I have been an avid user of Belotero Balance for a few years in my cosmetic injection practice. Last month (April 2015), I injected 4638 units of Botox and 75 syringes of fillers. 20% of the fillers I use is Belotero Balance. Much of what I do with Belotero is considered off-label FDA use. I am a frequent user of cannulas in my filler practice which includes the spectrum of Juvederm available in America and Radiesse.
Briefly about my Practice
I spend half of my clinical time personally performing cosmetic injections. I think I would be a bit busier if I spent more time on the Botox/filler side of the practice but I have plastic surgery assisting duties (my wife is a plastic surgeon, I am a general surgeon with trauma experience), a small cosmetic vein practice, and I also have an acupuncture practice which I love. After clinical hours, I am an administrator for our plastic surgery practice. I feel that I spend about 80 hours per week on our practice clinical+administrative.
Great for tear troughs and around the eyes
I use a cannula and lay down Belotero for tear troughs. It works well for many tear troughs, and flows very well through a cannula. I've learned over the years to tell the patients that the duration in that area seems to average about 6 months. Of course this varies from patient to patient. I was a Juvederm user for almost all tear troughs before and ran into some trouble with swelling for a few patients. I still run into some swelling issues with Belotero but it is much less. It also works well for building up a little bit of the cheek above the zygoma laterally.
Great for forehead lines
Some fine forehead lines are amenable to Belotero filling. It is especially useful for those patients who want a smoother forehead with less brow drooping which can happen with overzealous Botox use on the forehead. It is also great for those wrinkles in the eyebrows.
Great for a touch up on the oral commissures
Belotero is wonderful just as a small touch to a slight downturn in the oral commissure. I'm not talking about the entire marionette line, but just the corner of the mouth and injected superficially.
Great for crows feet
I need to be careful with the bruising in this area but it works well for some of the fine crows feet lines. It works well with Botox to battle those static lines.
Great for neck lines
Those horizontal lines - belotero becomes very labor intensive but well worth it. The patients get a bit of bumpy look for the first 2-3 weeks, but it settles and the Belotero works well to integrate into the skin. I'm not talking about platysmal bands - in that case - look to Botox.
Great for chest wrinkles
Or some call it decollatage area. These chest crinkles smoothes out well with Belotero well. For many patients, I have to bend the needle to get the angle I need - especially for the ones where my wife had performed breast augmentation. And it would be useful to have a chaperone in the room for these procedures.
Serial Puncture method
Yes, this is useful, and can at times reduce bruising because the needle doesn't go in very deep. A wrinkle is injected several times about 2 mm apart and the needle just barely goes into the skin. For most of what I like to do with Belotero, except for the tear troughs, I am injecting very superficially. If I'm threading the needle through (ie, in neck lines), I can see the needle through the skin. This superficial needling probably has an added collagen induction characteristic for the patients - similar to microneedling.
Superficial injections for longer lasting effect
Superficial injections lead to longer lasting effect. I have found that deeper injections in areas with movement seem to eat up the Belotero in 3 months. But 5-6 months can be derived from superficial injections.
I would recommend Belotero to other injectors
I like Belotero and would recommend it as part of our creative set of tools for beauty. It's like a very thin paintbrush. And Belotero works well with other fillers in a layered approach. Belotero has lasting effect when injected very close to the skin and when injected into areas with minimal movement. And it doesn't seem to have a bluish tint under the skin.
Calvin Lee, MD