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)
Medical institution with Dr. Tinson Lim
Hyaluronic acid injection therapy has evolved significantly over the past 30 years and has become an indispensable treatment in aesthetic medicine.
Hyaluronic acid injection is an injection method that simply fills in wrinkles to make them less noticeable, restores the volume of the subcutaneous tissue that has become thin, improves sagging by reinforcing and lifting the supporting ligament (ligament), and even improves the ideal sagging. It has evolved into something that realizes contour formation.
One of the factors behind this rapid development is the advancement of hyaluronic acid injections. KYSENSE®, a new hyaluronic acid injection launched in the EU in February 2021, is one of them.
Kaisense is said to have high viscoelasticity and uplifting power even with a small amount of cross-linking agent (*) due to the patented OXIFREE manufacturing method, excellent formability, and a natural finish that can be maintained for a long time .
In order to maximize the effect of Kaisense, it is important to know the characteristics and indications of the Kaisense ® series, use different preparations according to the treatment site and purpose, and inject the appropriate amount at the appropriate injection depth .
* Cross-linking agent: A kind of adhesive that binds the molecular structure of hyaluronic acid together to increase viscoelasticity and cohesiveness and prolong the effect.
KYSENSE® is a hyaluronic acid injection developed by a Swiss pharmaceutical manufacturer and is manufactured using the patented OXIFREE manufacturing method.
The Kaisense® series has four types: Precise , Define , Volume , and Extreme . getting the mark .
Before learning about the characteristics 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 characteristics of general hyaluronic acid injections in aesthetic medicine.
Hyaluronic acid originally exists in various parts of the human body such as skin, eyeballs, blood vessels, joints and ligaments.
Hyaluronic acid is gel-like and has high viscoelasticity and water-holding capacity. It is synthesized and decomposed in the body, but it begins to decrease after peaking in the twenties, and then rapidly decreases after the 40s. It is known that it leads to a decrease in moisturizing power and the occurrence of wrinkles and sagging.
In addition, wrinkles and sagging occur due to bone thinning, loosening of supporting ligaments, and changes in fat mass with aging . Hyaluronic acid, which is highly safe for skin, has come to be used.
Hyaluronic acid injections are used not only for wrinkles and sagging, but also for contouring, such as making the nose look higher and chin sharper .
The structure of hyaluronic acid is like a chain in which a number of molecules of glucuronic acid, a type of acid, and N-acetylglucosamine, a type of sugar, are alternately linked.
Hyaluronic acid, which exists in nature such as in the human body, has a long molecular structure (molecular weight of 1 million or more) in which many chains are naturally connected, so it is called high-molecular hyaluronic acid.
On the other hand, hyaluronic acid artificially produced for beauty purposes is short hyaluronic acid that is not connected to each other, so it is a low-molecular-weight hyaluronic acid.
Low-molecular-weight hyaluronic acid chains that are not linked to each other are in a state where they are easily decomposed and absorbed by enzymes in the body, resulting in a shorter duration of effect.
For this reason, hyaluronic acid injections are added with a glue-like substance called a cross-linking agent to bind the hyaluronic acid chains together . In order to give it a certain degree of durability, a cross-linking agent is added to connect the disjointed short hyaluronic acid chains together, and by reproducing the structure of the chain, it slows down the rate at which it breaks down in the body.
Many hyaluronic acid injections use 1,4-butanediol diglycidyl ether (BDDE) as a cross-linking agent.
By containing many cross-linking agents (BDDE), the action of binding hyaluronic acid chains is strengthened, but if there are too many cross-linking agents, it will be flexible against the movement of surrounding tissues and external pressure when injected into the skin. It is said that the ability to expand and contract and restore the shape of the skin is reduced, making it easier for lumps and unevenness to form on the skin .
In addition, a small amount of cross-linking agent has the advantage of reducing the risk of redness and inflammation, but the disadvantage is that the viscoelasticity and cohesiveness are low, so it spreads easily within the skin tissue and the effect of supplementing volume is difficult to maintain . had.
Active oxygen generated during 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, shortening the effect of maintaining volume.
