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Bon Betemps et al. Plast Aesthet Res 2018;5:19 I http://dx.doi.org/10.20517/2347-9264.2018.24 Page 3 of 8

Table 1. Description of Juvéderm Voluma and one HA volumizer benefiting from the OXIFREE technology
Product Manufacturer Manufacturing Crosslinked HA Clinical indications Comment
reference technology content (mg/mL)
Gel D Kylane Laboratoires OXIFREE 24 - Injection in the fat tissue or into the Product with the highest
(Geneva, Switzerland) supraperiostic zone projection capacity of the
- Restoration of the volume of the face HA filler range
Juvéderm Allergan (Pringy, VYCROSS 20 - Injection in the fat tissue or into the /
Voluma France) supraperiostic zone
- Restoration of the volume of the face

of the rheometer. The measurements were carried out over a frequency range of 0.1-5 Hz. The value of the
elastic modulus G’ was measured at the physiologically oscillation frequency of 1 Hz.

Compression test in static mode
The compression test in static mode enables the measurement of the normal force F . It was performed at a
N
temperature of 25 °C in normal force mode, with a cone/plate aluminium geometry of 40 mm 2 degrees: 1.0 g
of gel was placed between the cone and the plate and the cone was set in contact with the gel and lowered
toward the bottom plate, thus compressing the gel. The normal force (F ) was measured for a gap between
the cone and the plate of 1.11 mm (inverse gap = 0.9 mm ). N
-1

Compression test in dynamic mode
The compression test in dynamic mode enables the measurement of the elastic modulus E’. It was performed
at a temperature of 25 °C in compression oscillation mode at 1.0% of strain, within the linear viscoelastic
region, with a 40 mm plate/plate aluminium geometry and a 0.5-mm gap between the parallel rheometer
plates. The measurements were carried out over a frequency range of 0.1-5 Hz. The value of the elastic
modulus E’ was measured at the physiologically oscillation frequency of 1 Hz.

Data analysis
All measurements were carried out in triplicate. Data were expressed as the mean ± standard deviation.
Coefficients of variation lower than 10% were considered as satisfactory. Results were evaluated statistically
using Student's t-test with a level of significance fixed at α = 0.05.

Skin model assay
Skin model assay description
The skin model “Injection trainer” (Limbs and things, Bristol, UK) used to assess the projection capacity
is composed of multiple tissue layers: epidermis, dermis, fat and muscle. This artificial skin model could
be used for training in order to practice intradermal, subcutaneous and intramuscular tissue injection
techniques. The skin layers can be peeled back.

The following protocol is applied to evaluate the projection capacity of the two tested HA fillers, i.e. Juvéderm
Voluma and the OXIFREE product (gel D), with this artificial skin model:
- After peeling back the upper skin layer, exactly 0.80 g of each HA gel is deposited on the top of the
intermediate skin layer;
- The two HA gels are overlaid by the upper skin layer;
- Standardized pictures at a distance of 30 cm are taken (front view, with camera Nikon D5000 equipped
with a lens Nikon AF-S DX VR II 18-200 mm f/3.5 - 5.6 ED);
- The projection height induced by each HA gel’s bolus is measured in millimeter [difference between the top
and the baseline of the ellipse (baseline is plotted between the two bending points of the ellipse)].

One test is performed with Juvéderm Voluma on the left of the skin model and gel D on the right and a
second test is performed with Juvéderm Voluma on the right of the skin model and gel D on the left.