The Emervel French Survey: A Prospective Real-Practice Descriptive Study of 1,822 Patients Treated for Facial Rejuvenation With a New Hyaluronic Acid Filler

May 2013 | Volume 12 | Issue 5 | Original Article | e88 | Copyright © 2013

David Farhi MD,a,b Patrick Trevidic MD,c Philippe Kestemont MD,d Dominique Boineau MD,e
Hugues Cartier MD,f Isaac Bodokh MD,g Patrick Brun MD,g Benjamin Ascher MD,h
and Jacques Savary MD,b,i for the Emervel French Survey Group

aDermatology Clinic, 75013 Paris, France
bMedical Affairs, Galderma France, Tour Europlaza, France
cSurgical Clinic, Paris, France
dSurgical Clinic, Nice, France
eDermatology Clinic, Bordeaux, France
fDermatology Clinic, Arras, France
gDermatology Clinic, Cannes, France
hSurgical Clinic, Clinique Iena, Paris, France
iDermatology Clinic, 75014 Paris, France

Abstract

BACKGROUND: Emervel consists of a range of 5 hyaluronic acid (HA) fillers (Touch, Classic, Lips, Deep, and Volume), with a fixed HA concentration (20 mg/mL), and various degrees of cross-linking and calibration.
OBJECTIVES: To describe the current use of Emervel fillers in France.
METHODS: Prospective multicenter, cross-sectional, real-practice, descriptive survey, including 1,822 patients injected with Emervel fillers for face rejuvenation by 58 French physicians between September 2010 and July 2011. The injection modalities were left to the respective physician’s discretion.
RESULTS: The physicians were dermatologists (52.3%), surgeons (43.8%), or general practitioners (14.1%). Nasolabial folds (NLF) with a mean severity 2.4 were mainly injected with Emervel Deep (51.0%) and Emervel Classic (36.0%) (mean volume: 1.0 mL), and primarily with the linear retrograde (LR) technique (89.3%). Marionette lines (ML), with a mean severity 2.6 were mainly injected with Emervel Deep (52.5%) and Emervel Classic (34.6%) (mean volume: 0.8 mL), and mainly with the LR technique (79.5%). More than 90% of patients had scores of 0 or 1 for erythema, bruising, edema, and pain. No serious adverse events were reported up to 15 months after the injection.
CONCLUSION: These data could contribute to upcoming international consensus on optimal injection modalities of the Emervel range of HA fillers.

J Drugs Dermatol. 2013;12(5):e88-e93.

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INTRODUCTION

Hyaluronic acid (HA), a linear glycosaminoglycan that is naturally produced in conjunctive tissues, was first isolated in the vitreous of cows’ eyes in 1934. HA is a chain of disaccharide glucuronic acids and N-acetyl-glucosamine.1 HA has no antigenic specificity for species or tissues.2 In humans, HA is found in high concentration in the skin, eye vitreous, hyaline cartilage, synovial joint fluid, disc nucleus, and umbilical cord. HA is extremely hygroscopic; one gram of HA can bind up to 6 liters of water.3

During the last decade, temporary fillers based on cross- linked HA became the mainstay of noninvasive facial rejuvenation due to their biocompatibility, biodegradability, relatively low immunogenicity, and good safety profile compared with permanent fillers. Since the inaugural launch of the Restylane® range (Q-Med; Sweden) in 1995, more than 60 brands of HA skin fillers have been commercialized in Europe that have various rheological properties and clinical profiles.

The Emervel® (Galderma, Switzerland) products are a wide array of HA soft tissue fillers that received CE marking in Europe in 2008. Their efficacy and safety in facial rejuvenation have been shown in several prospective, randomized controlled trials,4, 5 and open, non-controlled trials.6-8

The Emervel products’ rheological features, and their performance in initial clinical trials and also in real-life experience, led to them receiving a wide range of indications for cosmetic surgery.9 Emervel Touch, injected with a 30 G ultrathin wall (UTW) needle, has been recommended for the correction of superficial perioral and periorbital wrinkles. Emervel Classic, injected with a 30 G UTW needle, is mainly indicated for the

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