Kaisense ® has made it possible to retain long chains of high-molecular-weight hyaluronic acid by thoroughly eliminating active oxygen generated during the manufacturing process using the OXIFREE manufacturing method, a patented manufacturing method. Therefore, Kaisense® maintains high viscoelasticity with a small amount of cross-linking agent (BDDE) and is highly capable of raising skin tissue, so it is said to achieve high forming and lifting power .
Cross-linking agent (BDDE) content: 3.5% to less than 4.4% for all types of Kaisense® series
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 forehead wrinkles and nasolabial folds, the injection stretches and contracts flexibly when the skin stretches or contracts due to changes in facial expressions. You can't and it can look unnatural.
Kaisense® has a high tissue affinity, so you can expect a natural finish that matches your facial expression.
Kaisense® has the CE mark, which proves that it meets the safety standards of the EU (European Union) member countries .
In addition, from March 2018 to March 2019, a multi-center clinical trial (multi-center clinical trial) at 6 centers in 4 countries conducted a satisfaction survey of 110 cases, and its efficacy and safety were verified by a third-party organization. I'm here.
Kaisense® maintains a high-molecular hyaluronic acid structure, so it is a hyaluronic acid injection that has high forming power even with a small amount of cross-linking agent and has a low risk of causing problems such as delayed inflammation .
Six investigators (5 injectors and 1 independent evaluator) participated in the multicenter clinical trial. The safety of the Kysense series was assessed immediately after injection and at 1, 6 and 12 months after injection using injection site reactions (ISR) by an independent rater.
All reported injection site reactions ISR were a normal sign observed with hyaluronic acid injections, and by 1 month post-injection most injection site reactions had disappeared. No serious adverse events occurred in this study.
The Kaisense® series has four types with different hyaluronic acid concentrations, viscoelasticity, and uplifting power .
|product name||KYSENSE® Precise||KYSENSE® Define||KYSENSE® Volume||KYSENSE® Extreme|
|injection depth||dermis or labial mucosa||deep dermis or labial mucosa||on subcutaneous adipose tissue or periosteum||on subcutaneous adipose tissue or periosteum|
|Main indication||Fine wrinkles around the eyes and corners of the mouth, contours of the lips||Moderate nasolabial folds, moderate skin dimples on the face, lip volume increase||Lifting up sagging cheeks to restore facial volume such as severe smile lines and cheek moss||Increase volume such as dimples on temples, lift up sagging cheeks, shape contours to shape nose, chin and face line|
|Volume per syringe||1ml||1ml||1ml||1ml|
|needles provided per box||4x30G 1/2||4x30G 1/2||4x27G 1/2||4x27G 1/2|
Caysense Precise contains 15mg of hyaluronic acid per 1ml, making it the softest hyaluronic acid injection in the series. It is used for treatments aimed at making fine wrinkles that occur in relatively shallow layers of skin, such as around the eyes and corners of the mouth, less noticeable .
Kaisense® Define has a hyaluronic acid concentration of 18mg per 1ml, making it a slightly softer hyaluronic acid injection. It is used for the purpose of making wrinkles inconspicuous by increasing the volume of the lips and filling in the grooves of nasolabial folds .
The concentration of hyaluronic acid per 1ml of Kaisense® Volume is 21mg, and it is a hyaluronic acid injection with moderate lifting power. It is used in treatments aimed at improving severe nasolabial folds and sagging around the mouth (marionette lines), as well as supplementing and lifting the volume of temples and cheeks that have thinned with age .
When used for the purpose of improving sagging, instead of injecting directly into the nasolabial fold to fill the groove, inject into a point that lifts the loosened supportive ligament of the cheek to naturally lift up the injection. You can use the method.
The concentration of hyaluronic acid per 1ml of Kaisense® Extreme is 24mg, and it is a hyaluronic acid injection with high lifting power. Despite its high concentration of hyaluronic acid, it is not stiff and moves flexibly according to muscle movements, so there is almost no tactile sensation after injection .
To increase the volume of temples that have become thinner with age and to lift sagging cheeks . 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 neater and smaller .
In a multi-center clinical trial (multi-center clinical trial) comparing the performance of Juvederm Vista® Voluma XC and Kaisense® Extreme, Kaisense® Extreme has a stronger ability to lift skin tissue than Voluma XC. , Kaisense® Extreme required 24% less injection volume than Voluma XC .
Kaisense, like other hyaluronic acid injections, can be expected to have effects such as lifting immediately after treatment .
