A review of the metabolism of 1,4-butanediol diglycidyl ether-crosslinked hyaluronic acid dermal fillers.
BACKGROUND
Cosmetic procedures are growing ever more common, and the use of soft tissue fillers is increasing. Practicing physicians need to be aware of the biological behavior of these products in tissue to enable them to respond to any safety concerns that their patients raise.


OBJECTIVE
To provide an overview of the metabolism of 1,4-butanediol diglycidyl ether (BDDE)-crosslinked hyaluronic acid (HA) dermal fillers and to examine the safety of the resulting byproducts.


METHODS
A review of available evidence was conducted.


RESULTS
After reaction with HA, the epoxide groups of BDDE are neutralized, and only trace amounts of unreacted BDDE remain in the product (<2 parts per million). When crosslinked HA, uncrosslinked HA, and unreacted BDDE degrade, they break down into harmless byproducts or into byproducts that are identical to substances already found in the skin.


CONCLUSIONS
Clinical and biocompatibility data from longer than 15 years support the favorable clinical safety profile of BDDE-crosslinked HA and its degradation products. Given the strength of the empirical evidence, physicians should be confident in offering these products to their patients.
Aalst Dermatology Clinic, Aalst, Belgium.
Koenraad
K
De Boulle
Richard
R
Glogau
Taro
T
Kono
Myooran
M
Nathan
Ahmet
A
Tezel
Jean-Xavier
JX
Roca-Martinez
Sumit
S
Paliwal
Dimitrios
D
Stroumpoulis
D000818:Animals; D001672:Biocompatible Materials / Q000378:metabolism; D002072:Butylene Glycols / Q000378:metabolism*; D003357:Cosmetic Techniques; D003432:Cross-Linking Reagents / Q000378:metabolism; D005990:Glycerol / Q000378:metabolism; D006801:Humans; D006820:Hyaluronic Acid / Q000378:metabolism*; D012060:Rejuvenation; D015595:Skin Aging; D055675:Viscosupplements / Q000378:metabolism*
D001672:Biocompatible Materials; D002072:Butylene Glycols; D003432:Cross-Linking Reagents; D055675:Viscosupplements; D006820:Hyaluronic Acid; C014376:1,4-bis(2,3-epoxypropoxy)butane; D005990:Glycerol