TEOSYAL PureSense Ultimate 1x3ml – a single 3 mL syringe, hyaluronic acid at 22 mg/mL, lidocaine at 0.3%

Ultimate is what Teoxane supplies when the objective is projection rather than crease correction. Class III, CE-marked, and part of the dermal filler class: a sterile viscoelastic gel of cross-linked hyaluronic acid, non-animal in origin, lidocaine already dissolved in it. The rest of the Teosyal range is stocked alongside.

Three millilitres in one barrel is the point of this presentation. A full-face volumetric plan – both malar regions, chin, mandibular border in one sitting – is the case this format was built for, and drawing it from a single syringe means no interruption to change syringes mid-plan and no leftover in a second barrel you have opened but not finished. The trade is flexibility: once broached, the syringe is committed to that appointment.

Take the 3 mL syringe when the plan is one continuous session over several regions. Take the two-syringe carton where a plan breaks in half, whether by side or by appointment.

Decision summary

Composition

What the gel does

Hyaluronic acid contributes to the mechanical support of facial soft tissue, and the quantity present falls decade by decade. Correction here is occupancy rather than stimulation – the gel takes up the space into which it is deposited, and resorbs on the timescale Teoxane publishes. Placement below the dermis is what makes that occupancy read as projection instead of as a smoothed line.

Nothing in this device stimulates collagen. It occupies volume, then goes away.

Placement

Quantity per point and per session belongs to the leaflet supplied in the box.

By objective: volume restoration and facial contouring. Cannulas and needles are ordered separately.

Consultation

Before anything is deposited, Teoxane wants the medical history, the conditions the patient currently has, and the medication they currently take – plus a plain account of what the result will and will not be. The question most easily left out is what has already been injected. No data exists on how one filler behaves next to another, so earlier work is declared and then weighed.

Dental work in the preceding fifteen days rules the session out. During the week before, aspirin, anti-inflammatories, anticoagulants and vitamin E are set aside, and the patient checks with their own doctor before stopping a prescription. Alcohol and strong sunlight are avoided on the day and the day before. Make-up is removed completely.

Aftercare

Twelve hours without make-up and without hard physical effort. Then a week without alcohol, without prolonged sun or UV, without sub-zero exposure, without sauna or steam. Fifteen days without dental treatment and without any other aesthetic procedure.

Reactions and risks

Reported at one in a hundred or more, usually mild and self-resolving: pain and tenderness where the needle went in, erythema, bruising with possible bleeding or blistering, oedema, induration, nodules and papules, itching. Between one in a thousand and one in a hundred: discolouration or blanching, inflammatory reaction with possible hyperthermia, infection including localised or generalised abscess, loss of sensation or temporary paraesthesia around the site, allergy including hypersensitivity and urticaria, nodules that may be granulomatous, migration of the implant.

At or below one in a thousand, and stated without softening: immediate hypersensitivity that may progress to anaphylactic shock, and vascular complications that may extend to necrosis of the injected area. Teoxane puts the gravest vascular occlusions at roughly one in a million and records that they may impair sight or cause blindness, or produce cerebral ischaemia or haemorrhage. Observation for at least thirty minutes after the injection is what the manufacturer advises, because that is the window in which a serious immediate event appears.

Most reactions resolve within a week. Those that do not send the patient to a doctor, and the event is reported to Teoxane on 00 41 22 344 96 36.

Contraindications

• Age under 18; equally, pregnancy or breastfeeding
• Porphyria; epilepsy
• Liver disease under treatment, or hepatocellular insufficiency
• Beta blockers, or the cardiac disease they are taken for
• Any autoimmune condition
• Recent treatment by peeling, by laser or by ultrasound
• Amide-type local anaesthetics, lidocaine among them, where allergy is known
• Hyaluronic acid allergy; separately, severe allergy or anaphylactic shock in the history
• Inflammation, infection or a skin disorder over the intended site or beside it, since injecting there can wake latent or subclinical herpes

A summary only. It replaces neither the product information Teoxane publishes nor the leaflet packed with the syringe.

Where it sits in the range

What separates the products in this range is the purpose the volume serves. Three of them – Ultimate together with Ultra Deep and RHA 4 – address contour. Four others, namely Global Action, Deep Lines and the RHA 2 and RHA 3 gels, address the crease. Of the contour three, only Ultimate is offered as a 3 mL syringe, and only Ultimate is formulated at 22 mg/mL.

Questions from practitioners

When is 3 mL the right choice over 2x1ml?

When one appointment covers several regions continuously. A full-face volumetric plan across both malar regions, the chin and the jaw line is more than two separate barrels handle without a pause, and a single barrel removes the syringe change. Where the work divides by side or across two visits, the two-syringe carton wastes less.

Which plane, and how deep?

Subcutaneous or supraperiosteal, never intradermal. That is the whole distinction between a volumising device and a crease device, and it is why the labelled regions are the malar area, chin, mandibular border and the outline of the lower face.

How long should I tell the patient it lasts?

Teoxane states 15 to 18 months, the same band as Ultra Deep and RHA 4. Where an individual patient falls within it depends on the region treated, the quantity deposited, skin quality and the patient’s own metabolism.

Can any of it be used for fine lines?

No. The device is built for placement beneath the dermis. Superficial lines and skin texture need a product designed for a different plane, and putting this gel there risks visible irregularity.

Does an opened syringe keep?

No. The syringe is single-use and sterile until broached, so the full 3 mL is committed to the appointment in which it is opened. That is the reason the plan is settled before the syringe is opened rather than during.