This article has been translated. For the original please click here.

Effect and safety of hyaluronic acid injection Kaisense ® with high lifting force




Tingsong Lim
Dr. Tingsong Lim

Clique Clinic

Board of Director for International Society of Dermatologic & Aesthetic Surgery(ISDS) Scientific Director for Aesthetic Dermatology Academy Conference(ADAC) Scientific Board for 5 Continent Congress(5CC) Scientific Committee for IMCAS World Congress Scientific Committee for AMWC World Congress International Scientific Director for iSWAM Treasurer for MSAM Japanese Medical Board United States Educational Commission for Foreign Medical Graduates(ECFMG) Malaysian Medical Council Letter of Credentialing and Privileging(LCP)


Hyaluronic acid injection therapy has evolved significantly over the last 30 years and has become an indispensable treatment in aesthetic medicine.

Hyaluronic acid injection is an injection method that simply fills wrinkles and makes them inconspicuous, restores the volume of thin subcutaneous tissue, reinforces the supporting ligaments (ligaments) and lifts them up to improve sagging, and is ideal. We are developing into something that realizes contour formation.

One of the factors behind this rapid development is the advancement of hyaluronic acid injectables. One of them is KYSENSE®, a new hyaluronic acid injection agent launched in the EU in February 2021.

Kaisense uses the patented OXIFREE manufacturing method to have high viscoelasticity and uplifting power even with a small amount of cross-linking agent (*), excellent forming power, and maintain a natural finish for a long period of time.

In order to maximize the effect of Kaisense, it is important to familiarize yourself with the characteristics and indications of the Kaisense® series, use the appropriate formulation according to the treatment site and purpose, and inject the appropriate amount at the appropriate injection depth .

* Cross-linking agent: An adhesive that binds the molecular structure of hyaluronic acid to increase viscoelasticity and cohesiveness and prolong the effect.

High effect by patented oxy-free manufacturing method = Lifting force and high quality = Kaisense ® that maintains safety

Hyaluronic Acid Injection Kaisense

KYSENSE® is a hyaluronic acid injection developed by a Swiss pharmaceutical manufacturer and is manufactured by the patented OXIFREE process .

There are four types of Kaisense® series, Precise , Define , Volume , and Extreme, each of which certifies that it meets the safety standards of EU (European Union) member states. I am getting the mark .

Before learning about the features of the Kaisense® series and the effects that can be expected from each of the four types, we will first explain the role, manufacturing method, and features of general hyaluronic acid injections in aesthetic medicine.

Role of hyaluronic acid injection

Hyaluronic acid originally exists in various parts of the body such as human skin, eyes, blood vessels, joints and ligaments.

Hyaluronic acid is gel-like and has high viscoelasticity and water retention, and is synthesized and decomposed in the body. It is known to reduce moisturizing power and cause wrinkles and sagging.

In addition, wrinkles and sagging occur due to bone thinning, loosening of supporting ligaments, changes in fat mass, etc. with aging, but as an injection agent that compensates for volume loss on the face and improves wrinkles and sagging, the living body Hyaluronic acid, which is highly safe for aging, has come to be used.

Hyaluronic acid injection is used not only for wrinkles and sagging, but also for contouring, such as making the nose look taller and sharpening the chin.

Hyaluronic Acid Structure and Crosslinker (BDDE)

The structure of hyaluronic acid is like a chain of alternating molecules of glucuronic acid, a type of acid, and N-acetylglucosamine, a type of sugar.

Hyaluronic acid, which exists in nature such as in the human body, is called high molecular weight hyaluronic acid because it has a long molecular structure (molecular weight of 1 million or more) in which a number of chains are gathered and connected naturally.

On the other hand, hyaluronic acid artificially made for the purpose of beauty is a small molecule hyaluronic acid because it is a short hyaluronic acid that is not connected to each other.

Chains of small molecule hyaluronic acid that are not linked to each other are easily decomposed and absorbed by enzymes existing in the body as they are, and as a result, the duration of the effect is shortened.

Therefore, in order to bind the chains of hyaluronic acid to each other, a cross-linking agent (kakyozai) is added to the hyaluronic acid injection agent. In order to maintain a certain level of persistence, a cross-linking agent is added to connect the short chains of hyaluronic acid that have been separated, and the structure of the chains is reproduced to slow down the rate of decomposition in the body.

Many hyaluronic acid injections use 1,4-butanediol diglycidyl ether (BDDE) as a cross-linking agent.