The duration of the effect of Kaisense was 12 months in the 2019 multi-center clinical trial (multi-center clinical trial), but we are continuing to follow the prognosis of the subjects and it is said that the effect lasts for 18 months .
Although there are individual differences, it is gradually absorbed into the body, so to maintain the effect, continue to inject about once every 6 to 12 months.
Some types of hyaluronic acid injections contain the anesthetic lidocaine, but the Kaisense® series does not contain lidocaine, so people with lidocaine allergies can also receive the treatment .
Topical anesthesia such as anesthetic cream or local anesthesia is used depending on the patient's request.
When injecting Caysense, either a very thin needle with a slanted tip (sharp needle) or a cannula with a round tip and a hole on the side through which the drug comes out (blunt needle). Use to inject into areas where wrinkles are a concern or where you want to add volume.
You may feel a sharp pain at the moment of pricking with the sharp needle, but it is said that you will not feel a strong pain during the injection .
The blunt needle cannula is also a thin needle, so there is little pain during the procedure, and the tip of the needle is round, so it does not damage small blood vessels, so it is said that the risk of internal bleeding is low . Since the needle hole from which the drug comes out is not on the tip but on the side, it is possible for the operator to adjust the direction of injection of the drug by rotating the needle intradermally.
Kaisense is mainly composed of hyaluronic acid, which originally exists in the human body, and it is said that there is almost no downtime because it does not involve procedures that place a burden on the body, such as skin incisions.
However, since the injection needle is used, 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 stop, usually subsiding in about 1 to 2 weeks .
Mild swelling, redness, and unevenness may occur at the treatment site for several days to two weeks .
In addition, a fine needle mark may remain at the injection site immediately after the treatment, but it is said to disappear in 1 to 2 days.
In rare cases, allergic reactions such as redness and inflammation may occur.
In the unlikely event that the formulation is accidentally injected into a blood vessel and clogs it, it may cause embolism, which blocks blood flow . If an embolism occurs, it can lead to serious risks such as vision loss, blindness, skin necrosis, and stroke.
If you experience any abnormalities such as sudden onset of abnormal pain, tingling discomfort, or changes in skin color, please contact a medical institution immediately.
To avoid the risk of blood clots from hyaluronic acid injections, it is important to select an experienced doctor who is familiar with the anatomy of the face .
Also, if a large amount of preparation is injected in one treatment, there is a risk of an unnatural finish, so the injection amount must be carefully determined while listening to the doctor's advice.
If you want to correct it because you don't like the finish after receiving the treatment, you can restore it to its original state by injecting an enzyme preparation called hyaluronidase that has the effect of decomposing hyaluronic acid.
Hyaluronidase is a type of enzyme preparation that has the effect of degrading hyaluronic acid injected in wrinkle treatment and contouring surgery.
Hyaluronidase has the function of decomposing hyaluronic acid into water and carbon dioxide, so hyaluronidase can be used for correction (removal) after injection, such as when excessive injection causes unnaturalness or when unevenness (lumps) appear at the injection site. Used when desired . However, the injected hyaluronic acid cannot be completely decomposed at once, and some may be left behind.
As the action of hyaluronidase, not only the hyaluronic acid injected in the procedure, but also the hyaluronic acid originally present in the body is decomposed in a few hours. However, hyaluronic acid, which originally exists in the body, is a substance that is naturally produced even after being 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 degraded. After hyaluronidase correction, it is necessary to wait 3 to 4 weeks before reinjecting hyaluronic acid.
If you are receiving or planning to receive irradiation treatment such as laser or peeling treatment, please consult a medical institution before receiving hyaluronic acid injection.
Please note that minors must have the consent of their parental authority to receive the treatment, and if the consent is not obtained, the treatment cannot be performed. It is recommended that a person with parental authority be present at the time of examination and counseling in order to carefully determine whether to receive the treatment by listening to the risks and precautions.
Also, if you are taking anticoagulants or anti-inflammatory drugs on a daily basis, please consult your doctor in advance to see if there are any problems with the treatment.
On the day of the procedure (before surgery), please refrain from drinking alcohol as it may cause internal bleeding by promoting blood circulation. Also, even after receiving the treatment on the day, it is necessary to refrain from activities that promote blood circulation, such as drinking alcohol, vigorous exercise, and saunas, in order to prevent internal bleeding .
