Dermal filler, Hyaluronic acid injection– Hyaluronic Acid Injection –

This is a beauty treatment that improves wrinkles and sagging by injecting hyaluronic acid into the skin.

At our clinic, we use hyaluronic acid called “Belotero®” from the German company Merz. Because Belotero is an unapproved product in Japan, it is not covered by the Pharmaceutical Side Effects Relief System (a guarantee provided by pharmaceutical companies in the event of serious side effects).

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Hyaluronic Acid Fillers for Wrinkles

By injecting hyaluronic acid into the skin, it lifts and improves wrinkles from within the skin. It thins existing wrinkles and makes them less noticeable, while also preventing future wrinkles.

Hyaluronic acid is suitable for treating the following wrinkles:

nasolabial fold wrinkles
wrinkles on the forehead
wrinkles between eyebrows
wrinkles around the eyes
Dimpling and thinning of the temples
midface depression
lip wrinkles
Wrinkles at the corners of the mouth (marionette lines)
wrinkles on the chin

Note that we do not inject the nose or tear bags.
Depending on the location and depth of wrinkles, such as forehead wrinkles, we may recommend a combination of botulinum toxin injection and hyaluronic acid injection.

How long does the effect last?

ヒアルロン酸注射剤のベロテロ — Belotero®-hyaluronic acid injections

At our clinic, we utilize three different levels of hyaluronic acid firmness, tailored to specific areas and the depth of wrinkles.

Types	Duration of Effect
Belotero® Soft	3～6 months
Belotero® Balance	6～12 months
Belotero® Volume	12～18 months

By repeatedly injecting hyaluronic acid, you can expect long-term effects as it stimulates your own collagen production and covers the hyaluronic acid with a film that makes it difficult to absorb.

If you have a large loss of volume across your face, you can inject 4 to 12 mL the first time to lift wrinkles and create a foundation, and then maintain it with a smaller amount.

Cases of wrinkle treatment with hyaluronic acid injections

Nasolabial folds / A man in his 30s

Left) Before injection Right) Immediately after injection

The patient wanted to slightly reduce the depth of his deep nasolabial folds, so we treated him with just one pen of hyaluronic acid (1 mL). Hyaluronic acid is injected under the nasolabial folds and zygomatic ligament to lift up the overall cheeks and improve them naturally.
His skin is peeling because he received Tranex Reti peel a few days ago.

Nasolabial folds and marionette lines / A woman in her 50s

This patient requested treatment for nasolabial folds and wrinkles at the corners of the mouth (marionette lines).

The areas that the patient is concerned about are the nasolabial folds and marionette lines, but since it will look unnatural if it is injected only into the wrinkles, we will decide on the injection area by considering the balance of the entire face.

This patient showed a reduction in fat in her cheeks, so we injected hyaluronic acid into the upper part of her cheeks and under the zygomatic ligament to give her an overall lift.

In addition, by injecting hyaluronic acid into the left and right jaw lines, the jaw becomes sharper and wrinkles at the corners of the mouth become less noticeable.

The right corner of the mouth had acne scars and wrinkles, so the injection was performed after removing the adhesions with a cannula. Skin with acne scars is tough and will improve less than healthy, elastic skin.

A total of 4 pens (4ml) of hyaluronic acid are injected.

Adding an additional 4 to 5 mL to correct volume in this patient’s forehead, cheeks, mid-chin, and temples will result in an overall firmer, more youthful appearance.

Face Lifting with Hyaluronic Acid

As we age, the ligaments that support the skin stretch and sag. Hyaluronic acid lift is a treatment that lifts the face by injecting hyaluronic acid under the ligament and supporting it. The cheeks are slightly raised, giving a natural lifting effect to the entire face.

Hyaluronic acid lift is especially recommended for young people. By performing a hyaluronic acid lift before the ligaments become loose, it is possible to suppress the stretching of the ligaments due to aging and maintain a youthful appearance.

On the other hand, if the ligaments are already severely loosened, a hyaluronic acid lift will not have a visible effect. However, performing a hyaluronic acid lift can be expected to be effective in preventing future ligament droop.

Duration and Dosage of Hyaluronic Acid Lift

Duration of Effect: For hyaluronic acid lifts, we use Belotero Volume, which is less absorbent and firmer. Effects last for 12 to 18 months.
Treatment Intervals: For those in their 20s, treatments are recommended every 1 to 2 years, while for those in their 30s and beyond, yearly treatments are advised.
Dosage: In Hyaluronic Acid Lift, typically, 2 syringes (2ml) of hyaluronic acid are used.

Case of hyaluronic acid lift

Hyaluronic acid lift / A man in his 30s

Hyaluronic Acid Lift on the Left Side of the Face

This is a photo of Dr. Lin who works at our hospital.

The first photo is right after he received a hyaluronic acid lift on the left side of his face. It is injected into the ligaments above the eyebrows, cheeks, base of nasolabial folds, and jaw.

The second photo is right after he received hyaluronic acid lift injections on both sides of his face. The position of the cheeks is raised on both the left and right sides.

The hyaluronic acid on the skin surface will be slightly raised, but it will gradually adjust within two weeks.

