By Giuseppe Sito, Prof. M.D. and Gabriella Brancaccio M.D.

The face is one of the most dynamic parts of the body. Recently a new line of filler designed for facial movements has been released. We tested the first product of this new range, TEOSYAL®RHA 1, for facial rejuvenation and filling of fine lines. The injection of micro-deposits in the dermal layer causes a significant improvement of skin elasticity and brightness as well as an extremely natural result at the end of the procedure.Fig1-gabriella Fig2

The popularity of dermal fillers has grown rapidly in recent years. After an initial trend of “overtreatment”, the goal is nowadays to achieve the most natural result as possible. The current premium hyaluronic acids (HAs) provide good results on the face in a static way, but they are not designed nor evaluated for facial movements.

It is truly a challenge to design specific fillers taking the dynamism of the face into account. The implant should not only be able to stretch with the movements of the injected area but also to resist to multiple constraints in order to provide a long‐lasting effect.

In this light, a new line of filler specially designed for the mobile areas of the face has recently been released.

Thanks to a completely innovative technology, named “preserved network method”1, a new type of hyaluronic acid has been developed. With a limited amount of BDDE and less chain degradation the crosslinking process is optimized. The result is a resilient gel with remarkable dynamic properties physiologically suitable for the skin.

From this base, 4 dermal fillers, named TEOSYAL®RHA (Resilient Hyaluronic Acid), have been perfected.

They were all tested by analyzing their stretch (stretching capacity of a gel) and strength (resistance to repeated constraints according to a new dynamic G’ test) properties. All the products demonstrated the highest profiles depending on the considered indication, each of them specifically designed for different face areas and desired effect/objective (volume restoring or thin filling).

From 1 to 4 there is a rise of strength and a lowering of stretch. With these rheological properties (high stretch, lower strength) TEOSYAL®RHA 1 is perfect for fine lines and superficial treatments. It is a subtle, soft, smooth gel, able to easily adapt to facial movements in order to stay invisible1.

These characteristics make TEOSYAL®RHA 1 a product of choice for the correction of fine wrinkles as well as for global skin restored by biorevitalization, a common aesthetic procedure used for facial rejuvenation.

We tested and evaluated TEOSYAL®RHA 1 in 2 patients performing three sessions of facial intradermal injections according to a standard protocol (multiple intradermal injections with a 30G 1/2’’ needle into the whole face from forehead to chin). The results (figure 1 and 2), already visible after the first session, are extremely natural and well tolerated thanks to light filling technique by which TEOSYAL®RHA 1 is evenly spread into the skin.

Figure 1: Before and after pictures of a 53 years old woman treated with 3 sessions of TEOSYAL®RHA 1, 4 weeks apart (cheeks, zygomatic and perioral area, 0.5 ml per side)

Figure 2: Before and after pictures of a 59 years old woman treated with 3 sessions of TEOSYAL®RHA 1, 4 weeks apart (cheeks, zygomatic and perioral area, 0.5 ml per side )

Through the apposition of TEOSYAL®RHA 1 micro-deposits in the deep dermal layer, it is possible to smooth the skin by filling of the superficial wrinkles and, at the same time, to improve elasticity and skin brightness. It is very helpful in correcting all the changes that the skin undergoes with advancing age as loss of density and hydration, opacification and change of tissue texture. The result is clearly visible with a smoother and more homogeneous skin, a result obtained with the absence of dull areas.

A protocol of 3 sessions at intervals of 4 weeks is recommended. Injection technique used is the micro-puncture technique that involves injecting very small amounts of HA into the deep dermis, about 1-2cm apart.

Also thanks to 0.3% lidocaine concentration, the treatment causes minimum discomfort to patients. Our patients returned to their everyday activities immediately after the procedure. The positive treatment response was also confirmed by analysis of the Global Aesthetic Improvement Scale (GAIS) scores and a self-assessment questionnaire completed by the patients who all stated a very high level of satisfaction.

Also benefits of TEOSYAL®RHA 1 allow to reduce all typical signs of photoaging. It is therefore indicated to treat neck and décolleté beside the face. The resulting tissue restoration is extremely appreciated by patients, but most of all the full integration of the product to natural face movements is of great satisfaction for the physician.

Given its characteristics, TEOSYAL®RHA 1 is extremely promising for the treatment of the bar code, because there is nothing better for fine lines of a subtle, smooth product that fits completely with the movements of the smaller face muscles.


S. Converset-Viethel, et al. Safety and effectiveness of three new commercially available injectable dermal fillers in moderate to severe nasolabial folds treatment. From: 2015; 13th Anti Aging Medicine World Congress – Monte Carlo.

Prof Sito: Professor at the postgraduate course for Aesthetic Medicine Agorà, Milan and at the school of Esthetic Medicine Fatebenefratelli Hospital Foundation, Rome.

Vice president of the Italian Association Botulinum Esthetic Therapy,

Forensic consultant in Esthetic medicine for the court of Naples


Gabriella Brancaccio, MD.: Member of the French and Italian Societies of Plastic and Reconstructive Surgery as well as the American Association of Facial Plastic Surgery, Rewarded with the Lifetime Achievement Award in Cosmetic Surgery.

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