Make-up other than the shower or treated area can be applied on the same day, make-up for the treated area can be applied the next day, and bathing in the bathtub can be done from the day after the treatment. Also, in order to prevent the infusion from flowing around, please refrain from strongly massaging the treatment site for about a week.
After receiving Kaisense injection treatment, it is recommended to wait a certain period of time before considering other treatments for the same area.
When receiving other treatments, please tell the medical institution the type of formulation injected and the timing of the last injection, and ask if it is possible to receive the treatment.
In addition to Kaisense, there are various types of hyaluronic acid injections used in aesthetic medicine procedures. The main hyaluronic acid injections used in many medical institutions include the following products, each with different characteristics, indications, duration, etc.
|hyaluronic acid injection||Approximate duration||Hardness||Main indication|
|Juvederm Vista® Volvera XC||9 to 12 months||soft||For soft areas such as lips, around eyes such as tear bag formation, and around the mouth|
|Juvederm Vista® Volift XC||12 to 18 months||somewhat soft||Nasolabial folds, marionette lines, etc.|
|Juvederm Vista® Voluma XC||18 to 22 months||moderate hardness||Forehead, nose, nasolabial fold, cheeks, face line, chin|
|Juvederm Vista® Borax XC||18 to 22 months||very hard||chin, nose|
|Theosial RHA1||9 to 12 months||soft||Fine wrinkles on the face, neck, and décolletage around the eyes and corners of the mouth|
|Theosial RHA2||9 months to 18 months||somewhat soft||Moderate wrinkles, gentle skin volume up|
|Theosial RHA3||12 to 20 months||moderate hardness||Deep facial wrinkles such as nasolabial folds, natural skin volume up|
|Theosial RHA4||12 to 22 months||hard||Contouring to shape the nose and face line|
|Theosial RHA KISS||6 to 8 months||soft||lip volume up|
|New Ramis||6 to 12 months||somewhat soft||medium wrinkles|
|Restylane Lido||12 to 18 months||moderate hardness||Moderate to severe wrinkles|
|Belotero Soft||9 to 12 months||soft||Around the eyes, tear bag formation, etc.|
|belotero balance||9 to 12 months||somewhat soft||Moderate wrinkles, expression wrinkles|
|Styleage S||9 to 12 months||soft||Mild wrinkles, lips|
|Crevier Contour||12 to 18 months||very hard||Contouring of nose, chin, etc.|
As an injection procedure, there are various treatments other than hyaluronic acid injection such as Kaisense, and each has different effects and problems that can be expected to improve.
|fat dissolving injection||face and body weight loss|
|rejuran injection||Wrinkles, open pores, dark circles, firmness, etc.|
|radiesse injection||deep wrinkles, contouring|
|Elance||Wrinkles, tightening, firmness, contouring, etc.|
|baby collagen injection||Shallow wrinkles, open pores, firmness, etc.|
|botulinum injection||Expression wrinkles such as forehead and corners of the eyes, tension of square jaws, etc.|
Botulinum injection can be expected to reduce muscle tension by inhibiting the action of substances that transmit commands from the brain, improve facial wrinkles, and adjust parts and contours.
Botulinum injection is effective for improving vertical wrinkles between the eyebrows, laugh wrinkles at the corners of the eyes, laugh wrinkles on the nose, and pickled plum wrinkles on the chin, which are difficult to improve with hyaluronic acid injections such as Kaisense.
In addition, botulinum injection is also used to reduce the tension of the developed gills (masseter muscle) and clean the face line.
By combining Kaisense and botulinum injection for each application area, wrinkles and sagging can be improved more delicately .
A thread lift (thread lift) is a treatment in which a special thread with a catch is placed under the skin to lift the sagging of the face and neck.
After effectively lifting the sagging by thread lift, you can expect to improve tired and aged faces by injecting hyaluronic acid using Kaisense into areas where volume is lacking, such as moss on the cheeks and temples .
After completing a medical questionnaire at a medical institution, you will receive an examination and counseling by a doctor and hear an explanation of the treatment details and risks. If you have any concerns, hopes, or concerns about the treatment, please consult your doctor at this time. Determine the type and amount of Kaisense to use according to the desired finish.
