® is produced with LG Chem’s proprietary HICE™† cross-linking technology, which is the mechanics optimised for making biphasic hyaluronic acid filler. Also, HICE™ cross-linking technology is characterised by cross-linking the high molecular weight HA with a low degree of BDDE, leaving the gel less modified and improving its safety. Thanks to these features, YVOIRE® has sold more than 10 million syringes in over 40 countries since its launch in 2010.
Based on its accumulated knowledge of HA, LG Chem released a new line up of YVOIRE® in 2018 which is called YVOIRE Y-Solution®. YVOIRE Y-Solution® was developed with S-HICE™‡ cross-linking technology, which brings the advantages of both biphasic and monophasic filler, enhancing the elasticity and the cohesivity in sync. With this S-HICE™ cross-linking technology, YVOIRE Y-Solution® presents a unique rheological property called Y-Phasic that features high elasticity and relatively high cohesivity simultaneously.
†High concentrated equalised, ‡ Stable-high concentrated equalized
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