By containing a large amount of cross-linking agent (BDDE), the action of binding hyaluronic acid chains is strengthened, but if too much cross-linking agent is injected into the skin, it is flexible to the movement of surrounding tissues and external pressure. It is said that the ability to expand and contract and restore the shape is reduced, making it easier for lumps and irregularities to form on the skin.

In addition, if the amount of cross-linking agent is small, there is an advantage that the risk of redness and inflammation is reduced, but since the viscoelasticity and cohesiveness are reduced, it easily spreads in the skin tissue and the effect of supplementing the volume is difficult to maintain. had.

Features and benefits of Kaisense®

Kaisense ® that maintains high forming power and lifting power even with a small amount of cross-linking agent

It is said that active oxygen generated in the manufacturing process of hyaluronic acid injection destroys the molecular structure of high molecular weight hyaluronic acid, resulting in faster decomposition and absorption in the body and a shorter effect of maintaining volume.

Kaisense ® uses the patented OXIFREE manufacturing method to thoroughly eliminate active oxygen generated during the manufacturing process, making it possible to maintain long chains of high molecular weight hyaluronic acid. Therefore, Kaisense ® maintains high viscoelasticity with a small amount of cross-linking agent (BDDE) and has a high ability to raise the skin tissue, so it is said to realize a high level of forming force and lifting force.

Kaisense's oxy-free manufacturing method

Crosslinker (BDDE) content: 3.5% -less than 4.4% for all types of Kaisense® series

High tissue affinity and natural finish

Hyaluronic acid injection supplements the volume of the skin and can be expected to have effects such as making wrinkles less noticeable while the action lasts. However, when an injection that does not have sufficient tissue affinity is injected into the face such as wrinkles and nasolabial folds on the forehead, the injection flexibly expands and contracts in response to the movement when the skin stretches or contracts due to changes in facial expressions. It cannot be done and may look unnatural.

Since Kaisense ® has a high tissue affinity, it easily blends into the skin tissue of the face, and you can expect a natural finish that matches your facial expression.

Safety of Kaisense®

Kaisense® has obtained the CE mark certifying that it meets the safety standards of EU (European Union) member states.

In addition, from March 2018 to March 2019, a satisfaction survey of 110 cases was conducted in a multicenter clinical trial (multicenter clinical trial) at 6 facilities in 4 countries, and its effectiveness and safety were proved by a third-party organization. I am.

Kaisense ® is a hyaluronic acid injection that maintains a high-quality high-molecular-weight hyaluronic acid structure, so even a small amount of cross-linking agent has high forming power and a low risk of causing troubles such as delayed inflammation.

Multicenter clinical trial (multicenter clinical trial)

Six researchers (five injectors and one independent evaluator) participated in the multicenter clinical trial. The safety of the Kaisense® series was assessed immediately after injection and after 1, 6, and 12 months using an injection site reaction (ISR) by an independent evaluator.

All reported injection site reactions ISRs were the usual sign observed with hyaluronic acid infusion, and one month after administration, most injection site reactions that occurred after injection disappeared. In addition, no serious adverse events occurred in this study.

4 types of Kaisense series to use properly according to purpose and part

There are four types of Kaisense ® series with different hyaluronic acid concentration, viscoelasticity, and uplifting force , and you can use them according to your purpose and application site.

product name KYSENSE® Precise KYSENSE® Define KYSENSE® Volume KYSENSE® Extreme
HA concentration 15 mg / ml 18mg / ml 21 mg / ml 24 mg / ml
Injection depth Dermis or lip mucosa Deep dermis or lip mucosa Subcutaneous adipose tissue or periosteum Subcutaneous adipose tissue or periosteum
Main adaptation Fine wrinkles on the face such as the eyes and corners of the mouth, contours of the lips Moderate nasolabial folds, moderate facial dents, increased lip volume Improvement of severe nasolabial fold, recovery of facial volume such as cheek moss, lift up of cheek sagging Volume up of temple dents, lift up of cheek slack, contour formation to adjust nose, chin and face line
Capacity per syringe 1ml 1ml 1ml 1ml
Needles provided for each box 4x30G 1/2 4x30G 1/2 4x27G 1/2 4x27G 1/2

Kaisense® Precise

The concentration of hyaluronic acid per ml contained in Kaisense® Precise is 15 mg, which is the softest hyaluronic acid injection in the series. It is used in treatments aimed at making fine wrinkles on relatively shallow layers of the skin, such as the eyes and corners of the mouth, less noticeable.

Kaisense® Define

The hyaluronic acid concentration per 1 ml of Kaisense ® Define is 18 mg, which is a slightly soft hyaluronic acid injection. It is used to make wrinkles less noticeable by increasing the volume of the lips and filling the grooves of the nasolabial fold.

