PRESIDENT MD. BYUNGSUN KIM

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HA FILLER Reborn Academy Atlas Book

20191st Version

REBORN ASTHETICO-PLASTIC CLINIC

PRESIDENT MD. BYUNGSUN KIM 원장 김병선

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PRESIDENT MD. BYUNGSUN KIM

원장 김병선

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A. FILLER History

History of Aesthetic Filler

PRESIDENT MD. BYUNGSUN KIM

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A. FILLER History

History of Aesthetic Filler

FAT : Started by Dr. Brung 1911

Using Cannula and Suction by Dr. Illouz 1978

Using Microlipoinjection by Dr. Pierre Fournier 1986

Using Tumescent by Dr. Jeffery Klein 1987

PARAFFIN : Started by Dr. Gersuny 1899

Faced Out : Granuloma and Migration

Liquid Silicone : Started by Someome 1940’s

USA FDA Proclaimed Negative Drug List at 1991

USA FDA Allowed Opthalmologic Usage 1994,1997

SilSkin => Off-Label Use

*Cohesive Silicone Gel :

USA FDA Breast Augmentation Material since 2006

“Gummy Bear”

COLLGEN:

• BOVINE COLLAGEN : COW Collagen

Strated by Zyderm (INAMED Corp.) 1981

Koken Atelocollagen 1986

Artecoll 1992

• POCINE COLLAGEN : PIG Collagen

Started by Fibrel 1985

Permacol Surgical Implant 2001

Evolence 2004 (Approved at 2008 in FDA)

• HUMAN COLLAGEN : HUMAN Collagen

Stared by Alloderm 1992

Cosmoderm 2003

PMMA: Poly-methyl-meth-acrylate

Started by Dr. Lemperle as Artecoll 1992 (Acryl 1: Bovine Collagen 3)

Artefill 2006

PAAG: Poly-Acryl-Amide Gel

Started by Interfall 1980s

Aquamid 2001

PLLA : Poly-L-Lactic Acid

Started by Sculptra 1999

CaHA

Started by Radiesse 2001

OTHERS

Bio-Alcamid: Polyalkyimid,

Isolagen: Fibroblast Culturing Solution,

Gore-Tex: ePTFE

Hyaluronic Acid . HA Filler

Started by Hylans 1980s(Hylan B Gel : Hyalform 1996)

Restylene 2003 FDA (NASHA : Patent 1995)

Hyalform 2004

Winners of Aesthetic Filler

HA Filler

PRESIDENT MD. BYUNGSUN KIM

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A. FILLER Characteristics

Characteristics of Hyaluronic Acid as Cosmetic Use

(C14H21NO11)n D-Glucuronic Acid N-Acetyl Glucosamine

Na

HUMAN BODY

COMPONENT

Natural Substance in Human Body

Human Cell Membrane, Cartilage, Eye, Skin

CHARACTERS

Molecular Weight: 401Da(3~4M Da in Human Body)

Melting Point : 107.8oC

Non-Immunogenicity. Non-carcinogenic.

Non-teratogenic . Non-migratory

High Viscoelasticity

Biocompatible Biosynthesis : Streptococcus Equi

Biodegradability(within Several days)

Polymer : Repeatable Disaccharide Structure

Possible Molecular Modifying Sites

Synthesis : Hyaluronan Synthase

Water Retention Capacity

Non-Cross Linked 300Times than MW

Cross-Linked 1000Times than MW

PRESIDENT MD. BYUNGSUN KIM

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A. FILLER Characteristics

Characteristics of Hyaluronic Acid as Cosmetic Use

Biodegradability(within Several days)

PRESIDENT MD. BYUNGSUN KIM

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A. FILLER Characteristics

Characteristics of Hyaluronic Acid as Cosmetic Use

Biodegradability(within Several days)

BDDE . DVS

PRESIDENT MD. BYUNGSUN KIM

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A. FILLER Characteristics

Characteristics of Hyaluronic Acid as Cosmetic Use

Biodegradability(within Several days)

Valuation Standards of HA Filler

Commercial

Standards

Experienced Doctor’s Opinion

Safety. Price. Longevity

Promotion and Marketing Power

Brand Value

Technical Standards

Size of Gel Particle

Uniformity and Distribution of Gel Particle

G’(Viscoelasticity )

Crosslink Rate

Crosslink/Pendant Ratio

Concentration of HA

Gel/Fluid Ratio

Hydration Rate

Dissolving Method

PRESIDENT MD. BYUNGSUN KIM

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A. FILLER Characteristics

Characteristics of Hyaluronic Acid as Cosmetic Use

Biodegradability(within Several days)

Crosslink

Site Radial –COOH and Radial -OH

Crosslink

Material

BDDE : 1,4 Butanediol Diglycidyl Ether

LD50 :1,134mg/kg

DVS : Divinyl Sulfone

LD50 :32mg/kg

Crosslink

Purpose

Water Insoluble : Increase ViscoElasticity

Hyaluronidase Insensitive : Increase

Longevity

Crosslink

Tip

Crosslink Rate : More and Less 1%

Crosslink-to-Pendant Ratio : 50%~80%

Visco-Elasticity

Index

G’ : Elastic Modulus

G” : Viscous Modulus

G’