Those who cannot receive hyaluronic acid injections

Patients who have had allergic reactions to hyaluronic acid injections in the past.
Patients who are allergic to anesthesia (lidocaine or xylocaine) *
Patients with prior non-hyaluronic acid injections (risk of granuloma)
Women who are pregnant or under breastfeeding
Those who have skin problems at the injection site.
Patients with keloids

* Belotero contains a small amount of anesthesia.

Side effects of hyaluronic acid injections

General side effects

Needle marks and bruising： Typically improve in 2-3 days for needle marks and about 2-3 weeks for bruising.
Pain： Dull pain or tenderness at the injection site, usually resolves in 2-3 days.
Swelling:：Apply a cold pack wrapped in a cloth if there’s swelling or warmth. Avoid icing the same area for more than 5 minutes to prevent frostbite. After injection in the forehead and around the eyes, swelling may occur in the eyelids, but this will gradually improve.
Tindal phenomenon：When hyaluronic acid is injected under lower eyelids, it may appear blue and translucent, like dark circles. At our clinic, we use Belotero Soft injection for this area, which is less likely to cause Tindal phenomenon.
Occasional swelling:：Due to hyaluronic acid’s water retention capacity, your face may temporarily swell, especially in the morning or when feeling unwell. This gradually improves, but if it concerns you, we can dissolve it with hyaluronidase.
Unevenness： We fine-tune injection depth and amount to prevent irregularities. For shallow wrinkle treatments, you may see some initial unevenness. Massaging the area the next day helps it settle in 1-2 weeks. Persistent issues can be addressed with hyaluronidase.
Palpable lumps： You may feel lumps under the skin where the hyaluronic acid is concentrated. If it’s merely lifting wrinkles and doesn’t create a visible bump, you can leave it as is. If there’s a visible bump, massage can help it gradually blend in.

Very rare but serious side effects

Allergy and anaphylactic shock：Some individuals may have allergies to cross-linking agents, additives, or anesthesia components in the formulation. Severe allergic reactions (such as widespread rash, swelling of the skin, lips, tongue, difficulty breathing, palpitations, low blood pressure, loss of consciousness, seizures) have also been reported. If you experience these symptoms after returning home, please call an ambulance immediately.
Foreign body granuloma：It has been reported that an excessive immune reaction or allergy can cause induration or nodules at the injection site, and in very rare cases, a subcutaneous mass called “foreign body granuloma” may appear and remain as a scar. This may occur when a non-absorbable filler agent has been injected in the past, but this is not caused by hyaluronic acid.
Infection：Although very rare, people who are immunocompromised may develop an infection.
Embolization：Serious complications such as arterial embolization, skin necrosis, skin discoloration, blindness, and cerebral infarction have been reported due to accidental intravascular injection.
Neuropathy：Needles may rarely cause sensory or motor nerves injury. Usually improves in about 3 months, but may remain in extremely rare cases.

Emergency Use and Correction By Using Hyaluronic Acid Degrading Enzymes, Hylenex

As a hyaluronic acid degrading enzyme, we use “Hylenex”, a human-derived preparation with the lowest allergy risk, to minimize allergic reactions.
Hylenex is administered when urgent dissolution of hyaluronic acid is needed, for cases like arterial embolism or skin necrosis.
It is also used for corrections, addressing issues like excessive swelling or noticeable unevenness.
Due to wider dissolution of hyaluronic acid, precise corrections may not be possible. Multiple injections may be necessary. Film or fiber-form hyaluronic acid may be harder to dissolve.
Re-injection after dissolving the previous hyaluronic acid requires an interval of at least 2 weeks.
Side effects may include rash, redness, itching, swelling, and in extremely rare cases, severe allergic reactions (such as widespread rash, swelling of the skin, lips, tongue, difficulty breathing, palpitations, low blood pressure, loss of consciousness, seizures).

Precautions after treatment

Do not rub or press the injection site on the day after the injection. From the next day, massage should be performed only when instructed by the doctor.
Please refrain from wearing makeup, taking a bath or sauna, drinking alcohol, and exercising on the day after injection. Gently washing of the face and showering are no problem on the same day.
Please contact us immediately if you notice any abnormalities, such as residual pain, strange skin coloration, or increased pain when cooled down your skin.
Please make an appointment for post-procedure check within 2 weeks to 1 month after the injection.

Treatment fee

Item	Fee (tax included)
Consultation fee	First visit ¥3,850 Revisit ¥1,650
Belotero 1mL syringe Hyaluronic acid	￥79,200
Hylenex (150Units） Hyaluronic Acid Degrading Enzymes	￥54,780
Anesthesia	Local injection anesthesia: ￥330 Tape anesthesia: 1 sheet ￥330

A consultation is required prior to each procedure.
The depth of wrinkles and treatment area may require multiple types and amounts of Belotero.
A cannula (a needle with a rounded tip) may be used depending on the area to be treated. There is no additional charge for this service.
Hyaluronic acid 1mL syringe is used in single use to prevent infection. Any leftover will be discarded.
There is no charge for hyaluronic acid degrading enzymes injections in case of emergency or within one month after the treatment, but there will be a charge thereafter.