Hyaluronic acid filler / Merz Aesthetics
Belotero Balance (+)
A cohesive HA formulation, tissue integration research and an important label-supplement distinction.
Product Atlas · September 2026
The exact product comes first
Scope of this monograph#
BELOTERO BALANCE (+), US. Non-lidocaine Balance and other CPM formulations require separate assessment.
Clinical statements below summarize the attached documents. They are not a complete prescribing label. Match the exact local product and current instructions to the clinical decision.
Composition & formulation#
Crosslinked HA, 22.5 mg/mL, with 0.3% lidocaine. The IFU describes consecutive BDDE crosslinking steps.[4]
How it works#
The viscoelastic gel fills tissue contours. Histological integration is a material characteristic, not a measure of guaranteed clinical performance.[4][6]
Indications & treatment areas#
The older IFU lists facial folds, including nasolabial folds. A subsequent FDA supplement adds infraorbital hollow improvement in adults over 21.[4][5]
Application considerations#
Consult the current site-specific IFU before treatment. The older nasolabial-fold document is not an infraorbital injection guide.[4][5]
Contraindications & precautions#
Severe allergies, bacterial-protein hypersensitivity and lidocaine or amide-anaesthetic allergy are contraindications. Delay treatment at inflamed or infected sites.[4]
Adverse effects & safety#
Swelling, erythema and tenderness may occur. Vascular occlusion can cause tissue necrosis, blindness or stroke; delayed inflammatory reactions are also described.[4]
Duration & follow-up#
Long follow-up can include retreatment: the older IFU's extension through 96 weeks allowed additional injections. It is not 96-week single-treatment durability.[4]
Distinctions that matter#
CPM histology studies help explain distribution between collagen bundles. Small non-facial biopsy studies cannot establish safer facial injection or superior long-term results.[6]
Four markets. Separate evidence.#
Documents below identify what has been attached in this research edition. “Source needed” means unverified here; it is not a statement that a product is unapproved.
February 2026 German IFU includes facial lines, lips and infraorbital hollows. Read the site-specific evidence and follow-up footnotes.[1]
February 2026 Great Britain IFU includes infraorbital hollow enhancement. The similarly named US Balance (+) retains its own label.[2]
Older IFU and later FDA indication supplement attached together; updated infraorbital IFU remains to be reconciled.[4][5]
September 2023 Australian IFU covers specified facial lines and lips. The German and British infraorbital wording is not imported into this document.[3]
Studies worth a closer look.#
A filler’s location inside the dermis matters.
Tissue integration should inform questions, not justify an untested claim of safer facial injection.
Follow the evidence.#
Retrieved 6 September 2026. A retrieval date does not establish that an older document is the latest approved revision. Studies marked “abstract” have not completed full-text appraisal.
- [1] BELOTERO Balance Lidocaine German instructions for use ↗Merz Aesthetics · label · Document accessed · Document: February 2026 · Checked 2026-09-06
- [2] BELOTERO Balance Lidocaine Great Britain instructions for use ↗Merz Aesthetics · label · Document accessed · Document: February 2026 · Checked 2026-09-06
- [3] BELOTERO Balance Lidocaine Australian instructions for use ↗Merz Aesthetics · label · Document accessed · Document: September 2023 · Checked 2026-09-06
- [4] BELOTERO BALANCE (+) US instructions for use ↗Merz Aesthetics · label · Document accessed · Document: Older nasolabial-fold labeling; supplements must also be checked · Checked 2026-09-06
- [5] BELOTERO BALANCE (+) infraorbital indication supplement ↗FDA · regulator · Document accessed · Checked 2026-09-06
- [6] Tran et al. — HA filler integration in human skin ↗Dermatology, 2014 · PMID 24503674 · study · Abstract accessed · Checked 2026-09-06
Cite this monograph#
Aesthetic Pass. Belotero Balance (+). Product Atlas research edition 2026.09.06.1. https://aestheticpass.com/products/monographs/belotero-balance-plus/