Kaisense ® Volume

The hyaluronic acid concentration per 1 ml of Kaisense ® Volume is 21 mg, and it is a hyaluronic acid injection agent with moderate uplifting power. It is used in treatments aimed at improving severe nasolabial folds and sagging mouths (marionette lines), and supplementing the volume of the temples and cheeks that have become thin with age.

When used for the purpose of improving slack, instead of injecting directly into the nasolabial fold to fill the groove, injection that lifts up naturally, such as injecting at a point that lifts the loosened supporting ligament of the cheek. The method can be used.

Kaisense® Extreme

The hyaluronic acid concentration per 1 ml of Kaisense ® Extreme is 24 mg, and it is a hyaluronic acid injection with high uplifting power. Despite its high hyaluronic acid concentration, it is not stiff and moves flexibly according to the movement of muscles, so there is almost no tactile sensation after injection .

For increasing the volume of thin temples and lifting up loose cheeks with aging. In addition, you can expect effects such as raising the nose and injecting it into the chin to adjust the contour and make the face line look neat and small.

Performance comparison between Jubiderm Vista® Voluma XC and Kaisense® Extreme

In a performance comparison between Juviderm Vista® Voluma XC and Kaisense® Extreme in a multicenter clinical trial, Kaisense® Extreme has a stronger ability to lift skin tissue than Voluma XC to achieve the same results. , Kaisense® Extreme has been shown to require 24% less injection than Voluma XC .

Duration of Kaisense ・ Number and frequency of treatments

Like other hyaluronic acid injections, Kaisense can be expected to have effects such as lift-up immediately after the procedure.

The duration of the effect of Kaisense is 12 months in the clinical trial of the multicenter clinical trial (multicenter clinical trial) in 2019, but the prognosis of the subjects is still being followed, and it is said that the effect is sustained for 18 months.

Although there are individual differences, it is gradually absorbed into the body, so in order to maintain the effect, the injection should be continued about once every 6 to 12 months.

Kaisense injection method and pain / downtime

Kaisense injection method and pain of treatment

Some types of hyaluronic acid injections contain lidocaine, an anesthetic, but the Kaisense® series does not contain lidocaine, so people with lidocaine allergies can also be treated .

If desired, use surface anesthesia such as anesthesia cream or local anesthesia.

When injecting Kaisense, an extra-fine needle (sharp needle) with a diagonally cut tip, or an injection needle (blunt needle) called a cannula with a rounded tip and a hole for the formulation to come out. Use to inject into areas where wrinkles are a concern or where you want to produce volume.

You may feel a tingling sensation at the moment of piercing with a sharp needle, but it is said that you will not feel a strong pain at the time of injection.

Since the cannula of the blunt needle is also a thin needle, there is less pain during the procedure, and since the tip of the needle is round, it is difficult to damage small blood vessels, so the risk of internal bleeding is low . Since the needle hole through which the drug comes out is on the side instead of the tip, the practitioner can adjust the direction in which the drug is injected by rotating the needle inside the skin.

Kaisense downtime and postoperative course

Kaisense is mainly composed of hyaluronic acid, which originally exists in the human body, and does not involve any burdensome treatment such as skin incision, so it is said that there is almost no downtime.

However, because it uses a needle, internal bleeding may occur if small blood vessels are damaged. Even if internal bleeding occurs, a blood clot will form naturally and the bleeding will be blocked, and it will usually settle in about 1 to 2 weeks.

Mild swelling, redness and unevenness may occur at the treatment site for several days to 2 weeks.

Immediately after the procedure, fine needle marks may remain on the injection site, but it is said that they disappear in 1 to 2 days.

Risks and complications of Kaisense and how to avoid them

In rare cases, it may cause allergic reactions such as redness and inflammation, but Kaisense is said to have a low risk of allergies by reducing the content of cross-linking agents that are irritants to the skin.

In the unlikely event that the drug is accidentally injected into a blood vessel and blocked, it can cause an embolus that blocks blood flow . Embolism can pose a serious risk of vision loss, blindness, skin necrosis, and stroke.

If you experience any abnormalities such as sudden abnormal pain, tingling discomfort, or changes in skin color, contact a medical institution immediately.

To avoid the risk of blood clots from hyaluronic acid injections, it is important to choose a doctor who is familiar with facial anatomy and has experience .

In addition, since there is a risk of unnatural finish if a large amount of the preparation is injected in one treatment, the injection amount should be carefully decided while listening to the doctor's advice.