Elastic Modulus

G’=Stress/Strain “Gel Hardness”

Resistance against External Physical Stress

Increase Life Span

Normal HA Filler G’: 100~1000Pa, Dermis G’:

3,000,000Pa

Monophasic << Biphasic

Shear Rate Injection: Low Viscosity at High Shear Rate

=> Intradermal: High Viscosity at Low Shear Rate

PRESIDENT MD. BYUNGSUN KIM

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A. FILLER Characteristics

Characteristics of Hyaluronic Acid as Cosmetic Use

Biodegradability(within Several days)

Degradation

Hyaluronidase

Vertebrate Type Endo-b-Acetyl-Hexosaminiudase

Hyaluronate-Lyase

Hyalurono- Glucuronidase

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A. FILLER Techniques

Techniques

Biodegradability(within Several days)

Classic Layer to Injection Modern Layer to Injection

Dermal Cutting Technique Linear Threading Technique

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A. FILLER

Biodegradability(within Several days)

Pushing Head Technique Linear Threading Technique

Cross Hatching Technique Fan Technique

Cross Technique

Fern Pattern Technique

Techniques

Techniques

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A. FILLER

Biodegradability(within Several days)

Cross Technique

Fern Pattern Technique

Techniques

Techniques

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A. FILLER

Biodegradability(within Several days)

Techniques

Techniques

PRESIDENT MD. BYUNGSUN KIM

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A. FILLER Filling

Forehead Anatomy

Biodegradability(within Several days)

Nerve Artery

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A. FILLER

Forehead Dermal Filler

Biodegradability(within Several days)

Forehead Augmentation

Filling

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A. FILLER

Forehead Dermal Filler

Biodegradability(within Several days)

Temple Hollow Augmentation Worry Line Filler

Filling

PRESIDENT MD. BYUNGSUN KIM

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A. FILLER

Mid Face Anatomy

Biodegradability(within Several days)

Filling

PRESIDENT MD. BYUNGSUN KIM

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A. FILLER

Mid Face Anatomy

Biodegradability(within Several days)

Filling

PRESIDENT MD. BYUNGSUN KIM

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A. FILLER

Mid Face Anatomy

Biodegradability(within Several days)

Filling

PRESIDENT MD. BYUNGSUN KIM

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A. FILLER

Mid Face Anatomy

Biodegradability(within Several days)

Filling

PRESIDENT MD. BYUNGSUN KIM

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A. FILLER Midface

Mid Face Anatomy

Biodegradability(within Several days)

PRESIDENT MD. BYUNGSUN KIM

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A. FILLER

Biodegradability(within Several days)

Mid-face Dermal Filler

Lower Eye-line Filler

Filling

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A. FILLER

Biodegradability(within Several days)

Mid-face Dermal Filler

Tear Trough Filler

Filling

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A. FILLER

Mid-face Dermal Filler

Nose Bridge Augmentation

Filling

PRESIDENT MD. BYUNGSUN KIM

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A. FILLER

Mid-face Dermal Filler

Nasal Columella Augmentation

Filling

PRESIDENT MD. BYUNGSUN KIM

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A. FILLER

Mid-face Dermal Filler

Cheek Augmentation

Filling

PRESIDENT MD. BYUNGSUN KIM

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A. FILLER

Mid-face Dermal Filler

Naso-labial Folder

Filling

PRESIDENT MD. BYUNGSUN KIM

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A. FILLER

Biodegradability(within Several days)

Low-face Anatomy

Filling

PRESIDENT MD. BYUNGSUN KIM

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A. FILLER

Biodegradability(within Several days)

Low-face Dermal Filler

Lip Augmentation

Filling

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A. FILLER

Biodegradability(within Several days)

Smoking Line, Philtrum Ridge, Cupids Bow, Vermilion Filler

Filling

PRESIDENT MD. BYUNGSUN KIM

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A. FILLER

Biodegradability(within Several days)

Low-face Dermal Filler

Chin Augmentation

Marionettes Line Filler

Filling

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A. FILLER

Biodegradability(within Several days)

Breast Filler

Above Pectoris Major

Filling

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A. FILLER

Biodegradability(within Several days)

Buttock & Hand Filler

Above Periosteal Area and Fat Layer Intra Dermal Layer

Filling

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A. FILLER

Biodegradability(within Several days)

Vagina & Penis Filler

Connective Tissue Connective Tissue

Filling

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A. FILLER

Biodegradability(within Several days)

Vaginal Filler

Connective Tissue Connective Tissue

Filling

Each 5ml LONG ACTING PLLA + HA FILLER

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A. FILLER

Scar Filler

Subcision and Filler

Filling

PRESIDENT MD. BYUNGSUN KIM

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THANKS A LOT

리본의원 리본의원

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