In the course of ageing we experience two overlapping and concurrent phenomena — ptosis and tissue atrophy — both of which cause the appearance of wrinkles, changes to the shape of the face, and the inversion from convexity to concavity.

The knowledge behind the physiological mechanisms of the ageing process has created, in recent years, a shift in the aesthetic medicine procedures that are performed today. The correction of the single wrinkle or individual defect has now evolved to a global treatment, such as increasing the volume of the middle third or remodelling the lower third for complete facial balance.

One particular characteristic of a ‘youthful’ look is facial fullness, and this feature should certainly be sought while performing facial rejuvenation treatments. Obtaining this goal means engaging a minimally invasive approach characterized by virtually zero downtime. The limits of the first volumising products were in fact due to the hardness of the products, their poor plasticity and reduced spreadability.

A new addition to the Aliaxin range

Aliaxin® EV — Essential Volume, the most recent addition to the Aliaxin® filler line of products from IBSA Farmaceutici Italia, is a monophasic hyaluronic acid (HA) gel with the presence of two different molecular weights: 1000 kDa and 2000 kDa . This is an advantage both from a biological and mechanical point of view. In fact, different molecular weights allow the physician to act on different HA receptors, putting a number of mechanisms in place that are involved in the regeneration of skin tissue. Furthermore, there is a mechanical advantage; a high molecular weight HA fills larger spaces, while a low molecular weight HA fills smaller spaces, resulting in a complete filling action.

Figure 1 Combination technique injection map

Figure 1 Combination technique injection map

Although Aliaxin® EV is characterised by a high volumising capacity, the extrusion strength required to expel the product is relatively low. The recommended injection technique is the bolus, most suitable with a 25 G needle, with which you can perform either an increase in the projection of the hypotrophic structures, or a resurgence of tissue infiltrating ‘support points’ according to the concept of a liquid facelift. However, the homogeneity of the gel allows infiltration even when using a microcannula.

Additional important features of this product are its safety and manageability. For example, as with most volumising fillers, it is indicated for use at the supraperiostial layer and deep tissue, but with Aliaxin® EV no problems arise if it is injected at the mid or deep dermal level. Therefore, it can be used safely throughout the malar region. The smoothness of the gel reduces the possibility of side-effects such as swelling and bruising, as well as the risk of over-correction.

Aliaxin® EV is indicated in all patients who wish to create or redefine facial contour, in those who have lost subcutaneous tissue, and for correcting deficits following injuries.

Combination treatment

Figure 2 Full face treatment (A) before and (B) after 1 month with: Aliaxin® EV — malar area and jawline 1 ml per side, chin 1 ml; Aliaxin® SR — cheeks 0.5 ml per side, glabella 0.5 ml

Figure 2 Full face treatment (A) before and (B) after 1 month with: Aliaxin® EV — malar area and jawline 1 ml per side, chin 1 ml; Aliaxin® SR — cheeks 0.5 ml per side, glabella 0.5 ml

A full face therapy requiring treatment to the various areas of the face in anatomo-histological and morphological terms cannot be carried out using one type of filler, but must be approached through the use of products designed for the different areas and regulated on the basis of the different pre-set goals.

A 360-degree facial treatment — the so-called full face treatment — is made possible with the combination of Aliaxin® EV and Aliaxin® SR.

The special feature of Aliaxin® SR is defined by its effect on tissues as a result of its formulation, which includes both natural and cross-linked HA, following the Hydrolift® Action concept created by IBSA Italia. Hydrolift® Action is a complete anti-ageing concept, aimed at hydrating (owing to its hygroscopic capacity), stimulating (biological stimulation action on fibroblasts), and lifting (mechanical filling and lifting action) a variety of skin imperfections.

With Aliaxin® SR, a monophasic gel comprising HA with three different molecular weights (500 kDa, 1000 kDa, 2000 kDa), it is possible to achieve an excellent lifting effect of the cutaneous wrinkles and a biorestructuration effect with the promotion of neocollagenesis. On the other hand, with the 10% presence of natural HA, a significant anti-ageing and hydrating effect is achieved, with maximum results visible in the weeks following treatment.

The combination technique for a full face treatment uses Aliaxin® EV, at a deep level, for the treatment of malar area, chin and jawline, and Aliaxin® SR, injected using a microcannula, at a more superficial level (middle dermis), for the treatment of the temporal region, the tear trough, and the low malar area (Figures 1 and 2).


Aliaxin® EV is one of the most reliable volumising HA-based fillers on the market, in terms of efficacy, safety and durability. This is in addition to the stimulating biological action of Aliaxin® SR, which completes the filling treatment with an anti-ageing action. The association of these two products allows the physician to complete the high volume effect with a full remodelling of the face, resulting in well-balanced features and an overall harmonious effect.