Belotero Balance (+) Lidocaine Dermal Filler is a popular and effective treatment option for patients looking to enhance their facial appearance. As a medical professional, it is essential to understand the proper administration technique to ensure the safety and satisfaction of your patients. In this comprehensive guide, we will walk you through the step-by-step process of administering Belotero Balance (+) dermal filler, including important contraindications, warnings, precautions, and post-treatment care.

Understanding Belotero Balance (+) Dermal Filler

Belotero Balance (+) is a sterile, bioresorbable, non-pyrogenic, viscoelastic, clear, and colorless gel made of hyaluronic acid. The hyaluronic acid is derived from bacterially fermented streptococcal cultures and is cross-linked with 1,4-butanediol diglycidyl ether (BDDE) through a series of reactions. Belotero Balance (+) is then reconstituted in a buffer with a pH of 7 and a concentration of 22.5 mg/mL. To minimize discomfort during the injection, 0.3% lidocaine hydrochloride is added to the dermal filler.

Contraindications for Belotero Balance (+)

Before administering Belotero Balance (+) to your patients, it is crucial to be aware of the contraindications to ensure their safety. Patients with severe allergies, particularly anaphylaxis, or multiple hypersensitivities should not use Belotero Balance (+). It is also contraindicated in individuals with a known sensitivity to lidocaine or amide anesthetics. Additionally, patients with a known allergy to gram-positive bacterial proteins, as Belotero Balance (+) contains trace amounts of these proteins, should avoid using this dermal filler. It should not be injected into blood vessels as it may lead to embolism or other occlusion issues.

Important Warnings and Precautions

As a healthcare professional, it is essential to review your patient’s medical history before administering Belotero Balance (+). Take caution when injecting the product into areas with active inflammatory processes such as cold sores, cysts, pimples, rashes, or hives. Intravascular injection may lead to serious adverse events, including temporary or permanent vision impairment, blindness, stroke, skin necrosis, and damage to underlying facial structures. If any of these symptoms occur during or after the procedure, the injection should be stopped immediately, and the patient should receive prompt medical attention.

Storage and How Supplied

Belotero Balance (+) is packaged in a blister pack with one 1-mL syringe of sterile gel, two sterile needles, and two patient record labels, all intended for single use only. The syringe should not be re-sterilized or used if the package is opened or damaged. Storage should be done at room temperature (up to 25°C/77°F), away from heat, and should not be frozen. The product expiry date is located on the syringe and blister labels. The syringe should have a clear, colorless appearance; if it does not, it should not be used.

Preparing for the Procedure

To ensure the proper attachment of a needle, use the provided needles that come with Belotero Balance (+) dermal filler. Remove the Luer syringe cap from the distal end and twist the needle tightly onto the syringe’s luer lock fitting. Make sure to wipe off any excess implant material on the Luer lock fittings with a sterile gauze. Depress the syringe plunger until the implant material is extruded from the needle’s tip. If there is leakage at the Luer fitting, the needle may need to be removed, and the surfaces cleaned or replaced.

Depth of Injection and Injection Technique

The technique for administering Belotero Balance (+) may vary depending on the desired results. The linear-threading technique, tunneling technique, serial puncture injections, or a combination of these methods have been used successfully. Regardless of the technique used, caution must be taken to prevent intravascular injection. For the linear-threading and tunneling technique, insert the needle at an angle of approximately 30° in parallel with the length of the wrinkle or fold and inject into the mid-to-deep dermis. For the serial puncture technique, insert the needle at multiple points along the wrinkle or fold. Observe a slight elevation of the skin without significant blanching to avoid visible bumps or discoloration. If immediate blanching occurs, the injection should be stopped, and the area massaged until the skin returns to its normal color.

Volume per Injection

In clinical trials, an average volume of 1.59 mL of Belotero Balance (+) was needed to achieve optimal correction of nasolabial folds. It is essential to avoid overcorrection by not exceeding this amount. The degree and length of correction depend on various factors, including the nature of the defect, tissue stress at the implant site, depth of the implant, and injection technique. Carefully assess each patient’s needs and adjust the volume accordingly.

Post-Treatment Care and Patient Instructions

After the procedure, it is crucial to provide your patients with clear instructions for post-treatment care. Advise them to avoid pressing on the treated facial areas, applying makeup, engaging in strenuous physical activity, and consuming alcohol for the initial 12-24 hours. Additionally, instruct patients to refrain from taking anti-coagulation pills, anti-platelet medications, thrombolytic drugs, aspirin, NSAIDs, or other substances known to prolong coagulation time for three days following the treatment.

Inform your patients about the potential need for additional injections to achieve their desired results and that individual outcomes may vary. Emphasize the importance of notifying you of any adverse reactions, such as vascular compromise, persistent redness, or swelling. Provide detailed instructions on how to take care of their skin and which products to utilize or avoid after the treatment.


Administering Belotero Balance (+) dermal filler requires a thorough understanding of the product, contraindications, warnings, precautions, and proper injection techniques. By following the guidelines outlined in this comprehensive guide, you can ensure the safety and satisfaction of your patients. Remember to always review your patient’s medical history, communicate clearly with them about the procedure and post-treatment care, and provide ongoing support throughout their aesthetic journey. With proper training and experience, you can achieve optimal results and help your patients enhance their natural beauty with Belotero Balance (+) dermal filler.

Disclaimer: The information provided in this article is for educational purposes only and should not be considered as medical advice. Always consult a qualified healthcare professional for personalized recommendations and treatment options.

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