If you want to make corrections because you don't like the finish after the treatment, you can restore it to its original state by injecting an enzyme preparation called hyaluronidase, which has the effect of decomposing hyaluronic acid.

Hyaluronidase used in the modification (removal) of hyaluronic acid injection

Hyaluronidase is a type of enzyme preparation that has the effect of decomposing hyaluronic acid injected during wrinkle treatment and contouring.

Since hyaluronic acid has the function of decomposing it into water and carbon dioxide, hyaluronidase can be corrected (removed) after injection, such as when unnaturalness occurs due to excessive injection or when unevenness (lump) appears at the injection site. It is used when desired . However, the injected hyaluronic acid cannot be completely decomposed at one time, and it may be left behind.

As a function of hyaluronidase, not only hyaluronic acid injected by the treatment but also hyaluronic acid originally present in the body is decomposed in about several hours. However, hyaluronic acid, which is originally present in the body, is a substance that is naturally produced even after it is decomposed, so it is said that it will return to its original state over several days.

In addition, not only recently injected hyaluronic acid, but also hyaluronic acid that has been injected for a long time, such as one year ago, can be decomposed. After receiving the correction with hyaluronidase, it is necessary to wait 3 to 4 weeks before re-injecting hyaluronic acid.

Precautions when receiving Kaisense treatment

Those who cannot receive treatment

  • Those who are pregnant or may be pregnant or breastfeeding
  • Those who have unhealed inflammation or trauma at the treatment site
  • Those with a keloid constitution or those with a constitution that makes it difficult for wounds to heal
  • Those with serious underlying illness
  • Those who are prone to bleeding or who are using anticoagulants
  • Those who may have an allergic reaction, inflammatory reaction, or infection
  • Those who have been diagnosed as unable to receive treatment at a medical institution

If you are undergoing or planning to undergo irradiation treatment such as laser or peeling treatment, please consult with a medical institution before receiving hyaluronic acid injection.

Please note that minors need the consent of their parent or guardian to receive the treatment, and if they do not have the consent, they will not be able to receive the treatment. It is recommended that a parent or guardian be present during the examination / counseling in order to listen carefully to the risks and precautions and carefully decide whether to receive the treatment.

Also, if you are taking anticoagulants or anti-inflammatory drugs on a daily basis, please consult with your doctor in advance if there is any problem with the treatment.

Precautions before and after the procedure

On the day of the procedure (before surgery), please refrain from drinking alcohol as it may cause internal bleeding due to the promotion of blood circulation. In addition, it is necessary to refrain from activities that promote blood circulation such as drinking alcohol, strenuous exercise, and sauna to prevent internal bleeding even after receiving the treatment on the day.

Makeup other than the shower and the treated area will be available on the day, makeup for the treated area will be available the next day, and bathing in the bathtub will be possible from the day after the procedure. Also, please refrain from strong massage on the treatment site for about a week to prevent the injection from flowing to the surroundings.

If you receive other treatment after injection

If you are considering other treatments for the same area after receiving Kaisense injections, it is recommended that you leave a certain interval between them.

When receiving other treatments, please inform your medical institution about the type of formulation injected and the timing of the last injection, and discuss whether it is possible to receive the treatment.

Comparison of Kaisense with other treatments

Major hyaluronic acid injections other than Kaisense

In addition to Kaisense, there are various types of hyaluronic acid injections used in aesthetic medicine. The main hyaluronic acid injections used in many medical institutions include the following products, each with different characteristics, indications, and duration .

Hyaluronic acid injection Estimated duration Hardness Main adaptation
Jubiderm Vista® Volvera XC 9-12 months soft For soft areas such as lips, tear bag formation, eyes, and mouth area
Jubiderm Vista® Bolift XC 12-18 months Slightly soft Nasolabial fold, marionette line, etc.
Jubiderm Vista® Voluma XC 18 to 22 months Moderate hardness Forehead, nose, nasolabial fold, cheeks, face line, chin
Jubiderm Vista® Borax XC 18 to 22 months Very hard Chin, nose
Theosial RHA1 9-12 months soft Small wrinkles on the face, neck, and décolletage, such as around the eyes and corners of the mouth
Theosial RHA2 9 to 18 months Slightly soft Moderate wrinkles, gentle skin volume up
Theosial RHA3 12 to 20 months Moderate hardness Deep wrinkles on the face such as nasolabial folds, volume up of natural skin
Theosial RHA4 12 to 22 months hard Contouring to trim the nose and face line
Theosial RHA KISS 6-8 months soft Volume up of lips
Neuramis 6-12 months Slightly soft Moderate wrinkles
Les styrene lid 12-18 months Moderate hardness Moderate to severe wrinkles
Bero terrorist software 9-12 months soft Eyes, tear bag formation, etc.
Bero terror balance 9-12 months Slightly soft Moderate wrinkles, facial expression wrinkles
Style S 9-12 months soft Mild wrinkles, lips
Cleviel Contore 12-18 months Very hard Contouring of nose and chin

Main injection treatments other than Kaisense (hyaluronic acid)

There are various injection treatments other than hyaluronic acid injection such as Kaisense, and each has different worries that the action and improvement of the preparation can be expected.

