Emerging Trends and Technologies: Promising Dermal Filler

by Dr. Jason Bloom

As published in the September/October 2018 edition of Facial Plastic times by the American Academy of Facial Plastic and Reconstructive Surgery

As part of the Emerging Trends & Technologies Committee for the AAFPRS, I will try to bring members up to date on the newest and most advanced surgical and non-surgical technologies to hit the market. In terms of injectable treatments, Revanesse Versa is the newest FDA-approved filler in the United States. This is a hyaluronic acid (HA) filler that is manufactured in North America (Ontario, Canada) by Prollenium in compliance with the FDA’s high quality and safety standards. Prollenium reports over 1 million syringes have been sold and used worldwide since 2002, and it was approved in August 2017 in the United States for the correction of facial wrinkles and creases, such as nasolabial folds.

It is important to realize that like all of the dermal fillers on the market, there are pluses and minuses with respect to each of the various technologies, and they all differ based on their manufacturing, rheology, hyaluronic acid concentration, and indications. As a result of performing extensive research, talking to the engineers, and most importantly, using the product for over 6 months in my own practice, I have learned a significant amount about Revanesse Versa.

When it comes to manufacturing, it is the uniqueness of Prollenium’s processes that differentiate Revanesse Versa from the other available hyaluronic acid fillers. For example, one of the manufacturing steps that sets it apart is the wet-milling process used to produce a homogenous spherical hyaluronic acid particle shape. In fact, when testing a batch of Revanesse Versa, over 68% of the particles were found to be perfectly spherical (Figures 1 & 2). Clinically, this means that the uniform spherical shape is more readily accepted by the body and looked at as less foreign. During Prollenium’s clinical trials, the company reported zero instances of inflammatory granulomas or delayed onset nodules during treatments. This is very important when discussing the safety of hyaluronic products with injectors and patients.

Additionally, Revanesse Versa boasts the highest hyaluronic acid concentration of any HA filler available in the U.S. at 25mg/mL. This was at first very intriguing because, in my experience, higher hyaluronic acid concentration typically leads to a greater degree of “tissue water” uptake and/or swelling in order for the product to reach equilibrium. However, in the case of Versa, the product is dialyzed for 7 days to help neutralize the product’s pH and osmolality, formulating it so that there is less absorption or release of water, and therefore reducing the risk of over or under correction. This process also removes excess BDDE (the cross-linking agent) to improve its purity. In my own practice, I have noticed that when I am injecting this product, “what you see is what you get.” There is the normal tissue swelling from the injection trauma that you would expect from any hyaluronic acid filler, but not the post-treatment influx of edema that you may expect from the high HA concentration. Swelling is really kept to a minimum.

 
Please click here for Important Safety Information and the most common adverse events with Revanesse Versa.
 

I have now incorporated this product into the repertoire of products that I regularly offer patients in my practice. From my clinical experience, Revanesse Versa has a moderate extrusion force coming out of the needle and incorporates nicely into the facial soft tissues. It has a good amount of lift and fill that is similar to other particulate HA products like Restylane, but is slightly smoother feeling in the tissue, similar to a Juvederm Ultra Plus XC. It sounds strange to say this, but I have found Revanesse Versa to be a “versatile” blend of what I like about a few different products. The one downside to the product is that there is no lidocaine in the syringe. I have personally not found this to be a problem, but some may find the injection to be more painful.

Finally, patients are getting increasingly cost conscious and there are many factors that force practices to compete on price. Due to the smaller nature of the company, Prollenium is competitively pricing their products against others the industry. The average MSRP for a syringe of Revanesse Versa is $175, while the average MSRP per syringe of the competition is about $366. Depending on how a practice incorporates it into their model and makes use of Prollenium Elite, the company’s patient rewards app, it can be a profitable choice for a practice.

While it takes some time and experience to ultimately feel comfortable incorporating a new product into an office’s injectable offerings, Revanesse Versa is a new player in the dermal filler marketplace that is safe, effective and profitable.

DISCLOSURE: Dr. Bloom serves on the advisory committee and is a consultant for Prollenium.

The American Academy of Facial Plastic and Reconstructive Surgery is the world’s largest specialty association for facial plastic surgery. It represents more than 2,500 facial plastic and reconstructive surgeons throughout the world. The AAFPRS is a National Medical Specialty Society of the American Medical Association (AMA), and holds an official seat in both the AMA House of Delegates and the American College of Surgeons board of governors. AAFPRS members are board certified surgeons whose focus is surgery of the face, head, and neck. AAFPRS members subscribe to a code of ethics.aafprs.org

Dr. Jason Bloom

Facial Plastic
Bloom Facial Plastic Surgery, Philadelphia, PA

Dr. Jason D. Bloom is an award-winning, double board-certified facial plastic and reconstructive surgeon who has worked at renowned institutions across the US. Facial plastic surgeon Dr. Jason Bloom has comprehensive experience in the medical aesthetic arts, including extensive training in non-surgical treatments. Dr. Bloom is a contributor on RealSelf, and a Premier Provider for VIP Beauty. He is frequently quoted in local and national media.facialplasticsurgeryphilly.com

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