JULÄINE™ by Nordberg Medical, Sweden

JULÄINE™ is a CE-marked, L-form polylactic acid injectable biostimulator, intended for use in adult, immune-competent individuals to compensate for skin depression: specifically, restoring lost volume to the folds and contours of the nasolabial fold.  JULÄINE™ contains microspheres of crystalline poly-L-lactic acid (PLLA) – a biocompatible, biodegradable, synthetic polymer from the alpha-hydroxy-acid family. Uniquely, JULÄINE’s PLLA microspheres have a highly uniform particle size and degrade slowly, which makes JULÄINE™ a particularly suitable implant for restoring volume to areas of depressed skin.

The majority of dermal fillers that we use at The Clinic Holland Park, West London are hyaluronic acid (HA) biodegradable fillers; and HA is one of the most current hydrating ingredients in skincare, being beneficial both topically (in serums and creams) and as a dermal filler. On average, the efficacy of HA fillers lasts from 6-18 months. 

JULÄINE™, on the other hand, is a poly-L-lactic acid (PLLA) with double the shelf-life. PLLA is a biostimulator – it naturally stimulates the production of collagen and elastin – and its effects last for up to 24 months. PLLA is FDA-approved for use as an injectable corrector for the loss of facial fat – which makes JULÄINE™ a particularly attractive option for those clients who have lost a lot of weight and are worried about looking gaunt or hollow-faced (the so-called ‘Ozempic face’ conundrum).

So: JULÄINE™ is a biodegradable biostimulator that promotes the natural production of collagen and elastin in the skin; it is not a dermal filler. The key ‘results’ difference between biostimulators and dermal fillers is that biostimulators offer a more gradual transformation. The collagen-stimulating effects of biostimulators mean that the results can take several weeks to appear, and typically last longer than those of dermal fillers – potentially up to 2 years with appropriate treatment.

With JULÄINE™, Nordberg Medical of Sweden has created a bespoke biomaterial for the active regeneration of skin tissue. JULÄINE™ is unique in consisting of uniform-size, high purity PLLA microspheres, which result in a product with superior safety and efficacy and long-lasting results. Other biostimulators are not made of the same high quality and uniform shape and size PLLA microspheres; and this really sets JULÄINE™ apart from any market competition. The homogeneous and smooth surface of JULÄINE™’s PLLA microspheres make it an easily dispersible product, allowing for the progressive release of high purity PLLA to achieve an active regenerative effect. These highly biocompatible microspheres allow for good tissue integration, with inflammation or potential for granuloma minimised.  Moreover, the high density of JULÄINE™ microspheres, together with their shape and size, make possible a controlled degradation over time for a predictable biological effect.  

This time-controlled degradation of the microspheres in JULÄINE™ ensures a constant source of product in the tissue, achieving a gradual increase in type III and type I collagen and a long-lasting result. In addition, JULÄINE™ is biodegradable, leaving no residue after complete degradation at 24 months. Moreover, this new, high purity PLLA has an excellent safety profile, with no detection of nodules or granuloma in any preclinical and clinical studies. JULÄINE™ gives predictable results and is safe – and although JULÄINE™ is only now coming to the UK and European aesthetics market, JULÄINE™ has been incredibly popular in Asia for years.

Ameela® is a polynucleotide injectable; JULÄINE™ is a poly-L-lactic acid (PLLA) injectable. Both are biostimulators, originating in wound-healing medicine; both are biodegradable. Both stimulate the production of fresh, rejuvenated skin cells; but whereas Ameela® is derived from salmon DNA, JULÄINE™ is a synthetic polymer product that is manufactured from start to finish by Nordberg Medical. Where Ameela® is great in delicate areas like the tear-trough, JULÄINE™ excels as a rejuvenating, revolumising treatment for the mid-to-lower face. So, Ameela® and JULÄINE™ are both collagen stimulators.

Ameela® is useful because it not only stimulates collagen, but also scavenges free radicals in the skin, slowing down further signs of ageing while improving the health and quality of the skin.  JULÄINE™ on the other hand, provides more collagen stimulation and has longer-lasting effects. So, it is not a case of one being better than the other; they are both excellent treatments.

What JULÄINE™ does brilliantly is rebuild volume and tighten the skin in the mid-to-lower face. Loss of volume is a particular concern for many clients as they age; and ‘hollow-faced’ or gaunt looks are currently subject to scrutiny in mainstream media in the wake of Ozempic’s popularity as a weight-loss drug. JULÄINE™ is perfect for these concerns, and better suited for those who want natural-looking volume restored in their middle and/or lower faces, especially around the nasolabial lines.

One set of injections of JULÄINE™ can be performed per side of face per clinic visit.  An initial treatment plan consists of around 3 sessions of treatment, a minimum of 4 weeks apart. Your aesthetic doctor will be responsible for devising your treatment plan, and will advise on maintenance treatments for the future. Patients with a Fitzpatrick I-III skin type may have a higher number of treatment sessions than patients with Fitzpatrick types IV-VI.

Within a few hours of your first treatment, expect swelling in the injected area.  This swelling will last for a maximum of 72 hours, and will be greatly reduced by lightly massaging the area for 2 minutes every 8 hours. Soon after treatment, your skin will improve in quality, colour and glow, with the volumising effect of the product progressing over time. The desired result will depend on the baseline diagnosis and your assigned treatment plan.

Possible side effects related to the injection site include redness, short-term pain and short-term bleeding, which are generally relieved within a few days. Side effects that may appear in the treatment area immediately after injection include redness, swelling and bruising. Post-treatment swelling will be greatly reduced by lightly massaging the area with circular movements using a facial moisturiser for 2 minutes every 8 hours for the first 72 hours.

The patient is advised to apply a facial moisturising cream to the treatment area and massage with a circular motion for 2 minutes every 8 hours for the following 72 hours. This circular massage will not only help reduce initial swelling, but also minimise the risk of nodule formation in the area by improving distribution and integration of the product.

Do not use saunas, steam rooms or swimming pools for 10 days. Do not partake in any physical exercise for 24 hours post treatment. Do not wear make-up for 12 hours post treatment. After injection of the product, avoid exposure to sunlight and UV light until the initial swelling and redness have subsided. Very high or very low temperatures should also be avoided.

To avoid any inflammatory or unwanted reactions, do consult with your aesthetics doctor at The Clinic Holland Park, West London before undergoing other aesthetics treatments that rely on an active dermal response (such as laser treatment or chemical peeling) before or after treatment with JULÄINE™.

JULÄINE™ is not recommended for patients with any of the following conditions:

• Acute or chronic skin disease (infection or inflammation)
• History of allergies to any of the constituents of the product
• Are under 18 years of age, pregnant, or breastfeeding
• Haemorrhagic disease or under anticoagulant therapy
• Have a known history of or susceptibility to keloid formation or hypertrophic scarring
• Immune deficiencies.