Both Belotero and Juvederm are ranges of hyaluronic acid-based dermal fillers. The Belotero range is now produced and distributed to Merz Pharmaceuticals, Anteis S.A. remains the manufacturer of the Belotero brand. Modern fillers nowadays, including Belotero and Juvederm fillers, use butanediol diglycidyl ether (BDDE), which is a compound used to cross-link hyaluronic acid molecules, so that they can better resist the rapid degrading enzymes of hyaluronidase and other factors when injected into the skin. In other words, the cross-linking process helps increase the duration of action of the hyaluronic acid dermal fillers, and this is true of Belotero and Juvederm fillers. A long duration of action, in turn, results in a longer-lasting aesthetic change after a treatment. Patients can also benefit by having a longer time frame until their next hyaluronic acid filler treatment. The duration of effect for both Belotero and Juvederm filler products ranges from six to 12 months. However, experienced practitioners would do well to inform their patients that there are a multitude of factors that may influence this timeline. Factors such as injection technique, injection site, patient hyaluronic acid metabolism, and even just initial treatment under-correction (correction may be difficult to judge due to swelling during and after injection) can lead to patients seeking retreatment sooner. As well, some Juvederm fillers can last up to 18 months or longer.The Belotero product line comes in different formulations that include the following: Belotero Hydro, Soft, Balance, Intense, and Volume. In ascending order, their names signify the depth of injection needed and the respective purposes of the fillers. BELOTERO® SOFT is used as a superficial volumizer, Balance is a superficial to mid-level volumizer that is appropriate for treating moderate to severe facial wrinkles and folds, Intense is a mid-level volumizer, and Volume is a deep level volumizer and is suitable for treating areas with major volume loss. Their proprietary formulas and cross-linking processes focus on providing a Cohesive Polydensified Matrix (CPM), which can increase the ease of injection for these fillers and their long-lasting aesthetic improvements. The formulation used in Belotero products reduces the occurrence of the Tyndall effect (the apparent bluish discoloration of the product when it is injected too superficially in the skin), which makes these fillers more advantageous in treating fine lines, thin skin, and superficial injections, making issues such as uneven skin tone less likely to develop. Belotero fillers are manufactured and premixed with or without lidocaine, which is a local anesthetic agent added to increase patient comfort during the injection process.
The Juvederm dermal filler collection is made by Allergan. The Juvederm brand is one of the most used HA-based filler brands worldwide. It markets two types of proprietary cross-linking technology: Hylacross Technology and Vycross Technology. In the Hylacross line, there is Juvederm Ultra and Ultra Plus, while the Vycross product line consists of Juvederm Voluma, Volbella, and Vollure. The indications between these fillers are different, though there might be some overlap between the products. This is mainly due to their rheological (i.e. how materials deform and react under mechanical stress) properties.
G’ is the value given to show how much the gel is able to resist lateral shearing forces and return to its original shape. Although the rheology of hyaluronic acid dermal fillers is complex, a filler with a high G’ value means it has a better ability to lift tissue. For example, low G’ products are more suited to correcting fine lines and wrinkles, as firmness is not as desired on these more superficial defects. Severe nasolabial folds and malar enhancement, on the other hand, would require higher G’ products to lift and correct these defects. Although there are also other rheological properties to consider, these statements remain true for products such as BELOTERO® BALANCE, which has a G’ value of 128, making it suitable for mid-to-deep level dermal injections to treat moderate to severe facial rhytids and folds. Likewise, JUVÉDERM® ULTRA XC (XC signifies Juvederm models with added lidocaine), which has a G’ value of 207, is better-suited towards treating nasolabial folds, lips, commissures, marionette lines, and the chin.
There is no product that is objectively better in either the Belotero or Juvederm product line when comparing them side by side. Practitioners determine what dermal filler to use based on the concentration of hyaluronic acid; the cross-linking technology used, as it determines the longevity of a hyaluronic acid dermal filler; and rheological properties.