Treatment Main adaptation
Fat dissolving injection Partial thinning of face and body
Rejuran injection Wrinkles, open pores, bears, firmness, etc.
Lady Esse injection Deep wrinkles, contouring
Elance Wrinkles, tightening, firmness, contouring, etc.
Baby collagen injection Shallow wrinkles, open pores, firmness, etc.
Botulinum injection Facial expression wrinkles on the forehead and outer corners of the eyes, tension of gills, etc.

Treatment that should be used in combination with Kaisense

Botulinum injection to improve facial wrinkles

Botulinum injection can be expected to relieve muscle tension by inhibiting the action of substances that transmit commands from the brain, improve facial expression wrinkles, and adjust parts and contours.

Botulinum injection is effective for improving vertical wrinkles between the eyebrows, laughing wrinkles at the corners of the eyes, laughing wrinkles at the nose, and umeboshi wrinkles on the chin, which are difficult to improve with hyaluronic acid injection such as Kaisense.

Botulinum injection is also used to reduce the tension of the developed gills (masseter muscle) and clear the face line.

By combining Kaisense and botulinum injection for each indication site, wrinkles and sagging can be improved more finely.

Thread lift that pulls up slack with thread (thread lift)

Thread lift is a treatment that puts a special thread (thread) with a catch under the skin to raise the slack on the face and neck.

After effectively pulling up the slack with a thread lift, you can expect improvement of tired face and old face by injecting hyaluronic acid using Kaisense to the part with insufficient volume such as moss and temples on the cheek.

Flow of Kaisense treatment

(1) Medical examination and counseling

After completing the questionnaire at the medical institution, you will be examined and counseled by a doctor to hear an explanation of the treatment details and risks. If you have any concerns, hopes, anxieties or uncertainties about the procedure, please consult your doctor at this time. Decide the type of Kaisense to use and the injection amount according to the desired finish.

(2) Face washing / anesthesia

Cleanse the treatment area by washing your face (and cleansing if you are wearing make-up). Those who wish to be anesthetized should wait for a while after using local anesthesia or surface anesthesia at the treatment site.

(3) Injection of Kaisense

Inject using a needle or cannula to the injection site determined at the time of counseling. The time required varies depending on the number of sites desired for treatment, but it is approximately 10 to 20 minutes excluding anesthesia treatment.

(4) Cooling / end

If redness or swelling occurs at the injection site, cooling treatment is performed. It ends after receiving explanations such as how to spend during downtime and precautions after treatment.

To receive better treatment ・ How to choose a medical institution

Kaisense is a hyaluronic acid injection that achieves both high forming power and safety by the patented oxy-free manufacturing method, and can be expected to improve wrinkles and sagging of the face and form the ideal face line.

However, since the face has many nerves and blood vessels running, there is a risk of causing various disorders such as vascular disorders, visual acuity abnormalities, stroke and skin necrosis if the injection location and injection amount are incorrect . It is important to choose a doctor who has accumulated practical experience while constantly brushing up his anatomical knowledge .

In addition, it is said that hyaluronic acid injection tends to make a difference in the finish depending on the practitioner's sense. You can also check the case photos posted on the website of each medical institution or the doctor's personal blog, and appoint a doctor who is in charge of the case that is close to your ideal.

Kaisense is an unapproved drug from the Ministry of Health, Labor and Welfare.
Drug acquisition route: The acquisition route is individual import from the manufacturer by the doctor of each medical institution.
Drugs to be aware of when importing personally (Ministry of Health, Labor and Welfare page)
Whether or not it is approved in Japan: There is no drug that has the same ingredients and actions as Kaisense and has been approved in Japan.
Information on safety in other countries: According to KYLANE, the developer of Kaisense, it is shown that the CE mark certifying safety and quality in Europe has been obtained by the certification body 2797 BSI Group based on MDR. It has been. No serious adverse events have been reported in other countries.