(2) Face washing/anesthesia
Wash your face and clean the treatment area (cleansing if you are wearing makeup). If you want anesthesia, wait for a while after using local anesthesia or surface anesthesia on the treatment site.
(3) Infusion of Kaisense
We will inject using a needle or cannula to the injection site decided at the time of counseling. The required time varies depending on the number of areas desired to be treated, but the standard is about 10 to 20 minutes, excluding anesthesia treatment.
(4) Cooling and termination
If redness or swelling occurs at the injection site, cooling treatment will be performed. It ends with an explanation of how to spend the downtime and points to note after the treatment.
Kaisense is a hyaluronic acid injection that achieves both high forming power and safety through a patented oxy-free manufacturing method.
However, since many nerves and blood vessels run through the face, there is a risk of various disorders such as vascular disorders, vision abnormalities, stroke, and skin necrosis if the injection site or injection amount is incorrect . It is important to choose a doctor who has accumulated practical experience while constantly brushing up on anatomical knowledge .
In addition, it is said that hyaluronic acid injection tends to cause differences in the finish depending on the practitioner's sense. There is also the option of appointing a doctor who is in charge of a case that is close to your ideal by checking the case photos posted on the website of each medical institution or the doctor's personal blog.
|Kaisense is an unapproved drug from the Ministry of Health, Labor and Welfare.|
| Acquisition route of pharmaceuticals: The acquisition route is personal import from the manufacturer by the doctor of each medical institution.|
About medicines to be careful about when importing for personal use (Ministry of Health, Labor and Welfare page)
|Approval 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 has obtained the CE mark, which certifies safety and quality in Europe, from certification body 2797 BSI Group based on the MDR. It has been. No serious adverse events have been reported in other countries.|
Dr. Tinson Lim, who supervised the article, taught me about Kaisense (hyaluronic acid) injection.
Introduction of supervising doctor
Dr. Tingsong Lim from Malaysia, who is one of the most active young doctors in Asia and serves as a director of the International Society of Dermatology and Cosmetic Surgery (ISDS). Known internationally for promoting a safer, more natural approach to aesthetic medicine to the industry. He is a major opinion leader in Asian facial and body aesthetics, clinical application of rheology of fillers, pigmentary disorders, laser treatment and regenerative medicine. In the selection and use of many hyaluronic acid preparations on the market, each product has its own rheological properties and is used properly according to the site to achieve the best results.
Medical institution with Dr. Tinson Lim
Dr. Tinsung Lim taught me about Kaisense (hyaluronic acid) injection.
KYSENSE® Precise showed high performance on perioral lines and lip contours.
Due to the large mechanical movement around the oral cavity, it should be noted that these two indications pose challenges in the sustainability of treatment.
Despite this fact, after 12 months, raters reported improvement in all subjects (100%).
KYSENSE® Define performed well on lip volume and moderate nasolabial folds.
More specifically, raters reported global aesthetic improvement in all subjects (100%) at each time point of the clinical trial.
KYSENSE® Volume demonstrated high performance in treating severe nasolabial folds with an rater improvement of 85% after 12 months.
The injector was not informed of the product, nor was he given any dosage recommendations, but simply treated according to the results.
Overall, 24% less injection volume was required with Kaisense® Extreme than with Juvederm® Voluma to achieve the same results.
The GAIS score*1 assessed by blind raters and subjects did not show any significant difference between the two devices.
*1 GAIS: Global Aesthetic Improvement Scale
MFVDS scores*2 assessed by blind raters showed no significant difference between the two devices at all time points.
*2 MFVDS: Mid-Face Volume Deficit Scale
KYSENSE® Extreme showed a mildly significant difference as evaluated by the injector in terms of product ease of application, immediate effect, and post-massage effect.
Kysense requires 24% less injection volume to reach similar GAIS over time
Percentage of improved GAIS independent raters
Obtained a very high evaluation in the overall evaluation after 12 months
Injection volume for each injection site (unit: ml)
Confirm the concept of less is more in all series
The overall safety of the KYSENSE® series was assessed at day 0 and 1 month after injection using injection site reactions (ISR) by independent raters.
All reported injection site reactions ISR were the usual signs observed with HA filler injections. After one month of administration, most post-injection site reactions had disappeared.
No serious adverse events occurred in this study.